Yes / Objective: To better understand the pathogenesis of DISH, identifying early or pre-DISH lesions in the spine and investigating the relationship between spinal and extra-spinal manifestations of DISH. Material: 44 skeletonized individuals with DISH from the WM Bass Donated Skeletal Collection. Methods: For each vertebra, location, extension, point of origin and appearance of vertebral outgrowths were recorded. The size of the enthesophytes at the olecranon process, patella and calcaneal tuberosity was measured with digital callipers. Results: At either end of the DISH-ankylosed segment, isolated vertical outgrowths arising from the central third of the anterior aspect of the vertebral body can usually be observed. These bone outgrowths show a well-organized external cortical layer, an internal structure of trabecular bone and usually are unaccompanied by or show minimal associated endplate degeneration. Analysis of the relationship between spinal and extra-spinal manifestations (ESM) suggests great inter-individual variability. No correlation between any ESM and the stage of spinal DISH was found. Conclusions: Small isolated outgrowths represent the earliest stages of the spinal manifestations of DISH. The use of ESM as an indicator of DISH should be undertaken with great caution until the relationship between these two features is understood. Significance: Improved accuracy of paleopathological diagnostic criteria of DISH. Limitations: Small sample comprised of only individuals with DISH. Future research: micro-CT analysis to investigate the internal structure of the spinal lesions. Analysis of extra-spinal enthesophytes in individuals with and without DISH to understand their pathogenesis and association with the spinal lesions in individuals with DISH. / Institute of Life Sciences Research Studentship awarded by the University of Bradford, Bradford, UK.

Thesis (MSc)--University of Stellenbosch, 2003. / ENGLISH ABSTRACT: Introduction: This is a multidisciplinary investigation of stress in working males. The physiological aspect of the stress response is focused primarily on the hypothalamic-pituitary-adrenal axis; the health outcomes focus on cardiovascular risk and the psychological aspect focuses on both personality and state. Aims: To assess psychological and physiological measures of stress and determine if they are associated. To assess the effect of massage as a relaxation intervention on these measures. Abstract: Section 1 This study consisted of 16 working, stressed males. Certain measures of allostatic load were determined, on 2 occasions 1 week apart with appropriate control (serum cortisol, dehydroepiandrosterone-sulphate (DHEAs), total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein) as well as perceived stress levels (State Anxiety, Profile of Mood (POMS), Job Satisfaction (JS), Symptoms of Stress (SYMP». Measurements of personality (Trait Anxiety and Hardiness, with subs cores Commitment, Control and Challenge) and anthropometric measurements were obtained. Repeatability was assessed and then data was averaged. Correlation analysis was done between baseline physiological and psychological parameters. (All r values reported in this abstract have P<0.05, unless otherwise stated). Section 2 11 of the 16 subjects then had 1 week of intensive massage (5 x Ihr each), after which a 3rd measurement was taken. Findings: Section 1 Certain personalities had differing perceptions of stress (Commitment correlated positively with Vigour, r= 0.59; and negatively with Fatigue and POMS, r= -0.51 and r= -0.54 respectively). Certain personalities influenced JS (Commitment correlated positively to JS, r= 0.55; Trait Anxiety correlated negatively to JS, r= -0.54). Certain personalities manifested stress physiologically (Control correlated negatively with CortisollDHEAs, r= -0.53). Increased perception of stress also resulted in an increased likelihood of experiencing physiological symptoms of stress (e.g. State Anxiety correlated with SYMP, r= 0.50). In contrast, lower perceived stress was associated with increased job satisfaction (POMS correlated with JS, r= -0.64; P<O.OI) and those who experienced more JS had decreased risk of cardiovascular disease (CVD) OS correlated negatively to LDL, r= -0.53). Physiological measures of CVD were also higher in subjects with antropometrically evaluated risk profiles. Section 2 Baseline variability of various parameters ranged form moderate to high (CV 4.4% to 73%). The intervention had no significant measured effect. 