Dissertations / Theses on the topic 'Neuropatias'
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Camargo, Marcela Regina de [UNESP]. "Parâmetros espaço temporais da marcha e inter-relação com equilíbrio e força muscular isométrica de tornozelos em diabéticos com neuropatia periférica." Universidade Estadual Paulista (UNESP), 2009. http://hdl.handle.net/11449/87311.
Full textCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
O Diabetes mellitus é uma enfermidade crônica que leva a alterações sensitivas e motoras. Tais alterações comprometem o equilíbrio e a deambulação predispondo seus portadores à ocorrência de quedas. Esta revisão teve por objetivo levantar, na literatura recente, estudos que visassem avaliar parâmetros da marcha e aspectos envolvidos com a deambulação. Para isso, foi realizada uma busca nas bases de dados MEDLINE, SciELO, LILACS e PEDro, cruzando as palavras-chaves: Neuropatias Diabéticas x Marcha; Diabetes Mellitus x Marcha e Pé Diabético x Marcha. Após passarem pelos critérios de seleção, foram obtidos 15 artigos, os quais foram sintetizados e discutidos, sendo, portanto, incluídos nesta revisão. Ficou claro que a neuropatia diabética leva a déficits na amplitude do passo, velocidade e cadência da marcha em superfícies planas, sem mudanças bruscas de direção ou paradas, e, déficits de equilíbrio e coordenação em aclives, declives e terrenos irregulares. Acarreta, também, aumento dos índices de pressão plantar e, devido à alteração de ativação do tríceps sural, dificuldade na fase de apoio terminal e prébalanço. Assim, o próximo contato inicial ocorrerá de maneira inadequada, com o antepé e sem absorção de choques.
Diabetes mellitus is a chronic disease that leads to sensory-motor changes. These changes affect balance and walking predisposing their patients to falls occurrence. This review aimed to investigate, in recent literature, assessing gait parameters and walking studies involved aspects. For this, a search was conducted in databases MEDLINE, SciELO, LILACS and PEDro, crossing the keywords: Diabetic neuropathies x Gait; Diabetes Mellitus x Gait and Diabetic Foot x Gait. After passing by selection criteria, it was remainder 15 articles, which were synthesized, discussed and is therefore included in this review. It was clear that diabetic neuropathy leads to deficits in the step amplitude, gait velocity and gait cadence on flat surfaces, without sudden changes of direction or stops, and balance and coordination deficits in slopes and uneven terrain. Diabetic neuropathies, provide, also increase plantar pressure rates due to the triceps sural activation change, difficulty in the terminal phase of support and pre-assessment. Thus, the next initial contact occurs in an inadequate way, with the forefoot and without absorption of shocks.
Lourenço, Paula Marques. "Aspectos clínico-neurológicos da neuropatia motora multifocal." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/17/17161/tde-05122016-145344/.
Full textThe multifocal motor neuropathy (MMN) is an inflammatory neuropathy that has low prevalence (0.6 / 100,000 patients). It is characterized by progressive, asymmetric and distal muscle weakness without sensory impairment. The MMN can mimic amyotrophic lateral sclerosis (ALS), other motor neuron disease variants and other chronic inflammatory demyelinating polyneuropathy, with asymmetric start. Differentiation is important, given the specificities of the development and treatment of these neuropathies. The main electrophysiological finding is the nerve conduction block in the absence of sensory abnormalities. The pathophysiology of MMN is little known. The frequent finding of circulating antibodies against monoassialogangliosides (GM1) is suggestive that there may be their involvement in nodal and perinodal structural changes with multifocal impairment of nerve conduction. The corollary of these disorders is paresis and paralysis, with also multifocal distribution. The human immunoglobulin intravenously in high doses constitutes the treatment of choice. New alternative treatment strategies are needed to prevent permanent muscle weakness and disability. Few studies and literature reviews have elucidated the clinical features of MMN and there are no case series publications in the national literature. In this study, from a retrospective review, will be assessed clinic and electrophysiological features of MMN in order to obtain a greater understanding of disease progression.
Matias, Ana Luísa Romualdo. "Interpretação clínica da histopatologia nas neuropatias congénitas intestinais." Dissertação, Instituto de Ciências Biomédicas Abel Salazar, 2010. http://hdl.handle.net/10216/62155.
Full textMatias, Ana Luísa Romualdo. "Interpretação clínica da histopatologia nas neuropatias congénitas intestinais." Master's thesis, Instituto de Ciências Biomédicas Abel Salazar, 2010. http://hdl.handle.net/10216/62155.
Full textGieseler, Ronny Knoch. "Sistema de avaliação de sudorese para detecção de neuropatias em diabetes." reponame:Repositório Institucional da UFSC, 2017. https://repositorio.ufsc.br/xmlui/handle/123456789/181456.
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Introdução: Testes de velocidade de condução nervosa (VCN) são realizados para detecção de neuropatias, mas estes testes são caros e pouco utilizados na rotina clínica de indivíduos com diabetes nos hospitais do Brasil. Uma forma secundária de detecção de neuropatia é a avaliação da função sudorípara, que sofre danos decorrentes da neuropatia. Uma forma já utilizada para esse diagnóstico e estudada neste trabalho estimula e analisa a função das glândulas sudoríparas com uma diferença de potencial elétrico contínuo no tempo. Outra forma também apresentada neste trabalho é por meio de espectroscopia de bioimpedância. Objetivo: Desenvolver um sistema de instrumentação e análise para estimular as glândulas sudoríparas das mãos e dos pés, visando detectar a neuropatia diabética ligada as alterações de sudorese e as variações no espectro de frequências, entre voluntários sem diabetes e com diabetes. Materiais e Métodos: Os dados de bioimpedância foram coletados e processados por meio de uma interface gráfica em C# com um aparato que utiliza conversores A/D, D/A, filtros e amplificadores com tratamento básico em FPGA e enviando essa informação via USB para um computador, que processa e apresenta os sinais. O sistema estimula as glândulas sudoríparas das mãos e dos pés com uma diferença de potencial de, no máximo, 4,0 Volts, composta de um sinal de 1,5 Volts CC e das frequências de 50 kHz, 100 kHz, 200 kHz, 300 kHz, 400 kHz, 500 kHz, 600 kHz, 700 kHz, 800 kHz e 900 kHz por meio de eletrodos de aço inoxidável em um período de 5 minutos. Foram analisados, no Hospital Universitário da UFSC, 24 pacientes com diabetes mellitus tipo 1 ou 2, sendo 8 destes com neuropatia. Os dados foram posteriormente trabalhados e comparados com 19 indivíduos sem diabetes por meio de scripts desenvolvido em Matlab. Resultados: O sistema eletrônico respondeu bem no decorrer dos testes, a interface em C# tornou mais prática a visualização dos dados. A utilização de valores absolutos de impedância forneceu uma correlação de p = 0,108 para a análise das mãos entre pacientes com neuropatia e sem diabetes, mas não suficiente para ser o único teste paradiagnóstico de neuropatia. A caracterização elétrica dos membros inferiores e superiores mostraram diferenças na característica capacitiva da camada lipídica com um aumento médio de 48% do valor capacitivo nas mãos. Conclusão: Os testes apresentados ainda precisam ser feitos com um grupo maior, já que não houve confirmação estatística devido a pequena quantidade de pacientes com neuropatia. Mesmo assim esta abordagem trouxe uma nova maneira utilizando a comparação do modelo elétrico para a detecção de neuropatias de forma simples e que apresenta potencial para aplicação no screening e avaliação dos indivíduos com diabetes.
Abstract : Introduction: Nerve conduction velocity tests (NCV) are performed for the detection of neuropathies, but these tests are expensive and rarely used in the clinical routine of individuals with diabetes in Brazilian hospitals. A secondary form of neuropathy detection is evaluation of the sweat function, which is damaged by neuropathy. A form already used for this diagnosis and studied in this work stimulates and analyzes the function of the sweat glands with a continuous electrical potential difference over time. Another form also presented in this work is by means of bioimpedance spectroscopy. Objective: To develop an instrumentation and analysis system to stimulate the sweat glands of the hands and feet with a DC signal superimposed by a multifrequential sinusoidal part to detect diabetic neuropathy associated with changes in sweating and variations in the frequency spectrum between volunteers without diabetes and with diabetes. Material and Method: The bioimpedance data were collected and processed through a C # graphical interface with an apparatus that uses A/D, D/A converters, filters and amplifiers. Initial data processing was carried outin FPGA, sending this information via USB to a computer that processes and displays the signals. The system stimulates the sweat glands of the hands and feet with a difference of voltageof 4.0 Volts, composed of 1,5Volts of DC current and frequencies of50 kHz, 100 kHz, 200 kHz, 300 kHz, 400 kHz, 500 kHz, 600 kHz, 700 kHz, 800 kHz e 900 kHz through stainless steel electrodes for a period of 5 minutes. Twenty-four patients with type 1 or type 2 diabetes mellitus, 8 of them with neuropathy, were analyzed at the UFSC University Hospital. These data were compared to data of 19 individuals without diabetes, using scripts developed in Matlab. Results: The electronic system responded well throughout the tests, the interface in C # made it more practical to view and analyse the data. The use of absolute impedance values provided a correlation of p = 0.108 for hand analysis between neuropathy and non-diabetic patients, but not sufficient to be the only diagnostic test for neuropathy. The electrical characterization of the lower and upper limbsshowed differences in the capacitive characteristic of the lipid layer with an average increase of 48% of the capacitive value in the hands. Conclusion: The tests presented still need to be done with a larger group, since there was no statistical confirmation due to the small number of patients with neuropathy. Therefore, this approach brought a new way for the detection of neuropathies, which is simple and presents the potential for application in the screening and evaluation of individuals with diabetes.
Gomes, Aline Arcanjo. "Cinemática de quadril, joelho e tornozelo e a atividade muscular de membros inferiores no ciclo completo da marcha de diabéticos neuropatas em diferentes cadências." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5163/tde-24022010-171458/.
Full textHip, knee and ankle kinematics and lower limbs muscle activity in the whole gait cycle of diabetic neuropathic individuals in different cadences
Onodera, Andrea Naomi. "Avaliação comparativa do padrão de locomoção em atividades da vida diária de diabéticos neuropatas por meio de eletromiografia de superfície e cinemática." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/5/5163/tde-27052010-155605/.
Full textThe diabetic neuropathy is one of the main chronic complications of Diabetes Mellitus which causes damage to somatosensory and motor control systems resulting in biomechanical alterations in locomotion patterns. Locomotion activities with greater mechanical and balance demands might be considered a risk factor for ulcer formation in diabetic neuropathic patients. Therefore, to have a better understanding of the diabetic neuropatic interference in the daily life of these individuals, it is essential to evaluate the biomechanics of lower limbs during real life activities. The aim of this study was to investigate the influence of the diabetic neuropathy in the discrete characteristics and in time series of muscle activation patterns, using superficial EMG, and sagittal kinematics, using electrogoniometers, of lower limbs during stair management in diabetics (n=23) and non-diabetic individuals (n=23). The discrete analyses were done by discrete variables of VL, GM and TA linear envelopes and the sagittal angular variation of hip, knee and ankle. These variables were compared between groups in each motor task, by t test for independent samples ( = 0.05). The analyses of electromyographic and sagittal angular variation time series were performed by cross-correlation of each serie between groups. Moreover, the strength of the phase relationship between muscle activity of VL, TA and GM with the angular variation of knee and ankle was assessed in each group. The correlation coefficients of these relationships were compared between groups by independent t tests ( = 0.05). The main findings showed that during the stair ascent, diabetics had lower ankle extension at the end of stance phase, and while projecting their body forward during the first half of stance, their ankle flexion angle was also smaller. Because of that, there was a worse ankle positioning in the beginning of the stance, necessary for an efficient action of VL. The mechanical disadvantage of VL observed in diabetic neuropathic patients at the beginning of the stance phase may have triggered an increased activation in the same muscle at the end of stance in the contralateral leg. In the stair descent, diabetics had lower ankle extension at the beginning of stance, but did not show significant alterations in EMG. In the time series analysis, the EMG signals of all muscles presented higher similarities in timing across time series between groups for stair ascent and descent. The correlation obtained between groups for the muscle activity and angular variation amongst all evaluated relationships were statistically lower in the diabetic group for stair ascent (for VL-knee and GM-ankle (both groups presented weak relation), except for the relation between TA and ankle joint variation, which was moderate for the diabetic individuals and weak for controls. In the stair descent, the correlations were similar between groups (moderate relation for VL- knee and GM - ankle, and a weak relation for TA - ankle). Apparently, the stair ascent explicited motor deficits caused by diabetic neuropathy in the discrete analysis and also in the time series analysis. Although the similarities in the time series in the stair descent, qualitative shape differences were observed, suggesting a impaired pattern of motor recruitment in neuropathic patients. In summary, diabetic neuropathic individuals presented an altered ankle kinematic and VL and TA muscles activities patterns during these real life activities, and also altered coordination between muscle activity of knee and ankle and adjacent joint motion. These facts, combined to higher vertical impacts of stair ascent and descent might raise the plantar ulceration risks in the daily activities of diabetic neuropathic individuals
Ferrari, Giselle Lopes. "Pupilometria dinâmica: aplicação na detecção e avaliação da neuropatia autonômica diabética e estudo da correlação entre a resposta temporal da pupila ao estímulo visual e a glicemia." Universidade Tecnológica Federal do Paraná, 2008. http://repositorio.utfpr.edu.br/jspui/handle/1/129.
Full textAutonomic neuropathy (AN) is a common and serious complication of diabetes. Early detection is essential to enable appropriate interventional therapy. Dynamic pupillometry has been proposed as simples and more sensitive tool to detect subclinical autonomic dysfunction. Moreover, the effect of actual glycaemia on autonomic function in diabetic subjects is unknown. The aims of this study weere: 1) to investigate pupil responsiveness in diabetic subjects with and without cardiovascular autonomic neuropathy (CAN), and in diabetic subjects with and without diabetic peripheral neuropathy (DPN) using dynamic pupillometry and, 2) to study the correlation between the pupil responsiveness in diabetic subjects and the actual glycaemia. In the first study, two tests were applied. during the first test, one flash was administered and the pupil response recorded for 3 seconds. In the second test, twenty-five flashes at one-second intervals were administered and the pupil response recorded for 30 seconds. Several time related parameters were computed from the results. A total of 36 diabetic subjects and 22 healthy volunteers took part in the study. Our results show that diabetic subjects with and without CAN, and with or without DPN have sympathetic and parasympathetic dysfunction evidenced by diminished amplitude reflexes and significant smaller pupil diameter. It suggests that pupillary autonomic dysfunction occurs early, before a more generalized involvement of the autonomic nervous system. In the second study, only the first test was applied in 4 diabetic subjects at three levels of glycaemia. Our results show that the pupil responsiveness is not affect of actual glycaemia. Dynamic pupillometry may provide a simple, inexpensive and non-invasive tool to screen high-risk diabetic patients for diabetic autonomic neuropathy.
Monteiro, Filipe Almeida. "Insights on signal transduction pathways involved in familial amyloidotic polyneuropathy neurodegeneration." Tese, Porto : Edição do Autor, 2006. http://catalogo.up.pt/F?func=find-b&local_base=UPB01&find_code=SYS&request=000105409.
Full textMonteiro, Filipe Almeida. "Insights on signal transduction pathways involved in familial amyloidotic polyneuropathy neurodegeneration." Doctoral thesis, Porto : Edição do Autor, 2006. http://hdl.handle.net/10216/64588.
Full textPontes, Clarisse Mourão Melo. "Neuropatia autonômica cardiovascular precoce em pacientes com lipodistrofia generalizada congênita." reponame:Repositório Institucional da UFC, 2016. http://www.repositorio.ufc.br/handle/riufc/20130.
