Made available in DSpace on 2015-07-22T20:49:30Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-10-26 / Objetivo: Avaliar em pacientes obesos mórbidos submetidos à derivação gástrica em Y de Roux com anel de contenção há mais de cinco anos: 1) o efeito a longo prazo da cirurgia nas comorbidades; 2) a relação deste efeito com o reganho de massa. Métodos: Foram estudados 140 pacientes (122 mulheres, média de idade de 41,4±10,6 (variação 19 a 62) anos, média de massa de 138,7±23,1 (variação 98 a 220) kg e média de IMC de 52,3±7,9 (variação 37 a 82) kg/m2 submetidos à derivação gástrica em Y de Roux com anel de contenção há cinco anos ou mais. Foram analisadas as seguintes comorbidades: diabetes tipo 2, hipertensão arterial, doença cardiovascular, dislipidemia, apnéia do sono, artropatia e infertilidade, e classificadas em Resolvida, Melhorada, Inalterada ou Piorada no momento de menor massa e no último seguimento. Resultados: Houve diferença significativa na variação da massa nos três momentos do estudo (inicial x mínimo, p<0.001; inicial x final, p<0.001; mínimo x final, p<0.001). Não houve variação do status obtido no momento de menor massa para diabetes tipo 2, doença cardiovascular e infertilidade. Hipertensão arterial mostrou discreta piora dos resultados, porém, sem significância estatística (p=0,8). Houve piora dos resultados para dislipidemia (p=0,012), apnéia do sono (p=0,046) e artropatia (p=0,007). Não há relação entre a variação do IMC e a evolução da comorbidade para infertilidade (p=0,71, massa mínima e p=0,42, massa final). Há relação direta entre a variação do IMC e a evolução das comorbidades para diabetes tipo 2 (p=0,013, massa mínima e p=0,014, massa final), hipertensão arterial (p=0,015, massa mínima e p=0,001, massa final) e doença cardiovascular (p=0,015, massa mínima e p=0,043, massa final). Há relação direta entre a variação do IMC e a evolução das comorbidades apenas no último seguimento para artropatia (p=0,096, massa mínima e p=0,0012, massa final), dislipidemia (p=0,054, massa mínima e p=0,015, massa final) e apnéia do sono (p=0,11, massa mínima e p=0,011, massa final). Conclusões: Em pacientes obesos mórbidos submetidos à derivação gástrica em Y de Roux com anel de contenção há mais de cinco anos: (1) Há manutenção do status obtido para o momento de menor massa para as comorbidades diabetes tipo 2, hipertensão arterial, doença cardiovascular e infertilidade, mas não para dislipidemia, apnéia do sono e artropatia; (2) A melhoria de todas as comorbidades avaliadas, com exceção da infertilidade, associou-se diretamente ao percentual de perda de massa corpórea. / BACKGROUND: Roux-en-Y gastric bypass (RYGB) is considered an effective therapy for weight loss although weight regain may be observed in a long-term follow-up. Obesity-related comorbidities are also well treated by RYGB due to weight loss and intestinal hormone changes. Few studies reported long-term status of comorbidities especially if weight regain is present. This study aims to analyze: (1) the resolution of obesity-related comorbidities after RYGB in a long-term follow-up and (2) its relationship to weight regain. METHODS: 140 patients (mean age 41, 18 male, mean body mass index (BMI) before operation 52 (range 39-82) kg/m2, mean BMI at nadir weight 29 (range 18-46) kg/m2, mean BMI at last follow-up 33 (range 19-49) kg/m2 were followed-up after RYGB for morbid obesity for at least 5 years (mean follow-up 90, range 60-155 months). Diabetes, cardiovascular disease, arterial hypertension, dyslipidemia, sleep apnea, arthropathy, and infertility were present when submitted to surgery in 26 (18%), 14 (10%), 88 (62%), 18 (13%), 83 (59%), 90 (64%), 9 (16%) patients; and in 6 (4%), 8 (5%), 38 (27%), 6 (4%), 45 (32%), 75 (53%), 7 (12%) patients at the Nadir weight, respectively. RESULTS: BMI was significantly different in the 3 periods. Comorbidities resolution was sustained in a long-term follow-up for diabetes, hypertension, cardiopathy and infertility. Comorbidities status was direct related to the % of weight loss for all comorbidities except infertility. CONCLUSION: Our results show that comorbidities remission after RYGB is sustained in the majority of patients in a long-term follow-up. Weight regain is linked to worse results for all comorbidities except infertility. / TEDE / BV UNIFESP: Teses e dissertações

