Bakgrund: Sjuksköterskor kommer alltid besitta en viktig roll i vårdandet av patienter där samhällsfarliga sjukdomar existerar. Covid-19 har resulterat i en förändrad vård och det finns idag bristande kunskaper kring hur svenska sjuksköterskor upplevde vården under pandemin. Syfte: Att undersöka sjuksköterskors upplevelser av att vårda patienter med Covid - 19. Metod: Metoden som valdes var en kvalitativ intervjustudie med nio deltagande sjuksköterskor. Materialet analyserades utifrån en kvalitativ innehållsanalys enligt Graneheim& Lundman (2004). Resultat: I resultatet framkom det att känslorna varierade i upplevelsen av att vårda patienter med Covid-19. Det framkom en maktlöshetskänsla av att inte inneha kunskap om sjukdomen vilket ledde till psykisk stress hos sjuksköterskorna. Kunskapsbristen ledde också till en minskad trygghet och patientsäkerhet. Rädslan att själv bli smittad var lägre än att riskera smitta sina anhöriga. Dock var uppskattningen från patienterna en stor bidragande faktor att sjuksköterskor fortsatte gå till arbetet med glädje. Slutsats: Sjuksköterskor saknar kunskap och erfarenhet av att vårda patienter med Covid-19 vilket har haft stor betydelse för deras välmående samt patientsäkerheten. Användandet av skyddsutrustning har haft inverkan på den vård sjuksköterskorna bedrev. Det visade sig vara av stor vikt att ta hänsyn till vad sjuksköterskorna kände sig säkra i gällande skyddsutrustning. Upplevelsen av pandemin har varit påfrestande men mycket lärorik. / Background: Nurses will always play an important role in the care of patients where socially dangerous diseases exist. Covid-19 has resulted in a change in care and today there is a lack of knowledge about how Swedish nurses experienced care during the pandemic. Aim: To investigate nurses' experiences of caring for patients with Covid - 19. Method: The method chosen was a qualitative interview study with nine participating nurses. The material was analyzed based on a qualitative content analysis according to Graneheim & Lundman (2004). Results: The result showed that the emotions varied in the experience of caring for patientswith Covid-19. There were feelings of powerlessness from not having knowledge about thedisease that have led to mental stress among the nurses. The lack of knowledge also led to reduced security and patient safety. The fear of becoming infected yourself was lower than the fear of infecting someone in their family. However, the appreciation from the patients and a major contributing factor was the reason why nurses returned to work with joy. Conclusion: Nurses lack knowledge and experience of caring for patients with Covid-19, which has been of great importance for their well-being and patient safety. The use ofprotective equipment has had an impact on the care provided by the nurses. It turned out to beof great importance to take into account what the nurses felt safe in current protective equipment. The experience of the pandemic has been stressful but very instructive.

Τα τελευταία χρόνια στον χώρο της Κλινικής Ογκολογίας πέρα από την εκτίμηση του θεραπευτικού αποτελέσματος των αντικαρκινικών θεραπειών, της ανταπόκρισης της νόσου και της συνολικής επιβίωσης των ασθενών, άρχισε να προσελκύει όλο και περισσότερο το ενδιαφέρον η εκτίμηση παραμέτρων της Ποιότητας Ζωής. Μια από τις σημαντικές παραμέτρους της ΠΖ είναι η σεξουαλική λειτουργικότητα που συνδέεται άμεσα και με την σεξουαλικότητα του ατόμου. Η σεξουαλικότητα αντιστοιχεί σε ένα φαινόμενο με διαστάσεις βιολογικές, διαπροσωπικές και ψυχολογικές. Αποτελεί τομέα που αρκετές φορές παραμελείται από τους θεράποντες ιατρούς, με αποτέλεσμα οι ασθενείς να μην ενημερώνονται για όλες τις παραμέτρους που αφορούν συνολικά την ανθρώπινη λειτουργικότητα. Η σεξουαλική λειτουργικότητα των καρκινοπαθών αποτελεί σημαντική παράμετρο της Ποιότητας-Ζωής η οποία πολλές φορές υποεκτιμάται. Σκοπός της παρούσας μελέτης είναι η αξιολόγηση της σεξουαλικής λειτουργικότητας σε ασθενείς με καρκίνο που υποβάλλονται σε ριζική ακτινοθεραπεία σε συνδυασμό με την εκτίμηση της ποιότητας ζωής, του άγχους και της κατάθλιψης για πιθανές συσχετίσεις μεταξύ τους. Υλικό και μέθοδοι: Η μελέτη ξεκίνησε τον Απρίλιο του 2006 και περατώθηκε τον Σεπτέμβριο του 2008. Ζητήθηκε από 174 ασθενείς να συμμετάσχουν στη μελέτη. Τελικά 138(79.3%) ασθενείς δέχτηκαν να ενταχθούν μετά από έγγραφη συγκατάθεση. Η μέση ηλικία αυτών ήταν 58.2 (29-84). Το δείγμα αφορούσε 48(34.8%) άνδρες και 90(65.2%) γυναίκες, με καρκίνο μαστού ή όγκους πυέλου. Ο σχεδιασμός της μελέτης περιλάμβανε την αξιολόγηση της σεξουαλικής λειτουργικότητας και της κατάθλιψης σε 3 χρονικές φάσεις, προ της έναρξης της ακτινοθεραπείας (Φάση 1), στο πέρας αυτής (Φάσης 2) και 12 μήνες μετά (Φάση 3) με τη χρήση των ερωτηματολογίων Female Sexual Function Index(FSFI), International Index of Erectile Function(IIEF), EORTC-QLQ C30 και Hamilton Depression Scale(HDS). Αποτελέσματα: Η πλειοψηφία των ασθενών κατέγραφε υψηλά ποσοστά σεξουαλικών διαταραχών και στις 3 χρονικές φάσεις της μελέτης. Τα ποσοστά της στυτικής δυσλειτουργίας στους άνδρες ήταν 79.2% στη Φάση 1 και 82.2% στη Φάση 3. Στη Φάση 1 το ποσοστό των γυναικών που παρουσίαζαν σεξουαλικές διαταραχές αγγίζει το 80%. Γυναίκες που υποβλήθηκαν σε ακτινοθεραπεία πυέλου κατέγραφαν υψηλότερα ποσοστά σεξουαλικών διαταραχών σε σύγκριση με αυτές που έλαβαν ακτινοθεραπεία στο μαστό. Στο