Orientador: Ricardo Della Coletta / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-20T21:55:08Z (GMT). No. of bitstreams: 1 Pinto_ElizabeteBagordakis_M.pdf: 1068355 bytes, checksum: 106aec8c4631e33ee9cf3204562103e1 (MD5) Previous issue date: 2012 / Resumo: Fissuras do lábio e/ou palato (FL/P) representam as anomalias congênitas mais comuns da face, correspondendo a aproximadamente 65% de todas as malformações da região craniofacial. Em 70% dos casos, as FL/Ps se apresentam como fenótipos isolados, recebendo a denominação FL/P não-sindrômica (FL/PNS). Embora estudos recentes de larga escala genômica descreveram várias regiões cromossômicas e genes candidatos à etiologia das FL/PNS, apenas poucos foram confirmados em diferentes populações. Um dos possíveis fatores que podem induzir uma discrepância nos resultados é a diferença na composição (mistura) étnica das populações. Então, como o Brasil é composto por uma população altamente miscigenada é importante confirmar se tais marcadores também mostram suscetibilidade à FL/PNS na população brasileira. O propósito deste estudo caso-controle foi avaliar o envolvimento de polimorfismos genéticos que foram recentemente descritos como marcadores de risco para o desenvolvimento de FL/PNS em um grupo brasileiro de pacientes com FL/PNS. A influência da ancestralidade populacional na suscetibilidade a FL/PNS destes marcadores genéticos também foi avaliada. Os polimorfismos rs560426 em 1p22.1, rs2013162 em 1q32, rs987525 e rs1530300 em 8q24, rs1443434 e rs3758249 em 9q21, rs7078160 em 10q25.3, rs17085106 em 18q22 e rs13041247 em 20q12 foram genotipados em 338 indivíduos saudáveis (grupo controle) e 345 pacientes com FL/PNS pelo método de discriminação alélica com sondas fluorescentes. A ancestralidade genômica de cada indivíduo foi determinada pela caracterização de 40 marcadores bialélicos de inserção/deleção (INDELs). A distribuição genotípica de todos os polimorfismos no grupo controle respeitou o equilíbrio de Hardy-Weinberg. A frequência do alelo G no polimorfismo rs560426 foi significantemente maior no grupo FL/PNS comparado ao grupo controle, gerando um odds ratio (OR) de 1,44 (IC 95%: 1,16-1,78; p=0,0008). A distribuição dos polimorfismos da região 8q24 (rs987525 e rs1530300) também foi significantemente correlacionada com a suscetibilidade ao desenvolvimento de FL/PNS como marcadores individuais ou em haplótipo. Os 3 polimorfismos (rs560426, rs987525 e rs1530300) revelaram associação com a fissura labial isolada (FL) e a fissura lábio-palatina (FLP), mas não com o risco de desenvolver fissura palatina isolada (FP). Após o ajuste para a ancestralidade genômica, as correlações dos polimorfismos rs560426, rs987525 e rs1530300 com FL/PNS foram mantidas. Em conclusão, os resultados do presente estudo demonstram a associação dos polimorfismos localizados em 1p22.1 (rs56042 6) e em 8q24 (rs987525 e rs1530300) com a suscetibilidade genética ao desenvolvimento de FL/PNS na população brasileira / Abstract: Cleft lip and/or palate (CL/P) is the most common congenital anomaly of the face, corresponding to approximately 65% of all malformations in the craniofacial region. In 70% of the cases, CL/Ps are found as an isolated phenotype, receiving the denomination nonsyndromic CL/P (NSCL/P). Although recent genome-wide association studies have been identified a varied of chromosomal loci and candidate genes in association with NSCL/P development, just few of them has been replicated in different populations. These contradictory results may be related to the differences in the ethnicity of the populations. Thus, as the Brazilian population is one of the most heterogeneous in the world, it is important to confirm the susceptibility of those markers identified in genetically homogenous populations in the Brazilian population. The purpose of this case-control study was to verify the association of single nucleotide polymorphisms, which were identified as NSCL/P risk markers, with NSCL/P in a Brazilian population. The influence of the genetic ancestry of the population on susceptibility of those markers was also investigated. The polymorphisms rs560426 in 1p22.1, rs2013162 in 1q32, rs987525 and rs1530300 in 8q24, rs1443434 and rs3758249 in 9q21, rs7078160 in 10q25.3, rs17085106 in 18q22, and rs13041247 in 20q12 were genotyped in 338 samples from healthy individuals (control group) and 345 NSCL/P patients by the allelic discrimination method with fluorescence probes. The genomic ancestry of each individual was determined by genotyping 40 biallelic short insertion-deletion polymorphic markers (INDELs). The genotype frequencies observed for all studied polymorphisms in the control group did not reveal statistically significant differences compared to those expected under Hardy-Weinberg equilibrium. The percentage of the G allele of rs560426 polymorphism was found to be significantly higher in the NSCL/P group as compared to the control group, revealing an odds ratio (OR) of 1.44 (95% CI 1.16-1.78; p=0.0008). The distributions of both 8q24 polymorphisms (rs987525 and rs1530300) were significantly correlated with NSCL/P susceptibility as individual or haplotype markers. All 3 markers were associated with the development of isolated (CL) and cleft lip and palate (CLP), but not with cleft palate only (CP). After adjustment to ancestry contribution, correlations of all 3 polymorphisms were kept. In conclusion, the findings of the present study demonstrate the association of polymorphisms located at 1p22.1 and 8q24 with NSCL/P in the Brazilian population / Mestrado / Patologia / Mestra em Estomatopatologia