For this final paper, I chose a rather serious topic that is very topical in our society. Hazardous chemical substance ? ammonia ? is used very widely at present. Ammonia is used as a coolant in various plants. I have compiled a list of all plants in South Bohemia that work with ammonia, including ice rinks. I characterized the properties of ammonia, what damage it causes to the human organism and the environment. I noted a list of accidents during which there have been ammonia leakages of ammonia and I analyzed one accident using a software programme called TerEx. I chose the building of the ice rink in České Budějovice for my research. The objective was to determine the amount of ammonia and to simulate, using the TerEx software programme, an accident with a potential ammonia leakage from the ice rink. I also listed all the activities of the individual components of the Integrated Rescue System, which would help during such an accident, as well as urgent and follow-up measures that would be used. Having assessed the results I came to the conclusion that ammonia leakage from the ice rink would have serious impacts on the residents of České Budějovice. Finally I explained what the terms of evacuation and individual protection mean for the people lining around the ice rink.

Present situation The theoretical part of the diploma thesis is divided into four separate chapters. The first chapter deals with cerebrovascular accident (CVA). Another chapter describes the consequences of illness in various areas of human life. The third chapter defines the concept of follow-up care and the fourth chapter deals with diagnosed obesity. Aims of the work and research questions The aim of the diploma thesis is to map out the influence of obesity on follow-up care of patients after cerebrovascular accident. Research questions: 1. How does obesity affect patient mobility after CVA? 2. How does obesity affect the hygienic care of patients after CVA? 3. How does obesity affect normal daily activities of CVA patients? 4. What is the impact of obesity on developing self-sufficiency in CVA patients? Quality research was done through semi-structured interviews with CVA patients who were hospitalized in the aftercare department. Other interviews were conducted with general nurses providing nursing care to CVA patients. Research group The research group consisted of 11 general nurses working at different follow-up care hospital stations, and 16 patients who were hospitalized at these departments after the CVA. Results By analyzing the information obtained, it has been determined that obesity affects the patients mobility especially after the cerebrovascular event. At the same time, it represents a physical and psychological burden for nursing staff, but also for patients. The problem has been the fact, that most patients do not perceive obesity as a condition affecting their whole life. Conclusion The diploma thesis has provided insight into the problematic of the influence of obesity on the follow-up care in patients after cerebrovascular accident. The findings should lead to a reflection on the issue of prevention of obesity in terms of both CVA risk and follow-up care, but also the need for educational activities.

Objetivo: Avaliar a resposta ao tratamento em longo prazo de pacientes com transtorno obsessivo-compulsivo (TOC) após cinco anos de terapia cognitivocomportamental em grupo (TCCG) ou sertralina 100mg/dia. Método: Em um estudo naturalístico foram acompanhados após cinco anos cinquenta pacientes que completaram 12 sessões semanais de duas horas de TCCG ou utilizaram 100mg de sertralina/dia pelo mesmo período. A intensidade dos sintomas foi avaliada cinco anos após o tratamento pela Yale-Brown Obsessive- Compulsive Scale (Y-BOCS), Impressão Clínica Global (CGI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) e a qualidade de vida através do World Health Organization Quality of Life Assesment – Abreviated Version (WHOQOL-bref). Resultados: Tanto os pacientes tratados com TCCG como os tratados com sertralina apresentaram redução significativa na gravidade dos sintomas e manutenção dos ganhos terapêuticos cinco anos após o término do tratamento. Observamos também no período de seguimento um aumento no