σύνολο των ασθενών παρατηρήθηκε ότι υπήρχε συσχέτιση της ηλικίας με την σεξουαλική λειτουργικότητα με αυξημένη επίπτωση σε ασθενείς > 65 ετών. Ασθενείς με PS=0 παρουσίαζαν καλύτερη σεξουαλική λειτουργικότητα σε σύγκριση με αυτούς που είχαν PS=1 ή 2. Το 25% των ασθενών παρουσίασε υψηλά ποσοστά κατάθλιψης. Δεν παρατηρήθηκε συσχέτιση της κατάθλιψης με την σεξουαλική λειτουργικότητα σε στατιστικώς σημαντικό επίπεδο. Ανεξάρτητα σταδίου νόσου, η μέση τιμή συνολικής ΠΖ για τις ασθενείς με καρκίνο μαστού ήταν 77.4, και για τους ασθενείς με όγκους πυέλου 73. Αγχώδεις διαταραχές παρατηρήθηκαν στο 10% των ασθενών και για τις δύο ομάδες. Επίσης παρατηρήσαμε ότι υψηλότερα επίπεδα άγχους συνδέονταν με χαμηλότερα επίπεδα ΠΖ (p<0.05). Ασθενείς με αρχικό στάδιο νόσου παρουσίαζαν υψηλότερα επίπεδα αγχωδών διαταραχών (p<0.05). Δεν παρατηρήθηκε συσχέτιση μεταξύ ΠΖ / άγχους / κατάθλιψης με προηγηθείσα χημειοθεραπεία, την ηλικία, το φύλο και την κατάσταση λειτουργικότητας. Από την ανάλυση των δεδομένων προέκυψε ότι η συντριπτική πλειοψηφία των ασθενών ανέφερε στην αρχή της ακτινοθεραπείας υψηλά επίπεδα ΠΖ με καλή λειτουργικότητα και σχεδόν απουσία συμπτωμάτων. Μεταξύ των δυο ηλικιακών ομάδων, μικρότεροι ή μεγαλύτεροι των 65 ετών δεν παρατηρήθηκε καμία διαφορά στατιστικά σημαντική στην ΠΖ. Συμπεράσματα: Θα λέγαμε συμπερασματικά ότι το ποσοστό των ασθενών που υποβάλλονται σε ακτινοθεραπεία βιώνει κάποιας μορφής και σημαντικού βαθμού σεξουαλικές διαταραχές τις οποίες οφείλει ο Ακτινοθεραπευτής-Ογκολόγος να μην τις αγνοεί. Η σεξουαλική λειτουργικότητα επηρεάζεται αρνητικά σε μεγαλύτερο βαθμό σε ασθενείς που ακτινοβολούνται στην πύελο σε σύγκριση με το μαστό. Κρίνεται αναγκαία η εκπαίδευση των νέων γιατρών σε θέματα σεξουαλικής συμβουλευτικής. Η εκτίμηση και η αντιμετώπιση των διαταραχών αυτών θα πρέπει να συμπεριληφθεί στη καθιερωμένη προσέγγιση των καρκινοπαθών. Η παράμετρος της σεξουαλικότητας στα πλαίσια της συγκεκριμένης αυτής νόσου αποτελεί πεδίο που χρήζει περαιτέρω έρευνας με προοπτικές και τυχαιοποιημένες μελέτες. / Quality of life (QoL) is now regarded important not only in oncology research, but in the daily clinical practice as well. QoL is composed of many parameters, including sexuality. Sexuality is a complex phenomenon that incorporates biologic, psychologic, interpersonal, and behavioral dimensions. Cancer diagnosis and treatments often cause physical and psychological disruptions to sexual health. The main objective of this study was to delineate the rates and clinical course of sexual function and depression in cancer patients undergoing radical radiotherapy. Patients and methods: The evaluation included the completion of patients’ self-reported questionnaires. Forty-eight male and 90 female RT-naive outpatients with breast cancer or pelvic tumors completed the Female Sexual Function Index (FSFI), the International Index of Erectile Function (IIEF), the EORTC-QLQ C30 and the Hamilton Depression Scale (HDS) prior to (Phase 1), at the end (Phase 2) and 12 months post-RT (Phase 3). Results: Out of the 174 patients initially assessed, 138 agreed to participate in the study. Overall, the majority of patients (93.8% of males and 80% of females) experienced intense sexual dysfunction. At presentation, males reported severe erectile dysfunction (ED) that was significantly associated with age. However, only in sexual desire (SD), was the difference between baseline and Phase 3 significant. Although the incidence of severe ED in all three Phases of the study was impressive, it remained stable over time (severe ED: 79.2% Phase 1 - 82.2% Phase 3). However, only in sexual desire, was the difference statistically significant, particularly at Phase 1 and 3 (p<0.05). For all women, an improvement was observed in all parameters of the FSFI over the course of the study. FSFI total scores at Phase 3 were higher compared to Phase 1 and 2 (p<0.05). It appeared that females who underwent pelvic radiotherapy scored lower than those who underwent breast radiotherapy. The differences were significant at all three Phases of the study (p<0.001). As to the primary site, the differences were statistically significant among females with breast cancer (p<0.05). Pts with ECOG PS=0 presented higher total FSFI scores at Phase 3 compared to those with PS 1 (p<0.05). 53% of all patients reported some kind of depressive symptomatology at Phase 1. Finally, depression was not related to sexual function. In general, the majority of patients reported high levels of quality of life. The global quality of life in breast cancer patients’ was 74 and in pelvic tumors group was 73. Conclusions: Overall, the current study showed that the majority of patients with cancer treated with radiotherapy experienced intense sexual dysfunction. We conclude that cancer patients undergoing radiotherapy, mainly in the pelvic region, experience an important degree of sexual dysfunction and depression, which the Radiation-Oncologist should not ignore. Pelvic radiotherapy affected sexual function to a higher degree than breast radiotherapy. The evaluation and the confrontation of these dysfunctions should be included in the standard routine approach of cancer patients offering them holistic care. In modern Oncology, sexuality constitutes a promising field for further research with the aim to devise proper interventions to enhance patients’ total function.

