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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
301

Corpo-casa : dança, manifestações populares tradicionais e percursos educativos com barro /

Silva, Elizabeth Menezes da January 2020 (has links)
Orientador: Kathya Maria Ayres de Godoy / Resumo: O território desta pesquisa é habitado pelas práticas em dança com barro desenvolvidas no percurso de formação e atuação artística pedagógica da autora. Os processos de aprendizagem sobre o corpo e o movimento em contexto educativo, brincante e artístico com a dança – sustentações de minha atuação profissional nessa área – emergem do encontro com a história dos trabalhadores de mutirão para a construção de casas de pau-a-pique e de sua relação com a Dança do Coco Alagoano, que associei ao trabalho com argila desenvolvido com crianças, jovens e adultos. Nessa perspectiva, a questão proposta para esta pesquisa é: como, em um grupo intergeracional, no contexto de educação não formal em um espaço público da cidade de São Paulo, práticas de dança com barro podem contribuir para a construção de um Corpo-casa? Três pilares sustentam esta arquitetura corporal proposta: os Fundamentos da Educação, dos estudos de Rudolf Steiner acerca da Antroposofia, foco da Pedagogia Waldorf; as Manifestações Populares Tradicionais do repertório selecionado de danças e brincadeiras da infância, relacionadas com o Coco Alagoano; e os Princípios do Movimento identificados em estudos de Rudolf Laban e Béziers-Piret, sobre as camadas do corpo, que nas práticas com barro possibilitaram a (in)corporação de saberes em dança, conceituados por Godoy, pelos participantes e pela autora. Por meio do relato de experiência da vivência “Sete encontros em família”, evidenciei aspectos particulares das práticas pedag... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This Dissertation is inhabited by dance practices with clay (argil). Researching body and movement in artistic and educational contexts - my daily environment and work in São Paulo - I incorporated rhythm and lyrics from dancing groups which revive the making of clay houses in Northeastern Brazil. Their ancestors used to dance and sing patterns from the gender "Coco" to energize the collective construction of each house, and tap the clay. With a long-term learning process I started transpositions of this cultural knowledge in body activities with clay, developed with children, youngsters and adults. The dialogue between local Brazilian dances and R. Laban's studies flourished in the concept of House- body, proposed and developed here. In an analogy with the clay house, built with dance and singing. The Dissertation explores aspects of dances with clay, and describes my work with intergenerational groups in public spaces. Three pillars were united, to articulate an architecture of the body in construction: Education fundamentals with R. Steiner's studies on Antroposophy, the focus for Waldorf Pedagogy; Popular dance manifestations (selected repertoire with childhood games and verses related to Coco dance from Northeastern Brazil); and the Principles of Movement identified in R. Laban's and Béziers-Piret's works about body layers, which, in the practices with clay/argil, enabled the (in)corporation of knowledges in dance, as conceptualized by (GODOY, 2013; 2016), and by the pa... (Complete abstract click electronic access below) / Mestre
302

An investigation into the neurological and neurobehavioural effects of long-term agrichemical exposure among deciduous fruit farm workers in the Western Cape, South Africa

