L’objectif de ce travail était d’’évaluer les effets d’un programme d’incitation et d’éducation à l’activité physique, à domicile chez des patients post-AVC en phase subaiguë, sur la performance au test de marche de 6 minutes (TM6M) et son maintien à six mois de l’arrêt du programme. Il s’agissait d’un essai clinique comparative, prospective, randomisée, en simple aveugle et monocentrique. La population de l’étude était composée de 84 patients post-AVC (Age 61.7 ± 13.2 ans, délai de l’AVC 2.5 ± 1.5 mois). Quarante-deux patients ont été randomisé pour le GE et 42 patients pour le GC. Le GE a suivi un programme d’incitation à l’AP à domicile pendant 6 mois. Trois moyens d’incitation ont été utilisés ; un accéléromètre (Armband Sensewear, Bodymedia), des appels téléphoniques hebdomadaires et des visites à domicile toutes les trois semaines. Également, une séance d’éducation sur l’AP et la fixation des objectives en termes du nombre de pas et de la durée de l’AP a été réalisée avant de commencer le protocole. Le GC a reçu simplement une information sur les bienfaits de l’AP et sur le niveau d’activité à réaliser selon les recommandations de pratique post-AVC. Les critères d’évaluation secondaires ont été l’échelle « fonctionnal ambulation classification » (FAC), l’indice de barthel (IB), l’indice moteur (IM), la qualité de vie (Euroqol-5D), la composition corporelle, le questionnaire « Health Care Comunication Questionnaire » (HCCQ), l’Echelle Visuelle Analogique de la douleur (EVA), le questionnaire Hospital Anxiety and Depression Scale (HADS) et questionnaire Multidimensionnal fatigue Inventory 20 (MFI-20). Les patients ont été évalué avant (T0), après l’intervention (T1) et six mois après l’arrêt du programme (T2). Les résultats montrent une augmentation significative de la distance de marche parcoure entre T0 et T1 pour le GE (18%, p<0.001), malgré cette augmentation, il n’y a pas de différence entre GE et GC à T1 (p=0.30). Une augmentation significative du score de FAC (+0.75, p=0.02) a été constaté pour le GE à T1, cette augmentation était différente entre les deux groupes (p=0.0013). A l’inverse, une diminution significative du score MFI-20 (-4.6, p<0.001) a été constaté pour le GE à T1, cette diminution était différente entre les deux groupes (p<0.001). A T2 les effets du programme sur le périmètre de marche (p=0.75), la capacité fonctionnelle (p=0.17) et la fatigue (p=0,74) se sont maintenus. Aucun effet n’a été constaté pour le reste des variables. De plus, en fin d’intervention le GE atteint les recommandations d’AP par jour, en termes de pas (5955 ± 5475) et de durée (105 ± 75 minutes). / The aim of the study was to evaluate the effect of a home-based physical activity incentive program on the 6 minutes walking distance performance (6MWT) and its evolution, 6 months after the end of the program. This is a comparative, prospective, randomized, single-blind and monocentric clinical trial. Participants were 84 post-stroke patients (average age 61.7 ± 13.2 years, time since stroke 2.5 ± 1.5 months). Forty-two patients were randomly assigned to an experimental group (EG) and the other forty-two to a control group (CG). EG followed a home-based physical activity incentive program for 6 months. Three incentive methods have been used; an accelerometer (Armband Sensewear, Bodymedia), weekly telephone calls, and home visits every three weeks. In addition, educational session about physical activity and information about physical activity recommendations were conducted before the start of the protocol. CG received general information about physical activity benefits and post-stroke practicing activity recommendations. Other assessment criteria were functional ambulatory classification (FAC), barthel index (BI), motricity index (MI), quality of life (Euroqol-5D), body composition, the health care communication questionnaire (HCCQ), visual analog scale of pain (VAS), the hospital anxiety and depression scale (HADS), the multidimensional fatigue inventory 20 questionnaire (MFI-20). Patients were evaluated before intervention (T0), after intervention (T1) and 6 months after the end of the program (T2). Walking distance increased significantly in the EG between T0 and T1 (18%, p<0.001); however, there was not a significantly difference between EG and CG at T1 (p=0.30). The score of FAC increased significantly (+0.75, p=0.02) in EG at T1, but it was different between EG and CG (p=0.0013). Furthermore, MFI-20 score decreased significantly at T1 (-4.6, p<0.001) for the EG, it results was different between both groups (p<0.001). The program effects on walking distance (p=0.75), functional ability (p=0.17), and fatigue (p=0.74) at T2 were maintained. No significant effect of other variables was found. In addition, at the end of the program, the EG achieved the physical activity recommendation per day, step number (5955 ± 5475) and activity duration (105 ± 75 minutes).

