Orientadores: Ilka de Fátima Ferreira Santana Boin, Raquel Silveira Bello Stucchi / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-20T01:05:47Z (GMT). No. of bitstreams: 1 Sampaio_AnaMaria_D.pdf: 2807263 bytes, checksum: d6e4e66e4a1625c1079f11fd900f0137 (MD5) Previous issue date: 2012 / Resumo: O herpes vírus humano HHV-6 e HHV-7 pertencem à subfamília herpes virinae, família herpes viridae, são vírus universais e após infecção primária permanecem latentes no organismo, podendo ser reativados por período de imunossupressão. O objetivo da pesquisa visou a padronização e implantação da antigenemia para diagnóstico precoce de HHV-6 e HHV-7 e a realização da sorologia para HHV-6 em pacientes submetidos ao transplante de fígado do Hospital das Clínicas da Unicamp. A partir dos dados obtidos da antigenemia para HHV-6 e HHV-7, avaliou com os achados de antigenemia do HCMV, N-PCR para HCMV, HHV-6, HHV-7 e outros aspectos clinico-laboratoriais. O protocolo foi seguido de acordo com os requerimentos para pesquisas e foi aprovado pelo Comitê de Ética Institucional da Faculdade de Ciências Médicas (FCM) da Universidade Estadual de Campinas (Unicamp). Conseguiu-se para o estudo amostras de 32 pacientes, com idade mediana de 47 (18-66) anos, sendo 20 (62,5%) do sexo masculino e 12 (37,5%) do sexo feminino. A monitorização dos pacientes foi realizada prospectivamente desde o pré-transplante e no pós-transplante, de modo semanal no 1º e 2º, quinzenal no 3º mês e mensal do 4º mês até o final do 6º mês. A partir de linfócitos extraídos de sangue periférico realizou-se a detecção de antígenos de HHV-6 com anticorpos monoclonais C65206M (marca Biodesign International, France) e MAB8535 (marca Biodesign International - USA) e conjugados de soro de coelho anti-IgG de camundongo Z0412-1 (marca Dako - CA, USA) e soro de cabra anti-IgG de coelho marcado com peroxidase 81-6120 (marca Zymed, CA, USA). Para a detecção de antígenos de HHV-7 foi utilizado o anticorpo monoclonal de rato KR4 (marca Advance Biotechnologies, Canada), conjugado soro de coelho anti-imunoglobulina de camundongo P0260 (marca Dako Cytomation, USA) e conjugado soro de cabra anti-IgG de coelho 81-6120 (marca Zymed, CA, USA) diluídos em PBS/BSA e aplicados sobre a fixação celular. Foi realizado a detecção de anticorpos IgM anti HHV-6 pelo teste de Elisa (marca Panbio, USA). Com essas metodologias a detecção de IgM anti HHV-6 foi positiva em 15,6% dos pacientes no pré transplante, 25% na quarta semana, 40,6% na 12 semana e em 46,9% na 24 semana após o enxerto. A antigenemia para HCMV, HHV-6 e HHV-7 foi positiva em 46,9%, 62,5% e 46,8% respectivamente. A N-PCR para HCMV e HHV-6 ocorreu em 81% dos casos, e para HHV-7 foi de 46,8%. Detectou-se que 50% dos pacientes estudados tiveram doença por HCMV. A doença causada pelo HHV-6 foi em 46,8% dos pacientes e em 15,6% para HHV-7. A concomitância de doenças foi observada nos pacientes com HCMV e HHV-6 em 21,9% e em 15,6% dos pacientes com HHV-6 e HHV-7. A doença causada pelos beta herpes vírus foi detectada com maior frequência ao redor da quinta semana. E os episódios de doença para HHV-6 e HHV-7 surgiram antes do aparecimento da doença por HCMV. Este estudo confirma a relevância da