Li Huan. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (p. 285-306). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Background. Diabetes mellitus is a complex metabolic disorder characterized by clustering of multiple cardiovascular risk factors. Diabetic albuminuria is associated with increased prevalence of both micro-vascular and macro-vascular complications. This thesis examined vascular function (Flow-mediated dilatation, FMD) in type 2 diabetic patients with particular emphasis on its relationships with nephropathy. Independent predictors for FMD in Chinese population using data from both diabetic and non-diabetic subjects as well as the predictive value of FMD on clinical endpoints and death in type 2 diabetic patients with nephropathy were examined. / Conclusions. In Chinese subjects with or without type 2 diabetes, hyperglycaemia, hypertriglyceridemia, smoking and albuminuria were independent predictors for FMD. Type 2 diabetic subjects with overt nephropathy had impaired endothelium-dependent and endothelium-independent dilatation, suggesting vascular dysfunction beyond the endothelium. In agreement with studies from Caucasians, smoking was the most important determinant for vascular dysfunction in Chinese type 2 diabetic patients with overt nephropathy. Furthermore, FMD was predictive of new onset of cardiovascular events and related death in Chinese type 2 diabetic patients with overt nephropathy. / In diabetic patients with overt nephropathy, smoking (current and ex-smokers), waist hip ratio (WHR) and serum creatinine were independent predictors for impaired FMD. The latter was predictive of advancement of IMT and was an independent predictor for new onset of combined cardiovascular diseases and related death after a follow up period of 42 months (log rank test=6.04, p=0.014 using Cox regression analysis) after controlling for all confounding factors. In addition, fasting total cholesterol and plasma glucose were predictive for all-cause mortality while serum creatinine predicted new onset of renal endpoint. In a subgroup analysis in diabetic patients with overt nephropathy, smokers who developed CVD or ESRD had greater diminution of FMD than those who did not develop clinical endpoints. / Methods and results. FMD was assessed using high-resolution ultrasound scan. In the cross-sectional study, the sample population was divided into four groups according to the presence or absence of type 2 diabetes and level of albuminuria. They included the non-diabetic group (N=52), diabetic group with normoalbuminuria (N=18), diabetic group with microalbuminuria (N=18) and diabetic group with overt nephropathy defined as macroalbuminuria and renal insufficiency (N=22). Compared to non-diabetic subjects, type 2 diabetic subjects with nephropathy had impaired FMD (4.54% +/- 2.25 vs. 2.50% +/- 2.31, p<0.05) and impaired GTN-dependent dilatation (GTND) (14.30% +/- 3.77 vs. 12.70% +/- 4.70, p<0.05). They also had reduced endothelium-dependent dilatation to endothelium-independent dilatation ratio when compared to non-diabetic subjects (0.19 +/- 0.17 vs. 0.32 +/- 0.15, p<0.05). These findings suggest that the impaired vascular dilatation was due to dysfunction of both endothelium and vascular smooth muscle cells. In the entire cohort, fasting plasma glucose, fasting triglyceride, smoking and albuminuria were independent predictors for FMD. / Lai Wai Keung Christopher. / "February 2006." / Source: Dissertation Abstracts International, Volume: 67-11, Section: B, page: 6298. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (p. 202-252). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Leung, Yeung Yeung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 134-154). / Abstracts in English and Chinese. / CONTENTS --- p.i / ACKNOWLEDGEMENTS --- p.iv / ABSTRACT --- p.v / 論文摘要 --- p.viii / LIST OF FIGURES --- p.x / LIST OF TABLES --- p.xiv / LIST OF ABBREVIATIONS --- p.xv / Chapter 1. --- INTRODUCTION --- p.1 / Chapter 1.1 --- Brain iron function and diseases --- p.1 / Chapter 1.1.1 --- Function of iron in the brain --- p.1 / Chapter 1.1.2 --- Iron involved oxidative damage --- p.2 / Chapter 1.1.3 --- Role of iron in neurodegenerative diseases --- p.6 / Chapter 1.1.4 --- Role of iron in Alzheimer's disease --- p.7 / Chapter 1.1.5 --- Deleterious effects of iron in memory function --- p.9 / Chapter 1.2 --- Iron regulation in the brain --- p.10 / Chapter 1.2.1 --- Transport and storage of brain iron --- p.10 / Chapter 1.2.2 --- Iron homeostasis in the brain --- p.14 / Chapter 1.2.3 --- Transport of iron in axon and synapse --- p.17 / Chapter 1.3 --- The hippocampus --- p.19 / Chapter 1.3.1 --- Hippocampus and memory function --- p.19 / Chapter 1.3.2 --- Structure of the hippocampus --- p.20 / Chapter 1.3.3 --- Cell composition in the hippocampus --- p.26 / Chapter 1.3.4 --- Wiring in the hippocampus --- p.28 / Chapter 1.4 --- Synaptic plasticity and long term potentiation --- p.30 / Chapter 1.4.1 --- Basic theory of synaptic plasticity --- p.30 / Chapter 1.4.2 --- Types of synaptic plasticity --- p.30 / Chapter 1.4.3 --- The discovery of long term potentiation --- p.31 / Chapter 1.4.4 --- Long term potentiation --- p.32 / Chapter 1.4.5 --- Cellular mechanism of long term potentiation --- p.33 / Chapter 1.4.6 --- Role of reactive oxygen species in long term potentiation --- p.36 / Chapter 1.5 --- Aim of the study --- p.38 / Chapter 2. --- MATERIALS AND METHODS --- p.39 / Chapter 2.1 --- Rat model of iron overload --- p.39 / Chapter 2.2 --- Multi-electrode field potential measurement --- p.40 / Chapter 2.2.1 --- Acute preparation of hippocampal slices --- p.40 / Chapter 2.2.2 --- Multi-electrode array recording system --- p.41 / Chapter 2.2.3 --- Recording of field excitatory postsynaptic potentials --- p.42 / Chapter 2.2.4 --- Induction of LTP --- p.47 / Chapter 2.2.5 --- Recording of paired-pulse ratio --- p.48 / Chapter 2.3 --- Whole cell patch-clamp recordings --- p.50 / Chapter 2.4 --- Biochemical assays --- p.57 / Chapter 2.4.1 --- Preparation of brain homogenate --- p.57 / Chapter 2.4.2 --- Total iron measurement --- p.57 / Chapter 2.4.3 --- Protein carbonyl measurement --- p.58 / Chapter 2.4.4 --- Determination of reactive oxygen species --- p.60 / Chapter 2.5 --- Drugs and data analysis --- p.61 / Chapter 3. --- RESULTS --- p.62 / Chapter 3.1 --- The acute effects of extracellular iron on synaptic transmission and long-term synaptic plasticity in the hippocampus in vitro --- p.63 / Chapter 3.1.1 --- Effects of ferric ion on basal synaptic transmission --- p.63 / Chapter 3.1.1.1 --- Effect of FAC on basal fEPSPs --- p.63 / Chapter 3.1.1.2 --- Comparison with the effect of AC on basal fEPSPs --- p.69 / Chapter 3.1.2 --- Effects of ferric ion on long-term synaptic plasticity --- p.72 / Chapter 3.1.2.1 --- Effect of acute FAC treatment on LTP --- p.72 / Chapter 3.1.2.2 --- Comparison with the effect of AC on LTP --- p.75 / Chapter 3.1.3 --- Effects of ferric chloride --- p.78 / Chapter 3.1.4 --- Effects of ascorbic acid on the action of FAC --- p.81 / Chapter 3.2 --- "The acute, in vitro effect of extracellular iron on the membrane properties and excitability of