Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-19T18:55:06Z No. of bitstreams: 1 Adilson Santos Andrade de Sousa.pdf: 1247821 bytes, checksum: 9a8380bf13484c105223476f4ae7b8b5 (MD5) / Made available in DSpace on 2018-07-19T18:55:06Z (GMT). No. of bitstreams: 1 Adilson Santos Andrade de Sousa.pdf: 1247821 bytes, checksum: 9a8380bf13484c105223476f4ae7b8b5 (MD5) Previous issue date: 2018-04-29 / Patients with peripheral arterial disease have low levels of physical activity and high cardiovascular risk. Although peripheral arterial disease has a similar prevalence between men and women, studies have shown that the consequences of the disease are extremely different between the sexes. Studies show that women have lower functional capacity and lower levels of physical activity than men. However, the sexes are different from the barriers to the practice of physical activity and cardiovascular health indicators have not yet been studied. Objective: To compare the barriers to the practice of physical activity, cardiovascular function and arterial rigidity among men and women with peripheral arterial disease. Material and Method: this is a descriptive epidemiological study. The study included 267 patients with peripheral arterial disease and symptoms of intermittent claudication divided into two studies, 102 patients in the first study and 167 patients in the second study. The patients were submitted to the evaluation of physical activity level and barriers to the practice of physical activity, as well as cardiovascular health indicators (auscultatory arterial pressure, autonomic cardiovascular modulation, and arterial stiffness). Results: Women had a higher rate of increase by 34% compared to men who presented 29%, women had a rate of increase corrected by 75 beats per minute 31%, men had 25%. Women with peripheral arterial disease had lower levels of physical activity with moderate and vigorous intensity and reported more frequently than the following barriers to physical activity: lack of companionship to practice physical activity, fear of physical activity aggravate the disease, no place to sit when pain is felt and no place to practice physical activity. Conclusion: Regarding the cardiovascular variables, women present higher reflected wave indicators than men, as well as presented more barriers to physical activity compared to men. / Pacientes com doença arterial periférica apresentam baixos níveis de atividade física e elevado risco cardiovascular. Embora a doença arterial periférica tenha prevalência similar entre homens e mulheres, estudos têm mostrado que as consequências da doença são extremamente diferentes entre os sexos. Estudos mostram que as mulheres apresentam menor capacidade funcional e menores níveis de atividade física do que os homens. Porém, o quanto os sexos são diferentes às barreiras para a prática de atividade física e os indicadores de saúde cardiovascular ainda não foram estudados. Objetivo: Comparar as barreiras para a prática de atividade física, função cardiovascular e rigidez arterial entre homens e mulheres com doença arterial periférica. Material e Método: trata-se de um estudo epidemiológico descritivo. Fizeram parte do estudo 267 pacientes com doença arterial periférica e sintomas de claudicação intermitente divididos em dois estudos, no primeiro estudo foram 102 pacientes e no segundo estudo 167 pacientes. Os pacientes foram submetidos à avaliação do nível de atividade física e das barreiras para a prática de atividade física, bem como dos indicadores da saúde cardiovascular (pressão arterial auscultatória, modulação autonômica cardiovascular, e rigidez arterial).Resultados: As mulheres apresentaram maior índice de aumento 34% em comparação aos homens que apresentaram 29%, as mulheres apresentaram um índice de aumento corrigido por 75 batimentos por minuto 31%, os homens apresentaram 25%. As mulheres com doença arterial periférica apresentaram menores níveis de atividade física com intensidade moderada e vigorosa e reportam mais frequentemente que as seguintes barreiras para a prática de atividade físca: falta de companhia para a prática de atividade física, medo da atividade física agravar a doença, não ter lugar para sentar quando sente dor e não ter lugar para a prática de atividade física. Conclusão: Com relação às variáveis cardiovasculares as mulheres apresentam maiores indicadores de onda refletida do que os homens, bem como apresentaram mais barreiras para a prática de atividade física em comparação aos homens.

