Submitted by Maria Medeiros (maria.dilva1@ufcg.edu.br) on 2018-07-11T13:58:12Z No. of bitstreams: 1 PEDRO CORDEIRO DE SÁ FILHO - DISSERTAÇÃO (PPGCEMat) 2015.pdf: 1184428 bytes, checksum: d45677e721a744535e61270be9ecd9c9 (MD5) / Made available in DSpace on 2018-07-11T13:58:12Z (GMT). No. of bitstreams: 1 PEDRO CORDEIRO DE SÁ FILHO - DISSERTAÇÃO (PPGCEMat) 2015.pdf: 1184428 bytes, checksum: d45677e721a744535e61270be9ecd9c9 (MD5) Previous issue date: 2015-07-09 / O Sistema Intrauterino (SIU) medicamentoso é um sistema de contracepção hormonal que é colocado dentro do útero, e libera uma progestina. Este sistema é adaptado ao útero normal, porém, também é utilizado em útero submetido à ablação endometrial. Para tanto, é necessária a obtenção de biomaterial que seja capaz de se adaptar ao novo espaço intrauterino, como alternativa à histerectomia, a fim de controlar o sangramento uterino anormal. Ante ao exposto, o presente estudo objetivou desenvolver um protótipo para sistema intrauterino liberador de levonorgestrel a partir da caracterização de um sistema comercial para ser utilizado em mulheres submetidas à ablação endometrial. Inicialmente foi realizada a caracterização do SIU comercial e em seguida utilizou-se o polietileno de baixo peso molecular para confecções dos protótipos. O SIU comercial foi caracterizado por Difração de Raios X (DRX), Espectroscopia na Região de Infravermelho com Transformada de Fourier (FTIR), Microscopia Eletrônica de Varredura (MEV), Espectroscopia por Energia Dispersiva de Raios X (EDS), Calorimetria Exploratória Diferencial (DSC) e Termogravimetria (TGA). Observou-se por meio dos ensaios de caracterização que o SIU comercial é composto por polietileno e silicone. O fármaco é disperso em uma matriz de silicone. O protótipo foi confeccionado de polietileno e com formato adaptado ao útero submetido à ablação endometrial. Desta forma pode-se concluir que é possível obter um SIU adaptado ao útero de mulheres submetidas à ablação endometrial. / The Intrauterine System (IUS) Drug is a hormonal contraceptive system that is placed inside the uterus and releases a progestin. This system is adapted to the normal uterus, however, it is also used in uterus underwent endometrial ablation. Therefore, obtaining the biomaterial is necessary to be able to adapt to the new intrauterine space, as an alternative to hysterectomy in order to control abnormal uterine bleeding. Before the above, this study aimed to develop a prototype for releasing intrauterine system levonorgestrel from the characterization of a trading system to be used in women who underwent endometrial ablation. Initially it was performed to characterize commercial SIU and then used the low molecular weight polyethylene, for clothing of the prototypes. The commercial SIU was characterized by X-Ray Diffraction (XRD), Infrared Spectroscopy in Region Fourier Transform (FTIR), Scanning Electron Microscopy (SEM), Spectroscopy Energy Dispersive X-ray (EDS), Differential Scanning Calorimetry (DSC) and Thermogravimetric Analysis (TGA). It has been observed through tests that characterize commercial SIU is composed of polyethylene and silicone. The drug is dispersed in a silicone matrix. The prototype was made of polyethylene and shaped similar to the uterus underwent endometrial ablation. Thus one can conclude that it is possible to get a SIU adapted to the uterus of women undergoing endometrial ablation.

Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Introduction Pregnancies in women with a previous unexplained stillbirth may be jeopardized by increased antenatal surveillance and higher rates of induction of labour and caesarean delivery without clear evidence of benefit. Despite the fact that there have been no studies that adequately tested fetal benefit in routine induction of labour for a previous stillbirth, a policy of routine induction of labour at 38 weeks, with all the associated maternal, fetal and health-care associated costs, was in practice at Tygerberg Hospital for the past 30 years. This study aimed to investigate the safety of continuation of these pregnancies until term (≥39 weeks). Aims and Objectives To assess the clinical outcome and impact on the health service in a pregnancy with a previous unexplained intra-uterine demise (IUD) by routine induction of labour at term instead of at 38 weeks. Methodology This was a prospective observational study on the safety of a new hospital protocol which was introduced in 2012. The protocol extended the gestation for induction after a previous IUD from 38 weeks to term. The study population included all pregnant patients with a current singleton pregnancy, and a previous unexplained or