Submitted by Johnny Rodrigues (johnnyrodrigues@ufcg.edu.br) on 2018-04-13T18:27:12Z No. of bitstreams: 1 ADRIANA DA COSTA BRAZ - DISSERTAÇÃO PPG-CEMat 2014..pdf: 2523605 bytes, checksum: 90e198ea98d95b535e91044abaf7e15f (MD5) / Made available in DSpace on 2018-04-13T18:27:12Z (GMT). No. of bitstreams: 1 ADRIANA DA COSTA BRAZ - DISSERTAÇÃO PPG-CEMat 2014..pdf: 2523605 bytes, checksum: 90e198ea98d95b535e91044abaf7e15f (MD5) Previous issue date: 2014-12-12 / O Carcinoma basocelular é o câncer mais comum do mundo, e apesar da sua evolução muitas vezes benigna, com altas taxas de cura, algumas vezes nos deparamos com casos mais agressivos, invasivos, destrutivos e de difícil controle. É sabido que já houve avanços terapêuticos para estes casos específicos, a exemplo do Vismodegib, entretanto o uso desta droga ainda é uma realidade distante para nossos pacientes brasileiros que se expõe a índices elevados de radiações solares, na maioria trabalhadores rurais de baixa renda e com grande dificuldade a acessibilidade ao sistema público de saúde. Por isso, o presente trabalho sugere uma alternativa para o controle das formas graves do carcinoma basocelular, através da produção de um filme de quitosana dopado de colchicina substância sabidamente antimitótica e com evidência clínica já citada na literatura no carcinoma basocelular, por via transdérmica por liberação controlada da droga que permita mantê-la em um nível sérico contínuo, suficiente para sua ação antimitótica, causando morte seletiva das células tumorais, diminuindo ou extirpando esses tumores, com custos mais acessíveis, pois é uma droga de baixo custo, melhorando consequentemente a morbidade da doença e a qualidade de vida destes pacientes. E os resultados obtidos através das caracterizações apresentaram membranas com variações de cristalinidade (por DRX) de acordo com o processo de reticulação. Por FTIR pode-se observar certa interação entre o fármaco e os grupos amina da quitosana. Pelas microscopias ótica e eletrônica, pode-se observar que o acréscimo de fármaco proporcionou alguma rugosidade a membrana. Também pelas microscopias verificou-se a reticulação não homogênea da superfície da membrana. Por EDS não se verificou nenhum elemento estranho a estrutura da quitosana e do fármaco. Por medida do ângulo de molhabilidade pode-se verificar aumento do perfil hidrofílico da membrana por adição do fármaco, perfil este que foi modificado pelo processo de reticulação. A partir do ensaio de citotoxicidade pode-se constatar que a membrana apresenta certa citotoxicidade. Este resultado demonstra também o potencial da membrana de quitosana em liberar o fármaco, considerando que a membrana apenas de quitosana não apresenta toxicidade em meio biológico, sendo a toxicidade observada no ensaio decorrente do fármaco liberado. / Basal cell carcinoma is the most common cancer in the world, and despite its evolution often benign, with high cure rates, sometimes we are faced with more aggressive, invasive cases, destructive and difficult to control. It is known that there have been advances in treatment for these specific cases, such as the Vismodegib, however this drug is still a distant reality for our Brazilian patients who are exposed to high levels of solar radiation in most rural workers from low-income, great difficulty accessibility to the public health system. Therefore, this study suggests an alternative for the control of severe forms of basal cell carcinoma, through the production of a chitosan film doped colchicine known antimitotic substance and with clinical evidence already mentioned in the literature in basal cell carcinoma, transdermally for release controlled drug that allows keep at a steady serum level, enough for their antimitotic, causing selective killing of tumor cells, reducing or extirpating these tumors, with more affordable because it is an inexpensive drug, consequently improving morbidity the disease and the quality of life of these patients. And the results obtained from the characterization showed membranes crystallinity variations (XRD) according to the crosslinking process. By FTIR one can observe some interaction between the drug and amino groups of chitosan. Through optical and electronic microscopy, it can be seen that addition of drug has provided some roughness to the membrane. Also by microscopy verified the inhomogeneous crosslinking of the membrane surface. EDS there was no foreign object the structure of chitosan and the drug. By measuring the wetting angle can be checked increase the hydrophilic profile of the drug by adding the membrane, this profile has been modified by the crosslinking process. From the cytotoxicity assay can be seen that the membrane has some cytotoxicity. This result also demonstrates the potential of chitosan membrane to release the drug, whereas only chitosan membrane shows no toxicity in biological medium, with the toxicity observed in this trial due to the released drug.

