Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-01-04T22:02:35Z No. of bitstreams: 1 LeonardoCapistranoFerreira_TESE.pdf: 3396619 bytes, checksum: bffb880b6907328ac1ce5051faaf28fd (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-01-07T21:08:47Z (GMT) No. of bitstreams: 1 LeonardoCapistranoFerreira_TESE.pdf: 3396619 bytes, checksum: bffb880b6907328ac1ce5051faaf28fd (MD5) / Made available in DSpace on 2016-01-07T21:08:47Z (GMT). No. of bitstreams: 1 LeonardoCapistranoFerreira_TESE.pdf: 3396619 bytes, checksum: bffb880b6907328ac1ce5051faaf28fd (MD5) Previous issue date: 2014-10-06 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / O desenvolvimento de doen?as complexas, como a pr?-ecl?mpsia, ? determinado por fatores ambientais e gen?ticos, al?m da poss?vel intera??o entre esses fatores. As doen?as hipertensivas da gravidez (DHGs) apresentam um amplo espectro cl?nico, que pode variar desde pr?-ecl?mpsia leve (hipertens?o e proteinuria) at? formas mais graves, como a ecl?mpsia (convuls?es) e s?ndrome HELLP (hem?lise, eleva??o das enzimas hep?ticas e plaquetopenia). O espectro cl?nico parece estar ligado a diferentes mecanismos patol?gicos. Este trabalho tem como objetivo identificar fatores (gen?ticos e ambientais) envolvidos no desenvolvimento das DHGs. Usando uma abordagem caso-controle, selecionamos um total de 1498 mulheres para os estudos epidemiol?gico e gen?tico, abrangendo 755 gr?vidas normotensas (controle); 518 pr?-ecl?mpsia; 84 eclampsia e 141 HELLP. As mulheres foram genotipados para 18 marcadores distribu?dos em cinco genes candidatos (FLT1, ACVR2A, ERAP1, ERAP2 e LNPEP). Como resultado das an?lises dos fatores ambientais, encontramos idade materna, paridade e o ?ndice de massa corporal pr?-gestacional como importantes fatores de risco associados ?s DHGs. As an?lises gen?ticas mostraram que os genes est?o associados de maneira fen?tipo-espec?fica: ACVR2A com pr?-ecl?mpsia precoce (rs1424954, p=0,002); FLT1 com s?ndrome HELLP (rs9513095, p=0,003), e ERAP1 com ecl?mpsia (rs30187, p=0,03). Nossos resultados sugerem que diferentes mecanismos gen?ticos, juntamente com fatores ambientais espec?ficos, contribuem na determina??o do espectro cl?nico das DHGs. Al?m disso, o refinamento fenot?pico parece ser um passo essencial na busca por genes de doen?as complexas / The development of complex diseases such as preeclampsia are determined by both environmental and genetic factors, but there is also interaction among these factors. Preeclampsia is a pregnancy-specific disorder characterized by de-novo hypertension and proteinuria after 20th week of gestation. There is a broad spectrum of clinical presentations related to hypertensive disorders of pregnancy (HDP) that can range from mild preeclampsia to eclampsia (seizures) or HELLP syndrome (Hemolysis, Elevation of Liver enzymes, Low Platelets). Those clinical outcomes might be linked to different pathological mechanisms. Our work aims to identify factors (i.e. genes and environmental) associated with the HDP?s clinical spectrum. Using a case-control approach, we selected a total of 1498 pregnant women for epidemiological and genetic studies, encompassing 755 normotensive (control); 518 preeclampsia; 84 eclampsia; and 141 HELLP. Women were genotyped for 18 SNPs across 5 candidate genes (FLT1, ACVR2A, ERAP1, ERAP2 and LNPEP). For the environmental factors, we found maternal age, parity status and pre-gestational body mass index as important risk factors associated with disease. Genes were associated in a phenotype-specific manner: ACVR2A with early preeclampsia (rs1424954, p=0.002); FLT1 with HELLP syndrome (rs9513095, p=0.003); and ERAP1 with eclampsia (rs30187, p=0.03). Our results suggest that different genetic mechanisms along with specific environmental factors might determine the clinical spectrum of HDP. In addition, phenotype refinement seems to be an essential step in the search for complex disease genes

