Avaliar a associação entre as infecções genito-urinárias, o comprimento do colo uterino e a prematuridade é importante para determinar quais podem ser os fatores preditivos para o parto pré-termo. Foi realizado estudo tipo coorte de conveniência, prospectivo, avaliando 1370 gestantes na cidade de Ribeirão Preto, com idade gestacional entre 20 e 25 semanas. Aplicou-se questionário sócio demográfico com história reprodutiva para a identificação do histórico obstétrico, idade materna, paridade, tabagismo e antecedente de parto pré-termo. Foi realizada ultrassonografia endovaginal para a avaliação do comprimento do colo uterino segundo as diretrizes da Fetal Medicine Foundation (FMF). Foram coletadas amostras de urina e conteúdo vaginal para avaliar a presença de infecção urinária e vaginose bacteriana respectivamente. A associação entre infecções, comprimento do colo uterino e parto pré-termo (PPT) foi realizada mediante teste não paramétrico e o cálculo do Risco Relativo das diferentes variáveis, por meio do ajuste de modelos log-binomiais. Das 1370 mulheres grávidas avaliadas, 132(9,63%) cursaram com parto pré-termo (<37 semanas), sendo que 19 (14,4%) dos partos pré-termo ocorreram em mulheres com colo <= 2,5 cm. O estudo microbiológico determinou que no grupo das mulheres que cursaram com parto pré-termo, 15 apresentaram ITU, 19 apresentaram vaginose bacteriana (VB) e uma apresentou ITU e VB. Avaliando as 75 pacientes com PPT espontâneos, 10 apresentaram ITU e 14, VB. Após a análise destes dados, foi possível concluir que o colo uterino curto entre 20 e 25 semanas de gestação está associado ao PPT e que ITU e VB rastreadas nesta idade não se associaram ao encurtamento do colo nem ao PPT. No entanto a ITU, mesmo assintomática apresentou relação com o PPT espontâneo. / To evaluate the association between the genito-urinary infections, cervical length and preterm birth is important to determine which can be predictive factors for preterm birth. It was conducted cohort study of convenience, prospective, evaluating 1370 pregnant women in the city of Ribeirão Preto, with gestational age between 20 and 25 weeks. Applied socio-demographic questionnaire with reproductive history to identify the obstetric history, maternal age, parity, smoking and preterm birth (PTB) history. Transvaginal ultrasonography was performed for evaluation of cervical length in the guidelines of the Fetal Medicine Foundation (FMF). Urine and vaginal discharge samples were collected to evaluate the presence of urinary tract infection (UTI) and bacterial vaginosis (BV) respectively. The association between infections, cervical length and preterm delivery was performed using non-parametric test and calculate the relative risk of different variables, by adjusting log-binomial model. Of the 1370 evaluated pregnant women, 132 (9.63%) presenting with preterm delivery (<37 weeks), and 19 (14.4%) of preterm deliveries occurred in women with cervix <=2.5 cm. The microbiological study found that the group of women presenting with preterm birth(PTB), 15 had UTI, 19 had BV and one presented UTI and VB. Evaluating 75 patients with spontaneous PTB, 10 had UTI and 14, BV. After the analysis of these data, it was concluded that the short cervix between 20 and 25 weeks of gestation is associated with the PTB and UTI and VB screened at this age not associated to the shortening of the cervix or the PTB. However, the UTI even asymptomatic were related to the spontaneous PTB.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2016-05-20T18:38:38Z No. of bitstreams: 1 Flavia Fragoso dos Santos Fioravante.pdf: 4669109 bytes, checksum: 06a096af88496108c603d145ab846516 (MD5) / Made available in DSpace on 2016-05-20T18:38:38Z (GMT). No. of bitstreams: 1 Flavia Fragoso dos Santos Fioravante.pdf: 4669109 bytes, checksum: 06a096af88496108c603d145ab846516 (MD5) Previous issue date: 2015 / Mestrado Profissional em Enfermagem Assistencial / O presente estudo contempla como objeto as ações educativas em saúde desenvolvidas pelo enfermeiro durante à assistência pré-natal, com enfoque na prevenção da infecção urinária em gestantes acompanhadas na Unidade de Saúde da Família. Objetivo geral: complementar a prática assistencial do enfermeiro através da utilização de uma cartilha educativa com foco na prevenção da infecção urinária na gravidez. Objetivos específicos: 1- construir uma cartilha educativa com foco na