La cristallisation des protéines est une étape cruciale dans l’élucidation de la structure tridimensionnelle des protéines. C’est un processus très délicat qui dépend de nombreuses variables environnementales dont le contrôle précis est difficile, voire impossible, dans les installations typiquement utilisées. Des approches basées sur la parallélisation massive des expériences et la réduction du volume d’échantillon par expérience, pour trouver les conditions initiales de cristallisation, montrent leur relative efficacité dans la recherche de ces conditions initiales mais aussi leurs limites quant à l’optimisation des cristaux obtenus.La méthode présentée dans cette thèse diffère de ce paradigme. La démarche proposée est une approche séquentielle plutôt que la parallélisation d’expériences et est basée sur la connaissance des diagrammes de phase. Cette thèse repose sur une suite de développements d’instruments mis en oeuvre pour maîtriser et rationaliser la cristallisation par la méthode de la dialyse, permettant ainsi l’exploration des diagrammes de phases sans consommer l’échantillon de protéine.Il en résulte un dispositif microfluidique permettant la cristallisation de protéines par la méthode de la dialyse, l’utilisation d’un flux continu d’agent de cristallisation et par conséquent l’échange continu de conditions de cristallisation ainsi que le contrôle de la température au cours de l’expérience. Il est compatible avec le rayonnement X pour la collecte de données de diffraction in situ sur les cristaux ayant poussés dans la puce microfluidique. Ce système microfluidique est basé sur la miniaturisation du banc de cristallisation qui a été amélioré d’un point de vue : de l’électronique pour l’automatisation, du transport de fluides pour le fonctionnement en flux continu, du développement logiciel pour le contrôle des paramètres de cristallisation, de la mécanique pour améliorer la cellule de dialyse et la thermorégulation, et enfin par l’intégration d’un système UV permettant de réaliser des mesures d’absorbance in situ qui offre pour l’avenir la possibilité de mesurer la solubilité de protéine au cours d’une expérience de cristallisation par la dialyse.Finalement les développements instrumentaux et méthodologiques ont été validés par la cristallisation de plusieurs protéines modèles dont les cristaux ont diffractés aux rayons X avec succès. En outre le transport d’espèces en solution par la dialyse a été étudié par une approche combinée expérimentale et théorique. / Protein crystallization is a key step in elucidating three-dimensional structure of proteins. This very sensitive process depends on many variables that are difficult to control precisely or simultaneously in the existing facilities. Instrumentation developments have concentrated on massive parallel experiments and sample volume reduction used by experiment. With this approach it is relatively easy to find initial crystallization conditions but their optimization to yield well diffracting crystals often proves to be more difficult.The method presented herein differs from the current paradigm, since we propose serial instead of parallel experiments based on the knowledge of phase diagrams. This project is based on a series of developments of instruments used to control and rationalize crystallisation using dialysis method, thus allowing phase diagrams exploration without consuming large quantity of protein sample.This results in a microfluidic device that allows crystallization of proteins by dialysis method, use of a continuous flow of crystallization agent and therefore continuous exchange of crystallization conditions as well as temperature control during experiment. It provides X-rays compatibility for in situ diffraction data collection of crystals grown in the microfluidic chip. This microfluidic system is based on the miniaturization of the crystallization bench which has been improved on electronics for automation, fluid transport to operate at a continuous flow, software development for the control of crystallization parameters, mechanics to improve both dialysis cell and thermoregulation, and finally by the integration of a UV system to perform in situ absorbance measurements that provide the future possibility to measure the solubility of proteins in a dialysis crystallization experiment.Finally both instrumental and methodological developments have been validated by the crystallization of several model proteins whose crystals diffracted succesfully X-rays. Furthermore understanding of the transport of species in solution by dialysis was investigated by combined experimental and theoretical approaches.

