Ο Σακχαρώδης Διαβήτης τύπου 1 (ΣΔ1) αποτελεί τη συχνότερη μορφή διαβήτη στα παιδιά, συχνά συνοδεύεται από σοβαρές μικρο- και μακρο-αγγειακές επιπλοκές ενώ, η επίπτωσή του εμφανίζει ανησυχητικά αυξητική τάση τις τελευταίες δεκαετίες. Η ενεργοποίηση των μονοκυττάρων, η χημειοταξία τους (κύριος χημειοτακτικός παράγοντας μονοκυττάρων: MCP-1) και η μετατροπή τους σε μακροφάγα (δείκτης μακροφάγων: CD68) θεωρείται πως διαδραματίζουν προεξέχοντα ρόλο στην ανάπτυξη των διαβητικών αγγειακών αλλοιώσεων. Η πλεονάζουσα γλυκόζη που υπάρχει στο διαβήτη, αλληλεπιδρώντας μη ενζυματικά με πλήθος υποστρωμάτων, προκαλεί την παραγωγή των AGEs (τελικά προϊόντα προχωρημένης γλυκοζυλίωσης) τα οποία με τη σειρά τους ασκούν τις βλαπτικές τους δράσεις, είτε αλληλεπιδρώντας άμεσα με τα μόρια της εξωκυττάριας ουσίας ή μέσω σύνδεσης στους κυτταρικούς τους υποδοχείς (κυριότερος εκπρόσωπος: RAGE). Η ενεργοποίηση του RAGE, διαμέσου της ενεργοποίησης του μεταγωγικού μονοπατιού της πρωτεϊνικής κινάσης Β (Akt2/PKB) και του μεταγραφικού παράγοντα NF-κΒ, οδηγεί στην αυξημένη έκφραση προ-φλεγμονωδών [παράγοντας νέκρωσης όγκου-α (TNFα), ιντερλευκίνη-6 (IL-6)] και προ-θρομβωτικών παραγόντων [ιστικού παράγοντα (TF)], συμβάλλοντας κατ’αυτό τον τρόπο στην εμφάνιση ενδοθηλιακής δυσλειτουργίας. Φραγμό στις δράσεις αυτές αποτελεί η διαλυτή μορφή του RAGE, sRAGE, η οποία συνδεόμενη με τα AGEs τα οδηγεί προς αποδόμηση και εμποδίζει την ενδοκυττάρια σηματοδότηση που πυροδοτούν τα AGEs. Σκοπός / μεθοδολογία: Προκειμένου να διερευνήσουμε τον πιθανό ρόλο των διεργασιών της φλεγμονής στην ανάπτυξη των διαβητικών επιπλοκών, σε μονοπύρηνα κύτταρα περιφερικού αίματος 47 προεφηβικών και εφηβικών παιδιών (ηλικίας 4-18 ετών) και 10 νεαρών ενηλίκων (ηλικίας 18-29 ετών) με ΣΔ1 και 39 μη διαβητικών μαρτύρων αντίστοιχης ηλικίας, μελετήσαμε: 1) με RT-PCR τη γονιδιακή έκφραση: του MCP-1, του CD68, της Akt2, του TNF-α, της IL-6 και του RAGE, 2) με ανοσοαποτύπωση κατά Western μετρήσαμε την πρωτεϊνική έκφραση της Akt2, του RAGE και του TF, 3) τα επίπεδα πλάσματος του sRAGE με τη μέθοδο της ELISA. Αποτελέσματα: Η μελέτη έδειξε ότι: (1) Το sRAGE: α) ήταν αυξημένο στους προεφηβικούς μάρτυρες σε σύγκριση με τους εφηβικούς και νεαρούς ενήλικες μάρτυρες, ενώ τα επίπεδα του ήταν μειωμένα στους προεφηβικούς διαβητικούς σε σύγκριση με τους αντίστοιχους μάρτυρες και β) είχε μία τάση μείωσης με τα αυξανόμενα επίπεδα της HbA1c. (2) Η γονιδιακή έκφραση του RAGE: α) έτεινε να αυξηθεί στους προεφηβικούς διαβητικούς και αυξανόταν σημαντικά στους νεαρούς ενήλικες διαβητικούς σε σύγκριση με τους αντίστοιχους μάρτυρες και β) σχετιζόταν αρνητικά με την HbA1c στους διαβητικούς ασθενείς >18ετών. (3) Η πρωτεϊνική έκφραση και των δύο ισομορφών του RAGE (46kDa και 80kDa) εμφάνισε μία τάση μείωσης με την εξέλιξη της εφηβείας (προεφηβικοί > εφηβικοί > νεαροί ενήλικες) στους μάρτυρες, μεταβολές που ακολούθησαν και οι διαβητικοί ασθενείς, αν και τα επίπεδα έκφρασης έτειναν να είναι πιο υψηλά. (4) Η 46kDa ισομορφή RAGE: α) ήταν αυξημένη στου νεαρούς ενήλικες διαβητικούς και μειωμένη στους διαβητικούς >13ετών με διάρκεια διαβήτη ≤5 έτη, σε σύγκριση με τους αντίστοιχους μάρτυρες αλλά και τους αντίστοιχης ηλικίας διαβητικούς με διάρκεια νόσου >5 έτη, β) έτεινε να αυξηθεί με τις τάξεις HbA1c: ≤7%-8% και να μειωθεί με τις τάξεις HbA1c: 8-10% και γ) συσχετίσθηκε θετικά με τη διάρκεια διαβήτη και με τα επίπεδα των τριγλυκεριδιών στο σύνολο των ασθενών. (5) Η 80kDa ισομορφή του RAGE: α) είχε μία τάση αύξησης στους διαβητικούς ασθενείς >13ετών με διάρκεια διαβήτη ≤5 έτη, σε σύγκριση με τους αντίστοιχους μάρτυρες και τους διαβητικούς αντίστοιχης ηλικίας αλλά διάρκεια νόσου >5έτη, β) συσχετίσθηκε αρνητικά με την HbA1c σε ασθενείς με διάρκεια νόσου ≤5έτη. (6) Το MCP-1: α) έτεινε να αυξηθεί στους διαβητικούς σε σύγκριση με τους μάρτυρες και συγκεκριμένα, η αύξηση ήταν σημαντική στους διαβητικούς με στάδιο εφηβείας ΙΙ και V, β) έτεινε να αυξηθεί με την HbA1c και αυξανόταν σημαντικά στους διαβητικούς με περίμετρο κοιλίας >75%. (7) Το CD68: α) βρέθηκε αυξημένο στα διαβητικά αγόρια >18 ετών σε σύγκριση με τους αντίστοιχους μάρτυρες, β) έτεινε να μειωθεί στους διαβητικούς >13ετών με διάρκεια διαβήτη >5έτη, σε σύγκριση με τους αντίστοιχης ηλικίας μάρτυρες και γ) έτεινε να μειωθεί με τα αυξανόμενα επίπεδα της HbA1c και στους διαβητικούς με LDL >100 mg/dL. (8) To TNF-α έδειξε: α) σημαντική μείωση στους διαβητικούς ασθενείς σε σχέση με τους μάρτυρες και ιδιαίτερα σε αυτούς που ήταν ≤13ετών με διάρκεια διαβήτη >5 έτη και σε αυτούς με ηλικία >18ετών, β) μία τάση αύξησης με τις τάξεις HbA1c μέχρι του 10%. (9) Η IL-6 έδειξε: α) σημαντική μείωση στους μάρτυρες με την παράλληλη αύξηση της ηλικίας, β) σημαντική αύξηση στους διαβητικούς >18ετών σε σύγκριση με τους αντίστοιχους μάρτυρες, γ) μία τάση μείωσης στους διαβητικούς ≤13ετών με διάρκεια διαβήτη >5έτη, σε σχέση με τους ηλικιακά αντίστοιχους μάρτυρες και δ) μία σημαντική μείωση στους διαβητικούς με HbA1c >10,1% σε σύγκριση με τις υπόλοιπες τάξεις της HbA1c. (10) Ο TF βρέθηκε: α) σημαντικά αυξημένος στα διαβητικά αγόρια ≤13 ετών και έτεινε να αυξηθεί στα διαβητικά αγόρια >18ετών σε σχέση με τους αντίστοιχους μάρτυρες, β) σημαντικά μειωμένος στους διαβητικούς με διάρκεια νόσου >5έτη και έτεινε να μειωθεί στους διαβητικούς με HbA1c >10,1% και σε αυτούς με LDL >100 mg/dL. (11) Η γονιδιακή έκφραση της Akt2 έδειξε: α) σημαντική αύξηση στους προεφηβικούς διαβητικούς, β) σημαντική μείωση στους διαβητικούς με LDL >100mg/dl και σε αυτούς με HbA1c >9%, σε σύγκριση με τους αντίστοιχους μάρτυρες. (12) Η πρωτεϊνική έκφραση της Akt2 έδειξε: α) μία τάση αύξησης στους προεφηβικούς διαβητικούς και στους διαβητικούς που βρίσκονται στις τάξεις HbA1c: 7,1%-9%, ενώ αυξανόταν σημαντικά στους διαβητικούς με διάρκεια διαβήτη >5έτη, β) σημαντική αύξηση στους διαβητικούς με LDL >100mg/dl.l Συμπέρασμα: Στα άτομα με ΣΔ1, φαίνεται να υπάρχει μια ήπια διαδικασία χημειοταξίας και ενεργοποίησης των μονοκυττάρων, ωστόσο η έκφραση των κυτταροκινών και των υπολοίπων μορίων που εμπλέκονται σε αυτή δεν είναι εντυπωσιακά αυξημένη σε σχέση με τους μάρτυρες. Το γεγονός αυτό μπορεί να σχετίζεται αφενός με τον καλό γλυκαιμικό και λιπιδαιμικό έλεγχο των ασθενών και αφετέρου στην τροποποιημένη ανοσολογική απόκριση που εμφανίζουν τα άτομα αυτά. / Diabetes Mellitus type 1 (DM1) is one of the most common types of diabetes in children and its prevalence has increased over the past decades. DM1 is usually associated with severe micro- and macro- angiopathic complications. The activation of monocytes, their chemotaxis (major chemotactic factor of monocytes: MCP-1) and their transformation to macrophages (marker of macrophages: CD68) is known to play a central role in the development of those complications. The redundant glucose, that characterizes DM1, reacts non enzymatically with plural substrates and causes the formation of AGEs (Advanced Glycation Endproducts). AGEs can cause tissue damage either by direct interaction with extracellular matrix’s domains or via their receptor (main representative: RAGE). RAGE’s activation, through the activation of the intracellular signaling pathways of protein kinase B (Akt2/PKB) and nuclear factor κB (NF-κB), leads to the increased expression of pro-inflammatory [Tissue Necrosis Factor-α (TNF-α), Interleukin-6 (IL-6)] and pro-thrombotic factors [Tissue Factor (TF)], contributing to the development of endothelial dysfunction. As a decoy to these actions of AGEs, the soluble form of RAGE, sRAGE, binds AGEs, leading them to degradation and therefore inhibiting the AGE-induced intracellular signaling. Aim / Material- Methods: In order to investigate the role of the inflammatory procedures in the development of diabetic complications, in peripheral blood mononuclear cells (PBMCs) of 47 pre-pubertal and pubertal children (4-18 years of age) and 10 young adults (18-29 years of age) with DM1 and 39 age-matched controls, we studied: 1) with RT-PCR the gene expression of: MCP-1, CD68, Akt2, IL-6 and RAGE, 2) with Western Immunoblotting the protein expression of Akt2, RAGE and TF, 3) sRAGE plasma levels were determined by ELISA. Results: Our study showed that: (1) sRAGE: a) was increased in pre-pubertal controls in comparison to the pubertal and the young adult controls, while its levels were decreased in pre-pubertal DM1 patients in comparison to their controls and b) tended to decrease with the progressive increase of HbA1c levels in DM1 patients. (2) RAGE gene expression: a) tended to increase in pre-pubertal DM1 patients and was significantly increased in young adults DM1 patients in comparison to their age-matched controls and b) was negatively correlated with HbA1c levels in DM1 patients >18years of age. (3) Protein expression of both RAGE isoforms (46kDa & 80kDa) tended to decrease with the progression of puberty (pre-pubertal > pubertal > young adults) in the control group, changes that were also found in DM1 patients, although the expression was at higher levels. (4) Protein expression of 46 kDa RAGE isoform: a) was increased in DM1 young adults and decreased in DM1 patients >13 years of age and duration of diabetes ≤5years, in comparison to age-matched controls and age-matched DM1 patients