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The metabolic abnormalities of congenital generalized lipodystrophy (LGC) can present with severe dyslipidemia, diabetes mellitus (DM) difficult to control and microvascular complications, among which diabetic neuropathy. Nevertheless, the evaluation of different forms of neuropathy, including the study of cardiovascular autonomic modulation in these patients is limited. It is believed that hyperglycemia alone can not explain all the pathophysiology of nerve injury and among the factors potentially involved the development stand to insulin resistance (IR) and abnormal lipid metabolism. It also observes association between cardiovascular autonomic neuropathy (CAN), inflammation, kidney disease and left ventricular hypertrophy (LVH). These observations make LGC an interesting biological model to study the mechanisms likely associated with these complications. The objectives of this study were to determine the prevalence of NAC through the evaluation tests of heart rate variability (HRV) and to analyze the association between clinical and metabolic markers, autonomic tests and cardiovascular parameters in patients with LGC. This was cross-sectional study conducted in the pediatric endocrinology clinic of the University Hospital Walter Cantídio, from October 2013 to December 2015. We included 10 patients with LGC, 20 individuals with DM1 and 20 healthy participants who underwent assessment clinical, laboratory exams and imaging, molecular analysis, measurement of mass index of VE (LVMI), QTc and thickness mean carotid intima (CEMI). For diagnosis of NAC were performed cardiovascular autonomic reflex tests - Valsalva coefficients (VAL), respiratory (E / I), orthostatic (30/15) and test of postural hypotension (THP) - and the spectral analysis of HRV - components very low frequency (VLF), low (FB) and high (AF). The clinical diagnosis of NAC was defined by the presence of at least two abnormal reflex tests. The results were expressed as median (min; max) and absolute and percentage frequency. We used Fisher's exact test, Mann-Whitney, Spearman correlation and resampling technique Bootstrap, Program: stata 13. Significant p <0.05. In the LGC group, six (60%) were female, age was 12 years (7; 30), 1 (10%) pre-pubescent, 7 (70%) pubescent and two 2 adults. There was no difference in age, sex, pubertal stage, and BMI between groups. All patients had LGC dyslipidemia, DM 70%, 60% and 30% nephropathy sensorimotor neuropathy. A higher prevalence of clinical NAC in patients with LGC (40%) compared to DM1 group (5%) and healthy (0%); p <0.05. A significant reduction in the ratio E / I and FMB components FB and FA in the LGC group vs DM1 and healthy and lower values of 30/15 and VAL coefficients in the LGC group vs healthy (p <0.05). Patients with LGC showed a high prevalence of LVH (40% vs. 0%; p = 0.008). In patients with LGC, cardiovascular autonomic tests were associated with HbA1c, HOMA-IR, triglycerides, CRP, albuminuria, LVMI and interventricular septum thickness (p <0.05). When evaluating the LGC and healthy groups, leptin levels associated with the 30/15 coefficient even after adjustment for triglycerides and insulin resistance (r = 0.396; p = 0.036). In conclusion, it was demonstrated a high prevalence of NAC in young patients with LGC, even compared to a group of DM1. These findings suggest that IR and hypertriglyceridemia may be involved in the early development of NAC. It was also observed association between leptin and cardiovascular autonomic modulation; it is noteworthy, however, that further studies are needed to evaluate the role of hipoleptinemia this context. The association between LVH and parameters of evaluation of cardiac autonomic modulation allows speculate that NAC may be involved in the pathogenesis of this complication in these patients.
As anormalidades metabólicas da lipodistrofia generalizada congênita (LGC) podem cursar com dislipidemia grave, diabetes mellitus (DM) de difícil controle e complicações microvasculares, dentre as quais a neuropatia diabética. Apesar disso, a avaliação das diferentes formas de neuropatia, incluindo o estudo da modulação autonômica cardiovascular, nesses doentes, é escassa. Acredita-se que a hiperglicemia isoladamente não explique toda a fisiopatologia da lesão neural e, dentre os fatores potencialmente envolvidos ao seu desenvolvimento destacam-se a resistência à insulina (RI) e o metabolismo anormal dos lipídios. Observa-se ainda associação entre neuropatia autonômica cardiovascular (NAC), inflamação, nefropatia e hipertrofia ventricular esquerda (HVE). Essas observações fazem da LGC um interessante modelo biológico para o estudo dos mecanismos provavelmente associados a essas complicações. Os objetivos desse estudo foram determinar a prevalência de NAC através dos testes de avaliação da variabilidade da frequência cardíaca (VFC) e analisar a associação entre os marcadores clínicos e metabólicos, os testes autonômicos e os parâmetros cardiovasculares nos pacientes com LGC. Tratou-se de estudo transversal realizado no Ambulatório de Endocrinologia Pediátrica do Hospital Universitário Walter Cantídio, no período de outubro de 2013 a dezembro de 2015. Foram incluídos 10 pacientes com LGC, 20 indivíduos com de DM1 e 20 participantes saudáveis que foram submetidos à avaliação clínica, coleta de exames laboratoriais e de imagem, estudo molecular, mensuração do índice de massa de VE (IMVE), do intervalo QTc e da espessura média intimal carotídea (cEMI). Para diagnóstico da NAC foram realizados os testes reflexos autonômicos cardiovasculares – coeficientes de valsalva (VAL), respiratório (E/I), ortostático (30/15) e teste da hipotensão postural (THP) – e a análise espectral da VFC – componentes de frequência muito baixa (FMB), baixa (FB) e alta (FA). O diagnóstico de NAC clínica foi definido pela presença de pelo menos dois testes reflexos alterados. Os resultados foram expressos em mediana (mín; máx) e em frequência absoluta e percentual. Foram utilizados o teste exato de Fisher, Mann-Whitney, correlação de Spearman e a técnica de reamostragem Bootstrap, Programa: stata 13. Significante p<0,05. No grupo LGC, seis (60%) eram do sexo feminino, a idade foi 12 anos (7; 30), sendo 1 (10%) pré-púbere, 7 (70%) púberes e dois 2 adultos. Não se observou diferença de idade, sexo, estadiamento puberal e IMC entre os grupos. Todos os pacientes com LGC tinham dislipidemia, 70% DM, 60% nefropatia e 30% neuropatia sensitivomotora. Observou-se maior prevalência de NAC clínica entre os pacientes com LGC (40%) em comparação aos grupos DM1 (5%) e saudáveis (0%); p<0,05. Observou-se redução significativa do coeficiente E/I e dos componentes de FMB, FB e FA no grupo LGC vs DM1 e saudáveis e menores valores dos coeficientes 30/15 e VAL no grupo LGC vs saudáveis (p<0,05). Os pacientes com LGC apresentaram elevada prevalência de HVE (40% vs 0%; p=0,008). Nos pacientes com LGC, os testes autonômicos cardiovasculares se associaram com HbA1c, HOMA-IR, triglicerídeos, PCRus, albuminúria, IMVE e espessura do septo interventricular (p<0,05). Ao se avaliar os grupos LGC e saudáveis, os níveis de leptina de associaram com o coeficiente 30/15 mesmo após ajuste para triglicerídeos e resistência à insulina (r=0,396; p=0,036). Em conclusão, demonstrou-se uma elevada prevalência de NAC em pacientes jovens com LGC, mesmo em comparação a um grupo de DM1. Esses achados sugerem que a RI e a hipertrigliceridemia podem estar envolvidas no desenvolvimento precoce da NAC. Observou-se ainda associação entre a leptinemia e a modulação autonômica cardiovascular; ressalta-se, no entanto, que estudos adicionais são necessários para se avaliar o papel da hipoleptinemia nesse contexto. A associação entre HVE e os parâmetros de avaliação da modulação autonômica cardíaca permite especular que a NAC pode estar envolvida na fisiopatogênese dessa complicação nesses pacientes.
Cardoso, Isabel dos Santos. "Dynamics of transthyretin fibrillogenesis : contribution to therapeutic approaches in familial amyloidotic polyneuropathy." Tese, Porto : Edição do Autor, 2002. http://catalogo.up.pt/F?func=find-b&local_base=UPB01&find_code=SYS&request=000090157.
Full textSchwingel, Tania Elaine. "Efeitos dos compostos quercetina, quercetina em nanoemulsão, resveratrol e rutina sobre a hepatotoxicidade e neurotoxicidade induzidas por oxaliplatina em camundongos." Pontifícia Universidade Católica do Rio Grande do Sul, 2013. http://hdl.handle.net/10923/5521.
Full textIntroduction : Oxaliplatin is an antineoplastic agent widely used in the treatment of some tumors. It is a third-generation platinum compound developed with the purpose of overcoming the limitations of toxicity, tumor resistance and poor oral bioavailability associated to cisplatin administration. Oxaliplatin-associated neurotoxicity represents the main dose limiting and there is not suitable treatment. Increasing doses of oxaliplatin can leed to the development of mechanical allodynia, cold sensitivity and peripheral sensory neuropathy, with increase of symptoms. Furthermore, despite its usefulness, chemotherapy with oxaliplatin increases the rate of developing hepatic damages together with inflammatory activity. This might be termed chemotherapy-associated steatohepatitis (CASH), a most severe form of non-alcoholic fatty liver disease. Therefore, in the presentstudy, we aimed to compare the effect of antioxidant compounds on simultaneous development of oxaliplatin-induced hepato and neurotoxicity in mice. Methods : The Balb/c mice were treated with doses of oxaliplatin (OXA) for 6 weeks, 10 mg/kg, intraperitoneally (i. p), resulting in mechanical allodynia, and hepatic steatosis. We administered antioxidants compounds such as rutin (RUT) (20 mg/Kg/d), resveratrol (RVS) (100 mg/Kg/d), quercetin (QT) (20 mg/Kg/d) and nanoquerecetin (NQT) (20 mg/Kg/d) daily by gavageto Balb/c. N-acetyl-cysteine was used as control. Euthanasiaoccurred onday 43after treatment. We evaluated mechanical nociceptive threshold, ALT/AST, histopathological analysisand MPOactivity. Statistical analyses were made one way ANOVA, followed by Bonferroni post hoc test. Results : The treatments with RSV, RUT or NQT were able to prevent mechanical allodynia when compared to OXA group. Regarding the effect on steatohepatitis, resveratrol, quercetin and quercetin nanoemulsion almost completely reversed the mean liver weight increase by OXA. In accordance with these previous data, histological evaluation depicted attenuation all features of hepatic steatosis evaluated in resveratrol, rutin, quercetin and quercetin nanoemulsion groups. On the other hand, only quercetin and quercetin nanoemulsion treatments were able to reduce neutrophils migration measured by MPO activity. Conclusion : These results suggest that the use of compounds such as resveratrol, rutin, quercetin and quercetin nanoemulsion can beeffective to avoid oxaliplatin-inducing hepato and neurotoxicity in a rodent model.
Introdução : A oxaliplatina é um agente antineoplásico e tem sido amplamenteutilizado no tratamento de vários tumores. É um composto derivado da platina de terceira geração desenvolvido com o propósito de ultrapassar as limitações da toxicidade, a resistência do tumor e a fraca biodisponibilidade oral associada à administração decisplatina. Sintomas de neurotoxicidade estão associados ao uso da oxaliplatina e não existe tratamento adequado. Doses crescentes de oxaliplatina podem levar ao desenvolvimento de sensibilidade a frio e neuropatia sensorial periférica, e a um aumento da intensidade dos sintomas. Além disso, apesar da sua utilidade, a quimioterapia aumenta a taxa de desenvolvimento de danos hepáticos com atividade inflamatória. Esta manifestação pode ser chamada de esteato-hepatite associada à quimioterapia (CASH), uma forma mais grave da doença hepática gordurosa não alcoólica. Deste modo, o presente estudo, objetivou comparar o efeito de alguns compostos antioxidantes no desenvolvimento simultâneo da hepato e neurotoxicidade induzida pela oxaliplatina em camundungos.Métodos : Os camundongos Balb/c foram tratados intraperitonealmente (i. p. ), com doses de 10 mg/kg de oxaliplatina durante 6 semanas, resultando em anodinia mecânica, e indução de esteatose hepática. Os compostos rutina (RUT) (20 mg/Kg/d), resveratrol (RSV) (100 mg/Kg/dia), quercetina (QT) (20 mg/Kg/dia) e nanoquerecetina (NQT) (20 mg/Kg/dia), foram administrados diariamente por gavagem aos camundongos. N-acetilcisteína foi utilizada como controle. A eutanásia ocorreu no 43º dia após o tratamento. Foram analisadas a nocicepção mecânica, as aminotransferases ALT/AST, foi realizada avaliação histopatológica e da atividade da mieloperoxidase. A análise estatística foi realizada por ANOVA de uma via seguida do teste de Bonferroni. Resultados : Os tratamentos comresveratrol, rutinaouquercetina em nanoemulsãoforam capazes de impedira alodiniamecânica, quandocomparados com o grupotratado com oxaliplatina. Em relação aoefeito sobre aesteato-hepatite, os tratamentos com resveratrol, quercetina e quercetina em nanoemulsãoreverteramsignificativamenteoaumento depeso médio do fígadoinduzido pela oxaliplatina. Corroborando com estes dados, a avaliaçãohistológicamostrou uma atenuação em todas as características deesteatose hepática avaliados nos grupostratados com resveratrol, rutina, quercetina e quercetina em nanoemulsão, apresentando características semelhantes ao controle positivo com N-acetilcisteína. Por outrolado, apenasos tratamentoscom quercetina e quercetina em nanoemulsão foram capazes dereduzir a migraçãode neutrófilosmedidapela atividadede mieloperoxidase. Conclusão : Os resultados sugerem que o uso dos compostos resveratrol, rutina, quercetina e quercetina em nanoemulsãopodem se alternativas efetivas para o tratamento.
Ferreira, Maria Elvira Wagner. "Neuropatia autonomica do diabete melito : estudo do tempo do ciclo da pupila e do teste da ejaculacao retrograda; relacao com os testes cardiovasculares e sintomas de neuropatia autonomica." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 1995. http://hdl.handle.net/10183/115309.
Full textThe aim o f the study was to evaluate if two tests, the pupil cycle time and the presence of retrograde ejaculation, can be used as methods for definig the presence o f autonomic neuropathy. With this purpouse, the results of the two tests were compared with four cardiovascular tests (blood pressure and heart rate response to standing, heart rate response to deep breathing and Valsalva maneuver), and with symptoms usually related to autonomic neuropathy. Twenty nine normal and 54 diabetic subjects (16 with autonomic neuropathy) were submitted to the pupil cycle time test. Twenty five normal and 26 diabetic subjects (10 with autonomic neuropathy) were tested for retrograde ejaculation. There were significantly differences among the mean of the results of both tests in the group of diabetic subjets with autonomic neuropathy when compared against controls and diabetic subjects without autonomic neuropathy. Dizziness to standing and gustatory sweating were autonomic symptoms associated to the altered pupil cycle time test. Dizziness to standing and loss of the anal sphincter control were symptoms associated to the presence of the retrograde ejaculation test. A correlation between the pupil cycle time test with the heart rate response to deep breathing, standing and Valsalva maneuver was observed. On the other hand, the retrograde ejaculation test showed to be correlated with the blood pressure response to standing and with the heart rate response to deep breathing, Valsalva maneuver and standing. The results of the pupil cycle time test showed a low sensitivity (58%) and a reasonable specificity (85%). These results suggest that such test might be used to diagnose autonomic neuropathy. The retrograde ejaculation test showed a good sensitivity ( 100%) and specificity ( 100%). Theoretically, these results suggest that the test can be used to diagnose and exclude the disease. Due to the pupil innervation reflex, the vesical sphincter innervation and the correlation o f the cardiovascular tests with the results of the two tests evaluated in this work it is possible to make two suggestions: frrst, that the pupil cycle time changes specially when there is impairment of the parasympathetic nervous system; second, that retrograde ejaculation is related to abnormalities of both, sympathetic and parasympathetic system. In this way, these tests, if used as auxiliary to the cardiovascular tests, might classify more precisely whether a diabetic subject has autonomic neuropathy or not.
Lopes, Luciano da Silva. "Estudo do efeito analgésico do topiramato em modelos de dor aguda e neuropatia diabética." reponame:Repositório Institucional da UFC, 2007. http://www.repositorio.ufc.br/handle/riufc/2494.
