Made available in DSpace on 2016-01-26T12:51:55Z (GMT). No. of bitstreams: 1 lucianogarcialourencao_dissert.pdf: 833601 bytes, checksum: 00a7823458263c5ee5f67007f775ba5b (MD5) Previous issue date: 2006-10-26 / Respiratory infections account for more than 25% of the whole medical, pediatric, outpatient and hospital services. Around 90% of those infections are related with viral agents. RSV is an important agent identified in those diseases. This study aimed at assessing the frequency of Respiratory Syncytial Virus (RSV) in children aged from 0 to 6 years with upper respiratory infection diseases (URID) from a nursery school, and to associate the clinical and epidemic data of mild degree of URID with the viral agent. The children had a daily follow-up in the period from July 2003 to July 2004, and viral investigation for RSV by means of Polimerase Chain Reaction (PCR), in the children's nasopharyngeal secretions that presented signs of breathing infection. A total of 259 events of URID in 173 children have occurred. A hundred twenty-two (70.5%) children were over 2 years in the beginning of the follow-up and 94 (54.3%) were male. The monthly number of episodes ranged from 0 to 53. RSV was diagnosed in 27 (10.5%) samples, and it was more frequent between the months of July to September. The signs observed in the children with RSV infection were coryza in 26 (96.3%) episodes, nasal obstruction in 19 (70.4%), coughs in 15 (55.6%), wheezing in 3 (11.1%) and sneeze and fever in 2 (7.4%) episodes. Antibiotics were administered in 16 (6.2%) episodes of breathing infection. One (3.7%) infection episode by RSV received treatment with antibiotic. One (0.4%) serious episode had developed for hospitalization. A high frequency of RSV was observed among the children from nursery school with mild breathing infections, mainly from the beginning of the autumn to the spring; the most frequent signs in the infections for RSV were cough, coryza and nasal obstruction; there was association between nasal obstruction and infections by RSV. / As infecções respiratórias são responsáveis por mais de 25% de todo o atendimento médico pediátrico, ambulatorial e hospitalar. Em torno de 90% dessas infecções estão relacionadas com agentes virais. O Vírus Sincicial Respiratório (VSR) é um importante agente identificado nessas afecções. Esse estudo objetivou estimar a freqüência do VSR em crianças com idade entre 0 e 6 anos com infecção das vias aéreas superiores (IVAS), procedentes de uma creche e associar os dados clínicos e epidemiológicos da IVAS de grau leve com o agente viral. Foi realizado seguimento diário das crianças no período de julho de 2003 a julho de 2004 e investigação virológica para VSR através de Polimerase Chain Reaction (PCR), em secreções nasofaríngeas das crianças que apresentaram sinais de infecção respiratória. Ocorreram 259 episódios de IVAS em 173 crianças. Cento e vinte e duas (70,5%) crianças tinham mais de 2 anos de idade no início do segmento e 94 (54,3%) eram do sexo masculino. O número mensal de episódios variou de 0 a 53. O VSR foi diagnosticado em 27 (10,5%) amostras e foi mais freqüente nos meses de julho a setembro. Os sinais observados nas crianças com infecção por VSR foram coriza em 26 (96,3%) episódios, obstrução nasal em 19 (70,4%), tosse em 15 (55,6%),chiado em 3 (11,1%) e espirro e febre em 2 (7,4%) episódios. O uso de antibióticos ocorreu em 16 (6,2%) episódios de infecção respiratória. Um (3,7%) episódio de infecção por VSR recebeu tratamento com antibiótico. Houve 1 (0,4%) episódio grave que evoluiu para internação. Observou-se uma alta freqüência de VSR entre as crianças com infecções respiratórias leves, principalmente do início do outono ao início da primavera; os sinais mais freqüentes nas infecções por VSR foram tosse, coriza e obstrução nasal; houve associação entre obstrução nasal e infecções por VSR.