Popliteal artery entrapment syndrome has been reported to be a rare disease typically found in athletic and otherwise healthy young adults. It manifests as a temporary lower limb pain that occurs in connection with physical exercise. It is caused by an anatomic anomaly, usually anaberrant head of the gastrocnemius muscle that compresses the popliteal artery on the backside of the knee joint. The popliteal artery is the main vessel supplying blood to the lower part of the leg and the condition, if left untreated, can lead to serious complications such as thrombosis or aneurysm. If detected in time and surgically corrected patients can expect full recovery within weeks.The purpose of this study was to examine a group of healthy asymptomatic individuals (n=50)using ultrasound and a series of provocation to see if there was a possibility of entrapment. A secondary objective was to find which maneuvers during the ultrasound would provide the best results. They were subjected to ultrasound examinations at rest, during plantar flexion without resistance, against a light resistance and against substantial resistance.The results showed that most of the test subjects could temporarily constrict blood flow greatly although ultrasound imagery alone was not enough to confirm diagnosis. It seems that detected occlusion of the artery in conjunction with other diagnostic data such as AnkleBrachial Index and symptomatology can be useful both in confirming or ruling out PAESwithout the use of more expensive and invasive methods.

No / Objectives It is hypothesised that endothelial cell reactive antibodies (ECRA) play a role in the progression of PAD through activation of endothelial cells and the release of inflammatory cytokines. We aimed to test this hypothesis by assessing levels of ECRA, E-selectin and IL-6 in patients with PAD of varying severity in a case controlled study. Design, materials, methods Patients were assessed clinically and with ankle¿brachial pressure indices. Patients with critical ischaemia (CI, n=30), stable claudicants (SC, n=30), and age-matched controls (AMC, n=20) were studied. Antibody, E-selectin and IL-6 levels were measured using ELISA. Results ECRA levels were significantly raised in the CI group over AMC. IL-6 levels were significantly elevated in both SC and CI over the control group and in CI over SC. There were no significant differences in E-selectin levels between the AMC, SC and CI. Conclusion Our findings support the hypothesis that autoantibodies play a role in promoting PAD by elevating IL-6. The absence of an elevation in E-selectin in this study may be due to its short half-life, and casts doubt on its value as a marker of inflammation in atherosclerosis.

No description available.

No description available.

Le diabète est une maladie grave et très fréquente. Elle est responsable de complications macrovasculaires dont l’artérite des membres inférieurs et microvasculaires dont les neuropathies périphériques. Desert hedgehog (Dhh) est l’un des trois membres de la famille hedgehog (Hh); cette protéine est notamment exprimée par les nerfs périphériques dont elle permet l’organisation structurale. Les membres de la famille Hh sont en outre impliqués dans la régulation de la physiologie des vaisseaux sanguins. Du fait de la diminution de l’expression de Dhh dans des conditions pathologiques comme le diabète, l’objectif de cette thèse a été de comprendre le rôle de cette protéine dans la physiopathologie des complications vasculaires associées au diabète. Nous avons montré d’une part que le défaut de Dhh altère la survie des nerfs en condition ischémique et ainsi entraîne un défaut de production par le nerf des facteurs pro-angiogéniques nécessaire à la réparation musculaire. D’autre part nous avons mis en évidence que le défaut d’expression de Dhh dans le nerf diabétique est responsable de la perte de l’intégrité de la barrière nerf-vaisseau et en conséquence de la neuropathie diabétique. Dhh apparait donc comme un nouvel acteur important du cross-talk nerf-vaisseau. La compréhension de sa fonction et de sa signalisation en font un candidat intéressant pour le développement de nouvelles stratégies thérapeutiques (thérapie génique Dhh, agonistes de la voie Hh) dans le traitement des complications du diabète. / Diabetes is a serious and frequent illness. It is responsible for macrovascular complications such as peripheral arterial disease and microvascular complications such as peripheral neuropathy. Desert Hedgehog (Dhh) is one of the three hedgehog (Hh) family members; this protein is expressed by Schwann cells of peripheral nerves and is necessary to orchestrate the organisation of nerve sheaths (i.e. Epi-, Peri-, and Endoneurium) by signaling to perineurial cells. Moreover, the Hh family members are also known to regulate blood vessel physiology. Because we found that Dhh is downregulated in pathological conditions such as diabetes, the purpose of this PhD thesis is to understand the contribution of Dhh in diabetes-associated vascular complications. We have shown that Dhh deficiency impairs peripheral nerve survival in the ischemic muscle and, by doing so, decreases the pool of nerve-derived proangiogenic factors. Then we have found that Dhh knockdown in peripheral nerves is responsible for blood nerve barrier breakdown and consequently diabetic neuropathy. Dhh appears as a new actor that plays a crucial role in nerve-vessel cross-talk. The understanding of Dhh function and signaling makes it an interesting candidate for the development of new therapeutic strategies (gene therapy, Hh agonists) in the setting of diabetic complications.