prevenção da infecção urinária na gravidez; 2- aplicar, com base na Metodologia da Problematização, a cartilha educativa em um grupo de gestantes acompanhadas na Unidade de Saúde da Família; 3- analisar a aplicação da cartilha educativa, tendo em vista os problemas de enfermagem que predispõem à ocorrência da infecção urinária na gravidez. Materiais e Métodos: estudo descritivo com abordagem qualitativa, tendo como referencial a Metodologia da Problematização. Cenário: Unidade de Saúde da Família em Petrópolis, Rio de Janeiro. Participantes: 15 gestantes. Coleta de dados: entrevista individual e grupal, com o uso de questionários, gravador e notas de campo. Análise: triangulação dos dados. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa do Hospital Universitário Antônio Pedro/ Universidade Federal Fluminense, parecer nº 866.758. Resultados: construiu-se uma cartilha educativa, que foi aplicada a um grupo de gestantes, e, que continha informações acerca da infecção urinária na gravidez e de como preveni-la. Das gestantes participantes, 80% eram maiores de 20 anos, 46,6% brancas, 66,7% com ensino fundamental, 46,7% solteiras, 60% do lar, 80% com renda familiar entre 1 a 2 salários mínimos, 66,6% com número de gestações entre 1 a 2 e 26,6% com histórico de doença sexualmente transmissível. Os problemas de enfermagem evidenciados foram a baixa ingestão hídrica, o baixo consumo de frutas e verduras, o déficit de higiene após a relação sexual e à evacuação, o atraso do esvaziamento voluntário da bexiga e o medo das gestantes quanto ao uso de antibióticos. A cartilha foi avaliada como adequada pelas gestantes, quanto aos objetivos, à organização, ao estilo da escrita, à aparência e à motivação. Conclusões: a cartilha complementa a prática assistencial do enfermeiro, sendo uma importante ferramenta de discussão e reflexão, facilitadora da autonomia e da tomada de decisão das gestantes frente às situações-problemas relacionadas à infecção urinária. / This study includes as an object the educative actions in health developed by the nurse during the prenatal care, focusing on prevention of urinary tract infection in pregnant women who have been observed by the Family Health Unit. Overall objective: to complement the professional abilities of nurses through the use of an educational booklet focusing on prevention of urinary tract infection in pregnancy. Specific objectives: 1- build an educational booklet focusing on prevention of urinary tract infection in pregnancy; 2 apply, based on the Curriculum Methodology , the educational booklet in a group of pregnant women of Family Health Unit; 3- Watch the implementation of the educational booklet, taking into consideration the nursing problems that predispose the occurrence of urinary tract infection in pregnancy. Materials and Methods: adescriptive study with a qualitative approach, taking as reference the Curriculum Methodology.Scenario: Family Health Unit in Petropolis, Rio de Janeiro. Participants: 15 pregnant women. Data collection: personal and group interviews, using questionnaires, recorder and field notes. Analysis: triangulation of data. The study was approved by the Ethics in Research Committee of the University Hospital Antônio Pedro / Fluminense Federal University, opinion No. 866,758. Results: An educational booklet has been built, and it was applied to a group of pregnant women. It contained information about urinary infection during pregnancy and how to prevent it. The participating pregnant women, 80% were older than 20 years, 46.6% white, 66.7% with primary education, 46.7% were single, 60% housewives, 80% with family income between 1-2 minimum wages, 66 , 6% with number of pregnancies between 1-2 and 26.6% with a history of sexually transmitted disease. The nursing problems discovered were low water intake, low consumption of fruits and vegetables, the hygiene deficit after sexual intercourse or draining, the delay of voluntary bladder emptying and fear of pregnant women about the use of antibiotics. The booklet was approved by the pregnant women, who liked the organization, the aim, the writing style, the appearance and the motivation it brings. Conclusions: the project complements the abilities of nurses and it is an important discussion and reflection tool, facilitating autonomy and decision-making of pregnant women in the face of situations-problems related to urinary tract infection.

