S��filis cong��nita : caracteriza����o da infec����o e avalia����o de t��cnicas laboratoriais para o seu diagn��stico

RESUMO: Um dos maiores problemas da s��filis �� a infec����o intra-uterina do feto, que pode resultar em morte fetal com aborto espont��neo. Os objectivos desta tese foram comparar os cinco testes serol��gicos para o diagn��stico de s��filis cong��nita e optimizar e aplicar a v��rias amostras cl��nicas, colhidas de indiv��duos com suspeita de infec����o por Treponema pallidum, uma t��cnica de PCR-Multiplex e uma t��cnica de PCR em tempo real. Na globalidade dos soros estudados obtiveram-se os seguintes resultados: o RPR reactivo em 87/517; TPHA reactivo em 135/517; e EIA reactivo em 127/517. A pesquisa de anticorpos espec��ficos de tipo IgM foi efectuada em 33 soros sendo estudada pelas t��cnicas de imunofluoresc��ncia indirecta e de westernblot. Quanto aos resultados obtidos pelas duas t��cnicas, o teste FTA-Abs-IgM demonstrou reactividade em 3/33, enquanto que a t��cnica de westernblot-M, apresentou reactividade em 18/33. Para a avalia����o de uma t��cnica de PCR-TR, foram estudadas 318 amostras de 236 indiv��duos classificados, com base em crit��rios cl��nicos e laboratoriais, em diferentes est��dios de infec����o por Treponema pallidum e em indiv��duos sem infec����o por aquele microrganismo. Relativamente a estas t��cnicas foi poss��vel observar amplifica����o de ADN de Treponema pallidum em 133/318 pela t��cnica de PCR-TR e 90/318 pela t��cnica de PCR-Multiplex. Mediante os resultados obtidos e de outros estudos efectuados parece poder concluir-se que o teste EIA �� o mais indicado para o rastreio da infec����o por Treponema pallidum, devendo um resultado reactivo por esta t��cnica, ser confirmado com a realiza����o de um teste n��o trepon��mico (RPR). Relativamente ao diagn��stico de infec����o cong��nita, o teste westernblot para pesquisa de anticorpos espec��ficos de tipo IgM, parece ser o mais apropriado. A t��cnica PCR-TR, parece ser a mais indicada, pois apresenta uma maior sensibilidade e especificidade que a PCR-Multiplex.----------------- ABSTRACT:The syphilis major problem is the intrauterine infection of the fetus, which may result in fetal death with spontaneous abortion. The objectives of this thesis were to compare the five serological tests for the diagnosis of congenital syphilis and optimize and apply several clinical samples taken from individuals suspected of infection with Treponema pallidum, a PCR-Multiplex and real-time PCR. In all sera studied were obtained the following results: the RPR reactive in 87/517; reactive TPHA in 135/517, and 127/517 in reactive EIA. The search for specific IgM antibodies was performed on 33 sera that were studied by indirect immunofluorescence and westernblot. The results obtained by both techniques, the test FTA-Abs-IgM showed reactivity in 3/33, while the technique westernblot-M, showed reactivity in 18/33. For an RT-PCR evaluation, we studied 318 samples from 236 individuals classified based on clinical and laboratory criteria at different stages of infection by Treponema pallidum and in individuals without infection by that organism. For these techniques it was possible to observe ADN amplification of Treponema pallidum in 133/318 by RT-PCR and 90/318 by PCR-Multiplex. Based on obtained results and in other studies seems that we can conclude that the EIA test is the most suitable for Treponema pallidum screening infection, and a reactive result by this technique, should be confirmed with the realization of a non-treponemal test (RPR). For the congenital infection diagnosis, testing for antibodies westernblot specific IgM appears to be the most appropriate. The RT-PCR seems to be the most suitable, since it has a higher sensitivity and specificity than the PCR-Multiplex.

Reactivity of human fetal and adult immortalized hepatocytes to potentially toxic bilirubin and bile acid species

Disserta����o apresentada para a obten����o do Grau de Mestre em Gen��tica Molecular e Biomedicina, pela Universidade Nova de Lisboa, Faculdade de Ci��ncias e Tecnologia

Sentido de coer��ncia : liga����o materno-fetal e estilo de vida da mulher durante a gravidez

