Premature ovarian Insufficiency (POI) is the cessation of the ovarian function before the age of 40, defined by high serum gonadotrophins, low estradiol and amenorrhea for at least 4 months. The etiology may be iatrogenic after a surgery, chemotherapy or radiotherapy treatment, environmental, autoimmune or genetic. However, in most of the cases the cause remains unknown. Clinical and family studies suggest a strong heritability of age at menopause and POI, but the number of genetic causes and genes identified to be involved in human POI remains very small. In POI patients, the two crucial functions of the ovary, hormonal secretion and reproduction, are absent. In the last decades, however, new advances in assisted reproduction techniques have allowed the possibility of carrying pregnancies to POI women, thanks to oocyte donation. The aim of this study was to identify new genetic factors implicated in the development of POI women and to analyse the reproductive possibilities and outcome of women with a genetic cause of POI. For the first part of the study, the DNA of a cohort of POI women recruited in the Fertility Clinic of the Hôpital Erasme of the Université Libre de Bruxelles was used to sequence five candidate genes (FSHR, GDF9, BMP15, AMH and AMHR2) known to be implicated in the ovarian folliculogenesis. The most important findings were two very rare variants and one unknown variant in the AMH gene. The functional study performed with these variants suggested a diminished function of the mutant protein. Furthermore, one of the variants was found in the mother of one of the patients, who was also diagnosed of POI at 32 years old. These arguments strongly suggest that a defective AMH could play a role in the development of POI. This is supported by previous studies with knock out mice models, which show an earlier depletion of the ovarian follicle pool due to a faster recruitment of the primordial follicles that constitute the ovarian reserve. The sequencing of the BMP15 gene led to the identification of two new variants not identified among controls but not predicted to be deleterious. Interestingly, one variant previously reported in POI women and predicted to be deleterious for the protein function, was found in a Sub-Saharan African POI patient as well as in our control cohort. This variant was already studied functionally and shown to have a reduced biological activity. However, we identified this variant in 6% of the Sub-Saharan African control population, which suggests that this is a more prevalent variant in the African genotype and raises up the importance of the ethnicity when studying genetic variants.The sequencing of the other genes (FSHR, GDF9 and AMHR2) did not lead to any association with POI.In the second part of the study, 24 women with Turner syndrome and POI were analysed in terms of reproductive, obstetrical and perinatal outcome after oocyte donation. This specific group of patients was chosen because of their specific systemic anomalies that could interfere with pregnancy outcome and because very few reports have been published on this subject. In the 23 patients finally transferred, the pregnancy rate was similar to that obtained after oocyte donation in other cohorts. There was a miscarriage rate of 23% and a rate of complications of pregnancy as high as 50%, mainly caused by pregnancy-induced hypertensive diseases. Four women at risk of genetic POI were included in the fertility preservation program in order to vitrify their oocytes. Three of them have already vitrified successfully their oocytes but none of them has yet used them.Oocyte vitrification represents a new hope for those women with genetic risk of POI to be able to carry a pregnancy with their own oocytes.In conclusion, three variants of the AMH gene could be implicated in the development of POI as demonstrated by the reduced in vitro bioactivity of the variants and the familial segregation of the cases. Since then, it sounds plausible to propose AMH sequencing in the case of familial POI and secondary amenorrhea.In the BMP15 gene, 2 new variants were predicted to be tolerated. A potentially deleterious variant of the BMP15 gene (L148P) previously associated to POI, was also found in 6% of the Sub-Saharan African controls which suggests that it is a common variant in the African ethnic. No clear association was found between the other tested candidate genes and our POI cohort.Regarding Turner’s Syndrome pregnancies, we can conclude that they are high-risk pregnancies that need of a multidisciplinary follow-up before and during pregnancy.Oocyte cryopreservation represents a new tool to be offered to women at risk of genetic POI to preserve their fertility, but not without previous genetic counselling. / Doctorat en Sciences médicales (Médecine) / info:eu-repo/semantics/nonPublished