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In the present study, Topiramate (TP) was evaluated in acute pain and diabetic neuropathic animal models. Male Swiss mice were used in the tests of acute nocicepcion (formalin, hot plat and capsaicin) e male Wistar rats in the neuropathic pain test (filaments of von Frey). In the formalin test (2%, 20 µL/i.pl), it was measured the time spent by the animal licking the left hind paw which received the stimulation during 0-10 min (phase 01) and 20-40 min (phase 02).The results showed a reduction of the second phase (*** p<0.001) in the three doses used of TP while only the biggest dose showed effect in the first stage of test (*** p< 0.001). The TP effect (80 mg/Kg) was reverted by naloxone 2 mg/kg in the second phase of the test of the formalin, but not for glibenclamide 3 mg/kg, cyproeptadine 5 mg/kg and ondansetron 0.5 mg/kg when compared to control in both phases. In the hot plate test (52º) was analysed the reaction of the mouse to the thermal stimulation where the animal respond tryning to jump or to lick one of its brack legs. The animals had been submitted the plate to 00, 30, 60 and 120 min after the treatments and compared the groups that had received TP in the different doses (20,40 e 80 mg/kg). The results showed, TP demonstrated activity to 90 and 120 min (**p < 0.01; *** p < 0.001) only in the biggest dose used (80mg/kg). In another protocol, the animals received capsaicin (20 µL/2µg/i.pl), but the results ere not significant. For evaluations of the antinociceceptive action in neuropathic pain, the animals had been initially induced diabetes with streptozotocine 40 mg/Kg i.p. and after thirty days had been submitted to the test with filaments of von Frey. No significant effect of TP was observed in all doses used when compared with the controls. TP did not modify the frequency of locomotion of the animals in the open field and presented no effect in the Rota rod test suggesting that the TP does not exert its analgesic effect by depressive actions or relaxant muscular activity. In conclusion, the results may suggest that TP presents antinociceptive effect front the different stimulations of acute pain, but not in diabetic neuropathic pain. The analgesic effect in acute pain, probably involves system opioid, and seems do not involve potassium canals or serotoninergic system.
No presente estudo, o Topiramato (TP) foi avaliado em modelos de dor aguda e de dor neuropática diabética. Camundongos Swiss machos foram utilizados nos testes de nocicepção aguda (formalina, placa quente e capsaicina) e ratos Wistar machos no teste de dor neuropática (filamentos de von Frey). No teste da formalina (2 %; 20 µL/i.pl.), foi quantificado o tempo que o animal lambia a pata que recebeu o estímulo durante 0-10 min (fase 01) e 20-40 min (fase 02). Os resultados mostraram uma redução na segunda fase (***p<0,001) nas três doses utilizadas do TP, enquanto que apenas a maior dose mostrou efeito na primeira fase do teste (***p<0,001). O efeito do TP (80 mg/Kg) foi revertido pela naloxona 2 mg/Kg na segunda fase do teste da formalina , mas não pela glibenclamida 3mg/Kg, ciproeptadina 5 mg/Kg e ondansetrona 0,5 mg/Kg quando comparado com o controle em ambas as fases. No teste da placa quente (52°) foi verificada a reação do camundongo ao estímulo térmico onde o animal responde tentando pular ou lamber uma de suas patas traseiras. Os animais foram submetidos a placa aos 00, 30, 60, 120 e 240 min após os tratamentos e comparou-se os grupos que receberam TP nas diferentes doses ( 20, 40 e 80 mg/Kg) e o grupo controle. Nesse modelo, TP demonstrou atividade aos 90 e 120min (**p<0,01; ***p<0,001) apenas na maior dose utilizada (80 mg/Kg). Em outro protocolo, os animais receberam capsaicina (20 µL, 2 µg/ i.pl), sendo quantificado o tempo durante 5 min que estes lamberam ou morderam a pata estimulada, com comparação posterior entre os grupos Não se verificou efeito significativo de TP em todas as doses utilizadas quando comparado com o controle. Para avaliação da ação antinociceptiva em dor neuropática, os animais foram inicialmente induzidos a diabetes com estreptozotocina 40 mg/Kg i.p e após trinta dias foram submetidos ao teste com filamentos de von. Não se verificou efeito significativo do TP nas doses utilizadas quando comparado com o controle. O TP não alterou a freqüência de locomoção dos animais no teste do campo aberto e no teste do Rota rod e não aumentou o número de quedas nem diminuiu o tempo de permanência na barra giratória, sugerindo que o TP não exerce sua atividade antinociceptiva por ação depressora ou relaxante muscular. Em conclusão, a partir desses resultados podemos sugerir que o TP apresenta efeito antinociceptivo frente a diferentes estímulos de dor aguda, mas não na dor neuropática diabética. O efeito analgésico nos testes de dor aguda, provavelmente envolve sistema opióide, porém não os canais de potássio sensíveis ao ATP e sistema serotoninérgico.
Cardoso, Isabel dos Santos. "Dynamics of transthyretin fibrillogenesis : contribution to therapeutic approaches in familial amyloidotic polyneuropathy." Doctoral thesis, Porto : Edição do Autor, 2002. http://hdl.handle.net/10216/64570.
Full textWatari, Ricky. "Análise da progressão das alterações eletromiográficas da marcha de diabéticos neuropatas classificados atráves de um modelo linguístico fuzzy." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5163/tde-19122012-101055/.
Full textThe use of Fuzzy expert model could be an interesting approach to enable a better distinction among different stages of diabetic sensorimotor polyneuropathy, and differences in muscle activity and in the time when these changes start occurring could be elucidated with this classification. EMG alterations during gait, supposedly caused by this disease, are subtle and still not consistent among authors, possibly due to difficulties in defining homogeneous experimental groups with clear definition of the disease stage of each subject. By classifying diabetic patients from absent to severe neuropathy with fuzzy logic, it clarified that muscle activity changes begin even before diabetic neuropathy is established , with delays of up to 31% in vastus lateralis peak activity at early stance and anticipation of 16% in tibialis anterior onset during terminal stance. The presence of diabetic neuropathy aggravates the changes in tibialis anterior, with 33% earlier onset time, and delayed peak activity at heel strike. Muscular alterations seem to be caused by structural and physiological changes in muscle tissue itself, caused by accumulation of advanced glycation end-products due to poor diabetes control, and these alterations become worse with the onset of neurological impairments when diabetic neuropathy is established
Lima, Renata Aparecida de Oliveira. "Revisão sistemática da eficácia da atividade física pré-programada e supervisionada no tratamento complementar da polineuropatia diabética periférica." Botucatu, 2017. http://hdl.handle.net/11449/150627.
Full textResumo: Além das complicações agudas relacionadas à hiperglicemia, os pacientes com Diabetes Mellitus terão ao decorrer da vida várias complicações crônicas que juntas contribuirão para uma maior morbidade e mortalidade nesses indivíduos. A Polineuropatia Diabética Periférica (PND) é uma dessas complicações, que além dos sintomas de parestesia e hiperestesia, bem como vários tipos de dor espontânea, pode levar a diminuição do equilíbrio postural e aumento do risco de quedas. Objetivo: realizar uma revisão sistemática para avaliar a eficácia do exercício físico pré-programado e supervisionado no tratamento complementar da PND. Métodos: foram criadas estratégias de busca gerais e adaptáveis às bases de dados eletrônicas na área da saúde EMBASE, MEDLINE, CENTRAL (Registro de Ensaios Controlados da Colaboração Cochrane), LILACS e PEDro. Nós incluímos estudos randomizados, nos quais os pacientes com PND foram alocados a participar ou não de um programa pré-determinado e supervisionado de atividade física. Os desfechos primários foram: número de quedas, melhora do risco de cair (aferida pelo Teste de Alcance Funcional (TAF), Teste Get Up and Go (TUG), Escala de Equilíbrio de Berg (EEB), estabilometria, apoio unipodal) e melhora do medo de cair (mensurada pelo Fall Efficacy Scale International – FES-I). Os desfechos homogêneos e com a mesma unidade de medida em pelo menos dois estudos foram plotados em uma metanálise, utilizando-se o software Review Manager 5.3. A qualida... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: In addition to acute complications related to hyperglycemia, patients with Diabetes Mellitus develop several chronic complications throughout life that together contribute to greater morbidity and mortality in these individuals. Peripheral Diabetic Polyneuropathy (PND) is one of these complications, which, in addition to symptoms of paresthesia and hyperesthesia, and several types of spontaneous pain, can lead to a decrease in postural balance and an increased risk of falls. Objective: We performed a systematic review to evaluate the effectiveness of pre-programmed and supervised physical activity in the complementary treatment of PND. Methods: General and adaptive search strategies were created for electronic databases in the health area; Embase, Medline, CENTRAL-Cochrane, Lilacs, and PEDro. We included randomized trials in which patients with PND were allocated to participate or not in a pre-determined and supervised program of physical activity. The primary outcomes were: number of falls, improvement in the risk of falls (measured by the Functional Reach Test (FRT), Get Up and Go Test (TUG), Berg Balance Scale (BBS), stabilometry, and one leg stance test) and improvement in fear of falling (measured by the Fall Efficacy Scale International – FES-I). The homogeneous outcomes, with the same unit of measurement in at least two studies were plotted in a meta-analysis, using the software Review Manager 5.3. The quality of evidence was generated in accordance w... (Complete abstract click electronic access below)
Doutor
Moreira, Carolina Lavigne. "Epidemiologia mutacional da polineuropatia amiloidótica familiar transtiretina em um serviço brasileiro terciário de neuropatias periféricas." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/17/17140/tde-30032017-142719/.
Full textBackground: Transthyretin amyloidosis is an autossomal dominant disease caused by variant transthyretin, that is misfolded, originating a unstable transthyretin tetramer, a rate-limiting step in the formation of the amyloid deposits in different organs and tissues. In most patients, the peripheral nervous system is the main target, leading to transtyretin familial amyloid neuropathy (TTR-FAP), classically characterized as a progressive sensory-motor and autonomic neuropathy, that leads to death in about 10 years. TTRVal30Met is the most frequent point mutation worldwide, including Brazil, but more than 100 different point mutations has been described. Objectives: describe the mutational epidemiology of TTR gene in TTR-FAP and characterize its clinical and electrophysiological findings. Methods: a descriptive and retrospective study of a group of Brazilian patients forwarded to the Neurogenetics or Peripheral Nerve Clinics from FMRP-USP whose etiological investigation identified a mutation in the TTR gene. A cross-sectional analysis evaluating the subgroups with different mutations was also carried on. Results: we identified one hundred and twenty eight patients carrying a TTR point mutation, of whom 12 (9,4%) harbored a non-Val30Met mutation, including 4 pathogenic (6 patients, 4,7%) and 2 non-pathogenic abnormalities (6 patients, 4,7%). The non Val30Met pathogenic mutations were TTRAsp38Tyr (2 patients), TTRIle107Val (2 patients), TTRVal71Ala (1 patient) and TTRVal122Ile (1 patient). Among the non-pathogenic mutations, we found the TTRGly6Ser (5 patients) and the TTRThr119Thr (1 patient). The TTRVal30Met mutation was present in 116 (90,6%) patients, of whom 52 had a complete clinical and neurophysiological data: 39 (75%) with early-onset and 13(25%) with late-onset neuropathies. The early-onset group presented as the classic TTRFAP, with no gender predominance (male: 53,8%), the first manifestations were those of a small fiber sensory and autonomic neuropathy (82,1%) and a highly positive family history (90,3%). EMG was normal in 36,7% of these patients. The cardiovascular involvement was characterized by frequent ECG abnormalities (84,2%), less often associated with cardiomayopathy (11,1%). On the other hand, the late-onset TTRVal30Met showed a male predominance (92,3%), presence of motor complaints in the first evaluation (38,5%) resulting in a sensory-motor polyneuropathy with large fiber involvement and a negative family history (69,2%). All patients presented a sensory and motor neuropathy on EMG examination. In this group, cardiomiopathy was frequently associated with the neuropathy (71,4%). All patients, in both groups, had autonomic symptoms at some point in clinical follow up. Conclusions: In our study almost 5% of the patients with TTR-FAP have a non Val30Met pathogenic mutation, highlighting the importance of sequecing the whole TTR gene in patients with a sugestive clinical history and negative screening for TTRVal30Met mutation. In adition, the Brazilian patients we studied with early and late onset TTR-FAP, present similar findings to TTRVal30Met populations from other countries submitted to similar studies.
Oliveira, Franassis Barbosa de. "Opções diagnósticas no monitoramento de neuropatias diabéticas : em busca de parâmetros para tomada de decisões clínicas." reponame:Repositório Institucional da UnB, 2015. http://dx.doi.org/10.26512/2015.12.T.19410.
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A neuropatia diabética é uma das principais complicações manifestadas tardiamente em indivíduos com diabetes mellitus. Apesar da alta prevalência, as opções diagnósticas no monitoramento das neuropatias diabéticas não oferecem atualmente parâmetros que sustentem tomadas de decisões clínicas. O objetivo do estudo foi investigar limites e possibilidades de instrumentos com diferentes características de aplicação na prática clínica serem utilizados no diagnóstico e monitoramento da função nervosa periférica cutânea das extremidades de membros inferiores de pessoas com diabetes mellitus do tipo 2. Para atingir esse objetivo foram elaborados quatro métodos para: (1) realizar um levantamento e sistematização de uma técnica de aplicação mais complexa: a Current Perception Threshold – CPT; (2) definir quais as frequências ideais para uso da CPT; (3) realizar a adaptação transcultural e avaliação da confiabilidade do Michigan Neuropathy Screening Instrument (MNSI-Brasil) e (4) analisar a validade concorrente entre o CPT, MNSI-Brasil e estesiometria por monofilamentos. A discussão dos resultados leva à conclusão de que não existe na literatura um protocolo padronizado para utilização do CPT; que há uma melhor discriminação obtida com frequências de 1 Hz, 250 Hz e 3000 Hz para estimular fibras do tipo C, Aδ e Aβ, respectivamente; que a versão brasileira do Michigan Neuropathy Screening Instrument, o MNSI-Brasil está pronto e é confiável para ser utilizado no Brasil e que não é possível estabelecer associação entre os valores de CPT com MNSI-Brasil e estesiometria por monofilamentos. Assim, por possuírem características particulares, os métodos de avaliação são complementares no diagnóstico e monitoramento da função nervosa periférica de membros inferiores em indivíduos com diabetes mellitus do tipo 2.
The diabetic neuropathy is one of the main and tardy complications in diabetic subjects. Despite its high prevalence, the diagnostic options in diabetic neuropathy monitoring do not offer parameters that support clinic decision making. The study aim was to investigate the limits and possibilities of instruments with different characteristics in clinical practice to be used for diagnosis and monitoring the nervous cutaneous peripheral function in type 2 diabetic´s extremities of lower limbs. To reach the objective it were elaborated four methods to: (1) realize a surveying and systematization of a complex application technique: the Current Perception Threshold – CPT; (2) define the ideal frequencies to use CPT; (3) realize the transcultural adaptation and reliability of Michigan Neuropathy Screening Instrument (MNSI-Brazil) and (4) analyze the concurrent validity between CPT, MNSI-Brazil and monofilaments esthesiometry. The discussion drive to conclusion that there is not a standardized protocol to use CPT; that there is better discrimination with 1 Hz, 250 Hz, 3000 Hz frequencies to stimulate type C, Aδ and Aβ, respectively; that Brazilian version of Michigan Neuropathy Screening Instrument is ready and it is reliable to be used in Brazil and that is not possible to associate the CPT values with monofilaments esthesiometry and MNSI-Brazil. In this manner, because of its particular characteristics, the evaluation methods are complementary to have the diagnosis and monitoring the nervous peripheral function of type 2 diabetic’s lower limbs.
Bonifácio, Maria João Macedo da Silva. "Studies on amyloid formation in familial amyloidotic polyneuropathy." Tese, Porto : Edição do Autor, 1996. http://catalogo.up.pt/F?func=find-b&local_base=UPB01&find_code=SYS&request=000084315.
Full textNeumann, Cristina Rolim. "Polineuropatia do diabetes mellitus : caracterização clínica e padronização de testes autonômicos e somáticos." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 1999. http://hdl.handle.net/10183/7361.
Full textCastro, Fabiola Monteiro de. "Prevalência de Alterações Cinesiológicas Funcionais e Baropodométricas em diabéticos Tipo 1." reponame:Repositório Institucional da UFC, 2015. http://www.repositorio.ufc.br/handle/riufc/14939.
