Thesis (M.Sc. (Physiology))--Mahidol University, 1983.

Thesis (M.S.)--Ohio University, November, 2004. / Includes bibliographical references (p. 115-117)

Thesis (M.S.)--Ohio University, November, 2004. / Title from PDF t.p. Includes bibliographical references (p. 115-117)

Orientador: Gabriel Hessel / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-09T01:55:34Z (GMT). No. of bitstreams: 1 Banin_MarciaRegina_M.pdf: 2211563 bytes, checksum: e16e20135efbf828907adc92ed40ba6b (MD5) Previous issue date: 2007 / Resumo: Racional - As doenças de depósito de glicogênio compreendem um grupo de doenças geneticamente determinadas e classificadas em 11 tipos, de acordo com as deficiências enzimáticas identificadas. Há pouca informação sobre a evolução dessas doenças. Objetivos - Descrever as características clínicas e laboratoriais, na admissão e evolução, de pacientes com doença de depósito de glicogênio. Pacientes e métodos ¿ Participaram do estudo 22 pacientes com diagnóstico de glicogenose hepática, sendo 11 (50%) do sexo feminino. O estudo foi descritivo e longitudinal. A ficha de coleta de dados constituiu-se de informações iniciais de: quadro clínico, peso, estatura, índice de massa corporal (IMC) e resultados dos exames laboratoriais (hemograma, enzimas hepáticas, colesterol total e frações, triglicérides, glicemia, ácido úrico, uréia e creatinina). Selecionou-se os momentos 1 (admissão), 3 (12 meses de evolução) e 7 (36 meses de evolução) para coleta dos seguintes dados: peso, estatura, IMC, ácido úrico, glicemia, colesterol e triglicérides. Também, foram comparados os resultados de antropometria e exames bioquímicos dos pacientes em dois momentos: admissão e última consulta. Para as variáveis peso e estatura, calculou-se o Z escore sendo considerado déficit quando o valor se situava abaixo do segundo desvio padrão. A velocidade de crescimento foi calculada a partir da 2ª e 1ª consulta (V1) e a partir da última e penúltima consulta (V2). A taxa de aderência foi determinada pela porcentagem de absenteísmo das consultas da seguinte forma: boa: se absenteísmo menor que 20%; regular: se absenteísmo entre 20% e 40% e ruim: se absenteísmo maior que 40%. Utilizou-se como teste estatístico a análise de variância e os testes de Kruskal-Wallis, Mann-Whintney e Wilcoxon, sendo o nível de significância adotado de 5%. Resultados - A média da idade de início dos sintomas foi de 10,7 meses e do diagnóstico de 28,18 meses. O tempo médio de seguimento foi de 105 meses. As manifestações clínicas iniciais mais freqüentes foram: hepatomegalia em 21 (95%), abdômen protuberante em 19 (86%), face de boneca em 14 (64%), diarréia em 10 (45%) e história de hipoglicemia em 8(36%). Nos exames laboratoriais, observou-se, na maioria dos casos, aumento das enzimas hepáticas, hipercolesterolemia, hipertrigliceridemia e hipoglicemia. Na admissão, o déficit de peso/idade foi de 26% (5/19) e de estatura/idade foi de 35% (7/20). Não houve diferença estatística na comparação do Z escore de peso/idade, estatura/idade, índice de massa corporal e exames laboratoriais na admissão, com 12 e 36 meses. Entre a admissão e a última consulta, observou-se diferença significativa no índice de massa corporal, enzimas hepáticas, glicemia e triglicérides, o que não aconteceu com Z escore de peso/idade, estatura/idade e os exames de ácido úrico e colesterol. A taxa de aderência foi considerada boa em 64% dos pacientes. Na comparação da velocidade de crescimento, observou-se tendência de aumento comparando V1 com V2. Conclusões ¿ Houve demora no encaminhamento ao centro de referência para o diagnóstico das glicogenoses. As manifestações clínicas mais freqüentes foram abdômen protuberante e hepatomegalia e as alterações laboratoriais mais significativas foram a elevação dos triglicérides, colesterol e diminuição da glicemia. Na evolução, não houve diferença nos parâmetros antropométricos, mas uma tendência de melhora de velocidade de crescimento. O tratamento melhorou o desarranjo metabólico / Abstract: Background ¿ Glycogen storage diseases comprise a group of genetic diseases determined and classified into 11 types, according to the identified enzymatic deficiency. There is little information regarding the disease evolution. Aim ¿ Describe clinical and laboratorial characteristics in the admission and evolution of patients with glycogen storage disease. Patients and methods ¿ Twenty-two patients with hepatic glycogen diagnosis participated in the study, 11 (50%) of which were female. The study was descriptive and longitudinal. The collected data file consisted of admission information: clinical features, weight, height, body mass index (BMI) and laboratorial exam results: hemogram, hepatic enzymes, total cholesterol and fractions, triglycerides, glycemia, uric acid, urea and creatin. Afterwards, the following phases were selected: 1 (admission), 3 (12 months of evolution) and 7 (36 months of evolution) for the weight, height, BMI and laboratorial tests: uric acid, glycemia, total cholesterol and triglycerides. The antropometric data, hepatic enzymes and mentioned tests were compared during 2 moments: admission and last appointment of each patient. The score Z was utilized to evaluate the weight and height of patients, considered if the standard deviation was under 2. The growth velocity was calculated among the second and first consult and the last and the penultimate consult. The adherence percentage was determined by the appointment absence percentage: Good: absenteeism minor 20%; regular: absenteeism major 20% and minor 40%; bad: absenteeism major 40%. The statistical tests applied were ANOVA, Kruskal-Wallis, Mann-Whintney, and Wilcoxon. The significance level was 5%. Results - The mean time during the first symptoms was 10,73 months and the mean time up to diagnosis was 28,18 months. The mean time of follow-up was 105 months. The most frequent initial clinical manifestations were: hepatomegaly in 21 (95%), protuberant abdomen in 19 (86%), doll face in 14 (64%), diarrhea in 10 (45%) and history hypoglycemia in 8 (36%). In the admission the deficit of the weight to age was 26% (5/19) and height to age was 35% (7/20), In the initial biochemical tests showed elevation of hepatic enzymes, hypercholesterolemia, hypertriglyceridemia, hypoglycemia. There was no statistical difference among the score Z weight to age, score Z height to age, body mass index and laboratorial tests of admission within 12 and 36 months. Significant differences were observed in BMI, hepatic enzymes, glycemia and triglycerides between the first and the last appointments, opposing to the score Z weight to age, score Z height to age, uric acid and cholesterol exam results. In the comparison of the growth velocity there was elevation tendency between the V1 and V2. There was difference significative of the growth velocity among the first and second versus the penultimate and the last consult. The adherence percentage was considered good in 64%. Conclusions - The patients delayed in seeking the reference center for glycogenosis early diagnosis. The most frequent clinical manifestations were protuberant abdomen, hepatomegaly, elevation of triglycerides and cholesterol, and glycemia reduction. In the evolution, there wasn¿t difference statistic in the antropometric parameters, but there was improvement tendency on the growth velocity. The treatment has improved the metabolic derangement / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

