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Nursing advocacy and the accuracy of intravenous to oral opioid conversion at discharge in the cancer patientGallo, Maria L. January 2009 (has links)
Thesis (M.S.)--University of South Florida, 2009. / Title from PDF of title page. Document formatted into pages; contains 35 pages. Includes bibliographical references.
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Response of motor and cognitive speed to increasing doses of methylphenidate in children diagnosed with attention deficithyperactivity disorderPolotskaia, Anna. January 2008 (has links)
This study has examined the effect of 3 doses of Methylphenidate (MPH) on the speed of motor and cognitive performance in children diagnosed with ADHD. Thirty children clinically diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD) aged 6-12 years were recruited through the ADHD Clinic and the Severe and Disruptive Behavior Disorders Program at the Douglas Mental Health University Institute. The three doses of MPH were administered according to a double blind randomized cross-over three day trial (0.3; 0.5 0.8 mg/kg/day in a bid schedule). An improvement across all three doses of MPH on motor, cognitive and behavioural measures was observed. The improvement is significant at low doses of MPH and an increase of dose up to 0.8 mg/kg/day does not lead to further improvement of the speed of simple motor task, but might be beneficial to specific cognitive tasks. No deterioration was observed in association with higher doses of MPH.
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Understanding the basis of 5-Bromo-2'-deoxuridine teratogen specificity in organogenesis stage mouse embryosGnanabakthan, Naveen. January 2008 (has links)
5-Bromo-2'-deoxyuridine (BrdU), a thymidine analogue, is genotoxic and teratogenic. The exposure of mouse embryos to BrdU at doses that cause malformations induces oxidative stress and an embryonic stress response characterized by an increase in c-Fos dependent AP-1 DNA binding. The goal of this thesis was to test the hypothesis that development is disturbed at sites where BrdU is incorporated into DNA, triggering oxidative stress and c-Fos induction. Gestation day 9 CD-1 mice were treated with BrdU and embryos were obtained for immunolocalization of BrdU, 8-oxoguanine, a biomarker for oxidative stress, and c-Fos. BrdU incorporation into DNA was dispersed throughout the embryo. In contrast, the staining for 8-oxoguanine and c-Fos were highest in the neuroepithelium. BrdU incorporation was not affected by the pre-administration of N-acetyl-cysteine (NAC), an anti-oxidant, although both 8-oxoguanine and c-Fos staining were decreased. Thus, the response of the embryo to insult is tissue specific.
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Diabetes and coronary surgery : metabolic and clinical studies on diabetic patients after coronary surgery with special reference to cardiac metabolism and high-dose GIK /Szabó, Zoltán. January 2001 (has links)
Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 5 uppsatser.
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Tratamento da incontinência anal através da injeção transesfincteriana de silicone: correlação entre os resultados clínicos, ultra-sonográficos e de manometria anorretal, incluindo o índice de assimetria esfincteriana / Trans-sphincteric silicone injection for the treatment of anal incontinence: correlation between clinical and physiological evaluation including the asymmetry indexLucia Camara de Castro Oliveira 03 October 2007 (has links)
Objetivo: Avaliar a segurança e eficácia da injeção transesfincteriana de silicone para o tratamento da incontinência anal, assim como correlacionar os resultados clínicos, ultra-sonográficos e manométricos. Métodos: Pacientes incontinentes foram submetidos à manometria e ultra-sonografia anorretal, índice de incontinência (II) e instrumento de qualidade de vida (FIQL), antes e após injeção do silicone (PTQ) sob anestesia local e profilaxia antibiótica. Os critérios de inclusão foram: incontinência anal, lesão isolada ou múltipla do músculo esfíncter interno do ânus, associada ou não à lesão isolada, em um quadrante, do músculo esfíncter externo do ânus. O instrumento FIQL utilizado inclui quatro domínios: estilo de vida, comportamento,depressão e constrangimento.Os parâmetros da manometria foram: pressão média de repouso (PMR), pressão média (PMCV) e máxima (PmaxCV) de contração voluntária, zona de alta pressão (ZAP) e índice de assimetria (IA). Após três meses de tratamento, os pacientes foram reavaliados através do II, FIQL, manometria e ultra-sonografia anorretal. Um grupo controle composto por 10 homens e 10 mulheres continentes e sem história prévia de cirurgia anorretal foi submetido à manometria após consentimento informado. Resultados: Foram estudados 35 pacientes, 28 mulheres e sete homens com idade média de 60,3 (19-80) anos, antes e após injeção do silicone anal. As complicações observadas incluíram dois hematomas (5,7%), um abscesso anal (2,8%), dor anal em dois pacientes (5,7%) e dificuldade evacuatória em um paciente (2,8%). Notou-se uma melhora do índice médio de incontinência de 11,3 para 4,3 (p < 0,001). Houve melhora de todos os domínios estudados no instumento FIQL (p<0,0001). Pacientes incontinentes apresentaram hipotonia esfincteriana quando comparados aos controles (p < 0,05). As pressões esfincterianas antes e após injeção foram respectivamente: PMR (29,4 mmHg x 35,1 mmHg; p = 0,07), PMCV (68,6 mmHg x 75,9 mmHg; p = 0,20) e PmaxCV (102,2 mmHg x 127,0 mmHg; p = 0,11). Houve aumento médio da ZAP de 1,0 para 1,7 cm (p = 0,002) Em relação aos resultados da manometria: o IA aos 3 e 2 cm apresentou redução significativa após injeção do silicone (p < 0.05 e 0,002). A ultra-sonografia de canal anal demonstrou a presença do silicone nos sítios de injeção em todos os pacientes. Conclusão: Em casos selecionados, a injeção transesfincteriana de silicone é um método seguro e proporciona uma melhora do quadro de incontinência anal, observada pela mudança significativa dos parâmetros de qualidade de vida e índice de incontinência. O provável mecanismo de ação pelo qual o agente estudado melhora o quadro de incontinência parece relacionar-se à correção da assimetria esfincteriana e aumento do comprimento da zona de alta pressão. / Aim: To evaluate safety and efficacy of trans-sphincteric silicone injection for the treatment of anal incontinence and to assess correlation between clinical and physiological results. Methods: Incontinent patients prospectively selected by clinical and physiological evaluation underwent trans-sphincteric silicone injection (PTQ) under local anesthesia. Eight channel manometry with asymmetry index and anal ultrasound were performed before and after injections. Incontinence scale (IS) and quality of life instrument (FIQL scale) were applied before and after injection.Inclusion criteria were: anal incontinence, isolated or multiple injury of the internal anal sphincter associated or not to small, restricted, external anal sphincter defect. FIQL scale included four domains: life-style, behavior, depression and embarrassment. Manometry evaluation included mean resting pressure (MRP), mean squeeze pressure (MSP), maximal squeeze pressure (MaxSP), high-pressure zone (HPZ) and asymmetry index (AI). After 3 months of treatment the patients had been reevaluated through the IS, FIQL scale, manometry and ultrasound. A controlled group of 20 healthy volunteers (10 men and 10 women) underwent anal manometry. Results: 35 patients (28 women and seven men) with a mean age of 60.3 (19-80) years were evaluated. Complications observed were two anal hematomas (5,7%), one perianal abscess (2.8%), two patients complained of anal pain (5,7%) and one patient required assistance for defecation (2,8%). Mean incontinence score improved significantly after injection: 11, 3 to 4,3 (p < 0.001). Significant improvement in the FIQL scale was noticed in all domains (p < 0.0001). Incontinent patients had significantly lower anal pressures when compared to controls (p < 0.05). Manometric pressures before and after injection did not change: MRP (29,4 mmHg x 35,1 mmHg; p = 0.07), MSP (68,6 mmHg x 75,9 mmHg; p = 0.20) e MaxSP (102.2 mmHg x 127.0 mmHg; p = 0.11) The HPZ changed from 1 to 1,7 cm after injection (p = 0.002) AI at 3 and 2 cm showed a significantly change (p < 0.05 and p = 0.001, respectively). Ultrasound images demonstrated the presence of silicone in all sites of injection. Conclusion: In selected cases, trans-sphincteric silicone injection is an effective treatment for anal incontinence, as significant changes in quality of life and incontinence scales can be observed. The mechanism of action for which the studied agent improves anal incontinence seems to be related to improvement in the asymmetry index as well as a change in the HPZ.
