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Made available in DSpace on 2015-07-22T20:50:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-24 / Objetivo: Analisar o número médio de sessões de fonoterapia necessárias para a liberação de ao menos uma consistência alimentar por via oral e fatores que interferem no número de sessões para reabilitação da deglutição. Método: Estudo observacional, analítico e retrospectivo com 260 pacientes disfágicos, de diversos diagnósticos, neurológicos e não neurológicos, internados no Hospital São Paulo (UNIFESP), com idade entre 02 e 105 anos, avaliados e tratados pelo Serviço Integrado de Fonoaudiologia, no período de agosto/2007 a agosto/2009. Resultados: O número médio de sessões de fonoterapia necessárias para a liberação da dieta por via oral na amostra estudada foi de 4,13 sessões. Os fatores que apresentaram significantemente mais sessões para a liberação da dieta oral foram: sexo masculino, tempo de internação hospitalar, tempo para solicitar a avaliação fonoaudiológica, tempo de via alternativa de alimentação, broncopneumonia, sepse, tempo de intubação orotraqueal, reintubação, tempo de traqueostomia, tempo de ventilação mecânica, tempo de nebulização, alteração na deglutição de saliva, alteração vocal, redução da elevação laríngea e penetração supraglótica. A análise de regressão evidenciou que a associação dos seguintes fatores implicou em maior número sessões de fonoterapia para liberação da dieta via oral: alteração na deglutição de saliva associada à alteração vocal, alteração na deglutição de saliva associada à redução da elevação laríngea e alteração na deglutição de saliva associada ao tempo para a avaliação fonoaudiológica inicial. Conclusões: O número médio de sessões para liberação da dieta por via oral foi de 4,13 sessões, o que corresponde a aproximadamente cinco dias. Foram identificados 15 fatores que ocasionaram o atraso para liberação da dieta por via oral. No entanto, a reabilitação da deglutição foi significativa na maioria dos pacientes disfágicos... / Purpose: To analyze the average number of swallowing rehabilitation sessions necessary for the release of oral intake, at least one consistency, and the factors that influenced the number of swallowing rehabilitation sessions. Methods: An observational, analytical and retrospective study of 260 dysphagic patients with different diagnosis, neurological or not, at the São Paulo Hospital (UNIFESP), ages between 02 and 105 years, evaluated and treated by Speech and Language Integrated Service among August / 2007 and August/2009. Results: The average number of swallowing sessions necessary for the release of oral intake was 4.13 sessions. The factors that contributed to a significantly higher number of rehabilitation sessions were male gender, duration of hospital stay, time to request initial bedside swallowing evaluation; time of tube feeding, pneumonia, sepsis, duration of intubation, reintubation, duration of tracheotomy, duration of mechanical ventilation, duration of nebulization, swallowing saliva impairment, voice impairment, reduction of laryngeal elevation and supraglottic penetration. Regression analysis showed that the combination of the following factors interfered in the number of swallowing rehabilitation sessions: swallowing saliva impairment associated with voice impairment, swallowing saliva impairment associated with reduced laryngeal elevation and swallowing saliva impairment associated with time to request initial bedside swallowing evaluation. Conclusions: The average number of sessions to release oral intake was 4.13, which corresponds to about 5 days. Were identified 15 factors that caused the delay to release the oral intake. However, the rehabilitation of swallowing showed significant improvement in these patients. / TEDE / BV UNIFESP: Teses e dissertações

EPDM and R-EPDM granules are used as infill on all of the artificial football fields in Uppsala. The aim of the study was to establish possible health risks related to the infill for players on artificial turf in Uppsala. Furthermore the aim was to investigate the possible ecotoxicological effect on surrounding waterways by the infill material. A comparative analysis concerning health and ecotoxicological effects for these materials was carried out. Eight different granules from the artificial turf in Uppsala was collected and analysed using TGA. The TGA results were modelled in two different scenarios to show possible air concentrations of 100-300 µg/m3 VOC over artificial football fields with EPDM granules. Calculations based on the tolerable daily dose of substances found in the granules were carried out. The conclusions of the study shows that the EPDM granules used today are safe from a health perspective. SBR granules from recycled tires does not constitute to any health risks either. The ecotoxicological risk for surrounding waterways is low. EPDM is less cost and energy efficient compared to SBR from recycled tires. Reduction of granular spill is very important from an environmental and cost point of view, regardless of the choice of material for artificial turf.