infecção pelo HCMV, HHV-6 e HHV-7 e a importância do monitoramento através de técnicas para a detecção precoce desses agentes, possibilitando a utilização de um tratamento preemptivo, com redução do risco de doença / Abstract: Introduction: The human herpes viruses type 6 (HHV-6) and 7 (HHV-7) belong to the herpes virus subfamily, herpes viridae family, are universal viruses and after primary infection remain latent in the organism and may be reactivated during an immunosuppression period. The aims of the research were to standardize, implement and monitor antigenemia for early diagnosis of HHV-6 and HHV-7 and serology for HHV-6 in patients who underwent liver transplantation in the Hospital of the State University of Campinas. The data obtained for HHV-6 and HHV-7 antigenemia were correlated with results for HCMV, N-PCR for HCMV, HHV-6, HHV-7 and other clinical and laboratorial aspects. The protocol was followed according to the research requirements and was approved by the Institutional Ethics Committee of the State University of Campinas. Thirty-two patients were studied, mean age 47 (18-66) years old, in which 20 (62.5%) were male and 12 (37.5%) were female. The monitoring of the patients was carried out prospectively since pre-transplantation and during post-transplantation period; weekly in the first and second month, fortnightly in the third month and monthly up to the sixth month. Detection of HHV-6 antigens was held from lymphocytes extracted from peripheral blood using monoclonal antibodies C65206M (Biodesign International, France) and MAB8535 (Biodesign International-USA); rabbit anti-mouse IgG Z0412-1 (Dako, USA) conjugate serum and goat anti-rabbit marked with peroxidase IgG 81-6120 (Zymed, USA) conjugate serum. For HHV-7 antigens detection, KR4 (Advance Biotechnologies, Canada) mouse monoclonal antibody, conjugate P0260 (Dako Cytomation, USA) rabbit anti-mouse IgG serum and conjugate goat anti-rabbit IgG serum 81-6120 (Zymed, USA) were used, diluted in PBS/BSA and applied over the cell fixation. IgM anti HHV-6 antibody detection was held by ELISA test (Panbio, USA). Using this methodology IgM anti HHV-6 detection was positive for 15.6% of the patients in pre-transplantation, 25% in the fourth week, 40,6% in the twelfth week and 46,9% in the 24th week after the transplantation. HCMV, HHV-6 and HHV-7 antigenemia was positive in 46.9%, 62.5% and 46.8%, respectively. HCMV and HHV-6 PCR occurred in 81% of the cases and for HHV-7, 46.8% of the cases. It was detected that 50% of the patients manifested HCMV disease. Disease manifested in 46.8% and 15.6% of the patients for HHV-6 and HHV-7, respectively. Concomitance of the diseases was observed in patients with HCMV and HHV-6 in 21.9% and 15.6% of the patients with HHV-6 and HHV-7. The disease caused by beta herpes virus was detected with higher frequency around the fifth week. HHV-6 and HHV-7 disease episodes appeared prior to HCMV disease. This study confirms the relevance of HCMV, HHV-6 and HHV-7 infection and the importance of monitoring through techniques for early detection of these agents, allowing the usage of a preemptive treatment, reducing the risk of disease / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