London, Leslie 19 April 2017 (has links)
It is increasingly being recognised that agrichemical exposure may have adverse chronic health effects in humans, particularly on central nervous system function. However, much of this evidence sterns from studies relating to the effects of acute intoxications (i.e. short-term high dose exposures) and little data exist on the chronic effects of long-term low-dose exposures to agrichemicals in the absence of acute poisoning. Such a finding would have substantial public health implications for prevention and control of chronic morbidity and mortality. This is particularly important in South Africa, where a sizeable portion of the rural population are employed in agricultural work, often under extremely unhealthy living and working conditions, and where occupational agrichemical exposures appear to be substantial. To address this question, this study investigated the prevalence of neurological and neurobehavioural abnormalities amongst 247 fruit farm workers in the Kouebokkeveld in the Western Cape, of whom 163 were current agrichemical applicators. Outcomes measured included neurological symptoms, peripheral vibration sense, motor tremor, as well as performance on the World Health Organisation Neurobehavioural Core Test Battery (WHO NCTB) and a set of neurobehavioural tests based on the Information Processing model of cognitive psychology. These latter tests have been developed in South Africa for subjects of low educational levels and aim to by-pass the powerful effects of culture that complicate traditional neuropsychological testing, which may mask the smaller effects due to occupational chemical exposures. Cumulative, and average lifetime intensity of exposure to organophosphates were estimated using a job- exposure matrix based on a combination of secondary industry data, interview reports and farmer records. Confounders measured included age, education, smoking and alcohol habits, non-occupational exposure to agrichemicals and other potential neurotoxins, past medical history and usage of personal protective equipment. The study results confirmed low levels of education and high alcohol consumption amongst the sample of farm workers. Multiple logistic and linear regression were used to identify exposure-effect relationships and to control for confounding. Neurological symptoms were significantly associated with a history of previous pesticide poisoning, although this may have arisen as a result of reporting bias. Vibration sense and the neurobehavioural tests exhibited associations with established covariates, and regression modelling of the WHO NCTB tests was remarkably similar to findings in another study of solvent-exposed factory workers in South Africa. None of the vibration sense, tremor or neurobehavioural outcomes were associated with past agrichemical poisoning in the sample, and only two tests showed significant relationships with long-term occupational exposure. These included the Pursuit Aiming subtest of the WHO NCTB and one of the tests of long-term semantic memory in the Information Processing tests. However, the strength of these the associations were small (partial r²s less than 2%) and these findings may have occurred due to chance arising from multiple comparisons. The neurobehavioural tests based on the Information Processing model appeared to offer little improvement on the WHO NCTB in terms of being less sensitive to cultural effects, although some evidence was present that tests of semantic access were able to detect occupational effects and were less sensitive to education. The absence of a demonstrable and consistent long-term agrichemical exposure-effect relationship appears to suggest that long-term agrichemical exposure is not associated with adverse chronic nervous system effects, although the lack of organophosphate specificity in construction of exposure indices in the job-exposure matrix may partly contribute to this finding. Recommendations to improve the characterisation of agrichemical exposures at farming work place are made, as well as suggestions concerning the role of biological monitoring for agrichemicals, improving working and living conditions on South African farms, and methods of neurological and neurobehavioural assessment in occupational health.
303

Gastroesofagael Reflux (Gerd) Och Oral Hälsa : En allmän litteraturstudie / Gastroesophageal reflux disease (GERD) and oral health : A literature study

