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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

Dinámica del proceso de desarrollo y crecimiento a edades de inicio puberal normales, temprana en niñas y tardía en niños.

Llop Viñolas, Maria Dolors 13 June 2006 (has links)
Objetivos: 1) Describir las características del crecimiento y desarrollo puberal en niñas yniños con diferentes edades de inicio puberal, incluyendo dos situaciones clínicasfrecuentes: la pubertad avanzada en niñas y la pubertad diferida en niños. 2) Describir losefectos del tratamiento farmacológico con análogos de la GnRH de la pubertad avanzada enrelación con un grupo control. 3) Describir los efectos del tratamiento farmacológico contestosterona de la pubertad diferida en relación con un grupo control.Material y métodos: Proyecto que consta de tres estudios, en los que los niños fueronestudiados hasta el momento de adquisición de su talla final. 1) Estudio longitudinalobservacional y prospectivo realizado en 116 niñas y 135 niños, con inicio puberal entre los10-13 y 11-14 años respectivamente, agrupados según la edad de inicio puberal. 2) Ensayoclínico controlado no aleatorio de intervención en niñas con pubertad avanzada (16pertenecientes al grupo tratado y 16 al grupo control) y 3) Ensayo clínico controlado noaleatorio de intervención en niños con pubertad diferida (17 tratados y 15 del grupocontrol). En los tres estudios, se realizaron mediciones antropométricas (peso, talla, plieguesdel tejido adiposo subcutáneo y perímetro braquial) y se evaluó la maduración puberalmediante los estadios de Tanner. Se procedió al cálculo del IMC, área muscular del brazo,suma de cuatro pliegues, talla diana, la duración puberal y el incremento puberal en talla.En varones también se determinó el índice del volumen testicular, y en niñas el tiempohasta la menarquia. En los estudios 2) y 3) se realizaron: valoración de la edad ósea,determinaciones hormonales y alguna exploración complementaria.Resultados y conclusiones: 1) Tanto en las niñas como en los niños con diferente edad deinicio puberal, el proceso biológico de crecimiento y desarrollo puberal, consiguecompensar las diferencias en talla observadas entre los diferentes ritmos madurativos alinicio puberal, incrementado la duración puberal, el incremento puberal en talla y en el casode las niñas el tiempo hasta la menarquia cuando la edad de inicio puberal es temprana.Todos los grupos alcanzan tallas finales similares. 2) El tratamiento con análogos de lapubertad avanzada, ejerce efectos a corto plazo clínicamente verificables, pero no modificala relación entre duración e intensidad del crecimiento puberal, ni tampoco tiene efectos alargo plazo sobre la talla final. 3) El tratamiento con testosterona de la pubertad diferida,ejerce efectos a corto plazo y permite alcanzar una talla final de acuerdo al potencialgenético sin afectar de forma negativa el eje gonadal. 4) En las niñas con pubertad avanzaday en los niños con pubertad diferida, al estudiar el proceso biológico del crecimiento ydesarrollo puberal, se observan dinámicas similares a las descritas en las niñas con iniciopuberal entre los 10-13 años y en los niños con inicio entre los 11-14 años, respectivamente.Las tallas finales, en niñas y niños son similares en todos los grupos de edad en cada sexo,por lo que dichos mecanismos compensatorios son efectivos en estas dos situacionesclínicas al límite de la normalidad. / Objectives: 1) To describe the characteristics of growth and pubertal development in girlsand boys with different ages of pubertal onset, including two frecuent clinical situations:advanced puberty in girls and delayed puberty in boys, 2) To describe the GnRH analoguestreatment effects in girls with advanced puberty, compared with a control group; 3) Todescribe the testosterone treatment effects in boys with delayed puberty compared with acontrol group.Patients and Methods: This project is composed of three studies, where children werestudied since the onset of puberty until the moment of attaintment of their final height. 1) Alongitudinal observational and prospective study, in 116 girls and 135 boys, with pubertalonset at 10-13 and 11-14 years of age respectively, grouped by age of pubertal onset. 2)Non-randomized clinical study in girls with advanced puberty (16 treated LHRH analogueduring 1 year and 16 control subjects) and 3) Non-randomized clinical study in boyswith delayed puberty (17 treated with testosterone during 6 months and 15 controlsubjects).In all the studies, we carried out anthropometric measurements (weight, height, skinfoldthicknesses and arm circumference) and we assessed pubertal maturation by means ofTanner stages. We calculated the body mass index, muscular area of the arm, the targetheight, the pubertal height growth (gain in height from the puberty onset up to the finalheight) and the pubertal duration (time in years from the puberty onset up to the age atwhich final height is attained). In boys, we analyzed the testicular volume and in girlsthe age of menarche. In the studies 2) and 3) we assessed the bone age and somehormonal analyses.Results and conclusions: 1) Both in girls and boys with different age of pubertal onset, thedifferent dynamics of development and pubertal growth, lead to attain similar finalheights.This is due to a compensation between a smaller height at pubertal onset in the earlymaturers, with a longer pubertal duration, greater pubertal growth and longer time betweenonset and menarche. 2) Treatment with LHRH analogue delayed the menarche age, led toan involution in secondary sexual characteristics and a temporary decrease in growth rate,and delayed skeletal maturation. However, pubertal duration, pubertal height growth andfinal heights were similar in both groups.3) Treatment with testosterone leads to the startof puberty, but without stopping the maturation of the hypothalamic-pituitary axis,allowing a normal testicular evolution. The final heights were similar in both groups. 4)Girls with advanced puberty and boys with delayed puberty present a dynamics ofgrowth and pubertal development which are similar of those presented by the girls andboys with puberal onset at normal ages. The attained final heights were similar in all theage groups.
2