with duration of diabetes >5years, b) tended to increase with levels of HbA1c ≤7%-8% and decrease with levels of HbA1c 8-10% and c) was positively correlated with the duration of diabetes and the levels triglycerides in DM1 patients’ group. (5) Protein expression of 80kDa RAGE isoform: a) tended to increase in DM1 patients aged >13 years and with duration of diabetes ≤5 years, in comparison to age-matched controls and age-matched DM1 patients with duration of diabetes >5years, b) negatively correlated with HbA1c levels in DM1 patients with ≤5 years duration of diabetes. (6) MCP-1: tended to increase in DM1 patients in comparison to controls and this increase was significant in DM1 patients with II and V Tanner stage of puberty, b) tended to elevate with the progressive increase of HbA1c and was significantly higher in DM1 patients with waist circumference >75%. (7) CD68: a) was increased in DM1 boys >18 years of age in comparison to the age-matched controls, b) tended to decrease in DM1patients >13 years of age and duration of diabetes >5years, in comparison to the age-matched controls and c) tended to decrease with the increasing levels of HbA1c and also in DM1 patients with LDL >100 mg/dL. (8) TNF-α: a) was significantly decreased in DM1 patients in comparison to controls and especially to those with age ≤13 years and duration of diabetes >5years and them with >18 years of age, b) tended to increase with the increasing levels of HbA1c until 10%. (9) IL-6 showed: a) significant decrease in controls with the parallel increase of the age, b) significant increase in DM1 patients >18 years of age in comparison to the age-matched controls, c) a tendency to decrease in DM1 patients ≤13 years of age and duration of diabetes >5years, in comparison to the age-matched controls and d) significant decrease in DM1 patients with HbA1c levels >10,1%, in comparison to the rest of the determined levels of HbA1c. (10) TF: a) was significant elevated in DM1 boys ≤13 years of age and tended to increase in DM1 boys >18 years of age in comparison to the age-matched controls, b) was significant decreased in DM1 patients with duration of diabetes >5years and tended to decrease in DM1 patients with HbA1c levels >10,1% and them with LDL >100mg/dl. (11) Akt2 gene expression showed: a) significant increase in pre-bubertal DM1 patients, b) significant decrease in DM1 patients with LDL >100mg/dl and them with HbA1c levels >9%, in comparison to their controls. (12) Akt2 protein expression showed: a) a tendency to increase in pre-pubertal DM1 patients and in those with HbA1c levels between 7,1-9%, whereas it was increased significantly in DM1 patients with duration of diabetes >5years, b) a significant increase in DM1 patients with LDL >100mg/dl. Conclusions: In the DM1 patients studied, a low grade procedure of chemotaxis and activation of macrophages is possibly present, although the cytokines’ and inflammatory factors’ expression was not remarkably increased in comparison to the controls. This may reflect the good glycemic and lipidemic control of these patients who at the same time possibly exhibit small modifications in their immunological response.

Bakgrund Diabetes mellitus typ 1 är en livslång autoimmun sjukdom med stort egenvårdsbehov. I yrket som sjuksköterska är det viktigt att ha kunskaper om erfarenheter kring hur det är att leva med sjukdomen för att ge rätt stöd, råd och information. Vald teoretisk referensram är Dorothea Orems’ egenvårdsteori.  Syfte Att belysa vuxna individers erfarenheter av att leva med diabetes mellitus typ 1.  Metod Metoden utgjordes av en litteraturstudie. Studien byggde på databassökningar i PsycINFO, PubMed och Cinahl. Efter kvalitetsgranskning valdes tio artiklar ut för analys.  Resultat Resultatet presenterades genom tre kategorier med sju underkategorier. De tre kategorierna var: att inte visa sjukdomendär erfarenheter av att dölja eller åsidosätta sjukdomen beskrevs, att låta sjukdomen vara en del av livet där prioritering och planering, begränsningar och att ha en positiv inställning dominerade och att lära känna sjukdomen tillsammans med andra där vikten av stöd och självkännedom beskrevs.  Slutsats För sjuksköterskor som möter individer med diabetes mellitus typ 1 är det viktigt att känna till de olika aspekterna av att leva med sjukdomen för att kunna ta hänsyn till dessa i den individualiserade vården som borde bedrivas. Genom denna studie kan författarna dra slutsatsen att det fanns ett stort behov av stöd och acceptans från omgivningen kring individer med diabetes mellitus typ 1.