hippocampal CA1 neurons" --- p.86 / Chapter 3.2.1 --- Membrane input resistance --- p.86 / Chapter 3.2.2 --- Voltage-Current relationship --- p.88 / Chapter 3.2.3 --- Membrane excitability --- p.90 / Chapter 3.2.3.1 --- Threshold current --- p.90 / Chapter 3.2.3.2 --- Action potential firing frequency --- p.92 / Chapter 3.2.4 --- Action potential characteristics --- p.95 / Chapter 3.2.4.1 --- "Action potential amplitude, area and width" --- p.95 / Chapter 3.2.4.2 --- Rise and decay kinetics of action potential --- p.98 / Chapter 3.3 --- The chronic effects of iron-loading in the brain on hippocampal long-term synaptic plasticity --- p.100 / Chapter 3.3.1 --- Validation of the iron-overload model --- p.100 / Chapter 3.3.1.1 --- Short-term (1 week) treatment --- p.100 / Chapter 3.3.1.2 --- Long-term (4 weeks) treatment --- p.103 / Chapter 3.3.2 --- Effects of chornic iron-overloading on LTP --- p.105 / Chapter 3.3.2.1 --- Short term iron treatment --- p.105 / Chapter 3.3.2.2 --- Long term iron treatment --- p.108 / Chapter 3.3.3 --- Oxidative stress measurement --- p.111 / Chapter 3.3.3.1 --- Protein oxidation --- p.111 / Chapter 3.3.3.2 --- Reactive oxidative species level --- p.116 / Chapter 4. --- DISCUSSION --- p.120 / Chapter 4.1 --- "Acute, in vitro effects" --- p.121 / Chapter 4.2 --- "Chronic, in vivo effects" --- p.125 / Chapter 5. --- REFERENCES --- p.134

Xiao, Kang. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 83-103). / Abstracts in English and Chinese. / Abstract --- p.I / 摘要 --- p.VI / Chapter Chapter 1 --- Background --- p.1 / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.2 --- Albuminuria --- p.3 / Chapter 1.2.1 --- Definition --- p.3 / Chapter 1.2.2 --- Albuminuria in adolescents/children --- p.6 / Chapter 1.2.3 --- Prevalence of albuminuria in adults and adolescents --- p.8 / Chapter 1.2.4 --- Pathogenesis of albuminuria --- p.10 / Chapter 1.3 --- CVD and risk factors --- p.12 / Chapter 1.4 --- The associations between microalbuminuria and CVD risk factors --- p.17 / Chapter 1.5 --- Heavy metals --- p.18 / Chapter 1.5.1 --- Definition of heavy metals --- p.18 / Chapter 1.5.2 --- Adverse effects of heavy metals --- p.19 / Chapter 1.5.3 --- Heavy metals exposure In Hong Kong population: the local scene --- p.28 / Chapter 1.6 --- MicroRNAs --- p.29 / Chapter 1.6.1 --- The discovery of microRNAs --- p.29 / Chapter 1.6.2 --- The biogenesis of microRNAs --- p.30 / Chapter 1.6.3 --- The function of microRNAs --- p.31 / Chapter 1.7 --- Hypothesis --- p.40 / Chapter Chapter 2 --- Methodology --- p.41 / Chapter 2.1 --- Population --- p.41 / Chapter 2.2 --- Laboratory assays --- p.42 / Chapter 2.3 --- Statistical analysis --- p.44 / Chapter Chapter 3 --- Results --- p.46 / Chapter 3.1 --- Demographic and baseline clinical data --- p.46 / Chapter 3.2 --- Microalbuminuria and cardiovascular risk factors --- p.48 / Chapter 3.3 --- Microalbuminuria and heavy metals --- p.51 / Chapter 3.4 --- Microalbuminuria and miRNAs --- p.54 / Chapter 3.5 --- "Microalbuminuria, miRNAs, heavy metals and cardiovascular risk factors" --- p.57 / Chapter 3.6 --- miRNAs and heavy metals --- p.60 / Chapter Chapter 4 --- Discussion --- p.62 / Chapter 4.1 --- Heavy metals and microalbuminuria --- p.62 / Chapter 4.2 --- Heavy metals and CVD risk factors --- p.68 / Chapter 4.3 --- Microalbuminuria and CVD risk factors --- p.75 / Chapter 4.4 --- miRNAs and Heavy metals --- p.76 / Chapter 4.5 --- miRNAs and microalbuminuria --- p.77 / Chapter 4.6 --- Conclusion --- p.79 / Acknowledgement --- p.82 / References --- p.83

No description available.