The thesis is an evaluation of a utilitarian argument for the permissibility of purchasing meat. The argument, which I call the replaceability argument, rests on four premises: 1. Meat purchases cause animals to be brought into existence. 2. The animals brought into existence by meat purchases live lives of positive final value. 3. If the first two premises are true, then meat purchases cause at least as good consequences as any alternative act. 4. If meat purchases cause at least as good consequences as any alternative act, then meat purchases are permissible. The first three premises are examined while the fourth one, representing consequentialism, is assumed to be true. The evaluation results in the conclusion that the argument is unsound because all of the premises evaluated turn out to be either doubtful or false.

Made available in DSpace on 2016-12-06T17:06:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-06-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: Erectile dysfunction has high prevalence in the middle-aged world population, which has been associated with heart failure (HF) and other risk factors for cardiovascular disease. Recently, it has been shown that high intensity exercise is more effective in treating patients with HF but no studies specifically assess the influence of high-intensity exercise in erectile function in these patients, which motivated us to develop a study with this goal. Methods: Twenty patients (53.25 ± 8.87 years) with stable HF, left ventricle ejection fraction &#8804; 45% were randomly allocated to continuous moderate exercise (CME) group or high-intensity exercise (HIE). The subjects underwent 12 weeks of exercise training, staying CME in heart rate (HR) of the anaerobic threshold and HIE in HR of the respiratory compensation point alternating with HR anaerobic threshold (recovery period). At baseline and after the intervention patients underwent assessment of sexual function by the International Index of Erectile Function (IIEF), determination of aerobic power by cardiopulmonary exercise testing (CPET), determination of distance walk by the six-minute walk test (6MWT), assessment of endothelial function by Doppler echocardiography, and quality of life by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). In statistical analysis was used Shapiro-Wilk test, Chi-square (x2) or Fisher exact test, t test or Mann-Whitney U and paired t test, with significance level of 5%. Results: In HIE were increased erectile function (11 ± 10.46 to 19.55 ± 9.07, p = 0.030), desire (from 4.77 ± 2.04 to 6.88 ± 2.08, p = 0.034) and sexual satisfaction (from 4.00 ± 4.63 to 8.33 ± 5.36, p = 0.017), while in CME there were no significant changes in these outcomes. Only in HIE was observed significant increase in peak aerobic power (from 21.07 ± 4.30 to 23.79 ± 5.26, p = 0.021). Intra groups there was an increase in distance walked in 6MWT (CME 462.63 ± 63.10 to 603.45 ± 67.50, p = 0.003; HIE from 456.44 ± 38.51 to 589.66 ± 59, 69, p = 0.008, the percentage of endothelial function increased in both groups (HIE 43.6%, p = 0.666; MCE 193%, p = 0.214, respectively), without significant differences within and between groups. Quality of life scores improved intra groups in emotional dimension (CME of 9.45 ± 4.86 to 4.09 ± 3.88, p = 0.008; HIE 9.22 ± 7.17 to 5.22 ± 6 , 97, p = 0.039) and total score (CME 38.18 ± 12.34 to 17.27 ± 8.93, p = 0.001; HIE 34.11 ± 18.41 to 19.89 ± 16.96 p = 0.011). The physical dimension increased only in CME (13.18 ± 6.77 to 7.18 ± 4.30, p = 0.012), with no significant difference between groups. Conclusion: High-intensity exercise led to significant benefits in erectile function, desire, sexual satisfaction and peak aerobic power, while in the EMC was no significant changes in these outcomes. Improvement in distance walked in 6 minutes test and the quality of life occurred in both groups, with no difference between them. / Introdução: A disfunção erétil apresenta grande prevalência na população mundial de meia-idade, algo que tem sido associado à insuficiência cardíaca (IC) e aos fatores de risco para outras doenças cardiovasculares. Recentemente, tem sido demonstrado que o exercício físico de alta intensidade é mais eficaz no tratamento de pacientes com IC mas inexistem estudos que avaliem especificamente a influência o exercício físico de alta intensidade na função erétil destes pacientes, o que nos motivou a desenvolver um estudo com este objetivo. Métodos: Vinte pacientes do sexo masculino (53,25 ± 8,87 anos) com IC estável, fração de ejeção do ventrículo esquerdo &#8804; 45%, foram aleatoriamente alocados no grupo de exercício moderado contínuo (EMC) ou exercício de alta intensidade (EAI). Os indivíduos foram submetidos a 12 semanas de treinamento, permanecendo o EMC próximo à frequência cardíaca (FC) do limiar anaeróbio e o EAI próximo à FC do ponto de compensação respiratória alternada com a FC do limiar anaeróbio (período de recuperação). No início do estudo e após intervenção os pacientes foram submetidos a avaliação da função sexual pelo Índice Internacional de Função Erétil (IIFE), determinação da potência aeróbia pelo teste cardiopulmonar (TCP), determinação da distância percorrida