S.aureus resistente à meticilina(SARM) é um problema em centros de fibrose cística(FC). Foi desenvolvido um multiplex PCR(mPCR) para detecção do SARM em secreção respiratória de 106 pacientes com FC. Foram usados 3 pares de primers para amplificar os genes: mecA, coa, 16S rRNA. O mPCR detectou até 0,25pg de DNA de SARM e identificou 70/106(66,0%) pacientes com S.aureus e 28/106(26,4%) com SARM. O mPCR mostrou especificidade, sensibilidade, valores preditivos positivo e negativo de 87,8%, 84,4%, 50% e 97,5%, considerando a cultura como padrão-ouro. Os resultados discordantes foram testados com outros primers, confirmando os obtidos pelo mPCR em 82/84. O mPCR mostrou-se método rápido e confiável para detecção de SARM / Methicillin-resistant S.aureus(MRSA) is a significant concern in cystic fibrosis(CF) centers. A multiplex PCR(MPCR) was developed to detect MRSA in respiratory secretion of 106 CF patients. Three pairs of primers were used for amplification of genes: mecA, coa, 16S rRNA. MPCR detected 0.25pg of MRSA DNA and identified 70/106(66.0%) of patients with S.aureus and 28/106(26.4%) with MRSA. MPCR showed specificity, sensitivity, positive and negative predicted values at 87.8%, 84.4%, 50% and 97.5%, considering culture as the gold standard. Discrepant results were retested using different primers, and confirmed MPCR results in 82/84. The developed MPCR was found to be a rapid and reliable method for MRSA detection

Les travaux présentés dans cette thèse font suite à celle de Melle LE GOFF. Ils se concentrent sur la technologie HIFI brevetée et développée pendant ses travaux. Une première partie du travail présenté dans ce manuscrit concerne le test HIFI Blood 96™ et plus particulièrement les améliorations et les évolutions apportées au test afin d'en faire un véritable outil de génotypage, multiparamétrique et haut-débit pouvant être installé dans les banques de sang dans le but de constituer des inventaires de sang génotypé de façon étendue, participant ainsi à améliorer la sécurité transfusionnelle. Il permet de caractériser 96 échantillons sur 15 polymorphismes (divisés en deux panels) associés aux groupes sanguins en approximativement 4h30. Cette plateforme a fait l'objet d'une étude de validation à moyenne échelle sur 583 donneurs pour le panel 1 et 190 donneurs pour le panel 2. La deuxième partie des travaux décrit l'adaptation de la technologie HIFI appliquée au diagnostic des pathologies respiratoires, avec le développement d'une autre plateforme, ReSynPlex, en partenariat avec 3 équipes de recherche de Grenoble / The work reported in this thesis follows the one undertaken by Ms LE GOFF. It is focused on HIFI technology, which is patented and developed during her thesis. The first part of this work concerns the HIFI Blood 96™ test, and particularly the improvements and developments adduced to the test to make it a real diagnostic tool, multiparametric and high-throughput which can be implemented in blood banks in order to constitute negative antigen inventories, thus contributing to improve blood safety. It allows to characterize 96 samples on 15 polymorphisms (divided in two panels) associated to blood group systems in approximately 4.5 hours. A mesoscale validation study has been conducted on 583 samples for panel 1 and 190 samples for panel 2. The second part of this work describes the adaptation of HIFI technology applied to diagnosis of respiratory tract infections, with the development of another platform, ReSynPlex, in partnership with 3 research teams in Grenoble

The general aim of this thesis is to describe and analyse the role of primary care in health care systems in terms of health, health care utilisation and costs, and to study the feasibility of retrieval of data from computerised medical records to monitor medical quality. The thesis includes five studies, a systematic literature review, a register study of utilisation of hospital and primary care, a study based on data from computerised medical records of individual patients cost for primary care, and two studies of management of respiratory infections in primary care based on data from computerised medical records of twelve health centres. The general findings of the literature review were that an expansion of the primary care component of the health care system would most likely result in better health, lower hospital care consumption and lower expenses for care. The personal physician and continuity of care were core elements to achieve this, and the significance of the way primary care is organised and funded was evident. In the register study fifty health centres were compared. Age and rates of outpatient hospital visits were the most important factors explaining the variation of rates of hospitalisations between the health centres’ areas. Hospital district also influenced hospitalisation rates in the different health centres’ areas, indicating that the health care structure in the district per se was an important factor. The rates of visits to general practitioners correlated negatively with rates of hospitalisations. The study of costs in primary care showed that the variation in the costs of the individual patients was substantial, also within age groups and within the diagnosis-related Adjusted Clinical Groups (ACG). Age and gender explained a smaller part of the variation in costs per patient in primary care. Adding the ACG weight had a major influence on improving the ability to explain the variation in costs at patient level. The ACG system might be of value in the calculation of weighted capitation in Swedish primary care, but appears to be sensitive to the thoroughness with which physicians register diagnoses. The retrieval of data from computerised medical records comprised a total number of 19 965 encounters for respiratory tract infections i.e. 199 per 1000 inhabitants during the year 2001. Most frequent diagnoses were common cold, acute tonsillitis, and acute bronchitis. The number of antibioticprescriptions was 7 961, accounting for 47% of the episodes. The most commonly prescribed antibiotics were phenoxymethylpenicillin (61%), tetracyclines (18%) and macrolides (8%). A rapid test was performed in 43% of the encounters: for C-reactive protein (CRP) in 31%; for Group A beta-haemolytic streptococci (StrepA) in 22%; and both tests were performed in 10% of the encounters. The findings in the study indicate that StrepA and CRP tests were used too frequently and often with minor contributions to patient management. The frequencies of tests and of antibiotic prescriptions varied greatly between health centres in a way that hardly could be explained by differences in morbidity. Computerised medical records provided a source of clinical information, which might be a feasible and pragmatic method for studying daily practice, and for follow-up of adherence to guidelines in general practice.

