Made available in DSpace on 2014-12-17T14:13:38Z (GMT). No. of bitstreams: 1 ErikaDMR.pdf: 1138296 bytes, checksum: 0a0b6c2daed88fef46a41da7760c0079 (MD5) Previous issue date: 2008-10-20 / Congenital generalized lipodystrophy is a rare genetic disease with autosomal recessive inheritance characterized by the generalized absence of subcutaneous adipose tissue and insulin resistance. The aim of our study was to determine the profile of patients with congenital generalized lipodystrophy (Berardinelli-Seip syndrome) through their clinical history, eating habits, and socioeconomic and cultural aspects; assess food consumption and nutritional status of the study group; propose and evaluate a diet therapy model associated to oral supplementation with zinc to help in the control and prevention of metabolic complications associated to the pathology. Initial assessment of food consumption indicated a voracious appetite in all the patients studied. The introduction of zinc reduced appetite, contributing to patient adherence to the food plan proposed. It was also observed that the proposed diet contributed mainly to glycidic control, specifically with respect to HbA1c. The nutritional status of the patients investigated was adequate in terms of body mass index (BMI), arm muscle circumference (AMC), arm muscle area AMA, but triceps skinfold (TSF) indicated serious malnutrition. Our study is unique in the literature and provides important information to the field of nutrition and to individuals with this pathology. Furthermore, it contemplates the interdisciplinary and multidisciplinary requirements of the Postgraduate Program in Health Sciences of the Federal University of Rio Grande do Norte (UFRN), Natal, Brazil / A lipodistrofia generalizada cong?nita ? uma rara doen?a gen?tica com heran?a autoss?mica recessiva caracterizada por aus?ncia generalizada de tecido adiposo subcut?neo e resist?ncia insul?nica. O nosso estudo objetivou conhecer o perfil de portadores de lipodistrofia generalizada cong?nita mediante hist?ria cl?nica, h?bitos alimentares, aspectos s?cio-econ?micos e culturais; avaliar o consumo alimentar e o estado nutricional do grupo estudado; propor e avaliar um modelo de interven??o dietoter?pica associada ? suplementa??o oral com o elemento zinco para auxiliar o controle e a preven??o de complica??es metab?licas associada ? patologia. A avalia??o inicial do consumo alimentar indicou apetite voraz comum em todos os portadores investigados. Com a introdu??o do elemento zinco, verificou-se redu??o do apetite contribuindo para a ades?o dos mesmos ao plano alimentar proposto. Observou-se, tamb?m, que a dieta proposta contribuiu, principalmente, ao controle do metabolismo glic?dico, especificamente, em rela??o ? hemoglobina glicada (HbA1c). O estado nutricional dos portadores investigados revelou-se adequado em rela??o ao ?ndice de massa corporal (IMC), circunfer?ncia do m?sculo do bra?o (CMB) e ?rea da massa do bra?o (AMB), e indicou desnutri??o grave em rela??o ? prega cut?nea do tr?ceps (PCT). O nosso estudo ? ?nico na literatura e traz contribui??es importantes ao campo da nutri??o e ? popula??o portadora desta patologia. Al?m disto, contemplou os requisitos de interdisciplinaridade e multidisciplinaridade exigidos pelo Programa de P?sgradua??o em Ci?ncias da Sa?de

Made available in DSpace on 2014-12-17T14:13:42Z (GMT). No. of bitstreams: 1 MariaGNS_TESE.pdf: 2077468 bytes, checksum: edab1b162a07155c0e97ed375ab4b0f2 (MD5) Previous issue date: 2012-07-06 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / A S?ndrome de Berardinelli-Seip (SBS) ? uma doen?a muito rara caracterizada, sobretudo, pela extrema escassez de tecido adiposo subcut?neo, hipoleptinemia, hipertrigliceridemia e diabetes insulino resistente ou lipoatr?fico. Sua etiologia envolve implica??es hipotal?micas e pituit?rias, altera??es nos receptores de insulina e muta??es nos genes AGPAT2, Gng3lg, CAV1 e PTRF. A predisposi??o ? defici?ncia de zinco e a dist?rbios renais, relacionados ao diabetes lipoatr?fico, motivou a investiga??o do status de zinco e da sensibilidade da cin?tica de zinco em portadores dessa s?ndrome. Nesse sentido, foram