Thèse d'exercice : Médecine. Médecine générale : Université de Nantes : 2005. / Bibliogr. f. 78-82 [41 réf.].

Landau (Pfalz), Universiẗat, Diss., 2005--Koblenz. / Literaturverz.

Th.--Lett.--Montpellier 3, 1985.

Contextualização: As complicações agudas do diabetes, embora em grande parte evitáveis, apresentavam considerável mortalidade em diversas localidades do mundo no século passado. No Brasil, a organização do Sistema Único de Saúde pode ter resultado em importante queda na mortalidade por esta causa. Objetivos: Descrever a mortalidade por complicações agudas do diabetes no Brasil entre 1991 e 2010. Métodos: Os óbitos declarados no Sistema de Informações sobre Mortalidade por complicações agudas do diabetes (CID-9 249 e 250, seguidos pelos dígitos 1, 2 ou 3, e CID-10 E10 a E14, seguidos pelos dígitos 0 ou 1) foram corrigidos para causas mal definidas e sub-registro. A partir da população obtida do Instituto Brasileiro de Geografia e Estatística, foram calculadas taxas de mortalidade padronizadas de acordo com a população mundial. Correlações lineares foram realizadas para descrever a relação entre mortalidade e idade, e regressões Joinpoint foram utilizadas para descrever tendências. Resultados: Houve queda de 70,9% na mortalidade por complicações agudas do diabetes no Brasil entre 1991 e 2010, de 8,42 para 2,45 óbitos por 100.000 habitantes. A redução ocorreu em ambos os sexos, todas as faixas etárias, todas as regiões e quase todas as unidades federativas. O declínio foi menor nos últimos anos, quando as taxas já estavam bem mais baixas. A mortalidade aumentou exponencialmente com a idade e foi maior nas regiões Norte e Nordeste. Conclusões: A marcante redução na mortalidade por complicações agudas do diabetes no Brasil nas últimas duas décadas indica que a cobertura ampla e gratuita adotada pelo sistema nacional de saúde do Brasil, com disponibilização de insulina e organização do cuidado, foi capaz de reduzir substancialmente as complicações agudas dessa doença. Entretanto, considerando especialmente as iniquidades regionais existentes, ainda há espaço para redução na mortalidade por essas complicações no Brasil. / Background: Acute complications of diabetes, though largely preventable, presented considerable mortality in various locations around the world in the 20th Century. In Brazil, the organization of the national health system may have resulted in an important decline in this cause of mortality. Objectives: To describe mortality rates from acute complications of diabetes in Brazil from 1991 to 2010. Methods: The deaths reported in the Mortality Information System for acute complications of diabetes (ICD-9 249 and 250, followed by the digits 1, 2 or 3, and ICD-10 E10 to E14, followed by the digits 0 or 1) were corrected for ill-defined and under-reporting. Using the population obtained from national censuses, we calculated mortality rates standardized to the world population. Linear correlations were performed to describe the relationship between mortality and age, and Joinpoint regressions were used to characterize trends. Results: Mortality from acute complications of diabetes decreased 70.9%, from 8.42 to 2.45 deaths / 100000 inhabitants, in Brazil from 1991 to 2010. The reduction occurred in both sexes, all ages, all regions and almost all states. The decline was less marked in recent years. Mortality rates increased exponentially with age and were higher in the North and Northeast regions. Conclusions: The marked reduction in mortality from acute complications of diabetes in Brazil over the last two decades suggests that the universal coverage adopted by the national health system of Brazil, provided without charge and in an increasingly organized fashion, coupled with greater availability of insulin, was able to substantially reduce deaths due to the acute complications of diabetes. However, especially considering regional inequities, much room still exists for further reduction in mortality from these complications in Brazil.