pelo teste de caminhada de seis minutos (TC 6), avaliação da função endotelial pelo ecodoppler, e qualidade de vida pelo Minnesota Living with Heart Failure Questionaire (MLHFQ). Na análise estastística foi utilizado o teste Shapiro-Wilk, Qui-Quadrado (x2), Exato de Fisher, teste t, U de Mann Whitney e teste t pareado, sendo adotado nível de significância de 5%. Resultados: No EAI houve melhora da função erétil (de 11 ± 10,46 para 19,55 ± 9,07; p = 0,030), desejo (de 4,77 ± 2,04 para 6,88 ± 2,08; p =0,034) e satisfação sexual (de 4,00 ± 4,63 para 8,33 ± 5,36; p = 0,017), enquanto no EMC não houve alterações significativas destes desfechos. Foi observado apenas no EAI aumento significativo da potência aeróbia pico (de 21,07 ± 4,30 para 23,79 ± 5,26; p =0,021). Intra grupos ocorreu aumento da distância percorrida no TC 6 (EMC de 462,63 ± 63,10 para 603,45 ± 67,50; p =0,003; EAI de 456,44 ± 38,51 para 589,66 ± 59,69 ; p =0,008) e os percentuais da função endotelial aumentaram nos dois grupos (EIA 43,6%, p = 0,666; EMC 193%, p = 0,214, respectivamente), sem diferença significativa intra e entre os grupos.Os escores da qualidade de vida melhoraram intra grupos na dimensão emocional (EMC de 9,45 ± 4,86 para 4,09 ± 3,88; p = 0,008; EAI de 9,22 ± 7,17 para 5,22 ± 6,97; p =0,039) e escore total (EMC de 38,18 ± 12,34 para 17,27 ± 8,93; p =0,001; EAI de 34,11 ± 18,41 para 19,89 ± 16,96; p = 0,011). A dimensão física aumentou apenas no EMC (de 13,18 ± 6,77 para 7,18 ± 4,30; p = 0,012), sem diferença significativa entre os grupos. Conclusão: O exercício de alta intensidade promoveu benefícios significativos na função erétil, desejo, satisfação sexual e potência aeróbia pico, enquanto no EMC não houve alterações significativas destes desfechos. A melhora da distância percorrida no teste de 6 minutos e da qualidade de vida ocorreu em ambos os grupos, sem diferença entre eles.

Enhanced external counterpulsation (EECP) is a noninvasive treatment modality which can increase arterial blood flow in peripheral and coronary arterial disease. Several studies have demonstrated an increase in the flow of the internal iliacal artery and in carotid and renal perfusion during EECP treatment. We investigated the effect of EECP in patients with erectile dysfunction (ED). Thirteen patients were treated with EECP for 20 days, 1 h per day. Patients reported a significant improvement of penile rigidity after completion of the EECP treatment and a significant improvement of penile peak systolic flow was measured by Doppler sonography. No adverse effects were observed. In conclusion, EECP seems to be an effective treatment modality in patients with ED. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

INTRODUÇÃO: O câncer de próstata é a neoplasia sólida mais comum em homens. Na doença localizada, as alternativas de tratamento cirúrgico são a Prostatectomia Radical Retropúbica (PRR), Prostatectomia Radical Perineal (PRP), Prostatectomia Radical Laparoscópica (PRL) e Prostatectomia Radical Robótica Assistida (PRRA). A cirurgia robótica tem recebido atenção de especialistas pelas perspectivas de melhores resultados funcionais, se comparado às demais técnicas, porém não há evidências suficientes na literatura que defina fatores prognósticos para os resultados funcionais. OBJETIVO: Identificar fatores prognósticos para resultados funcionais em portadores de câncer de próstata localizado submetidos à PRRA. MÉTODO: Analisaram-se vídeos de 143 PRRA realizadas de janeiro de 2009 a janeiro de 2012 no Hospital Alemão Oswaldo Cruz, São Paulo (Brasil) por um único cirurgião. A potência sexual foi avaliada considerando os parâmetros de dissecção bilateral ou unilateral, nota de dissecção, uso de cautério, uso de tração, uso de pontos hemostáticos no Feixe Vásculo Nervoso (FVN) e dados pré e pós-operatórios. Em relação à continência urinária, considerou-se o comprimento e qualidade do coto uretral, o tamanho do colo vesical e dados pré e pós-operatórios. No pós-operatório, potência sexual foi definida como a capacidade de penetração em mais de 50% das tentativas de intercurso sexual (escore >= 3 na Questão 2 do IIEF-5) com ou sem o uso de inibidores de Fosfodiesterase tipo 5. Continência urinária foi considerada quando não houve necessidade do uso de forros ou, se usados, que fosse no máximo um e apenas como segurança, ou que apresentaram escore zero no ICIQ-SF. RESULTADOS: Observou-se correlação para recuperação da potência com dissecção bilateral do FVN (p=0,001), maior nota de dissecção do FVN no 6º (p < 0,01) e 12º mês (p < 0,01), mediana de nota 9 para dissecção do FVN (p < 0,01), menor idade no 6º (p < 0,01) e 24º mês (p=0,01), idade média de 59 (p=0,007), 58,35 (p=0,02) e 57,7 anos (p=0,005) no 6º, 18º e 24º mês, respectivamente, peso corporal médio de 76,18 Kg (p=0,01), peso prostático com mediana de 31 g (p=0,03), menor valor de Gleason total (p=0,03), Gleason total com mediana de 6 (p=0,009), mediana de 12 fragmentos retirados (p=0,001), menor volume tumoral no 1º (p=0,01) e 18º mês (p=0,02), volume tumoral com mediana de 5,25 (p=0,03), 5,40 (p=0,02) e 5,25 cm³ (p=0,04) no 1º, 18º e 24º mês, respectivamente, tumor unilateral (p=0,02), e ausência de invasão capsular (p=0,02). As