Introdução: A composição corporal nos seres humanos se altera com a idade, mas as causas e consequências dessas mudanças são apenas em parte compreendidas. Uma mudança que é cada vez mais reconhecida por ter efeitos importantes na velhice é a perda de tecidos moles, particularmente de massa muscular esquelética, denominada \"sarcopenia\". Recentemente, tem sido demonstrada a relação entre a composição corporal e estado nutricional do paciente com a evolução e prognóstico em certas doenças. Existem várias estratégias e métodos para avaliação da sarcopenia, incluindo-se a tomografia computadorizada (TC) e a ressonância magnética (RM). Objetivos: Comparar variações das medidas lineares e de área do músculo psoas entre TC e RM, avaliar a variação inter-observador das medidas obtidas e identificar as ações para implantação desta medida nos relatórios de exame, instituindo protocolo de avaliação de sarcopenia para todos pacientes submetidos à TC ou RM de abdome em serviço de imagem. Materiais e métodos: Estudo retrospectivo de pacientes que foram submetidos à TC e RM do abdome, com um intervalo entre os exames de até 7 dias, tendo sido incluídos 47 indivíduos par análise. Os exames foram analisados buscando obtenção das medidas lineares e de área do músculo psoas por dois observadores independentes, utilizando o software de visualização DICOM OsiriX®. Resultados: Não foi observada diferença estatisticamente significante entre as medidas lineares, bem como entre as medidas de área para o mesmo observador na comparação entre TC e RM, com alta concordância entre os métodos. Houve excelente concordância entre os dois observadores para as medidas lineares e de área nos dois métodos. Conclusões: As medidas lineares e de área dos músculos psoas obtidas na TC e na RM são comparáveis, com alta concordância na avaliação pareada, indicando a possibilidade de serem utilizadas de maneira intercambiável na avaliação de sarcopenia. Houve excelente concordância entre os observadores para as medidas lineares e de área dos músculos psoas obtidas na TC e na RM, indicando alta reprodutibilidade. / Introduction: Body composition in humans changes with age, but the causes and consequences of these changes are understood only in part. One change is increasingly recognized to have significant effects on aging is loss of soft tissue, particularly skeletal muscle, called \"sarcopenia\". It has been recently demonstrated the relationship between body composition and nutritional status of the patient with the evolution and prognosis in certain diseases. There are several strategies and methods for evaluation of sarcopenia, including computed tomography (CT) and magnetic resonance imaging (MRI). Purposes: To compare variations of linear measurements and the psoas muscle area between CT and MRI to evaluate the inter-observer variation in measurements obtained and identify the actions to implement this measure in the examination reports, establishing sarcopenia evaluation protocol for all patients undergoing CT or MRI of the abdomen in image service. Methods: Retrospective study of patients who underwent CT and MRI of the abdomen, with an interval between examinations of up to 7 days and were included 47 subjects pair analysis. The tests were analyzed seeking obtain measures and the psoas muscle area by two independent observers, using the visualization software DICOM OsiriX®. Results: There was no statistically significant difference between the linear measurements, and between the area measurements for the same observer in the comparison between CT and MRI with high concordance between the methods. There was excellent agreement between the two observers for linear and area for both methods. Conclusions: The linear measurements and area of the psoas muscles obtained from CT and MRI are comparable with high concordance in paired assessment, indicating the possibility of being used interchangeably in the evaluation of sarcopenia. There was excellent agreement between observers for linear and area of the psoas muscles obtained from CT and MRI, indicating high reproducibility.