Mes travaux ont concerné 1) l'ascite, 2) l'inflammation systémique, et 3) l'identification de la l'insuffisance surrénale au cours de la cirrhose. L'analyse prospective de 515 paracentèses montrait que les taux de complications mineures et majeures étaient respectivement de 8,9% et de 1,6%. La paracentèse évacuatrice (vs. exploratrice) était associée au risque de complication majeure, tandis que l'étiologie alcoolique, la gravité de la cirrhose (Child-Pugh C) et l'intensité de la thrombopénie rendaient plus compte des complications mineures. Les performances de deux bandelettes urinaires (BU) pour le diagnostic de l'infection spontanée du liquide d'ascite (ISLA) étaient excellentes (100 paracentèses testées). Avec un seuil de 125 leucocytes/mm3, les performances de la BU Multistix 8SG affichaient de moins bons résultats dans notre étude multicentrique (2123 paracentèses): sensibilité à 45,3% et VPP à 77,9%. Une élévation persistante de la C-réactive protéine (CRP) >29 mg/L entre JO et J15 prédisait la survie à 6 mois chez 175 patients cirrhotiques (Child-Pugh>7) hospitalisés, indépendamment du MELD, de l'existence de comorbidités extra-hépatiques et d'un carcinome hépatocellulaire. Nous avons montré que les concentrations de cortisol total sérique (CTS) diminuaient avec la dégradation de la fonction hépatique alors que les concentrations du cortisol libre sérique (CLS) et salivaire augmentaient ; cette chute du CTS était en rapport avec une chute des concentrations des protéines porteuses du cortisol [albumine et cortisol binding protein (CBG)] produites par le foie. Nous avons aussi montré que des concentrations élevées de CLS étaient associées à une surmortalité. / My research has been focused on: 1) managing ascitis, 2) the systemic inflammation, and 3) the adrenal insufficiency in cirrhosis. Our prospective analysis of 515 paracentesis showed that the rates of minor and major complications were of 8.9% and of 1.6%, respectively. Therapeutic (vs. diagnostic) paracentesis was associated with risk of major complications, whereas the aetiology related to alcohol, the severity of cirrhosis (Child-Pugh C) and the intensity of thrombopenia were associated with minor complications. The performances of two urinary strips for the diagnosis of spontaneous bacterial peritonitis (SBP) were excellent (100 paracentesis tested). Using the cut-off of 125 leukocytes/mm3, the performances of the Multistix 8SG strip displayed disappointing results in our multicenter study (2123 paracentesis): sensitivity of 45.3% and PPV of 77.9%. A Persistent C-reactive protein (CRP) >29 mg/L within the first 15 days predicted the 6-month mortality in 175 cirrhotic inpatients (Child-Pugh>7), independently of the MELD score, extra-hepatic comorbidities and hepatocellular carcinoma. We demonstrated that concentrations of serum total cortisol (STC) decreased along with the altération of hepatic function while the concentrations of serum free cortisol (SPC) and salivary cortisol increased. The low concentrations of STC in these patients were related to reduced serum concentrations of cortisol-binding proteins [albumin and corticosteroid-binding globulin (CBG)], both synthesized in the liver. Unlike previously reported. we have shown that patients who died at 12 months had high levels of SPC after 1ug of Synacthen, challenging the concept of "hepatoadrenal syndrome".