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Impacto da preservação parassimpática sobre os aspectos morfofuncionais cardíacos em ratos infartados / Parassympathic preservation impact in cardiac morphofunctional aspects in myocardial infarcted ratsRaquel Nitrosi de La Fuente 20 March 2009 (has links)
Neste estudo, testamos a hipótese de que a estimulação colnérgica pela administração de piridostigmina, um agente anticolinesterásico reversível, protege o miocárdio submetido à isquemia miocárdica crônica durante 3 tempos de observação: 7, 21 e 42 dias. Para essa avaliação foram medidos a área de acinesia (índicador de área de infarto), os índíces das funções sistólica e diastólica pela ecocardiografia e por medida direta bem como marcadores da função autonômica como a sensibilidade do barorreflexo e a variabilidade da frequência cardíaca (FC) e da pressão arterial (PA). O bloqueio farmacológico do sistema nervoso autônomo e o estudo da via eferente parassimpática foram também realizados. Utilizou-se ratos Wistar machos divididos em 4 grupos: controle, controle piridostigmina, infartado e infartado piridostigmina. Os resultados mostraram os efeitos protetores da piridostigmina nos diferentes tempo de infarto com redução da área de acinesia ( maior que 80%) tanto pelo ecocardiograma quanto pela histologia. Além disso observou-se recuperação das funções sistólica e diastólica, com normalização da pressão diastólica final e das derivadas de contração e relaxamento. Essas melhoras foram mais consistentes em 21 e 42 dias, sem diferenças entre esses tempos de tratamento. Em 7 dias ainda persistiram alguns índices de disfunção ventricular, embora a função autonômica estivesse bem preservada. Parte dessa melhora se deve, provavelmente, ao aumento do tônus vagal e redução do simpático. A potenciação da bradicardia pela estimulação elétrica do vago induzida pela piridostigmina confirma seu papel com estimulador colinérgico. A sensibilidade do barorreflexo reduzida de forma semelhante pelo infarto do miocárdio aos 7, 21 e 42 dias, voltou aos valores controle após o tratamento com piridostigmina, sem diferenças devidas ao tempo de tratamento. Da mesma forma, a variabilidade da FC foi aumentada após o tratamento com o brometo de piridostigmina no grupo infartado o que também ocorreu no grupo controle. Em adição, o aumento da banda de alta frequência e a redução da banda de baixa frequência que refletem respectivamente a modulação parassimpática e simpática da variabilidade da frequência cardíaca, levaram a uma redução no balanço simpato-vagal dos animais infartados tratados. Em conclusão, a estimulação colinérgica por piridostigmina preserva a função parassimpática protegendo o miocárdio da isquemia induzida por oclusão coronariana, mantendo a função cardíaca e a função autonômica dentro dos valores da normalidade / In this study we tested the hypothesis that cholinergic stimulation by pyridostigmine administration, a reversible cholinergic inhibitor, protects the ischemic myocardial in three periods of follow-up: 7, 21 and 42 days. For this evaluation we measured the akinetic area (infacrtion area indicator), systolic and diastolic indexes by echocardiography and left ventricle direct measurements as well as autonomic function markers, as baroreflex sensitivity and heart rate (HR) and blood pressure (BP) variabilities. Pharmacological blockade of the autonomic nervous system and the study of the efferent parasympathetic pathway were also performed. Male Wistar rats were divided in 4 groups: control, control treated with pyridostigmine, infarcted and infarcted treated with pyridostigmine. The results showed the protective effects of pyridostigmine in the different periods of infarction, with the reduction of the akinetic area (more than 80%), either by the echocardiography and by histology. Moreover, we observed systolic and diastolic functions recovery, with normalization of the end diastolic pressure and the maximum rates of