Abstract Different metabolic and environmental factors affect the blood pressure level, constituting a cluster, especially in hypertensives, that leads to an increased risk of cardiovascular diseases. The present research was designed to determine the prevalence and the predictors of the metabolic syndrome and the role of insulin and blood pressure in carotid atherosclerosis in 600 treated male and female hypertensives aged 40-59 years and 600 age- and sex-matched controls. The prevalence of the metabolic syndrome in different population-based cohorts varied, depending on the definition, from 0.8% to 35.3%, being lowest in control men and women and highest in hypertensive men. 73.8% of a random, middle-aged, urban population showed at least one cardiovascular risk factor, and 91.3% of all hypertensive subjects showed at least one cardiovascular risk factor in addition to hypertension itself. The independent predictors of the metabolic syndrome were waist circumference, uric acid, total cholesterol and gamma-glutamyl transpeptidase. Hypertension had a significant effect on carotid intima-media thickness and the prevalence of plaques in men, but its effect in women was not significant. A long duration of hypertension resulted in greater intima-media thickness and a higher prevalence of plaques, particularly in men. There were significant associations between gamma-glutamyl transpeptidase and the components of the metabolic syndrome after adjustment for alcohol consumption and also in teetotallers. There were inconsistent associations between the different insulin measures and the intima-media thickness as a measure of carotid atherosclerosis. The exclusion of diabetic subjects did not change the results. In conclusion, a cluster of metabolic abnormalities related to hypertension is frequent among both controls and treated hypertensive subjects. Hypertensive subjects have higher prevalences of carbohydrate and lipoprotein aberrations and structural and functional cardiovascular complications than age- and sex-matched controls.

Abstract Several studies have shown that altered cardiovascular autonomic regulation is associated with hypertension, diabetes, aging, angiographic severity of coronary artery disease (CAD), and increased mortality after acute myocardial infarction (AMI). The purpose of this study was to assess the temporal changes and prognostic significance of various measures of heart rate (HR) behaviour and their possible associations to coronary risk variables, and the progression of CAD in different populations. This study comprised five patient populations. The first consisted of 305 patients with recent coronary artery bypass graft surgery (CABG) and lipid abnormalities, the second of 109 male patients with recent CABG, the third of 53 type II diabetic patients with CAD, the fourth of 600 patients with recent AMI, and the fifth of 41 elderly subjects. HR variability and non-linear measures of HR dynamics were analysed. Among the patients with prior CABG, a significant correlation existed between the baseline HR variability (standard deviation of N-N intervals, SDNN) and the progression of CAD (r = 0.26, p < 0.001)). In the longitudinal study of patients with prior CABG, only the fractal indexes of HR dynamics, such as the power law slope (β) and the short-term fractal exponent (α1), decreased significantly. In diabetic patients, SDNN decreased significantly (p < 0.001) during the three-year period. The reduction of SDNN was related to cholesterol, triglyceride, and glucose levels, and also to progression of CAD (r = 0.36, p < 0.01). In the longitudinal follow-up study of patients with recent AMI, reduced fractal indices (α1 and β), and reduced HR turbulence predicted cardiac death when measured at the convalescent phase after AMI. Reduced β and turbulence slope predicted cardiac death when measured at 12 months after AMI. In the elderly population, β (p < 0.001) and α1 (p < 0.01) reduced significantly. Low-frequency power spectra were the only traditional measure of HR variability that decreased significantly during the 16-year period. HR variability is associated with many risk factors of atherosclerosis and with progression of CAD among patients with ischemic heart disease. Fractal HR dynamics are more sensitively able to detect age-related changes in cardiovascular autonomic regulation. Altered fractal HR dynamics and HR turbulence are associated with increased mortality after AMI.

