Submitted in partial fulfilment of the requirements for the Degree of Masters in Technology: Clinical Technology, Durban University of Technology, 2013. / Introduction : Effusive constrictive pericarditis (ECP) is a clinical syndrome characterized by concurrent pericardial effusion and pericardial constriction where constrictive haemodynamics are persistent after the pericardial effusion is removed. Although first observed in the 1960s, it was not until the publication of a 13 patient-case series by Hancock in 1971, and the prospective cohort publication by Sagrista-Sauleda in 2004, that more information about the aetiology, incidence, and prognosis of effusive-constrictive pericarditis became known (Sagrista-Sauleda, Angel, Sanchez, Permanyer-Miralda, and Soler-Soler 2004). Hancock (1971) first recognized that some patients presenting with cardiac tamponade did not have resolution of their elevated right atrial pressure after removal of the pericardial fluid. In these patients, pericardiocentesis converted the haemodynamics from those typical of tamponade to those of constriction. Thus, the restriction of cardiac filling was not only due to the pericardial effusion but also resulted from pericardial constriction (predominantly the visceral pericardium). The hallmark of effusive-constrictive pericarditis is the persistence of elevated right atrial pressures after the intrapericardial pressure has been reduced to normal levels by the removal of the pericardial fluid. Aims and Objectives : This study was carried out to determine the prevalence of ECP in a cohort of patients with large effusions of Tuberculosis origin. The primary objective was to measure pre and post- pericardiocentesis intrapericardial and right atrial cardiac pressures in all patients undergoing pericardiocentesis in order to determine the relative proportion of effusive constrictive pericarditis in these patients. The secondary objective was to determine if any echocardiographic features can help predict the presence of ECP by studying the three parameters two-week post-pericardiocentesis. Methodology : Fifty consecutive patients with pericarditis presenting to Groote Schuur Hospital and surrounding hospitals referred for pericardiocentesis, who met the inclusion criteria were recruited to participate in the study. All patients had the right atrial and intrapericardial pressures simultaneously measured and recorded, before and after pericardiocentesis. The pressures were analyzed to determine the presence of ECP, which was defined as failure of the right atrial pressure to fall by 50% or to a new level of ≤12 mmHg after the intrapericardial pressure is lowered to below 2 mmHg. Participants also had an echocardiogram done two weeks post pericardiocentesis. Three echocardiographic features of constriction were studied, to determine if they can predict the presence of ECP. The parameters studied were 1) Thickened pericardium, 2) Dilated inferior vena cava (IVC) and 3) Septal bounce. Results : This study showed a 34% (17 0f 50) prevalence of ECP in patients with TB pericarditis. It also showed a statistically difference in the right atrial and intrapericardial pressures pre and post pericardiocentesis, between patients with ECP and those without. The echocardiographic parameters studied showed no difference between ECP and non ECP, and also did not predict the presence of ECP. Discussion : In the cohort of patients (n=50), the prevalence of ECP was found to be 34%. This is much higher than that observed in the Sagrista-Sauleda et al., (2004) study. They found a prevalence of 1.3% amongst patients with pericardial disease of any type and 6.95% amongst patients with clinical tamponade. The authors did state that they expected the true prevalence to be higher than estimated as not all patients underwent catheterization. Pre-pericardiocentesis pressures, both right atrial and intrapericardial, were found to be higher in patients with ECP than in those without. This is in keeping with published results, such as the study of Hancock (1971) The echocardiographic parameters studied were two weeks post pericardiocentesis, because the diagnostic accuracy of echocardiogram has been shown to be very poor at the time of tamponade. The presence of these parameters (thickened pericardium, dilated IVC and septal bounce), did not predict the presence of ECP. This could be due to the fact that less than 50% of participants had an echocardiogram two weeks post pericardiocentesis. Conclusions : The results of this study show that ECP is actually more common than thought in a population with TB pericarditis. This syndrome may be missed in most patients due to the fact that not all centres measure right atrial and intrapericardial pressures at the time of pericardiocentesis. Echocardiography is not able to predict the presence of ECP. Other non-invasive imaging techniques such is computerized tomography (CT) and cardiac magnetic resonance imaging (CMRI) have shown good results in diagnoses of ECP. The importance of early diagnosis of ECP lies in recognition that removal of pericardial fluid alone may not be enough; patients may need to have surgery. Given the high prevalence shown by the study, ideally all patients with pericardial effusion should have haemodynamic monitoring at the time of pericardiocentesis.