silamud@gmail.com / Introducción: La ausencia a una sesión mensual en un esquema de diálisis convencional puede incrementar la mortalidad en 30%. Objetivos: Describir la frecuencia y la percepción de las causas de falta de adherencia a diálisis en una población prevalente de un hospital público de referencia nacional en Perú. Diseño: Estudio descriptivo. Institución: Servicio de Nefrología, Hospital Nacional 2 de Mayo, Lima, Perú. Participantes: Pacientes con más de un año en diálisis Intervenciones: Se determinó el número de faltas y se aplicó un cuestionario para describir su percepción respecto a las causas de las faltas, validado por juicio de expertos. Principales medidas de resultados: Baja adherencia a diálisis definida como: pacientes con más de una falta al mes o más de 12 faltas, entre julio de 2012 y julio de 2013. Resultados: Se incluyó 54 pacientes, 27 eran varones, con una edad y tiempo de diálisis promedio de 57 ± 16,4 años y 40,6 ±11,5 meses, respectivamente; 7/54 pacientes tenían educación superior. Hubo 504 faltas (5,45%). El segundo día de la programación semanal fue el día con mayor frecuencia de faltas (292), seguido del tercer día (145); 13/54 tuvieron baja adherencia. Las principales causas reportadas fueron: una residencia alejada (6/13), la sensación de bienestar (6/13), el contar con escasos recursos económicos para solventar el traslado (5/13). Conclusiones: Uno de cada cuatro pacientes tuvo baja adherencia. El residir lejos o que se sintiera bien fueron las principales causas de la baja adherencia. / Background: Failing to attend a monthly session within a scheme of conventional dialysis may increase mortality by 30%. Objectives: To describe the frequency and perceived causes of non-adherence to dialysis in a Peruvian national reference public hospital. Design: Descriptive study. Setting: Nephrology department, Hospital Nacional 2 de Mayo, Lima, Peru. Participants: Patients with more than one year on dialysis. Interventions: The number of absences to appointed sessions was determined and a validated questionnaire was used to describe perceptions regarding the causes of absences. Main outcomes measures: Low adherence to dialysis defined as patients with more than one absence per month or more than 12 absences between July 2012 and July 2013. Results: The study included 54 patients, of which 27 were male. Average age was 57 ± 16.4 years and average time on dialysis was 40.6 ± 11.5 months. Only 7 patients had higher education. There were 504 absences (5.45%). The second day of the weekly schedule was the day with more absences (292), followed by the third day (145). Overall 13 patients showed low adherence. Main causes of absence reported included a remote residence (6/13), feeling good (6/13), and insufficient financial resources to cover transportation costs (5/13). Conclusions: A quarter of patients had low adherence, and main factors were distance to health facility and wellbeing self-perception.

Orientadores: Cristina Laguna Benetti Pinto, Rose Luce Gomes do Amaral / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-28T09:13:50Z (GMT). No. of bitstreams: 1 GiraldoSouza_HelenaPatriciaDonovan_M.pdf: 2305470 bytes, checksum: add3640d7732bc5676b5b9eb414466b0 (MD5) Previous issue date: 2015 / Resumo: Introdução: Insuficiência Ovariana Prematura 46XX (IOP) é um estado de hipogonadismo, caracterizado por oligoamenorréia, infertilidade e deficiência estrogênica em mulheres abaixo de 40 anos. Mulheres com IOP deveriam ser tratadas com reposição estrogênica até pelo menos a idade da menopausa, para reduzir os sinais e sintomas do hipoestrogenismo e se possível, preservar a massa mineral óssea. Objetivos: Avaliar se Terapia Hormonal (TH) com baixa dose estrogênica é adequada para reduzir a perda de massa óssea de mulheres com IOP. Métodos: Estudo de corte transversal. Foram avaliadas 239 mulheres com IOP: 132 usando TH baixa dose (17-Beta-Estradiol 1mg + Noretisterona ou estrogênio conjugado 0,625mg + acetado de Medroxiprogesterona) e 107 mulheres sem TH. Todas responderam anamnese detalhada (idade, idade na última menstruação e idade no início de tratamento) e foram submetidas a avaliação de densidade mineral óssea (DMO) na coluna lombar (CL), colo femoral (CF) e fêmur total (FT) através da técnica DEXA. Resultados: As médias de idade, idade na última menstruação e de IMC para o grupo sem tratamento e para o grupo com TH foram 38,1 ± 6,1 e 36,8 ± 7,3 anos; 31,4 ± 7,3 e 30,7 ± 7,2 anos; 26,6 ± 7,1 e 25,8 ± 4,6, respectivamente (p=NS). A DMO média na CL foi 1,06 ± 0,15 e 1,00 ± 0,17g/cm2 (p=0,003), para CF 0,92 ± 0,15 e 0,89 ± 0,14 (p=0,0479) e FT de 0,92 ± 0,19 e 0,91 ± 0,13 g/cm2 (p=0,039), respectivamente para os grupos. Verificou-se DMO alterada na CL em 