Abstract The aims were to evaluate the occurrence of vesicoureteral reflux (VUR) in children, to assess the frequency of significant ultrasonography (US) abnormalities and to study whether abandoning the use of voiding cystourethrographies (VCUG) is safe in children with urinary tract infection (UTI). We analysed reports on US and VCUG in a consecutive series of 406 paediatric patients and in a large population-based group of 2036 children with UTI. Based on the urine culture data, we analysed the frequencies of VUR and US abnormalities in relation to the reliability of the UTI diagnoses. Using a cohort of 1185 children on whom both VCUG and US had been performed, we evaluated whether US imaging alone is sufficient. In a follow-up study, we excluded 24 cases with major renal dysplasia or obstruction of the urinary tract from this cohort of 1185 children leaving a series of 1161 cases, of which 228 were randomly selected for follow-up and 193 (85%) participated, with a mean follow-up time of 11 years (range 6 to 17 years). The occurrence of VUR was similar among the children with proven (37%) or certain (36%) versus false (35%) or improbable (36%) UTI and decreased with increasing age. Significant US abnormalities were found in 10% and the frequency increased as the diagnostic reliability improved (15% in the proven UTI class and 8% in the false class). In the cohort of 1185 children, initial US was normal in 861 (73%), out of whom VCUG identified two cases of urethral valves and 40 cases of grade III to V VUR who could have benefited from surgical treatment, giving a figure of 42/861 (5%) for pathological findings that might have been missed if VCUG had not been performed. In the follow-up study, unilateral renal parenchymal defect was found in 22 (15%) out of the 150 patients who underwent control US, all except one of these being in patients with grade III to V VUR. Serum cystatin C concentration, estimated glomerular filtration rates and blood pressure were within the normal ranges in all the patients despite the defects seen in US. We conclude that VUR is a common age-related phenomenon in children and is not as closely associated with UTI as was previously thought. Children with UTI could be examined using US alone. Once obstructive uropathy and major renal dysplasia have been ruled out, the risk of long-term consequences in a case of childhood UTI is very low. / Tiivistelmä Tutkimuksen tavoitteena oli selvittää virtsan takaisinvirtauksen (vesikoureteraalinen takaisinvirtaus, VUR) esiintyvyyttä lapsilla sekä arvioida merkittävien virtsateiden rakennepoikkeavuuksien yleisyyttä ja ultraäänitutkimuksen (UÄ) riittävyyttä virtsatieinfektion (VTI) sairastaneilla lapsilla. Analysoimme sairastetun VTI:n vuoksi tehtyjen UÄ- ja miktiokystografiatutkimusten löydökset 406 lapsen potilassarjassa ja 2036 lapsen väestöpohjaisessa aineistossa. Virtsaviljelytulosten pohjalta luokittelimme potilaat VTI-diagnoosin luotettavuuden mukaan. Väestöpohjaisen aineiston 1185 lapselle oli tehty sekä UÄ-tutkimus että miktiokystografia, ja tässä kohortissa arvioimme pelkän UÄ:n riittävyyttä virtsateiden kuvantamisessa. Seurantatutkimusta varten 1185 lapsen kohortista jätimme pois 24 potilasta, joilla oli todettu munuaisdysplasia tai virtsateiden virtauseste. Jälkitarkastukseen kutsuimme tästä 1161 potilaan tutkimusaineistosta ryväsotannalla 228 potilasta, joista 193 (85 %) osallistui. Keskimääräinen seuranta-aika oli 11 vuotta (vaihtelu 6–17 vuotta). Tutkimuksemme mukaan VUR on yleinen myös lapsilla, jotka eivät ole sairastaneet varmennettua VTI:ta. Näillä lapsilla VUR:n esiintyvyys oli 35–36&#160;%, joka oli sama kuin varman VTI:n sairastaneilla (36–37 %), ja esiintyvyys väheni merkittävästi iän myötä. Merkittävä UÄ-poikkeavuus todettiin kaikkiaan 10 %:lla, ja riski oli suurin varman VTI:n sairastaneilla. 1185 lapsen kohortissa UÄ-tutkimus oli normaali 861:lla (73 %). Miktiokystografiassa heistä 42/861:lla (5&#160;%) löydettiin merkittävä virtsatieanomalia (n = 2) tai VUR, joka oli hoidettu kirurgisesti (n&#160;=&#160;40). Jälkitarkastuksessa 22:lla (15&#160;%) UÄ:llä tutkitusta 150 potilaasta todettiin toispuoleinen munuaisarpi, ja yhtä tapausta lukuun ottamatta arvet löytyivät niiltä, joilla oli lapsena ollut III−V asteen VUR. Todetuista munuaisarvista huolimatta kaikilla seurantatutkimukseen osallistuneilla potilailla oli normaali munuaisten toiminta ja verenpaine. Aiemmasta käsityksestä poiketen VUR näyttäisi olevan yleinen, kasvun myötä häviävä ilmiö myös terveillä lapsilla. Virtsatieinfektion sairastaneilla lapsilla UÄ-tutkimus riittää virtsateiden kuvantamiseen ja kun synnynnäinen munuaisdysplasia ja virtsateiden virtauseste on poissuljettu, riski merkittäviin myöhäiskomplikaatioihin on hyvin pieni.

