Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-04-28T12:47:21Z No. of bitstreams: 1 467728.pdf: 981861 bytes, checksum: 76c363f1c278d35dc7748686a0e90d9d (MD5) / Made available in DSpace on 2015-04-28T12:47:21Z (GMT). No. of bitstreams: 1 467728.pdf: 981861 bytes, checksum: 76c363f1c278d35dc7748686a0e90d9d (MD5) Previous issue date: 2015-03-12 / Objective : To evaluate workload of nurses in a Peritoneal Dialysis (PD) program based on the activities and time spent to perform them.Method : Qualitative design (focus group) in the first phase and quantitative in the second stage. From the list of activities of care derived from the focus group, an instrument was created and the time spent for each activity measured for 4 months. The average time for each task was multiplied by the number of occurrences of the same in the month in hours, reflecting the monthly time in hours that nurses use to perform each activity.Results : The estimation was of 495,25 of days to care for 47 patients. with a avarege of 10 days per patients. Considering number of patients (47) and 10 days for each an optimal ratio is one nurse for 23,45 patients . The most frequent nursing care activity was to assist patients during hospitalization (137,15 days), management and supervision of other health professionals, in education participating in scientific meetings and in research activities.Conclusion : We could list the nursing activities for a peritoneal dialysis nurse and suggest an easy formula to evaluate workload of nurses in PD in order to improve outcomes for patients. / Objetivo : avaliar o dimensionamento de enfermeiros em uma unidade de di?lise peritoneal (DP) baseado nas atividades e tempo gasto para execut?-las.M?todo : delineamento qualitativo (grupo focal) na primeira fase e transversal quantitativa na segunda etapa. A partir das atividades de cuidado oriundas do grupo focal, foi criado um instrumento, e o tempo gasto para as atividades mensurado por 4 meses. A m?dia de tempo de cada tarefa foi multiplicada pelo n?mero de ocorr?ncias da mesma no m?s em horas, refletindo o tempo mensal em horas que o enfermeiro utiliza para desempenhar cada atividade.Resultados : A estimativa de dias gastos por cada atividade totalizou 495,25 dias, com uma m?dia de 10 dias por paciente. Para um programa de 47 pacientes estima-se que a propor??o ideal seja de um enfermeiro para assist?ncia de 23,45 pacientes em DP. Em rela??o ?s atividades assist?ncias, o enfermeiro gasta maior tempo para atender pacientes internados (137,15 dias), gerenciais para supervisionar profissionais da sa?de, em educacionais para participar de reuni?es cient?ficas e em realiza??o e participa??o em atividades de pesquisa.Conclus?o : foi poss?vel sugerir uma f?rmula f?cil para avaliar carga de trabalho dos enfermeiros em DP de maneira a melhorar os resultados para os pacientes.

Made available in DSpace on 2015-04-14T13:34:30Z (GMT). No. of bitstreams: 1 401326.pdf: 6259433 bytes, checksum: a272d8837f195ed27768f8f2ad8bfdb2 (MD5) Previous issue date: 2008-03-19 / Introdu??o: Em pacientes com insufici?ncia renal cr?nica, s?o comuns altera??es nos n?veis s?ricos de pot?ssio, f?sforo e de c?lcio. Este estudo verificou a associa??o entre a ingest?o de pot?ssio, f?sforo e c?lcio e os n?veis s?ricos desses elementos em pacientes com insufici?ncia renal cr?nica em tratamento hemodial?tico. M?todos: Estudo transversal e contempor?neo que incluiu pacientes com insufici?ncia renal cr?nica em tratamento hemodial?tico h? pelo menos tr?s meses, de ambos os sexos, maiores de 18 anos de idade, n?o hospitalizados e pass?veis de avalia??o antropom?trica de peso e altura, que aceitassem participar do estudo. Realizou-se a avalia??o diet?tica e bioqu?mica de pot?ssio, f?sforo e c?lcio. Resultados: Foram avaliados 74 pacientes (47 masculinos). Utilizando-se o coeficiente de correla??o de Pearson, com signific?ncia determinada pelo teste t, houve correla??o positiva de regular intensidade (r = 0,44; p < 0,001) em an?lise bivariada entre a ingest?o de pot?ssio e o n?vel s?rico desse elemento. Ocorreu aus?ncia de correla??o (r = 0,14; p = 0,25) entre a ingest?o de f?sforo e o n?vel s?rico desse elemento, como tamb?m a aus?ncia de correla??o (r = 0,062; p = 0,60) entre a ingest?o de c?lcio e o n?vel s?rico desse elemento. Dois (3%) pacientes do estudo foram classificados como desnutridos, 40 (54%) pacientes como eutr?ficos e 32 (43%) pacientes como pr?-obesos ou obesidade. Conclus?es: Houve correla??o positiva entre a ingest?o de pot?ssio e seus n?veis s?ricos, assim como a aus?ncia de correla??o entre a ingest?o de f?sforo e c?lcio e seus n?veis s?ricos no grupo estudado.