unexplored (no data available) singleton fetal demise ≥24 weeks/500grams. All patients with a previous stillbirth in the metropolitan drainage area of Tygerberg Hospital are referred to Tygerberg for further care; and all referrals during 2012 were recruited for the study. Patients with known or recurrent risks for intra-uterine death were managed according to the relevant clinical condition and were excluded from the study. Results During the audit period, 306 patients with a previous intra-uterine fetal death were referred for further management. Of these, 161 had a clear indication for either earlier intervention or no intervention and were excluded from the protocol. Of the remaining 145 patients, 9 met exclusion criteria and there were 2 patients who defaulted. Forty-two of the study patients (with no known previous medical problems) developed complications during their antenatal course that necessitated a change in clinical management and earlier (<39 weeks) delivery. Of the remaining 92 patients in the audit, 47 (51%) went into spontaneous labour before their induction date. There were no intra-uterine deaths prior to delivery. Conclusions Careful follow up at a high risk clinic identifies new or concealed maternal or fetal complications in 29% of patients with a previous IUD and no obvious maternal or fetal disease in the index pregnancy. When all risks are excluded and the pregnancy allowed to progress to 39 weeks before an induction is offered, 51% will go into spontaneous labour. / AFRIKAANSE OPSOMMING: Inleiding Swangerskappe in vroue met vorige onverklaarbare stilgeboorte mag in gevaar gestel word deur meer intense voorgeboorte sorg en ‘n groter hoeveelheid induksies van kraam en keisersnitte sonder duidelike bewyse dat dit tot voordeel strek. Ten spyte van die feit dat daar geen studies is wat bewys het dat roetine induksie van kraam vir ‘n vorige stilgeboorte op 38 weke tot voordeel van die baba was nie, was ‘n beleid van roetine induksie van kraam op 38 weke, met al die geassosieërde moederlike en fetale risikos daaraan verbonde; asook die hoë gesondheidskostes, roetine praktyk in Tygerberg Hospitaal vir die afgelope 30 jaar. Hierdie studie het ten doel gehad om die veiligheid van voortsetting van hierdie swangerskappe tot voltyd (≥39 weke) te ondersoek. Doelwitte Om die kliniese uitkoms; asook die impak op gesondheidsdienste te evalueer in ‘n swanger vrou met n vorige onverklaarbare intra-uteriene sterfte; deur roetine induksie van kraam aan te bied op voltyd in plaas van 38 weke. Metodologie Hierdie was n prospektiewe kohort studie om die veiligheid van ‘n nuwe hospitaal protokol wat in 2012 geïmplimenteer is, te bepaal. Hierdie protokol het die gestasie tydperk van induksie van kraam van alle swanger pasiënte na ‘n vorige onverklaarbare stilgeboorte van 38 weke na voltyd verleng. Die studiepopulasie het alle swanger pasiënte met ‘n huidige enkelswangerskap en ‘n vorige onverklaarbare of onbekende (geen data beskikbaar) enkelvoudige fetale sterfte ≥24 weke/500gram, ingesluit. Alle pasiënte in die metropolitaanse dreineringsarea van Tygerberg Hospitaal met ‘n vorige stilgeboorte word na Tygerberg verwys vir verdere hantering, en alle verwysings gedurende 2012 was gewerf vir die studie. Pasiënte met bekende of herhalende risikofaktore vir ‘n intra-uteriene sterfte was hanteer volgens die relevante kliniese inligting en was uitgesluit by die studie. Resultate Drie-honderd-en-ses pasiënte met ‘n vorige intra-uteriene fetale sterfte was gedurende die oudit periode verwys vir verdere hantering. In 161 pasiënte was daar ‘n duidelike indikasie vir of vroeër intervensie of geen intervensie nie; en hulle was uitgesluit van die protokol. Van die oorblywende 145 pasiënte is 9 pasiënte uitgesluit as gevolg van die uitsluitingskriteria en daar was 2 pasiënte wat versuim het om op te volg. Twee-en-veertig pasiënte (met geen bekende vorige mediese probleme nie) het komplikasies gedurende hulle voorgeboorte verloop ontwikkel wat gelei het tot verandering in kliniese hantering en vroeëre verlossing (≤39 weke) genoodsaak het. Van die oorblywende 92 pasiënte in die oudit, het 47 (51%) in spontane kraam gegaan voor hulle induksiedatum. Daar was geen intra-uteriene sterftes voor verlossing nie. Gevolgtrekkings Noukeurige opvolg by ‘n hoërisiko kliniek identifiseer nuwe of versteekte moederlike en fetale komplikasies in 29% van pasiënte met ‘n vorige intra-uteriene sterfte sonder enige duidelike moederlike of fetale siekte in die indeks swangerskap. Wanneer alle risikos uitgesluit word en die swangerskap toegelaat word om voort te gaan tot 39 weke voor ‘n induksie aangebied word, sal 51% van pasiënte spontaan in kraam gaan.

