Doctor of Medicine / Publications 1-49 represent studies that I have undertaken myself or conjointly over a 34 year period to investigate a variety of issues relating to diseases of the kidney and urinary tract in children. The studies were carried out at the Royal Alexandra Hospital for Children, Camperdown when I was Clinical Superintendent from 1968 - 1970; The Department of Paediatrics, University of Minnesota, Minneapolis, USA when I was Overseas Research Fellow of the Post Graduate Foundation in Medicine, University of Sydney, 1970 - 1972, then as Staff Physician in Nephrology at the Royal Alexandra Hospital for Children, Camperdown, 1972 - 1977, and then Head of that Department at the Hospital until 1995 and then as an Honorary Staff Specialist at that hospital. Some of the studies were done conjointly with members of the Renal Unit of Royal Prince Alfred Hospital where I hold an Honorary appointment and others conjointly with members of the Renal Unit of Prince Henry Hospital, Little Bay. I was appointed Clinical Associate Professor to the Department of Paediatrics and Child Health, University of Sydney in 1993. In 1966 paediatric nephrology was in the early phase of development as a medical subspecialty. There was no definitive textbook, the first was published in 1975 (Pediatric Nephrology, Ed. Mitchell I. Rubin. Williams and Wilkins.). In the preface to the 2nd edition of Renal Disease (Blackwell) in 1967 the editor D.A.K. Black noted that he had included a chapter on paediatric aspects which had been planned for the 1st edition in 1962 but ”it could not be arranged”. In the chapter on Renal Disease in Children the author, D.Macauly, comments that the mortality rate of acute renal failure in children was 50%. When I joined the resident staff of the Royal Alexandra Hospital for Children in 1966, children with renal disease were managed by general paediatricians. There was no active program for the treatment of children with acute or chronic renal failure. A small number of kidney biopsies had been performed by Dr Trefor Morgan who, together with Dr Denis Wade, had taught me the technique while I was a resident medical officer at the Royal Prince Alfred Hospital in the preceding year. With the guidance and support of Dr S.E.J. Robertson and Dr C. Lee, Honorary Medical Officers, and Dr R.D.K. Reye, Head of the Department of Pathology, I began performing kidney biopsies on children at the request of the paediatrician in charge. In the same year, encouraged again by Doctors Robertson and Lee, and by J.C.M. Friend and J. Brown, I introduced peritoneal dialysis for the treatment of children with acute renal failure, a technique which I had also been taught by Dr Trefor Morgan whilst I was a resident at Royal Prince Alfred Hospital. Dr Robertson encouraged me to present my experience in percutaneous renal biopsy in children at the Annual Meeting of the Australian Paediatric Association in 1968 and this study became the first paper I published in relation to disease of the urinary tract in children (1). In 1970 I was granted an Overseas Research Fellowship by the Post Graduate Foundation in Medicine, University of Sydney, to enable me to undertake a fellowship in the Department of Paediatrics at the University of Minnesota. I had the great fortune in undertaking studies in the new discipline of paediatric nephrology and related research under the guidance of Dr A. F. Michael, Dr R.L.Vernier and Dr A. Fish. I acquired the techniques of immunopathology and electron microscopy. On my return to Australia I established a Department of Nephrology at the Royal Alexandra Hospital for Children. I introduced immunofluorescent and electron microscopic studies for the kidney biopsies that I continued to perform and, with the support of Dr R.D.K. Reye, I provided the official reports of these studies until 1990. As a result these studies became part of the histopathologic service provided by the hospital. I continue to be consulted concerning the interpretation of some electron microscopic findings in renal tissue. With the assistance of Dr J.D. Harley I set up a laboratory in the Children’s Medical Research Foundation to continue and expand the studies I had commenced during my Fellowship. Establishing a dialysis and transplant program for children with end stage renal disease (ESRD) was extremely time consuming. At that time most children with ESRD died. The program was initially established jointly with the Renal Unit at Royal Prince Alfred Hospital in 1972 and eventually dialysis facilities were established at the Children’s Hospital using predominantly peritoneal dialysis. By 1978 the existence of the Unit was well known in the general community and articles appeared in the press. One prompted the late Sir Lorimer Dods, the first Professor of Paediatrics in Australia to write to me congratulating me on what I had achieved. He remarked “I have just read with special interest Shaun’s review in the SMH of some of your recent achievements in the field of renal failure in infancy and childhood and want to offer you my personal congratulations on all that you have achieved and are achieving in this area of paediatrics which, in my little world of yesterday, meant nothing more than progressive and unrelenting fatal illness”. Taking part in the development of a relatively new discipline led me to study a number of areas. I encouraged trainees to write reports concerning clinical observations and eventually I was joined by Fellows whom I encouraged and supported to study a number of different areas to ensure that children were being cared for in an environment of strong and open enquiry. This led to studies on investigations of chronic renal failure which Dr Elisabeth Hodson pursued and studies on urinary tract infection in small children for which Dr Jonathon Craig was awarded a PhD. As I had been a contributor and co-author in a number of these studies they have been included in my list of publications. As a result of this diversity I have listed the publications in 9 sections. The overall theme is to study diseases of the renal tract in children and treatments used to understand the processes and ensure the most effective treatment. Some published abstracts of papers presented at scientific meetings have been included to clarify invitations I received to prepare reviews and chapters on various subjects and my involvement in some conjoint studies. I was author or coauthor of several book chapters, reviews, editorials and certain published studies to which I was invited to contribute as a result of my primary studies and these I have included as “Derivative References”numbered 50-76.