Abstract Frostbite of the face and ears is a common problem in cold winters. Application of an emollient on the face is a traditional way to prevent frostbite in Finland. The preliminary results of an epidemiological study on frostbite in Finnish conscripts unexpectedly showed that the use of cold protecting emollients increased the risk of facial frostbite. This finding motivated studies on the effects and use of cold protecting emollients. 830 male Finnish conscripts answered a questionnaire concerning the use of cold protecting emollients, subjective experience of using them in cold and cumulative incidence of frostbite in the ears and face. Risk factors of frostbite were investigated in a prospective epidemiological study including 913 Finnish conscripts needing medical attention for frostbite of the ears or face and their 2478 matched, uninjured controls. Thermal properties of four different emollients were studied in vitro with a skin model and in vivo in experimental cold exposures of test persons. Test emollient was applied on one half of the face, as the other half acted as control. The skin temperatures of the face-halves were compared symmetrically by thermistors and infrared thermography. Subjective sensation of thermal half-difference was also registered. 21% of the conscripts had used emollients in the cold, a majority with an experience of protection. 47% of the conscripts had had frostbite in the head (42% in the ears and 23% on the face). There was a statistically significant correlation between the use of emollients and the incidence of facial frostbite in both epidemiological studies. Applying protective emollients formed an independent risk factor for frostbite of the cheeks, nose and ear lobes (odds ratios 3.3-5.6). The thermal insulation of test emollients on the skin model was minimal. On living skin, the applied half was somewhat cooler in a majority of comparisons. However, white petrolatum gave often a subjective perception of a warming effect. False sensation of safety may form the principal cause for the increased risk of frostbite associated with the use of emollients. When the warning symptoms of cold are weak, necessary protective measures are not carried out.

Abstract Primary intracerebral hemorrhage (ICH) comprises 10–15% of all strokes. Arterial hypertension and warfarin use are well documented risk factors for ICH, but aspirin use also seems to predispose to ICH. The annual incidence of primary ICH in western populations is 12–31 / 100,000. Mortality is high: 14–52% during the first month and 14–80% during the first year after ICH. The size and location of the hemorrhage, a midline shift in head computed tomography, intraventricular spread of the hemorrhage, level of consciousness on admission, and high blood glucose independently predict mortality. For a risk factor study, 98 consecutive patients admitted into the Department of Neurology, Oulu University Hospital, because of ICH between January 1993 and September 1995 were compared with 206 control subjects drawn from a population register. Thromboxane and prostacyclin biosynthesis were measured from serial urine samples of 43 patients. For outcome studies, all subjects (n = 208) with incident ICH during the study period in the population of Northern Ostrobothnia, Finland, were identified. Untreated hypertension was the main modifiable risk factor for ICH. Use of aspirin appeared to be a significant risk factor for ICH in the subjects with a history of epistaxis. Enhanced thromboxane and prostacyclin biosynthesis were observed in the acute phase and 3 months after ICH. Regular use of aspirin preceding ICH doubled the 3-month mortality rate compared with nonusers of aspirin/warfarin. Aspirin use also associated with early hematoma growth. Patients with ICH showed increased long-term mortality up to 7 years after ICH compared to controls. No excess mortality was observed among those with good recovery at 3 months, but those who were severely disabled at 3 months after ICH showed marked excess mortality.