Abstract Urinary tract infections (UTIs) are among the most common bacterial infections in childhood and have a tendency to recur. The ability of uropathogens to form biofilm may be important in the pathogenesis of UTI. Although childhood UTIs are thought to increase the risk of chronic kidney disease (CKD), evidence showing this association is scarce. Cranberry juice has been shown to prevent UTIs in women, but evidence of its efficacy in children is lacking. The aim of this work was to evaluate the significance of biofilm formation for the clinical presentation of UTI, the long-term consequences of UTI in childhood and the efficacy, safety and acceptability of cranberry juice in the prevention of UTIs in children. The formation of biofilm in clinical samples was assessed in vitro with optical density measurements and verified by scanning electron microscopy and confocal scanning laser microscopy. A systematic literature search on the association between childhood UTIs and CKD was conducted, and data on patients with CKD treated or monitored at Oulu University Hospital were reviewed. The efficacy of cranberry juice in preventing recurrences of UTIs in children and its effects on the normal flora were evaluated with two randomized controlled trials. About one third of the uropathogenic E. coli strains were capable of forming biofilm, and the strains isolated from patients having pyelonephritis formed biofilm better than those from cystitis cases. We did not find any cases among the 1576 reviewed in the literature search or the 366 in our patient series who had structurally normal kidneys in their first kidney imaging and in whom childhood UTIs could have been the cause of subsequent CKD. The aetiological fraction of childhood UTIs as a cause of CKD was at most 0.3%. The administering of cranberry juice did not reduce the number of children who experienced a recurrence of UTI, but it did reduce the number of recurrences per person year at risk by 39% (0.25 vs. 0.41 episodes, 95% CI for difference -0.31 to -0.01) and the number of days on antimicrobials per patient year by 34% (11.6 vs. 17.6 days, 95% CI for difference -7 to -5). Cranberry juice was well accepted and tolerated by the children and did not cause harmful changes in the normal flora. The ability of bacteria to persist and grow in a biofilm seems to be one of the significant factors in the pathogenesis of UTIs. A child with normal kidneys is not at risk of developing CKD because of UTIs in childhood, so that imaging procedures after the first UTI can be focused on finding severe urinary tract abnormalities. Taking into account the relatively innocent nature of childhood UTIs, cranberry juice offers an alternative to antimicrobials for preventing UTIs in children. The mechanism of action of cranberry juice may be associated with biofilm formation by uropathogens. / Tiivistelmä Virtsatieinfektio (VTI) on yksi tavallisimpia lasten bakteeri-infektioita, ja sillä on taipumus uusiutua. Bakteerien biofilminmuodostuskyky voi olla merkittävä tekijä VTI:n synnyssä. Lapsuudessa sairastetun VTI:n ajatellaan lisäävän kroonisen munuaisten vajaatoiminnan riskiä, mikä ei kuitenkaan perustu tieteelliseen näyttöön. Karpalomehu ehkäisee aikuisten naisten VTI:n uusiutumisia, mutta sen tehoa lapsilla ei tiedetä. Tämän väitöskirjatyön tavoitteena oli selvittää bakteerien biofilminmuodostuskyvyn yhteyttä VTI:n kliiniseen kuvaan, lapsuudessa sairastetun VTI:n pitkäaikaisvaikutuksia sekä karpalomehun tehoa, turvallisuutta ja käyttökelpoisuutta lasten VTI:n ehkäisyssä. Kliinisistä virtsanäytteistä viljeltyjen E. coli –kantojen muodostama biofilmi mitattiin optisen tiheyden perusteella, ja elävien biofilmirakenteiden muodostuminen varmistettiin elektronimikroskooppi- ja