Orientador: André Luís Balbi / Banca: José Mauro Vieira Junior / Banca: Emerson Quintino de Lima / Resumo: Pacientes com Lesão Renal Aguda (LRA) em Diálise Peritoneal Contínua (DPC) ou Hemodiálise Diária (HD) podem apresentar alterações da função pulmonar relacionadas à hipóxia, retirada de líquidos ou toxinas uremias e, no caso da DPC, ao aumento da pressão intra-abdominal (PIA). Os objetivos deste estudo foram realizar avaliação respiratória de pacientes com LRA dialítica internados em Unidades de Terapia Intensiva (UTI) em Ventilação Mecânica Invasiva (VMI), submetidos à DPC e ou HD e avaliar a PIA nos pacientes em DPC. Foi realizado estudo prospectivo descritivo em que foram avaliadas complacência estática (Cest, expresso em mL/cmH2O), resistência do sistema respiratório (Rsr, expresso em cmH2O/L/s), relação PaO2/FiO2 e FiO2 (expresso em %) em pacientes submetidos a DPC e HD e PIA (expresso em mmHg) naqueles em DPC. Os pacientes do Grupo DPC foram avaliados nos momentos M0 (pré-diálise/cavidade vazia), M1(pós-infusão do dialisato da 1ª sessão de diálise/cavidade cheia), M2, M3 e M4 (após cada sessão de DP/cavidade vazia) e do Grupo HD nos momentos M1, M3 e M5 (pré-diálise) e M2, M4 e M6 (pós-diálise). Análise Estatística: Para comparar as variáveis de Cest, Rsr, PaO2/FiO2, FiO2 e PIA no tempo foi utilizado o modelo Anova de medidas repetidas e comparações múltiplas ajustado por Tukey ou o modelo de medidas repetidas usando uma distribuição assimétrica (Gama) através do procedimento GENMOD pela opção DIFF. Nível de significância de 5%. NO grupo DPC foram avaliados 20 pacientes em 44 sessões. A média de idade foi de 73,2± 11 anos, o APACHE II foi 24,1±4 e o ATN-ISS foi 0,64±23. A Cest diminuiu após a infusão do dialisato (cavidade abdominal cheia) em relação ao Pré- Diálise/cavidade abdominal vazia (M0= 36± 14,7 e M1= 33,85± 13,8 ml/cmH2O; p=ns) e após as trocas do dialisato... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Acute kidney injury (AKI) patients on continuous peritoneal dialysis (CPD) or daily hemodialysis (HD) may show changes in lung function related to hypoxia or removal of uremic toxins and fluids and in those undergoing PD also due to increased intraabdominal pressure (IAP). Objective of this study was to evaluate respiratory mechanic of critical AKI patients undergoing invasive mechanical ventilation (IMV) and treated by CPD or HD and assessment the IAP in patients on CPD. A prospective descriptive study was performed to determine static compliance (Cest expressed in mL/cmH2O), respiratory system resistance (Rsr expressed in cmH2O/L/s), PaO2/FiO2 ratio and Fi2O (expressed in %) in patients undergoing HD and CPD and PIA (expressed in mmHg) in those on CPD. CPD group was evaluated at M0 (pre dialysis/ empty cavity), M1 (post-infusion of the dialysate / filled cavity), M2, M3 and M4 (after each session of DP / empty cavity ) and the HD group at M1, M3 and M5 (pre-dialysis) and M2, M4 and M6 (post-dialysis). Statistical Analysis: To compare the variables Rsr, PaO2/FiO2, FiO2 and PIA was used ANOVA for repeated measures and Tukey adjusted for multiple comparisons or repeated measures model GENMOD procedure for the DIFF option. Significance level of 5%. Twenty patients (44 sessions) were evaluated in CPD group. Age was 73.2 ± 11 years, APACHE II was 24.1 ± 4 and ATN-ISS was 23 ± 0.64. Cest decreased after infusion of the dialysate (abdominal cavity filled) compared to the Pre-Dialysis / empty abdominal cavity (M0 = M1 and 36 ± 14.7 ± 13.8 mL/cmH2O = 33.85, p = ns) and increased progressively after exchanges of dialysate (empty abdominal cavity) (M2 = 38.42 ± 13.4; M3= 40.6± 13.5; and M4 = 53.4 ± 21.9 mL/cmH2O; M4 vs M0: p = 0.0018; M4 vs M1: p = 0.0004; M4 vs M2: p = 0.0017 M4 vs M3: p = 0.04). PIA... (Complete abstract click electronic access below) / Mestre

Made available in DSpace on 2014-06-11T19:28:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-25Bitstream added on 2014-06-13T19:16:41Z : No. of bitstreams: 1 martucci_af_me_botfm.pdf: 228219 bytes, checksum: ce34b2e82a7242601a90e1e535b1b1ed (MD5) / O aumento sérico da creatinina em 0,3mg/dL define o termo lesão renal aguda (LRA) e associa-se a maior incidência de mortalidade pós-operatória em pacientes submetidos a revascularização do miocárdio. Os estudos clínicos quanto à influência da dexmedetomidina (DEX) sobre a função renal ainda são escassos. Avaliou-se a LRA no pós operatório de revascularização do miocárdio com e sem circulação extracorpórea (CEC) quando se anestesiou com DEX. Neste estudo, retrospectivo, fez-se análise seriada da creatinina sérica (CrS) até 48h de pós-operatório de 286 pacientes submetidos a revascularização do miocárdio para avaliar a incidência de LRA. Testou-se a homogeneidade entre os grupos, avaliando-se os pacientes separadamente quanto ao uso de CEC e de DEX. Cada paciente foi avaliado em relação à sua concentração sanguínea de creatinina nos períodos pré-operatório, pós-operatório imediato, de 