Made available in DSpace on 2014-06-11T19:27:18Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-12-15Bitstream added on 2014-06-13T18:07:11Z : No. of bitstreams: 1 manaia_cn_me_araca.pdf: 1017780 bytes, checksum: 5bfc19d12454af90b8f644211fa95235 (MD5) / Diabetes é uma desordem metabólica que interfere no tecido ósseo. Objetivou-se avaliar a fragilidade de fêmures de ratos diabéticos tipo 1 (DM1), pela densitometria e ensaio biomecânico. Foram utilizados 22 animais (Rattus novegicus, albinus, Wistar), com aproximadamente 250 gramas, divididos em grupo: Controle e Diabetes aleatoriamente. A DM1 foi inoculada pela estreptozotocina dissolvida em tampão citrato a 0,01M, pH 4,5, na concentração de 35mg/Kg na via peniana. Após 4 semanas da indução, foram sacrificados e os fêmures desarticulados. Para análise densitométrica utilizouse densitômetro DPX Lunar ™, para densidade radiográfica o sistema digital Digora®. No ensaio mecânico usou a máquina universal de ensaio EMIC® na região diafisária do fêmur. Os resultados passaram por análise estatística, teste t de Student, paramétrico e não pareado, onde o Conteúdo Mineral Ósseo (g), Densidade Mineral Óssea (g/cm²), Densidade Óssea (mmAl), Força Máxima (N) observadas nos fêmures de portadores de diabetes foi inferior ao grupo controle comprovado estatisticamente. Na Rigidez (x103N/m) e na Área (cm²) não houve diferença estatística. Conclui-se que o diabetes tipo 1 causou fragilidade nos fêmures dos ratos, reduzindo sua densidade mineral e consequentemente sua resistência mecânica. / Diabetes is a metabolic disorder that interferes with bone mass reducing the minerals density and consequently its mechanical strength. Our objective was to evaluate the femurs fragility in rats with type 1 diabetes (DM1)by densitometry and biomechanical tests. A total of 22 animals (Rattus novegicus, Albinus, Wistar), with approximately 250 grams were divided into group: Control and Diabetes. In-group Diabetes animals received streptozotocin dissolved in citrate buffer 0.01 M, pH 4.5, at a concentration of 35 mg/kg single dose in the penile vein. After 4 weeks of induction, the animals were sacrificed and the femurs were disarticulated for biomechanical analysis (Maximum Strength and stiffness) and densitometric analysis (Bone Mineral Density, Bone Mineral Content and Area). For densitometric analysis was used densitometer Lunar DPX ™ for the radiographic density digital Digora®. The biomechanical analysis used the universal testing machine EMIC ® in the femoral shaft. The results passed through statistical analysis, Student t test, parametric and nonpaired where of bone mineral content (g), bone mineral density (g/cm²), Bone Density (mmAl) Maximum Force (N) observed in the femurs of diabetic patients was lower than the control group accused significative differences. In Stiffness (x103N/m) and Area (cm²) there was no statistical difference.. Concluded that type 1 diabetes has caused weaknessin the femurs of mice, reducing its mineral density and consequently its mechanical strength.

Orientador: Mário Jefferson Quirino Louzada / Banca: Alessandra Aranega / Banca: Stela Márcia Mattiello Gonçalves Rosa / Resumo: Diabetes é uma desordem metabólica que interfere no tecido ósseo. Objetivou-se avaliar a fragilidade de fêmures de ratos diabéticos tipo 1 (DM1), pela densitometria e ensaio biomecânico. Foram utilizados 22 animais (Rattus novegicus, albinus, Wistar), com aproximadamente 250 gramas, divididos em grupo: Controle e Diabetes aleatoriamente. A DM1 foi inoculada pela estreptozotocina dissolvida em tampão citrato a 0,01M, pH 4,5, na concentração de 35mg/Kg na via peniana. Após 4 semanas da indução, foram sacrificados e os fêmures desarticulados. Para análise densitométrica utilizouse densitômetro DPX Lunar ™, para densidade radiográfica o sistema digital Digora®. No ensaio mecânico usou a máquina universal de ensaio EMIC® na região diafisária do fêmur. Os resultados passaram por análise estatística, teste t de Student, paramétrico e não pareado, onde o Conteúdo Mineral Ósseo (g), Densidade Mineral Óssea (g/cm²), Densidade Óssea (mmAl), Força Máxima (N) observadas nos fêmures de portadores de diabetes foi inferior ao grupo controle comprovado estatisticamente. Na Rigidez (x103N/m) e na Área (cm²) não houve diferença estatística. Conclui-se que o diabetes tipo 1 causou fragilidade nos fêmures dos ratos, reduzindo sua densidade mineral e consequentemente sua resistência mecânica. / Abstract: Diabetes is a metabolic disorder that interferes with bone mass reducing the minerals density and consequently its mechanical strength. Our objective was to evaluate the femurs fragility in rats with type 1 diabetes (DM1)by densitometry and biomechanical tests. A total of 22 animals (Rattus novegicus, Albinus, Wistar), with approximately 250 grams were divided into group: Control and Diabetes. In-group Diabetes animals received streptozotocin dissolved in citrate buffer 0.01 M, pH 4.5, at a concentration of 35 mg/kg single dose in the penile vein. After 4 weeks of induction, the animals were sacrificed and the femurs were disarticulated for biomechanical analysis (Maximum Strength and stiffness) and densitometric analysis (Bone Mineral Density, Bone Mineral Content and Area). For densitometric analysis was used densitometer Lunar DPX ™ for the radiographic density digital Digora®. The biomechanical analysis used the universal testing machine EMIC ® in the femoral shaft. The results passed through statistical analysis, Student t test, parametric and nonpaired where of bone mineral content (g), bone mineral density (g/cm²), Bone Density (mmAl) Maximum Force (N) observed in the femurs of diabetic patients was lower than the control group accused significative differences. In Stiffness (x103N/m) and Area (cm²) there was no statistical difference.. Concluded that type 1 diabetes has caused weaknessin the femurs of mice, reducing its mineral density and consequently its mechanical strength. / Mestre

