Pharmaceuticals in the environment are raising concern and since our municipal wastewater treatment plants normally don’t remove pharmaceuticals or resistant bacteria, it could be of interest to study the emissions from potential point sources. In general, households contribute with the greatest amount of pharmaceuticals to the municipal wastewater, but in some regions hospitals are a major point source of for example antibiotics.   One of Sweden’s largest hospitals, Akademiska sjukhuset, wants to reduce the amount of pharmaceuticals and resistant bacteria in their waste water, but the treatment process can be long, complicated and may require large areas. Cleaning of source-separated urine can be a more sustainable and efficient solution, since most of the pharmaceuticals are excreted via urine.   The aim of the study was to find out which one of the treatment methods; ozonation, biochar treatment and enzymatic treatment that are most suitable for reducing antibiotics from source separated urine. Ozonation was carried out at IVL, Stockholm, with a small-scale ozone generator, and biochar experiment and enzyme treatment was tested through batch tests and column test at Uppsala University.   The small-scale treatment experiments revealed that biochar treatment was the most promising method for reducing antibiotics in urine.  The treatment methods ozonation and enzymatic treatment showed low reduction in this study, but may work better with some sort of pre-treatment.   To be able to develop a cleaning process with biochar (e.g. a filter system or a tank system), further studies on adsorption capacity, EBCT and breakthrough curves most be carried out. / Resistenta bakterier och spridning av läkemedelsrester i miljön har blivit allt mer uppmärksammat. Då våra konventionella reningsverk vanligtvis inte renar dessa substanser kan punktutsläppskällor vara intressanta att studera. Utöver det stora gemensamma bidraget av läkemedelsrester från hushållen kan t.ex. vissa sjukhus bidra till en stor del av avloppets antibiotika. Akademiska sjukhuset i Uppsala är ett av Sveriges största sjukhus som nu växer då både renoveringar och stora utbyggnationer sker.  Sjukhuset är miljöcertifierat enligt ISO 14001 vilket betyder att de strukturerat jobbar med miljöfrågor. En expansion av sjukhuset kan komma att kräva större insatser i miljöarbetet och Akademiska sjukhuset önskar att ligga i framkant. Ett av miljömålen som Akademiska sjukhuset strävar mot är minskade utsläpp, varför de nu vill reducera halterna av läkemedelsrester och multiresistenta bakterier i avloppet. Det kan dock vara svårt att hitta en enkel reningsprocess som inte kräver någon för- eller efterbehandling av avloppsvattnet eller som tar upp stora ytor. Att behandla urinen separat kan vara ett motiverat alternativ istället för att behandla hela avloppsfraktionen, då urin innehåller största delen av avloppets läkemedelsrester och dessutom utgör en betydligt mindre volym.   Syftet med det här examensarbetet var att undersöka vilka av metoderna ozonering, behandling med biokol och enzymatisk nedbrytning som lämpar sig bäst för rening av urin från antibiotika. Metoderna studerades både teoretiskt och praktiskt i form av litteraturstudier respektive småskaliga reningsförsök. Ozonering genomfördes på IVL, Stockholm som tillhandahåller en mindre ozongenerator med en maxkapacitet att tillföra 50 mg ozon/l.  Reningsförmågan hos ett biokol testades genom skakförsök samt kolonnförsök och enzymatisk rening testades med produkter från företaget Pharem Biotech, också genom kolonnförsök och skakförsök.   Resultaten i examensarbetet visade att biokol har stor potential att adsorbera antibiotika i urin. Under kolonnförsöket uppgick den maximala reduktionen till 55 %, något som tros kunna förbättras med exempelvis mindre partikelstorlek och längre kontakttid. Den högsta reduktionen nåddes vid skaktesten där upp till 96 % av antibiotikan reducerades.   För ozon- och enzymförsöken var resultaten inte lika positiva. Endast en antibiotika visade en nämnvärd reduktion i ett av försöken. Den låga reduktionsgraden för ozonförsöken tros framförallt bero på att ozondosen är för låg och att den tillförda ozondosen inte motsvarar den adsorberade ozondosen. Resultaten av enzymreningen kunde inte visa att enzymer i produkter från företaget Pharem Biotech hade någon reduktionseffekt på antibiotikan. Detta tros bero på att en inaktivering av enzymerna har skett av ämnen i urinen vilket gör att produkten måste anpassas för att bli applicerbar på urin.

