A Insuficiência Renal Crônica (IRC) é uma alteração sistêmica, relativamente comum, onde os principais fatores de risco estão representados pelo diabetes e pela hipertensão. A disfunção acarreta redução ou limitação da capacidade de filtração glomerular dos rins, causando uremia, alterações sistêmicas diversas, especialmente cardiovasculares (hipertensão arterial, aterosclerose, pericardites, cardiomiopatias, arritmias cardíacas e hipertensão pulmonar), anemia, problemas hemostáticos e linfocitopenia. Também podem ser observadas alterações ósseas e bioquímicas, além de distúrbios gastrintestinais e dermatológicos. No âmbito bucal várias alterações tem sido descritas, tanto em tecidos moles quanto em tecidos duros (hálito urêmico, pH salivar mais alcalino; aumento na capacidade-tampão, elevada formação de cálculo dentário, aumento do número de cáries e incidência de doença periodontal), associadas aos distúrbios fisiológicos. Além disso, os pacientes portadores de enfermidades crônicas são frequentemente afetados por maiores níveis de estresse emocional, decorrente da necessidade de tratamento contínuo e limitação de suas atividades sociais, com consequente prejuízo de sua qualidade de vida. Este trabalho teve como objetivo caracterizar as manifestações orais destes pacientes, buscando estabelecer correlações entre o estado de ansiedade e depressão, qualidade de vida, valorização da saúde oral; características biodemográficas e status da insuficiência renal dos indivíduos incluídos no estudo. Nosso plano foi o de examinar pacientes que frequentam instituições especializadas em hemodiálise (duas) e, paralelamente, compor grupo controle, não portador de IRC, tabulando as variáveis propostas na investigação. A metodologia desenvolveu-se com a aplicação de questionários referentes a qualidade de vida (Sf36), indicativo de depressão (Inventário de Beck) e percepção de saúde bucal ( OHIP-14). Os dados foram coletados com o auxílio de ficha clínica específica. Os resultados indicaram níveis maiores de ansiedade e depressão, declínio na qualidade de vida e percepção de saúde bucal. Houve diferença estatisticamente significante no índice PSR quando comparados grupo teste (GT) e controle (GC). Houve maior número de queixas bucais nas mulheres do GC. Em ambos os grupos e gêneros houve relação inversa entre escore de xerostomia e nível de fluxo salivar. Conclui-se que a menor qualidade de vida influencia negativamente o sintoma de depressão que, por sua vez, reduz a percepção de saúde oral. O ciclo se fecha pela influencia negativa do distúrbio metabólico (e as sequelas medicamentosas) sobre a saúde bucal. / Chronic Kidney Disease (CKD) is a relatively common systemic dysfunction which main risk factors are represented by diabetes and hypertension. CKD implies in reduction or limitation of kidneys\' glomerular filtration capacity, causing uremia, various systemic disturbances, particularly cardiovascular (hypertension, atherosclerosis, pericarditis, cardiomyopathies, cardiac arrhythmias and pulmonary hypertension), anemia, lymphopenia and hemostatic problems. Biochemical changes in calcium metabolism can also be observed, as well as gastrointestinal and dermatological disturbances. Oral cavity disturbances may be represented either by soft tissue as hard tissue diseases (uremic breath, more alkaline saliva pH, increase in buffering capacity, high formation of dental calculus, increase in the incidence of tooth decay and periodontal disease). In addition, patients with chronic diseases are often affected by higher levels of emotional stress as a result of the need of continuous treatment that limits their social activities, impairing their quality of life as a consequence. This study aimed to characterize oral and systemic manifestations of these patients in order to establish correlations among anxiety and depression state, quality of life, appreciation of oral health, biodemographic data and the status of renal failure of the individuals included in the study. Our plan was to examine patients attending specialized institutions in hemodialysis and compare this population to a control group, no IRC. The data collected were discussed descriptively and analyzed according to appropriate statistical tests. The methodology was developed with the use of questionnaires regarding quality of life (SF36), indicative of depression (Beck Depression Inventory), and perception of oral health (OHIP-14). Data were collected with the assistance of medical record. The results indicated higher levels of anxiety and depression, impairment of quality of life and perception of oral health. There was a statistical significant difference when compared with the PSR index test (GT) and control group (CG). There was a higher number of oral complaints in women in CG. In both groups and genders there was an inverse relationship between scores of xerostomia and salivary flow rate. We conclude that the lower quality of life negatively influences depression level which, in turn, reduces the perception of oral health. The cycle completes by the negative influence of metabolic (and drug sequels) on oral health quality.

