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1
D'Addea, Ottavio <1976>. "Michele Sindona e l'economia italiana." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2016. http://amsdottorato.unibo.it/7294/1/D%27ADDEA_OTTAVIO_TESI.pdf.
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La vicenda personale di Michele Sindona è utile per ricostruire l'economia italiana degli anni sessanta e settanta. Divenuto uno dei massimi esperti in Italia nell'evasione del fisco e nell'esportazione di capitali all'estero, il banchiere si insinua nel capitale di Banca unione e Banca privata finanziaria acquisendo le partecipazioni della famiglia Feltrinelli.
Il tentativo di scalare la Bastogi viene bloccato dal governatore di Bankitalia. Il banchiere cerca l'apoggio negli States della comunità italo americana e della P2 di Licio Gelli. La sua competenza in materia finanziaria e i suoi legami lo rendono il punto di contatto ideale tra ideali dei circoli repubblicani atlantici e la sponda anticomunista facente capo alla Dc e alla P2 in Italia.<br>The aim of the present thesis is to describe the Italian economic context in which Michele Sindona worked.
He soon became the most famous italian expertice in financial advisory and tax; at that time he also come into contact with Moizzi which gave him its personal shares in” financial Private Bank” and, thanks to the good relation with Cesare Merzagora, he catched the stock of the Feltrinelli family so granting himself the access to the “Union Bank's capital” ; Sindona seems to transfer his activities to the States. After the OPA defeat in '72 the group's activities begin to operate outside of any legal ; Infact By Fasco Ag, a Lichtenstein brokerage , Sindona export capital on deposit at foreign sited branch banks ;this way of doing allows him to act outside of any legal constraint, virtually masking financial activities. The creation of Moneyrex, the first Italian agency broker, made the Sindona group began to expose too heavily in the foreign exchange market. The economic crisis of '74 leads to the collapse of the Franklin Bank and other institutions of the group.
Clashing with the Industrial Italian financial establishment Sindona preclude himself at the end any attempt to reform the Italian financial system ,so strictly connected to the Statal Industry and to the Italian political party system. The banker was involved in the defeat of the referendum on divorce in 1974 that he had generously funded. Not any more able to count on the Dc his fate is always more tied up to P2; the banker is so used by that organization to finance its economic activities. Sindona is finally crushed by the Italian economy and political system tied to opposing blocs of the Cold War.
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D'Addea, Ottavio <1976>. "Michele Sindona e l'economia italiana." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2016. http://amsdottorato.unibo.it/7294/.
Full textAbstract:
La vicenda personale di Michele Sindona è utile per ricostruire l'economia italiana degli anni sessanta e settanta. Divenuto uno dei massimi esperti in Italia nell'evasione del fisco e nell'esportazione di capitali all'estero, il banchiere si insinua nel capitale di Banca unione e Banca privata finanziaria acquisendo le partecipazioni della famiglia Feltrinelli.
Il tentativo di scalare la Bastogi viene bloccato dal governatore di Bankitalia. Il banchiere cerca l'apoggio negli States della comunità italo americana e della P2 di Licio Gelli. La sua competenza in materia finanziaria e i suoi legami lo rendono il punto di contatto ideale tra ideali dei circoli repubblicani atlantici e la sponda anticomunista facente capo alla Dc e alla P2 in Italia.<br>The aim of the present thesis is to describe the Italian economic context in which Michele Sindona worked.
He soon became the most famous italian expertice in financial advisory and tax; at that time he also come into contact with Moizzi which gave him its personal shares in” financial Private Bank” and, thanks to the good relation with Cesare Merzagora, he catched the stock of the Feltrinelli family so granting himself the access to the “Union Bank's capital” ; Sindona seems to transfer his activities to the States. After the OPA defeat in '72 the group's activities begin to operate outside of any legal ; Infact By Fasco Ag, a Lichtenstein brokerage , Sindona export capital on deposit at foreign sited branch banks ;this way of doing allows him to act outside of any legal constraint, virtually masking financial activities. The creation of Moneyrex, the first Italian agency broker, made the Sindona group began to expose too heavily in the foreign exchange market. The economic crisis of '74 leads to the collapse of the Franklin Bank and other institutions of the group.
Clashing with the Industrial Italian financial establishment Sindona preclude himself at the end any attempt to reform the Italian financial system ,so strictly connected to the Statal Industry and to the Italian political party system. The banker was involved in the defeat of the referendum on divorce in 1974 that he had generously funded. Not any more able to count on the Dc his fate is always more tied up to P2; the banker is so used by that organization to finance its economic activities. Sindona is finally crushed by the Italian economy and political system tied to opposing blocs of the Cold War.
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Ghoce, Monique. "Sindhia : En queerteoretisk diskursanalys." Thesis, Södertörns högskola, Institutionen för kultur och lärande, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-21766.
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The purpose of this paper is to explore the female experience as it is spoken of in the novel Sindhia written by Rut Hillarp (1954) and how the main character in the book violates the experience from a queer perspective. My aim is to through a close reading highlight a number of discourses that underpin the book's imminent theme of love and submission. According to Norman Faircloughs critical-discourse analysis, the text one reads produces a certain amount of discourses that one consumes. This way there is a dialectical interaction that can be set into a practical analysis together with a suitable academic perspective. This is the method I use in this thesis.The academic perspective I add isJudith Butler's queer theoriessupported by Michel Foucaults social genealogyin order to understand/analyze the woman’s position in relation to a social empirical history. I came to the conclusion that Sindhia produces the woman's discourse from an ancient biblical/ mythological time up to modern time. It brings forth untold perspectives that disclose the social hierarchies and women's rebellion against them, a rebellion that has been silenced. The text simply transcends the myths and highlights what has been made invisible, it brings new perspectives to the discourse about women. This shows that the ancient stories that have submissioned the position of women also carry subversive possibilities.
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Darko, Ivanović. "Inteligentni softverski sistem za dijagnostiku metaboličkog sindroma." Phd thesis, Univerzitet u Novom Sadu, Fakultet tehničkih nauka u Novom Sadu, 2018. https://www.cris.uns.ac.rs/record.jsf?recordId=107048&source=NDLTD&language=en.