INTRODUÇÃO: Pré-condicionamento isquêmico remoto (PCIR) é o fenômeno pelo qual curtos períodos de isquemia sub-letal sobre um órgão ou tecido, intercalados com reperfusão do mesmo, conferem a outros órgãos ou tecidos distantes deste, um aumento na capacidade da resistir a episódios subsequentes de isquemia, a qual os mesmos possam ser expostos. Com base nesse fato, testamos a hipótese de que o pré-condicionamento isquêmico remoto em pacientes portadores de claudicação intermitente de membros inferiores poderia aumentar a capacidade de deambulação desses pacientes, extrapolando o conceito do PCIR de aumento da capacidade de preservação da integridade celular frente à isquemia, para a manutenção da função celular, tornando a célula mais apta ao trabalho em situações de privação de oxigênio, geradas pela restrição do fluxo sanguíneo, como ocorre nos pacientes com claudicação intermitente de membros inferiores, durante o exercício. OBJETIVOS: Avaliar se o PCIR aumenta a distância de início de claudicação e/ou a distância total de claudicação em pacientes com doença arterial obstrutiva periférica. MÉTODOS: Foram estudados 52 pacientes ambulatoriais que apresentavam queixa de claudicação intermitente dos membros inferiores, associada a um pulso arterial ausente ou reduzido no membro sintomático e/ou um índice tornozelo-braço <0,90. Estes pacientes foram randomizados em três grupos (A, B e C). Todos os pacientes foram submetidos a dois testes de caminhada em esteira de acordo com o protocolo de Gardner. O grupo A fez o primeiro teste de esteira sem o pré-condicionamento isquêmico remoto e, após 7 dias, foi submetido a um novo teste de esteira, agora precedido pelo pré-condicionamento isquêmico remoto. O grupo B foi submetido ao pré-condicionamento isquêmico remoto antes do primeiro teste de esteira e, após 7 dias, realizou novo teste de esteira, agora sem o pré-condicionamento isquêmico remoto. Já no Grupo C (grupo controle), ambos os testes de esteira foram realizados sem pré-condicionamento isquêmico remoto, também com 7 dias de intervalo. RESULTADOS: Os grupos A e C mostraram um aumento na distância de início de claudicação, no segundo teste, em comparação com o primeiro teste. O grupo A teve um aumento estatisticamente significativo, em relação ao grupo C (grupo controle). Com relação à distância total de claudicação, todos os grupos (A, B e C), mostraram um aumento estatisticamente significativo a favor do segundo teste, porém não foi observada diferença entre os grupos (A, B e C). CONCLUSÕES: O pré-condicionamento isquêmico remoto aumentou a distância inicial de claudicação em pacientes com claudicação intermitente, no entanto, ele não afetou a distância total de claudicação dos pacientes portadores de claudicação intermitente de membros inferiores / INTRODUCTION: Remote ischemic preconditioning (RIPC) is a phenomenon in which a short period of sub-lethal ischemia in one organ protects against subsequent bouts of ischemia in another organ. Extrapolating the RIPC concept of increasing the preservation of cell integrity capability against ischemia, for the maintenance of cellular function, making the cell more able to work in oxygen deprivation generated by the restriction of blood flow, as occurs in patients with intermittent claudication of the lower limbs during exercise, we hypothesized that RIPC in patients with intermittent claudication would increase muscle tissue resistance to ischemia, thereby resulting in an increased ability to walk. OBJECTIVES: To test this hypothesis, we performed gait tests in patients with claudication with and without prior RIPC and then compared the initial claudication distance (ICD) and the total walking distance (TWD). METHODS: In a claudication clinic, 52 ambulatory patients who presented with complaints of intermittent claudication in the lower limbs associated with