Orientador: Maria Valnice Boldrin Zanoni / Co-orientador: Thaís Tasso Guaraldo / Banca: Raquel Fernandes Pupo Nogueira / Banca: Regina Helena Pires Gonçalves / Resumo: O acesso à água de qualidade, livre de microrganismos patogênicos e de subprodutos potencialmente nocivos ao homem é um desafio constante do ser humano. Dentre os diversos microrganismos patogênicos, a presença daqueles pertencentes ao Reino Fungi tem chamado a atenção, principalmente em águas de hemodiálise, devido às consequências que a presença destes e de suas respectivas micotoxinas podem ocasionar a um paciente imunocomprometido. O presente trabalho teve como objetivo investigar a potencialidade de fotoânodos do tipo W/WO3 em sistemas de desinfecção fotoeletrocatalítica de águas contaminadas por Candida parapsilosis. Para isto, foram sintetizados eletrodos de trióxido de tungstênio usando anodização oxidativa através do crescimento eletroquímico de filmes de WO3 sobre W como substrato. O eletrodo proposto mostrou a formação de um filme homogêneo com nanoporos ao redor de 100nm, conforme a imagem de FEGSEM e apresentou um band gap em torno de 2,5 eV calculado a partir do gráfico de Tauc pelo método Kubelka-Munk. O material construído é fotoativo e A curva de Iph vs E sob radiação UV em NaCl 0,1 molL-1 revelou uma fotocorrente igual a 19 mA. Estudos da degradação de C. parapsilosis em NaCl 0,1 molL-1, pH 7, potencial igual a 1,5V e irradiação UV-Vis e Vis, condições previamente otimizadas, mostraram a morte das leveduras em 30 segundos de tratamento. Não foi verificada a formação significativa de cloro ativo nas condições empregadas assim como não há formação de íons clorato e perclorato durante a degradação fotoeletrocatalítica. Para as medidas fotoeletrocatalíticas realizadas no dialisato, verificou-se a morte microbiana em torno de 5 minutos e remoção de carbono orgânico total em torno de 73% e 45% para as soluções ácidas e básicas respectivamente. / Abstract: The access to quality water, free of pathogenic microorganisms and potentially harmful to the community is a constant challenge of being human. Among the various pathogenic microorganisms, the presence of those belonging to the kingdom Fungi has drawn attention, especially in hemodialysis water, due to the consequences that the presence of these and their respective mycotoxins causes to an immunocompromised patient. The aim of this study was to investigate the capability of W/WO3 as photoanode in disinfection systems using photoelectrocatalysis in water contaminated by Candida parapsilosis. For this, tungsten trioxide was synthesized using electrodes via electrochemical anodization by the growth of WO3 films in tungsten foil as a substrate. The prepared electrode was characterized morphologically and electrochemically and was subsequently applied in a photoelectrochemical system. The FEMSEM image showed a formation of a homogeneous film in the surface foil with nanopores around 100 nm. There was obtained a band gap of 2.5 eV calculated from Tauc's plot of the Kubelka-Munk method and photocurrent observed in NaCl 0.1 molL-1 was equal to 19 mA. Studies of C. parapsilosis degradation in NaCl 0.1 molL-1, pH 7, the potential equal to 1.5V and irradiating UV-Vis and Vis, previously optimized conditions, showed the death of yeast at 30 seconds of treatment. There was no significant formation of active chlorine under the conditions employed just as there is formation of chlorate and perchlorate ions during photoelectrocatalytic degradation. For photoelectrocatalytics measurements in the dialysate, there was microbial death in about 5 minutes and removal of total organic carbon at around 73% and 45% for acidic and basic solutions, respectively. / Mestre