EPDM and R-EPDM granules are used as infill on all of the artificial football fields in Uppsala. The aim of the study was to establish possible health risks related to the infill for players on artificial turf in Uppsala. Furthermore the aim was to investigate the possible ecotoxicological effect on surrounding waterways by the infill material. A comparative analysis concerning health and ecotoxicological effects for these materials was carried out. Eight different granules from the artificial turf in Uppsala was collected and analysed using TGA. The TGA results were modelled in two different scenarios to show possible air concentrations of 100-300 µg/m3 VOC over artificial football fields with EPDM granules. Calculations based on the tolerable daily dose of substances found in the granules were carried out. The conclusions of the study shows that the EPDM granules used today are safe from a health perspective. SBR granules from recycled tires does not constitute to any health risks either. The ecotoxicological risk for surrounding waterways is low. EPDM is less cost and energy efficient compared to SBR from recycled tires. Reduction of granular spill is very important from an environmental and cost point of view, regardless of the choice of material for artificial turf.

Coronavirus disease 2019 (covid-19) är en smittsam infektionssjukdom som orsakas av viruset severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Sedan sjukdomens utbrott i december 2019 har viruset spridits globalt och infekterat fler än 270 miljoner människor världen över. Majoriteten av de som insjuknar i covid-19 får lindriga till måttliga besvär, men en liten del blir allvarligt sjuka och behöver sjukhusvård. Bland de patienter som blir allvarligt sjuka i covid-19 diagnostiseras en betydande del i det akuta skedet med sväljsvårigheter, eller dysfagi. Föreliggande studie bestod i en retrospektiv journalgranskning, som en del av ett kvalitetssäkringsarbete inom Region Gävleborg. Syftet med studien var att undersöka hur sväljsvårigheter kan manifesteras hos personer som vårdas på sjukhus till följd av covid-19 och som remitterats till logoped för bedömning och åtgärder. 60 deltagare inkluderades i studien, varav 17 var kvinnor och 43 var män. Resultaten visar att förekomsten av dysfagi var hög i det akuta skedet, där 42 deltagare (70 %) bedömdes ha dysfagi vid första logopedbedömning. Många deltagare återhämtade sig från sin dysfagi under vårdtiden, men 12 deltagare (20 %) hade kvarstående dysfagi vid utskrivning. Behovet av nutritionsstöd och andningsstöd under vårdtiden var stort. Vanliga fynd under de kliniska sväljbedömningarna var hosta, trögutlöst sväljning och nedsatt oral bearbetning. Deltagarna erhöll logopediska rekommendationer främst gällande anpassad kost, sittställning och munvård. Deltagarnas sväljförmåga skattades med Functional Oral Intake Scale (FOIS) vid första logopedbedömning och vid utskrivning. Vid första bedömning rekommenderades en majoritet av deltagarna anpassad kost (FOIS 1–6) och medelvärdet för FOIS var 3,5 ± 2,1. Vid utskrivning hade de flesta återgått till normalkost (FOIS 7) och medelvärdet för FOIS var 6,0 ± 1,8 (p < 0,001). Denna studie visar att en majoritet av de som vårdats på sjukhus till följd av covid-19 i Region Gävleborg och som remitterats till logoped, uppvisade dysfagi i det akuta skedet men kunde vid utskrivning äta normalkost. Behovet av mer forskning och vidare analyser av hur sväljsvårigheter manifesteras och upplevs hos patientgruppen är fortsatt stort. / Coronavirus disease 2019 (COVID-19) is a contagious infectious disease caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the outbreak in December of 2019, the virus has spread globally and infected more than 270 million people worldwide. The majority of people infected with COVID-19 will have mild to moderate symptoms, but some will suffer from severe illness which requires hospital care. Many of those who experience severe illness from COVID-19 are diagnosed with swallowing difficulties, or dysphagia, in the acute stage. This study consisted of a retrospective medical chart review and is part of a review of quality control in Region Gävleborg. The aim of the study was to investigate how swallowing difficulties manifest in people who require hospital care due to COVID-19 and who have been referred to the Speech and Language Therapy department. 