Submitted by carla santos (biblioteca.cp2.carla@bahiana.edu.br) on 2018-08-23T19:30:26Z No. of bitstreams: 1 Disserta????o de Danielle Sodr?? p??s-defesa_Vers??o final_30.11.2017.pdf: 2534031 bytes, checksum: 4e7c93bd9d92f79baf190a3d4bb0aa89 (MD5) / Approved for entry into archive by JOELMA MAIA (ebmsp-bibliotecacp2@bahiana.edu.br) on 2018-08-24T14:26:45Z (GMT) No. of bitstreams: 1 Disserta????o de Danielle Sodr?? p??s-defesa_Vers??o final_30.11.2017.pdf: 2534031 bytes, checksum: 4e7c93bd9d92f79baf190a3d4bb0aa89 (MD5) / Made available in DSpace on 2018-08-24T14:26:45Z (GMT). No. of bitstreams: 1 Disserta????o de Danielle Sodr?? p??s-defesa_Vers??o final_30.11.2017.pdf: 2534031 bytes, checksum: 4e7c93bd9d92f79baf190a3d4bb0aa89 (MD5) Previous issue date: 2017-10-20 / Introdu????o: A radiofrequ??ncia (RF) ?? um tipo de corrente com ondas eletromagn??ticas que promove um aumento da produ????o de col??geno e realinhamento do mesmo, baseada no aumento da temperatura. Desta forma, surge a hip??tese que a RF pode auxiliar no tratamento da incontin??ncia urin??ria p??s-prostatectomia radical (IUPPR). Objetivos: Descrever os efeitos adversos e a resposta cl??nica da RF no tratamento da IUPPR. Casu??stica e m??todos: Trata-se de um estudo piloto. Foram inclu??dos homens com at?? 65 anos de idade, com queixa cl??nica de IUPPR, que apresentassem res??duo p??s-miccional (RPM) aceit??vel (<50ml) verificado por ultrassom (US), Pad Test de 1 hora ??? 1 grama e PSA < 0,2 ng/ml. Foram exclu??dos pacientes com tempo menor que 45 dias de p??s-operat??rio, incontin??ncia urin??ria de urg??ncia (IUU), portadores de doen??as cr??nicas degenerativas neurol??gicas, cardiodesfibrilador implant??vel e metais iatrog??nicos na regi??o p??lvica. A coleta foi iniciada por meio de question??rio anamn??sico b??sico com informa????es sociodemogr??ficas e cl??nicas. Al??m disso, foi realizada avalia????o da for??a muscular do assoalho p??lvico. Para avaliar a resposta cl??nica, foi realizado, antes e ap??s o tratamento, Pad Test de 1 hora e question??rios autoaplic??veis: International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) e Medical Outcomes Study 36 - Item Short ??? Form Health Survey (SF-36). Ao final, foi aplicada a escala Likert para mensurar o grau de satisfa????o em rela????o ao tratamento e a EVA modificada para incontin??ncia urin??ria (IU) para avaliar a evolu????o dos sintomas. Para verifica????o dos efeitos adversos, foi questionado a presen??a de sinais e sintomas durante e logo ap??s a aplica????o da t??cnica. O US p??s-tratamento foi realizado para avaliar a presen??a de RPM. Os participantes foram submetidos a cinco sess??es de RF n??o ablativa endoanal. O equipamento de RF possui um eletrodo ativo, endoanal, e outro dispersivo, que funciona como terra. A frequ??ncia utilizada foi de 1,0 Mhz e a temperatura foi de 41??C. Ao alcan??ar o aquecimento desejado, a temperatura foi mantida durante 2 minutos. Os resultados foram submetidos a an??lise descritiva e ao teste n??o param??trico de Wilcoxon. Resultados: A amostra foi composta por 10 indiv??duos com idade m??dia de 57,5??4,9 anos. A mediana do grau de for??a muscular foi 3 (3,0-3,2) e do Pad Test inicial foi de 6,5g (1,7-50,0) e final de 2,0g (0,0-9,0) (p<0,01). O US n??o apresentou altera????o no RPM. No Pad Test, 90% apresentaram diminui????o e 30% resolu????o completa da perda urin??ria. O ICIQ-OAB indicou diminui????o significativa dos sintomas de enchimento vesical. O ICIQ-SF e o SF-36 n??o apresentaram diferen??a significativa. Em rela????o ao grau de satisfa????o, dois pacientes ficaram inalterados, seis satisfeitos e dois muito satisfeitos. No relato dos participantes, quatro sentiram dor na introdu????o do eletrodo endoanal, cessando durante a aplica????o. Conclus??o: A RF demonstrou dor como efeito adverso durante o tratamento da IUPPR, com resultados positivos, tanto na melhora da perda urin??ria quanto na redu????o dos sintomas de enchimento vesical, promovendo satisfa????o dos participantes.