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The preventive approach of subjects with diabetes mellitus (DM) does not avoid the appearance of serious foot lesions or amputations. Changes in static and dynamic posture, the joint motion, muscle strength and balance modify the plant load distribution and increase the risk of ulcers, it is important to use methods to assess these parameters. To evaluate the prevalence of functional kinesiological changes and baropodométricas of patients with DM type 1 (DM1). METHODS: 107 patients with DM1 and 32 controls (matched for sex, age and BMI) were investigated for the presence of peripheral arterial disease, peripheral neuropathy (PN), cardiovascular autonomic neuropathy. Performed functional kinesiological evaluation (measures the range of motion of the ankle (AAT), muscle strength (MS) of the lower limbs and postural evaluation, baropodometry (for evaluation of load distribution plant and postural balance), and measurement of glycohemoglobin A1c (A1c). We used the Epi-Info 7 and STATA 11.2 for statistical tests: Pearson's chi-square, Fisher's exact test, Kruskal-Wallis and Pearson's correlation coefficient (r), with (p ≤ 0.05) RESULTS. : In DM group, 58.8% were female, 28.7 ± 1.1 years and BMI of 23.7 ± 0.4 kg / m² A significant reduction in the control of AAT (p. . = 0.001), the FM leg (p = 0.023) and foot (p = 0.005) was observed association between: reduction of AAT with age (p = 0.002), disease duration (p = 0.018) and neuropathy peripheral (p = 0.023), reduction FM age (p = 0.009), BMI (p <0.05), and HbA1c levels (p <0.05) and change in stabilometry with age (p = 0.0212 ), disease duration (p = 0.000) and HbA1c (p = 0.035). Postural and load distribution plant in forefoot changes were frequent, 100% and 75.7% respectively, but with no difference compared to the control. In the group analysis DM1 without NP also observed a reduction of AAT (p = 0.003) and FM, but only the foot (p = 0.014). But there was no significant difference in the findings of baropodometry, stabilometry and postural assessment. CONCLUSION: The functional kinesiological changes in individuals with DM1 showed high prevalence even at a young age and these seem to precede the diagnosis of clinically detectable peripheral neuropathy. In addition, the body segment, both in terms of strength as compared to the range of motion were feet, suggesting that this engagement begins in distal body segments and may subsequently rise to other joints, and muscle groups. Recognizing and addressing these changes, today neglected, may contribute to the prevention of foot lesions.
A abordagem preventiva dos indivíduos com diabetes mellitus (DM) não tem evitado o surgimento de lesões podais graves nem de amputações. Alterações na postura estática e dinâmica, na movimentação articular, na força muscular e no equilíbrio modificam a distribuição da carga plantar e aumentam o risco de ulcerações, sendo importante utilizar métodos que avaliem esses parâmetros. OBJETIVO: Avaliar a prevalência de alterações cinesiológicas funcionais e baropodométricas de pacientes com DM tipo1 (DM1). MÉTODOS: Os 107 pacientes com DM1 e 32 controles (pareados para sexo, idade e IMC) foram investigados quanto à presença de doença arterial periférica, neuropatia periférica (NP), neuropatia autonômica cardiovascular. Realizaram avaliação cinesiológica funcional (medidas da amplitude articular do tornozelo (AAT), força muscular (FM) dos membros inferiores e avaliação postural, baropodometria (para avaliação da distribuição da carga plantar e equilíbrio postural), e dosagem da glicohemoglobina A1c (A1c). Utilizou-se o Epi-Info 7 e o STATA 11.2 para os testes estatísticos: qui-quadrado de Pearson, exato de Fisher, Kruskal-Wallis e coeficiente de correlação de Pearson (r), com (p ≤ 0,05). RESULTADOS: No grupo DM, 58,8% eram do sexo feminino, com 28,7±1,1 anos e IMC de 23,7±0,4 kg/m². Observou-se redução significativa em relação ao controle da AAT (p=0,001), da FM da perna (p=0,023) e do pé (p=0,005). Observou-se associação entre: redução da AAT com a idade (p=0,002), tempo de doença (p=0,018) e neuropatia periférica (p=0,023); redução da FM com idade (p=0,009), IMC (p < 0,05) e níveis de A1c (p < 0,05) e alteração na estabilometria com a idade (p=0,0212), tempo de doença (p=0,000) e A1c (p=0,035). As alterações posturais e da distribuição da carga plantar em antepé foram freqüentes, 100% e 75,7% respectivamente, mas sem diferença em relação ao controle. Na análise do grupo com DM1 sem NP observou-se também a redução da AAT (p=0,003) e da FM, mas apenas no pé (p=0,014). Mas não houve diferença significativa nos achados da baropodometria, estabilometria e da avaliação postural. CONCLUSÃO: As alterações cinesiológicas funcionais em indivíduos com DM1 apresentaram alta prevalência mesmo em uma faixa etária jovem e essas parecem preceder ao diagnóstico da neuropatia periférica clinicamente detectável. Além disso, o segmento corporal comprometido, tanto em relação à força como em relação à amplitude articular, foram os pés, sugerindo que esse comprometimento se inicia nos segmentos corporais mais distais e posteriormente pode ascender para os demais grupos musculares e articulações. O reconhecimento e a abordagem de tais alterações, hoje negligenciadas, podem contribuir para a prevenção de lesões podais.
Bonifácio, Maria João Macedo da Silva. "Studies on amyloid formation in familial amyloidotic polyneuropathy." Doctoral thesis, Porto : Edição do Autor, 1996. http://hdl.handle.net/10216/64551.
Full textHeise, Carlos Otto. "Avaliação prognóstica de pacientes com plexopatia braquial obstétrica: comparação entre a avaliação clínica e o estudo da condução motora." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5138/tde-23102007-114055/.
Full textEarly prognostic assessment of obstetric brachial plexopathies would be a major step for rational selection of infants for brachial plexus surgery. We performed nerve conduction studies in 54 patients from 10 to 60 days of life. We compared sideto-side the compound muscle action potentials amplitudes from the axillary (deltoid muscle), musculocutaneous (biceps), proximal radial (triceps), distal radial (extensor digitorum communis), median (thenar eminence) and ulnar nerves (hypothenar eminence). The ratio between the amplitude of the affected limb and that of the healthy side was called Viability Axonal Index (VAI), which was calculated using both the negative and the peak-to-peak amplitudes. The patients were followed-up and classified in three groups: Group A, with full recovery at six months of age; Group B, with satisfactory recovery at twelve months of age, and Group C, with poor recovery at twelve months of age. We analyzed the ROC (Receive Operator Characteristic) curve of each VAI to define the best cut-off point for detection of Group C patients (bad prognosis). The best cut-off point for the axillary nerve was a VAI of less than 10%, whith sensibility of 88.2% and specificity of 89.2% or 91.9%. For the musculocutaneous nerve, the cut-off point was an absent motor action potential, with sensibility of 88.2% and specificity of 73.0%. For the proximal radial nerve, the cut-off point was a VAI of less than 20%, with sensibility of 82.4% or 94.1% and specificity of 97.3% or 100%. For the distal radial nerve, the cut-off point was a VAI of less than 50%, with sensibility of 76.5% or 82.4% and specificity of 97.3%. For the ulnar nerve, the cut-off point was a VAI of less than 50%, which sensibility of 58.8% and specificity of 97.3% or 100%. The VAI from the median nerve had a poor performance and its use could not be recommended. The VAIs from proximal radial, distal radial and ulnar nerves had better specificities compared to the most used clinical criterion: absence of biceps function at three months of age. The VAIs sensitivities from axillary, musculocutaneous, proximal radial and distal radial nerves were equivalent to the clinical criterion. The use of motor conduction studies between 10 and 60 days of age yielded an earlier and more specific prognostic estimation than the clinical criterion, and could be used for indication of surgery in these patients.
Lima, Renata Aparecida de Oliveira [UNESP]. "Revisão sistemática da eficácia da atividade física pré-programada e supervisionada no tratamento complementar da polineuropatia diabética periférica." Universidade Estadual Paulista (UNESP), 2017. http://hdl.handle.net/11449/150627.
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Além das complicações agudas relacionadas à hiperglicemia, os pacientes com Diabetes Mellitus terão ao decorrer da vida várias complicações crônicas que juntas contribuirão para uma maior morbidade e mortalidade nesses indivíduos. A Polineuropatia Diabética Periférica (PND) é uma dessas complicações, que além dos sintomas de parestesia e hiperestesia, bem como vários tipos de dor espontânea, pode levar a diminuição do equilíbrio postural e aumento do risco de quedas. Objetivo: realizar uma revisão sistemática para avaliar a eficácia do exercício físico pré-programado e supervisionado no tratamento complementar da PND. Métodos: foram criadas estratégias de busca gerais e adaptáveis às bases de dados eletrônicas na área da saúde EMBASE, MEDLINE, CENTRAL (Registro de Ensaios Controlados da Colaboração Cochrane), LILACS e PEDro. Nós incluímos estudos randomizados, nos quais os pacientes com PND foram alocados a participar ou não de um programa pré-determinado e supervisionado de atividade física. Os desfechos primários foram: número de quedas, melhora do risco de cair (aferida pelo Teste de Alcance Funcional (TAF), Teste Get Up and Go (TUG), Escala de Equilíbrio de Berg (EEB), estabilometria, apoio unipodal) e melhora do medo de cair (mensurada pelo Fall Efficacy Scale International – FES-I). Os desfechos homogêneos e com a mesma unidade de medida em pelo menos dois estudos foram plotados em uma metanálise, utilizando-se o software Review Manager 5.3. A qualidade da evidência foi gerada de acordo com o Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Resultados: foram identificadas 3.999 referências e dois revisores independentemente leram os títulos e resumos dos artigos. Dos oito estudos potencialmente elegíveis, apenas seis foram incluídos nessa revisão. Um total de 390 pacientes foi aleatoriamente designado para a intervenção ou grupo controle. Puderam ser plotados na metanálise o medo de cair pela FES e o risco de quedas pelo apoio unipodal, EEB, TAF e TUG. Favoreceram a intervenção o medo de cair e o teste do apoio unipodal com olhos abertos e fechados (MD -2,97, IC: -5.37, -0.57, I2=0%; MD 3.73 IC: 0.64, 6.83, p=0.02, I2 = 0% e MD 1.23, IC: 0.31, 2.16, p=0.009, I2=0%, respectivamente). Não houve diferenças significativas entre os grupos para os demais desfechos analisados. Conclusão: a atividade física pré-programada e supervisionada em indivíduos com PND foi eficaz na melhora do equilíbrio estático e diminuiu o medo de cair. A qualidade da evidência de acordo com GRADE para esses dois resultados foi moderada, o que significa dizer que há moderada confiança na estimativa de efeito e que o verdadeiro efeito esta próximo ao estimado, porém, existe a possibilidade de ser substancialmente diferente.
In addition to acute complications related to hyperglycemia, patients with Diabetes Mellitus develop several chronic complications throughout life that together contribute to greater morbidity and mortality in these individuals. Peripheral Diabetic Polyneuropathy (PND) is one of these complications, which, in addition to symptoms of paresthesia and hyperesthesia, and several types of spontaneous pain, can lead to a decrease in postural balance and an increased risk of falls. Objective: We performed a systematic review to evaluate the effectiveness of pre-programmed and supervised physical activity in the complementary treatment of PND. Methods: General and adaptive search strategies were created for electronic databases in the health area; Embase, Medline, CENTRAL-Cochrane, Lilacs, and PEDro. We included randomized trials in which patients with PND were allocated to participate or not in a pre-determined and supervised program of physical activity. The primary outcomes were: number of falls, improvement in the risk of falls (measured by the Functional Reach Test (FRT), Get Up and Go Test (TUG), Berg Balance Scale (BBS), stabilometry, and one leg stance test) and improvement in fear of falling (measured by the Fall Efficacy Scale International – FES-I). The homogeneous outcomes, with the same unit of measurement in at least two studies were plotted in a meta-analysis, using the software Review Manager 5.3. The quality of evidence was generated in accordance with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: In total, 3,999 references were identified and two reviewers independently read the titles and abstracts of the articles. Of the eight potentially eligible studies, six were included in this review. A total of 390 patients were randomly assigned to intervention or control groups. The fear of falling through the FES and the risk of falls through the one leg stance test, BBS, FRT, and TUG were plotted in the metaanalysis. The intervention favored the fear of falling and the test of one leg stance test with eyes open and closed (MD -2.97, CI: -5.37, -0.57, I2=0%; MD 3.73 CI: 0.64, 6.83, p=0.02, I2 = 0% and MD 1.23, CI: 0.31, 2.16, p=0.009, I2=0%, respectively). There were no significant differences between the groups for the other outcomes analyzed. Conclusion: Pre-programmed and supervised physical activity in individuals with PND was effective in improving static balance and decreasing fear of falling. The quality of the evidence according to the GRADE for these two results was moderate, which means that there is moderate confidence in the estimated effect and that the true effect is close to the estimated; however there is a possibility of it being substantially different.
Siles, Gómez Ana Mª. "Cribado sistemático de autoanticuerpos en neuropatías inmunomediadas." Doctoral thesis, Universitat Autònoma de Barcelona, 2018. http://hdl.handle.net/10803/650411.
Full textInflammatory neuropathies are rare autoinmune diseases of the peripheral nerve that encompass multiple conditions. Among them, Chronic inflammatory demyelinating poliradiculoneuropathy (CIDP) and paraneoplastic neuropathies can be found. Although the pathogenesis of these diseases remains largely unknown, autoantibodies have been postulated to play a pivotal role in disease progression. Identification of novel autoantibodies in these conditions might provide new biomarkers with relevant clinical implications in the diagnosis, prognosis and treatment of these patients. Antibodies against peripheral nerve antigens in chronic inflammatory demyelinating polyradiculoneuropathy. Luis Querol MD PhD, Ana Mª Siles MSc, Roser Alba-Rovira MSc, Agustín Jáuregui MD, Jerome Devaux PhD, Catherine Faivre-Sarrailh PhD, Josefa Araque BN, Ricard Rojas-Garcia MD PhD, Jordi Diaz-Manera MD PhD, Elena Cortés-Vicente MD, Gisela Nogales-Gadea PhD, Miquel Navas-Madroñal MSc, Eduard Gallardo PhD, Isabel Illa MD PhD. CIDP is a heterogeneous condition featuring a lack of clinically-useful biomarkers, in which the description of specific autoantibodies would benefit patients’ diagnosis and prognosis, as has been previously demonstrated with the discovery of antibodies against paranodal proteins. In this study, a group of 65 CIDP patients were screened for IgG and IgM reactivity against previously described antigens as well as for new reactivities towards dorsal root ganglia neurons, motor neurons and Schwann cells. A subset of seronegative CIDP patients reacted against neural structures and gangliosides. However, immunoprecipitation experiments in patients reacting against neural cells did not reveal novel antigens, and frequencies of reactivity against neural cells did not differ from normal controls. Conclusion: Although immunoprecipitation experiments failed to identify novel antigens, we provide the most comprehensive autoantibody screening study performed to date in CIDP and demonstrate a heterogeneous autoantibody profile in CIDP patients, reinforcing the hypothesis of a significant pathophysiological heterogeneity in this disease. Antibodies against cell adhesion molecules and neural structures in paraneoplastic neuropathies Ana Mª Siles MSc, Eugenia Martínez-Hernández MD PhD, Josefa Araque BN, Jordi Diaz-Manera MD PhD, Ricard Rojas-Garcia MD PhD, Eduard Gallardo PhD, Isabel Illa MD PhD, Francesc Graus MD PhD, Luis Querol MD PhD. Paraneoplastic neuropathies are rare immune-mediated neurological conditions in which description of novel specific autoantibodies might benefit patients’ diagnosis and prognosis. Two of our CIDP patients with antibodies against Contactin 1 (CNTN1) developed cancer in addition to their neuropathy. Since CNTN1, as well as other cell adhesion molecules have been described to contribute to cancer pathogenesis, we assessed their possible involvement as antigens in patients with paraneoplastic neuropathies. In this study, a group of 34 patients with paraneoplastic neuropathies were screened for reactivity against neural cell adhesion molecules as well as for new IgG and IgM reactivities towards relevant neural structures. Overall, nine (26.5%) patients showed significant reactivity against dorsal root ganglia neurons, motor neurons or Schwann cells. Compared with control sera, serum samples from patients with paraneoplastic sensory motor neuropathies had a higher frequency of IgM antibodies against Schwann cells. Conclusion: Although our experiments failed to identify novel antigens in paraneoplastic neuropathies, we provide a comprehensive autoantibody screening study that not only demonstrates the heterogeneous autoantibody profile in these patients but also proves that a remarkable proportion of them target dorsal root ganglia neurons, motor neurons or Schwann cells.