RESUMO - Um dos grandes desafios actuais enfrentados pela Sa��de P��blica diz respeito ao fardo representado pelas doen��as cr��nicas n��o transmiss��veis enquanto co-respons��veis pela maioria das mortes que ocorrem no mundo, pela significativa e progressiva redu����o da qualidade de vida e aumento das incapacidades dos indiv��duos afectados e por uma fasquia bastante elevada das despesas em sa��de. Entretanto, a complexa din��mica gen��tica, biol��gica, psicol��gica, afectiva, s��cio-cultural e ambiental que envolve o comportamento humano, t��o amplamente relacionado com algumas destas doen��as ��� doen��as cardiovasculares, alguns tipos de cancro, obesidade, hipertens��o, diabetes e doen��as osteo-articulares ��� imp��e o desafio constante da busca de novas e efectivas interven����es em promo����o da sa��de que influenciem positivamente os estilos de vida dos indiv��duos, dos grupos e das comunidades. Sendo o sentido de coer��ncia um tra��o da personalidade do indiv��duo desenvolvido sob a influ��ncia directa ou indirecta dos mesmo factores acima referidos, o estabelecimento de uma rela����o entre este constructo e os comportamentos humanos pode revelar-se promissor para a elabora����o de novas interven����es em promo����o da sa��de. Por sua vez, a gravidez, talvez por influ��ncia da liga����o materno-fetal, pode representar um ponto de viragem na vida da mulher no que respeita ao sentido de coer��ncia e aos comportamentos de sa��de e um bom come��o na vida do beb�� que ir�� nascer sob a influ��ncia dos mesmos. Com a finalidade de contribuir para a constru����o de interven����es efectivas em promo����o da sa��de, atrav��s da descoberta de prov��veis potencialidades salutog��nicas dos constructos referidos ��� sentido de coer��ncia e liga����o materno-fetal ���, foi desenvolvido um estudo quantitativo, observacional que teve por objectivos: ampliar o conhecimento sobre as mudan��as do sentido de coer��ncia no decorrer da vida, especificamente durante a gravidez; ampliar o conhecimento acerca das rela����es de alguns factores de natureza s��cio-demogr��fica, psico-afectiva e obst��trica com o sentido de coer��ncia das mulheres gr��vidas e com a liga����o materno-fetal; e identificar poss��veis rela����es entre o sentido de coer��ncia, a liga����o materno-fetal e o estilo de vida das mulheres gr��vidas, este ��ltimo representado pelos h��bitos alimentares, consumo de cafe��na, consumo de ��lcool, h��bitos tab��gicos, pr��tica regular de actividade f��sica e ganho de peso durante a gravidez. O presente relat��rio descreve a concep����o e os resultados deste estudo, que envolveu a uma amostra de 61 mulheres gr��vidas que estavam a ser acompanhadas nos servi��os de sa��de materna dos Centros de Sa��de de Carnaxide extens��o Linda-a-Velha e de Oeiras, no Distrito de Lisboa, Portugal, entre os meses de Fevereiro e Julho de 2005. Os resultados demonstram que, para a amostra de 61 mulheres gr��vidas que responderam ao inqu��rito por question��rio de auto-resposta, foram encontradas associa����es estatisticamente significativas entre o sentido de coer��ncia e a escolaridade e entre o sentido de coer��ncia e a percep����o do pr��prio estado de sa��de. Al��m disso, foi encontrada alguma evid��ncia das associa����es entre o sentido de coer��ncia e a faixa et��ria, estado civil e rendimento mensal familiar e foi observada alguma tend��ncia para que as mulheres gr��vidas com n��veis de sentido de coer��ncia mais elevados consumissem menos ��lcool do que as mulheres gr��vidas com n��veis de sentido de coer��ncia inferiores. Entretanto, as demais associa����es testadas n��o foram confirmadas. Relativamente �� liga����o materno-fetal, foram encontradas, para a amostra de 41 mulheres gr��vidas que participaram do segundo momento de colheita de dados do estudo, entre a 20�� e a 24�� semanas de gravidez, associa����es estatisticamente significativas com a escolaridade e o n��vel de rendimento familiar das mulheres gr��vidas, n��o tendo sido confirmadas as demais associa����es testadas. Embora n��o tenham sido estatisticamente evidenciadas as rela����es entre o sentido de coer��ncia e a liga����o materno-fetal e entre estes e os comportamentos de sa��de, o car��cter preliminar destes resultados, devido �� subjectividade do processo de selec����o n��o probabil��stico da amostra estudada e �� reduzida dimens��o desta amostra, e a escassez de estudos descritos na literatura fazem com que seja prudente a realiza����o de estudos de follow-up, com amostras de maiores dimens��es, aleat��rias e representativas da popula����o, para que sejam estabelecidas quaisquer conclus��es acerca destas quest��es.