O bocavirus humano (HBoV) é um parvovirus recentemente identificado em associação com a presença de sintomas de infecção do trato respiratório. Esse vírus possui um genoma de aproximadamente 5217 nucleotídeos que contém 3 open reading frames que codificam 4 proteínas (NS1, NP-1, VP-1 e VP-2). HBoV tem sido detectado em amostras respiratórias de diversas partes do mundo, incluindo Austrália, América do Norte, Europa, Ásia e África, o que sugere uma distribuição global desse vírus. Entretanto, nenhum estudo longitudinal de HBoV em amostras respiratórias foi realizado na América Latina. Dessa forma, nós realizamos um estudo prospectivo de HBoV em lavados nasofaríngeos (LFNs) coletados de pacientes com sintomas de infecção do trato respiratório (IRA) atendidos em um hospital universitário de Ribeirão Preto, SP e em um hospital universitário de Salvador, BA no período entre 2005 a 2007. 1288 LFNs de 1217 pacientes foram encaminhados ao laboratório de virologia e foram testados por PCR para HBoV. Desses pacientes, 962 eram menores de 5 anos e 177 eram maiores de 5 anos. Além disso, também foram analisados 50 LFNs de crianças menores de 5 anos que não tinham sintomas respiratórios. Todas as amostras positivas para HBoV foram testadas para todos os outros vírus respiratórios, incluindo o vírus sincicial respiratório (HRSV), rinovirus humano (HRV), influenza humano (HFLU), metapneumovirus humano (HMPV), parainfluenza humano (HPIV), coronavirus humano (HCoV) e adenovirus humano (HAdV). A carga viral de HBoV foi determinada por PCR em tempo real em todas as amostras positivas e o genoma completo de 19 amostras de HBoV foi seqüenciado. Com intuito, de fazer um levantamento sorológico e determinar sítios replicativos de HBoV, nós ainda clonamos e expressamos em S. cerevisae (Y258) o gene de VP2, que codifica uma das proteínas do capsídeo viral. A prevalência desse vírus foi de 4,8% em crianças menores de cinco anos e de 1% em pacientes maiores de cinco anos. HBoV não foi detectado em crianças sem sintomas. Dos 259 pacientes analisados em 2005, 25 (10%) foram positivos para HBoV. Esse vírus circulou mais frequentemente em abril, mês de maior incidência do HRSV. Em 2006, HBoV foi detectado em apenas 10 LFNs de 334 (3%) amostras testadas, sem qualquer pico de freqüência. Em 2007 HBoV foi detectado em 13 de 552 (2%) amostras, com uma freqüência de detecção um pouco maior em junho e julho. Os sintomas mais comumente observados foram rinorréia, tosse, febre e chiado, que foram observados geralmente em mais de 50% dos casos positivos para HBoV. Não houve uma diferença significativa na prevalência desses sintomas entre as crianças positivas e negativas para HBoV. Entretanto, foi observada uma maior freqüência de diarréia entre as crianças com esse vírus. Nesse estudo também foi documentado uma alta freqüência de co-infecções virais entre os pacientes com HBoV. Os vírus mais frequentemente associados com o bocavirus humano foram: HRSV, HRV e HAdV. Além disso, foi detectado uma maior carga viral media e uma maior freqüência de diarréia nos 15 pacientes com infecção exclusiva por HBoV do que nos pacientes com co-infecção. Esses resultados mostraram que HBoV pode alcançar títulos enormes (tão grandes como1014/mL) em LFNs de pacientes com sintomas respiratórios e que isso é associado a de diarréia. O seqüenciamento do genoma inteiro de HBoV realizado nesse estudo indica que a divergência genômica entre as amostras desse vírus é muito pequena. Como conclusão, nós demonstramos que HBoV circula e é detectado em associação com sintomas de infecção respiratória e diarréia no