Procesamiento emocional en psicosis: un estudio de neuroimagen funcional

Escartí Fabra, M. José 07 October 2009 (has links)
Las alteraciones en el procesamiento emocional han sido ampliamente descritas en la esquizofrenia (Cohen & Minor, 2008; Kring & Moran, 2008). Estas alteraciones emocionales se han relacionado tanto con los síntomas negativos como los síntomas positivos de la enfermedad. En relación con las alucinaciones auditivas algunos modelos explicativos destacan el papel crítico de los factores emocionales en la fisiopatología de las mismas. El desarrollo de las técnicas de neuroimagen ha permitido el estudio de las bases neurobiológicas de las funciones cerebrales mediante técnicas no invasivas. Pocos de estos estudios han investigado la asociación entre las alucinaciones y las alteraciones emocionales mediante el uso de un paradigma auditivo emocional. Para el análisis de los datos obtenidos de la resonancia magnética (RM) se ha utilizado dos enfoques, los modelos guiados por el paradigma y los modelos guiados por los datos. Para este estudio se ha utilizado el Análisis de Componentes Independientes (ICA) que es un método de análisis especialmente útil para la descomposición de la activación cerebral durante el procesamiento de las tareas cognitivas complejas sin necesidad de introducir un modelo previo obteniendo las redes funcionales implicadas en el proceso estudiado. Objetivos: 1. Identificar las redes funcionales implicadas en el procesamiento de un estímulo auditivo emocional y neutro en un grupo de pacientes psicóticos con y sin alucinaciones auditivas y en un grupo de sujetos sanos. 2. Estudiar las diferencias cualitativas en las redes funcionales identificadas entre los tres grupos de estudio. Hipótesis: Los pacientes con y sin alucinaciones auditivas mostrarán diferencias en las redes funcionales responsables del procesamiento de las palabras emocionales y neutras escuchadas. Material y método: Se reclutaron tres grupos de sujetos: 41 pacientes con diagnóstico del espectro psicótico (27 con alucinaciones auditivas y 14 sin alucinaciones auditivas) y 31 sujetos sanos. A los participantes se les realizó una RM funcional en la que se aplicó un paradigma auditivo con dos sesiones una con palabras emocionales y otra con palabras neutras. El análisis de los datos se realizó con un enfoque multivariante, con ICA. Resultados: 1. En la sesión emocional se identificaron las siguientes redes funcionales: • En controles se identificaron 4 redes: temporal, fronto-parieto-temporal, subcortical-fronto-temoporal y occipito-cerebelar; • En pacientes con alucinaciones auditivas se identificaron 5 redes: temporal, fronto-parieto-temporal, subcortical-fronto-temporal, límbica y occipito-cerebelar; • En los pacientes sin alucinaciones auditivas se identificaron 4 redes: temporal, fronto-parieto, fronto-temporal, fronto-parietal. • 2. En la sesión neutra se identificaron: • En controles, 3 redes funcionales: temporal y fronto-parietal derecha/izquierda; • En pacientes con alucinaciones auditivas, 2 redes: temporal y fronto-parietal derecha; • En pacientes sin alucinaciones auditivas, 2 redes: temporal y fronto-parietal derecha. / Background: Alterations in emotional processing have been widely described in schizophrenia (Cohen & Minor, 2008, Kring & Moran, 2008). These emotional disorders have symptoms related to both negative and positive symptoms. In relation to auditory hallucinations some explanatory models highlight the critical role of emotional factors in its pathophysiology. The development of neuroimaging techniques has allowed the study of the neurobiological basis of brain function. Few studies have investigated association between hallucinations and emotional disorders. For the analysis of data from magnetic resonance imaging (MRI) has used two approaches, guided by the paradigm models and models guided by the data. For this study we used the Independent Component Analysis (ICA). This approach is a model-independent multivariate statistical computational technique designed to extract spatially independent and temporally synchronous activity patterns in brain regions, giving functional covariance in brain regions. The present study has two principal aims. First, we aim to analyze differences in functionally connected networks between control subjects and non-affective psychotic patients during passive listening to an emotional auditory paradigm using an ICA approach. Secondly, we aim to compare patients with non-affective psychosis and auditory hallucinations with non-hallucinatory patients. Methods: A total of 41 male patients with non-affective psychosis diagnosis, 27 with chronic auditory hallucinations and 14 without hallucinations, were recruited. Thirty-one healthy controls were also examined. Participants underwent functional MRI was applied in the auditory paradigm with two sessions with each other with emotional words and neutral words. The data analysis was performed using a multivariate approach with ICA. Results: Limbic networks responded differently in patients with auditory hallucinations compared to healthy controls and patients without auditory hallucinations. Unlike control subjects and non-hallucinators, the group of hallucinatory patients showed an increase of activity in the parahippocampal gyrus and the amygdala during the emotional session. Conclusions: These findings may reflect an increase in parahippocampal gyrus and amygdala activity during passive listening of emotional words in patients with schizophrenia and auditory hallucinations.
3

Prognostic Value of Ciculating Pregnancy-Associated Plasma Protein-A (PAPP-A) and Proform of Eosinophil Major Basic Protein (pro-MBP) Levels in Patients with Chronic Stable Angina Pectoris