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS (tede2@pucrs.br) on 2015-07-07T12:46:56Z No. of bitstreams: 1 471709 - Texto Completo.pdf: 1964920 bytes, checksum: 322c3402ce4feed16d4833fcbeb64c63 (MD5) / Made available in DSpace on 2015-07-07T12:46:56Z (GMT). No. of bitstreams: 1 471709 - Texto Completo.pdf: 1964920 bytes, checksum: 322c3402ce4feed16d4833fcbeb64c63 (MD5) Previous issue date: 2015-03-24 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / Objective : To develop a meta-analysis on ultrasonographic methods for preecalmpsia prediction.Methods : The databases MEDLINE, EMBASE, LILACS and SCIELO were searched for selecting studies and data extraction. We assessed study validity by QUADAS II. The statistical analysis was performed using summary operating point for qualitative variables and using summary ROC curves for quantitative variables.Results : In the gestation?s first trimester, ultrasound methods are not applicable for preeclampsia prediction due to low sensitivity. In the second trimester there are three feasible tests. For early preeclampsia prediction (birth < 34 weeks) the uterine arteries mean pulsatility index above 95th centile plus bilateral notching have a low negative likelihood ratio (0.28) and high sensitivity (89%). For preeclampsia prediction at any time of gestation, resistance index may be used. Mean resistance index > 0.58 is applicable for high risk pregnant women with an AUC of 0.804. For pregnant women without risk for preeclampsia, the specificity of the bilateral resitance index > 0.70 was 97%.Conclusion : In the first trimester ultrasound methods can not be used to predict preeclampsia. During the second trimester, the mean pulsatility index above 95th centile has the best predictive power. This test is applicable for low risk patients to predict preeclampsia below 34 weeks. The mean resistance index > 0.58, with sensitivity and specificity around 74%, to predict preeclampsia at any time of gestation in high risk patients, can also be used. For low risk patients and preeclampsia prediction at any time of gestation , all tests had low sensitivities. / Objetivo : Realizar uma metan?lise para testar a acur?cia dos m?todos ultrassonogr?ficos para predi??o de pr?-ecl?mpsia.M?todos : Foi efteuada pesquisa nas bases de dados MEDLINE, EMBASE, LILACS e CIELO, onde os estudos foram selecionados. A validade dos estudos foi acessada pela ferramenta QUADAS II. A an?lise estat?stica foi feita utilizando summary operating point para vari?veis qualitativas e summary ROC curve para vari?veis quantitativas.Resultados : No primeiro trimestre da gesta??o, os m?todos ultrassonogr?ficos n?o t?m aplicabilidade para predi??o de pr?-ecl?mpsia devido ? sua baixa sensibilidade. No segundo trimestre, encontramos tr?s testes que podem ser utilizados. Para predi??o de pr?-ecl?mpsia precoce (que culmina com nascimento abaixo das 34 semanas) o ?ndice de Pulsatilidade m?dio das art?rias uterinas acima do percentil 95 associado ? incisura protodiast?lica bilateral teve uma baixa raz?o de verossimilhan?a negativa (0,28) e uma alta sensibilidade (89%). Para predi??o de pr?-ecl?mpsia a qualquer momento da gravidez, o ?ndice de resist?ncia pode ser usado. ?ndice de Resist?ncia m?dio > 0,58 ? aplic?vel para pacientes de alto risco, tendo uma ?rea abaixo da curva de 0,804. Para gr?vidas de baixo risco de pr?-ecl?mpsia, a especificidade do ?ndice de Resist?ncia bilateral > 0,70 foi de 97%.Conclus?o : No primeiro trimestre n?o encontramos bons resultados com m?todos ultrassonogr?ficos para predi??o de pr?-ecl?mpsia. No segundo trimestre o ?ndice de pulsatilidade m?dio acima do percentil 95 teve o melhor poder preditivo. Este teste ? aplic?vel para pacientes de baixo risco e para predizer pr?-ecl?mpsia abaixo de 34 semanas. Podemos utilizar tamb?m o ?ndice de Resist?ncia maior que 0,58, com sensibilidade e especificidade pr?ximas as 74%, para predizer pr?-ecl?mpsia em pacientes de alto risco, com a doen?a ocorrendo em qualquer momento da gravidez. Para pacientes de baixo risco e predi??o de pr?-ecl?mpsia a qualquer momento da gesta??o os testes t?m baixa sensibilidades.

