Made available in DSpace on 2014-06-11T19:29:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-08-28Bitstream added on 2014-06-13T19:38:42Z : No. of bitstreams: 1 longo_fr_me_botfm.pdf: 199438 bytes, checksum: 5570cb34fea1a50aaeccfeb828712466 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A hanseníase é uma doença crônica que de um modo geral compromete a parte dermatológica e neurológica de um indivíduo, sendo que as alterações neurológicas, quando não diagnosticadas e tratadas adequadamente, podem levar a deformidades, causando incapacidades físicas. Realizou-se estudo retrospectivo utilizando-se de registros médicos de pacientes de hanseníase atendidos no Ambulatório da Faculdade de Medicina de Botucatu - UNESP. No total de 150 pacientes com diagnóstico confirmado, 48 (32 %), apresentaram neurites e, dentre estes, 28 (58,33 %) apresentaram reações, 17 (35,42 %) lesões neurológicas e lesões conseqüentes a estas. O objetivo principal foi avaliar a qualidade do atendimento dispensado pela equipe multiprofissional que acompanha estes pacientes, quanto à prevenção de incapacidades físicas entre doentes provenientes de outros serviços e dos diagnosticados no referido Ambulatório. Observou-se que os pacientes provenientes de outros serviços foram os que mais apresentaram seqüelas (94,12 %), mais episódios reacionais (60,71 %) e neurites (66,66 %). Concluiu-se que a prevenção de incapacidades ocorreu de modo mais efetivo em um serviço que conta com equipe multiprofissional especializada. / Leprosy is a chronic illness that in a general way compromises the dermatological and neurological part of an individual, being that the neurological alterations, when not diagnostic and treated adequately, can take the deformities, causing disabilities. Retrospective study using itself of medical registers of taken care of patients of leprosy in the Clinic of the College of Medicine of Botucatu - UNESP was become follow-up. In the total of 150 patients with confirmed diagnosis, 48 (32%), had presented neuritis and, amongst these, 28 (58.33%) had presented reactions, 17 (35.42%) neurological injuries and consequent injuries to these. The main objective was to evaluate the quality of the attendance excused for the multi-professional team that follows these patients, how much to the prevention of disabilities between sick people proceeding from other services and of the diagnostic ones in the related Clinic. It was observed that the patients proceeding from other services had been the ones that had more presented sequels (94.12%), more reactions episodes (60.71%) and neuritis (66.66%). One concluded that the prevention of incapacities occurred in more effective way in a service that specialized multi-professional counts on team.

Orientador: Joel Carlos Lastória / Banca: Jorge Antonio de Almeida / Banca: Jairo Aparecido Ayres / Resumo: A hanseníase é uma doença crônica que de um modo geral compromete a parte dermatológica e neurológica de um indivíduo, sendo que as alterações neurológicas, quando não diagnosticadas e tratadas adequadamente, podem levar a deformidades, causando incapacidades físicas. Realizou-se estudo retrospectivo utilizando-se de registros médicos de pacientes de hanseníase atendidos no Ambulatório da Faculdade de Medicina de Botucatu - UNESP. No total de 150 pacientes com diagnóstico confirmado, 48 (32 %), apresentaram neurites e, dentre estes, 28 (58,33 %) apresentaram reações, 17 (35,42 %) lesões neurológicas e lesões conseqüentes a estas. O objetivo principal foi avaliar a qualidade do atendimento dispensado pela equipe multiprofissional que acompanha estes pacientes, quanto à prevenção de incapacidades físicas entre doentes provenientes de outros serviços e dos diagnosticados no referido Ambulatório. Observou-se que os pacientes provenientes de outros serviços foram os que mais apresentaram seqüelas (94,12 %), mais episódios reacionais (60,71 %) e neurites (66,66 %). Concluiu-se que a prevenção de incapacidades ocorreu de modo mais efetivo em um serviço que conta com equipe multiprofissional especializada. / Abstract: Leprosy is a chronic illness that in a general way compromises the dermatological and neurological part of an individual, being that the neurological alterations, when not diagnostic and treated adequately, can take the deformities, causing disabilities. Retrospective study using itself of medical registers of taken care of patients of leprosy in the Clinic of the College of Medicine of Botucatu - UNESP was become follow-up. In the total of 150 patients with confirmed diagnosis, 48 (32%), had presented neuritis and, amongst these, 28 (58.33%) had presented reactions, 17 (35.42%) neurological injuries and consequent injuries to these. The main objective was to evaluate the quality of the attendance excused for the multi-professional team that follows these patients, how much to the prevention of disabilities between sick people proceeding from other services and of the diagnostic ones in the related Clinic. It was observed that the patients proceeding from other services had been the ones that had more presented sequels (94.12%), more reactions episodes (60.71%) and neuritis (66.66%). One concluded that the prevention of incapacities occurred in more effective way in a service that specialized multi-professional counts on team. / Mestre

