Made available in DSpace on 2014-06-11T19:31:09Z (GMT). No. of bitstreams: 0 Previous issue date: 2005Bitstream added on 2014-06-13T20:41:28Z : No. of bitstreams: 1 dornbusch_pt_dr_botfmvz.pdf: 1000026 bytes, checksum: 9d7db83dca777b01eccbd74b45e0a741 (MD5) / Universidade Estadual Paulista (UNESP) / A trombose de jugular é problema freqüente na medicina eqüina, implicando muitas vezes em conseqüências fatais. O diagnóstico é relativamente simples, baseado nos achados físicos, nas imagens angiográficas e ultra-sonográficas. A terapêutica conservativa empregada em grande parte dos casos é insatisfatória. O objetivo deste trabalho foi avaliar em eqüinos a aplicabilidade da trombectomia com cateter de fogarty, técnica esta rotineiramente empregada pela medicina humana, no restabelecimento da perviedade vascular. Foram utilizados 10 eqüinos divididos em 2 grupos, com cinco animais cada, em que se induziu a trombose de jugular unilateral direita, através do acesso cirúrgico à veia e aplicação de sutura estenosante e injeção de glicose a 50%. No grupo controle avaliou-se a evolução da tromboflebite sem qualquer tipo de intervenção terapêutica. Os animais do grupo tratado foram submetidos a trombectomia com cateter de Fogarty. Foram avaliados os parâmetros físicos gerais, regionais, ultra-sonográficos e angiográficos contrastados, nos momentos pré-indução (MPRÉ), indução da trombose (MTI) e dez dias de evolução da trombose (M13). A técnica empregada induziu a tromboflebite, que obstruiu completamente um segmento da veia jugular de todos os animais. Os animais do grupo controle mantiveram os trombos obstruindo totalmente o lume vascular até o final do período de avaliação, sendo que avaliações regionais mostraram principalmente o edema parotídeo e o ingurgitamento vascular, cranial a tromboflebite de jugular. Nos exames ultra-sonográficos e angiográficos, o grupo tratado apresentou todas as veias pérvias ao final do experimento, com remissão total dos sinais clínicos. Concluiu-se que a técnica da trombectomia com cateter de Fogarty foi eficiente na desobstrução da veia jugular submetida à trombose experimental. / Thrombosis of jugular vein is a frequent problem in the equine medicine, implying many times in fatal consequences. The diagnosis is relatively simple, based in the clinical findings, angiographics images and ultrasonographycs. The therapeutic employed to a large extent of the cases is unsatisfactory. The objective of this work was to evaluate in horses the applicability of the thrombectomy with Fogarty catheter, technique routinely used in medicine, in the reestablishment of the perviousness vascular. 10 horse divided in 2 groups had been used, with five animals each, and induced thrombosis of right unilateral jugular vein, through the surgical access to the vein and application of stenotic suture and glucose 50% injection. In the controlled group it was evaluated evolution of the thrombophlebitis without any type of therapeutical intervention. The animals of the treatead group had been submitted to the thrombectomy with Fogarty catheter. General clinical parameters were analysed at the moment of the preinduction (MPRÉ), induction of thrombosis (MTI), and ten days of evolution of thrombosis (M10). The employed technique induced the thrombophlebitis that completely obstructed a segment of the jugular vein in all the animals. The animals of the control group had kept the thrombus totally obstructing the vascular lumen until the end of the period of evaluation, being that regional evaluations had mainly shown parotid edema and the vascular dilated, cranial the thrombophlebitis of jugular vein. The treated group presented all the pervious veins to the end of the experiment, confirmed by angiographics and ultrasonographics examinations, with total remission of the clinical sign. So far, it was concluded that the technique of the thrombectomy with catheter of Fogarty was efficient in eliminating the obstruction of the jugular vein submitted to experimental thrombosis.