Made available in DSpace on 2015-04-14T13:32:51Z (GMT). No. of bitstreams: 1 433664.pdf: 556146 bytes, checksum: f1547b214dce555fdf116d5fa8243c45 (MD5) Previous issue date: 2011-08-29 / Objetivo: Avaliar as medidas do timo fetal atrav?s da ultrassonografia 24 e 48 horas ap?s o uso de Betametasona para matura??o pulmonar em gesta??es entre 24 e 34 semanas. M?todos: estudo prospectivo com 25 gestantes que receberam Betametasona intramuscular para matura??o pulmonar fetal antes de 34 semanas de gesta??o. As medidas do per?metro e do di?metro do timo foram realizadas antes, 24 e 48 horas ap?s o uso do corticoide. Resultados: o di?metro e o per?metro do timo diminu?ram ap?s 24 e 48 horas da administra??o de Betametasona. As m?dias do di?metro foram 25,5 ? 3,7; 21, 7 ? 3,6 e 20,2 ? 5,5 mm e do per?metro foram 89,8 ? 9,5; 78,6 ? 8,6 e 76,6 ? 15,0 mm para 0, 24h e 48 h, respectivamente (P < 0.001). Conclus?o: O uso de Betametasona para matura??o pulmonar fetal pode estar associada com a diminui??o do di?metro e do per?metro do timo fetal. Este fato pode aumentar falsamente o n?mero de fetos com timos considerados abaixo do percentil 5, caso a medida seja realizada ap?s o uso de corticoide

Made available in DSpace on 2015-04-14T13:35:35Z (GMT). No. of bitstreams: 1 443353.pdf: 1896369 bytes, checksum: 19ecf303e539b93de8c9bda585ba0ebd (MD5) Previous issue date: 2012-08-28 / Objective: To estimate RANTES levels at maternal plasma, umbilical cord blood plasma and placenta in preeclampsia syndrome and normal pregnancy. Methods: A cross-sectional study was conducted to estimate RANTES levels in maternal plasma, placenta and cord blood plasma in preeclampsia syndrome (n=33) compared to a control group of women with normal pregnancy (n=36) attended at S?o Lucas Hospital/PUCRS, Porto Alegre, RS Brazil. Concentrations of RANTES were measured using a human RANTES ELISA assay. Results: Women with preeclampsia syndrome showed significantly higher RANTES levels in plasma and placenta in comparison to women with normal pregnancy (P<0.01). The cord blood plasma of infants born from women with preeclampsia syndrome had a significantly decreased RANTES levels compared to infants born from a normal pregnancy (P<0.01). The concentration of placental RANTES was positively correlated with RANTES in the maternal plasma (Pearson?s correlation r= 0.697; p<0.001), and negatively with the cord blood plasma (r= -0.818; p<0.001). A strong negative correlation was also demonstrated between maternal plasma and cord blood plasma RANTES (r= -0.751, p<0.001). Conclusion: This study shows a distinct inflammatory response between mother and new born in preeclampsia syndrome and normal pregnancy. In preeclampsia syndrome maternal plasma and placenta displayed increased pro-inflammatory RANTES cytokine concentration, however a reduced levels were detected in the umbilical cord plasma from women with preeclampsia syndrome, suggesting a fetal antiflammatory response. / Objetivo: O objetivo deste trabalho foi estimar os n?veis de RANTES na placenta e nos plasmas materno e do cord?o umbilical na s?ndrome de pr?-ecl?mpsia e gesta??o normal. M?todos: Estudo transversal e observacional estimou os n?veis de RANTES na placenta e nos plasmas materno e do cord?o umbilical na s?ndrome de pr?-ecl?mpsia (n=33) comparando com um grupo controle de gestantes normais (n=36) atendidas no Hospital S?o Lucas/PUCRS, Porto Alegre, RS, Brasil. As concentra??es de RANTES foram verificadas atrav?s do m?todo de enzima imuno ensaio (ELISA) espec?fico para humanos. Resultados: Mulheres com s?ndrome de pr?-ecl?mpsia apresentaram n?veis significativamente maiores de RANTES no plasma e placenta quando comparadas a gestantes normais (P<0,01). O plasma do cord?o umbilical de rec?m-nascidos de gestantes com pr?-ecl?mpsia mostraram n?veis de RANTES significativamente menores que o plasma do cord?o umbilical de rec?m-nascidos de gestantes normais (P<0,01). A concentra??o de RANTES placent?rio correlacionou-se positivamente com a concentra??o de RANTES no plasma materno (r= 0,697; P<0,001) e negativamente com o plasma do cord?o umbilical (r= - 0,818; P< 0,001). Forte correla??o negativa na concentra??o de RANTES foi demonstrada entre plasma materno e plasma do cord?o umbilical (r= - 0,751; P<0,001). Conclus?o: Este estudo mostra uma resposta inflamat?ria distinta entre a m?e e o rec?m-nascido em ambas as condi??es, gesta??o normal e s?ndrome de pr?-ecl?mpsia. A placenta e o plasma materno demonstraram uma concentra??o da citocina inflamat?ria RANTES aumentada na s?ndrome de pr?-ecl?mpsia, entretanto, no plasma do cord?o umbilical dos rec?m-nascidos dessas gestantes estava reduzida, sugerindo uma resposta fetal anti-inflamat?ria.

