Orientador: Eliana Aguiar Petri Nahas / Coorientador: Steven Witkins / Banca: Maria Terezinha Serrão Peraçoli / Banca: Cesar E. Fernandes / Banca: Aarão Mendes Pinto / Banca: Renata D. Jouiliano / Resumo: Não disponível / Abstract: Not available / Doutor

Thesis (MTech (Biomedical Technology))--Cape Peninsula University of Technology, 2006 / Research has shown that the activation of the NO-cGMP pathway leads to myocardial protection from oxidative stress conditions, such as ischaemia and reperfusion. Few of these studies have however combined diet induced oxidative stress with ischaemia/reperfusion injury. Although little is known about the effects of supplements such as red palm oil (RPO) on the NO-cGMP pathway, research has shown that dietary RPO-supplementation improved reperfusion aortic output recovery through mechanisms that may include activation of the NO-cGMP- and inhibition of the cAMP pathway. RPO is an antioxidant-rich oil containing ~carotene and Vitamin E (tocopherols and tocotrienols). The aims of this study were to determine: 1) whether RPO-supplementation of an oxidative risk induced diet (ORD) and a high saturated fat diet (HFD) offers protection against ischaemia/reperfusion injury in the isolated perfused rat heart and 2) the possible mechanisms for this protection. Male Wistar rats were randomly divided into four groups for a period of 14 weeks according to the dietary supplementation they received. The control groups received either an oxidative risk induced diet (ORD) or a high saturated fat diet (HFD), while the experimental groups received an ORD supplemented with RPO (ORD+RPO) or a HFD supplemented with RPO (HFD+RPO).

Thesis (MTech (Biomedical Technology))--Cape Peninsula University of Technology, 2012. / Oxidative stress, in recent times appears to be a major underlying risk factor in the occurrence of various diseases such as cardiovascular disease (CVD) and ischemic heart disease (IHD). During oxidative stress, there is an imbalance between the production of reactive oxygen species (ROS) and antioxidant defence mechanisms in favour of ROS. This results in severe cellular damages in the heart, vascular membranes and other organs. Potential benefits of dietary supplements as one of the major quenching elements against oxidative stress have been highlighted. Thus, a growing interest has been stimulated in finding natural alternatives for the treatment and! or prevention of oxidative stress-mediated diseases. Red palm oil (RPO), refined from the tropical plant Elaeis guineensis was used in this study since it has captivated much attention in the health sector lately. The effects of RPO-supplementation on oxidative stress biomarkers as well as homocysteine, a cardiovascular disease risk factor in an oxidative stress-induced rat model were investigated in this in vivo study. All experiments were conducted for a period of six weeks. Male Wistar rats (120-150g) were randomly divided into six groups (n=5) where all the rats received a standard diet. Two groups (groups C, D) were supplemented with 0.175g RPO (7g RPO/kg chow) for four weeks whereas groups (groups E, F) were given 0.175g RPO (7g RPO/kg chow) supplementation for six weeks. Rats in control groups (groups A, B) were not given any RPO-supplementation. Groups B, 0, F were induced with oxidative stress by injection of 0.5ml (20IlM/100g of body weight) organic tertiary-butyl hydroperoxide. All parameters were determined using appropriate methods in plasma, serum and erythrocytes. Data were expressed as mean ± SEM. No significant differences were obtained between groups for total antioxidant capacity and glutathione peroxidase activity. Red palm oil supplementation significantly increased superoxide dismutase activity after 6 weeks consumption, total glutathione levels after 4 weeks consumption and homocysteine levels after four and six weeks consumption in rats not subjected to oxidative stress. Under oxidative stress conditions, malondialdehyde (MOA) level, a marker of oxidative stress related damage, significantly increased in rats receiving a standard diet. However, when RPO diet was supplemented for 4 and 6 weeks, MOA levels significantly decreased towards the value of normal controls. In conclusion, our findings suggest that RPO-supplementation could ameliorate antioxidant status in the body through its potential ability to increase some antioxidant enzymes activity. Similarly, it is suggested that RPO-supplementation could protect the rat against oxidative stress induced damage in diseased state.