Consuegra Sánchez, Luciano 20 January 2010 (has links)
Background: The search for markers to improve risk prediction for individuals at risk of developing serious cardiovascular events is ongoing. New markers of coronary artery disease progression have been identified in recent years, among which, circulating levels of pregnancy-associated plasma protein-A (PAPP-A) offer an interesting profile. PAPP-A may play a role in the development of atherosclerotic lesions and represent also a marker of atheromatous plaque instability and extent of cardiovascular disease. PAPP-A has been shown to be a marker of adverse outcome in the acute coronary syndrome. The proform of eosinophil major basic protein (pro-MBP) is the endogenous inhibitor of the proteolytic activity of PAPP-A. PAPP-A levels and PAPP-A/pro-MBP ratio are increased in chronic stable angina (CSA) patients with complex coronary artery stenoses. Little is known however, about the long-term prognostic value of PAPP-A and pro-MBP in “real-life” CSA patients. We sought to assess whether PAPP-A, pro-MBP and PAPP-A/pro-MBP levels predict long-term all-cause mortality in patients with CSA. Methods: We recruited 663 consecutive patients (169 women [25.5 %]; mean age 62.9 ± 9.7 years) undergoing routine diagnostic coronary angiography. Samples for PAPP-A and pro-MBP were taken at study entry. Patients were followed for a median of 8.8 years (interquartile range 3 - 10.6 years). Results: One hundred and six patients (16 %) died during follow-up. On a Cox proportional hazards model, increased PAPP-A concentration (> 4.8 mIU/L) was an independent predictor of the occurrence of all-cause mortality (HR 1.953, 95% CI 1.135-3.360, p = 0.016). Neither pro-MBP nor PAPP-A/pro-MBP ratio were markers of all-cause mortality (p = 0.45 and 0.54, respectively). Conclusions: High PAPP-A levels (> 4.8 mIU/L) showed an association with all-cause mortality during long-term follow-up in patients with CSA. Keywords: PAPP-A, pro-MBP, chronic stable angina, prognosis. / Antecedentes: La búsqueda de marcadores para mejorar la predicción de individuos en riesgo de desarrollar eventos cardiovasculares está en marcha. Recientemente se han identificado nuevos marcadores de progresión de la enfermedad coronaria, entre los cuales, la proteína plasmática asociada a embarazo tipo A (PAPP-A) presenta un perfil interesante. PAPP-A podría desempeñar un papel en el desarrollo de las lesiones ateroscleróticas, así como representar un marcador de inestabilidad de placa ateromatosa y extensión de la enfermedad aterosclerótica. Además PAPP-A es un marcador de eventos adversos en el contexto del síndrome coronario agudo. La proforma de la proteína mayor básica eosinofílica (pro-MBP) es un inhibidor endógeno de la actividad proteolítica de PAPP-A. Los niveles de PAPP-A y del cociente PAPP-A/pro-MBP están aumentados en pacientes angina crónica estable que presentan lesiones coronarias complejas en la angiografía. Se desconoce el valor pronóstico a largo plazo de los niveles de PAPP-A y pro-MBP en pacientes con angina crónica estable de la “práctica real”. Se pretendió en este estudio evaluar si los niveles de PAPP-A, pro-MBP y del cociente PAPP-A/pro-MBP predicen la mortalidad por cualquier causa a largo plazo en pacientes con angina crónica estable. Métodos: Reclutamos 663 pacientes consecutivos (169 mujeres [25.5 %]; edad media 62.9 años ± 9.7 años) con angina crónica estable remitidos para angiografía coronaria diagnóstica. Se tomaron muestras para medir PAPP-A y pro-MBP al inicio del estudio. Los pacientes fueron seguidos por una mediana de tiempo de 8.8 años (rango intercuartílico 3 – 10.6 años). Resultados: Ciento seis (16 %) pacientes murieron durante el seguimiento. La concentración de PAPP-A (> 4.8 mIU/L) fué un predictor independiente de la mortalidad por cualquier causa (HR 1.953, 95% CI 1.135-3.360, p = 0.016) en un modelo de riesgos proporcionales de Cox. Ni pro-MBP ni el cociente PAPP-A/pro-MBP fueron marcadores de mortalidad por cualquier causa (p = 0.45 and 0.54, respectivamente). Conclusiones: En el presente estudio, los niveles altos de PAPP-A superiores a 4.8 mIU/L se asociaron con la muerte por cualquier causa a largo plazo en pacientes con angina crónica estable. Palabras clave: Proteína plasmática asociada a embarazo tipo A, proforma de la proteína mayor básica eosinofílica, angina crónica estable, pronóstico.
4

Uma contribuição ao estudo de sinais de EEG para avaliar estados emocionais e mentais de crianças com autismo na interação com robô móvel

Goulart, Christiane Mara 09 February 2015 (has links)
Submitted by Elizabete Silva (elizabete.silva@ufes.br) on 2015-03-25T18:35:29Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Christiane Mara Goulart.pdf: 1869537 bytes, checksum: 41796bc6555e56c8687b28988c86a877 (MD5) / Approved for entry into archive by Elizabete Silva (elizabete.silva@ufes.br) on 2015-04-14T19:06:50Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Christiane Mara Goulart.pdf: 1869537 bytes, checksum: 41796bc6555e56c8687b28988c86a877 (MD5) / Made available in DSpace on 2015-04-14T19:06:50Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Christiane Mara Goulart.pdf: 1869537 bytes, checksum: 41796bc6555e56c8687b28988c86a877 (MD5) Previous issue date: 2015-02 / O Transtorno do Espectro do Autismo (TEA) caracteriza-se por uma série de distúrbios cognitivos e neurocomportamentais e sua prevalência mundial é estimada em 1 criança com TEA a cada 160 crianças com típico desenvolvimento (TD). Indivíduos com TEA apresentam dificuldade em interpretar as emoções alheias e em expressar sentimentos. As emoções podem ser associadas à manifestação de sinais fisiológicos, e, dentre eles, os sinais cerebrais têm sido muito abordados. A detecção dos sinais cerebrais de crianças com TEA pode ser benéfica para o esclarecimento de suas emoções e expressões. Atualmente, muitas pesquisas integram a robótica ao tratamento pedagógico do TEA, através da interação com crianças com esse transtorno, estimulando habilidades sociais, como a imitação e a comunicação. A avaliação dos estados mentais de crianças com TEA durante a sua interação com um robô móvel é promissora e assume um aspecto inovador. Assim, os objetivos deste trabalho foram captar sinais cerebrais de crianças com TEA e de crianças com TD, como grupo controle, para o estudo de seus estados emocionais e para avaliar seus estados mentais durante a interação com um robô móvel, e avaliar também a interação dessas crianças com o robô, através de escalas quantitativas. A técnica de registro dos sinais cerebrais escolhida foi a eletroencefalografia (EEG), a qual utiliza eletrodos colocados de forma não invasiva e não dolorosa sobre o couro cabeludo da criança. Os métodos para avaliar a eficiência do uso da robótica nessa interação foram baseados em duas escalas internacionais quantitativas: Escala de Alcance de Metas (do inglês Goal Attainment Scaling - GAS) e Escala de Usabilidade de Sistemas (do inglês System Usability Scale - SUS). Os resultados obtidos mostraram que, pela técnica de EEG, foi possível classificar os estados emocionais de crianças com TD e com TEA e analisar a atividade cerebral durante o início da interação com o robô, através dos ritmos alfa e beta. Com as avaliações GAS e SUS, verificou-se que o robô móvel pode ser considerado uma potencial ferramenta terapêutica para crianças com TEA. / Autism Spectrum Disorder (ASD) is characterized by a series of cognitive and neurobehavioral disorders and its global prevalence is estimated at 1 child with ASD per 160 children typically developed (TD). Individuals with ASD have difficulty in interpreting others' emotions and expressing feelings. The emotions may be associated to the manifestation of physiological signals, and, among them, the brain signals have been much discussed. The detection of brain signals of children with ASD can be beneficial to clarify their emotions and expressions. Currently, many researches integrate robotics to pedagogical treatment of ASD, through the interaction with children with this disorder, stimulating social skills such as the ability of imitation and communication. The evaluation of mental states of children with ASD during their interaction with a mobile robot is promising and innovative. Therefore, the goals of this study were to capture brain signals of children with ASD and TD, as control group, for the study of their emotional states and to evaluate their mental states during the interaction with a mobile robot, and evaluating also the interaction of these children with the robot, using quantitative scales. The technique of brain signals recording chosen was lectroencephalography (EEG), which uses electrodes placed noninvasively and painless on the scalp. The methods to evaluate the efficiency of the use of the robotics in this interaction were based on two quantitative international scales: Goal Attainment Scaling (GAS) and System Usability Scale (SUS). Results showed that, using EEG, it was possible to classify emotional states of children with ASD and TD and analyze brain activity during the start of the interaction with the robot, through the alpha and beta rhythms. With GAS and SUS scales, it was found that the robot can be considered a potential therapeutic tool for children with ASD.
5