Orientador: Carlos Alberto Hussni / Resumo: A trombose de jugular é problema freqüente na medicina eqüina, implicando muitas vezes em conseqüências fatais. O diagnóstico é relativamente simples, baseado nos achados físicos, nas imagens angiográficas e ultra-sonográficas. A terapêutica conservativa empregada em grande parte dos casos é insatisfatória. O objetivo deste trabalho foi avaliar em eqüinos a aplicabilidade da trombectomia com cateter de fogarty, técnica esta rotineiramente empregada pela medicina humana, no restabelecimento da perviedade vascular. Foram utilizados 10 eqüinos divididos em 2 grupos, com cinco animais cada, em que se induziu a trombose de jugular unilateral direita, através do acesso cirúrgico à veia e aplicação de sutura estenosante e injeção de glicose a 50%. No grupo controle avaliou-se a evolução da tromboflebite sem qualquer tipo de intervenção terapêutica. Os animais do grupo tratado foram submetidos a trombectomia com cateter de Fogarty. Foram avaliados os parâmetros físicos gerais, regionais, ultra-sonográficos e angiográficos contrastados, nos momentos pré-indução (MPRÉ), indução da trombose (MTI) e dez dias de evolução da trombose (M13). A técnica empregada induziu a tromboflebite, que obstruiu completamente um segmento da veia jugular de todos os animais. Os animais do grupo controle mantiveram os trombos obstruindo totalmente o lume vascular até o final do período de avaliação, sendo que avaliações regionais mostraram principalmente o edema parotídeo e o ingurgitamento vascular, cranial a tromboflebite de jugular. Nos exames ultra-sonográficos e angiográficos, o grupo tratado apresentou todas as veias pérvias ao final do experimento, com remissão total dos sinais clínicos. Concluiu-se que a técnica da trombectomia com cateter de Fogarty foi eficiente na desobstrução da veia jugular submetida à trombose experimental. / Abstract: Thrombosis of jugular vein is a frequent problem in the equine medicine, implying many times in fatal consequences. The diagnosis is relatively simple, based in the clinical findings, angiographics images and ultrasonographycs. The therapeutic employed to a large extent of the cases is unsatisfactory. The objective of this work was to evaluate in horses the applicability of the thrombectomy with Fogarty catheter, technique routinely used in medicine, in the reestablishment of the perviousness vascular. 10 horse divided in 2 groups had been used, with five animals each, and induced thrombosis of right unilateral jugular vein, through the surgical access to the vein and application of stenotic suture and glucose 50% injection. In the controlled group it was evaluated evolution of the thrombophlebitis without any type of therapeutical intervention. The animals of the treatead group had been submitted to the thrombectomy with Fogarty catheter. General clinical parameters were analysed at the moment of the preinduction (MPRÉ), induction of thrombosis (MTI), and ten days of evolution of thrombosis (M10). The employed technique induced the thrombophlebitis that completely obstructed a segment of the jugular vein in all the animals. The animals of the control group had kept the thrombus totally obstructing the vascular lumen until the end of the period of evaluation, being that regional evaluations had mainly shown parotid edema and the vascular dilated, cranial the thrombophlebitis of jugular vein. The treated group presented all the pervious veins to the end of the experiment, confirmed by angiographics and ultrasonographics examinations, with total remission of the clinical sign. So far, it was concluded that the technique of the thrombectomy with catheter of Fogarty was efficient in eliminating the obstruction of the jugular vein submitted to experimental thrombosis. / Doutor

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Considering the relevance of study of traumatic spinal cord injury in humans and animals, the aim of the study was investigated the use of the prednisone and meloxicam in treatment of rats submitted the experimental model of acute spinal cord injury with 2Fr Fogarty catheter with evaluation of oxidative stress, Neurological tests and histological exam. Ninety rats were divided in six groups: GCS or saline (n=15), GCP or prednisone control (n=15), GCM or meloxicam control, GTS or trauma saline (n=15), GTP or trauma meloxicam (n=15) and GTM or trauma prednisone (n=15). Each group was divided into three subgroups according to treatment time in the postoperative period of 24h, 72h and seven days. All groups were submitted laminectomy and in the groups GTS, GTM and GTP, after exposure of the spinal cord was performed compressive spinal cord injury with 2Fr Fogarty catheter. The GCS and GTS was treated with saline (0,5ml/rat/day), GSM and GTM with meloxicam (2mg/kg/day) and GSP and GTP with prednisone (2mg/kg/dia). Neurological tests were performed (BBB, inclined plane and deep pain) 24 hours before and after surgery and repeated every 48 hours until the day of euthanasia. The parameters of oxidative stress were evaluated and performed histopathological analysis of the spinal cord. The groups GTS, GTM and GTP in the different times were no point in the BBB scale and three points in the inclined plane and absence of deep pain. GTM and GTS groups had lower catalase activity and TBARS levels when compared to the GTS and they were more evident to 72 hours postoperative period, indicating a possible antioxidant effect. In the GTS group, there was persistence of this action until the seventh day after trauma. In the histopathological exam were found Wallerian degeneration and necrosis of gray matter of intensity variation, with no significant difference between undergone to trauma. Meloxicam and prednisone can have neuroprotective and antioxidant effect, but the necrosis and Wallerian degeneration were not stop in rats submitted the acute spinal cord injury with 2Fr Fogarty