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Made available in DSpace on 2016-03-15T19:36:37Z (GMT). No. of bitstreams: 1 Ana Maria Thiago de Souza.pdf: 2094696 bytes, checksum: 273c11aa7e66f79b17b1b157ad199bc4 (MD5) Previous issue date: 2013-02-22 / The nanotechnology research progressed significantly over the past 30 years, allowing for the development of new materials with applications that meet the interests of various sectors. In health, the pharmaceutical industry has used nanostructured materials to develop the release of drugs. Application of the nanoparticles offers numerous advantages compared to conventional release, such as progressive and controlled release of drugs from the matrix degradation, effective plasma levels with less fluctuation over time, less risk of toxicity, biological penetration through the barriers and targeting to specific tissue targets. In this study, the material used in drug delivery is pseudoboehmite. This is an oxyhydroxide of aluminum and consists of a structure similar to boehmite. With its production by sol-gel process, starting from high purity reagents, it is possible to obtain high-purity pseudoboehmite with high specific area and with total absence of contaminants, making it therefore promising for applications in controlled release of drugs. In view of the possible use of pseudoboehmite as carriers for controlled drug delivery, this study aimed to determine its acute (50mg/kg, 300mg/kg and 2000mg/kg) and. subacute toxicity (1000mg/kg) in male rats (Wistar rats). The methodology consisted of toxicity tests from the evaluations and analyzes of the biochemical and histopathological parameters resulting from its administration. Finally, the pseudoboehmite was tested in vivo as possible releasing controlled drug acyclovir. In both tests, the administration has not determined mortality in groups and histopathological evaluation of the livers of the animals were not observed any changes in tissue integrity. These readings showed there to absorption of the acyclovir systemic circulation in animals receiving the pseudoboehmite. The readings were taken with a high performance liquid chromatography showed that there was absorption of acyclovir systemic circulation in animals receiving the pseudoboehmite with acyclovir. Acyclovir administered with pseudoboehmite was absorbed from the gastrointestinal tract. The results showed that the pseudoboehmite has low toxicity at high doses of short and falls under the category of nontoxic; the absence of aluminum in the plasma samples emphasizes the absence of aluminum absorption into the systemic circulation and acyclovir present in the plasma of rats allowed confirm that this is present in the systemic circulation of animals even after the steps of the desorption of pseudoboehmite. / As pesquisas em nanotecnologia avançaram consideravelmente nos últimos 30 anos, possibilitando o aparecimento de novos materiais com aplicações que atendem aos interesses de diversos setores. Na área da saúde, a indústria farmacêutica tem utilizado os materiais nanoestruturados para desenvolver novos medicamentos e veiculadores de fármacos. A aplicação das nanopartículas oferece inúmeras vantagens comparativamente ao sistema convencional de liberação, tais como: liberação controlada e progressiva dos fármacos a partir da degradação da matriz, nível plasmático efetivo com menor flutuação ao longo do tempo, menor risco de toxicidade, maior penetração pelas barreiras biológicas e direcionamento específico aos alvos teciduais. Neste trabalho, o material utilizado como liberador de fármaco foi a pseudoboemita. Esta é um oxi-hidróxido de alumínio e consiste em uma estrutura similar a boemita. Com sua produção via processo sol-gel, a partir de reagentes de alta pureza, foi possível obter pseudoboemita de pureza elevada, com área específica elevada e com total ausência de contaminantes, tornando-a, portanto, promissora para aplicações na liberação controlada de fármacos. Em vista da possível utilização da pseudoboemita como excipiente para liberação controlada de fármacos, este trabalho teve como objetivo determinar a sua toxicidade aguda (50mg/kg, 300mg/kg e 2000mg/kg) e. subaguda (1000mg/kg) em ratos machos (Wistar rats). A metodologia consistiu em testes de toxicidade a partir das avaliações e análises dos parâmetros bioquímicos e histopatológicos resultantes de sua administração. Para finalizar, a pseudoboemita foi testada in vivo como possível liberador controlado do fármaco aciclovir. Em ambos os testes, a administração não determinou mortalidade nos grupos e na avaliação histopatológica dos fígados dos animais também não foram observadas qualquer alterações na integridade tecidual. As leituras realizadas com cromatografia líquida de alta eficiência mostraram que ocorreu absorção do aciclovir para circulação sistêmica nos animais que receberam a pseudoboemita com aciclovir. O aciclovir administrado com a pseudoboemita foi absorvido pelo trato gastrointestinal. Os resultados demonstraram que a pseudoboemita tem baixa toxicidade em altas doses em curto prazo e se enquadra na categoria de atóxico; a ausência de alumínio nas amostras de plasma enfatiza a ausência de absorção do alumínio para a circulação sistêmica e o aciclovir presente no plasma dos ratos permitiu confirmar que este está presente na circulação sistêmica dos animais mesmo após as dessorções da pseudoboemita.