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Doktorska disertacija razmatra problem algoritamske dijagnostikemetaboličkog sindroma na osnovu lako merljivih parametara: pol,starosna dob, indeks telesne mase, odnos obima struka i visine,sistolni i dijastolni krvni pritisak. U istraživanju su primenjene ieksperimentalno ispitane tri različite metode mašinskog učenja:stabla odluke, linearna regresija i veštačke neuronske mreže.Pokazano je da veštačke neuronske mreže daju visok nivoprediktivnih vrednosti dovoljan za primenu u praksi. Korišćenjemdobijenog rezultata definisan je i implementiran inteligentnisoftverski sistem za dijagnostiku metaboličkog sindroma.<br>The doctoral dissertation examines the problem of algorithmic diagnostics ofthe metabolic syndrome based on easily measurable parameters: sex, age,body mass index, waist and height ratio, systolic and diastolic bloodpressure. In the study, three different methods of machine learning wereapplied and experimentally examined: decision trees, linear regression andartificial neural networks. It has been shown that artificial neural networksgive a high level of predictive value sufficient to be applied in practice. Usingthe obtained result, an intelligent software system for the diagnosis ofmetabolic syndrome has been defined and implemented.
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Andrijana, Milankov. "Povezanost estara ftalne kiseline i sindroma policističnih jajnika." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2019. https://www.cris.uns.ac.rs/record.jsf?recordId=108382&source=NDLTD&language=en.
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Uvod: Ftalati su vrsta endokrinih disruptora koji se široko koriste kao plastifikatori i rastvarači ali i kao aditivi brojim proizvodima koji se svakodnevno koriste. Prema dosadašnjim studijama na eksperimentalnim životinjama, ali i u humanoj populaciji, diestri ftalne kiseline utiču na reproduktivni sistem, učestvuju u nastanku insulinske rezistencije i gojaznosti. Sindrom policističnih ovarijuma (PCOS) je najčešći endokrinološki poremećaj reproduktivnog sistema žena u generativnom periodu. Insulinska rezistencija i centralna gojaznost, kao faktori kardiometaboličkog sindroma imaju značajnu ulogu u etiologiji PCOS. Ciljevi: Utvrditi prisustvo metabolita ftalne kiseline kod žena u reproduktivnom periodu u našoj sredini, kao i da li postoji povezanost ovih endokrinih disruptora sa antropometrijskim parametrima, parametrima glikoregulacije, lipidima i lipoproteinima seruma, gonadotropinima, polnim hormonima, leptinom i indeksima kardiometaboličkog rizika kod žena sa sindromom policističnih jajnika. Metode: Istraživanje je obuhvatalo 61 ženu sa sindromom policističnih jajnika koje su podeljene u dve podgrupe: 31 ispitanica sa PCOS i prisutnim ftalatnim metabolitima u urinu i 30 ispitanica sa PCOS bez ftalatnih metabolita u urinu. Kontrolnu grupu je činilo 30 zdravih žena. Kod svih ispitanica vršena su antropometrijska merenja (TV, TM, OS) i određivane vrednosti parametara glikoregulacije (glikemija i insulinemija, izačunat je HOMA index), lipidi i lipoproteini seruma (ukupan holesterol, trigliceridi, LDL i HDL holesterol), gonadotropini (LH i FSH), polni hormoni (estradiol i testosteron) i leptin. U proceni kardiometaboličkog rizika korišćena su dva indeksa LAP i VAI. Iz jutarnjeg uzorka urina određivano je prisustvo i koncentracija 10 ftalatnih metabolita: Mono-metil ftalat- MMP, Mono-etil ftalat - MEP, Mono-n-butil ftalat - MBP, Mono-n-propil ftalat- MPP, Mono-izo-amil ftalat - MiAP, Mono-n-amil ftalat - MnAP, Mono-cikloheksil ftalat - MCHP, Monobenzil ftalat- MBzP, Mono-(2-etilheksil) ftalat- MHEP, Mono-n-octil ftalat-MOP. Za statističku obradu podataka korišćeni su odgovarajući parametarski i neparametarski testovi. Rezultati: Kod 51 % ispitanica sa PCOS potvrđeno je prisustvo ftalatnih metabolita u urinu. Najzastupljeniji ftalatni metabolit je bio MEHP, zatim MEP, ali je potvrđeno i prisustvo MMP, MPP i MOP. Kod ispitanica sa PCOS su potvrđene statistički značajne korelacije između ukupnih ftalatnih metabolita i BMI, obima struka, glikemije, insulinemije, HOMA indeksa, ukupnog holesterola, triglicerida, LDL holesterola, leptina i testosterona. Analizom pojedinačnih ftalatnih metabolita utvrđene su pozitivne korelacije između MMP i obima struka, parametara glukoznog metabolizma, ukupnog holesterola, LDL holesterola, triglicerida, LAP i VAI indeksa. Zaključak: Kod žena sa PCOS u reproduktivnom periodu u našoj sredini je potvrđeno prisustvo ftalanih metabolita. Najviše koncentracije su verifikovane za MEHP i MEP, ukazujući na visoku ekspoziciju di-etilheksil ftalatu (DEHP) i di-etil ftalatu (DEP). Ukupni ftalati značajno povećavaju vrednosti parametara koje učestvuju u razvoju metaboličkog sindroma kod PCOS, ali i povećavaju kardiovaskularni rizik ovih bolesnica. Direktna, značajna veza je potvrđena između MMP i testosterona, parametara i indeksa kardiometaboličkog sindroma.<br>Introduction: Phthalates are a type of endocrine disruptor widely used as plasticizers and solvents but also as additives to many products that are used daily. According to previous studies in experimental animals, but also in the human population, phthalic diesters affect the reproductive system, participate in the onset of insulin resistance and obesity. Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of the reproductive system of women in the generative period. Insulin resistance and central obesity, as factors of cardiometabolic syndrome, have a significant role in the etiology of PCOS. Objectives: To determine the presence of phthalic acid metabolites in women in the reproductive period in our environment, and whether there is a connection between these endocrine disruptors with anthropometric parameters, glycoregulation parameters, lipids and serum lipoproteins, gonadotrophins, sex hormones, leptin and indexes of cardiometabolic risk in women with polycystic ovarian syndrome. Methods: The study included 61 women with polycystic ovarian syndrome divided into two subgroups: 31 subjects with PCOS and present phthalate metabolites in urine and 30 subjects with PCOS without phthalate metabolites in urine. The control group consisted of 30 healthy women. In all subjects, anthropometric measurements were carried out (TV, TM, WC) and the values of glycoregulation parameters (glycemia and insulinemia, HOMA index), lipids and serum lipoproteins (total cholesterol, triglycerides, LDL I HDL cholesterol), gonadotropins FSH), sex hormones (estradiol and testosterone) and leptin. In the assessment of cardiometabolic risk LAP and VAI indexes were determined. From the morning urine sample, the presence and concentration of 10 phthalate metabolites were determined: Mono-methyl phthalate-MMP, Mono-ethyl phthalate-MEP, Mono-n-butyl phthalate-MBF, Mono-n- propyl phthalate- MPP, Mono-iso-amyl phthalate – MiAP, Mono-n-amyl phthalate – MnAP, Mono-cyclohexyl phthalate-MCHP, Monobenzyl phthalate-MBzP, Mono- (2-ethylhexyl) phthalate-MHEP, Mono-n-octyl phthalate-MOP. For statistical data processing, appropriate parametric and non-parametric tests were used. Results: 51% of subjects with PCOS confirmed the presence of phthalate metabolites in urine. The most common phthalate metabolite was MEHP, then MEP, but the presence of MMP, MPP and MOP also was confirmed. In subjects with PCOS, a statistically significant correlations between total phthalate metabolites and BMI, waist circumference, glycemia, insulinemia, HOMA index, total cholesterol, triglyceride, LDL cholesterol, leptin and testosterone were confirmed. By analyzing individual phthalate metabolites, a positive correlations between MMP and waist circumference, glycoregulation parameters, total cholesterol, LDL cholesterol, triglyceride, testosterone and LAP and VAI index were determined. Conclusion: In women with PCOS in the reproductive period, the presence of phthalic metabolites in our environment was confirmed. The highest concentrations were verified for MEHP and MEP, indicating a high exposure of DEHP and DEP. Total phthalates significantly increase the values of parameters involved in the development of metabolic syndrome in PCOS, but also increase the cardiovascular risk of these patients. A direct, significant association was confirmed between MMP and testosterone, parameters and index of cardiometabolic syndrome.
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Nataša, Milenović. "Uticaj sindroma gornjeg otvora grudnog koša na spavanje." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2016. http://www.cris.uns.ac.rs/record.jsf?recordId=100573&source=NDLTD&language=en.
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Uvod - Etiologija sindroma gornjeg otvora grudnog koša (thoracic outlet syndrome- TOS) je udruženost više faktora koji su posledica narušavanja anatomsko-topografskih odnosa u nivou gornjeg otvora grudnog koša: kostoklavikularnog prostora, prednjeg skalenskog otvora, kao i same mehanike rebarnih zglobova i hrskavica, koji dovode do suženja prostora kroz koje prolaze neurovaskularne strukture, njihove kompresije, a samim tim i iritacije neurovaskularnih struktura. Sindrom gornjeg otvora grudnog koša je kompleks simptoma uzrokovanih kompresijom brahijalnog spleta, vene subklavije, arterije subklavije i simpatičkih vlakana, koji karakterišu bol, parestezije, mišićna slabost i osećaj nelagodnosti u ruci/rukama koji se pojačava podizanjem ruke/ruku ili prekomernim pokretima glave i vrata, te dovode do smanjenja funkcionalne sposobnosti ruke/ruku i poteškoća u obavljanju svakodnevnih aktivnosti. Pored toga imaju često izraženu tahikardiju, osećaj stezanja u grudima, glavobolju, vrtoglavicu, zujanje u ušima. Navedene tegobe su izraženije ponekad noću i dovode do poremećaja spavanja (problemi usnivanja, hrkanje, kašljanje, osećaj toplo/hladno, apnea, poremećaj dnevno/noćnog ritma- hronotipizacija, itd). Kao posledica lošeg spavanja moguća je pojava depresivnih simptoma. U raspoloživoj literaturi, spavanje i kvalitet spavanja se uglavnom posmatraju kroz prizmu drugih bolesti i stanja. Materijal i metode - Istraživanjem je obuhvaćeno ukupno 181 (sto osam deset jedna) osoba. Od tog broja 53 muškarca i 128 žena. Test grupu sačinjavalo je 82 ispitanika sa dijagnostikovanim TOS, a 99 zdravih osoba/osoba oba pola koji nemaju simptomatologiju TOS, je predstavljalo kontrolnu grupu. Grupe su bile ujednačene po polu i starosti (od 18 do 65). Tokom studije ispitanici su podvrgnuti kliničkom pregledu – fizikalnom i neurološkom pregledu. Pregled je podrazumevao pregled posture obolelog (posmatranje mišića regije vrata, ramena i ruku- trofika, tonus, konzistencija, mobilnost i kontraktilnost), posmatranje promena na koži (sa posebnim osvrtom na promene boje kože, trofičkih promena kože i noktiju i temperature kože ruku - šaka), testiranje refleksa, ispitivanje senzibiliteta u regijama inervacije odgovarajućih spinalnih korenova brahijalnog spleta. Takođe vršena je analiza stanja uhranjenosti (telesna visina, telesna masa, indeks telesne mase) i izvođenje provokativnih testova (Adson manevar, Rus test, Halsted test, Elvi test i Kostoklavikularni test). Kao deo ispitivanja obavljeno je i radiološko snimanje vratne kičme kao i pregled oscilografom. Ispitanici su imali za zadatak da ispune sledeće upitnike: Upitnik o nesposobnosti ruke, ramena i šake (DASH), Pitsburški indeks kvaliteta spavanja (PSQI), Upitnik o hronotipizaciji (MEQ), Bekov upitnik o depresiji (BDI II). Na kraju ispitanici su davali odgovore na pitanja iz vodiča za istraživača sastavljenog sa ciljem evaluacije različitih aspekata spavanja. Rezultati - Rezultati su pokazali da su upotrebljene skale dale zadovoljavajuću pouzdanost. Pokazalo se da osobe sa dijagnozom TOS pored bogate simptomatologije imaju još i probleme sa spavanjem. Analizom rezultata došlo se do zaključka da osobe sa dijagnozom TOS su starije, imaju više problema sa spavanjem i veću nesposobnost ruke, ramena i šake. Nije se pokazala razlika u hronotipizaciji kod osoba sa TOS u odnosu na kontrolnu grupu. Takođe može se zaključiti da osobe koje imaju izraženu nesposobnost ruku, ramena i šake imaju značajno veću šansu da imaju sindrom gornjeg otvora grudnog koša. Ove osobe pri tom imaju i veću šansu da razviju depresiju i poremećaj spavanja, te se zaključuje da ova dva parametra svoj uticaj na TOS ostvaruju preko problema sa funkcionisanjem ruke, ramena i šake. Dobar prediktor za postavljanje dijagnoze TOS može biti testiranje osoba DASH skalom. Zaključak - Rezultati studije mogu biti putokaz daljim istraživanjima, koja bi otvorila vrata formiranju protokola i opservaciji kvaliteta života osoba sa sindroma gornjeg otvora grudnog koša, sa posebnim osvrtom na poremećaje spavanja.<br>Etiology of thoracic outlet syndrome (TOS) is an association of several factors which are the result of disruption in the anatomical-topographical relations, in the level of superior thoracic aperture: costoclavicular space, anterior scalene aperture, as well as the mechanics of rib joints and cartilage, causing narrowing of space through which the neurovascular structures pass, their compression, and thus the irritation of neurovascular structures. Thoracic outlet syndrome is a complex of symptoms caused by the compression of the brachial plexus, subclavian vein, subclavian artery and sympathetic fibres, which is characterized by pain, parasthesias, muscle weakness and a feeling of discomfort in the arm / arms, which increases with raising the arm/arms or by excessive head and neck movements leading to a reduction of functional capabilities of the hands / arms and difficulties in everyday activities. In addition, patients often have expressed tachycardia, feeling of tightness in the chest, headache, dizziness, tinnitus. These problems are more pronounced at night and sometimes lead to