As infecções do trato urinário (ITUs) são uma das causas mais comuns de consultas médicas. No ambiente hospitalar estão entre as mais frequentes infecções relacionadas à assistência à saúde (35 a 45%). Nos Estados Unidos da América, resultam em 3.600.000 consultas médicas anuais e mais de 100.000 hospitalizações. No Reino Unido, representam 23% das infecções relacionadas à assistência à saúde. Estudos mostram que a E. coli é a bactéria mais isolada em uroculturas (75% a 80%), tanto em pacientes hospitalizados quanto não hospitalizados. A antibioticoterapia para ITU é comumente iniciada empiricamente, antes da urocultura e do antibiograma, por isso, faz-se necessário conhecer a sensibilidade e resistência dos prováveis agentes etiológicos, deve-se considerar o histórico clínico epidemiológico do paciente. No presente estudo foi realizada a análise da resistência das cepas de E. coli isoladas em 261 uroculturas de pacientes assistidos no serviço ambulatorial e hospitalar do Hospital Universitário Pedro Ernesto (HUPE) e, também, de 81 cepas isoladas em uroculturas de pacientes assistidos no serviço ambulatorial de um Hospital Maternidade do Município do Rio de Janeiro (HMMRJ), no período de maio de 2010 a dezembro de 2010. A susceptibilidade aos antimicrobianos foi determinada pela metodologia de disco difusão por Kirby e Bauer. Foram realizadas triagens fenotípicas para cepas produtoras de ESBL e para cepas produtoras de carbapenemases. Através dos dados contidos nos prontuários dos pacientes com uroculturas positivas para E. coli (≥ 105 ufc/mL), foi realizada a pesquisa clínica epidemiológica para se verificar a ocorrência de fatores de risco diversos, para ITU por E. coli. Observou-se que pacientes do sexo feminino são mais susceptíveis a ITU e o uso de antibiótico até 03 meses antes do episódio infeccioso (p= 0,04746), diabetes (p= 0,01683), trauma recente (p= 0,000238), cirurgia abdominal ou pélvica prévia (p= 0,00221), patologia crônica de bexiga (p= 0,002150), uso de cateter urinário (p=0,0002), insuficiência renal crônica (p= 0,02178), e hospitalização por até 06meses prévios (p= 0,01802) podem ser considerados fatores de risco para ITU por E. coli. Verificou-se que o uso de cateter urinário (p=0,000399), cirurgia abdominal ou pélvica prévia (p=0,004458) e o uso de antimicrobianos prévios ao processo infeccioso (p=0,002625), podem ser considerados fatores de risco importantes, para ITU por E. coli multirresistentes. Os pacientes do sexo masculino, apesar de minoria no estudo, representam a maioria dos pacientes com ITU por E. coli multirresistente. Verificou-se que a classe de antimicrobiano utilizado previamente ao episódio infeccioso, aumenta a chance de ocorrer ITU por E. coli multirresistente, principalmente quando associadas ao uso de cateter urinário e cirurgia abdominal ou pélvica prévia. Os perfis de resistência da cepas isoladas dos pacientes assistidos no serviço ambulatorial e hospitalar do HUPE apresentam semelhanças. Apesar do baixo número de cepas multirresistentes entre as isoladas dos pacientes assistidos no serviço ambulatorial do HMMRJ, essas apresentam perfil de resistência semelhante aos perfis das cepas isoladas dos pacientes assistidos no serviço ambulatorial e hospitalar do HUPE. A partir das evidências, percebe-se que o uso racional de antimicrobianos é muito importante para diminuir a problemática da resistência bacteriana / Urinary tract infections (UTIs) are one of the most common cause of medical visits. In the hospital setting, are the most common infections among health care associated infections (35 to 45%). In the United States of America, UTIs result in 3.6 million doctor visits annually and over 100,000 hospitalizations. In the UK, represent 23% of infections related to health care. Studies show that the bacterium E. coli is the most common microorganism isolated from urine cultures (75% to 80%), both in inpatients and in outpatients. Antibiotic treatment for UTI is usually initiated empirically before urine culture and antibiogram, so it is necessary to know the profile sensitivity and resistance of the likely etiologic agents and should consider clinical and epidemiological history of the patient. The present study was conducted to analyze the resistance of E. coli strains isolated from urine cultures in 261 patients assisted as outpatients and hospitalized patients at the Hospital Universitário Pedro Ernesto (HUPE) and also of 81 strains isolated in urine cultures of outpatients from a Municipal Maternity Hospital from Rio de Janeiro (MMHRJ), from May 2010 to December 2010. The antimicrobial susceptibility was determined by disk diffusion method of Kirby and Bauer. The phenotypic screening for ESBL production and confirmation of strains producing carbapenemases were performed. We conducted the clinical