ANALYSIS OF PREVALENCE OF VITAMIN D DEFICIENCY IN ADULTS Author: Jana Nováková Supervisor: PharmDr. Eva Zimčíková, PhD. INTRODUCTION Estimated vitamin D deficiency occurs in up to 1/3 of the population. Vitamin D deficiency occurs in a number of diseases and in different countries of the world. AIMS The aim of the theoretical part of the diploma thesis was to get acquainted with vitamin D and its deficit in general. The objective of the practical part was to map vitamin D levels in adults, to assess prevalence of vitamin D deficiency, to determine if vitamin D levels fluctuate over the course of the year depending on age or gender and how they are related to individual illnesses. METHODS PubMed and Embase database search was performed to find evidence on vitamin D deficiency in adults. Only studies in humans, published in English in the period from 2000 to 2016 were included. Non-systematic review was provided, the quality of the studies was not evaluated. RESULTS Overall, 84 studies were included. Most of the studies enrolled healthy adults (n = 34). Among the studies concerning various diseases, musculoskeletal disorders were the most prevalent (n = 13). The highest prevalence of vitamin D deficiency was seen in the study from USA (in healthy adults) using cut-off value for deficiency ≤ 50...

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Clients with specific deficits in communication, memory, processing of information, or attention, may have difficulties with the counselling process. This study was been designed to explore the experiences of individuals with these specific deficits in counselling, and thereby increase awareness of the existence and effect of possible barriers or supports in the counselling process. The methodology used was Interpretive Description, developed by Sally Thorne (Sally Thorne, Kirkham, & O'Flynn-Magee, 2004). Ten individuals with particular learning disabilities (one or more of the above deficits) who have experienced counselling were interviewed. Up to four interviews were conducted with each participant; one screening interview, an initial interview, an optional interview including a significant other, and a member check at the end of the study. The researcher recorded a field and research journal during data collection. For the initial and optional interviews the researcher gathered transcripts, and then immersed himself in the data, in order to find themes about the participants’ experiences of counselling. The participants confirmed themes for accuracy and completeness. Finally, four participants contributed a short paragraph at the end of the thesis, nine participants contributed drawings that represented their counselling experience, and five participants created poses representing their relationship with their therapist. These alternate forms of data were used as further evidence in the study. The data gathered demonstrated that participants believed that they needed a more flexible approach to therapy which depended on having a safe relationship with a therapist that was sensitive to their needs. Although certain kinds of counselling processes were preferred by certain participants, the participants’ particular cognitive deficits were not the determining factors of what kinds of help the participants wanted in therapy. Rather, the participants were more interested in the creation of a counselling process based on a collaborative approach between them and their therapist, dependant on the participant’s knowledge about his or her needs and the therapist’s experience in counselling and with learning disabilities. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

Maternal iron deficiency is a world wide and major public health issue. Despite recent researchers’ interest related to this topic, its impact in the offspring still remains unclear. The aim of this study is to understand the impact of maternal iron deficiency on the auditory functions and serum cortisol levels in the young and adult guinea pig at post-natal day (PNd) 24 and PNd84, respectively. Pregnant guinea pigs were given an iron deficient (ID) or iron sufficient (IS) diet during gestation and lactation. An iron sufficient diet was provided to all pups after weaning day. No significant difference was observed in the hearing threshold and latencies in siblings from both groups at PNd24 and PNd84. However, ID offspring showed a significant higher interpeak latency I-IV at 100 dB than IS pups at PNd24. ID offspring also had significant elevated cortisol levels at PNd24 compared to IS control group. Maternal iron deficiency affects negatively the auditory functions and raises the serum cortisol levels, a biomarker of stress in the offspring.

Maternal iron deficiency is a world wide and major public health issue. Despite recent researchers’ interest related to this topic, its impact in the offspring still remains unclear. The aim of this study is to understand the impact of maternal iron deficiency on the auditory functions and serum cortisol levels in the young and adult guinea pig at post-natal day (PNd) 24 and PNd84, respectively. Pregnant guinea pigs were given an iron deficient (ID) or iron sufficient (IS) diet during gestation and lactation. An iron sufficient diet was provided to all pups after weaning day. No significant difference was observed in the hearing threshold and latencies in siblings from both groups at PNd24 and PNd84. However, ID offspring showed a significant higher interpeak latency I-IV at 100 dB than IS pups at PNd24. ID offspring also had significant elevated cortisol levels at PNd24 compared to IS control group. Maternal iron deficiency affects negatively the auditory functions and raises the serum cortisol levels, a biomarker of stress in the offspring.