Brasil. Novos estudos, com um longo acompanhamento em diferentes populações serão necessários para determinar a sazonalidade e o real impacto clínico de HBoV em nosso país. / Human bocavirus (HBoV) is a parvovirus recently identified in association with respiratory tract infections. HBoV 5217 nt genome contains 3 open reading frames encoding four proteins (NS1, NP-1, VP-1 and VP-2). HBoV has been reported in respiratory samples from children in several parts of the world (including Australia, North America, Europe, Asia, and Africa), suggesting that the virus circulates worldwide. However, no longitudinal studies of HBoV in respiratory samples have been reported in Latin America. We report a prospective study of HBoV in nasopharyngeal aspirates (NPAs) collected from patients seen for acute respiratory tract infections (ARI) at the University of Sao Paulo Hospital in Ribeirao Preto, southeast Brazil and at the University Hospital in Salvador, Brazil. 1288 NPAs from 1217 patients was submitted to the virology lab for respiratory virus detection from 2005 to 2007 and were screened for HBoV by polymerase chain reaction (PCR), whom 962 were under 5 years of age and 177 were older than 5 years. In addition, NPAs from 50 children under 12 years without IRA was also tested to HBoV for PCR. All samples positive of HBoV was tested for others respiratory virus, including the human respiratory syncitial virus (HRSV), human rhinovirus (HRV), human influenza (HFLU), human metapneumovirus (HMPV), human parainfluenza virus (HPIV), human coronavirus (HCoV) and human adenovirus (HAdV). These samples had their HBoV viral load determined by real time PCR and the viral entire genome of nineteen HBoV sample was sequenced. We also cloned and expressed in S. cerevisae (Y258) the gene of VP2, one protein of viral capside. The prevalence of this virus was of 4,8% in children under 5 years and 1% in adults, both with IRA. HBoV was not found on the patients without symptoms. In 2005, of the 259 patients tested, 25 (10%) were positive for HBoV. Interestingly, the virus circulated more frequently in April, the month of peak activity of respiratory HRSV. In 2006 HBoV was detected in only 10 NPAs out of 334 samples (3%) tested, without any notable peak of frequency. In 2007 HBoV was detected in 13 out of 552 (2%) tested samples with little higher frequency of detection in June an July. Rhinorrhea, cough, and wheezing were observed in more than 50% of the HBoV-positive children, and no obvious respiratory clinical differences were noted between HBoV-positive and negative children. However, was noted a higher frequency of diarrhea on HBoV-positive patients. In this study was also observed a larger frequency (71%) of viral coinfections between the HBoV-positive patients. The respiratory viruses more frequently associated with human bocavirus were: HRSV, HRV and HAdV. Interestingly, on the 15 HBoV-alone patients was observed a higher viral load and a higher prevalence of diarrhea than HBoV-coinfection patients. These results showed that this virus can reach enormous titles (like 1014) in NPAs from patients with respiratory infection symptoms and this is associated with diahhrea. The entire genome sequencing of HBoV of our study indicates that the genetic divergence between the HBoV lineages is small. In conclusion, we demonstrated that HBoV circulates and is detected in association with respiratory symptoms and diarrhea in Brazil. Long term surveillance will be needed to determine whether or not an HBoV season occurs and what is the real clinical impact of this virus in our country.