Submitted by Carla Santos (biblioteca.cp2.carla@bahiana.edu.br) on 2018-11-20T18:36:55Z No. of bitstreams: 1 DISSERTACAO ENEIDA FINAL POS DEFESA 27 10 enviada 17 30 (1).pdf: 1373600 bytes, checksum: 146d362c40bf3d1ccbab9ce75aa46406 (MD5) / Approved for entry into archive by JOELMA MAIA (ebmsp-bibliotecacp2@bahiana.edu.br) on 2018-11-20T18:41:05Z (GMT) No. of bitstreams: 1 DISSERTACAO ENEIDA FINAL POS DEFESA 27 10 enviada 17 30 (1).pdf: 1373600 bytes, checksum: 146d362c40bf3d1ccbab9ce75aa46406 (MD5) / Made available in DSpace on 2018-11-20T18:41:05Z (GMT). No. of bitstreams: 1 DISSERTACAO ENEIDA FINAL POS DEFESA 27 10 enviada 17 30 (1).pdf: 1373600 bytes, checksum: 146d362c40bf3d1ccbab9ce75aa46406 (MD5) Previous issue date: 2018-08-24 / A disfun????o do trato urin??rio inferior ?? comum em crian??as e adolescentes, apresentando sintomatologia variada. A sua associa????o com problemas emocionais e comportamentais vem sendo demonstrada em estudos populacionais, com ??nfase na presen??a de incontin??ncia urin??ria. Entretando, os demais sintomas envolvidos nessa disfun????o e a coexist??ncia da constipa????o funcional necessitam de melhor an??lise nessa poss??vel associa????o. Objetivo: Testar a hip??tese que crian??as e adolescentes com disfun????o do trato urin??rio inferior apresentam mais problemas emocionais e comportamentais. Material e M??todos: Estudo transversal multic??ntrico, populacional, realizado em pra??as e parques p??blicos de duas cidades do Brasil, entrevistando pais que aceitaram participar do estudo ap??s assinatura do termo de consentimento, respondendo sobre quest??es urin??rias e aspectos psicol??gicas dos seus filhos de 5 a 14 anos. Foram exclu??dos deste estudo crian??as ou adolescentes com problemas neurol??gicos e com altera????es anat??micas do trato urin??rio. Os question??rios utilizados foram o Disfunctional Voiding Score Symptom (DVSS) para avalia????o da disfun????o urin??ria, Roma III para avalia????o dos sintomas intestinais e o Strenghts and Difficulties Questionare (SDQ) para avaliar as quest??es emocionais e comportamentais. Resultados: Participaram 806 crian??as e adolescentes, com idade m??dia de 9,1??2,7 anos, sendo 427(53%) do sexo feminino. A preval??ncia de disfun????o do trato urin??rio inferior, segundo o DVSS foi de 16,4% e 26,2% dos participantes apresentaram altera????o na escala total do SDQ. As subescalas do SDQ que tiveram maior frequ??ncia de escores anormais foram a de sintomas emocionais (29,2%) e de problemas de conduta (30%). Dentre as crian??as com disfun????o do trato urin??rio inferior, 40,5% apresentaram rastreamento positivo para problemas emocionais e comportamentais, com associa????o estatisticamente significativa tanto na escala total (p<0,001), como nas subescalas de sintomas emocionais (p<0,001), problema de conduta (p<0,001) e na de hiperatividade (p=0,037). Quando avaliadas em rela????o aos sintomas da disfun????o do trato urin??rio inferior, como presen??a de urg??ncia, incontin??ncia urin??ria e posterga????o da mic????o, foram associadas ?? maior preval??ncia de clinica relevante de problemas emocionais e comportamentais, com altera????es na escala total do SDQ, sendo estatisticamente significante, com os respectivos valores: (p=0,005), (p=0,004) e (p=0,012). Ter disfun????o vesical, associada ?? constipa????o funcional, denominada Bladder and Bowel Dysfunction, foi fator agravante para os problemas emocionais e comportamentais, com sintomas mais intensos, tanto na escala total do SDQ, como nas subescalas de dificuldade, quando comparado com quem s?? tinha disfun????o do trato urin??rio inferior ou constipa????o, sem a citada disfun????o. A an??lise multivariada demonstrou que disfun????o do trato urin??rio inferior (OR:1,91), constipa????o (OR:1,7), estudar em col??gio p??blico (OR: 2,2 ) e menor escolaridade do chefe da fam??lia (OR: 1,9), foram fatores com associa????o independente para a presen??a de problemas emocionais e comportamentais em crian??as e adolescentes. Conclus??o: Crian??as e adolescentes com disfun????o do trato urin??rio inferior e constipa????o tem mais problemas emocionais e comportamentais e ter Bladder and Bowel Dysfunction ?? um fator agravante para essa associa????o.

Submitted by PPG Gerontologia Biom?dica (geronbio@pucrs.br) on 2018-06-29T19:06:00Z No. of bitstreams: 1 Jorge_Luisa_Braga_Dis.pdf: 2913612 bytes, checksum: 382cfcf1d996787dfca8855eca162d5e (MD5) / Rejected by Sheila Dias (sheila.dias@pucrs.br), reason: Devolvido devido ? diverg?ncia do t?tulo entre capa institucional e demais folhas (folha de rosto, ficha catalogr?fica e folha da banca). on 2018-07-09T13:02:30Z (GMT) / Submitted by PPG Gerontologia Biom?dica (geronbio@pucrs.br) on 2018-07-09T17:36:57Z No. of bitstreams: 1 Jorge_Luisa_Braga_disserta??o.pdf: 3056527 bytes, checksum: 8dd68e98e9a393d3374246ba71cb7a1a (MD5) / Approved for entry into archive by Sheila Dias (sheila.dias@pucrs.br) on 2018-07-13T14:41:23Z (GMT) No. of bitstreams: 1 Jorge_Luisa_Braga_disserta??o.pdf: 3056527 bytes, checksum: 8dd68e98e9a393d3374246ba71cb7a1a (MD5) / Made available in DSpace on 2018-07-13T14:47:56Z (GMT). No. of bitstreams: 1 Jorge_Luisa_Braga_disserta??o.pdf: 3056527 bytes, checksum: 8dd68e98e9a393d3374246ba71cb7a1a (MD5) Previous issue date: 2018-01-15 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Introduction: Population aging is a worldwide phenomenon, emphasizing the important increase of people with more than 80 years, elderly people. This increase in longevity may be accompanied by some functional impairment leading to some disabling events and causing animportant quality of life (QoL) impairment. Regarding the functional impairments, there is the decrease of the urinary tract function. This study aimed to evaluate the possible factors related to urinary discomfort in elderly people. Methods: Cross-sectional, observational and quantitative study. The sample was composed of elderlypeoplefrom Porto Alegre, RS, and participants in the multiprofessional attention to elderly project. The impact of urinary discomfort on QOL was assessed by the Kings Health Questionnaire (KHQ) instrument adapted for men and women with and without urinary incontinence (UI). In addition to KHQ, the elderly still answered an urogynecologic questionnaire with sociodemographic and clinical questions. The statistical program used was Epiinfo ? 