Orientador: Gláucia M. F.S. Mazeto / Coorientador: Célia Regina Nogueira / Banca: Adriana L. Mendes / Banca: José A. Sgarsi / usar p/ notas tambem / Resumo: A síndrome metabólica (SM) engloba um conjunto de alterações metabólicas que predispõem ao maior risco para as doenças cardiovasculares (DCV). Recentemente, alguns estudos têm relatado a associação entre hipotireoidismo subclínico e aumento deste risco. A medida da espessura íntima-média das carótidas (EIM), por ultrassonografia (US), é capaz de detectar alterações iniciais da aterosclerose, podendo predizer o risco de doença aterosclerótica subclinica. O objetivo deste estudo é avaliar a medida da EIM, nos pacientes com hipotireoidismo subclínico, correlacionado-a com a função tireoidiana e com marcadores clínicos e laboratoriais para a SM. Foram selecionados 32 pacientes com hipotireoidismo subclínico que foram subdivididos em dois grupos: hipotireoidismo subclínico com SM (HSCSM) e hipotireoidismo subclínico sem SM (HSC), segundo os critérios da Federação Internacional de Diabetes (IDF). Houve um grupo controle de pacientes eutireoidianos (n=31) que também foram subdivididos quanto à presença (EUTSM) ou não de SM (EUT). Os grupos foram comparados quanto a parâmetros clínicos e comportamentais (idade, sexo, tabagismo, grau de atividade física, histórico de eventos cardiovasculares e de doenças tireoidianas prévias), parâmetros laboratoriais (glicemia de jejum, função tireoidiana, perfil lipídico) e à diferença nas medidas da EIM. Para análise estatística foram utilizados os testes de Goodman, complementado com o teste de comparações múltiplas de TuKey, e de Comparações Múltiplas de Dunn. Para análise de algumas variáveis quantitativas, clínicas e laboratoriais, foram realizadas também Medidas de Associações Múltiplas (teste de Correlação Linear de Pearson), a fim de verificar correlação com a EIM Média e Máxima. O nível de significância adotado foi de 5%. As medidas das EIM Média e Máxima (média±desvio padrão) foram maiores no grupo ... / Abstract: The metabolic syndrome (MS) encompasses a set of metabolic abnormalities that predispose to increased risk for cardiovascular disease (CVD). Recently, some studies have reported an association between subclinical hypothyroidism and increase this risk. The measurement of carotid intima-media thickness (IMT), as assessed by ultrasonography (US), is capable of detecting early changes of atherosclerosis and can predict the risk of subclinical atherosclerosis. The aim of this study were to determine carotid IMT in patients with subclinical hypothyroidism and association with thyroid function and clinical and laboratory markers for MS. We selected 32 patients with subclinical hypothyroidism who were divided in two groups: subclinical hypothyroidism with MS (SHMS) and subclinical hypothyroidism without MS (SH), according to the criteria of the International Diabetes Federation (IDF). There was a control group of euthyroid patients (n = 31) who were also divided on the presence (EUTMS) or not SM (EUT). The groups were compared regarding clinical and behavioral parameters (age, sex, smoking, physical activity, history of cardiovascular events and previous thyroid diseases), laboratory parameters (fasting glucose, thyroid function, lipid profile) and the difference in mean carotid IMT.����Statistical analyses were performed by Goodma test, complemented by the multiple comparison test of Tukey Multiple Comparisons and Dunn. For analysis of some quantitative variables, clinical and laboratory measures were also undertaken Multiple Associations (Linear correlation test of Pearson), to verify correlation with IMT Average and Maximum. The level of significance was set at 5%. Mean and maximum IMT were greater in the patients SHMS group compared to patients SH group [0.59 ± 0.10 mm vs. 0.73 ± 0.19 (p <0.05) vs. 0.69 ± 0.15 mm. 0.86 ± 0.21 (p <0.05), respectively]. Comparing the groups with MS, the group SHMS showed higher maximum IMT than group ... / Doutor