uso de medicação no grupo TCCG (p<0.001) e busca por atendimento psicoterápico no grupo que usou sertralina (p=0,084) embora este último em nível não significativo. Os resultados indicaram que 61,9% dos pacientes seguiram usando ou iniciaram o uso de medicamentos, e 41,5% iniciaram ou continuaram a TCC. Houve um aumento significativo de pacientes em remissão no grupo da sertralina (p=0,046), não ocorrendo o mesmo no grupo da TCCG (p=0,083). Houve aumento nos escores dos diferentes domínios da qualidade de vida independente do grupo. Conclusões: Nossos resultados demonstram que tanto o grupo que realizou TCCG como o que usou sertralina mantiveram a melhora alcançada logo após o término do tratamento, cinco anos após. Além disto, observou-se uma melhora em todos os domínios da QV. Talvez isso se deva ao fato de que mais da metade dos pacientes terem continuado em tratamento durante o seguimento. / Objective: Assess obsessive-compulsive disorder (OCD) patients' long term response to treatment after five years of cognitive-behavioral group therapy (CBGT) or sertraline 100mg/day. Methods: Fifty patients who completed 12 two-hour weekly CBGT sessions or had sertraline 100 mg/day for the same period were followed up in a naturalistic study. The severity of symptoms were evaluated after five years from the conclusion of treatment by Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Clinical Global Impressions Scale - Severity underscore (CGI-S), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and quality of life with World Health Organization Quality of Life Assesment – Abreviated Version (WHOQOL-bref). Results: Both patients treated with CBGT and those treated with sertraline showed a significant reduction in the severity of symptoms and maintained therapeutic gains five years after the end of treatment. We also noticed an increase in the use of medication in the CBGT group (p<0.001) during the follow-up period and a search for psychotherapeutic treatment in the group who took sertraline (p=0.084), although this latter occurred at a non-significant level. Results indicated that 61.9% of patients continued using or started using the medication and 41.5% started or continued with the CBT. There was a significant increase of remissive patients in the sertraline group (p=0.046), while the same did not occur in the CBGT group (p=0.083). There was an increase in the scores of different quality of life domains (QL) regardless of the group. Conclusions: Our results showed that both the group that underwent CBGT and the one that took sertraline maintained their levels of improvement at the end of the five-year treatment. As well, an increase in all QL domains was noticed. Perhaps this may be put down to the fact that over half the patients continued with the treatment during the follow-up period.

Objetivo: Avaliar a resposta ao tratamento em longo prazo de pacientes com transtorno obsessivo-compulsivo (TOC) após cinco anos de terapia cognitivocomportamental em grupo (TCCG) ou sertralina 100mg/dia. Método: Em um estudo naturalístico foram acompanhados após cinco anos cinquenta pacientes que completaram 12 sessões semanais de duas horas de TCCG ou utilizaram 100mg de sertralina/dia pelo mesmo período. A intensidade dos sintomas foi avaliada cinco anos após o tratamento pela Yale-Brown Obsessive- Compulsive Scale (Y-BOCS), Impressão Clínica Global (CGI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) e a qualidade de vida através do World Health Organization Quality of Life Assesment – Abreviated Version (WHOQOL-bref). Resultados: Tanto os pacientes tratados com TCCG como os tratados com sertralina apresentaram redução significativa na gravidade dos sintomas e manutenção dos ganhos terapêuticos cinco anos após o término do tratamento. Observamos também no período de seguimento um aumento no uso de medicação no grupo TCCG (p<0.001) e busca por atendimento psicoterápico no grupo que usou sertralina (p=0,084) embora este último em nível não significativo. Os resultados indicaram que 61,9% dos pacientes seguiram usando ou iniciaram o uso de medicamentos, e 41,5% iniciaram ou continuaram a TCC. Houve um aumento significativo de pacientes em remissão no grupo da sertralina (p=0,046), não ocorrendo o mesmo no grupo da TCCG (p=0,083). Houve aumento nos escores