45% of subjects increased state-related stress. These subjects had had significant lower scores for Commitment (P<0.05). Conclusion: Section 1 Certain personality types are associated with decreased perception of stress, decreased stress symptomology and improved endocrine markers of allostatic load. Certain personality dispositions are associated with improved job satisfaction and decreased risk of CVD. These characteristics include e.g. high commitment, low anxiety and a sense of control i.e. all inherent predispositions. To improve sensitivity to intervention, 3 baseline samples should be considered in future studies. Section2 Contrary to what was hypothesized, massage had no effect. This is possibly due to the large daily variations in these variables and outside influences, which are necessarily a part of real-life as opposed to laboratory studies. Possibly I week of intensive relaxation therapy is insufficient and longer-term, lifestyle changing intervention is recommended for future studies. / AFRIKAANSE OPSOMMING: Inleiding: Hierdie studie is 'n multi-dissiplinêre ondersoek na stres in werkende mans. Die fisiologiese aspek van die stresrespons fokus primêr op die hipotalamo-pituitêre-adrenale as, terwyl die gesondsheidsuitkomste op die kardiovaskulêre risiko, en die psigologiese aspek op beide persoonlikheid en status fokus. Doel: Om psigiese en fisiologiese parameters van stress te bepaal, en om vas te stelof hulle met mekaar korrelleer. Om die effek van massering, as ontspanningsterapie, op hierdie parameters te bepaal. Afdeling 1 Sestien gespanne, werkende mans het aan hierdie studie deelgeneem. Sekere parameters van allostatiese lading (serum kortisol, dehidroepiandrosteroon-sulfaat (DHEAs), totale cholesterol, lae digtheid- (LDL) en hoë digtheid lipoproteïene (HDL) is twee maal bepaal, met 'n tussenpose van een week, met gepaste kontrole. Terselfdertyd is subjektiewe ervaring van stres (Toestand Angs, Profiel van Gemoedstemming (POMS), Werksbevrediging (JS), Simptome van Stres (SYMP», metings van persoonlikheid (Trekangs en Hardiness, i.e. Gebondenheid, Beheer en Uitdaging) en antropometriese metings ook verkry. Herhaalbaarheid is getoets en daarna is die gemiddelde van hierdie twee basislyn bepalings gebruik. Korrelasie analises is gedoen tussen basislyn fisiologiese en psigiese parameters. (Alle r-waardes gerapporteer in hierdie samevatting het P< 0.05, behalwe waar anders aangedui.) Afdeling 2 Elf van die sestien proefpersone het 1 week van intensiewe masseerterapie (5 x 1 uur elk) ondergaan, waarna 'n derde meting geneem is. Resultate: Afdeling 1 Sekere persoonlikhede het verskillende ervarings van stres getoon (Toegewydheid het positief gekorreleer met lewenslus, r= 0.59; en negatief met uitputting en POMS, r= -0.51 en r= -0.54 onderskeidelik). Sekere persoonlikhede het werksbevrediging (JS) beïnvloed (Toegewydheid het positief gekorreleer met JS, r = 0.55; Trait anxiety het negatief gekorreleer met JS, r= -0.54). Sekere persoonlikhede het ook fisiologiese geneigdheid tot stres getoon (Beheer het negatief gekorreleer met CIDHEAs, r= -0.53). Verhoogde ervaring van stres het 'n verhoogde waarskynlikheid vir ervaring van fisiologiese simptome van stres tot gevolg gehad (bv. Toestand Angs het positief gekorreleer met SYMP, r= 0.50). In teenstelling, is laer ervaring van stres geassosieer met verhoogde werksbevrediging (POMS het positief gekorreleer met JS, r= -0.64; P<O.Ol). Die persone wat hoer werksbevrediging ervaar het, het 'n laer risiko om kardiovaskulêre siektes (eVD) op te doen (JS het negatief gekorreleer met LDL, r= -0.53). Fisiologiese mates van CVD was ook hoër in proefpersone met antropometries geëvalueerde risiko profiele. Afdeling 2 Die mate van variasie in die basislyn fisiologiese bepalings het gewissel van gemiddeld tot hoog (KV 4.4 % tot 73 %). Die ingreep het geen meetbare effek getoon nie. 45 % van proefpersone het verhoogde status-verwante stres gerapporteer. Hierdie proefpersone het betekenisvollaer waardes vir Toewyding gehad (P< 0.05). Gevolgtrekking: Afdeling 1 Sekere persoonlikheidstipes word geassosieer met verlaagde ervaring van stres, verlaagde voorkoms van simptome van stres en verbeterde endokriene merkers van allostatiese lading. Sekere persoonlikheidstrekke word geassosieer met verhoogde werksbevrediging en verlaagde risiko vir CVD. Hierdie karaktertrekke sluit hoë toegewydheid, lae angstigheid en die vermoë om beheer uit te oefen in, d.i. alle inherente karaktertrekke. Drie basislyn metings behoort in die toekoms oorweeg te word, om die sensitiwiteit vir die ingreep te verbeter. Afdeling 2 Teenoorgesteld aan die hipotese, het massering geen effek getoon nie. Dit kan moontlik as gevolg van die groot daaglike variasie in hierdie veranderlikes wees, asook buite-invloede, wat noodwendig 'n deel van regte-lewe studies is, in teenstelling met laboratoriumstudies. Een week van intensiewe ontspanningsterapie kon ook moontlik onvoldoende gewees het. Daarom word langer-termyn, leefstyl-veranderende ingrepe aanbeveel.