Orientador: Jaqueline Costa Teixeira Caramori / Resumo: Introdução: A evolução clínica da doença renal crônica está associada a altas taxas de morbidade. As complicações decorrem da progressão da doença renal, levando ao declínio cognitivo, anemia, distúrbios minerais e ósseos, fraturas, riscos nutricionais e aumento da mortalidade cardiovascular e por outras causas. Dentre as alterações nutricionais está a sarcopenia, definida como diminuição global e progressiva da força e massa muscular, com efeitos na função muscular, diminuição da mobilidade e da atividade física. Em diálise, maior atenção merece ser dada para esses fatores, visando prevenir mais complicações. A complexidade da doença renal avançada sugere que sejam buscadas ferramentas que possam avaliar a maior gravidade dos pacientes. Neste contexto, torna-se importante, identificar grupos de pacientes com características semelhantes e considerando o risco de desfechos. Objetivo: Interpretar por análise de agrupamento de parâmetros clínicos e nutricionais, uma população de pacientes prevalentes em hemodiálise, considerando a evolução clínica e com ênfase no diagnóstico de sarcopenia. Metodologia: Estudo de coorte, retrospectivo, descritivo e observacional. Foram identificadas características clínicas, laboratoriais e nutricionais, seguido da investigação de sarcopenia e análise de agrupamento com acompanhamento de desfechos clínicos dos pacientes em hemodiálise. Para diagnóstico de sarcopenia foi realizada avaliação da composição corporal usando bioimpedância unifrequencia... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Background: Clinical evolution of chronic kidney disease is associated with high morbidity rates. Complications arise from the progression of renal disease, leading to cognitive decline, anemia, mineral and bone disorders, fractures, nutritional risk and increased cardiovascular and all causes mortality. Among the nutritional changes, sarcopenia, which is defined as a global and progressive reduction of muscle strength and mass, with effects on function muscle, decreases mobility and physical activity. In dialysis, these factors should receive greater attention, in order to prevent further complications. The complexity of advanced kidney disease suggests that tools that assess the severity of patients should be sought. In this context, it is important to identify groups of patients with similar characteristics considering the risk of outcomes. Objective: To analyze clinical and nutritional parameters using cluster analysis of a population of patients on maintenance hemodialysis, considering the clinical evolution with emphasis in sarcopenia diagnosis. Methods: This is a cohort, retrospective, descriptive and observational study. Clinical, laboratory and nutritional characteristics were identified, followed by sarcopenia investigation and cluster analysis, with follow-up of clinical outcomes of patients in maintenance hemodialysis. For sarcopenia diagnosis, body composition evaluation was performed using unifrequencial bioimpedance and handgrip strength. To compare the samples... (Complete abstract click electronic access below) / Mestre

Orientador: Flávio Quaresma Moutinho / Resumo: Durante a realização das sessões de hemodiálise (HD) observam-se alterações relacionadas à coagulação, pelo contato do sangue do paciente com os circuitos extracorpóreos. Essas alterações podem ser decorrentes da ativação dos mecanismos intrínsecos da cascata de coagulação sangüínea, que resultam na formação de trombos. No modelo hemodialítico, utilizam-se substâncias anticoagulantes com a finalidade de prevenir a formação destes trombos. A substância padrão utilizada para anticoagulação em HD é a heparina sódica. As heparina de baixo peso molecular (HBPM) são fragmentos da heparina sódica com muitas vantagens. Exibe uma biodisponibilidade maior, possui menor ligação com proteínas plasmáticas e meia vida superior, resultando desta maneira, menor risco de sangramento. O objetivo principal desta pesquisa foi comparar e avaliar a heparina sódica com HBPM em cães submetidos à HD. Utilizou-se 14 cães que foram divididos em 2 grupos. O primeiro grupo, foi utilizada a heparina sódica e o segundo grupo a HBPM. Para avaliação do sistema hemostático dos animais foram colhidas amostras de sangue durante o período de 3 horas em 4 momentos distintos (M1, M2 e M3) e 24 horas (M4) após o término das sessões de hemodiálise para a realização de provas de coagulação como: tempo de tromboplastina parcial ativada (TTPA), tempo de protombina (TP), tempo de coagulação ativada (TCA), prova Anti-Xa e hemograma completo. Neste estudo a dose padronizada de heparina foi de 100UI/Kg/IV/Bolus com repetição de o da dose 60 e 120 minutos após o inicio, e 125 U anti-Xa/Kg/IV/Bolus com repetição de ? da dose após 90 minutos para HBPM. De acordo com os resultados obtidos nesta pesquisa pode-se concluir que não existiram diferenças estatisticamente significantes quando se utiliza a heparina sódica e HBPM como substâncias anticoagulantes... (Resumo completo, clicar acesso eletrônico abaixo). / Abstract: Coagulation disturbances, with thrombus formation, are common in hemodialysis due to activation of the intrinsic mechanism of the coagulation cascade. Anticoagulant substances are used for preventing thrombus formation. Heparin is the standard substance used for this purpose. However, heparin has troublesome pharmacokinetics, its clearance is dose dependent, it is highly protein bound and a minimum or threshold level is necessary to achieve an antithrombotic effect. Low molecular weight heparins are depolymerized preparations of heparin with multiple advantages over heparin. They exhibit less binding to cells and proteins and have superior bioavailability, a longer plasma half life and more predictable dose-response characteristics and carry a lower risk of hemorrhage and the immune mediated thrombocytopenia is less common. This research was planned to compare the effect of the low molecular weight heparin with the standard heparin in dogs submitted do hemodialysis. 14 dogs divided in two groups were studied.Group 1 used heparin 50 UI/Kg/IV Bolus with o of the initial dose repeated at 60 and 120 minutes after the beginning of the experiment. Group 2 used Low molecular weight heparin (Nadroparin) 125 U anti aX/kg//IV with a 1/3 of the initial dose repeated 90 minutes after the beginning of the experiment.Blood samples were drawn at 3 hours interval called (M1, M2,M3) and at 24 hours (M4) after ending the hemodialysis session.The coagulation system of the dogs was evaluated by the aPTT, PTT, aCT, aX and hemogram. The patency of the dialytic system was also evaluated. Our results showed no statistically significant differences between the two heparins, and the dose of the low-molecular-weight heparin was standardized for hemodialysis in dogs. / Mestre

