nÃo hà / Diabetes mellitus (DM) à uma sÃndrome associada a secreÃÃo de insulina deficiente, resistÃncia à aÃÃo da insulina ou uma associaÃÃo de ambas. Caracteriza-se por hiperglicemia crÃnica que a longo prazo poderà causar retinopatia, nefropatia, neuropatia perifÃrica e autonÃmica. Este estudo do tipo intervencionista, prospectivo e aberto teve como objetivo avaliar a eficÃcia terapÃutica da sitagliptina no controle metabÃlico do diabetes mellitus do tipo 2 recentemente diagnosticado (menos de seis meses) e nas vias de conduÃÃo nervosa somato-sensitiva e visual. Antes de iniciar o tratamento, foram avaliados os Ãndices antropomÃtricos e a pressÃo arterial. TambÃm foram realizadas as dosagens em jejum de triglicerÃdeos, colesterol total, colesterol de alta densidade (HDL), gama glutamil transferase, aspartato amino transferase, alanina amino transferase, proteÃna C reativa, microalbuminÃria, Ãxido nÃtrico, glicose, hemoglobina glicada (A1C), peptÃdeo C, insulina e glucagon. ApÃs um estÃmulo alimentar de 566 Kcal foram feitas coletas de sangue seriadas durante 3 horas nos tempos de 5, 15, 30, 45, 60, 90, 120, 150 e 180 minutos para a dosagem de glicose, insulina e glucagon com a construÃÃo da Ãrea sob a curva (AUC) destes analitos. Um subgrupo de 20 pacientes realizou ainda, anÃlises seriadas das incretinas (GLP-1 ativo e GIP total) apÃs estÃmulo alimentar e, tambÃm, exames eletroneurofisiolÃgicos (potenciais evocados somato-sensitivos â PESS, e visuais - PEV). ApÃs estas avaliaÃÃes, os pacientes receberam sitagliptina 100 mg (1 comprimido/dia) por um perÃodo de 3 meses, apÃs o qual, eles retornaram para avaliaÃÃo clÃnica e para realizar todas as dosagens bioquÃmicas e os exames de PESS e PEV que haviam realizado no inÃcio do estudo. Dos 41 pacientes avaliados, 28 eram do sexo feminino e 13 do sexo masculino, idade mÃdia de 53,2  9,43 anos, em mÃdia obesos e 50% deles eram hipertensos. ApÃs o tratamento, observou-se a melhora dos Ãndices antropomÃtricos, de todos os parÃmetros laboratoriais com Ãnfase na glicose em jejum (prÃ: 174,43  67,18 e pÃs: 129,07  29,19 mg/dL), A1C (prÃ: 8,76  2,68 e pÃs: 6,64  1,11%) e Ãxido nÃtrico (prÃ: 85,21  44,02 e pÃs: 39,91  20,99 ÂM), todos com P<0,0001 e ainda, aumento da concentraÃÃo da AUC de GLP-1 ativo (P=0,003) e diminuiÃÃo da AUC de GIP total (P=0,001), bem como diminuiÃÃo das latÃncias N9D (P<0,0001), N13E (P=0,036), N20D (P=0,028) e dos tempos de conduÃÃo central N13-N9E (P=0,045), N20-N13D (P=0,044), alÃm de correlaÃÃes com significÃncia estatÃstica entre parÃmetros bioquÃmicos e eletroneurofisiolÃgicos. Este estudo concluiu que houve melhora clÃnica, metabÃlica e nas vias de conduÃÃo do impulso nervoso somato-sensitivo e visual dos pacientes tratados com sitagliptina. / Diabetes mellitus (DM) is a syndrome associated with deficient insulin secretion, resistance to insulin action or the combination of both. It is characterized by chronic hyperglycemia that in a long term can cause retinopathy, nephropathy, peripheral and autonomic neuropathy. The present interventional, prospective and open study was designed to evaluate therapeutic efficacy of sitagliptin in metabolic control of diabetes mellitus type 2 recently diagnosed (less than 6 months) and in pathways of visual and somatosensory nerve conduction. Blood pressure and anthropometric data were colected before treatment. Measures of fasting triglycerides, total cholesterol, high density lipoprotein cholesterol gamma glutamyl transpeptidase, alanine aminotransferase, aspartate aminotransferase, microalbumin, nitric oxide, glucose, glycated hemoglobin (A1C), C-peptide, insulin and glucagon were also collected. Also during the pre-study, after a feeding stimulus of 566 Kcal, biochemical evaluations were conducted of the metabolism in fasting and during 3 hours, in standard intervals of 5, 15, 30, 45, 60, 90, 120, 150 and 180 minutes for glucose, insulin and glucagon for design of the area under curve (AUC) of these analytes. In a subgroup of 20 patients were performed dosages in pre-fixed times of incretins (active Glucagon Like Peptide -1, GLP-1, and total Glucose-dependent Insulinotropic polypeptide, GIP) after feeding stimulus and electroneurophysiological tests (somatosensory evoked potentials - SEP, and