Made available in DSpace on 2014-06-11T19:33:27Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-12-14Bitstream added on 2014-06-13T18:45:11Z : No. of bitstreams: 1 miranda_jegb_dr_botfm.pdf: 452583 bytes, checksum: e49feaadec832a47890a0269d2b98b50 (MD5) / O controle esfincteriano é um marco do desenvolvimento na vida de uma criança. É uma área do cuidado pediátrico que apresenta uma ótima oportunidade para prevenção, orientação e intervenção clínica. Avaliar a prática do treinamento do controle esfincteriano anal (TEA) em crianças saudáveis, na faixa etária de três a seis anos de idade, por meio de entrevista aplicada aos pais ou cuidadores. Estudo transversal observacional e descritivo que constou de inquérito baseado em entrevista, utilizando casos consecutivos de cem crianças entre 3 e 6 anos de idade no período de junho de 2005 a agosto de 2006. Resultados. A retirada das fraldas iniciou-se antes dos 18 meses em 31% das crianças, entre os 18 e 30 meses em 58% e após os 30 meses em 11%. Em relação à duração do treinamento, 43% das crianças foram treinadas em menos de 3 meses, 34% entre 3 e 6 meses e 23% em mais de 6 meses, não houve diferença entre a idade do início e a duração do TEA (p = 0,6489). Observou-se que não houve diferença estatisticamente significante entre os gêneros masculino e feminino tanto para a idade de início (p = 0,6181), quanto para a duração do TEA (p = 0,4709). Já para a escolaridade das mães com relação à idade de início, observou-se diferença estatisticamente significante entre a escolaridade menor ou igual a 11 anos ou maior que 11 anos (p = 0,0008), entretanto não houve diferença estatisticamente significante para a duração do TEA (p = 0,2001). Não houve diferença estatisticamente significante para o filho único e não único, tanto para a idade de início (p = 0,9285), quanto para o tempo de duração do TEA (p = 0,7318). Houve diferença estatisticamente significante entre as classes A-B bem e as classes C-D-E para a idade de início (p = 0,0032), entretanto, não houve diferença estatisticamente significante... / The control of the sphincter is a milestone in a child’s development. It’s an area of the pediatric care which stands a great opportunity for prevention, guidance and clinical intervention. To study the toilet training practice in children between three and six years old, by interviewing parents and caregivers. Observational and descriptive transversal study, consisting of an inquiry based on interviews using consecutives one hundred children, from June 2005 to August 2006. The removal of diapers started before 18 months in 31% of the children, between 18 and 30 months in 58% and after 30 months in 11%. As for the duration of the toilet training, 43% of the children had been trained for less than three months, 34% between three and six months and 22% over six months. There was no difference between the age of initiation and the duration of the toilet training (p = 0,6489). For male and female genders there was no statistically significant difference either for age of initiation (p = 0,6181), or duration of the toilet training (p = 0,4709). It has been observed that there was a statistically significant difference for schooling under or equal to 11 years or over 11 years for the age of initiation (p = 0,0008). However, there has been no statistically significant difference for the duration of the toilet training (p = 0,2001). Mothers of little schooling started training earlier, but this does not interfere with the duration of training. It has been observed that there was no statistically significant difference whether it was an only child or not, either for the age of initiation (p = 0,9285) or for the duration of the toilet training (p = 0,7318). It has been observed that there was a statistically significant difference between A-B and C-D-E social classes for the age of initiation (p = 0,0032). However there has been no statistically significant... (Complete abstract click electronic access below)

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Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, 2015. / Submitted by Albânia Cézar de Melo (albania@bce.unb.br) on 2016-02-23T15:55:08Z No. of bitstreams: 1 2015_MarceloMeloAndradeCoura.pdf: 3142110 bytes, checksum: e9568a78e4627c1bbb5c84230ce7da97 (MD5) / Approved for entry into archive by Marília Freitas(marilia@bce.unb.br) on 2016-02-28T11:16:01Z (GMT) No. of bitstreams: 1 2015_MarceloMeloAndradeCoura.pdf: 3142110 bytes, checksum: e9568a78e4627c1bbb5c84230ce7da97 (MD5) / Made available in DSpace on 2016-02-28T11:16:01Z (GMT). No. of bitstreams: 1 2015_MarceloMeloAndradeCoura.pdf: 3142110 bytes, checksum: e9568a78e4627c1bbb5c84230ce7da97 (MD5) / A incontinência fecal (IF) é sintoma que causa impacto importante na qualidade de vida. Estima-se que mais de 2/3 das mulheres com incontinência fecal têm lesão esfincteriana, em sua maioria decorrente de parto vaginal. Não se conhece o significado dessas lesões na gravidade