Bertotti, Márcia Elaine Zeugner [UNESP]. "Alterações odontológicas em pacientes urêmicos em hemodiálise e suas possíveis correlações com neuropatias de nervos cranianos." Universidade Estadual Paulista (UNESP), 2006. http://hdl.handle.net/11449/86335.
Full textEste trabalho analisa alterações odontológicas em pacientes com insuficiência renal crônica, em programa de hemodiálise. As alterações odontológicas estudadas foram índice de dentes cariados, perdidos e obturados (CPOD), presença ou ausência de doença periodontal, número de desdentados totais e parciais. Os pacientes foram submetidos a exame neurológico dos nervos cranianos. Foi determinado o pH da saliva antes e após diálise. Dentre os 44 pacientes estudados, foram encontrados 23 desdentados totais, 7 desdentados parciais e 14 dentados. Vários apresentaram cáries, sem diferenças estatisticamente significativas em relação ao grupo controle; 7 pacientes apresentaram doença periodontal. Alterações de nervos cranianos foram encontradas em 36 pacientes. Os nervos cranianos mais freqüentemente acometidos foram VIII - vestíbulo-coclear, II - óptico e V - trigêmio. Alterações trigeminais foram encontradas em 20 pacientes. É provável que as alterações trigeminais aferentes estejam relacionadas com as perdas dentárias, na insuficiência renal crônica.
This paper analyzes odontological alterations in hemodialysis patients with chronic renal failure. Odontological alterations were: index of decayed, lost, or filled teeth (DLFT); presence or absence of periodontal disease; and totally and partially toothless. Patients were submitted to neurological examination of the cranial nerves. Saliva pH was recorded before and after dialysis. Out of 44 patients, 23 were totally toothless, 7 partially toothless, and 14 dentate. Several had decay, but this was not statistically significant to controls; 7 had periodontal disease. Cranial nerve alterations were found in 36 patients. The most frequently compromised nerves were the VIII - vestibulocochlear, II - optic, and V - trigeminal. Trigeminal alterations were found in 20 patients. Probably afferent trigeminal alterations are related to tooth loss in chronic renal failure.
Luz, Marcus Alexandre Mendes. "Bases anatômicas e histomorfométricas para a compreensão das neuropatias dos nervos mediano e ulnar em crianças." [s.n.], 2011. http://repositorio.unicamp.br/jspui/handle/REPOSIP/317585.
Full textTese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia
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Resumo: A região carpal anterior apresenta dois túneis delimitados por tecido fibroso: o túnel do carpo e o túnel ulnar. A importância clínica e cirúrgica dessa região está diretamente ligada às síndromes de compressão nos túneis do carpo e ulnar, comprometendo a função motora. Contudo, a abordagem clínica, tanto para diagnóstico como para o tratamento dessas lesões baseia-se em dados anatômicos de indivíduos adultos, sendo escassas as descrições em crianças. Assim sendo, o presente trabalho tem por objetivo descrever anatomicamente e histologicamente o túnel do carpo e o túnel ulnar em crianças. Foram analisadas 33 mãos de crianças de 2 a 11 anos de idade sem identificação de sexo, provenientes do Laboratório de Anatomia Humana do Departamento de Anatomia, Biologia Celular e Fisiologia e Biofísica do Instituto de Biologia da UNICAMP. Uma amostra de sete peças foi submetida à técnica de ressonância magnética e dissecadas, 14 foram dissecadas e 12 destinadas à histologia. A análise histomorfométrica das estruturas em secção transversal revelou que 58,1% da área do túnel do carpo é ocupada pelos tendões dos músculos flexores superficial e profundo dos dedos, tendão do músculo flexor radial do carpo e tendão do músculo flexor longo do polegar, sendo que 12,1% dessa área é ocupada pelo nervo mediano. Nos dados obtidos das imagens por ressonância magnética, observou-se que o nervo mediano pode assumir duas posições no túnel do carpo: lateral (71,4%) e mediana (28,5%). O túnel ulnar revelou localização palmar, e em 93,8% dos casos observou-se que o limite inferior desse túnel se constitui do retináculo dos músculos flexores e do hâmulo do hamato. Em 16% das amostras analisadas observou-se a artéria acompanhante do nervo mediano persistente, ocupando 1,1% da área do canal do carpo. Em 41,6% das amostras, a densidade de volume de tecido conjuntivo não variou na área de túneis do carpo com maior e menor dimensão, independente do espaço ocupado pelos componentes tendinosos nesse compartimento. De acordo com os dados obtidos, podemos concluir que a anatomia dos componentes neurovasculares dos túneis do carpo e ulnar em crianças apresentam particularidades em relação aos descritos em adultos e devem ser consideradas nas intervenções cirúrgicas
Abstract: The anterior carpal region has two tunnels limited by fibrous tissue: the carpal tunnel and the ulnar tunnel. The clinical and surgical importance of this region is related to the carpal and ulnar tunnel syndromes, both able to impair motor and sensitive functions. The diagnosis and clinical approach to treat these syndromes are mainly based on anatomical features of the tunnels in adults. In children, little is known about the anatomy of these tunnels. In the present study, we describe the anatomy and histology of the carpal and ulnar tunnels in children. Thirty-three hands from children between ages 2 and 11 were studied. Seven samples were submitted to magnetic resonance and dissected; 14 samples were dissected and 12 processed to histology. The histomorphometric analysis in transversal sections showed 58.1% of the areas of the carpal tunnel are occupied by tendons of both superficial and deep flexor muscles of the fingers, by the tendon of the carpal radial flexor muscle and the tendon of the long flexor muscle of the thumb. The median nerve occupied 12.1% of the tunnel area. Magnetic resonance analysis showed that the median nerve was positioned either lateral (71,4%) or median (28,5%) in the carpal tunnel. The ulnar tunnel revealed a palmar location and 93.8% of the samples the inferior limit of the ulnar tunnel was made by the retinaculum of flexor muscles and of the hook of the hamate. In 16% of the samples, an accompanying artery of the median nerve persisted, occupying 1.1% of the area of the carpal tunnel. In 41,6% of the samples the density of the volume of the conjunctive tissue did not change in relation to the dimensions of the carpal tunnel or in relation to the space occupied by the tendons. According to these data, we concluded that the anatomy of the neurovascular components of carpal tunnel and ulnar tunnel in children have individual in relation to those described in adults and these differences may be of relevance to perform safer surgical approaches to the treatment of carpal and ulnar tunnel syndromes
Doutorado
Anatomia
Doutor em Biologia Celular e Estrutural
Bertotti, Márcia Elaine Zeugner. "Alterações odontológicas em pacientes urêmicos em hemodiálise e suas possíveis correlações com neuropatias de nervos cranianos /." Botucatu : [s.n.], 2006. http://hdl.handle.net/11449/86335.
Full textBanca: Luiz Antônio de Lima Resende
Banca: Pasqual Barretti
Banca: Heloisa Almeida de Lima Castro
Resumo: Este trabalho analisa alterações odontológicas em pacientes com insuficiência renal crônica, em programa de hemodiálise. As alterações odontológicas estudadas foram índice de dentes cariados, perdidos e obturados (CPOD), presença ou ausência de doença periodontal, número de desdentados totais e parciais. Os pacientes foram submetidos a exame neurológico dos nervos cranianos. Foi determinado o pH da saliva antes e após diálise. Dentre os 44 pacientes estudados, foram encontrados 23 desdentados totais, 7 desdentados parciais e 14 dentados. Vários apresentaram cáries, sem diferenças estatisticamente significativas em relação ao grupo controle; 7 pacientes apresentaram doença periodontal. Alterações de nervos cranianos foram encontradas em 36 pacientes. Os nervos cranianos mais freqüentemente acometidos foram VIII - vestíbulo-coclear, II - óptico e V - trigêmio. Alterações trigeminais foram encontradas em 20 pacientes. É provável que as alterações trigeminais aferentes estejam relacionadas com as perdas dentárias, na insuficiência renal crônica.
Abstract: This paper analyzes odontological alterations in hemodialysis patients with chronic renal failure. Odontological alterations were: index of decayed, lost, or filled teeth (DLFT); presence or absence of periodontal disease; and totally and partially toothless. Patients were submitted to neurological examination of the cranial nerves. Saliva pH was recorded before and after dialysis. Out of 44 patients, 23 were totally toothless, 7 partially toothless, and 14 dentate. Several had decay, but this was not statistically significant to controls; 7 had periodontal disease. Cranial nerve alterations were found in 36 patients. The most frequently compromised nerves were the VIII - vestibulocochlear, II - optic, and V - trigeminal. Trigeminal alterations were found in 20 patients. Probably afferent trigeminal alterations are related to tooth loss in chronic renal failure.
Mestre
Muzilli, Junior Augusto 1952. "Avaliação do desenvolvimento de neuropatia diabética na ATM de ratos e a relação da expressão das isoformas da proteinoquinase C (PKC) neste processo." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/289489.
Full textDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: A doença diabetes em sua fase inicial é conhecida por induzir dor neuropática, como resultado de complicações neurovasculares mediada pela via diacilglicerol/ Proteinoquinase C (DAG/PKC). Considerando que a neuropatia induzida pelo diabetes está associada com diferentes isoformas da PKC, o objetivo deste estudo foi avaliar a expressão de diferentes isoformas da PKC nas condições dolorosas induzidas pelo diabetes tipo 1 na articulação temporomandibular (ATM) de ratos. Ratos Wistar (± 150 g, 2 meses de idade, n=4-6/grupo) foram tratados com uma injeção intraperitoneal de tampão citrato (veículo; normoglicêmicos ¿ NG) ou Estreptozotocina 75 mg/kg (diabéticos ¿ DB). As alterações dolorosas induzidas pelo diabetes tipo 1 foram avaliadas através da mensuração do comportamento nociceptivo dos animais induzido por uma injeção intra-articular de formalina 1,5% ou capsaicina 1,5% nos dias 7, 14, 21, 28, 35 ou 42 dias após a indução do diabetes ou veículo. Após a avaliação dos comportamentos nociceptivos, os animais foram mortos por anestesia e o tecido periarticular removido para análise de Western Blot. A fase inicial do diabetes tipo 1 induziu uma hiponocicepção na ATM dos ratos 7, 14, 21, 28, 35 e 42 dias depois da indução do diabetes (p<0.05: Two-way ANOVA, Bonferroni¿s test). Os animais diabéticos tratados com uma injeção intra-articular de capsaicina demonstraram hiponocicepção 7, 14, 21 e 28 dias depois da indução do diabetes (p<0.05: Two-way ANOVA, Bonferroni¿s test). A análise por Western Blot demonstrou que a expressão das proteinoquinases PKC-?1, PKC-?2, PKC-delta e PKC-epsilon no tecido periarticular foi significativamente maior nos ratos DB em comparação aos animais NG (p<0.05: Two-way ANOVA, Bonferroni¿s test), enquanto a expressão da PKC-? no tecido periarticular foi significativamente menor nos ratos DB em comparação aos animais NG (p<0,05). Os resultados sugerem que a hiponocicepção induzida pelo diabetes na ATM de ratos está associada à variação da expressão das diferentes isoformas da PKC: -?, -?1, -?2, -delta e -epsilon
Abstract: Diabetes in early phase is known to result in painful neuropathy as a result of neurovascular complications mediated by the activation of Diacylglycerol/Protein kinase C pathway (DAG/PKC). Considering that diabetes-induced neuropathy is associated with different PKC isoforms, the aim of this study was to evaluate the expression of PKC in diabetes type 1-induced pain condition in the temporomandibular joint (TMJ) of rats. Wistar rats (± 150 g, 2 month-old, n=4-6/group) were treated with an intraperitoneal injection of citrate buffer (vehicle; normoglycemic ¿ NG) or Streptozotocin 75 mg/kg (diabetic ¿ DB). Diabetes-induced pain conditions were assessed by the animals¿ nociceptive behavior induced by an intra-articular injection of 1.5% formalin or 1.5% capsaicin 7, 14, 21, 28, 35 or 42 days after the diabetic induction or vehicle. After behavioral assays, animals were terminally anesthetized and their periarticular tissue removed for Western Blot analysis. Early phase of diabetes type 1 induced hyponociception into TMJ of rats 7, 14, 21, 28, 35 and 42 days after the diabetic induction (p<0.05: Two-way ANOVA, Bonferroni¿s test). DB animals treated with an intra-articular injection of capsaicin demonstrated hyponociception 7, 14, 21 and 28 days after diabetes induction (p<0.05: Two-way ANOVA, Bonferroni¿s test). Western Blot analysis demonstrated that the expression of PKC-?1, PKC-?2, PKC-delta and PKC-epsilon into periarticular tissue was significantly higher in the DB rats than in the NG rats (p<0.05: Two-way ANOVA, Bonferroni¿s test), whereas the expression of PKC-? into periarticular tissue was significantly higher in the DB rats than in the NG rats (p<0.05). Early phase of diabetes type 1 induce hyponociception into rats TMJ that involves changes in the expression of different kinds of PKC isoforms: -?, -?1, -?2, -delta and -epsilon. OBSERVAÇÃO Tanto no resumo como no abstract, os símbolos equivalentes à "delta" e "epsilon" haviam ficado como um quadrado, sendo assim, eu escrevi por extenso o nome do símbolo, mas o ideal seria ficar como os símbolos ? e ?
Mestrado
Fisiologia Oral
Mestre em Odontologia
Querol, Gutiérrez Luis Antonio. "Nuevas reactividades antigénicas en neuropatías inmunomediadas." Doctoral thesis, Universitat Autònoma de Barcelona, 2013. http://hdl.handle.net/10803/125868.
Full textThe description of clinical-immunological correlations in autoimmune diseases is of paramount importance to characterize disease phenotypes, diagnostic and prognostic subgroups and to choose therapies depending on the immunological profile of patients. Inflammatory neuropathies constitute a group of infrequent diseases of the peripheral nerves of presumed autoimmune pathogenesis. It includes acute neuropathies such as Guillain-Barré syndrome (GBS) and chronic neuropathies such as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). In all of them it has been postulated a prominent role of autoantibodies in their pathogenesis. However, the antigenic reactivities and the pathogenic mechanisms of these diseases remain largely unknown. GBS is a post-infectious acute neuropathy in which antibodies against gangliosides play an important role. There are various phenotypes of GBS, including sensory-motor, ataxic, sensory-ataxic and loco-regional variants. Each variant has been associated to different antiganglioside antibody patterns. Miller-Fisher syndrome (MFS) is a GBS variant characterized by ataxia, arreflexia and ophtalmoparesis. It associates with antiganglioside antibodies bearing the NeuNAcNeuNAcGal epitope, such as GQ1b and GT1a. In ataxic GBS patients present with ataxia and negative Romberg sign and there is no apparent ophtalmoparesis. It is also associated to GQ1b antibodies. On the other hand, a pure sensory form of GBS associated to GD1b antibodies known as acute sensory-ataxic neuropathy (ASAN) can also present with ataxia of peripheral origin. Distinguishing ASAN, MFS and ataxic GBS can be difficult from a clinical perspective. Moreover, demyelinating features, a diagnostic criteria in sensory GBS, are usually absent in ASAN and the inclusion of this form in the GBS spectrum is controversial. We designed a study to describe the clinical and immunological features of ASAN. All patients from a database including sera sent for routine antiganglioside-antibody testing and fulfilling ASAN criteria were collected and their epidemiological, clinical and electrophysiological features analyzed. Of 12 patients fulfilling criteria for ASAN, 7 had antibodies against gangliosides bearing disialosyl epitopes (GQ1b, GD2, GD3, GD1b). All ASAN patients with positive disialosyl antibodies presented with gait unsteadiness and sensory symptoms and reported an upper respiratory tract infection before disease onset. Five of the 7 patients presented eyelid ptosis. All patients had a good recovery with IVIg treatment or spontaneously. Considering these features we concluded that ASAN is, in fact, a GBS variant, and constitutes a specific phenotype different from ataxic GBS or MFS. CIDP is a chronic inflammatory neuropathy in which antibodies are thought to play an important role. Antibodies against myelin proteins had been described using ELISA and western-blot assays, but results were not reproduced in cell-based assays preserving protein conformation and none proved useful as biomarker. Recently, studies on sural nerve biopsies of CIDP patients have shown disorganization of node of Ranvier and the search of autoantibodies focused on proteins of the node of Ranvier. We used an unbiased approach with neuron immunocytochemistry, immunoprecipitation and confirmation of relevant antigens with transfected cells to find autoantibodies that could be useful in everyday practice. Starting with 46 well-characterized CIDP patients we found 7 patients reacting against neurons. Two patients precipitated contactin-1 (CNTN1) and one CNTN1 and contactin-associated protein-1 (CASPR1). Reactivity was confirmed with immunocytochemistry, inmmunohistochemistry and absorption studies. None of the 104 controls tested positive. All three patients shared old age, aggressive onset, motor predominance, prominent axonal degeneration at onset and poor response to IVIg. These features identify a subgroup of CIDP with homogeneous phenotype. Anti-CNTN1 antibodies are the first biomarker identified in CIDP with diagnostic, prognostic and therapeutic implications. These results strengthen the idea that autoimmune neuropathies are a very heterogeneous group of diseases in which autoantibody discovery and the definition of clinical-immunological correlations can have diagnostic, prognostic and therapeutic implications
Vieira, Lizyana. "Compressão nervosa e exercício físico resistido: efeitos sobre a morfologia da articulação talocrural de ratos." Universidade Estadual do Oeste do Parana, 2015. http://tede.unioeste.br:8080/tede/handle/tede/663.