variáveis, uso de cautério, tração e pontos hemostáticos no FVN não apresentaram correlação com recuperação de potência sexual. A continência urinária apresentou correlação com maior tempo de cirurgia no 3º (p < 0,01) e 12º mês (p=0,02), mediana de tempo de cirurgia de 3,45 (p=0,001), 3,35 (p=0,04) e 3,30 horas (p=0,04) no 3º, 6º e 12º mês, respectivamente. As variáveis, comprimento do coto uretral, qualidade do coto uretral e tamanho do colo vesical não se correlacionaram com continência urinária, apesar de tamanho do colo vesical mostrar tendência com mediana de 15,92 mm (p=0,054). CONCLUSÃO: As variáveis, dissecção bilateral, nota de dissecção do FVN, idade, peso corporal, peso da próstata, Gleason total, número de fragmentos retirados, volume tumoral, estadiamento tumoral e tempo de cirurgia apresentaram-se como ferramentas úteis para definir fatores prognósticos para resultados funcionais em homens portadores de câncer de próstata localizado, submetidos à PRRA / INTRODUCTION: Prostate cancer is the most common solid malignancy in men. For localized disease, surgical alternatives include Radical Retropubic Prostatectomy (RRP), Radical Perineal Prostatectomy (RPP), Radical Laparoscopic Prostatectomy (RLP) and Robotic Assisted Radical Prostatectomy (RARP). The robotic approach has received great attention, due to the perspective of better functional outcomes when compared to the other surgical alternatives; however, there is not enough evidence in the literature to define prognostic factors for functional outcomes. OBJECTIVE: To identify prognostic factors for functional outcomes in prostate cancer patients undergoing RARP. METHODS: We analyzed the video files of 143 RARP performed by a single surgeon between January 2009 and 2012 at Oswaldo Cruz German Hospital in São Paulo, Brazil. Sexual potency was evaluated considering unilateral or bilateral dissection, grade of dissection, use of electrocautery, use of traction, and use of hemostatic stitches on the neurovascular bundles (NVB), and pre and postoperative data. Urinary continence was evaluated considering the length and quality of the urethral stump, size of the bladder neck, and pre and postoperative data. Postoperatively, sexual potency was defined as successful vaginal penetration in more than 50% of sexual intercourses (IIEF-5, Question 2, score >= 3) with or without the use of Phosphodiesterase type 5 inhibitors. Urinary continence was defined as no pad use, or the use of up to one pad for safety, or an ICIQ-SF score of zero. RESULTS: For the sexual potency recovery, we found correlations with bilateral NVB dissection (p=0.001), higher NVB dissection grade at 6º month (p<0.01) and 12º month (p < 0.01), median NVB dissection grade of 9 (p < 0.01), younger age at 6º month (p < 0.01) and 24º month (p<0.01), mean age of 59 (p=0.007), 58.35 (p=0.01) and 57.7 years (p=0.005) at the 6º, 18º and 24º months respectively, median body weight of 76.18 kilograms (p=0.01), median prostatic weight of 31 g (p=0.03), lower total Gleason score (p=0.03), total Gleason with a median of 6 (p=0.009), median of 12 fragments removed at biopsy (p=0.001), lower tumor volume at 1º (p=0.01) and 18º months (p=0.02), median tumor volume of 5.25 (p=0.03), 5.40 (p=0.02) and 5.25cc (p=0.04) at 1º, 18º and 24º months respectively, unilateral tumor (p=0.02), and absence of capsular invasion (p=0.02). Use of electrocautery, traction and hemostatic stitches on the NVB where not significant. Urinary continence showed correlation with longer surgical times at 3º (p < 0.01) and 12º months (p=0.02), median surgical times of 3.45 (p=0.001), 3.35 (p=0.04) and 3.3 hours (p=0.04) at 3º, 6º and 12º months, respectively. Urethral stump length, quality, and bladder neck size did not show correlation with continence, although there was a trend for bladder necks of 15.92 mm (p=0.054). CONCLUSIONS: The following parameters: NVB bilateral dissection, NVB dissection grade, patient age and weight, prostate weight, total Gleason, number of removed fragments, tumor volume, tumor stage, and surgical time are useful prognostic factors for predicting functional outcomes in prostate cancer patients undergoing RARP

Made available in DSpace on 2016-03-22T17:27:42Z (GMT). No. of bitstreams: 1 disser falchi.pdf: 571946 bytes, checksum: e11617af872b8ff7dd9b92c3c4d9fa36 (MD5) Previous issue date: 2006-11-28 / OBJECTIVE: to assess the prevalence and factors associated to erectile dysfunction (ED) in urban area men. METHODS: a cross-sectional population-based study was carried out in the municipality of Pelotas, Southern Brazil, 2006. Men between 40 and 70 years old were asked to complete a self-administered questionnaire (international index of erectile dysfunction IIEF-15 ; to the World Health Organization quality of life questionnaire WHOQOL 100 domain 4 and to the sociodemographic questionnaire). Of 50 areas drawn, 60 dwellings were visited in each area, comprising a total of 433 men interviewed. Erectile Dysfunction prevalence was defined based on the international index of erectile dysfunction, according to cutoff values and adjusted to erectile dysfunction grade. Multivariate analysis with Poisson regression was performed using a hierarchical