Orientador: Beatriz Bojikian Matsubara / Coorientador: Regina Moura / Banca: Ana Glória Pontes / Banca: Paulo Traiman / Banca: Ana Caolina Japur de Sá Rosa e Silva / Banca: Gustavo Arantes Rosa Maciel / Banca: João Carlos Hueb / Resumo: Introdução Mulheres com Síndrome dos Ovários Policísticos (SOP) apresentam prevalência aumentada de fatores de risco cardiovascular. Entretanto, os estudos que confirmam a associação entre SOP e a morbimortalidade por doença cardiovascular são limitados. Objetivos Avaliar o risco de Framingham a prevalência de evento cardiovascular em mulheres com SOP. Pacientes e Método Foram analisados os dados clínicos, bioquímicos e ultrassonográficos de mulheres com idade entre 18-40 anos com e sem diagnóstico de SOP, do HC-FMB no período de 1997 a 2010. Para verificar o risco de primeiro evento coronariano em dez anos, foi utilizado o escore de risco de Framingham (ERF), modificado pelo NCEP-ATPIII, 2002. A prevalência de evento cardiovascular maior e menor foi obtida pela análise dos prontuários médicos, cruzamento de dados e busca ativa. O teste do qui-quadrado, o teste exato de Fisher e análises de regressão logística multivariada corrigidas para idade e índice de massa corporal (IMC), foram empregados nas análises estatísticas e o nível de significância considerado foi de 5%. Resultados Foram identificadas 267 mulheres com SOP e 190 sem SOP seguidas no período de um a 13 anos. A mediana de idade foi de 25 anos (SOP) e de 29,5 (não SOP) (p<0,0001). As pacientes com SOP apresentaram maior prevalência de obesidade (p=0,017), circunferência da cintura (p= 0,012), hipertensão arterial sistêmica (p=0,047), intolerância à glicose (p=0,027), Diabetes mellitus do tipo 2 (p=0,007), hipercolesterolemia (p=0,005) e hipertrigliceridemia (0,002) em relação às não SOP. As pacientes com SOP apresentaram uma prevalência de 7,5% de ERF alto contra 1,3% nas não SOP (p=0,008), e a análise de regressão logística multivariada mostrou uma chance cinco vezes maior de evento coronariano quando se comparou às não SOP (OR 5,16 IC95%:1,16-22,96;p=0,031). Entretanto, não houve diferença estatística entre a prevalência de eventos ... / Abstract: Introduction: Women with polycystic ovary syndrome (PCOS) have an increased prevalence of cardiovascular risk factors. However, most studies available are limited to confirming the association of PCOS with cardiovascular morbidity and mortality. Objectives: To assess the Framingham risk score and the prevalence of cardiovascular events in women with PCOS. Patients and Methods: Clinical, biochemical and ultrasonographic data were collected from women (18-40 years) with and without PCOS attending the Botucatu Medical School Hospital from 1997 to 2010. The Framingham Risk Score (FRS), calculated according to NCEP-ATPIII-2002 criteria, was used to estimate the 10-year risk of first coronary event. The prevalence of major and minor cardiovascular events was obtained through the analysis of medical records, crossing of data, and active search. Statistical analyses were performed using the Chi-square test, Fischer's exact test and multiple logistic regression adjusted for age and BMI, with significance set at 5%. Results:t A total of 267 women with PCOS and 190 without PCOS were followed up for 1-13 years. Median age was 25 years in women with PCOS, and 29.5 yearsnin those without it (p<0.0001). Women with PCOS had higher prevalence of obesity (p=0.017), waist circumference (p= 0.012), arterial hypertension (p=0.047), glucose intolerance (p=0.027), type 2 diabetes mellitus (p=0.007 hypercholesterolemia (p=0.005), and hypertriglyceridemia (0.002) than those without PCOS. The prevalence of high FRS was 7.5% and 1.3% in women with and without PCOS, respectively (p=0.008). Multiple logistic regression analysis revealed that women with PCOS had a 5-fold greater chance of having a coronary event than those without PCOS (OR: 5.16 95%CI:1.16-22.96, p=0.031). However, the prevalence of cardiovascular events did not statistically differ between women with and without PCOS. Conclusions: In the women with PCOS at childbearing age who participated in this ... / Doutor