epidemiological research, using data contained in the records of patients with urine cultures positive for E. coli count ≥ 105 cfu / mL, to identify risk factors predisposing UTI by E. coli. It was observed that female patients are more suceptible to UTI and the use of antibiotics within 03 months before the infectious episode (p= 0,04746), diabetes (p= 0,01683), recent trauma (p= 0,000238), previous abdominal or pelvic surgery (p= 0,00221), chronic bladder disease (p= 0,002150), urinary catheter (p=0,0002), chronic renal failure (p= 0,02178), and previous hospitalization prior to 06 months (p= 0,01802), can be considered important risk factors for UTI by E. coli. And it was found that the use of urinary catheter (p=0,000399), abdominal or pelvic surgery (p=0,004458) and antibiotic use prior to the infectious process (p=0,002625) can be considered important risk factors for UTI by multidrug resistant E. coli. Although male patients represent the minority of patients with UTI, they represent the majority of patients with UTI by multidrug resistant E. coli, in the study. It was observed that the class of antimicrobial used within 03 months before the infectious episode enhances the chance of UTI by multidrug resistant E. coli, principally when associated to the use of urinary catheter and abdominal or pelvic surgery. The resistance profiles of strains isolated from outpatients and inpatients in the HUPE are similar. Althoug only a few multidrug strains were isolated from outpatients in the MMHRJ, they presented a resistance profile similar to the multidrug strains isolated from from outpatients and inpatients in the HUPE. Through the evidences, it is clear that the rational use of antimicrobials is very important to minimize the set of problems envolving the antimicrobial resistance

Στην παρούσα εργασία μελετήθηκαν οι γνώσεις / αντιλήψεις των μαθητών του Νηπιαγωγείου, της Ε’ και της ΣΤ’ τάξης του Δημοτικού και των φοιτητών του Τ.Ε.Ε.Α.Π.Η. αναφορικά με τα εσωτερικά όργανα του ανθρωπίνου σώματος και ειδικότερα του ουροποιητικού συστήματος. Οι συμμετέχοντες στην έρευνα, 82 μαθητές ηλικίας 5-6 και 10-12 ετών και 30 τριτοετείς φοιτητές, απάντησαν στα ερωτήματα ενός δομημένου ερωτηματολογίου, όπου ζητήθηκε από τους ερωτηθέντες εκτός των άλλων να αποτυπώσουν μέσω ζωγραφικής τις γνώσεις τους αναφορικά με τα εσωτερικά όργανα του ανθρωπίνου σώματος και ειδικότερα του ουροποιητικού συστήματος. Στη συνέχεια, έγινε διδακτική παρέμβαση ανά τάξη και ζητήθηκε από τους μαθητές του Νηπιαγωγείου και του Δημοτικού Σχολείου να συμπληρώσουν ξανά το ίδιο ερωτηματολόγιο. Σύμφωνα με τα αποτελέσματα της μελέτης φάνηκε ότι η ηλικία επηρεάζει το γνωστικό επίπεδο των μαθητών, αν και οι διαφορές δεν ήταν τόσο εμφανείς μεταξύ των μαθητών της Ε’ και της ΣΤ’ τάξης του Δημοτικού. Αντίθετα, δεν παρατηρήθηκαν σημαντικές διαφορές στο επίπεδο των γνώσεων των μαθητών ανάλογα με το επάγγελμα των γονέων τους, ή με την ύπαρξη κατοικίδιων ζώων στο σπίτι. Επίσης παρατηρήθηκε ότι τα κορίτσια υπολείπονται των αγοριών στην αποτύπωση του ουροποιητικού συστήματος πιθανώς λόγω προκαταλήψεων (taboo). Η διδακτική παρέμβαση βελτίωσε σημαντικά τις γνώσεις των μαθητών αναφορικά με τα εσωτερικά όργανα του ανθρώπινου σώματος και ειδικότερα του ουροποιητικού συστήματος. Τα αποτελέσματα της παρούσας μελέτης επιβεβαιώνουν προηγούμενες μελέτες και δείχνουν ότι οι μαθητές του Νηπιαγωγείου και του Δημοτικού Σχολείου έχουν περιορισμένες γνώσεις σχετικά με το ουροποιητικό σύστημα, αλλά οι επικεντρωμένες διδακτικές παρεμβάσεις μπορούν να βελτιώσουν σημαντικά το επίπεδο των γνώσεων τους σχετικά με το θέμα αυτό. / Children’s conceptions about internal human anatomy have been extensively studied. However, scientific data about the urinary tract system are rather scarce. We used a structured questionnaire and drawing as equipments in 82 students aged 5-6 and 10-12 years and 30 third year university students in order to explore any differences regarding these issues. We also applied a teaching intervention and investigated its possible impact on students’ knowledge about the urinary tract system. According to our findings, age was a significant determinant of student’s current knowledge, as students of higher classes scored better. In addition, males scored higher than females indicating a possible taboo about this system in young women. We were not able to find any significant impact of parents’ vocational status on students’ perceptions about urinary tract system, nor any impact of the presence of pets at home. The teaching intervention significantly improved students’ knowledge about the urinary tract system irrespective of age. Our results confirm previous studies about the relative lack of knowledge of young students about the urinary system, but simple structured interventions may help to improve it.