FundaÃÃo de Amparo a CiÃncia e Tecnologia de Pernambuco / A preocupaÃÃo com a qualidade de vida das pessoas tem sido alvo de interesse de pesquisadores nacionais e internacionais em virtude do aumento da expectativa de vida e maior prevalÃncia de condiÃÃes crÃnicas de saÃde. A qualidade de vida em indivÃduos com condiÃÃes crÃnicas foi, por muito tempo, avaliada exclusivamente em termos de sobrevida e sinais da presenÃa da doenÃa, sem considerar as suas consequÃncias psicossociais, fÃsicas e espirituais. Dessa forma, o objetivo desta pesquisa à avaliar a qualidade de vida relacionada à saÃde de adolescentes com diabetes mellitus tipo 1. Trata-se de uma pesquisa observacional, quantitativa com desenho transversal. Foram avaliados 92 adolescentes em seguimento terapÃutico no Centro MÃdico Senador Josà de Moraes durante janeiro e julho de 2013. Os dados foram coletados por meio da tÃcnica de entrevista e consulta aos prontuÃrios mediante a utilizaÃÃo de formulÃrios para investigaÃÃo de indicadores sociodemogrÃficos e clÃnicos; antropomÃtricos, pressÃo arterial e bioquÃmicos e do instrumento especÃfico para mensurar qualidade de vida de jovens com diabetes (IQVJD). Os dados sofreram dupla digitaÃÃo e foram analisados no software Statistical Package for Social Sciences (SPSS) para Windows, versÃo 20.0, e analisados por meio de estatÃstica descritiva, inferencial bivariada e anÃlise mÃltipla. Para os procedimentos descritivos, foram apresentados os dados absolutos e relativos (frequÃncias e percentuais), medidas de tendÃncia central (mÃdia) e de variabilidade (desvio-padrÃo). Os procedimentos de inferÃncia estatÃstica, por sua vez, foram realizados por meio dos testes t de Student e AnÃlise de VariÃncia (ANOVA), que identificam diferenÃas entre grupos por meio da comparaÃÃo de suas mÃdias e cÃlculo do coeficiente de correlaÃÃo r de Pearson. Foi adotado um intervalo de confianÃa de 95%, e nÃvel de significÃncia de 5% (p<0,05). Procedeu-se, tambÃm, a anÃlise da confiabilidade do instrumento, por meio do cÃlculo do coeficiente &#945; de Cronbach. Para a anÃlise mÃltipla foi aplicado o Modelo de RegressÃo LogÃstica atravÃs do Odds Ratio (OR). A amostra compÃs-se, na sua maioria, por adolescentes do sexo masculino, de raÃa branca, solteiros, estudantes cursando o ensino fundamental e com idade mÃdia de 14,6 anos (desvio-padrÃo = 2,9). Os escores mÃdios da qualidade de vida total e seus respectivos domÃnios (satisfaÃÃo, impacto e preocupaÃÃo) estÃo mais prÃximos dos escores mÃnimos reportados por esta amostra, o que caracteriza uma avaliaÃÃo de qualidade de vida alta, com os respectivos escores e desvio-padrÃo 117,5Â20,1, 38,6Â9,3, 53,0Â10,4 e 25,8Â6,6. Para o cenÃrio econÃmico foram identificadas diferenÃas estatisticamente significativas para a qualidade de vida total (p=0,02) e para o domÃnio impacto (p=0,009). O teste post hoc de Tukey identificou um maior comprometimento naqueles indivÃduos pertencentes à classe D (M=132,2), se comparados Ãqueles da classe B2 (108,0). Quanto Ãs caracterÃsticas clÃnicas, observa-se que, a maioria, estava na fase crÃnica da doenÃa, com mÃdia de 6,8 anos de diagnÃstico (desvio-padrÃo de 4,5 anos), com mÃdia da idade do surgimento dos primeiros sintomas aos 7,6 anos (desvio-padrÃo de 4 anos) e com mÃdia da pressÃo arterial menor que o percentil 90. 70,7% faziam uso de insulina de aÃÃo intermediÃria e 57,6% de aÃÃo rÃpida, sendo que 59,8% realizam quatro ou mais aplicaÃÃes por dia. Verificou-se predominÃncia de Ãndices glicÃmicos nÃo controlados e lipÃdeos sÃricos acima do desejÃvel, com exceÃÃo da lipoproteÃna de baixa densidade. Quanto à presenÃa de complicaÃÃes associadas à doenÃa, foram identificadas diferenÃas estatisticamente significativas para o escore geral da qualidade de vida (p=0,004) e para o domÃnio âimpactoâ (p=0,002). Em relaÃÃo à ocorrÃncia de internaÃÃes no Ãltimo ano, foram identificadas diferenÃas significativas para a pontuaÃÃo geral da qualidade de vida (p=0,01), e para os domÃnios âsatisfaÃÃoâ (p=0,01) e âpreocupaÃÃoâ (p=0,02). Na comparaÃÃo entre os escores de qualidade de vida total e seus domÃnios, e a variÃvel hipoglicemia foram observadas diferenÃas estatisticamente significativas entre os escores de qualidade de vida total (p=0,01) e o domÃnio satisfaÃÃo (p=0,02). NÃo foram identificadas correlaÃÃes significativas, segundo critÃrios estatÃsticos, da qualidade de vida e seus domÃnios com as variÃveis clÃnicas Ãndice de massa corporal, pressÃo sistÃlica mÃdia, pressÃo diastÃlica mÃdia, tempo de tratamento e idade do primeiro sintoma. Para o instrumento geral, observou-se um alfa de Cronbach de 0,85, configurando um nÃvel satisfatÃrio de confiabilidade. Portanto, conclui-se que os escores mÃdios da qualidade de vida total e de seus domÃnios estÃo mais prÃximos dos escores mÃnimos reportados pela amostra, o que caracteriza uma avaliaÃÃo da qualidade de vida alta e reforÃa o fato de que a presenÃa de uma doenÃa crÃnica nÃo influenciou, de forma geral, negativamente na qualidade de vida desse nicho populacional. Este estudo reforÃa a ideia de que à importante realizar investigaÃÃes sobre diabetes na adolescÃncia, particularmente, na valorizaÃÃo da percepÃÃo da qualidade de vida relacionada a saÃde, na tentativa de minimizar a carÃncia de estudos nacionais e identificar fatores que deterioram a qualidade de vida para que se possa intervir em tempo hÃbil.