an absent or reduced arterial pulse in the symptomatic limb and/or an ankle-brachial index < 0.90 were recruited for this study. The patients were randomly divided into three groups (A, B and C). All of the patients underwent two tests on a treadmill according to the Gardener protocol. Group A was tested first without RIPC. Group A was subjected to RIPC prior to the second treadmill test. Group B was subjected to RIPC prior to the first treadmill test and then was subjected to a treadmill test without RIPC. In Group C (control group), both treadmill tests were performed without RIPC. The first and second tests were conducted seven days apart. Brazilian Clinical Trials: RBR-7TF6TM. RESULTS: Group A and C showed an increase in the initial claudication distance in the second test compared to the first test. Group A had a statistically significant increase, compared with C group (control group). With respect to total claudication distance, all the groups (A, B and C) showed a statistically significant increase in favor of the second test, but there was no difference between groups (A, B and C). CONCLUSIONS: RIPC increased the initial claudication distance in patients with intermittent claudication; however, RIPC did not affect the total walking distance of the patients

INTRODUÇÃO: A Doença Arterial Periférica dos membros inferiores (DAP) é um acometimento relacionado à obstrução arterial desses membros, causada pela doença aterosclerótica, uma doença sistêmica. Por essa razão, a DAP costuma associar-se ao aumento da espessura íntima-média (EIM) carotídea e ao prejuízo cognitivo. No entanto, não se sabe qual o papel da EIM no prejuízo cognitivo observado na DAP. OBJETIVOS: Avaliar as funções cognitivas de pacientes com DAP, associá-las ao grau de prejuízo da circulação periférica e avaliar o papel da EIM nessa associação. CASUÍSTICA E MÉTODO: Foram selecionados 26 pacientes com DAP (68,57+8,34 anos; 65,4% do sexo masculino) e 40 indivíduos-controle (67,17+8,24 anos; 62,5% do sexo masculino). Todos participantes foram submetidos a uma avaliação sócio-demográfica, que coletou dados de caracterização do indivíduo e antecedentes clínicos; a uma investigação clínica, composta pela avaliação do índice tornozelo-braquial (ITB), pela medida da espessura íntima-média (EIM) carotídea, e pelo teste de caminhada de seis minutos (TC6\'); e a uma avaliação neuropsicológica, que consistiu nos seguintes instrumentos: Vocabulário (WAIS-III), Cubos (WAIS-III), Dígitos (WAIS-III), Wisconsin Card Sorting Test (WCST), Stroop Color Word Test (SCWT), FAS (COWAT), Animais (COWAT), Teste do Desenho do Relógio e Mini-Mental State Examination (MMSE). RESULTADOS: O grupo DAP apresentou pior desempenho na memória verbal tardia, na amplitude da atenção, na memória operacional, na atenção, no grau de abstração, na flexibilidade mental, na velocidade de processamento da informação, no controle inibitório/impulsividade, no vocabulário, na fluência verbal fonêmica, na fluência verbal semântica, na praxia construtiva e na função cognitiva global em relação ao grupo controle. Após ajuste para escolaridade, nível sócio-econômico, QI e sintomas psiquiátricos, o desempenho do grupo DAP se manteve pior na flexibilidade mental e na fluência verbal fonêmica. O grau de prejuízo da circulação periférica, avaliado pelo ITB, apresentou associação com a memória visual tardia, com a memória operacional, com a atenção, com o grau de abstração, com a velocidade de processamento da informação, com o controle inibitório/impulsividade, com o vocabulário, com a fluência verbal fonêmica e com a função cognitiva global. Após ajuste para escolaridade, nível sócio-econômico, QI e sintomas psiquiátricos, o ITB manteve associação com a fluência verbal fonêmica. Após ajuste para EIM, o ITB manteve associação com o vocabulário. CONCLUSÃO: O grupo de pacientes com DAP