dos diferentes domínios da qualidade de vida independente do grupo. Conclusões: Nossos resultados demonstram que tanto o grupo que realizou TCCG como o que usou sertralina mantiveram a melhora alcançada logo após o término do tratamento, cinco anos após. Além disto, observou-se uma melhora em todos os domínios da QV. Talvez isso se deva ao fato de que mais da metade dos pacientes terem continuado em tratamento durante o seguimento. / Objective: Assess obsessive-compulsive disorder (OCD) patients' long term response to treatment after five years of cognitive-behavioral group therapy (CBGT) or sertraline 100mg/day. Methods: Fifty patients who completed 12 two-hour weekly CBGT sessions or had sertraline 100 mg/day for the same period were followed up in a naturalistic study. The severity of symptoms were evaluated after five years from the conclusion of treatment by Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Clinical Global Impressions Scale - Severity underscore (CGI-S), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and quality of life with World Health Organization Quality of Life Assesment – Abreviated Version (WHOQOL-bref). Results: Both patients treated with CBGT and those treated with sertraline showed a significant reduction in the severity of symptoms and maintained therapeutic gains five years after the end of treatment. We also noticed an increase in the use of medication in the CBGT group (p<0.001) during the follow-up period and a search for psychotherapeutic treatment in the group who took sertraline (p=0.084), although this latter occurred at a non-significant level. Results indicated that 61.9% of patients continued using or started using the medication and 41.5% started or continued with the CBT. There was a significant increase of remissive patients in the sertraline group (p=0.046), while the same did not occur in the CBGT group (p=0.083). There was an increase in the scores of different quality of life domains (QL) regardless of the group. Conclusions: Our results showed that both the group that underwent CBGT and the one that took sertraline maintained their levels of improvement at the end of the five-year treatment. As well, an increase in all QL domains was noticed. Perhaps this may be put down to the fact that over half the patients continued with the treatment during the follow-up period.

Made available in DSpace on 2014-12-17T14:13:51Z (GMT). No. of bitstreams: 1 MariaLCS_TESE.pdf: 740512 bytes, checksum: d109f443eb2da08401d2bbd676359e7c (MD5) Previous issue date: 2013-11-27 / The aim of the present study was to analyze cardiovascular risk of women with a history of preeclampsia, as well as its follow-upin the National Health System.This is a cross-sectional quantitative research conducted at the Janu?rio Cicco Maternity School. The study population was composed of 573 women selected from a databank belonging to the Women s Health Research Group of the Gynecology Department at Universidade Federal do Rio Grande do Norte, with a history of preeclampsia, and normotensives who gave birth at this institution five years before. The final sample consisted of 147 women, 64 in the group with a history of PE and 83 normotensives. Data were collected on a questionnaire containing the following: sociodemographic aspects, anthropometric measures, life habits, personal and family history of pregnancy-induced hypertension, family history of cardiovascular diseases and frequency of measuring current blood pressure levels. In relation to the association between cardiovascular risk and altered blood pressure (&#8805;130x85 mmHg), the likelihood of exhibiting the latter condition was significantly higher in women with a history of preeclampsia (CI 95% 4.12-38.92), the overweight and obese (CI 95% 1.70-20.75), and in those with a family historyof CVD and personal history of PIH (CI 95% 0.78-47.07 and CI 95% 3.20-25.39) respectively. Likewise, the probability of having altered blood pressure was higher in women with fasting glycemia &#8805;100mg/dL (CI 95% 2.09-24.73), as well as in those with triglycerides &#8805;150mg/dl (CI 95% 1.72-9.66). After fitting the logistic model, diagnosis previous preeclampsia and altered triglycerides remained as explanatory variables.The women with a history of preeclampsia five years before exhibited altered blood pressure levels, clinical and laboratory manifestations suggestive of elevated risk for cardiovascular disease, as well as family and personal history of hypertension. There is no differential treatment or adequate outpatient follow-up for this population in basic health care units / O estudo teve como objetivo analisar o risco cardiovascular atual em mulheres com hist?rico de pr?