45,1% (35,2% Osteopenia e 9,8% Osteoporose) das mulheres sem tratamento e 60,1% (38,1 Osteopenia e 22% Osteoporose) quando usavam TH baixa dose (p=0,01). No CF 25,4% (21,5% Osteopenia e 3,9% Osteoporose) das mulheres sem tratamento e 29,6% (22,8% Osteopenia e 6,7% Osteoporose) quando usavam TH baixa dose (p=0,38) mostravam alteração e, para FT, em 32,35% (19,6% Osteopenia e 12,7% Osteoporose) das sem tratamento e 36,4% (21,2% Osteopenia e 15,2% Osteoporose) para TH de baixa dose (p=0,34). Conclusão: A TH de baixa dose não parece ser adequada para reduzir a perda de massa óssea de coluna lombar, colo de fêmur e fêmur total em mulheres com IOP / Abstract: Introduction: Premature Ovarian Insufficiency (POI) is a hypogonadism state, characterized by oligoamenorhea, infertility and estrogen deficiency in women below the age of 40. Women with POI should be treated with estrogen replacement until at least the age of menopause, in order to reduce the signs and symptoms of hypoestrogenism and if possible, preserve bone mineral density (BMD). Aim: To assess whether hormone therapy (HT) with low estrogen dose is sufficient to avoid bone mass loss in women with POI. Methods: Cross-sectional study. Two hundred and thirty nine women were evaluated: 132 using low dose TH (1 mg of 17-Beta-Oestradiol + Norethisterone or 0.625 mg of conjugated estrogen + medroxyprogesterone acetate) and 107 women without HT. Detailed history was obtained from the studied women (age, age of last menstrual period and age of onset of treatment) and were subjected to evaluation of bone mineral density (BMD) in the lumbar spine (LS), femoral neck (FN) and total femur (TF) through DEXA technique. Results: The mean age, age at last menstrual period and BMI for the untreated group and the group with HT were 38.1 ± 6.1 and 36.8 ± 7.3 years; 31.4 ± 7.3 and 30.7 ± 7.2 years; 26.6 ± 7.1 and 25.8 ± 4.6 respectively (p = NS). The mean LS BMD was 1.06 ± 0.15 and 1.00 ± 0,17g / cm2 (p = 0.003), CF 0.92 ± 0.15 and 0.89 ± 0.14 (p = 0.0479) and FT 0.92 ± 0.19 and 0.91 ± 0.13 g / cm2 (p = 0.039) respectively for the groups. BMD at LS was compromised in 45.1% (35.2% osteopenia and osteoporosis 9.8%) for women without treatment and 60.1% (38.1% osteopenia and 22% osteoporosis) low dose HT (p = 0.01). For the FN 25.4% (21.5% Osteopenia and Osteoporosis 3.9%) of women without treatment and 29.6% (22.8% Osteopenia and Osteoporosis 6.7%) for the ones in use of TH low dose, were compromised (p = 0 38). For TF compromise was found in 32.35% (19.6% osteopenia and 12.7% osteoporosis) of the untreated women and 36.4% (21.2% and 15.2% osteoporosis osteopenia) for low dose HT (p = 0.34). Conclusion: The low dose HT seems to be inadequate to reduce bone loss in the lumbar spine, femoral neck and total femur in women with IOP / Mestrado / Fisiopatologia Ginecológica / Mestra em Ciências da Saúde

[pt] A histeria foi usada como modelo para expressar uma forma de sofrimento psíquico típica do final do século XIX. Esta tese se propõe a justificar o uso da melancolia como a formação psíquica mais adequada para traduzir a forma de padecimento psíquico atual. Para isso é empreendido um aprofundamento na teoria freudiana a respeito da circunscrição deste quadro. Para demonstração da pertinência desta proposta o afeto da vergonha é destacado e analisado. O problema narcísico articulado ao desenvolvimento deste afeto e sua particularidade na melancolia são mencionados como pontos de aproximação com os ruídos clínicos atuais e com uma forma própria do homem de hoje lidar com a idéia de não se bastar e precisar do outro. / [en] Histery was used as model to express the typical form of psychic suffering of the end of century XIX. This thesis tries to justify the use of the melancholy as a psychic formation more adjusted to approach the form of the contemporary psychic suffering. For this a study on Freudian theory regarding the circumscription of this affection is undertaken. To demonstrate the relevancy of this proposal, the affect of the shame is circumscribed and analyzed. The narcissistic problem related to the development of this affect and its specificity in melancholy are taken as points of approach to the current clinical questions and a proper form of the man today to deal with the idea of not being enough themselves and needing other people.