apresentou desempenho cognitivo prejudicado, quando comparado ao grupo controle, independente de escolaridade, nível sócio-econômico, QI e sintomas psiquiátricos. O grau de prejuízo da circulação periférica associou-se ao desempenho cognitivo, mas a EIM carotídea pareceu exercer um papel importante nessa associação / BACKGROUND: Peripheral arterial disease of the lower limbs (PAD) is related to arterial obstruction of these limbs, caused by atherosclerosis, a systemic disease. Therefore, PAD is usually associated with increased carotid intima-media thickness (IMT) and cognitive impairment. However, the role of IMT in cognitive impairment observed in PAD is unknown. OBJECTIVES: To evaluate the cognitive functions of patients with PAD, to associate them with the degree of impairment of peripheral circulation and to evaluate the role of IMT in this association. METHODS: 26 patients with PAD (68.57+8.34 years, 65.4% male) and 40 control subjects (67.17+8.24 years, 62.5 % male) were selected. All participants underwent a socio-demographic assessment, which collected data on individual\'s characteristics and medical history; a clinical investigation, consisting of the evaluation of the ankle-brachial index (ABI), the measurement of carotid intima-media thickness (IMT) and the six-minute walk test (6MWT); and a neuropsychological evaluation, which consisted of the following instruments: Vocabulary (WAIS - III), Block Design (WAIS - III), Digit Span (WAIS - III), Wisconsin Card Sorting Test (WCST), Stroop Color Word Test (SCWT) , FAS (COWAT) Animals (COWAT) , Clock Drawing Test and Mini - Mental State Examination (MMSE). RESULTS: The PAD group scored worse on delayed verbal memory, attention span, working memory, attention, degree of abstraction, mental flexibility, information processing speed, inhibitory control/impulsivity, vocabulary, phonemic verbal fluency, semantic verbal fluency, constructive praxis and global cognitive function compared to the control group. After adjustment for education, socioeconomic status, IQ and psychiatric symptoms, the performance of the PAD group remained worse in mental flexibility and phonemic verbal fluency. The degree of impairment of peripheral circulation, assessed by ABI, was associated with delayed visual memory, with working memory, with attention, with degree of abstraction, with information processing speed, with the inhibitory control/impulsivity, with vocabulary, with phonemic verbal fluency, and with global cognitive function. After adjustment for education, socioeconomic status, IQ and psychiatric symptoms, ABI remained associated with phonemic verbal fluency. After adjustment for IMT, ABI remained associated with the vocabulary. CONCLUSION: The group of patients with PAD showed impaired cognitive performance, when compared to the control group, regardless of education, socioeconomic status, IQ and psychiatric symptoms. The degree of impairment of peripheral circulation was associated with cognitive performance, but carotid IMT appeared to play an important role in this association

Die Thrombozytenaktivierung ist von zentraler Bedeutung für die Pathogenese der Arteriosklerose und wird bei Patienten mit instabiler Angina pectoris, Myokardinfarkt und TIA sowie nach koronarangioplastischen und operativen Eingriffen als Verursacher okklusiver vaskulärer Ereignisse in Betracht gezogen. Wir gingen der Frage nach, ob ein Zusammenhang zwischen peripherer arterieller Verschlußkrankheit (PAVK) und der Aktivierung zirkulierender Thrombozyten besteht und ob die intraarterielle digitale Subtraktionsangiographie (DSA) sowie die perkutane transluminale Angioplastie (PTA) im Bereich der unteren Extremitäten die Aktivierung zirkulierender Plättchen beeinflussen. Unsere Studie schloß 16 Kontrollprobanden mit PAVK, 25 gesunde Kontrollprobanden und 36 Patienten ein, von denen 14 einer