The treatment of spontaneous pneumothorax in the civilian population can be influenced by the age of the patient and the presence of associated pulmonary disease. The medical records of 130 patients who presented with 168 occurrences of SP were reviewed during an 11-year period (1973 to 1984). Follow-up was from a minimum of 30 months to 13 years (mean 6.3 years). The therapeutic options included observation alone (40 occurrences), thoracentesis (6 occurrences), chest tube thoracostomy (102 occurrences), and thoracotomy (20 occurrences). Treatment of SP should be prompt with the objective of complete re-expansion of the lung and prevention of recurrent pneumothorax. This should be accomplished by the use of chest tube thoracostomy with early addition of thoracotomy as necessary. Selected use of thoracentesis can be effective. The use of observation alone can be dangerous and is associated with a higher recurrence rate.

A doença cardiovascular (DCV) é uma condição clínica comum entre pacientes (pcts) portadores de doença renal crônica (DRC) e é causa de eventos fatais observados peri transplante renal (TX). A melhor estratégia de avaliação cardiovascular em candidatos a transplante (CTR) ainda é controversa.Ignora-se se todos os pacientes devem ser submetidos a testes não-invasivos/invasivos ou se estes devem ser reservados aqueles com determinadas características clínicas, como população geral. O objetivo deste estudo foi comparar a estratificação de risco baseada em método nãoinvasivo de detecção de doença coronária com dois métodos de estratificação clínica de risco cardiovascular preconizados pela American Society of Transplantation (AST) e European Renal Association (ERA). A AST subdivide os pcts em : alto risco (idade maior ou igual a 50 anos e/ou diabete e/ou DCV clínica) e baixo risco (os demais). A ERA subdivide em: alto risco (DCV clínica), risco intermediário (diabéticos e/ou idade maior ou igual a 50 anos) e baixo risco (os demais). Nós estudamos 386 pcts com DRC em diálise enviados ao nosso serviço para avaliação cardiovascular antes da inclusão na lista de espera de TX. Foram estratificados quanto ao risco de eventos de acordo com os dois algoritmos acima e alterações na cintilografia de perfusão miocárdica (SPECT-MIBI) com dipiridamol e acompanhados até a morte, TX ou ocorrência de eventos. A estratificação clínica (RR:1,8 [IC95% 1,3 2,6- P<0,0001] e o SPECT-MIBI (RR:1,5 [IC95% 1,2-1,9-P=0,002] identificaram os pcts de maior risco de eventos cardiovasculares . Apenas os pcts ASTalto risco (RR1,4 [IC95%1,1-1,8-P=0,002] e ERA médio risco com SPECTMIBI alterado (RR:1,7 [IC95% 1,2-2,3-P=0,003] tiveram maior incidência de eventos. Os pcts de baixo risco pelos dois algorítmos de estratificação clínica (P=0,50) e do sistema ERA alto risco (RR:1,1 [IC95% 0,8-1,5-P=0,41], não se beneficiaram dos resultados do estudo não-invasivo. Concluímos que os estudos não-invasivos não devem ser utilizados em todos os CTR mas devem ser reservados aos pcts previamente identificados pela estratificação clínica de risco. Esses resultados permitem uma abordagem mais racional da avaliação pré- TX com melhor uso dos recursos econômicos escassos. / Cardiovascular (CV) disease is a common condition in chronic kidney disease (CKD) patients and is the leading cause of fatal events during and after renal transplantation. The best strategy for CV evaluation and coronary risk stratification in renal transplant candidates remains controversial. Moreover, there is no consensus regarding the best strategy for detection of coronary artery disease (CAD). We still do not know if all patients should be evaluated by noninvasive testing or if this approach should be restricted to individuals with clinical evidence of CAD, as in the general population. The objective of this study was to compare CV risk stratification based on nonivasive testing for CAD with