avaliados 10 pacientes com a SBS e 10 indiv?duos saud?veis. Uma ?nica dose de 25 mg (382,43 μmol) de zinco foi administrado via intravenosa antes e ap?s 3 meses de suplementa??o oral de zinco oral (25 mg Zn/dia). Amostras de sangue foram coletadas, no bra?o contralateral, em 0, 30, 60, 90 e 120 min ap?s a inje??o de zinco. Sangue total e soro foram obtidos para medi??o de par?metros hematol?gicos e bioqu?micos. A urina foi coletada para medir creatinina, prote?na e zinco. Diferente do zinco s?rico basal que apresentou concentra??o semelhante nos dois grupos do estudo, o perfil do zinco s?rico foi significativamente menor no grupo experimental, assim como a altera??o no clearance total do zinco foi mais elevada, indicando que estes pacientes t?m defici?ncia sub?tima de zinco. O desenvolvimento desse estudo, com perfil multidisciplinar, concretizou a tese, ora defendida, na ?rea das an?lises cl?nicas e contribuiu para defesa de uma disserta??o na ?rea de nutri??o e tr?s teses na ?rea m?dica, sendo duas em cardiologia e uma em gen?tica molecular

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-04-03T22:22:49Z No. of bitstreams: 1 SamaraIsabelaMaiaDeOliveira_DISSERT.pdf: 1784979 bytes, checksum: b34f948642b206c54a12e4d4583fcf0c (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-04-11T18:05:37Z (GMT) No. of bitstreams: 1 SamaraIsabelaMaiaDeOliveira_DISSERT.pdf: 1784979 bytes, checksum: b34f948642b206c54a12e4d4583fcf0c (MD5) / Made available in DSpace on 2017-04-11T18:05:37Z (GMT). No. of bitstreams: 1 SamaraIsabelaMaiaDeOliveira_DISSERT.pdf: 1784979 bytes, checksum: b34f948642b206c54a12e4d4583fcf0c (MD5) Previous issue date: 2016-12-15 / A s?filis ? uma doen?a infecciosa que permanece como um dos principais agravos de notifica??o a ser enfrentado em ?mbito global. No contexto materno-infantil relaciona-se a efeitos delet?rios a partir da transmiss?o vertical e exp?e o bin?mio m?e e filho a riscos como o aborto e a morte perinatal. Desse modo, a??es efetivas para o controle da doen?a devem ser realizadas no pr?-natal, em momento oportuno, para garantir a preven??o da forma cong?nita da doen?a. Neste sentido, esta pesquisa objetiva analisar as notifica??es de s?filis gestacional e cong?nita e os fatores relacionados ? transmiss?o vertical. Trata-se de uma pesquisa de abordagem quantitativa epidemiol?gica, tipo seccional, de dados secund?rios, realizado no ano de 2016. A amostra foi composta a partir dos crit?rios de elegibilidade e totalizou 129 notifica??es de s?filis em gestantes e 132 notifica??es para s?filis cong?nita no per?odo entre junho de 2011 e dezembro de 2015, no Munic?pio de Natal/RN. A coleta de dados ocorreu entre os meses de maio a agosto por meio do banco do Sistema de Informa??o de Agravos de Notifica??o. Os dados foram analisados pela estat?stica descritiva e inferencial. Os testes Qui-Quadrado, T-Student e Fisher foram utilizados para verificar as associa??es entre as vari?veis de interesse. A pesquisa recebeu parecer favor?vel pelo Comit? de ?tica da Universidade Federal do Rio Grande do Norte, sob o n?mero 1.449.134 e Certificado de Apresenta??o para Aprecia??o ?tica 53305315.3.0000.5537. No per?odo investigado foi observado um incremento de casos notificados no ano de 2012. O perfil materno registrado aponta mulheres com idade m?dia de 24,78 anos, pardas (70,5%), residentes na zona urbana (95,3%) do Munic?pio de Natal. A an?lise do pr?-natal identificou predom?nio do diagn?stico materno no terceiro trimestre gestacional (69%) e presen?a de testes n?o trepon?micos reagentes em 94,6% das mulheres no momento do parto. No tocante ao tratamento materno, apenas 1,6% destas mulheres foram registradas com esquema de tratamento adequado e 16,3% dos parceiros foram tratados concomitantemente ?s gestantes. Nos desfechos relativos ?s crian?as, 78,8% foram registradas como assintom?ticas, contudo, essa vari?vel apresentou signific?ncia estat?stica quando relacionada ? titula??o do teste n?o trepon?mico materno e ? realiza??o de tratamento antes do parto. Na an?lise espacial por georreferenciamento, foi identificado o predom?nio de casos nos bairros Quintas e Felipe Camar?o, ambos assistidos