The clinical features in six patients with mitral insufficiency due to chordae tendineae have been. The patients in whom the etiology was not known did not become symptomatic till they were past 40, although a murmur had been present for several years. Pulmonary edema or paroxysmal nocturnal dyspnea were the initial symptoms in a number of these patients, preceding the more usual shortness of breath with exertion. The auscultatory and phonocardiographic features are specific. On fluoroscopy readily recognizable paradoxical pulsation of the left atrium was present in some of them. At cardiac catheterization a tall left atrial “v” wave with peak pressure as high as or higher than the peak pressure in the pulmonary artery was constantly found. In a patient with mitral insufficiency where the murmur is harsh and accompanied by a thrill in the fourth intercostal space near the left sternal border and in whom an ejection type systolic murmur is heard unaccompanied by the slow rising pulse of aortic stenosis, the possibility of mitral insufficiency due to ruptured chordae tendineae should be considered.

Orientador: José Roberto Fioretto / Resumo: Objetivos: A eficácia da ventilação não invasiva com pressão positiva na prevenção da reintubação por insuficiência respiratória em crianças permanece incerta. Este estudo foi projetado para avaliar a eficácia da VNI comparada com oxigênio inalatório (cateter nasal ou máscara facial), no que diz respeito à taxa de reintubação em 48 horas em crianças que desenvolveram insuficiência respiratória pós-extubação, tempo de internação em UTIP e hospitalar. Desenho: estudo clínico prospectivo randomizado. Local: Hospital das clínicas de Botucatu - UNESP. Pacientes: crianças com idade entre 28 dias e 3 anos submetidas à ventilação mecânica invasiva por mais de 48 horas com insuficiência respiratória após extubação programada. Intervenções: os pacientes foram avaliados prospectivamente e distribuídos aleatoriamente em grupo de ventilação não invasiva de pressão positiva e grupo de oxigênio inalatório após extubação programada de maio de 2012 a maio de 2013. Medidas: tempo de internação em UTIP e hospitalar; índice de oxigenação; gases sanguíneos, frequência cardíaca e frequência respiratória antes e 1 hora após a extubação traqueal; motivo da falha de extubação traqueal; variáveis de ventilação mecânica antes da extubação traqueal. Resultados: Foram incluídos 108 pacientes (grupo de ventilação de pressão positiva não invasiva, n = 55 e grupo de oxigênio inalado, n = 53), com 66 exclusões. Os grupos não diferiram significativamente em termos de sexo, idade, gravidade da doença, risco pe... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Objectives: The efficacy of noninvasive positive pressure ventilation in preventing reintubation due to respiratory failure in children remains uncertain. This study was designed to evaluate the efficacy of NIV compared to inhaled oxygen (nasal catheter or face mask), with regard to the reintubation rate in 48 hours in children who developed post-extubation respiratory failure, length of hospital stay in the PICU and hospital. Design: Prospective randomized clinical study. Setting: PICU at a university-affiliated hospital. Patients: Children aged between 28 days and 3 years undergoing invasive mechanical ventilation for greater than or equal to 48 hours with respiratory failure after programmed extubation. Interventions: Patients were prospectively enrolled and randomly assigned into noninvasive positive-pressure ventilation group and inhaled oxygen group after programmed extubation from May 2012 to May 2013. Measurements: Length of stay in PICU and hospital, oxygenation index, arterial blood gas, and respiratory and heart rates before and 1 hour after tracheal extubation, failure and reason for tracheal extubation, mechanical ventilation variables before tracheal extubation, arterial blood gas, were analyzed. Main Results One hundred eight patients were included (noninvasive positive pressure ventilation group, n = 55 and inhaled oxygen group, n = 53), with 66 exclusions. Groups did not significantly differ for gender, age, disease severity, Pediatric Risk of Mortality at ad... (Complete abstract click electronic access below) / Doutor

Background: Chronic aortic regurgitation (AR) patients demonstrate left ventricular (LV) remodeling with increased LV mass and volume but may have a preserved LV ejection fraction (EF). We hypothesize that in chronic AR, global longitudinal systolic and diastolic function will be reduced despite a preserved LV EF. Methods: We studied with Doppler echocardiography 27 normal subjects, 87 patients with chronic AR with a LV EF > 50% (AR + PEF), 66 patients with an EF < 50% [AR + reduced LV ejection fraction (REF)] and 82 patients with hypertensive heart disease. LV volume, transmitral spectral and tissue Doppler were obtained. Myocardial velocities and their timing and longitudinal strain of the proximal and mid wall of each of the 3 apical views were obtained. Results: As compared to normals, global longitudinal strain was reduced in AR + PEF (13.8 ± 4.0%) and AR + REF (11.4 ±4.7%) vs. normals (18.4 ± 3.6%, both p < 0.001). As an additional comparison group for AR + PEF, global longitudinal strain was reduced as compared to patients with hypertensive heart disease (p = 0.032). The average peak diastolic annular velocity (e’) was decreased in AR + PEF (6.9 ± 3.3 cm/s vs. 13.4 ± 2.6 cm/s, p < 0.001) and AR + REF (4.8 ± 2.1 cm/s, p < 0.001). Peak rapid filling velocity/e’ (E/e’) was increased in both AR + PEF (14.4 ± 6.2 vs. 6.2 ± 1.3, p < 0.001) and AR + REF (18.8 ± 6.4, p <0.001 vs. normals). Independent correlates of global longitudinal strain (r = 0.6416, p < 0.001) included EF (p < 0.0001), E/e’ (p < 0.0001), and tricuspid regurgitation velocity (p = 0.0176). Conclusion: With chronic AR, there is impaired longitudinal function despite preserved EF. Moreover, global longitudinal strain was well correlated with noninvasive estimated LV filling pressures and pulmonary systolic arterial pressures.