O vírus respiratório sincicial (RSV) é responsável por importante morbidade em receptores de transplante de células tronco-hematopoéticas (TCTH), especialmente no período que antecede a enxertia. A imunidade induzida pela infecção pelo RSV é transitória e as reinfecções são freqüentes. O comportamento e papel dos anticorpos anti-RSV em receptores de TCTH é desconhecido. Em amostras de soro estocadas, ensaio imunoenzimático (ELISA) foi aplicado para detecção de anticorpos anti-RSV para avaliar a dinâmica desses anticorpos antes e após o TCTH, em pacientes com e sem infecção pelo RSV, bem como a resposta de anticorpos específicos nos pacientes com infecção pelo RSV diagnosticada por imunofluorescência direta. A mediana do tempo de coleta das amostras pré-TCTH foi de -35 e -44 dias nos casos e controles, respectivamente, com média de títulos de anticorpos anti-RSV de 2490 UA/mL e 2872 UA/mL, respectivamente. Após o transplante, as medianas de tempo das 3 amostras analisadas dos pacientes com infecção pelo RSV foram d+14, d+52 e d+89 e os respectivos títulos de anticorpos foram 2457 UA/mL, 2715 UA/mL e 2950 UA/mL. Nos pacientes sem infecção pelo RSV (controles), as medianas de tempo das 3 amostras analisadas foram d+9, d+69 e d+93 e os respectivos títulos de anticorpos foram 2738 UA/mL, 2794 UA/mL e 2642 UA/mL. Não houve diferença estatística entre os dois grupos. Nenhum dos pacientes com infecção pelo RSV apresentou elevação de quatro vezes nos títulos de anticorpos / Respiratory syncytial virus (RSV) infection can cause significant morbidity and mortality in haematopoietic stem cell transplant (HSCT) recipients, especially when upper respiratory tract infection (RTI) progresses to lower RTI, which is expected to occur in more than 50% of the patients. The humoral immunity induced by RSV infection is transient and reinfections are frequent. The dynamics and role of anti-RSV antibodies in HSCT recipients are unknown. In stored serum samples, an enzyme-linked immunosorbent assay (EIA) was applied to evaluate the dynamics of anti-RSV antibodies in HSCT recipients with and without RSV infection, as well as the specific humoral response in HSCT recipients with RSV infection diagnosed by direct immunofluorescent assay in nasal wash samples. Pre-transplant samples were selected at a median time of 35 and 44 days and the mean concentration of RSV antibodies were 2490 AU/mL and 2872 AU/mL, in cases and controls, respectively. After HSCT, serum samples from patients with RSV infection (cases) were evaluated at median time of 14, 52 and 89 days, and the respective mean concentrations of anti- RSV antibodies were 2457 AU/mL, 2715 AU/mL and 2950 AU/mL. In patients without RSV (controls), serum samples were evaluated at median time of 9, 69 and 93 days, and the respective mean concentrations of anti-RSV antibodies were 2738 AU/mL, 2794 AU/mL e 2642 AU/mL. Difference was not statistically significant. No patient developed a four-fold rise in RSV antibody titers

Abstract Respiratory tract infections are the most common acute illnesses, and innate immunity and inflammation are important in defence against these infections. Mannose-binding lectin (MBL) mediates innate immune defences by recognising microbial structures. MBL deficiency caused by polymorphisms in the MBL2 gene has been associated with susceptibility to recurrent infections. Interleukin-6 (IL-6) is a mediator of inflammatory response. Polymorphisms in the IL-6 and IL-6 receptor (IL-6R) genes have been previously associated mainly with metabolic disorders and cardiovascular diseases. Chlamydia pneumoniae is a common pathogen in acute respiratory tract infections, but it also has a tendency to cause persistent infections, which have been associated with cardiovascular diseases and its risk factors, such as obesity. The aims of this study were to investigate if selected polymorphisms of the MBL2, IL-6 and IL-6R genes are associated with respiratory tract infections and markers of C. pneumoniae infection, and to study if persistent C. pneumoniae infection is connected with an elevated body mass index (BMI) in 893 Finnish male military conscripts. Respiratory tract infections were followed during their military