left ventricle BP rise and fall. These improvements were more consistent in 21 and 42 days, with no differences between these two periods of treatment. In 7-day treatment, some indexes of ventricular dysfunction remained, although the autonomic function seemed to be preserved. Part of these improvements is probably due to the increase in the vagal tonus and the decrease in the sympathetic tonus. The pyridostigmine effects in the potencialization of the bradycardia induced by vagus nerve electrical stimulation confirms its role as a cholinergic stimulator. The reduced baroreflex sensitivity by myocardial infarction, which was similar in 7, 21 and 42 days, returned to control values after pyridostigmine treatment, without differences related to treatment extent. Similarly, HR variability was increased after pyridostigmine treatment in the infarcted group, which also occurred in the control group. In addition, the increase in the high frequency band and the reduction in the low frequency band, which reflect, respectively, the parasympathetic and the sympathetic modulation of HR variability, led to the diminishment in the sympatho-vagal balance in the infarcted-treated animals. In conclusion, cholinergic stimulation by pyridostigmine preserves parasympathetic function, protecting the myocardial against the ischemia induced by coronary occlusion, maintaning cardiac and autonomic functions within normal values
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Avaliação do resultado terapêutico de um ambulatório antitabágico multidisciplinar / Assessment of outpatient smoking cessation clinic, in a general hospitalJoão Paulo Becker Lotufo 03 November 2014 (has links)
INTRODUÇÃO: O tabagismo é reconhecido, atualmente, como um dos maiores problemas de saúde em todo o mundo. Há uma \"epidemia\" global de uso de tabaco nos países em desenvolvimento, no século 21. OBJETIVOS: Analisar: as características gerais dos indivíduos matriculados espontaneamente em um ambulatório antitabágico; a eficácia geral do tratamento antitabágico e dos medicamentos; as mudanças nas características dos participantes antes e após a Lei Ambiente Fechado Livre do Cigarro em São Paulo e os níveis de cotinina urinária em fumantes ativos, passivos e controles. CASUÍSTICA E MÉTODOS: Foi realizado um estudo de coorte histórica cujo critério de inclusão foi a matrícula no ambulatório antitabágico do HU USP, no período de 2004 a 2011. Os dados foram coletados por meio de consulta a protocolos padronizados e ao sistema informatizado do serviço. Foram analisados os resultados de dosagens de cotinina e creatinina realizadas em amostras biológicas. RESULTADOS: Dentre os 1736 pacientes atendidos houve predomínio de mulheres (62,1%), brancos (75,3%) e indivíduos com idade entre 41 e 60 anos (63,1%). Aproximadamente 80% iniciaram o tabagismo antes dos 20 anos e 75% apresentaram grau de dependência moderado a grave. Dentre os 620 indivíduos acompanhados a partir de 2009, 34,5% abandonaram o tabagismo. Dentre eles, 21,5% obtiveram êxito até o quarto contato com o ambulatório. O uso de vareniclina e terapia de reposição de nicotina (TRN) aumentaram a probabilidade de sucesso (RRR= 2,73 e 2,78, respectivamente; p < 0,001 para ambas). Quanto maior o número de reuniões frequentadas no ambulatório, maior a probabilidade de sucesso terapêutico (p < 0,001). A análise da dosagem da cotinina urinária mostrou concentrações de cotinina urinária 18,7 vezes maior no grupo de tabagistas ativos comparados aos tabagistas passivos. CONCLUSÃO: O sucesso do ambulatório antitabágico do HU manteve-se em acordo com grande parte dos índices de sucesso terapêutico presentes na literatura médica. O abandono do hábito de fumar foi fortemente associado ao número de contatos dos fumantes com o grupo e a terapêutica medicamentosa. A cotinina urinária mostrou-se um bom marcador do tabagismo ativo / INTRODUCTION: Smoking is recognized today as one of the major health problems worldwide. There is a