Orientador: Priscylla Tatiana Chalfun Guimarães [Unesp] Okamoto / Resumo: A Hemodiálise Intermitente (HDI) é uma modalidade de substituição renal, que vem sendo utilizada nas últimas décadas na veterinária nos casos de remoção de drogas, distúrbios hidroeletrolíticos, lesão renal aguda e doença renal crônica (DRC) em crise urêmica. O objetivo do estudo consistiu em avaliar o efeito da hemodiálise intermitente, instituída em cães DRC, em comparação aos manejados apenas com tratamento clínico, sem diálise, visando proporcionar uma melhor qualidade de vida. Foram selecionados 12 cães com DRC no estádio III e 25 cães DRC no estádio IV pelos critérios de inclusão, randomizados em grupo controle (n=6) no estádio III e (n=11) no estádio IV, onde foi preconizado apenas tratamento clínico e fluidoterapia, e grupo hemodiálise (n=6) no estádio III e (n=14) no estádio IV, em que além do tratamento clínico, foi realizada a hemodiálise intermitente. As coletas de sangue para avaliação laboratorial foram realizadas antes e após a fluidoterapia e antes e após a hemodiálise intermitente. As intercorrências e os parâmetros clínicos foram avaliadas a cada 30 minutos durante a HDI. A eficácia das sessões de HDI foi avaliada por meio da mensuração da taxa de remoção da ureia (URR). A instituição do tratamento dialítico promoveu uma eficaz diminuição das concentrações séricas de ureia, creatinina e fósforo em ambos estádios, porém com diminuição da sobrevida dos cães no estádio III. Apesar da evidente remoção dos compostos nitrogenados, é necessária uma constante avalia... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Intermittent Hemodialysis (IHD) is a modality of renal replacement that has been used in the last decades in the veterinarian in cases of drug withdrawal, hydroelectrolytic disorders, acute kidney injury and chronic kidney disease (CKD) in uremic crisis. The objective of the study was to evaluate the effect of intermittent hemodialysis, instituted in dogs CKD, in comparison to those managed only with clinical treatment, without dialysis, in order to provide a better quality of life. Twelve dogs with stage III CKD and 25 stage four CKD dogs were selected by inclusion criteria, randomized in a control group (n = 6) in stage III and (n = 11) in stage IV, where only clinical treatment was recommended and and hemodialysis group (n = 6) in stage III and (n = 14) in stage IV, in which, in addition to clinical treatment, intermittent hemodialysis was performed. Blood samples for laboratory evaluation were performed before and after fluid therapy and before and after intermittent hemodialysis. Intercurrences and clinical parameters were assessed every 30 minutes during IHD. The efficacy of the IHD sessions was assessed by measuring the urea removal rate (URR). The establishment of the dialytic treatment promoted an effective decrease in the serum concentrations of urea, creatinine and phosphorus in both stages, but with a decrease in the survival of dogs in stage III. Despite the obvious removal of the nitrogen compounds, a constant evaluation of the hematological and serum biochemica... (Complete abstract click electronic access below) / Mestre

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No. of bitstreams: 1 geraldes_ss_me_bot.pdf: 2708926 bytes, checksum: b9570de413ca4e3c069dbc02803bfc8d (MD5) Previous issue date: 20-09-20 / A Hemodiálise Intermitente (HDI) é uma modalidade de substituição renal, que vem sendo utilizada nas últimas décadas na veterinária nos casos de remoção de drogas, distúrbios hidroeletrolíticos, lesão renal aguda e doença renal crônica (DRC) em crise urêmica. O objetivo do estudo consistiu em avaliar o efeito da hemodiálise intermitente, instituída em cães DRC, em comparação aos manejados apenas com tratamento clínico, sem diálise, visando proporcionar uma melhor qualidade de vida. Foram selecionados 12 cães com DRC no estádio III e 25 cães DRC no estádio IV pelos critérios de inclusão, randomizados em grupo controle (n=6) no estádio III e (n=11) no estádio IV, onde foi preconizado apenas tratamento clínico e fluidoterapia, e grupo hemodiálise (n=6) no estádio III e (n=14) no estádio IV, em que além do tratamento clínico, foi realizada a hemodiálise intermitente. As coletas de sangue para avaliação laboratorial foram realizadas antes e após a fluidoterapia e antes e após a hemodiálise intermitente. As intercorrências e os parâmetros clínicos foram avaliadas a cada 30 minutos durante a HDI. A eficácia das sessões de HDI foi avaliada por meio da mensuração da taxa de remoção da ureia (URR). A instituição do tratamento dialítico promoveu uma eficaz diminuição das concentrações séricas de ureia, creatinina e fósforo em ambos estádios, porém com diminuição da sobrevida dos cães no estádio III. Apesar da evidente remoção dos compostos nitrogenados, é necessária uma constante avaliação do perfil hematológico e bioquímico sérico para evitar distúrbios derivados da redução indesejada dos compostos, para evitar danos posteriores ao paciente. / Intermittent Hemodialysis (IHD) is a modality of renal replacement that has been used in the last decades in the veterinarian in cases of drug withdrawal, hydroelectrolytic disorders, acute kidney injury and chronic kidney disease (CKD) in uremic crisis. The objective of the study was to evaluate the effect of intermittent hemodialysis, instituted in dogs CKD, in comparison to those managed only with clinical treatment, without dialysis, in order to provide a better quality of life. Twelve dogs with stage III CKD and 25 stage four CKD dogs were selected by inclusion criteria, randomized in a control group (n = 6) in stage III and (n = 11) in stage IV, where only clinical treatment was recommended and and hemodialysis group (n = 6) in stage III and (n = 14) in stage IV, in which, in addition to clinical treatment, intermittent hemodialysis was performed. Blood samples for laboratory evaluation were performed before and after fluid therapy and before and after intermittent hemodialysis. Intercurrences and clinical parameters were assessed every 30 minutes during IHD. The efficacy of the IHD sessions was assessed by measuring the urea removal rate (URR). The establishment of the dialytic treatment promoted an effective decrease in the serum concentrations of urea, creatinine and phosphorus in both stages, but with a decrease in the survival of dogs in stage III. Despite the obvious removal of the nitrogen compounds, a constant evaluation of the hematological and serum biochemical profile is necessary to avoid disorders derived from the undesired reduction of the compounds, to avoid further damage to the patient.

INFECTIOUS COMPLICATIONS IN CHRONIC RENAL FAILURE Infections represent a serious problem in chronic kidney disease (cohort and they are) associated with signifficant morbidity and mortality. The thesis originated in the nephrology division of the Department of Internal Medicine I., Charles University Teaching Hospital and Medical Faculty in Pilsen, an institution with a long standing research activity in the field. In the theoretical part of this work, a general summary of infectious complications in chronic kidney disease population is presented. The other part of this work presents results of our research dealing with pharmacoeconomical aspects of cytomegalovirus infection and finally our results in the field of influenza vaccination. The Aim of the first presented work was to evaluate the cost impact of four different strategies for prevention of cytomegalovirus infection after renal transplantation. We provide post hoc analysis of 2 randomized studies performed in our department and calculating direct CMV-related expenses using valacyclovir prophylaxis, ganciclovir prophylaxis, preemptive vlaganciclovir treatment and deferred therapy. To simulate ihe impact of varying prices of prharmacotherapy or diagnostic procedures, a sensitivity analysis was performed. With respect to our results, valacyclovir...

Orientador: Priscylla Tatiana Chalfun Guimarães-Okamoto / Resumo: A dimetilarginina simétrica (SDMA) é um aminoácido formado da metilação da arginina, liberada na corrente sanguínea durante a degradação proteica e excretada principalmente pela urina. Este aminoácido foi descoberto há 45 anos, presente na urina humana e estudado como possível biomarcador pela sua aparente estrita excreção renal e por suas concentrações serem altamente correlacionadas com a da taxa de filtração glomerular (TFG) em animais e seres humanos. Recentemente, este biomarcador foi validado e inserido na Medicina Veterinária pelo seu rico valor no diagnóstico precoce da doença renal crônica (DRC), assim como na sua monitoração ao longo da doença e também como um biomarcador alternativo na avaliação da TFG. Este trabalho visou avaliar o comportamento da SDMA em pacientes com DRC classificados no estádio 4 submetidos à terapia de hemodiálise intermitente e no grupo controle, bem como comparar e correlacionar seus valores com a creatinina sérica (sCr) em ambos os grupos. Foram avaliados 24 animais, todos previamente diagnosticados e classificados no estádio 4. SDMA e sCr foram avaliados antes e após os protocolos terapêuticos. Os resultados obtidos foram a diminuição da concentração sérica de SDMA e sCr após o tratamento dialítico. Já no grupo fluído houve a diminuição dos valores de sCr e inversamente, o aumento das concentrações séricas de SDMA. Assim, apesar do SDMA ser um excelente biomarcador de TFG e de diagnóstico precoce da DRC, este não pode ser utilizado para a... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Symmetrical dimethylarginine (SDMA) is an amino acid formed from the methylation of arginine, released into the bloodstream during protein degradation and excreted primarily by urine. This amino acid was discovered 45 years ago in human urine and studied as a possible biomarker due to be strictly eliminated by renal excretion and its concentrations highly correlates with glomerular filtration rate (GFR) in animals and humans. Recently, this biomarker was validated and inserted in Veterinary Medicine for its rich value in the early diagnosis of chronic kidney disease (CKD) as well as its monitoring throughout the disease and as an alternative biomarker in the evaluation of GFR. This study aimed to evaluate the behavior of SDMA in dogs with CKD in stage 4 submitted to intermittent hemodialysis therapy and in the control group, as well as to compare and correlate their values with serum creatinine (sCr) in both groups. We evaluated 24 animals, all previously diagnosed and classified in stage IV. SDMA and sCr were evaluated before and after the therapeutic protocol. The results obtained were lower serum concentrations of SDMA and sCr after the dialytic treatment. However, in the fluid therapy group, inversely sCr levels lowered while SDMA serum concentrations increased . Thus, despite SDMA is an excellent biomarker of GFR and early diagnostic CKD, we do not recommend its use for diagnosis and follow up in dogs undergoing intermittent hemodialysis. / Mestre

Submitted by repositorio ufvjm (repositorio@ufvjm.edu.br) on 2017-01-10T10:52:39Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) evandro_silveira_de_oliveira.pdf: 3657139 bytes, checksum: c42584f30e68c8e424c7de51074af2cc (MD5) / Approved for entry into archive by repositorio ufvjm (repositorio@ufvjm.edu.br) on 2017-01-10T10:58:35Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) evandro_silveira_de_oliveira.pdf: 3657139 bytes, checksum: c42584f30e68c8e424c7de51074af2cc (MD5) / Made available in DSpace on 2017-01-10T10:58:35Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) evandro_silveira_de_oliveira.pdf: 3657139 bytes, checksum: c42584f30e68c8e424c7de51074af2cc (MD5) Previous issue date: 2015 / Justificativa: Considerou-se que o impacto do tratamento odontol?gico na qualidade de vida e na autoestima de pacientes submetidos ? hemodi?lise ainda n?o est? esclarecido, sendo necess?rios novos estudos de base populacional para melhor conhecimento dos efeitos dessa patologia. Objetivo: Verificar se o tratamento odontol?gico minimamente invasivo ? capaz de gerar melhoria na qualidade de vida e na autoestima de pacientes submetidos a hemodi?lise. M?todos: Realizou-se um estudo intervencional com 46 pacientes Submetidos ? hemodi?lise na cidade de Diamantina, Brasil. Os pacientes foram divididos em dois grupos de acordo com a presen?a ou n?o de dentes; dentados e desdentados. Os pacientes desdentados receberam informa??o sobre higiene bucal e realizaram bochechos com gluconato de clorexidina a 0,12%. O grupo dentado recebeu raspagem em sess?o ?nica de 45 minutos e tamb?m realizou o bochecho, caso fosse necess?rio tamb?m eram realizados: resinas anteriores, recontorno de restaura??es, fechamento de cavidades com cimento de ion?mero de vidro e exodontias de emerg?ncia. As informa??es sobre as condi??es de sa?de bucal e fatores socioecon?micos foram obtidas atrav?s de um prontu?rio aplicado por um cirurgi?o dentista. A qualidade de vida foi avaliada atrav?s do instrumento Medical Outcomes Study 36-Item Short Form Health Questionnaire (SF-36) e Oral Health Impact Profile (OHIP) na sua vers?o 14. J? para a autoestima utilizou-se a Escala de Autoestima de Rosenberg. Os question?rios foram aplicados antes do tratamento e ap?s 45 dias. As an?lises estat?sticas foram efetuadas com o pacote estat?stico SPSS? para Windows? (Statistical Package for the Social Sciences Inc., IBM) na vers?o 22.0. Foram realizadas an?lises descritivas, teste de Wilcoxon, Mann_Whitney e Spearman. O n?vel de signific?ncia adotado foi de 5% (p<0,05). Resultados: A m?dia de idade foi 50,24 anos (?15,60) e o ?ndice CPO-D m?dio foi de 21,83 (?11,12). Houve signific?ncia estat?stica nas dimens?es do SF-36 no grupo ed?ntulo e dentado. O grupo dentado apresentou signific?ncia em quase todas as dimens?es do OHIP-14 e melhora da autoestima. Conclus?es: O tratamento odontol?gico gerou melhora significativa da qualidade de vida e da autoestima dos pacientes submetidos ? hemodi?lise, sendo o impacto maior nos pacientes que possuem dentes. / Disserta??o (Mestrado) ? Programa de P?s-Gradua??o em Odontologia, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2015. / Background: The impact of dental treatment on quality of life and self-esteem of patients undergoing hemodialysis is not clear, requiring population-based studies to better understand the effects of this disease. Objective: To verify if the minimally invasive dental treatment is able to improve quality of life and self-esteem of hemodialysis patients. Methods: It was an interventional study with 46 patients subjected to hemodialysis in the city of Diamantina, Brazil. The patients were divided into two groups according to the presence or absence of teeth; toothed and toothless. The edentulous patients received information about oral hygiene and performed mouthwash with 0.12% chlorhexidine gluconate. The dentate group received one session scraping in 45 minutes and also held the mouthwash, if necessary were performed: previous resins, restorations recontouring, closing cavities with glass ionomer cement and emergency extractions. Information on oral health status and socioeconomic factors were obtained through a chart applied by a dentist. Quality of life was assessed using the instrument Medical Outcomes Study 36-Item Short Form Health Questionnaire (SF-36) and Oral Health Impact Profile (OHIP) in their version 14. As for the self-esteem used the Rosenberg Self-Esteem Scale. The questionnaires were applied before treatment and after 45 days. Statistical analyzes were performed with the statistical package SPSS for Windows (Statistical Package for Social Sciences Inc., IBM) in version 22.0. Descriptive analyzes were carried out, Wilcoxon test and Spearman Mann_Whitney. The significance level was 5% (p <0.05). Results: The mean age was 50.24 years (? 