Protocolos e Técnicas de Análise de Sinais sEMG e Eeg Aplicados à Avaliação Motora e Robótica

Vela, Jhon Freddy Sarmiento 16 December 2013 (has links)
Made available in DSpace on 2016-08-29T15:34:41Z (GMT). No. of bitstreams: 1 tese_7233_Tese_Jhon Freddy S. Vela.pdf: 11620731 bytes, checksum: 181bc89b6c59cfbb94b31f42de4f4b95 (MD5) Previous issue date: 2013-12-16 / Os avanços tecnológicos na última década permitiram o desenvolvimento de sistemas de processamento de informação com alta capacidade de armazenamento de dados. Estes avanços na linha de saúde têm evoluiram para o desenvolvimento de dispositivos para aplicações na Bioengenharia e Engenharia Biomédica, no auxílo à compreensão do comportamento fisiológico, diagnóstico, monitoramento, controle e tratamento de variadas alterações biológicas. Juntamente com os avanços tecnológicos, a quantidade e complexidade da informação é cada vez maior, em comparação com a utilidade e compreensão da mesma, representando, para diferentes áreas de conhecimento, um desafio na busca de alternativas viáveis que permitam utilizar os atributos dos sistemas biológicos no desenvolvimento de novas tecnologias para a melhoria da qualidade de vida dos seres humanos. Na atualidade, o desenvolvimento de protocolos de captura de sinais bioelétricos não invasivos está conformando uma opção viável para o diagnóstico de miopatias, reabilitação motora, análise biomecânica, desenvolvimento de Interface Homem-Máquina, e controle autônomo de dispositivos robóticos para pessoas com deficiência motora grave, entre outras aplicações. Em todos os casos, o auxílio de técnicas computacionais como processamento de sinais digitais (DSP), e novos algoritmos baseados em inteligência artificial, abriram a possibilidade de desenvolver técnicas de classificação para o reconhecimento de padrões que podem ser aplicadas na área de biotecnologia para a saúde. A presente tese de doutorado desenvolve protocolos e técnicas de análise de sinais mioelétricas (SME) por eletromiografia de superfície (sEMG) constituídos por “tarefas de atraso instruídas”, aplicados à avaliação motora e reabilitação, que envolve análise e critérios de inclusão-exclusão por anamnese clínica, controle de variáveis no ambiente experimental, captura, aquisição e transformação do sina, digitalização, filtragem, segementação, seleção de características, classificação e reconhecimento de padrões. As aplicações biotecnológicas com SME apresentam uma abordagem quantitativa experimental em forma de estudo de caso. O primeiro estudo de caso desenvolve três protocolos de aquisição para avaliação proprioceptiva do joelho, controle de uma cadeira de rodas robótica por pessoas com deficiência motora grave, e manipulação de um robô móvel por crianças com deficiência cognitiva e motora, utilizando um sensor híbrido (inclinação+sEMG), o qual conformou inclusive uma patente de invenção derivada da presente tese. O segundo estudo de caso desenvolve um protocolo de aquisição SME, para o auxílio ao diagnóstico de fibromialgia utilizando algoritmos para avaliação da fadiga muscular no domínio do tempo (ARV, RMS) e da frequência (MNF, MDF, AIF) com 30%, 60% e 80% de MVC. O terceiro estudo de caso desenvolve um protocolo de aquisição de SME de baixa densidade e baixo nível de contração muscular, com controle do repouso, para o reconhecimento de diferentes gestos da mão, em pessoas saudáveis e com amputação na região do terço distal do cotovelo, avaliando 14 características, 8 no domínio do tempo, 5 no domínio da frequência e Dimensão Fractal (FD), além de várias das sua combinações, as quais foram classificadas com técnicas computacionais de inteligênica artificial como lógica difusa (FL) e redes neurais artificiais do tipo MLP. Os resultados obtidos para o primeiro estudo de caso demonstrou a utilidade da predeterminação de limiares para as variáveis RMS e inclinação obtidas com o sensor híbrido (inclinação+sEMG), melhorando a precisão do senso de posicionamento na análise proprioceptiva do joelho em comparação com um eletrogoniômetro comercial em combinação com o SME. O sensor híbrido facilitou também o controle de uma cadeira de rodas robótica, utilizando o movimento da cabeça para o deslocamento autônomo de pessoas com tetraplegia, assim como, a manipulação autônoma de um robô móvel por pessoas com deficiência cognitiva e motora, os quais obtiveram, com o treinamento, um melhor desempenho na interação com o robô, avaliado pelo índice GAS. No segundo estudo de caso, os resultados obtidos para avaliação da fadiga em pessoas com fibromialgia (FM) indicaram uma relação entre o aumento da carga e a dor muscular, especialmente para 80% de MVC. A regressão linear dos algoritmos RMS, ARV e MNF apresentaram na inclinação (α) e intercepto (β) uma tendência esperada no grupo controle, com regressão linear positiva para características no domínio do tempo e negativas para características no domínio da frequência, para 60% de MVC e 60% do segmento isométrico do SME, obtidos com 20 contrações isotônicas durante a flexãoextensão do bíceps braquii (RMS α=1.1319, β=275.706; MNF α=-0.470, β=91.482). No iii caso de voluntárias com FM, a voluntária N3 apresentou dados com maior relação de tendência esperada da fadiga muscular, para 80% de MVC e 60% do segmento isométrico obtidos durante movimento isotônico do bíceps braquii (RMS α=5,92 β=113,33; MNF α=-1,21 β=96,96). Por último, o terceiro estudo de caso identificou, com UM classificador MLP, e taxa de sucesso de 94,9% seis movimentos de dedos individuais, incluindo repouso, (categoria A), e com 97,5% de taxa de sucesso, sete movimentos que compreendem dedos, punho e agarre (categoria B), ambos os casos, com combinação de características RMS, WL,MAV e ZC. Por outro lado, resultados obtidos por voluntários amputados