The outbreak of the Ebola virus was declared a Public Health Emergency of International Concern by the World Health Organisation (WHO). Due to the complex nature of the outbreak, the Centers for Disease Control and Prevention (CDC) had created interim guidance for monitoring people potentially exposed to Ebola and for evaluating their intended travel and restricting the movements of carriers when needed. Tools to evaluate the risk of individuals and groups of individuals contracting the disease could mitigate the growing anxiety and fear. The goal is to understand and analyze the nature of risk an individual would face when he/she comes in contact with a carrier. This thesis presents a tool that makes use of contextual data intelligence to predict the risk factor of individuals who come in contact with the carrier.

This study articulates the phenomenon of living under a constant threat of Ebola haemorrhagic fever, including what people’s reactions towards individuals and families affected by the illness symbolizes as well as the meanings ascribed to Ebola. The study was conducted in Kibale district in Midwestern Uganda to aid understanding of the human aspects of Ebola which has continued to result in widespread fear and anxiety, thereby creating challenges for affected individuals, families and health care professionals. A phenomenological inquiry was undertaken using Wertz’s (1983, 2005, 2011) empirical psychological reflection approach for data analysis, after utilizing purposive, convenience and criterion sampling techniques to select twelve (12) adult survivors and caregivers who anticipated, experienced and survived the outbreak and were in good health and also willing to take part in the study. Data were generated using in-depth qualitative interviews and the interviews continued until data redundancy was reached. The interview proceedings were digitally audio-recorded in addition to taking field notes and these were transcribed verbatim. Data analysis occurred at idiographic and nomothetic levels according to the principles of Wertz’s empirical psychological reflection. Thematic analysis of the research data revealed seven (7) themes, namely:  Living under constant threat of Ebola  Nature of Ebola experience: unique and general meanings  Surviving Ebola: physical, psychological, social, spiritual and economic implications on survivors  Caring for Ebola patients: social and psychological implications  Public reaction toward persons affected by Ebola  Social-cultural beliefs and practices related to Ebola  Coping with and living in the aftermath of Ebola outbreaks Adaptation emerged as the single most encompassing and accommodating concept that united the various themes, categories and sub-categories. It further grounded survivors’, caregivers’ and community’s experience of anticipating, experiencing and coping with challenges associated with Ebola. The findings add substantial knowledge about how survivors and caregivers experience Ebola outbreaks. Important recommendations are made and guidelines that may be used to increase survivors’, caregivers’ as well as the community’s resilience to challenges of future Ebola outbreaks are suggested. / Health Studies / D. Lit. et Phil. (Health Science)

This study articulates the phenomenon of living under a constant threat of Ebola haemorrhagic fever, including what people’s reactions towards individuals and families affected by the illness symbolizes as well as the meanings ascribed to Ebola. The study was conducted in Kibale district in Midwestern Uganda to aid understanding of the human aspects of Ebola which has continued to result in widespread fear and anxiety, thereby creating challenges for affected individuals, families and health care professionals. A phenomenological inquiry was undertaken using Wertz’s (1983, 2005, 2011) empirical psychological reflection approach for data analysis, after utilizing purposive, convenience and criterion sampling techniques to select twelve (12) adult survivors and caregivers who anticipated, experienced and survived the outbreak and were in good health and also willing to take part in the study. Data were generated using in-depth qualitative interviews and the interviews continued until data redundancy was reached. The interview proceedings were digitally audio-recorded in addition to taking field notes and these were transcribed verbatim. Data analysis occurred at idiographic and nomothetic levels according to the principles of Wertz’s empirical psychological reflection. Thematic analysis of the research data revealed seven (7) themes, namely:  Living under constant threat of Ebola  Nature of Ebola experience: unique and general meanings  Surviving Ebola: physical, psychological, social, spiritual and economic implications on survivors  Caring for Ebola patients: social and psychological implications  Public reaction toward persons affected by Ebola  Social-cultural beliefs and practices related to Ebola  Coping with and living in the aftermath of Ebola outbreaks Adaptation emerged as the single most encompassing and accommodating concept that united the various themes, categories and sub-categories. It further grounded survivors’, caregivers’ and community’s experience of anticipating, experiencing and coping with challenges associated with Ebola. The findings add substantial knowledge about how survivors and caregivers experience Ebola outbreaks. Important recommendations are made and guidelines that may be used to increase survivors’, caregivers’ as well as the community’s resilience to challenges of future Ebola outbreaks are suggested. / Health Studies / D. Litt. et Phil. (Health Science)