-ecl?mpsia havia cinco anos e oseu seguimento no Sistema ?nico de Sa?de. Trata-se de pesquisa quantitativa do tipo transversal, realizada na Maternidade Escola Janu?rio Cicco. Avaliaram-se 147 mulheres, sendo 64 com hist?rico de pr?-eclampsia, comparadasa 83 com gesta??o normal. A pesquisa foi realizada atrav?s de busca ativa com coleta de sangue para mensura??o bioqu?mica de marcadores cardiovasculares e verifica??o da press?o arterial. Averiguaram-se aspectos sociodemogr?ficos, medidas antropom?tricas, h?bitos de vida, antecedentes pessoais e familiares para hipertens?o na gesta??o e antecedentes familiares de doen?a cardiovascular. Utilizou-se pacote estat?stico para as an?lises considerando n?vel de signific?ncia de 5%. O estudo foi aprovado pelo Comit? de ?tica em Pesquisa da Universidade do Federal do Rio Grande do Norte. No que se refere ? associa??o entre condi??es de risco cardiovascular e presen?a de n?veis press?ricos alterados (&#8805;130x85 mmHg), observa-se que a chance de ter press?o arterial alterada foi significativamente maior nas mulheres com hist?rico de pr?-ecl?mpsia (P< 0,001), nas com sobrepeso e obesas (P= 0,002), e ainda entre as com antecedente familiar de doen?a cardiovascular (P= 0,039) e com antecedente pessoal de doen?a hipertensiva da gesta??o (P< 0,001). Da mesma forma, a chance de ter press?o arterial alterada foi maior nas mulheres com glicemia de jejum &#8805;100mg/dL (P= 0,002), bem como nas com triglicer?deos &#8805;150mg/dl (P= 0,001). Conclui-se que as mulheres com hist?rico de pr?-ecl?mpsia havia cinco anos apresentavam atualmente manifesta??es sugestivas de risco elevado para doen?a cardiovascular, antecedentes familiares e pessoais de hipertens?o, bem como n?o h? atualmente atendimento diferenciado, nem seguimentoambulatorial adequado nas redes de aten??o prim?ria para essa popula??o

The Effectiveness of Therpay for Drug Addicts and Their Integration within Society The purpose of my thesis "The Effectiveness of Therapy for Drug Addicts and Their Integration in Society" is to elucidate the lifestyles of addicts during different stages of therapy and to help people to understand the problems of drug addicts. The function of the brain can be altered by a number of psycho-active drugs that can influence a person's behavior, conscience, morals and mood. Drug addiction results in an uncontrollable urge to acquire drugs, regardless of the consequences. This behavior leads to a gradual exclusion of the drug addict from society. Re-integration into society must be the goal of treatment. The social exclusion of addicts seriously hampers their attemts to find employment. Many addicts started to use illicit drugs before the age of 18 years. Their education has not been completed and their bonds with their family members have been broken. Health problems caused by drugs, alcohol, a low quality nourishment, often untreated infections, poor hygiene, poor or absent living arrangements are factors that contribute to the exclusion of drug addicts from society. The abstinence from drugs, for longer than three months, creates a precondition for recovery and re-integration into society. However, in the absence of a postive change in attitude of the addict towards society and in the abscence of a social safety net, drug abstinence alone does not represent a reliably positive prognostic indicator. Complex social services that include protected housing, employment, job counselling, out-patient or in-patient psychotherapy, are necessary for successful treatment.