model of variables associated to erectile dysfunction grade. RESULTS: erectile dysfunction and severe erectile dysfunction prevalence were 44,9% and 9,3% respectively. The age increase was associated to the presence of ED with a linear trend, or either, men of 50 to the 60 years had presented 1,7 times more possibilities to have ED e, with 61 to the 70 years, a 1,9 time possibility more when compared with the group reference. Also, low income (RP=1,86; IC95%=1,3-2,64), retirement (RP=1,36; IC95%=1,06-1,76), low quality of life (RP=1,89; IC95%=1,44- 2,48) and tobaccoism (RP=1,35; IC95%=1,11-1,65) are factors associates to ED. 30 CONCLUSIONS: The ED affects the interpersonal relationship and compromises the well-being and the quality of life of men and women. The raised prevalence must be considered as a problem of public health that must receive attention from the politics of health for the health of the man. The prevalence of ED in the region is preoccupying, even so similar to national and international literature. There is a need to implement more effective campaigns to provide better guidance to the population to prevent the erectile dysfunction that is a problem of world-wide public health / OBJETIVO: determinar a prevalência e os fatores associados à disfunção erétil (DE) em homens entre 40 e 70 anos de zona urbana. MÉTODOS: estudo transversal de base populacional, realizado no município de Pelotas, Rio Grande do Sul, em 2006. Homens entre 40 e 70 anos de idade responderam a questionário auto-aplicável (índice internacional de função erétil IIEF-15 ; questionário da qualidade de vida da Organização Mundial da Saúde WHOQOL 100 faixa de domínio 4 e questionário sócio-demográfico). De 50 setores sorteados, foram visitados 60 domicílios em cada setor, totalizando 433 homens. A prevalência da disfunção erétil foi definida a partir do IIEF-15, mediante a utilização dos pontos de corte, ajustando o grau de disfunção erétil. Realizou-se análise multivariada com regressão de Poisson, considerando um modelo hierárquico das variáveis associadas ao grau de disfunção erétil. RESULTADOS: a prevalência da DE foi de 44,9% e 9,3% da DE grave. O aumento da idade esteve associado à presença de DE com uma tendência linear, ou seja, homens de 50 a 60 anos apresentaram 1,7 vezes mais chances de ter DE e, os com 61 a 70 anos, uma chance de 1,9 vezes mais quando comparados ao grupo referência. Baixa renda (RP=1,86; IC95%=1,3-2,64), aposentadoria (RP=1,36; IC95%=1,06- 1,76), baixa qualidade de vida (RP=1,89; IC95%=1,44-2,48) e tabagismo (RP=1,35; IC95%=1,11-1,65). CONCLUSÕES: a DE afeta o relacionamento interpessoal e compromete o bem-estar e a qualidade de vida de homens e mulheres. A elevada prevalência deve ser 28 considerada como problema de saúde pública que deve receber atenção das políticas de saúde para a saúde do homem. A prevalência de DE na região é preocupante, embora semelhante à literatura nacional e internacional. É necessária a implantação de campanhas mais eficazes, direcionadas a orientar melhor a população para prevenir a disfunção erétil que é um problema de saúde pública mundial

No description available.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-27T11:52:11Z No. of bitstreams: 2 Tese - Márcio Rodrigues Costa - 2016.pdf: 2910843 bytes, checksum: 62ef04b309bbf0cca3a09b8973a910c7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-27T11:52:38Z (GMT) No. of bitstreams: 2 Tese - Márcio Rodrigues Costa - 2016.pdf: 2910843 bytes, checksum: 62ef04b309bbf0cca3a09b8973a910c7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-09-27T11:52:38Z (GMT). No. of bitstreams: 2 Tese - Márcio Rodrigues Costa - 2016.pdf: 2910843 bytes, checksum: 62ef04b309bbf0cca3a09b8973a910c7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-09-20 / Objective: The objective of this study was to determine the prevalence, severity, factors associated and that influence erectile function in patients with chronic kidney disease on conservative treatment. Methods: This transversal study was developed between May 2013 and December 2015. Male volunteer patients, heterosexual, 18 years of age or older, carriers of chronic renal disease on conservative treatment participated of this study. The patients had follow up in the specific ambulatories of chronic renal disease in two hospitals of Goiânia. The erectile dysfunction of the patients was assessed using the six erectile function domain questions (questions numbers 1 to 5 and 15) of the International Index of Erectile Dysfunction. While the questions of the International Index of Erectile Dysfunction were applied, the researchers reviewed medical records and filled search forms containing lifestyle habits, clinical, laboratory and sociodemographic data. The factors associated with erectile dysfunction in patients with chronic renal disease in conservative treatment were determined by univariate and multivariate logistic regression analysis. The prevalence and degree of erectile dysfunction among patients with chronic renal disease in conservative treatment in stage III versus IV/V were compared with the application of chi-square test. The correlation between glomerular filtration rate and International Index of Erectile