The term 'gum', in its broadest sense, refers to both hydrophobic and hydrophilic substances of high molecular weight which usually exhibit colloidal properties when dispersed in an appropriate solvent. Hydrophobic substances often called gums include high molecular weight hydrocarbons and other petroleum products, rubbers, certain synthetic polymers and resinous saps which often exude from evergreens. More specifically, the term gum applies to plant polysaccharides or their derivatives which are dispersible in either cold or hot water to produce viscous solutions or suspensions. As much as three-quarters of the dry weight of plants may be polysaccharide and, consequently, such substances are of wide occurrence. The most important gums, however, are those which are readily obtainable in large amounts from the plant. Some of these gums are used industrially and, indeed, many have been known since ancient times. One of the chief sources of such polysaccharides is seaweed which furnishes agar, algin and carrageenin while seed gums, such as gum guar and locust bean gum, are also important, particularly from the point of view that the plant which produces the seeds is often grown extensively as a food crop. In contrast to these naturally occurring gums, other gums are obtained from cellulose, one of the main components of the plant cell wall, and starch, a food reserve polysaccharide, by esterification and etherification. Commercially, however, the most important gums are plant exudates and most plant families have been found to include species which exude gums to a greater or lesser degree. In this context, the term 'exudate gum' strictly refers to those commercially important gums which exude in copious amounts from shrubs or low-growing trees, forming, on exposure to the atmosphere, glossy nodules or flakes which are usually brown or yellow in colour. These gum producing trees grow predominantly in Africa or Asia indicating the climatic requirements for their growth.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

by Mo-Lung Chen. / Thesis (M.Sc.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 70-75). / Abstract also in Chinese. / ABBREVIATIONS --- p.iv / LIST OF TABLES --- p.v / LIST OF FIGURES --- p.vii / ACKNOWLEDGEMENT --- p.ix / ABSTRACT --- p.xi / Chapter CHAPTER 1. --- INTRODUCTION --- p.1 / Chapter CHAPTER 2. --- BACKGROUND --- p.4 / Chapter 2.1 --- Production of pleural fluid --- p.4 / Chapter 2.2 --- Pathophysiology of pleural effusion --- p.5 / Chapter 2.3 --- Separating exudate from transudate --- p.8 / Chapter 2.4 --- Receiver operating characteristic curve --- p.9 / Chapter CHAPTER 3. --- ADENOSINE DEAMINASE --- p.12 / Chapter 3.1 --- Background --- p.12 / Chapter 3.2 --- Differentiation of tuberculous and non-tuberculous pleural effusion --- p.12 / Chapter CHAPTER 4. --- MATERIALS AND METHODS --- p.17 / Chapter 4.1 --- Patients --- p.17 / Chapter 4.2 --- Collection and handling of specimens --- p.17 / Chapter 4.3 --- Diagnostic criteria --- p.18 / Chapter 4.4 --- Methods --- p.19 / Chapter 4.4.1 --- Routine chemistries --- p.19 / Chapter 4.4.2 --- Protein zone electrophoresis --- p.19 / Chapter 4.4.3 --- Adenosine deaminase --- p.19 / Chapter 4.4.3.1 --- Instrumentation --- p.22 / Chapter 4.4.3.2 --- Optimization of reaction time --- p.24 / Chapter 4.4.4 --- Analytical performance --- p.24 / Chapter 4.4.4.1 --- Imprecision --- p.24 / Chapter 4.4.4.2 --- Recovery --- p.26 / Chapter 4.4.4.3 --- Lowest detection limit --- p.26 / Chapter 4.4.4.4 --- Linearity --- p.26 / Chapter 4.4.4.5 --- Interference by ammonia --- p.26 / Chapter 4.4.4.6 --- Interference by turbidity --- p.28 / Chapter 4.4.4.7 --- Interference by haemoglobin --- p.28 / Chapter 4.4.4.8 --- Interference by bilirubin --- p.29 / Chapter 4.4.4.9 --- Storage stability of ADA at -80°C --- p.29 / Chapter 4.4.5 --- Statistical analysis --- p.30 / Chapter CHAPTER 5. --- RESULTS OF OPTIMIZATION AND EVALUATION EXPERIMENTS --- p.31 / Chapter 5.1 --- Optimization of reaction time --- p.31 / Chapter 5.2 --- Analytical performance --- p.31 / Chapter 5.2.1 --- Imprecision --- p.31 / Chapter 5.2.1.1 --- Within-run --- p.31 / Chapter 5.2.1.2 --- Between-run --- p.31 / Chapter 5.2.2 --- Recovery --- p.31 / Chapter 