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An adequate activity of the sciatic nerve is essential for the morphofunctional integrity of the lower limb structures, including the ankle joint or talocrural, responsible for providing a stable base of support for the body, in addition to propel it effectively during locomotion. These motor functions may be affected by changes in the peripheral nervous system by various pathological conditions, such as sciatica, which can be generated through the sciatic nerve compression, leading to functional incapacities. Among the treatment modalities, the resistive exercise stands out, and despite of its widespread use, still shows divergences in literature as to the best type, its intensity and the most indicated period for its outset. Therefore, the objective of this research was to verify the effects of experimental model of nerve compression and treatment with resistive exercise on the morphology of the talocrural joint of Wistar rats. For this purpose, 32 rats were divided into 4 groups (n = 8 / group): G1 (control), G2 (injury), G3 (exercise) and G4 (injury and exercise). Three days after the sciatic nerve compression surgery, groups G3 and G4 were submitted to resistive exercise stair climbing during 21 days. After euthanasia, the talocrural joints followed the protocol for paraffin embedding. The slides were colored with hematoxylin-eosin and Safranin O-Fast Green, photomicrographed and analyzed using Image Pro Plus 6.0®. Data were presented in mean and standard deviation, and ANOVA one way with posttest t was used for comparison. No significant differences in the thickness of the articular cartilage in the tibia and the talus were found. As for the number of chondrocytes in the tibia, G2 and G3 presented more cells in the anterior region of articular cartilage compared to G1, condition reversed in G4 animals. In the talus, there was an increase in the number of chondrocytes in anterior and posterior articular region of G2 and G3, and in G4, this hypercellularity was maintained only in the posterior region. As the central region of the joint, all groups presented a higher cell density compared to G1. In the morphological analysis, in the injury group (G2), changes were observed in the tibia and talus with the presence of flocculation, invagination of the subchondral bone, tidemark discontinuity and presence of pannus in the talus. In the exercise group (G3), discrete alterations were found only in talus and, in G4, the cartilage presented similar characteristics to G1. As for the morphology of the synovial membrane, this showed to be fibrous in the injury group, while in the other groups tissue changes were not noticed. Thus, sciatica led to an increase of the number of chondrocytes mainly in the talus and also produced morphological changes in the cartilage and in the synovial membrane of the talocrural joint, and the resistive physical exercise proved to be effective in the recovery of morphological characteristics of the joint components.
Atividade adequada do nervo isquiático é essencial para a integridade morfofuncional das estruturas do membro inferior, entre elas a articulação do tornozelo/talocrural, responsável por proporcionar base estável de suporte para o corpo, além de impulsioná-lo efetivamente durante a locomoção. Essas funções motoras podem ser afetadas por alterações no sistema nervoso periférico pelas mais diversas condições patológicas, como por exemplo a ciatalgia, que pode ser gerada por meio da compressão do nervo isquiático, levando a incapacidades funcionais. Dentre as modalidades de tratamento, destaca-se o exercício resistido, que apesar do seu uso difundido, ainda apresenta divergências na literatura quanto ao melhor tipo, sua intensidade e o período mais indicado para seu início. Assim, o objetivo dessa pesquisa foi verificar os efeitos do modelo experimental de compressão nervosa e o tratamento com exercício resistido sobre a morfologia da articulação talocrural de ratos Wistar. Para tanto, foram utilizados 32 ratos divididos em 4 grupos (n = 8/grupo): G1 (controle), G2 (lesão), G3 (exercício) e G4 (lesão e exercício). Três dias após a cirurgia de compressão do nervo isquiático, os grupos G3 e G4 foram submetidos ao exercício resistido de subida de escada durante 21 dias. Após a eutanásia, as articulações talocrurais seguiram o protocolo para emblocamento em parafina. As lâminas foram coradas com hematoxilina-eosina para análise morfológica geral do tecido e Safranina O-fast Green para cartilagem articular. Posteriormente fotomicrografadas e analisadas através do programa Image Pro Plus 6.0®. Os dados foram apresentados em média e desvio-padrão e para comparação dos diferentes grupos foi utilizado ANOVA one-way com pós teste t. Não foram encontradas diferenças significativas quanto a espessura da cartilagem articular na tíbia e o tálus. Já quanto ao número de condrócitos na tíbia, G2 e G3 apresentaram mais células na região anterior da cartilagem articular em relação a G1, condição revertida nos animais de G4. No tálus, houve um aumento do número de condrócitos tanto na região articular anterior quanto na posterior de G2 e G3, sendo que em G4, esta hipercelularidade se manteve apenas na região posterior. Quanto a região central da articulação, todos os grupos apresentaram uma maior densidade celular em relação ao G1. Na análise morfológica, no grupo lesão (G2), foram verificadas alterações na tíbia e tálus, com presença de floculações, invaginação do osso subcondral, descontinuidade da tidemark e presença de panus no tálus. No grupo exercício (G3), foram encontradas alterações discretas apenas no tálus e em G4, a cartilagem se apresentou com características próximas ao G1. Quanto a morfologia da membrana sinovial, essa se mostrou fibrosa no grupo lesão, sendo que nos demais grupos não foram notadas alterações teciduais. Assim, a ciatalgia levou ao aumento do número de condrócitos principalmente no tálus e também produziu alterações morfológicas na cartilagem e na membrana sinovial da articulação talocrural, e o exercício físico resistido se mostrou eficaz na recuperação das características morfológicas dos componentes articulares.
Vieira, Suzy Anne Tavares. "Estudo comparativo da sensibilidade do pé com e sem úlcera em pacientes diabéticos utilizando o Dispositivo Específico de Sensibilidade de Pressão - PSSD (Pressure-Specified Sensory Device)." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5158/tde-05052008-095724/.
Full textThe diabetes mellitus remains a problem with increasing incidence in the entire world, getting epidemic proportions in present time. This fact is followed by the increase in complications. The foot complications in these patients represent the highest morbimortality levels. The loss of protective sensibility is a preponderant factor in the appearing of foot ulcers in diabetic patients. Thus, the diagnostic methods must have elevated sensitivity, reproducibility and must quantify the disease stage, so specific procedures can be established. The author did a cross-sectional study, with the objective to determine the cutaneous sensibility thresholds in diabetic patients recruited from Hospital das Clinicas, Faculty of Medicine, University of São Paulo, with ulcer in only one of the lower extremities, comparing the thresholds of the member with ulcer with the member without ulcer. The sensibility was evaluated using the Semmes-Weinstein monofilament, the two points discrimination test with the disk-criminator(TM) and the PSSD (Pressure-Specified Sensory Device(TM)). An instrument capable to determine in a quantitative manner, reporting results in g/mm2, the exact pressure at which the individual can feel a touch in their skin, and to measure the pressure at which two points can be distinguished from one point touching the skin. The PSSD was used in four areas in patient\'s lower extremities: great toe pulp, dorsal feet, medial heel and lateral calf. The test was realized in four manners 1 point static, 1 point dynamic, 2 points static and 2 points dynamic. A total of 20 patients were included in the study, average age 61,6 years, average diabetic time 12,4 years. All the patients reported positively with the Semmes-Weinstein monofilament test. The mean of 2 point discrimination test was higher in the feet with ulcer, thus the results had statistic significance only in the hallux and lateral calf. All the patients reported cutaneous pressure thresholds higher in the feet with ulcer when comparing with the feet without ulcer, in both static and dynamic tests, with statistic significance in the four areas measured. As the conclusion, the PSSD was capable to differentiate the cutaneous thresholds among the extremity with ulcer and the extremity without ulcer in diabetic patients.
Akashi, Paula Marie Hanai. "Influência da neuropatia periférica e da ulceração plantar nas variáveis cinéticas e eletromiográficas durante a marcha de diabéticos." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5163/tde-21082007-105944/.
Full textThe aim of this work was to investigate the influence of diabetic neuropathy and the clinical history of plantar ulceration in the somatossensorial plantar sensitivity and in kinectic and electromyographic lower limb variables during gait of diabetic neuropathic subjects with (UDG) and without (DG) history of plantar ulceration. The casuistics was composed by 45 gender and age matched adult subjects, who were divided into three groups: DG - diabetic neuropathic group (n=19), UDG - diabetic neuropathic group composed by diabetic neuropathic subjects who presented at least one foot ulceration in the past two years (n=10), and a control group (CG) composed by non-diabetics asymptomatic adults. The results of somatossensorial tests showed a gradual loss of plantar sensitivity with the neuropathy progression. Subjects from UDG had worse plantar sensitivity than the DG. UDG also showed higher total contact time than DG (CG=693,1 ± 65,98; DG=681,5 ± 51,2; UDG=758,5 ± 105,1, in miliseconds). These numbers indicate that UDG subjects have a longer exposition time of the plantar surface to the pressures made by the contact with the ground durint gait. There was a gradual reduction of the vertical GRF second peak, from CG to DG, and from this last group to the UDG (CG=1,09 ± 0,06; DG = 1,05 ± 0,08; UDG = 1,02 ± 0,06). The main electromiographic changes found in UDG were: a delayed peak of activation of vastus lateralis muscle, right after the heel contact (CG=10,82 ± 3,33; DG=11,97 ± 2,31; UDG=14,83 ± 3,53,% of contact time), and a delayed peak of activation of gastrocnemius lateralis muscle (CG=63,53 ± 3,65; DG=62,84± 5,06; UDG=68,00± 4,78,% of contact time). These biomechanical changes suggest that diabetic neuropathic subjects with history of foot ulceration have a muscleskeleton system inefficacy during the shock absorption phase and during the propulsion phase of the gait. Although there were no significant differences in tibialis anterior muscle activity, DG subjects showed higher TA EMG activity, which suggests a compensatory mechanism to diminish overload on the forefoot during flat foot phase. The biomechanical changes found, associated with other sign and symptoms of neuropathy, like the loss of sensitivity, could be considerate predisposable factors for plantar ulcers formation or its recurrence.
Oliveira, Diego Henrique Andrade de. "Prevalência de neuropatia autonômica cardiovascular e preditores do seu desenvolvimento em pacientes com diabetes melito do tipo l." reponame:Repositório Institucional da UFPR, 2014. http://hdl.handle.net/1884/37955.
Full textCo-orientadora: Profª. Drª. Rosângela Roginski Réa
Dissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Medicina Interna. Defesa : Curitiba, 14/11/2014
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Resumo: INTRODUÇÃO: A neuropatia autonômica cardiovascular (NAC) é uma complicação crônica do diabetes que está associada ao aumento de morbimortalidade cardiovascular e que é subdiagnosticada em nosso meio devido à escassez de métodos diagnósticos para a mesma. OBJETIVO: Avaliar a prevalência de NAC em pacientes com diabetes melito do tipo 1 (DM1) do Ambulatório de Diabetes do Hospital de Clínicas da Universidade Federal do Paraná, bem como verificar a associação de NAC com as outras complicações crônicas do diabetes e com dados demográficos, clínicos e laboratoriais dos pacientes. METODOLOGIA: Estudo transversal, em que 80 pacientes com DM1 e 56 indivíduos controle de ambos os sexos foram submetidos à avaliação de NAC por meio de uma bateria de sete testes, compostos por três bandas da análise espectral (componentes de frequências altas, baixas e muito baixas) e quatro testes autonômicos cardiovasculares (teste da respiração profunda, manobra de Valsalva, teste ortostático e teste da hipotensão ortostática). A presença de dois e três ou mais testes alterados determinaram o diagnóstico de NAC incipiente e instalada, respectivamente. Foram coletados dados demográficos dos pacientes e dados clínicos e laboratoriais dos prontuários dos mesmos. RESULTADOS: A NAC foi diagnosticada em 26,25% (n = 21/80) dos sujeitos, sendo a NAC incipiente discretamente mais prevalente (n = 11/80). Observou-se significativa associação de NAC incipiente com a nefropatia diabética e com a hemoglobina glicada (HbA1c). Não foi detectada esta associação no subgrupo com NAC instalada. A NAC não se associou com idade, sexo, índice de massa corpórea, tempo de diagnóstico de DM1, glicemia capilar no dia do exame da NAC, colesterol total e frações, creatinina sérica, hipertensão arterial sistêmica, hipotireoidismo primário, retinopatia e polineuropatia periférica. CONCLUSÃO: A NAC foi uma complicação crônica do diabetes prevalente, diagnosticada em aproximadamente um quarto da população estudada com DM1. A nefropatia e a HbA1C se associaram com a NAC incipiente, mas não com a NAC instalada. Palavras chave: Diabetes melito do tipo 1. Neuropatia autonômica cardiovascular. Fatores predisponentes.
Abstract: INTRODUCTION: Cardiovascular autonomic neuropathy (CAN) is a chronic complication of diabetes that is associated with increased cardiovascular morbidity and mortality that is underdiagnosed in our environment due to lack of diagnostic methods for the same. OBJECTIVE: To evaluate the prevalence of CAN in patients with diabetes mellitus type 1 (T1DM) from the Diabetes Outpatient of Hospital de Clínicas da Universidade Federal do Paraná, and to verify the association of CAN with other chronic complications of diabetes and demographic, clinical and laboratory data of patients. METHODS: Cross-sectional study in which 80 patients with T1DM and 56 control subjects of both sexes were examined for CAN through a battery of seven tests, composed of three bands of spectral analysis (components of high, low and very low frequencies) and four cardiovascular autonomic tests (deep breathing test, Valsalva maneuver, orthostatic test and orthostatic hypotension test). The presence of two and three or more abnormal tests determined the diagnosis of incipient and installed CAN, respectively. Demographic, clinical and laboratory data of patients were collected from medical records. RESULTS: CAN was diagnosed in 26.25% (n = 21/80) of subjects and incipient CAN was slightly more prevalent (n = 11/80). Incipient CAN was associated with diabetic nephropathy and glycated hemoglobin (HbA1c). This association was not detected in the subgroup of installed CAN. CAN was not associated with age, sex, body mass index, diabetes duration, capillary blood glucose testing on the day of CAN exam, total cholesterol and fractions, serum creatinine, hypertension, primary hypothyroidism, retinopathy and peripheral polyneuropathy. CONCLUSION: CAN was a prevalent chronic complication of diabetes, diagnosed in approximately one fourth of patients with T1DM. Nephropathy and HbA1c were associated with incipient CAN, but not with installed CAN. Keywords: Diabetes mellitus type 1. Cardiovascular autonomic neuropathy. Predisposing factors.
Cardoso, Vinicius Saura. "Estudo da marcha e de alterações biomecânicas no pé de pacientes com diabetes." Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/5/5135/tde-02062009-100404/.