Early pregnancy is characterized by complex interactions between blood vessels, leukocytes, and conceptus-derived trophoblasts within the gestational uterus. Uterine Natural Killer (uNK) cells become the most abundant leukocyte during decidualization and produce a wide array of angiogenic factors, yet little is known regarding their early pregnancy functions. To characterize the role(s) of uNK cells, whole mount in situ immunohistochemistry of live early implant sites was performed. A timecourse examination of murine early pregnancy (virgin, and gd4.5-9.5) implantation sites was performed. Comparison of Gd6.5, 8.5 and 9.5 implant sites from BALB/c+/+ controls (BALB/c) and BALB/c-Rag2-/-Il2rg-/- (alymphoid) identified anomalies that result from the absence of lymphocytes. In alymphoid decidua basalis, mesometrial angiogenesis was widespread but pruning of nascent vessels within alymphoid decidua basalis was deficient. As early gestation progressed, vessels of alymphoid decidua basalis showed no evidence for remodeling. Alymphoid implantation sites showed ~24h delay in uterine lumen closure and embryonic development. To determine if uNK cells would normalize the anomalies observed in alymphoid implantation sites, adoptive cell transfer of NK+ B- T- marrow to alymphoid mice was performed. All of the above anomalies were reversed by adoptive transfer of NK+B-T- marrow. My results suggest that uNK cells support vascular growth and development which ensures the decidua can support the growing conceptus early in pregnancy prior to formation and function of the placenta. Human decidual NK cells may fill similar roles and be important targets for strategies designed to correct intra-uterine growth restriction. / Thesis (Master, Anatomy & Cell Biology) -- Queen's University, 2013-08-02 08:42:06.487

Diagnostiquées à partir de douleurs pelviennes, de dysfonctionnements menstruels ou dans le cadre d’un bilan d’infertilité, les adhérences intra-utérines sont des accolements fibreux des faces internes de la cavité utérine, qui peuvent obstruer partiellement ou totalement la cavité utérine. Tout acte traumatique dans la cavité utérine est considéré comme pourvoyeurs d’adhérences post-opératoires. Pour prévenir l’apparition de ces adhérences intra-utérines, nous avons développé un dispositif médical anti-adhérentiel, résorbable et autodéployable. Pour cela, nous avons synthétisé une famille de copolymères innovants constitués de poly (acide lactique) – poly (éthylène oxyde) – poly (acide lactique) avec des propriétés de gonflement adaptés à l’application. L’évaluation biologique in vitro des copolymères a permis de démontrer l’absence de cytotoxicité et le caractère anti-adhérentiel des biomatériaux en contact avec des cellules endométriales humaines. Les études in vivo ont permis de démontrer l’efficacité du copolymère sélectionné comme barrière physique résorbable permettant la non-adhérence de tissus lésés. L’implantation du copolymère n’entraîne pas de réactions biologiques majeures dans les cornes utérines et n’altère pas la fonction de reproduction de l’animal. De plus, l’étude du déploiement du dispositif dans des utérus issus d’hystérectomies chez des patientes nous a permis de confirmer que le dispositif médical développé est adapté à la morphologie utérine. / The symptoms of intrauterine adhesions are pelvic pain, menstrual abnormalities and infertility. Intrauterine adhesions result in the fibrous adherence of opposing uterine walls, which produce partial or complete obliteration in the uterine cavity. Trauma to a gravid uterine cavity is known to be the main cause of adhesions formation. In order to prevent postsurgical adhesion formation, a new anti-adhesive and resorbable medical device was developed to maintain separated uterine walls after surgical trauma. Anti-adhesive barrier was obtained from polylactic acid – polyethylene oxyde – polylactic acid triblock copolymers presenting specific swelling properties. In vitro biocompatibility and anti-adhesive effects of triblock copolymers were demonstrated using human endometrial cells. In vivo adhesion models have allowed us to confirm the anti-adhesive efficiency and the accuracy of the degradation time of a copolymer. This copolymer does not cause major biological responses after implantation in uterine horns and does not alter reproductive functions. A deployment study of the medical device in uterus of patients from hysterectomy has allowed us to demonstrate that our medical device is adapted to the uterine morphology.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: The objective of the study was to determine the prevalence of certain known risk factors for intra-uterine growth restriction (IUGR) in women who gave premature birth to growth-restricted infants at a large regional hospital (Kalafong) in the Gauteng province of South Africa and to investigate the possible associations between the presence of various risk factors and the severity of growth restriction found in these infants. METHOD: The study was designed as cross-sectional, descriptive and observational. The subjects included singleton growth-restricted premature infants (n=80), without congenital abnormalities and their mothers (n=80). Anthropometric data [weight, height, mid-upper arm circumference (MUAC) and triceps skinfold thickness (TSF)] were collected from these mothers three to four days post-partum. Infant birth weights were recorded at birth, while the lengths and head circumferences were recorded within 2 days post-partum. Additional information, such as birth spacing, maternal age, smoking habits and alcohol use, was collected by personal interview and blood pressure data and HIV status was obtained from medical records. Data capturing and descriptive statistics were done using Microsoft Excel and comparative analytical statistics were performed with the Statistical Package for the Social Sciences (SPSS), version 12.0. RESULTS: The study demonstrated a high prevalence (69%) of infants born with a birth weight <3rd percentile. In the sample, 81% of the mothers were aged 17-34 years and most (93%) had their children 18 months or longer apart. Malnutrition prevalence was moderate. In 58% of the mothers the BMI was normal (18.5-24.9 kg/m2) and in 47% the upper arm muscle area (UAMA) was between the 10th-85th percentile. Grade III overweight occurred in 3% and TSF ≤5th percentile occurred in 35% of the mothers. About half (51%) of the mothers in the sample population had hypertension during the second trimester of pregnancy. Smoking and alcohol use during pregnancy was rare (1% and 6% respectively) and the prevalence of HIV infection in the mothers was 26%. The prevalence (16%) of Grade II overweight among the mothers of symmetric growth-restricted (SGR) infants was higher than among the mothers of asymmetric growth-restricted (AGR) infants (7%). Of the hypertensive mothers, 55% had infants with SGR compared to 45% with AGR (p=0.47). Although rare, smoking occurred only in mothers with AGR infants (3%). No significant differences were found between the smoking and non-smoking group (p=0.21). Although the use of alcohol was more prevalent at 6% in mothers with SGA infants and 7% in mothers with AGR infants, no significant associations were found (p=0.95). Although not significant (p=0.76), there was a higher prevalence of HIV infection in mothers with SGR infants at 29%, compared to 23% of mothers of AGR infants. CONCLUSION: Although further studies are needed before intervention strategies can be planned and implemented, the findings of this study suggest that apart from the usual factors (maternal age and nutritional status, smoking and alcohol use during pregnancy and birth spacing) that may influence intra-uterine growth, hypertension may contribute greatly to IUGR in this study population.