global \"epidemic\" of tobacco use in developing countries in the 21st Century. OBJECTIVES: Analyze: the general characteristics of individuals spontaneously enrolled in an outpatient smoking cessation clinic; the overall effectiveness of the smoking cessation treatment and medication; the changes in the characteristics of participants before and after the Smoke-Free Environment Act in São Paulo and the levels of urinary cotinine in active and passive smokers and controls. CASES AND METHODS: A historical cohort study was conducted, of which the inclusion criterion was the registration in the outpatient smoking cessation Clinic in the HU USP, in the period from 2004 to 2011. Data were collected by consultation of standardized protocols and of the computerized service system. The results of cotinine and creatinine measurements performed on biological samples were analyzed. RESULTS: Among the 1736 patients treated, there was a predominance of women (62.1%), whites (75.3%) and individuals aged between 41 and 60 years (63.1%). Approximately 80% began smoking before age 20 and 75% showed moderate to severe degree of dependence. Among the 620 individuals monitored from 2009 on, 34.5% quit smoking. Among them, 21.5% obtained success up to the fourth contact with the clinic. The use of varenicline and nicotine replacement therapy (NRT) increased the probability of success (RRR= 2.73 and 2.78, respectively; p < 0.001 for both). The greater the number of meetings attended at the clinic, greater the probability of treatment success (p < 0.001). The analysis of urinary cotinine dosage showed urinary cotinine concentrations 18.7 times higher in the active smokers group, compared to the passive smokers group. CONCLUSION: The success of the smoking cessation clinic in the HU remained largely in accordance with most therapeutic success rates found in medical literature. Quitting smoking was strongly associated to the number of contacts of the smokers with the group and drug therapy. Urinary cotinine proved to be an accurate marker for active smoking
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Response of motor and cognitive speed to increasing doses of methylphenidate in children diagnosed with attention deficithyperactivity disorderPolotskaia, Anna. January 2008 (has links)
No description available.
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Understanding the basis of 5-Bromo-2'-deoxuridine teratogen specificity in organogenesis stage mouse embryosGnanabakthan, Naveen. January 2008 (has links)
No description available.
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Supplemented zinc does not alter mood in healthy older European adults - a randomised placebo-controlled trial: the Zenith studyStewart-Knox, Barbara, Rae, G., Simpson, E.E.A., McConville, C., O'Connor, J.M., Polito, A., Andriollo-Sanchez, M., Coudray, C., Strain, J.J. January 2011 (has links)
OBJECTIVE: Older people are vulnerable to zinc deficiency, which may impact upon their mood. This randomised, placebo-controlled, double-blind intervention study aimed to investigate the effect of oral zinc gluconate supplementation (15 mg/d; 30 mg/d; and placebo) on subjective mood (affect) in older Europeans. SUBJECTS: Healthy volunteers (n 387) aged 55-87 years were recruited. SETTING: Volunteers in Rome (Italy; n 108) and Grenoble (France; n 91) were aged 70-87 years and those in Coleraine (Northern Ireland; n 93) and Clermont-Ferrand (France; n 95) were aged 55-70 years. DESIGN: Mood was measured using the Positive and Negative Affect Scale on four occasions per day over 4 d at baseline, 3 and 6 months post-intervention. RESULTS: Mixed ANOVA indicated that neither positive nor negative affect altered in response to zinc (15 mg/d or 30 mg/d) compared to placebo in either the 55-70 years or the >/=70 years age group. CONCLUSIONS: These results suggest that zinc does not benefit mood in healthy older people.
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