Orientador: Sandra Cordellini / Coorientador: Agnaldo Bruno Chies / Banca: Luiz Borges Bispo da Silva / Banca: Carlos Alan Cândido Dias Júnior / Banca: Patrícia de Souza Rossignoli / Banca: Andreia Fresneda Gaspar / Resumo: Introdução: o estresse e o consumo de etanol são importantes fatores de risco cardiovascular. Objetivos: avaliar os efeitos da exposição ao estresse e do consumo de etanol, isoladamente e em associação sobre a pressão arterial e a reatividade da aorta torácica in vitro. Métodos: ratos Wistar machos adultos (8- 10 por grupo) foram separados em grupos: controle, etanol (20% de etanol na água de beber por 6 semanas), estresse (contenção 1h/dia 5 dias/semana durante 6 semanas) e etanol/estresse (ambos procedimentos em associação). A pressão arterial sistólica caudal (PAS), a concentração plasmática de corticosterona e a capacidade antioxidante do plasma foram avaliadas. Curvas concentração-efeito à noradrenalina na ausência ou presença de ioimbina (bloqueador-α2), L-NAME (inibidor da sintase do óxido nítrico), ou indometacina (inibidor da ciclooxigenase); à fenilefrina; e à angiotensina II na ausência e presença de losartan (bloqueador-AT1), PD123-319 (bloqueador-AT2), L-NAME, ou indometacina foram obtidas em anéis de aortas intactas e desnudadas de endotélio. Concentração efetiva 50% (CE50) e resposta máxima (RM) foram comparadas entre os grupos utilizando MANOVA/Tukey. P < 0,05 foi considerado estatisticamente significativo. Resultados: a exposição ao estresse, isoladamente e em associação ao consumo de etanol aumentou a PAS. Estresse ou estresse em associação aumentou as RM à noradrenalina em aortas intactas. Esta hiperreatividade foi abolida pela remoção do endotélio e pela presença de indometacina ou ioimbina, mas não foi alterada pela presença de L-NAME. Por sua vez, o consumo de etanol isoladamente não alterou a reatividade à noradrenalina. As respostas à fenilefrina em aortas com e sem endotélio e à noradrenalina em aortas sem endotélio permaneceram inalteradas independentemente do protocolo. Etanol e estresse, isoladamente e em associação, não alteraram a reatividade da aorta ... / Abstract: Introduction: stress and ethanol consumption are important cardiovascular risk factors. Objectives: to evaluate the effects of stress exposure and ethanol consumption, alone and in association on blood pressure and thoracic aorta reactivity in vitro. Methods: Wistar adult male rats (8-10 per group) were separated into groups: control, ethanol (20% ethanol in their drinking water for 6 weeks), stress (restraint 1h/day 5 days/week for 6 weeks) ethanol/stress (both procedures in association). Caudal systolic blood pressure (SBP), plasma corticosterone and plasma antioxidant capacity were evaluated. Concentrationeffect curves to noradrenaline in the absence or presence of yohimbine (α2- blocker), L-NAME (inhibitor of nitric oxide synthase) or indomethacin (cyclooxygenase inhibitor); phenylephrine; and angiotensin II in the absence and presence of losartan (AT1-blocker), PD123-319 (AT2-blocker), L-NAME or indomethacin were obtained from the intact and denuded-endothelium aortas. 50% effective concentration (EC50) and maximum response (MR) were compared between groups using MANOVA/Tukey. P < 0.05 was considered statistically significant. Results: exposure to stress, alone and in association with ethanol consumption increased SBP. Stress and stress in association increased the MR to noradrenaline in intact aortas. This hyperreactivity was abolished by both removal of the endothelium and the presence of indomethacin or yohimbine, but was not changed by the presence of L-NAME. In turn, the consumption of ethanol alone did not alter the reactivity to noradrenaline. Responses to phenylephrine in aortas with and without endothelium and to noradrenaline in aortas without endothelium remained unchanged regardless of protocol. Ethanol and stress, alone and in association, did not alter the reactivity of intact aorta to angiotensin II. PD123-319 decreased MR to angiotensin II in intact rat aortas of ethanol and ethanol/stress groups compared to the ... / Doutor