Objetivos: Avaliar a saúde bucal e o seu impacto na qualidade de vida e indivíduos com doença renal crônica. Material e Métodos: Avaliamos um grupo de indivíduos com doença renal crônica sob hemodiálise e outro sem doença renal crônica, cada grupo com 100 participantes. Realizou-se avaliação odontológica e mensuração de índices de dentes cariados, perdidos e obturados, de edentulismo, sangramento gengival, placa dentária e o periodontal comunitário. Foi realizado sialometria mecanicamente estimulada e não estimulada para classificar a hipossalivação. Foi utilizado um questionário que avalia o impacto da saúde bucal na qualidade de vida, o OHIP-14, e outro que avalia o impacto negativo da qualidade de vida geral, o SF-36. Resultados: A xerostomia, disfagia, disgeusia, ardor bucal e dor bucal apresentaram prevalência significativa no grupo sob hemodiálise. As alterações bucais com prevalência significativa no grupo sob hemodiálise foram a saburra lingual, palidez da mucosa bucal, ressecamento bucal e labial, língua despapilada, candidíase bucal, abscessos periodontais agudos, halitose, língua fissurada e queilite actínica. A hipossalivação também foi mais prevalente no grupo sob hemodiálise. Os indivíduos com doença renal crônica demonstraram pior condição dentária e periodontal, e maior necessidade de uso de prótese dentária. Foi constatado um maior impacto mensurado pelo OHIP-14 total e na dimensão de limitação funcional no grupo sob hemodiálise. O impacto mensurado pelo SF-36 também foi mais significativo no grupo sob hemodiálise, porém foi expressivo em 7/8 domínios. A inflamação gengival e a necessidade de uso de prótese dentária foram correlacionados a maiores índices do OHIP-14 no grupo sob hemodiálise. A disgeusia, disfagia e ardor bucal foram associados ao aumento do OHIP-14 total e nas dimensões de limitação funcional, dor, desconforto psicológico, incapacidade física, psicológica e social deste mesmo questionário. A dor bucal foi correlacionada com o aumento do impacto da saúde bucal na qualidade de vida total e nas dimensões dor física, incapacidade social e desconforto psicológico. A única alteração bucal associada ao aumento do impacto mensurado pelo OHIP-14 foi o ressecamento labial que impactou na dimensão de incapacidade social. Diferentemente, o aumento do impacto mensurado pelo SF-36 foi associado à prevalência de candidíase eritematosa, saburra lingual, abscesso periodontal, ressecamento labial e língua fissurada, impactando negativamente domínios de capacidade funcional, vitalidade, aspectos sociais e mentais e saúde mental. Todas as dimensões mensuradas pelo OHIP-14 correlacionam-se com os domínios avaliados pelo SF-36, com exceção da capacidade funcional nos indivíduos sob hemodiálise. Conclusão: As manifestações bucais, juntamente com maiores índices de inflamação gengival e de necessidade de uso de prótese dentária foram correlacionadas e associadas com a piora na qualidade de vida no grupo com doença renal crônica, porém as queixas bucais pioraram diretamente a qualidade de vida relacionada com a boca e as lesões pioraram especificamente a qualidade de vida geral. As complicações bucais e sistêmicas que a doença renal crônica proporciona pioram a qualidade de vida através da saúde bucal e da saúde geral simultaneamente durante a realização de hemodiálise. / Aim: To evaluate the oral health condition and its impact in the quality of life of chronic kidney patients. Material and Methods: The sample of this study was divided into two groups, one group was composed by chronic kidney disease patients undergoing hemodialysis and the other group was composed by kidney healthy patients, each group contained 100 individuals. Individuals of both groups were submitted to standard odontological evaluation that included decayed, missing and filled index, evaluation of edentulism, gingival bleeding, dental plaque and community periodontal index. In order to evaluate the salivation, we applied unstimulated and stimulated saliva flow rate measurements. For the evaluation of the health-related quality of life impact we used the OHIP-14 profile index, and to estimate general quality of life we used the SF-36 questionnaire. Results: We found that xerostomia, dysphagia, dysgeusia and burning mouth sensation were significantly prevalent on chronic kidney patients. The most prevalent oral manifestations and lesions on those patients were oral candidiasis, acute periodontal abscess, dry lips, dry mouth, halitosis, smooth tongue, pale mucosa, fissured tongue, tongue coating, and actinic cheilitis. Hyposalivation was also observed to be more prevalent