24h e de 48h. Em cada período foi efetuada a comparação da concentração de creatinina com a concentração no pré-operatório. Se em pelo menos um dos períodos esta comparação indicou aumento de creatinina≥0,3 mg/dL, o paciente foi classificado como tendo LRA. Foi também avaliado o risco de LRA em pacientes com creatinina sanguínea pré-operatória alterada (valores entre 1,1 a 2,0mg/dL para mulheres ou 1,3 a 2,0mg/dL para homens) em comparação com os pacientes com creatinina normal.Os resultados foram homogêneos quanto a peso, idade e creatinina alterada no pré-operatório e os pacientes que fizeram uso de DEX e foram submetidos a CEC apresentaram maior incidência de LRA, com p=0,043. Dentre aqueles que não foram submetidos a CEC, houve maior incidência de LRA após DEX, porém com p=0,066.O uso da DEX no intraoperatório aumentou a incidência de LRA no pós-operatório de revascularização do miocárdio de pacientes submetidos a CEC / The increase of 0.3mg/dL in serum creatinine defines the term acute kidney injury (AKI) and is associated with higher incidence of postoperative mortality in patients undergoing coronary artery bypass grafting surgery (CABG). Clinical studies regarding the influence of dexmedetomidine (DEX) on renal function are scarce. We evaluated the LRA in postoperative of patients submitted to CABG with and without cardiopulmonary bypass (CPB) under anesthesia with DEX. In this retrospective study it was made serial analysis of serum creatinine (SCr) until 48h after the surgery of 286 patients undergoing CABG under DEX to evaluate the incidence of AKI. We tested the homogeneity among groups, evaluating patients separately for the use of CPB and DEX. Each patient was evaluated with respect to their blood concentration of creatinine in the preoperative and postoperative: early, 24h and 48h. In each period, it was compared the creatinine concentration with creatinine concentration preoperatively. If at least in one of the periods this comparison showed increased creatinine ≥ 0.3mg/dL, the patient was classified as having AKI. It has also assessed the risk of AKI in patients with preoperative blood creatinine changed: values between 1.1 to 2.0mg/dL for females or 1.3 to 2.0mg/dL for men compared with patients with normal creatinine concentration. The results were homogeneous for weight, age and creatinine concentration altered to 2.0mg/dL preoperatively. Patients who used DEX and underwent CPB had a higher incidence of AKI, with p = 0.043. Among those who were not undergoing CPB, there was a higher incidence of AKI after DEX, but with p = 0.066. Conclusion. The use of intraoperative DEX increased the incidence of AKI in the postoperative myocardial revascularization in patients undergoing CPB

Made available in DSpace on 2015-12-10T14:24:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-23. Added 1 bitstream(s) on 2015-12-10T14:30:15Z : No. of bitstreams: 1 000847368.pdf: 673411 bytes, checksum: 255b0a78f8ece2608074e9983676a072 (MD5) / As doenças crônicas, não transmissíveis são problemas de saúde pública de âmbito mundial. Dentre estas, encontra-se a doença renal crônica (DRC), que acarreta prejuízos físicos, psicológicos e sociais ao portador. O tratamento para DRC é dividido em tratamento conservador e terapia renal substitutiva (TRS). O diagnóstico de uma doença crônica pode provocar diversas mudanças no cotidiano do individuo, sendo muitas vezes acompanhado de desorganização psicológica e reações emocionais variadas. Assim, considera-se relevante conhecer e abordar o paciente, sua percepção e conhecimento sobre sua doença. Este estudo objetivou identificar a percepção do paciente com doença renal crônica (estágios 3 e 4) e sua vivência a respeito da mesma. Trata-se de pesquisa qualitativa, de cunho descritivo, com os pacientes portadores de DRC, atendidos no Ambulatório de Nefrologia do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP. Foram realizadas entrevistas semiestruturadas, onde a quantidade de pessoas a serem entrevistadas foi determinado pelo ponto de saturação. No total participaram 14 pessoas, sendo 7 mulheres e 7 homens, com idade médica de 59,9 anos. A maioria residia com seu cônjuge, apresentava renda familiar de até dois salários mínimos e havia cursado até o ensino fundamental completo. Apesar da maioria já apresentar uma doença crônica (diabetes mellitus e ou hipertensão arterial sistêmica), a preocupação mais intensa com o tratamento e a adesão às recomendações médicas ocorreram efetivamente após o diagnóstico da DRC que se deu, em média, há 6,2 anos. Os entrevistados apresentaram diferentes sentimentos e vivencias relacionados a doença. A DRC ocasiona inicialmente um misto de sentimentos como revolta, tristeza, e medo, que em alguns se transforma posteriormente em uma postura mais positiva para o enfrentamento. As principais mudanças relatadas dizem respeito à própria... / The non-communicable chronic diseases are public health problems worldwide . Among these, we find