M.Cur. / The cardiothoracic intensive care unit is a dynamic environment which is characterised by a high patient turnover, staff shortages, medication, doctor's and nursing protocols and specialised nursing skills are required of the registered nurse. The registered nurse working in this environment is an independent practitioner and is accountable for her acts and omissions. The registered nurse can only accept accountability if she/he has the ability (knowledge, skills and values), the responsibility and authority to carry out the actions (Bergman, 1982:8). The learner enters the cardiothoracic intensive care unit as part of the clinical teaching she receives at a specific university. Due to staff shortages, the learner is often given the responsibility and authority to carry out actions for which she is accountable, without having the ability (knowledge, skills and values) to act. She may, therefore, not be able to nurse the patient safely and effectively. The unit manager is responsible for creating a learning climate in the unit and utilises an orientation programme to create this climate. An orientation programme introduces new staff members to the philosophy, goals and procedures necessary to work in a particular setting (Brookfield, 1986:64). The adult learner wants to learn that which is task- and problem-orientated in a selfdirective, independent way ida climate that is conducive to learning. The question arises: What must the content of an orientation programme for a certain cardiothoracic intensive care unit of a specific private hospital be and how must it be managed to facilitate safe and effective nursing by learners working in the cardiothoracic intensive care unit? The objective of the study is to explore and describe the content and management of an orientation programme for a specific cardiothoracic intensive care unit in a specific private hospital. A qualitative, exploratory and descriptive contextual study was conducted to explore and describe the content and management of the orientation programme. A contextual framework is described and focus group interviews were conducted with learners and registered nurses. From the results of the conceptual framework and focus group interviews, the content and manageent of the orientation programme was described. Due to the function perspective of the study, an orientatio nprogramme was developed from the results of the study.

D.Litt.et Phil. (Psychology) / Cardiovascular disease, and specific disorders associated with this complex disease pattern, has been the subject of numerous investigations to determine the nature and cause of this disturbance in both white and Black population groups in various countries around the world. Although the findings of research into this matter has been directed mainly towards more effective drugs and more advanced surgical techniques, there are numerous indications in literature and current research that certain social and psychological factors might indeed play an important part in the aetiology and nature of cardiovascular diseases. In a developing Third World country such as the Republic of South Africa, with its complex and heterogenous population, evidence derived from past and current research indicates that cardiovascular disease and the consequences of cardiovascular disease are assuming epidemiological proportions among both White and Black South Africans. Against this background, it appeared necessary to establish whether Black patients with cardiovascular disease also showed the type A behaviour pattern which is closely associated with diseases of the cardiovascular system among Whites. The present study was therefore performed to test the hypothesis firstly that cardiovascular disease and the type A behaviour pattern are closely associated in Blacks, and secondly whether factors such as stress, caused by social readjustment and urbanization, as well as anxiety and diet, plays significant role in cardiovascular disease amongst Blacks. Four groups of patients were selected on the basis of the presence or absence of cardiovascular disorders, and the presence or absence of the type A behaviour pattern. All four groups were then subjected to assessment by the Structured Interview, Jenkins Activity Survey, Taylor Manifest Anxiety Scale, Grant's Urban-Rural Scale" the Social Readjustment Rating Scale and a Health Scale to test the hypothesis that basic differences, regarding cardiovascular diseases, existed among people who differ in respect of personality type, social readjustment, the experiencing of anxiety and changing lifestyle due to urbanization and dietary patterns. A prior validation procedure for the assessment devices indicated that the tests demonstrated adequate construct validity and factorial validity. After examining the data of the four groups of patients obtained from the scales, the results were statistically analysed.