Submitted by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-08-02T13:38:03Z No. of bitstreams: 1 DIS_SORAIA_LEMOS_DE_SIQUEIRA_COMPLETO.pdf: 1770308 bytes, checksum: 4220afcfa71b4f29b7880a79649bc375 (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-08-02T13:38:32Z (GMT) No. of bitstreams: 1 DIS_SORAIA_LEMOS_DE_SIQUEIRA_COMPLETO.pdf: 1770308 bytes, checksum: 4220afcfa71b4f29b7880a79649bc375 (MD5) / Made available in DSpace on 2017-08-02T13:39:14Z (GMT). No. of bitstreams: 1 DIS_SORAIA_LEMOS_DE_SIQUEIRA_COMPLETO.pdf: 1770308 bytes, checksum: 4220afcfa71b4f29b7880a79649bc375 (MD5) Previous issue date: 2012-08-29 / Hand hygiene is an important procedure in preventing peritoneal dialysis-related infections. OBJECTIVE: To compare the effectiveness of two distinct techniques for hand hygiene in reducing the number of colony-forming units in patients on peritoneal dialysis. PATIENTS AND METHOD: Observational study. Twenty-two patients underwent two collections of microbiological flora from the hands in two different instances: after hand washing with non-antimicrobial soap and water followed by rubbing with 70% ethyl alcohol, gel presentation, after application of 70% ethyl alcohol, presentation gel. Cultures were obtained by applying the fingers surface directly on agar-blood plates. RESULTS: The comparison between groups showed a significant difference (p <0.01) in colony-forming units in the right hands and left hands, mean 59.6 ? 43.1 in the group not antimicrobial soap and water, proved higher than in group 70% ethyl alcohol, presentation gel (31.8 ? 39.9). This difference is characterized by the presence of colonies of Staphylococcus coagulase-negative, and this was predominant in the seed crops. CONCLUSION: Hand rubbing with gel-alcohol was more effective in reducing the number of colonies recovered than the other methods. / INTRODU??O: A higieniza??o das m?os ? um importante procedimento para a preven??o de infec??es relacionadas a di?lise peritoneal. OBJETIVO: comparar a efic?cia de duas t?cnicas de higieniza??o das m?os, na redu??o do n?mero de unidades formadoras de col?nia em pacientes em programa de di?lise peritoneal. MATERIAIS E M?TODO: Estudo observacional, transversal. Vinte e dois indiv?duos submetidos a duas coletas da flora microbiol?gica das m?os, em dois momentos distintos: ap?s higieniza??o das m?os com ?gua e sab?o n?o antimicrobiano seguida de fric??o com ?lcool et?lico 70%, apresenta??o gel; ap?s aplica??o de ?lcool et?lico 70%, apresenta??o gel. Culturas obtidas da superf?cie dos dedos das m?os, diretamente em placas de Agar Sangue de Carneiro. RESULTADOS: A compara??o entre grupos mostrou uma diferen?a significativa (p<0,01), nas unidades formadoras de col?nia nas m?os direitas e m?os esquerdas, a m?dia 59,6?43,1 do grupo ?gua e sab?o n?o antimicrobiano; mostrou-se mais elevada que no grupo ?lcool et?lico 70%, apresenta??o gel (31,8?39,9). Esta diferen?a ? caracterizada pela presen?a de col?nias de Staphyloccocus coagulasenegativa, sendo que este foi o germe prevalente nas culturas. CONCLUS?O: A higieniza??o com ?lcool et?lico 70%, apresenta??o gel produziu maior redu??o no n?mero de unidades formadoras de col?nia.

Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2017-08-24T12:28:10Z No. of bitstreams: 1 DIEGO_SILVEIRA_SIQUEIRA_DIS.pdf: 1193582 bytes, checksum: cad7014fa8412a61994647486edc8e93 (MD5) / Rejected by Caroline Xavier (caroline.xavier@pucrs.br), reason: Devolvido devido ? falta de capa institucional. on 2017-08-25T17:56:57Z (GMT) / Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2017-08-30T11:26:00Z No. of bitstreams: 1 DIEGO_SILVEIRA_SIQUEIRA_DIS.pdf: 1121335 bytes, checksum: f6f699bc9f8c699563be863b36e27d98 (MD5) / Approved for entry into archive by Marcelo Texeira (marcelo.texeira@pucrs.br) on 2017-08-30T13:18:13Z (GMT) No. of bitstreams: 1 DIEGO_SILVEIRA_SIQUEIRA_DIS.pdf: 1121335 bytes, checksum: f6f699bc9f8c699563be863b36e27d98 (MD5) / Made available in DSpace on 2017-08-30T13:19:58Z (GMT). No. of bitstreams: 1 DIEGO_SILVEIRA_SIQUEIRA_DIS.pdf: 1121335 bytes, checksum: f6f699bc9f8c699563be863b36e27d98 (MD5) Previous issue date: 2017-03-20 / Introduction: chronic kidney disease (CKD) is characterized by structural changes or kidney function present for more than three months with health implications. Faced with these changes and complications, the patients undergo stressors capable of influencing their coping with the disease and treatment perspectives. Objective: to characterize the coping profile of patients on the waiting list for renal transplantation based on the Jalowiec Coping Scale (CJD) and to evaluate quality of life using SF-36. Method: a cross-sectional quantitative study that took place at the hemodialysis unit of Hospital S?o Lucas PUCRS, patients on the waiting list for renal transplantation, who are over 18 years of age and literate were included. Data was collected through a questionnaire with patient socio demographic information, CJD and SF36. Results: 58 patients were included, 51.7% (n = 30 males, mean age of 44.6 (? 