on chronic kidney patients. Dental and periodontal condition were poorer on chronic kidney patients and they had more need to use dental prothesis. We found a lower health-related quality of life total and in functional limitation dimension in chronic kidney patients. However, a lower general quality of life impact was estimated in 7/8 domains. Higher gingival and needs to use dental prothesis indexes were correlated to higher mensuration of OHIP-14 profile on chronic kidney patients. The dysphagia, dysgeusia and burning mouth sensation were associated to higher mensuration of OHIP-14 total and functional limitation, pain, psychological discomfort, physical, psychological and social disability dimension. The only oral manifestation associated with OHIP-14 profile was dry lips, increasing the social disability dimension. Differently, a higher impact evaluated for SF-36 was associated with prevalence of erythematous candidiasis, tongue coating, acute periodontal abscess, dry lips and fissured tongue, improving a higher negative impact in functional capacity, vitality, social and mental aspects and mental health domains. In chronic kidney patients all OHIP-14 dimensions were correlated with the SF-36 domains, exception to functional capacity. Conclusion: Oral manifestation, higher gingival inflammation index and prevalence of dental prosthesis use were correlated and associated to worsen health-related quality of life and general quality of life in chronic disease patients, but the symptoms impacted the health-related quality of life and the oral lesions and signs alterations specifically worsens general quality of life. The oral and systemic complications related to the chronic kidney disease negatively impacted the quality of life through the oral and general health simultaneously during the hemodialysis treatment.

Thesis (M.Sc. (Optometry)) --University of Limpopo (Turfloop Campus), 2010 / Human Immunodeficiency Virus (HIV) and the associated Acquired Immunodeficiency Syndrome (AIDS) are major public health concerns worldwide and present socioeconomic burden to many governments. To combat this scourge, a deep knowledge about this pandemic is required as one of the preventive methods. Also, the knowledge can serve as a tool to help those who are infected. HIV/AIDS is common among adolescents; therefore, one of the aims of this study is to establish the knowledge of basics of HIV/AIDS among high school learners in the Capricorn district of the Limpopo Province, South Africa.HIV/AIDS also affects the eye; identification of the ocular problem can sometimes help with the diagnosis of HIV/AIDS the condition. Therefore may have both sight and life-saving implications. The school curriculum and HIV/ AIDS awareness campaigns in South Africa do not include basic knowledge of the effects of HIV/AIDS on the eye; therefore an additional aim of this study was to establish the basic knowledge of the effects of HIV/AIDS on the eye among the participants, so that an informed recommendation can be made for the inclusion of the eye component in the awareness campaign and school curriculum. Methodology Following relevant research and ethics approval of the proposal, relevant permissions were obtained before the study commenced. A quantitative survey design was used for the study. Stratified random sampling method was used to select high schools and students that took part in the research. The participants were learners from 18 selected high schools in the Capricorn district of the Limpopo Province. A questionnaire containing demographic data, information on general and ocular effects of HIV/AIDS was used to collect information from the learners, following a pilot study involving 20 high school learners. Data was analyzed with Statistical Packages for Social Sciences (SPSS) computer program version 16. Descriptive statistics (range, mean, standard deviations and frequencies) was used to describe the findings, and analysis of covariance (ANCOVA) model was used to model the scores on each of the dependent variables i.e. general knowledge of HIV/AIDS and basic knowledge of the effects of HIV/AIDS on the eye. Results The participants were 2659 black South African learners in grades 10 to 12 in the high schools. Eighty eight percent were from rural high schools and (12%) were from a semi-urban high school. Their ages ranged from 14 to 28 years with a mean age of 17.82 and SD of ±1.766 years. The participants included (46.4%) males,(53.1%) females, and (0.5%) learners did not indicate their gender.The meaning of the acronym HIV was known by 63.6% of the participants, and