no terço distal do cotovelo, apresentaram melhores resultados com características no domínio do tempo, em comparação as que incluiram dimensão fractal (DF), com taxas de sucesso de 93,9%, utilizando combinação de características RMS, WL e MAV para a categoria A, e 95,4% de taxa de sucesso, com uma combinação de características RMS, WL, MAV e ZC na categoria B. / Technological advances in the last decade opened up the field for the development of information processing systems with high capacity of data storage. These advances in health have evolved in the development of devices for applications in Bioengineering and Biomedical Engineering, supporting the understanding of the physiological behavior, diagnosis, monitoring, treatment and control of various biological changes. Along with technological advances, the amount and complexity of information is increasing, compared to its usefulness and understanding, representing, for different areas of knowledge, a challenge to find viable alternatives for using the attributes of biological systems in the development of new technologies directed to improve the quality of life of human beings. Currently, the development of noninvasive protocols for capturing bioelectric signals are becoming a viable option for the diagnosis of myopathies, motor rehabilitation, biomechanical analysis, development of Human-Machine Interface, and autonomous control of robotic devices for people with severe motor disabilities among other applications. In all cases, the support of computational techniques, such as digital signal processing (DSP), and new algorithms based on artificial intelligence, has opened the opportunity to develop classification techniques for recognizing patterns which can be applied in biotechnology for health. This doctoral thesis develops protocols and techniques for analysis of sEMG signals, consisting of "instructed delay tasks", applied to the motor assessment and rehabilitation estrategies, involving analysis of inclusion-exclusion criteria for clinical history, control variables in experimental environment, capture, acquisition and processing of sEMG signal, digital group, filtering, segmentation, feature selection, classification and pattern recognition. Biotechnological applications with sEMG signals present a quantitative experimental approach in the form of case studies. The first case study is centered on three acquisition protocols for evaluation of proprioceptive knee, control of a robotic wheelchair for people with severe motor disabilities, and manipulation of a mobile robot for children with cognitive and motor disability, using a hybrid sensor (inclination + sEMG), which is a patent derivate of this thesis. The second case study, develops a protocol for acquisition of sEMG signals in order, to support the diagnosis of fibromyalgia using algorithms for evaluation of muscle fatigue in time domain (ARV, RMS) and frequency domain (MNF, MDF, AIF), with 30%, 60% and 80% of MVC. The third case study, develops a protocol for the acquisition of sEMG signals with low density and low level of muscle contraction, with control of the rest, for the recognition of different hand gestures in healthy and amputees, evaluating 14 characteristics , 8 in time domain, and 5 in frequency domain and Fractal Dimension (FD), with several of their combinations, which were classified with computational techniques of artificial intelligence, such as fuzzy logic (FL) and artificial neural networks of MLP type. The results for the first case study, has demonstrated the usefulness of threshold predetermination as RMS and slope, acquired with the hybrid sensor (inclination + sEMG), improving the accuracity sense of positioning in proprioceptive analysis of the knee compared to a commercial electrogoniometer in combination with sEMG signal. The hybrid sensor also was applied to the control of a robotic wheelchair, using head movements for self-displacement of persons with tetraplegia, as well as autonomous manipulation of a mobile robot by people with cognitive and motor disabilities, which was obtained with training, whose performance in interacting with the robot was evaluated by GAS index. In the second case study, the results obtained for assessment of fatigue in people with fibromyalgia (FM)have indicated a relationship between increasing load and muscle pain, especially with 80% of MVC. The linear regression of algorithms RMS, ARV and MNF havshown in both the inclination (α ) and intercept (β) an expected trend in the control group, with positive linear relationship to characteristics in the time domain and negative characteristics to the frequency domain, with 60% MVC, and 60% of isometric segment of sEMG signal, which were obtained with 20 isotonic contractions during flexion-extension of biceps braquii (RMS α = 1.1319, β = 275 706; MNF α = -0470, β = 91 482). In the case of volunteers with FM, the N3 voluntary presented a behavior with the highest expected trend of muscular fatigue at 80% MVC and 60% of isometric segment, obtained during isotonic movement of biceps braquii (RMS α = 5.92 β = 113.33; MNF α = β = -1.21 96.96). Finally, the third case study, identified, with the MLP classifier, a success rate of 94.9% for six movements of individual fingers, including rest (category A), and 97.5% of success rate for seven movements, including: fingers, wrist and grip (category B), both cases, with a combination of features RMS, WL, MAV and ZC. On the other hand, the results obtained by amputee volunteers showed better results with features in time domain, compared to fractal dimension (DF), with success rates of 93.9% using combination RMS, WL and MAV characteristics for category A, and 95.4% of success rate with combination of RMS, WL, MAV and ZC in category B.
6