published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

L’agression sexuelle est considérée comme un trauma qui est associée à de nombreuses conséquences négatives. En partie distincte de la résilience, la croissance post-traumatique est le résultat d’une restructuration cognitive, qui puise sa source dans les ressources de la victime et dans la détresse engendrée par le trauma. C’est à partir de cette lutte contre l’adversité que des conséquences positives peuvent émerger. C’est un phénomène très peu étudié scientifiquement chez les adolescentes, particulièrement lorsque cette population est victime d’agression sexuelle. Selon leur modèle théorique, Tedeschi et Calhoun (1996, 2004) identifient cinq dimensions de la croissance post-traumatique: les forces personnelles, les nouvelles possibilités, la relation avec les autres, l’appréciation de la vie et le changement spirituel. Comme l’adolescence est une période empreinte de vulnérabilité et d’enjeux majeurs, nous croyons qu’il est pertinent d’explorer la façon dont ces adolescentes victimes d’AS vivent leur moment présent et se projettent dans l’avenir. Ainsi, nous avons retenu deux dimensions de la croissance post-traumatique, que sont l’appréciation de la vie et les nouvelles possibilités, afin de décrire les différentes manifestations de ces dimensions que peuvent expérimenter les adolescentes. Le temps écoulé depuis l’agression sexuelle semble aussi être une variable importante à considérer lorsqu’il est question de croissance post-traumatique. Les objectifs de cette étude sont de décrire les manifestations de la croissance chez les adolescentes victimes d’agression sexuelle sévère pour les deux dimensions qui sont l’appréciation de la vie et les nouvelles possibilités et d’explorer les différences sur le plan des manifestations de la croissance post-traumatique chez ces adolescentes sur ces mêmes dimensions selon différents niveaux de croissance, le temps écoulé depuis la fin de l’agression sexuelle et le niveau de résilience. Pour répondre à ces objectifs, ce sont 40 adolescentes victimes d’agression sexuelle sévère, provenant de 2 centres jeunesse du Québec, qui ont participé à cette étude. Un questionnaire sociodémographique ainsi que le Sexual Abuse Rating Scale (Friedrich, 1992) ont permis d’obtenir des données sur les participantes et leur agression. Elles ont passé une entrevue semi-dirigée: le Multidimensional Trauma Recovery and Resiliency Interview (Harvey, Westen, Lebowitz, Saunders et Harney, 1995). Une cotation de certains items de l’entrevue a permis d’évaluer le niveau de résilience. Afin de ressortir les manifestations de croissance des deux dimensions retenues, des extraits d’entrevue ont été ciblés. À l’aide d’une analyse thématique qualitative (Paillé et Mucchielli, 2012), différentes manifestations de croissance post-traumatique ont été ressorties de façon déductive et inductive suivant le modèle de Tedeschi et Calhoun (1996, 2004). Les résultats montrent que les adolescentes victimes d’agression sexuelle peuvent réellement expérimenter de la croissance post-traumatique. Elles ont plus de faciliter à aborder la dimension d’appréciation de la vie que celle des nouvelles possibilités. De plus, certaines particularités spécifiques aux adolescentes victimes d’agression sexuelle sévères sont ressorties, comme le fait qu’elles n’abordent pas la manifestation des nouveaux intérêts. De plus, deux manifestations viennent enrichir le modèle théorique initial de la CPT soit: a) entretenir des projets et une vision positive de l’avenir, b) prise de conscience/compréhension de la vie. Par ailleurs, il n’y a pas de différence notable concernant la croissance post-traumatique selon que le temps écoulé depuis l’agression sexuelle est faible ou élevé. Enfin, la résilience et la croissance post-traumatique partagent effectivement certaines similitudes, car elles ont tendance à évoluer dans le même sens. Bien que le développement de la croissance post-traumatique demeure un objectif d’intervention, ce ne sont pas toutes les personnes qui y parviennent. Lorsqu’il est question de croissance post-traumatique auprès d’une population d’adolescentes, il est pertinent de considérer leur niveau de maturité et de respecter leur rythme. Une intervention précoce et adaptée peut influencer l’impact des événements. Il est donc important de soutenir l’adolescente vers la restructuration cognitive en tenant compte de ses capacités.

Introdução: Neurocisticercose (NCC) é a doença parasitária do sistema nervoso central (SNC) mais freqüente no mundo, afetando mais de 50 milhões de pessoas. No entanto, alguns de seus achados clínicos, tais como comprometimento cognitivo, é um aspecto pouco estudado na literatura e ainda permanece mal caracterizado. Objetivos: Avaliar o desempenho cognitivo de pacientes portadores de NCC e comparar o desempenho deste grupo em testes de avaliação cognitiva com o desempenho de indivíduos saudáveis (GC) e de indivíduos com epilepsia criptogênica (GE). O estudo objetivou também relacionar os achados com o tipo morfológico, número, localização dos cisticercos e fase de desenvolvimento do parasita. Métodos: 32 pacientes (média de idade = 45,2 ± 10,2 anos) com diagnóstico de NCC, com ou sem tratamento específico e em ambas as fases de desenvolvimento do parasita (formas ativa e inativa) foram submetidos a uma avaliação cognitiva, constituída de dez testes (memória, habilidades visuoespaciais, cálculo, abstração, praxias e gnosias e o Mini Exame do Estado Mental - MEEM), sendo comparados a 32 GC e 24 GE emparelhados por idade, gênero e nível educacional. Resultados: Pacientes com NCC apresentam prejuízo cognitivo, em comparação aos controles