Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-08-26T22:54:47Z No. of bitstreams: 1 ThaisTeixeiraDosSantos_DISSERT.pdf: 2050154 bytes, checksum: c36701c9eedb7a6bcc1d9a377927dadf (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-08-30T20:05:59Z (GMT) No. of bitstreams: 1 ThaisTeixeiraDosSantos_DISSERT.pdf: 2050154 bytes, checksum: c36701c9eedb7a6bcc1d9a377927dadf (MD5) / Made available in DSpace on 2016-08-30T20:05:59Z (GMT). No. of bitstreams: 1 ThaisTeixeiraDosSantos_DISSERT.pdf: 2050154 bytes, checksum: c36701c9eedb7a6bcc1d9a377927dadf (MD5) Previous issue date: 2016-03-30 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / A doen?a renal cr?nica se caracteriza pela perda progressiva e irrevers?vel das fun??es renais a partir de uma doen?a ou ap?s uma insufici?ncia renal aguda, podendo causar problemas do sono e dist?rbios no metabolismo, absor??o e excre??o de nutrientes, prejudicando o estado nutricional. A m? qualidade do sono est? presente entre 80% dos pacientes renais e pode afetar diversos mecanismos relacionados ao funcionamento do nosso organismo, tais como a imunidade, as fun??es cognitivas e as manifesta??es afetivas. J? as altera??es nutricionais tamb?m s?o muito frequentes em pacientes com DRC e, entre as m?ltiplas causas dessa doen?a, destacam-se: a ingest?o deficiente de nutrientes, catabolismo, uremia, dist?rbios endocrinol?gicos e do equil?brio eletrol?tico. Devido ?s complica??es relacionadas com uremia, metabolismo, imunidade, maior susceptibilidade a doen?as inflamat?rias e cardiovasculares e ao risco aumentado de morte associados a uma qualidade de sono ruim e a um status nutricional inadequado, avaliaram-se as vari?veis qualidade do sono e qualidade nutricional de pacientes com doen?a renal cr?nica no pr? e p?s-transplante renal em um hospital universit?rio do munic?pio de Natal, Rio Grande do Norte. O estudo contou com 10 pacientes. No pr?-transplante renal houve associa??o dos sintomas de ansiedade com ins?nia, narcolepsia e s?ndrome das pernas inquietas (SPI); do uso de medicamentos para dormir com narcolepsia e SPI. No p?s-transplante renal, apneia esteve relacionada com a ansiedade e com o uso de medicamentos para dormir; a ins?nia e a narcolepsia com diabetes e hipoteiroidismo. O peso esteve relacionado com lat?ncia do sono, cochilos e qualidade de sono; o IMC e a circunfer?ncia da cintura com a lat?ncia do sono. Foi poss?vel concluir que, ap?s o transplante renal, houve melhora significativa na qualidade de sono, al?m de redu??o dos sintomas indicativos de dist?rbios do sono. O estado nutricional de modo geral tamb?m foi elevado assim como o aporte energ?tico-prot?ico. / Chronic kidney disease is characterized by progressive and irreversible loss of kidney function from an illness or after an acute renal failure, may cause sleep problems and impairing the nutritional status. The quality of bad sleep is present among 80% of renal patients and can affect immunity, cognitive functions and emotional manifestations. Already nutritional changes are related to poor nutrient intake, catabolism, uremia, endocrinological disorders and electrolyte balance. Because of the complications mentioned, we evaluated the variables sleep quality and nutritional status of patients with chronic kidney disease before and after renal transplantation in a university hospital of Natal, Rio Grande do Norte. The study included 10 patients and applied the sociodemographic questionnaire and for control over the variables, the Hospital Anxiety and Depression Scale. To evaluate the quality of sleep was used Sleep Quality Index of Pittsburgh, the Journal Sleep, Sleepiness Scale Epworth and H?biots Sleep Questionnaire; for sleep disorders Sleep Disorder Screening Questionnaire and the assessment of nutritional