Class of 2014 Abstract / Specific Aims: To evaluate the association of weight-based insulin dose with hypoglycemia in critically ill patients receiving continuous intravenous insulin infuions. To determine whether higher weight-based doses of insulin were associated with a higher incidence of hypoglycemia Methods: This was a retrospective, case-control study conducted at a tertiary care, academic medical center. Adult (>18 years) patients admitted to the intensive care unit (ICU) receiving intravenous (IV) regular insulin infusions for the management of hyperglycemia between 1 January 2008 and 30 March 2013 were included. Medical records were retrospectively reviewed. Each patient with hypoglycemia was matched with a non-hypoglycemic control subject, based on age range and sex. Laboratory data, patient demographics, hypoglycemic events, insulin infusion data, SOFA scores, length of hospital and ICU stay, and patient outcomes were collected and evaluated. Main Results: Sixty-one patients experienced a hypoglycemic event and were matched with 61 non-hypoglycemic control subjects for statistical analysis. With the exception of ethnicity (p = 0.041) as a demographic predictor of hypoglycemia; age, sex, weight, height, and BMI were not significant. The starting insulin infusion rate and the total number of insulin units per day administered were not found to be associated with hypoglycemia, p=0.107 and p=0.357, respectively. Conclusion: This study failed to show significance in the total units per day of insulin and the incidence of hypoglycemia. There was no statistical significance in BMI between case and control groups, thus no clear conclusion can be made associating hypoglycemia with weight-based insulin dosing.