visual - VEP). After these evaluations, the patients received sitagliptin 100 mg (1 tablet a day) for 3 months and then returned for clinical evaluation and to repeat all the biochemical dosages, SEP and VEP exams. From 41 patients evaluated, 28 were female and 13 male, the average age was 53.2  9.43 years, in average obese and 50% were hypertensive. After treatment, improvement was observed in all anthropometric and laboratory parameters, specially fasting glucose (pre: 174,43  67,18 mg/dL and post: 129,07  29,19 mg/dL), A1c (pre: 8,76  2,68 and post: 6,64  1,11%), and nitric oxide (pre: 85,21  44,02 and post: 39,91  20,99 ÂM), all with P<0.0001, and also increase in the concentration of the AUC of active GLP-1 (P=0.003), decrease of the AUC of total GIP (P=0.001), and decrease of the N9D (P<0.0001), N13E (P=0.036 ), N20D (P=0.028) latencies and of the central conduction time N13-N9E (P=0.045), N20-N13D (P=0.044). There were also statistically significant correlations between biochemical and electrophysiological parameters. This study concluded that there was clinical, metabolic and somatosensory and visual nerve impulse conduction pathways improvement in patients treated with sitagliptin.

A hérnia perineal é uma enfermidade que ocorre comumente em cães machos, principalmente não castrados com faixa etária entre cinco e 14 anos. A etiologia é desconhecida, sendo que vários fatores já foram associados tais como alterações hormonais, neurogênicas ou características anatômicas. Sabe-se que a atrofia muscular, principalmente do músculo elevador do ânus, está relacionada diretamente com o desenvolvimento da hérnia perineal e, de acordo com os músculos envolvidos, é classificada em caudal, dorsal, ventral ou ciática. Várias técnicas cirúrgicas foram descritas para sua correção, porém as taxas de complicações e recidivas são elevadas, sem que tenha havido avaliações comparativas das técnicas e determinação de qual é mais adequada para cada caso. Portanto, objetivou-se com o presente estudo a avaliação crítica das técnicas de herniorrafia perineal realizadas em cães machos, por meio da colimação dos resultados coligidos em trabalhos científicos observados na literatura. Para tanto foi realizada uma busca nas bases de dados referenciais eletrônicas Embase, Google Acadêmico, PubMed, SciELO, Science Direct e Web of Science. Os processos de reparação de hérnia perineal tais como a técnica de sutura padrão, transposição do músculo obturador interno; transposição do músculo glúteo superficial; transposição do músculo semitendinoso; reparação com uso de membranas sintéticas ou biológicas; e colopexia associada ou não a cistopexia foram avaliados quanto à presença de complicações e recidivas. Com a busca por meio das bases de dados referenciais eletrônicas obteve-se 5311 resultados em português e inglês. A busca manual resultou na obtenção de outros 41 artigos. Após avaliação do título e resumo, exclusão dos resultados repetidos, e leitura do texto completo, foram selecionados 30 artigos de acordo com os critérios de inclusão e exclusão. Baseando-se na comparação e avaliação dos resultados é possível concluir que existe falta de dados clínicos padronizados bem como informações sobre o tempo de acompanhamento pós-operatório e taxas de recidiva extremamente variáveis, dificultando estabelecer paralelo entre o nível de gravidade da enfermidade com as complicações advindas após realização das diferentes técnicas cirúrgicas preconizadas, dificultando a avaliação da eficácia de tais técnicas / Perineal hernia is a disease that occurs commonly in male dogs, especially uncastrated aged between five and 14 years. The etiology is unknown, and several factors have been associated such as hormonal, neurogenic or anatomical features changes. It is known that muscle atrophy, mainly of the levator ani muscle, is directly related to the development of perineal hernia and, according to the involved muscles, it is classified into caudal, dorsal, ventral or sciatica. Several surgical techniques have been described for its repair, but the complications and recurrences rates are high, without there have been comparative evaluation techniques and determination of which is more appropriate for each case. Therefore, the present study had