Full textThe human gait is one of the most studied movement in biomechanics. Its considered a repetitive cycle which is characterized by a stance and a swing phase. Gaits disturbance were found in patients with diabetic disease who have diabetic neuropathic foot. Some researchers found differences during the patients gait with diabetic neuropathic foot. The purpose of this study was to analyze comparatively in diabetic patients with and without neuropathic foot. The casuistic was composed by 36 subjects divided into three groups: CG - control group (n=10), DG - diabetic group (n=10) and DNG - diabetic neurophatic group (n=16). All subjects had their gait analyzed by capturing the vertical ground reaction force and recording the ankle joint range of motion. In order to analyze the data, a routine was developed and using Matlab® program. The results showed that the 1st. and 2nd. vertical ground reaction force peaks are statistically higher in diabetic patients with diabetic neuropathy and the ankle range of motion is statistically lower in this group. Hence, it can be concluded that vertical ground reaction force and the ankle range motion have different characteristics among the studied groups. Actions to reduce the vertical ground reaction force and to increase the range of the ankle joint motion are necessary in order to decrease the probability of developing foot ulcer
Suda, Eneida Yuri. "Padrões dinâmicos de recrutamento muscular por EMG de alta densidade de diabéticos em diferentes níveis de severidade de neuropatia classificados por um modelo linguistico fuzzy." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5170/tde-22092017-134024/.
Full textIntroduction: The general proposal of this study is to get a better understanding on how motor control is affected in diabetic polyneuropathy (DPN) individuals. Fluctuations of the force and sEMG signal during isometric voluntary contractions have been studied as a simplified model of the physiological mechanism that underlies the control of movement. The analysis of the muscular recruitment patterns from lower limbs, obtained by high-density sEMG, together with the corresponding force signal outputs from knee and ankle joints, in the light of complexity analysis, adds to the knowledge of the disease effects in motor control. Additionally, examining the complexity of force and muscle activity of DPN individuals, along with the development of DPN from subclinical to the more severe stages, will help us understanding how the alterations will develop with the DPN progression. The hypotheses of this study are that: DPN alters the motor complexity, expressed as an increased amount of variability and a decreased structure of variability in sEMG and force outputs, and these alterations are aggravated by the severity of the disease. Methods: We assessed 10 control subjects and 38 diabetic subjects, classified as absent, mild, moderate, or severe DPN, by a fuzzy-system based on clinical variables. Multichannel sEMG (64-electrode matrix) of tibialis anterior, gastrocnemius medialis, vastus lateralis and biceps femoris muscles were acquired during isometric contractions at 10%, 20%, and 30% of the maximum voluntary contraction, and force levels were recorded during dorsiflexion, plantarflexion, knee extension and knee flexion. Standard deviation and sample entropy of force signals were calculated and root mean square and sample entropy were calculated from sEMG signals. Differences among groups of force and sEMG variables were verified using a multivariate analysis of variance (alpha=0.05). Results: Overall, during dorsiflexion contractions, moderate and severe subjects had higher force standard deviation and moderate subjects had lower force sample entropy. During plantarflexion, moderate subjects had higher force standard deviation and all diabetic subjects had lower entropy. During knee extension moderate DPN subjects demonstrated high force standard deviation and low force sample entropy. Tibialis anterior presented higher root mean square in absent group and lower entropy in mild subjects. For gastrocnemius medialis, entropy was higher in severe and lower in moderate subjects. Severely affected participants showed low sample entropy in vastus lateralis at all force levels. Conclusions: DPN affects the complexity of the neuromuscular system during low-level isometric contractions, reducing the system\'s capacity to adapt to challenging mechanical demands. The observed patterns of neuromuscular complexity were not associated with disease severity, with the majority of alterations recorded in moderate subject
Robinson, Caroline Cabral. "Baropodometria em indivíduos diabéticos e pré-diabéticos, com e sem neuropatia." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2011. http://hdl.handle.net/10183/37225.
Full textSubjects with diabetic disease, mainly that with peripheral neuropathy, are susceptible to develop plantar ulcers that could be associated with neuropathy or with the high plantar pressure values found in the plantar forefoot (midfoot, metatarsal heads and hallux) due the peripheral sensory loss and/or foot deformities that occurs as the developing of diabetes. Pre-diabetic subjects show a potential risk for peripheral neuropathy development, too. The main objective of this work was to study the plantar pressure distribution, through baropodometry access, in a group of diabetic and a group of pre-diabetic subjects (both the two groups with or without peripheral neuropathy or autonomic cardiac neuropathy) comparing to a group of healthy subjects. The baropodometric variables were compared among the three groups and correlated whit intervenient factors that could modify plantar pressure distribution. The diabetic group showed alterations in plantar pressure distribution with increased peak plantar pressures and pressure time integral at midfoot, metatarsal heads and hallux, without association whit other studied intervenient factors, and an increase in the total step time contact and percentage of contact time, during the roll over progress, in the midfoot. The pre-diabetic group presented a plantar pressure distribution pattern and baropodometric parameters similar to the diabetic group, excepting the total step time contact which was similar to the healthy group. This fact is been shown for the first time and points to a demand of interventions to pre-diabetic in order to prevent plantar injuries, like ulcers. In conclusion, diabetic subjects without foot deformities, with or without peripheral neuropathy show early modifications in plantar pressure distribuition and pre-diabetic sujtects can show modifications in plantar pressure distribution similar to those found in the diabetic subjects.
Zaslavsky, Lerida Maria Araujo. "Disfunção cognitiva em pacientes diabéticos não insulino-dependentes com neuropatia autonômica." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 1994. http://hdl.handle.net/10183/171790.
Full textAbnormal cognitive function in Type 2 diabetic patients has been associated with peripheral neuropathy, poor metabolic contrai and a non-specific effect of chronic disease. A cross-sectional controlled study was conducted to determine whether autonomic neuropathy (AN), defined according to cardiovascular tests as proposed by Ewing, is independently associated with cognitive dysfunction in Type 2 diabetic patients. Study participants were 20 Type 2 diabetic patieuts witb AN (14 males and 6 females; age = 60±1 years); 29 Type 2 diabetic patients without AN (14 males and 15 females; age = 59±1 years) aud 34 non diabetic patients with non-inflammatory articular disease (10 males and 24 females; age = 58± 1 years), matched by age, educational level and duration of disease. Cognitive functiou was evaluated by tests of verbal - immediate and receut (digit span; word span), visual - immediate and recent (recognition of silhouettes of towers and famous faces) and remate memory (dates of important events). Diabetic patients with AN obtained significantly lower scores in visual memory tests than diabetic patients without AN and controls (towers immediate = 7 versus 6 versus 6; towers recent = 4 versus 6 versus 6; faces = 16 versus 18 versus 18, respectively; Kruskal-Wallis; p < 0.05). Talking into account other factors (age, educational level, duration of disease and fasting plasma glucose) that could interfere with performance in cognitive tests, stepwise multiple regression analysis disclosed that performance in visual tests remained significantly associated to AN (p = 0,0054; partial r2 = 0,166 aud p = 0,0076; parcial r2 = 0,163 for TOWER 1 and TOWER F, respectively). Negative correlations (Spearman; r = -0,25 and r= -0, 24) were observed between the scores in visual memory tests (FACES and TOWER F, respectively) and the number of abnormal cardiovascular tests. In conclusion, decreased visual cognitive function in Type 2 diabetic patients is associated to the presence and degree of AN.
Butugan, Marco Kenji. "Influência da progressão do diabetes nos padrões dinâmicos de recrutamento de fibras musculares analisados através de eletromiografia de alta densidade." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5170/tde-24062014-113902/.
Full textThis study aimed at investigating the influence of different stages of diabetic neuropathy in the muscle fiber conduction velocities estimated in four lower limb mucles during isometric maximal voluntary contraction using surface electromyography. Eighty-five adults were studied: 16 non-diabetic individuals and 69 diabetic patients classified into four neuropathy stages, defined by a fuzzy system: absent (n=26), mild (n=21), moderate (n=11) and severe (n=11). Average muscle fiber conduction velocities of gastrocnemius medialis, tibialis anterior, vastus lateralis and biceps femoris were assessed using linear array electrodes, and the studied groups were compared by ANOVAs (p < 0.05). Conduction velocities were significantly decreased in the moderate neuropathy group for the vastus lateralis compared to other groups (from 18 to 21% decrease), and were decreased in all diabetic groups for the tibialis anterior (from 15 to 20% from control group). Not only the distal anatomical localization of the muscle affects the conduction velocity, but also the proportion of muscle fiber type, where the tibialis anterior, with greater type I fiber proportion, is affected already at the absent group while the vastus lateralis with greater type II fiber proportion is affected in later stages of the disease. Generally, the muscles of the lower limb have different responsiveness to the effects of diabetes mellitus and neuropathy and show a reduction in the conduction velocity as the neuropathy progresses
MAIA, Juliana Netto. "Efeitos do treinamento físico na organização estrutural e funcional do tecido nervoso periférico em ratos com diabetes experimental." Universidade Federal de Pernambuco, 2012. https://repositorio.ufpe.br/handle/123456789/24982.
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Neste estudo avaliou-se o efeito do treinamento físico aeróbico de moderada intensidade sobre a instalação da neuropatia periférica em ratos com diabetes experimental. Foram utilizados 40 ratos machos, adultos, da linhagem Wistar. Estes foram divididos em 4 grupos: controle sedentário (CS), controle treinado (CT), diabético sedentário (DS), diabético treinado (DT). A indução do diabetes foi realizada nos animais, com 70 dias de vida, através da administração intraperitoneal de estreptozotocina, dose única de 60 mg/kg. O protocolo de exercício constou de treino em esteira rolante por 8 semanas. Na primeira semana, adaptação, os animais correram por 10 minutos diariamente. Nas sete semanas seguintes a velocidade e o tempo foram aumentados gradativamente. O treino foi realizado cinco vezes por semana. Antes da indução e na semana seguinte após o término do protocolo do exercício, foi realizada a velocidade de condução nervosa (VCN). Após 10 semanas da indução, os animais foram anestesiados com solução de Cloridato de ketamina (50 mg) e de Xilasina a 2% (20 mg) (0,2 mL/100g), em seguida o nervo isquiático, foi dissecado e cortado proximalmente, seguindo para uma pré-fixação realizada com solução Karnowisky por 24h a 4°C, depois pós-fixado com solução de tetróxido de ósmio e processado para obtenção de cortes semi-finos (0,5μm), corados com azul de toluidina. Foram avaliados: a VCN, o diâmetro das fibras mielínicas (DFM) e do axônio mielínico (DAM), espessura da bainha de mielina (EBM), razão ―g‖ (RZG), área de secção transversa do nervo isquiático, quantidade e densidade de fibras nervosas mielínicas, percentual de fibras finas e grossas e quantidade de vasos endoneurais de 4 animais de cada grupo, escolhidos aleatoriamente. A análise estatística foi realizada através da análise de variância (ANOVA) e havendo interação foi realizado o Post Hoc (Tukey HSD), sendo p < 0,05. Ao final do experimento observou-se que os animais diabéticos apresentaram peso inferior quando comparados aos seus grupo controle (p=0,0001). Não houve diferença entre os valores glicêmicos dos animais dos grupos DS e DT. A DFM e a DAM foi maior nos animais submetidos ao treinamento (p= 0,0226; 0= 0,0110, respectivamente). A EBM não apresentou diferença entre os grupos. Os animais dos grupo DS apresentaram valores de RZG de 0,58, classificando-os em extramielinizados, os demais grupos apresentaram valores dentro na normalidade. Em relação à VCN, houve uma interação pelo ANOVA (p=0,0124; TUKEY: p=0,0004) mostrando que o grupo DS apresentou queda neste parâmetro. Houve uma diminuição na área e na quantidade de fibras mielínicas nos grupos diabéticos (p<0,007; p=0,005, respectivamente). No entanto o percentual de fibras grossa foi maior nos DT que no DS (p=0,04). Apesar de não haver diferença significativa, o número de vasos endoneurais foi melhor preservados nos animais DT que nos animais do grupo DS. Pode-se perceber que os animais do grupo DT apresentou valores dos parâmetros avaliados mais e próximos aos dos grupos controle. Diante destes resultados, pode-se observar que o treinamento físico parece melhorar/preservar a estrutura nervosa dos animais diabéticos.
This study evaluated the effect of moderate intensity aerobic exercise training on the peripheral neuropathy installation among rats with experimental diabetes. This experiment was conducted in 40 male mice, adult, Wistar breed. The experiment used 4 groups: sedentary control (SC), trained control (TC), sedentary diabetic (SD), trained diabetic (TD). The induction of diabetes was performed in 70 days old animals by intraperitoneal administration of streptozotocin, in a single dose of 60 mg/kg. The exercise protocol consisted of treadmill training for 8 weeks. In the first week, adaptation week, animals ran for 10 minutes daily. In the following seven weeks, speed and time were increased gradually. The training was performed five times per week. Before the induction and after the exercise protocol, the nerve conduction velocity (NCV) was performed. After 10 weeks of induction, animals were anesthetized with ketamine hydrochloride solution (50mg) and xylazine 2% (20mg) (0,2ml/100g), then the sciatic nerve was dissected and proximal cut, then it was conducted a pre-setting with Karnowisk solution for 24h at 4°C, after that a postfixed was conducted with osmium tetroxide for obtaining semi-thin sections (0,5μm), stained with toluidine blue. Thus, it were evaluated: NCV, the diameter of myelinated fibers (DMF) and myelin axon (DMA), thickness of the myelin sheath (TMS), "g" ratio (RZG), cross-sectional area of the sciatic nerve, quantity and density of myelinated nerve fibers, the percentage of fine and coarse fibers and endoneural vessels amount of 4 animals of each group randomly selected. The statistical analysis was performed using analysis of variance (ANOVA) method and in cases of interaction detected, it was performed Post Hoc test (Tukey HSD), p <0.05. At the end of the experiment, it was observed that diabetic animals presented lower weight when compared to their control group (p = 0.0001). There was no difference between the glycemic values of SD and TC groups. The DMF and DMA were higher in animals exposed to training (p = 0.0226; 0 = 0.0110, respectively). There were no TMS difference between the groups. The animals of the DS group had RZG values of 0.58, ranking them in extramielinizados, the other groups presented their values within the normal range. Regarding the NCV, there was an interaction by ANOVA (p = 0.0124; Tukey: p = 0.0004) presenting a SD decrease in this parameter. There was a decrease in the area and in the quantity of myelinated fibers in diabetic groups (p <0.007; p = 0.005, respectively). However, the percentage of coarse fibers was higher in TD than in SD (p = 0.04). Even though no significant difference were found, the vessels endoneurial was better preserved in TD animals than in SD animals. Animals in TD group presented values of their evaluated parameters more closer to the control group. Considering those results, physical training seems to improve / maintain nerve structure in diabetic animals.
Braz, Patrícia Cardoso. "Nível de atividade física e ocorrência de neuropatia em diabéticos tipo 2 da atenção primária do município de Rosário do Catete - Sergipe." Universidade Federal de Sergipe, 2015. https://ri.ufs.br/handle/riufs/4933.
Full textIntrodução: A atividade física (AF) faz parte das recomendações do Ministério da Saúde para o controle do Diabetes Mellitus (DM) e suas complicações. Objetivo: Avaliar o nível de atividade física e ocorrência de neuropatia diabética periférica em idosos com DM tipo 2. Casuística e Métodos: Trata-se de estudo transversal com amostra escolhida por conveniência, equivalente a 11.8% dos diabéticos de Rosário do Catete - SE, correspondente a 49 indivíduos. Critérios de inclusão: idade ≥ 18 anos e cadastro nas Unidades de Saúde da Família como diabéticos tipo 2. Critérios de exclusão: incapacidade de realizar atividade física e déficit cognitivo. Instrumentos utilizados: Questionário Internacional de Atividade Física, Escore de Sintomas e Comprometimento Neuropático. Dados coletados nos ambulatórios e residências. Análises estatísticas realizadas com os testes T Student, U de Mann Whitney e Regressão Logística Multivariada por meio da versão 13.0 Stata. Resultados: Foram selecionados 52 indivíduos, idade média igual a 63±12.3 anos, categorizados em neuropáticos (n=29) e não neuropáticos (n=23), bem como em mais ativos (n=16) e menos ativos (n=36). Verificou-se que apenas 31% dos indivíduos eram mais ativos, esses tinham idade média e glicemias menores, assim como maior tempo de diagnóstico. A presença da neuropatia diabética foi estatisticamente significante naqueles menos ativos (p<0,01) tal qual o inverso (p<0,01). Conclusão: Não foram encontrados parâmetros adequados do nível de atividade física em 69% da amostra e a neuropatia diabética apresentou prevalência de 56%.