Orientador: Sebastião Araujo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-03T06:47:46Z (GMT). No. of bitstreams: 1 Oliveira_RosmariAparecidaRosaAlmeidade_M.pdf: 1318500 bytes, checksum: 0af28eeaf42f3dd68b1c5e4d5b913c78 (MD5) Previous issue date: 2002 / Resumo: Introdução. O traumatismo craniencefálico (TCE) tem aumentado na população civil numa relação direta com o desenvolvimento tecnológico, especialmente devido à grande circulação de veículos automotores, e, mais recentemente, devido ao aumento da violência nos grandes centros urbanos. Atinge principalmente a população jovem, na fase mais produtiva da vida, gerando seqüelas físicas, econômicas e psicossociais de grandes proporções. A escala de resultados de Glasgow (ERG) é utilizada mundialmente para acompanhar a evolução desses pacientes. Objetivos. Avaliar se a gravidade da lesão, estimada pela escala de coma de Glasgow (ECG) na entrada, e se a ERG na alta hospitalar (ERGALTA) podem ser utilizadas como índices prognósticos e quais são os principais fatores que interferem na evolução final a longo prazo (t ³ 1 ano) após TCE grave (ECG £ 8). Metodologia. Esta pesquisa foi realizada junto ao HC-UNICAMP, em duas fases: a primeira foi retrospectiva, com coleta de dados de prontuários relativos ao período de internação hospitalar dos pacientes; a segunda foi prospectiva, onde os pacientes foram submetidos a uma avaliação neurológica clínica e fisioterápica após um tempo ³ 1 ano do TCE para verificar suas evoluções. A ERG foi aplicada em dois momentos: na alta hospitalar (ERGALTA) e após um tempo ³ 1 ano de evolução (ERGTARDIA). Resultados. Foram incluídos na análise 45 pacientes vítimas de TCE grave (36M, 9F), com idade média de 24,6 ± 10,4 anos. A causa mais freqüente do TCE foi o acidente automobilístico (46,7%). A pontuação da ERGALTA foi: 2 = 2 (4,4%); 3 = 27 (60%); 4 = 15 (33,3%) e 5 = 1 (2,2%). A pontuação da ERG tardia foi: 1 = 5 (11,1%); 2 = 1 (2,2%); 3 = 7 (15,6%); 4 = 9 (20%) e 5 = 23 (51,1%). As seguintes variáveis mostraram-se estatisticamente significativas como índices prognósticos de longo prazo: ERGALTA (p = 0,03), a necessidade de neurocirurgia (p = 0,008) e o tipo de lesão (difusa vs focal; p = 0,009). Nas associações isoladas, a presença de pneumonia e a idade mais avançada mostraram-se também fatores de pior prognóstico (p < 0,05). Outros achados importantes foram: alterações de comportamento (97,7% dos casos) e queda da produtividade profissional prévia em 35% (p = 0,001). A fisioterapia mostrou-se como uma parte importante da reabilitação dos pacientes, relatada em 67% dos casos, porém não esteve associada ao prognóstico dos mesmos, mas apenas ao seus graus de dependência segundo a ERGTARDIA (p = 0,007). Conclusões. Nestes pacientes com TCE grave (ECG £ 8), a ECG de entrada não se mostrou útil como índice prognóstico a longo prazo, mas a ERGALTA sim. Os principais fatores que estiveram associados a uma pior evolução tardia (ERGTARDIA) dos pacientes após o TCE foram: o tipo de lesão (difusa vs focal), a presença de pneumonia, a necessidade de neurocirurgia e a idade mais avançada dos pacientes / Abstract: Introduction. Severe traumatic brain injury (STBI) has been increasing in civilian life in a direct relationship to technological development, especially do to traffic accidents and escalating urban violence. Young people, who are in their most productive phase of life, are more vulnerable to SBTI, leading to enormous medical, psychological, economical and social sequels. The Glasgow Outcome Scale (GOS) has been largely used for long term evaluation of SBTI patients. Objectives. To evaluate if initial injury severity, estimated by Glasgow Coma Scale (GCS), and if GOS at hospital discharge (GOS-HD) can be used as prognostic indexes, and which are the main factors that affect long term (t ³ 1 year) SBTI (GCS £ 8) patients outcome. Methodology. This was an observational study and had been conducted in a teaching hospital (HC-UNICAMP), in two phases: the first one was retrospective, with data acquisition from patient¿s hospital staying medical records; and the second one was prospective, when patients with a pasting time ³ 1 year since SBTI were submitted to neurological and physiotherapeutic evaluation. The GOS was estimated at two moments: at hospital discharge (GOS-HD) and after a an evolution time ³ 1 year after head trauma (GOS-LATE). Results. Forty five SBTI patients (36 M; 9 F), age 24.6 ± 10.4 years, were included in this study. The most frequent SBTI cause was car accident (46.7%). GOS-HD evaluation has shown: 2 = 2 (4.4%); 3 = 27 (60%); 4 = 15 (33.3%); and 5 = 1 (2.2%). GOS-LATE has shown: 1 = 5 (11.1%); 2 = 1 (2.2%); 3 = 7 (15.6%); 4 = 9 (20%) e 5 = 23 (51.1%). The following variables has been established as significantly long term prognostic indexes: GOS-HD (p = 0.03), the need of neurosurgical interventions (p = 0.008) and the type of lesion (diffuse vs focal; p = 0.009). The presence of pneumonia and more advanced age were also associated with poorest prognosis (p < 0.05). Additional important findings were: behavioural alterations (97.7%) and a 35% decline in previous professional productivity (p = 0.001). Physiotherapeutic interventions had been shown to be an important tool in patients¿ rehabilitation, reported by 67% of them, but it was not associated with long term prognosis, only reflecting their physical dependence grade according to GOS-LATE (p = 0.007). Conclusions. In these SBTI patients (GCS £ 8), GCS has not been shown as an useful long term prognostic index, but GOS-HD has did. The main factors that had been associated with poor long term outcome (GOS-LATE) were: the type of lesion (diffuse vs focal), the presence of pneumonia, the need of neurosurgical interventions and more advanced age / Mestrado / Pesquisa Experimental / Mestre em Cirurgia