Dysfunction score was estimated by Pearson correlation coefficient. Results: Among 245 patients with chronic renal disease on conservative treatment in the study, 71.02% had erectile dysfunction and the sexual disorder was severe in 36.73%. Individual analysis of the variables in these patients, without excluding the influence of one over the other, pointed erectile dysfunction associated with the age more than 50 years, body mass index less than 25, diabetes mellitus, stage IV/V of chronic kidney disease, cardiac arrhythmias and conduction disorders, benign prostatic hyperplasia, present or prior cigarette use, cigarette use for 10 years or more, pack-year cigarette index greater or equal to 20, alcohol usage time equal to or greater than 10 years, albumin less than 3.5 g /100 mL and creatinine clearance levels between 15 and 29 mL/min/1.73 m2. The conjunct analysis of the variables studied in this same group of patients has showed an independent association of erectile dysfunction with diabetes mellitus (P = 0.015). A comparison of patients with chronic renal disease on conservative treatment stage III versus IV/V has demonstrated a higher prevalence of erectile dysfunction in more advanced stages of chronic renal disease (P = 0.001) and similar frequency of severe, moderate, moderate to mild and mild erectile dysfunctions. Glomerular filtration rate has showed a positive correlation with the score of the International Index of Erectile Dysfunction. Conclusions: The prevalence of erectile dysfunction in patients with chronic renal disease in conservative treatment is high. Many factors are associated with erectile dysfunction in chronic renal disease population on conservative treatment. The only factor associated with erectile dysfunction that is not subject to influence from other agents is diabetes mellitus. The prevalence of erectile dysfunction increases with the progression of chronic renal disease on conservative treatment. / Objetivo: O objetivo deste estudo foi determinar a prevalência, gravidade e os fatores associados e influenciadores na função erétil de pacientes portadores de doença renal crônica em tratamento conservador. Material e métodos: Este estudo transversal desenvolveu-se entre maio de 2013 a dezembro de 2015. Participaram do estudo pacientes masculinos, voluntários, heterossexuais, com 18 anos de idade ou mais, portadores de doença renal crônica em tratamento conservador. Os pacientes tinham seguimento em ambulatórios específicos de doença renal crônica de dois hospitais em Goiânia. A disfunção erétil dos pacientes foi avaliada com as seis perguntas do domínio de função erétil (questões números 1 a 5 e 15) do International Index of Erectile Dysfunction. Enquanto as questões do IIEF eram aplicadas, os pesquisadores revisavam prontuários e preenchiam os formulários de pesquisa, que continham hábitos de vida, dados clínicos, laboratoriais e sociodemográficos. Os fatores associados à disfunção erétil nos portadores de doença renal crônica em tratamento conservador foram determinados por análise de regressão logística uni e multivariada. Compararam-se a prevalência e o grau de disfunção erétil entre pacientes com doença renal crônica em tratamento conservador em estágios III versus IV/V, com a aplicação do teste qui-quadrado. A correlação da taxa de filtração glomerular com o IIEF foi estimada pelo coeficiente de correlação de Pearson. Resultados: Dentre os 245 pacientes com doença renal crônica em tratamento conservador que participaram do estudo, 71,02% tinham disfunção erétil e, em 36,73%, o distúrbio sexual era grave. A análise individual das variáveis estudadas nestes pacientes, sem excluir a influência de uma sobre a outra, apontou associação de disfunção erétil com idade superior a 50 anos, índice de massa corpórea inferior a 25, diabetes mellitus, estágios IV/V de doença renal crônica, arritmias cardíacas e distúrbios de condução, hiperplasia prostática benigna, uso atual ou prévio de cigarro, uso de cigarro por 10 anos ou mais, índice maço-ano de cigarro maior ou igual a 20, tempo do uso de álcool igual ou superior a 10 anos, albumina inferior a 3,5 g/100 mL e níveis de depuração da creatinina entre 15 e 29 mL/min/1,73 m2. A análise conjunta das variáveis estudadas nesse mesmo grupo de pacientes apontou associação independente de disfunção erétil com diabetes mellitus (P = 0,015). A comparação entre portadores de doença renal crônica em tratamento conservadores estágios III versus IV/V demonstrou maior prevalência de disfunção erétil nos graus mais avançados de doença renal crônica (P = 0,001) e frequência similar de disfunção erétil grave, moderada, moderada a leve e leve. A taxa de filtração glomerular demonstrou correlação positiva com a pontuação do IIEF. Conclusões: A prevalência de disfunção erétil em portadores de doença renal crônica em tratamento conservador é alta. Muitos fatores associam-se à disfunção erétil na população portadora de doença renal crônica em tratamento conservador. O único fator associado à disfunção erétil que não está sujeito à influência de outros agentes é a diabetes mellitus. A prevalência de disfunção erétil aumenta com a progressão da doença renal crônica em tratamento conservador.