-----------------------------ABSTRACT - One of the greatest challenges faced by Public Health in nowadays is the burden represented by chronic diseases as co-responsible for the majority of deaths that occurs in the world, for the meaningful and progressive reduction of quality of life and increase of disabilities in affected individuals and for an important part of health expenses. However, the complexity of the genetic, biological, psychological, emotional, social, cultural and environmental dynamics that involves human behaviours related to some of these diseases ��� cardiovascular diseases, some kind of cancers, obesity, hypertension, diabetes and joint and bone diseases ��� poses the continuous challenge of searching for new and effective interventions of health promotion that positively influence individuals, groups and community lifestyles. Due to the fact that sense of coherence is an individual personality trace directly or indirectly influenced by the same factors listed above, the discovery of a relationship between this construct and human behaviours might be promising to the creation of new health promotion interventions. On the other hand, pregnancy may represent a turn point to the mother���s life and a good start in the baby���s life in relation to sense of coherence and health behaviours and It might occur because of the influence of maternal-fetal attachment. With the purpose of contributing with the creation of effective health promotion interventions through the discovery of probable salutogenic potentials in the referred constructs ��� sense of coherence and maternal-fetal attachment ��� , it was developed a quantitative observational study with the following objectives: to increase knowledge about changes in sense of coherence throughout life, specifically during pregnancy; to increase knowledge about the relationship between sense of coherence and maternal-fetal attachment and some social, demographical, psychological, emotional and obstetric factors of pregnant women; to identify probable relationships between sense of coherence, maternal-fetal attachment and pregnant women���s lifestyles, represented by diet habits, caffeine consumption, alcohol consumption, smoking habits, physical activity habits and weigh gain during pregnancy. This report describes the structure and the findings of this study involving a sample of 61 pregnant women who had been followed by health professionals in the mother health services of Carnaxide (Linda-a-Velha unity) and Oeiras Health Centres, in Lisbon, Portugal, between February and July of 2005. The results show that, for the 61 pregnant women who filled the self-reported questionnaire, it was found a statistically significant association between sense of coherence and education level. It was also found some evidence of the associations between sense of coherence and age, marital status and mensal household income and a trend toward pregnant women with higher levels of sense of coherence to drink less alcoholic beverages than pregnant women with lower levels of sense of coherence. However, the others associations tested were not confirmed. Regarding maternal-fetal attachment, it was found, for the sample of 41 women who participated in the second moment of data collection, between the 20th and the 24th week of pregnancy, statistically significant associations with education level and mensal household income. The others associations tested were not confirmed. Although the associations between sense of coherence and maternal-fetal attachment and between these constructs and health behaviours were not confirmed, all findings presented here are considered preliminary because of small dimension of sample and non-probabilistic criteria used for sample selection. What���s more, there are almost no studies described in the literature which could confirm or contradict these findings. Therefore, it is better to be careful and develop follow-up studies, with bigger and representative of population samples, before draw any conclusions about these theme.