Made available in DSpace on 2015-03-26T13:47:28Z (GMT). No. of bitstreams: 1 texto completo.pdf: 758192 bytes, checksum: 7d08ae26d20f3239be31bb31bc6ab288 (MD5) Previous issue date: 2003-08-20 / Embryo transfer (ET) in mares has been performed by transcervical or surgical methods. Pregnancy rates resulting from the transcervical method are more variable; however this is the more routine ET technique used nowadays. The surgical method has resulted in higher and less variable pregnancy rates. Although, this technique is much more invasive than the transcervical method and it demands a surgical environment and specialized personnel. In 1998, GASTAL et al. developed a transvaginal ultrasound-guided intra-uterine injection (IUI) technique and suggested it as a possible method for ET in mares. This technique would likely avoid cervical manipulation, one of the disadvantages of the transcervical ET technique. The objective of this study was to evaluate the efficiency of the IUI technique as an alternative method to the transcervical technique for ET in mares. In addition, dynamics of the uterus, corpus luteum, and embryonic vesicle were also studied. A real-time ultrasound scanner, equipped with a 5.0 MHz sector-array convex transducer, placed in a plastic extension for transvaginal procedures, a plastic epidural catheter (1.05 x 0.6 x 1000 mm), and a 16-ga needle (56 cm) were used. Immediately prior to ET, mares were sedated using detomidine (1 mg, i.v.). The right uterine horn was positioned transrectally against the vaginal wall over the transducer face. The needle with the catheter was introduced through the needle-guide of the transducer extension and inserted into the uterine lumen. The position of the catheter was verified by ultrasound and the embryo was placed into the uterus. Pregnancy diagnosis was done by ultrasound on Day 15. In Experiment 1, 33 IUI of 0.9% sterile saline (20 mL) were performed in 15 cyclic mares. The success of injection, indicated by the presence of fluid within the uterine lumen, was confirmed by transrectal ultrasonography. In Experiment 2, 77 embryos were transferred on Day 7 (Day 0 = ovulation) by IUI (n=39) or transcervical method (n=38). In Experiment 3, 31 embryos were transferred on Day 7 by IUI (n=16) or transcervical method (n=15). The control group consisted of inseminated mares (n=16) which were subjected to the same protocol of data collection as the ET groups. In Experiment 1, the operator successfully deposited saline into the uterus in 97% (32/33) of the IUI procedures. The overall embryo recovery rate in Experiments 2 and 3 was 71.8% (122/170). In Experiment 2, the pregnancy rates resulting from IUI (76.9%) and transcervical (78.9%) ET techniques were not different (P>0.05). In Experiment 3, the pregnancy rates obtained from IUI (75.0%, 12/16), transcervical (73.3%, 11/15), and control (68.7%, 11/16) groups were similar. On Day 7, mares treated by transcervical ET displayed increased (P<0.0001) uterine contractility from 5 to 60 min following the procedure compared to the other groups. No changes in uterine contractility were observed between control and IUI treated mares. No differences in uterine tone or echotexture were detected among groups. From Days 6 to 16 there were no differences in daily uterine contractility, tone, and echotexture between ET treated and control mares. In addition, similar luteal lifespan was observed among treatments. Patterns of transuterine embryonic vesicle mobility and the day of embryo fixation were not different among groups. Results of the present study suggest that the ultrasound-guided IUI ET technique may be a suitable alternative to the traditional transcervical method of ET in mares. In addition, the IUI ET technique may be a valuable tool for future studies involving ET in other species. / Embriões eqüinos têm sido comumente transferidos por dois