15.2) years, 12.3% (n = 7) were above 65 years of age, more than half, 57.9% (n = 33) had elementary education. Thirty-one (54.4%) patients were married, (n = 31); 37.5% (n = 21) had one children and were of the catholic religion 62,5% (n = 35). In relation to CJD, the predominant profile was self - confident (0.455) and optimistic (0.404) 42 and 6 patients, respectively, of which 54 were focused on emotion. The dimensions evaluated with the best quality of life were: pain (67.2), social aspects (66.6) and mental health (65.4). There was a weak significant negative correlation, (r <0.333), between palliative style and vitality (r = -0.288, p = 0.028) and palliative and social aspects (r = -0.283; p = 0.031). There was a moderate negative correlation between general well being and emotive style (R = -0.424, p = 0.025) and palliative (r = -0.524, p = 0.004), as well as between Vitality and Palliative style (r = -0.530; P = 0.004). In males, there was a significant, negative moderate correlation result with a (0.300 <r?0.600) beteween Pain dimension with the Confrontive style (r = -0.413; p = 0.023) and Emotive (r = -0.370). Conclusion: the coping profile of patients on hemodialysis and in waiting list for tranplant was mostly self-confident and optimistic. The best domains in the quality of life were Pain, Social Aspects and Mental Health, and the worst physical and emotional aspects. / Introdu??o: a doen?a renal cr?nica (DRC) ? caracterizada por altera??es estruturais ou da fun??o dos rins presentes por mais de tr?s meses com implica??es para a sa?de. Diante dessas altera??es e complica??es os pacientes sofrem a??o de estressores capazes de influenciar no seu enfrentamento em rela??o ? doen?a e perspectivas de tratamento. Objetivo: caracterizar o perfil de enfrentamento dos pacientes em lista de espera de transplante renal baseado na Escala de Jalowiec Coping Scale (ECJ) e avaliar a qualidade de vida SF-36. M?todo: trata-se de um estudo transversal de abordagem quantitativa desenvolvida na unidade de hemodi?lise do Hospital S?o Lucas da PUCRS, em pacientes em lista de espera para transplante renal, com mais de 18 anos de idade e alfabetizados. Os dados foram coletados por meio de question?rio com informa??es s?cio demogr?ficas sobre o paciente, ECJ e SF36. Resultados: foram inclu?dos 58 pacientes com preval?ncia do sexo masculino 51,7% (n=30), m?dia de idade de 44,6 ?15,2 anos, 12,3% (n=7 ) acima de 65 anos e mais da metade da amostra, 57,9% (n=33) apresentou o ensino fundamental. Trinta e um (54,4%) pacientes eram casados (n=31); com um filho, 37,5% (n=21) e de religi?o cat?lica 62,5% (n=35). Em rela??o ? ECJ, o perfil predominante foi o Autoconfiante (0,455) e Otimista (0,404) 42 e 6 pacientes, respectivamente, sendo que 54 focados na emo??o . As dimens?es avaliadas com a melhor qualidade de vida foram: a dor (67,2), aspectos sociais (66,6) e sa?de mental (65,4). Houve correla??o significativa, fraca e negativa( r<0,333), entre o estilo paliativo e vitalidade (r=- 0,288; p=0,028) e paliativo e aspectos sociais (r=-0,283; p=0,031) . houve correla??o significativa, negativa classificada como moderada entre o Estado Geral de Sa?de e os estilos Emotivo (r=-0,424; p=0,025) e Paliativo (r=-0,524; p=0,004), bem como, entre a Vitalidade e o estilo Paliativo (r=-0,530; p=0,004). No sexo masculino, ocorreu resultado significativo, negativo com grau moderado (0,300<r?0,600) na compara??o da dimens?o Dor com os estilos Confrontivo (r=-0,413; p=0,023) e Emotivo (r=-0,370; ;p=0,044). Conclus?o: o perfil de enfrentamento dos pacientes em hemodi?lise e em lista de espera de transplante renal, foi em sua maioria autoconfiante e otimista. Os melhores dom?nios na qualidade de de vida foram Dor, Aspectos sociais e Sa?de mental, e os piores aspectos os f?sicos e os emocionais.

Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2017-08-24T12:57:55Z No. of bitstreams: 1 ADRIANA_CONTI_DIS.pdf: 1862760 bytes, checksum: d04417c4b0e9dd7ce859909035772034 (MD5) / Rejected by Caroline Xavier (caroline.xavier@pucrs.br), reason: Devolvido devido ? falta de capa institucional no arquivo PDF. on 2017-08-25T18:09:08Z (GMT) / Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2017-08-29T11:31:27Z No. of bitstreams: 1 ADRIANA_CONTI_DIS.pdf: 1902344 bytes, checksum: 5866bfc2071b034ae6ff6dedc003d26f (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-09-08T17:28:07Z (GMT) No. of bitstreams: 1 ADRIANA_CONTI_DIS.pdf: 1902344 bytes, checksum: 5866bfc2071b034ae6ff6dedc003d26f (MD5) / Made available in DSpace on 2017-09-11T11:26:00Z (GMT). No. of bitstreams: 1 ADRIANA_CONTI_DIS.pdf: 1902344 bytes, checksum: 5866bfc2071b034ae6ff6dedc003d26f (MD5) Previous issue date: 2017-03-20 / Introduction: Peritonitis remains a major complication in peritoneal dialysis patients, with the predominant infectious agent being coagulase-negative Staphylococcus (CNS). Intraperitoneal administration of antibiotics is the required treatment, however, no consensus exists on the appropriate disinfection of the medication port (MP). Objective: To compare different disinfection techniques for the peritoneal dialysis bag MP. Methods: An experimental study was conducted testing different cleaning agents (70% alcohol vs 2% chlorhexidine) and time periods (5, 10 and 60seconds) for disinfection of the MP. Four microorganisms (S. aureus, E.coli, A. baumannii and C.parapsilosis) were prepared for use as contaminants of the MP. MP were incubated in Tryptic soybroth at 36?C for 24 h, after which, they were seeded on a Biom?rieux? blood agar plate and incubated for 24 h at 36?C. Results: A total of 240 PD bags were contaminated with four different microorganisms. Two positive cultures (E. coli and S. aureus) were identified, both after disinfection with alcohol after 5 and 10 seconds of friction, and none in the chlorhexidine group. Conclusion: although there was no statistical difference between the antiseptics used and the cleaning time, the use of chlorhexidine for 1 minute was the only one in which there was no bacterial growth, therefore we considered this recommendation. / Introdu??o: A Di?lise Peritoneal utiliza a membrana peritoneal para realizar trocas entre o sangue e a solu??o de di?lise. Peritonite ? a maior complica??o, e o germe predominante ? o Staphylococcus coagulase negativa (SCN). O tratamento para peritonite ? realizado com a administra??o de antibi?tico intraperitoneal. Durante o treinamento, o paciente e/ou familiar s?o capacitados a administrar antibi?tico via intraperitoneal, se necess?rio. No entanto, n?o existe consenso quanto ? maneira mais apropriada para a desinfec??o do tubo entrada de medica??o (TEM). Empresas que comercializam o material de DP recomendam que, para a administra??o de antibi?ticos e outros medicamentos, o TEM deve ser limpo durante cinco minutos com ?lcool a 70%, iodo povidine alc?olico ou clorexidina alco?lica. Objetivo: Comparar a efic?cia das t?cnicas e produtos de desinfec??o do TEM da bolsa de di?lise peritoneal. M?todo: Foi realizado um estudo experimental com diferentes agentes de limpeza (?lcool x clorexidina 2%) e per?odos de tempo (5, 10, 60 segundos) para a desinfec??o do TEM. Foram preparados quatro micro-organismos (S. aureus, E. coli, A. baumanni e C. parapsilosis) para utiliza??o como contaminantes e foram incubados em Caldo de Soja Tripticase?na a 36? C durante 24 horas, ap?s foram semeados por deple??o em placas de ?gar sangue (AS) e incubados durante 24 horas a 36? C. Resultados: No total, 240 bolsas PD foram contaminadas com quatro micro-organismos diferentes. Foram identificadas duas culturas positivas (E. coli e S. aureus), ambas ap?s desinfec??o com ?lcool 70% com o tempo de 5 e 10 segundos de atrito. Conclus?o: Embora sem diferen?a estat?stica entre os antiss?pticos utilizados e o tempo de limpeza, o uso de clorexidine por 1 minuto foi o ?nico em que n?o houve crescimento bacteriano, portanto achamos pertinente esta recomenda??o.

Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-01-26T13:27:51Z No. of bitstreams: 1 RAFAELA_SIVIERO_CARON_LIENERT_TES.pdf: 9419976 bytes, checksum: f123a0ee4d12fb6dd455c726f40ece4f (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2018-01-31T13:24:29Z (GMT) No. of bitstreams: 1 RAFAELA_SIVIERO_CARON_LIENERT_TES.pdf: 9419976 bytes, checksum: f123a0ee4d12fb6dd455c726f40ece4f (MD5) / Made available in DSpace on 2018-01-31T13:29:24Z (GMT). No. of bitstreams: 1 RAFAELA_SIVIERO_CARON_LIENERT_TES.pdf: 9419976 bytes, checksum: f123a0ee4d12fb6dd455c726f40ece4f (MD5) Previous issue date: 2017-11-21 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Background: During 24 hours of peritoneal dialysis (PD), it is estimated that 100 to 300g of the glucose are absorbed, which can generate metabolic changes and nutritional disorders. Objective: To study pathophysiological and clinical aspects related to nutritional status of PD patients. Materials and Methods: Observational study of PD patients evaluating body composition by bioimpedance (Body Composition Monitor; Fresenius Medical Care), examining peritoneal membrane characteristics, measuring biochemical parameters and using inductively coupled plasma mass spectrometer to measure serum concentrations of copper (63Cu), zinc (66Zn), selenium (78Se), chromium (52Cr) and nickel (58Ni). Results for each