Submitted by Liliane Ferreira (ljuvencia30@gmail.com) on 2018-09-24T13:26:49Z No. of bitstreams: 2 Dissertação - Tatiana Luciano Sardeiro - 2018.pdf: 2225911 bytes, checksum: 9b46a49c5ee584255e48a89553d577a7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-09-24T13:32:45Z (GMT) No. of bitstreams: 2 Dissertação - Tatiana Luciano Sardeiro - 2018.pdf: 2225911 bytes, checksum: 9b46a49c5ee584255e48a89553d577a7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-09-24T13:32:45Z (GMT). No. of bitstreams: 2 Dissertação - Tatiana Luciano Sardeiro - 2018.pdf: 2225911 bytes, checksum: 9b46a49c5ee584255e48a89553d577a7 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-07-04 / Clinical-laboratory follow-up after an accident with biological material should be performed at occupational exposures with a positive or unknown source. The objective of this study was to analyze the epidemiology of occupational accidents with exposure to biological material among health workers who abandoned clinical-laboratory follow-up. Cohort study developed from work accidents registered in the SINAN (National Institute of Public Health) Information System between 2006 and 2016 in the city of Goiania - Goias. Data were analyzed in Stata with descriptive and analytical statistics. During the study period, 7,265 accidents were reported. Of these, 2,104 exposures were analyzed and the majority of the workers were females, with completed high school and belonged to the nursing team. The accidents occurred mostly due to percutaneous injury (72.6%), involving lumen needles (56.1%) which were used for drug administration or vascular access puncture. In most exposures (60.1%) the resource person was known and the most recommended prophylaxis was chemoprophylaxis against VIH. The dropout rate of clinical and laboratory follow-up was 41.5%. In the multivariate analysis, it was observed that the chances of interruption of follow-up were higher among workers aged 40 or over, belonging to the nursing, dentistry and cleaning staff, who were not using personal protective equipment (apron) at the time of exposure, were injured by other objects that were not a lumen needle, were working on the books, had not been issued with a work accident report and refused chemoprophylaxis against VIH. It was also observed that the injured persons exposed during procedures in the laundry or in the washing of material presented less chance of drop-out. It is concluded that the interruption of follow-up is a multifactorial event, influenced by the care offered after the exposure, the support of the employer and the convictions of the injured. / O acompanhamento clínico-laboratorial após acidente com material biológico deve ser realizado nas exposições ocupacionais com fonte positiva ou desconhecida. O objetivo deste estudo foi analisar a epidemiologia do abandono do acompanhamento clínico – laboratorial entre trabalhadores da área da saúde que sofreram exposição a material biológico. Estudo de coorte, desenvolvido a partir dos acidentes de trabalho registrados no Sistema de Informação de Agravos de Notificação (SINAN) entre 2006 – 2016 no município de Goiânia - Goiás. Os dados foram analisados no Stata com estatística descritiva e analítica. Haviam 7.265 acidentes notificados no período do estudo. Desses foram avaliadas 2.104 exposições, nas quais a maioria dos trabalhadores era do sexo feminino, tinha ensino médio completo e pertencia a equipe de enfermagem, cujos acidentes ocorreram com maior frequência por lesão percutânea (72,6%), envolvendo agulhas com lúmen (56,1%), que foram utilizadas para administração de medicamentos ou punção de acesso vascular. Na maioria das exposições (60,1%) a pessoa fonte era conhecida e a conduta profilática mais recomendada foi a quimioprofilaxia contra o VIH. A taxa de abandono do acompanhamento clínico – laboratorial foi de 41,5%. Na análise multivariada verificou-se que as chances de interrupção do seguimento foram maiores entre os trabalhadores com idade igual ou maior a 40 anos, pertencentes às equipes de enfermagem, odontologia e do serviço de limpeza, que não estavam utilizando o avental no momento da exposição, sofreram lesão por outros objetos que não eram agulha com lúmen, trabalhavam com carteira assinada, não tiveram a emissão da comunicação de acidente de trabalho e recusaram a quimioprofilaxia contra o VIH. Constatou-se ainda que os acidentados expostos durante a realização de procedimentos na lavanderia ou na lavagem de material apresentaram menor chance de abandono. Frente a elevada taxa de abandono encontrada sugere-se a implementação de estratégias para garantir o seguimento e reduzir o risco para o trabalhador.