status Nutritional Subjective Global Assessment Modified, food surveys and laboratory tests. In pre-renal transplantation was associated symptoms of anxiety with insomnia, narcolepsy and restless legs syndrome (RLS); the use of sleep medications with narcolepsy and SPI. In post-renal transplant, apnea was associated with anxiety and the use of medications to sleep; insomnia and narcolepsy with diabetes and hipoteiroidismo. The weight was related to sleep latency, quality of sleep and naps; BMI and waist circumference with sleep latency. It was concluded that, after renal transplantation, there was significant improvement in quality of sleep, and reduction of the target symptoms of sleep disorders. The general nutritional status has also improved, as well as protein-energy contribution.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-06-27T17:53:00Z No. of bitstreams: 1 LuisAlcidesDeLucenaMarinho_DISSERT.pdf: 1320162 bytes, checksum: cef9d2a20ccf311289d904d465faabe9 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-06-29T21:36:17Z (GMT) No. of bitstreams: 1 LuisAlcidesDeLucenaMarinho_DISSERT.pdf: 1320162 bytes, checksum: cef9d2a20ccf311289d904d465faabe9 (MD5) / Made available in DSpace on 2016-06-29T21:36:17Z (GMT). No. of bitstreams: 1 LuisAlcidesDeLucenaMarinho_DISSERT.pdf: 1320162 bytes, checksum: cef9d2a20ccf311289d904d465faabe9 (MD5) Previous issue date: 2015-08-07 / INTRODU??O: A doen?a renal cr?nica (DRC) ? um problema de sa?de mundial, com preval?ncia crescente no seu est?gio terminal, fatos que podem ser justificados pela falha no reconhecimento da doen?a e dos seus fatores de risco. OBJETIVO: Avaliar o perfil de conhecimento de m?dicos residentes (MR) e m?dicos preceptores (MP) em hospitais da Universidade Federal do Rio Grande do Norte em Natal-RN - Brasil, sobre a DRC, com base na diretriz do Kidney Disease Outcomes Quality Initiative (KDOQI). M?TODOS: Estudo de corte transversal, onde 64 MR (R1=32; R2=15; R3=17) e 63 MP responderam um question?rio baseado na diretriz do KDOQI, dividido em sete sess?es, abordando aspectos da DRC desde a defini??o, at? o encaminhamento ao nefrologista. RESULTADOS: Apenas 20 participantes (15.7%) informaram utilizar alguma diretriz para o manejo da DRC. Os scores obtidos por sess?o foram: Defini??o e classifica??o (46.1?47.8); Fatores de risco (70.5?27.9); Avalia??o laboratorial (58.2?8.8); Plano de a??o cl?nica (57.6?19.9); Redu??o da protein?ria (68.3?15.0); Complica??es (64.8?19.9); Encaminhamento ao nefrologista (73.0?44.6). Observamos que houve uma diferen?a estatisticamente significante entre o conhecimento dos MR e MP nas sess?es: Avalia??o laboratorial (MR 61.5?8.4 vs MP 54.8?7.9; p<0.001); Redu??o da protein?ria (MR 73.1?11.4 vs MP 63.5?16.7; p<0.001) e Encaminhamento ao nefrologista (MR 81.2?39.3 vs MP 64.5?48.2; p=0.035). Entre os MR, os R2 obtiveram a melhor pontua??o (R1 63.9?22.6 vs R2 71.9?17.2 vs R3 63.5?22.5; p=0.445). Observamos um baixo percentual de acerto dos m?dicos sobre a defini??o da DRC (MP=46%; R1=40.6%; R2=60%; R3=52.9%; p=0.623), assim como a classifica??o da DRC (MP=34.9%; R1=53.1%; R2=60%; R3=52.9%; p=0.158). CONCLUS?O E CONSIDERA??ES FINAIS: Diretrizes para DRC s?o pouco utilizadas por m?dicos que, mesmo atuando em ambiente universit?rio, ainda exp?em lacunas no conhecimento sobre o tema. Nesse sentido, propomos a realiza??o de uma oficina para os m?dicos participantes e estudantes do internato da UFRN, utilizando estrat?gias educacionais centradas no estudante, no sentido de fortalecer a incorpora??o das diretrizes da DRC no ensino de gradua??o e na pr?tica cl?nica de m?dicos em geral. / INTRODUCTION: Chronic kidney disease (CKD) is a global health problem, with increasing prevalence in its terminal stage and one of the factors that