the objective of critically evaluate the perineal hernia repair techniques performed in male dogs through collimation of the results collected in scientific studies reported in the literature. Therefore it was carried out a search in the electronic reference databases Embase, Google Scholar, PubMed, SciELO, Science Direct and Web of Science. The perineal hernia repair procedures such as standard suture technique, transposition of the internal obturator muscle; transposition of superficial gluteal muscle; transposition of semitendinosus muscle; repair with the use of synthetic or biological membranes; and colopexy with or without cistopexia were evaluated for the presence of complications and recurrences. With the search through the electronic reference databases, it was obtained 5311 results in Portuguese and English. The manual search resulted in obtaining another 41 articles. After evaluation of the title and abstract, excluding the repeated result and reading the full text, it was selected 30 articles according to the inclusion and exclusion criteria. Based on the comparison and evaluation of the results it is possible to conclude that there is a lack of standardized clinical data as well as information about the time of postoperative follow-up and extremely variable recurrences rates, making it difficult to establish a parallel between the level of the disease severity with complications arising after implementation of the various preconized surgical techniques, making it difficult to evaluate the effectiveness of such techniques

O cirurgião dentista comumente em sua prática clínica se vê diante de pacientes sistemicamente comprometidos. Entre esses pacientes encontramos o grupo dos hipertensos que merecem especial atenção pelo profissional, devido às possíveis alterações psicossomáticas que podem vir a acontecer durante um atendimento odontológico. O presente estudo teve como objetivo estabelecer a prevalência e suas implicações em pacientes hipertensos em uma amostra de 424 pacientes sob tratamento na FO-USP. Com os resultados da amostra, quase 1/3 da população analisada era hipertensa, confirmando a alta prevalência da patologia na amostragem estudada. Os fatores de risco que mais influenciaram na presença de hipertensão observados nesta pesquisa foram o diabetes e o sedentarismo, elucidando o quão é necessário correlacionar a história médica e os hábitos do paciente para chegar a um diagnóstico diferencial. Já 10,53% dos pacientes hipertensos não eram cientes sobre sua condição sistêmica e, um grande número daqueles que já eram cientes, todavia apresentavam-se descompensados, confirmando a importância e a necessidade do cirurgião dentista aferir a pressão arterial de seus pacientes em clínica rotineiramente. Enfim, uma completa anamnese, acompanhada de exames complementares, como mensurações da pressão arterial, garante um tratamento odontológico seguro e efetivo. / The dentist commonly takes care of patients with systemic diseases in its routine clinic. Among these patients we find the group of the hypertensives that deserve special attention for the professional, whom had possible psychosomatic alterations that can come to happen during an odontology attendance. The present study had the objective to establish the prevalence and its implications among hypertensives in a sample of 424 patients under treatment in the FOUSP. As a result of the sample, almost 1/3 of the analyzed population was hypertensive, confirming the high prevalence of the pathology in the studied sampling. The risk factors that had increased the appearance of hypertension observed in this research were diabettes and the sedentary life, elucidating how is necessary to correlate medical history and the habits of the patient to establish a distinguishing diagnosis. In addition, 10.53% of the hypertensive patients did not know about their systemic condition and a great number of the patients that had already known, were not medicated, confirming the importance and the necessity of the dentist to survey the arterial pressure of its patients in clinic routinely. Therefore, complete anamnesis, followed by complementary examinations such as measurement of the arterial pressure, guarantees a safe and effective odontology treatment.