7.2 and considered significant values p <0.05. Results: 82 participants, 56 women and 26 men with a mean age of 92,3?2,69 years participated. 43% of the participants reported urinary discomfort and of this percentage, 97% reported UI. The factors related to urinary discomfort with statistical significance were: obstetric issues such as: vaginal delivery, number of pregnancies and number of higher weight gain at birth. In KHQ, limitations in outside activities, travel, physical activity, relationships, feelings of depression, anxiety, angriness, concern in smelling urine as well as behavioral changes like wearing protective, decreased water intake were related to discomfort. Conclusion: With this study it was possible to conclude that several factors are associated with urinary discomfort. Despite a low percentage, there was also a report of urinary discomfort in the absence of UI. Therefore, special attention to urinary health is important during the evaluation of the longevity, providing an intervention before the appearance of symptoms, repercussions on a more active aging with a higher quality of life. / Introdu??o: O envelhecimento populacional ? um fen?meno mundial, destacando-se o aumento importante de pessoas com mais de 80 anos, tamb?m chamadas de longevos (a). Esse aumento da longevidade pode vir acompanhado de alguns preju?zos funcionais gerando alguns eventos incapacitantes e que causam uma perda significativa da qualidade de vida (QV). Entre os preju?zos funcionais destaca-se a diminui??o do funcionamento do sistema urin?rio. Este estudo buscou avaliar os poss?veis fatores relacionados ao desconforto urin?rio em longevos e longevas. M?todos: Estudo transversal, observacional e anal?tico de car?ter quantitativo. A amostra foi composta por longevos residentes da cidade de Porto Alegre, RS, participantes do projeto Aten??o Multiprofissional ao Longevo. O impacto do desconforto urin?rio na QV foi avaliado pelo instrumento Kings Health Questionnaire (KHQ) adaptado para homens e mulheres com e sem incontin?ncia urin?ria (IU). Al?m deste question?rio, os longevos ainda responderam um question?rio uroginecol?gico com perguntas sociodemogr?ficos e clinicas. O programa estat?stico utilizado foi o Epiinfo? 7.2 e considerados significativos valores de p<0,05. Resultados: Participaram 82 longevos, 56 mulheres e 26 homens com idade m?dia de 92,3?2,69 anos. 43% dos participantes referiram desconforto urin?rio e deste percentual, 97% relataram IU. Os fatores relacionados ao desconforto urin?rio com signific?ncia estat?stica foram: quest?es obst?tricas como: parto normal, n?mero de gesta??es, n?mero de filhos e beb?s pesados ao nascer. No KHQ, limita??es em atividades fora de casa, viagens, atividade f?sica, conv?vio social, sentimentos de depress?o, ansiedade, nervosismo, preocupa??o em cheirar urina assim como mudan?as comportamentais como uso de protetores, diminui??o da ingest?o h?drica foram relacionadas com o desconforto. Conclus?o: Com este trabalho foi poss?vel concluir que diversos fatores est?o associados ao desconforto urin?rio. Apesar de baixo percentual, houve relato tamb?m de desconforto urin?rio na aus?ncia de IU. A partir disso, torna-se importante durante a avali??o com longevos, um cuidado especial ? sa?de urin?ria, propiciando uma interven??o antes do aparecimento dos sintomas, repercutindo em um envelhecimento mais ativo com maior qualidade de vida.

Urinary tract infection (UTI) is a very common infection in humans and a majority is caused by Escherichia coli. UTI are commonly treated empirically. However, empiric treatment has become more problematic due to increased antibiotic resistance to commonly used antibiotic agents. It is therefore desirable with short turnover times for antimicrobial susceptibility testing and species identification to improve antibiotic treatment at an early stage. Matrix Assisted Laser Desorption/Ionisation Time of Flight (MALDI-TOF) can provide species identification faster than former routine methods. This study compared direct and standard susceptibility testing using disk diffusion on Enterobacteriaceae (EB) from urine samples. The possibility to standardise the inoculum for direct susceptibility testing via a pellet obtained by a series of centrifugations was also evaluated, as well as direct species identification with MALDI-TOF from the pellet. Results from direct susceptibility testing from urine samples with EB, performed either directly from the urine or with a standardised inoculum, correlated well to those obtained with standardised susceptibility testing using EUCAST disk diffusion methodology with few errors, of which most were associated with Proteus mirabilis. The concept of standardising the inoculum for direct susceptibility testing to 0.5 McFarland was labour intensive and did not improve the results further. However, direct species identification from the urine pellet using MALDI-TOF showed good correlation to routine identification. Of 238 samples, an EB was correctly identified in 148 samples using MALDI-TOF.