saudáveis em tarefas de memória visual, memória lógica imediata e recente. Pacientes com NCC e aqueles do GC apresentaram um desempenho cognitivo superior, em comparação ao GE; nos testes que envolveram a atenção e a memória operacional e na praxia reflexiva. Não houve diferença estatisticamente significativa no desempenho cognitivo nos três grupos estudados nos testes cognitivos que avaliaram a praxia construcional e ideomotora, cálculo e capacidade de abstração e julgamento. Não foi encontrada correlação entre alterações nos testes cognitivos dos pacientes com NCC e número de lesões e a fase de desenvolvimento do parasita. Em relação ao tipo morfológico, foi observado que os indivíduos que apresentavam a forma racemosa obtiveram um desempenho inferior no teste do Mini Exame do estado mental (MEEM), quando comparados aos que apresentavam a forma cística simples. Em relação à localização dos cisticercos, pode-se notar que os indivíduos com lesões de localização parenquimatosa demonstraram escores inferiores no teste de Faces Famosas e no teste de memória lógica recente, quando comparados àqueles com lesões ventriculares e no espaço subaracnóide. Conclusões: O declínio cognitivo foi uma manifestação clínica muito freqüente em nossa amostra de pacientes com NCC. Estes dados podem fornecer um conhecimento mais abrangente das manifestações clínicas presentes na NCC / Introduction: Neurocysticercosis (NCC) is the most frequent parasitic disease of the central nervous system (CNS), affecting more than 50 million people. However, some its clinical findings, such as cognitive impairment, are is an aspect little studied in the literature and remain poorly characterized. Aim: Assess the cognitive performance of patients with NCC and compare the performance of this group healthy controls (HC) and cryptogenic epilepsy (CE) patients. The study also aimed to relate the findings with the morphological type, number, location of cysticerci and development phase of the parasite. Methods: thirty-two patients (mean age = 45.2 ± 10.2 years) with diagnosis of NCC, with or without specific treatment and in both stages of parasite development (active and inactive forms) underwent a cognitive evaluation, constituted of ten tests. They were then compared to HC 32 and 24 CE, matched for age, gender and educational level. Results: NCC patients presented cognitive impairment compared to healthy controls in tasks of visual memory, immediate and recent logical memory. NCC patients and the HC presented a higher cognitive performance, compared to CE, in tests involving attention, working memory and reflective praxis. There was no statistically significant difference in cognitive performance among the three groups on cognitive tests that assessed ideomotor and constructional praxis, calculation and capacity for abstraction and trial. No correlation was found between changes in cognitive tests of patients NCC and number of lesions and stage of parasite development. Regarding to the morphological type, it was observed that individuals with the racemose form a lower performance in tests of the Mini Mental State Examination (MMSE), when compared to those who had the simple cystic form. Regarding location of cysticerci, it was noted that individuals with parenchymal lesions showed lower scores in the Famous Faces Test and recent test of logical memory when compared to those with lesions in the ventricular and subarachnoid space. Conclusions: The cognitive decline was a very frequent clinical manifestation in our sample of patients NCC. This data provide a better understanding of the broader clinical manifestations in patients with NCC

Com a introdução da terapia antirretroviral altamente ativa na década de 90, assistimos ao aumento da longevidade das pessoas vivendo com HIV/AIDS que passaram a apresentar uma incidência cada vez menor de doenças oportunistas, e aumento de outros agravos à saúde relacionados ao uso prolongado da terapia e à própria longevidade. Este estudo observacional transversal buscou determinar a prevalência de comorbidades que podem afetar o manejo clínico odontológico desta população, bem como conhecer as alterações orofaciais mais prevalentes nos pacientes HIV positivos atendidos no Centro de Atendimento a Pacientes Especiais da FOUSP. Adicionalmente, comparamos os dados obtidos nesse estudo, com estudo semelhante desenvolvido no mesmo centro, há uma década, e também avaliamos o impacto da condição bucal na qualidade de vida destes indivíduos. Foram incluídos 101 pacientes HIV positivos, examinados sempre pela mesma pesquisadora. Todos estavam sob HAART. Foram aplicados questionários aos participantes a respeito da história médica e odontológica pregressa e atual, aplicação do OHIP-14 e avaliação de exames hematológicos. Em todos os participantes foi realizado exame orofacial em cadeira odontológica, índice CPOD e ICP, e em 95 deles também a quantificação do fluxo salivar estimulado. Do total, 42,5% apresentaram ao menos uma manifestação orofacial, sendo a lipoatrofia facial de maior incidência (32,7%), seguida pela xerostomia (29,7%), aumento de glândulas salivares (11,9%) e aumento de linfonodos cervicais (4,9%). Ao menos uma comorbidade, excluindo-se alergia para a contagem, acometeu 88,1% (89/101) dos participantes e as mais prevalentes foram lipodistrofia (49,5%) e desordens psiquiátricas (37,6%). As alterações do hemograma foram observadas em 7,3% dos participantes para leucócitos, 4,9% neutrófilos e 10,9% em hemoglobina, sendo os valores críticos raramente evidenciados. Foi verificado impacto negativo moderado quanto à autopercepção de qualidade de vida relacionada à condição oral. A comparação com os dados obtidos há