Urolithias, calculus formation in the urinary system, affects 5 – 10% of the population and is a painful and recurrent medical condition. A common approach in the treatment of calculi is the use of laser radiation, a procedure known as laser lithotripsy, however, the technique has not yet been fully optimised. This research examines the experimental parameters relevant to the interactions of the variable microsecond pulsed holmium laser (λ = 2.12 μm, τp = 120 – 800 μs, I ~ 3 MW cm-2) and the Q-switched neodymium laser (λ = 1064 nm, τp = 6 ns, I ~ 90 GW cm-2) with calculi. The laser-calculus interaction was investigated from two perspectives: actions that lead to calculus fragmentation through the formation of shockwave and plasma, and the prospect of material analysis of calculi by laser induced breakdown spectroscopy (LIBS) to reveal elemental composition. This work is expected to contribute to improved scientific understanding and development of laser lithotripsy. The results support the general model of thermal and plasma processes leading to vaporization and pressure pulses. Nd:YAG laser interaction processes were found to be plasma-mediated and shockwave pressure (~ 12 MPa) dependent on plasma and strongly influenced by metal ions. Ho:YAG laser-induced shockwaves (~ 50 MPa) were found to be due to direct vaporisation of water and dependent on laser pulse duration. The characteristics of the pressure pulse waveforms were found to be different, and the efficiency and repeatability of shockwave and the nature of the dependencies for the lasers suggest different bubble dynamics. For the Nd:YAG laser, LIBS has been demonstrated as a potential tool for in situ analysis of calculus composition and has been used for the identification of major and trace quantities of calcium, magnesium, sodium, potassium, strontium, chromium, iron, copper, lead and other elements.

As infecções do trato urinário (ITUs) são uma das causas mais comuns de consultas médicas. No ambiente hospitalar estão entre as mais frequentes infecções relacionadas à assistência à saúde (35 a 45%). Nos Estados Unidos da América, resultam em 3.600.000 consultas médicas anuais e mais de 100.000 hospitalizações. No Reino Unido, representam 23% das infecções relacionadas à assistência à saúde. Estudos mostram que a E. coli é a bactéria mais isolada em uroculturas (75% a 80%), tanto em pacientes hospitalizados quanto não hospitalizados. A antibioticoterapia para ITU é comumente iniciada empiricamente, antes da urocultura e do antibiograma, por isso, faz-se necessário conhecer a sensibilidade e resistência dos prováveis agentes etiológicos, deve-se considerar o histórico clínico epidemiológico do paciente. No presente estudo foi realizada a análise da resistência das cepas de E. coli isoladas em 261 uroculturas de pacientes assistidos no serviço ambulatorial e hospitalar do Hospital Universitário Pedro Ernesto (HUPE) e, também, de 81 cepas isoladas em uroculturas de pacientes assistidos no serviço ambulatorial de um Hospital Maternidade do Município do Rio de Janeiro (HMMRJ), no período de maio de 2010 a dezembro de 2010. A susceptibilidade aos antimicrobianos foi determinada pela metodologia de disco difusão por Kirby e Bauer. Foram realizadas triagens fenotípicas para cepas produtoras de ESBL e para cepas produtoras de carbapenemases. Através dos dados contidos nos prontuários dos pacientes com uroculturas positivas para E. coli (≥ 105 ufc/mL), foi realizada a pesquisa clínica epidemiológica para se verificar a ocorrência de fatores de risco diversos, para ITU por E. coli. Observou-se que pacientes do sexo feminino são mais susceptíveis a ITU e o uso de antibiótico até 03 meses antes do episódio infeccioso (p= 0,04746), diabetes (p= 0,01683), trauma recente (p= 0,000238), cirurgia abdominal ou pélvica prévia (p= 0,00221), patologia crônica de bexiga (p= 0,002150), uso de cateter urinário (p=0,0002), insuficiência renal crônica (p= 0,02178), e hospitalização por até 06meses prévios (p= 0,01802) podem ser considerados fatores de risco para ITU por E. coli. Verificou-se que o uso de cateter urinário (p=0,000399), cirurgia abdominal ou pélvica prévia (p=0,004458) e o uso de antimicrobianos prévios ao processo infeccioso (p=0,002625), podem ser considerados fatores de risco importantes, para ITU por E. coli multirresistentes. Os pacientes do sexo masculino, apesar de minoria no estudo, representam a maioria dos pacientes com ITU por E. coli multirresistente. Verificou-se que a classe de antimicrobiano utilizado previamente ao episódio infeccioso, aumenta a chance de ocorrer ITU por E. coli multirresistente, principalmente quando associadas ao uso de cateter urinário e cirurgia abdominal ou pélvica prévia. Os perfis de resistência da cepas isoladas dos pacientes assistidos no serviço ambulatorial e hospitalar do HUPE apresentam semelhanças. Apesar do baixo número de cepas multirresistentes entre as isoladas dos pacientes assistidos no serviço ambulatorial do HMMRJ, essas apresentam perfil de resistência semelhante aos perfis das cepas isoladas dos pacientes assistidos no serviço ambulatorial e hospitalar do HUPE. A partir das evidências, percebe-se que o uso racional