these included 65.8% of the females and 61.5% of males. A lesser proportion (61.5%) knew what the acronym AIDS stands for. They included 70.9% of the females and 60.8% of the males. Knowledge about the different modes of HIV transmission varied from 87.0% (transmission through unprotected sex) to 62.5% (transmission from mother-to–child during pregnancy). Regarding the misconception on the modes of HIV/AIDS transmission, a majority (81.5%) of the learners knew that HIV/AIDS could not be transmitted from one person to another through hugging a person infected with HIV; this percentage includes 82.6% of the females and 80.3% of the males.Only two respondents (0.1%) out of the total population knew the meaning of window period in HIV and they were both females. Only about a third (33.2%) knew the difference between HIV positive and negative results. Majority (85.9%) knew that it is important for one to know his or her HIV status. However, only 5.6% knew the reason why people should know their HIV status. Many (60.1%) knew that the manifestation of HIV symptoms can take many years to develop on an HIV infected person, and 54.9% knew that immune system suppression is the first effect of HIV on the body. Knowledge of the effects of HIV on the body during the seroconversion phase (acute phase), varies from 29.9% (HIV can cause continuous nausea) to 73.0% (HIV can cause tiredness). On the facilities that can be used to test for HIV status, knowledge of the participants varied from 93.4% (knew that HIV test can be done at a hospital) to 34.2% (HIV test can be done at the offices of family general medical practitioner). Only a few (27.8%) knew that HIV/ AIDS can affect the eye. Many (65.5%) of the participants knew that an ophthalmologist or an optometrist should be consulted for ocular problems that are related to HIV/AIDS. Knowledge on the effects of HIV on the eye ranges from 20.6% (HIV can cause an itching and burning sensation in the eye) to 58.6% (HIV can cause severe headaches). Forty six percent knew that HIV can cause blindness. Less than half of the participants (46.9%) knew that exchanging contact lenses with the infected person could not transmit HIV from an HIV positive person. Generally the performance was poor on the ocular manifestation of HIV/AIDS. Young learners were more knowledgeable than the older ones, for both general knowledge of HIV/AIDS and knowledge of the effect of HIV/AIDS on the eye (p < 0.05). Gender of the participants was not statistically significant for both components of the survey (p > 0.05). The pattern of performance among the grades across the schools was not consistent for both components of the survey. Also ages of the learners and their grades did not correspond in terms of performance in this study. Conclusion and recommendations General knowledge of HIV/AIDS was fairly good, but the basic knowledge of the effects of HIV/AIDS on the eye was poor. Therefore, to improve the knowledge about HIV/AIDS of the target population people, there is a need for more awareness campaigns in the rural areas of South Africa. Also, it is recommended that basic knowledge of the effects of HIV/AIDS on the eye should be included in the awareness campaigns (e.g. TV, newspapers, radio, magazines, fliers and HIV/AIDS workshops) and should also be integrated into HIV education syllabus as early as primary level. Educators teaching life orientation and life skills should have regular continuing educational programmes to increase their knowledge on the subject of HIV/AIDS and its effects on organs of the body such as the eye. / University of Limpopo

Esta dissertação tem como objetivo central a análise das transformações do espaço urbana metropolitano a partir do estudo de um fragmento de São Paulo, o Largo da Batata, no bairro de Pinheiros. Entende-se que, por ter passado por intensas transformações socioespaciais, encaminhadas na relação entre o Estado e o Setor Privado, o lugar possa apontar para as transformações mais amplas do capitalismo, principalmente no período atual, em que a reprodução do capital passa, inequivocamente, pela reprodução do espaço. Este fragmento, constituído como centralidade comercial, na mobilidade e na vida cotidiana ao longo do século XX, foi inserido na Operação Urbana Faria Lima, a partir da reconversão urbana do Largo da Batata. Desde 2001, quando foi lançado o edital para o Projeto, até 2013, quando as principais obras foram finalizadas o Largo foi transformado em um imenso canteiro de obras: desapropriações, mudanças viárias, construção das estações do metrô e a metamorfose do próprio espaço do Largo