sleep disorders (difficulty in falling asleep, snoring, coughing, feeling hot/cold, apnea, day/night rhythm disorder - Morningness/Eveningness disorder, etc.). As a result of poor sleeping depressive symptoms may occur. In the available bibliography, sleep and quality of sleep are mainly viewed through other diseases and conditions. The study included a total number of 181 (one hundred eighty one) people. Out of that 53 men and 128 women. The test group consisted of 82 patients diagnosed with TOS, and 99 healthy persons of both genders who had no symptoms of TOS, and constitute the control group. Groups were equalled by gender and age (18 to 65). Throughout the study subjects underwent clinical examination - both physical and neurological. This included an assessment of posture of the patient (observation of muscles in region of the neck, shoulders and arms - trophic, muscle tone, consistency, mobility and contractility), observation of changes on the skin (with a special emphasis on skin colour changes, trophic changes of the skin, nails and skin temperature of arms - hands), reflex testing, sensitivity testing in regions of innervations which correspond to spinal roots of the brachial plexus. Moreover, an analysis was conducted on the body composition analysis (body height, body weight, body mass index) as well as provocative tests (Adson manoeuvre, the Roos test, Halstead test, Elvy test and Costoclavicular test). Radiology scan of the cervical spine as well as oscillograph testing was conducted as a part of the test. The subjects were asked to fulfil the following questionnaires: Questionnaire on Disabilities of the Arm, Shoulder and Hand (DASH), Pittsburgh Sleep Quality Index (PSQI), The Morningness / Eveningness Questionnaire (MEQ), Beck Questionnaire on Depression (BDI II). Finally the subjects answered questions that researcher had drawn up in order to evaluate different aspects of sleep. The results showed that the scales used were reliable. It proved that persons diagnosed with TOS in addition to numerous symptoms also had problems with sleep. By analyzing the results it was concluded that people diagnosed with TOS are older, have more problems with sleep and greater disability of arms, shoulders and hands. There was no difference in Morningness/Eveningness type in patients with TOS in comparison to the control group. It can also be concluded that people who have pronounced disability of arms, shoulders and hands have a significantly greater chance of having thoracic outlet syndrome. These persons are more likely to develop depression and sleep disorders therefore those two entities impact TOS through the problems with the functioning of the arms, shoulders and hands. A good predictor in diagnosis of TOS may be testing people with DASH scale. The study findings can serve as a guideline for further research, opening the door into forming protocols and observation of the quality of life of people with the thoracic outlet syndrome, with special emphasis on sleep disorders.
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Oliveira, Ecila Paula dos Mesquita de. "Alterações de linguagem em familias com sindome perisylviaia." [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311188.
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Previous issue date: 2006<br>Resumo:Distúrbio específico do desenvolvimento da linguagem (DEDL) se refere à aquisição inadequada da linguagem em crianças que não tenham outras alterações do desenvolvimento, ou seja, o prejuízo no desenvolvimento da linguagem é a principal dificuldade do paciente, mesmo havendo queixas secundárias de menor relevância. O quadro de manifestações lingüísticas de crianças com DEDL pode ser freqüentemente correlacionado com a presença de polimicrogiria perisylviana em exames de neuroimagem (síndrome perisylviana). O objetivo do presente estudo foi investigar famílias de crianças que possuem um quadro de DEDL associado à polimicrogiria e caracterizar as manifestações lingüísticas nos membros (crianças e adultos) dessas famílias, além de correlacionar os achados com exames de neuroimagem. Foram selecionadas três famílias com história de alterações no desenvolvimento da linguagem e com exames de neuroimagem evidenciando polimicrogiria na região sylviana. Os pacientes foram submetidos à avaliação psicológica e fonoaudiológica (audiológica e específica de linguagem). Os nossos dados confirmaram que quadros de alterações específicas de linguagem fazem parte do espectro da síndrome perisylviana; o presente estudo verificou a presença de distúrbios do desenvolvimento de linguagem co-ocorrendo com alterações na leitura e/ou escrita em membros de uma mesma família; os nossos achados mostraram que na síndrome perisylviana, em crianças, observa-se predominantemente alterações na linguagem oral e, em adultos, observa-se predominantemente alterações na linguagem escrita; os nossos resultados confirmaram que sujeitos com envolvimento cortical extenso apresentam manifestações clínicas mais graves, enquanto sujeitos com imagens evidenciando comprometimento cortical posterior e/ou focal apresentam manifestações clínicas mais sutis; ressalta-se finalmente que o exame de ressonância magnética realizado com critério e dirigido para a hipótese diagnóstica, frente a uma criança com atraso na aquisição e desenvolvimento da linguagem associado a sinais clínicos de disfunção oromotora e/ou sinais pseudobulbares é bem indicado<br>Abstract: Specific language impairment (SLI) refers to inadequate language development in a child without other development disorder, that is, inadequate language acquisition is the main difficulty, even if the child may present with other symptoms. SLI may occur in patients who have polymicrogyria around Sylvian fissure on neuroimaging studies (perisylvian syndrome). The aim of this study was to investigate family members of children with perisylvian syndrome and characterize the linguistic profile found in those families. We selected three families with perisylvian syndrome. Patients underwent a psychological assessment and a comprehensive phonologic evaluation (audiologic evaluation and language evaluation). This study found that SLI and reading/writing impaiment may co-occur in different members of the same family; our data showed that children with perisylvian syndrome present mostly with SLI while adults with perisylvian syndrome present mostly with reading/writing impairment; our results confirmed that clinical picture is correlated with the extent of cerebral involvement; and finally, MRI imaging is indicated when a child has SLI and pseudobulbar signs<br>Mestrado<br>Ciencias Biomedicas<br>Mestre em Ciências Médicas
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Debanné, Janine. "Guarino Guarini's SS. Sindone Chapel : between reliquary and cenotaph." Thesis, McGill University, 1995. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=23318.