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-05-28T12:14:02Z No. of bitstreams: 1 469458 - Texto Completo.pdf: 15561298 bytes, checksum: 3e2aef91e88f708205203abd85b8f44c (MD5) / Made available in DSpace on 2015-05-28T12:14:02Z (GMT). No. of bitstreams: 1 469458 - Texto Completo.pdf: 15561298 bytes, checksum: 3e2aef91e88f708205203abd85b8f44c (MD5) Previous issue date: 2015-03-18 / This is a retrospective study reporting 35 years of kidney transplantation at Hospital S?o Lucas da Pontif?cia Universidade Cat?lica do Rio Grande do Sul. An historical approach of the origins and development of the Nephrology Unit over the years was performed. Data were separated into different eras, based on the type of immunosuppression, and the patient?s characteristics before, during and after transplantation were assessed. There were significant differences between each era, mainly on the characteristics of the recipients and donors, but also in the rates of complications and technical aspects of surgery. A total of 1231 transplants were performed until 2013, April 30. Of these, 55.8% were male, white (86.9%) and 76.6% from deceased donors. Most recipients aged between 19 and 59 years (77.5%), and 1.9% over 70 years. Significant differences were observed between the characteristics of each era, especially in relation to recipients and donors. Through the eras, an increased number of patients are being transplanted, with grafts from older donors (p<0.001) subjected to longer cold ischemia times (p<0.001) transplanted in an increasing proportion of elderly recipients (p<0.001), maintained in a longer period on the waiting list (p<0.001). Fewer episodes of rejection were observed (p<0.001), lower incidence of some clinical complications such as myocardial infarction (p<0.001), strokes (p=0.02) and post-??transplant diabetes (p<0.001), along of the time. In the present era, survival of patients at 1, 3 and 5 years were 98.3%, 94.6% and 90.5% for living donors and 92.4%, 87.2% and 80.7% for deceased donors, respectively. Survival of grafts were, for living donors, 92.2%, 88.7% and 82.4% and deceased donors 80.4%, 71.1% and 63.7%. Transplants with acute pyelonephritis in the first 30 days after transplantation, had significantly worse graft and patients survivals, compared to patients without pyelonephritis in the first 30 days. In addition, age, use of ureteral stents, thymoglobulin induction and longer hospital stays increased the risk of this infection. Recipients of expanded criteria donors transplants induced with thymoglobulin may be at a 25.75 fold increase in risk for death 24 hours after diagnosis of CRAB septicemia, a severe complication occurring in 10 recipients between January 2000 and April 2013, of 807 transplants patients. In recent years, our study showed a low incidence of cytomegalovirus (CMV) infection, despite the increased use of Thymoglobulin. We found that the use of low thymoglobulin doses reduces the risk of cytomegalovirus and, the use of oral ganciclovir had a protective effect on CMV, in the first year of transplantation. Finally, patients with a positive polyomavirus urinary cytology had worse renal function and graft survival in a seven years follow-??up period, compared with the patients without the presence of decoy cells in urine. The analysis of the 35 years of transplantation at the Renal Unit of Hospital S?o Lucas da PUCRS depicts the evolution and development of a program that is a reference in South Brazil, and the different management and results through the different eras. There were changes in donor and recipient?s characteristics, inclusion selection, compatibility assessment and immunosuppression protocols, among others. / Este trabalho consiste em um estudo retrospectivo que abordou a hist?ria dos 35 anos de transplantes renais no Hospital S?o Lucas da Pontif?cia Universidade Cat?lica do Rio Grande do Sul. Foi realizado um levantamento da hist?ria das origens do servi?o de nefrologia e sua evolu??o ao longo dos anos. Os dados foram separados em diferentes eras, com base no tipo de imunossupress?o, sendo avaliadas as caracter?sticas dos pacientes antes, durante e ap?s o transplante. Encontramos diferen?as significativas entre cada era, principalmente nas caracter?sticas dos receptores e doadores, mas tamb?m na ocorr?ncia de complica??es e nos aspectos cir?rgicos. Foram realizados 1231 transplantes at? 30 de abril de 2013, sendo 55,8% do sexo masculino, ra?a branca (86,9%) e com 76,6% de doadores falecidos. A maioria dos receptores com idade entre 19 e 59 anos (77,5%), sendo 1,9% acima de 70 anos. Diferen?as significativas entre as caracter?sticas de cada era, principalmente em rela??o aos receptores e doadores. Estamos transplantando um n?mero progressivamente maior de pacientes, significativamente mais idosos (p<0,001), com maior tempo em lista de espera (p<0,001), com doadores mais idosos (p<0,001) e tempos mais longos de isquemia (p<0,001). Foram verificados menos epis?dios de rejei??o (p<0,001), menor ocorr?ncia de algumas complica??es cl?nicas, tais como infarto de mioc?rdio (p<0,001), AVE (p=0,02) e diabete p?s transplante (p<0,001), ao longo do tempo. Na era atual, sobrevida de pacientes foram em 1, 3 e 5 anos de 98,3%, 94,6% e 90,5% para doadores vivos e de 92,4%, 87,2% e 80,7% para doadores falecidos, respectivamente. Sobrevida de enxertos foram para doadores vivos de 92,2%, 88,7% e 82,4% e doadores falecidos de 80,4%, 71,1% e 63,7%. Foi encontrado que transplantados que apresentaram pielonefrite aguda nos primeiros 30 dias ap?s o transplante, apresentavam significativamente pior sobrevida de enxertos e pacientes, comparado com os que n?o apresentavam pielonefrite nos primeiros 30 dias. Al?m disto, idade, uso de cateteres de duplo J, indu??o com timoglobulina e tempo maior de hospitaliza??o aumentam o risco desta infec??o. Pacientes que receberam rins com doadores com crit?rios expandidos e induzidos com timoglobulina podem apresentar risco maior para morte ap?s 24 horas do diagn?stico de septicemia por Acinetobacter baumannii resistentes a carbapen?micos, complica??o grave que ocorreu em 10 pacientes transplantados, dentre os 807 transplantados entre janeiro de 2000 e abril de 2013. Ocorreu baixa incid?ncia de citomegalov?rus nos ?ltimos anos, apesar do aumento do uso de timoglobulina. Verificamos que o uso de timoglobulina em doses menores diminui o risco de citomegalov?rus e que o uso de ganciclovir oral tem efeito protetor para o desenvolvimento de citomegalov?rus no primeiro ano do transplante. E por fim, verificamos que pacientes que apresentavam presen?a de citologia urin?ria positiva para poliomav?rus apresentaram pior fun??o renal e pior sobrevida de enxerto, em acompanhamento de 7 anos, comparado com grupo de pacientes que n?o tinha presen?a de c?lulas decoy na urina. A an?lise de 35 anos de transplante do Servi?o de Nefrologia da PUCRS, mostra a evolu??o de um programa de refer?ncia no nosso meio e as diferentes condutas e resultados nas diversas ?pocas. Ocorreram mudan?as nas caracter?sticas dos doadores e receptores, crit?rios de sele??o, avalia??o de compatibilidade e protocolos de imunossupress?o, entre outros.