Orientador: Ricardo de Lima Zollner / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-08T16:26:14Z (GMT). No. of bitstreams: 1 Ferro_KarlaPriscilaVieira_M.pdf: 1249697 bytes, checksum: a31e2763981008c52bfdee0373185f3f (MD5) Previous issue date: 2007 / Resumo: A linhagem de camundongos NOD (non obese diabetic) desenvolve espontaneamente diabetes mellitus tipo 1 (DM-1) com marcante similaridade ao observado em humanos, que se estabelece entre 12ª e 24ª semana de vida, com presença de autoanticorpos específicos contra antígenos pancreáticos. Grande parte das células encontradas são linfócitos T CD4+ e T CD8+ e, embora células NK, linfócitos B, células dendríticas e macrófagos também possam ser identificados nas lesões, o desenvolvimento da doença é primariamente dependente de linfócitos T CD4+ e CD8+ auto-reativos. A diferenciação e funcionamento de células ß são regulados por uma variedade de hormônios e fatores de crescimento, incluindo Nerve Growth Factor (NGF). Sabe-se que células-ß pancreáticas expressam receptores funcionais para NGF e esta neurotrofina induz modificações morfológicas e fisiológicas, incluindo estimulação da secreção de insulina. Estudos de terapias para o DM-1 baseadas na intervenção sobre o sistema imunológico revelam que estas podem ser estratégias promissoras para impedir a instalação e/ou evolução da doença. Neste contexto, investigamos os efeitos da administração de GM1 sobre a incidência do DM-1 e insulite em camundongos NOD, expressão de citocinas, NGF e seu receptor de alta afinidade TrkA. Nossos resultados sugerem que administração de GM1 na dose de 100mg/kg/dia em camundongos NOD fêmeas a partir da 4ª semana de vida é capaz de diminuir o índice de infiltrado inflamatório e conseqüentemente a expressão do diabetes, modulando negativamente o infiltrado inflamatório bem como a expressão gênica de citocinas pró-inflamatórias (IL-12, IFN-?, TNF-a e IL-1ß), além de aumentar a expressão gênica e protéica de NGF e TrkA, que pode atuar como regulador de sobrevivência da célula ß de maneira a inibir a apoptose desta célula / Abstract: The strain of NOD mice (non obese diabetic) spontaneously develops diabetes mellitus type 1 (DM-1) with strong similarity to the observed in humans. In this model, the diabetes manifestation occurs among 12th and 24th weeks of life, with presence of pancreas-specific autoantibodies. Great part of the cells are CD4+ and CD8+T cells, and even so NK cells, lymphocytes B, dendritics cells and macrophages also can be identified in the injuries, the development of the disease is essentially dependent of autoreactive CD4+ and CD8+ T cells. It was demonstrated that ? - pancreatic cells express NGF functional receptors and that this neurotrophin induces morphological and physiological modifications in pancreatic ? cells, including stimulation in insulin secretion. The inquiries of therapies for the DM-1 based on the intervention on the immune system disclose that these can be promising strategies to hinder the installation and/or evolution of the disease. In this context, we investigate the effect of GM1 administration on the incidence of DM-1 and insulitis in NOD mice, cytokines expression, NGF and its high affinity receptor TrkA. Our results suggest that administration of GM1 in the dose of 100mg/kg/dia in female NOD mice from 4ª week of life are capable to reduce the index of inflammatory infiltrated and consequently the expression of diabetes, down-modulating the inflammatory infiltrated as well as the gene expression of pro-inflammatory cytokines (IL-12, IFN-?, TNF-? and IL-1?), besides increasing the gene and protein expression of NGF and TrkA, that can act as regulating of ß cell - survival in way to inhibit apoptosis of this cell / Mestrado / Ciencias Basicas / Mestre em Clinica Medica

Orientadores: Maria Cândida Ribeiro Parisi, Denise Engelbrecht Zantut Wittmann / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T05:08:24Z (GMT). No. of bitstreams: 1 Bovi_TicianeGoncalez_M.pdf: 3137224 bytes, checksum: 8adaf0924763fa6c8dbae022b9ff6537 (MD5) Previous issue date: 2014 / Resumo: Avaliou-se a relação entre consumo alimentar de portadores de diabetes tipo 1 (DM1) seguidos em serviço de referência e de suas respectivas famílias. Trata-se de um estudo transversal no qual foram avaliados concomitantemente o consumo alimentar (Recordatório de 24 horas), o perfil nutricional (Índice de Massa Corporal), assim como, o nível socioeconômico de famílias e pacientes DM1. O controle glicêmico foi classificado pelo índice de hemoglobina glicada (HbA1c). Houve correlação positiva entre o consumo alimentar dos pacientes e familiares/acompanhantes para o consumo de carboidratos, proteínas e lipídios. O tempo de diagnóstico, tempo de acompanhamento no serviço, nº de avaliações da glicemia capilar, dose de insulina Kg/dia e parentesco dos familiares/acompanhantes mostraram-se relevantes sobre a HbA1c. O consumo alimentar tanto de pacientes quanto de familiares foi semelhante, inadequado e discordante das recomendações estabelecidas. Maior tempo de diagnóstico, maior tempo de acompanhamento no serviço, maior nº de avaliações da glicemia