de antimicrobianos é muito importante para diminuir a problemática da resistência bacteriana / Urinary tract infections (UTIs) are one of the most common cause of medical visits. In the hospital setting, are the most common infections among health care associated infections (35 to 45%). In the United States of America, UTIs result in 3.6 million doctor visits annually and over 100,000 hospitalizations. In the UK, represent 23% of infections related to health care. Studies show that the bacterium E. coli is the most common microorganism isolated from urine cultures (75% to 80%), both in inpatients and in outpatients. Antibiotic treatment for UTI is usually initiated empirically before urine culture and antibiogram, so it is necessary to know the profile sensitivity and resistance of the likely etiologic agents and should consider clinical and epidemiological history of the patient. The present study was conducted to analyze the resistance of E. coli strains isolated from urine cultures in 261 patients assisted as outpatients and hospitalized patients at the Hospital Universitário Pedro Ernesto (HUPE) and also of 81 strains isolated in urine cultures of outpatients from a Municipal Maternity Hospital from Rio de Janeiro (MMHRJ), from May 2010 to December 2010. The antimicrobial susceptibility was determined by disk diffusion method of Kirby and Bauer. The phenotypic screening for ESBL production and confirmation of strains producing carbapenemases were performed. We conducted the clinical epidemiological research, using data contained in the records of patients with urine cultures positive for E. coli count ≥ 105 cfu / mL, to identify risk factors predisposing UTI by E. coli. It was observed that female patients are more suceptible to UTI and the use of antibiotics within 03 months before the infectious episode (p= 0,04746), diabetes (p= 0,01683), recent trauma (p= 0,000238), previous abdominal or pelvic surgery (p= 0,00221), chronic bladder disease (p= 0,002150), urinary catheter (p=0,0002), chronic renal failure (p= 0,02178), and previous hospitalization prior to 06 months (p= 0,01802), can be considered important risk factors for UTI by E. coli. And it was found that the use of urinary catheter (p=0,000399), abdominal or pelvic surgery (p=0,004458) and antibiotic use prior to the infectious process (p=0,002625) can be considered important risk factors for UTI by multidrug resistant E. coli. Although male patients represent the minority of patients with UTI, they represent the majority of patients with UTI by multidrug resistant E. coli, in the study. It was observed that the class of antimicrobial used within 03 months before the infectious episode enhances the chance of UTI by multidrug resistant E. coli, principally when associated to the use of urinary catheter and abdominal or pelvic surgery. The resistance profiles of strains isolated from outpatients and inpatients in the HUPE are similar. Althoug only a few multidrug strains were isolated from outpatients in the MMHRJ, they presented a resistance profile similar to the multidrug strains isolated from from outpatients and inpatients in the HUPE. Through the evidences, it is clear that the rational use of antimicrobials is very important to minimize the set of problems envolving the antimicrobial resistance

Urolithias, calculus formation in the urinary system, affects 5 – 10% of the population and is a painful and recurrent medical condition. A common approach in the treatment of calculi is the use of laser radiation, a procedure known as laser lithotripsy, however, the technique has not yet been fully optimised. This research examines the experimental parameters relevant to the interactions of the variable microsecond pulsed holmium laser (λ = 2.12 μm, τp = 120 – 800 μs, I ~ 3 MW cm-2) and the Q-switched neodymium laser (λ = 1064 nm, τp = 6 ns, I ~ 90 GW cm-2) with calculi. The laser-calculus interaction was investigated from two perspectives: actions that lead to calculus fragmentation through the formation of shockwave and plasma, and the prospect of material analysis of calculi by laser induced breakdown spectroscopy (LIBS) to reveal elemental composition. This work is expected to contribute to improved scientific understanding and development of laser lithotripsy. The results support the general model of thermal and plasma processes leading to vaporization and pressure pulses. Nd:YAG laser interaction processes were found to be plasma-mediated and shockwave pressure (~ 12 MPa) dependent on plasma and strongly influenced by metal ions. Ho:YAG laser-induced shockwaves (~ 50 MPa) were found to be due to direct vaporisation of water and dependent on laser pulse duration. The characteristics of the pressure pulse waveforms were found to be different, and the efficiency and repeatability of shockwave and the nature of the dependencies for the lasers suggest different bubble dynamics. For the Nd:YAG laser, LIBS has been demonstrated as a potential tool for in situ analysis of calculus composition and has been used for the identification of major and trace quantities of calcium, magnesium, sodium, potassium, strontium, chromium, iron, copper, lead and other elements.