Proposta educativa de enfermagem na síndrome de apneia e hipopneia obstrutiva do sono

Caniçali, Renato Alves 16 July 2015 (has links)
Made available in DSpace on 2016-08-29T15:38:35Z (GMT). No. of bitstreams: 1 tese_7612_Dissertacao - Proposta educativa de enfermagem na síndrome de apneia e.pdf: 1120811 bytes, checksum: e068fc03f054de682119095f1540dea2 (MD5) Previous issue date: 2015-07-16 / Nas últimas décadas, o câncer ganhou uma dimensão maior, convertendo-se em um evidente problema de saúde pública mundial. No Brasil, as estimativas para o ano de 2012 apontam a ocorrência de aproximadamente 518.510 casos novos de câncer, incluindo os casos de pele não melanoma. O objetivo da radioterapia é alcançar um índice terapêutico favorável, levando as células malignas a perderem a sua clonogenicidade e, ao mesmo tempo, preservando os tecidos normais. A radioterapia é administrada durante um período de tempo que permita que o tecido saudável se recupere entre as sessões, o retorno das células para as fases radiossensíveis do ciclo celular e a reoxigenação das células tumorais resistentes. A radioterapia, apesar de indolor ao paciente no momento da aplicação, pode trazer efeitos colaterais e complicações para o paciente. Esses efeitos colaterais e complicações estão relacionados com a área irradiada e com os órgãos e tecidos atingidos pela radiação. A assistência de enfermagem aos pacientes acometidos pelo câncer visa proporcionar qualidade de vida, com foco na reabilitação e na facilitação da independência de forma mais rápida possível. O processo de enfermagem prevê que a assistência de enfermagem seja fundamentada na avaliação do paciente, de forma que forneça dados para fazer decisões apropriadas sobre quais são as necessidades de cuidados dos pacientes, ou seja, os diagnósticos de enfermagem, como também as intervenções e resultados. O diagnóstico de enfermagem é um processo no qual são realizadas inferências com base nos dados objetivos e subjetivos obtidos na coleta de dados. JUSTIFICATIVA: Diante da vivência atual do autor em um Setor de Raditerapia e da identificação das carências e complicações enfrentadas pelos pacientes submetidos a radioterapia, propõe-se a elaboração deste estudo. OBJETIVO: Elaborar as principais afirmativas diagnósticas e intervenções relacionadas aos pacientes em tratamento de radioterapia. METODOLOGIA: Trata-se de um estudo descritivo onde se pretende utilizar a Classificação Internacional para a Prática de Enfermagem (CIPE®) na elaboração de afirmativas diagnósticas e intervenções de enfermagem para os pacientes em tratamento de raditerapia, através dos dados coletados nas Consultas de Enfermagem realizadas no Setor de Radioterapia do Hospital Santa Rita de Cássia. / Introduction: The obstructive sleep apnoea syndrome (OSAS) is a chronic disease characterized by recurrent episodes of partial or total obstruction of the upper airway during sleep, despite continued respiratory efforts. Objectives: To describe the sociodemographic and clinical profile, assess gender differences and correlate body mass index (BMI) and apneas and hypopneas index (AHI) in patients with OSA. Methodology: Descriptive study carried out through consultation with records of OSA patients treated in a CPAP/BiPAP Program, in the Vitória’s Regional specialties center. Statistical analysis was performed using ANOVA one way to compare the means. After we used the Tukey test (post-hoc). The degree of correlation between variables was calculated using Pearson's correlation coefficient (r). The test Square, the Z test and Fisher's exact test were required to evaluate the relationship and the differences between the proportions of genres with the variables. To evaluate the relationship of cause and effect of variables with the genres, the simple logistic regression was used. Results: We found a predominance of OSA in men (63%), married (83.3%), aged between 51-60 years (30%), hypertension (59%), from the city of Vila Velha (24 %). The mean AHI and BMI in men and women was 48.3 ± 12.1 versus 44.97 ± 10 events / hour and 31.7 ± 5.7 versus 32.97 ± 5.9 kg / m², respectively. Women with OSA in the above 41 groups are at increased risk for OSA than men when comparing the range 21-40 years. In addition, women with grade III obesity have 4.3 times more risk to have OSA than those of normal weight. There was strong correlation between BMI and AHI in men (r=0.71) and moderate correlation in women (r=0.67). Conclusion: Patients treated at the program CPAP/BiPAP, mostly, have a similar profile to the global carrier OSAS population: predominantly men aged 51 and 60, hypertensive and with increased BMI. We also note that BMI is an important risk factor for worsening of OSA, especially in males.
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Development of multifunctional biopolymeric materials for teatment of decubitus ulcers

Rocasalbas Lozano, Guillermo 30 November 2012 (has links)
Chronic wounds including pressure, venous, arterial and diabetic neuropathic ulcers, represent a significant burden to the healthcare system. These different chronic wound types do not share origin or cause, however they have common features as bacterial infection and continuing influx of polymorphonuclear neutrophils that release high concentrations of matrix metalloproteases (MMPs), myeloperoxidase (MPO) and reactive oxidative species causing excessive degradation of the extracellular matrix (ECM) and the growth factors. Because of the multifactorial nature of virtually all chronic wounds, the therapeutic wound healing approach should emphasize the necessity to investigate wound dressings that possess the ability to directly and indirectly modulate the biochemical environment based on the pathology of chronic to encourage the healing process. The overall aim of the present work was to develop biopolymer wound dressings capable to improve the management of chronic wounds. The specific research objective was defined in three main targets: i) to balance the proteolytic activity of MMPs, ii) to balance the MPO activity and the oxidative environment, and iii) antimicrobial protection. The first part of the thesis aimed to provide suitable materials to perform bioactive biopolymer-based wound dressings. The first step was to provide a versatile functionalization of chitosan platform to improve the sequestering ability over metal dependent enzymes (MMPs) in chronic wounds. In order to impart to chitosan the ability to inhibit MMP, chitosan was functionalized with deferent thiol moieties, which can chelate the zinc cation in the active site of the enzyme, modifying MMP activity. In addition the combination of -NH2 and -SH chemistry allowed grafting of other active agents on the chitosan platform. The second step was the identification and evaluation of natural active agents as chronic wound healing promoters. Polyphenols from bark, twigs and leaf extracts from the medicinal plant Hamamelis virginiana (Witch hazel) were studied for this porpoise and it was found to have both a strong antioxidant activity and an inhibitory effect on MPO and collagenase. The second part of the thesis was focused in the performance and evaluation of new materials for wound healing applications. To this aim, chitosan and/or thiolated chitosan were modified with H. virginiana extracts following different approaches. The first approach was focused to develop a new method for covalent functionalization of thiolated chitosan with polyphenols from H. virginiana extracts. The novelty of this approach consists in the use of thiolysis - a common analytical method for proanthocyanidins characterization - to covalently functionalize natural macromolecules such as chitosan with bioactive phenolic moieties. The phenolics-functionalized chitosan showed improved therapeutic properties in vitro. The second approach focused on the use of laccase-assisted cross-linking between phenolic moieties of H. virginiana with chitosan and gelatin as a functionalization method to obtain stable and bioactive hydrogel wound dressings. H. virginiana extract was oxidized by laccase in a one-step process under mild reaction conditions to covalently crosslink chitosan and gelatin. The physical and mechanical properties of these hydrogels were investigated using different analytical techniques and their potential for chronic wound treatment was evaluated in vitro in terms of antibacterial and inhibitory effect on MPO and collagenase. The results indicated that the polyphenols exerted a dual role in the hydrogel: i) "passive" being a structural element, and ii) "active" modifying the chronic wound environment by attenuating the deleterious MMPs, MPO and ROS activities, and reducing the bacterial load.
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Situations in which treatment of acute exacerbations of non-severe copd with antibiotics is not necessary