konfokaalimikroskooppikuvauksilla. Lapsena sairastetun VTI:n yhteyttä munuaisten vajaatoimintaan tutkittiin systemaattisella kirjallisuuskatsauksella ja selvittämällä OYS:ssa munuaisten vajaatoiminnan vuoksi hoidossa olevien potilaiden munuaissairauden etiologia. Karpalomehun tehoa, turvallisuutta ja käyttökelpoisuutta lasten VTI:n ehkäisyssä selvitettiin kahdella lumekontrolloidulla tutkimuksella. Kolmasosa E. coli –kannoista muodosti biofilmiä, ja pyelonefriittipotilailta eristetyt kannat olivat parempia biofilminmuodostajia kuin kystiittipotilailta eristetyt. Kirjallisuuskatsauksen 1576:n ja OYS:n 366:n tapauksen joukossa ei ollut potilaita, joilla olisi ollut ensimmäisessä kuvantamistutkimuksessa rakenteeltaan normaalit munuaiset ja lapsuuden VTI:t olisivat johtaneet munuaisten vajaatoimintaan. Lapsuuden VTI:n etiologinen fraktio munuaisten vajaatoiminnan syynä oli teoriassakin korkeintaan 0.3&#160;%. Karpalomehu ei vähentänyt uusintainfektion saaneiden lasten määrää, mutta se vähensi uusintaepisodeja 39&#160;% riskiaikaa kohti (0,25/vuosi vs. 0,41/vuosi) ja antibioottipäiviä 34&#160;% potilasvuotta kohti (11,6 vs. 17,6 päivää). Lapset joivat karpalomehua mielellään, eikä sillä ollut haitallisia vaikutuksia normaaliflooraan. Aiheuttajabakteerien biofilminmuodostuskyky vaikuttaa olevan merkittävä tekijä VTI:n patogeneesissä. Lapsi, jolla on rakenteellisesti normaalit munuaiset, ei ole lapsuuden VTI:n vuoksi riskissä sairastua munuaisten vajaatoimintaan. Siten ensimmäisen VTI:n jälkeiset kuvantamistutkimukset voidaan suunnata toteamaan vaikeat rakenteelliset poikkeavuudet. Koska lapsuuden VTI on suhteellisen vaaraton sairaus, karpalomehu on hyvä vaihtoehto VTI:n ehkäisyyn myös lapsilla. Biofilminmuodostuksen esto on sen yksi mahdollinen vaikutusmekanismi.

L’infection des voies urinaires est l'une des infections bactériennes les plus courantes avec des coûts de soins de santé très élevés. On estime que 50% des femmes connaîtront une infection urinaire au cours de leur vie, ceci de manière récurrente chez la moitié d’entre elles. Le développement de thérapies efficaces a été limité par le manque de connaissance concernant la mise en place de la réponse immune adaptative lors de cette infection. Dans cette étude, nous avons démontré qu'une réponse adaptative est générée lors de l'infection urinaire, cependant celle-ci n’a pas d’action protectrice. Afin de comprendre les mécanismes aboutissant à ce phénomène, nous avons cherché à caractériser les cellules immunitaires présentes dans la vessie. Des tests d’absorption bactérienne ont montré que ces macrophages phagocytent la majorité des bactéries au début de l'infection. Pour évaluer l’influence de ces cellules sur la mise en place de la réponse immune adaptative, nous avons déplété les macrophages et évalué la clairance bactérienne lors d’une deuxième infection. En comparaison avec les animaux non traités, les souris déplétées présentaient une réduction de la charge bactérienne conséquente lors de la seconde infection, cette clairance dépendant de la réponse immune adaptative. Pour comprendre ce mécanisme d'inhibition par les macrophages, nous avons évalué le microenvironnement vésical et la phagocytose au début de l'infection chez les souris déplétées, et chez les souris non traitées. Bien que nous n’ayons pas observé de différences dans la production de cytokines, l'absorption bactérienne par les cellules dendritiques s’avère deux fois plus importante chez les animaux déplétés. Ces données suggèrent que l'absorption bactérienne par les macrophages tissulaires est néfaste pour la mise en place de la réponse adaptative, ouvrant de nouvelles options thérapeutiques. Nous avons également évalué le rôle des lymphocytes T dans ce processus en déplétant