Submitted by Carla Santos (biblioteca.cp2.carla@bahiana.edu.br) on 2018-10-18T19:36:12Z No. of bitstreams: 1 DISSERTAC??A??O CRISTINA BRASIL PDF.pdf: 2405469 bytes, checksum: 337b1badc04cafa7796ce0bf24a529f6 (MD5) / Approved for entry into archive by JOELMA MAIA (ebmsp-bibliotecacp2@bahiana.edu.br) on 2018-10-18T20:03:36Z (GMT) No. of bitstreams: 1 DISSERTAC??A??O CRISTINA BRASIL PDF.pdf: 2405469 bytes, checksum: 337b1badc04cafa7796ce0bf24a529f6 (MD5) / Made available in DSpace on 2018-10-18T20:03:36Z (GMT). No. of bitstreams: 1 DISSERTAC??A??O CRISTINA BRASIL PDF.pdf: 2405469 bytes, checksum: 337b1badc04cafa7796ce0bf24a529f6 (MD5) Previous issue date: 2017-11-21 / A incontin??ncia urin??ria de esfor??o (IUE) ?? definida como qualquer perda involunt??ria de urina no esfor??o, espirro ou tosse, no qual acomete cerca de 14 a 50% da popula????o feminina. A radiofrequ??ncia (RF) ?? uma nova possibilidade terap??utica que pode auxiliar em um dos mecanismos fisiopatog??nicos da IUE que ?? a diminui????o de col??geno nas paredes uretrais. Objetivo: Verificar a resposta cl??nica, qualidade de vida, fun????o sexual e satisfa????o ao tratamento com a radiofrequ??ncia n??o ablativa para a incontin??ncia urin??ria de esfor??o em mulheres Metodologia: Trata-se de um estudo piloto randomizado. Foram inclu??das mulheres com IUE (Pad Test>1g), fun????o muscular ???3 na escala de OXFORD, faixa et??ria de 30 a 59 anos atendidas no Centro de Aten????o ao Assoalho P??lvico. Ap??s o consentimento, foi realizado uma avalia????o inicial composta por anamnese, di??rio miccional, avalia????o da fun????o dos m??sculos do assoalho p??lvico (PERFECT), Pad Test de 1 hora e aplica????o dos question??rios Female Sexual Function Index (FSFI) e King's Health Questionnaire (KHQ). As mulheres foram randomizadas em dois grupos, grupo radiofrequ??ncia (GR) no qual foram realizadas 5 sess??es de cinesioterapia ambulatorial associada a RF monopolar n??o ablativa, em meato externo uretral, com temperatura de 39-41???C por 2 minutos, e o grupo controle (GC) seguir?? o mesmo protocolo, por??m a RF estar?? desligada com glicerina aquecida. Ambos realizaram exerc??cios domiciliares. Ap??s uma semana da ??ltima sess??o de RF foram reavaliados o Pad Test, question??rios, fun????o muscular, di??rio miccional e questionado as participantes a satisfa????o com o tratamento. Esta pesquisa foi aprovada pelo Comit?? de ??tica em Pesquisa (CAAE ??? 35038914.3.0000.5544) e registrada no Clinical Trial (NCT02617797). Resultados: A amostra foi composta de 13 mulheres no GR e 9 no GC. O GR apresentou uma redu????o da mediana, em gramas, de 7,0 (4,5-14,5) para 1,0 (0,0-4,0) (p=0,002), enquanto que o GC apresentou mediana de 8,0 (2,5-18,5) para 2,0 (0,0-31,0) (p=0,515). No GR apresentou uma redu????o da perda urinaria atrav??s do di??rio miccional (p=0,025), aumento da forca, endurance, resist??ncia e fast do esquema PERFECT (p<0,05 para todos) e impacto positivo do KHQ no dom??nio de limita????o f??sica e gravidade dos sintomas (p<0,05). N??o houve modifica????o na fun????o sexual. 11 (88%) mulheres do GR relataram est?? muito satisfeita/satisfeita com o tratamento enquanto que no GC apenas 4 (44%) Conclus??o: Houve uma redu????o da perda urin??ria em gramas das mulheres submetidas a radiofrequ??ncia n??o ablativa em meato externo uretral. Contudo, n??o apresentou associa????o na resolu????o completa desta sintomatologia. Demonstrou-se um aumento da for??a dos m??sculos do assoalho p??lvico. Na qualidade de vida, apresentou impactos positivos na limita????o f??sica. As mulheres tratadas com a RF demonstraram satisfa????o com o tratamento.