pelo Distrito Sanit?rio Oeste do munic?pio. Os resultados apontam, al?m disso, para lacunas importantes nos processos de vigil?ncia epidemiol?gica quanto ao preenchimento das notifica??es no que versa a informa??es ignoradas e em branco. A an?lise da notifica??o da s?filis gestacional e cong?nita, possibilitou concluir que a transmiss?o vertical esteve relacionada a perdas de oportunidades diagn?sticas e terap?uticas. A elabora??o de estrat?gias para detec??o precoce e ades?o ao tratamento da doen?a devem ser adotadas, tendo em vista o fortalecimento da assist?ncia e a quebra na cadeia da transmiss?o vertical da s?filis. Ressalta-se a necessidade de qualifica??o profissional para notifica??o da doen?a e amplia??o no fornecimento de informa??es ? vigil?ncia epidemiol?gica, a fim de possibilitar a continuidade da an?lise ao agravo. / Syphilis is an infectious disease that remains as one of the major reporting aggravations to be addressed globally. In the maternal-infant context it is related to deleterious effects from the vertical transmission and exposes the mother-child binomial to risks such as abortion and perinatal death. Thus, effective actions to control the disease must be performed in prenatal care, in a timely manner, to ensure the prevention of the congenital form of the disease. In this sense, this research aims to analyze the reports of gestational and congenital syphilis and the factors related to vertical transmission. This is a cross-sectional, epidemiological, epidemiological approach to secondary data, conducted in 2016. The sample was composed of eligibility criteria and totaled 129 reports of syphilis in pregnant women and 132 reports for congenital syphilis in the period Between June 2011 and December 2015, in the Municipality of Natal / RN. Data collection occurred between May and August through the Database of the Notification of Injury Information System. Data were analyzed by descriptive and inferential statistics. The Chi-square, T-Student, and Fisher tests were used to verify the associations between the variables of interest. The research received a favorable opinion by the Ethics Committee of the Federal University of Rio Grande do Norte under number 1,449,134 and Certificate of Presentation for Ethical Appraisal 53305315.3.0000.5537. In the period under investigation, there was an increase in reported cases in the year 2012. The registered maternal profile indicates women with a mean age of 24.78 years, browns (70.5%), living in the urban area (95.3%) of the Municipality from Natal. The prenatal analysis identified a predominance of maternal diagnosis in the third gestational trimester (69%) and presence of non-treponemal reactive tests in 94.6% of the women at the time of delivery. Regarding maternal treatment, only 1.6% of these women were registered with an adequate treatment regimen and 16.3% of the partners were treated concomitantly with the pregnant women. In the outcomes related to the children, 78.8% were registered as asymptomatic, however, this variable presented statistical significance when related to the titration of the non-treponemal maternal test and to the pre-delivery treatment. In the spatial analysis by geo - referencing, the predominance of cases in Quintas and Felipe Camar?o neighborhoods, both assisted by the Sanitary District West of the municipality, was identified. The results point, moreover, to important gaps in the epidemiological surveillance processes regarding the filling of notifications regarding unknown and blank information. The analysis of the notification of gestational and congenital syphilis made it possible to conclude that vertical transmission was related to loss of diagnostic and therapeutic opportunities. The development of strategies for early detection and adherence to treatment of the disease should be adopted, with a view to strengthening care and breaking down the vertical syphilis transmission chain. The need for professional qualification for notification of the disease and extension in the provision of information to epidemiological surveillance is emphasized, in order to allow the continuity of the analysis to the disease.