We examined the extracellular vesicle (EV) and RNA composition of pooled normal cerebrospinal fluid (CSF) samples and CSF from five major neurological disorders: Alzheimer's disease (AD), Parkinson's disease (PD), low-grade glioma (LGG), glioblastoma multiforme (GBM), and subarachnoid haemorrhage (SAH), representing neurodegenerative disease, cancer, and severe acute brain injury. We evaluated: (I) size and quantity of EVs by nanoparticle tracking analysis (NTA) and vesicle flow cytometry (VFC), (II) RNA yield and purity using four RNA isolation kits, (III) replication of RNA yields within and between laboratories, and (IV) composition of total and EV RNAs by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and RNA sequencing (RNASeq). The CSF contained similar to 106 EVs/mu L by NTA and VFC. Brain tumour and SAH CSF contained more EVs and RNA relative to normal, AD, and PD. RT-qPCR and RNASeq identified disease-related populations of microRNAs and messenger RNAs (mRNAs) relative to normal CSF, in both total and EV fractions. This work presents relevant measures selected to inform the design of subsequent replicative CSF studies. The range of neurological diseases highlights variations in total and EV RNA content due to disease or collection site, revealing critical considerations guiding the selection of appropriate approaches and controls for CSF studies.

Philosophiae Doctor - PhD / Lumbo-sacral radiculopathy (LSR) is clinically defined as low back and referred leg symptoms accompanied by an objective sensory and/or motor deficit due to nerve root compromise. LSR is a common condition encountered by physiotherapists in clinical practice and the assessment and diagnosis remains a challenge owing to the complex anatomy of the lumbo-sacral spine segment and the various differentials. Moreover, LSR imposes a significant impact on patients’ health, functional ability, socio-economic status and quality of life. There are several diagnostic tools and procedures which are commonly utilised in practice, including diagnostic neuropathic pain screening questionnaires, clinical neurological tests, electro-diagnostics and imaging. However, the diagnostic utility and correlation of these tests have not been fully explored and remains debatable among clinicians and researchers in the fields of musculo-skeletal health and neurology. The aim of this study was to determine a correlation of the S-LANSS score, clinical neurological examination (CNE) findings and magnetic resonance imaging (MRI) reports in the diagnosis of LSR among patients who presented with low back and referred leg symptoms. The study was conducted in three phases. In phase one, two systematic literature reviews were conducted; firstly, to establish the evidence-based accuracy of CNE in diagnosing LSR, and secondly, to establish the evidence-based accuracy of MRI in diagnosing LSR. In both systematic literature reviews, the diagnostic tests accuracy (DTA) protocol was used in planning, design and execution of literature search, selection of relevant studies, quality assessment, data analysis and presentation of the results. In phase two, clinical validation of an adopted S-LANSS scale and lumbar MRI reporting protocol were established, and a standardised evidence based lumbar CNE protocol developed.The face and content validity of the original S-LANSS score was established among a sample of Kenyan physiotherapists and patients who presented with low back and referred leg symptoms, using both quantitative and qualitative research designs. This was followed by a test-re-test reliability study on the adapted version of the S- LNASS score. The face and content validity of the adopted lumbar MRI reporting protocol was established among a sample of Kenyan radiologists followed by an inter-rater reliability. An evidence-based lumbar CNE protocol was developed; standardised and inter-examiner reliability was also examined among a sample of Kenyan physiotherapists. Finally, in phase three, a cross-sectional blinded validity study was conducted in six different physiotherapy departments. Participants (patients, physiotherapists and radiologists) were recruited using strict in- and exclusion criteria and data was collected using a pain and demographic questionnaire, the S-LANSS scale, the CNE protocol, the Oswestry Disability Index (ODI) and