métodos: transcervical ou cirúrgico. As taxas de prenhez originadas pelo primeiro oscilam bastante, embora seja de mais fácil aplicação. O método cirúrgico tem originado taxas de prenhez mais elevadas e mais homogêneas. No entanto, é mais oneroso por demandar condições e pessoal especializados. Em 1998, GASTAL et al. desenvolveram uma técnica ultra-sonográfica de injeção intra-uterina (IIU) em eqüinos e a sugeriram como método alternativo para transferência de embriões (TE), pois evitaria algumas desvantagens da técnica transcervical advindas da manipulação cervical. O objetivo deste estudo foi avaliar a eficiência da técnica ultra-sonográfica de IIU como método alternativo de TE em eqüinos, comparando-a com a técnica transcervical (TC), assim como estudar a dinâmica uterina, do corpo lúteo e da vesícula embrionária. Para as injeções intra-uterinas foram utilizados transdutor setorial de 5 MHz, agulha de 16-ga e cateter colocados em uma extensão plástica para procedimentos transvaginais. A extensão foi introduzida na vagina e o operador tracionou o corno uterino contra a parede vaginal via transretal, posicionando-o frente à face do transdutor transvaginal. A IIU foi realizada quando o operador visualizou a ponta da agulha, do cateter e movimentos de vai-e-vem do cateter no lúmen uterino, por ultrasonografia. As TE foram realizadas no Dia 7 (Dia 0 = ovulação). Diagnósticos de gestação foram realizados no Dia 15, por ultrasonografia transretal. No Experimento 1, 33 IIU foram realizadas com 20 mL de solução estéril de NaCL a 0,9%. A eficiência da técnica foi verificada por pesquisa de fluido uterino imediatamente após as injeções, por meio de exame ultra-sonográfico transretal. No Experimento 2, 77 embriões foram transferidos por IIU (n=39) ou via TC (n=38), em duas estações reprodutivas. No Experimento 3, três grupos foram estudados: TE por IIU, TE via TC e Controle. O grupo Controle foi formado com éguas previamente inseminadas e submetidas ao mesmo protocolo de coleta de dados dos grupos de TE. No Experimento 1, obteve-se taxa de sucesso de 97% (32/33) na deposição de solução salina no lúmen uterino por IIU. Adicionalmente, verificou-se que os parâmetros ultrasonográficos de visualização da ponta da agulha, da ponta do cateter, dos movimentos de vai-e-vem e da ejeção de fluido, foram fundamentais na avaliação da eficiência da técnica de IIU. A taxa de recuperação embrionária total nas duas estações foi de 71,8% (122/170). No Experimento 2, as taxas de prenhez obtidas pelas técnicas de TE por IIU (76,9%; 30/39) e TE via TC (78,9%; 30/38), não diferiram (P>0,05). No Experimento 3, as taxas de prenhez das técnicas de TE por IIU (75,0%; 12/16), TE via TC (73,3%; 11/15) e do grupo Controle (68,7%; 11/16) foram similares (P>0,05). Nas TE por IIU e no grupo Controle não foram detectadas alterações na contratilidade uterina no Dia 7. No entanto, efeito estimulatório na contratilidade uterina foi detectado entre 5 a 60 minutos após TE via TC (P<0,0001). Não foram detectadas diferenças entre tônus e ecotextura uterina no Dia 7 entre as técnicas de TE e o grupo Controle. Entre os Dias 6 e 16 as éguas receptoras de embriões e do grupo Controle apresentaram o mesmo padrão diário de tônus e ecotextura uterina. Não foram detectadas alterações na vida média do corpo lúteo entre os grupos estudados. Os padrões de mobilidade da vesícula embrionária e o dia de fixação da mesma foram similares entre os grupos. Os resultados do presente estudo indicam que a técnica ultra-sonográfica de IIU é um método alternativo de TE, originando taxas de prenhez similares ao método transcervical. Esta pode ser uma opção valiosa para éguas com histórico de dificuldade de transposição cervical durante o procedimento de inovulação. Além disso, esta técnica poderá colaborar para estudos futuros de utilização de TE em outras espécies de animais domésticos e silvestres.