Submitted by Jadson Francisco de Jesus SILVA (jadson@uefs.br) on 2018-07-20T21:53:39Z No. of bitstreams: 1 DISSERTA??O PAULO ROBERTO finalz?o 09 03.pdf: 3626215 bytes, checksum: a916a4a7fbf307b65ccad4330d1dd18c (MD5) / Made available in DSpace on 2018-07-20T21:53:39Z (GMT). No. of bitstreams: 1 DISSERTA??O PAULO ROBERTO finalz?o 09 03.pdf: 3626215 bytes, checksum: a916a4a7fbf307b65ccad4330d1dd18c (MD5) Previous issue date: 2018-02-22 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Study qualitative, exploratory, with the objective of understanding the experiences of families of children with microcephaly by Zika virus. For the production of empirical data we explore the narratives of relatives contained in videos posted on the YouTube Internet platform published between 10/01/2015 and 07/31/2016, as well as narratives obtained from an in-depth interview, of the story-theme design applied in 11 family members of children with microcephaly attended at the Association of Parents and Friends of the Exceptional in Feira de Santana, as well as field diary material. The data collection took place between September and November 2017. For the treatment of the data we adopted the thematic content analysis and the iconographic analysis. The results are organized in: Article 1 - Bad news: experiences and feelings of families regarding the diagnosis of microcephaly by Zika virus; A session entitled: Understanding the family dynamics of study participants; Article 2 - "Well run, very fast ...": experiences of care of mothers of children with microcephaly by Zika; Article 3 - Family organization to take care of the child with microcephaly by z?ka virus. Microcephaly is revealed in the prenatal period, through imaging tests, or during the immediate or late postpartum. Relatives live with feelings of sadness, despair, pain, fright, commotion, disorientation and terror. After diagnosis, family members seek to understand microcephaly through internet resources, and question God's permission and the relevance of scientific knowledge. Mothers experience day-to-day organizing and cleaning the home environment, caring for their children and the specific care of the child with microcephaly, regarding lullaby, since children cry frequently, requiring the mother to spend hours with the child in the lap; Give a shower; change diapers; to feed; play; and, stimulate. They learn to differentiate cognitive, psychomotor, auditory, and visual impairments; recognize progress in the development and new needs of children; identify episodes of seizure; consider patience and attention relevant to care; and, seek to learn about new thematic and unknown terms such as calcifications. Family members build a network of solidarity and unity for the benefit of the child, family relationships are strengthened, bringing together previously conflicting relationships. Caregivers include mothers, fathers, grandparents, sisters, cousins, aunts, friends and neighbors, with the mother being the protagonist who also coordinates and defines the roles played by other people. Family members practice care that has been organized in four dimensions: "Take care"; Encourage; Access Resources and Services. We recommend that family members and health workers attend to the restriction of social interaction, weakening marital relationships, jealousy behaviors on the part of siblings, worsening of grandparents' health conditions, and financial difficulties that may affect the family of children with microcephaly. / Estudo qualitativo, do tipo explorat?rio, com objetivo de compreender as experi?ncias de fam?lias de crian?as com microcefalia por Zika v?rus. Para produ??o de dados emp?ricos exploramos as narrativas de familiares contidas em v?deos postados na plataforma virtual da internet YouTube publicados entre 01/10/2015 e 31/07/2016, e tamb?m narrativas obtidas de entrevista em profundidade, do desenho est?ria-tema aplicados em 11 familiares de crian?as com microcefalia atendidos na Associa??o de Pais e Amigos dos Excepcionais em Feira de Santana, al?m de material do di?rio de campo. A coleta de dados ocorreu entre setembro a novembro de 2017. Para tratamento dos dados adotamos a an?lise de conte?do tem?tica e a an?lise iconogr?fica. Os resultados encontram-se organizados em: Artigo 1 ? M?s not?cias: experi?ncias e sentimentos de fam?lias face o diagn?stico de microcefalia por Zika v?rus; Uma se??o intitulada: Compreendendo a din?mica familiar dos participantes do estudo; Artigo 2 ? ?Bem corrido, muito corrido...?: experi?ncias de cuidado de m?es de crian?as com microcefalia por Zika; Artigo 3 ? Organiza??o familiar para cuidar da crian?a com microcefalia por z?ka v?rus. A microcefalia ? revelada no per?odo pr?