do sintoma e sua repercussão funcional. O objetivo deste estudo é avaliar se existe correlação entre a gravidade do sintoma, as alterações manométricas e o grau de defeito muscular, em mulheres com defeito esfincteriano e IF. Foi adotado escore de IF de Wexner e os casos foram estratificados em leves (<=9) ou graves (>9). Foi utilizada manometria anorretal por perfusão de 8 canais e ultrassonografia endoanal tridimensional (USEA 3D) para diagnóstico e classificação do defeito esfincteriano. Foram avaliadas 73 mulheres com sintomas de IF. A média de idade foi de 57,79 anos (±14,94). Trinta e oito (52,05%) com incontinência urinária associada. Sessenta e cinco mulheres (89,04%) tiveram partos vaginais prévios, 54 (83,07%) com episiotomia. Vinte e uma mulheres (28,76%) relataram operações anorretais. O escore mediano de incontinência foi de 9, com 36 (49,32%) casos graves. Quarenta casos (54,79%) apresentaram defeitos extensos à ultrassonografia. Houve correlação negativa fraca entre o escore de IF e a capacidade retal (ρ=-0,267, p= 0,022). Mulheres com sintomas mais graves eram mais velhas que aquelas com sintomas mais leves (p=0,018) e tinham maior prevalência de incontinência urinária (p=0,005). Não houve diferença entre o número de gestações (p= 0,530), o número de partos vaginais (p=0,281), as pressões de repouso (p=0,073), as pressões de contração (p=0,521), o incremento pressórico (p=0,649), a sensibilidade retal (p=0,902), a capacidade retal (p=0,086), a extensão do canal anal à ultrassonografia (p=0,179), a extensão anterior de esfíncter externo do ânus (EEA) (p=0,980), o grau de defeito muscular (p=0,381) e a medida do corpo perineal (p=0,129) de mulheres com incontinência leve ou grave. Não houve diferença de idade (p=0,673), do índice de massa corporal (IMC) (p=0,127), do número de gestações (p=0,980), do número de partos vaginais (p=0,581) e de ao menos uma episiotomia (p=0,077) entre as pacientes com defeito esfincteriano leve ou grave. Mulheres com lesões mais graves (escore>4) apresentaram menores pressões de contração (p=0,007), menor comprimento do corpo perineal (p=0,001) e menor extensão anterior de EEA (p=0,001) quando comparadas àquelas com lesões leves. Por esses achados pode-se concluir que mulheres com sintomas mais graves são mais idosas e têm mais incontinência urinária e as com defeitos mais extensos têm menores pressões de contração, sem repercussão clínica. / Fecal incontinence (FI) is a symptom that causes impact on patient quality of life. It is believed that over 70 % of women have sphincter defects on endoanal ultrasound, mostly from obstetric anal sphincter injuries (OASIS). There is a lack of consensus regarding to what is its role on FI severity and functional impairment. We aimed demonstrate a possible correlation between FI severity, manometric findings and muscle defect grade depicted on three-dimensional endoanal ultrasound in women with sphincter defects and FI. The Wexner score (WS) was used to grade symptoms which was further divided into two groups: mild symptoms (<=9) and severe symptoms (>9). The sphincteric defect was graded by using an endoanal ultrasound 3D (EAUS 3D) scoring system. Eighty eight women were enrolled and 73 completed all steps. Mean age was 57,79 years old (±14,94). Thirty-eight women (52,05%) reported associated urinary incontinence. Sixty-five (89,04%) had vaginal deliveries, 54 (83,07%) had episiotomies. Twenty-one (28,76%) reported at least one anorectal operation. Median WS was 9. Thirty-six (49,32%) had severe symptoms. Forty cases (54,79%) had severe defects on EAUS 3D. We found a weak negative correlation between WS and rectal capacity (ρ=-0,267, p=0,022). Women with more severe symptoms were older than women with mild symptoms (p=0,018) and had a two-fold risk of having double incontinence (p=0,005). It was found no difference between women with mild or severe symptoms regarded to number of pregnancy (p=0,530), vaginal deliveries (p=0,281), resting pressures (p=0,073), incremental pressures (p=0,649), squeeze pressures (p=0,521), rectal sensation (p=0,902), rectal capacity (p=0,086), anal canal length (p=0,179), external anal sphincter anterior length (p=0,980), defect grade (p=0,381) and perineal body measurement (p=0,129). There was no significant difference in aging (p=0,673), body mass index (BMI) (p=0,127), number of pregnancies (p=0,980), vaginal deliveries (p=0,581) and episiotomies (p=0,077) between cases with mild and severe defects. Women with more severe defects shown lower squeeze pressures (p=0,007), shorter perineal body measurement (p=0,001) and shorter external anal sphincter anterior length (p=0,001) than mild cases. According to these data, women with severe IF symptoms were older and had more double incontinence than women with mild symptoms. Cases with more severe defects had lower squeeze pressures, shorter external anal sphincter anterior length and perineal body thickness, although no impact on symptoms severity.