Magnusson, Karin, Pankeviciute, Viktorija January 2022 (has links)
Syfte: Studiens syfte var att undersöka hur den orala hälsan påverkas hos patienter med gastroesofagael reflux sjukdom (GERD) med frågeställningarna: Förekommer orala sjukdomar och/eller kliniska tecken hos patienter med GERD? och Hur påverkas oral hälsorelaterad livskvalitet hos patienter med GERD? Metod: Sökningen av artiklar i denna litteraturstudie utfördes i tre databaser: Dentistry & oral sciences source (DOSS), MEDLINE och CINAHL. Artiklarna vilka inkluderades i denna litteraturstudie var publicerade mellan åren 2011–2022 och besvarade studiens syfte samt frågeställningar. Totalt valdes 17 st relevanta artiklar till studiens resultat. Resultat:  Gastroesofagael reflux sjukdom (GERD) kan påverka den orala hälsan negativt samt minska individens livskvalitet på olika sätt, då den kan bidra till ökad risk för olika orala sjukdomar och tillstånd såsom karies, gingivit och parodontit. GERD kan även leda till tandsubstansförlust framför allt genom erosionsskador. Högre prevalens av munslemhinneförändringar, minskad salivsekretion, oral halitosis och ilningar kunde ses hos personer med GERD sjukdomen. Slutsats: Det finns ett samband mellan GERD och negativ påverkan på den orala hälsan, välbefinnandet samt oral livskvalitet. Mer forskning kring hur GERD påverkar den orala hälsan krävs, för att i framtiden kunna skapa hälsofrämjande och preventiva åtgärder som reducerar konsekvenserna av GERD på den orala hälsan. / Aim: The aim of this study was to investigate how the oral health is affected regarding patients with gastroesophageal reflux disease (GERD) with the focus on the following questions: Does oral diseases and/or clinical signs occur in patients with GERD? and How is oral health related quality of life effected in patients with GERD? Method: In this literature study the searching of articles was performed in three databases: Dentistry & Oral Sciences Source (DOSS), MEDLINE and CINAHL. The included articles were published between 2011–2022 and were relevant to the aim of the study. In total there were 17 relevant articles selected for the study’s results. Results: Gastroesophageal reflux disease (GERD) can adversely affect the oral health and reduce the individual's quality of life in different ways, as it can lead to an increased risk of different oral diseases and conditions such as caries, gingivitis, and periodontitis. GERD can also lead to tooth surface loss, especially due to dental erosions. A higher prevalence of mouth mucosa changes, reduced saliva secretion, oral halitosis and tooth sensitivity were seen in people with GERD disease. Conclusion: There is a connection between GERD and a negative impact on the oral health, well-being, and oral quality of life. More research on how GERD affects oral health is required, in order to create health-promoting and preventive measures that reduce the consequences of GERD on oral health.
304

Манифестациони туризам Војводине / Manifestacioni turizam Vojvodine / Manifestations tourism in Vojvodina

Bjeljac Zeljko 11 June 1999 (has links)
<p>Досадашња теоријска истраживања указују на недовољан приступ проучавању манифестационог туризма. Географска основа није узимана у обзир. Полазећи од туристичко - географског приступа и методологије, као новина и посебност издвојена је повезаност природно -географских елемената Војводине и манифестационог туризма. Та повезаност, пре свега, указује на географски положај и специфичности природно - географских елемената Војводине. Проучавајући досадашње дефиниције, а узимајући у обзир и специфичности Војводине, уз лична запажања, предложена је и детаљна дефиниција манифестационог туризма. Извршена је и детаљнија класификација облика манифестационог туризма. Код облика је дата подела са образложењем на: уметничке, привредне, научно - стручне, географске, спортске, забавне, политичко-историјске, и туристичко-пропагандне манифестације. У оквиру манифестационог туризма, утврђено је да друштвено - географски елементи Војводине, са својим специфичностима, представљају својеврстан основ за што тешњу и разноврснију сарадњу Војводине са иностранством. Дат је и образложен предлог нових манифестација, као и место и улога у укупном Војвођанском туризму. Такође, детаљније су образложени елементи организовања манифестационог туризма (мотиви организовања, планирање, маркетинг, пропаганда), указано је на економске ефекте, као и аспекте манифестационог туризма.</p> / <p>Dosadašnja teorijska istraživanja ukazuju na nedovoljan pristup proučavanju manifestacionog turizma. Geografska osnova nije uzimana u obzir. Polazeći od turističko - geografskog pristupa i metodologije, kao novina i posebnost izdvojena je povezanost prirodno -geografskih elemenata Vojvodine i manifestacionog turizma. Ta povezanost, pre svega, ukazuje na geografski položaj i specifičnosti prirodno - geografskih elemenata Vojvodine. Proučavajući dosadašnje definicije, a uzimajući u obzir i specifičnosti Vojvodine, uz lična zapažanja, predložena je i detaljna definicija manifestacionog turizma. Izvršena je i detaljnija klasifikacija oblika manifestacionog turizma. Kod oblika je data podela sa obrazloženjem na: umetničke, privredne, naučno - stručne, geografske, sportske, zabavne, političko-istorijske, i turističko-propagandne manifestacije. U okviru manifestacionog turizma, utvrđeno je da društveno - geografski elementi Vojvodine, sa svojim specifičnostima, predstavljaju svojevrstan osnov za što tešnju i raznovrsniju saradnju Vojvodine sa inostranstvom. Dat je i obrazložen predlog novih manifestacija, kao i mesto i uloga u ukupnom Vojvođanskom turizmu. Takođe, detaljnije su obrazloženi elementi organizovanja manifestacionog turizma (motivi organizovanja, planiranje, marketing, propaganda), ukazano je na ekonomske efekte, kao i aspekte manifestacionog turizma.</p> / <p>The abstract has been processed with OCR optical text recognition technology:</p><p>Manifestation tourism in Vojvodina, has been studied according to the<br />methods with have been applied for the study in social scienaics and according to the tasus of this work. During the research we come to the fact that Vojvodina &#39;s geographic space like touristics stimulans is not full exploited and with ooranizing manifestation touristic offer in Vojvodina can be broth to higer level and better organization. We notist that their is most sport, art economy and acience manifestations. It is pointed to meaning of planing and touristic propaganda, where subjects - organisations motivs are economica, touristic, comercial, also cultural, ecology, or public political.</p>
305

