Hypertension guidelines recommend out of office blood pressure (BP) measurement especially 24- hour ambulatory measurement (ABPM), to diagnose and manage hypertension but this is not routinely performed in kidney transplant units. This study was to determine if 24-hour ABPM, compared with office BP in kidney transplant recipients, would be more informative regarding BP management, and if pulse wave analysis (PWA) would assist in risk stratification. This study included patients older than 18 years, with working graft kidney for >12 months, and without problems affecting BP measurement and interpretation. After performing office BP measurements, a 24-hour ABPM with additional capability of calculating pulse wave velocity (PWV),augmentation index and central BP was undertaken. Patients were assessed for controlled hypertension, uncontrolled hypertension, masked hypertension, nocturnal hypertension, white coat hypertension, and dipping BP status. Data were analysed using standard statistical tests. Of 30 patients, 15 were Black Africans and 15 were of Mixed Ancestry with a mean age of 48.9 years. Seventeen patients were males and 36.7% had controlled hypertension, 30% uncontrolled hypertension, 6.7% white coat hypertension and 33.3% masked hypertension, of whom 70% had isolated nocturnal hypertension. 70% had a non-dipping, 26.7% a reverse dipping and only 3.3% had a normal dipping BP pattern. The mean difference between brachia! systolic BP and central systolic BP was 10.4 mm Hg, whereas PWV and augmentation index were similar to healthy populations. CONCLUSION: In kidney transplant recipients, 24-hour ABPM was superior to office BP in defining hypertensive status that qualified for modification of therapy but PWA did not contribute to risk assessment.

Quand elle est possible, la greffe de rein est le meilleur traitement de l’insuffisance rénale chronique terminale. La qualité de vie des patients joue un rôle essentiel dans la réussite de la transplantation. Dans ce contexte, notre objectif était d’analyser la qualité de vie dans une cohorte de patients transplantés rénaux en France. Dans un premier temps, nous avons analysé la qualité de vie des patients au moment de leur inclusion dans l’étude dans le but de déterminer les facteurs associés à la qualité de vie. Nous avons retrouvé des caractéristiques socio-démographiques et cliniques connues dans la littérature et de nouvelles variables psycho-sociales ont été identifiées. Ce travail nous a ensuite amené à analyser le profil des patients qui utilisent l’Internet et les réseaux sociaux : près de 80% de patients utilisent Internet et la plupart d’entre eux ont besoin de soutien informatif. Nous avons pu montrer, dans un deuxième temps, une faible concordance de l’évolution de l’état de santé du patient du point de vue du patient et du médecin. Enfin, pour interpréter les scores de qualité de vie dans cette cohorte, nous avons calculé la différence minimale cliniquement significative par la méthode des courbes ROC, en utilisant le changement d’état de santé du point de vue du patient comme critère de changement (anchor). Cette analyse a montré que l’évolution de la qualité de vie de ces patients n’est pas liée au changement d’état de santé des patients. Cette thèse fournit une analyse approfondie sur la qualité de vie des patients transplantés rénaux francophones. / Kidney transplant is the best treatment for chronic end-stage renal failure. The quality of life of the patient plays a vital role in the success of the transplantation. In this context, our objective was to analyze the quality of life in a cohort of kidney transplanted patients in France. As a first step, we analyzed the quality of life of patients at the time of their inclusion in the study in order to determine the factors associated with the quality of life. Socio-demographic and clinical characteristics known in literature were found and new psycho-social variables were identified. This work then led us to analyze the profile of patients using the Internet and social networks: nearly 80% of the patients use Internet and the majority need an informative support. We were able to show, in a second time, a weak concordance of the evolution of the state of health of the patient from the patient and the doctor point of view. Finally, to interpret the quality of life scores in this cohort, we calculated the minimal clinically significant difference, by the ROC curve method and using the change in health status from the patient's point of view as a criteria for change. This analysis showed that the quality of life of these patients is not related to the patient's state of health, and no clinical changes could be detected for the quality of life scores of the two questionnaires. This thesis provides an in-depth analysis of the quality of life of French kidney transplanted patients.