Moragas Moreno, Ana 20 December 2011 (has links)
Fonament. La malaltia pulmonar obstructiva crònica (MPOC) representa un dels principals motius de salut en atenció primària. Les exacerbacions són events típics que caracteritzen el curs de l’MPOC. El tractament antimicrobià és un tema controvertit, principalment en les exacerbacions de l’MPOC lleu-moderada. Encara que la majoria dels pacients atesos a la comunitat presenten MPOC lleu i moderada, la prescripció antibiòtica en les exacerbacions és molt elevada a Espanya. Objectius. L’objectiu principal fou avaluar l’efectivitat de l’antibioteràpia en comparació amb el placebo en el dia 9-11 en les exacerbacions de l’MPOC lleu a moderada. Els objectius secundaris foren avaluar la taxa d’èxit clínic de la teràpia antibiòtica en comparació amb el placebo en el dia 20 i avaluar l’interval lliure de símptomes; és a dir, nombre de dies fins a la següent exacerbació, en ambdós grups. Disseny. Assaig clínic aleatori, controlat amb placebo, doble cec, paral·lel i multicèntric, dut a terme des de gener de 2006 fins a juny de 2011. Emplaçament. Vint-i-tres centres de salut de Catalunya. Subjectes. Pacients de 40 o més anys, fumadors o exfumadors de deu paquets-any o més, amb diagnòstic espiromètric d’MPOC lleu-moderada (volum espiratori forçat en un segon (FEV1) > 50% esperat i raó FEV1/capacitat vital forçada < 0,7% esperat) basat en una espirometría feta en els 24 mesos previs a la inclusió i presència d’exacerbació definida com la presència d'almenys un dels següents signes i símptomes: augment de la dispnea, augment del volum d'expectoració i/o augment de la purulència de l'esput. Es van excloure als pacients amb asma bronquial, hipersensibilitat als β-lactàmics, bronquièctasis d'origen diferent d’MPOC, neoplàsia, traqueotomia, presència de signes radiològics de pneumònia o criteris d'hospitalització i aquells que van declinar participar. Mesuraments i intervencions. Els pacients s’aleatoritzaren en dos grups: amoxicil·lina i àcid clavulànic (500/125 mg/8 hores, 8 dies) o placebo (cada 8 hores, 8 dies). Es va permetre ús d’antitèrmics, analgèsics, β-adrenèrgics d'acció llarga i curta, anticolinèrgics, teofil·lines, corticoides inhalats o orals i qualsevol altra medicació que iv | P a g e el pacient estigués prenent per a una malaltia crònica i s'hagués iniciat tres mesos abans de la inclusió en l'estudi, menys antibiòtics. Es va definir guariment quan va haver-hi desaparició dels signes aguts i els símptomes relacionats amb la infecció, millora com a falta de resolució completa dels símptomes i fracàs com a reducció insuficient dels signes i símptomes de la infecció. Es va considerar èxit clínic quan es va observar guariment o millora. Resultats. S’inclogueren en l’estudi un total de 353 subjectes, dels quals 43 es van excloure per no complir els criteris d’inclusió. Un total de 310 (158 pacients en el grup assignat a amoxicil·lina i àcid clavulànic i 152 pacients a placebo) resultaren ser avaluables en l’anàlisi d’eficàcia. L’edat mitjana fou de 68,1 anys (DE: 10,4 anys) i el FEV1 mig va ser del 65% (DE: 11,9%). No s’observaren diferències entre els dos grups quant a les distintes variables basals analitzades. Es guariren en el dia 9-11 un total de 117 pacients en el grup d’intervenció (74,1%) i 91 del grupo control (59,9%; p<0.05). En l'anàlisi de regressió logística multivariant es va observar una associació entre el fracàs clínic amb les concentracions de proteïna C reactiva (PCR) ≥ 40 mg/l (OR: 7,9; IC 95%: 3,9 –16,3), estar assignat al grup placebo (OR: 2,9; IC 95%: 1,4 – 6) i presència de cardiopatia isquémica (OR: 2,6; IC 95%: 1 – 6,7). Els predictors clínics de fracàs entre els pacients no tractats amb antibiòtics van ser la PCR ≥ 40 mg/l (OR de guariment: 0,1; IC 95%: 0 – 0,2) i la purulència de l’esput (OR: 0,2; IC 95%: 0 – 0,7). El valor dels criteris d’Anthonisen per predir resultat clínic en aquests pacients, amb l’àrea sota la corba ROC, fou de 0,708 (IC 95%: 0,616 – 0,801) i va pujar a 0,842 (IC 95%: 0,76 – 0,924; p<0,001) quan es va afegir la PCR ≥ 40 mg/l. Amb independència del nombre de criteris d’Anthonisen, la presència de valors baixos de PCR i esput no purulent s’associaren amb un percentatge d’èxit del 90% entre els pacients no tractats amb antibiòtics. Conclusions. El tractament de les exacerbacions de l’MPOC lleu-moderada amb amoxicil·lina i àcid clavulànic és més efectiu que el placebo. No obstant això, aquesta tesi aclareix quan una exacerbació d’MPOC lleu-moderada pot ser tractada sense necessitat de donar antibiòtics. Paraules clau. Exacerbació aguda. MPOC lleu-moderada. Antibiòtic. Efectivitat. Assaig clínic aleatori. / Background. Chronic obstructive pulmonary disease (COPD) constitutes one of the principal demands on healthcare in primary care. Acute exacerbations of COPD are typical events that characterize the course of the disease. Antimicrobial therapy remains a controversial issue, mainly in acute exacerbations of mild-to-moderate COPD. Even though most of the patients attended in the community correspond to mild and moderate COPD, antibiotics are highly prescribed for exacerbations in Spain. Aims. The main objective was to evaluate the effectiveness of antibiotic therapy compared with placebo at day 9-11 in acute exacerbations of mild-to-moderate COPD. The secondary objectives were to evaluate the rate of clinical success of antibiotic therapy compared with placebo at day 20 and assess the symptom-free interval, i.e. days till next exacerbation in both groups. Design. Multicentre, parallel, double-blinded placebo-controlled randomized clinical trial carried out from January 2006 to June 2011. Study setting: Twenty-three primary care centres in Catalonia. Subjects. Patients aged 40 or older, smokers or ex-smokers of ten packs-year or more, with spirometrically-based diagnosis of mild-to-moderate COPD (forced expiratory volume in one second (FEV1) > 50% expected and FEV1/forced vital capacity ratio < 0.7% expected) from a lung function test performed within 24 months prior to inclusion, and the presence of an acute exacerbation defined as the presence of at least one of the following signs and symptoms: increase of dyspnoea, increase in sputum volume and/or increase of sputum purulence. Patients with bronchial asthma, hypersensitivity to β-lactams, bronchiectasis of origin other than COPD, active neoplasm, tracheotomy, presence of radiological signs of pneumonia or hospital admission criteria, and those who refused to participate in the study were all excluded. Measurements and interventions. The patients were randomised into two treatment groups: amoxicillin and clavulanic acid (500/125 mg three times daily for 8 days) or placebo three times daily for 8 days). The use of antithermics or analgesics was allowed as were short-acting and long-acting β-adrenergics, anticholinergics, ii | P a g e theophyllines, inhaled or oral corticosteroids and any medication that the patient may been have taken for chronic disease and which had been initiated three months prior to inclusion in the study, except for antibiotics. Cure was defined as the disappearance of the acute signs and symptoms related to the infection, improvement, as the non-complete resolution of the symptoms and failure was defined as with an insufficient reduction in the signs and symptoms of infection. Clinical success was considered when either cure or improvement was observed. Results. A total of 353 subjects were included in the study. Forty-three patients were excluded as they did not fulfil the inclusion criteria. Three hundred ten (158 patients in the amoxicillin and clavulanic acid arm and 152 patients in the placebo arm) fulfilled all the criteria for efficacy analysis. The mean age was 68.1 years (SD: 10.4 years) and the mean FEV1 was 65% (SD: 11.9%). No differences were found between the two groups regarding the different basal variables analysed. A total of 117 patients assigned to the intervention group (74.1%) and 91 to control group (59.9%) were considered cured at days 9-11 (p<0.05). In the multivariate regression analysis failure was associated with C-reactive protein (CRP) concentrations ≥ 40 mg/l (OR: 7.9; 95% CI: 3.9 –16.3), placebo treatment (OR: 2.9; 95% CI: 1.4 – 6) and presence of coronary heart disease (OR: 2.6; 95%CI: 1 – 6.7). Among patients treated with placebo clinical predictors for failure were CRP ≥ 40 mg/l (OR of cure: 0.1; 95% CI: 0 – 0.2) and purulent sputum (OR: 0.2; 95% CI: 0 – 0.7). The predictive value of Anthonisen criteria for clinical outcome in those patients was 0.708 (95% CI: 0.616 – 0.801) and rose to 0.842 (95% CI: 0.76 – 0.924; p<0.001) when CRP ≥ 40 mg/l was added. Regardless of the number the Anthonisen criteria, the presence of both CRP low levels and uncoloured sputum was associated with a clinical success of 90% among patients not treated with antibiotics. Conclusions. Treatment of acute exacerbations of mild-to-moderate COPD with amoxicillin and clavulanic acid is more effective than placebo. Nonetheless, this thesis indicates when antibiotic therapy may be safely withheld in acute exacerbations of mild-to-moderate COPD. Key words. Acute exacerbations. Mild-to-moderate COPD. Antibiotic. Effectiveness.Randomised clinical trial.
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Estado de hierro de la madre en relación con sus niveles iniciales y la pauta de suplementación con hierro. Efecto sobre la salud materno-filial