can contribute is the failure to recognize the disease and its risk factors. OBJECTIVE: To evaluate the knowledge of medical residents (MR) and medical preceptors (MP) in hospitals in the Federal University of Rio Grande do Norte in Natal-RN - Brazil, on the DRC, based on the policy of the Kidney Disease Improving Global Outcomes (KDIGO ). METHODS: Cross-sectional study where 64 MR (R1 = 32; R2 = 15; R3 = 17) and 63 MP answered a questionnaire divided into seven sessions that addressed aspects of the DRC since the setting up referral to a nephrologist. RESULTS: Only 20 participants (15.7%) reported using any guidelines for the management of CKD. The scores obtained by session were: Definition and classification (46.1 ? 47.8); Risk factors (70.5 ? 27.9); Laboratory evaluation (58.2 ? 8.8); Clinical action plan (57.6 ? 19.9); Reduction in proteinuria (68.3 ? 15.0); Complications (64.8 ? 19.9); Referral to a nephrologist (73.0 ? 44.6). There was a statistically significant difference between the knowledge of MR and MP in the sessions: Laboratory evaluation (MR 61.5 ? 8.4 vs 54.8 ? 7.9 MP; p <0.001); Reduction in proteinuria (73.1 ? 11.4 vs MR MP 63.5 ? 16.7; p <0.001) and Referral to a nephrologist (MR 81.2 ? 39.3 vs 64.5 ? 48.2 MP; p = 0.035). Among the MR, the R2 obtained the best score (63.9 ? 22.6 vs R1 R2 R3 71.9 ? 17.2 vs 63.5 ? 22.5, p = 0.445). It identified a low percentage of success of the doctors on the definition of CKD (MP = 46%; R1 = 40.6%; R2 = 60%; R3 = 52.9%; p = 0.623) and classification (MP = 34.9%; R1 = 53.1%, R2 = 60%; R3 = 52.9%; p = 0.158). CONCLUSION: The study showed that most doctors do not use any guidelines for clinical management of CKD and that there are gaps in knowledge on the subject, even among physicians who work in the university environment. In this sense, we propose the realization of mini-workshops for participants and students from boarding UFRN, using Case-Based Learning Strategy (CBL), with small group discussion, to strengthen the incorporation of CKD guidelines in undergraduate teaching and in clinical medical practice in general.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2018-03-13T13:00:59Z No. of bitstreams: 1 MabelleAlvesFerreiraDeLima_DISSERT.pdf: 1207975 bytes, checksum: 05ebcc203d3c42173700e4d39eb4bf9b (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2018-03-19T16:38:35Z (GMT) No. of bitstreams: 1 MabelleAlvesFerreiraDeLima_DISSERT.pdf: 1207975 bytes, checksum: 05ebcc203d3c42173700e4d39eb4bf9b (MD5) / Made available in DSpace on 2018-03-19T16:38:35Z (GMT). No. of bitstreams: 1 MabelleAlvesFerreiraDeLima_DISSERT.pdf: 1207975 bytes, checksum: 05ebcc203d3c42173700e4d39eb4bf9b (MD5) Previous issue date: 2017-12-04 / A hipovitaminose D tem sido demonstrada em doentes renais. Nos indiv?duos submetidos ao transplante renal, pode causar progress?o da albumin?ria, aumentando o decl?nio da fun??o renal e o risco de perda de enxerto. O objetivo do estudo ? avaliar o status da vitamina D em indiv?duos submetidos ao transplante renal e sua rela??o com os par?metros da fun??o renal no tempo zero, 3 meses e 6 meses p?s-transplante. Trata-se de um estudo longitudinal desenvolvido com 49 transplantados renais no per?odo de agosto de 2015 a janeiro de 2017. No tempo zero foram exclu?dos 3 indiv?duos devido a suplementa??o de vitamina D (n=46), nos 3 meses houve 1 ?bito, 1 desist?ncia e 2 rejei??es ajudas do enxerto (n=43) e aos 6 meses 1 paciente apresentou rejei??o aguda do enxerto (n=42). Os indiv?duos foram submetidos ? avalia??o antropom?trica, avalia??o da exposi??o solar, an?lises bioqu?micas, incluindo 25-hidroxivitamina D [25(OH)D], e coleta de urina para avaliar a rela??o albumina: creatinina (RAC) em todos os tempos estudados. A taxa de filtra??o glomerular (TFG) foi