Cecchini, Marina Valente Guimarães. "Contribuição do espaço da escuta terapêutica, com orientação fenomenológica hermenêutica, para a compreensão do discurso dos doentes após alívio abrupto e agudo da nocicepção." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5138/tde-17082018-101433/.
Full textINTRODUCTION: Considering that pain is multifaceted and acknowledging the importance to approach the experiences of people affected by illness related to its chronicity, this work sought to contribute to the knowledge about the phenomenon of pain emphasizing the discourse of both patients submitted to acute reduction of nociception by surgery, and also of people with congenital peripheral neuropathy. METHODS: The follow-up of the 15 participants with chronic pain (patients with cervical cordotomy for refractory oncologic pain and percutaneous trigeminal rhizotomy for trigeminal neuralgia) occurred at the Neurology outpatient clinic of the Hospital das Clínicas during 12 months at three different moments: preoperative (V1), immediate postoperative (V2) and late postoperative (V3) (after 4 months of intervention). For the quantitative evaluation of pain phenomenon, instruments commonly used in the Department were applied: the Sociodemographic Questionnaire and the Conditioned Pain Modulation (CPM) protocol only at the first moment; and the Questionnaire for Diagnosis of Neuropathic Pain (DN4), the Neuropathic Pain Symptom Inventory (NPSI), the Brief Pain Inventory (BPI), the McGill Pain Questionnaire, the Pain Catastrophizing Scale (PCS) and Hospital Anxiety and Depression Scale (HADS). The open interviews were carried out in three moments, based on the hermeneutic phenomenological method. To enrich the understanding that nociception is one of the factors, but not the only one that influences the occurrence of pain phenomenon and to approach the aspect of suffering, two people affected by Autonomic Sensorial Hereditary Neuropathies (HSAN) were also interviewed. These participants were followed in a single moment, in which, in addition to the interview, the Sociodemographic Questionnaire and the Hospital Anxiety and Depression Scale (HADS) were applied. RESULTS: It was noticed through the quantitative analysis of the scales that, in general, there was a tendency to decrease pain and anxiety indexes after performing the surgical procedure. This reduction was more significant among cancer patients. The DN4 scores (6,9±2,3; 2,7±2,2; 5,5±2,5) were significant at different moments and decreased between visits V1 and V2. For NPSI values were significant only between visits V1 and V2, presenting the respective values (65,6±12; 26,4±13,7). The mean value of BPI interference was different between moments V1 and V2 with mean values of (60,3±14,1; 15,7±13,3). The values of McGill questionnaire for pain were (6,1±1,5 e 2,0±1,0) respectively for V1 and V2 in the sensory component, and for the affective component the values were (2,8±1,8; 0,3±0,6) respectively. For mood scales the patterns remained similar to those of the pain scales, there was a decrease in the values between visit 1 and 2 for the scale PCS that remained at visit 3. For HADS Depression scale there was no significance between the different moments. Considering the HADS Anxiety scale there was a decrease in the values between V1 and V2, as well as between visits V1 and V3, but there was no significance between V2 and V3 moments. The interviews were analyzed from Units of Meaning that emerged from the discourse of the participants. For the V1 moment, the following units were considered: Search Time for a Diagnosis, Relationship with Spouse and Family, Work, Relationship with Death and Expectation of Improvement. At moments V2 and V3, the same units were maintained, except for \"Search Time for a Diagnosis\". In the analysis of patients with HSAN condition the same Units of Meaning were kept, except for \"Relationship with Death\" and \"Expectation of Improvement\". The listening aspect was extremely important for the understanding of patients with chronic pain in the three different moments, before performing a neurosurgical procedure, immediately after neurosurgery and at a later time. It also brought the opportunity to listen to the ones with HSAN condition who present a differentiated experience of suffering towards pain
Parisi, Maria Candida Ribeiro. "Ocorrencia de ulceras em pacientes com pe diabeticos : fatores clinicos preditivos." [s.n.], 2001. http://repositorio.unicamp.br/jspui/handle/REPOSIP/310704.
Full textDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: o principal objetivo deste trabalho é comparar características clínicas e laboratoriais de pacientes com diagnóstico de pé diabético e úlcera, com pacientes com diagnóstico de pé diabético sem úlcera, buscando a presença de marcadores que poderiam estar relacionados à ocorrência de úlcera no grupo de pacientes de risco. Estudamos trinta e nove pacientes com diagnóstico de pé diabético com úlcera (grupo A) e trinta e nove pacientes com diagnóstico de pé diabético sem úlcera (grupo B), pareados por sexo, idade e tempo de doença. Todas as avaliações clínicase laboratoriais de rotina tiveram como intuito verificar se alguma delas poderia ser considerada preditiva na ocorrência de úlcera. Encontramos prevalência de 74,4% de neftopatia no grupo A e 43,6% no grupo B (p=0,005). Alterações neuro- vasculares foram encontradas simultaneamenteem 30,8% do grupo A e 7,7% do grupo B (P=0,005). Nossas conclusões foram: a coexistência de alterações neurológicas e vasculares em pacientes com pé diabético aumenta em dez vezes o risco de ocorrência de úlcera e, a neftopatia diabética, por si só, aumenta em 2,7 vezes o risco
Abstract: The rnain objective of the present work is to compare clinical evaluation and laboratory tests assessment in patients diagnosed with diabetic foot with and without ulcers and search for clinical or biological markers, which might be involved with the ulcer's occurrence in a group ofpatients at risk. For this we had studied thirty-nine patients diagnosed with diabetic foot and plantar ulcer (group A) and thirty-nine patients with diabetic foot but no ulcers (group B). All the clinical files and routine laboratory tests were assessed in order to evaluate if those factors might be considered as predictive for the etiology ofulcers. We found a 74,4% prevalence of nephropathy in-group A and 43,6% group B (P=0,OO5).Neurological and vascuIar abnormalitieswere found simultaneouslyin 30,8% of group A patients and in 7,7% ofthe patients in-groupB (p=O,OO5). Our concIusions were: co-existence of neurological and vasculopathy in patients diagnosed with diabetic foot leads to a lO-fold increased risk ofplantar ulcers, and nephropathy alone leads to a 2,7-fold increased risk
Mestrado
Clinica Medica
Mestre em Ciências Médicas
CORREIA, Cristiano de Almeida. "Impacto da suplementação de vitamina D em adultos com diabetes Mellitus tipo 2." Universidade Federal de Alfenas, 2015. https://bdtd.unifal-mg.edu.br:8443/handle/tede/542.
Full textThe relationship between diabetes mellitus, its complications and vitamin D deficiency has been shown to be increasingly evident in several recent studies. However, many of these studies are observational and the few intervention studies have short duration or utilize small dosages which turns it difficult to define a causal relationship between these factors. This study aims to evaluate the influence of vitamin D replacement on glycemic control and diabetic complications. Type 2 diabetic patients deficient in vitamin D [25 (OH) vitamin D below 30 ng / ml] were evaluated and randomized in a double-blind fashion concerning to replacement of vitamin D into two groups: group 1 (n = 20) and group 2 (n = 13) that were crossed in the middle of the study. In addition to levels of 25 (OH) vitamin D, plasma concentrations of calcium, phosphorus, magnesium, glycated hemoglobin, fasting glucose, fasting insulin, C-peptide, ultrasensitive PCR, lipid profile and plasma creatinine, along with the albumin / creatinine ratio in spot urine sample were analyzed and calculated HOMA-IR and beta indexes (Homeostasis Model Assessment - Insulin resistance and beta) to determine the degree of insulin resistance and secretion, respectively. The neuropathy was assessed by Neuropathy Symptom Score. Such markers were measured at baseline and after 3 and 6 months of follow-up. At 3 months of follow-up patients had intervention changed (vitamin D3 to placebo and vice versa) featuring a cross-over clinical trial. After data collection and statistical analysis correcting for the intervening sequence or carry-over effect, was observed that none of the variables suffered statistically significant interference by the intervention, including 25-hydroxyvitamin D itself, demonstrating that replacement of vitamin D3 in a dose of 5000 IU per day for three months are not able to lead to changes in the concentration of 25- hydroxyvitamin D, glycemic control parameters, systemic inflammation, lipid profile, the renal function parameters, in albuminuria and Neuropathy Symptom Score. It raises issues about the ideal and proper dosage of vitamin D3 to bring forth a real increase in concentrations of 25-hydroxyvitamin D and thus influence glycemic control nephropathy and neuropathy in type 2 diabetic patients.
Gomes, Aline Arcanjo. "Papel da atividade muscular no padrão de marcha de diabéticos neuropatas: um estudo por modelagem computacional." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5170/tde-04012018-094648/.
Full textMuscle force estimation could support a better understanding of the mechanical and muscular strategies that diabetic patients adopt to preserve walking ability and to guarantee their independence as they deal with their neural and muscular impairments due to diabetes and neuropathy. Our aim was to estimate and compare the lower limb\'s muscle force distribution during gait in diabetic patients with and without diabetic neuropathy. Data from ground reaction force (AMTI OR61000 force plate at 100Hz) and three-dimensional kinematics of ankle, knee and hip (eight-camera Optitrack® at 100 Hz) of 10 neuropathic (DNG), 10 diabetic non-neuropathic (DG) and 10 healthy individuals (CG) were used as input variables for the musculoskeletal model gait 2392 (23 degrees of freedom and 92 musculoskeletal actuators) in the OpenSim software. The standard generic model was scaled to fit the anthropometry of each individual collected, prior to the execution of the simulations. The musculoskeletal model of neuropathic individuals presented maximum isometric force reduced in 30% for ankle extensors and 20% for ankle dorsiflexors to mimic the atrophy of ankle muscles due to diabetic neuropathy. The force time series of lower limb muscles were calculated using the static optimization procedure. The peak muscle forces were calculated during selected time bands of the gait cycle. The peak force was compared between groups using MANOVA for the flexor and extensor muscle groups of hip, knee and ankle joints followed by ANOVA and post-hoc of Newman-Keuls (p < 0.05). DNG showed higher knee flexors peak force (biceps femoris short head / p < 0,001, semitendinous / p < 0,001 and semimenbranous / p < 0,001) during push-off, compared to DG and CG. DNG also presented lower peak force for gastrocnemius medialis and soleus, as well as higher peak force for gastrocnemius lateralis compared to DG and CG in the same gait phase. DG exhibited lower peak force for the hip extensor muscles (semitendinous and semimembranous) in the final swing and hip abductor muscles during stance, as well as higher peak force for the knee extensor muscles (vastus medialis and lateralis / p=0,004) in the early stance compared to DNG and CG. Diabetic patients with and without neuropathy appear to adopt different muscle force distribution strategies in spite of the progressive worsening in their health condition. While reducing ankle extensor forces, DG increased knee extensor muscle forces at early stance and reduced the hamstrings force at the end of swing phase, whereas DNG increased the hamstrings muscle forces at push-off. A resistance training program for the proximal muscles related to the knee joint could be considered in a rehabilitation routine for diabetic patients. Other potential inclusions in rehabilitation protocols consist of gait retraining and practicing functional exercises focusing on the activation of the hamstring muscles
Xavier, Antônia Tayana da Franca. "Adaptação cultural e validação do instrumento Neuropathy - and Foot Ulcer - Specific Quality of Life (NeuroQol) para o Brasil - fase 1." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-14012011-093233/.
Full textDiabetes mellitus (DM) is considered a public health problem which can affect people\'s quality of life (QoL) through the consequences of its complications, such as peripheral neuropathy. Research on Health-related Quality of Life (HRQL) investigates and evaluates the impact of diseases and their treatment in people\'s life. Among the specific instruments of HRQL for DM, NeuroQol was identified for evaluation of the QoL of people with peripheral neuropathy and ulcers. This methodological study aimed to carry out the pilot stage of cultural adaptation and validation for Brazil of the NeuroQol instrument. NeuroQol has 35 items, of which 27 are distributed into six domains, Pain, Loss/reduction of sensitivity, Diffuse sensitive-motor symptoms, Limitations of daily life activities, Disorder in social relations and Emotional affliction. The process of adaptation followed the steps recommended in literature. Data were collected in an outpatient clinic of a public teaching hospital in the interior of the state of São Paulo, through interviews, physical examination and consultation of patient files. The sample consisted of 50 people, according to inclusion/exclusion criteria, between October 2009 and May 2010. The following psychometric properties were initially analyzed: face and content validity (board of experts); convergent construct validity (Pearson\'s correlation tests among the NeuroQol domains and the two SF-36 components); discriminant construct validity (Student\'s t test of NeuroQol among the group of people with ulcers and without ulcers); reliability (internal consistency - Cronbach\'s alpha). Results showed that most participants were female (58%), average age of 55 years; 70.6% had low educational level; average DM time of 16 years; 62% presented altered fasting plasma glucose and 66% glycated hemoglobin higher or equal to 7%. The convergent construct validity had negative correlations in the evaluation of the psychometric properties, with most correlations from moderate to high magnitude. As to the discriminant construct validity, the comparison of the averages of the instrument among groups with and without ulcer was significant in the domain Limitations of daily life activities. Reliability showed an adequate value for internal consistency of the adapted version of NeuroQol (Cronbach\'s ? =0.94). The adapted version of NeuroQol to Brazil is valid and reliable, in the studied sample. There is need to widen the psychometric analysis in samples which involve a higher number of participants.
Toledano, Sierra Pilar. "Afectación neurológica en el lupus eritematoso sistémico: Alteraciones en la neuroimagen y caracterización de la afectación del sistema nervioso periférico." Doctoral thesis, Universitat de Barcelona, 2017. http://hdl.handle.net/10803/585890.
Full textNeuropsychiatric (NP) involvement is one of the leading morbidity and mortality causes in systemic lupus erythematosus (SLE) patients. However, the correct attribution of NP presentation in SLE or to an alternative etiology is a challenge for clinicians given the absence of "gold standard tests” for their diagnosis, although the magnetic resonance imaging (MRI) is the preferred imaging procedure as it is a widely available test and allows the exclusion of other conditions causing NP symptoms. In addition, involvement of the peripheral nervous system (PNS) in patients with SLE is an important complication. However, it has not yet been well characterized in SLE in terms of prevalence, onset, clinical severity, immunological and electrophysiological associations. In this context we develop our research work, objectifying that the inflammatory pattern in the cerebral MRI is more frequently associated with the presence of a higher SLEDAI and low levels of complements. This supports the fact that this pattern is related to the damage mediated by antibodies and cytokines, so these data suggest that the treatment in these cases should be based on the administration of immunosuppressants. In addition, myelopathy syndrome seems to be related to a specific MRI pattern: inflammatory or mixed lesions, a focal pattern and infratentorial lesions. However, although MRI is currently the imaging technique of choice in patients with suspected LESNP, alone does not allow establishing of diagnosis certainty. Regarding the involvement of the SNP in SLE, it is a frequent neuropsychiatric affection affecting one in five patients with SLE, although it may be underdiagnosed. Sensory-motor polyneuropathy is the most frequent manifestation. In addition, patients with PNS involvement are diagnosed with SLE at older age, perhaps this delay with the diagnosis of SLE at the beginning of the treatment favors the development of this condition, which has also been related to the absence of hematological compromise throughout the evolution of SLE, although the clinical significance of this finding remains to be determined. However, it has been found that there is no immunological pattern characteristic to PNS involvement in SLE. This thesis broadens the knowledge about the neuropsychiatric manifestations of SLE and can contribute to a better control of SLE.
Weinert, Paulo Roberto. "Estudo de associação entre neuropatia periférica e a capacidade de abertura dos dedos dos pés em pacientes diabéticos." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2000. http://hdl.handle.net/10183/1665.
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