service and serum samples were collected at the beginning and end of their service and during each infectious episode. A variation in serum MBL levels between different MBL2 genotypes and a MBL deficiency in homozygous exon 1 variant genotypes (at codons 52, 54 and 57) were observed. Low MBL levels and MBL2 polymorphisms in exon 1 and promoter region were found to be risk factors for susceptibility to respiratory tract infections as well as for positivity and a rise in C. pneumoniae antibodies during military service. Associations between IL-6R gene polymorphisms in the promoter region (-183G/A) and in intron 1 and respiratory tract infections were found. In addition, the IL-6 -174G/C polymorphism was associated with persistently elevated C. pneumoniae antibodies and with slightly elevated serum C-reactive protein (CRP) levels, pointing to chronic C. pneumoniae infection. Furthermore, persistent C. pneumoniae antibodies as a suggestive marker of chronic infection, and elevated serum CRP levels as a marker of systemic inflammation, were associated with an elevated BMI. In conclusion, the findings support the role for MBL in susceptibility to infections and provide new information about the association between MBL and common respiratory tract infections. The results also suggest that the 5’ area of the IL-6R gene may be a possible candidate region for respiratory tract infection susceptibility, and that IL-6 genetics may be associated with C. pneumoniae infection. The study also provides new information about the role of possible chronic C. pneumoniae infection in obesity. / Tiivistelmä Hengitystieinfektiot ovat yleisimpiä äkillisiä sairauksia, ja synnynnäisellä immuunivasteella ja tulehduksella on tärkeä rooli puolustuksessa näitä infektioita vastaan. Synnynnäiseen immuniteettiin kuuluva mannoosia sitova lektiini (MBL) tunnistaa infektioita aiheuttavien mikrobien rakenteita. MBL2-geenin polymorfismien aiheuttaman MBL-proteiinin puutteen on todettu altistavan toistuville infektioille. Interleukiini-6 (IL-6) on tulehduksen välittäjänä toimiva sytokiini. IL-6- ja IL-6-reseptori (IL-6R) -geenien polymorfismit on aikaisemmin yhdistetty lähinnä metabolisiin häiriöihin sekä sydän- ja verisuonitauteihin. Chlamydia pneumoniae eli keuhkoklamydia on yleinen hengitystieinfektioiden aiheuttaja, mutta se voi myös aiheuttaa kroonisia infektioita, jotka on yhdistetty sydän- ja verisuonitauteihin sekä niiden riskitekijöihin kuten lihavuuteen. Työn tarkoituksena oli tutkia tiettyjen MBL2-, IL-6- ja IL-6R-geenien polymorfismien yhteyttä hengitystieinfektiohin ja keuhkoklamydiavasta-ainetasoihin sekä keuhkoklamydiainfektion yhteyttä painoindeksiin 893 suomalaisella varusmiehellä. Hengitystieinfektioita seurattiin palveluksen aikana, ja seeruminäytteet kerättiin palveluksen alussa, lopussa ja jokaisen infektion aikana. Tutkimuksessa havaittiin vaihtelua seerumin MBL-pitoisuudessa eri MBL2-genotyyppien välillä sekä MBL:n puute homotsygooteissa eksoni 1 -alueen varianttigenotyypeissä (kodoneissa 52, 54 ja 57). Alhaiset MBL-tasot sekä MBL2-geenin polymorfismit eksoni 1 -alueella ja säätelyalueella olivat riskitekijöitä hengitystieinfektioalttiudelle sekä keuhkoklamydiavasta-aineiden esiintymiselle ja vasta-aineiden nousulle palveluksen aikana. IL-6R-geenin polymorfismit säätelyalueella (-183G/A) ja introni 1 -alueella liittyivät hengitystieinfektioihin. Lisäksi IL-6-geenin -174G/C polymorfismi oli yhteydessä jatkuvasti kohonneisiin keuhkoklamydiavasta-aineisiin sekä seerumin C-reaktiivisen proteiinin (CRP) tasoihin, jotka mahdollisesti osoittaisivat kroonista keuhkoklamydiainfektiota. Lisäksi krooniseen keuhkoklamydia-infektioon viittaavat vasta-ainetasot sekä tulehdukseen liittyvä kohonnut CRP-pitoisuus olivat yhteydessä ylipainoon. Tutkimuksen tulokset tukevat aikaisemmin havaittua MBL:n vaikutusta infektioalttiuteen ja lisäksi antavat uutta tietoa MBL:n yhteydestä tavallisiin hengitystieinfektioihin. Tulokset viittaavat myös siihen, että IL-6R-geenin 5’-alueella voi olla yhteyttä hengitystieinfektioalttiuteen ja että IL-6-polymorfismi olisi yhteydessä keuhkoklamydiainfektioon. Tutkimus antaa myös uutta tietoa mahdollisen kroonisen keuhkoklamydiainfektion liittymisestä ylipainoon.