the MRI lumbar spine reporting protocol. Data was captured, cleaned and analysed using SPSS version 21. Descriptive analysis was done using frequencies, means and percentages, while inferential analysis was conducted using Spearman’s rank correlation coefficient test r to establish the correlation between the diagnostic tests. Cross tabulations, receiver operating curves (ROC) and scatter plots were used to establish the sensitivity and/or specificity of S-LANSS scale and individual CNE tests as defined by MRI. In phase three, which formed the main study of the research project, a total of 102 participants were recruited in this study with a gender distribution of 57% females and 43% males. The majority (67%) had neuropathic pain according to the S-LANSS scale and their pain intensity ranged from moderate (4-6) to severe (7-9) as recorded on a Numeric Pain rating Scale (NPRS), and was more common among manual workers. Similarly, patients whose pain had a neuropathic component had moderate to severe disability. The S-LANSS scale and lower limb neuro-dynamic tests were the most sensitive tests 0.79 and 0.75 respectively, while deep tendon reflexes were the most specific tests (0.87). The S-LANSS and CNE correlated fairly but significantly with MRI (r=0.36, P=0.01).LSR is a common condition and its assessment and diagnosis remains a clinical challenge among physiotherapists. MRI is a high-cost diagnostic tool but is being used by many clinicians in making decisions regarding the management of patients. Rapid and low-cost neuropathic pain screening by the use of the S-LANSS scale, together with use of evidence-based CNE of neuro-conduction and neuro-dynamic tests may be used in confirming nerve-root related MRI findings. These may be used in making a decision on whether to manage a patient conservatively using pharmacological agents and manual physiotherapy and therapeutic exercise, or consider surgery in the initial management of patients with clinical suspicion of LSR. This is especially valuable in the resource-poor settings like Kenya and other sub-Saharan African countries where MRI is costly or unavailable.

American-style football participation is associated with high risks to a spectrum of sports-related brain injury involving acute reactions and chronic manifestations. Traditional methods of identifying injury have proven ineffective at protecting athletes and mitigating risk as they rely on the presence and recognition of inconsistent symptom expression. This is, in part, due to the lack of an objective measure of quantifying exposure. Brain trauma profiling was defined to capture a spectrum of exposure by incorporating the primary characteristics that associate with risk of neurological injury. This profile includes strain magnitude associated with impact, frequency at which impacts are experienced, time interval between impacts, over the duration of exposure. Trauma profiling methods differentiated player field position in professional American-style football where three unique trauma profiles were identified based on similarities among the characteristics of trauma. Regional strain from common head impacts showed that distribution was independent of field position regardless of variation in impact conditions. Rather, brain regions vulnerable to strains were dictated by the frequency and magnitude that govern the position profile. The extent of tissue volume involved in common head impacts was field position dependent. Skill positions tended to experience impacts involving greater tissue volumes reaching deeper white matter structures, but were infrequent. Impacts common to line positions typically involved less brain tissue of predominately superficial cortical gray matter, but were experienced at high frequency counts. The primary findings from this research show that brain trauma profiling may be used as an objective measurement tool to define exposure. The results indicate that exposure is not uniform and that brain trauma and injury risk can be described using unique combinations of these characteristics. Regional areas vulnerable to strain are dictated by the frequency and magnitude of impact and therefore in order to effectively protect against brain injury, both characteristics need to be managed. Lastly, this research demonstrates that either few impacts involving high brain volume or frequent impacts with little brain volume involvement may both result in brain dysfunction. Brain trauma profiling methods has broad application in future research. This measurement tool will be useful in identifying how injury occurs in various sports, military units, and particularly important for vulnerable populations and the developing brain. This knowledge is instrumental in establishing risk prevention strategies and public health policies for specific environments.