Previous research has shown that orienting attention in time can help to improve behavioural outcomes. However, the extent to which temporal orienting can be preserved in ageing and in the context of neurological disorders remains unresolved. This thesis therefore explores temporal expectations in the healthy ageing and diseased brain by taking a neuropsychological approach. To begin, I provide an overview of the literature in <b>Chapter 1</b> most relevant for the following investigation. Four chapters of experiments then follow. To examine the effects of ageing on temporal expectation, the performance of healthy young adults and healthy older adults is presented and the results are discussed in <b>Chapter 2</b> and <b>3</b>. Though it had been previously shown that older adults seem to experience an expectation deficit on temporal expectation tasks, these chapters demonstrate the preservation of temporal expectation in ageing. On their own, these findings represent an important and novel contribution to the literature; however, this research is incapable of establishing the causal mechanisms involved in temporal expectation. To explore the causal role of relevant brain regions in temporal expectation, <b>Chapter 4</b> and <b>5</b> investigate the effects of temporal orienting in participants with damage to the basal ganglia - a brain region strongly implicated in temporal processing. In <b>Chapter 4</b>, the role of the basal ganglia in temporal expectations is examined using data collected from participants with Parkinson's disease and contrasts their performance with age-matched healthy controls. To complement this investigation, and to provide converging evidence for the basal ganglia's role in temporal expectations, Chapter 5 investigates the behavioural performance of individuals with focal lesions to the basal ganglia. The findings in this thesis are discussed in their wider context in Chapter 6, and directions for future research are proposed.

Bakgrund En demenssjukdom är inte möjlig att bota men man kan lindra symtom och förbättra livskvaliteten för den drabbade individen under förutsättning att patienten har genomgått en utredning för att säkerställa sjukdomens typ och stadium. I dagsläget är utredningstiderna för basalutredning i primärvården långa vilket skapar påfrestning både för patienten och dennes anhöriga. Syfte Det övergrippande syfte var att skapa förutsättningar för att patienten med demenssjukdom skulle kunna få rätt vård tidigare för att kunna ha ett bra liv med god livskvalitet. Det specifika syftet var att förkorta utredningstiden vid basal utredning i primärvården till 12 veckorsperiod. Syftet med studien var att belysa medarbetarnas erfarenheter av förbättringsarbetet samt anhörigas upplevelser av utredningsprocessen.  Metod I förbättringsarbetet användes PDSA hjul vid ändring av arbetssättet gällande bokning av läkartider för patienter med misstänkt demens. Semistrukturerad fokusgruppsintervju användes i studien. Resultat Andelen utredningar avslutade inom 12 veckor ökade från 62 % till 93 % och från 61 % till 95 % på respektive vårdcentral. Medarbetarna ansåg teamarbete och samarbete över gränser som en förutsättning för att kunna effektivisera utredningsprocessen. Anhöriga upplevde processen som smidig, och snabba diagnoser skapade möjligheter till snabbare vård- och omvårdnadsinsatser vilket ledde till en bättre vardag för både patienten och dennes anhöriga. / Background Dementia is not curable, although provided adequate examination one can relive symptoms and improve the quality of life of patients. However, the excessive time taken for basic assessment in Swedish primary care today is causing distress for the patient and their kin. Purpose The overall purpose of this improvement project was to enable earlier care for dementia patients, thus improving their quality of life. The specific purpose was to enable diagnosis or completed assessment within 12 weeks. The project also analysed the experience of staff during the project, as well as the experience of the patients’ relatives throughout the assessment process. Method A PDSA cycle was implemented when adjusting working methods related to booking of appointments with physicians. Semi-structured focus group interviews were also used.     Results The number of cases completed within 12 weeks increased from 62% to 93% and 61% to 95% at the two health centers respectively. Staff saw improved collaboration between teams and units as a key success factor. Patients’ relatives experienced the assessment process as smooth, and that shorter process times led to improved quality of life for the patient and their kin.

The concept of basal stimulation is currently one of the most popular concepts in nursing care. Basal stimulation is intended for people with changes in perception and communication. The aim of this thesis was to map the use of basal stimulation in the surgical department of the district hospital of South Bohemia. Furthermore, I investigated the possibilities of using this concept for restless patients hospitalized in a standard surgical ward. The last goal was to determine whether basal stimulation effects medical treatment. The topic of the thesis was researched using expert sources. The research part uses methods of qualitative research. The research was conducted in four phases. The research showed that respondents have little knowledge of the concept of basal stimulation, but showed interest in it during the implementation its elements. The surgical ward, where the research has been conducted, currently does not use any elements of basal stimulation, nor is it being used in the hospital itself. During the research in the surgical ward, only two elements of the basal stimulation were implemented, the application of which is summarized in the tables showing the results of stimulation in the individual case reports. Patients showed both verbally and nonverbally increased levels of well-being, peacefulness, relief and comfort during stimulation. Nurses who participated in the research and monitored the patients also held this view. The third focus of the research did not provide unambiguous data. I focused only on the treatment of pain, the area in which the data obtained proved to be insufficient. It would be appropriate to expand the scope of the study in this respect, using both qualitative and quantitative methods.

As a result of urgent medicine acceleration and neurosurgery care improvement individuals that had minimum chance of life saving in the past survive brain insults. Increasing occurrence of people with apallic syndrome is a consequence of this progress. This thesis compares domestic and institutional care of apallic people. It examines whether the care quality and complexity are comparable. As the domestic care is more economical for the government it has to be supported in the times of insufficient funds for health care. Quantitative research technique of non-standardized interview was used for data collection. The research sample consisted of six healthcare workers and six family members caring for apallic patients. One respondent had a son in institutional care, however she took him temporarily to domestic care. Questions for healthcare staff and for caring family members were prepared separately. The results show that apallic patients in domestic care achieve substantially better results. The physical load is comparable, mental load is higher for family members. The basal stimulation, which is extremely important for apallic patients, is purposefully applied in institutional care only, as it is provided by trained staff there. The results of this work were presented at the 4th National Student Conference organized by the Faculty of Healthcare Studies of the Pardubice University. The data are published in the proceedings: SOUSEDÍKOVÁ, Zuzana. Comparison of nursing care about apallic patients in domestic and institutional care. In VI. National Student Scientific Conference of Bachelor and Master Programmes General Nurse, Midwife, Healthcare Rescuer, Nursing. Pardubice: Pardubice University, 2011. p. 18. ISBN 978-80-7395-391-1. The thesis will also be provided to the Cerebrum Association, which is going to publish it on its website and provide it to its clients, who are in touch with patients after brain injury. Distribution of this work among people having individuals with insulted brain around is the best way how to highlight the urgency of the problem.

Les tissus épithéliaux sont des couches de cellules adhérentes qui servent de barrières entre différents compartiments morphologiques et procurent un transport directionnel de molécules. L’action coopérative de plusieurs déterminants de la polarité gouverne l’identité et la morphogenèse spécifiques de ces domaines : 1) le cytosquelette d’actomyosine, 2) les jonctions adhérentes (AJs) basées sur la E-cadhérine et 3) les complexes de polarité conservés au cours de l’évolution. Une perte de l’adhérence via la DE-cadhérine (DE-Cad) conduit à des défauts de polarité apico-basale, tandis que la localisation apicale de DE-Cad nécessite les protéines de polarité Crumbs (Crb) et Bazooka (Baz) (L’homologue de Par3 chez la mouche). Notablement, DE-Cad forme des amas qui co-localisent partiellement avec les amas de Baz, génèrent l’adhésion intercellulaire et transmettent la tension. Les mécanismes impliqués dans le contrôle de la taille, le nombre, la répartition et la dynamique des amas de DE-Cad restent peu connus.J’ai étudié le rôle de Crumbs et Baz dans la régulation de la distribution fine de DE-Cad. J’ai montré que Crb contrôle la distribution macroscopique de DE-Cad, au moins, partiellement via Baz. En générant des mutations de Baz sur des sites régulateurs variés grâce à de la transgenèse spécifique de site et en utilisant de la microscopie en temps réel quantitative, j’ai montré que Crb agit via le domaine d’oligomérisation CR1 et le site Ser980 de Baz afin d’ajuster les niveaux de DE-Cad. Remarquablement, j’ai aussi révélé que le domaine d’oligomérisation de Baz est inutile à la formation d’amas Baz-DE-Cad et j’ai caractérisé la réciprocité de l’interaction DE-Cad-Baz. / Epithelia are sheets of adherent cells that serve as barriers between distinct morphological compartments and provide directed transport of molecules.. The cooperative action of several polarity determinants governs the proper identity and morphogenesis of these domains: 1) actomyosin cytoskeleton; 2) E-Cadherin-based adherens junctions (AJs) and 3) evolutionarily conserved polarity complexes.A loss of DE-cadherin (DE-Cad) adhesion leads to apico-basal polarity defects, while the apical localization of DE-Cad requires the polarity proteins Crumbs (Crb) and Bazooka (Baz) (Par3 homolog in fly). Notably, DE-Cad builds clusters that display a certain degree of colocalization with the clusters of Baz, provide intercellular adhesion and transmit tension.I have addressed the role of Crumbs and Baz in the regulation of DE-Cad fine distribution. I demonstrated that Crb controls DE-cad macroscopic distribution, at least, partially via Baz. By generating Baz mutants on various regulatory sites using site-specific transgenesis and quantitative live-imaging microscopy, I showed that Crb acts via CR1 oligomerization domain and Ser980 site of Baz to adjust DE-Cad levels. I also revealed that Baz oligomerization domain is dispensable for Baz-DE-Cad clusters formation and characterized the reciprocity of DE-Cad-Baz crosstalk.