5.2.3 --- Lowest detection limit --- p.34 / Chapter 5.2.4 --- Linearity --- p.34 / Chapter 5.2.5 --- Interference by / Chapter 5.2.5.1 --- ammonia --- p.34 / Chapter 5.2.5.2 --- turbidity --- p.34 / Chapter 5.2.5.3 --- haemoglobin --- p.37 / Chapter 5.2.5.4 --- bilirubin --- p.37 / Chapter 5.2.6 --- Storage stability of ADA at -80°C --- p.37 / Chapter CHAPTER 6. --- TRANSUDATIVE AND EXUDATIVE PLEURAL EFFUSION --- p.39 / Chapter 6.1 --- Results of routine chemistries --- p.39 / Chapter 6.2 --- Decision thresholds by ROC curve --- p.39 / Chapter 6.3 --- Discussion --- p.39 / Chapter 6.4 --- Results of protein zone electrophoresis --- p.49 / Chapter 6.5 --- Discussion --- p.51 / Chapter 6.6 --- Comparison of protein zone electrophoresis and Light's criteria --- p.55 / Chapter 6.7 --- Discussion --- p.55 / Chapter CHAPTER 7. --- TUBERCULOUS AND NON-TUBERCULOUS EXUDATIVE PLEURAL EFFUSION --- p.59 / Chapter 7.1 --- Results of adenosine deaminase assay --- p.59 / Chapter 7.2 --- Combinations of analysis --- p.59 / Chapter 7.3 --- Decision thresholds by ROC curve --- p.64 / Chapter 7.4 --- Discussion --- p.64 / Chapter CHAPTER8. --- GENERAL DISCUSSION --- p.69 / REFERENCES --- p.70

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2017-02-22T18:44:53Z No. of bitstreams: 1 Willian Alves dos Santos.pdf: 2856868 bytes, checksum: 09e364c04de604bece868531688a5915 (MD5) / Made available in DSpace on 2017-02-22T18:44:53Z (GMT). No. of bitstreams: 1 Willian Alves dos Santos.pdf: 2856868 bytes, checksum: 09e364c04de604bece868531688a5915 (MD5) Previous issue date: 2016 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / A ferida neoplásica acomete cerca de 5% a 10% dos pacientes com câncer em cuidados paliativos. O foco central do cuidado dessas feridas é o controle dos sintomas, em que o odor está presente em 10,4% e o exsudato em 14,6% dos casos, sendo responsáveis pelo impacto no aspecto psicossocial do paciente. O estudo teve como objetivo de avaliar as associações entre odor, exsudato e isolamento social em pacientes com feridas neoplásicas. Trata-se de uma pesquisa quantitativa do tipo transversal prospectivo realizado com os pacientes com feridas neoplásicas no Ambulatório de cuidados paliativos do Núcleo de Atenção Oncológica do Hospital Universitário Antônio Pedro, aprovada pelo Comitê de Ética do HUAP c/nº: 183.757. A coleta de dados foi realizada durante a consulta de enfermagem pela da aplicação das escalas de odor, exsudação (Push) e escala de Likert de três dimensões para avaliação dos aspectos sociais do paciente, bem como dados contidos em prontuário para caracterização da clientela. Para a análise estatística aplicou-se o teste de normalidade Shapiro wilk, verificando que a amostra não é paramétrica (p valor ≤ 0,05) para as variáveis: tamanho da lesão, ferida total, odor total e exsudato total (escala likert) e paramétrica (p valor > 0,05) para a variável idade. Os dados foram apresentados em forma de mediana e intervalo interquartil (x ̃± Q3-Q1) para análises das variáveis não paramétricas; média e desvio padrão (x̅ ±D.P) para variável paramétrica. Realizou-se o teste de Kruskal Wallis para verificação de associação multivariada entre os dados clínicos e da escala e o teste de Spearman para verificar se o grau do odor, quantidade de exsudato, tamanho e localização da lesão apresentam correlação com a interferência da socialização do paciente. A confiabilidade da ISPOE foi medida pelo coeficiente Alfa de Cronbach. Constatou-se, então a correlação entre o grau de odor e as perguntas 1 e 5 da escala da dimensão odor. Assim, o odor interfere no constrangimento (p; 0,0053) e frequentar locais públicos (p; 0,0495). A quantidade de exsudato apresentou correlação com a primeira questão da escala da dimensão exsudato, interferindo no constrangimento (p; 0,0453). A variável tipo de ferida apresentou correlação com as questões 3 e 5, logo, interferindo na relação com a família e em frequentar locais públicos, fatores esses que favorecem o isolamento social em pacientes com feridas neoplásicas As variáveis: tamanho da lesão e local da lesão não apresentaram correlação significativa com as questões da escala na dimensão ferida. As três dimensões da escala apresentaram consistência interna