ces cellules au cours de l'infection primaire ou avant la deuxième infection. Ainsi, nous avons observé que les lymphocytes T sont nécessaires dans la réponse adaptative, mais ne sont cependant pas indispensables à la clairance bactérienne lors d'une réinfection. De plus, l'infection des souris Batf3-/-, déplétées en cellules dendritiques spécialisées dans la présentation croisée, a montré que ces souris contrôlent une seconde infection aussi bien que les souris contrôle. Ces résultats suggérent que la présence lymphocytes T CD8+ n’est pas nécessaire pour lutter contre l’infection urinaire. Notre étude révèle un mécanisme par lequel le système immunitaire est compromis lors de l'infection urinaire, offrant un point de départ intéressant pour une recherche plus approfondie sur le rôle du système immunitaire adaptatif dans ce contexte, élément fondamental dans le développement de nouvelles thérapies. / Urinary tract infection (UTI) is one of the most common bacterial infections with exorbitant health care costs. It is estimated that 50% of women will experience a UTI during their lifetime and approximately half will suffer recurrent infections. Infected women are treated with antibiotics, however, antibiotic resistance is increasing, raising the need for new therapeutic options. Development of efficient therapies has been impeded by the lack of knowledge of events leading to adaptive immunity. In this study, we demonstrated that an adaptive immune response is generated during UTI, however this response does not confer protective immunity. To begin to understand why the response induced during UTI was not effective, we delineated the immune cell compartment of the bladder and identified macrophages as the most populous immune cell. We evaluated bacterial acquisition in the bladder observing that macrophages phagocytize the majority of the bacteria early in infection. To evaluate the impact of macrophages on the generation of adaptive immunity, we depleted bladder resident macrophages and evaluated bacterial clearance during a challenge infection. Interestingly, mice depleted of resident macrophages, prior to primary infection, exhibited a nearly 2-log reduction in bacterial burden following secondary challenge compared to untreated animals. This improvement in clearance was dependent on the adaptive immune system. To shed light on the mechanism of macrophage inhibition, we evaluated the bladder microenvironment and bacterial acquisition early in infection in macrophage-depleted and control-treated mice. While we did not observe differences in the cytokine microenvironment, bacterial uptake by dendritic cells was increased nearly 2-fold in macrophage-depleted animals. These data suggest that bacterial uptake by tissue macrophages negatively impacts the development of adaptive immunity, revealing a novel target for enhancing host responses to bacterial infection of the bladder. We also evaluated the role of T cells during UTI by depleting these cells during the course of the infection or just prior to challenge infection. We observed that T cells were necessary to mount an adaptive immune response to UTI, however, they were dispensable for bacterial killing during challenge infection. Additionally, infection of Batf3-/- mice, lacking cross-presenting dendritic cells, suggested that CD8+ T cells are dispensable for the response against UTI as these mice cleared a challenge infection as well as wildtype mice. Our study has revealed a mechanism by which the immune system is compromised during UTI, providing an interesting start point for further investigation of the role of the adaptive immune system during UTI, which will be fundamental for the development of new therapies to efficiently treat infection.