Made available in DSpace on 2015-04-14T13:35:54Z (GMT). No. of bitstreams: 1 457551.pdf: 12875247 bytes, checksum: 7692e146a26179178ba4309a48e59226 (MD5) Previous issue date: 2014-02-24 / Pre-eclampsia is one of the leading cause of maternal mortality worldwide. Although some etiological factors such as poor placentation, endothelial dysfunction, excessive maternal inflammation, poor angiogenesis, and placental hypoxia have been proposed, the etiology of pre-eclampsia has not been fully understood. An immune maladaptation theory suggests that pre-eclampsia might be envolved in an inappropriate regulation of normally Th2-deviated maternal immune response, leading to a shift toward harmful Th1 immunity, delivering a large amount of cytokines and growth factor molecues throw maternal circulation. The presence of these mediators seems to play a role in the pathophysiology of pre-eclampsia, resulting in the clinical signs of the disease: hypertension and protein?ria. Thus, this study pretended to analize different pathways during gestation in order to try to elucidate a biomarcar for the disease. We hypothesize that moleculas related to inflammatory system would be up-regulated in maternal plasma and placenta from women with pre-eclampisa and down regulated in fetal plasma. The study was performed at Hospital S?o Lucas of PUCRS, Brazil, where we made Mediating molecules and pre-eclampsia , and at St Thomas&#8223; Hospital, London, UK, where Lipoproteins and pre-eclampsia and Caveola proteins and pre-eclampsia projects were developed. At HSL/PUCRS, maternal/fetal plasma and placenta samples were collected from 117 pre-eclampsia and normal pregnant women in third trimester pregnancy, after informed written consent. The cytokines (Endocan-1, PlGF, IL-6, TNF&#945;, MCP-1, NGF, LIGHT, Leptina) were measured by multiplex detecting assay. In London, a study with 51 pregnant women was conducted analising placenta expression of the following molecules: lipoproteins pathway (LRP-1, LDL-R, SRB1, ABCA1, MTTP and PDIA2) and protein caveolae complex (Caveolin-1-3, cavins 1-4, eNOS and iNOS) which were performed by PCR-RT e immunohistochemistry. Briefly we found high levels of Endocan-1 and TNF&#945; in pre-eclamptic maternal plasma, low levels of IL-6 in fetal plasma in cytokines assay. Also a correlation between LRP-1 gene and small for gestational age infants in lipoproteins receptor assay was found. Finally, a reduction expression of Caveolin-1 found in pre-eclampstic placenta seems to result in a compensatory chronic activation of eNOS to attenuate vasoconstriction seen in pre-eclampsia. In conclusion, our results showed new data in relation to pre-eclampsia, which might be helpful for the understanding of its pathofisiology. / A pr?-ecl?mpsia ? uma das principais causas de mortalidade materna no mundo. Embora alguns fatores etiol?gicos, tais como m? placenta??o, disfun??o endotelial, inflama??o materna exacerbada, angiog?nese deficiente e hipoxia placent?ria t?m sido propostos, a etiologia da pr?-ecl?mpsia ainda n?o foi completamente compreendida. A teoria da m? adapta??o imune sugere que a pr?-ecl?mpsia pode estar envolvida com um desbalan?o Th1/Th2 prejudicial ? gesta??o, com libera??o de citocinas e fatores de crescimento na circula??o materna. A presen?a desses mediadores parece desempenhar um papel na fisiopatologia da pr?-ecl?mpsia, resultando nos sinais cl?nicos da doen?a: a hipertens?o e a protein?ria. Assim, este estudo pretendeu analisar diferentes vias metab?licas durante a gesta??o, a fim de tentar elucidar um biomarcar para a doen?a. Nossa hip?tese ? a de que mol?culas relacionadas ao sistema inflamat?rio estariam aumentadas no plasma materno e na placenta de mulheres com pr?-eclampsia e diminu?das no plasma fetal. O estudo foi realizado no Hospital S?o Lucas da PUCRS, Brasil, onde fizemos a coleta das amostras para o projeto Mol?culas mediadoras e a pr?-ecl?mpsia, e no St Thomas Hospital, em Londres, Reino Unido, onde os projetos Lipoprote?nas e a pr?-eclampsia e Prote?nas das cav?olas e a pr?-ecl?mpsia foram desenvolvidos. No HSL/PUCRS, amostras de plasma materno-fetal e placenta foram coletadas de 117 gestantes com e sem pr?-ecl?mpsia no terceiro trimestre da gesta??o. As mol?culas (Endocan-1, PIGF, IL-6, TNF&#945;, MCP-1, NGF, LIGHT e Leptina) foram dosadas por ensaio de detec??o multiplex. Em Londres, um estudo com 51 gestantes foi realizado analisando express?o placent?ria das seguintes mol?culas: receptores e mediadores de lipoprote?nas (LRP-1, LDL-R, SRB1, ABCA1, MTTP e PDIA2) e prote?nas do complexo das cav?olas (Caviolina-1-3, Cavins 1-4, eNOS e iNOS ), que foram analisadas por PCR-TR e imuno-histoqu?mica. Resumidamente, encontramos altos n?veis de Endocan-1 e TNF&#945; no plasma materno, baixos n?veis de IL-6 no plasma fetal de pacientes com pr?-eclampsia, no ensaio de citocinas. Ainda, foi encontrada uma correla??o entre o gene LRP-1 e rec?m-nascidos pequenos para a idade gestacional, no grupo com pr?-ecl?mpsia, no ensaio de receptor de lipoprote?nas. E, por fim, uma redu??o da express?o de Caveolina-1 na placenta pr?-ecl?mptica foi observada e parece ter resultado numa ativa??o compensat?ria cr?nica da eNOS para tentar atenuar a vasoconstri??o observada na pr?-eclampsia. Concluindo, nossos resultados mostraram novos dados em rela??o ? pr?-ecl?mpsia, que podem ser ?teis para o entendimento de sua fisiopatologia.