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-28T17:31:22Z No. of bitstreams: 1 carlacristinasoaresdeoliveiradovale.pdf: 1707127 bytes, checksum: e1b81c2967dbd6666fa4116846b99fdd (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-29T11:02:10Z (GMT) No. of bitstreams: 1 carlacristinasoaresdeoliveiradovale.pdf: 1707127 bytes, checksum: e1b81c2967dbd6666fa4116846b99fdd (MD5) / Made available in DSpace on 2016-01-29T11:02:10Z (GMT). No. of bitstreams: 1 carlacristinasoaresdeoliveiradovale.pdf: 1707127 bytes, checksum: e1b81c2967dbd6666fa4116846b99fdd (MD5) Previous issue date: 2014-02-10 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O objeto de pesquisa da presente investigação é a verificação de uma possível resposta emocional dos pacientes comatosos frente aos estímulos de seus familiares. Pretende-se identificar se o paciente comatoso internado na Unidade de Terapia Intensiva responde aos estímulos do visitante. E como objetivos específicos: Descrever as alterações das respostas fisiológicas monitoradas nos pacientes comatosos internados na UTI durante as visitas e destacar a importância ou não da comunicação verbal e não verbal com os pacientes comatosos. Atualmente, apesar dos avanços da Medicina e da Neurociência, ainda não se tem uma resposta precisa sobre o que se passa emocionalmente com o paciente em coma, o que demanda uma melhor compreensão dos seus processos emocionais. A pesquisa caracteriza-se por ser um estudo qualitativo, realizado na Unidade de Terapia Intensiva do Hospital Universitário da Universidade Federal de Juiz de Fora. Utilizou-se como metodologia a Análise do Conteúdo proposta por Bardin e a observação. A análise de conteúdo foi aplicada às entrevistas realizadas com os visitantes enquanto que a observação foi utilizada para identificar as alterações fisiológicas no momento da visita. A coleta de dados se deu em 45 dias de observação com pacientes que estavam dentro dos critérios de inclusão da pesquisa. Foram pesquisados 11 pacientes comatosos que estavam ligados a um monitor eletrônico multiparâmetros e à respiração artificial. Estes aparelhos mediam em tempo real os parâmetros fisiológicos que indicariam uma resposta do paciente frente ao estímulo do visitante (pressão arterial, frequência cardíaca e frequência respiratória). Essa medição foi feita antes, durante e depois das visitas e os dados foram registrados em uma planilha com o intuito de comparar os padrões fisiológicos e identificar alterações. Essa medição foi registrada em dois momentos sem estímulo (antes e depois da visita) e em três momentos com estímulo do visitante (durante a visita). A análise temática das entrevistas e do diário de campo resultou em três grandes categorias: 1- Respostas Emocionais nos pacientes comatosos, na qual se constatou a presença de respostas emocionais nos pacientes comatosos, identificadas através de dois aspectos: alterações fisiológicas e superficialização do nível de consciência; 2- A importância de um outro em que foi descrito os tipos de interação entre visitantes e pacientes, além de abordar a importância da visita na perspectiva do visitante; 3- Possibilidades de humanização no atendimento ao paciente comatoso onde foi discutida a relevância da atuação do psicólogo na UTI. Desta forma, a pesquisa indica a presença de respostas emocionais do paciente comatoso e possibilita informações para que se realizem o preparo da equipe multiprofissional para acolher os familiares que vivenciam este momento de crise estimulando de forma adequada e eficaz a interação dos binômios: “profissionais-família” e “família-doente”. Quanto ao binômio “profissional-paciente” a pesquisa contribui para a humanização combatendo a reificação do paciente em estado de coma. Como desdobramento desse estudo indica-se ainda novas pesquisas com outras tecnologias como a ressonância magnética e uma maior quantidade de pacientes. / Objective: The research aims at finding possible emotional responses to stimuli from their family members in comatose patients. It seeks to identify whether comatose patients admitted to the Intensive Care Unit respond to stimuli of visitors. The specific objectives: (i) to describe the changes in the monitored physiological responses in comatose ICU patients during family visits. (ii) To assess the degree of importance of verbal and nonverbal communication with comatose patients. Despite the advances in Medicine and Neuroscience, no answer to what precisely occurs with comatose patients is satisfactory, since further understanding of their emotional processes is still required. Methodology: The research comprises a qualitative study conducted in the Intensive Care Unit of the University Hospital of the Federal University of Juiz de Fora. Content Analysis (Bardin) of the visitors’ interviews and direct observation to identify the patients’ physiological changes during the family visits were used as methodology. The data collection lasted 45 days of direct observation of selected patients who met the criteria for inclusion in the survey. Eleven comatose patients connected to multi-parameter electronic monitors and artificial respirator were under scrutiny. These devices measured in real time physiological parameters that indicate a patient's response to the stimulus from the visitors (blood pressure, heart rate and respiratory rate). The measurements were conducted before, during and after the visits. The collected data were recorded in spreadsheets in order to compare physiological patterns and identify changes. One measurement was recorded at two moments without stimulation (before and after the visit), and another one three times with the visitor’s stimulus (during the visit). Results: A thematic analysis of the interviews and the field diary resulted in three major categories: (i) Emotional Responses in comatose patients, in which the presence of emotional responses were found and classified into two categories: physiological changes and superficialization of the consciousness’ level. (ii) The importance of the “other”, through which the types of interaction between visitors and patients were described, in addition to addressing the importance of the visit under a visitor's perspective. (iii) Possibilities of humanization in comatose patient care, in which the relevance of the psychologist in the ICU. Conclusion: The research indicates the presence of emotional responses in comatose patients and provides information on the preparation of a multidisciplinary team to sort out family members who best experience the moment of crisis and stimulate proper and effective interaction of the binomials: "Professional versus family" and "family versus patient." As for the binomial "physician versus patient", the research underscored the need for the humanization of such environments, and contended the reification of the patient in coma. The study also indicates the need for further research with other technologies such as magnetic resonance imaging with a larger number of patients.