Orientador: Carlos Arturo Levi D'Ancona / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-14T10:41:25Z (GMT). No. of bitstreams: 1 Leitao_VictorAugustoSanguinettiScherrer.pdf: 1700258 bytes, checksum: 2379024277024619e3fd370dd428bf85 (MD5) Previous issue date: 2009 / Resumo: O tratamento da litíase urinária foi revolucionado em 1980 pelo desenvolvimento do litotridor extracorpóreo, capaz de fragmentar cálculos por meio de ondas acústicas. Inicialmente, a litotripsia extracorpórea por ondas de choque foi vista como a solução para todos os pacientes com cálculos urinários, porém o tempo provou que existem limitações e que a evolução dos aparelhos não melhorou a taxa de fragmentação. Geradores mais modernos não produzem resultados comparáveis àqueles do Dornier HM3®, o primeiro litotridor eletrohidráulico, com aumento nas taxas de re-tratamento. O objetivo deste estudo foi descrever um modelo experimental in vivo de litotripsia e comparar a um equipamento eletromagnético, o Siemens Modularis®, com o HM3, considerado o "padrão ouro". Doze suínos fêmeas (n=24 rins), com peso médio de 36 kg (34- 38 kg), foram separados em grupos de três animais, de acordo com o equipamento e o número de choques aplicados (eletrohidráulico: EH500 e EH2000, eletromagnético: EM500 e EM2000). Os animais foram submetidos a laparotomia mediana e ureterotomia proximal para implante de cálculos artificiais de BegoStone Plus® em ambos os rins. Os cálculos mediam 10x5 mm, com peso médio de 0,452 g (0,439 - 0,464 g). O HM3® original foi utilizado com 20 quilovolts, sendo usado um eletrodo novo para cada rim. O litotridor Modularis® utilizou nível de energia 4.0 e para acoplamento foi usado gel acústico. Após a litotripsia, os animais foram sacrificados e os rins abertos para remoção dos fragmentos. A ausência de fragmentos residuais foi confirmada por radiografia. Os fragmentos foram separados, com o auxílio de peneiras geológicas, conforme o tamanho em: maiores que 4,0 mm; entre 2,8mm e 4 mm; entre 2,0mm e 2,8 mm e menores que 2,0 mm. A eficiência do aparelho foi definida pela soma da massa de fragmentos que passaram pela peneira de 2,0 mm somada à massa dos fragmentos não recuperados. Após 500 choques o HM3 foi mais eficiente (p=0,012). Após 2000 choques o HM3 obteve melhor fragmentação sem, contudo, alcançar diferença estatística (p=0,206). Foi excluído de cada grupo o cálculo com a menor massa de fragmentos <2mm e refeita a análise com cinco amostra por grupo. O HM3 apresentou melhores resultados tanto após 500 como após 2000 choques (p=0,008 e p=0,072, respectivamente). O HM3 possui vantagens de acoplamento ideal devido à imersão em água, assim como ponto focal (F2) aleatório e aumento progressivo da distância entre os pólos do eletrodo, que são características intrínsecas ao equipamento eletrohidráulico. Essas qualidades fazem do HM3 um aparelho mais eficiente. O método in vivo descrito é factível e consistente, revelando a superioridade do Dornier HM3® quando comparado ao Siemens Modularis®. / Abstract: Urinary stone treatment was revolutionized in 1980 by the development of extracorporeal lithotripter, which is capable of stone comminution by means of acoustic waves. Initially, extracorporeal shock wave lithotripsy (ESWL) was seen as the solution for all stone patients, but time has proved that there are limitations and that lithotripter evolution did not increase fragmentation rates. Modern generations of lithotripter did not produce comparable results to the Dornier HM3, the first electrohydraulic lithotripter, with an increase in re-treatment rates. The objective of this study was to describe an experimental model of in vivo lithotripsy and compare an electromagnetic device (Siemens Modularis) to the electrohydraulic HM3, considered the gold standard. Twelve female swines (n=24 kidneys) weighing on average 36 kg (34- 38 kg) underwent midline laparotomy and proximal ureterotomy for implantation of BegoStone Plus artificial stones in both kidneys. Stones measured 10 x 5 mm and weighed on average 0.452 (0.439 - 0.464 g). An original HM3 was set on 20kV and a new electrode used for each kidney. Modularis was set on energy level 4.0 and water based gel used as coupling agent. Upon treatment completion animals were euthanized and kidneys removed for fragment collection. Complete removal of fragments was confirmed by radiography. Fragments were then separated according to size (>4 mm, 2.8 - 4.0 mm, 2.0 - 2.8 mm, and <2.0 mm) using brass geological sieves. Efficiency was defined as the sum of fragment mass passing the 2 mm mash and those not recovered. After 500 shocks the HM3 had higher efficiency (p=0.012). At 2000 shocks HM3 had better comminution results, although statistical significance was not achieved (p=0.206). After exclusion of the calculus with the least mass of fragments <2mm for each group, HM3 presented better results than Modularis both after 500 and 2000 shocks (p=0.008 and 0.072, respectively). The HM3 has the advantages of ideal coupling, utilizing a water tub, as well as random focal point and spark gap increase, which are intrinsic to the electrohydraulic equipment These characteristics make the HM3 a more efficient lithotripter. The in vivo method described is feasible and consistent, revealing the superiority of HM3 when compared to the Siemens Modularis. / Universidade Estadual de Campi / Cirurgia / Doutor em Cirurgia