Made available in DSpace on 2014-06-11T19:23:46Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-02-11Bitstream added on 2014-06-13T19:50:57Z : No. of bitstreams: 1 joao_cf_me_jabo.pdf: 526121 bytes, checksum: c3baa3dbdea179c60aaaa5d5df24f283 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O carcinoma de células escamosas é uma neoplasia maligna que emerge dos queratinócitos e corresponde a aproximadamente 5% dos tumores cutâneos dos cães. Os tumores de células basais são compostos quase exclusivamente por células basais e apresentam uma incidência de 4 a 12% entre as neoplasias cutâneas caninas. O carcinoma de células escamosas e o tumor de células basais são neoplasias comumente registradas na clínica de pequenos animais. As caderinas compreendem uma classe de moléculas de adesão celular expressas na superfície de todas as camadas epidérmicas. A E-caderina é a principal caderina envolvida na adesão celular epitelial. A redução de sua expressão está envolvida com a progressão de alguns tipos de câncer, principalmente os carcinomas, seu poder metastático, e ainda na definição do prognóstico. Não há muitos estudos na veterinária com relação à expressão dessas moléculas em tumores. O fator de crescimento do endotélio vascular (VEGF) é um potente mitógeno para células endoteliais e sua expressão tem sido relacionada com o aumento da angiogênese tumoral. O VEGF além de estimular a angiogênese, produz colagenase e outras enzimas degradativas que facilitam a saída das células neoplásicas para a circulação, além de estimularem o crescimento das células tumorais. O objetivo desse estudo foi avaliar a expressão da E-caderina e do fator de crescimento do endotélio vascular (VEGF) em tecidos caninos histologicamente classificados como carcinoma de células escamosas e tumor de células basais, buscando-se uma correlação com o grau histológico desses tumores. A expressão normal e reduzida da Ecaderina apresentou diferenças significativas comparando-se o tumor de células basais com o carcinoma de células escamosas quando avaliada pelo teste de Fisher... / The squamous cell carcinoma (SCC) is a malignant epithelial neoplasm of keratinocytes and accounts for about 5% of the canine skin neoplasms The basal cells tumors (BCT) are made up almost entirely of basal cells and accounts for 4 to 12% of the canine skin neoplasms. Squamous cell carcinoma and basal cell tumor are neoplasms commonly seen in the Small Animal Practice. The cadherins are a group of cellular adhesion molecules that are expressed on the surface of all epidermic layer. The Ecadherin is the main cadherin involved in epithelial cellular adhesion; the decrease in its expression is related to the progression of some types of cancer, specially carcinomas, to its metastatic characteristics, and to the prognosis. There are few studies in Veterinary Medicine researching the expression of this molecule in canine tumors. The vascular endothelial growth factor (VEGF) is a potent mitogen to endothelial cells and its expression has been correlated with increased tumoral angiogenesis. Besides stimulating angiogenesis, VEGF produces colagenase and other enzymes thus helping neoplastic cells scape into the vascular system and stimulating tumoral cell growth. The goal of this study was to evaluate E-cadherin’s and vascular endothelial growth factor expression in canine tissues that were classified as squamous cell carcinoma or basal cell tumor, and to find a correlation with the histological grade of the tumors. Both normal and decreased expression of E-cadherin had significant differences when comparing squamous cell carcinoma to basal cell tumor using the Fisher test (P=0,0039). Also, in some samples the more differentiated neoplastic cells had a higher intensity of color than the less differentiated...(Complete abstract, click electronic access below)