Introducción: Dentro de los factores que se asocian a la morbimortalidad por enfermedades respiratorias en niños, uno de los principales es la falta de búsqueda de atención por el sistema de salud. Sin embargo, existe poca información sobre los factores asociados a ella. Objetivo: Evaluar la asociación entre variables sociodemográficas y la falta de búsqueda de atención en menores de 5 años con síntomas de Infección respiratoria aguda (IRA) según la ENDES 2019 en el Perú. Material y métodos: Estudio observacional, transversal analítico, a partir de análisis secundario de la ENDES 2019. Se incluyeron a los cuidadores de pacientes menores de 5 años con síntomas de infecciones respiratorias agudas que hayan respondido a la encuesta antes mencionada. Resultados: 34.35% no buscaron atención en establecimientos de salud. La presencia de medicamentos en el hogar (RP=1.64, IC 95%: 1.37-1.97) y la edad del menor (RP=1.26, IC 95%: 1.17-1.35). En contraparte, los hogares que pertenecen al quintil más rico (RP=0.26, IC95%: 0.11- 0.55) y la edad del cuidador(a) (RP= 0.99; IC95%: 0.98 - 1.00) tuvieron una asociación negativa con la falta de atención. Conclusiones: La falta de búsqueda de atención es frecuente en la población peruana. El bajo nivel socioeconómico persisten como barrera para la atención en establecimientos. La automedicación podría explicar la disponibilidad de medicación en el hogar como factor de riesgo para no acudir a los establecimientos de salud. / Introduction: Among the factors that are associated with morbidity and mortality from respiratory diseases in children, one of the main problems is the lack of care seeking by the health system. However, there is little information on the factors associated with it. Objective: To determine the association between sociodemographic characteristics and the lack of seeking care in health facilities in children under 5 years of age with acute respiratory infection symptoms according to the 2019 Perú Demographic and Health Survey (ENDES 2019). Material and methods: Observational, cross-sectional analytical study, based on the secondary analysis of ENDES 2019, which will include caregivers of patients under 5 years of age with acute respiratory infection symptoms who have responded to the survey. Results: 34.35% did not seek care in health facilities. The presence of medications in the home (RP=1.64, IC 95%: 1.37-1.97)and the age of the minor (RP=1.26, IC 95%: 1.17-1.35). On the other hand, be part of the richest quintile (RP=0.26, IC95%: 0.11- 0.55) and the age of the caregiver (RP= 0.99; IC95%: 0.98 - 1.00) had a negative association with the lack of care in health facilities. Conclusions: The lack of seeking care in health facilities is frequent in the Peruvian population. Lower wealth persists as a barrier to seek care in health facilities. Self-medication could explain the availability of medication at home as a risk factor for not going to health facilities. / Tesis

No description available.

Para avaliar os benefícios da comunicação rápida ao clínico do diagnóstico de vírus respiratórios, foi analisado a viabilidade econômica de 2 testes, com o tempo de entrega de resultado em 2 horas para teste rápido e 48 horas para Biologia Molecular. As amostras coletadas foram processadas utilizando técnicas convencionais e os testes disponíveis no mercado local. Foram escolhidos dois testes rápidos pelo método de imunocromatografia para quatro parâmetros analíticos: Influenza A, Influenza H1N1, Influenza B e Vírus Sincicial Respiratório (RSV) e em Biologia Molecular um teste de RT-PCR multiplex com 25 patógenos entre vírus e bactérias. O tipo de amostra utilizada foi swab e lavado de nasofaringe. A população escolhida para o estudo foi paciente adulto, em tratamento de câncer, que necessita de uma resposta rápida já que a maioria se encontra com comprometimento do sistema imune por doença ou por tratamento. O estudo foi transversal, realizado entre os anos de 2012 e 2013, para avaliar a viabilidade econômica da introdução de testes de diagnóstico da infecção respiratória aguda de etiologia viral a partir de amostras de nasofaringe em pacientes com câncer atendidos no Centro de Atendimento de Oncologia Intercorrência (CAIO ), do Instituto do Câncer do Estado de São Paulo (ICESP), hospital público que atende exclusivamente Sistema Único de Saúde (SUS) e Hospital A.C. Camargo, que atende tanto a pacientes do SUS como da rede privada. O estudo incluiu 152 pacientes em tratamento para qualquer tipo de câncer, predominantemente do sexo feminino (81 mulheres e 70 homens) com idades entre 18-86 anos. Para participar do estudo o paciente era consultado e o critério