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This thesis was composed of three scientific papers. The first paper was the more comprehensive. All lesions of the urinary system of dogs necropsied between 1999 and 2010 were analyzed. In this time frame, 3,189 dogs were necropsied at the Laboratório de Patologia Veterinária of the Universidade Federal de Santa Maria (LPV-UFSM) and 1,063 had lesions in the urinary system. In most of the dogs (79.1%), lesions were single and in about 21% they were multiple, totalizing 1,373 lesions. Kidneys were 2.8 times more affected than the lower urinary tract (LUT). One third of the lesions in the urinary system were cause of spontaneous death or reason for euthanasia (SD/EUTH) of the affected dogs. The other lesions were considered incidental findings. The main renal lesions diagnosed were: tubulointerstitial nephritis, infarct, granulomatous nephritis, glomerulonephritis, metastatic/multicentric neoplasms, pyelonephritis/pyelitis, and hydronephrosis. The main LUT lesions were: cystitis, presence of viral inclusions bodies, urolithiasis, urinary bladder dilatation, urinary bladder rupture, and metastatic/multicentric neoplasms. Epidemiological aspects such as gender, breed, and age of affected dogs had significant variations according to the type of lesion diagnosed. Uremia was observed in a significant number of cases of SD/EUTH and was mostly due to renal lesions. The second paper was focused on urolithiasis. From 1990 to 2010, 4,872 dogs were necropsied at LPV-UFSM. Out of these, 1.5% had uroliths along the urinary tract. The epidemiological profile of the affected dogs showed predominance of males; adults; and pure breeds. Clinical signs suggestive of urolithiasis were informed in 30.3% of the dogs and consisted mainly of hematuria, anuria, dysuria and urinary incontinency. The uroliths were found in one or more anatomical sites, and the main affected ones, in descending order, were urinary bladder, kidney, and urethra. Secondary lesions to urolithiasis were observed in about 40% of the cases. The most prevalent were cystitis, urethral obstruction, hydroureter, hydronephrosis, urinary bladder rupture, and pyelonephritis. In 25% of the affected dogs, SD/EUTH occurred due to the secondary lesions of urolithiasis. Extra-renal lesions of uremia were observed in 9 out of the 76 cases. The third article was focused on urinary system neoplasms of dogs. The main purposes of this study were to establish the prevalence and types of primary and metastatic/multicentric neoplasms of the urinary system in dogs submitted to necropsy in about 21 years at the LPV-UFSM. Neoplasms of the urinary system were present in 113 (2.4%) dogs. Twenty seven were primary neoplasms and 86 were metastatic or part of a multicentric tumor. The majority of the primary neoplasms were of epithelial origin. Thirteen dogs had primary renal neoplasms (prevalence of 0.27% over all dogs necropsied). Cystadenocarcinoma/cystadenoma and renal cell carcinoma were the most prevalent primary renal neoplasms and transitional cell carcinoma was the most prevalent urinary bladder neoplasm. Metastatic or multicentric tumors affecting the urinary system were the most prevalent (76.1%); mesenchymal tumors were more common than epithelial tumors; most of them were localized in the kidney. Metastases of mammary tumors and multicentric lymphoma were the most prevalent histologic types. / Esta tese foi constituída de três partes que resultaram em três artigos científicos. O primeiro artigo foi o mais abrangente, onde todas as lesões do sistema urinário em cães necropsiados entre 1999 e 2010 foram analisadas. No período estudado foram necropsiados 3.189 cães no Laboratório de Patologia Veterinária da Universidade Federal de Santa Maria (LPV-UFSM) e destes, um terço (1.063) apresentou lesões no sistema urinário. Na maioria (79,1%) dos cães foram observadas lesões únicas e em aproximadamente 21% havia lesões múltiplas, totalizando 1.373 lesões. Os rins foram 2,8 vezes mais afetados que o trato urinário inferior (TUI). Um terço das lesões no sistema urinário foram causa de morte espontânea/eutanásia (ME/EUT). As demais foram consideradas achados incidentais. As principais lesões renais diagnosticadas foram: nefrite túbulo-intersticial, infarto, nefrite granulomatosa, glomerulonefrite, neoplasmas metastáticos/multicêntricos, pielonefrite/pielite e hidronefrose. As principais lesões do TUI diagnosticadas foram: cistite, presença de inclusões virais, urolitíase, dilatação da bexiga, ruptura de bexiga e neoplasmas metastáticos/multicêntricos. As características epidemiológicas como sexo, raça e idade dos cães afetados tiveram variações significativas de acordo com o tipo de lesão diagnosticada. Uremia foi observada em um número significativo de casos de ME/EUT e foi, principalmente, secundária a lesões renais. O segundo artigo enfocou a urolitíase. No período analisado (1990 2010) foram necropsiados 4.872 cães. Destes, 1,5% apresentaram urólitos ao longo do sistema urinário. O perfil epidemiológico mostrou o predomínio de cães machos; adultos; e com raça definida. Sinais clínicos indicativos de urolitíase foram computados em cerca de um terço dos casos e consistiram principalmente de hematúria, anúria, disúria e incontinência urinária. Os urólitos tiveram localização única ou múltipla e os locais anatômicos mais frequentemente acometimentos, em ordem decrescente de prevalência, foram bexiga, rim e uretra. Lesões secundárias à urolitíase foram observadas em aproximadamente 40% dos cães afetados. As mais prevalentes foram cistite, obstrução uretral, hidroureter, hidronefrose, ruptura vesical e pielonefrite. Em 25% do total de cães afetados ocorreu ME/EUT decorrentes das lesões secundárias à urolitíase. Uremia foi observada em 9 dos 76 casos. O terceiro artigo enfocou os neoplasmas que acometem o sistema urinário de cães. Nesse estudo foram determinados a prevalência e os tipos de neoplasmas primários e metastáticos/multicêntricos que ocorreram no sistema urinário de cães recebidos para necropsia no LPV-UFSM num período de aproximadamente 21 anos (janeiro de 1990 julho de 2010). Em 113 (2,4%) dos cães necropsiados no período estudado, foram diagnosticados 27 neoplasmas primários e 86 metastáticos ou como parte de tumores multicêntricos no sistema urinário. Dos neoplasmas primários, a grande maioria teve origem epitelial. Treze casos eram neoplasmas renais primários (0,27% do total de cães necropsiados). Cistadenocarcinoma/cistadenoma e o carcinoma de células renais foram os neoplasmas primários mais prevalentes no rim e o carcinoma de células de transição foi o mais prevalente na bexiga. Os neoplasmas metastáticos e multicêntricos que afetaram o sistema urinário foram os mais prevalentes (76,1%), com predomínio mesenquimal. Destes, a grande maioria estava localizada no rim e, quanto ao tipo histológico, as metástases de neoplasmas mamários e o linfoma multicêntrico predominaram.