Cardiac arrest is a common cause of coma with frequent poor outcomes. Palliative medicine teams are often called upon to discuss the scope of treatment and future care in cases of anoxic brain injury. Understanding prognostic tools in this setting would help medical teams communicate more effectively with patients’ families and caregivers and may promote improved quality of life overall. This article reviews multiple tools that are useful in determining outcomes in the setting of postarrest anoxic brain injury.

In 2010, comet 103P/Hartley 2 was observed pre- and post-perihelion using the George and Cynthia Mitchell Integral Field Spectrometer on the 2.7-m telescope at McDonald Observatory in Texas. Data for gaseous radicals C2, C3, CH, CN, and NH2 were collected over six nights from 15 July to 10 November. The spectral data were used to create coma maps for each of the observed species, and the maps were processed using radial and azimuthal mean division techniques to create enhanced images of the coma, revealing subtle morphological features. 340 enhanced coma images were created for each observation and species. Visual inspection reveals that the coma is heterogeneous between the five detected radicals, and statistical analyses verify this result. To compliment the ongoing investigation of Hartley 2 as studied by the EPOXI flyby mission, findings from other researchers (Belton et al., 2012; Syal et al., 2012; and Thomas et al., 2012) are used to characterize the nucleus spin state and identify dust jet locations on the nucleus. With rotational period measurements from EPOXI, dust jet vectors on the nucleus surface are rotated to relevant observation times in November to compare the computed jet directions with the radical densities in the coma. Dust jet sites on the smaller nucleus lobe show a stronger correlation with high radical concentrations than the dust sites on the larger nucleus lobe. Production rates for potential parentage of radical species are calculated using the radial outflow Haser model (Haser, 1957), which are compared to mixing ratios relative to water from separate campaigns to constrain parentage. NH3 is likely the sole producer of NH2, whereas CN may be produced from a combination of HCN, C2N2, and CH3CN. Traditional parentage of C2, C3, and CH do not yield acceptable fits or suitable mixing ratios with the Haser model, and it is possible that extended coma ices having relatively short scale lengths greatly contribute to production of these radicals. These results provide further evidence that the Hartley 2 nucleus is heterogeneous in composition, and the rotational analysis indicates that specific jet sites are correlated with certain radical species.