two clinical stratification methods as advanced by The American Society of Transplantation (AST) and by The European Renal Association (ERA), respectively. The AST divides patients in high risk (age50 years and/or diabetes and/or CV disease) and low risk (all others).The ERA divides : high risk (CV disease), intermediate risk (age 50 years and/or diabetes), and low risk (as above). We studied 386 CKD patients treated by hemodyalisis, to CV evaluation before being admitted to the renal transplant waiting list. All patients were stratified for the risk of future major cardiovascular events (MACE) using the clinical algorithms and also by myocardial scintigraphy (SPECT-MIBI) with dipyridamol and followedup until death, transplant or MACE. Clinical algorithms (RR:1,8 [IC95% 1,3 2,6-P<0,0001] and SPECT-MIBI(RR:1,5 [IC95% 1,2-1,9-P=0,002] identified patients at increased risk of events. The combined use of clinical stratification followed by SPECT showed that the only patients that would benefit from SPECT risk stratification were those belonging the AST-high risk (RR1,4 [IC95%1,1-1,8-P=0,002] and ERA-intermediate risk groups (RR:1,7 [IC95% 1,2-2,3-P=0,003]. In all other groups :ERA-high-risk (RR:1,1[IC95% 0,8-1,5- P=0,41] and ERA and AST-low-risk (P=0,50) SPECT did not add to the probability of events defined by clinical stratification alone. We conclude that SPECT should not be applied to all renal transplant candidates but should be restricted to those considered at a category of risk as defined by clinical algorithms. These results delineate a more rational approach to risk stratification in renal transplant candidates with a better utilization of economical resources.

Made available in DSpace on 2015-07-22T20:50:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-04-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Introdução: O acidente vascular cerebral isquêmico (AVCi) é geralmente um evento catastrófico, particularmente em pacientes com idade maior ou igual a 80 anos. A idade avançada já é um fator de risco para AVCi e o acometimento cardiovascular é a principal causa de AVCi nessa população. A fibrilação atrial também (FA) é um importante fator de risco para AVCi, por isso os esquemas de estratificação de risco são importantes na indicação de tratamento antitrombótico e prevenção do AVCi nestes pacientes. Além disso, nível socioeconômico baixo tem sido descrito como um fator de maior risco para AVCi. Objetivos: Avaliar a prevalência dos fatores de risco cardiovasculares em pacientes com idade maior ou igual a 80 anos em uma população hospitalar com AVCi. Avaliar a relação desta doença com o nível socioeconômico em diferentes grupos etários, utilizando um novo modelo de estratificação socioeconômica. Método: Análise retrospectiva de pacientes consecutivos com diagnóstico de AVCi num serviço de saúde terciário. Nesta população, nós descrevemos a prevalência dos fatores de risco cardiovasculares e para os pacientes com FA, nos aplicamos os esquemas de estratificacao CHADS2 score e CHA2DS2-VASc score. Para avaliar a relacao entre nivel socioeconomico e AVCi, avaliamos a incidencia de AVCi em dois hospitais que atendem populacoes de diferentes niveis socioeconomicos da cidade de Sao Paulo, classificando os pacientes com uma nova ferramenta de segmentacao geografica socioeconomica. Os pacientes foram estratificados por nivel socioeconomico e idade (30 a 64 anos, 65 a 79 anos e maior ou igual a 80 anos). Nos tambem comparamos o numero de pacientes com AVCi com pacientes de um grupo controle dos mesmos hospitais, calculando a taxa de AVCi em cada hospital. O odds ratio entre as taxas de AVCi dos dois hospitais foi calculada. Resultados: Houve um predominio do sexo feminino (p<0.01) em 215 pacientes admitidos com AVCi. Considerando os pacientes com idade maior ou igual a 80 anos, 72% tinham hipertensao arterial sistemica (HAS) e a FA foi mais comum entre os mais idosos (p<0.01). Dentre os pacientes com FA, nenhum apresentou CHADS2 score de 0 e 25.5% tiveram score de 1 previamente ao AVCi. Todos os pacientes com CHADS2 score de 1 nao estavam em uso de anticoagulante oral, mas tinham CHA2DS2-VASc score . 