BACKGROUND: A comprehensive Primary Health Care approach includes clear referral and continuity of care pathways. South Africa lacks data that describe Intermediate Care (IC) services and its role in the health system. This study aimed to describe the model of service provision at an IC facility and the role it plays in the continuity of care in Cape Town. METHODS: Sixty-eight patients (65% Response Rate) were recruited in a prospective cohort design over a one-month period in mid-2011. Patient data were collected from a clinical record review and an interviewer-administered questionnaire, administered at a median interval between admission and interview of 11 days to assess primary and second ary diagnosis, knowledge of and previous use of Home Based Care (HBC) services, reason for admission, demographics and information on referring institution. A telephonic interviewer-administered questionnaire to patients or their family members post-discharge recorded their vital status, use of HBC post-discharge and their level of satisfaction with care received at the IC facility. A Cox regression model was run to identify predictors of survival and the effect of a Care-plan on survival. Seventy staff members (82%) were recruited in a cross-sectional study using a self-administered questionnaire to describe demographics, level of education and skills in relation to what they did for patients and what they thought patients needed. RESULTS: Of the 68 participants, 38 % and 24% were referred from a secondary and tertiary hospital, respectively, and 78% were resident of a higher income community. Stroke (35%) was the most common single reason for admission at acute hospital. The three most common reasons reported by patients why care was better at the IC facility than the referring institution was the caring and friendly staff, the presence of physiotherapy and the wound care. Even though a large proportion of the IC inpatients had been admitted in a health facility on the year preceding the study, only 13 patients (21%) had used a Community Health Worker (CHW) ever before and only 25% (n=15) of the discharged patients had a confirmed CHW visit post-discharge. The presence of a Care-plan was significantly associated with a 62% lower risk of death (Hazard Ratio: 0.380; CI 0.149-0.972). Notably, 46% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks. In addition, of the 57 patients that could be traced on follow-up 21(37%) had died. CONCLUSION: Patients and family understood this service as a caring environment that is primarily responsible for rehabilitation services. Furthermore, a Care-plan which extends beyond admission could have a significant impact on reducing mortality. IC services should therefore be recognised as an integral part of the health system and it should be accessed by all who need it.