Orientador: Nilton Carlos Machado / Banca: Antonio Augusto C. Santos / Banca: Herculano Dias Bastos / Banca: Rodrigo Crespo Barreiros / Banca: Francisca V. Faleiros / Resumo: O controle esfincteriano é um marco do desenvolvimento na vida de uma criança. É uma área do cuidado pediátrico que apresenta uma ótima oportunidade para prevenção, orientação e intervenção clínica. Avaliar a prática do treinamento do controle esfincteriano anal (TEA) em crianças saudáveis, na faixa etária de três a seis anos de idade, por meio de entrevista aplicada aos pais ou cuidadores. Estudo transversal observacional e descritivo que constou de inquérito baseado em entrevista, utilizando casos consecutivos de cem crianças entre 3 e 6 anos de idade no período de junho de 2005 a agosto de 2006. Resultados. A retirada das fraldas iniciou-se antes dos 18 meses em 31% das crianças, entre os 18 e 30 meses em 58% e após os 30 meses em 11%. Em relação à duração do treinamento, 43% das crianças foram treinadas em menos de 3 meses, 34% entre 3 e 6 meses e 23% em mais de 6 meses, não houve diferença entre a idade do início e a duração do TEA (p = 0,6489). Observou-se que não houve diferença estatisticamente significante entre os gêneros masculino e feminino tanto para a idade de início (p = 0,6181), quanto para a duração do TEA (p = 0,4709). Já para a escolaridade das mães com relação à idade de início, observou-se diferença estatisticamente significante entre a escolaridade menor ou igual a 11 anos ou maior que 11 anos (p = 0,0008), entretanto não houve diferença estatisticamente significante para a duração do TEA (p = 0,2001). Não houve diferença estatisticamente significante para o filho único e não único, tanto para a idade de início (p = 0,9285), quanto para o tempo de duração do TEA (p = 0,7318). Houve diferença estatisticamente significante entre as classes A-B bem e as classes C-D-E para a idade de início (p = 0,0032), entretanto, não houve diferença estatisticamente significante... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The control of the sphincter is a milestone in a child's development. It's an area of the pediatric care which stands a great opportunity for prevention, guidance and clinical intervention. To study the toilet training practice in children between three and six years old, by interviewing parents and caregivers. Observational and descriptive transversal study, consisting of an inquiry based on interviews using consecutives one hundred children, from June 2005 to August 2006. The removal of diapers started before 18 months in 31% of the children, between 18 and 30 months in 58% and after 30 months in 11%. As for the duration of the toilet training, 43% of the children had been trained for less than three months, 34% between three and six months and 22% over six months. There was no difference between the age of initiation and the duration of the toilet training (p = 0,6489). For male and female genders there was no statistically significant difference either for age of initiation (p = 0,6181), or duration of the toilet training (p = 0,4709). It has been observed that there was a statistically significant difference for schooling under or equal to 11 years or over 11 years for the age of initiation (p = 0,0008). However, there has been no statistically significant difference for the duration of the toilet training (p = 0,2001). Mothers of little schooling started training earlier, but this does not interfere with the duration of training. It has been observed that there was no statistically significant difference whether it was an only child or not, either for the age of initiation (p = 0,9285) or for the duration of the toilet training (p = 0,7318). It has been observed that there was a statistically significant difference between A-B and C-D-E social classes for the age of initiation (p = 0,0032). However there has been no statistically significant... (Complete abstract click electronic access below) / Doutor