Made available in DSpace on 2015-04-14T13:35:57Z (GMT). No. of bitstreams: 1 458594.pdf: 1623070 bytes, checksum: 141e39e7200c7e85ea7cf51cf01083c9 (MD5) Previous issue date: 2014-02-24 / Imbalance in hemostatic mechanisms can occur during pregnancy with a tendency for hypercoagulability and increased thrombosis risk. Pregnant women with a hypertensive disorder, especially preeclampsia, may disclose alterations in total platelet count and the platelet indexes, mean platelet volume (MPV) and immature platelet fraction (IPF). The IPF has been suggested as a sensitive index for monitoring changes in platelet production and destruction. An automated technique for obtaining this parameter has been used. The aim of the present study was to evaluate the immature platelet fraction behavior in patients diagnosed with a gestational hypertensive disorder (GHD), using fluorescent flow cytometry. A crosssectional study conducted at the S?o Lucas Hospital, Porto Alegre, Brazil to estimate IPF levels in the maternal blood of 99 pregnant women, divided into 3 groups: normotensive controls (NP), preeclampsia syndrome (PES) and non-proteinuric hypertensive pregnancy (nPHP). Following ethical approval and written informed consent, samples were collected from 33 NP, 34 PES, and 32 nPHP women. IPF levels were measured by fluorescent flow cytometry using the XE-5000? (Sysmex Corporation, Kobe, Japan). The IPF and MPV count in pregnant women with a GHD was significantly higher than the control group. No significant difference was detected between the PES and nPHP groups. The MPV for the NP group was normal. A distinct profile in platelet indexes was detected in hypertensive pregnancies. It is suggested that these markers could be used in daily routine as an additional tool in the management of hypertensive pregnant women. / Um desequil?brio nos mecanismos hemost?ticos pode ocorrer durante a gesta??o com tend?ncia ? hipercoagulabilidade e aumento do risco de trombose. Nas gestantes com dist?rbio hipertensivo, principalmente nas pr?-ecl?mpticas, h? dados na literatura que indicam haver altera??o no n?mero total de plaquetas e nos ?ndices plaquet?rios, volume plaquet?rio m?dio (VPM) e fra??o de plaquetas imaturas(IPF). A IPF tem sido sugerida como um ?ndice sens?vel para monitorar mudan?as na produ??o e destrui??o plaquet?ria. Uma t?cnica automatizada para a obten??o deste par?metro tem sido utilizada. O objetivo do presente estudo ? avaliar o comportamento da IPF utilizando citometria de fluxo fluorescente em pacientes com diagn?stico de doen?a hipertensiva gestacional. Foi realizado estudo transversal controlado com 99 gestantes a fim de estimar os n?veis de IPF no sangue materno das pacientes com s?ndrome de pr?-ecl?mpsia (SPE) comparando com hipertensas gestacionais sem protein?ria (HGsP) e gestantes normais normotensas (NT) atendidas no Hospital S?o Lucas/PUCRS, Porto Alegre, Brasil. O termo de consentimento livre e esclarecido foi empregado nas 34 gestantes com SPE, 32 com GHsP e nas 33 NT. A IPF foi contada atrav?s do equipamento XE-5000 (Sysmex Corporation, Kobe, Japan), utilizando citometria de fluxo fluorescente. A contagem de IPF e VPM em gestantes com doen?a hipertensiva gestacional (DHG) foi significativamente maior que no grupo controle. N?o houve diferen?a estat?stica entre os grupos SPE e HGsP. O VPM foi normal em todas as gestantes do grupo controle. Detectou-se um distinto perfil dos ?ndices plaquet?rios em gestantes hipertensas, e sugere-se que esses marcadores possam ser utilizados na rotina cl?nica di?ria como uma ferramenta adicional no aux?lio do diagn?stico precoce da DHG.

Made available in DSpace on 2014-12-17T14:13:51Z (GMT). No. of bitstreams: 1 AnaCAAG_TESE.pdf: 1218484 bytes, checksum: 515ab0b05a0c78a389b8ec33b20042ef (MD5) Previous issue date: 2013-11-27 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Preeclampsia is defined as an extremely serious complication of the pregnancy-puerperium cycle with delayed emergence of cardiovascular risk factors, including metabolic syndrome. The research aimed estimate the prevalences of metabolic syndrome and associated factors in women with preeclampsia and normal pregnancy followed five years after childbirth. This is a cross-sectional observational study using a quantitative approach, conducted at a maternity school in the city of Natal in Rio Grande do Norte state. The sample was composed of 70 women with previous preeclampsia and 75 normal selected by simple random probability sampling. Subjects were analyzed for sociodemographic, obstetric, clinical, anthropometric and biochemical parameters. International Diabetes Federation criteria were adopted to diagnose metabol ic syndrome. The Kolmogorov-Smirnov, Mann-Whitney, Student s t, Pearson s chi-squared, and Fisher s exact tests, in addition to simple logistic regression, were used for data analysis, at a 5% significance level (p &#8804; 0.05). Statistical tests demonstrated elevated body mass index (p = 0.001), predominance of family history of diabetes mellitus (p = 0.022) and significantly higher prevalence of metabolic syndrome in the preeclampsia group (37.1%) when compared to normal (22.7%) (p = 0.042). Intergroup comparison showed a high number of metabolic syndrome components in women with previous preeclampsia. Altered systolic and diastolic blood pressure (p < 0.001) was the most prevalent, followed by low concentrations of high-density lipoproteins (p = 0.049), and hyperglycemia (p=0.030). There was a predominance of the metabolic syndrome in women with schooling 0-9 years (42.4%) (p = 0.005), body mass index above 30Kg.m 2 (52.3%) (p < 0.001), uric acid high (62.5%) (p = 0.050 and family history of hypertension (38.5%) (p< 0.001). Multivariate analysis of the data showed that the body mass index above 30 kg.m2, education level less than 10 years of study (p < 0.001) and family history of hypertension (p = 0.002) remained associated with the metabolic syndrome after multivariate analysis of the data. It is considered Women with previous preeclampsia exhibited high prevalence of metabolic syndrome and their individual components in relation to normal, especially, altered systolic and diastolic blood pressure, low concentrations of high-density lipoproteins and hyperglycemia. The factors associated to this ou tcome were obesity, less than 10 years of schooling, and family history of hypertension. Overall, this study identified young women with a history of PE exposed to a higher cardiovascular risk than normal / A pr?-ecl?mpsia ? uma complica??o de extrema gravidade do ciclo grav?dico puerperal e contribui com o surgimento tardio de fatores de risco cardiovascular, dentre os quais a s?ndrome metab?lica. A pesquisa objetivou estimar as preval?ncias da s?ndrome metab?lica e fatores associados em mulheres que apresentaram pr?-ecl?mpsia e gravidez normal, acompanhadas cinco anos ap?s o parto. Trata-se de um estudo observacional transversal de abordagem quantitativa, realizado em uma maternidade escola no munic?pio de Natal, Rio Grande do Norte. A amostra foi constitu?da por 70 mulheres com pr?-ecl?mpsia pr?via e 75 normais selecionadas por meio do m?todo de amostragem probabil?stica aleat?ria simples, do banco de dados do grupo de pesquisa Sa?de da Mulher do Departamento de Tocoginecologia da Universidade Federal do Rio Grande do Norte, das quais foram analisados os par?metros sociodemogr?ficos, obst?tricos, cl?nicos, antropom?tricos e bioqu?micos. Para diagn?stico da s?ndrome metab?lica, adotou-se o crit?rio estabelecido pela International Diabetes Federation. Quanto ? an?lise dos dados, foram aplicados testes estat?sticos de Kolmogorov-Smirnov, Mann-Whitney, t de Student, Qui Quadrado de Pearson, exato de Fisher e modelo de regress?o log?stica simples com n?vel de signific?ncia estat?stica de 5% (p&#8804; 0,05). Ap?s aplica??o dos testes estat?sticos constatou-se um ?ndice de massa corp?rea elevado (p = 0,001), predom?nio de antecedentes familiares de diabetes mellitus (p = 0,022) e preval?ncia significativamente maior da s?ndrome metab?lica no grupo com pr?-ecl?mpsia (37,1%) em rela??o ?s normais (22,7%) (p = 0,042). Comparando os grupos, verificou-se um n?mero elevado de componentes da s?ndrome metab?lica nas mulheres com pr?-ecl?mpsia pr?via. A press?o arterial sist?lica e diast?lica alteradas (p < 0, 001) foi o mais prevalente, seguido da baixa concentra??o de lipoprote?nas de alta densidade (p = 0, 049) hiperglicemia (p = 0,030). Houve o predom?nio da s?ndrome metab?lica nas mulheres com escolaridade de 0 a 9 anos (42,4%) (p = 0,005), ?ndice de massa corp?rea acima de 30Kg.m 2 (52,3%) (p < 0,001), ?cido ?rico elevado (62,5%) (p = 0,050) e hist?rico familiar de hipertens?o arterial (38,5%) (p < 0,001). A an?lise multivariada dos dados apontou que o ?ndice de massa corp?rea acima de 30 kg.m 2 , grau de escolaridade menor que 10 anos de estudo (p < 0,001) e antecedentes familiares de hipertens?o arterial (p = 0,002) permaneceram associados ? s?ndrome metab?lica. Considera-se que as mulheres com PE pr?via apresentavam uma elevada preval?ncia da s?ndrome metab?lica e de seus componentes individuais em rela??o ?s normais, em particular, a press?o arterial sist?lica e diast?lica alteradas, os n?veis baixos da concentra??o de lipoprote?nas de alta densidade e a hiperglicemia. Os fatores independentemente associados a esse desfecho foram: obesidade, grau de escolaridade inferior a 10 anos e hist?rico familiar de hipertens?o arterial. De forma geral, este estudo identificou mulheres jovens com hist?rico de PE expostas a um risco cardiovascular mais elevado do que as normais

Made available in DSpace on 2014-12-17T14:46:33Z (GMT). No. of bitstreams: 1 MariadeLourdesCS.pdf: 416532 bytes, checksum: 7b06ce16706cd477da59914b569ac29d (MD5) Previous issue date: 2008-04-17 / The objective of this exploratory descriptive study with a qualitative approach was to analyze the perception of the nursing team and the pregnant women hospitalized with pre-eclampsia regarding the interactive process occurring in the care relationship. Data were collected by semi-structured interview with twenty nursing professionals that work in the high-risk ward and ten pregnant women with the diagnosis of pre-eclampsia. The discourses were analyzed using the content analysis method, in the modality of thematic identification. Three categories were identified that describe the perception of the interaction by the nursing professionals: recognizing the needs of the hospitalized pregnant woman, understanding the woman with pre-eclampsia, and presenting difficulties in the interactive process. With regards to the pregnant women, four categories emerged: recognizing the clinical care, feeling the lack of information, experiencing feelings during the hospitalization, and envisioning the interaction process. The meaning of the discourses was analyzed according to the principles of symbolic interactionism. The results indicate that both, the nursing professionals and the pregnant women, have a limited perception of their interaction, suggesting a need for further reflection about this reality in the health service units and in the nursing education environment / Trata-se de um estudo explorat?rio descritivo com abordagem qualitativa, tendo como objetivo analisar a percep??o da equipe de enfermagem e das gestantes hospitalizadas, com pr?