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Guarino Guarini's SS. Sindone Chapel and its relic offer the occasion to contemplate the paradox of the Incarnation in architecture--a dialectic of presence and absence. The thesis begins with a return to the Gospel accounts of the Empty Tomb, and examines the tradition of reliquary and martyria which the Chapel is inscribed in. The Incarnation theme is then traced to the late seventeenth century context of the Chapel and is considered in the Counter-Reformation context of Turin. The architectural organization of the theme of presence and absence is then explored in the Chapel. In Part II, an examination of Architettura Civile, Guarini's treatise on architecture, seeks to understand the theory of parallel projection (ortografia) with regards to the Chapel's themes. In the last stage Guarini's philosophical treatise sheds some interesting light on ortografia--Presence and absence weave an architectural idea, a geometrical theory, a theological mystery.
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Aleksandra, Lovrenski. "Komparacija kliničkog i patološko-morfološkog nalaza akutnog respiratornog distres sindroma." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2015. http://www.cris.uns.ac.rs/record.jsf?recordId=94727&source=NDLTD&language=en.
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Akutni respiratorni distres sindrom (ARDS) predstavlja klinički sindrom koji se manifestuje teškom respiratornom insuficijencijom sa razvojem akutnog edema pluća u odsustvu znakova popuštanja leve polovine srca. S obzirom da ovaj sindrom ima heterogenu etiologiju, progresivan tok i visoku stopu mortaliteta, pravovremena i tačna dijagnoza esencijalna je u primeni efektivne i rane terapije, a samim tim i u poboljšanju prognoze bolesti. Cilj ove doktorske disertacije bio je da se ispita povezanost kliničke i patohistološke dijagnoze ovog sindroma, kao i da se analiziraju i uporede vrednosti kliničkih parametara neophodnih za postavljanje dijagnoze ARDS-a sa patohistološkim parametrima oštećenja plućnog tkiva. Studija je obuhvatila 67 pacijenata Instituta za plućne bolesti Vojvodine koji su umrli pod kliničkom slikom ARDS-a i/ili kod kojih je na obdukciji patohistološki dokazan ARDS. Za postavljanje kliničke dijagnoze ARDS-a korišćeni su kriterijumi The American-European Consensus Conference iz 1994. Nakon semikvantitativne analize patohistoloških parametara difuznog alveolarnog oštećenja određivan je histološki stadijum ARDS-a i svi pacijenti podeljeni su u dve grupe: I grupa - pacijenti u eksudativnoj fazi i II grupa - pacijenti u proliferativnoj fazi difuznog alveolarnog oštećenja. Formirane grupe pacijenata upoređivane su u odnosu na vrednosti kliničkih parametara 12h pre smrtnog ishoda. U cilju procene prisustva komorbiditeta analizirani su indeks telesne mase (engl. body mass index- BMI) i podaci o prethodno dijagnostikovanoj arterijskoj hipertenziji. Kod svih pacijenata uključenih u studiju upoređivane su kliničke dijagnoze sa obdukcionim nalazom. Za klasifikaciju autopsijskih dijagnoza korišćena je Goldman-ova klasifikacija. Na osnovu provedenog istraživanja, došlo se do zaključka da slaganje klinički dijagnostikovanih i patohistološki potvrđenih slučajeva ARDS-a iznosi 68%. Senzitivnost kliničke dijagnoze ARDS-a iznosi 82%, a pozitivna prediktivna vrednost 80%. Pacijenti sa nalazom eksudativne faze DAD-a u plućnom tkivu su u najvećem procentu imali klinički težak ARDS, dok su se pacijenti sa nalazom proliferativne faze sindroma češće manifestovali pod kliničkom slikom srednje teškog ARDS-a, odnosno utvrđeno je da postoji statistička povezanost između nižih vrednosti PaO2/FiO2 i teže faze ARDSa. Patohistološkom analizom promena u plućnom tkivu nađeno je da najvažnija obeležja eksudativne faze ARDS-a predstavljaju: hijaline membrane, edem i krvarenje, dok su se kao najvažnija obeležja proliferativne faze ARDS-a izdvojili: proliferacija pneumocita tipa II, intersticijalna i mutilantna fibroza i organizirajuća pneumonija. Kod pacijenata sa kliničkom dijagnozom ARDS-a kod kojih ARDS nije i patohistološki dokazan, najčešći nalaz na plućima bila je fibrinozno-purulentna bronhopneumonija. Analizom etioloških faktora koji doprinose razvoju ovog sindroma otkriveno je da je ARDS najčešće nastao kao posledica delovanja direktnih/pulmonalnih činilaca: pneumonije i virusa gripa H1N1. Najzastupljeniji komorbiditeti prisutni kod pacijenata sa ARDS-om bili su sistemska hipertenzija i gojaznost. Najzad, kod svih pacijenata uključenih u istraživanje upoređivane su kliničke dijagnoze sa obdukcionim nalazom i na osnovu Goldman-ove klasifikacije kliničke dijagnoze i obdukcioni nalaz slažu se u 72% slučajeva. Rezultati ove studije mogli bi se upotrebiti u daljim istraživanjima kako bi omogućili bolji dijagnostički pristup ovom problemu, a samim tim i bolji terapijski pristup i smanjivanje stope mortaliteta.<br>Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by severe respiratory failure with development of acute pulmonary edema in the absence of left heart failure signs. Since this syndrome has a heterogeneous etiology, progressive course and high mortality, timely and accurate diagnosis is essential in the implementation of effective and early treatment, and therefore in improving the prognosis of the disease. The aim of this PhD thesis was to examine the association between clinical and pathohistological diagnosis of this syndrome, as well as to analyze and compare the values of clinical parameters necessary for the diagnosis of ARDS with pathohistological parameters of diffuse alveolar damage. The study included 67 patients of the Institute for Lung Diseases who died under clinical picture of ARDS and / or in which, at the autopsy, pathohistological diagnosis of ARDS was set. To set up a clinical diagnosis of ARDS the criteria of the American-European Consensus Conference in 1994 were used. After a