-natal, atrav?s de exames de imagens, ou durante o p?s-parto imediato ou tardio. Os familiares convivem com sentimentos de tristeza, desespero, dor, susto, como??o, desorienta??o e terror. Ap?s o diagn?stico, os familiares buscam compreender a microcefalia atrav?s dos recursos da internet, e questionam a permiss?o de Deus e a relev?ncia do conhecimento cient?fico. As m?es experienciam o dia a dia organizando e limpando o ambiente dom?stico, exercendo os cuidados aos filhos e o cuidado espec?fico ? crian?a com microcefalia, referentes a: ninar, pois as crian?as choram com frequ?ncia, necessitando que a m?e passe horas com a crian?a no colo; dar banho; trocar fralda; alimentar; brincar; e, estimular. Elas aprendem a diferenciar as defici?ncias cognitivas, psicomotoras, auditivas e visuais; reconhecem os avan?os no desenvolvimento e as novas necessidades das crian?as; identificam epis?dios de convuls?o; consideram a paci?ncia e a aten??o relevantes para o cuidado; e, buscam apreender sobre novas tem?ticas e termos desconhecidos como calcifica??es. Os familiares constroem uma rede de solidariedade e uni?o em prol da crian?a, as rela??es familiares s?o fortalecidas, aproximando rela??es antes conflituosas. Participam do cuidado as m?es, pais, av?s, irm?s (os), primos (as), tias (os), amigas e vizinhas, havendo protagonismo da m?e que tamb?m coordena e define os papeis desempenhados pelas outras pessoas. Os familiares exercem cuidados que foram organizados em quatro dimens?es: Cuidar Integralmente; ?Tomar Conta?; Estimular; Acessar Recursos e Servi?os. Recomendamos que os familiares e trabalhadores da sa?de atentem para a restri??o do conv?vio social, enfraquecimento das rela??es conjugais, comportamentos que indiquem ci?mes por parte dos irm?os, agravamento das condi??es de sa?de das av?s e dificuldades financeiras que podem repercutir na fam?lia de crian?as com microcefalia.

Excessive unobserved firepower expenditures by Allied forces during the Vietnam War defied the traditional counterinsurgency principle that population protection should be valued more than destruction of the enemy. Many historians have pointed to this discontinuity in their arguments, but none have examined the available firepower records in detail. This study compiles and analyzes available, artillery-related U.S. and Allied archival records to test historical assertions about the balance between conventional and counterinsurgent military strategy as it changed over time. It finds that, between 1965 and 1970, the commanders of the U.S. Military Assistance Command, Vietnam (MACV), Generals William Westmoreland and Creighton Abrams, shared significant continuity of strategic and tactical thought. Both commanders tolerated U.S. Army, Marine Corps, and Allied unobserved firepower at levels inappropriate for counterinsurgency and both reduced Army harassment and interdiction fire (H&I) as a response to increasing budgetary pressure. Before 1968, the Army expended nearly 40 percent of artillery ammunition as H&I – a form of unobserved fire that sought merely to hinder enemy movement and to lower enemy morale, rather than to inflict any appreciable enemy casualties. To save money, Westmoreland reduced H&I, or “interdiction” after a semantic name change in February 1968, to just over 29 percent of ammunition expended in July 1968, the first full month of Abrams’ command. Abrams likewise pursued dollar savings with his “Five-by-Five Plan” of August 1968 that reduced Army artillery interdiction expenditures to nearly ten percent of ammunition by January 1969. Yet Abrams allowed Army interdiction to stabilize near this level until early 1970, when recurring financial pressure prompted him to virtually eliminate the practice. Meanwhile, Marines fired H&I at historically high rates into the final months of 1970 and Australian “Harassing Fire” surpassed Army and Marine Corps totals during the same period. South Vietnamese artillery also fired high rates of H&I, but Filipino and Thai artillery eschewed H&I in quiet areas of operation and Republic of Korea [ROK] forces abandoned H&I in late 1968 as a direct response to MACV’s budgetary pressure. Financial pressure, rather than strategic change, drove MACV’s unobserved firepower reductions during the Vietnam War.