the chronic kidney disease, which causes physical, psychological and social damage to the bearer. The pair treatment CKD is divided into conservative and TRS treatment. The diagnosis of a chronic disease results several changes in the individual's daily life, often accompanied by psychological disorganization and varied emotional reactions. Thus, it is considered relevant to know and approach the patient, their perception and knowledge of the disease. This study aimed to identify the perception of the patient with chronic kidney disease (stages 3 and 4) and their experience about the same. It is a qualitative research, of descriptive nature, with patients suffering from CKD who have been treated at the Nephrology Clinic of the Hospital of the Medical School of Botucatu - UNESP. Semistructured interviews were conducted, which, with the amount of people to be interviewed determined by the saturation point. In total 14 people participated, 7 women and 7 men with medical age of 59.9 years. Most of them have lived with their spouse, have had family income of up to two minimum wages and had attended to complete primary school. Although most already follow a chronic disease (diabetes and or hypertension), the most intense concern about the treatment and adherence to medical recommendations effectively occur after diagnosis of CKD that happened, on average, 6.2 years ago .The interviewees had different feelings and experiences related to the disease. The DRC initially causes mixed feelings as resentment, sadness, and fear, that in some was later transformed into a more positive attitude to face. The main changes relate to own family relationship around the sick one, in addition to dietary restrictions and physical impairment. Thus, it was observed that experience the DRC, means facing physical, psychological and social changes, requiring a great ...

Made available in DSpace on 2014-08-13T14:50:57Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-02-24Bitstream added on 2014-08-13T17:59:54Z : No. of bitstreams: 1 000769601.pdf: 3033772 bytes, checksum: 836d4d63f7f8df56f8982b5a85eff009 (MD5) / Estudo de cunho metodológico de construção e validação de instrumentos de avaliação em saúde, com o objetivo de construir e validar escalas de conhecimento sobre o acesso vascular definitivo em usuários de hemodiálise para os profissionais de enfermagem de nefrologia. As etapas para a elaboração das escalas foram: seleção das práticas envolvendo o acesso vascular definitivo em usuários de hemodiálise, fundamentação teórica das práticas selecionadas e elaboração das escalas pautadas nas diretrizes clínicas (guidelines) Clinical practice guidelines for vascular Access, Guías de Acceso Vascular em Hemodiálisis (Sociedade Espaῆola de Nefrología) e Guía de acceso vascular en hemodiálisis. O produto desse estudo foi a construção de quatro escalas: Escala de conhecimento sobre acesso vascular definitivo em usuários de hemodiálise (ECAVD) – Cuidados universais, Escala de conhecimento sobre acesso vascular definitivo em usuários de hemodiálise (ECAVD) – Cuidados específicos, Escala de conhecimento sobre acesso vascular definitivo em usuários de hemodiálise (ECAVD) – Exame físico e Escala de conhecimento sobre acesso vascular definitivo em usuários de hemodiálise (ECAVD) – Vigilância hemodinâmica. A coleta de dados ocorreu nos meses de fevereiro a agosto de 2013, por meio de um questionário, composto das seguintes partes: julgamento do conteúdo (constructo), dos atributos e dos componentes de cada escala construída. A validação de conteúdo das escalas foi realizada por doze juízes, com ampla experiência na área de nefrologia. Todas as escalas construídas foram validadas pelos profissionais, sob consenso favorável mínimo de 75%. Ressalta-se que após validação as escalas foram aplicadas a 84 profissionais de enfermagem que atuam em terapia de substituição renal em 3 centros no interior do Estado de São Paulo, onde 2,3% dos profissionais demonstraram apresentar pouco conhecimento, 33,3% ... / Methodological nature study of the construction and validation of assessment tools in health, in order to build and validate knowledge scales about the permanent vascular access in hemodialysis users for nephrology nurses. The steps to prepare the scales were: practices selection involving permanent vascular access to hemodialysis users, theoretical basis of selected practices and development of guided scales in clinical guidelines (guidelines) Clinical practice guidelines for vascular Access, “Guías de Acceso Vascular em Hemodiálisis” (Espanish Society of Nephrology) and “Guía de acceso vascular en hemodialysis”. Thus, four scales were built : knowledge Scale of permanent vascular access in hemodialysis users (KSPVA) – Universal Care, knowledge Scale of permanent vascular access in hemodialysis users (KSPVA) – Specific Care, knowledge Scale of permanent vascular access in hemodialysis users (KSPVA) – physical examination and knowledge Scale of