estimada pela equa??o da Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). A idade mediana dos indiv?duos foi de 44 anos, a maioria do sexo masculino (60,9%; n=28) e a etnia parda (73,9%; n=34). Houve uma predomin?ncia de indiv?duos com hipovitaminose D nos tr?s tempos estudados. Os indiv?duos com status de vitamina D adequado nos 6 meses p?s-transplante apresentaram exposi??o solar significativamente maior em compara??o aos indiv?duos com hipovitaminose D (p = 0,008). Nos 6 meses p?s-transplante, 45,2% dos indiv?duos (n = 19) apresentaram hipovitaminose D em todos os momentos e 19,1% (n = 8) desenvolveram hipovitaminose D aos 3 meses, totalizando 27 indiv?duos com esse perfil. Desses, 37,0% (n = 10) n?o apresentaram melhora na TFG. A RAC de indiv?duos com hipovitaminose D foi maior aos 6 meses p?s-transplante em rela??o ao grupo com status adequado (p = 0,037) e correlacionada negativamente com o 25(OH)D (r = - 0,358; p = 0,02). O paratorm?nio (PTH) apresentou uma influ?ncia negativa na TFG no tempo zero e correlacionou-se positivamente com a RAC aos 6 meses ap?s o transplante (r = 0,420; p = 0,007). Em conclusao, existe uma alta frequ?ncia de hipovitaminose D nos indiv?duos at? 6 meses ap?s o transplante renal, sendo este status poss?velmente relacionado as altera??es observadas na fun??o renal do enxerto.S?o necess?rios mais estudos que apoiem interven??es, tais como suplementa??o de vitamina D, a fim de suportar os resultados obtidos para os pacientes neste est?gio p?s-transplante renal. / Hypovitaminosis D has been a frequent finding in renal patients. In kidney transplant recipients, this may cause progression of albuminuria, increasing the decline in renal function and the risk of graft loss. The objective of this study was to evaluate the vitamin D status in kidney transplant recipients and its relation with renal function parameters at time zero, 3 months and 6 months post-transplantation. This is a longitudinal study with 46 kidney transplant recipients from August 2015 to January 2017. At zero time, 3 subjects were excluded due to vitamin D supplementation (n = 46), in 3 months there was 1 death, 1 (n = 43) and at 6 months 1 patient presented acute rejection of the graft (n = 42). The subjects were evaluated using anthropometric evaluation, a sun exposure questionnaire, biochemical evaluation, including 25-hydroxyvitamin D [25(OH)D], and urine collection to evaluate the albumin: creatinine ratio (ACR) at all times studied. The glomerular filtration rate (GFR) was computed by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. The median age of the subjects was 44 years, predominantly males (60.9%; n=28), and with brown ethnicity (73.9%; n=34). Most of the subjects had hypovitaminosis D during the three studied periods. In subjects with adequate Vitamin D status at 6 months post-transplant, the sun exposure was significantly lower. At 6 months post-transplant, 45.2% (n=19) presented with hypovitaminosis D at all times, and 19.1% (n=8) developed hypovitaminosis D at 3 months, totalizing 27 individuals with this profile. Of these, 37.0% (n=37) had no improvement in the GFR. The ACR of subjects with hypovitaminosis D were higher at six months post-transplant (p=0.037). This was negatively correlated with the 25(OH)D (r=- 0.358; p=0.02). The parathyroid hormone (PTH) had a negative influence on GFR at time zero but was positively correlated with ACR at six months post-transplantation (r=0.420; p=0.007). Therefore, there is a high frequency of hypovitaminosis D up to 6 months after renal transplantation, which may be related to greater changes in graft renal function. More studies are needed to support interventions, such as supplementation, in order to obtain better results after renal transplantation.