The effects of highly active antiretroviral therapy on the cognitive-linguistic abilities of adults living with HIV and AIDS in South Africa.

Mupawose, Anniah 24 July 2013 (has links)
In the context of HIV high infection rate in South Africa, an assumption can be made that there is a high prevalence of HIV-associated neurocognitive disorders or cognitive linguistic deficits. The aim of this study was to determine assess whether highly active antiretroviral therapy (HAART) affected the cognitive – linguistic abilities of individuals living with HIV and AIDS before and after HAART use; and to determine whether their functional performance in terms of engaging in activities of daily living was affected by HAART use. Adults living with HIV and AIDs were recruited through purposive convenience sampling to participate in the study. They were divided into three groups. The experimental and cross sectional group included participants who were HIV infected and initiated HAART. The comparison group included participants who elected not to start HAART. Participants in all three group were assessed using the Cognitive – Linguistic Quick Test and were also required to fill out a structured interview scale at baseline, four and eight months. For the experimental group 55 participants were tested at baseline, 55 at four months and 52 at eight months after HAART initiation. The comparison group included 21 participants who tested at baseline, ten at four months and nine at eight months. The cross sectional group included different participants who recruited at baseline (55) before HAART initiation, then again at four (44) and eight months (42) after HAART initiation. Descriptive analysis revealed that the mean scores for both the Cognitive – Linguistic Quick Test (CLQT) and the structured interview schedule (IS) in all the cognitive domains increased for all three groups from four and eight months after testing. However the severity ratings provided by the CLQT indicated that neurocognitive deficits were still prevalent among the participants after HAART intiation. The most impaired cogntive – linguistic ability was executive functions and the least impaired was language. One way ANOVA analysis on the CLQT and IS revealed that was a signiifcant difference in performance between the three groups at baseline, four and eight months. Repeated measures analysis revealed significant differences or improvements within participants across the three time periods. The greatest improvement was observed from baseline to eight months especially on the CLQT. ANCOVA analysis on the Cognitive- Linguistic Quick Test indicated that education had a major impact on cognitive – linguistic abilities followed by age and CD4 count. However, ANCOVA analysis on the structured interview scale revealed that the effect of time, participant group and to a lesser extent age influenced the participants cognitive – linguistic abilities when it came to perfroming activities of daily living. Quantitave inquiry using content analysis showed that participants in all three groups cited attention, followed by visual and language problems as hindering their abilities to perform activities of daily living. The implications from this study revealed that even though HAART improves cognitive –linguistic abilities, neurocognitive deficits were still prevalent. Therefore findings suggest that health professionals need to monitor the neurocognitive impairments of their patients so as determine levels of functional performance.
306

Perspectives of Pro-revivalism: The Christian History and the Great Awakening

Brown, Lisa Thurston 12 March 2004 (has links) (PDF)
The Christian History was a pro-revivalist magazine printed in Boston from 1743-1745 during what is known as the Great Awakening. It contained accounts of revivalism written by pro-revivalist ministers from throughout the American colonies, England and Scotland. These ministers believed that the Holy Spirit was being poured out upon the land in a shower of grace, causing unprecedented numbers of people to convert to Christ. In The Christian History, pro-revivalist ministers expressed their support for the revivals and shared their experiences. Thus the magazine has typically been viewed as religious propaganda advocating a single, polemical viewpoint. However, in spite of its pro-revival stance, The Christian History contains a spectrum of ideas pertaining to theology, religious history and the controversial issues that surfaced during the Awakening. For instance, although revival supporters sought to defend the Awakening as an authentic outpouring of God's grace, they did not all agree on how to handle the revivals. When it came to the "errors of doctrine" and "disorders of practice" that surfaced during the Awakening -- things like Antinomianism, bodily manifestations and itinerancy -- Christian History ministers responded differently. Though they sought to form a more uniform policy regarding these issues and others in a pro-revival ministerial meeting, in the end their opinions and reactions were shaped by their personal experiences with the revivals. In spite of their differing views regarding errors and disorders, Christian History ministers evaluated and contextualized the revivals similarly. In their revival narratives they frequently drew upon the Bible to explain and support their pro-revival stance. Some also used historical precedents as tropes for demonstrating that aspects of revivalism were perhaps unusual, but not thoroughly new. Most, however, sought to legitimize the revivals by describing their positive social qualities. For example, they wrote how tavern-going and neighborly contentions decreased, whereas occasions for religious worship multiplied. These "good fruits" of revivalism, asserted Christian History contributors, showed that the Awakening had changed the "face" of society for the better and was therefore an authentic outpouring of God's grace.
307

Технологии профилактики деструктивных протестных проявлений в студенческой среде в социальных сетях : магистерская диссертация / Technologies for the prevention of destructive protest manifestations in the student environment in social networks

Чебарь, Е. В., Chebar, E. V. January 2023 (has links)
Магистерская диссертация «Технологии профилактики деструктивных протестных проявлений в студенческой среде в социальных сетях» состоит из двух глав, введения, заключения, библиографического списка, трех приложений. Целью диссертационной работы является совершенствование механизмов профилактики протестных проявлений в социальных сетях в студенческой среде с использованием информационных технологий. Объектом исследования является профилактика деструктивных протестных проявлений в студенческой среде в социальных сетях. Предметом исследования – технологии профилактики деструктивных протестных проявлений в студенческой среде в социальных сетях на примере УрФУ. Объем работы составил 121 страниц. В работе содержатся 4 приложения, 3 таблицы, 25 рисунков. В библиографическом списке представлено 68 источников. / Master's thesis "Technologies for the prevention of destructive protest manifestations in the student environment in social networks" consists of two chapters, an introduction, a conclusion, a bibliographic list, and three appendices. The purpose of the dissertation work is to improve the mechanisms for the prevention of protest manifestations in social networks among students using information technology. The object of the study is the prevention of destructive protest manifestations in the student environment in social networks. The subject of the research is the technology of prevention of destructive protest manifestations in the student environment in social networks on the example of Ural Federal University. The volume of work was 121 pages. The work contains 4 applications, 3 tables, 25 figures. The bibliographic list contains 68 sources.
308

Complications suivant l'admission à l'hôpital pour un traumatisme craniocérébral : une étude de cohorte rétrospective