60 participants were included in the study, of whom 17 were women and 43 were men. The results show that the prevalence of dysphagia was high in the acute stage, where 42 participants (70%) were diagnosed with dysphagia during the first SLT assessment. Many participants recovered from their dysphagia during their hospital stay, but 12 participants (20%) had persistent dysphagia at discharge. The need for nutritional and respiratory support was high. Common findings from the clinical swallowing assessments were coughing, difficulty initiating swallowing as well as affected oral processing. Common SLT recommendations included modified consistencies, posture and oral care. Swallowing ability was graded with the Functional Oral Intake Scale (FOIS) at first SLT assessment and at discharge. At first SLT assessment a majority of the participants were recommended a modified diet (FOIS 1-6) and the average FOIS was 3.5 ± 2.1. At discharge most participants had returned to a normal diet (FOIS 7) and the average FOIS was 6.0 ± 1.8 (p < 0,001). This study shows that a majority of the people who were hospitalized due to COVID-19 in Region Gävleborg and who were referred for an SLT evaluation, had dysphagia in the acute stage and recovered from their swallowing difficulties before discharge. More research and further analyses of how swallowing difficulties manifest in patients hospitalized due to COVID-19 is still needed.

Lectinas são proteínas cuja principal característica é a de se ligar específica e reversivelmente a carboidratos. BanLec é a lectina presente na polpa de bananas, que se liga especificamente a manose e glicose, e é capaz de induzir a proliferação de células T, podendo estimular a resposta imune. Existem indícios de que o teor de BanLec pode variar dependendo do estádio de amadurecimento e do tipo de cultivar, o que pode afetar a quantidade de BanLec existente na fruta quando consumida in natura e a possível resposta imune frente ao consumo de banana. Por este motivo, um dos objetivos desse trabalho foi determinar os teores e a atividade hemaglutinante de BanLec em extratos de farinha de banana verde, além de bananas das cultivares Pacovan, Figo, Terra, Mysore e Nanicão, nos estádios de maturação verde e maduro, e submetidas a tratamento com 1-MCP e baixa temperatura (para cv. Nanicão). Com vista a atender ao objetivo de avaliar seus efeitos imunomoduladores in vivo, a BanLec foi purificada da cultivar Nanicão e administrada por via oral a camundongos BALB/c. Os ensaios de atividade hemaglutinante dos extratos de banana apontaram para maior quantidade de BanLec no fruto maduro, quando comparado ao verde, e ausência dessa proteína na cultivar Figo. Os parâmetros imunológicos analisados após administração de BanLec aos camundongos demonstram que a resposta imune gerada após ingestão de BanLec é dose dependente, além disso, a administração de 50 µg de BanLec aos animais foi capaz de modular citocinas importantes na resposta imunológica, provavelmente causando um efeito que pode ser interpretado como mais protetor do que patogênico. Com base nos resultados obtidos, podemos concluir que existem diferenças nos teores de BanLec dependendo da cultivar e estádio de maturação analisado, sendo que essa proteína não está presente na polpa de todas as variedades de banana e finalmente, que ela tem grande potencial imunomodulador in vivo, uma vez que ativou citocinas de resposta anti-inflamatória. / Lectins are proteins which bind specifically and reversibly to carbohydrates. BanLec is the lectin present in banana pulp, and it binds to mannose and glucose, being capable of inducing T-cell proliferation, and to stimulate the immune response. There are some evidence that the amount of BanLec may vary depending on the maturation stage of the fruit and the cultivar (cv.), which may affect the amount of BanLec and the possible immune response after consumption of banana. Thus, this study aimed to evaluate the amount of BanLec and its hemagglutinating activity in crude extracts of bananas from cultivars Pacovan, Figo, Terra, Mysore and Nanicão, in both unripe and ripe maturation stage, and also fruits which were treated with 1-MCP and low temperature. In addition, in order to access their immunomodulatory effects in vivo, BanLec was purified by affinity chromatography and administered orally to BALB/c mice. The hemagglutinating activity assays indicate higher amount of BanLec in ripe fruit. Moreover, the possible was undetectable in the pulp of banana Figo. The immunological parameters of mice orally fed with BanLec showed that the immunological response is dependent on the amount of protein administrated, in agreement to previous in vitro studies. Besides, 50 µg of BanLec, were able to modulate some cytokines in immune response, causing an effect that seems to be more protective than pathogenic. We conclude that there are important differences in amount of BanLec depending on the cultivar and the maturation stage, and BanLec has a dose-dependent immunomodulatory effect in vivo.