BACKGROUND: Soft neurological signs (SNS) are subtle, nonspecific neurological abnormalities that are present in first episode psychosis (FEP) patients. SNS are associated with clinical variables such as poor long term psychosocial functioning, executive functioning, and positive and negative symptomology. However, few studies have evaluated treatment responsiveness with respect to SNS. OBJECTIVE: To investigate whether SNS show: 1.) baseline and longitudinal differences between both diagnostic groups (schizophrenia (FEP-SZ), non-schizophrenia FEP-NSZ, and healthy controls (HC)) and treatment outcome (week 26 and year 1); 2.) relationships to clinical measures; 3.) predictive characteristics of treatment response. METHODS: SNS scores (Neurological Evaluation Scale) were obtained for 312 FEP (236 FEP-SZ and 76 FEP-NSZ subjects and 169 HC subjects and for subjects classified as treatment responsive and non-responsive at week 26 (N=105, N=105) and year 1 (N=101, N=97), respectively. Diagnostic group and treatment responsiveness group comparisons were assessed with ANCOVA and logistic regression models and both were co-varied for age, sex, race, and handedness. Baseline and longitudinal SNS relationships to clinical variables were determined using Spearman correlations and repeated measures correlations, and both were corrected by False Discovery Rate. Linear mixed effects model was utilized to analyze the data longitudinally. RESULTS: Baseline cognitive perceptual SNS measures had the greatest effect size differences, were predictive of group membership, and differentiated the two proband groups with FEP-SZ having worse SNS scores. Baseline cognitive perceptual SNS did not significantly predict treatment response at week 26 or year 1, but changes in cognitive perceptual at week 26 was predictive of treatment responsiveness at week 26 and year 1. Longitudinally, SNS scores drop in both FEP groups and treatment groups. The FEP-SZ group showed greater longitudinal within subject correlations than FEP-NSZ. SNS scores were only differentiated between year 1 outcome groups at week 8. There were greater longitudinal within subject correlations for the responsive group. CONCLUSION: Our findings indicate that there are baseline group differences and that changes in cognitive perceptual SNS scores at week 26 are predictive of treatment responsiveness at week 26 and year 1. / 2019-07-03T00:00:00Z

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects communication, socialization, and restricted/repetitive behaviors. In 2012, one out of every 55 children (1 in 42 boys and 1 in 189 girls) have been diagnosed with ASD in the United States. Only 30-40% of ASD has a known etiology (e.g., genetic predisposition) and the other 60-70% is unknown. Prior to this study, there was no known literature on age and gender differences related to neuro-developmental functioning of ASD. The purpose of this study was to examine how the differences in age and gender of people with ASD were related to total and domain scores, as measured by the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2). This quantitative research study included a sample size of 80 and 2 independent variables: age groupings (ages 1-4, 5-8, 9-17, and 18-older), and gender (male and female). The 4 dependent variables were the total and domain scores measured by the ADOS-2. The statistical analyses included a multiple analysis of variance (MANOVA) and a 2-way analysis of variance (ANOVA) to examine age and gender differences in the ADOS-2 domain and total scores. There was a statistically signi�cant difference for age on the domain dependent variables, F(9, 171) = 2.64, p = .007; Wilks' Lambda = .73; partial η2 = .10. However, there were no statistically significant differences for gender on domain scores and there were no statistically significant differences for age and gender on the overall scores. Those with ASD between ages 5-8 were more severely impaired for socialization when compared to other age groups and other domains. This research can be used for the improvement of intervention strategies for the diverse ASD population, and to improve the understanding of the neurodevelopmental functioning of individuals with ASD based on age and gender.