DSA, 12 einer PTA und 10 beiden Eingriffen unterzogen wurden. Wir entnahmen Blutproben aus einer peripheren Vene oder aus Einführungsbestecken in der Arteria und Vena femoralis vor, direkt nach und 4 h nach den Interventionen. Die Plättchenaktivierung wurde anhand durchflußzytometrischer Messungen der Expression aktivierungsspezifischer Antigene (CD62 und CD63) bestimmt, die Sensibilität der Thrombozyten analysierten wir mittels einer zusätzlichen in-vitro-Aktivierung. Wir beobachteten 4 h nach der DSA einen Abfall der Aktivierung und eine erhöhte Sensibilität von Plättchen im arteriellen und venösen Strombereich (p < 0,02). Wir sehen diese Wirkungen als Kontrastmittel(KM)-induziert an und führen die Abnahme der Relativzahl aktivierter Thrombozyten hauptsächlich auf ihre verkürzte Lebensdauer zurück. 4 h nach der PTA kam es arteriell und venös zu einem Abfall der Relativzahl aktivierter Thrombozyten (p < 0,02). Weiterhin beobachteten wir unmittelbar nach der PTA eine Verringerung des prozentualen Anteils aktivierter Plättchen in der arteriellen Zirkulation (p = 0,021) in Korrelation mit zunehmenden Dilatationszeiten und Ballonlängen (p < 0,03). Diese Beobachtungen führen wir auf eine geringe Anlagerung bzw. reduzierte Lebensdauer aktivierter Thrombozyten zurück. Von geringer quantitativer Bedeutung waren Einflüsse des Heparins und KM. Die Wirkung der DSA und PTA auf die Thrombozytenfunktionen schien sich in den 4 postinterventionellen Stunden abzuschwächen. Unsere Ergebnisse zeigen, daß die Angioplastie in peripheren Gefäßen eine Aktivierung und vermutlich geringe Anlagerung bzw. verkürzte Lebensdauer zirkulierender Plättchen unmittelbar nach der PTA und 4 Stunden später verursacht. Diese Prozesse führen wir in erster Linie auf Endothelläsionen als Folge der Dilatation zurück. Die DSA führt 4 h nach dem Eingriff zu einer Aktivierung, Sensibilisierung und in wahrscheinlich sehr geringem Umfang zu einer Anlagerung bzw. verringerten Lebensdauer der Plättchen. PAVK-Patienten im Stadium II nach Fontaine mit kardiovaskulären Risikofaktoren wiesen im Vergleich zu gesunden Probanden eine höhere Relativzahl aktivierter und sensibilisierter Plättchen auf (p = 0,0001). Deshalb vermuten wir, daß präinterventionell aktivierte Plättchen besonders in die Prozesse Aktivierung, Sensibilisierung und Anlagerung involviert bzw. von einer verkürzten Lebensdauer betroffen sind. / Platelet activation plays a crucial role in the pathogenesis of artherosclerosis. Circulating activated platelets are thought to trigger thrombotic events in patients with instable angina pectoris, myocardial infarction and transient ischaemic attacks as well as after coronary angioplasty and surgery. We studied the effect of peripheral arterial disease (PAD) on activation of circulating thrombocytes and evaluated the influence on platelet activation of intraarterial digital subtraction angiography (DSA) and percutaneous transluminal angioplasty (PTA) in the area of the lower extremities. Our study included sixteen control subjects with PAD, twenty-five healthy control subjects and thirty-six patients, fourteen of whom were undergoing DSA, twelve were undergoing PTA and ten we examined during both interventions. Blood samples were obtained from a peripheral vein or from the arterial and venous catheter introducer before and directly and four ours after the procedures. To characterize platelet activation, the expression of activation-dependent platelet antigens (CD62 and CD63) was measured using flow cytometry. Platelet sensibility was analysed by an additional in-vitro-activation. Four hours after DSA, we observed a decrease in activation and an increase in sensibility of thrombocytes in both arterial and venous circulation (p < 0.02), most likely due the contrast medium (CM). We assume, that the relative decrease of platelet activation is caused by