Bakgrund: Fotledsdistorsioner är en vanligt förekommande skada och en icke adekvat behandlad fotledsdistorsion kan leda till långvariga besvär. I Sverige är det oklart hur det fysioterapeutiska omhändertagandet för fotledsdistorsioner ser ut. Det finns inte heller några svenska/regionala riktlinjer över vilka åtgärder som bör användas av fysioterapeuter. Det finns tidigare forskning som visar skillnader i patientnöjdhet mellan privata och offentliga vårdcentraler i Sverige men det råder bristande forskning kring skillnader i fysioterapeutiska omhändertagandet av fotledsdistorsioner.  Syfte: Syftet med denna studie var att kartlägga förekomst och frekvens av de fysioterapeutiska åtgärder som användes i den subakuta fasen för fotledsdistorsion av fysioterapeuter på vårdcentraler i Sverige. Syftet var dessutom att undersöka om det fanns skillnader i vilka åtgärder som användes mellan privat och offentligt anställda fysioterapeuter.  Metod: Studien var en kvantitativ studie med deskriptiv och komparativ design. Datainsamlingen gjordes med en egenkonstruerad enkät som skickades ut i Facebookgruppen “Fysioterapeuternas framtidsgrupp” och besvarades av 83 deltagare. Skillnader mellan privata och offentliga vårdcentraler analyserades med Mann-Whitney U-test.  Resultat: Sammantaget användes 18 olika fysioterapeutiska åtgärder vid fotledsdistorsioner i subakut fas på vårdcentraler i Sverige. De mest frekvent använda åtgärderna var styrketräning i form av grundläggande övningar (exempelvis tåhävningar), rörlighetsträning i form av aktiva rörelser samt neuromuskulär träning i form av balansövningar. Studiens resultat visade ingen signifikant skillnad mellan vilka åtgärder som användes på privata och offentliga vårdcentraler i Sverige. / Background: Ankle sprains are a commonly encountered sport injury and without proper treatment, ankle sprains can cause long-lasting complaints. So far, there has been a lack of clarification of what physiotherapeutic interventions that Swedish physical therapists utilize to treat ankle sprains. Furthermore, there are currently no national or regional guidelines for physical therapists to follow. Recent studies have shown differences in patient satisfaction levels between private and public primary care centers (PCC) but limited research has been conducted on the specific interventions physical therapists provide to patients with ankle sprains.  Objective: The purpose of this study was to survey the occurrence and frequency of the physiotherapeutic interventions utilized by physical therapists to treat ankle sprains during the subacute phase in Swedish PCC. It was also investigated what differences exist between the treatments chosen by physical therapists in private versus public PCC. Design: A quantitative study with descriptive and comparative design. The data collection was conducted using a self-constructed questionnaire, which was posted in the Facebook group “Fysioterapeuternas framtidsgrupp” and was completed by 83 physical therapists. The differences between public and private PCC were analyzed by Mann Whitney U test.  Results: Overall, 18 different physiotherapeutic interventions were utilized for subacute ankle sprains in Swedish PCC. Basic strength training (for instance, toe raises), active range of motion exercises and neuromuscular balance exercises were the most frequently utilized interventions among physical therapists. No significant difference was found in the occurrence and frequency of physiotherapeutic interventions in public and private PCC.

Acupuncture (AP) is an important constituent of the therapeutic repertoire of traditional Chinese medicine and has been widely used to alleviate chronic painful conditions all over the world. We studied in rats the efficiency of electroacupuncture (EAP) applied to the Zusanli acupoint (ST36) as an analgesic treatment over a 3-week period of time on purine (α,β-methylene ATP, dibenzoyl-ATP)- and acid (pH 6.0 medium)-induced pain in the rat paw. The two ATP derivatives stimulated P2X3 and P2X7 receptors, respectively, while the slightly acidic medium stimulated the “acid-sensitive ion channel 3” (ASIC3). It was found that the P2X7 receptor and ASIC-mediated pain was counteracted by EAP with greater efficiency at the end than at the beginning of the treatment schedule, while the P2X3 receptor–mediated pain was not. Our findings have important clinical and theoretical consequences, among others, because they are difficult to reconcile with the assumption that AP is primarily due to the release of peripheral and central opioid peptides causing the well-known tolerance to their effects. In consequence, AP is a convenient therapeutic instrument to treat subacute and chronic pain.

Made available in DSpace on 2014-07-29T16:11:52Z (GMT). No. of bitstreams: 1 Dissertacao Flaubertt 1iniciais.pdf: 86457 bytes, checksum: 527b584507a695284399e78f10a55608 (MD5) Previous issue date: 2008-03-12 / O uso de plantas medicinais tem sido muito significativo nos últimos anos, sendo incentivado pela Organização Mundial de Saúde (OMS). Synadenium umbellatum Pax, Euphorbiacea (vulgo cola-nota, cancerola, milagrosa) tem o látex usado empiricamente como anti-tumoral e antiinflamatório. Por existir espécies tóxicas nesta família e visando à segurança no uso de extratos vegetais, tal estudo avaliou a toxicidade pré-clinica do látex e do extrato etanólico das folhas (EEF) de S. umbellatum, por via oral, em ratas Wistar. O estudo seguiu diretrizes da OECD (Organisation for Economic Cooperation and Development) para teste de toxicidade aguda (Guideline 423) e de toxicidade subaguda (Guideline 407). Na toxicidade aguda do látex e do EEF, não se observou, na dose de 2000 mg/kg, alterações fisiológicas e comportamentais, e nem a morte dos animais. No entanto, o látex ocasionou congestão e infiltrado leucocitário nos rins, fígado e pulmões, efeitos não observados com o EEF. Na toxicidade subaguda, doses de 50, 100 e 200 mg/kg de EEF não produziram alterações dose-dependentes significativas nos parâmetros laboratoriais e nem alterações fisiológicas, macroscópicas e histopatológicas dos órgãos. O EEF da S. umbellatum é praticamente atóxico em exposição aguda, já o látex pode ocasionar alterações histopatológicas no fígado e pulmões. O uso crônico da planta S. umbellatium merece mais estudos.