Ribot Serra, Blanca 28 September 2012 (has links)
El objetivo de este estudio fue valorarel efecto del estado en hierro inicial y de diferentes pautas de suplementación con hierro sobre la evolución de los parámetros bioquímicos del hierro en la gestante y sobre la salud del recién nacido.El porcentaje de déficit de hierro va aumentando a medida que avanza la gestación.Este aumento depende tanto de las reservas iniciales como de la suplementación con hierro.El mayor perjuicio sobre el recién nacido se observa en las mujeres no suplementadas con hierro y las que inician la gestación con reservas de hierro exhaustas al presentar más partos prematuros y menor peso al nacer respectivamente. La suplementación con hierro moderada, de 60-100 mg/día, parece ser la más recomendable pues conduce a un menor porcentaje de déficit de hierro al final de la gestación que dosis más bajas y menor riesgo de hemoconcentración que dosis más altas / The aim of the study was to assessthe effect of initial iron status and of different patterns of iron supplementation on the iron biochemical parameters evolution inpregnant women and on the newborn's health. The percentage of iron deficiency increases as pregnancy progresses. This increase depends on both, initial iron stores and iron supplementation.The greatest harm on the newborn is observed in women who do not take iron supplementation during pregnancy and in the ones who start pregnancy with exhausted iron stores, as they have more risk of preterm deliveries and lower birth weight respectively. Moderate iron supplementation from 60 to 100 mg/day, seems to be the most recommendable as it leads to a lower percentage of iron deficiency at the end of pregnancy than lower doses and a lower risk of haemoconcentration than higher doses.
10

Factor de necrosis tumoral alfa y vih: implicación en la evolución natural de la enfermedad y en la lipodistrofia asociada al vih y al tratamiento antirretroviral

Veloso Esteban, Sergio 09 July 2013 (has links)
La lipodistrofia es uno de los principales efectos secundarios que presentan los pacientes VIH en tratamiento antirretroviral. Es conocida, en ellos, la presencia de un fenómeno inflamatorio crónico donde juegan un papel importante las citoquinas pro-inflamatorias. Destaca el Factor de Necrosis Tumoral alfa (TNF-α). En esta tesis, se estudia su papel en la inmunopatogenia de la infección y la aparición de la lipodistrofia Las conclusiones más relevantes son, respecto a la lipodistrofia, la existencia de un aumento en los niveles de TNF-α en los pacientes infectados por VIH y mayor apoptosis adipocitaria en los pacientes con lipodistrofia. Los datos obtenidos sugieren la existencia de un efecto inflamatorio local en el tejido adiposo. No hemos encontrado relación entre los polimorfismos del TNF-α y el riesgo de desarrollar lipodistrofia. Respecto a la historia natural no encontramos relación entre los polimorfismos y la susceptibilidad y/o progresión de la enfermedad. / Lipodysytrophy is a common and relevant problema in HIV-1 infected patients taking antiretroviral therapy. It is known the existence of a chronic inflammatory state in which the proinflammatory cytokines such a Tumor Necrosis factor alpha (TNF- α) play an important role. In this thesis, we studied their role in the immunopathology of infection and the onset of lipodystrophy. The most relevant conclusions are, with regard to the lipodystrophy, the existence of increased TNF-α levels in HIV-infected patients and increased adipocyte apoptosis in patients with lipodystrophy. The data obtained suggest the existence of a local inflammatory effect in the adipose tissue. We have found no relationship between the polymorphisms of TNF-α and the risk of developing lipodystrophy. With regard to the natural history we found no relationship between the polymorphisms and susceptibility and/or progression of the disease.

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