a reduced life-time. The relative number of activated thrombocytes decreased in both arterial and venous circulation (p < 0.02) four hours after PTA. Furthermore, we observed reduced amounts of activated platelets in the arterial circulation (p = 0.021) immediately after PTA, in correlation with increased times of dilatation and larger ballon-catheters (p < 0.03). This could be explained by slight migration or shortened life-time of activated thrombocytes. The amount of CM and heparin did not have a pronounced effect. The influence of both interventions on the platelet features and functions seemed to attenuate in the four postinterventional hours. Our results show that angioplasty in peripheral vessels causes activation and presumably slight migration or reduced life-time of circulating thrombocytes immediately and four hours after PTA. We postulate that this is mainly induced by dilatation. DSA was also found to be associated with platelet activation, sensibilisation and presumptive minor migration or shortened life-time of circulating platelets. More activated and sensitized thrombocytes circulated in patients with PAD (clinical stage II according to Fontaine) with cardiovascular risk-factors compared to healthy control subjects (p = 0.001). This supports our assumption that preactivated platelets are particularly involved in activation, sensitizing and migration processes or affected by a reduced life-time.

Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2017-12-04T16:02:45Z No. of bitstreams: 1 Simone Bonatto_.pdf: 2268264 bytes, checksum: dcd646cb8a64927b37f97cc69f407e26 (MD5) / Made available in DSpace on 2017-12-04T16:02:46Z (GMT). No. of bitstreams: 1 Simone Bonatto_.pdf: 2268264 bytes, checksum: dcd646cb8a64927b37f97cc69f407e26 (MD5) Previous issue date: 2017-09-25 / Nenhuma / A vitamina D exerce papel fundamental no metabolismo ósseo, além de participar de diferentes funções no organismo, entre elas no sistema cardiovascular. Baixos níveis séricos desta vitamina podem predizer a ocorrência de doença arterial obstrutiva periférica (DAOP), uma doença cardiovascular provocada pela presença de lesões ateroscleróticas nos vasos sanguíneos. Avaliar os níveis séricos de vitamina D e sua relação com a DAOP em usuários de um ambulatório para doenças vasculares no sul do Brasil. Estudo transversal, com amostra consecutiva de 144 indivíduos, de ambos os sexos, ≥ 40 anos, de março/2016 a janeiro/2017. Foram considerados com DAOP pacientes com índice tornozelo braquial ≤ 0,90 ou com revascularização arterial. Variáveis demográficas, socioeconômicas, comportamentais e comorbidades foram obtidas por meio de questionário padronizado. O nível sérico de vitamina D foi determinado bioquimicamente e classificado em: suficiente (≥30 ng/mL), insuficiente (>20 a 29 ng/mL) e deficiente (<20 ng/mL). Na investigação dos fatores associados ao nível sério de vitamina D, as análises foram estratificadas por sexo. Na análise bivariada utilizou-se o teste do qui-quadrado de Pearson para as variáveis categóricas, o teste U de Mann-Whitney para as variáveis numéricas assimétricas e o teste t para as variáveis numéricas simétricas. A regressão linear múltipla foi utilizada para avaliar a relação entre as variáveis independentes e o nível sérico de vitamina D e a regressão de Poisson para analisar a associação entre os níveis séricos desta vitamina e a ocorrência de DAOP. Os participantes apresentaram 36,1% (IC95% 28-44) de insuficiência e 45,1% (IC95% 36-53) de deficiência de vitamina D. A idade associou-se inversamente com nível sérico de vitamina D (β = -0,22; IC95% -0,38; -0,07), enquanto as variáveis exposição solar (β = 0,49; IC95% 0,13; 0,84) e consumo de vitamina D (β = 2,92; IC95% 0,84; 5,00) mostraram-se positivamente associadas. Na amostra estratificada por sexo, foi demonstrado um efeito independente e inverso