M.Tech. (Homoeopathy) / Menopause is the natural or iatrogenic termination of menstrual periods as a result of decreasing ovarian function. Natural menopause begins when menstrual periods have been absent for one year (Beers et al., 2006). The Climacteric is the period which encompasses the transition from the reproductive state to the non-reproductive state. Menopause, therefore, is a specific event that takes place during the climacteric (Collins et al., 2010). The symptoms are usually treated conventionally with Hormonal Replacement Therapy (HRT), but a large number of adverse side-effects are associated with its use (Harvey and Champe., 2009). De Schepper (2001) states that the true Homoeopathic Similimum strengthens a person’s vital force which results in the improvement of disease symptoms. Barton (2008) states that it is very difficult to accurately find the Homoeopathic Similimum for each case; therefore, Grant Bentley and his team have worked to develop a system of analysis, to facilitate the identification of the Similimum for each case. The Grant Bentley Method requires photography of the face and analysis of the facial features necessary to ascertain the miasmatic category into which the participant falls (Barton, 2008). There is no research verifying the effectiveness of this method in the treatment of climacteric symptoms. The aim of the study is to evaluate the effect of the Homoeopathic Similimum, using the Grant Bentley-method, on Climacteric symptoms. The study was carried out in the form of case studies over a twelve week period. Eleven females, between the ages of forty and sixty-five years, who were experiencing climacteric symptoms and who met the inclusion and exclusion criteria were recruited, using purposive sampling, by placing advertisements (Appendix A) in local newspapers, pharmacies and medical practices in the Vanderbijlpark area and at the Doornfontein Campus of the University of Johannesburg. The process of the study was explained to the participants and consent forms were signed (Appendix C and D). Participants, with the researcher’s help, completed a Suitability Criteria Questionnaire (Appendix B). During the first consultation the Menopause Rating Scale (MRS) (Appendix E and F) was completed and evaluated (Appendix G). The Homoeopathic case studies took the form of one-on-one conversations in order to complete a Case Taking Form (Appendix I) and incorporated a relevant physical examination and a Grant Bentley Evaluation of each participant’s facial features from which their miasmatic categories were determined (Appendix H). The participant’s case information was examined in accordance with the principles of homoeopathic classical prescribing, based on the entirety of symptoms. From this process the similimum was determined and given according to homoeopathic principles...

M.Tech. (Radiography) / Monitoring the growth and wellbeing of the foetus is a major purpose of antenatal care. The use of diagnostic ultrasound to assess foetal wellbeing has become an important part of prenatal care in both low and high risk pregnancies. Pre-eclampsia and foetal growth restriction (FGR) remains important causes of maternal and perinatal mortality and morbidity. Pre-eclampsia is characterised by an abnormal vascular response to placentation and is a multisystem disorder of unknown cause specific to pregnancy which affects the health of both mother and fetus. Prep-eclampsia complicates between 2 and B % of all pregnancies and is the second most common cause of maternal deaths in the developing world. The aim of this study was to assess the sensitivity of uterine artery spectral Doppler screening in the prediction of pregnancies with a high risk of developing pre-eclampsia or FGR before the clinical onset of the disease. The research objectives were to: 1) Determine the sensitivity of first and second trimester uterine artery spectral Doppler assessment in predicting pre-eclampsia or FGR Identify associations between normal and abnormal uterine artery Doppler waveforms and pregnancy outcomes. 2) Determine the most effective Doppler indices 3) Develop ultrasound management guidelines The data was statistically analyzed to determine the sensitivity of uterine artery Doppler screening. In this study uterine artery Doppler screening performed well. in the risk assessment of the most severe cases of pre-eclampsia and FGR. A larger prospective multicenter trial in South Africa is long overdue and therefore a follow-up study to assess Doppler as a screening tool in a high risk population, as per the guidelines formulated.

M.Tech.