Made available in DSpace on 2014-12-17T14:16:35Z (GMT). No. of bitstreams: 1 WalicyranisonPS_DISSERT.pdf: 2780035 bytes, checksum: 20a70f53e533bfb0816b6d9b02b8af32 (MD5) Previous issue date: 2013-06-11 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Candida albicans is a diploid yeast that in some circumstances may cause oral or oropharyngeal infections. The investigation of natural products is mandatory for the discovery of new targets for antifungal drugs development. This study aimed to determine the genotypes of 48 clinical isolates of C. albicans obtained from the oral cavity of kidney transplant patients from two distinct geographic regions of Brazil. In addition, we investigated three virulence factors in vitro: phospholipase activity, morphogenesis and the ability to evade from polymorphonuclear neutrophils. The expression of these virulence factors in vitro was also investigated in the presence of the crude extract of Eugenia uniflora. The genotype A was the most prevalent (30 isolates; 62.5%), followed by genotype C (15 isolates; 31.5%) and genotype B (3 isolates; 6.25%). When microsatellite technique with primer M13 was applied, 80% of the isolates from the South were placed within the same cluster. All Genotype C strains were grouped together within two different clusters. Genotype C was considered more resistant to PMNs attack than genotypes A and B. Strains isolated from the South of Brazil showed higher ability to combat PMNs phagocytosis. We found a high rate of genotype C strains isolated from the oral cavity of this group of patients. The crude extract of E. uniflora inhibited proper hypha formation and phagocytosis by PMNs, but had no significant effect on phospholipase activity. This study characterized oral C. albicans strains isolated from kidney transplant recipients and will contribute for the better understanding of the pathogenesis and alternative therapeutics for oral candidiasis / Candida albicans ? uma levedura dipl?ide que em certas circunst?ncias pode causar infec??es da cavidade oral e da orofaringe. A investiga??o de produtos naturais ? fundamental para a descoberta de novos alvos para o desenvolvimento de drogas antif?ngicas. Este estudo objetivou determinar os gen?tipos de 48 isolados cl?nicos de C. albicans obtidos da cavidade oral de pacientes transplantados renais de duas distintas regi?es geogr?ficas do Brasil. Al?m disso, foram investigados tr?s fatores de virul?ncia in vitro: atividade de fosfolipase, morfog?nese e a capacidade de escapar do ataque de neutr?filos polimorfonucleares. A express?o destes fatores de virul?ncia tamb?m foi investigada na presen?a do extrato bruto de Eugenia uniflora. O gen?tipo A foi o mais prevalente (30 isolados; 62,5%), seguido do gen?tipo C (15 isolados; 31,5%) e do gen?tipo B (3 isolados; 6,25%). Quando a t?cnica do microssat?lite com o primer M13 foi empregada, 80% dos isolados da regi?o Sul foram agrupados no mesmo cluster. Todos os isolados do gen?tipo C foram agrupados juntos em dois diferentes clusters bem definidos. Isolados do gen?tipo C foram considerados mais resistentes ? a??o de PMNs do que os dos gen?tipos A e B. As cepas isoladas do Sul do Brasil demonstraram maior habilidade em combater a fagocitose por PMNs. Encontrou-se uma alta taxa de isolados do gen?tipo C da cavidade oral deste grupo de pacientes. O extrato bruto de E. uniflora inibiu a forma??o de hifa e fagocitose por PMNs, mas n?o apresentou efeito significativo na atividade de fosfolipase. Este estudo caracterizou isolados cl?nicos de C. albicans da cavidade oral de pacientes transplantados renais, contribuindo para um melhor entendimento da patog?nese e terap?utica alternativa para a candid?ase oral