Lectinas são proteínas cuja principal característica é a de se ligar específica e reversivelmente a carboidratos. BanLec é a lectina presente na polpa de bananas, que se liga especificamente a manose e glicose, e é capaz de induzir a proliferação de células T, podendo estimular a resposta imune. Existem indícios de que o teor de BanLec pode variar dependendo do estádio de amadurecimento e do tipo de cultivar, o que pode afetar a quantidade de BanLec existente na fruta quando consumida in natura e a possível resposta imune frente ao consumo de banana. Por este motivo, um dos objetivos desse trabalho foi determinar os teores e a atividade hemaglutinante de BanLec em extratos de farinha de banana verde, além de bananas das cultivares Pacovan, Figo, Terra, Mysore e Nanicão, nos estádios de maturação verde e maduro, e submetidas a tratamento com 1-MCP e baixa temperatura (para cv. Nanicão). Com vista a atender ao objetivo de avaliar seus efeitos imunomoduladores in vivo, a BanLec foi purificada da cultivar Nanicão e administrada por via oral a camundongos BALB/c. Os ensaios de atividade hemaglutinante dos extratos de banana apontaram para maior quantidade de BanLec no fruto maduro, quando comparado ao verde, e ausência dessa proteína na cultivar Figo. Os parâmetros imunológicos analisados após administração de BanLec aos camundongos demonstram que a resposta imune gerada após ingestão de BanLec é dose dependente, além disso, a administração de 50 µg de BanLec aos animais foi capaz de modular citocinas importantes na resposta imunológica, provavelmente causando um efeito que pode ser interpretado como mais protetor do que patogênico. Com base nos resultados obtidos, podemos concluir que existem diferenças nos teores de BanLec dependendo da cultivar e estádio de maturação analisado, sendo que essa proteína não está presente na polpa de todas as variedades de banana e finalmente, que ela tem grande potencial imunomodulador in vivo, uma vez que ativou citocinas de resposta anti-inflamatória. / Lectins are proteins which bind specifically and reversibly to carbohydrates. BanLec is the lectin present in banana pulp, and it binds to mannose and glucose, being capable of inducing T-cell proliferation, and to stimulate the immune response. There are some evidence that the amount of BanLec may vary depending on the maturation stage of the fruit and the cultivar (cv.), which may affect the amount of BanLec and the possible immune response after consumption of banana. Thus, this study aimed to evaluate the amount of BanLec and its hemagglutinating activity in crude extracts of bananas from cultivars Pacovan, Figo, Terra, Mysore and Nanicão, in both unripe and ripe maturation stage, and also fruits which were treated with 1-MCP and low temperature. In addition, in order to access their immunomodulatory effects in vivo, BanLec was purified by affinity chromatography and administered orally to BALB/c mice. The hemagglutinating activity assays indicate higher amount of BanLec in ripe fruit. Moreover, the possible was undetectable in the pulp of banana Figo. The immunological parameters of mice orally fed with BanLec showed that the immunological response is dependent on the amount of protein administrated, in agreement to previous in vitro studies. Besides, 50 µg of BanLec, were able to modulate some cytokines in immune response, causing an effect that seems to be more protective than pathogenic. We conclude that there are important differences in amount of BanLec depending on the cultivar and the maturation stage, and BanLec has a dose-dependent immunomodulatory effect in vivo.