<p>Pojava alergijskog kontatnog dermatitisa koji nastaje kao komplikacija tokom lečenja hronične venske insuficijencije je dobro poznata. Cilj istraživanja je bio da se kod obolelih od hronične venske insuficijencije utvrdi učestalost kontaktne senzibilizacije ekcemskog tipa, potom da li postoji rizik za nastanak kontaktne senzibilizacije kao i postojanje korelacije između dužine trajanja bolesti i kontaktne senzibilizacije. Hipoteza rada je da osobe sa hroničnom venskom insuficijencijom značajno če&scaron;će razvijaju kontaktnu senzibilizaciju nego osobe bez hronične venske insuficijencije, da imaju veći rizik za nastanak kontaktne senzibilizacije kao i da je učestalost kontaktne senzibilizacije u pozitivnoj korelaciji sa dužinom trajanja bolesti. Istraživanje je sprovedeno nad 266 ispitanika. Formirane su dve grupe. Eksperimentalnu grupu su činili oboleli od hronične venske insuficijencije upućeni na alergolo&scaron;ko testiranje pod sumnjom na postojanje kontaktnog dermatitisa, a kontrolnu grupu su činili bolesnici bez hronične venske insuficijencije epikutano testirani pod sumnjom na postojanje kontaktnog dermatitisa. Obolelima od hronične venske insuficijencije je procenjena težina bolesti na osnovu CEAP klasifikacije. Potom je svaki ispitanik podvrgnut alergolo&scaron;kom epikutanom testiranju pač testom. Istraživanje je pokazalo da je učestalost kontaktne senzibilizacije među obolelima od hronične venske insuficijencije iznosila 49,3%. Učestalost kontaktne senzibilizacije kod osoba sa hroničnom venskom insuficijencijom na alergene: iz sastava Evropske standardne baterije je iznosila 31,55%; baterije specifične za hroničnu vensku insuficijenciju je iznosila 28,45%; komercijalno dostupne baterije alergena ubikvitarnih korovskih biljaka iz porodice Compositae je iznosila 6,69%; originalno spravljene ekstrakte ubikvitarnih korovskih biljaka Vojvodine je iznosila 6,11%. Ne postoji statistički značajna razlika u odnosu na pol. Prevalencija kontaktne senzibilizacije kod osoba sa hroničnom venskom insuficijencijom se nije statistički značajno razlikovala od osoba koje nisu imale hroničnu vensku insuficijenciju. Pozitivnost epikutanog alergolo&scaron;kog testa kojim se potvrđuje postojanje kontaktne senzibilizacije je bila statistički značajno vi&scaron;a kod osoba sa hroničnom venskom insuficijencijom. Osobe sa hroničnom venskom insuficijencijom su imale 2,45 puta vi&scaron;i rizik za nastajanje kontaktne senzibilizacije na dva i vi&scaron;e alergena, a 3,69 puta vi&scaron;i rizik za nastajanje kontaktne senzibilizacije na pet i vi&scaron;e alergena u odnosu na one bez hronične venske insuficijencije. Učestalost kontaktne senzibilizacije je u pozitivnoj korelaciji sa dužinom trajanja bolesti.</p> / <p>Development of allergic contact dermatitis as a complication of treatment of chronic venous insufficiency is well known. The aim of this study was to determine the incidence of eczematous contact sensitization in patients with chronic venous insufficiency, possible risks for the development of contact sensitization, and the correlation between disease duration and contact sensitization. The working hypothesis was that the incidence of contact sensitivity is significantly higher in individuals with chronic venous insufficiency than in those without chronic venous insufficiency, that they are at greater risk of developing contact sensitization, and that there is a positive correlation between the incidence of contact sensitization and the disease duration. The study included 266 patients. They were divided into two groups: the study group included patients with chronic venous insufficiency referred for allergy testing due to suspected contact dermatitis, and the control group included patients without chronic venous insufficiency patch tested for suspected contact dermatitis. The severity of chronic venous insufficiency was assessed by CEAP classification. Thereafter, each patient underwent patch testing. The research has shown that the incidence of contact sensitization among patients with chronic venous insufficiency