L’objectif de ce travail était 1) déterminer si la prise en charge thérapeutique journalière proposée aux patients en phase subaiguë de l’AVC était suffisamment sollicitante pour atteindre les recommandations à l’activité en hospitalisation 2) déterminer quelles méthodes étaient utilisables pour évaluer l’activité physique et leur utilité dans la prise en charge thérapeutique post-AVC.La population étudiée était constituée de patients en phase subaiguë de l’AVC, hospitalisés dans le service de Médecine Physique et de Réadaptation. Les résultats ont permis de montrer qu’un tiers des patients n’atteignait pas les recommandations à l’activité physique quand ils quittaient le service et que la majorité de la dépense énergétique (≥ 3 METs) journalière était réalisée en dehors du temps de prise en charge thérapeutique. Concernant les méthodes d’évaluation de l’activité physique, les résultats ont mis en avant que la perception de l’effort ne semblait pas utilisable pour évaluer l’intensité de l’activité physique sur une séance de rééducation et que les actimètres, à l’exception du Armband SenseWear, n’étaient pas précis pour estimer la dépense énergétique journalière des patients en phase subaiguë de l’AVC.Sachant que pour une part de la population les recommandations à l’activité physique ne sont pas atteintes, il y a un intérêt d’évaluer l’activité physique en phase subaiguë de l’AVC, pour notamment contrôler la réalisation de ces dernières. Cependant, que les méthodes d’évaluation soient subjectives ou objectives, il est difficile d’obtenir une mesure précise de l’activité physique au cours de la phase subaiguë de l’AVC. / The aim of this work was to 1) determine whether daily therapeutic care offered to patients in subacute stroke phase was demanding enough to reach hospitalization activity recommendations 2) determine the possible methods to measure physical activity and its usefulness in post-stroke therapeutic care.The studied population was composed of subacute stroke phase patients admitted to the Physical Medicine and Rehabilitation unit. The results showed that one third of the patients did not reach physical activity recommendations once they left the unit. Furthermore, most of the daily energy expenditure (3 METs) was achieved outside the therapeutic care. Regarding the physical activity evaluation methods, results highlighted that perceived exertion did not seem valuable to evaluate physical activity intensity during reeducation session. Additionally, actimeters were not accurate enough to measure patient's daily energy expenditure except for Armband SenseWear. Knowing that physical activity recommendations are not reached by part of the population, it seems useful to measure physical activity during subacute stroke phase in order to ensure these activities are performed as requested. However, should the evaluation methods be subjective or objective, it is hard to obtain an accurate physical activity measurement during subacute stroke phase.