2, apresentando indicacao para este tratamento. Trezentos e setenta e sete pacientes com AVCi e 2.297 pacientes do grupo controle foram estudados nos dois hospitais. Houve uma maior proporção de pacientes mais idosos na população de nível socioeconômico mais alto (χ2obs= 28.7, gl= 2, p-value < 0.0001). Em todas as idades, a taxa de AVCi foi significativamente mais alta nos pacientes com nível socioeconômico mais baixo quando comparado com os pacientes com nível socioeconômico mais alto, com χ2obs=21.3 (valor de p< 0.0001) para idade de 30 a 64 anos; χ2obs=39.8 (valor de p< 0.0001) para idade de 65 a 79 anos; e χ2obs=14.1 (valor de p= 0.0002) para pacientes com idade maior ou igual a 80 anos. O odds ratios entre as taxas de AVCi nos dois hospitais foi de 2.4, 3.6 e 2.7 para os grupos etários 30 a 64 anos, 65 a 79 anos e maior ou igual a 80 anos, respectivamente. Conclusão: HAS e FA são fatores de risco prevalentes e devem ser sempre considerados para tratamento em idosos. Estratificação de risco com CHA2DS2-VASc score poderia ter otimizado a indicação de anticoagulação oral em nossos pacientes. Nosso estudo mostrou que, em uma população estudada do município de São Paulo, nível socioeconômico baixo é associado a mais altas taxas de AVCi, independente da idade. / Background and Purpose – Ischemic stroke is usually a catastrophic event, mostly in the elderly. Advanced age itself is a risk factor for stroke and cardiovascular involvement is the leading cause of ischemic stroke in this age population. Atrial fibrillation is also an important risk factor for ischemic stroke and therefore risk stratification schemes are important in these patients for indicating antithrombotic therapyand prevent stroke. Low socioeconomic status is also associated with a higher risk for ischemic stroke. Objectives - To evaluate the prevalence of cardiovascular risk factors in patients with age 80 or older in a hospital population with ischemic stroke and the relationship between socioeconomic status and ischemic stroke in different age groups, using a new socioeconomic stratification model. Methods – Retrospective analysis of consecutive patients diagnosed with ischemic stroke admitted to a tertiary health facility. For this population, we described the prevalence of cardiovascular risk factors and, for the patients who had the diagnosis of atrial fibrillation, we applied CHADS2 score and CHA2DS2-VASc score. For assessment of the relationship beteween socioeconomic status and ischemic stroke, we evaluated the incidence of ischemic stroke in two hospitals that serve different socioeconomic populations in Sao Paulo, with a new geographic socioeconomic segmentation tool. The patients were stratified by socioeconomic status and age (30 to 64 years, 65 to 79 years and 80 years or older). We also compared the number of ischemic stroke patients with patients from control groups from the same hospitals, to obtain the ischemic stroke rates in both hospitals. The odds ratio between ischemic stroke rates in the hospitals was calculated. Results .There was a female preponderance (p<0.01) in 215 patients admitted for ischemic stroke. Considering patients over eighty, 72% had hypertension and atrial fibrillation was more common among the oldest old (p<0.01). Among those patients who had ischemic stroke and atrial fibrillation, no patient had CHADS2 score of 0 and 25.5% had score of 1. All patients with CHADS2 score of 1 were not under anticoagulation, but in retrospect, had CHA2DS2-VASc score . 