In the United States alone, hundreds of millions of blood tests are performed annually, and a significant number of those tests are compromised due to hemolysis: e.g., 31% compromised in emergency rooms (inpatient) and 10% at blood banks, clinics, and other outpatient venues. Currently there is no way to reliably detect hemolysis without plasma separation. As a result, significant delays ensue, potentially negatively affecting patient diagnosis and treatment. In addition to in vitro hemolysis, which compromises the quality of blood tests, hemolysis can also occur in vivo. The in vivo occurrence of hemolysis is an indication of life-threatening complications. Being able to detect early signs of in vivo hemolysis would significantly improve outcomes for many patients, including pregnant women affected by HELLP (Hemolysis, Elevated Liver Enzymes, Low Platelet counts) syndrome. Therefore, there is a critical need to be able to detect hemolysis near the patient, immediately following the collecting of blood sample. The goal of this research is to provide an alternative to the traditional testing of blood samples, which requires large volumes of blood, centrifugation, and bulky instrumentation. The proposed alternative hemolysis detection system is a simple miniature setup that produces test results in minutes. This miniature, near-patient sensor would improve patients’ diagnosis, treatments, general satisfaction, and overall experience. The potential reduction of healthcare costs associated with hemolysis would be another significant benefit. The technology demonstrated in this dissertation is based on a novel combination of microfluidics, spectroscopy, and optical-fiber sensing. The microfluidics provide the capability to handle small volumes of liquid and to filter particles from solution. Novel membrane fabrication and modular integration provides the means to characterize and culture the captured particles. Spectroscopy and optical fibers provide the means to characterize the filtrate. These capabilities can be used for not only the detection of hemolysis but also other biomedical applications. . The first step in detecting hemolysis is to separate blood cells and other unwanted particulates from the plasma needed for optical analysis of concentration of hemoglobin. To that end, we focused initially on the problem of particle separation—specifically, within a microfabricated chamber with a custom-designed transparent membrane. To create a miniature microfluidic system capable of processing microliter blood samples, microelectromechanical systems (MEMS) fabrication techniques were required. The fabrication process included steps such as low-stress vapor deposition, photolithography, plasma, and wet etching. The resulting microdevice proved capable of filtering a variety of biological test fluids, including human lung fibroblast cancer cells from medium. The transparent membrane also allows for spectroscopic studies in broader applications, such as spectroscopic analysis or culturing of the cells retained on the filter. These capabilities were demonstrated using microbeads and cancer cells in solution. Optical techniques are used to analyze the separated blood plasma for concentration of hemoglobin. To integrate spectroscopic capabilities with the above microfluidics system, an optical fiber–based miniature probe was attached to the microfabricated chamber. As proof of concept, this system was tested in an application that required the measurement of physiologically relevant concentrations of cobalamin (vitamin B12). This application was used to address human error in drug administration showing measurements of cobalamin concentration as an example drug that can be monitored. The clinical means range of concentrations is from 1 µg/ml to 1000 µg/ml. The achieved results showed measurements of concentrations between 1 µg /mL to 5 mg/mL to monitor the physiological range and potential overdose in microliter of volume. This device has potential for numerous applications, ranging from single cell spectroscopy to measurements of glucose concentrations. This integrated system was then applied to the detection of hemolysis. The complete system conducts optofluidic spectroscopy with the optical fiber probe connected to the microfabricated chamber, which locally filters out blood cells, and reliably determine amount of free hemoglobin with the need for centrifuging. The utility of the device was demonstrated by its accurate measurement of hemoglobin concentrations in blood plasma. Finally, to apply the concept of the detection system to clinical condition with a reliable, and low-cost system, especially useful for developing countries, a smartphone-based technology, is proposed. This technology delivers ultra-fast results for the detection of early signs of HELLP syndrome and preeclampsia with the goal to decrease mortality and morbidity. The smartphone-based diagnostics is low cost, high speed of operation together with high accuracy. Detection of 1 mg/dL of free hemoglobin was achieved which is comparable to gold standard assay which are time consuming, difficult to operate and expensive. This technology, in summary, integrates microfluidics with microfiltration and spectroscopic technology to conveniently separate and characterize blood plasma. The device can also provide important information about other complex biological samples. These measurements require only very small sample volumes.