M.Cur. / Please refer to full text to view abstract

Bakgrund: Fysisk aktivitet vid diabetes typ 1 är viktig. Den kan förbättra blodsockerkontrollen över tid. Det har uttryckts ett behov av vidare studier för att undersöka vilket stöd diabetiker får från sjukvården gällande fysisk aktivitet. Det behöver även undersökas om personer med diabetes upplever rädsla för att vara fysiskt aktiva på grund av risken för hypoglykemi.    Syfte: Syftet med denna kvalitativa studie är att via intervjuer undersöka vilket stöd individer med nydiagnostiserad diabetes typ 1 upplever att de får från sjukvården gällande fysisk aktivitet. Studien ska även belysa vilka erfarenheter patienter med diabetes typ 1 har gällande rädsla kopplad till fysisk aktivitet samt vad de anser skulle kunna minska den rädslan.    Metod: I studien användes en kvalitativ deskriptiv design och datainsamlingen genomfördes med fem semistrukturerade intervjuer. Databearbetningen gjordes med kvalitativ innehållsanalys.   Resultat: Upplevelserna av råden från sjukvården gällande fysisk aktivitet skiljde sig mellan de intervjuade. För dem som haft diabetes kortast tid framstod råden som bra men generella, medan de som levt med sin diabetes en längre tid tyckte att råden var mer individanpassade. Mer individanpassade råd önskades. Ingen av de intervjuade uttryckte specifik rädsla för att vara fysiskt aktiv.   Konklusion: Råden diabetiker får från sjukvården är bra men otillräckliga. I framtiden skulle det behövas mer stöd kring fysisk aktivitet i form av träningsspecifika råd och uppmuntran. / Background: For people diagnosed with type 1 diabetes physical activity is important. It can improve glucose control over time. A need for further research about the support diabetics receive from healthcare professionals regarding physical activity has been expressed. There is also a need for investigating if diabetics experience fear of being physically active due to the risk of hypoglycemia.    Purpose: The purpose of this qualitative study is to explore, through interviews, what support individuals with newly diagnosed type 1 diabetes receive from healthcare professionals regarding physical activity, and how they experience this support. The study will also illustrate what experiences people with type 1 diabetes have regarding fear of being physically active as well as what they believe can reduce that potential fear.   Method: The study used a qualitative descriptive design, and data collection was conducted through five semi-structured interviews. Qualitative content analysis was used to process the data.   Results: The interviewees’ experiences of the advice from healthcare professionals regarding physical activity was inconsistent. For those who have lived with diabetes for a shorter period of time, the advice was considered good but quite general. Those who have lived with their diabetes for a longer period of time thought that the advice was more individualized. More individualised advice was requested. None of the interviewees expressed specific fear of being physically active.   Conclusion: The advice diabetics receives from healthcare professionals is considered good but insufficient. In the future more support will be needed regarding physical activity in the form of exercise-specific advice and encouragement.

Introduction: Insulinomas are pancreatic endocrine neoplasms with a low incidence between 1-4 cases per million per year. Case description:'A female 49 years-old with neurological and psychiatric symptoms were treated for two years as a psychiatric patient. Presented a glucose value, which reflects hypoglycemia. The patient was operated with resolution of symptoms. Conclusion: Assess all patients with psychiatric symptoms and perform a complete medical history and laboratory findings, being the most opportune glucose. / Revisión por pares