Orientador: José Wilson Magalhães Bassani / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Elétrica e de Computação / Made available in DSpace on 2018-08-26T12:41:31Z (GMT). No. of bitstreams: 1 Almeida_JoaoCarlosMartinsde_M.pdf: 13918269 bytes, checksum: 78378428b79af0919ecab395a454bf98 (MD5) Previous issue date: 2014 / Resumo: O estudo urodinâmico tem importante papel na determinação da necessidade de pacientes portadores de sintomas do trato urinário inferior (STUI) se submeterem à cirurgia da próstata. O estudo pressão-fluxo pode contribuir muito para a quantificação dos STUI, porém é invasivo, demorado e de custo elevado. Métodos alternativos têm sido desenvolvidos procurando minimizar o procedimento invasivo necessário para medição da pressão vesical. Um método alternativo foi desenvolvido no Centro de Engenharia Biomédica da UNICAMP e consiste num dispositivo denominado conector uretral (Pat. N. PI 0502171-5). Trata-se de um dispositivo cilíndrico e vazado, que permite o escoamento de urina por seu interior. O paciente é orientado a introduzir o conector na uretra antes de iniciar a micção e, ao urinar, solicitado a ocluir a saída do dispositivo, interrompendo o fluxo urinário por um curto intervalo e permitindo o registro da pressão dentro da bexiga urinária. Neste trabalho, uma instrumentação e uma nova versão do conector uretral foram desenvolvidas para medir a pressão vesical em homens. Aplicado em testes clínicos em indivíduos com sintomas de obstrução infravesical decorrente de hiperplasia benigna da próstata, o conjunto demonstrou capacidade de diferenciar indivíduos com obstrução de indivíduos não obstruídos sem diferença significativa do que se obtém no estudo pressão-fluxo (p > 0,05). O conector apresentou sensibilidade e especificidade de 66,7%, valores similares aos dos métodos alternativos descritos na literatura. Além disso, 88,5% dos indivíduos relataram preferir o conector uretral ao estudo pressão-fluxo, indicando a importância do conector como método alternativo minimamente invasivo ao estudo urodinâmico convencional / Abstract: Urodynamic assessment has an important role in the decision of patients complaining of lower urinary tract symptoms (LUTS) to undergo prostate surgery. Pressure-flow study may contribute to the evaluation of LUTS, but its procedure is invasive, time-consuming and expensive. Alternative methods have been developed aiming at measuring vesical pressure in a less invasive manner. An alternative method was developed in the Center for Biomedical Engineering at UNICAMP and consists of a device named urethral connector (Pat. N. PI 0502171-5). The device has a cylindrical shape and an internal longitudinal hole that permits urine to pass through it. The patient is instructed to insert the urethral connector into his urethra before starting to urinate. During micturition, he is instructed to occlude the urine outlet of the device for a short period of time so that vesical pressure may be measured. In this work, an instrumentation and a new version of the urethral connector were developed to measure vesical pressure in men. The device and instrumentation were applied in clinical tests in individuals reporting LUTS secondary to infravesical obstruction due to benign prostatic hyperplasia. It was shown that this new method is capable of differentiating obstructed individuals from nonobstructed ones. Results were not significantly different from those obtained when conventional pressure-flow study was applied (p > 0.05). The urethral connector had a sensibility and specificity of 66.7%, values similar to those found by the alternative methods described in the literature. About 88.5% of the individuals evaluated reported to prefer the new method instead of the conventional assessment which reinforces the importance of the urethral connector as a less invasive and alternative method to the conventional urodynamic study / Mestrado / Engenharia Biomedica / Mestre em Engenharia Elétrica

Les infections urinaires (IUs) sont un motif très fréquent de consultation et de prescription d’antibiotique en médecine générale. Le choix de l’antibiotique repose sur les caractéristiques du patient, la susceptibilité des germes aux antibiotiques et des analyses de coût. Cette démarche thérapeutique est devenue de plus en plus complexe en raison de l’augmentation des résistantes aux antibiotiques. Dans ce contexte, mon travail de thèse repose sur deux principales études :A partir des données d’IMS-health France, une analyse spectrale des ventes d’antibiotiques urinaires a montré l’existence d’une saisonnalité annuelle entre 2001 et 2012 avec des pics estivaux. A partir des données de recherche de Google en France et dans six autres pays, le même phénomène a été observé. Ceci représente un argument en faveur d’une saisonnalité des cystites aigues simples.Une étude a été mise en place, visant à estimer l’incidence des IUs à germes résistants et à déterminer les facteurs associés à l’acquisition de ces germes. Un taux d'incidence annuel des IUs présumées en médecine générale a été estimé à 3 200 pour 100 000 femmes en France [IC 95%: 2 400-4 000], avec un taux d'incidence annuel des infections urinaires à E. coli résistant au fluoroquinolone en médecine générale à 102 pour 100 