was 49.3%. In these patients, the incidence of contact sensitization to the European standard battery of allergens was 31.55%; to the battery specific for chronic venous insufficiency it was 28.45%; to commercially available batteries of allergens of ubiquitous plants from the Compositae family it was 6.69%; and to originally prepared extracts of ubiquitous plants found in Vojvodina it was 6.11%. There was no statistically significant difference in relation to sex. The prevalence of contact sensitization in patients with chronic venous insufficiency was not significantly different from those without chronic venous insufficiency. Positive patch test reaction rates, confirming the existence of contact sensitization, were significantly higher in patients with chronic venous insufficiency. Patients with chronic venous insufficiency had a 2.45-fold higher risk for developing contact sensitization to two or more allergens, and a 3.69-fold higher risk for developing contact sensitization to five or more allergens compared to those without chronic venous insufficiency. There was a positive correlation between the incidence of contact sensitization and the duration of the disease.</p>

Kompressionsbehandling är den basala behandlingen vid venös insufficiens och venösa bensår. Att leva med venösa bensår påverkar patienters välbefinnande och det dagliga livet. Sjuksköterskan har en viktig roll i omvårdnad vid venös insufficiens och venösa bensår att på olika sätt främja sårläkning genom samarbete med patienten. Enligt studier är patienters följsamhet till kompressionsbehandling bristfällig, vilket kan leda till uppkomst eller recidiv av bensår och förlängd läkningstid. Syftet med studien var att belysa faktorer av betydelse för följsamhet vid kompressionsbehandling hos patienter med venös insufficiens. Studien genomfördes som en allmän litteraturstudie med induktiv ansats. Resultatet utgjordes av fyra kvantitativa, fem kvalitativa och två vetenskapliga artiklar med mixad metod. I litteraturstudiens resultat framkom två huvudteman: inre faktorer och yttre faktorer med sammanlagt nio subteman. Resultatet visade att motivation, psykisk ohälsa, kunskap och förståelse, obehag, självbild, självständighet, utbildning, ekonomi och vårdrelation är faktorer med betydelse för följsamhet till kompressionsbehandling. Vidare behövs ytterligare forskning kring patienters erfarenheter för att få en ökad förståelse över patientens situation, som senare kan utformas till exempel riktlinjer eller PM, där det bland annat kan framgå vilka omvårdnadsåtgärder sjuksköterskan kan vidta för att förebygga samt hantera patienters ovilja till behandling. / Compression therapy is the basic treatment for venous insufficiency and venous leg ulcers. Living with venous leg ulcers has an impact on patients’ well-being and daily life. The nurse has an important role in promoting wound healing through collaboration with the patient. According to studies patients’ adherence to compression therapy is insufficient, which can lead to origin and recurrence of leg ulcers and extended healing time. The purpose of the study was to illustrate significant factors for adherence to compression therapy in patients with venous insufficiency. The study was conducted as a general literature study based on an inductive approach. The result is based on five qualitative studies, four quantitative studies and two studies with a mixed method approach. Two main themes emerged in the result of the literature study: Internal factors and external factors with a total of ten sub themes. The result of the literature study reveals that motivation, mental illness, knowledge and understanding, discomfort, self – image, independence, education, finances and trusting relationship between nurse and patient are key factors in adherence to compression therapy. Further research on the patients’ experiences is needed to gain better understanding, which can develop into guidelines, where it can be stated which nursing actions to prevent and manage the patients that are unwilling to be treated.