satisfatória com alfa: 0,82 (dimensão ferida); 0,94 (dimensão exsudato) e 0,88 (dimensão odor). Com isso, o odor e o exsudato interferem negativamente fatores sociais e psicológicos que podem favorecer, diretamente, o isolamento social. Além do conhecimento sobre as particularidades dessas lesões e dos produtos adequados ao cuidados, é fulcral que o profissional de enfermagem conheça os principais queixas relacionadas à lesão e o impacto que causam ao cotidiano do paciente. Conhecer esse conflito social e psicológico fará toda a diferença no cuidado de enfermagem, pois, dessa forma, poderá atuar de maneira assertiva e holística no cuidado no cotidiano do paciente, enxergando-o para além dos sintomas: seus anseios psicológicos e sociais. A constatação da associação entre as variáveis poderá auxiliar a avaliação dos aspectos que podem interferir na qualidade de vida e no cuidado prestado aos pacientes com feridas neoplásicas. / Neoplastic wound affects about 5% to 10% of cancer patients in palliative care. The central focus of the care of these wounds is to control the symptoms, where the odor is present in 10.4% and exudate in 14.6% of cases, being responsible for the impact on the psychosocial aspect of the patient. The study aimed to evaluate the association between odor, exudate and social isolation in patients with neoplastic wounds. This is a quantitative study of the kind prospective cross-sectional with patients with neoplastic wounds in outpatient palliative care in Oncology Attention Core of University Hospital Antonio Pedro, approved by HUAP Ethics Committee c / No: 183757. Data collection was performed during the nursing consultation by the application of odor scales, exudation (Push) and Likert scale of three dimensions to assess the social aspects of the patient, as well as data contained in records for population. The statistical analysis was applied to the normality test Shapiro Wilk, verifying that the sample is not parametric (p value ≤ 0.05) for the variables: size of the lesion, the total wound, the total odor and overall exudate (Likert scale) and parametric (p value> 0.05) for the age variable. Data were presented as median and interquartile range ((x) ± Q3-Q1) for analysis of nonparametric variables; mean and standard deviation (x ̅ ± S.P) for parametric variable. He held the Kruskal Wallis test for multivariate association check between clinical data and scale and the Spearman test to see if the odor degree, amount of exudate, size and location of the lesion correlate with the interference of socialization patient. The reliability of ISPOE was measured by Cronbach alpha coefficient. It was found, then the correlation between the degree of odor and the questions 1 to 5 scale of the odor scale. Thus, the odor interferes with the constraint (p, 0.0053) and attend public places (p; 0.0495). The amount of exudate correlated with the first issue of exudate size scale, interfering with embarrassment (p; 0.0453). The variable type of injury correlated with the issues 3:05, so interfering with the relationship with the family and attend public places, factors that favor social isolation in patients with neoplastic Variables wounds: lesion size and location of injury no significant correlation with the range of issues in the wound size. The three dimensions of the scale showed satisfactory internal consistency with alpha: 0.82 (wound size); 0.94 (exudate dimension) and 0.88 (size odor). Thus, the odor and exudate negatively affect social and psychological factors that may contribute, directly, social isolation. In addition to the knowledge about the characteristics of these injuries and products suitable for care, it is crucial that nursing professionals know the main complaints related to the injury and the impact they cause to the daily life of the patient. Knowing that social and psychological conflict will make all the difference in nursing care, because thus may act assertively and holistic care in the patient's daily life, seeing it beyond the symptoms: their psychological and social aspirations. The finding of association between variables may assist the evaluation of aspects that can interfere with quality of life and care provided to patients with neoplastic wounds.