Introdução: Os mecanismos responsáveis pela evolução do diabetes associado à obesidade entre pacientes bariátricos são alvos de muitos estudos atualmente. As principais linhas de pensamento envolvem alterações no índice de massa corporal (IMC), hormônios gastrointestinais, inflamação sistêmica e a reformatação ou reeducação alimentar. A maioria destes quesitos foi examinada sob a ótica do curto prazo, sendo que informações concernentes a casos com 10 anos de pós-operatório ainda são escassos. Objetivos: Avaliar o desfecho da homeostase glicídica tardio após a DGYR, em pacientes com e sem diabetes prévio, e documentar os parâmetros clínicos e nutricionais que diferenciem estes grupos. Metodologia: Estudo observacional controlado retrospectivo e prospectivo de 100 pacientes submetidos à derivação gástrica em Y de Roux. Estes pacientes foram divididos em dois grupos iniciais, um com diabetes no pré-operatório e outro sem diabetes. Em seguida, os dois foram subdivididos em quatro subgrupos conforme a evolução do diabetes, sendo eles refratário, responsivo, estáveis e não estáveis, respectivamente. Dados demográficos, laboratoriais, nutricionais, prescrições medicamentosas e evolução clínica do diabetes no pós-operatório a longo prazo foram coletados. Resultados: Dos 96 pacientes efetivamente avaliados, a idade situou-se em 50,39 (± 10,98) no grupo refratário, 56,63 (± 8,29) no grupo responsivo, 47,62 (± 10,72) no grupo estável e 48,17 (± 10,45) no grupo não estável. O sexo feminino prevaleceu em todos os grupos. Uma taxa de 66,7% dos pacientes com diabetes alcançaram a remissão da doença após a DGYR, o tempo de diagnóstico de diabetes pré-operatório se relacionou com o grupo refratário, e uma população de novos diabéticos se configurou tardiamente em pacientes sem a doença no período pré-operatório. Conclusão: 1) A derivação gástrica em Y de Roux induziu remissão em 66,7% dos pacientes com diabetes prévio; 2) O tempo de diagnóstico de diabetes tipo 2 esteve associado com ausência da resposta cirúrgica; 3) Pacientes euglicêmicos desenvolveram diabetes após a intervenção na proporção de 17,7%, comprovando que a proteção do procedimento bariátrico contra a instalação do diabetes tipo 2 se atenua com o passar dos anos; 4) Tanto os pacientes com a glicemia anormal quanto os euglicêmicos submetidos à DGYR, necessitam de um seguimento a longo prazo do homeostase glicídica / Introduction: The mechanisms responsible for the development of diabetes associated with obesity among bariatric patients are targets of many ongoing studies. The main lines of thought involve changes in body mass index (BMI), gastrointestinal hormones, systemic inflammation and reformatting nutritional education. Most of these issues were examined from a short term perspective, with information concerning cases after 10 years still scarce. Objectives: Evaluate the outcome of long term of glucose homeostasis after DGYR in patients with and without previous diabetes, and document the clinical and nutritional parameters that differentiate these groups. Methods: An observational retrospective and prospective controlled study with 100 patients undergoing Roux-en-Y gastric bypass. These patients were divided into two initial groups, one with diabetes preoperatively and another without. Then the two groups were subdivided into four subgroups according to the evolution of diabetes, namely refractory, responsive, stable and unstable respectively. Demographic, laboratory, nutritional, and clinical information along with drug prescriptions were collected Results: Among the 96 patients effectively studied, age was 50.39 (± 10.98) in the refractory group, 56.63 (± 8.29) in the responsive group, 47.62 (± 10.72) in the stable group and 48 , 17 (± 10.45) in the unstable group. Females were the majority in all groups. About 66,7% of patients with diabetes achieved disease remission after DGYR, and duration of diabetes was associated with the refractory group. A population of new-onset diabetes was identified in patients without disease in the preoperative period. Conclusion: 1) Roux-en-Y gastric bypass induced remission in 66,7% of patients with previous diabetes; 2) Duration of diagnosis of type 2 diabetes was associated with surgical response, 3) Euglycemic patients developed diabetes after the intervention in the proportion of 17,7%, proving that the protection of bariatric procedure against type 2 diabetes is attenuated over the years; 4) Both patients with abnormal glucose profile as well as those euglycemic undergoing DGYR, require long follow-up of glucose homeostasis