capilar, influenciaram positivamente a HbA1c. O parentesco sobre a HbA1c demanda mais estudos enfocando a influência parental no tratamento do Diabético tipo 1 adulto / Abstract: To evaluate the relationship between dietary intake of patients with type 1 diabetes (T1D) followed in reference to their families and service. Cross-sectional study in which were concomitantly evaluated the dietary intake (24-hour recall), the nutritional status (body mass index), as well as the socioeconomic status of families and T1DM. Glycemic control was classified by the index of glycated hemoglobin (A1C). There was a positive correlation between inadequate dietary intake of patients and family members / caregivers to the consumption of carbohydrates, proteins and lipids. The time of diagnosis, follow-up time in the service, number of reviews of capillary blood glucose, insulin dose kg / day and kinship of family members / caregivers were relevant on HbA1c. Dietary intake of both patients and relatives was similar, inappropriate and discordant set of recommendations. Delayed diagnosis, longer follow-up in the service, the greater number of assessments of blood glucose, HbA1C positively influenced. Kinship on A1C demand more studies focusing on parental influence in the treatment of type 1 diabetic adult / Mestrado / Clinica Medica / Mestra em Clínica Médica

Orientador: Ricardo de Lima Zollner / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T01:15:46Z (GMT). No. of bitstreams: 1 Silva_LuisGuilhermeStivanin_M.pdf: 3878753 bytes, checksum: bb8270f964b31680efc65e277f167c0a (MD5) Previous issue date: 2012 / Resumo: Empregando as linhagens de camundongos NOD (non-obese diabetic) de desenvolvimento espontâneo do diabetes mellitus tipo 1 e BALB/c como linhagem controle, administrou-se exogenamente gangliosídeo GM1, mistura de gangliosídeos (GGs) (GM1 21%, GD1a 40%, GD1b 16%, GT1b 19%) e solução salina (0,9% NaCl) estéril da 4ª à 28ª semana de vida. Os efeitos da administração dos gangliosídeos sobre a frequência da manifestação do diabetes, índice de insulite, imunofenotipificação e atividade apoptótica de células presentes em ilhotas pancreáticas de NOD foram verificados por meio de análise glicêmica semanal, técnica colorimétrica com Eosina-Hematoxilina, imunofluorescência e TUNEL. A expressão gênica e os níveis séricos de insulina, além das expressões celular protéica e gênica dos fatores de regeneração GLP-1, PDX-1 e Ngn3 nos tecidos pancreáticos de BALB/c e NOD foram analisados por meio de ELISA, imunofluorescência e RT-PCR em tempo real. Após 28 semanas de tratamento, pôde-se verificar que os animais tratados com GM1 reduziram o diabetes de 70% observado nos animais controle salina, para 38%. Os animais tratados com GGs não apresentaram diabetes. O índice de insulite estava diminuído nos animais tratados com GM1 (p=0.09), GGs (p=0.004) e salina não-diabético (ND) (p=0.02) em relação ao grupo salina diabético (DM). O número de células apoptóticas nas ilhotas dos grupos NOD salina ND e NOD DM estava aumentado em relação aos grupos tratados com GM1 e GGs. Os níveis de insulina sérica estavam aumentados nos grupos BALB/c GGs (p=0.01) e BALB/c GM1 (p=0.03) em relação ao grupo BALB/c salina e nos grupos NOD GGs (p=0.008) e NOD salina ND (p=0.01) em relação ao grupo diabético. Por outro lado, os níveis de expressão gênica de insulina no grupo NOD GM1 (p=0.02) estavam aumentados em relação ao grupo salina. Quanto às expressões protéicas de GLP-1, PDX-1 e Ngn3, em ilhotas pancreáticas e tecido acinar, verificamos aumento no grupo NOD tratado com GGs. O conjunto dos resultados demonstra que os gangliosídeos diminuem a manifestação do diabetes espontâneo na linhagem NOD. Hipotetizamos que uma das propriedades dos gangliosídeos estudados é a de estimular a expressão de GLP-1, PDX-1 e Ngn3 em células do tecido acinar e em células da linhagem endócrina nas ilhotas pancreáticas dos animais tratados seja NOD ou BALB/c. Desta forma abrem-se novas frentes de estudos das propriedades antiinflamatórias e possivelmente regenerativas dos gangliosídeos / Abstract: In the present study we evaluate the properties of GM1 and GGs (21% GM1, 40% GD1a 16% GD1b, 19%GT1b) in NOD (non-obese diabetic) mice and BALB/c as a control lineage. Animals of both lineages were treated with GM1, GGs or saline from 4th to the 28th weeks of life. The ganglioside-treated NOD mice demonstrated a decrease in insulitis compared with saline-treated mice: 70% of saline control animals, 38% of GM1 group and 0% of GGs group. GLP-1 gene expression was increased in GM1-treated BALB/c and in GGs-treated NOD groups in comparison to the saline groups. Insulin gene expression was increased only in the GM1-treated NOD group. Serum insulin levels were increased in ganglioside-treated BALB/c and NOD groups. In the islets, the cell co-labeling of Insulin/GLP1 and somatostatin/GLP1 was increased in NOD and BALB/c gangliosides-treated mice compared to saline-treated mice. PDX-1 and Ngn3 protein expression were increased in pancreatic islets and exocrine tissues of GGs treated NOD mice in comparison to the saline treated group. Results suggest that gangliosides have modulatory properties, decreasing the insulitis score, maintaining of insulin levels, increasing GLP-1 protein expression in ? and ? pancreatic cells and retarding diabetes onset in NOD mice. Similarly to observation in neural tissue, the gangliosides studied could contribute to islets survival. We hypothesize that ganglioside play a role stimulating growth factor expression GLP-1, PDX-1 and Ngn3 in the cells from acinar tissue and islets cells / Mestrado / Clinica Medica / Mestre em Clinica Medica