000 femmes en France [IC 95%: 30-50]. Les facteurs associés aux IU à entérobactéries résistantes à plus de trois classes d’antibiotique étaient l'utilisation de la pénicilline par la patiente (OR = 3,1 ; [1,2-8,0]), avoir fourni un hébergement à un résident d'un pays à haut risque de résistance aux antibiotiques (OR = 4,0 [1,2-15,1]) et la consommation de viande crue (OR = 0,3 ; [0,1-0,9]). / Urinary tract infections (IUs) are a frequent reason for consultation and prescription of antibiotics in general practice. The choice of the antibiotic is based on the patient’s characteristics, the antibiotic susceptibility of bacteria and cost analyzes. This therapeutic approach has become increasingly complex due to the increase in antibiotic resistance. In this context, my thesis is based on two main studies:From the data of IMS health France, a spectral analysis of urinary antibiotic sales was shown the existence of an annual seasonality between 2001 and 2012 with summer peaks. The same phenomenon was been observed from Google search data in France and in six other countries. This is an argument for seasonality in acute cystitis.Another study was set up, to estimate the incidence of resistant germs in IUs and identify factors associated with the acquisition of these germs. An annual incidence rate of IUs in general practice was estimated at 3,200 per 100,000 women in France [95% CI: 2,400-4,000], with an annual incidence rate of IUs due to E. coli resistant to fluoroquinolone in general practice at 102 per 100,000 women in France [95% CI: 30-50]. Factors associated with IU due to Enterobacteriaceae resistant to more than three classes of antibiotic were having used penicillin by the patient (OR = 3.1; [1.2 to 8.0]), having provided accommodation to a resident of a country at high risk for antibiotic resistance (OR = 4.0 [1.2 to 15.1]) and raw meat consumption (OR = 0.3; [0.1-0.9] ).

Catheter-associated urinary tract infections (CAUTIs) are the most frequently reported hospital-acquired condition, affecting more than 560,000 patients each year. CAUTIs prolong hospital stays and increase health care costs, and they can result in patient morbidity and mortality. Nurses can be empowered by receiving education and knowledge to manage and identify urinary catheters that are not clinically indicated. The purpose of this project was to develop an education program on CAUTI prevention for critical care nurses using the teach-back method. The conceptual framework that guided this project was Knowles's adult learning theory. The theoretical model was based on 4 fundamental assumptions of self-concept development. A total of 32 critical care unit nurses participated in the evaluation of the teach-back method. Demographic data were collected from these 32 participants, and the results of a frequency analysis were obtained. Deidentified CAUTI data were provided by the organization prior to the educational intervention. The postintervention CAUTI rate and increase in nurses' knowledge level were evaluated 1 month after the educational intervention using a 1-sample t test. The finding was statistically significant (p < .001). The incidence of CAUTI was followed, and the outcomes indicated that the overall incidence of CAUTI in these patients was decreased. The education program was effective in improving critical care unit nurses' knowledge of evidence-based practices to prevent CAUTIs. Improving nurses' knowledge to decrease CAUTI rates is a strategy that may be effective in many healthcare settings. This educational intervention may create social change by improving the health of patients and serving as an educational resource for nurses.

No description available.

Antibiotic resistance is now a recognized problem in global health. In attempts to find solutions to detect bacteria causing antibiotic resistance we turn to technological solutions that are miniaturized, portable and cheap. The current diagnostic procedures cannot provide correct information outside laboratory settings, at the point-of-care, within necessary time. This has led to ineffective treatment of urinary tract infections causing recurrent infections and multi-drug resistant bacteria to spread. The bacteria genes show which antibiotic that is required to eliminate disease and spread of resistance. Hence, the solution would be to perform nucleic acid testing at the point-of-care. By using new DNA amplification methods it is possible to miniaturize the diagnostic test to a so-called Lab-on-a-chip. These solutions would enable sample-in-results-out capability of the system at the point-of-care. For this to work one of the most important factors is fluorescent signal read-out from DNA amplification products. In this project the design parameters of such a read-out device was investigated with focus on image sensor sensitivity and device integration. During the project it was found that a low-cost commercial image sensor could be used to record images of a (3.76 x 2.74 mm2) micro well array of nanoliter sized PCR chambers. Different imaging artifacts appearing during sample partitioning were observed, distance dependency between sensor surface well array was investigate, and finally the image sensor function was compared to a fluorescent microscope.