paper: Article 1: After 1y on PD, 50.6% had dry weight (DW) gain, 41.2% showed lean tissue mass (LTM) loss, and 65.9% presented fat mass (FM) gain and significant differences in DW, body mass index (BMI), adipose tissue mass (ATM), FM and fat tissue index (FTI) were disclosed. Patients with lower dialysate-to-plasma creatinine ratio showed FM gain. We observed a higher percentage of nonfast transporters in DW gain when comparing with no gain. Artigo 2: No differences were disclosed regarding body composition changes between PD modalities (CAPD and APD). Article 3: At baseline 29.9% of the patients were classified as having undernutrition (Lean Tissue Index (LTI) percentile <10th), 55.5% as obese (FTI percentile >90th), 7.9% as having fat tissue undernutrition (FTI percentile <10th) and 23.8% had LTI undernutrition and obesity in combination. The cumulative survival rates were 92%, 83%, 69%, 67% and 60% (12, 24, 36, 48 and 60 months, respectively). Kaplan-Meier survival and Cox regressions analysis showed that only PhA bellow 5? had an impact on mortality during the follow-up, even after adjusting for age, gender and diabetes. Artigo 4: Values below references were disclosed for Zn (5.8 ? 1.1 ?mol/L) in 100%; Cu (15.7 ? 5.0 ?mol/L) in 20.7%; Se (0.59 ? 0.22 ?mol/L) in 75.9%. Values above references were disclosed for Cr (0.29 ? 0.08 ?mol/L) in 86.3% and Ni (0.21 (0.17 ? 0.26) ?mol/L) in 96.6%. We observed significant positive corretations between Cu and DW (r=0.407, P=0.028), BMI (r=0.460, P=0.012) and FTI (r=0.370, P0.048). Zn was positivily correlated to albumin (r=0.527, P=0.003) and negatively correlated with OH (r=-0.394, P=0.034) and extracellular water (%ECW) (r=-0.466, P=0.014). Se had a positive correlation with serum albumin (r=0.515, P=0.005) and total cholesterol (r=0.443, P=0.021), but a negative correlation with %ECW (r=-0.404, P=0.041) and extracellular water/intracellular water (r=0.398, P0.036). Ni was negatively correlated to dry weight (r=-0.377, P0.044). Cu/Zn ratio was only correlated to BMI (r=0.376, P=0.044). Conclusions: Body composition changes over PD treatment and it does not seems to be related to the exposure of glucose or to the PD modality, however, it seems to be related to patients with slower peritoneal transports at the beginning of the treatment. Detailed analysis of body composition can generate more accurate data of nutritional status. The use of the phase angle as a marker of nutritional status is suggested and further studies are needed to better understand the association of serum microelements and body composition in this population. / Introdu??o: Durante 24 horas de Di?lise Peritoneal (DP), estima-se que cerca de 100 a 300g da glicose s?o absorvidas, o que pode gerar altera??es metab?licas e no estado nutricional. Objetivos: Estudar aspectos fisiopatol?gicos e cl?nicos relacionados ao estado nutricional de pacientes em DP. Materiais e m?todos: Estudo observacional de pacientes em DP com an?lise da composi??o corporal atrav?s da bioimped?ncia espectrosc?pica (Body Composition Monitor, Fresenius Medical Care), avalia??o da caracter?stica de transporte peritoneal, exames bioqu?micos e concentra??o s?rica de cobre (63Cu), zinco (66Zn), sel?nio (78Se), cromo (52Cr) e n?quel (58Ni) atrav?s de espectometria de massa com plasma indutivamente acoplado. Resultados por artigo: Artigo 1: Ap?s 1 ano de DP, 50,6% ganharam peso, 41,2% perderam massa magra, 65,9% aumentaram massa gorda, sendo encontrado aumento significativo para peso, ?ndice de massa corporal (IMC), tecido adiposo e ?ndice de massa gorda. Os pacientes que ganharam peso predominantemente apresentavam baixo transporte peritoneal. Artigo 2: A modifica??o da composi??o corporal encontrada n?o foi diferente entre modalidades de DP, ambulatorial cont?nua (CAPD) e automatizada (APD). Artigo 3: No in?cio da DP, os pacientes foram classificados em: 29,9% desnutridos (massa magra percentil <10), 55,5% obesos (massa gorda percentil >90) e 7,9% como desnutridos por massa gorda (massa gorda percentil <10) e 23,8% desnutri??o e obesidade em combina??o. A sobrevida cumulativa foi de 92%, 83%, 69%, 67% e 60% (12, 24, 36, 48 e 60 meses, respectivamente). O ?ngulo de fase (abaixo de 5?) possui impacto na mortalidade, inclusive ap?s ajuste para idade, sexo e diabetes. Artigo 4: Valores abaixo da refer?ncia foram observados para Zn (5,8 ? 1,1 ?mol/L) em 100%; Cu (15,7 ? 5,0 ?mol/L) em 20,7%; Se (0,59 ? 0,22 ?mol/L) em 75,9%. Valores acima do recomendado foram encontrados para Cr (0,29 ? 0,08 ?mol/L) em 86,3% e Ni (0,21 (0.17 ? 0.26) ?mol/L em 96,6%. Foi observada correla??o positiva entre Cu e peso seco (r=0,407, P=0,028), IMC (r=0,460, P=0,012) e ?ndice de massa gorda (r=0,370, P0,048). Zn apresentou correla??o positiva com albumina (r=0,527, P=0,003) e negativa com hiperhidrata??o (r=-0,394, P=0,034) e percentual de ?gua extracelular (r=-0,466, P=0,014). Se apresentou correla??o positiva com albumina (r=0,515, P=0,005) e colesterol total (r=0,443, P=0,021), mas negativa com percentual de ?gua extracelular (r=-0,404, P=0,041) e ?gua extracelular/?gua intracelular (r=0,398, P0,036). Ni correlacionou-se negativamente com peso seco (r=-0,377, P0,044). Cu/Zn apresentou correla??o com IMC (r=0,376, P=0,044). Conclus?es: A composi??o corporal de pacientes em DP se modifica ao longo do tratamento, o que n?o parece estar relacionado a exposi??o a glicose ou ? modalidade de DP, por?m, as altera??es parecem estar relacionadas ? pacientes que apresentam transportes peritoneais mais lentos no in?cio da terapia. A an?lise da composi??o corporal de forma detalhada pode gerar dados mais precisos de avalia??o nutricional. Sugere-se o uso do ?ngulo de fase como um marcador de estado nutricional e mais estudos s?o necess?rios para o melhor entendimento da associa??o de microelementos s?ricos e composi??o corporal nesta popula??o.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-05-28T12:17:14Z No. of bitstreams: 1 469509 - Texto Completo.pdf: 1433319 bytes, checksum: 69adb0d2b5f0bd949fea8c36366fca5a (MD5) / Made available in DSpace on 2015-05-28T12:17:14Z (GMT). No. of bitstreams: 1 469509 - Texto Completo.pdf: 1433319 bytes, checksum: 69adb0d2b5f0bd949fea8c36366fca5a (MD5) Previous issue date: 2015-03-02 / Background: Adequate control of extracellular volume is a major goal of hemodialysis (HD) in chronic kidney disease (CKD) patients. Fluid overload contributes significantly to the high morbidity and mortality rates of these patients. The body composition monitor by multifrequency bioimpedance (BCM) is equipment tool able to quantify objectively and accurately the hydration status of each patient. The aim of this study was to compare the efficacy between bioelectrical impedance analysis (BIA) and clinical evaluation to adjust dry weight (DW) in HD patients. Methods: A randomized crossover study. Patients were randomized in two groups: A, in which patients were evaluated by the clinical evaluation and B, wherein the dry weight of the patients was assessed by BIA, for four weeks. Following a wash-out period a crossover between the groups was performed and patients observed for 1 month. The study was approved by the ethics committee of Pontificia Cat?lica University of Rio Grande do Sul. Results: The study included 57 CKD in HD. Blood pressure, hydration parameters and DW were not significantly different between the groups indicating an equivalence between BIA and clinical evaluation treatments to determine DW in HD. Conclusion: The study shows that the BIA is similar than the clinical evaluation to guide ultrafiltration and determine DW in HD. / Introdu??o: O controle adequado do volume extracelular ? um dos principais objetivos da terapia renal substitutiva (TRS) em doentes renais cr?nicos (DRC), pois a sobrecarga h?drica contribui com as altas taxas de morbimortalidade destes pacientes. O monitor de composi??o corporal por bioimped?ncia multifrequencial (BCM) ? um equipamento capaz de quantificar de maneira objetiva o estado de hidrata??o de cada paciente, visando avaliar o peso seco (PS). O objetivo desse estudo foi comparar a efic?cia entre an?lise por bioimped?ncia el?trica (BIA) e avalia??o cl?nica (AC) para adequa??o de PS em pacientes em hemodi?lise (HD). M?todo: Estudo randomizado, do tipo crossover. Os pacientes foram randomizados em dois grupos: A, iniciou o estudo com o PS sendo determinado por AC e B, por BIA, por 1 m?s. Ap?s, foi realizado o cruzamento dos grupos e invers?o dos tratamentos, por mais 1 m?s. O estudo foi aprovado pelo comit? de ?tica da Pontif?cia Universidade Cat?lica do Rio Grande do Sul. Resultados: Participaram do estudo 57 DRC em HD. Comparando os dois tratamentos para dados de press?o arterial, par?metros de hidrata??o e PS, independente dos grupos, os resultados n?o detectaram diferen?as significativas, apontando uma equival?ncia entre os tratamentos de BIA e AC para determinar PS em HD. Conclus?o: Estudo demonstra que a BIA ? equivalente ? AC para guiar a ultrafiltra??o e determinar PS em HD.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-06-15T11:36:19Z No. of bitstreams: 1 469479 - Texto Completo.pdf: 2563289 bytes, checksum: 2184e2738a496b030cd61b0f8c50e376 (MD5) / Made available in DSpace on 2015-06-15T11:36:19Z (GMT). No. of bitstreams: 1 469479 - Texto Completo.pdf: 2563289 bytes, checksum: 2184e2738a496b030cd61b0f8c50e376 (MD5) Previous issue date: 2015-03-26 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / Chronic kidney disease is a progressive condition, with no healing prospect, yet extended upholding under adequate monitoring and treatment. Approximately 100,000 patients currently undergo dialysis therapy - ninety percent on hemodialysis. Mortality ratio varies between 15 to 20%, being cardiovascular events mainly responsible. Among mental ailments thwarting kidney disease patients, depression is the most frequently associated co-morbidity, and linked to increased mortality and morbidity rates. In patients undergoing hemodialysis, malnourishment may relate with depressive symptoms, besides inflammation and cardiovascular diseases. Life style changes induced by end-stage renal disease impose a number of limitations that end up affecting the quality of life. Protein depletion is commonly observed in patients submitted to hemodialysis, and is associated with higher mortality. Strangely enough, it may be accompanied by weight gain and central fat accumulation. The role of adipocytokines in chronic kidney disease has recently drawn attention: association of serum chemerin to metabolic syndrome indicators, inflammation and obesity has been suggested. The aim of this study was to longitudinally evaluate nutritional status, presence of depressive symptoms, quality of life and mortality of hemodialysis patients, in a cohort study at the S?o Lucas Hospital /PUCRS, Porto Alegre, Brazil. Stable patients, undergoing hemodialysis for at least three months, were enrolled and evaluated at twelve month-intervals, thereafter. Participants were assessed for: depressive symptoms using the Beck Depression Inventory and for quality of life perception by the WHOQOL-bref questionnaire. Anthropometric data: weight, height, waist circumference; blood collection: for biochemical determinations, high-sensitivity C-reactive protein, chemerin; body composition analysis by direct segmental multi frequency bioimpedance, were obtained at a mid week dialysis session. One hundred and five participants were included. Patients classified as having standard percentage of body fat predominated, although more than half of the enrolled participants presented with excess body fat. There was no significant difference in the rate of depressive symptoms or in the quality of life between groups, classified by nutritional status. The cause more often associated with the outcome death by any cause was cardiovascular event, followed by infection. Lean body mass had a protective effect on survival. Chemerin may have an anti-inflammatory effect, being associated with increased body fat percentage and augmented waist circumference, on end-stage renal disease patients. / A doen?a renal cr?nica ? uma doen?a progressiva, que n?o contempla expectativa de cura, mas o prolongamento da cronicidade, com acompanhamento e tratamento adequados. Quase 100.000 pacientes s?o submetidos a tratamento dial?tico, 90% em hemodi?lise. A taxa de mortalidade bruta varia entre 15 a 20%, sendo eventos cardiovasculares os principais respons?veis. Dentre os problemas mentais que acometem pacientes com doen?a renal, depress?o ? a comorbidade mais frequente, associada a aumento das taxas de morbimortalidade. Desnutri??o pode se relacionar com sintomas de depress?o, assim como inflama??o e doen?a cardiovascular, em pacientes tratados por hemodi?lise. As mudan?as de estilo de vida induzidas pela doen?a renal cr?nica terminal causam in?meras limita??es que afetam a qualidade de vida. Deple??o proteica em pacientes submetidos a hemodi?lise ? frequentemente observada, e se associa com elevada mortalidade. Curiosamente, pode se acompanhar por excesso de peso e ac?mulo de gordura central. O papel das adipocitocinas na doen?a renal cr?nica tem despertado interesse: associa??o de quemerina s?rica com indicadores de s?ndrome metab?lica, inflama??o e obesidade foram sugeridas. O objetivo do presente estudo ? correlacionar estado nutricional, sintomas de depress?o, qualidade de vida e mortalidade em hemodi?lise. Foi realizado estudo prospectivo de coorte com pacientes em hemodi?lise no Hospital S?o Lucas/PUCRS, Porto Alegre, Brasil. Os pacientes estavam h? tr?s ou mais meses em hemodi?lise, clinicamente est?veis. A cada doze meses, pacientes inclu?dos no estudo foram reavaliados para: sintomas de depress?o ? por question?rio Beck de depress?o; percep??o da qualidade de vida ? pelo question?rio WHOQOL-bref; medidas antropom?tricas ? peso, altura, circunfer?ncia da cintura; coleta de sangue - para dosagens de par?metros bioqu?micos, prote?na C-reativa e quemerina; an?lise da composi??o corporal ? por bioimped?ncia segmentar de multi-frequ?ncias. Foram inclu?dos 105 pacientes. Houve um predom?nio de pacientes com percentagem de gordura padr?o, mas mais da metade dos pacientes tinha excesso de gordura corporal. N?o houve diferen?a na presen?a de sintomas depressivos e na qualidade de vida entre os grupos classificados por estado nutricional. A principal causa associada ao desfecho ?bito por qualquer causa foi evento cardiovascular, seguida por infec??o. A massa muscular apresentou efeito protetor para sobrevida. Quemerina s?rica aparentemente tem a??o anti-inflamat?ria em pacientes com doen?a renal cr?nica terminal, e est? associada a percentual de gordura corporal e a circunfer?ncia da cintura aumentada.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-09-28T11:52:13Z No. of bitstreams: 1 475280 - Texto Completo.pdf: 525795 bytes, checksum: 5c0f0bf5209210648acdb4e6e91772b1 (MD5) / Made available in DSpace on 2015-09-28T11:52:13Z (GMT). No. of bitstreams: 1 475280 - Texto Completo.pdf: 525795 bytes, checksum: 5c0f0bf5209210648acdb4e6e91772b1 (MD5) Previous issue date: 2015-03-26 / Introduction - The Chronic Kidney Disease Stage V requires substitution therapy of renal function. The dialysis demand treatment, where possible, support from caregivers / family members. Objectives: Profile Coping caregivers / family members, according to Jalowiec Coping Scale (JCS), and the perception of social support and Score Davies Comorbidity (SDC) of patients. Study Type: This is a prospective cross-sectional study. Sample: Caregivers / family members of patients with chronic kidney disease on dialysis and patients themselves. Materials and Methods: The following measuring instruments were used: Coping Scale Jalowiec (affirmative multiple choice), Score of Davies Comorbidity (0-7 points), Inventory Social Support Network (ISSN; 0-40 points) and lifting sociodemographic data. Results - study included 138 subjects, 69 caregivers / family members, 69 patients, 48 patients agreed to respond to ISSN. The sample of caregivers / family members was characterized by 72.5% women, 78.2% in "Domestic Partnership", and kinship: spouse (53.6%), followed son of (a) 26.1%. In category Coping, the most frequent was the Focused Problems (78.0%) and the predominant subcategory JCS was the Sustentative profile (42.7%) and Confrontive (24.4%). The analysis of patients showed that: 79.2% had hemodialysis, 58.3% were men, 36.2% had SCD> 2 and at ISSN, 