Omar, Madiba 12 March 2021 (has links)
Les complications hospitalières potentiellement liées aux soins chez les patients avec un traumatisme craniocérébral (TCC) sont peu connues. Notre étude de cohorte rétrospective s’intéressait à l’incidence et aux déterminants de ces complications ainsi qu’à leur influence sur la mortalité et la durée de séjour à l’hôpital. Notre population d’étude comprenait les adultes (≥16 ans) admis entre 2007 et 2012 pour un TCC dans un des centres hospitaliers du système de traumatologie du Québec. Le taux d’incidence des complications neurologiques et non neurologiques était respectivement de 35 et 375 par 1000 admissions. Les déterminants reliés au traitement expliquaient 60,3% et 51,2% de la variance dans le risque de complications neurologiques et non-neurologiques respectivement. Les complications neurologiques ont augmenté de 85% la cote de mortalité et 60% la moyenne de la durée de séjour. Les complications non-neurologiques augmentaient de 53% la cote de mortalité et 124% la durée de séjour. / Hospital complications potentially related to care in patients admitted for traumatic brain injury (TBI) are not well known. Our retrospective cohort study assessed the incidence and determinants of these complications as well as their influence on mortality and length of hospital stay. Our study population included adults (≥16 years) admitted between 2007 and 2012 for TBI in one of the designated centers of the integrated trauma system of the province of Quebec, Canada. The incidence of neurological and non-neurological complications was respectively 35 and 375 per 1,000 admissions. Treatment-related determinants explained 60.3% and 51.2% of the variance in the risk of neurological and non-neurological complications respectively. Neurological complications increased the odds of mortality by 85% and hospital length of stay by 60%. Non neurological complications increased the odds of mortality by 53% and hospital length of stay by 124%.
309

Estudo prospectivo para avaliar a evolução radiológica de 12 pacientes portadores de esclerodermia da face e perfil demográfico, manifestações clínicas e alterações laboratoriais de 34 casos / Prospective study to evaluate the radiological evolution of 12 patients with localized scleroderma of the face and the demographic, clinical and laboratory findings of 34 cases

Careta, Mariana Figueiroa 17 July 2013 (has links)
Introdução: A esclerodermia é rara doença do tecido conectivo que se manifesta através da esclerose cutânea e variável acometimento sistêmico. Duas categorias de esclerodermia são conhecidas: esclerose sistêmica, caracterizada por esclerose cutânea e acometimento visceral e a esclerodermia localizada ou morfeia que classicamente apresenta evolução benigna e autolimitada, confinada a pele e/ou tecidos subjacentes. Estudos recentes demonstram que a forma localizada possa eventualmente apresentar acometimento de órgãos internos e morbidade variável. Objetivo: Neste estudo objetivamos determinar as características demográficas, a prevalência de manifestações sistêmicas e alterações laboratoriais, bem como a associação com doenças autoimunes, em pacientes com esclerodermia da face. Métodos: Pacientes com esclerodermia localizada, incluindo os casos de esclerodermia em golpe de sabre, síndrome de Parry-Romberg e morfeia em placas com acometimento facial, foram avaliados e submetidos à investigação neurológica, incluindo exame clínico neurológico e ressonância magnética de crânio, e avaliação oftalmológica. Após 3 anos, o subgrupo de pacientes disponível para seguimento foi ressubmetido à ressonância magnética. Resultados: Foram estudados 34 pacientes com esclerodermia localizada da face. Deste total, 64,7% apresentavam uma ou mais manifestações extracutâneas, sendo cefaleia a queixa mais frequente, encontrada em 61,8% dos pacientes. Dos 23 pacientes submetidos à avaliação neurológica, 56,5% apresentaram alterações neurológicas possivelmente associadas à esclerodermia. Alterações à ressonância magnética foram observadas em 50% dos casos. O achado mais frequente foi a presença de lesões parenquimatosas com alteração de sinal em 50% dos pacientes. Dos pacientes que apresentavam alteração neurológica, 80% também apresentavam alguma alteração à ressonância magnética. Doze pacientes foram ressubmetidos a novo exame após 3 anos. Em todos os pacientes os achados de imagem se mantiveram inalterados. Durante esse intervalo de 3 anos, 25% dos pacientes apresentaram sinais de atividade da esclerodermia. Quanto à avaliação oftalmológica, 67,9% dos pacientes avaliados apresentaram alteração, sendo os achados mais frequentes a ocorrência de alterações orbiculares da esclerodermia (20,6%) e xeroftalmia (10,7%). Conclusão: Pacientes com esclerodermia localizada da face apresentam alta prevalência de alterações neurológicas e oftalmológicas. Baseado nestes achados, sugerimos que todos os casos de esclerodermia localizada da face devam ser detalhadamente examinados quanto à presença de alterações sistêmicas / Introduction: Scleroderma is a rare connective tissue disease that manifests as skin sclerosis and variable systemic involvement. Two categories of scleroderma are known: systemic sclerosis, characterized by cutaneous sclerosis and visceral involvement and localized scleroderma or morphea which classically presents benign evolution and selflimited, confined to the skin and / or underlying tissue. Recent studies show that the localized form may possibly course with involvement of internal organs and variable morbidity. Objective: This study aimed to determine the demographic characteristics, the prevalence of systemic manifestations and laboratory findings, as well as the association with autoimmune diseases, in patients with scleroderma of the face. Methods: Patients with localized scleroderma, including cases of scleroderma en coup de sabre, Parry-Romberg syndrome and morphea plaque with facial involvement were evaluated and underwent neurological examination, including neurologic examination and magnetic resonance imaging, and ophthalmology evaluation. After 3 years, the subgroup of patients available for follow-up was subjected again to MRI. Results: We studied 34 patients with localized scleroderma of the face. Of this total, 64,7% had one or more extracutaneous manifestation, headache being the most frequent complaint found in 61,8% of patients. Of the 23 patients undergoing neurological evaluation, 56,5% had neurological changes possibly associated with scleroderma. MRI changes were observed in 50% of cases. The most frequent was the presence of parenchymal lesions with signal alteration in 50% of patients. Of the patients who had neurological deficits, 80% also had a change to MRI. Twelve patients were subjected again to another MRI scan after 3 years. In all patients, imaging findings were unchanged. During this interval of 3 years, 25% of patients showed signs of activity of scleroderma. As for ophthalmologic evaluation, 67,9% of patients showed abnormalities, with the most frequent findings being the occurrence of orbicular changes of scleroderma (20.6%) and xerophthalmia (10.7%). Conclusion: Patients with localized scleroderma face have a high prevalence of neurological and ophthalmological changes. Based on these findings, we suggest that all cases of localized scleroderma of the face should be thoroughly examined for the presence of systemic changes
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Estudo prospectivo para avaliar a evolução radiológica de 12 pacientes portadores de esclerodermia da face e perfil demográfico, manifestações clínicas e alterações laboratoriais de 34 casos / Prospective study to evaluate the radiological evolution of 12 patients with localized scleroderma of the face and the demographic, clinical and laboratory findings of 34 cases