Chronic illness of a child has an influence over the whole family system. Despite this fact healthy siblings have been overlooked by the majority of research. Some foreign studies declare that this population is in higher risk of developing psychsocial problems. The purpose of this thesis is to conduct a closer study on psychosocial characteristics of the siblings of children with diabetes mellitus type 1. The main concern of the theoretical part is the review of current literature dealing with the topic of siblings of chronically ill child and their families. The conducted research included quantitative and qualitative methods exploring sibling psychosocial problems and prosocial behaviour, self-esteem, siblings attitude towards illness and family functioning. The results stress out the important relationship between sibling adjustment, self-esteem and individual and family characteristics. The results also present the main themes connected with siblings feeling of fear, sadness and anger, with applied coping strategies and perceived rewards and costs of the illness for family. Keywords: siblings, diabetes mellitus type 1, psychosocial situation

Bakgrund: Diabetes Mellitus typ 1 debuterar under barn- och ungdomsåren. Behandlingen är egenvård som innebär blodglukoskontroller, läkemedelsbehandling och att följa rekommendationer om kost och motion. Sjuksköterskans yrkesområde innefattar barn- och ungdomar. Avvikande från egenvårdsaktiviteter och hemlighetsmakeri kring sjukdomen påverkar vårdkvaliteten för ungdomar. Syfte: Att beskriva ungdomars upplevelse av att leva med Diabetes Mellitus typ 1 samt att beskriva de granskade studiernas undersökningsgrupper. Metod: Deskriptiv litteraturstudie med tolv vetenskapliga artiklar med kvalitativ samt kvalitativ- och kvantitativ ansats. Samstämmigheter och olikheter i artiklarnas resultat har kategoriserats och teman och subteman har identifierats. Huvudresultat: En del ungdomar upplevde svårigheter att acceptera sin sjukdom och önskade ha kontroll över och ta eget ansvar för sin sjukdom och öka oberoendet. Ungdomar upplevde känslan av att vara annorlunda och undvek att utföra egenvård i sociala sammanhang. Svårigheter att följa kostrekommendationer varierade och att utföra blodglukoskontroller upplevdes ansträngande. Stöd från vänner och jämnåriga underlättade utförandet av egenvård. Det upplevdes positivt att sjuksköterskor visade intresse för ungdomarnas liv utöver deras DMT1. Sjuksköterskor upplevdes brista i att kunna sätta sig in i ungdomarnas situation och vara ett känslomässigt stöd. Slutsats: Det finns ett behov av ökat stöd och förståelse från sjuksköterskor. Genom ökad förståelse kan sjuksköterskan bidra med stöd för att underlätta överföringen av ansvar. Detta kan leda till en ökad trygghet och känsla av kontroll hos ungdomarna, vilket kan bidra till att de vågar dela med sig av sin sjukdom till omgivningen. / Background: Diabetes Mellitus Type 1 debuts in childhood and adolescence. The treatment is self-care that involves blood glucose control, drug treatment and following recommendations on diet and exercise. Nursing's professional area includes children and adolescents. Deviating from self-care activities and secrecy around the disease affects the quality of care for young people. Purpose: To describe the young people's experience of living with Diabetes Mellitus type 1 as well as describing the study groups of the studies examined. Method: Descriptive literature study with twelve scientific articles with qualitative as well as qualitative and quantitative approach. Consequences and differences in the results of the articles have been categorized and themes and subthemes have been identified. Results: Young people experienced difficulties in accepting their illness and wanted to have control over and take responsibility for their illness and increase independence. Young people experienced the feeling of being different and avoiding self-care in social contexts. Difficulties to follow dietary recommendations varied and blood glucose controls were exerted. Support from friends and peers facilitated the performance of self-care. It was positive that nurses showed interest in the lives of adolescents in addition to their DMT1. Nurses were found to fail to get into the situation of young people and to be an emotional support. Conclusion: There is a need for increased support and understanding from nurses. Through increased understanding, the nurse can help to facilitate the transfer of responsibility. This can lead to increased safety and sense of control among adolescents, which may help them dare to share their illness with the environment.