da Batata, tornado uma explanada. Estas transformações, encaminhadas pelo Estado interferiram profundamente na dinâmica de todo o entorno, com destaque para o aumento significativo da verticalização trazida pela expansão imobiliário-financeira, o que gerou uma valorização que, em menos de uma década, mudou o padrão do comércio e o perfil dos moradores do lugar. O comércio popular, característico das últimas décadas do século XX, foi trocado por atividades do setor terciário superior, apesar de algumas permanências. O uso residencial, transformado por edifícios de alto padrão, trouxe para o entorno uma população de maior renda. Com isso, houve um aumento significativo de restaurantes, comércios em geral e serviços voltados a esta população. Observa-se um processo de homogeneização e fragmentação deste espaço que, com sua centralidade voltada aos setores mais modernos da economia, alcança outro patamar na hierarquia dos lugares na metrópole. Desde que as obras iniciaram, coletivos e movimentos questionam as imposições da Prefeitura e o avanço do mercado imobiliário. Estes coletivos, em geral, são responsáveis por atuar no Largo como incentivadores e viabilizadores de uma série de atividades políticas, culturais, artísticas e esportivas que visam o uso e a apropriação do espaço público. Nesse sentido, o Largo torna-se também, sobretudo a partir de 2013, um lugar privilegiado nas manifestações políticas na metrópole de São Paulo, indicando que de fato o lugar ganhou centralidade na escala metropolitana e, mesmo com ação direta das forças homogeneizantes, o espaço é usado e apropriado de forma a apontar seu caráter público. / This dissertation has as main objective the analysis of the transformations of the metropolitan urban space from the study of a fragment of São Paulo, Largo da Batata, in the district of Pinheiros. It is understood that, because it has undergone intense socio-spatial transformations, rooted in the relationship between the State and the Private Sector, the place may point to the broader transformations of capitalism, especially in the present period, when the reproduction of capital unequivocally, by the reproduction of space. This fragment, constituted as a commercial center, in mobility and in daily life throughout the 20th century, was inserted in Operation Faria Lima Urban, from the urban reconversion of the Largo da Batata. Since 2001, when the project was published, until 2013, when the main works were completed, Largo was transformed into an immense construction site: expropriations, road changes, construction of subway stations and the metamorphosis of Largo da Batata\'s own space, made an esplanade. These transformations, driven by the State, deeply interfered in the dynamics of the whole environment, with emphasis on the significant increase in verticalization brought by the real estate-financial expansion, which generated a valuation that, in less than a decade, changed the pattern of commerce and the profile of the locals. Popular trade, characteristic of the last decades of the twentieth century, was replaced by activities of the higher tertiary sector, despite some permanence. The residential use, transformed by buildings of high standard, brought to the surroundings a population of greater income. With this, there was a significant increase of restaurants, commerce in general and services directed to this population. It is observed a process of homogenization and fragmentation of this space that, with its centrality directed to the most modern sectors of the economy, reaches another level in the hierarchy of places in the metropolis. These processes, however, did not occur continuously and without embargos. Since the works began, collectives and movements question the impositions of the City Hall and the advance of the real estate market. These collectives, in general, are responsible for acting in the Largo as incentive and enablers of a series of political, cultural, artistic and sports activities that aim at the use and appropriation of the public space. In this sense, the Largo also becomes, especially from 2013, a privileged place in the political manifestations in the metropolis of São Paulo, indicating that in fact the place has gained centrality in the metropolitan scale and, even with direct action of the homogenizing forces, the space is used and appropriate in order to point out its public character.

Reproduction de : Thèse d'exercice : Chirurgie dentaire : Nantes : 2008. / Bibliogr.

Reproduction de : Thèse de doctorat : Pharmacie. Ingénierie de la santé. Biophysique : Reims : 2009. / Bibliogr. p.151-162.

Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 120-128).

 Neuropsychiatric systemic erythematosus (NPSLE) is a complicated complication of systemic erythematosus (SLE). Asian patients are associated with high prevalence of systemic disease and mortality It increases patients’ morbidity and mortality (Samanta et al., 1991). But the detailed pathology and pathogenesis are still remained unclear. Our study’s purpose is to use advanced functional imaging method, including diffusion tensor imaging (DTI) and magnetic resonance spectroscopy imaging (MRSI) to detect intracranial volumetry, functional and other metabolite changes in NPSLE patients. We recruited 3 age-matched female groups, one patient group with NPSLE (20 patients), one patient group with SLE (20 patients) and one control group (15 normal controls). Each patient was applied to structural 3D-T1 and axial T2, DTI and MRSI. Whole brain volumetry and hippocampus volumetry were analyzed by FSL and MARINA software from T1 images. White matter hyperintensity was calculated manually. Whole brain FA and other indices were collected. Regional FA was also collected and was collected with MRS over corpus callosum slice. The result showed no significant whole brain atrophy in NPSLE patients and SLE patients compared with controls. But with segmentation of grey matter, white matter and CSF, NPSLE patients showed significant decrease volume from SLE patients in white matter. Left hippocampus showed significant decreased volume in white matter and grey matter compared with control, while right hippocampus showed significant decreased volume in white matter. No other significant difference was found between NPSLE vs SLE and SLE vs controls. Whole brain FA was significantly decreased in NPSLE compared to SLE and controls, but not significantly different between SLE and controls. MD, λ∥ and λ⊥ were significantly increased in NPSLE and SLE compared with controls, but not significantly different between SLE and controls. White matter hyperintensity score was consistent with MD, λ∥ and λ⊥ results, showed significantly higher scores in two patients groups compared to controls. Regional FA, involving frontal lobes and corpus callosum, periventricular regions adjacent to centrum semiovale and posterior lateral temporal lobe, confirmed the regional FA decrease showed in whole brain FA statistical color map and NPSLE patients’ regional FA decrease correlated with MRS metabolic changes. N-acetyl aspartate (NAA)/ Creatine (Cr), the marker of neurons, decreased significantly in NPSLE patients compared with SLE and controls. Choline (Cho)/Cr showed significant increase of tendency of significant increase in NPSLE and SLE patients in some ROIs compared with controls. Our finding suggested that, although the whole brain atrophy is not obvious in NPSLE, the hippocampus and white matter suffered atrophy in NPSLE patients. These atrophy in white matter of whole brain and hippocampus combined with functional imaging results of DTI and MRS, indicated that NPSLE endured more severe axonal damage than SLE, which might be due to a variety of lesions, such as demyelination, microangiopathy, large vessel thrombosis, cytokine, etc. Varying ratio of NAA/Cr and Cho/Cr may be associated with the severity of axonal damage, probably due to demyelination in the background of inflammatory/ischemic/vasculitic changes. / published_or_final_version / Diagnostic Radiology / Master / Master of Philosophy

No description available.

Katecholamine beeinflussen durch direkte Stimulation über adrenerge Rezeptoren die Funktion von Immunzellen. Ziel der Untersuchungen an Patienten mit Rheumatoider Arthritis war es, das Expressionsprofil unterschiedlicher adrenerger Rezeptorsubtypen in CD4(+)T-Lymphozyten dieser Patienten zu bestimmen. Zur Quantifizierung der Expression wurden semiquantitative RT-PCR-Analysen durchgeführt. Die Untersuchung zeigte, dass alpha1-adrenerge Rezeptoren in CD4(+)-T-Lymphozyten von RA-Patienten exprimiert werden. Es scheint eine Korrelation zwischen bestimmten extraartikulären Organmanifestationen (z.B. Sicca-Sydrom und Tenosynovitis) und der Expression alpha1-adrenerger Rezeptoren zu bestehen. Die gefundene differenzielle Expression der Rezeptoren in CD4(+)-T-Lymphozyten von RA-Patienten legen vertiefende Untersuchungen zur Relevanz des adrenergen Systems bei der Lymphozytenfunktionsmodulation nahe.