15.60) and the average DMFT index was 21.83 (? 11.12). There was statistical significance in the dimensions of the SF-36 in edentulous and dentate group. The dentate group showed significance in almost all dimensions of OHIP-14 and improved self-esteem. Conclusions: The treatment produced a significant improvement in quality of life and self- esteem of patients undergoing hemodialysis. The largest impact occured on patients who have teeth.

Peritoneal dialysis is one of the possibilities of the chronic renal failure treatment. Its advantage is that the patient is treated alone in his home environment. The main indication of this method is the inability to secure vascular access for hemodialysis. Contraindications include damage to the peritoneum and adhesions in the abdominal cavity. The principle of the method is the exchange of solutes between blood and dialysis solution filled into the peritoneal cavity. Timely and proper education by the nurse is the most important precondition for successful treatment with peritoneal dialysis. The thesis is focused on the role of nurses in the education of patients with peritoneal dialysis. It deals mainly with issues of patient education in connection with the occurrence of complications during their treatment. The first section describes the problems of peritoneal dialysis, including technical aspects, complications and their treatment. Furthermore, the attention is focused on the automated peritoneal dialysis, which takes place mostly at night and therefore the patient has more time to care about his normal daily activities. The second section of the theoretical part is devoted to education. The first target of the research was the examination of the effect of educational activities on the occurence of complications. Before starting treatment, patients have always been educated about the issues of this kond of treatment. The informative materials about the treatment and its related complications were also provided. Some of them did look up the information on the internet, and they discussed it further with the nurse. All of the respondents were able to name and describe the symptoms of complications occurring at the beginning and during the therapy. The second goal was to compare awareness among patients with frequent complications compared to those with the least complications. We did not find any benchmark to determine, whether the inconvenience was caused y the degree of unawareness of the patients, or their attitude to the treatment. The discussion will reflect on the question, which errors did subsequently led to the complications. The third objective was to compare the incidence of complications on patients with APD compared to patients on CAPD. With CAPD, the patient opens and closes the transfer set at least 4 times a day, thereby increasing the risk of infection through the peritoneal catheter. The research shows that among respondents undergoing the APD treatment method, the number of complications is lower. It is not possible to determine, whether the numer of complications on APD is lower due to minimal use of the peritoneal catheter, or because some patients on CAPD have already suffered the complications and have been instructed to approach the APD more responsibly. The empirical part of the thesis is presented by a qualitative research. The survey was carried out in the form of non-standardized interview based on prepared questions, which were extended during interviews. The research group consists of ten patients from dialysis clinics in Tabor, Ceske Budejovice and Jindrichuv Hradec. The patients on CAPD and APD were of different ages and with different duration of treatment. Peritoneal dialysis is the elimination method of replacing the kidneys function, and it is performed by the patient himself, in their own social environment. A prerequisite for successful treatment is high-quality patient education, which is mainly provided by the nurse. This introductory education continues with ongoing reeducation. The results of this thesis may be used as the basis for further research. They can also be used as study material for students of nursing fields. Created brochure can help the patients to decide, how to select the treatment method, or mastering the problems of this treatment.