catheter. / Considerando a relevância dos estudos destinados às lesões traumáticas da medula espinhal em humanos e animais, o objetivo deste estudo foi investigar o efeito da prednisona e meloxicam na terapia de ratos submetidos ao modelo experimental de trauma agudo da medula espinhal induzida pelo cateter de Fogarty 2Fr, mediante avaliação do perfil oxidativo, dos testes neurológicos e exame histopatológico da medula espinhal. Foram utilizados 90 ratos Wistar, distribuídos em seis grupos denominados GCS ou salina (n=15), GCP ou controle prednisona (n=15), GCM ou controle meloxicam (n=15), GTS ou trauma mais salina (n=15), GTP ou trauma mais prednisona (n=15) e GTM ou trauma mais meloxicam (n=15). Cada grupo foi redistribuído em três subgrupos de acordo com o tempo de tratamento no pós-operatório de 24h, 72h e sete dias. Todos os grupos foram submetidos à laminectomia e nos grupos GTS, GTM e GTP, após a exposição da medula espinhal, foi realizado o trauma medular compressivo utilizando o cateter Fogarty 2Fr. Os grupos GCS e GTS foram tratados com solução salina (0,5ml/rato/dia), os GSM e GTM receberam meloxicam (2mg/kg/dia) e os grupos GSP e GTP receberam prednisona (2mg/kg/dia). Foram realizados testes neurológicos (BBB, plano inclinado e percepção a dor profunda) 24 horas antes e após o procedimento cirúrgico e repetido a cada 48 horas até a realização da eutanásia, ou seja, 24h, 72h e sete dias. Foram avaliados os parâmetros do estresse oxidativo através da enzima catalase, quantificado as substâncias reativas ao ácido tiobarbitúrico (TBARS) e realizado exame histopatológico da medula espinhal. Os ratos dos grupos GTS, GTM e GTP e nos diferentes tempos (24h, 72h e sete dias) tiveram pontuação zero na escala BBB, ou seja, nenhum movimento observado no membro pélvico; no plano inclinado, permaneceram com pontuação 3, ou seja, em um ângulo dez graus menor que antes da cirurgia e perda da percepção da dor profunda Os grupos GTM e GTS apresentaram menor atividade da catalase e níveis de TBARS quando comparado ao grupo GTS e foi mais evidente nas primeiras 72 horas de PO, indicando um possível efeito antioxidante. No grupo GTS, houve persistência desta ação até o sétimo dia pós-trauma. No exame histopatológico da medula espinhal foi constatada degeneração Waleriana e necrose da substância cinzenta de intensidades variáveis, não apresentando diferença entre os grupos submetidos ao trauma. Conclui-se que o meloxicam e a prednisona apresentam possível efeito antioxidante e neuroprotetora, mas não impedem a necrose e a degeneração Walleriana da medula espinhal de ratos submetidos a trauma medular agudo utilizando o cateter de Fogarty 2Fr.

From Dar es Salaam to Dartmouth: A Case Study of the Experiences of Fogarty AIDS International Training and Research Program Fellows at Dartmouth Lisa Purvis, EdD Candidate, MPH, MBA Background The United States (US) is a major host nation to international college students and scholars who study a variety of disciplines (Farrugia & Bhandari, 2014). Beginning in the last decade, the demand for global health training has risen (Kanter, 2008; Kerry, Ndung'u, Walensky, Lees, Kayanjas, & Bangsberg, 2011). Since 2000, Geisel School of Medicine at Dartmouth has been one of 26 US universities participating in a global health training program, funded by the National Institutes of Health, Fogarty International Center's AIDS International Training and Research Program (AITRP). The Fogarty AITRP annually trains scholars (Fogarty Fellows) and focuses on building HIV/AIDS research and medical capacity in low- and middle-income countries through advanced training. Along with the economic, social, and cultural assets that international students bring, are key challenges in students' transition, assimilation, and acculturation. It has been observed that many of the Dartmouth Fogarty Fellows have experienced issues in matriculating at Dartmouth. Purpose of Research Little data exists on the experiences of international students studying global health in the US. Using a case study of the Fogarty Fellows at Dartmouth, this qualitative research project sought to examine their unique transition and assimilation experiences as international graduate students. A secondary purpose of the case study was to identify ways to improve students' experiences. Berry's theory of acculturation provided the theoretical framework for the project (Berry, 1997). Research Approach A qualitative approach was used, guided by Action Research methodology. Action Research focuses on problem-solving and it is typically defined as a reflective process of progressive problem-solving led by an individual(s), who is part of the community of practice, to address issues and solve problems (Bargal, 2008). Research Methods To gain a fuller understanding of the issues and to identify solutions to problems of acculturation that may already exist, in-depth interviews took place with 22 participants: 1) 10 alumni of the Fogarty Program at Dartmouth College; 2) 5 MPH faculty at Dartmouth; 3) 2 MPH administrators; 4) 4 Dartmouth Fogarty Program administrators; and 5) the Fogarty International Fellows Program Officer at NIH. Field research also took place in Tanzania, the home country of the Fogarty Fellows at Dartmouth, to understand the Tanzanian context. Findings Recommendations for program improvement included formalizing the program at several milestones; providing comprehensive pre-matriculation information; using technology to orient Fellows to their new environment; formal mentoring and networking; cross-cultural training with students; and orienting the faculty to the program and the needs of international students. Colleges and universities need to understand the unique experiences and the student support needs of the international student. Future research at the 25 Fogarty AITRP US-based sites is recommended before implementing any of the Dartmouth-based recommendations.