Machine Learning for Analysis of Brain Signals / Event-Related Potential (ERP) measures derived from the electroencephalogram (EEG) have been widely used in outcome prediction of brain disorders. Recently, the ERPs that are transient (EEG) responses to auditory, visual, or tactile stimuli, have been introduced as useful predictors of a positive coma outcome (i.e. emergence from coma). In this study, machine learning techniques were applied for detecting the Mismatch Negativity (MMN) component, which is a transient EEG response to auditory stimuli, and its existence has a high correlation with coma awakening, through analyzing ERPs signals recorded from healthy control brain signals. To this end, two different dimensionality reduction methods, Localized Feature Selection (LFS) and minimum-redundancy maximum-relevance (mRMR) were employed, where a localized classifier and the support vector machine (SVM) with radial basis function (RBF) kernel are used as classifiers. We trained both LFS and mRMR algorithms using signals of healthy brains and evaluated their performance for MMN detection on both healthy subjects and coma patients. The evaluation on healthy subjects, using leave-one-subject-out cross-validation technique, shows the detection accuracy performance of 86.6% (using LFS) and 86.5% (using mRMR). In addition to analyzing brain signals for MMN detection, we also implemented a machine learning algorithm for discriminating healthy subjects from those who have experienced TBI. The EEG signals used in the TBI study were recorded using an ERP paradigm. However, we treated the recorded signals as resting state signals. To this end, we used the mRMR feature selection method and fed the selected features into the SVM classifier that outputs the estimated class labels. This method gives us a poor performance compared to the methods that directly used ERP components (without considering them as resting signals.). We conclude that our hypothesis of treating ERP data as resting data is not valid for TBI detection. / Thesis / Master of Applied Science (MASc)

Assessing cognitive abilities in disorders of consciousness (DOC) relies on assessments of overt behaviour, such as the ability to follow commands. Neuroimaging has shown that absence of overt behavior does not necessarily indicate absence of covert cognition, raising questions about behaviour-only assessment. Several electroencephalographic (EEG) markers of higher cognitive functions (event-related potentials; ERPs) have shown the potential to differentiate between DOC states, as well as predict awakening and condition upon emergence. However, no one ERP has emerged with sensitivity and specificity high enough to be widely accepted, showing that further investigation is needed. More recently, evidence has emerged for fluctuations of ERP detectability in DOC over the course of several hours, and for prognostic power of changes in ERP presentation between testing sessions. This investigation builds on such findings towards improving evaluation of cognition in DOC. A testing battery combining several well-known auditory ERPs was administered to a comatose patient over a 24-hour period during two recording sessions one week apart, as well as to a sample of healthy young adults. The patient scored 3 and 6 on the Glasgow Coma Scale (GCS) during the first and second session, respectively. The results show that changes in GCS score were accompanied by changes in ERP detectability. The results also suggest detectability fluctuations over the course of 24 hours, which in turn suggests that repeated testing is necessary for complete evaluation. Future work should validate these findings with a larger sample; additionally, establishing population norms for single-subject prevalence, latency, and amplitude of ERPs would improve confidence in interpreting patient results. With the current understanding of both healthy and DOC ERPs, detecting ERP presence may contribute to a positive DOC prognosis with a degree of confidence, but caution must be exercised in making negative prognoses or high-stakes care decisions based on ERP absence. / Thesis / Master of Science (MSc) / Assessing cognitive abilities in disorders of consciousness such as coma currently relies on assessments of overt behaviour, such as the ability to follow commands or react to a stimulus. Neuroimaging has shown that absence of overt behavior does not necessarily indicate absence of covert cognition, raising questions about behaviour-only assessment. This study describes a neuroimaging testing battery aimed at evaluating a hierarchy of cognitive functions without the need for a behavioural response by measuring brain activity driven by auditory stimulation. This battery was administered to a comatose patient over a 24-hour period during two recording sessions one week apart, as well as to a sample of healthy young adults. The results show that changes in the patient’s condition between testing sessions was accompanied by detectable and quantifiable change in their stimulus-driven brain activity. The results also suggest fluctuations in the patient’s ability to produce detectable responses over the course of 24 hours, which in turn suggests that repeated testing is necessary for a complete evaluation. Overall, neuroimaging provides a promising avenue for non-behavioral assessment of cognition, which will greatly benefit a population whose physical faculties may be compromised.