O objetivo deste estudo foi avaliar as condições de saúde bucal de crianças com desnutrição intra-uterina, acompanhadas no Ambulatório de Nutrição e Puericultura do Departamento de Pediatria da Faculdade de Medicina da Universidade de Santo Amaro (UNISA). Essa instituição adota o padrão ouro da alimentação, crescimento e desenvolvimento, através do incentivo ao aleitamento materno exclusivo até os 4-6 meses de idade e segue as normas aprovadas pelo Departamento de Nutrição da Sociedade Brasileira de Pediatria quanto à suplementação mineral e da vitamina D. A amostra foi constituída de 28 crianças na faixa etária de 6 à 60 meses, nascidas a termo, com mais de 37 semanas, sendo classificadas de acordo com o peso de nascimento como Normais, com peso maior que 3000g, e Pequenas para a Idade Gestacional (PIG), com peso menor que 2500g. Em relação à saúde bucal, foram avaliados os seguintes fatores: visita ao cirurgião dentista, orientação de higiene bucal, limpeza dos dentes, uso de fio dental, placa bacteriana visível na superfície vestibular dos incisivos decíduos superiores, uso de mamadeira, hábitos de sucção (chupeta ou dedo), prevalência de cárie e defeitos de desenvolvimento do esmalte (DDE). Também foi avaliada a condição nutricional (NCHS) na data do exame odontológico. Não houve diferença estatística significante quanto ao tempo médio de aleitamento, que foi em torno de nove meses para ambos os grupos (teste de Mann-Whitney, Z=0,02 / Z crítico=1,96). As crianças Normais e as PIG não apresentaram diferenças estatisticamente significantes quando se consideram as possíveis alterações dos fatores avaliados, com exceção do uso do fio dental, o qual foi significante nas crianças PIG (teste Exato de Fisher p=0,0126). Através do coeficiente de correlação de Spearman verificou-se que tanto para o grupo PIG quanto para o Normal, os três primeiros fatores favoráveis à saúde bucal foram: limpeza dos dentes, ausência de placa visível e orientação sobre higiene bucal. Concluiu-se, que apesar da condição nutricional de nascimento, as crianças PIG não mostraram diferença quanto à saúde bucal, o que pode ser explicado devido às ações educativas voltadas para prevenção e promoção de saúde global que são ministradas nos Ambulatórios Materno-Infantil e de Puericultura da UNISA, com a orientação da Disciplina de Odontopediatria da Faculdade de Odontologia da mesma Entidade. / This study’s objective was value the oral conditions of children with intra-uterine under nutrition, accompanied at the Nutrition an childcare outpatient department of the Pediatric department of Medicine college of Santo Amaro ‘ s University (UNISA). This institution adopt the old Standard of feeding, growth and development, by the breast feeding incentive, exclusive until 4-6 mouths of age and follows the norms approved by the Nutrition Department of the Brazilian ‘ s Pediatric Society that refers to the mineral supplement and supplement of D vitamin. The sample was constituted by 28 children aged between 6 and 60 months, born at the right moment, with more than 37 weeks, being classified according with the weigh of birth as Normal, weighting over 3000g, and small to their gestational age (SGA), weighting less than 2500g. About the oral health, the following factors were valued: visit to a dentist surgeon, oral hygiene orientation, teeth cleanliness, usage of dental floss, visible bacterial plaque at the vestibular surface of the superior incisors, usage of feeding bottle, suck habits (dummy or finger), prevalence of caries and development defects of the enamel (DDE). The nutrition condition was valued (NCHS) at the dental exam. There was no significant difference at the breast feeding time that was about 9 mouths for both groups(Mann-Whitney test, Z+0,02 / critics Z =1,96). The normal children and the ones SGA did not present significant differences when took into account the possible alteration of the valued factors, except of the usage of dental floss, that was significant at children that was small for the gestational age (Exact Fisher test p=0,0126). By the Spearman ‘ s correlation’s coefficient was observed that to both groups, the three more important factors to the oral health were: teeth cleanliness, no visible plaque and oral hygiene orientation. The conclusion was that in spite of the nutritional condition of birth, the children that were small for the gestational age, did not show differences in the oral health, what can be explained by the educational actions done to prevention and promotion of global health that are learned at the Motherly-Infant and child care outpatient department of UNISA, with orientation of Pediatric dentistry of Dental College discipline. Key-words: intra-uterine growth retardation – fetal undernutrition – breast feeding – oral health children

p. 1-204 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-05-02T19:30:43Z No. of bitstreams: 1 999999999999999999.pdf: 821652 bytes, checksum: a675e81264e0276fcd87b509e674c613 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:40:30Z (GMT) No. of bitstreams: 1 999999999999999999.pdf: 821652 bytes, checksum: a675e81264e0276fcd87b509e674c613 (MD5) / Made available in DSpace on 2013-05-04T17:40:30Z (GMT). No. of bitstreams: 1 999999999999999999.pdf: 821652 bytes, checksum: a675e81264e0276fcd87b509e674c613 (MD5) Previous issue date: 2007 / Fatores associados ao retardo no crescimento intra-uterino ainda não foram totalmente esclarecidos. Recém-nascidos (RN) pequenos para a idade gestacional (PIG) apresentam alterações nos valores hematológicos comparados aos RN adequados para a idade gestacional (AIG) e pré-termos. Persistem também limitações metodológicas inerentes a acurácia dos métodos de determinação da idade gestacional. Objetivos: Determinar os fatores associados ao RCIU, as características hematológicas dos recém nascidos portadores