-ecl?mpsia, sobre o processo de intera??o durante a realiza??o dos cuidados. A coleta dos dados foi realizada atrav?s de entrevista semiestruturada junto a 20 profissionais de enfermagem, que atuam na enfermaria de alto risco, e 10 gestantes com diagn?stico de pr?-ecl?mpsia. As informa??es originadas dos depoimentos foram tratadas, conforme o m?todo de an?lise de conte?do, na modalidade de an?lise tem?tica. Desse processo, em rela??o aos profissionais, surgiram tr?s categorias que descrevem como estes percebem a sua intera??o com a gestante no cuidado: reconhecimento das necessidades da gestante hospitalizada, compreens?o da mulher com pr?-ecl?mpsia e apresenta??o das dificuldades no processo de intera??o. No que diz respeito ?s gestantes, emergiram tr?s categorias: percep??o das especificidades do cuidado, aus?ncia de informa??o/acolhimento/v?nculo e percep??o do processo de intera??o. O significado das falas foi interpretado ? luz dos princ?pios do Interacionismo Simb?lico. Os resultados mostraram que tanto os profissionais quanto as gestantes percebem haver uma intera??o limitada entre eles, sendo necess?rio refletir sobre esta realidade nas institui??es de sa?de e no ensino de enfermagem

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-07-25T23:07:30Z No. of bitstreams: 1 PatriciaIngridMacedoDeCastro_DISSERT.pdf: 960843 bytes, checksum: 3369f0056a2e2ab1f071631a2015066a (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-08-04T20:48:06Z (GMT) No. of bitstreams: 1 PatriciaIngridMacedoDeCastro_DISSERT.pdf: 960843 bytes, checksum: 3369f0056a2e2ab1f071631a2015066a (MD5) / Made available in DSpace on 2016-08-04T20:48:06Z (GMT). No. of bitstreams: 1 PatriciaIngridMacedoDeCastro_DISSERT.pdf: 960843 bytes, checksum: 3369f0056a2e2ab1f071631a2015066a (MD5) Previous issue date: 2015-11-30 / A pr?-ecl?mpsia ? uma doen?a que afeta 3-8% das mulheres gr?vidas. Os fatores de risco para essa doen?a n?o s?o completamente compreendidos, mas incluem desregula??o da resposta imune oriundos de defeitos na placenta??o, fatores ambientais e gen?ticos. O presente estudo teve como objetivo investigar associa??o varia??o na quantidade de receptores de citocinas pr?-inflamat?rias (IL-1R, IL-6R e TNF-?R) estariam envolvidos com a pr?-ecl?mpsia. Receptores de citocinas (IL-1R2, TNF-?R1 e IL-6R) foram avaliados em c?lulas mononucleares das gr?vidas normotensas (controle n=11) e gr?vidas com pr?-ecl?mpsia (PE, n=24). Mulheres com pr?-eclampsia tinham peso mais elevado no in?cio da gravidez (p=0.0171). Foi observado uma diminui??o de mon?citos cl?ssicos, mas n?o de mon?citos intermedi?rios e n?o-cl?ssicos na pr?-ecl?mpsia. A frequ?ncia dos receptores de citocinas proinflamat?rias IL-1R2, TNF-?R IL-6R aderidos a membrana das subpopula??es de mon?citos (cl?ssicos, intermedi?rios e n?o cl?ssicos) e linf?citos (CD3+CD4+ e CD3+CD8+) estavam diminu?das em pacientes com pr?-ecl?mpsia, quando comparados com gr?vidas normais. A redu??o na quantidade de receptores de citocinas IL-1R2, TNF-?R1 e IL-6R em mon?ciots e linf?citos pode ser um fator mantenedor do estado inflamat?rio na pr?-eclampsia. / Preeclampsia is a disease specific of human pregnancy that affects 3-8% of pregnant women, and it is one of the three leading causes of maternal mortality and morbidity. The disease is characterized by hypertension and proteinuria after the 20th week of gestation. The risk factors for this disease are not completely understood but appear to include dysregulation of the immune response arising from defects in placentation, environmental and genetic factors. This study aimed to determine whether the variation in the amount of proinflammatory cytokine receptors IL-1R2, IL-6R and TNF-?R1 would be involved in preeclampsia. They were recruited women with preeclampsia (n=24) and women who evolved during pregnancy without changes in blood pressure (n=12) were recruited. Clinical and laboratory data were collected. The cytokine receptors (IL-1R2, TNF-?R1 and IL-6R) were assessed in mononuclear cells isolated from peripheral blood using flow cytometry (Control = 8; PE = 24). C-reactive protein (CRP) was determined by CRP ultrasensitive method (Control = 7; PE = 18) was performed using sera pregnant women. Women with preeclampsia had higher weight at the beginning of the pregnancy (p=0.0171) and lower gestational age at delivery (0.0008). Classical monocytes were decreased in preeclampsia but not intermediate or non-classical monocytes. The frequency of IL-1R2 pro inflammatory cytokine receptors is decreased in women with PE only in the subpopulation of non-classical monocytes (p = 0.0011). TNF-?R1 receptor and IL-6R, had a decreased frequency in the three subpopulations of monocyte (classic, intermediate and non-classical) when compared to women with normal pregnancy. An increase in IL-1R2 receptor in TCD4+ lymphocytes, but a decrease in TNF-receptor and IL-6R in women with preeclampsia were found. No differences in the frequency of those receptors in CD3+/CD8+ in preeclampsia. There was no difference in C-reactive protein in preeclampsia. The reduction in the amount of IL-1R2, TNF- ?R1 and IL-6R monocytes and lymphocytes can be involved in the regulation of inflammation observed in preeclampsia, contributing to disease.