INTRODUCTION: The worldwide incidence of acute kidney injury is 18% and the overall hospital mortality can rise above 50%. In Peru, there are few series about mortality of acute kidney injury in hemodialysis patients. OBJECTIVES: To identify risk factors associated to hospital mortality of acute kidney injury in hemodialysis patients. METHODS: This is a retrospective cohort of patients with acute kidney injury in hemodialysis of Hospital Nacional Edgardo Rebagliati Martins gathered between January 2013 and December 2015. The sample size was 154 patients which allowed a power of 80% and a CI of 95%. ICD-10 codes were used to identify medical records of patients with acute kidney injury (N.17) and hemodialysis (Z.49). The independent variable was oliguria, and the primary outcome was hospital mortality. Poisson regression was used for multivariate analysis. RESULTS: We identified a total of 285 patients; 212 medical records were analyzed and 44 were excluded. Out of the 168 medical records, 129 belonged to living patients and 39 to deceased ones. The overall mortality incidence was 17.2%. The principal etiologies of acute kidney injury while in hemodialysis were sepsis (39.2%), and severe dehydration (10.8%). In the adjusted model, the risk factors associated to hospital mortality of acute kidney injury while in hemodialysis were elevated serum lactate (RR 1.09), elevated serum potassium (RR 0.93), and mean arterial pressure (RR 0.97). CONCLUSIONS: Lactate is an objective parameter that can predict prognosis and contributes to a better management of acute kidney injury in hemodialysis patients. INTRODUCCIÓN: La incidencia de insuficiencia renal aguda a nivel mundial es 18% y la mortalidad intrahospitalaria puede alcanzar más del 50%. En Perú, existen escasos estudios acerca de la mortalidad en pacientes con insuficiencia renal aguda en hemodiálisis. OBJETIVOS: Identificar los factores de riesgo asociados a mortalidad intrahospitalaria en pacientes con insuficiencia renal aguda en hemodiálisis. MÉTODOS: Es una cohorte retrospectiva, en la cual se estudió a los pacientes con insuficiencia renal aguda en hemodiálisis en el Hospital Nacional Edgardo Rebagliati Martins entre enero de 2013 y diciembre de 2015. Se halló un tamaño de muestra de 154 pacientes con una potencia de 80%, y un intervalo de confianza de 95%. Se utilizaron los códigos de la Clasificación Internacional de Enfermedades-10 para identificar las historias clínicas de pacientes con insuficiencia renal aguda (N.17) y hemodiálisis (Z.49). La variable independiente fue oliguria y la variable dependiente fue mortalidad intrahospitalaria. Para el análisis multivariado, se utilizó regresión de Poisson. RESULTADOS: El universo fue de 285 pacientes. Se revisaron 212 historias clínicas y se excluyeron 44. De las 168 historias clínicas estudiadas, 129 pertenecían a pacientes vivos y 39 a fallecidos. La incidencia de mortalidad fue de 17,2%. Las principales causas de insuficiencia renal aguda en hemodiálisis fueron sepsis (39,2%) y deshidratación severa (10,8%). En el modelo ajustado, los factores de riesgo asociados a mortalidad intrahospitalaria de insuficiencia renal aguda en hemodiálisis fueron lactato (riesgo relativo 1,09), potasio (riesgo relativo 0,93), y presión arterial media (riesgo relativo 0,97). CONCLUSIONES: El lactato es un parámetro objetivo que permite predecir el pronóstico y contribuye a un mejor manejo de los pacientes con insuficiencia renal aguda en hemodiálisis.

Master of Public Health - MPH / Background: Namibia is one of the sub-Saharan African countries where diabetes mellitus ranks among the top ten health conditions contributing to the disease burden and among the top 15 in-patient causes of death. An understanding of the population's knowledge, attitudes and perceptions is required to inform health education and interventions targeting diabetes mellitus. Aim: The aim was to assess the level of knowledge, attitudes and perceptions about diabetes mellitus among an adult population living in Windhoek, Namibia. Methodology: A quantitative cross-sectional descriptive survey design was used. Data was collected from 300 adult respondents using a structured questionnaire administered by research assistants. Data was analysed using Epi-Info version 7. Descriptive statistics were used primarily to summarise and describe levels of knowledge, perceptions and attitudes. A scoring framework was developed to categorize responses. Analytical statistics was used to describe association between knowledge, attitudes and perceptions scores and demographic and socio-economic variables. A P-value < 0.05 was regarded as statistically significant. Results: Of the 300 respondents interviewed, 50.3% were males, 49.3% were females and 0.4 were missing. The majority of the respondents were between 26 – 30 years. With regards to employment, majority (62%) were employed full time. About 10.7% of the respondents had post-graduate degree, while 3.3% had no schooling. Knowledge about diabetes mellitus was higher amongst females (51.2%) compared to males (48.2%) and was associated with age. Only 34.7% of respondents had poor perceptions about diabetes (i.e. diet, curability and distribution). About 49.7% respondents had good knowledge about risk factors for diabetes mellitus while 50.3% had poor knowledge thereof. Conclusion: This study reveals that the general knowledge of respondents regarding diabetes mellitus was poor in Windhoek. Despite the respondents having good knowledge there were still misconceptions about diabetes related complications, risk factors and its treatment. In addition, attitudes and perceptions of respondents about diabetes were favourable and thus suggesting some level of understanding about diabetes in the different communities in Windhoek. This study shows that there is knowledge about diabetes, however lack of diabetes knowledge among some respondents suggests a need for a systematic education programme for diabetes. This study highlighted the areas that diabetes education programmes should focus on aspects or issues such as life style and healthy food intake.