do RCIU e avaliar a acurácia dos métodos da avaliação da idade gestacional utilizados no diagnóstico antropométrico desses recém-nascidos. Metodologia: Estudo envolvendo puérperas e 564 RN em 2 maternidades públicas da cidade de Salvador. Foram classificados de AIG, RN com o peso ≥10th e <90th, de PIG aqueles com peso <10th, avaliados pela curva de Williams; e pré-termo, aqueles com <37 semanas de gestação. Os dados foram coletados utilizando-se de questionário padronizado. Foram tomadas as medidas antropométricas da criança e da puérpera e coletou-se o sangue do cordão umbilical. A idade gestacional foi calculada pelos métodos da data da última menstruação, ultrassonografia e físico de Capurro. Estudo 1 de desenho caso-controle. Estudos 2 e 3 de desenhos de corte transversal. Análise estatística: No estudo 1, utilizou-se a regressão logística não condicional para testar a associação entre a variável dependente e as preditoras e Odds Ratio foi adotado como medida de associação. No estudo 2, a média e seu respectivo DP, valor máximo e mínimo foram usados para descrever os valores hematológicos do cordão umbilical. Para o estudo 3, realizou-se a diferença entre as medianas da idade gestacional segundo os métodos, utilizando-se do teste não paramétrico “Wilcoxon Signed Rank Test”. A correlação entre as idades gestacional estimadas pelo DUM, USG e Capurro e entre estes métodos e o peso ao nascer foi realizada utilizando-se do coeficiente de correlação de Pearson. Utilizou-se o Coeficiente Kappa para avaliar a concordância entre os métodos na estimação do estado antropométrico do recém-nascido. A validade dos métodos na estimação da idade gestacional foi avaliada por meio do cálculo da sensibilidade, especificidade, VPP, VPN e pela curva ROC. Foram utilizados os pacotes estatístico SPSS.11 e o Stata 8, aceitando-se a significância de 5% nas estimativas de interesse. Resultados: Com o estudo 1, identificou-se que a primeira gestação (OR:2,85; 1,73-4,71), o hábito de fumar (OR: 2,65; 1,35-5,19) e a gestação anterior desfavorável (OR:2.10; 1,21-3,64) se comportaram como fatores de risco para retardo no crescimento intra-uterino. Os resultados do estudo 2 indicaram que valores mais altos de hemácias (4,21×1012/l±0,48), hemoglobina (14,50 g/dl ±1,42), hematócrito (43,50%±4,36), ferritina (162,61 µg/l ±100,10); RDW (13,34±0,85%) e leucócitos (12,82 109/l ±3,39) foram identificados nos RN PIG, quando comparados com aqueles dos AIG a termo e pré-termos. Os RN AIG pré-termos apresentaram valores mais altos de VGM e HGM. Os valores médios das plaquetas foram mais altos nos RN AIG a termo. A partir dos resultados do estudo 3, observou-se que o método de Capurro incrementou a idade gestacional em intervalos menores de 39 semanas e a USG a aumentou a partir deste patamar, em relação ao método DUM. Os métodos DUM e USG apresentaram maior correlação entre a estimativa da idade gestacional e o estado antropométrico para o conjunto dos RN (r=0,668) e para a identificação do RN AIG (r=0,685). Considerando a idade gestacional estimada pelo DUM e a relação com o peso ao nascer, o coeficiente de correlação foi mais elevado (r=0,609) na identificação dos RN PIG’s. Na predição de RN PIG’s, maior sensibilidade foi observada para a USG (96,6%) e maior especificidade para o Capurro (75,5%). Acurácia mais elevada na estimativa da idade gestacional foi observada para a USG na 41ª, tomando como referencia o DUM (ROC=77%). Conclusão: O RCIU associou-se à primeira gestação, à gestação anterior desfavorável e ao hábito de fumar. RN portadores de RCIU apresentaram valores ematológicos mais elevados em relação os RN AIG e pré-termos e o método físico de Capurro apresentou pior desempenho na identificação de RCIU. / Salvador

O objetivo deste estudo foi avaliar as condições de saúde bucal de crianças com desnutrição intra-uterina, acompanhadas no Ambulatório de Nutrição e Puericultura do Departamento de Pediatria da Faculdade de Medicina da Universidade de Santo Amaro (UNISA). Essa instituição adota o padrão ouro da alimentação, crescimento e desenvolvimento, através do incentivo ao aleitamento materno exclusivo até os 4-6 meses de idade e segue as normas aprovadas pelo Departamento de Nutrição da Sociedade Brasileira de Pediatria quanto à suplementação mineral e da vitamina D. A amostra foi constituída de 28 crianças na faixa etária de 6 à 60 meses, nascidas a termo, com mais de 37 semanas, sendo classificadas de acordo com o peso de nascimento como Normais, com peso maior que 3000g, e Pequenas para a Idade Gestacional (PIG), com peso menor que 2500g. Em relação à saúde bucal, foram avaliados os seguintes fatores: visita ao cirurgião dentista, orientação de higiene bucal, limpeza dos dentes, uso de fio dental, placa bacteriana visível na superfície vestibular dos incisivos decíduos superiores, uso de mamadeira, hábitos de sucção (chupeta ou dedo), prevalência de cárie e defeitos de desenvolvimento do esmalte (DDE). Também foi avaliada a condição nutricional (NCHS) na data do exame odontológico. Não houve diferença estatística significante quanto ao tempo médio de aleitamento, que foi em torno de nove meses para ambos os grupos (teste de Mann-Whitney, Z=0,02 / Z crítico=1,96). As crianças Normais e as PIG não apresentaram diferenças estatisticamente significantes quando se consideram as possíveis alterações dos fatores avaliados, com exceção do uso do fio dental, o qual foi significante nas crianças PIG (teste Exato de Fisher p=0,0126). Através do coeficiente de correlação de Spearman verificou-se que tanto para o grupo PIG quanto para o Normal, os três primeiros fatores favoráveis à saúde bucal foram: limpeza dos dentes, ausência de placa visível e orientação sobre higiene bucal. Concluiu-se, que apesar da condição nutricional de nascimento, as crianças PIG não mostraram diferença quanto à saúde bucal, o que