Indiana University-Purdue University Indianapolis (IUPUI) / Volatile organic compounds (VOCs) are endogenous byproducts of metabolic pathways that can be altered by a disease or condition, leading to an associated and unique VOC profile or signature. Current methodologies for VOC detection include canines, gas chromatography-mass spectrometry (GC-MS), and electronic nose (eNose). Some of the challenges for canines and GC-MS are cost-effectiveness, extensive training, expensive instrumentation. On the other hand, a significant downfall of the eNose is low selectivity. This thesis proposes to design a breathalyzer using chemiresistive gas sensors that detects VOCs from human breath, and subsequently create an interface to process and deliver the results via Bluetooth Low Energy (BLE). Breath samples were collected from patients with hypoglycemia, COVID-19, and healthy controls for both. Samples were processed, analyzed using GC-MS, and probed through statistical analysis. A panel of 6 VOC biomarkers distinguished between hypoglycemia (HYPO) and Normal samples with a training AUC of 0.98 and a testing AUC of 0.93. For COVID-19, a panel of 3 VOC biomarkers distinguished between COVID-19 positive symptomatic (COVID-19) and healthy Control samples with a training area under the curve (AUC) of receiver operating characteristic (ROC) of 1.0 and cross-validation (CV) AUC of 0.99. The model was validated with COVID-19 Recovery samples. The discovery of these biomarkers enables the development of selective gas sensors to detect the VOCs. Polyethylenimine-ether functionalized gold nanoparticle (PEI-EGNP) gas sensors were designed and fabricated in the lab and metal oxide (MOX) semiconductor gas sensors were obtained from Nanoz (Chip 1: SnO2 and Chip 2: WO3). These sensors were tested at different relative humidity (RH) levels and VOC concentrations. The contact angle which measures hydrophobicity was 84° and the thickness of the PEI-EGNP coating was 11 µ m. The PEI-EGNP sensor response at RH 85% had a signal 10x higher than at RH 0%. Optimization of the MOX sensor was performed by changing the heater voltage and concentration of VOCs. At RH 85% and heater voltage of 2500 mV, the performance of the sensors increased. Chip 2 had higher sensitivity towards VOCs especially for one of the VOC biomarkers identified for COVID-19. PCA distinguished VOC biomarkers of HYPO, COVID-19, and healthy human breath using the Nanoz. A sensor interface was created to integrate the PEI-EGNP sensors with the printed circuit board (PCB) and Bluno Nano to perform machine learning. The sensor interface can currently process and make decisions from the data whether the breath is HYPO (-) or Normal (+). This data is then sent via BLE to the Hypo Alert app to display the decision.

This study examined the rates and risks of premature neonates >2500grams developing intraoperative non-euglycemia events (IONEE). A retrospective chart review of 26 premature neonates >2500 grams who underwent surgical procedures between January 1 and December 31, 2009 was conducted. Statistical analysis was done using Chi square and t-tests. Ten of the 26 subjects (38%) experienced an IONEE. Hyperglycemia was the primary IONEE that was noted in the neonates. (Mean: 143.19; sd: 56.041) Length of surgery was significantly longer in those premature neonates with IONEE than those with euglycemia (71.7 0± 27.03 vs. 45.62 ± 17.98 minutes). All IONEE subjects received general anesthesia (n=10) while none of those with only intravenous anesthesia had an IONEE (X2 (1) = 4.875, p=.027). Subjects with IONEE had a higher mean preoperative glucose level (127.11 gm/dL ± 31.66) than those who did not experienced IONEE (86.36 gm/dL ± 29.39; t(21) = 3.151, p=.005). A higher proportion of subjects who developed IONEE had the capillary heel (60%) as opposed to an arterial (40%) site for blood collection (X2 (1) = 6.518, p =.001). Also, subjects free of preoperative pulmonary complications were more prone to develop IONEE (X2 (1)= 8.60, p = .003). The presence of IONEE was associated with development of metabolic acidosis (X2 (1)= 5.426, p=.020) and lower postoperative pH values (7.19 ± 0.20 vs. 7.35 ± 0.11). Anesthesia providers need to establish intraoperative guidelines for the monitoring and treatment of IONEE to protect these premature neonates from having complications such as developmental delay.