Azidotische Belastungen des Pansens gelten bei Milchkühen besonders in der Frühlaktation als weit verbreitet. Sie werden als subakute Pansenazidosen (SARA) für die häufigen Produktionskrankheiten verantwortlich gemacht. Ziele : dieser Untersuchungen waren a) die Kontrolle des Säure-Basen-Haushalt (SBH) bei HF- Hochleistungskühen im peripartalen Zeitraum zum Vorkommen von SARA, b) die Prüfung bewährter sowie neuer Methoden zur Pansensaftanalyse, c) die Analyse von SBH-Harnparametern sowie d) die Prüfung möglicher Beziehungen von Stoffwechselparametern im Blut zu SBH-Parametern im Pansensaft. Versuchsanordnung : In 10 Betrieben Niedersachsens wurden an je 10 Kühen Verlaufsuntersuchungen mit vier Proben/Tier durchgeführt: 1. Trockenstehperiode/Färsen -30 Tage ante partum (d a.p.) bis zur Kalbung; 2. 2 bis 7 Tage post partum (d p.p.); 3. in der Frühlaktation 8 bis 30 d p.p. und 4. in der Mittellaktation 80 bis 150 d p.p. Pansensaft vormittags mit Geishauser- Sonde gewonnen, Blut aus der V. jugularis externa sowie Harn per Blasenkathederisierung. Analysiert wurden im Pansensaft der pH-Wert, die Pufferkapazität als Titrationsbilanz über die Titrationsazidität und - alkalität, die Methylenblauprobe sowie die Sedimentaktivitätszeit (SAT), im Harn der pH-Wert, die Netto-Säure-Basen-Ausscheidung (NSBA) sowie der Basen-Säure-Quotient (BSQ) und im Blutserum Glukose, freie Fettsäuren (FFS), Betahydroxybutyrat (BHB), L-Laktat, Cholesterol, Protein, Albumin, Bilirubin, Harnstoff, Kreatinin, Na, K, Cl, Ca, P, Mg, ALP, ASAT, GLDH sowie die CK. Ergebnisse: Zwischen Kühen und Färsen wurden bei den gemessenen Parametern keine gesicherten Unterschiede festgestellt. Es gab auch keine Unterschiede zwischen den Betrieben. Die Pansen-pH-Werte bewegten sich von x= 6,8 (6,43/7,0;1./3. Quartil) zu Beginn des Trockenstehens über minimal x = 6,3 (5,9/6,7) 30 bis 60 d p.p. bis x = 6,6 (6,2/6,8) in der Mittellaktation. Sie lagen alle im physiologischen Bereich. 20 Kühe hatten Pansen-pH-Werte von < 5,8, 6 Kühe von < 5,5 und 21 Kühe von > 7,2. Damit kamen die Kühe der SARA-Definition, bezogen auf das einmalige Auftreten von pH-Werten < 5,8 bei einer Kuh, nahe; bezogen auf alle gemessenen Pansen-pH-Werte betrug der Anteil < 5,8 aber nur 9,8 %. Die Titrationsbilanz war in der Trockensteherperiode ausgeglichen; bei allen drei Kontrollen p.p. bestand ein Basendefizit. Die Pufferkapazität war in der 1. Woche p.p. und in der Frühlaktation vermindert. Panse-pH-Werte und Titrationsbilanz korrelierten sehr eng (r=0,98,p<0,001). Die Methylenblauprobe war a.p. mit x = 3:37 (2:22/4:59) Minuten am längsten, in der Mittellaktation mit 3:01 (2:25/4:30) Minuten am kürzesten und ingesamt physiologisch. Es gab keine signifikanten Unterschiede zwischen den einzelnen Kontollzeiträumen. Die SAT war physiologisch und schwankte zwischen zwei und fünf Minuten ohne signifikante Unterschiede zwischen den Entnahmezeiträumen. Im Harn lagen die NSBA mit x = 70 mmol/l (20/122 = 1./3.Quartil) und der BSQ mit x = 2,2 (1,6/2,8) nur bei den Frischmelkern unter den unteren Grenzwerten und deuteten die Gefahr von SARA an. Der Harn-pH-Wert war mit x = 7,98 (7,7/8,2) physiologisch. Von der Gesamtheit alle NSBA-Werte waren 37% < 83 mmol/l sowie 28,9% < 25 mmol/l; beim BSQ waren es 52,6% < 2,5 sowie 27,4% < 1,5. Die für die NSBA, den BSQ und den Harn-pH-Wert berechneten Sensivitäten und Spezifitäten für einen Pansen-pH-Wert < 5,8 liegen mit 44,8% und 64,5% (NSBA), 55,8% und 47,9% (BSQ) sowie 2,3% und 97% (Harn-pH-Wert) unter den diagnostischen Erfordernissen.Sie können somit keine sicheren Rückschlüsse auf den Pansenzustand geben. Bei den Blutbefunden wurden Kühe mit Pansen-pH-Werten < 5,8 (SARA) und >5,8 gegenüber gestellt. Die Korrelationskoeffizienten, die Sensitivität und die mittels Receiver-Operating-Characteristics Analysen ermittelten Flächen unter der Kurve zwischen Pansen-pH-Wert und den Blutparametern waren niedrig ( p> 0,05). Schlussfolgerung: Hochleistende HF-Kühe haben peripartal nicht zwangsläufig eine SARA. Die Titrationsbilanz ergänzt den Pansensaft-pH-Wert, ist routinemäßig aber nicht nötig. Im Harn liegen die NSBA und BSQ häufiger unter den Grenzwerten und korrelieren nicht gesichert mit dem Pansen-pH-Wert. Auch Blutparameter erlauben keine sichere Aussage über den Pansenzustand. Die Diagnose von SARA muss mit direkter Messung des Pansen-pH-Wertes gestellt werden.