No description available.

Magister Public Health - MPH / The aim of this study was to assess the factors associated with HIV risk behaviours in women in Livingstone, Zambia. A cross-sectional analytical survey using a structured questionnaire was carried out in two sites in Livingstone, which were selected on the basis of differences in socio-economic status. Married women and women in the urban community are at high risk of contracting HIV and every effort should be made to ensure that HIV/AIDS programmes help to reduce their vulnerability to HIV infection. / South Africa

Magister Scientiae Dentium - MSc(Dent) / Introduction: Dental fluorosis is a developmental disturbance of enamel that results from ingestion of high amounts of fluoride during tooth mineralization. Drinking water remains the main source of fluoride. Other sources of fluoride include infant formula, vegetables; canned fish as well as early, improper utilization of fluoridated toothpastes in children. Knowledge of risk factors in the causation of dental fluorosis may improve strategies to prevent dental fluorosis. Objective: To determine the prevalence of dental fluorosis among children aged 12-15 years old in Athi River sub-county, Machakos County, Kenya and assesses the level of knowledge on risk factors for dental fluorosis among their parents. Methodology: This was a descriptive study with an analytic component. A total of 281 children aged 12-15 years attending public primary schools within Athi River sub-county, Machakos County were included. A self-administered questionnaire was send to parents for socio-demographic characteristics and oral health practices. Children whose parents consented were examined and dental fluorosis scored according to the Thylstrup and Fejerskov index. Fourty randomly selected children were requested to bring water samples from their homes. Retail stores located in the area were visited for purchase of six different brands of bottled water. These samples were sent to a certified laboratory for fluoride analysis and reported in milligrams of fluoride per litre. Data analysis: Data was entered into SPSS version 20 and analysed for means, ANOVA of means and chi-square test of significance for categorical variables. All tests for significance were set at 95% confidence level (α≤0.05). Results: A total of 314 self-administered questionnaires were send to parents together with consent forms for their children‟s participation in the study. Two hundred and eighty six responded positively, giving a response rate of 91%. The overall prevalence of dental fluorosis among children aged 12-15 years was 93.4% with only 6.6% (n=19) recording a TFI score of 0. About one quarter 70(24.4%) of children had severe fluorosis with TFI scores of ≥5. The mean TFI score for all children was 3.09 (SD=2.0), with males recording a mean TF score of 3.01 (SD=2.11) and females a mean TF score of 3.16 (SD=1.88). Out of 44 water samples analysed, 29 (65.9%) had a fluoride content of less than 0.6mg/l, 5 (11.4%) had fluoride content of 0.7 - 1.5mg/l while 10 (22.7%) of samples had a fluoride content ≥1.5mg/l. The highest fluoride content recorded was 9.3mg/l, with another sample reflecting 8.9mgF/l. Three of the bottled water samples had a fluoride content of less than 0.6mg/l, while the other half of the bottled water reported 0.7 - 0.8mg/l fluoride. A majority (87.8%) of parents indicated that they had noticed children with brown staining of their permanent teeth in their community. About 80% of parents thought dental fluorosis was caused by salty water, while only 12.9% correctly identified water with high fluoride content as being responsible for the discolored teeth. Conclusion: Although about one in five water sources sampled had fluoride content of ≥1.5mg/l, the prevalence of dental fluorosis in this community was very high. Parental knowledge on the risk factors for dental fluorosis was low. Further research is necessary to identify the water distribution networks to provide sound evidence for engaging with the county authorities on provision of safe drinking water to the community.