A solid��o na gravidez : determinantes da solid��o e seu impacto na liga����o materno-fetal

RESUMO - O sentimento de solid��o tem vindo a tornar-se cada vez mais frequente entre os indiv��duos, fruto do desenvolvimento da sociedade moderna. Especificamente, ocorrendo durante a gravidez, situa����o que produz na mulher importantes altera����es n��o s�� f��sicas, como tamb��m psicol��gicas, familiares e sociais, deve passar a ser alvo de uma aten����o especial. De um ponto de vista da Sa��de Mental, o desenvolvimento saud��vel da gravidez exige uma rede de suporte social e uma rela����o conjugal satisfat��rias. Tais elementos devem ser considerados como factores protectores do aparecimento de sentimentos de solid��o. Pelo contr��rio, um baixo sentido de coer��ncia e o aparecimento de depress��o durante a gravidez s��o factores de risco que, inevitavelmente, ir��o interferir na qualidade da liga����o materno-fetal, com repercuss��es no desenvolvimento psico-social do futuro ser humano. Este protocolo de projecto prop��e um estudo transversal, explorat��rio e de natureza quantitativa. Engloba dois sub-estudos, focando os determinantes da solid��o e o impacto desta na liga����o materno-fetal, e pretende identificar associa����es pertinentes entre as v��rias dimens��es envolvidas. A amostra em estudo ser�� constitu��da por 202 gr��vidas que frequentam o Centro de Sa��de de Torres Vedras. As vari��veis correspondentes ser��o operacionalizadas atrav��s de question��rios estandardizados e validados para a popula����o portuguesa, sendo eles a Escala de Solid��o da UCLA, a Escala de Satisfa����o com o Suporte Social, a Escala de Avalia����o de ��reas da Vida Conjugal, a Escala de Liga����o Materno-Fetal, a Escala de Depress��o P��s-Parto de Edimburgo e o Question��rio de Orienta����o para Viver. Espera-se identificar e caracterizar as poss��veis associa����es entre a solid��o e a satisfa����o com o suporte social, a satisfa����o conjugal, a depress��o durante a gravidez e o sentido de coer��ncia, que a explicar��o, e a liga����o materno-fetal, que ser�� influenciada por ela. Os question��rios ser��o respondidos pelas gr��vidas seleccionadas de acordo com crit��rios de inclus��o e exclus��o. Al��m das descri����es estat��sticas iniciais, as an��lises de associa����o ser��o realizadas em fun����o das distribui����es encontradas, e tendo em conta dimens��es do contexto sociodemogr��fico. Os resultados da investiga����o ser��o divulgados num relat��rio final. ----------------------- ABSTRACT - The feeling of loneliness is increasing as a result of developments in modern society. Specifically occurring during pregnancy, when important changes - physical, psychological and related to the family structure and interaction with society - take place, special attention should be devoted. To maintain good mental health during pregnancy it is important to have good social support and harmonious conjugal relations, both considered as factors preventing the emergence of feelings of loneliness. By contrast low sense of coherence and depression during the pregnancy are risk factors which, inevitably, will affect the quality of the maternal-fetal attachment and have repercussions on the psycho-social development of the future individual. This protocol of draft proposes a transversal exploratory study of a quantitative nature on two sub-studies, exploring the determinants of loneliness and its impact on the maternal-fetal attachment, which intends to identify some correlations between parameters. The study sample is made up of 202 pregnant women who are patients at the Health Centre of the city of Torres Vedras. They will be selected according to criteria of inclusion and exclusion. All variables will be measured through standardized and validated surveys illustrating the Portuguese population, like the Scale of Loneliness of the UCLA, Scale of Satisfaction with the Social Support, Scale of Evaluation of Areas of the Conjugal Life, Maternal-Fetal Attachment Scale, Edinburgh Postnatal Depression Scale, and Orientation To Life Questionnaire. We expect to identify correlations between loneliness and satisfaction with social support and conjugal relations, depression during pregnancy and sense of coherence, which will explain it, and the maternal-fetal attachment, which will influence it. Beyond the initial statistical descriptions, the data analysis will be executed according to the distributions found and will be carried taking into account the socio-demographic context. The results of the survey will be published in a final report.

Unraveling maternal and fetal genetic factors protecting from Pregnancy Associated Malaria in the mouse

Malaria is one of the most devastating diseases in the world. In Plasmodium endemic regions, pregnant women are among the most vulnerable groups. Pregnancy Associated Malaria (PAM) threatens both maternal and foetal lives. Despite differences between human and mouse placentas PAM mouse models recapitulate key pathological features of human PAM. Here we describe new PAM models of mid gestation infection in the C57BL/6 mouse.(...)

Electrohysterogram signal component cataloging with spectral and time-frequency methods

The Electrohysterogram (EHG) is a new instrument for pregnancy monitoring. It measures the uterine muscle electrical signal, which is closely related with uterine contractions. The EHG is described as a viable alternative and a more precise instrument than the currently most widely used method for the description of uterine contractions: the external tocogram. The EHG has also been indicated as a promising tool in the assessment of preterm delivery risk. This work intends to contribute towards the EHG characterization through the inventory of its components which are: ��� Contractions; ��� Labor contractions; ��� Alvarez waves; ��� Fetal movements; ��� Long Duration Low Frequency Waves; The instruments used for cataloging were: Spectral Analysis, parametric and non-parametric, energy estimators, time-frequency methods and the tocogram annotated by expert physicians. The EHG and respective tocograms were obtained from the Icelandic 16-electrode Electrohysterogram Database. 288 components were classified. There is not a component database of this type available for consultation. The spectral analysis module and power estimation was added to Uterine Explorer, an EHG analysis software developed in FCT-UNL. The importance of this component database is related to the need to improve the understanding of the EHG which is a relatively complex signal, as well as contributing towards the detection of preterm birth. Preterm birth accounts for 10% of all births and is one of the most relevant obstetric conditions. Despite the technological and scientific advances in perinatal medicine, in developed countries, prematurity is the major cause of neonatal death. Although various risk factors such as previous preterm births, infection, uterine malformations, multiple gestation and short uterine cervix in second trimester, have been associated with this condition, its etiology remains unknown [1][2][3].