Cardiovascular disease contributes to mortality and morbidity statistics worldwide and in South Africa. The current focus in health care revolves around activities aimed at preventing the development of cardiovascular disease, rather than the treatment of disease. The identification of risk factors that can predispose a patient to the development of cardiovascular disease is an essential component of any cardiovascular disease management programme. It is necessary that in the management of these risk factors, they are not considered to be isolated, but inter-related. Through the provision of point-of-care cardiovascular risk screening and monitoring services as well as disease-related counselling, the community pharmacist, as a readily accessible source of healthcare, can play an essential role in the cardiovascular disease management process. The aim of this study was to describe the nature of the services provided by community pharmacists with respect to cardiovascular risk and disease management in the Nelson Mandela Metropole. The research design was a non-experimental, descriptive study using a crosssectional survey method. Data was obtained through the utilisation of a questionnaire. The questionnaire consisted of three sections and was administered to community pharmacies in the Nelson Mandela Metropole, that provided cardiovascular point-of-care screening services. The community pharmacists correctly identified cardiovascular risk factors such as obesity (76.6 percent; 36, n=47) and smoking (27.7 percent; 13, n=47). Other cardiovascular risk factors such as abdominal obesity (4.2 percent; 2, n=47), gender (2.1 percent; 1, n=47) and family history (4.2 percent; 2, n=47) were largely ignored by the pharmacists. Point-of-care testing services were readily available in the pharmacies, with all of the pharmacies providing blood glucose and blood pressure measurements. Blood cholesterol measurements were only provided in 87.8 percent (36, n=41) of the pharmacies. The services were generally provided in a clinic facility, with 90.2 percent (37, n=41) of the pharmacies having a clinic facility available. Pharmacists were involved in the provision of point-of-care services, with 85.4 percent (35, n=41) of the pharmacies indicating that the pharmacists participated. Pharmacists readily provided counselling prior (70.7 percent; 29, n=41) to and after (80.5 percent; 33, n=41) the conduction of the screening services on areas such as lifestyle modification and treatment options. Only 15 percent (7, n=47) of the pharmacists indicated that they were aware of Cardiovascular Risk Calculator Tools and none of the pharmacists indicated that they had utilised such a tool. Pharmacists recommended frequent monitoring (60.5 percent; 26, n=43) and lifestyle modification (67.4 percent; 29, n=43) to patients, if the result of their screening service was within normal limits. However, the majority of the pharmacists indicated that they would refer patients, if the results obtained were out of the normal range. Conclusions based on the findings indicated that the pharmacists are readily providing cardiovascular risk screening services. The pharmacists were also able to identify the presence of any risk factors that can lead to the development of cardiovascular disease in the patients. However, active pharmaceutical involvement in further cardiovascular disease monitoring seemed to be lacking. Recommendations were made on areas such as reimbursement for pharmaceutical care services, increased utilisation of support staff and Continuing Professional Development events that could assist in improving the role of the community pharmacist in cardiovascular disease management.

Please read the abstract in the section 00front of this document / Dissertation (MSc (Chemical Pathology))--University of Pretoria, 2005. / Chemical Pathology / unrestricted