Mariana Figueiroa Careta 17 July 2013 (has links)
Introdução: A esclerodermia é rara doença do tecido conectivo que se manifesta através da esclerose cutânea e variável acometimento sistêmico. Duas categorias de esclerodermia são conhecidas: esclerose sistêmica, caracterizada por esclerose cutânea e acometimento visceral e a esclerodermia localizada ou morfeia que classicamente apresenta evolução benigna e autolimitada, confinada a pele e/ou tecidos subjacentes. Estudos recentes demonstram que a forma localizada possa eventualmente apresentar acometimento de órgãos internos e morbidade variável. Objetivo: Neste estudo objetivamos determinar as características demográficas, a prevalência de manifestações sistêmicas e alterações laboratoriais, bem como a associação com doenças autoimunes, em pacientes com esclerodermia da face. Métodos: Pacientes com esclerodermia localizada, incluindo os casos de esclerodermia em golpe de sabre, síndrome de Parry-Romberg e morfeia em placas com acometimento facial, foram avaliados e submetidos à investigação neurológica, incluindo exame clínico neurológico e ressonância magnética de crânio, e avaliação oftalmológica. Após 3 anos, o subgrupo de pacientes disponível para seguimento foi ressubmetido à ressonância magnética. Resultados: Foram estudados 34 pacientes com esclerodermia localizada da face. Deste total, 64,7% apresentavam uma ou mais manifestações extracutâneas, sendo cefaleia a queixa mais frequente, encontrada em 61,8% dos pacientes. Dos 23 pacientes submetidos à avaliação neurológica, 56,5% apresentaram alterações neurológicas possivelmente associadas à esclerodermia. Alterações à ressonância magnética foram observadas em 50% dos casos. O achado mais frequente foi a presença de lesões parenquimatosas com alteração de sinal em 50% dos pacientes. Dos pacientes que apresentavam alteração neurológica, 80% também apresentavam alguma alteração à ressonância magnética. Doze pacientes foram ressubmetidos a novo exame após 3 anos. Em todos os pacientes os achados de imagem se mantiveram inalterados. Durante esse intervalo de 3 anos, 25% dos pacientes apresentaram sinais de atividade da esclerodermia. Quanto à avaliação oftalmológica, 67,9% dos pacientes avaliados apresentaram alteração, sendo os achados mais frequentes a ocorrência de alterações orbiculares da esclerodermia (20,6%) e xeroftalmia (10,7%). Conclusão: Pacientes com esclerodermia localizada da face apresentam alta prevalência de alterações neurológicas e oftalmológicas. Baseado nestes achados, sugerimos que todos os casos de esclerodermia localizada da face devam ser detalhadamente examinados quanto à presença de alterações sistêmicas / Introduction: Scleroderma is a rare connective tissue disease that manifests as skin sclerosis and variable systemic involvement. Two categories of scleroderma are known: systemic sclerosis, characterized by cutaneous sclerosis and visceral involvement and localized scleroderma or morphea which classically presents benign evolution and selflimited, confined to the skin and / or underlying tissue. Recent studies show that the localized form may possibly course with involvement of internal organs and variable morbidity. Objective: This study aimed to determine the demographic characteristics, the prevalence of systemic manifestations and laboratory findings, as well as the association with autoimmune diseases, in patients with scleroderma of the face. Methods: Patients with localized scleroderma, including cases of scleroderma en coup de sabre, Parry-Romberg syndrome and morphea plaque with facial involvement were evaluated and underwent neurological examination, including neurologic examination and magnetic resonance imaging, and ophthalmology evaluation. After 3 years, the subgroup of patients available for follow-up was subjected again to MRI. Results: We studied 34 patients with localized scleroderma of the face. Of this total, 64,7% had one or more extracutaneous manifestation, headache being the most frequent complaint found in 61,8% of patients. Of the 23 patients undergoing neurological evaluation, 56,5% had neurological changes possibly associated with scleroderma. MRI changes were observed in 50% of cases. The most frequent was the presence of parenchymal lesions with signal alteration in 50% of patients. Of the patients who had neurological deficits, 80% also had a change to MRI. Twelve patients were subjected again to another MRI scan after 3 years. In all patients, imaging findings were unchanged. During this interval of 3 years, 25% of patients showed signs of activity of scleroderma. As for ophthalmologic evaluation, 67,9% of patients showed abnormalities, with the most frequent findings being the occurrence of orbicular changes of scleroderma (20.6%) and xerophthalmia (10.7%). Conclusion: Patients with localized scleroderma face have a high prevalence of neurological and ophthalmological changes. Based on these findings, we suggest that all cases of localized scleroderma of the face should be thoroughly examined for the presence of systemic changes

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