O mosaico rugoso, causado pelo begomovirus ToSRV, é uma das principais doenças do tomateiro. Neste trabalho avaliou-se a eficácia de quatro inseticidas, ciantranilliprole foliar, ciantraniliprole solo, espiromesifeno e tiametoxam no controle das infecções primária e secundária do ToSRV, em tomateiros, transmitido por Bemisia tabaci biótipo B. Os tratamentos, confinados separadamente em gaiolas a prova de insetos, foram: controle, representado por tomateiros sadios e infectados, pulverizados com água, mais insetos avirulíferos; infecção primária, simulada com tomateiros sadios pulverizados com inseticida, mais insetos virulíferos e infecção secundária, simulada com tomateiros sadios e infectados com o ToSRV, pulverizados com inseticida, mais insetos avirulíferos. Nenhum inseticida foi eficiente no controle da infecção primária. No caso da simulação da infecção secundária, 4% e 16% respectivamente, dos tomateiros tratados com os inseticidas ciantraniliprole solo e ciantraniliprole foliar foram infectados, contra 84% e 74% de tomateiros infectados nos respectivos controles. Para os tratamentos com os inseticidas tiametoxam e espiromesifeno, na simulação da infecção secundária, 58% e 62% dos tomateiros foram infectados, respectivamente, contra 66% e 74% de plantas infectadas nos respectivos controles. O uso racional de inseticidas que reduzem a infecção secundária associado com a eliminação de fontes externas de inóculo poderá contribuir para o manejo da doença. / The severe mosaic, caused by ToSRV begomovirus, is a major disease of tomato. This study evaluated the efficacy of four insecticides, sprayed cyazypyr, drench cyazypyr, sprayed spiromesifen and thiamethoxam on controlling primary and secondary infections by ToSRV to tomato plants, transmitted by Bemisia tabaci biotype B. Treatments were confined separately in proof insects cages, which were: control, represented by healthy and infected tomato plants sprayed with water and aviruliferous insects releasing; primary infection, simulated by healthy tomato plants with insecticide spraying and viruliferous insects releasing, and secondary infection, simulated with healthy tomato plants and ToSRV infected tomato plants, sprayed with insecticide, and aviruliferous insects releasing. None of the insecticides was effective in controlling primary infection. In the case of secondary infection simulation, 4% and 16% of the tomato plants treated with soil and foliar cyazypyr insecticides, respectively, were infected; against 84% and 74% of infected tomato plants in their respective controls. For treatments with thiamethoxam and spiromesifen insecticides spraying, in secondary infection simulation, 58% and 62% of tomato plants were infected, respectively, versus 66% and 74% of infected plants in their respective controls. The rational use of insecticides to reduce secondary infection associated with elimination of external sources of inoculum may contribute to disease management.

This dissertation is made up of three distinct parts: 1) A comprehensive, structured literature review 2) a mixed-methods descriptive study and 3) an inductive thematic qualitative analysis. The objective of this dissertation is to explore the concepts of compassion fatigue, compassion satisfaction and burnout as they relate to the practices of narrative medicine among expatriate humanitarian aid workers. Data collected for this research focuses on expatriate healthcare workers who provided direct patient care during the 2013-2016 Ebola response in Sierra Leone, Liberia and Guinea. Findings from these studies support the growing body of evidence and discussion regarding psychosocial support of healthcare workers in humanitarian contexts. To the extent that global health is public health (Fried, 2010), results from this dissertation will contribute guidance in the understanding and management of aid workers in contexts beyond the Ebola response.

No description available.

Increasing global occurrences of highly infectious, easily transmissible diseases unfamiliar to nurses affect the learning environment and the required skill set for professional nurses. The global threat of Ebola Virus Disease and other high-risk diseases requiring biocontainment necessitates competency in the management of complex patient needs, while ensuring safety measures that prevent spread of the potentially fatal disease. Guided by Bandura's social cognitive theory, this quantitative correlational study addressed the relationships between nurses' professional characteristics and their perceived self-efficacy when providing care to highly infectious patients requiring biocontainment. A full census of 92 nurses was used to recruit participants from eligible nurses for this study. Participants anonymously completed a cross-sectional electronic survey consisting of the Nursing Care Self-Efficacy Scale (NCSES) and questions related to the nurses' professional practice characteristics. Data analysis included descriptive statistics, correlations, and multiple linear regression. Results showed that the number of biocontainment drills and a higher level of formal education were significantly correlated with a higher total NCSES score. Years of nursing significantly predicted a higher total NCSES score. Results support the establishment of prerequisites criteria for learner participation in biocontainment training and the inclusion of multiple drill within the education design. Findings from this study may inform positive social change through educational enhancements that support the development of professional self-efficacy and competency in skill performance for nurses who care for patients with highly contagious diseases requiring biocontainment.

Thesis--Auburn University, 2009. / Abstract. Vita. Includes bibliographical references.

Thesis (Ph. D.)--McMaster University, 2005. / Advisor: Vic Stzewich. Includes bibliographical references (leaves 267-290). Also available online.