semi-quantitative analysis of histopathological parameters of diffuse alveolar damage, all patients were divided into two groups: Group I - patients in the exudative stage and Group II - patients in the proliferative phase of diffuse alveolar damage. Formed groups of patients were compared with respect to clinical parameters values 12 h before death. In order to assess the presence of comorbidities body mass index (BMI) and data on previously diagnosed arterial hypertension were analyzed. In all patients included in the study the clinical diagnosis were compared with autopsy findings according to Goldman's classification. According to this study, agreement of clinically diagnosed and histologically confirmed cases of ARDS is 68%. The sensitivity of clinical diagnosis of ARDS is 82%, and positive predictive value is 80%. Patients with exudative phase of DAD most frequently had a severe form of ARDS, whereas patients with proliferative phase often manifested with moderate form of ARDS, ie it was found that there is a statistical association between lower values PaO2 / FiO2 and more severe phase of ARDS. Pathological analysis of changes in lung tissue revealed that the most important characteristics of exudative phase of ARDS are: hyaline membrane, edema and bleeding, while the most important features of the proliferative phase of ARDS are: the proliferation of type II pneumocytes, interstitial fibrosis and mutilating and organizing pneumonia. In patients with a clinical diagnosis of ARDS in which ARDS was not pathohistologically proven, the most common finding in the lungs was fibrinous-purulent bronchopneumonia. The analysis of etiological factors that contribute to the development of this syndrome discovered that ARDS usually develop as a result of pulmonary factors: pneumonia and influenza virus H1N1. The most common comorbidities present in patients with ARDS were systemic hypertension and obesity. Finally, in all patients included in the study clinical diagnosis and autopsy findings were compared and based on Goldman's classification clinical diagnosis and autopsy findings are in agreement in 72% of cases. The results of this study could be used in further research to enable better diagnostic approach to this problem, and therefore a better therapeutic approach and reducing mortality rates.
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Mirjana, Jovančević Drvenica. "Validacija standardizovanih upitnika za procenu sindroma poremećaja disanja tokom spavanja." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2016. http://www.cris.uns.ac.rs/record.jsf?recordId=97036&source=NDLTD&language=en.
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Poremećaji disanja tokom spavanja (Sleep disordered breathing – SDB) obuhvataju spektar bolesti koje nastaju usled povećanog otpora u gornjem disajnom putu i reflektuje se na spavanje. Najveća podgrupa SDB su prekidi disanja tokom spavanja ili sleep apnea sindrom (Sleep Apnea Syndrome – SAS). SDB su prisutni kod 20% opšte populacije, dok je 82% muškaraca i 93% žena koje imaju umerenu i tešku OSA nedijagnostikovano. Kako osnovna dijagnostička metoda, polisomnografija, zahteva stručan kadar i adekvatnu laboratorijsku opermu nameće se potreba za brzom, efikasnom i jeftinom skrining metodom pri dijagnostici SAS. Cilj ove studije jeste da se uradi validacija i prevođenje “STOP BANG“ upitnika sa engleskog na srpski jezik i utvrdi njegova specifičnost i senzitivnost u odnosu na vrednosti AHI indeksa kod odraslih ispitanika pri dijagnostikovanju SAS i da se utvrdi senzitivnost i specifičnost “STOP BANG“ upitnika i Epfortove skale pospanosti zajedno. Istraživanje je u potpunosti sprovedeno u Centru za patofiziologiju disanja sa medicinom sna Instituta za plućne bolesti Vojvodine, Sremska Kamenica. Studijsku grupa se sastojala od 102 ispitanika koji su popunjavali oba upitnika, a potom je svima urađena polisomnografija. Testiranje „STOP BANG“ upitnikom, kao i retest nakon mesec dana uradilo 30 ispitanika. Rezultati istraživanja pokazuju da su u uzorku dominirale osobe muškog pola 69,6%. Prosečna starost je iznosila 50,1±13,8 godina. Najveći broj ispitanika je imao poremećaj disanja tokom spavanja (73,5%). Prema stepenu težine najveći broj ispitanika (30,4%) je bolovao od teškog oblika (apnea/hipopnea indeks- AHI>30), a prema tipu poremećaja dominirali su opstruktivni poremećaji sa 66,7% u ukupnom uzorku. Prekomerna dnevna pospanost, merena Epfortovom skalom pospanosti, bila je prisutna kod 58,8% ispitanika i korelirala je sa stepenom težine poremećaja (r=0,43). Dobijena senzitivnost i specifičnost za „STOP BANG“ upitnik je iznosila 62,7% i 51,9% respektivno. „STOP BANG“ upitnik je preveden na srpski jezik, a zatim je urađen test i retest upitika gde nije bilo razlike u odgovorima. Dobijena je granična vrednost za „STOP BANG“ upitnik koja iznosi 4.5, a senzitivnost i specifičnost testa za različit stepen težine SAS je zadovoljavajuća i iznosila je 70,7%/66,7% za laku, 78,6% /60,9% za umerenu i 87,4%/ 50,7% za tešku sleep apneu. Pri poređenju oba upitnika zajedno dobijena je bolja specifičnost 85,2%, 76,1%, 69,0% ali lošija senzitivnost 53,3%, 58,9% ,71,0% za laku , umerenu i tešku sleep apneu respektivno u grupi ispitanika koji su imali vrednosti oba upitnika iznad graničnih vrednosti. U grupi ispitanika gde je jedan od upitnika imao vrednosti iznad granične vrednosti dobijena je bolja senzitivnost ali lošija specifičnost u odnosu na samo „STOP BANG“ upitnik. Istraživanjem je utvrđen skrining metod -“STOP BANG“ upitnik, koji stratifikuje pacijente na osnovu kliničkih simptoma, fizičkog pregleda i prisustva faktora rizika, na one pacijente sa visokim rizikom kojima treba hitno uraditi polisomnografiju i uputiti ih dalje na lečenje i na one kojima polisomnografija nije potrebna.