permanent vascular access in hemodialysis users (KSPVA) – Hemodynamic Monitoring. Data collection occurred from February to August 2013, using a questionnaire, consisting of the following parts : trial content (constructo), of the attributes and components of each built scale. The scales content validity was performed by twelve judges with extensive experience in the field of nephrology. All built scales were validated by professionals under minimum favorable consensus of 75 %. It is noteworthy that after validation, scales were applied to 84 nurses, working on renal replacement therapy in 3 centers in towns of São Paulo State, where 2.3% of the professionals have demonstrated little knowledge, 33.3 % have demonstrated satisfactory knowledge and 64.2 % of the professionals have demonstrated full knowledge about care and complications with AVF

Made available in DSpace on 2016-07-01T13:10:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-08-22. Added 1 bitstream(s) on 2016-07-01T13:14:10Z : No. of bitstreams: 1 000866290.pdf: 647674 bytes, checksum: 4f5b629fd7ab086c433234638ac87a25 (MD5) / Introdução: A seroconversão à vacina contra o vírus da hepatite B (VHB) em indivíduos imunocompetentes varia de 90-95% enquanto nos pacientes em hemodiálise varia de 40-80%. Manter níveis adequados de anticorpos contra o VHB nas unidades de diálise é estratégia importante para diminuição do risco de transmissão do VHB e redução da incidência de complicações crônicas da hepatite B. Objetivo: Avaliar os fatores que influenciam a seroconversão do anticorpo anti- HbS, em pacientes vacinados contra o VHB, em diferentes estádios da doença renal crônica (DRC) e nos tratados por hemodiálise (HD) e diálise peritoneal (DP). Pacientes e Métodos: Foram incluídos pacientes maiores que 18 anos, portadores de DRC prevalentes em dezembro de 2011 e incidentes entre janeiro de 2012 e abril de 2014, que receberam o primeiro esquema de vacinação completo contra o VHB. Os pacientes foram divididos em quatro grupos conforme o estádio da DRC e a modalidade de diálise: grupo DRC (pacientes no estádio IV da DRC), grupo Pré-diálise (pacientes no estádio V da DRC), grupo DP (pacientes tratados por DP) e grupo HD (pacientes tratados por HD). Associações entre fatores demográficos, laboratoriais, clínicos, dialíticos e nutricionais com a seroconversão à vacina contra o VHB (anticorpo anti-Hbs >10 UI/dl) foram analisadas por regressão logística univariada e multivariada. Resultados: Foram incluídos 191 pacientes, 72 no grupo HD, 40 no DP, 36 no DRC e 43 no Pré diálise). A média de idade foi de 59,6 ± 15,1 anos; 49,7% eram masculinos, 83,5% da raça branca e 47,6% diabéticos. A porcentagem geral de seroconversão foi de 72,8%, sendo 76,4% para o grupo HD, 67,5% para o grupo DP, 75% para o grupo DRC e 69,8% para o grupo Pré-Diálise (p=0,72). Os fatores independentemente associados à maior chance de seroconversão foram a contagem total de linfócitos (p=0,02) e o ângulo de fase (p= 0,02), considerando a amostra total de... / Introduction: Seroconversion to the vaccine against hepatitis B virus (HBV) in immunocompetent individuals ranges from 90-95% while in hemodialysis patients varies from 40-80%. The maintenance of adequate levels of antibodies against HBV in the dialysis units is an important strategy for reducing the risk of HBV transmission and of incidence of chronic complications of hepatitis B. Objectives: To evaluate the factors influencing seroconversion of antibody anti-HbS in patients vaccinated against HBV in different stages of chronic kidney disease (CKD) and treated by hemodialysis (HD) or peritoneal dialysis (PD). Patients and Methods: We included patients greater than 18 years, patients with CKD prevalent in December 2011 and 2012 incidents between January and April 2014, who received the first full vaccination scheme against HBV. The patients were divided into four groups according to the stage of CKD and dialysis modality: DRC Group (patients in stage IV of the CKD), Pre-dialysis group (patients in stage V of the CKD), HD group (patients treated by HD), and PD Group (patients treated by PD). Associations between demographic, clinical, laboratory, dialytic, and nutritional factors with seroconversion to the vaccine against HBV (antibody anti-HBS > 10 IU/dl) were analyzed by univariate and multivariate logistic regression. Results: A total of 191 patients were included; 72 in the HD, 40 at DP, 36 in the DRC, and 43 in the Pre dialysis group). The average age was 59.6 ± 15.1 years; 49.7% were male, 83.5% of the white race and 47.6% diabetics. The overall percentage of seroconversion was 72.8%; 76.4% for the HD, 67.5% for DP, 75% for the DRC and 69.8% for Pre dialysis group (p = 0.72). The factors independently associated with the greater chance of seroconversion were the total lymphocyte count (p = 0.02) and the phase angle (p = 0.02), considering the total sample of patients; the total lymphocyte count (p = 0.033) and the use of vitamin D ...