para escolha do paciente foi ser portador de câncer, com história de febre (ainda que referida) acompanhada de tosse ou dor de garganta, tosse e sintomas respiratórios agudos, atendidos por protocolo padronizado que inclui avaliação na admissão, seguimento e manejo antimicrobiano. Para a avaliação econômica os pacientes foram classificados de acordo com o estado geral de saúde, se apresentavam bom estado de estado de saúde poderiam receber alta e faziam uso da medicação em casa evitando 5 dias de internação se recebessem algum resultado para Influenza ou RSV, no entanto os pacientes que apresentavam outro vírus, resultado negativo ou o estado geral era ruim permaneciam internados por 7 dias em observação e cuidados com medicação adequada. Foram realizadas análises econômicas em dois âmbitos: o sistema de saúde publico e o privado considerando o fator diminuição de dias de internação. A analise de Custo-benefício foi eficiente no Sistema privado mas inadequada para o SUS assim como, qualquer outra medida monetária já que os valores de reembolso do SUS estão defasados do custo de qualquer internação. A análise de Custo-efetividade que olha para outros fatores além do monetário foi efetiva nos dois sistemas que enfrentam falta de leitos além da condição de saúde do paciente de evitar a ingestão desnecessária de antibióticos, evitar os gastos do acompanhante, perda de dias de trabalho e estudo. Não houve correspondência de resultados dos testes rápidos com o multiplex de Biologia Molecular / To evaluate the benefits of the rapid communication of the respiratory viruses\' diagnosis to the doctor, the economic feasibility of two tests was analyzed, with the result delivery time within 2-hours for the rapid test and 48 hours for Molecular Biology. The samples were processed using conventional techniques and the available tests in the local market. Two rapid tests were selected by the immunochromatography method for four analytical parameters: Influenza A, Influenza A H1N1, Influenza B, and Respiratory Syncytial Virus (RSV) and in Molecular Biology a multiplex RT-PCR assay with 25 pathogens between viruses and bacteria. The type of sample used was swab and nasopharyngeal wash. The population chosen for the study was of adult patients undergoing cancer treatment, which requires a rapid response since most have a compromised immune system due to the disease or treatment. The study, conducted between 2012 and 2013, was cross-sectional to evaluate the economic feasibility of introducing diagnostic tests for acute respiratory infection of viral etiology from nasopharyngeal samples of patients with cancer attended at the Oncology Intercurrence Care Center (CAIO), at the Cancer Institute of the São Paulo State (ICESP), at public hospital that attends exclusively the Unified Health System (SUS) and at AC Camargo hospital, which attends SUS patients as well as the private health system. The study included 152 patients undergoing treatment for any type of cancer, predominantly female (81 women and 70 men) between 18 and 86 years. To participate in the study, the patients were consulted and the criteria for choosing a patient was to be a cancer patient with a history of fever (even if referred) accompanied by cough or sore throat, coughing and acute respiratory symptoms, attended by standardized protocol that includes an evaluation at the admission, tracking and antimicrobial management. For the economic evaluation, patients were classified according to the general health condition. If they were in a good health condition, they could receive medical discharge and make use of the medication at home avoiding five days of hospitalization when receiving a result for influenza or RSV. However, the patients with other viruses, negative results or with bad general condition remained hospitalized for seven days under observation and care with proper medication. Economic analyzes were carried out in two areas: the public health system and private health system considering the factor decreased length of hospital stay. The cost-benefit analysis was efficient in the private system but inadequate for the NHS as well as any other monetary measure since the SUS reimbursement values are too low when compared to the cost of any other hospital. The cost-effectiveness analysis that looks at other factors besides money was effective in both systems that were facing lack of beds in addition to the health condition of the patient to avoid unnecessary intake of antibiotics, avoid the costs of the accompanying person, loss of working and study days. There were no results correspondences of the rapid tests with the Molecular Biology multiplex