2, i.e., with indication for oral anticoagulation. Three hundred and seventy-seven patients with ischemic stroke and 2,297 patients of control group were analyzed in both hospitals. There was a greater proportion of older patients in the higher socioeconomic status population (χ2obs= 28.7, df= 2, p-value < 0.0001). In all ages, the odds of ischemic stroke was significantly higher in patients with lower socioeconomic status than in those with higher status, with χ2obs=21.3 (p-value< 0.0001) for age 30 to 64 years; χ2obs=39.8 (p-value< 0.0001) for age 65 to 79 years; and χ2obs=14.1 (p-value= 0.0002) for ≥ 80 years patients. The odds ratios between ischemic stroke odds in both hospitals were 2.4, 3.6 and 2.7 for groups of ages 30 to 64 years, 65 to 79 years and 80 years or older, respectively. Conclusions – Hypertension and atrial fibrillation are prevalent risk factors and should be treated aggressively in the elderly. Risk stratification using CHA2DS2-VASc score would have optimized indication for oral anticoagulation in our patients. Our study showed that, in São Paulo, lower socioeconomic status is associated with a higher odds of ischemic stroke, independent of age. / TEDE / BV UNIFESP: Teses e dissertações

A doença cardiovascular (DCV) é uma condição clínica comum entre pacientes (pcts) portadores de doença renal crônica (DRC) e é causa de eventos fatais observados peri transplante renal (TX). A melhor estratégia de avaliação cardiovascular em candidatos a transplante (CTR) ainda é controversa.Ignora-se se todos os pacientes devem ser submetidos a testes não-invasivos/invasivos ou se estes devem ser reservados aqueles com determinadas características clínicas, como população geral. O objetivo deste estudo foi comparar a estratificação de risco baseada em método nãoinvasivo de detecção de doença coronária com dois métodos de estratificação clínica de risco cardiovascular preconizados pela American Society of Transplantation (AST) e European Renal Association (ERA). A AST subdivide os pcts em : alto risco (idade maior ou igual a 50 anos e/ou diabete e/ou DCV clínica) e baixo risco (os demais). A ERA subdivide em: alto risco (DCV clínica), risco intermediário (diabéticos e/ou idade maior ou igual a 50 anos) e baixo risco (os demais). Nós estudamos 386 pcts com DRC em diálise enviados ao nosso serviço para avaliação cardiovascular antes da inclusão na lista de espera de TX. Foram estratificados quanto ao risco de eventos de acordo com os dois algoritmos acima e alterações na cintilografia de perfusão miocárdica (SPECT-MIBI) com dipiridamol e acompanhados até a morte, TX ou ocorrência de eventos. A estratificação clínica (RR:1,8 [IC95% 1,3 2,6- P<0,0001] e o SPECT-MIBI (RR:1,5 [IC95% 1,2-1,9-P=0,002] identificaram os pcts de maior risco de eventos cardiovasculares . Apenas os pcts ASTalto risco (RR1,4 [IC95%1,1-1,8-P=0,002] e ERA médio risco com SPECTMIBI alterado (RR:1,7 [IC95% 1,2-2,3-P=0,003] tiveram maior incidência de eventos. Os pcts de baixo risco pelos dois algorítmos de estratificação clínica (P=0,50) e do sistema ERA alto risco (RR:1,1 [IC95% 0,8-1,5-P=0,41], não se beneficiaram dos resultados do estudo não-invasivo. Concluímos que os estudos não-invasivos não devem ser utilizados em todos os CTR mas devem ser reservados aos pcts previamente identificados pela estratificação clínica de risco. Esses resultados permitem uma abordagem mais racional da avaliação pré- TX com melhor uso dos recursos econômicos escassos. / Cardiovascular (CV) disease is a common condition in chronic kidney disease (CKD) patients and is the leading cause of fatal events during and after renal transplantation. The best strategy for CV evaluation and coronary risk stratification in renal transplant candidates remains controversial. Moreover, there is no consensus regarding the best strategy for detection of coronary artery disease (CAD). We still do not know if all patients should be evaluated by noninvasive testing or if this approach should be restricted