Orientador: Yara Marcondes Machado Castiglia / Banca: Paulo do Nascimento Junior / Banca: Simone Maria D'Angelo Vanni / Resumo: O aumento sérico da creatinina em 0,3mg/dL define o termo lesão renal aguda (LRA) e associa-se a maior incidência de mortalidade pós-operatória em pacientes submetidos a revascularização do miocárdio. Os estudos clínicos quanto à influência da dexmedetomidina (DEX) sobre a função renal ainda são escassos. Avaliou-se a LRA no pós operatório de revascularização do miocárdio com e sem circulação extracorpórea (CEC) quando se anestesiou com DEX. Neste estudo, retrospectivo, fez-se análise seriada da creatinina sérica (CrS) até 48h de pós-operatório de 286 pacientes submetidos a revascularização do miocárdio para avaliar a incidência de LRA. Testou-se a homogeneidade entre os grupos, avaliando-se os pacientes separadamente quanto ao uso de CEC e de DEX. Cada paciente foi avaliado em relação à sua concentração sanguínea de creatinina nos períodos pré-operatório, pós-operatório imediato, de 24h e de 48h. Em cada período foi efetuada a comparação da concentração de creatinina com a concentração no pré-operatório. Se em pelo menos um dos períodos esta comparação indicou aumento de creatinina≥0,3 mg/dL, o paciente foi classificado como tendo LRA. Foi também avaliado o risco de LRA em pacientes com creatinina sanguínea pré-operatória alterada (valores entre 1,1 a 2,0mg/dL para mulheres ou 1,3 a 2,0mg/dL para homens) em comparação com os pacientes com creatinina normal.Os resultados foram homogêneos quanto a peso, idade e creatinina alterada no pré-operatório e os pacientes que fizeram uso de DEX e foram submetidos a CEC apresentaram maior incidência de LRA, com p=0,043. Dentre aqueles que não foram submetidos a CEC, houve maior incidência de LRA após DEX, porém com p=0,066.O uso da DEX no intraoperatório aumentou a incidência de LRA no pós-operatório de revascularização do miocárdio de pacientes submetidos a CEC / Abstract: The increase of 0.3mg/dL in serum creatinine defines the term acute kidney injury (AKI) and is associated with higher incidence of postoperative mortality in patients undergoing coronary artery bypass grafting surgery (CABG). Clinical studies regarding the influence of dexmedetomidine (DEX) on renal function are scarce. We evaluated the LRA in postoperative of patients submitted to CABG with and without cardiopulmonary bypass (CPB) under anesthesia with DEX. In this retrospective study it was made serial analysis of serum creatinine (SCr) until 48h after the surgery of 286 patients undergoing CABG under DEX to evaluate the incidence of AKI. We tested the homogeneity among groups, evaluating patients separately for the use of CPB and DEX. Each patient was evaluated with respect to their blood concentration of creatinine in the preoperative and postoperative: early, 24h and 48h. In each period, it was compared the creatinine concentration with creatinine concentration preoperatively. If at least in one of the periods this comparison showed increased creatinine ≥ 0.3mg/dL, the patient was classified as having AKI. It has also assessed the risk of AKI in patients with preoperative blood creatinine changed: values between 1.1 to 2.0mg/dL for females or 1.3 to 2.0mg/dL for men compared with patients with normal creatinine concentration. The results were homogeneous for weight, age and creatinine concentration altered to 2.0mg/dL preoperatively. Patients who used DEX and underwent CPB had a higher incidence of AKI, with p = 0.043. Among those who were not undergoing CPB, there was a higher incidence of AKI after DEX, but with p = 0.066. Conclusion. The use of intraoperative DEX increased the incidence of AKI in the postoperative myocardial revascularization in patients undergoing CPB / Mestre

Orientador: Juliany Gomes Quitzan / Resumo: A laparoscopia tem sido cada vez mais empregada na rotina médica e veterinária com o intuito de promover intervenções cirúrgicas e diagnósticas menos invasivas. Apesar de seus benefícios, há evidências de que a insuflação abdominal pode levar à isquemia dos órgãos, seguida pela injúria de reperfusão. Algumas medicações tem sido utilizadas na tentativa de prevenir ou minimizar os danos que podem ser causados pela injúria isquemia/reperfusão. O presente estudo teve por objetivo avaliar se o uso do sildenafil via oral, antes da realização do pneumoperitôneo, seria capaz de atenuar estes efeitos da isquemia/reperfusão. Foram utilizados 26 ratos Wistar machos, divididos em 3 grupos: controle (6), Sham (10) e S/P (10). O grupo S/P foi suplementado com 1mg/kg de citrato de sildenafil via oral. Os animais dos grupos Sham e S/P foram submetidos ao pneumoperitônio por 60 minutos, com pressão intra-abdominal de 12mmHg. A artéria carótida direita foi dissecada e canulada para que fossem colhidas amostras sanguíneas e avaliadas variáveis de oxigenação e ventilação (pressão parcial de oxigênio, pressão parcial de gás carbônico e saturação de oxigênio). Durante o procedimento também foram avaliadas variáveis hemodinâmicas (frequência cardíaca, frequência respiratória e pressão arterial média). Após 24 horas os animais foram submetidos à eutanásia e foram colhidos os rins para dosagem do estresse oxidativo, através da mensuração da atividade das enzimas antioxidantes superóxido dismutase, glutationaperoxidase e catalase, além do subproduto da peroxidação lipídica, o hidroperóxido. Os resultados observados em relação às variáveis hemodinâmicas e também de oxigenação e ventilação, não apresentaram diferença quando comparados os diferentes momentos dentro de um mesmo grupo, e na comparação entre os... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Laparoscopy has been increasingly used in medical and veterinary routine in order to promote less invasive surgical and diagnostic interventions. Despite its benefits, there is evidence that abdominal insufflation can lead to ischemia of the organs, followed by reperfusion injury. Some medications have been used in attempts to prevent or minimize the damage that can be caused by injury ischemia/reperfusion. This study aimed to assess whether the use of oral sildenafil, prior to the pneumoperitoneum, was able to mitigate these effects of ischemia/reperfusion. We used 26 male Wistar rats, divided in 3 groups: control (6) Sham (10) and S/P (10). The S/P group was supplemented with 1 mg/kg of oral sildenafil citrate. The animals of the sham group and S/P were subjected to pneumoperitoneum for 60 minutes with intra-abdominal pressure of 12mmHg. The right carotid artery was dissected and cannulated in order to collect blood samples and evaluated oxygenation and ventilation variables (partial pressure of oxygen, partial pressure of carbon dioxide and oxygen saturation). During the procedure, hemodynamic variables were also evaluated (heart rate, respiratory rate and mean arterial pressure). After 24 hours the animals were euthanized and their kidneys were collected for dosage of oxidative stress by measuring the activity of antioxidant enzymes superoxide dismutase, catalase and glutationaperoxidase, besides the byproduct of lipid peroxidation, hydroperoxide. The results observed for the hemodynamic variables and also oxygenation and ventilation, showed no difference when comparing the diferente times whithin the same group, and compared between groups. The values found for the antioxidant enzyme activity were similar in the S/P and control group. It was observed that the activities of the enzymes glutathione peroxidase and catalase were markedly increased, while... (Complete abstract click electronic access below) / Mestre

Orientador: Wilza Carla Spiri / Banca: Carmen Maria Casquel Monti Juliani / Banca: Maria Justina Dalla Bernardina Felipe / Resumo: Estudo de cunho metodológico de construção e validação de instrumentos de avaliação em saúde, com o objetivo de construir e validar escalas de conhecimento sobre o acesso vascular definitivo em usuários de hemodiálise para os profissionais de enfermagem de nefrologia. As etapas para a elaboração das escalas foram: seleção das práticas envolvendo o acesso vascular definitivo em usuários de hemodiálise, fundamentação teórica das práticas selecionadas e elaboração das escalas pautadas nas diretrizes clínicas (guidelines) Clinical practice guidelines for vascular Access, Guías de Acceso Vascular em Hemodiálisis (Sociedade Espaῆola de Nefrología) e Guía de acceso vascular en hemodiálisis. O produto desse estudo foi a construção de quatro escalas: Escala de conhecimento sobre acesso vascular definitivo em usuários de hemodiálise (ECAVD) - Cuidados universais, Escala de conhecimento sobre acesso vascular definitivo em usuários de hemodiálise (ECAVD) - Cuidados específicos, Escala de conhecimento sobre acesso vascular definitivo em usuários de hemodiálise (ECAVD) - Exame físico e Escala de conhecimento sobre acesso vascular definitivo em usuários de hemodiálise (ECAVD) - Vigilância hemodinâmica. A coleta de dados ocorreu nos meses de fevereiro a agosto de 2013, por meio de um questionário, composto das seguintes partes: julgamento do conteúdo (constructo), dos atributos e dos componentes de cada escala construída. A validação de conteúdo das escalas foi realizada por doze juízes, com ampla experiência na área de nefrologia. Todas as escalas construídas foram validadas pelos profissionais, sob consenso favorável mínimo de 75%. Ressalta-se que após validação as escalas foram aplicadas a 84 profissionais de enfermagem que atuam em terapia de substituição renal em 3 centros no interior do Estado de São Paulo, onde 2,3% dos profissionais demonstraram apresentar pouco conhecimento, 33,3% ... / Abstract: Methodological nature study of the construction and validation of assessment tools in health, in order to build and validate knowledge scales about the permanent vascular access in hemodialysis users for nephrology nurses. The steps to prepare the scales were: practices selection involving permanent vascular access to hemodialysis users, theoretical basis of selected practices and development of guided scales in clinical guidelines (guidelines) Clinical practice guidelines for vascular Access, "Guías de Acceso Vascular em Hemodiálisis" (Espanish Society of Nephrology) and "Guía de acceso vascular en hemodialysis". Thus, four scales were built : knowledge Scale of permanent vascular access in