I Sverige har 379 barn och ungdomar under 19 år fått en cancerdiagnos under 2012.På de arbetsplatser där personalen inte var tillräcklig informerade observerades enhögre exponering för cytostatika i patienternas urin. Arbetare vid Avdelning förOnkologi är regelbundet exponerad för de toxiska substanserna. På lång sikt innebärdetta en yrkesmässig exponering för låga doser av cytostatika. Sammanfattningsvis ärdet sannolikt att exponeringen sker via huden och inte via luft och man vet ännu inteidag konsekvenserna av cytostatika substanser i avloppsvattnet. Detta till följd av förlite forskning om vilka konsekvenser detta har för miljön. Däremot finns det tydligastadgar och lagar för hantering och riskavfall som kan vara till hjälpmedel för de somhanterar dessa substanser. / In Sweden, 379 children and adolescents under the age of 19 was diagnosed withcancer in 2012. In workplaces where staff were not sufficiently informed they couldobserve a higher exposure in patients to cytotoxic drugs in urine. Workers at theDepartment of Oncology are regularly exposed to the toxic substances. In the longterm, it means an occupational exposure to low doses of chemotherapy drugs. Inconclusion, a probable exposure occurs through the skin and not through the air and atthis time we do not know the consequences of chemotherapy drugs in the sewage.This is the result of too little research, and what impact these substances have on theenvironment. However, there are clear statutes and laws for handling and waste thatcan help to reduce exposure for the staff.

The Baltic Sea is a brackish water that is severely affected by eutrophication. Anthropogenic (human) nitrogen emissions is a contributing factor leading to algal blooms and hypoxic and anoxic seabeds. Municipal wastewater treatment plants account for 27 percent of the nitrogen emissions into the Baltic Proper. According to an article published by Karlsson-Ottosson in the magazine Ny Teknik and the HAVET 2015/2016 report, the increased meat consumption causes difficulties for the sewage treatment plants to purify the nitrogen in the wastewater. This, according to the article and report mentioned, correlates with increased nitrogen emissions from the municipal wastewater treatment plants. The purpose of this study was to investigate if this observed correlation could be confirmed. This study has measured the nitrogen content of urine from participants (n=36) categorized by diet. The diet categories that was included in this study were meat (K), lacto-ovo vegetarian (LOV) and vegan (V). The daily protein intake from the participants in the categories mentioned above was analyzed in this study. Furthermore, the growth of green algae (Cladophora glomerata) and presence of phytoplankton was investigated by fertilizing the collected samples with urine. The results show that there is no difference in nitrogen content in urine, neither in the protein intake between the three diet categories, nor in the case of presence of phytoplankton. Regarding the growth of the green algae, there was a significant difference between the diet groups of meat (K) and control (KON), and also between meat (K) and people on a vegan diet (V). The green algae therefore grew better in brackish water with urine from people who had a meat (K) diet than it did in brackish water with urine from people who had a vegan (V) diet. Though the growth results showed a significant difference between these diet groups (K and V), the alleged correlation between increasing meat consumption and increasing nitrogen emissions from municipal wastewater treatment plants needs to be further studied. / Östersjön är ett brackvattenhav som är svårt drabbat av eutrofiering. Antropogena (mänskliga) kväveutsläpp är en bidragande orsak som leder till algblomning samt hypoxiska och anoxiska bottnar. Kommunala avloppsreningsverk står för 27 procent av kvävetillförseln till Egentliga Östersjön. I en artikel som publicerats av Karlsson-Ottosson samt i rapporten HAVET 2015/2016, orsakar den ökade köttkonsumtionen svårigheter för avloppsreningsverken att rena avloppsvattnet från kväve. Detta korrelerar, enligt artikeln och rapporten, med de ökade kväveutsläppen från avloppsreningsverken. Syftet med studien var att undersöka om korrelationen kunde fastställas. Denna studie har mätt kvävehalten i urin från deltagare kategoriserade efter kosthållning. Dessa kategorier är kött (K), lakto-ovo vegetarian (LOV) samt vegan (V). Proteinintaget hos deltagarna undersöktes, kategoriserat efter ovan nämnda kategorier. Vidare har tillväxten av grönslick (Cladophora glomerata) samt förekomsten av fytoplankton med tillsatt urin från de insamlade proverna undersökts. Resultaten visade ingen skillnad gällande kvävehalten i urin mellan de tre kategorierna. Det var inte heller någon skillnad gällande proteinintaget mellan dessa. Förekomsten av fytoplankton påvisade inte någon skillnad. Angående tillväxten av grönslick påvisades en signifikant skillnad mellan grupperna kött (K) och kontroll (KON) samt mellan kött (K) och vegan (V). Grönslick tillväxer därför mer i brackvatten med urin från människor som äter kött än den gör i brackvatten med urin från människor med vegansk kost. Då resultaten gällande tillväxt på grönslick visade en signifikant skillnad mellan kosthållningarna (K och V) behöver den påstådda korrelationen mellan ökad köttkonsumtion och ökade kväveutsläpp från kommunala avloppsreningsverk studeras vidare.

Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2018-12-14T19:17:12Z No. of bitstreams: 1 CHRISTIANA CAMPANI NYGAARD.pdf: 992119 bytes, checksum: 0e3c84a17685ae1544f808e01570d97b (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2018-12-18T16:12:24Z (GMT) No. of bitstreams: 1 CHRISTIANA CAMPANI NYGAARD.pdf: 992119 bytes, checksum: 0e3c84a17685ae1544f808e01570d97b (MD5) / Made available in DSpace on 2018-12-18T16:31:38Z (GMT). No. of bitstreams: 1 CHRISTIANA CAMPANI NYGAARD.pdf: 992119 bytes, checksum: 0e3c84a17685ae1544f808e01570d97b (MD5) Previous issue date: 2018-10-19 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Introduction: Urinary incontinence(UI) symptoms have a high prevalence in women with obesity. The excess of weight is the most well-established and potentially modifiable risk factor for developing UI. Weight loss is known to improve symptoms. This thesis was divided into two papers Objectives: The aim of the first paper is to evaluate the prevalence, risk factors and impact on the quality of life of UI symptoms in patients with obesity. The second study aims to evaluate the modification of symptoms after bariatric surgery and identify factors associated with remission of symptoms. Methods: A cross-sectional study was performed with female patients in the preoperative period of bariatric surgery, followed by a prospective cohort with patients who presented UI symptoms. The evaluation was carried out with the application of a form and with quality of life questionnaires specific to UI, validated for the Portuguese language. Results: In the cross-sectional study, of the 221 patients evaluated, 118 (53.4%) reported episodes of UI. The prevalence of UI was 47% higher in patients who had a vaginal delivery and 34% higher in postmenopausal women. The severity of the symptoms was considered moderate in 63 (53.3%) patients. In the cohort study, eighty-eight (74.6%) of the patients were followed up and re-evaluated after 6-12 months after the Roux-en-Y gastric bypass. Of these, 50 (56.8%) had remission of symptoms. Patients who only had a cesarean delivery type had a greater probability of remission of symptoms. Patients with an additional point in the "International Consultation on Incontinence Questionnaire-Short Form" (ICIQ-SF) result prior to surgery had a 4% lower probability of remission of symptoms. Conclusion: UI has a high prevalence in patients with obesity and has a negative impact on quality of life. In the cross-sectional study, vaginal delivery and menopause were independent risk factors associated with UI. In the cohort study, cesarean section was associated with greater remission of symptoms, while patients with higher ICIQ-SF scores had lower remission of symptoms. / Introdu??o: Os sintomas de incontin?ncia urin?ria (IU) s?o altamente prevalentes em mulheres com obesidade. O excesso de peso ? o fator de risco mais bem estabelecido e potencialmente modific?vel no desenvolvimento da IU. A perda de peso est? associada a melhora dos sintomas. Esta tese foi dividida em dois trabalhos. Objetivos- O primeiro trabalho tem como objetivo avaliar a preval?ncia, os fatores de risco e o impacto na qualidade de vida dos sintomas de IU em pacientes com obesidade. O segundo trabalho visa avaliar a modifica??o dos sintomas ap?s a cirurgia bari?trica e identificar fatores associados a remiss?o dos sintomas. M?todos: Foi realizado um estudo transversal com pacientes femininas no pr?operat?rio da cirurgia bari?trica, seguido de uma coorte prospectiva com as pacientes que apresentaram sintomas de IU. A avalia??o foi realizada com a aplica??o de um formul?rio e com question?rios de qualidade de vida espec?ficos para IU, validados para a l?ngua portuguesa. Resultados: No estudo transversal, das 221 pacientes avaliadas, 118 (53,4%) relataram epis?dios de IU. A preval?ncia de IU foi 47% maior em pacientes que tiveram parto vaginal e 34% maior em mulheres na menopausa. A gravidade dos sintomas foi considerada moderada em 63 (53.3%) pacientes. No estudo de coorte, oitenta e oito (74,6%) pacientes foram seguidas e reavaliadas 6-12 meses ap?s o bypass g?strico em Y-de-Roux. Destas, 50 (56,8%) obtiveram remiss?o dos sintomas. Pacientes com apenas ces?rea como tipo de parto tiveram uma probabilidade maior de remiss?o dos sintomas. Pacientes com um ponto adicional no resultado do ?International Consultation on Incontinence Questionnaire-Short Form? (ICIQ-SF) antes da cirurgia tiveram uma probabilidade 4% menor de remiss?o dos sintomas. Conclus?o: A IU ? altamente prevalente em pacientes com obesidade e tem um impacto negativo na qualidade de vida. No estudo transversal, parto vaginal e menopausa foram fatores de risco independentes associados a IU. No estudo decoorte, a ces?rea foi associada a maior remiss?o dos sintomas ap?s a cirurgia, enquanto pacientes com escores mais elevados no ICIQ-SF tiveram menor remiss?o de sintomas.