INTRODUÇÃO: O câncer de próstata é a neoplasia sólida mais comum em homens. Na doença localizada, as alternativas de tratamento cirúrgico são a Prostatectomia Radical Retropúbica (PRR), Prostatectomia Radical Perineal (PRP), Prostatectomia Radical Laparoscópica (PRL) e Prostatectomia Radical Robótica Assistida (PRRA). A cirurgia robótica tem recebido atenção de especialistas pelas perspectivas de melhores resultados funcionais, se comparado às demais técnicas, porém não há evidências suficientes na literatura que defina fatores prognósticos para os resultados funcionais. OBJETIVO: Identificar fatores prognósticos para resultados funcionais em portadores de câncer de próstata localizado submetidos à PRRA. MÉTODO: Analisaram-se vídeos de 143 PRRA realizadas de janeiro de 2009 a janeiro de 2012 no Hospital Alemão Oswaldo Cruz, São Paulo (Brasil) por um único cirurgião. A potência sexual foi avaliada considerando os parâmetros de dissecção bilateral ou unilateral, nota de dissecção, uso de cautério, uso de tração, uso de pontos hemostáticos no Feixe Vásculo Nervoso (FVN) e dados pré e pós-operatórios. Em relação à continência urinária, considerou-se o comprimento e qualidade do coto uretral, o tamanho do colo vesical e dados pré e pós-operatórios. No pós-operatório, potência sexual foi definida como a capacidade de penetração em mais de 50% das tentativas de intercurso sexual (escore >= 3 na Questão 2 do IIEF-5) com ou sem o uso de inibidores de Fosfodiesterase tipo 5. Continência urinária foi considerada quando não houve necessidade do uso de forros ou, se usados, que fosse no máximo um e apenas como segurança, ou que apresentaram escore zero no ICIQ-SF. RESULTADOS: Observou-se correlação para recuperação da potência com dissecção bilateral do FVN (p=0,001), maior nota de dissecção do FVN no 6º (p < 0,01) e 12º mês (p < 0,01), mediana de nota 9 para dissecção do FVN (p < 0,01), menor idade no 6º (p < 0,01) e 24º mês (p=0,01), idade média de 59 (p=0,007), 58,35 (p=0,02) e 57,7 anos (p=0,005) no 6º, 18º e 24º mês, respectivamente, peso corporal médio de 76,18 Kg (p=0,01), peso prostático com mediana de 31 g (p=0,03), menor valor de Gleason total (p=0,03), Gleason total com mediana de 6 (p=0,009), mediana de 12 fragmentos retirados (p=0,001), menor volume tumoral no 1º (p=0,01) e 18º mês (p=0,02), volume tumoral com mediana de 5,25 (p=0,03), 5,40 (p=0,02) e 5,25 cm³ (p=0,04) no 1º, 18º e 24º mês, respectivamente, tumor unilateral (p=0,02), e ausência de invasão capsular (p=0,02). As variáveis, uso de cautério, tração e pontos hemostáticos no FVN não apresentaram correlação com recuperação de potência sexual. A continência urinária apresentou correlação com maior tempo de cirurgia no 3º (p < 0,01) e 12º mês (p=0,02), mediana de tempo de cirurgia de 3,45 (p=0,001), 3,35 (p=0,04) e 3,30 horas (p=0,04) no 3º, 6º e 12º mês, respectivamente. As variáveis, comprimento do coto uretral, qualidade do coto uretral e tamanho do colo vesical não se correlacionaram com continência urinária, apesar de tamanho do colo vesical mostrar tendência com mediana de 15,92 mm (p=0,054). CONCLUSÃO: As variáveis, dissecção bilateral, nota de dissecção do FVN, idade, peso corporal, peso da próstata, Gleason total, número de fragmentos retirados, volume tumoral, estadiamento tumoral e tempo de cirurgia apresentaram-se como ferramentas úteis para definir fatores prognósticos para resultados funcionais em homens portadores de câncer de próstata localizado, submetidos à PRRA / INTRODUCTION: Prostate cancer is the most common solid malignancy in men. For localized disease, surgical alternatives include Radical Retropubic Prostatectomy (RRP), Radical Perineal Prostatectomy (RPP), Radical Laparoscopic Prostatectomy (RLP) and Robotic Assisted Radical Prostatectomy (RARP). The robotic approach has received great attention, due to the perspective of better functional outcomes when compared to the other surgical alternatives; however, there is not enough evidence in the literature to define prognostic factors for functional outcomes. OBJECTIVE: To identify prognostic factors for functional outcomes in prostate cancer patients undergoing RARP. METHODS: We analyzed the video files of 143 RARP performed by a single surgeon between January 2009 and 2012 at Oswaldo Cruz German Hospital in São Paulo, Brazil. Sexual potency was evaluated considering unilateral or bilateral dissection, grade of dissection, use of electrocautery, use of traction, and use of hemostatic stitches on the neurovascular bundles (NVB), and pre and postoperative data. Urinary continence was evaluated considering the length and quality of the urethral stump, size of the bladder neck, and pre and postoperative data. Postoperatively, sexual potency was defined as successful vaginal penetration in more than 50% of sexual intercourses (IIEF-5, Question 2, score >= 3) with or without the use of Phosphodiesterase type 5 inhibitors. Urinary continence was defined as no pad use, or the use of up to one pad for safety, or an ICIQ-SF score of zero. RESULTS: For the sexual potency recovery, we found correlations with bilateral NVB dissection (p=0.001), higher NVB dissection grade at 6º month (p<0.01) and 12º month (p < 0.01), median NVB dissection grade of 9 (p < 0.01), younger age at 6º month (p < 0.01) and 24º month (p<0.01), mean age of 59 (p=0.007), 58.35 (p=0.01) and 57.7 years (p=0.005) at the 6º, 18º and 24º months respectively, median body weight of 76.18 kilograms (p=0.01), median prostatic weight of 31 g (p=0.03), lower total Gleason score (p=0.03), total Gleason with a median of 6 (p=0.009), median of 12 fragments removed at biopsy (p=0.001), lower tumor volume at 1º (p=0.01) and 18º months (p=0.02), median tumor volume of 5.25 (p=0.03), 5.40 (p=0.02) and 5.25cc (p=0.04) at 1º, 18º and 24º months respectively, unilateral tumor (p=0.02), and absence of capsular invasion (p=0.02). Use of electrocautery, traction and hemostatic stitches on the NVB where not significant. Urinary continence showed correlation with longer surgical times at 3º (p < 0.01) and 12º months (p=0.02), median surgical times of 3.45 (p=0.001), 3.35 (p=0.04) and 3.3 hours (p=0.04) at 3º, 6º and 12º months, respectively. Urethral stump length, quality, and bladder neck size did not show correlation with continence, although there was a trend for bladder necks of 15.92 mm (p=0.054). CONCLUSIONS: The following parameters: NVB bilateral dissection, NVB dissection grade, patient age and weight, prostate weight, total Gleason, number of removed fragments, tumor volume, tumor stage, and surgical time are useful prognostic factors for predicting functional outcomes in prostate cancer patients undergoing RARP