Orientadora: Mirela Tinucci Costa / Banca: Rosemeri de Oliveira Vasconcelos / Banca: Renée laufer Amorim / Resumo: O carcinoma de células escamosas é uma neoplasia maligna que emerge dos queratinócitos e corresponde a aproximadamente 5% dos tumores cutâneos dos cães. Os tumores de células basais são compostos quase exclusivamente por células basais e apresentam uma incidência de 4 a 12% entre as neoplasias cutâneas caninas. O carcinoma de células escamosas e o tumor de células basais são neoplasias comumente registradas na clínica de pequenos animais. As caderinas compreendem uma classe de moléculas de adesão celular expressas na superfície de todas as camadas epidérmicas. A E-caderina é a principal caderina envolvida na adesão celular epitelial. A redução de sua expressão está envolvida com a progressão de alguns tipos de câncer, principalmente os carcinomas, seu poder metastático, e ainda na definição do prognóstico. Não há muitos estudos na veterinária com relação à expressão dessas moléculas em tumores. O fator de crescimento do endotélio vascular (VEGF) é um potente mitógeno para células endoteliais e sua expressão tem sido relacionada com o aumento da angiogênese tumoral. O VEGF além de estimular a angiogênese, produz colagenase e outras enzimas degradativas que facilitam a saída das células neoplásicas para a circulação, além de estimularem o crescimento das células tumorais. O objetivo desse estudo foi avaliar a expressão da E-caderina e do fator de crescimento do endotélio vascular (VEGF) em tecidos caninos histologicamente classificados como carcinoma de células escamosas e tumor de células basais, buscando-se uma correlação com o grau histológico desses tumores. A expressão normal e reduzida da Ecaderina apresentou diferenças significativas comparando-se o tumor de células basais com o carcinoma de células escamosas quando avaliada pelo teste de Fisher...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The squamous cell carcinoma (SCC) is a malignant epithelial neoplasm of keratinocytes and accounts for about 5% of the canine skin neoplasms The basal cells tumors (BCT) are made up almost entirely of basal cells and accounts for 4 to 12% of the canine skin neoplasms. Squamous cell carcinoma and basal cell tumor are neoplasms commonly seen in the Small Animal Practice. The cadherins are a group of cellular adhesion molecules that are expressed on the surface of all epidermic layer. The Ecadherin is the main cadherin involved in epithelial cellular adhesion; the decrease in its expression is related to the progression of some types of cancer, specially carcinomas, to its metastatic characteristics, and to the prognosis. There are few studies in Veterinary Medicine researching the expression of this molecule in canine tumors. The vascular endothelial growth factor (VEGF) is a potent mitogen to endothelial cells and its expression has been correlated with increased tumoral angiogenesis. Besides stimulating angiogenesis, VEGF produces colagenase and other enzymes thus helping neoplastic cells scape into the vascular system and stimulating tumoral cell growth. The goal of this study was to evaluate E-cadherin's and vascular endothelial growth factor expression in canine tissues that were classified as squamous cell carcinoma or basal cell tumor, and to find a correlation with the histological grade of the tumors. Both normal and decreased expression of E-cadherin had significant differences when comparing squamous cell carcinoma to basal cell tumor using the Fisher test (P=0,0039). Also, in some samples the more differentiated neoplastic cells had a higher intensity of color than the less differentiated...(Complete abstract, click electronic access below) / Mestre

INTRODUÇÃO: Embora seja reconhecida a existência do espessamento da membrana basal e da fibrose da concha nasal na rinite alérgica, não há estudos descritivos do comportamento da mucosa nasal nos pacientes com rinite idiopática. O propósito desse estudo é descrever possíveis alterações na membrana basal e na lâmina própria da concha nasal inferior em pacientes com rinite alérgica ou idiopática, além do estudo quantitativo das fibras colágenas nesta localização. MÉTODOS: Analisou-se na concha nasal inferior obtida através de turbinectomia bilateral em 28 pacientes - 14 com rinite alérgica e 14 com rinite idiopática - a área ocupada pelo colágeno, a espessura da membrana basal e o diâmetro das fibrilas de colágeno através do uso de microscopia óptica (coloração Hematoxilina-eosina e Picrossírius-hematoxilina), microscopia eletrônica e imunoistoquímica para laminina e colágeno IV. RESULTADOS: 1) pacientes com rinite alérgica apresentaram significantemente maior área da concha nasal ocupada por colágeno do que o grupo com rinite idiopática. 2) a membrana basal de pacientes com rinite alérgica foi significantemente mais espessa. 