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-10-25T22:11:32Z No. of bitstreams: 1 MariaDoPerpetuoSocorroNobreMedeirosESilva_DISSERT.pdf: 4435722 bytes, checksum: 0ac09f0f1b827536094c554256270a58 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-12-16T17:07:52Z (GMT) No. of bitstreams: 1 MariaDoPerpetuoSocorroNobreMedeirosESilva_DISSERT.pdf: 4435722 bytes, checksum: 0ac09f0f1b827536094c554256270a58 (MD5) / Made available in DSpace on 2016-12-16T17:07:52Z (GMT). No. of bitstreams: 1 MariaDoPerpetuoSocorroNobreMedeirosESilva_DISSERT.pdf: 4435722 bytes, checksum: 0ac09f0f1b827536094c554256270a58 (MD5) Previous issue date: 2016-04-19 / O trabalho foi realizado como requisito para a obten??o do t?tulo de Mestre em Ci?ncias da Sa?de no Programa de P?s-Gradua??o em Ci?ncias da Sa?de da Universidade Federal do Rio Grande do Norte. O programa constitui uma proposta multidisciplinar onde temos a oportunidade de trocar ideias e conhecer experi?ncias de diversos profissionais da ?rea, e inclui disciplinas que ampliam o nosso campo de vis?o. Os conhecimentos de estat?stica, reda??o de trabalho cient?fico e pr?ticas educativas foram fundamentais para n?o restringir o nosso olhar a ser simplesmente m?dico. Foram produzidos tr?s artigos a partir da pesquisa realizada. O primeiro trata-se de uma revis?o bibliogr?fica por meio dos portais Pubmed, Embase, Scielo, Web of science e Cancerlit utilizando as palavras-chaves HPV, citologia, anal e c?ncer. Os demais artigos resultaram dos dados colhidos de um estudo transversal em 200 mulheres com e sem les?o genital que foram recrutados para exames de Papanicolaou anais. As mulheres que tiveram resultados anormais a partir de Atipia de C?lulas Escamosas foram classificadas como citologia anal anormal. A m?dia de idade foi de 41 anos. A maioria ? de pele n?o branca (56%), com at? 08 anos de escolaridade (50,5%) e n?o fumantes (91,5%). Quanto ? descri??o de vari?veis contextuais, 63,5% utilizava m?todos anticoncepcionais, 80% j? tinham ficado gr?vidas e destas, 30% tiveram algum tipo de aborto, a maioria possu?a at? tr?s parceiros (73,5%) e n?o referia nenhuma DST anterior (74%). Mais da metade relatou que n?o praticava sexo anal (75,5%), 91% referia que seus parceiros n?o tinham HPV, n?o usavam drogas (87,5%) e n?o mantinham rela??es bissexuais (96,5%). A maior parte das mulheres n?o possu?a nenhuma alergia (85%), patologia anal (92%) ou sangramento anal (68,5%), por?m mais da metade possu?a LIEG (les?o intraepitelial escamosa genital) (57,5%) e uma expressiva quantidade apresentava citologia anal anormal (13%). Observou-se uma associa??o significativa entre a citologia anal anormal e as mulheres que apresentavam LIEG (RP=2,46; p=0,032) demonstrando ser importante a pesquisa de citologia anal nesse grupo de pacientes. / The study was conducted as a requirement for obtaining the title of Master in the Health Sciences Program of the Federal University of Rio Grande do Norte. The program has a multidisciplinary proposal where we have the opportunity to exchange ideas and to know multi-professional experience, including subjects that expand our field of vision. The knowledge of topics such as analytical, scientific paper writing and educational practices were essential not to restrict our attention as a doctor. The survey produced three articles: the first one is a literature review through Pubmed portals, Embase, Scielo, Web of Science and CancerLit using keywords HPV, cytology, and anal cancer. The other articles resulted from data collected from a cross-sectional study in 200 women with and without genital lesions who were recruited for anal Pap smears. Women who had abnormal results from Atypical Squamous Cells were classified as abnormal anal cytology. The average age was 41 years. Most are non-white skin (56%), with up to eight years of education (50.5%) and non-smokers (91.5%). Regarding the description of contextual variables, 63.5% used contraceptive methods, 80% had been pregnant and of these, 30% had some abortion, most had up to three partners (73.5%) and did not report any previous STD (74%). More than half indicated that did not practice anal sex (75.5%), 91% stated that their partners did not have HPV, did not use drugs (87.5%) and not had bisexual relations (96.5%). Most women did not have any allergies (85%), anal pathology (92%) or anal bleeding (68.5%), but more than half had GSIL (genital squamous intraepithelial lesion) (57.5%) and a significant amount had abnormal anal cytology (13%). There was a significant association between abnormal anal cytology and GSIL (PR = 2.46; p = 0.032) demonstrating that is important to perform anal cytology in this group of patients.