Two experiments were undertaken to evaluate the baby pig as a biomedical model with which to study Protein-Calorie malnutrition. In the first experiment, 32Yorkshire and Yorkshire X Landrace pigs weaned at 21 days were fed either an 18% or 4% protein ration. Blood samples were taken biweekly from the anterior vena cava and the serum samples analyzed for calcium, phosphorus, glucose, cholesterol, lactic dehydrogenase, glutamic oxaloacetic transaminase, amylase, a 1ka1ine phosphatase, total protein, albumin and blood urea nitrogen. Significant (p ≤.01) treatment effects were observed for total protein, albumin, amylase, alkaline phosphatase, lactic dehydrogenase, cholesterol, calcium and phosphorus. In the second experiment, 40 Yorkshire and Yorkshire X Landrace pigs weaned at 28 days were fed rations containing 18%, 10%, 8%, 6%, and 4% protein. Blood samples were again taken biweekly and serum samples were analyzed for the same parameters as in trial one. In addition, serum copper, iron, magnesium, and zinc were measured. The livers of any animals which died on the low protein diets, were fat extracted, and the level of fat compared to that obtained from livers of animals killed as suckling pigs at a slaughter plant. Total body water was determined on three animals on the 18% ration and three on the h% ration utilizing tritiated water as a tracer. Total protein, albumin, amylase, lactic dehydrogenase, calcium, phosphorus, copper, iron and magnesium correlated well with dietary protein intake. Significant treatment effects were observed for total body water and fat content of the liver. An attempt was made to find a biochemical parameter which might be used in diagnosing developing protein calorie malnutrition. The results of the study would indicate that serum phosphate and amylase are the most sensitive parameters to dietary protein intake. Not every lesion or biochemical serum change occurring in man was reproduced in the present study. Nevertheless, characteristic symptoms such as the development of fatty liver, growth retardation, abnormal hair texture, hypoalbuminemia, and apathy were reproduced in the protein deficient swine. The baby pig would therefore appear to be a good model for the study of protein-calorie malnutrition. / Land and Food Systems, Faculty of / Graduate

Pulmonary embolism (PE) is a common clinical problem affecting 600,000 patients per year in the United States. Although the diagnosis can be easily confirmed by imaging techniques, such as computed tomographic angiography of the chest, the identification of underlying mechanism leading to PE is important for appropriate duration of anticoagulation, and prevention of subsequent episodes. The differential diagnosis of underlying mechanism is broad and must include careful review of medication history. Drug-related thromboembolic disease can be easily missed and may have catastrophic consequences. The identification of the culprit drug is important for prevention of subsequent episodes and choosing appropriate duration of anticoagulation. We report a case of a middle-aged man who developed PE after administration of intravenous immunoglobulin.

Orientador: Gustavo Luis Gutierrez / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação Física / Made available in DSpace on 2018-08-26T21:34:29Z (GMT). No. of bitstreams: 1 FerreiradosSantos_Renata_M.pdf: 1050876 bytes, checksum: 3c5d54ed6fd897da80fa445cddcb30e3 (MD5) Previous issue date: 2015 / Resumo: Em virtude do grande avanço tecnológico, e do crescente debate relacionado à deficiência nos últimos anos, este trabalho busca compreender se as Tecnologias Assistivas exercem algum tipo de influência na qualidade de vida de pessoas com deficiência. Foram realizadas entrevistas semi-estruturadas com pessoas com deficiência física/motora, deficiência visual, e deficiência auditiva. Esta pesquisa reflexiva apresenta alguns aspectos relacionados ao histórico, terminologias, e modelos conceituais empregados à deficiência. Além disso, relata de que forma as mudanças sociais contribuíram para a inserção de novas tecnologias, enfatizando a Tecnologia Assistiva. O conteúdo obtido nas entrevistas foi relacionado às obras de autores de referência, e por meio de análise interpretativa, concluímos que as Tecnologias Assistivas geram impactos significantes na qualidade de vida de pessoas com deficiência. Elas são facilitadoras de atividades, promovem autonomia e independência, contribuem positivamente para o estabelecimento e manutenção de relações sociais, e são estimuladoras no processo de reabilitação de pessoas com deficiência / Abstract: Because of the great technological advances, and the growing debate related to disabilities in recent years, this paper seeks to understand whether the Assistive Technologies exert some kind of influence on the quality of life of people with disabilities. We conducted semi-structured interviews with people with physical / motor impairment, visual impairment, and hearing impairment. This reflective study presents some aspects related to the history, terminology and conceptual employees disability models. In addition, reports of how social changes have contributed to the introduction of new technologies, emphasizing the Assistive Technology. The contents obtained in the interviews was related to the works of major authors, and through interpretative analysis, we conclude that the Assistive Technologies generate significant impacts on the quality of life of people with disabilities. They are activities that facilitate, promote autonomy and independence, contribute positively to the establishment and maintenance of social relationships and are stimulating the process of rehabilitation of people with disabilities / Mestrado / Atividade Fisica Adaptada / Mestra em Educação Física

Orientador: Cecilia Guarnieri Batista / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T00:44:36Z (GMT). No. of bitstreams: 1 Souza_FernandaSantos_M.pdf: 1217797 bytes, checksum: 698c03b54c66a1fe9231660b8c240982 (MD5) Previous issue date: 2015 / Resumo: A condição atualmente designada como deficiência intelectual tem sido tratada de diferentes formas. Nesse sentido, alguns dos marcos relevantes indicam: localização do problema no organismo (SNC e sistema endócrino), distinção entre deficiência e doença mental, ênfase na educabilidade e, a partir da segunda metade do século XX, na Educação Inclusiva. Diferentes organismos internacionais definem critérios para diagnóstico, que têm, em comum, nas versões mais recentes, as seguintes exigências: limitações significativas no funcionamento intelectual e no comportamento adaptativo, e início antes dos 18 anos. Algumas das definições enfatizam a modificabilidade da condição e a importância do contexto sociocultural. Esses aspectos foram valorizados por Vygotsky, que salientou a importância da compensação sociopsicológica, nos casos de alterações de origem orgânica (deficiências). O autor também enfatizou a importância da detecção de habilidades em início de desenvolvimento ("brotos" do desenvolvimento); o que tem implicações para a avaliação de pessoas com deficiência. Tendo em vista essas considerações, o objetivo do presente estudo foi identificar habilidades sociais e cognitivas em crianças e adolescentes com dificuldades para aprender, com QI igual ou inferior a 70 no teste WISC-IV (compatível com o valor delimitado para o diagnóstico de deficiência intelectual). O estudo foi composto de duas etapas: a primeira envolveu a seleção dos participantes; a segunda, a realização de estudos de caso. Para a seleção dos participantes, a pesquisadora aplicou o teste WISC-IV em 8 crianças e adolescentes, com idade entre 6 e 16 anos, que participavam dos atendimentos no Serviço de Psicologia do Desenvolvimento (SPD) do CEPRE/Unicamp. Foram selecionados, para a segunda etapa, cinco crianças e adolescentes que, no teste WISC-IV, apresentaram QI total inferior a 70 e valores inferiores à média nas quatro escalas do teste e que frequentaram com assiduidade os atendimentos do SPD. Em relação a cada participante, foram realizadas consultas a prontuários, entrevistas com os pais ou responsáveis e com os profissionais das escolas em que eles estavam matriculados. Foram realizadas observações sistemáticas das sessões de atendimento no SPD e, para alguns participantes, foram programadas sessões adicionais de atendimento. Todas as sessões foram filmadas e analisadas. A apresentação de cada estudo de caso incluiu: histórico, quadros relativos às habilidades sociais e cognitivas relatados pela família e profissionais da escola, análise dos modos de lidar com o participante (família e escola), descrição dos modos de participação no SPD, análise microgenética de episódios significativos e síntese. A análise dos casos permitiu a identificação de várias habilidades nos participantes, bem como favoreceu a compreensão de cada caso, ao identificar exemplos de incentivo ao desempenho e ainda evidenciou situações que provavelmente representavam obstáculos a novas aquisições. Os dados sugerem que, ao se enfatizar a busca de habilidades, pode-se obter uma visão abrangente de cada caso, de forma a contemplar, para além das limitações, as potencialidades e indícios de desenvolvimento das crianças e dos adolescentes / Abstract: The condition currently designed as intellectual deficiency has been treated in different ways. On this matter, some of the relevant marks point: localization of the problem in the organism (CNS and endocrinal system), distinction between deficiency and mental disease, as well as the emphasis in the education area and, the Inclusive Education starting from the second half of the 20th century. Different international organisms define criteria for diagnosis which has in common, in the most updated version, the following demands: considerable limitations in the intellectual work as well as the adaptive behavior, and beginning before the age of 18. Some of the definitions emphasize the changeability of the condition and the importance of the socio cultural context. These aspects were valued by Vygotsky, who mentioned the importance of the socio psychological compensation, in the alterations of organic origin cases (deficiency). The author also emphasized the importance of detection of abilities in the beginning of the development (sprout of the development); which has some implications to the evaluation of people with deficiency. Having in mind these considerations, the target of this study was to identify social and cognitive abilities in children and teenagers facing learning difficulties, with the same IQ or inferior to 70 in the WISC-IV test (compatible to the delimited value for the intellectual deficiency diagnosis). This study was made of two parts: the first envolved selecting the participants; the second, studying the case. In order to select the participants, the researcher gave the WISC-IV test in eight children and teenagers, aged from six to sixteen, who were part of the Development of the Psychology Service sessions (SPD) of Cepre/ Unicamp. It was selected for the second part five children and adolescents who presented in total an IQ less than 70 and values inferior to the average in the four scales evaluated in the test and that were frequent in the attendance in the SPD sessions. Related to each participant, it was made some sessions with medical record, interview with parents or some responsible for the children and the professionals of the schools where they were enrolled. It was made systematic observations of the sessions in the SPD and, for some participants, it was programmed additional sessions. All the sessions were filmed and analyzed. The presentation of each case study included: historic, table related to social and cognitive abilities related by the family and school professionals, analysis of the way to deal with the participant (family and school), description of the ways of participation in SPD, micro genetics analysis of important episodes and synthesis. The cases analysis allowed the identification of a lot of abilities in the participants, as well as enhanced the comprehension of each case by identifying examples of performance motivation and pointed situations that probably represented to an obstacle to new acquisitions. The data suggests that, when emphasizing the search of abilities, it¿s possible to have a wide view of each case, in a way to contemplate, beyond limitations, the potentialities and indications of the children and teenagers¿ development / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

Vitamin B12 and folate are necessary for bone marrow progenitor growth and division. Deficiencies are common in lymphoproliferative disorders due to increased demands of rapidly growing malignant cells. Isolated vitamin B12 deficiency is seen in 13% of these patients and may be their only manifestation. We present the case of vitamin B12 deficiency anemia due to an underlying malignancy that was discovered following supplementation. A 77-year-old nonsmoker female with chronic kidney disease and hypothyroidism presented to her internist with dyspnea, tachycardia and unintentional 7-pound weight loss. Age-appropriate cancer screenings were up-to-date. Physical exam was notable for an overweight female with tachycardia and trace ankle edema bilaterally. Electrocardiogram demonstrated sinus tachycardia. Labs were remarkable for hemoglobin 10.3 mg/dL (12.1 mg/dL one year ago) and serum B12/mL. She was started on intramuscular vitamin B12 supplementation. At her one-month follow-up, she reported debilitating gastrointestinal distress, rash, and fatigue lasting 5-6 days with every vitamin B12 injection. Physical exam was notable for 20-pound weight loss. Labs revealed hemoglobin 9.9 mg/dL despite serum B12 750 pg/mL and worsening kidney function with marked proteinuria. Additional work-up by primary team and subsequent Hematology & Oncology referral demonstrated elevated M-spike on urine protein electrophoresis and abnormal bone marrow biopsy suspicious for lymphoid malignancy. CT abdomen and whole body PET scan revealed increased uptake in the T12 vertebrae and multiple nodal basins consistent with stage IV lymphoma. Biopsy of vertebral body confirmed diffuse large B-cell lymphoma. The patient received one cycle of chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Her course was complicated by pathologic hip fracture requiring hospitalization and surgical repair. The patient died following cardiac arrest in the setting of septic shock from sigmoid colon perforation 7 months from initial presentation. Vitamin B12 and folate play critical roles in nucleic acid synthesis for bone marrow progenitors. Vitamin B12 deficiency arrests cell growth and division, leading to macrocytic anemia and various neuropsychiatric manifestations. It is a common diagnosis with numerous causes: autoantibodies to digestive proteins, poor dietary intake, small bowel malabsorption, etc. Diagnose with low hemoglobin (/dL or 13 mg/dL in non-pregnant women or men, respectively) and mean corpuscular volume >100 fL plus low serum B12 or elevated homocysteine and methyl-malonic acid levels. Replacement is given orally or intramuscularly. Vitamin B12 and folate deficiencies are found in lymphoproliferative disorders due to increased demands of rapidly growing malignant cells. Isolated vitamin B12 deficiency is seen in 13% of patients and may be the only clue. Replacement will not resolve their anemia. Physicians should monitor patients receiving supplementation. If anemia fails to improve or patients experience systemic symptoms, further investigation for lymphoid malignancies is warranted. This patient had dramatic deterioration with acceleration of underlying malignancy following vitamin B12 replacement. We believe supplementation enabled malignant lymphoid precursors to resume cell cycle growth and division. Only one report of vitamin B12 supplementation associated with unmasking a lymphoid malignancy exists in literature. Further research is needed to support whether supplementation can accelerate lymphoid malignancies.