Introdução: A hemodiálise (HD) requer um acesso vascular funcionante para sua realização. A fístula arteriovenosa nativa (FAV) constitui-se no acesso ideal para essa prática, com menores índices de morbidade e trombose e melhor qualidade de vida. A estenose da FAV é a maior causa de trombose e perda do acesso vascular. A monitorização continuada dos acessos através de diferentes métodos pode reduzir a incidência de trombose da FAV, conforme indicado por estudos com controle histórico e não-randomizados. Objetivos: Avaliar se uma estratégia intervencionista através de ecografia com Doppler (ED), angiografia digital (AD) e angioplastia (ATP) reduz a incidência de trombose e necessidade do uso de cateter em veia central temporário (CVC) em relação ao manejo conservador em pacientes com FAV em programa de HD. Métodos: Estudo prospectivo randomizado controlado de 108 pacientes e 111 FAV em programa de HD durante 11 meses. No grupo controle, foram realizadas mensurações quinzenais de parâmetros hemodinâmicos durante sessões de HD. No grupo intervenção, além da mensuração dos parâmetros hemodinâmicos, foi realizada ED a cada três meses, seguido de AD em casos de disfunção do acesso, definida pela ocorrência de pelo menos 1 dos seguintes critérios: redução do frêmito da FAV, aumento das pressões venosas, pobre fluxo arterial ou formação de hematoma ou edema no membro superior recorrentes durante HD, e/ ou pela presença de estenose vascular maior que 50% e/ou um fluxo estimado inferior à 500ml/min na ED. Em estenoses angiográficas superiores a 50% foi realizada ATP. Os desfechos avaliados foram trombose e necessidade de implantação de CVC, bem como desfecho composto, dado pela associação dos desfechos referidos. Resultados: Foram randomizadas 58 FAV para o grupo controle e 53 FAV para o grupo intervenção. Não foram observadas diferenças significativas entre os grupos em relação aos dados demográficos, comorbidades e características do acesso. O tempo médio de seguimento foi de 7,5 meses. No grupo intervenção, foram realizadas 97 ED, com média de 1,83 exame por paciente. Foram indicadas 14 AD, sendo que um paciente não compareceu ao estudo. Foi evidenciada trombose da FAV em 4 casos, e estenose não-significativa em 1. Estenose significativa foi observada em 8 pacientes, sendo então realizada ATP nesses casos. Não houve diferença significativa entre os grupos quanto à incidência de trombose (24,1% vs 17,0% p=ns). A estratégia intervencionista determinou redução significativa na incidência de necessidade de CVC (25,9% vs 7,5%, p=0,021), e na incidência do desfecho composto (44,8% vs 20,8%, p=0,033). Conclusões: A estratégia intervencionista no manejo das FAV promoveu uma redução significativa da necessidade de CVC e do desfecho composto de trombose e CVC. / Background: Hemodialysis (HD) requires a functioning vascular access in appropriate conditions. Native arteriovenous fistulae (NAF) provide the ideal access for that practice. Stenosis of the NAF is the highest cause of thrombosis and loss of the HD vascular access. The continuous monitorization of the NAF through different methods reduce the incidence of thrombosis according to non-randomized studies with historical control. Objective: To evaluate an interventionist strategy through the follow up of the NAF with Color Flow Doppler ultrasound (US), digital angiography and transluminal angioplasty (ATP), when suitable, to reduce the thrombosis and need for the use of a temporary central vein catheter (CVC) rates in relation to the conservative strategy. Methods: A prospective randomized controlled study of 108 patients and 111 permanent vascular access in an HD program. In the control group, assesment of the hemodynamic parameters of the vascular access were performed every fiftheen days. In the intervention group , besides the assesment of the hemodynamic parameters, was submitted to US every three months, as well as with angiography in cases that presented criteria for dysfunction of