83% noticed a lot of support (35.5 + 5.1). Conclusions: Coping strategy of caregivers / family members depend on the Score of Davies Comorbidity of patients, and the relationship between perceived social support and Coping Jalowiec profiles. / Introdu??o: A Doen?a Renal Cr?nica de est?gio V requer terapia de substituti??o da fun??o renal. O tratamento dial?tico demanda, quando poss?vel, suporte por parte de acompanhantes /familiares. Objetivos: Perfil de Coping de acompanhantes/familiares, segundo a Escala de Coping Jalowiec, bem como a percep??o de apoio social e Escore de Comorbidade de Davies dos pacientes. Tipo de Estudo: Trata-se de um estudo transversal prospectivo. Amostra: Acompanhantes/familiares de pacientes com doen?a renal cr?nica em tratamento dial?tico, bem como os pr?prios pacientes. Materiais e M?todos: Foram utilizados os seguintes instrumentos de medida: Escala de Coping Jalowiec (afirmativas de escolha m?ltiplas), Escore de Comorbidade de Davies (0 a 7 pontos), Invent?rio de Rede de Suporte Social (0 a 40 pontos) e levantamento de dados sociodemogr?ficos. Resultados: Foram inclu?dos 138 indiv?duos, sendo 69 acompanhantes/familiares, 69 pacientes, sendo que 48 pacientes aceitaram responder ao IRSS. A amostra dos acompanhantes/familiares caracterizou-se por 72,5% mulheres, 78,2% em ?Uni?o Est?vel?, e grau de parentesco: c?njuge (53,6%), seguido de filho (a) 26,1%. Em rela??o ? categoria de Coping, a mais frequente foi a Focado no Problema (78,0%) e a subcategoria predominante na ECJ foi o perfil Sustentativo (42,7%) e Confrontivo (24,4%). A an?lise dos pacientes mostrou que: 79,2% realizavam hemodi?lise, 58,3% eram homens, 36,2% possu?am ECD >2 e, pelo IRSS, 83% perceberam muito apoio (35,5 + 5,1). Conclus?es: A estrat?gia de Coping dos acompanhantes/familiares independe do Escore de Comorbidade de Davies dos pacientes, bem como a rela??o entre a percep??o de apoio social e os perfis de Coping Jalowiec.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-10-30T10:52:58Z No. of bitstreams: 1 475957 - Texto Completo.pdf: 1765051 bytes, checksum: d50405a18587ae97ec45079b34e7561b (MD5) / Made available in DSpace on 2015-10-30T10:52:59Z (GMT). No. of bitstreams: 1 475957 - Texto Completo.pdf: 1765051 bytes, checksum: d50405a18587ae97ec45079b34e7561b (MD5) Previous issue date: 2015-03-30 / INTRODUCTION: One of the main postoperative complications of kidney transplant is delayed graft function (DGF), which means absence of graft function after transplant or the need for dialysis during the first week post procedure. The occurrence of DGF currently in our hospital is high and has been attributed to a combination of many factors. OBJECTIVE: to evaluate the factors associated to DGF and their influence in the outcome of kidney transplants. METHODS: historical cohort of 150 patients transplanted with live or deceased donor kidneys from 2011 to 2013. RESULTS: DGF was associated to time in dialysis and the number of recipient pre-transplant transfusions, donors age, serum creatinine level, use of vasoactive drugs in the donor, distance from place of organ retrieval and transplant center, and duration of cold ischemia time. DGF influenced post-transplantation outcome in regard to length of stay in intensive care, length of hospital stay, acute rejection episodes, and higher creatinine levels at discharge. Patients and graft survival were shorter in the DGF group. CONCLUSION: There are multiple factors related to DGF, the most important being those related to donors, and organ storage. The most important factor related to the recipient was the dialysis vintage. We did not find a correlation between DGF and HLA-compatibility. DGF consequences are important, including worse graft function and survival, as well as impact in recipient morbidity and mortality. / INTRODU??O: Uma das principais complica??es do p?s-operat?rio de transplante de rim ? a disfun??o precoce do enxerto (DPE) que significa a aus?ncia de fun??o do enxerto ap?s o transplante ou a necessidade de di?lise na primeira semana ap?s o procedimento. A ocorr?ncia de DPE em nosso Hospital, atualmente, ? elevada e tem sido atribu?da ao longo dos anos ? combina??o de diversos fatores. M?TODOS: coorte hist?rica com 150 pacientes transplantados de rim de doador vivo ou falecido de 2011-2013. OBJETIVOS: verificar os fatores associados ? DPE e a sua influ?ncia na evolu??o do transplante de rim. RESULTADOS: DPE foi associada com o tempo de di?lise e o n?mero de transfus?es realizadas pelo receptor no pr?-transplante, idade, valor da creatinina e utiliza??o de drogas vasoativas pelo doador, dist?ncia do ?rg?o doado e tempo de isquemia fria. Os valores de creatinina e pot?ssio no p?s-operat?rio, assim como o volume urin?rio foram determinantes para a realiza??o de di?lise ap?s o transplante. DPE influenciou na evolu??o do transplante em maior tempo de interna??o na UTI e no tempo de interna??o, epis?dios de rejei??o aguda e maior n?vel de creatinina no momento da alta hospitalar. A sobrevida do enxerto e do paciente foi menor no grupo de pacientes que apresentou DPE. CONCLUS?O: V?rios s?o os fatores relacionados ? DPE, em especial os relacionados aos doadores e com a preserva??o do ?rg?o. O principal fator atrelado ao receptor foi o tempo de di?lise. N?o encontramos rela??o na ocorr?ncia de DPE com a compatibilidade HLA. As consequ?ncias da DPE s?o importantes incluindo pior fun??o e sobrevida do enxerto, e tamb?m o impacto na morbidade e da mortalidade dos receptores.