<p>The purpose of the study was to describe hemodialysis patients self-reporting salt habits associated with cooking and food intake. Furthermore, the purpose was to investigate possible differences in inter Dialyze significant weight gain at low and high self-reported salt consumption. The study was an empirical descriptive study of comparative features and consisted of a convenience sample from two hemodialysis units in southern Norrland. Study group consisted of 37 persons who had been ongoing hemodialysis treatment and their age ranged from 42-86 years. A questionnaire was used in two parts and both parts contained 15 foods. The first part was stated how often the food consumed in a week on the basis of six possible answers. In the second set of salt to the cooking in and / or eating for the food on the basis of four possible answers. Information on age, gender and type of accommodation indicated in the survey and data on weight before and after dialysis was collected from the medical record. The results showed that the study group predominantly consumed foods that have a moderate natural salt content. Half of the study group ate soft bakery bread baked daily and only 16 people at homemade bread less than once a week. Participants put extra salt to all eligible food and salted also on the green salat. There was no difference in inter Dialyze weight gain at the high and low self-reported salt consumption.</p>

Thesis (M. D.)--University of Hong Kong, 2006. / Title proper from title frame. Also available in printed format.

The purpose of the study was to describe hemodialysis patients self-reporting salt habits associated with cooking and food intake. Furthermore, the purpose was to investigate possible differences in inter Dialyze significant weight gain at low and high self-reported salt consumption. The study was an empirical descriptive study of comparative features and consisted of a convenience sample from two hemodialysis units in southern Norrland. Study group consisted of 37 persons who had been ongoing hemodialysis treatment and their age ranged from 42-86 years. A questionnaire was used in two parts and both parts contained 15 foods. The first part was stated how often the food consumed in a week on the basis of six possible answers. In the second set of salt to the cooking in and / or eating for the food on the basis of four possible answers. Information on age, gender and type of accommodation indicated in the survey and data on weight before and after dialysis was collected from the medical record. The results showed that the study group predominantly consumed foods that have a moderate natural salt content. Half of the study group ate soft bakery bread baked daily and only 16 people at homemade bread less than once a week. Participants put extra salt to all eligible food and salted also on the green salat. There was no difference in inter Dialyze weight gain at the high and low self-reported salt consumption.

Patient-related barriers may reduce the effectiveness of screening for depression. This study aimed to explore perceived barriers to participation in a Screening Program for Depression by hemodialysis patients. In a cross-sectional study of hemodialysis patients, the Perceived Barriers to Psychological Treatment questionnaire was used to measure barriers to the Screening Program. Of 160 participants, 73.1% perceived at least one barrier (95% CI, 66.2% to 80.0%). The most common barriers were concerns about the side effects of antidepressant medications (40%), concerns about having more medications (32%), feeling that the problem is not severe enough (23%), and perceiving no risk of depression (23%). A high depression score was an independent predictor of barriers related to perceiving no benefit of the Screening Program and psychological, social, and practical barriers. We believe that patient-related barriers need to be addressed before implementing any case identification and treatment program for depression.