Made available in DSpace on 2014-12-17T14:13:56Z (GMT). No. of bitstreams: 1 CarlosAAG.pdf: 323369 bytes, checksum: 093c86d6d5662ee9fb5d64b4afd66037 (MD5) Previous issue date: 2004-02-19 / The objective of this study is to estimate the prevalence of Ocular Toxocariasis, Diffuse Unilateral Subacute Neuroretinitis (DUSN), Toxoplasma gondii infection and Ocular Toxoplasmosis in a student population in Natal-RN/Brazil and relate it to demographic, epidemiologic and socio-economic risk factors. The incidence of DUSN was observed in patients at the Federal University of Rio Grande do Norte Ophthalmology Service and the Prontoclinica de Olhos Ophthalmology clinic in Natal. In cases where a worm was found in the subretinal space, the result of treatment with photocoagulation using Green Laser (Eye Light ALCON) was evaluated in relation to final visual result. The sample was randomly selected among the schools of the four districts of Natal, according to the type of institution (public or private), its level (elementary or secondary), and study period (morning, afternoon or evening). The school population was studied from March to May, 2001. Initially, the students answered a questionnaire to evaluate demographic, epidemiologic and socio-economic risk factors. Afterwards, the following procedures were carried out: blood samples were taken for Toxoplasmosis (IgG, IgM) serology, hemogram, ophthalmological examination, consisting of clinical history, measurement of visual acuity, refraction under cycloplegia, biomicroscopy of the anterior segment and annexa, funduscopy and examination of extrinsic motility. The prevalence of Toxocariasis was 0.2% or 2 per one thousand students. The sample was insufficient to estimate the prevalence of DUSN. Seventy patients with DUSN diagnosis were examined from January, 2001 to January, 2003. A live worm was found in the subretinal space of all four patients in the acute phase, and these were treated with laser photocoagulation. After follow-up (average = 11.5 months), visual acuity improved in three eyes and remained unaltered in one eye. Worms were found in 22 of the 66 patients in the chronic phase, and these also were treated with laser photocoagulation. After a follow-up period of 13.1 months, on average, visual acuity improved in two of the patients, remained unchanged in 19 and worsened in one. The comparison of visual result before and after treatment was not statistically significant (p = 0.302). The diagnosis of DUSN in the acute phase, followed by prompt localization and destruction of the worm by photocoagulation, can improve the patient s vision. However, destruction of the worm by laser photocoagulation in eyes with DUSN in the chronic phase does not improve visual acuity. Seroprevalence for IgG was 46% (Confidence Interval CI 95%-42.9-49.2%) and for IgM it was 1.4% (CI 95% = 0.8-2.4%). The prevalence of ocular lesion was 1.15% (CI 95% = 0.6 - 2.0%). Socio-economic conditions were determinants in the prevalence of Systemic and Ocular Toxoplasmosis in the bivaried analysis and confirmed in the multivaried analysis (mother s scholarity illiterate/ OR = 2.9 and p < 0.001). The T. gondii infection prevalence, although high, was less than that found in studies performed in the South and Southeast of Brazil and that of Ocular Toxoplasmosis was completely discrepant, varying from 5 to 17 times less. Although important epidemiological variables such as owning a cat, drinking unfiltered water, and coming into contact with rivers or lakes showed an association in the preliminary analysis, they lost their influence when included in the logistic model. Future studies are scheduled to begin in March, 2004, in collaboration with other Brazilian and American universities in an attempt to discover the reason for these findings, as well as identifying the different strains of Toxoplasma gondii, and studying the sources of water utilized by the population of Natal Brazil / Esta pesquisa teve como objetivo, estimar a preval?ncia da Toxocar?ase Ocular, Neuroretininte Sub-aguda Difusa Unilateral (DUSN), Infec??o pelo Toxoplasma gondii e Toxoplasmose Ocular na popula??o de escolares de Natal-RN/Brasil e relacion?