<br>Sleep disordered breathing (SDB) includes a spectrum of diseases occurring due to an increased resistance in the upper airway, which affects sleeping. The major SDB subgroup is sleep apnea syndrome (SAS). SDB is present in 20% of the general population, and among the subjects with a moderate or severe SAS, 82% of males and 93% of females remain undiagnosed. Since polysomnography - the basic diagnostic method, requires a well-trained staff and adequate laboratory equipment, the need for a fast, efficient and cheap screening method in the diagnosis of SAS has breen imposed. Objectives of the study are to evaluate and translate the “STOP BANG“ questionnaire from English to Serbian, establish its specificity and sensitivity in relation to the apnea hypopnea index (AHI) values while diagnosing SAS in adults, and to assess the cumulative sensitivity and specificity of the “STOP BANG“ questionnaire and Epworth Sleepiness Scale. The investigation has been entirely carried out in the Lung Function and Sleep Medicine Centre of the Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica. The study cohort included 102 subjects who were all, having answered both questionnaires first, submitted to polysomnography. Thirty subjects were tested by the „STOP BANG“ questionnaire, and retested a month later. Results of the investigation show the male sex predominated in the study sample (69.6%). The subjects' mean age was 50.1±13.8 years. Most subjects had SDB (73.5%). The majority of ther subjects (30.4%) had a serious SDB form (AHI>30). Obstuctive disorders prevailed, registered in 66.7% of the study population. Excessive daily sleepiness, measured by the Epworth sleepiness scale, was registered in 58.8% of the examined subjects, correlating well to the disorder severity level (r=0.43). Sensitivity and specificity obtained for the „STOP BANG“ questionnaire amounted to 62.7% and 51.9% respectively. The „STOP BANG“ questionnaire was translated to Serbian first, followed by testing an retesting using the questionairre, providing no differences in the obtained answeres. The obtained cut-off value for the „STOP BANG“ questionnaire was 4.5, and the test sensitivity and apecificity for different SAS severity levels were satisfactory, amounting to 70.7%/66.7% for mild, 78.6% /60,9% for moderate, and 87.4%/50.7% for severe sleep apnea. The cumulative comparation of the two questionnaires has disclosed a better specificity of 85.2%, 76.1%, and 69.0%, but a worse sensitivity of 53.3%, 58.9%, and 71.0% for a mild, moderate and severe sleep apnea respectively in the group of subjects whose values for both questionnaires exceeded the cutoffs. In the group of subjects with one of the questionnaire values exceeding the cutoffs, a better sensitivity but a worse specificity were obtained related to only the „STOP BANG“ questionnaire. The investigation has established the screening method – the “STOP BANG“ questionnaire which (on the basis of the clinical symptoms, physical examination and present risk factors) stratifies the patients into the high risk group requiring urgent polysomnography and referral for further treatment, and to those requiring no polysomnography.
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Milenko, Kolarski. "Prenatalni ultrazvučni skrining drugog trimestra trudnoće u predikciji Daunovog sindroma." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2016. http://www.cris.uns.ac.rs/record.jsf?recordId=100904&source=NDLTD&language=en.
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UVOD Prenatalna dijagnostika predstavlja skup metoda i postupaka čiji je cilj da potvrde ili isključe postojanje kongenitalnih anomalija ploda. Prenatalni skrining može biti ne invazivni i invazivni. Ne invazivni skrining treba da ima visku senzitivnost i da omogući adekvatnu selekciju trudnica kojima će se predložiti genetsko ispitivanje ploda iz uzoraka dobijenih invazivnim metodama prenatalne dijagnostike. Prenatalni skrining prvog trimestra trudnoće obuhvata ultrazvučni pregled debljine nuhalne translucencije i laboratorijsku analizu dva biohemijska markera od 11 do 14 nedelje trudnoće, Prenatalni skrining drugog trimestra trudnoće koji se zasniva na biohemijskom skriningu i tripl testu iako je jedini koji se primenjuje zbog niske senzitivnosti od 20% do 40%, ne može se smatrati validnim. Integrativni biohemijski test prvog i drugog trimestra imaj veću senzitivnost (od 40 do 60%) ali ni on nije dao očekivane rezultate u adekvatnoj selekciji trudnica za genetsku analizu ploda zbog visoke stope lažno pozitivnih rezultata. Drugi trimestar trudnoće omogućava sonografskim pregledima i biohemijskim analizama dopunski način a u nekim slučajevima i jedini u proceni postojanja rizika Daunovog sindroma ili nekih drugih hromozomskih aberacija ploda Zato je primena integrativnih prenatalnih ne invazivnih metoda prvog i drugog trimestra trudnoće veoma značaja u poboljšanju dijagnostičkih vrednosti prenatalnih skrining testova i ima za cilj da smanji procenat invazivnih procedura zbog mogućih komplikacija i ne potrebnih finansijskih troškova. Daunov sindrom(trizomija 21 para hromozoma) je najčešća hromozomska numerička aberacija praćena mentalnom retardacijom dece (I.Q<70. ) Deca sa Daunovim sindromom su karakterističnog fenotipskog izgleda i sa čestim kongenitalnim anomailjama koje im onemogućavaju normalan život a često su i uzrok njihove prerane smrtnosti. Kongenitalne anomalije su zastupljene kod 2% do 5% živo rođene dece, predstavljaju 25 % perinatalne smrtnosti, četvrtina su uslovljnene hromozomskim aberacijama ili naslednom osnovom, od čega 0, 2%-0, 4% su sa Daunovim sindromom. CILJEVI Ciljevi četrorogodišnjeg istraživanja su bili da se poboljša dijagnostička vrednost postojećih prenatalnih testova, da se potvrdi značaj ultrazvučnog skrininga drugog trimestra trudnoće analizom debljine vratne brazde i dužine butne kosti ploda te da se poboljša njegova senzitivnost korporativnom sonografskom analizom cefaličnog indexa, intraorbitalnog rastojanja i dužine fronto-talamične distance. MATERIJAL I METODE Ukupan broj