Enterovirus D68 (EV-D68) is a virus that normally causes disease in children. While this virus typically causes a respiratory infection, in 2014, a large outbreak of the virus was associated with patients that had paralysis of the arms or legs. Even though the virus was discovered in 1962, little was known about the life cycle of the virus or its ability to cause disease. An animal model of disease was needed to understand how the virus causes disease and to develop antiviral compounds to target the virus life cycle. We adapted the virus by serial-passage in lung tissues from mice deficient in interferon receptors. Using the adapted virus, we established a model of respiratory disease where the virus was able to replicate and cause moderate damage to the lung tissue. We created a separate model of disease where the virus caused paralysis and mortality in infected mice, similar to symptoms seen in infected children. Lastly, we evaluated several antiviral compounds to determine if they were able to protect the mice from virus replication and mortality. Guanidine was able to reduce the amount of virus in each tissue as well as protect mice from paralysis and mortality. In addition, human intravenous immunoglobulin (hIVIG), a mixture of pooled antibodies from human donors, did not reduce the amount of virus in the lungs, but did protect mice from paralysis and mortality.

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24142号 / 人健博第105号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 青山 朋樹, 教授 黒木 裕士, 教授 小林 恭 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Parkinson’s disease (PD) is one of the most common neurodegenerative diseases in the United States (Kowal, Dall, Chakrabarti, Storm, & Jain, 2013), affecting approximately 1 million Americans (American Parkinson’s Disease Association, 2020). However, there is limited research on the employment experiences of individuals with Parkinson’s disease (PD) (Koerts, Konig, Tucha, & Tucha, 2016). Informed by the capability approach (Sen, 2009) and social cognitive career theory (Lent & Hackett, 1994), this dissertation study addressed gaps in the extant literature, examining what employment options individuals with Parkinson's disease perceive as feasible after disease onset. This research explored the effects of contextual factors on employment options, including how understanding of workplace accommodations influences employment options, the role of discrimination and stigma in shaping employment options, and the extent to which individuals with Parkinson’s disease are receiving work-related decision support from health care providers. The author conducted individual semi-structured interviews with 23 adults under the age of 65 with Parkinson’s disease. Interviews were audio-recorded and transcribed. The author utilized an integrated approach to analysis, primarily employing a thematic analysis approach, as outlined by Braun and Clarke (2006). Additionally, a more interpretive analysis strategy (the Listening Guide, as outlined by Gilligan, Spencer, Weinberg & Bertsch, 2003) was integrated into the broader thematic analysis in order to deepen analysis of discrimination and stigma. Findings highlight specific facilitators and barriers to sustaining employment after the onset of PD, exploring how individuals with PD identify and gain crucial access to accommodations. This research demonstrates how a participant’s history of access to workplace accommodations influences participants’ perceived employment options, as well as the perceived effects of work on health. Participants’ narratives demonstrate how stigma and discrimination affect employment experiences and outcomes, influencing participants’ outcome expectations regarding current and future employment options. Participants reported that work-related conversations with health care providers were limited, with the data offering several explanations as to why these conversations were limited in nature. This study provides meaningful insights into the employment experiences of adults with Parkinson’s disease, with potential relevance to the experiences of adults with chronic and/or progressive diseases more broadly. These findings have important implications for social work and health care practice and education, disability policy, early intervention strategies after the onset of PD and priorities for future research. / 2024-05-31T00:00:00Z