hemodialysis users (KSPVA) - Universal Care, knowledge Scale of permanent vascular access in hemodialysis users (KSPVA) - Specific Care, knowledge Scale of permanent vascular access in hemodialysis users (KSPVA) - physical examination and knowledge Scale of permanent vascular access in hemodialysis users (KSPVA) - Hemodynamic Monitoring. Data collection occurred from February to August 2013, using a questionnaire, consisting of the following parts : trial content (constructo), of the attributes and components of each built scale. The scales content validity was performed by twelve judges with extensive experience in the field of nephrology. All built scales were validated by professionals under minimum favorable consensus of 75 %. It is noteworthy that after validation, scales were applied to 84 nurses, working on renal replacement therapy in 3 centers in towns of São Paulo State, where 2.3% of the professionals have demonstrated little knowledge, 33.3 % have demonstrated satisfactory knowledge and 64.2 % of the professionals have demonstrated full knowledge about care and complications with AVF / Mestre

Orientador: Pasqual Barretti / Banca: Giovanni Faria Lima / Banca: Marli Terezinha C. Duarte / Banca: José Abrão Cardeal da Costa / Banca: Joáo Egydio Romão Junior / Resumo: Introdução: A seroconversão à vacina contra o vírus da hepatite B (VHB) em indivíduos imunocompetentes varia de 90-95% enquanto nos pacientes em hemodiálise varia de 40-80%. Manter níveis adequados de anticorpos contra o VHB nas unidades de diálise é estratégia importante para diminuição do risco de transmissão do VHB e redução da incidência de complicações crônicas da hepatite B. Objetivo: Avaliar os fatores que influenciam a seroconversão do anticorpo anti- HbS, em pacientes vacinados contra o VHB, em diferentes estádios da doença renal crônica (DRC) e nos tratados por hemodiálise (HD) e diálise peritoneal (DP). Pacientes e Métodos: Foram incluídos pacientes maiores que 18 anos, portadores de DRC prevalentes em dezembro de 2011 e incidentes entre janeiro de 2012 e abril de 2014, que receberam o primeiro esquema de vacinação completo contra o VHB. Os pacientes foram divididos em quatro grupos conforme o estádio da DRC e a modalidade de diálise: grupo DRC (pacientes no estádio IV da DRC), grupo Pré-diálise (pacientes no estádio V da DRC), grupo DP (pacientes tratados por DP) e grupo HD (pacientes tratados por HD). Associações entre fatores demográficos, laboratoriais, clínicos, dialíticos e nutricionais com a seroconversão à vacina contra o VHB (anticorpo anti-Hbs >10 UI/dl) foram analisadas por regressão logística univariada e multivariada. Resultados: Foram incluídos 191 pacientes, 72 no grupo HD, 40 no DP, 36 no DRC e 43 no Pré diálise). A média de idade foi de 59,6 ± 15,1 anos; 49,7% eram masculinos, 83,5% da raça branca e 47,6% diabéticos. A porcentagem geral de seroconversão foi de 72,8%, sendo 76,4% para o grupo HD, 67,5% para o grupo DP, 75% para o grupo DRC e 69,8% para o grupo Pré-Diálise (p=0,72). Os fatores independentemente associados à maior chance de seroconversão foram a contagem total de linfócitos (p=0,02) e o ângulo de fase (p= 0,02), considerando a amostra total de... / Abstract: Introduction: Seroconversion to the vaccine against hepatitis B virus (HBV) in immunocompetent individuals ranges from 90-95% while in hemodialysis patients varies from 40-80%. The maintenance of adequate levels of antibodies against HBV in the dialysis units is an important strategy for reducing the risk of HBV transmission and of incidence of chronic complications of hepatitis B. Objectives: To evaluate the factors influencing seroconversion of antibody anti-HbS in patients vaccinated against HBV in different stages of chronic kidney disease (CKD) and treated by hemodialysis (HD) or peritoneal dialysis (PD). Patients and Methods: We included patients greater than 18 years, patients with CKD prevalent in December 2011 and 2012 incidents between January and April 2014, who received the first full vaccination scheme against HBV. The patients were divided into four groups according to the stage of CKD and dialysis modality: DRC Group (patients in stage IV of the CKD), Pre-dialysis group (patients in stage V of the CKD), HD group (patients treated by HD), and PD Group (patients treated by PD). Associations between demographic, clinical, laboratory, dialytic, and nutritional factors with seroconversion to the vaccine against HBV (antibody anti-HBS > 10 IU/dl) were analyzed by univariate and multivariate logistic regression. Results: A total of 191 patients were included; 72 in the HD, 40 at DP, 36 in the DRC, and 43 in the Pre dialysis group). The average age was 59.6 ± 15.1 years; 49.7% were male, 83.5% of the white race and 47.6% diabetics. The overall percentage of seroconversion was 72.8%; 76.4% for the HD, 67.5% for DP, 75% for the DRC and 69.8% for Pre dialysis group (p = 0.72). The factors independently associated with the greater chance of seroconversion were the total lymphocyte count (p = 0.02) and the phase angle (p = 0.02), considering the total sample of patients; the total lymphocyte count (p = 0.033) and the use of vitamin D ... / Doutor