INTRODUÇÃO: O cuidado nutricional é parte essencial para o acompanhamento integral da crescente população idosa, principalmente quando na presença de doenças crônicas e neurodegenerativas e morbidades psiquiátricas. A Mini Avaliação Nutricional (MAN®), tem sido utilizada para este fim, e em algumas situações, informações adicionais a essa ferramenta são necessárias. OBJETIVOS: Caracterizar o estado nutricional de idosos acompanhados em ambulatório de neuropsiquiatria geriátrica. MÉTODOS: Foi obtida uma amostra de conveniência selecionada aleatoriamente entre pacientes idosos com diagnóstico de depressão (DEP), doença de Alzheimer (DA) e outros transtornos psiquiátricos (OTP). O estado nutricional foi avaliados através da MAN®, pelo índice de massa corporal (IMC= peso/altura2) e pelas circunferências do braço (CB) e panturrilha (CP). Os dados referentes ao consumo de medicamentos também foram obtidos, considerando-se como polifarmácia o consumo de mais de três medicamentos/dia. Os dados de diagnóstico médico e exames laboratoriais foram obtidos do prontuário médico. Foram avaliados 217 indivíduos no total, distribuídos conforme o diagnóstico clínico: grupo DEP= 107 (49,3%); grupo DA=59 (27,2%) e grupo OTP=51 (23,5%). RESULTADOS: O escore da MAN® identificou risco nutricional em 67,3%, 69,5% e 54,9%, e desnutrição em 14,0%, 13,6% e 27,5% dos pacientes em DEP, DA e OTP respectivamente. O baixo peso, avaliado pelo IMC foi observado em 29,0% (DEP), 24,1% (DA) e 45,1% (OTP) dos avaliados. A prevalência de anemia foi de 11,2% (DEP), 10,2% (DA) e 19,6% (OTP); sendo mais frequente em mulheres em DEP e OTP e em homens em DA. A média para vitamina D em todos os grupos encontrava-se na insuficiência. A presença de colesterol total acima dos intervalos de normalidade foi de 47,0% (DEP), 36,3% (DA) e 31,8% (OTP). Foi observada hiperglicemia em 52,9% (DEP), 48,1% (DA) e 41,6% (OTP) dos pacientes. A polifarmácia foi observada em 18,7% (DEP), 15,2% (DA) e 19,6% (OTP). Não houve associação significativa entre o uso de medicamentos e o estado nutricional, embora tenha sido apontado um direcionamento ao risco de desnutrição com o uso de medicamentos para o tratamento da depressão (inibidores seletivos de receptação de serotonina), demências (inibidores de colinesterase), cloridrato de omeprazol e indutores do sono. CONCLUSÕES: o risco nutricional e a desnutrição são prevalentes na população estudada, independente do grupo específico de doença neuropsiquiátrica ou demência. Esses achados demandam e justificam um monitoramento nutricional permanente para esses indivíduos, uma vez que vem acompanhados de outras deficiências específicas que comprometem a saúde de forma geral, como a anemia e insuficiência de vitamina D. A elaboração de planos educativos envolvendo os pacientes, cuidadores e a equipe médica, poderá contribuir para a melhora dessas condições. / INTRODUCTION: Nutritional care is an essential part for the integral follow - up of the growing elderly population, especially in the presence of chronic and neurodegenerative diseases and psychiatric morbidities. The Mini Nutrition Assessment (MAN®) has been used for this purpose, and in some situations, additional information to this tool is necessary. OBJECTIVES: To characterize the nutritional status of elderly patients in a geriatric neuropsychiatry clinic. METHODS: A randomly selected convenience sample was obtained among elderly patients diagnosed with depression (DEP), Alzheimer\'s disease (AD) and other psychiatric disorders (OTP). The nutritional status was evaluated through MAN®, body mass index (BMI = weight / height2) and circumference of arm (CB) and calf (CP). The data referring to the consumption of medicines were also obtained, considering as polypharmacy the consumption of more than three medications/day. The data of medical diagnosis and laboratory tests were obtained from the medical record. A total of 217 individuals were evaluated, distributed according to the clinical diagnosis: DEP = 107 (49.3%); Group DA = 59 (27.2%) and OTP group = 51 (23.5%). RESULTS: The MAN® score identified nutritional risk in 67.3%, 69.5% and 54.9%, and malnutrition in 14.0%, 13.6% and 27.5% of the patients in DEP, DA and OTP respectively. Low weight, evaluated by BMI, was observed in 29.0% (DEP), 24.1% (AD) and 45.1% (BTP) of the evaluated patients. The prevalence of anemia was 11.2% (DEP), 10.2% (AD) and 19.6% (OTP); Being more frequent in women in DEP and OTP and in men in AD. The mean for vitamin D in all groups was in the insufficiency. The presence of total cholesterol above the normality intervals was 47.0% (DEP), 36.3% (DA) and 31.8% (OTP). Hyperglycemia was observed in 52,9% (DEP), 48,1% (AD) and 41,6% (OTP) of the patients. Polypharmacy was observed in 18.7% (DEP), 15.2% (DA) and 19.6% (OTP). There was no significant association between drug use and nutritional status, although there was a trend towards malnutrition with the use of drugs to treat depression (selective serotonin reuptake inhibitors), dementias (cholinesterase inhibitors), Omeprazole hydrochloride and sleep inducers. CONCLUSIONS: nutritional risk and malnutrition are prevalent in the population studied, regardless of the specific group of neuropsychiatric disease or dementia. These findings demand and justify a permanent nutritional monitoring for these individuals, since they are accompanied by other specific deficiencies that compromise health in general, such as anemia and insufficiency of vitamin D. The elaboration of educational plans involving patients, caregivers and The medical team, could contribute to the improvement of these conditions.

Made available in DSpace on 2016-04-28T20:58:07Z (GMT). No. of bitstreams: 1 Soraya Ramirez Moreno.pdf: 857215 bytes, checksum: 3fd04385b3a452dcfe91c58643162951 (MD5) Previous issue date: 2009-11-11 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The present study had the purposed of analyzing the concept of school inclusion - having students with deficiencies as primary focus - as expressed in educational and psychological literature. The search for publications was done at PEPSIC and SCIELO inside CAPES website, educational online bases and manual search in books and papers published from 1994 to 2008. Four elements were analyzed linked to the concept of school inclusion: the target population, the principles that underlay school inclusion, the school inclusion objectives and school inclusion policies. As a result, it was verified that school inclusion is a wide-ranging concept, inserted in a wide social inclusion concept; the basic principles behind it were already built-in in the first education initiatives to the people with deficiencies. The origins of problematic aspects of school inclusion have been identified and discussed. It was concluded that, being a complex matter, there is not a single concept of school inclusion of students with deficiencies. Such a diversity of conceptions may be due to the fact that the population that seeks/has to be included has grown and collisions appeared between the regular school and the special school as holders of the education of students with deficiencies / O presente estudo teve como objetivo analisar o conceito de inclusão escolar para alunos com deficiências, expresso na literatura das áreas da educação e da psicologia. A busca de publicações foi feita por acesso às bases de dados S PEPSIC e SciELO pertencentes ao Portal da Coordenação Aperfeiçoamento de Pessoal de Nível Superior CAPES, na base de dados Educação Online, e pela busca manual em livros e artigos publicados no período de 1994 a 2008. Foram analisados quatro elementos vinculados ao conceito de inclusão escolar: a população-alvo, os princípios que subjazem à inclusão escolar, os objetivos da inclusão escolar e a implantação da inclusão escolar. Como resultado constatou-se- que a inclusão escolar é um conceito abrangente que se insere num conceito mais amplo de inclusão social, e que os princípios que subjazem a ele, já estavam embutidos nas primeiras iniciativas de educação às pessoas com deficiências. Foram identificadas as origens de aspectos problemáticos que, na atualidade são discutidos quando se fala de inclusão escolar. Concluiu-se que não há uma concepção única de inclusão escolar para alunos com deficiências por ser este um conceito complexo. Apontam-se como prováveis causas dessa diversidade de concepções, o fato de que a abrangência da população que visa atingir foi ampliada, e os embates surgidos entre a escola regular e a escola especial como detentoras da educação ou escolarização dos alunos com deficiências

Made available in DSpace on 2016-04-27T18:11:45Z (GMT). No. of bitstreams: 1 Dissertacao Cristina Dantas.pdf: 662289 bytes, checksum: 37cf68ec55bb9fc5d535ff56f0ff2cdd (MD5) Previous issue date: 2005-08-16 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The objective of this dissertation is to analyze some speech therapy practices developed in institutions for people with deficiencies. These practices have, among other proposals, the aim to be include such people in the work universe. Four such institutions were selected, all situated in the city of São Paulo and in the Greater São Paulo area. Speech therapy specialists who work in these institutions were interviewed. The professional experience of the researcher was also presented in a fifth institution. The question of symbolic inclusion deserved special attention. It has been defined as a way of allowing access to elements of culture, aiming for integration and the recognition of differences. It has been said that the mere physical inclusion , in other words, the law enforcing the hiring of people with deficiencies, does not promote social insertion on its own and, many times, masks prejudiced attitudes. The effectuation and implementation of the Protection Laws, i.e. the rights that guarantee the hiring of these people either in the public or private sectors, were also presented and discussed, as were the need to recognize them as effective members of society and the ambivalence exclusion/inclusion. In this sense, it is suggested that the people with deficiencies should act as active citizens and fight for their rights in order to belong to diverse social contexts. It has been concluded that it is essential that the speech therapist engage himself/herself in such problems not only by knowing the laws, but also by taking the theme and its implications to clinical approaches, as to allow patients to develop their potential / O objetivo dessa dissertação é analisar algumas práticas fonoaudiológicas desenvolvidas em instituições para pessoas portadoras de deficiência (PPDs) que têm entre suas propostas a inserção das mesmas no universo do trabalho. Foram selecionadas quatro dessas instituições, situadas na cidade de São Paulo e na Grande São Paulo, e realizadas entrevistas com os fonoaudiólogos que nelas atuam. Também foi apresentada a experiência profissional da pesquisadora em uma quinta instituição. A questão da inclusão simbólica mereceu atenção especial, sendo esta definida como uma forma de possibilitar o acesso aos elementos da cultura, visando então a integração e o reconhecimento das diferenças. Constatou-se que a simples inclusão física , ou seja, a contratação exigida por lei da pessoa portadora de deficiência não promove, por si só, a inserção social, podendo, muitas vezes, mascarar atitudes preconceituosas. Também foram apresentadas e discutidas a efetivação e implementação das Leis de Proteção, ou seja, os direitos que garantem a contratação dessas pessoas, tanto na esfera pública quanto na privada, bem como a necessidade de reconhecê-las como membros efetivos da sociedade e a ambivalência exclusão/inclusão. Nesse sentido, sugere-se que as próprias PPDs devem agir como cidadãs ativas e lutar por seus direitos, buscando pertencer aos diversos contextos sociais. Concluiu-se que é imprescindível que o fonoaudiólogo se engaje nessa problemática, não só inteirando-se das leis, mas também trazendo o tema e suas implicações nos atendimentos clínicos, possibilitando que os pacientes desenvolvam suas mais diversas potencialidades

Made available in DSpace on 2016-04-27T18:12:05Z (GMT). No. of bitstreams: 1 Danielle Giacometti Nagy.pdf: 444167 bytes, checksum: 5346da3dea18bdd6be32ea629477e37c (MD5) Previous issue date: 2005-12-13 / This essay has, as its core objective, the analysis of clinical situations that reveal a mother s difficulties in the reception, acknowledgement and care of her offspring, when the child displays multiple deficiencies. As an integral part of this, the analysis also discusses how the Speech Therapy may, in the course of therapeutic intervention, contribute for a mother s development of a greater disposition for facing the hindrances that may be presented by her child. To that end, the main theoretical basis that served as reference were Winnicott s psychoanalytic theories on the relationship between a mother and her impaired child (Winnicott, D.W. (1957). Mother and Child. A Primer of First Relationships., New York: Basic Books, Inc.), which is important in understanding the phono-audiologic work dedicated to the relationship between mother and disabled child. The methodology employed was a qualitative-clinic one with four distinct relationship dynamics being applied under frequent observation of Speech Therapy Clinic. These, once understood by the healthcare professional, may aid in the success of a particular treatment by propitiating a singular analysis of factors contributing to the dysfunctional relationship between mother and child, such as: body stigmas that prevent attachment, excessive or insufficient care, denial and hindrances to the feeding process. Seven distinct cases had their summarised profiles presented and, through categories, it was ultimately possible to understand and analyse their clinic indications. For every one among the cases, phono-audiological procedures were reviewed to demonstrate that clinical intervention may cause the psychological profile of these challenged women to be altered positively, in a manner such as to enable them to internally transform that which has brought them suffering, and assimilate it. Hence, the essay deals with a Speech Therapy intervention such, that is not restricted to the technical questions of the sort of the suitability of phono-articulatory organs, feeding or the development of communication, but open to fundamental aspects of a child s psychological development. Additionally, in so doing, this proposition will be possibly contributing to the Speech Therapyst s referential in considering developing an effort with the mothers of impaired children that surpasses the orientation and teaching of procedures to offer a basis in interventions that promote the embracing of these mothers and consequential better development of children with multiple deficiencies / Este trabalho teve como objetivo analisar situações clínicas que revelam algumas dificuldades das mães na recepção, no reconhecimento e no cuidado de seus filhos que apresentam múltiplas deficiências; e discutir como o fonoaudiólogo, em sua intervenção terapêutica, pode contribuir para que elas desenvolvam uma disponibilidade maior para o enfrentamento dos entraves e das complicações que uma criança com deficiência pode apresentar. Para tanto, o principal referencial teórico foi a teoria psicanalítica de Winnicott, importante para a compreensão do trabalho fonoaudiológico voltado à relação da mãe com seu filho deficiente. A metodologia utilizada foi a clínico-qualitativa, sendo apresentadas quatro dinâmicas relacionais entre mãe e filho, as quais foram observadas com certa freqüência na clinica fonoaudiológica, e que, uma vez compreendidas pelo terapeuta, podem auxiliar no sucesso do tratamento, já que permitem que cada díade seja acolhida de maneira singular. São elas: evidências no corpo dificultando o vínculo; cuidados excessivos ou insuficientes; negação do diagnóstico; problemas para alimentar o filho. Sete casos tiveram seus perfis apresentados resumidamente, e através das categorias, foi possível compreender e analisar vinhetas clínicas destes casos, sendo que em cada uma delas foram abordados procedimentos fonoaudiológicos, mostrando como a intervenção clínica pôde provocar deslizamentos no perfil destas mulheres, ajudando a transformar aquilo que as faz sofrer. Trata-se de uma intervenção fonoaudiológica que não se restringe às questões técnicas, como a adequação dos órgãos fonoarticulatórios, da alimentação ou do desenvolvimento de linguagem, mas abre campo para aspectos fundamentais do desenvolvimento psíquico da criança, podendo contribuir na constituição de referenciais para o fonoaudiólogo pensar em um trabalho com mães de deficientes que não seja, apenas, voltado para as orientações e o ensino de procedimentos, mas que possa se basear em intervenções que promovam o acolhimento dessas mães e que facilitem o amadurecimento da criança com múltipla deficiência.

Le risque de LH est augmenté en cas de déficit immunitaire acquis ou inné. Les déficits immunitaires innés associés à un risque accru de LH, sont les DICV (Déficit Immunitaire Commun Variable), XLP (Syndrome lymphoprolifératif lié au chromosome X) et ALPS (Syndrome lymphoprolifératif Autoimmun). L’objectif de notre travail était d’évaluer la prévalence de ces déficits immunitaires chez des enfants atteints de LH. Nous avons reçu, 395 prélèvements de patients atteints de LH au diagnostic. L’âge médian de la population étudiée est de 13 ans, allant de 3 à 18 ans. Le sex-ratio M/F est de 1.1. Il augmente à 3 au dessous de l’âge de 10 ans. Parmi les biopsies (n=84) qui ont été relues, 87% sont de type scléro-nodulaires (SN), 7% à cellularité mixte (CM) et 6% non spécifié. L’EBV est détecté in situ dans 23% des cas de LH. Les patients atteints de LH-EBV+ sont significativement plus jeunes que ceux atteints de LH-EBV- (p=3.10-4). Ce sont plus fréquemment des garçons que des filles (63% ; M/F : 1,7) et fréquemment de sous-type CM (40%). Enfin, ils ont une charge virale EBV significativement plus élevée (p=3.10-3) que les enfants qui ont un LH-EBV-.Parmi les 83 premiers enfants analysés, un immunophénotypage approfondi a montré une diminution de la population lymphocytaire par rapport aux témoins et une lymphopénie B fréquente (31 patients sur 83 soit 37% des patients). La lymphopénie B était corrélée aux facteurs pronostiques connus du LH. Dans un cas parmi les 31, une baisse des immunoglobulines a été mise en évidence ce qui est évocateur de DICV. Nous avons montré que dans les autres cas, les lymphopénies se corrigeaient à distance de la maladie. La recherche de profil cytokinique associé à ces lymphopénies (TGF, BAFF, IL-7) n’a pas permis de mettre en évidence de mécanisme physiopathologique simple pour expliquer ces lymphopénies. Nous émettons l’hypothèse qu’elles sont liées à l’exposition au contact des cellules tumorales à des signaux favorisant l’apopotose.En ce qui concerne la recherche d’autres déficits immunitaires innés, aucun cas évocateur de XLP n’a été mis en évidence sur la base de la quantification des lymphocytes NKT. Cinq cas parmi les 83 (6%) avaient une expansion de lymphocytes T DN (Lymphocytes TCRαβ CD4-CD8-) dans le sang périphérique. Des dosages de Fas ligand et d’IL-10 plasmatiques ont permis d’exclure un ALPS. Au total, nous n’avons pas pu affirmer de défaut qualitatif des sous-populations lymphocytaires évoquant les déficits immunitaires de type XLP et ALPS. Seule une lymphopénie B avec baisse des IgG est évocatrice de DICV. Nous avons étendu l’analyse à l’ensemble des patients (395patients) avec un contrôle à distance du diagnostic pour ceux qui étaient anormaux. Nous avons identifié 4 patients potentiellement atteints de DICV, 1,5%. Parallèlement, nous avons recherché un déficit de la réponse T anti-EBV par cytomètrie de flux et l’Elispot. L’étude de la réponse T anti-EBV par la cytométrie de flux, a montré une tendance vers une baisse de la production d’IL-2 par les CD4 et les CD8 de patients avec une charge virale EBV élevée en réponse à une stimulation par des peptides EBV en présence de lignées autologues. L’étude de la réponse T anti EBV par la technique d’ELISPOT sur 9 patients n’a pas montré globalement de déficit du contrôle de l’EBV sauf pour une jeune patiente de 10 ans ayant une charge virale EBV très élevée sans réponse T anti-EBV efficace. Les résultats que nous avons obtenus restent à approfondir, ce qui permettra d’enrichir les connaissances actuelles sur cette pathologie. / Hodgkin’s Lymphoma (HL) is one of the most frequent lymphomas occurring in childhood. In young children, there is a high predominance in boys and frequent association with Epstein-Barr Virus (EBV). Cohort studies have shown that patients affected by several immune deficiency syndromes - e.g. X-linked lymphoproliferative syndrome (XLP), functional deficit of Fas/FasL pathway and common variable immunodeficiency (CVID) - are risk factors of HL. We intend to search for qualitative and quantitative immune deficiencies as susceptibility factors to child's HL in a prospective study related to Euronet –PHL C1 protocol. Eighty-three patients at diagnosis of HL have been analysed. Median age of the study population is 13 years, (5-18 years). Gender-ratio M/F is 1.1 with a larger male predominance before the age of 10 (gender-ratio of 3). The search for a defect of NKT population that would be suggesting of XLP was negative in all patients. A moderate expansion of circulating TCRαβ+ double negative cells (DNT) has been detected in 5 patients. This expansion has been further explored in the hypothesis of a defect of Fas/FasL pathway by plasmatic quantification of Fas ligand and Il-10. This led to the exclusionof the diagnosis of ALPS. An unexpected high frequency of B-cell lymphopenia has been detected in 31 out of 83 patients (37%). Peripheral B cell lymphopenia was associated with the following poor prognostic factors: advanced stages (p<0.04), low hemoglobin (p<0.06) and B symptoms (p<0.01). B-cell lymphopenia was not statistically correlated with morphology (subtype, amount of tumor cells and necrosis). Remarkably, B-lymphocytic counts were significantly higher in patients with in situ EBV (<0.05).Only a B lymphopenia with low IgG level suggesting DICV was detected. We extended the analysis to all the 395 patients included in the protocol EURONET, so we identified 4 patients with CVID. These cases will be further explored by molecular analyses. In parallel, the specific T-cells response against EBV was studied by flow cytometry in 15 patients and ELISPOT assay in 9 patients with HL. Flow cytometry , suggested a decrease in production of IL-2 by CD4 T cells in patients with high EBV viral load in response to EBV latent and lytic-cycle peptides and autologous lymphoblatoid cells lines compared to controls or patients with LH-EBV-. The ELISPOT-IFNγ assay was used to determine the frequency of T cells that produced IFNγ in response to peptides. One patient demonstrated inappropriate EBV-specific T-cell IFNγ production (<10 IFNγ secreted T cells and >1,000 EBV copies per 250000 PBMCs). These cases will be further explored by molecular analyses.Our findings confirm the known epidemiological data of HL now mainly associated to NS subtype in children and adolescents and EBV status in HL at this age. We show that peripheral B cell lymphopenia in paediatric and adolescent HL patients is frequent and associated with poor prognosis factors. We confirm the association between CVID and HL.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2017-02-15T12:32:08Z No. of bitstreams: 1 DANIELA VICINANSA MONACO FERREIRA.pdf: 2575283 bytes, checksum: e154c9b7ae508a96205c1d597a55aee6 (MD5) / Made available in DSpace on 2017-02-15T12:32:08Z (GMT). No. of bitstreams: 1 DANIELA VICINANSA MONACO FERREIRA.pdf: 2575283 bytes, checksum: e154c9b7ae508a96205c1d597a55aee6 (MD5) Previous issue date: 2016-12-01 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Morbid obesity, a chronic and multifactorial disease, causes metabolic disorders and increases the risk of morbidity. Its prevalence has been increasing, with alarming data in Brazil and elsewhere. Globally, Brazil ranks second in number of bariatric surgeries, but surgical treatment is a challenge for the patients and the teams that provide care for these patients. Given the above, the present study aimed to assess changes in nutritional status and identify nutritional deficiencies before and 10 years after Roux-en-Y gastric bypass. This retrospective study lasted two years and included 166 patients submitted to Roux-en-Y gastric bypass at a private clinic. The statistical analyses included the chi-square, Fisher?s, Mann-Whitney, and Wilcoxon tests, analysis of variance (ANOVA), and generalized estimating equations. The significance level was set at 5%. At the ten-year follow-up, the percentage of excess weight loss (%EWL), body mass index (BMI), and weight regain were 51.64?18.03 (p<0.0001), 32.53?4.83 kg/m2 (p<0.0001), and 41% (p<0.0001), respectively, and the lipid and blood glucose profiles had improved (p<0.0001). Iron-deficiency anemia was found in 37.5% and 45.0% of the patients who attended the 10-year follow-up based on ferritin levels <15 ug/L and <30 ug/L, respectively. The effect of time was significant for hemoglobin, ferritin, iron overload (p<0.0001), and hematocrit (p=0.0007). Vitamin D deficiency was found in 29 patients (82.86%), and high parathormone (PTH), in 13 (41.94%). The effect of time was significant for PTH (p=0.0059). In conclusion, gastric bypass was a surgical success and improved the metabolic profile. Weight regain increased over time. The nutritional outcomes were iron-deficiency anemia and vitamin D deficiency associated with secondary hyperparathyroidism. These findings reaffirm the importance of multidisciplinary care and monitoring of nutritional deficiencies for the treatment of morbid obesity. / A obesidade m?rbida considerada uma doen?a cr?nica e multifatorial, que ocasiona desordens metab?licas e aumenta o risco de morbidade, vem crescendo, com dados alarmantes no Brasil e no Mundo. O Brasil ? o segundo Pa?s que mais realiza cirurgia bari?trica, sendo o tratamento cir?rgico, um desafio para os pacientes e para as equipes envolvidas no cuidado destes pacientes. Diante do exposto, o presente trabalho teve como objetivo avaliar a evolu??o do estado nutricional e identificar as defici?ncias nutricionais no pr? e no p?s-operat?rio de pacientes submetidos ao bypass g?strico em Y-de-Roux, com 10 anos de seguimento. O estudo realizado em dois anos, com delineamento retrospectivo longitudinal, envolveu 166 pacientes submetidos ao bypass g?strico em Y-de-Roux, em uma cl?nica privada. Na an?lise estat?stica, utilizou-se os testes Qui-Quadrado, Fisher, Mann-Whitney, Anova, Wilcoxon e Equa??es de Estimativas Generalizadas. O n?vel de signific?ncia adotado foi de 5%. Os resultados deste estudo, ap?s 10 anos de seguimento, demostraram percentual de perda do excesso de peso (%PEP) de 51,64?18,03 (p<0,0001); Indice de Massa Corporal (IMC) de 32,53?4,83 kg/m2 (p<0,0001); reganho de peso de 41% (p<0,0001). O perfil lip?dico e glic?mico diminuiu ao longo de 10 anos de seguimento (p<0,0001). Dos pacientes que permaneceram no estudo at? o final de 120 meses, 37,5% e 45,0%, apresentaram diagn?stico de anemia ferropriva, considerando-se os crit?rios utilizados de ferritina <15 ug/L e ferritina <30 ug/L, respectivamente. O efeito do tempo foi significativo para a hemoglobina, ferritina e sobrecarga de ferro, (p<0,0001) e hemat?crito (p=0,0007). Em rela??o ao metabolismo do c?lcio, 82,86% (29), apresentaram n?veis de defici?ncia de vitamina D e 41,94% (13) apresentaram PTH elevado. O efeito do tempo foi significativo para o PTH (p=0,0059). Em conclus?o, pacientes submetidos ao bypass g?strico, apresentaram sucesso cir?rgico e melhora do perfil metab?lico. O reganho de peso aumentou com o tempo de seguimento. A anemia ferropriva e a defici?ncia de vitamina D, associada ao hiperparatireoidismo secund?rio, foram desfechos nutricionais encontrados Tais achados reafirmam a import?ncia do cuidado multidisciplinar e ? aten??o ?s defici?ncias nutricionais para o tratamento da obesidade m?rbida.

The master thesis is focused on problems surrounding defects and deficiencies of running a swimming pool site. It deals with particular defects which can occur at swimming pool's site. Different public swimming pools in Brno were visited to conduct an evaluation of real defects and deficiencies. After conducting the overview of defects, a correction solution was design for each defect. The defects are ranked according a scale measuring danger which I created

<p>In this thesis, a parsimoniously parameterized digital predistorter is derived for linearization of the IQ modulation mismatch and the amplifier imperfection in the signal generator [1]. It is shown that the resulting predistorter is linear in its parameters, and thus they may be estimated by the method of least-squares. Spectrally pure signals are an indispensable requirement when the signal generator is to be used as part of a test bed. Due to the non-linear characteristic of the IQ modulator and power amplifier, distortion will be present at the output of the signal generator. The device under test was the IQ modulation mismatch and power amplifier deficiencies in the signal generator.</p><p>In [2], the dynamic range of low-cost signal generators are improved by employing model based digital pre-distortion and the designed predistorter seems to give some improvement of the dynamic range of the signal generator.</p><p>The goal of this project is to implement and verify the theory parts [1] using data program (Matlab) to improve the dynamic range of the signal generator. The design digital pre-distortion that is implemented in software so that the dynamic range of the signal generator output after predistortion is superior to that of the output prior to it. In this project, we have observed numerical<strong> </strong>problems in the proposed theory and we have found other methods to solve the problem.</p><p>The polynomial model is commonly used in power amplifier modeling and predistorter design. However, the conventional polynomial model exhibits numerical instabilities when higher order terms are included, we have used the conventional and orthogonal polynomial models. The result shows that the orthogonal polynomial model generally yield better power amplifier modeling accuracy as well as predistortion linearization performance then the conventional polynomial model.</p>

According to previous research, internalizing and externalizing problems tend to be comorbid or co-occur at different ages in development (Angold, Costello, & Erkanli, 1999). The question that this dissertation addresses is how and why internalizing and externalizing problems, two disorders that represent separate forms of psychopathology, co-occur in children. This is an important question for the developmental psychopathology perspective because an appreciation of the concept of co-occurrence is essential for explaining the development and taxonomy of internalizing and externalizing psychopathology, and for understanding the etiology and course of these symptoms (Achenbach, 1990). Attempts to explain co-occurrence have proposed that co-occurring psychopathology might represent distinct, meaningful syndromes (Angold & Costello, 1992; O’Connor et al., 1998), and in support of this idea, evidence of the existence of pure and co-occurring internalizing and externalizing problems has been found (Keiley et al., 2003). However, no previous study has identified heterogeneous developmental patterns of pure or combined internalizing and externalizing problems within a dynamic framework by taking trajectories of change into account. This dissertation uses data from the NICHD study of Early Child Care to explore the co-occurrence between internalizing and externalizing problems from age 2 to 12 with the use of Latent Class Growth Analysis. The sample included 1232 children (52% male). Different groups of children exhibiting low/normative, pure internalizing, pure externalizing, and co-occurring internalizing and externalizing problems across the 10 year period were identified. The higher risk groups deviated from the low/normative group in terms of antecedents, SES risk, medical risk, difficult temperament, and home environment. Moreover, children who exhibited pure moderate externalizing problems, and children who exhibited chronic externalizing problems, with and without co-occurring internalizing problems, engaged in more risky behaviors and were more likely to have friends who also engaged in risky behaviors. Furthermore, the pure chronic externalizing group and the groups scoring high on internalizing problems, with and without co-occurring externalizing problems, were more asocial with peers. Finally, children exhibiting chronic co-occurring externalizing and internalizing problems were more excluded by peers in comparison to the rest of the sample’s population.