-la aos fatores de risco demogr?ficos, epidemiol?gicos e socioecon?micos. Estudar a incid?ncia de DUSN em pacientes atendidos no Servi?o de Oftalmologia da Universidade Federal do Rio Grande do Norte e Prontoclinica de Olhos, em Natal, bem como, avaliar, nos casos em que foi encontrada larva no espa?o sub-retiniano, o resultado do tratamento com fotocoagula??o utilizando o Laser Verde (Eye Light ALCON) em rela??o ao resultado visual. A amostra foi selecionada aleatoriamente e distribu?da nas escolas dos quatro distritos da cidade de Natal de acordo com a natureza da institui??o (p?blica ou privada), seu n?vel (fundamental ou m?dio) e turno em que o escolar estudava (matutino, vespertino ou noturno). A popula??o de escolares foi estudada no per?odo de mar?o a maio de 2001. Inicialmente, responderam a um question?rio para avalia??o de fatores de risco demogr?fico, epidemiol?gico e socioecon?mico. Depois foram feitos os seguintes procedimentos: coleta de sangue para realiza??o de sorologia para Toxoplasmose (IgG, IgM), hemograma, exame oftalmol?gico constando de hist?ria cl?nica, medida da acuidade visual, refra??o sob cicloplegia, biomicroscopia do segmento anterior e anexos, fundoscopia e exame da motilidade extr?nseca. A preval?ncia de Toxocar?ase foi de 0,2% ou 2 por mil escolares. A amostra n?o foi suficiente para estimar a preval?ncia de DUSN. Foram examinados 70 pacientes com diagn?stico de DUSN, no per?odo de janeiro de 2001 a janeiro de 2003. Foi encontrada larva viva no espa?o sub-retiniano de todos os quatro que se encontravam na fase aguda, e tratados com fotocoagula??o a laser. Ap?s acompanhamento dos pacientes (m?dia = 11,5 meses), a acuidade visual melhorou em tr?s olhos e permaneceu inalterada em um olho. Dos 66 pacientes na fase cr?nica, foi encontrada larva em 22 deles e tratados com fotocoagula??o a laser. Ap?s acompanhamento por um per?odo de 13,1 meses em m?dia, a acuidade visual melhorou em dois, permaneceu a inicial em 19 e diminuiu em um paciente. A compara??o do resultado visual antes e ap?s o tratamento, n?o foi estatisticamente significante (p = 0,302). O diagn?stico de DUSN na fase aguda, seguida por pronta localiza??o e destrui??o da larva por fotocoagula??o, pode melhorar a vis?o dos pacientes. No entanto, a destrui??o da larva por fotocoagula??o a laser em olhos com DUSN, na fase cr?nica, n?o melhora a acuidade visual. A soropreval?ncia para IgG foi de 46% (Intervalo de Confian?a -IC 95% - 42,9-49,2%) e para IgM foi 1,4% (IC 95% = 0,8-2,4%). A preval?ncia de les?o ocular foi 1,15% (IC 95% = 0,6 2,0%). As condi??es socioecon?micas foram determinantes na preval?ncia da Infec??o pelo T. gondii e Toxoplasmose Ocular na an?lise bivariada e confirmada na an?lise multivariada (escolaridade da m?e n?o alfabetizada/OR = 2,9 e p< 0,001). A preval?ncia de Toxoplasmose Sist?mica, embora elevada, foi menor do que a encontrada em estudos realizados no Sul e Sudeste do Brasil e, a da Toxoplasmose Ocular foi totalmente discrepante, variando de 5 a 17 vezes menos. Embora importantes vari?veis epidemiol?gicas, tais como possuir gato, beber ?gua n?o filtrada, ter contato com lagoas ou rios, tenham mostrado associa??o na an?lise preliminar, perderam sua influ?ncia quando inclu?das no modelo log?stico. Estudos futuros j? est?o planejados para ter inicio em mar?o pr?ximo, em colabora??o com outras Universidades do Brasil e dos Estados Unidos com a finalidade de encontrar a raz?o destes achados, bem como, identificar diferentes tipos de cepas do Toxoplasma gondii, e estudar as fontes de ?gua utilizadas pela popula??o de Natal-RN