the access, defined by the occurrence of at least 1 of the following: reduction of the thrill; increase of the vein pressure during HD sessions; impossibility of obtaining a flow of 300 ml/min during HD; recurring hematoma or edema formation and/or the presence of larger vascular stenoses than 50% or a flow lower than 500ml/min at the US. The patients that presented angiographic evidence of hemodymically significant stenoses were submitted to ATP. The primary outcomes were need for temporary CVC during the follow up, FAV thrombosis and composite outcome. The outcomes were compared between the groups at the end of a 11 months period of follow-up. Results: Fifht eight FAV were randomized to control group and 53 FAV to interventional group. No significant differences were observed between the groups in relation to the demographic data, comorbidities and characteristics of the access. The NAF studied were followed up for a mean time of 7,5 months. In the interventional group, 97 US were performed, with an average of 1,83 exam per patient. A total of 14 digital angiography were required, and evidenced thrombosis in 4 patients and nonsignificant stenosis in 1. Significant stenosis was observed in 8 patients, and ATP was performed in those cases. No statistically significant difference was observed between the groups in thrombosis rates 24,1% vs 17,0%, p=ns). The interventional strategy showed statistically significant redution in the incidence of the need for placement of CVC (25,9% vs 7,5%, p=0,021). The differences in the composite outcome was statistically significant (44,8% vs 20,8%, p=0,033). Conclusions : The interventional strategy promoted a significant reduction rates for the need of placement of central vein catheter and of the combined outcome in the studied sample, showing benefits in patients with FAV in hemodialysis program.

p. 1-116 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-09T19:56:18Z No. of bitstreams: 1 DISSERTACAO_DE_MESTRADO_MARIA_HELENA_GUSMAO seg.pdf: 422680 bytes, checksum: 13c973ea27fcacc1aed66fde60a1152e (MD5) / Approved for entry into archive by Rodrigo Meirelles(rodrigomei@ufba.br) on 2013-04-10T17:49:04Z (GMT) No. of bitstreams: 1 DISSERTACAO_DE_MESTRADO_MARIA_HELENA_GUSMAO seg.pdf: 422680 bytes, checksum: 13c973ea27fcacc1aed66fde60a1152e (MD5) / Made available in DSpace on 2013-04-10T17:49:04Z (GMT). No. of bitstreams: 1 DISSERTACAO_DE_MESTRADO_MARIA_HELENA_GUSMAO seg.pdf: 422680 bytes, checksum: 13c973ea27fcacc1aed66fde60a1152e (MD5) Previous issue date: 2007 / Avaliar a associação entre desnutrição, inflamação e outros fatores de risco para doença cardiovascular em pacientes sob diálise peritoneal contínua. Métodos Estudo transversal, envolvendo 61 pacientes em Diálise Peritoneal Contínua em duas Unidades de Diálise em Salvador-Ba. O estado nutricional foi avaliado por meio da Avaliação Subjetiva Global. Realizou-se a dosagem de Proteína C Reativa Ultra Sensível para determinar inflamação. Foram estudados fatores de risco tradicionais para Doença cardiovascular, como sexo, idade, etilismo, tabagismo, sedentarismo, hipertensão, diabetes, dislipidemia e hábitos alimentares e fatores não tradicionais, como alterações no metabolismo de cálcio e fósforo e anemia. Nesta população 36% dos pacientes encontravam-se desnutridos e 49,2% com processo inflamatório. Desnutrição e inflamação foram evidenciadas em 21,3% dos pacientes. O grupo de pacientes desnutridos apresentou níveis maiores de Proteína C Reativa Ultra Sensível do que aqueles de pacientes com bom estado nutricional (p=0,04). Não foram evidenciadas associações entre desnutrição na presença de inflamação e outros fatores de risco para Doença Cardiovascular. A desnutrição ainda é freqüente nos pacientes sob Diálise Peritoneal Contínua, assim como a inflamação. Ambos agravos estão associados nesta população, contudo não há associação entre desnutrição na presença de inflamação e os outros fatores de risco para doença cardiovascular. / Salvador