da idade e direto da exposição solar ainda que limítrofe, sobre os níveis séricos de vitamina D nos homens e, um efeito independente e direto do consumo de vitamina D nos níveis séricos desta vitamina nas mulheres. A prevalência de DAOP foi de 50,7% (IC95% 42-59). As RP ajustadas para DAOP foram 1,08 (IC95% 0,66-1,76) para nível sérico insuficiente e 1,57 (IC95% 0,96-2,57) para o nível sérico deficiente de vitamina D; (p para tendência = 0,020). O presente estudo encontrou alta prevalência de insuficiência e deficiência de vitamina D na população estudada. As variáveis associadas com a vitamina D foram idade e exposição solar entre os homens e consumo de vitamina D entre as mulheres. O nível sérico de vitamina D mostrou uma relação dose resposta inversa e significativa com DAOP. Considerando a elevada prevalência de baixos níveis séricos de vitamina D e as diferentes funções exercidas por esta vitamina no organismo, incluindo o seu efeito na DAOP, é importante orientar a população para uma exposição solar e consumo de alimentos fontes de vitamina D adequados. / Vitamin D plays a key role in bone metabolism, besides taking part in many body functions, for instance in the cardiovascular system. Low serum levels of this vitamin can predict the onset of peripheral arterial disease (PAD), a cardiovascular disease caused by atherosclerotic lesions in blood vessels. Evaluate vitamin D serum levels and their relation with PAD among users of a vascular disease outpatient clinic in Southern Brazil. Cross-sectional study with a consecutive sample of 144 individuals of both sexes, aged at least (≥) 40 years, between March 2016 and January 2017. We considered PAD patients those with ankle-brachial index (ABI) ≤ 0.90 or with arterial revascularization. Demographic, socioeconomic, and behavioral variables and comorbidities were obtained through standardized survey. Vitamin D serum level was biochemically assessed and rated as sufficient (≥30 ng/mL), insufficient (>20 a 29 ng/mL) and deficient (<20 ng/mL). A gender layered analysis was performed in the research of vitamin D serum level associated factors. Pearson's chi-square test was used for the bivariate analysis, Mann–Whitney U test for categorical variables, and T test for symmetries on numerical variables. Multiple linear regression was used to evaluate the relation between independent variables and vitamin D serum level and Poisson regression to analyze the association between this vitamin's serum levels and PAD. The participants presented 36.1% (CI95% 28-44) vit D insufficiency and 45.1% (CI95% 36-53) vit D deficiency. Age was inversely associated with vitamin D serum level (β = -0.22; CI95% -0.38; -0.07), while variables like sun exposure (β = 0.49; CI95% 0.13; 0.84) and vitamin D intake (β = 2.92; CI95% 0.84; 5.00) were positively associated. In a gender layered sample, an independent and inverse effect was demonstrated on age, a direct effect – although bordering – on sun exposure on vitamin D serum levels among men, and an independent and direct effect of vitamin D intake on women serum levels of this vitamin. PAD prevalence was 50.7% (CI95% 42-59). After adjustment for PAD, PRs were 1.08 (CI95% 0.66-1.76) for insufficient serum level and 1.57 (CI95% 0.96-2.57) for deficient vitamin D serum level; (p for trend = 0.020). The present study found a high prevalence of vitamin D deficiency among the studied population. The vitamin D associated variables were age and sun exposure among men and vitamin D intake among women. Vitamin D serum level showed an inverse and significant dose-response relationship with PAD. Considering the high prevalence of lower vitamin D serum levels and the different body functions performed by this vitamin, including its effect on PAD, it is important to guide the population towards sun exposure and vitamin D rich food intake adequate.