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The evaluation of the feasibility and clinical utility of liquid based cytology, human papillomavirus testing and high-resolution anoscopy to screen for anal intraepithelial neoplasia in high-risk groups. Dr Alice Martha Schofield: The University of Manchester for the degree of Doctor of Medicine, January 2016. Background: The increased incidence and natural history of anal cancer in high-risk groups, provides a screening opportunity to detect precancerous lesions, anal intraepithelial neoplasia (AIN), as well as early invasive lesions. The ANALOGY study was performed to strengthen the evidence base required to determine the case for anal screening in terms of the feasibility and clinical utility of liquid based cytology (LBC), high-risk human papillomavirus (HR-HPV) testing and high-resolution anoscopy (HRA) in high-risk groups. Methods: This prospective study offered screening to four cohorts aged over 25 at varying but elevated risk; human immunodeficiency virus (HIV) positive and negative men who have sex with men (MSM), HIV positive women with prior history of abnormal cervical cytology or anogenital warts, HIV negative women who practice anoreceptive sex and transplant recipients (TR). Recruitment commenced in March 2013 and concluded in December 2014, with follow-up until March 2015. All participants underwent testing for HR-HPV, LBC and had HRA performed, sites of abnormality were biopsied. Participants were seen at initial consultation and at a second visit six months later. Immunostaining with Ki67 and p16 antibody was performed on 100 anal tissue biopsies. The cellular positivity of each biomarker were scored by automated and manual methods. H-SCORES of p16 biomarker and block positive staining of AIN2 were quantified and analysed. Results: 409 participants were recruited; 284 MSM (203 HIV positive, 81 HIV negative), nine HIV positive women, four HIV negative women and 112 TR. HR-HPV was highly prevalent in anal samples from MSM (HIV positive 88.0% and HIV negative, 77.8%) and much less so in HIV positive and negative women and TR (19.3%). Despite the high prevalence of cytological abnormality in MSM, almost half of AIN of all grades was associated with negative cytology. AIN3+ on biopsy was found in 4.4% (18/409) of participants; three HIV positive MSM had cancer. One new case of AIN3 was identified at the second visit. Low-grade disease (AIN1/2) was highly prevalent in all groups. Ki67 and p16 biomarker expression increase as the grade of anal disease increased when scored manually. AIN2 histology samples, which demonstrate block positive p16 staining, have an association with an increased H-SCORE.Conclusions: Anal screening in some high-risk groups is clinically feasible in terms of diagnostics with evidence of significant disease prevalence particularly amongst MSM. The high prevalence of HR-HPV infection and frequency of false negative cytology indicates that in terms of sensitivity and specificity, HRA would be the best primary screening tool. The use of Ki67 and p16 in the identification of anal disease appears to have clinical utility, especially in the detection of AIN2; with the majority of samples displaying block p16 staining that corresponded with an increased H-SCORE. The prevalence of AIN3+ in HIV positive MSM lends support for a policy of screening in this group, however limitations of treatment, as well as highly prevalent low-grade lesions of dubious significance, require careful consideration.

Introduktion: Att kvinnor drabbas av en bristning efter en vaginal förlossning är vanligt förekommande och drabbar cirka 80% av alla förstföderskor. Bristningarna innebär i vissa fall direkta skador på muskler, nerver och stödfunktioner vilket kan leda till urinläckage, avföringsläckage, tarmtömningssvårigheter, framfall av vaginal-väggarna och sexuell dysfunktion. Uppföljningen av denna patientgrupp varierar i landet, allt mellan utebliven uppföljning och noggrann uppföljning av profession med specialistkunskap. Syfte: Syftet var att ta reda på fysioterapeutens interventioner och roll vid vård av kvinnor som drabbats av en obstetrisk analsfinkterruptur i samband med vaginal förlossning vid landets sju regionsjukhus. Metod: För att besvara syftet genomfördes en kvantitativ enkätstudie. En egenkonstruerad eenkät användes och utformades med inspiration från nationella riktlinjer och en tidigare enkät. De som svarade på enkäten var fysioterapeuter som arbetar med förlossningsskador vid sex av landets sju regionsjukhus. Resultat: Fysioterapeuter var involverade vid eftervård och rehabilitering av kvinnor vid olika grader av skada efter vaginal förlossning. Fysioterapeutiska riktlinjer, interventioner och rutiner för uppföljning skilde sig mellan regionsjukhusen. Konklusion: Alla regionsjukhus i Sverige förutom ett har fysioterapeuter inkopplade vid vård av kvinnor som drabbats av en obstetrisk analsfinkterruptur i samband med vaginal förlossning. De fysioterapeutiska riktlinjerna skiljer sig något mellan regionsjukhusen då fysioterapeuterna bygger sina riktlinjer på olika direktiv och fakta. Baserat på denna studie finns behov av mer forskning som undersöker fysioterapeutens interventioner och roll vid vård av kvinnor med obstetrisk analsfinkterruptur i samband med vaginal förlossning.