Das ADAMTS16-Gen kodiert für eine Metalloproteinase, deren Funktion und Regulation bislang nicht beschrieben sind. Die ADAMTSs werden von Zellen verschiedener Organsysteme sezerniert und sind für den Abbau extrazellulärer Matrixbestandteile und die Prozessierung von Oberflächenrezeptoren, Signalmolekülen oder Wachstumsfaktoren verantwortlich. In der vorliegenden Arbeit wurden die gewebespezifische Lokalisation von Adamts16 und die möglichen Funktionen der Metalloproteinase im Urogenitalsystem untersucht. Weiterhin konnte die Regulation der Adamts16-Expression durch das Wilms-Tumor Protein beschrieben werden. In verschiedenen Zelllinien des Urogenitalsystems konnte eine Wt1-abhängige Adamts16-Expression festgestellt werden. Zudem erfolgte im Urogenitalsystem eine Koexpression von Adamts16 und Wt1 in embryonalen und adulten Podozyten, somatische Zellen der XX-Gonadenanlage und Granulosazellen und Epithelzellen des adulten Ovars. Im Testis war Adamts16 ohne signifikante Wt1-Koexpression in Spermatozyten und elongierten Spermatiden lokalisiert. Außerhalb des Urogenitalsystems waren Adamts16 und Wt1 im Epikard koexprimiert. Ein Wt1-Knockdown in Epikardzellen und embryonalen Nieren zeigte jeweils einen Rückgang des Adamts16-Expressionsniveaus. Ein Adamts16-Knockdown in embryonalen Nieren resultierte in verminderten Ureterverästelungen, was eine funktionelle Rolle von Adamts16 in der murinen Nierenentwicklung ex vivo andeutet. Der Wt1-Knockdown in Gonadenkulturen zeigte, dass Wt1 die Adamts16-Expression in XY-Gonaden hemmt, in XX-Gonaden hingegen aktiviert. Innerhalb des Adamts16-Gens konnten drei Wt1-Konsensusmotive identifiziert werden. Mit Hilfe von EMSAs und ChIPs konnte die Bindung der Wt1(-KTS)-Isoform an diese Konsensusmotive belegt werden. Ein Reportergenassay zeigte die Aktivierung des Adamts16-Promotors durch Wt1(-KTS) in Granulosazellen, wobei eine Verkürzung der Adamts16-Promotorsequenz zu einer Reduktion der Promotoraktivität führte. / The Adamts16 gene encodes for a metalloproteinase, whose function and regulation is hardly explored. ADAMTSs are secreted by different cells of various organs and are responsible for breaking down extracellular matrix compounds and processing signaling molecules, growth factors and surface receptors. In this work the tissue specific localization of Adamts16 and its possible function and regulation within the genito-urinary system were analyzed. Furthermore the regulation of Adamts16 through the wilms tumor transcription factor Wt1 is described. Different cell lines derived from the genito-urinary system showed a Wt1-dependent mRNA expression of Adamts16. In addition both proteins were co-expressed in embryonic and adult podocytes, somatic cells of the embryonic XX-gonad and granulosa and epithelial cells of the adult ovary. The testes showed a Wt1-independent Adamts16 expression in spermatocytes and elongated spermatids. Outside the genito-urinary system Adamts16 and Wt1 were co-expressed in the epicardium. Knockdown of Wt1 in both epicardial cells and embryonic kidney explants showed a decrease in the Adamts16 mRNA expression level. In turn the Knockdown of Adamts16 led to an inhibited branching morphogenesis in embryonic kidney explants. This indicates a functional role of Adamts16 in the ex vivo kidney development. Knockdown of Wt1 in cultured embryonic gonads revealed that Wt1 inhibits the expression of Adamts16 in XY-gonads but activates it in XX-gonads. Three Wt1 consensus motives were identified within the Adamts16 gene. Using EMSA and ChIP the binding of the Wt1(-KTS)-isoform to all three consensus motives was verified. The ability of Wt1 to activate the Adamts16 promoter was confirmed through reporter gene assays in granulosa cells.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-04T13:46:25Z No. of bitstreams: 1 Graziele Ribeiro Bitencourt.pdf: 1711818 bytes, checksum: 645e2fdf583da945434702493ca5e33d (MD5) / Made available in DSpace on 2015-12-04T13:46:25Z (GMT). No. of bitstreams: 1 Graziele Ribeiro Bitencourt.pdf: 1711818 bytes, checksum: 645e2fdf583da945434702493ca5e33d (MD5) Previous issue date: 2012 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Introdução: Trata-se de um estudo de validação do resultado de enfermagem Eliminação urinária da Classificação de Resultados de Enfermagem (NOC) em idosos no pós-operatório. Com isso, tem-se como objetivos: validar o Resultado de Enfermagem Eliminação Urinária em idosos hospitalizados; identificar na literatura os possíveis critérios de levantamento dos níveis de 1 a 5 para o resultado Eliminação Urinária; avaliar os critérios dos níveis de 1 a 5 do resultado de enfermagem Eliminação Urinária em idosos em pós-operatório longitudinalmente; e analisar o resultado das ações de enfermagem no idoso com eliminação urinária prejudicada no pós operatório. Como método, adotaram-se 2 fases. A primeira consistiu na revisão integrativa, a partir da questão de quais os critérios para avaliação dos indicadores do Resultado de Enfermagem Eliminação urinária no idoso em pós-operatório. Para discuti-la, analisaram-se a partir dos descritores Sistema