Made available in DSpace on 2015-07-22T20:49:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-10-27 / Introdução A incidência de insuficiência renal crônica em crianças tem se mantido estável nas últimas décadas, mas a prevalência quase triplicou. Apesar de a melhor opção de tratamento para essa patologia ser o transplante renal, a maioria dos pacientes necessita de meses a anos de diálise antes do procedimento. Metade dos pacientes pediátricos inicia a terapia de reposição renal em hemodiálise. Infecção relacionada ao acesso vascular é uma grande preocupação nesses pacientes, porque a maioria da população pediátrica começa a hemodiálise usando um cateter como acesso vascular Métodos De outubro de 2006 a abril de 2009, o sistema de vigilância de infecção de corrente sanguínea proposto pelo Centers for Disease Control and Prevention foi conduzido prospectivamente em uma unidade extra-hospitalar de hemodiálise pediátrica. Resultados Durante o estudo, 30 pacientes pediátricos foram incluídos. O sexo masculino foi predominante e a média de idade foi de 9,5 anos. A maioria dos pacientes (73%) começou o estudo com cateter como acesso vascular. A média do tempo de permanência dos cateteres permanentes foi de 170,6 dias e das fístulas de 2,2 anos. As principais razões para a remoção de cateteres foram problemas mecânicos e infecção. Um a cada três pacientes foi hospitalizado a cada mês e 20% faleceram. Foram relatados 181 eventos e 450 pacientes-mês. A taxa de infecção relacionada ao acesso vascular foi de 21,1 por 100 pacientes-mês, e variou de 16,7 por 100 pacientes-mês, em pacientes com cateter temporário, a 30 por 100 pacientes-mês, naqueles com cateter permanente. Staphylococcus aureus foi o microrganismo mais frequentemente identificado em 34% dos isolados, com uma taxa de resistência a oxacilina de 21%. Conclusão Nosso estudo demonstrou um cenário muito diferente do que o observado nos pacientes adultos, com maiores taxas de infecção relacionada ao acesso vascular nas crianças. Esta vigilância ajudará na identificação e monitoramento das taxas locais, na implementação de estratégias para a prevenção de infecção associada ao acesso vascular e na avaliação da efetividade das intervenções de prevenção na população pediátrica em hemodiálise. / Background: Hemodialysis vascular access infections are a great concern in children with end stage renal disease because in the majority of the pediatric population a venous catheter is used for the initiation of hemodialysis. Methods: From October 2006 to April 2009, the bloodstream infection surveillance system proposed by the Centers for Disease Control and Prevention was prospectively conducted in a pediatric outpatient hemodialysis unit. Results: Thirty pediatric patients were included. Male gender was predominant and mean age was 9.5 years. Most patients (73%) had a catheter for vascular access at study entry. While the mean permanent catheter duration was 170.6 days, it was 2.2 years for fistulas. The main reasons for catheter removal were mechanical problems and infection. During the period of study, one in three patients were hospitalized each month and 20% of them died. We reported 181 events and 450 patients-month. The rate of vascular access infection was 21.1 per 100 patients-month, 16.7 per 100 patients-month for patients on temporary catheters and 30 per 100 patients-month for those on permanent catheters. Staphylococcus aureus was the microorganism most frequently identified, having been isolated in 34% of the blood samples. Conclusions: Our study showed different results than what is observed in adult patients, with higher rates of vascular access infection in children. The use of this surveillance system will help identify and monitor local infection rates, implement strategies for preventing vascular access infection and evaluate the effectiveness of interventions to prevent infections in the pediatric population on hemodialysis. / TEDE / BV UNIFESP: Teses e dissertações