uma década revelaram aumento na incidência de lipodistrofia e distúrbios psiquiátricos como depressão e ansiedade. A incidência de manifestações bucais manteve-se semelhante, à exceção de xerostomia, que apresentou aumento, e a pigmentação da mucosa bucal, que apresentou diminuição nestes dez anos. Além disso, a média obtida entre os valores de CD4 foi significativamente maior no presente estudo, assim como a média etária dos pacientes (p<0,05). Concluímos que, de modo geral, as alterações sistêmicas encontradas não limitaram o atendimento odontológico ambulatorial, e que embora raras, as alterações hematológicas encontradas demonstram a importância da solicitação do hemograma previamente ao tratamento. O dentista deve estar atento às manifestações orofaciais, principalmente as oportunistas, que podem denunciar falta de adesão ou falha da TARV. Foi evidenciado um impacto negativo moderado quanto à qualidade de vida relacionada à condição bucal, que deve ser investigado em estudos futuros. Decorrida uma década, nota-se maior longevidade dos pacientes, associada à qualidade de vida, que pode ser demonstrada através da maior média de linfócitos T CD4 encontrada. / With the introduction of highly active antiretroviral therapy in the 1990s, we have seen an increase in the longevity of people living with HIV/AIDS, which has had a decreasing incidence of opportunistic diseases and an increase in other health problems related to long-term use of HIV. therapy and longevity itself. This cross-sectional observational study aimed to determine the prevalence of comorbidities that may affect the dental management of this population, as well as to know the most prevalent orofacial alterations in HIV positive patients seen at the FOUSP Special Patient Care Center. In addition, we compared the data obtained in this study, with a similar study developed in the same center a decade ago, and also evaluated the impact of the oral condition on the quality of life of these individuals. We included 101 HIV positive patients, always examined by the same researcher. Everyone was under HAART. Questionnaires were applied to participants regarding previous and current medical and dental history, OHIP-14 application, and evaluation of hematological exams. In all the participants, dental examinations were carried out in a dental chair, CPOD index and PCI, and in 95 of them the quantification of stimulated salivary flow. From the total, 42.5% had at least one orofacial manifestation, with facial lipoatrophy with a higher incidence (32.7%), followed by xerostomia (29.7%), salivary glands (11.9%) and increased of cervical lymph nodes (4.9%). At least one comorbidity, excluding allergy for counting, affected 88.1% (89/101) of the participants and the most prevalent were lipodystrophy (49.5%) and psychiatric disorders (37.6%). Changes in blood counts were observed in 7.3% of the participants for leukocytes, 4.9% neutrophils and 10.9% in hemoglobin, and the critical values were rarely evidenced. Moderate negative impact on self - perceived quality of life related to the oral condition was verified. The comparison with data obtained a decade ago revealed an increase in the incidence of lipodystrophy and psychiatric disorders such as depression and anxiety. The incidence of oral manifestations remained similar, with the exception of xerostomia, which presented an increase, and the pigmentation of the buccal mucosa, which presented a decrease in these ten years. In addition, the average value obtained between CD4 values was significantly higher in the present study, as was the average age of the patients (p<0.05). We concluded that, in general, the systemic alterations found did not limit outpatient dental care, and although rare, the hematological alterations found demonstrate the importance of requesting the blood count prior to treatment. The dentist should be aware of orofacial manifestations, especially opportunists, who may report lack of compliance or failure of ART. A moderate negative impact on the quality of life related to the oral condition was evidenced, which should be investigated in future studies. After a decade, there is a greater longevity of the patients, associated to the quality of life, which can be demonstrated through the higher CD4 T lymphocyte count found.

Apesar da introdução da HAART, formas leves de Transtornos Neurocognitivos Associados ao HIV (HAND) permanecem altamente prevalentes, afetando metade de todos os indivíduos infectados. A inflamação sistêmica e localizada induzida pelo HIV é considerada um dos mecanismos da HAND, e embora muitos biomarcadores potenciais tenham sido estudados, até o momento nenhum deles provou ser útil na prática clínica. Portanto, o objetivo desse trabalho foi investigar os níveis de biomarcadores de ativação celular, neurodegeneração e virológicos, no líquido cefalorraquidiano (CSF), e também marcadores genéticos no sangue, buscando associá-los à presença de HAND. Materiais e métodos: Utilizando um desenho transversal, níveis dos marcadores de ativação celular sCD14, Neopterina, MCP-1, IL-1b, IL-6, TNF-?, CXCL-10, IFN-? e MIP-1?; marcadores neuronais Tau, p-Tau, A?40, A?42 e Neurofilamentos; carga viral de HIV e níveis ApoE foram mensurados em 84 amostras de LCR , e a genotipagem do vírus, bem como a genotipagem da ApoE, foram feitas no sangue de 33 indivíduos infectados pelo HIV com alteração neurocognitiva assintomático (ANI), 15 com alteração neurocognitiva de leve a moderada (MND), 15 com demência associada ao HIV ( HAD), 14 controles infectados pelo HIV (C HIV +) e 7 controles não infectados pelo HIV (C HIV-). Os dados clínicos também foram avaliados. Resultados: O parâmetro de idade diferiu estatisticamente entre os grupos, por isso foi ajustado para análise posterior. Os controles HIV+ e o grupo HAND estavam todos sob HAART e aproximadamente 96% deles apresentaram carga viral plasmática e liquórica suprimidas. Os marcadores de neurodegeneração não diferiram estatisticamente entre os grupos. No entanto, os marcadores de ativação celular IFN-gama, IL-1beta e sCD14, juntamente com a ApoE, mostraram diferenças significativas. A análise discriminatória revelou que ApoE e IL-1? juntos possuem maior poder discriminatório para diferenciar o grupo HAND dos controles HIV+. A IL-1b mostrou um aumento progressivo no declínio cognitivo, enquanto os níveis de ApoE mostraram-se mais elevados nos controles HIV+, grupo que também teve a maior porcentagem de genótipo ?4. sCD14 por sua vez mostrou-se elevado no grupo HAND, enquanto IFN-? apresentou queda. Conclusão: Os resultados reforçam o conceito de que a elevação da regulação das citocinas pró-inflamatórias, como sCD14 e IL-1beta, pode desempenhar um papel na patogênese da HAND, mesmo nos pacientes com supressão viral.Em contrapartida, nenhum marcador de neurodegeneração apresentou diferença estatística entre os grupos. É possível que as diferenças encontradas em relação a ApoE nos grupos, tanto tem termos de regulação como a presença do genótipo e4, indique algum mecanismo compensatório, que poderia resultar em um fator protetor contra HAND, portanto deve ser melhor estudado. / Despite the introduction of HAART, mild forms of HIV-associated Neurocognitive Disorders (HAND) remain highly prevalent, affecting half of all infected individuals. Systemic and localized inflammation induced by HIV is considered to be one of the mechanisms of HAND, and although many potential biomarkers have been studied, none of them have proven to be useful in clinical practice. Therefore, the objective of this study was to investigate the levels of biomarkers of cellular activation, neurodegeneration and virological, in the cerebrospinal fluid (CSF), as well as genetic markers in the blood, seeking to associate them with the presence of HAND. Materials and methods: Using a cross-sectional design, levels of the cell activation markers sCD14, Neopterin, MCP-1, IL-1b, IL-6, TNF-?, CXCL-10, IFN-? and MIP-1?; neuronal markers Tau, p-Tau, A?40, A?42 and Neurofilaments; HIV viral load and ApoE levels were measured in 84 CSF samples, and virus genotyping and ApoE genotyping were done in the blood of 33 HIV-infected individuals with asymptomatic neurocognitive impairment (ANI), 15 with neurocognitive impairment (MND), 15 with HIV-associated dementia (HAD), 14 HIV-infected controls (C HIV +), and 7 non-HIV-infected controls (C HIV-). Clinical data were also evaluated. Results: The age parameter differed statistically between the groups, so it was adjusted for later analysis. HIV + controls and HAND group were all under HAART and approximately 96% of them had suppressed plasma and CSF viral load. Neurodegeneration markers did not differ statistically between the groups. However, the cell activation markers IFN-gamma, IL-1beta and sCD14, along with ApoE, showed significant differences. Discriminatory analysis revealed that ApoE and IL-1? together have greater discriminatory power to differentiate HAND group from HIV + controls. IL-1b showed a progressive increase in cognitive decline, while ApoE levels were higher in HIV + controls, which also had the highest percentage of ?4 genotype. sCD14 in turn showed to be elevated in the HAND group, while IFN-? showed decrease. Conclusion: The results reinforce the concept that increased regulation of proinflammatory cytokines, such as sCD14 and IL-1beta, may play a role in the pathogenesis of HAND, even in patients with viral suppression. On the other hand, no neurodegeneration marker presented statistical difference between groups. It is possible that the differences found regarding ApoE in the groups, both in terms of regulation and the presence of the e4 genotype, indicate some compensatory mechanism, which could result in a protective factor against HAND, so it should be better studied.

Esta tese atende a proposta estabelecida pela Linha de Pesquisa “Paradigmas para a Pesquisa sobre o Ensino Científico e Tecnológico” do Programa de Pós-Graduação em Informática na Educação (PGIE) do Centro Interdisciplinar de Novas Tecnologias na Educação (CINTED) da Universidade Federal do Rio Grande do Sul (UFRGS). A tese busca a compreensão de fenômenos que decorrem do seguinte problema: Como sistematizar procedimentos de produção audiovisual, com estratégias que não afetem o desempenho de professores universitários e que não interfiram de forma negativa no resultado final de apresentação dos conteúdos durante a gravação de vídeos educacionais? Em seu objetivo geral pretende-se identificar os procedimentos e estratégias que apoiam o desenvolvimento de vídeos educacionais. O desenho teórico está fundamentado nas questões técnicas de produção audiovisual, na utilização do audiovisual na educação e as manifestações emocionais do professor dentro deste processo de produção. A metodologia utilizada foi através de uma abordagem qualitativa, mediante procedimento de estudo de casos e através de investigação descritiva e exploratória. Como instrumentos de coleta foram utilizados a documentação audiovisual, a entrevista semiestruturada e a observação direta de rotinas de produção audiovisual. Para a análise e interpretação dos dados foram empregadas as técnicas de Análise Textual Discursiva e sistematizações conceituais e fotográficas, utilizadas para identificação de expressões faciais. A seleção de sujeitos contemplou 15 professores, que responderam as entrevistas e, após, analisados 15 fotogramas resultantes de vídeos educacionais com a participação destes professores. Os resultados identificaram interferências ocasionadas pelo ambiente de produção, pelos equipamentos e por ações da equipe de produção, afetando o desempenho do professor durante a gravação dos vídeos, como também indicaram as alternativas para melhorar a interação do professor dentro do processo de produção audiovisual. Como produto dessa tese, foi elaborado o Guia de Procedimentos de Produção de Vídeos Educacionais, sistematizando estratégias de ações que colaboram para a interação do professor com o ambiente de produção audiovisual. / The dissertation hereof meets the proposal drawn up by the Research Line "Paradigms for the Research on the Scientific and Technological Teaching" of the Graduate Program in Information Technology in Education (known by its Portuguese acronym PGIE), of the Interdisciplinary Center of New Technologies in Education (Portuguese acronym: CINTED), of the Federal University of Rio Grande do Sul (UFRGS).This dissertation searches the understanding of phenomena that derive from the following problem: How to systematize the audiovisual production procedures, with strategies that do not affect the performance of university professors and do not interfere with the final result of presentation of the contents during the recording of educational videos? In its general objective, it aims to identify the procedures and strategies which support the development of educational videos. The theoretical picture is based on the technical issues of audiovisual production, on the use of audiovisual media in education and the emotional manifestations of the professor within this production process. The methodology put to use is through a qualitative approach, through study procedure cases and by means of descriptive and exploratory research. As data collection instruments, it is used the visual documentation, the semi-structured interviews, and the direct observation of routines of audiovisual production. For the analysis and interpretation of the collected data, are applied the Discursive Textual Analysis techniques and the conceptual and photographic systematizations used for identification of facial expressions. The selection of subjects contemplated 15 subjects, who answered to the interviews and, afterwards, analyzed 15 frames resulting from educational videos with the participation of these subjects. The results have identified interferences brought about by the production environment, by the equipment, and by actions of the team of production, in a way that not only affected the professor performance during the recording of the videos, but also indicated alternatives to improve the interaction of such professor within the process of audiovisual production.

INTRODUÇÃO: Lúpus eritematoso (LE) é uma doença inflamatória crônica, autoimune. A presença de citocinas do tipo 1 nas lesões cutâneas discoides sugere que estas sejam críticas para a indução, desenvolvimento e manutenção destas manifestações. As citocinas do tipo 2 em combinação com Interferon- local podem estar relacionadas com a fisiopatologia do lúpus cutâneo. O perfil das citocinas ainda é desconhecido nas lesões orais do LE. MÉTODOS: Foram investigadas e comparadas as expressões das citocinas Th1 e Th2, representadas por IL-4, IL-5, IL-6, IL-10, IL-12, fator de necrose tumoral alfa (TNF-) e interferon gama (IFN-), de 29 biopsias de LE de mucosa intraoral (área não exposta ao sol) e semimucosa labial (área exposta) por meio da técnica de imuno-histoquímica. RESULTADOS: O infiltrado inflamatório das lesões de LE foi fortemente positivo para IFN- (97%) e TNF- (90%), ambas citocinas Th1. Interleucina 10 (IL-10), citocina Th2, foi fortemente expressa. Outras citocinas foram apenas moderadamente positivas. O padrão de citocinas foi semelhante nas lesões orais do LE na mucosa intraoral (área não exposta) e na semimucosa labial (área exposta). CONCLUSÕES: As lesões orais de LE estão associadas tanto a citocinas Th1 quanto a citocinas Th2, caracterizadas por expressão forte de IFN-, TNF- e IL-10. Além disso, os achados sugerem que apesar da radiação ultravioleta estar envolvida na indução das lesões de LE, os mecanismos de formação das lesões podem ser similares nas áreas expostas e não expostas ao sol. / Lupus erythematosus (LE) is a chronic inflammatory disease, autoimune. Presence of type 1 cytokines in cutaneous discoid lesions suggests that they may be critical for induction, development and maintenance of these manifestations. Type 2 cytokines in combination with local interferon (IFN-) are thought to be related to the physiopathology of cutaneous LE. Cytokines profiles are still unknown in oral LE lesions. Material and Methods: Expression of Th1 and Th2 cytokines (including IL-4, IL-5, IL-6, IL-10, IL-12, tumor necrosis factor (TNF-) and IFN- was investigated and compared in 29 biopsies of intra-oral (sun-protected) and labial lesions (sun-exposed) of LE using immunohistochemistry. Results: Inflammatory infiltrate of LE lesions was strongly positive for IFN- (97%) and TNF- (90%), both Th1 type cytokines. Interleukin-10, a Th2 cytokine was also strongly expressed. Other cytokines were only mildly positive. Cytokines patterns were similar in intra-oral (sun-covered) and labial (sun-exposed) LE lesions Conclusions: Oral LE lesions are associated with both type 1 and type 2 cytokines, characterized by stronger expression of IFN-, TNF- and IL-10. These findings suggest that although ultraviolet light is involved in the induction of LE lesions, mechanisms of lesions formation may be similar in sun-exposed as well as sun-covered areas.