to individuals with clinical evidence of CAD, as in the general population. The objective of this study was to compare CV risk stratification based on nonivasive testing for CAD with two clinical stratification methods as advanced by The American Society of Transplantation (AST) and by The European Renal Association (ERA), respectively. The AST divides patients in high risk (age50 years and/or diabetes and/or CV disease) and low risk (all others).The ERA divides : high risk (CV disease), intermediate risk (age 50 years and/or diabetes), and low risk (as above). We studied 386 CKD patients treated by hemodyalisis, to CV evaluation before being admitted to the renal transplant waiting list. All patients were stratified for the risk of future major cardiovascular events (MACE) using the clinical algorithms and also by myocardial scintigraphy (SPECT-MIBI) with dipyridamol and followedup until death, transplant or MACE. Clinical algorithms (RR:1,8 [IC95% 1,3 2,6-P<0,0001] and SPECT-MIBI(RR:1,5 [IC95% 1,2-1,9-P=0,002] identified patients at increased risk of events. The combined use of clinical stratification followed by SPECT showed that the only patients that would benefit from SPECT risk stratification were those belonging the AST-high risk (RR1,4 [IC95%1,1-1,8-P=0,002] and ERA-intermediate risk groups (RR:1,7 [IC95% 1,2-2,3-P=0,003]. In all other groups :ERA-high-risk (RR:1,1[IC95% 0,8-1,5- P=0,41] and ERA and AST-low-risk (P=0,50) SPECT did not add to the probability of events defined by clinical stratification alone. We conclude that SPECT should not be applied to all renal transplant candidates but should be restricted to those considered at a category of risk as defined by clinical algorithms. These results delineate a more rational approach to risk stratification in renal transplant candidates with a better utilization of economical resources.

A doença de Alzheimer é responsável por mais da metade dos quadros de demência e ainda não se conhece a sua cura. Portanto, quando se levanta esta hipótese diagnóstica, os pacientes e as famílias se confrontam com as implicações desta doença, que apresenta um curso com declínio progressivo e global das funções cognitivas. A presente pesquisa teve como objetivo geral estudar as repercussões psicossociais que ocorrem na família de pacientes com a doença de Alzheimer. Especificamente, pretendeu-se identificar os sentimentos vivenciados e as necessidades sentidas pela família. Trata-se de uma pesquisa qualitativa e a amostra pesquisada foi composta por seis familiares de pacientes portadores da Doença de Alzheimer, que foram atendidos no Ambulatório de Neurologia Cognitiva e do Comportamento (ANCC), do Hospital Geral de Areias, em Recife. O instrumento foi um roteiro de entrevista contendo questões relacionadas aos objetivos e aos dados sóciodemográficos dos familiares. A técnica utilizada para análise dos dados foi a Análise de Conteúdo Temática. Os resultados apontaram que o ato de cuidar de um familiar com a doença de Alzheimer acarreta sentimentos de ansiedade, perplexidade, impotência e tristeza, os quais se intensificam com o agravamento do quadro. As principais repercussões ocorridas no contexto familiar referem-se a uma mudança na sua rotina e na relação estabelecida entre o paciente e os demais membros da família. Quando o cuidado é assumido por uma única pessoa, o desgaste físico e mental interfere na saúde, na vida social e, conseqüentemente, na qualidade de vida do cuidador. Neste estudo, percebemos a importância de que se ampliem a discussão e o conhecimento sobre a doença de Alzheimer, focalizados na família e, especialmente, no cuidador. Espera-se que ele possa oferecer respostas úteis aos profissionais que lidam com o tema, para elaborarem intervenções mais direcionadas e efetivas, assim como às famílias que buscam orientação e ajuda para minimizar seu sofrimento psíquico