pode ser explicado devido às ações educativas voltadas para prevenção e promoção de saúde global que são ministradas nos Ambulatórios Materno-Infantil e de Puericultura da UNISA, com a orientação da Disciplina de Odontopediatria da Faculdade de Odontologia da mesma Entidade. / This study’s objective was value the oral conditions of children with intra-uterine under nutrition, accompanied at the Nutrition an childcare outpatient department of the Pediatric department of Medicine college of Santo Amaro ‘ s University (UNISA). This institution adopt the old Standard of feeding, growth and development, by the breast feeding incentive, exclusive until 4-6 mouths of age and follows the norms approved by the Nutrition Department of the Brazilian ‘ s Pediatric Society that refers to the mineral supplement and supplement of D vitamin. The sample was constituted by 28 children aged between 6 and 60 months, born at the right moment, with more than 37 weeks, being classified according with the weigh of birth as Normal, weighting over 3000g, and small to their gestational age (SGA), weighting less than 2500g. About the oral health, the following factors were valued: visit to a dentist surgeon, oral hygiene orientation, teeth cleanliness, usage of dental floss, visible bacterial plaque at the vestibular surface of the superior incisors, usage of feeding bottle, suck habits (dummy or finger), prevalence of caries and development defects of the enamel (DDE). The nutrition condition was valued (NCHS) at the dental exam. There was no significant difference at the breast feeding time that was about 9 mouths for both groups(Mann-Whitney test, Z+0,02 / critics Z =1,96). The normal children and the ones SGA did not present significant differences when took into account the possible alteration of the valued factors, except of the usage of dental floss, that was significant at children that was small for the gestational age (Exact Fisher test p=0,0126). By the Spearman ‘ s correlation’s coefficient was observed that to both groups, the three more important factors to the oral health were: teeth cleanliness, no visible plaque and oral hygiene orientation. The conclusion was that in spite of the nutritional condition of birth, the children that were small for the gestational age, did not show differences in the oral health, what can be explained by the educational actions done to prevention and promotion of global health that are learned at the Motherly-Infant and child care outpatient department of UNISA, with orientation of Pediatric dentistry of Dental College discipline. Key-words: intra-uterine growth retardation – fetal undernutrition – breast feeding – oral health children

L'objectif de ce projet repose sur le développement d’un dispositif médical intra-utérin résorbable prévenant l’apparition ou la récidive d'adhérences intra-utérines (synéchies). La mise en place de ce dispositif suite à chaque agréssion endométriale représenterait un bénéfice symptômatique et économique dans la prise en charge de l’infertilité par trouble de l'implantation. Ce dispositif repose sur l'association originale de polymères résorbables mis sous forme de films stérilisés et maléables, répondants aux contraintes spécifiques de la voie endo-utérine. Des tests sur culture cellulaire ont permis de valider son potentiel anti-adhérentiel en retrouvant des résultats comparables à ceux d’agents barrières disponibles sur le marché. La dégradation in vitro et in vivo du polymère a été étudiée afin de valider un délai d’efficacité suffisant. Des travaux expérimentaux ont été conduits après accord des comités d’éthiques. D’une part, des tests de reproduction animale ont été menés afin de démontrer l’innocuité du dispositif et son efficacité sur la fertilité. D’autre part, des travaux ont permis de valider sur le plan histologique l’effet préventif sur les synéchies. Un travail de modélisation a permis d’adapter la forme du film pour la voie utérine. Les tests de déploiement ont été conduits sur des utérus de cadavre et sur des pièces d’hystérectomie. Après mise en place aisée par les voies naturelles, le dispositif se déploie et gonfle afin de recouvrir la cavité utérine. Des travaux précliniques pourraient être envisagés avant un développement industriel afin d’améliorer les outils disponibles pour la prévention des synéchies intra-utérines. / The objective of this study was to develop an resorbable intra-uterine medical device preventing the appearance or the recurrence of intra-uterine adhesions (synechiaes). The insertion of the device following each endometrial injury would represent a symptomatic and economic benefit in the treatment of infertility by implantation failure. This device is base on the unique combination of resorbables polymers formed into sterilized and malleable films, respondents to the specific constraints of the endo-uterine way. Cellular assays allowed validating the anti-adhesive effect with results comparable to those of currents agents available for the clinical practice. The in vitro and in vivo degradation of the polymer was study to validate a sufficient period of efficiency. The use of experimental models allowed an evaluation of the polymer. On one hand, tests of animal reproduction were lead to demonstrate the harmlessness of the device and the efficiency on the fertility. On the other hand, work has validated histologically preventive effect on synechiaes. Finally, a modeling work allowed adapting the form and dimension of the film for the human uterine way. Tests of deployment carried out on fresh uterus from hysterectomy. After the insertion by the cervical way, the device unfolds and inflates to cover the uterine cavity. Preclinical studies could be done before an industrial development in order to improve the available tools for the clinical prevention of the intra-uterine synechiaes.