Stress within healthcare environments can be the result of uncertainty, illness, or the environment itself. In order to promote better health outcomes for dialysis users, scientific literature advocates stress reduction within healthcare environments. Dialysis patients are subject to numerous stressors, including the threat of potential losses and lifestyle change. Studies have revealed that patients who suffer from chronic illness perceive different levels of quality of life than those who are considered healthy and because of these lifestyle changes they employ various coping mechanisms when dealing with stress. There is a rising movement to mitigate stress through the use of holistic healing, an approach that addresses a person’s mental, emotional, physical, and spiritual elements to create a total healing environment. In accordance with this growing movement, the intent of this practicum is to create an outpatient centre for Manitoba’s dialysis patients that increases their perceived quality of life. The inquiry process began by questioning dialysis patients and conducting observational research at the Winnipeg Health Sciences Centre. Literature and precedent reviews were conducted, and the design programme was developed. The result of this research-based design proposal is an outpatient hemodialysis centre located within the Winnipeg Health Sciences Centre that helps mitigate stress while patients attempt to cope with lifestyle changes. The resulting design is one that is warm, welcoming, home-like and comfortable, which is supported by the theories explained in the literature review. This environment provides a greater sense of control, creates positive distractions and allows spiritually evoking opportunities to take place for all users of this new facility. / February 2009

Chronic inflammation is considered strongly influence the morbidity and mortality of patients with end-stage renal disease (ESRD) through its multiple pathogenic roles, in association with oxidative stress, accelerated aging, endothelial dysfunction and atherosclerosis, malnutrition, dialysis-related amyloidosis, anaemia, and immune dysfunction . Hemodialysis ¡]HD¡^ is widely used for kidney failure patients,it is a method for removing waste products such as creatinine and urea. However, at present it is well known the course of hemodialysis can create obvious inflammation condition and oxidation pressure. The oxidation stress of HD can arise from the osmosis pressure and oxidative environment of dialysis tube. The oxidative stresses will finally modify proteins which turn out initiate the short term and long term complications related to renal diseases of HD patients. We identified oxidated proteins in the hemodialysis tube of 16 HD patients. The protein oxidation level was determined by Oxyblot assay. The oxidation proteins were further identified by LC/MS detection. Many serum proteins were detected to be oxidized including albumin, apoA, immunoglobin,beta-globin, hemoglobin, etc. It has been well documented that albumin is quite vulnerable to ROS and elevated levels of carbonyl groups of albumin have been reported in plasma of dialysis patients. Inflammatory effects were further tested. The oxidation proteins of HD patients induce pro-inflammatory factor TNF-alpha expression of HEK293T and HEK293 cells. These results indicate HD induce protein oxidation, and inflammatory response which may responsible for complications of End-stage kidney disease (ESRD). Keywords¡GHemodialysis, oxidative stress, ESRD, HEK293, inflammatory

The U.S. Institute of Medicine estimates that there are 98,000 people died yearly from medical errors; approximate 20,000 people died from medical adverse events annually was estimated in Taiwan. All these reports indicate that the medical errors have great impact on patient safety. The hemodialysis population in Taiwan keeps increasing these years, and this means more attention should be paid to patient safety with the growing hemodialysis population. In 2005, Taiwan Joint Commission on Hospital Accreditation sets six goals for patient safety, general guidelines for healthcare facilities, and relative regulations are mostly on standard devices. This study tries to provide more possible root causes about patient safety at a hemodialysis center. Root cause analysis (RCA) has been greatly used in patient safety because latent factors can be determined by RCA. RCA was simulated in this study at a hemodialysis center. Firstly, a series of formal questions, developed by the U.S. Department of Veteran Affairs, were used to examine the current situation. The questions used are composed of six dimensions. Then, cause-effect-diagram was used to locate latent causes, and finally identified four dimensions. Research results are mainly summarized as human resource management issues, including two root causes of inadequate professional training and overwork. Adjusted job assignment and job content are also suggested in this study.