Submitted by Erika Demachki (erikademachki@gmail.com) on 2015-05-11T21:18:50Z No. of bitstreams: 2 Dissertação - Valéria Costa Peres - 2014.pdf: 1086390 bytes, checksum: d7d4f057f959093aea29c55a320a2f26 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Erika Demachki (erikademachki@gmail.com) on 2015-05-11T21:26:32Z (GMT) No. of bitstreams: 2 Dissertação - Valéria Costa Peres - 2014.pdf: 1086390 bytes, checksum: d7d4f057f959093aea29c55a320a2f26 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-05-11T21:26:32Z (GMT). No. of bitstreams: 2 Dissertação - Valéria Costa Peres - 2014.pdf: 1086390 bytes, checksum: d7d4f057f959093aea29c55a320a2f26 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-04-11 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / INTRODUCTION: Breast cancer is the leading cause of women’s death in many countries and the cancer type of highest incidence among Brazilian women. It is important to strengthen public health policies for women's health through multidisciplinary teamwork to identify the best interventions aiming early detection of the disease recurrence and suiting follow-up after the treatment has begun. OBJECTIVE: To evaluate the association between relapse and survival of women with breast cancer staging and follow-up for five years after diagnosis. METHODOLOGY: retrospective cross-sectional study made in a specialized cancer institute in the state of Goiás. The study population consisted of 460 records of women diagnosed with breast cancer in 2008 and treated in this institution. Data collection was conducted in the period of June and October of 2013 through semi-structured script prepared by the researcher and validated by an expertise of the area. The data were transferred to an excel spreadsheet and analyzed in Statistical Package for Social Science (SPSS) 19.0. Categorical variables were presented as absolute value (f) and percentage value (%) and continuous variables were presented as average ± standard deviation. Fisher’s exact test was used to verify the association among categorical variables. It was considered statistically significant if p <0.05. The Kaplan Meier estimator was also used to identify the survival of women in a period of five years. The project was approved by the ethics research committee and complied with the ethical and legal aspects set out in Resolution No. 466 / 012. RESULTS: It was identified a rate of 14% of deaths, 6% of local/regional recurrence and 25% of metastatic within five years. It was pointed that 26% of women missed follow-up, from these, 45% were diagnosed at stage III, 35% had cancer recurrence and 77% of women did not have consultation with the nurse during the period. CONCLUSION: It is noticed an improvement in survival of women with breast cancer in five years, but there are still a significant number of women being diagnosed in advanced stages. Among women who lost follow-up, a considerable number of them were identified as relapsed before leaving the following, which confirms the need for effective strategies to ensure follow-up of these women in the health service during the recommended period. / INTRODUÇÃO: O câncer de mama se apresenta como a principal causa de morte em mulheres em diversos países e como o tipo de câncer de maior incidência entre as mulheres brasileiras. É importante consolidar políticas públicas de saúde voltadas à saúde da mulher com atuação da equipe multidisciplinar para análise das melhores intervenções que visem a detecção precoce de recidivas da doença e o seguimento adequado após instituição do tratamento. OBJETIVO: Avaliar a associação entre recidiva e sobrevida de mulheres com câncer de mama com estadiamento e seguimento durante cinco anos após o diagnóstico. METODOLOGIA: estudo de coorte transversal do tipo retrospectivo realizado em uma instituição especializada em oncologia do estado de Goiás. A população foi constituída de prontuários de mulheres diagnosticadas com câncer de mama no ano de 2008 atendidas nessa instituição, perfazendo o total de 460 prontuários. A coleta de dados foi realizada no período entre junho e outubro de 2013 por meio de roteiro semiestruturado elaborado pela pesquisadora e validado por expertise da área. Os dados foram transferidos para uma planilha do excel e analisados em Statistical Package for Social Science (SPSS) 19.0. As variáveis categóricas foram apresentadas como valor absoluto (f) e valor percentual (%) e as variáveis contínuas apresentadas como média±desvio padrão. O teste Exato de Fisher foi usado para verificar a associação entre as variáveis categóricas. Considerou-se estatisitcamente significativo p<0,05. Foi utilizado ainda a curva de Kaplan Meier a fim de identificar a sobrevida das mulheres em um período de cinco anos. O projeto foi aprovado pelo comitê de ética em pesquisa e atendeu aos aspectos ético-legais enunciados na Resolução nº466/012. RESULTADOS: Identificou-se uma taxa de 14% de óbitos, de 6% de recidiva locorregional e de 25% de metástase à distância em cinco anos. Detectou-se que 26% das mulheres apresentaram perda de seguimento, destas, 45% foram diagnosticadas no estágio III, 35% apresentaram recidiva da doença e 77% das mulheres não realizaram consulta com o enfermeiro durante o período. CONCLUSÃO: Percebe-se uma melhora da sobrevida de mulheres com câncer de mama em cinco anos, porém ainda há um número considerável de mulheres diagnosticadas em estágios avançados. Entre as mulheres que perderam o seguimento, um número considerável apresentou recidiva antes de abandonar o seguimento, o que confirma a necessidade de estratégias eficazes na garantia de acompanhamento dessas mulheres no serviço de saúde durante o período recomendado.