Apesar da introdução da HAART, formas leves de Transtornos Neurocognitivos Associados ao HIV (HAND) permanecem altamente prevalentes, afetando metade de todos os indivíduos infectados. A inflamação sistêmica e localizada induzida pelo HIV é considerada um dos mecanismos da HAND, e embora muitos biomarcadores potenciais tenham sido estudados, até o momento nenhum deles provou ser útil na prática clínica. Portanto, o objetivo desse trabalho foi investigar os níveis de biomarcadores de ativação celular, neurodegeneração e virológicos, no líquido cefalorraquidiano (CSF), e também marcadores genéticos no sangue, buscando associá-los à presença de HAND. Materiais e métodos: Utilizando um desenho transversal, níveis dos marcadores de ativação celular sCD14, Neopterina, MCP-1, IL-1b, IL-6, TNF-?, CXCL-10, IFN-? e MIP-1?; marcadores neuronais Tau, p-Tau, A?40, A?42 e Neurofilamentos; carga viral de HIV e níveis ApoE foram mensurados em 84 amostras de LCR , e a genotipagem do vírus, bem como a genotipagem da ApoE, foram feitas no sangue de 33 indivíduos infectados pelo HIV com alteração neurocognitiva assintomático (ANI), 15 com alteração neurocognitiva de leve a moderada (MND), 15 com demência associada ao HIV ( HAD), 14 controles infectados pelo HIV (C HIV +) e 7 controles não infectados pelo HIV (C HIV-). Os dados clínicos também foram avaliados. Resultados: O parâmetro de idade diferiu estatisticamente entre os grupos, por isso foi ajustado para análise posterior. Os controles HIV+ e o grupo HAND estavam todos sob HAART e aproximadamente 96% deles apresentaram carga viral plasmática e liquórica suprimidas. Os marcadores de neurodegeneração não diferiram estatisticamente entre os grupos. No entanto, os marcadores de ativação celular IFN-gama, IL-1beta e sCD14, juntamente com a ApoE, mostraram diferenças significativas. A análise discriminatória revelou que ApoE e IL-1? juntos possuem maior poder discriminatório para diferenciar o grupo HAND dos controles HIV+. A IL-1b mostrou um aumento progressivo no declínio cognitivo, enquanto os níveis de ApoE mostraram-se mais elevados nos controles HIV+, grupo que também teve a maior porcentagem de genótipo ?4. sCD14 por sua vez mostrou-se elevado no grupo HAND, enquanto IFN-? apresentou queda. Conclusão: Os resultados reforçam o conceito de que a elevação da regulação das citocinas pró-inflamatórias, como sCD14 e IL-1beta, pode desempenhar um papel na patogênese da HAND, mesmo nos pacientes com supressão viral.Em contrapartida, nenhum marcador de neurodegeneração apresentou diferença estatística entre os grupos. É possível que as diferenças encontradas em relação a ApoE nos grupos, tanto tem termos de regulação como a presença do genótipo e4, indique algum mecanismo compensatório, que poderia resultar em um fator protetor contra HAND, portanto deve ser melhor estudado. / Despite the introduction of HAART, mild forms of HIV-associated Neurocognitive Disorders (HAND) remain highly prevalent, affecting half of all infected individuals. Systemic and localized inflammation induced by HIV is considered to be one of the mechanisms of HAND, and although many potential biomarkers have been studied, none of them have proven to be useful in clinical practice. Therefore, the objective of this study was to investigate the levels of biomarkers of cellular activation, neurodegeneration and virological, in the cerebrospinal fluid (CSF), as well as genetic markers in the blood, seeking to associate them with the presence of HAND. Materials and methods: Using a cross-sectional design, levels of the cell activation markers sCD14, Neopterin, MCP-1, IL-1b, IL-6, TNF-?, CXCL-10, IFN-? and MIP-1?; neuronal markers Tau, p-Tau, A?40, A?42 and Neurofilaments; HIV viral load and ApoE levels were measured in 84 CSF samples, and virus genotyping and ApoE genotyping were done in the blood of 33 HIV-infected individuals with asymptomatic neurocognitive impairment (ANI), 15 with neurocognitive impairment (MND), 15 with HIV-associated dementia (HAD), 14 HIV-infected controls (C HIV +), and 7 non-HIV-infected controls (C HIV-). Clinical data were also evaluated. Results: The age parameter differed statistically between the groups, so it was adjusted for later analysis. HIV + controls and HAND group were all under HAART and approximately 96% of them had suppressed plasma and CSF viral load. Neurodegeneration markers did not differ statistically between the groups. However, the cell activation markers IFN-gamma, IL-1beta and sCD14, along with ApoE, showed significant differences. Discriminatory analysis revealed that ApoE and IL-1? together have greater discriminatory power to differentiate HAND group from HIV + controls. IL-1b showed a progressive increase in cognitive decline, while ApoE levels were higher in HIV + controls, which also had the highest percentage of ?4 genotype. sCD14 in turn showed to be elevated in the HAND group, while IFN-? showed decrease. Conclusion: The results reinforce the concept that increased regulation of proinflammatory cytokines, such as sCD14 and IL-1beta, may play a role in the pathogenesis of HAND, even in patients with viral suppression. On the other hand, no neurodegeneration marker presented statistical difference between groups. It is possible that the differences found regarding ApoE in the groups, both in terms of regulation and the presence of the e4 genotype, indicate some compensatory mechanism, which could result in a protective factor against HAND, so it should be better studied.