3) a lâmina reticular da membrana basal dos pacientes com rinite alérgica apresentaram fibrilas de colágeno com menor diâmetro que os pacientes com rinite idiopática. 4) não houve diferenças significativas entre os grupos na distribuição de laminina e de colágeno IV. CONCLUSÕES: Alterações na mucosa nasal ocorrem na rinite alérgica, sendo caracterizadas pelo aumento da espessura da membrana basal e por fibrose. Na rinite idiopática, observou-se uma mucosa com aspecto estrutural semelhante aos pacientes normais / INTRODUCTION: Despite our knowledge about nasal conchae fibrosis and basement membrane thickening in allergic rhinitis, there are no descriptive studies on nasal mucosa behavior in patients with idiopathic rhinitis. The aim of our study was to describe possible changes in the basement membrane and lamina propria of the inferior concha in patients with idiopathic or allergic rhinitis, in addition to a quantitative study of collagen fibers in this site. METHODS: The inferior nasal concha obtained from 28 patients submitted to bilateral turbinectomy was examined - 14 with allergic rhinitis and 14 with idiopathic rhinitis; analyzing the collagen area, the basement membrane thickness and the collagen fibrils diameter using optical microscopy (Hematoxylin-eosin and Picrosirius-hematoxylin staining), electron microscopy and immunohistochemistry for laminin and collagen IV. RESULTS: 1) patients with allergic rhinitis had a significantly larger area of the nasal concha occupied by collagen than the group with idiopathic rhinitis. 2) the basement membrane of patients with allergic rhinitis was significantly thicker. 3) the reticular lamina of the basement membrane of patients with allergic rhinitis had collagen fibrils with diameters which were smaller than those from patients with idiopathic rhinitis. 4) there were no significant differences between the groups concerning the distribution of laminin and collagen IV. CONCLUSIONS: Alterations to the nasal mucosa that happen in allergic rhinitis are characterized by basement membrane thickening and fibrosis. In idiopathic rhinitis the patients\' mucosae were structurally similar to those from normal patients

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2014-10-21T11:25:06Z No. of bitstreams: 2 Dissertacao Lorena Dias Resende - 2013.pdf: 1401725 bytes, checksum: b4f101e9ff3343d1112e15b4cb3e94f5 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2014-10-23T11:24:49Z (GMT) No. of bitstreams: 2 Dissertacao Lorena Dias Resende - 2013.pdf: 1401725 bytes, checksum: b4f101e9ff3343d1112e15b4cb3e94f5 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-10-23T11:24:49Z (GMT). No. of bitstreams: 2 Dissertacao Lorena Dias Resende - 2013.pdf: 1401725 bytes, checksum: b4f101e9ff3343d1112e15b4cb3e94f5 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-10-01 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Introduction: Gait apraxia is characterized by a deficiency in the integration of the sensorial, motor and cerebellar functions necessary for gait. The patients with this compromise have difficulty initiating and there is a congelation of the gait, mainly when turning ove their own axle. It is frequently associated with an emotional instability, a urinary bladder dysfunction and behavioral abnormalities. It is generally observed in gait disturbances high level cortical functions, but its relationship to disease progression and cognitive function is unknown. Objectives: To evaluate the gait apraxia in patients with dementia, its prevalence and association with other types of apraxia as well as observing what phase of the disease in which it appears. Methods: Gait apraxia has been researched in a universe of patients with dementia consecutively assisted in the HC-UFG Neurodementia Ambulatory. The instruments used were the Mini-Mental State Examination and Clinical Dementia Rating Scale (CDR) to evaluate the cognitive functions, Pfeffer's Questionnaire for the functional evaluation of the activities of the daily life, the Scale of Berg's Functional Balance (BERG) and the Timed Up and Go Test (TUG) for the balance mensuration, besides the evaluation of the gait and the posture of the trunk (AWS). Results: A total of fifteen patients, a sample 160, with gait apraxia were included in the study and all had some other associated apraxia. The