Submitted by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-08-23T12:34:29Z No. of bitstreams: 1 DIS_DANIELE_SPAREMBERGER_OLIVEIRA_PARCIAL.pdf: 1288404 bytes, checksum: 60ff1db869977cfce3d9f24357c12e59 (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-08-23T12:35:16Z (GMT) No. of bitstreams: 1 DIS_DANIELE_SPAREMBERGER_OLIVEIRA_PARCIAL.pdf: 1288404 bytes, checksum: 60ff1db869977cfce3d9f24357c12e59 (MD5) / Made available in DSpace on 2017-08-23T12:35:31Z (GMT). No. of bitstreams: 1 DIS_DANIELE_SPAREMBERGER_OLIVEIRA_PARCIAL.pdf: 1288404 bytes, checksum: 60ff1db869977cfce3d9f24357c12e59 (MD5) Previous issue date: 2017-03-31 / Introduction: Gestational diabetes is a potentially harmful disease for the mother and fetus during pregnancy. It is associated with higher risk of developing a hypertensive syndrome during pregnancy and maternal cardiovascular diseases, but also with increased risk of adverse fetal outcomes such as macrosomia and fetal death. Objectives: the aim was to evaluate endothelial function in pregnancies with and without gestational diabetes mellitus (GDM). Methods: this case control study measured endothelial function trough brachial artery flow mediated dilatation (FMD) using ultrasound, evaluating pregnant women between twenty and thirty six weeks gestation. Sample size was calculated to detect a difference of one standard deviation in FMD (90% power and alpha 0.05) between groups. Results: The study sample consisted of thirty-six patients in each group. The clinical and demographic characteristics were similar in both groups, although the glucose status and the basal body mass index (BMI) were significantly higher in the group of pregnant women with diabetes. Median FMD was significantly reduced in gestational diabetes group (18.3%, IQR: 11.9-23.3%) compared to the control group (9.7%, IQR: 5.7-14.1%; p<0.001), indicating impaired endothelial function. Cohen's d was 0.90 and the effect-size r was 0.41, which is considered a large Cohen?s Standard effect. Conclusions: Gestational diabetes is associated with endothelial dysfunction. / Introdu??o: A diabetes gestacional ? uma doen?a potencialmente lesiva ? m?e e ao feto durante a gesta??o, est? associada a maior risco de desenvolvimentos de s?ndrome hipertensivas na gesta??o, aumento de doen?as cardiovasculares e desfechos adversos fetais como macrossomia e morte fetal. Objetivos: Analisar a fun??o endotelial em gesta??es com e sem diabetes mellitus gestacional (DMG). M?todos: Estudo caso-controle que avaliou a fun??o endotelial atrav?s da dilata??o mediada por fluxo (DMF) da art?ria braquial, aferida atrav?s de um m?todo ecogr?fico entre vinte e trinta e seis semanas de gesta??o, em pacientes com e sem DMG. A amostra foi calculada para detectar uma diferen?a de um desvio padr?o na DMF, com poder de 90%, e erro alfa de 0,05. Resultados: Foram selecionadas trinta e seis (36) pacientes em cada grupo, as caracter?sticas cl?nicas e demogr?ficas foram semelhantes nos dois grupos, apenas o status da glicose e o ?ndice de massa corporal basal (IMC) foram diferentes entre eles. A mediana da DMF da art?ria braquial foi significativamente menor no grupo diabetes gestacional (18,3%, IQR: 11,9-23,3% e 9,7%, IQR: 5,7-14,1%;nos grupos-controle e GDM respectivamente, p <0,001), indicando comprometimento na fun??o endotelial. O d de ?Cohen`s? foi de 0,90 e o tamanho do efeito r foi de 0,41, considerado grande de acordo com a escalada de efeitos de Cohen. Conclus?es: Diabetes gestacional esteve associado ? disfun??o endotelial neste estudo, com a metodologia proposta.