The effects of repeated mild concussive head injury on professional rugby players were examined. Data were collected for rugby players (n=26) and cricket player controls (n=21) using a comprehensive neuropsychological test battery comprising five modalities (Verbal Memory, Visual Memory, Verbal Fluency, Visuoperceptual Tracking and Hand Motor Dexterity) and a self-report Postconcussive Symptomology Questionnaire. Group statistical comparisons of the percentage of individuals with deficit were carried out for (i) rugby versus cricket; (ii) rugby forwards versus rugby backs; and (iii) rugby forwards versus cricket. Rugby players performed significantly poorer than controls on SA W AIS Digit Symbol Substitution subtest and on the Trail Making Test. On Digits Forward and Digit Symbol Incidental Recall, the results approached significance with the rugby players showing a tendency toward impairment on these tests. Rugby players exhibited impairment in areas of visuoperceptual tracking, speed of information processing and attention, and there are tendencies of impairment in verbal and/or visual memory. Results obtained on the self-report questionnaire strongly reinforced cognitive test results and a significant proportion of rugby players reported difficulties with sustained attention, memory and lowered frustration tolerance as well as symptoms of anxiety and depression. It was consistently noted that players in the more full contact positions (rugby forwards) were most susceptible to impairment, confirming that these players, who are exposed to repeated mild head injuries, are at greater risk of exhibiting postconcussive sequelae.

Objetivo: Determinar la eficacia y seguridad de la técnica de doble guía en pacientes con canulación difícil durante una CPRE. Materiales y métodos: El presente estudio se realizó, entre el mes de enero del 2015 y julio del 2016. Se procedió a sintetizar la data, de éxito y complicaciones de la TDG en pacientes con canulación difícil y cuando la inserción de la guía en el conducto pancreático fue hecha involuntariamente después de una técnica estándar. Resultados: 24 pacientes sometidos a una CPRE con TDG; 17 fueron mujeres (70,8%) y 7 varones (29,2%). La edad promedio fue 65,21±16,49 años. La indicación más frecuente fue coledocolitiasis en 62,5 %, luego colangiocarcinoma, 12,5 %. El diagnóstico final post CPRE, fue coledocolitiasis en 45,8%, seguido por fibrosis de papila, 29,2%. El éxito de la técnica de la doble guía fue de 87,5%. Hubo 3 casos de canulación frustra con la TDG, dos pacientes presentaron pancreatitis post CPRE (8,3%), no hubo casos de perforaciones. Conclusiones: La TDG es una alternativa eficaz a la CPRE catalogada como de canulación difícil por técnica convencional, sea cual fuere la etiología, con un alto porcentaje de éxito técnico y con una tasa baja de pancreatitis post CPRE, semejante a la reportada en otros países. / Objective: To determine the efficacy and safety of double guidewire technique in patients with difficult biliary cannulation during ERCP. Materials and methods: We conducted a retrospective cohort study of all ERCPs performed between January 2015 and July 2016. DGT was performed in patients for whom biliary cannulation was difficult and guidewire insertion into the pancreatic duct (PD) was inadvertently achieved while attempting the standard WGC technique. Results: 24 patients were enrolled with ERCP and DGT; 17 were female (70.8%) and 7 male (29.2%). The average age was 65.21±16.49 years. The most frequent indication was choledocholithiasis (62.5%), then cholangiocarcinoma (12.5%). Post ERCP diagnosis was choledocholithiasis (45.8%), and papillary fibrosis (29.2%). The success of DGT was 87.5%. Three cases of failure cannulation with the DGT were reported, two patients had pancreatitis post ERCP (8.3%), there were no cases of perforations. Conclusions: TDG, is an effective alternative to difficult biliary cannulation during ERCP with conventional methods; with a high success rate and low rate of post ERCP pancreatitis, similarly to reported in other countries.

Introduction: Older persons usually suffer from multiple chronic disorders and consequently use more medications than younger adults and often polypharmacy. Polypharmacy is, unfortunately, one of the risk factors for negative outcomes in the old age. The aim of this diploma thesis was to summarize by narrative literature review the negative outcomes of polypharmacy in older adults documented in pharmacoepidemological studies published between 2005 and 2015 years. The outputs of this diploma thesis create part of results of the research subgroup "Aging and Changes in the Therapeutic Value of Medications in the Aged" (Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles Univerzity) and the EU COST Action initiative IS1402 (2015-2018). Methods: Using datasets of Web of Science, PubMed and Embase, the narrative literature review was conducted in the period 2014 - 2015, in which we summarized outcome studies dealing with negative outcomes of polypharmacy in older patients published between 2005- 2015 years. Key words for the literature review were: "seniors, older patients, elderly, older age, polypharmacy, polymedication, multiple drug use, negative outcomes, impact, hospitalization, mortality, averse reactions, averse drug events, costs, expenditures. We identified 563 studies...