trudnica obuhvaćen četvorogodišnjim ispitivanjem koje su ultrazvučno pregledane i kojima je savetovano genetsko ispitivanje ploda blio je 4552. Tokom Retrospektivnog dvogodišnjieg ( 2010.2011)bila je 2169 dok je prospektivnom dvogodišnjom analizom (2012, 2013)je bilo obuhvaćeno 2383 trudnica. Ispitivana grupa su bile trudnice kod kojih je genetskom analizom otkriven patološki kariotip ploda, kontrolna grupa je obuhvatila sve ostale trudnice kod je kariotip ploda bio normalan od kojih su 124 trudnice odabrane metodom slučajnog izbora. Retrospektivnom studijom ultrazvučna je pregledana dužina vratne brazde(>6mm i dužina butne kosti<0, 6 od 14 do 22 nedelje trudnoće. Analizirana je cirkulacija fetalne krvi kroz duktus venosus ploda( a talas) i postojanje nosne kosti ploda(+, -). Prospektivnom analizom je ultrazvučnim pregledom ploda dodatno analiziran cefalični index(>85%), i intraorbitalna distanca i duzina fronto-talamične distance(<80%) ploda. Korišćene su metode deskriptivne statističke analize, aritmetička sredina, standardna devijacija, najmanja i najveća vrednost kod parametrijskih obeležja dok su za ne parametrijska postojanje nosne kosti i alfa talasa duktusu venozusu korišćene druge statističke metode, a komparativnim statističkim metodama kod normalnih, patoloških i kariotipova sa Daunovim sindromom ploda. Statistička značajnost je dokazana t testom a definisana nivoom p<0, 05 i p<0, 001 odnosom kod normalnih, patoloških kariotipova i Daunovog sindroma. Multifaktorskom regresivnom logističkom analizom je urađena procena senzitvnosti prenatalnog ultrazvučnog skrininga sa ispitivanim obeležjima drugog trimestra trudnoće REZULTATI I DISKUSIJA Od ukupnog broja ultrazvučno pregledaninh trudnica 4552 kojima je savetovano genetska analiza ploda citogenetskom analizom je otkriveno 66 patoloških kariotipova 1, 49%, sa Dunovim sindromom 31 0, 68%. Deskriptivnom statističkom obradom ultrazvučno ispitivanih obeležja od 14 do 22 nedelje trudnoće, uočeno je odstupanje i potvrđen značaj starije životne dobi trudnica, debljine vratne brazde i dužine frontotalamične distance u odnosu na normalne nalaze katiotipova ploda u predikciji Daunovog sindroma.Vrednosti dužine butne kosti, cefaličnog indeksa i intraorbitalnog rastojanja nisu imala veća odstupanja u poređenju patoškokih i normalnih nalaza kariotipova.Studentovim t testom je i dokazano p<0, 001 za debljinu vratne brazde i dužinu fronto-talamične distance, dok je za stariju životnu dob trudnice potvrđeno a;0, 001. Senzitivnost prenatalnog skrininga drugog trimestra analizom debljine vratne brazde i dužine butne kosti je veća u odnosu na standardno primenjivan biohemijski skrining drugog trimestra tripl testa (senzitivnost 40%-60) sa velikom stopom lažno pozitivnih rezultata.Dokazan je značaj poboljšanja senzitivnosti prenatalnih skrining testova dopunskom analizom tri ultrazvučna parametra, dužine fronto-talamične distance, cefaličnog indeksa i intraorbitalnog rastojanja u predikciji Daunovog sindroma, ali i kod ostalih hromozomskih aberacija ploda u periodu od 14 do 22 nedelje trudnoće primenomi multifaktorske logističke regresivne analize senzitivnost preko 93% sa 7% lažno pozitivnih rezultata. Postojanje korelacije između debljine vratne brazde i dužine fronto-talamične distance ploda poboljšavai senzitivnost prenatalnih ultrazvučnog skrininga. Integrativnim pristupom ultrazvučnog i biohemijskog skrininga drugog trimesra trudnoće, tripl testa očekuje se poboljšati dijagnostičkih vrednosti prenatalnog skrininga senzitivnost ne invazivnog skrininga u predikciji Daunovog sindroma i ostalih hromozomskih aberacija ploda. ZAKLJUČCI 1Potvrđen je značaj starije životne dobi trudnice u povećanju rizika Daunovog sindoma, i ostalih hromozomskih aberacija ploda ( p<0, 001) Potvrđen je značaj zadebljanja vratne brazde ploda >6mm(p<0, 001) i skraćenja butne kosti kod Daunovog sindroma ploda od 14 do 22 nedelje trudnoće u prenatalnom otkrivanju Dunovog sindroma i ostalih hromozomskih aberacija ploda i selekciji trudnica kojima će se predložiti genetsko ispitivanje ploda.Potvrđena je hipoteza da skraćenje fronto-talamične distance poboljšava senzitivnost ultrasonografskog skrininga, jer češće postoji kod Daunovog sindroma ploda ali i ostalih numeričkih hromozomskih aberacija tipa, nego kod normalnih nalaza kariotipa ploda( p<0, 001).Komparativnom analzom ultrazvučnim pregledom fronto-talamična distance debljine vratne brazde i dužine butne kosti ploda od 14 do 22 nedelje trudnoće može se značajno poboljšati vrednost dijagnostičkih prenatalnih testova u predikciji Daunovog sindroma. Postojanje korelacija između fronto-talamične distance i debljine vratne brazde dopunjuje ultrazvučni skrining i povećava njegovu senzitivnost na preko 90%, što je multifaktorskom regresivnom logaritamskom analizom i potvrđeno. Značaj multidisciplinarnog pristupa pogotovo je izražen u predikciji Daunovog sindroma, obzirom na različite specijalnosti koje u njemu učestvuju. Cost – benefit analiza. Visoka senzitivnost ne invazivnog prenatalnog skrininga u predikciji Daunovog sindroma, smanjuje troškove za pojedince i državu jer je njihova cena i do dest puta manja od cene citogenetskih analiza, a i trudnice se ne izlažu riziku mogućih komplikacija prilikom izvođenja invazivnih metoda<br>INTRODUCTIONS Prenatal diagnostic procedure represent a set of methods and techniques with the aim to afirmate or eliminate the presence of Down’s syndrome and other congenital anomalies Can be non-invasive and invasive methods. Non-invasive methods (laboratory or ultrasonographic) have the aim to make possible the most valid assessment of the risk of presence of an affected fetus in the pregnancy, selected pregnancy for invasive diagnostics procedures and citogenetics analisseskariotipingfoeti. Down’s syndrome, aneuploidy with trisomy 21 chromosomal, is the most common chromosomal numerical aberration associated with mental retardation of children (IQ< 70). