Resumo: Tendo em vista que existem controvérsias na literatura quanto à existência de associação entre a doença periodontal e a artrite reumatóide e que as metodologias empregadas são tão diversas quanto os seus resultados e conclusões, este estudo transversal teve por objetivo avaliar a condição periodontal em portadores de artrite reumatóide e verificar se existe associação entre essas duas condições. Para isso, foram aplicados questionários de saúde geral e bucal, e foi realizado o exame periodontal em 49 portadores de artrite reumatóide e em 22 indivíduos não portadores de artrite reumatóide ou qualquer outra doença auto-imune. Fumantes e portadores de diabetes mellitus foram excluídos deste estudo. Os resultados indicaram que portadores de artrite reumatóide possuem menor número de dentes na cavidade bucal, apresentam maior extensão de placa bacteriana e maior proporção de sítios com perda de inserção periodontal avançada do que os indivíduos não portadores de artrite reumatóide Apesar da maior extensão de placa bacteriana dentre portadores de artrite reumatóide, a porcentagem de sítios que apresentaram sangramento marginal foi semelhante nos dois grupos, provavelmente devido ao uso de drogas antiinflamatórias e drogas de base, imunoreguladoras. Além disso, portadores de artrite reumatóide que utilizavam a associação de drogas de base apresentaram menor perda de inserção periodontal do que aqueles que não utilizavam a associação dessas drogas. Os resultados do estudo sugerem que existe associação entre periodontite e artrite reumatóide e que novos estudos serão necessários para identificar os fatores presentes nos portadores de artrite reumatóide que predispõem esses indivíduos a uma maior perda de inserção periodontal. / Abstract: There are controversies in the literature concerning the association between periodontal disease and rheumatoid arthritis. There are no consistent methodologies and results. The aim of this cross-sectional study was to assess periodontal condition in rheumatoid arthritis patients and verify if there is an association between these two conditions. We have produced general and dental health questionnaires and periodontal examination was achieved in 49 rheumatoid arthritis patients and 22 healthy individuals. Smokers and diabetes mellitus patients were excluded of the sample. Our results indicated that rheumatoid arthritis patients had lesser remaining teeth, higher extension of dental plaque and higher proportion of sites presenting advanced attachment loss than controls. Although rheumatoid arthritis patients had higher extension of dental plaque than the control group, gingival bleeding was similar between them, maybe because of the fact that rheumatoid arthritis patients take anti-inflammatory and disease-modifying antirheumatic drugs (DMARDs) for their treatment. Rheumatoid arthritis patients who were taking an association of two or more disease-modifying antirheumatic drugs had lesser attachment loss than patients that were taking only one of these drugs. Our results suggest that there is an association between periodontitis and rheumatoid arthritis and that more studies are required to identify specific risk factors for attachment loss in rheumatoid arthritis patients. / Orientador: Mirian Aparecida Onofre / Coorientador: Carlos Rossa Junior / Coorientador: Manoel Barros Bertolo / Banca: Silvana Regina Perez Orrico / Banca: Ricardo Guimarães Fischer / Mestre

abstract: Alcohol use disorders and internalizing disorders are highly comorbid in adults, but how this comorbidity unfolds over development is not well understood. Previous retrospective studies in adults have shown that internalizing problems are associated with a rapid transition from first drink and first regular drinking to the onset of alcohol dependence. Some results also suggest that internalizing is a stronger predictor of rapid transitions through later stages of alcohol involvement, but these stage-specific effects have not been explicitly tested. The present study utilized a prospective dataset to investigate effects of adolescent internalizing symptoms on speed of transition through multiple stages of alcohol involvement. Specifically, it was hypothesized that greater early internalizing symptoms would predict a later age of first drink, a slower transition from first drink to first binge, and a faster transition from first binge to first dependence symptom. The moderating effects of gender were also examined. Data were from a longitudinal study of children of alcoholics and matched controls (n = 454) followed from late childhood to mid-life. Linear regression and Cox regression were the primary analytic strategies. Covariates were externalizing symptoms, family history of alcohol use disorders, and gender. Analyses also controlled for age at which the participant entered each interval. Generally, stage-specific hypotheses concerning the effects of internalizing were not supported. Internalizing symptoms marginally predicted an earlier age of first drink and a faster transition from first binge to first dependence symptom, and significantly predicted a faster transition through the overall interval from first drink to first dependence symptom. Internalizing was a stronger predictor of rapid transitions for women, and the effects of internalizing were not specific to early or later stages of alcohol involvement among women. These results suggest that early internalizing problems are a general risk factor for a rapid transition through all stages of alcohol involvement, and this risk may be stronger for women than for men. These results have important implications for our theoretical understanding of the relationship between internalizing problems and alcohol use disorders as well as prevention and intervention efforts targeting these problems. / Dissertation/Thesis / Masters Thesis Psychology 2014

A coledocolitíase residual representa grande desafio na avaliação diagnóstica e proposta terapêutica. Neste contexto, realizamos estudo retrospectivo com o objetivo de avaliar critérios clínicos, laboratoriais e métodos de imagem para o seu diagnóstico; avaliar o resultado do tratamento através de procedimentos endoscópicos e cirúrgicos, bem como a ocorrência de complicações e sua repercussão no período de internação. Foram estudados 32 (trinta e dois) pacientes portadores de coledocolitíase residual internados na Clínica Cirúrgica do Hospital das Clínicas da Faculdade de Medicina da Universidade Federal de Goiás, no período de janeiro de 1995 a julho de 2001. Foram incluídos pacientes submetidos previamente a colecistectomia, nos quais o diagnóstico de coledocolitíase foi feito posteriormente (pela não realização de colangiografia trans-operatória) ou no próprio curso da colecistectomia, porém postergando-se o tratamento. Pudemos concluir: a maioria dos pacientes portadores de coledocolitíase residual tem como sintoma principal a icterícia; a ultra-sonografia não é um método diagnóstico eficaz, uma vez que demonstrou alteração de via biliar em cerca de 50% dos pacientes; tanto o procedimento endoscópico como o cirúrgico mostraram alto índice de clareamento da via biliar (acima de 90%), sendo a morbidade baixa e mortalidade nula em ambos os procedimentos; o período de internação foi menor quando o procedimento endoscópico foi realizado / Choledocholithiasis represents a great challenge in diagnostic evaluation and therapeutics. Because of it we\'ve proposed a retrospective study to analise the clinical and laboratorial criteria and image studies to the diagnosis of such condition. It was possible to evaluate the treatment (endoscopic or surgical) and complications with these information. Thus, with this aim, 32 (thirty-two) patients were evaluated. They were suffering from residual choledocholithiasis and were admitted on the Surgical Unit of the General Hospital of the Medical School of University of Goiás, from january 1995 to july 2001. It was included patients that were performed on a previous cholecistectomy. The diagnose of choledocholithiasis was get either during the surgery, although the definitive treatment had been postponed, or on the follow-up. We concluded that most part of the patients with residual choledocholithiasis were icteric and that the ultrasound study is not an effective method to detect residual choledocholithiasis (positive around 50%). Besides, both therapeutic procedures (endoscopic and surgical) were successful in the cleaning of biliary ducts (above 90%), had low morbidity and no mortality. The discharge of the patient was faster in case of endoscopic procedure

A fissura labiopalatina (FL/P) é uma das malformações craniofaciais mais comuns em humanos, com variação epidemiológica nas diferentes populações. Possui diferentes apresentações clínicas, divergindo de acordo com a extensão e estruturas acometidas, podendo acometer somente o lábio ou lábio e palato em conjunto, uni ou bilateralmente, de maneira completa ou incompleta ou apenas o palato (FP) tanto completa como incompletamente. Podem fazer parte de um quadro sindrômico, recebendo a denominação de FL/P sindrômica ou acontecer como um fenótipo isolado, sendo chamada de FL/P isolada ou não sindrômica. Em relação a etiologia da FL/P não sindrômica, a literatura afirma ser multifatorial com a predisposição genética associada a fatores ambientais. Apesar de se apresentarem frequentemente associadas, a FL/P e FP não sindrômicas são consideradas etiologicamente e embriologicamente distintas. Objetivo: Aprofundar e ampliar o conhecimento das FP isoladas não sindrômicas, descrevendo o fenótipo principal (FP isolada) e seus subfenótipos clínicos, investigando o fator genético relacionado à recorrência por meio do histórico familial e buscando elucidar possível fatores ambientais envolvidos por meio do histórico gestacional. Material e métodos: Foram coletados dados de 165 prontuários médicos de pacientes com FP isolada não sindrômica matriculados no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP). Para a coleta desses dados foram analisados segmentos do prontuário referentes a atendimentos realizados no HRACUSP em diferentes setores. Resultados: Em 165 pacientes estudados, o sexo feminino foi o mais acometido com 106 casos (64,24%) encontrados. O tipo de FP predominante foi a incompleta correspondendo a 88,48% da amostra total, sendo dentre elas a fissura de palato duro parcial a mais prevalente. Em cinco casos não foi possível realizar a classificação nos grupos referentes ao tipo de fissura adotados, sendo necessária a criação de um grupo de classificação adicional. Recorrência familial positiva foi relatada em 28,47% de 144 casos em que havia informação, e na maioria das vezes havia apenas 1 outro familiar acometido. A média da idade das mães e dos pais no momento da concepção foi de 26,9 e 31,4 anos, respectivamente. A porcentagem de abortos anteriores foi de 11,95% dos 92 casos informados e a consanguinidade foi de 3,29% dos 91 casos informados. A intercorrência mais frequentemente relatada (25 em 154 casos informados) foi o uso de medicamentos, tais como, antibióticos, anti-hipertensivos e medicamentos que auxiliam na prevenção do parto prematuro. Conclusão: O fenótipo FP isolada possui variações quanto à extensão de cometimento, sendo que as fissuras incompletas foram as mais frequentes e o sexo feminino predominantemente acometido. Em relação ao histórico familial e gestacional os dados que mais chamaram atenção estão relacionados ao percentual de recorrência familial (28,47%) e o uso de medicação durante a gestação. / Cleft lip and palate (CL/P) is one of the most common craniofacial malformations in humans, with epidemiological variation in different populations. It has different clinical presentations that diverge according to the extension and affected structures, and may either affect the lip or lip and palate together, unilaterally or bilaterally, in a complete or incomplete way or just affect the palate (CP) completely or incompletely. CL/P can either be related to a syndrome, classified as syndromic CL/P or unrelated to a syndrome, occurring as an isolated phenotype, designated as isolated or nonsyndromic CL/P. Regarding the etiology of nonsyndromic CL/P, research indicates multifactorial causes with a genetic predisposition associated with environmental factors. Although it is often present in association, nonsyndromic CL/P and CP are considered embryologically and etiologically distinct. Objective: To deepen and broaden the knowledge of individual nonsyndromic CP, describing the main phenotype (isolated CP) and its clinical subphenotypes, investigating the genetic factors related to recurrence through family history and to elucidate possible environmental factors involving gestational history. Material and Methods: Data were collected from 165 medical patients records with isolated nonsyndromic CP enrolled at the Hospital de Reabilitação de Anomalias Craniofaciais da Universidade de São Paulo (HRAC-USP). For data collection, segments of the records pertaining to care provided by HRAC-USP in different sectors were analyzed. Results: In the 165 patients studied, females were the most affected with 106 cases (64.24%) found. The predominant type of CP was incomplete corresponding to 88.48% of the total sample, and among these incomplete CP, the clefts involving partial hard palate were the most prevalent. In five cases it was impossible to classify the type of cleft, and the creation of an additional classification group was required. Positive familial recurrence was reported in 28.47% of 144 cases where information was available and in most cases there was only one other affected family member. The average age of mothers and fathers at conception was 26.9 and 31.4 years respectively. The percentage of previous miscarriages was 11.95% of the 92 reported cases and consanguineous marriage was found in 3.29% of the 91 reported cases. The most frequently reported complication (25 in 154 reported cases) was the use of drugs such as antibiotics, antihypertensives drugs, and drugs used to prevent premature birth. Conclusion: The phenotype Isolated CP presents variations in the extent of involvement, and incomplete clefts were the most frequent, with females predominantly affected. Regarding family history and gestational data what calls more attention were the percentage of familial recurrence (28.47%) and the use of medication during pregnancy.

Tuberculosis (TB) is acknowledged as an epidemic in South Africa. Health care professionals (HCPs), including dieticians, are at an increased risk for TB-infection compared to the general population. Implementation of the World Health Organization (WHO) TB infection control measures can protect HCPs from contracting TB; however, many studies have shown poor adherence to guidelines by HCPs. The aim of the study was to determine dieticians’ knowledge, attitudes and experiences in relation to TB at the workplace. A descriptive quantitative, cross-sectional research design was employed. Convenience sampling was applied. The online survey was conducted between August 2014 and March 2015. Data analysis included descriptive and inferential statistics. Ethical principles were adhered to. The sample consisted of 102 registered dieticians in South Africa. Good knowledge was displayed as two-thirds of dieticians correctly identified the National TB Management Guidelines and the main signs and symptoms of TB. However, a critical knowledge gap regarding TB transmission was identified, as only 42% of dieticians knew that TB could spread by talking. Favourable attitudes towards TB and infection control measures were present, except towards inadequate staffing levels and being worried about TB. The respondents reported that the fear of contracting TB affected patient interaction. Poor adherence to infection control measures was found. Only 45% of dieticians reported having a written TB infection control plan at their workplace, and only 23% were trained on TB infection control measures. Coughing patients were not always triaged and education material was not always available for TB patients. The availability of N-95 respirators was reported by 76% of dieticians. Training on TB infection control measures could influence dieticians’ adherence to infection control measures, ultimately protecting them from contracting TB at the workplace.

Intracerebral hemorrhage (ICH) is a severe form of stroke, with a high mortality rate and often resulting in irreversible neurological deterioration. Although animal studies have provided insight into the etiology of the disease, many of the causative genes and mechanisms implicated in cerebral-vascular malformations are unknown. Treatment options remain ineffective. With the present models, the pathophysiological consequences of ICH can only be assessed in situ and after histological analysis. Furthermore, common deficiencies of the current models include the heterogeneity, low expression and low reproducibility of the desired phenotype. Hence, there is a requirement for novel approaches to model ICH pathogenesis. Zebrafish (Danio rerio) has gained recognition as a vertebrate model for stroke research. Through a combination of pharmacological blockers, metabolite rescue, genetic approaches, and confocal imaging analysis, I demonstrate a requirement for the 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) pathway in regulating developmental cerebral-vascular stabilization. A transient loss in HMGCR function induces ICH, characterised by progressive dilation of blood vessels, vascular permeability and vessel rupture. These effects are likely due to reduced prenylation of Rho GTPases, evidenced by morpholino-mediated blocking of the prenylation pathway and in vivo assessment of endothelial-specific localization of cdc42, a Rho GTPase family protein. These results are in conformity with recent clinical and experimental evidence. I have further shown that this model consistently replicates common pathoghysiological processes associated with ICH. The hemorrhages are associated with the disruption of the blood-brain barrier, vessel disintegration, hematoma expansion and edema into the adjacent brain regions. Also, enhanced apoptosis, activation of inflammatory mediators in the periphery of the hematoma, enriched heme oxygenase 1 (HO-1) expression and localised thrombosis were observed in these embryos. I show that the patterning and distribution of catecholaminergic neurons, response to sensory stimulus and swimming speed were impaired as a consequence of ICH. These results suggest that HMGCR contributes to cerebral-vascular stabilisation through Rho GTPase mediated-signalling and that zebrafish can serve as a powerful paradigm for the systemic analysis of the etiological and pathophysiological underpinnings of ICH and can help establish the basis for future studies into screening for putative therapeutics and elucidating mechanisms aiding functional recovery.

The isolated perfused working heart was used to study hypertensive- diabetes induced alterations in cardiac function at 6 and 12 weeks after the induction of diabetes. There was no difference in cardiac function between normotensive Wistar and spontaneously hypertensive (SHR) diabetic rats at 6 weeks after diabetes induction. Wistar-Kyoto (WKY) rats were also included as normotensive controls in our 12-week study. Successful induction of diabetes was confirmed by the presence of hyperglycemia, hypoinsulinemia, glycosuria and increased haemoglobin glycosylation in all three diabetic groups. However, quantitation of various parameters of heart function revealed highly significant differences between SHR diabetic animals and all other groups, associated with an increased mortality. Serum lipids were elevated in SHR and Wistar and unaffected in WKY diabetic rats. Furthermore, thyroid hormone levels were not depressed in WKY diabetic rats and could explain the lack of cardiac dysfunction in these animals. The data provide further evidence that the combination of hypertension and diabetes mellitus produces greater myocardial dysfunction than is seen with either disease alone and is associated with a significant mortality. The effects of hydralazine on blood lipids, systolic pressure and cardiac performance were assessed in male Wistar rats, 6 weeks after they were made diabetic with streptozotocin (STZ). When hydralazine was administered for a 6-week period to the diabetic rats, their blood lipids were not significantly different from that of non-diabetic rats despite a low serum insulin. In contrast, blood lipids were elevated in the diabetic rats that were not treated with hydralazine; these animals also had low insulin levels. Cardiac performance was depressed in the untreated diabetic animals, but the cardiac performance of the hydralazine-treated diabetic animals showed a definite improvement which could be partly explained by their normal thyroid status in contrast to the untreated diabetic animals which were slightly hypothyroid. Blood pressure was elevated only in the untreated diabetic animals. Thus hydralazine controlled the high serum lipids and blood pressure and improved cardiac performance in STZ diabetic rats. To examine the influence of sex differences in the STZ model of diabetes, we studied left ventricular function in hearts from 6 week male and female rats. Significantly lower values for +dP/dt occurred in male diabetic rats compared with their own controls or female diabetics at most left atrial filling pressures. Decreases in this value for female diabetic rats compared to their own controls occurred only at high left atrial pressures. It appears that diabetes mellitus produces greater myocardial dysfunction in male diabetic rats. / Pharmaceutical Sciences, Faculty of / Graduate

Amino acids and other ninhydrin-positive compounds were measured in post-mortem thalamus from 25 Huntington's choreics, 10 schizophrenics, 5 schizophrenic-like psychotics, and 23 controls dying without neurological disease. Gamma-aminobutyric acid (GABA) was significantly reduced in choreic thalami, in accord with deficiencies found in other brain regions choreics (Perry et al., 1973a,b). GABA was also significantly reduced in schizophrenic thalami, suggesting a biochemical link between these two diseases, and supporting the hypothesis of a defect in the GABA system in schizophrenia (Roberts, 1972). Homocarnosine, a GABA-containing dipeptide, was also low in choreic and 9 out of 10 schizophrenic thalami. One schizophrenic had extremely high homocarnosine. Glycerophosphoethanolamine was significantly elevated in Huntington's choreics, but not in schizophrenics. A number of other variables were considered for their potential influence on amino acid concentrations in thalamus. The majority of amino acids were found to rise in a significantly linear fashion in the interval 3 to 49 hours post-mortem, although other models might have described the change better. GABA, ornithine, histidine and tyrosine were found to decrease significantly with increasing age between 21 and 80 years, in controls. The effects of pre-mortem hypoxia, regional variation within the thalamus, and neuroleptic drug treatment could not be rigorously tested with these data. Neuroleptics were unlikely to have been the cause of group differences in GABA concentration, since they failed to deplete GABA in brain of chronically treated rats. On the other hand, bronchopneumonia and other causes of pre-mortem hypoxia could not be ruled out as potential contributers to reduced GABA in thalamus. / Medicine, Faculty of / Medical Genetics, Department of / Graduate

Orientador: Altair Antoninha Del Bel Cury / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-07-31T15:14:31Z (GMT). No. of bitstreams: 1 Oliveira_PauloAntoniode_D.pdf: 6996623 bytes, checksum: c54fe9e3e6e9361a6e5856b4bdcf51d5 (MD5) Previous issue date: 2001 / Resumo: Foi propósito deste trabalho avaliar a prevalência de distúrbios da Articulação Têmporo Mandibular (DATM), em jovens universitários em uma amostra padronizada (n = 178) e relacionar prováveis agentes etiológicos. A metodologia utilizada para obtenção de dados foi questionário, exame clínico e eletrovibratografia computadorizada. A prevalência de distúrbios de ATM foi de 42,70% (76) sendo 31,46% (56) do sexo feminino e 11,24% (20) do sexo masculino; para dor 16,29% (29) sendo 9,55% (17) do sexo feminino e 6,74% (12) do sexo masculino; ruídos articulares 17,98% (32) sendo 14,61% (26) do sexo feminino e 3,37% (6) do sexo masculino; dor e ruído articular foi de 8,43% (15) sendo 7,30% (13) do sexo feminino e 1,12% (2) do sexo masculino. Para a etiologia dos distúrbios foram encontrados hipermobilidade articular sistêmica, apertamento dental, correção ortodôntica anterior e tensão emocional. A prevalência de portadores de hipermobilidade na amostra foi de 44,94% (80) sendo 31,46% (56) do sexo feminino e 13,48% (24) do sexo masculino. Destes apresentaram DATM 21,91% (39) sendo 17,42% (31) do sexo feminino e 4,49% (8) do sexo masculino; quanto ao apertamento 44,94% (80) apertavam dentes sendo 35,96% (64) do sexo feminino e 8,99% (16) do sexo masculino. Dentre estes apresentaram DATM 26,03% (41) sendo 20,22% (36) do sexo feminino e 2,81% (5) do sexo masculino; quanto a correção ortodôntica anterior, encontrou-se 64,04% (114) sendo 41,57% (74) do sexo feminino e 22,47% (40) do sexo masculino. Dentre estes apresentaram DATM 30,90% (55) sendo 21,91% (39) do sexo feminino e 8,99% (16) do sexo masculino. Relataram ser portadores de tensão emocional 62,92% (112) sendo 47,19%(84) do sexo feminino e 15,73% (28) do sexo masculino. Dentre estes apresentaram DATM 29,21% (52) sendo 24,16% (43) do sexo feminino e 5,06% (9) do sexo masculino. Os resultados sugeriram que a prevalência de DATM na amostra examinada foi relativamente alta sendo o sexo feminino o mais susceptivel. Não se encontrou um agente etiológico predominante no estudo, concluindo-se que DA TM tem etiologia multifatorial / Abstract: The purpose of this work was to evaluate the TMJs of young high school students, in a custom sample (# = 178) with the objective of acquiring a prevalence of signs and symptoms. The studies were also re1ated to probable etiological agents. The methods used in the data acquirement was questionnaire, c1inica1 examination and computerized eletrovibratography. The prevalence for TMJ disorders in the sample was 42,70% (76 young people) being 3],46% (56) female and 11,24% (20) male. The prevalence of pain was ]6,29% (29) being 9,55% (17) female and 6,74% (12) male. The prevalence of TMJ sounds was ]7,98% (32) being 14,6]% (26) female and 3,37% (6) male. The prevalence of pain and TMJ sounds was 8,43% (15) being 7,30% (13) female and 1,12% (2) male. About probable etiological agents: general joint hypermobility, dental compress, former orthodontic correction and emotional tension were studied. People with hypermobility represented 44,94% (80) being 31,46% (56) female and 13,48% (24) male. Between then 2],91% (39) had TMJ disorders, being 17,42% (31) female and 4,49% (8) male. In the sampke 44,94% (80) had dental compress, being 35,96% (64) female and 8,99% (16) male. Between then 26,03% (41) had TMJ disorders being 20,22% (36) female and 2,81% (5) male. The prevalence of young people with former orthodontic correction in the sample was 64,04% (114) being 41,57% (74) female and 22,47% (40) male. Between then 30,90% (55) being 21,21% (39) female and 8,99% (16) male. Reported to have emotional tension 62,92% (112) in the sample, being 47,19% (84) female and 15,73% (28) Was concluded that the prevatence of TMJ disorders in the sample is relatively high mate. Between then 29,21% (52) had TMJ disorders, being 24,16% (43) femate and 5,06% (9) mate and the femate sex is, for sure, most susceptible. No predominant etiological agent was found with this study, witch makes us conclude that TMJ disorders has multifactoriat etiology / Doutorado / Protese Dental / Doutor em Clínica Odontológica

One purpose of this primarily exploratory study was to explore whether differences in beliefs about the etiology of homosexuality exist between homosexuals and nonhomosexuals. Another purpose was to investigate whether differences exist between groups in the extent to which they feel that it is appropriate to manifest homosexual behaviors in public. Finally, this study examined the question of whether a relationship exists between one's perception of the cause of homosexuality and the degree to which that person felt it was appropriate to manifest homosexual behaviors.