urinário; Enfermagem perioperaória;Idoso; avaliação em enfermagem os artigos presentes nas bases de dados CINAHL, LILACS, SCOPUS E MEDLINE publicados entre os anos de 2002 a 2011 em português ou inglês. Como produto, elaborou-se um formulário com os critérios de avalição dos indicadores do resultado de enfermagem em estudo. A segunda fase compreendeu na investigação clinica de 103 idosos em pós-operatório avaliados por 2 especialistas em enfermagem gerontológica e médico-cirúrgica. Acompanharam-se os sujeitos diariamente desde o primeiro dia de pós-operatório imediato até a alta hospitalar. Como resultados, Na fase 1, 41 estudos contribuíram com os critérios de análise dos indicadores. Observou-se 10(24,4%) publicados em 2007; 23(56,1%) na área de enfermagem, sendo que 29(70,7%) referia-se a diagnóstico médico e 2 específicos de diagnóstico enfermagem; e 38(92,1%) com grau de recomendação C.A maioria dos métodos de avaliação abordou a observação pela equipe de enfermagem, na transparência e cor da urina; entrevista com as informações do paciente nos indicadores dor e ardência ao urinar, hesitação e frequência urinária; bem como a noctúria. A fita reagente também contribuiu com a análise dos indicadores odor, partículas, e sangue na urina. Na fase2, dos 103 idosos, observa-se (67%) do sexo feminino; entre 65 e 74 anos; 49(47,6%) casados; e 24(23,3%) da especialidade cirúrgica urológica; 56(54,4%) de 3 a 5 dias de pós-operatório; e (61,2%) sem eliminação urinária prejudicada no pré-operatório. O grau de concordância dos avaliadores foi maior no esvaziamento completo da bexiga (0,928) e presença de leucócitos (0,885). Já a quantidade de urina (0,262) e frequência urinária (0,307) apresentaram menor concordância. Observa-se ainda que quanto mais velhos os idosos pioro esvaziamento completo da bexiga (-0,241), e a ardência ao urinar (-0,196). Como conclusão, há necessidade de estudos clínicos que abordem as faixas etárias na determinação dos critérios e as melhores práticas na avaliação urinária dos resultados de enfermagem. E aoacompanhar o idoso em pós-operatório, com o avançar da idade e/ou com os dias de pós-operatório, alguns deles apresentaram comportamentos variados. / Introduction: This is a validation study of the outcome nursing in urinary elimination of Nursing Outcomes Classification (NOC) in elderly postoperative. Thus, we have the following aims: to validate the outcomes in Urinary Elimination in hospitalized aged; to identify possible criteria in the literature survey of levels 1 to 5 to the outcome Urinary Elimination; to evaluate the criteria levels 1 to 5 Urinary Elimination outcome nursing in aged postoperative patients longitudinally, and to analyze the outcome in nursing actions in the aged with impaired urinary elimination postoperative. Method: we adopted two steps. The first consisted in a integrative review, from the question of what criteria for evaluation of indicators of outcome nursing urinary elimination for aged in postoperative. To discuss it, we analyzed the descriptors Urinary System; Perioperative Nursing; Elderly nursing assessment items present in the databases CINAHL, LILACS, SCOPUS and MEDLINE published between the years 2002 to 2011 in English or Portuguese. As a product, we prepared a form with the criteria avalição indicators of the outcome under study nursing. The second phase consisted in the clinical investigation of 103 elderly postoperative patients evaluated by two experts in gerontological nursing and medical-surgical. The subjects followed up daily from the first day of early postoperative until discharge. As a result, at 1st step, 41 studies contributed to the analysis criteria of the indicators. We observed 10 (24.4%) published in 2007, 23 (56.1%) in nursing, and 29 (70.7%) referred to two specific medical diagnosis and nursing diagnosis and 38 (92.1%) with grade of recommendation C. Most methods of evaluation addressed the observation by nursing staff, transparency and color of urine; interview with patient information on indicators pain and burning on urination, hesitancy and urinary frequency, and nocturia. The dipstick also contributed to the analysis of indicators odor, particulates, and blood in the urine. At 2nd step, we observed the most people were female(67%), between 65 and 74 years, 49 (47.6%) were married, and 24 (23.3%) of surgical specialty urology, 56 (54 4%) of 3 to 5 days postoperatively, and (61.2%) without urinary elimination impaired preoperatively. The concordance of evaluators was higher in complete emptying of the bladder (0.928) and leukocytes (0.885). The quantity of urine (0.262) and urinary frequency (0.307) showed less agreement. It was also observed that the older the elderly worse complete emptying of the bladder (-0.241), and burning during urination (-0.196). As aconclusion,we need for clinical studies that address the age groups in determining the criteria and best practices in the evaluation of urinary results nursing. And to accompany the elderly postoperative patients with advancing age and / or the days after surgery, some of them had varied behaviors