prevalence of patients with dementia and apraxia of gait was 9,37%. Regarding the CDR showed that 33,3% of patients were mild stage of the disease, 46,7% in the moderate and 20% in the severe. In Pfeffer Questionnaire patients had an average of 19,6±1,40. There balance and coordination deficit in all patients, since the scores of the tests BERG and TUG showed inferior results. On the scale of BERG total score obtained average 11,07±8,06 and varying between 2 and 24 points. The TUG test was performed above 20 seconds for all the patients. In AWS the average score was 14,0±6,88 ranging between 7 and 27 points. The correlation between AWS and scale BERG was significant (p=0,001). Apraxia dynamics (90,9%), ideatory (72,2%) and kinetic members (63,6%) were more frequent among patients. Forms of dementia who had gait apraxia were corticobasal degeneration (53,3%), frontotemporal dementia (13,3%), Alzheimer's disease (6,6%), dementia with chronic subdural hematoma (6,6%), normal pressure hydrocephalus (6,6%), dementia in Parkinson's disease (6,6%) and multiple system atrophy (6,6%). Conclusion: Gait apraxia is little prevalent in the universe of dementia and it is always associated with corticcortical dementia. Other forms of apraxia frequently follow gait apraxia. The corticobasal degeneration is the type of dementia most associated with the gait apraxia. / Introdução: Apraxia da marcha é caracterizada por deficiência na integração das funções sensoriais, motoras e cerebelares necessárias para a deambulação. Os pacientes com este comprometimento têm dificuldade em iniciar a marcha e há um congelamento desta, principalmente ao girar sobre o próprio eixo. É freqüentemente associada a uma instabilidade emocional, disfunção da bexiga e anormalidades comportamentais. É geralmente observada em distúrbios da marcha de alto nível das funções corticais, mas sua relação com aprogressão da doença e função cognitiva é desconhecida. Objetivos: Avaliar a apraxia da marcha em pacientes com demência, sua prevalência e associação com outras formas de apraxia, bem como observar em que fase da doença mais aparece. Métodos: Foi pesquisada a apraxia de marcha em um universo de pacientes com demência consecutivamente atendidos no ambulatório de neurodemência do HC-UFG, entre 2012 e 2013. Os instrumentos utilizados foram o Mini-Exame do Estado Mental e a Escala Clínica de Demência (CDR) para se avaliar o grau da demência, o questionário de Pfeffer para avaliação funcional das atividades instrumentais de vida diária, a Escala de Equilíbrio Funcional de Berg (BERG) e o Timed Up and Go Test (TUG) para a mensuração do equilíbrio; além da avaliação qualitativa da marcha e avaliação postural do tronco (AWS). Resultados: Um total de quinze pacientes, de uma amostra de 160, que apresentavam apraxia da marcha foi incluído no estudo e todos apresentaram alguma outra apraxia associada. A prevalência de pacientes com demência e apraxia da marcha foi de 9,37%. Em relação ao CDR observou-se que 33,3% dos pacientes estavam em estágio leve da doença, 46,7% no moderado e 20% no grave. No questionário de Pfeffer os pacientes obtiveram média de 19,6±1,40. Houve déficit de equilíbrio e coordenação em todos os pacientes, uma vez que a pontuação dos testes de BERG e TUG apresentaram resultados inferiores. Na escala de BERG a pontuação total obteve média de 11,07±8,06 e variação entre 2 e 24 pontos. O teste de TUG foi realizado com tempo acima de 20 segundos por todos os pacientes. Na AWS a média de pontuação foi de 14,00±6,88 variando entre 7 e 27 pontos. Houve correlação significativa entre AWS e a escala de BERG. A apraxia dinâmica (90,9%), ideatória (72,2%) e cinética de membros (63,6%) foram as mais frequentes entre os pacientes. As formas de demência que apresentaram apraxia da marcha foram: degeneração córtico-basal (53,3%), demência fronto-temporal (13,3%), doença de Alzheimer (6,6%), demência por hematoma sub-dural crônico (6,6%), hidrocefalia de pressão normal (6,6%), demência na doença de Parkinson (6,6%) e atrofia de múltiplos sistemas (6,6%). Conclusão: A apraxia de marcha é pouco prevalente no universo das demências e mostrou-se associada a demências córtico-subcorticais. Outras formas de apraxia frequentemente acompanham a apraxia de marcha. Degeneração córtico-basal é a forma de demência mais associada à apraxia de marcha.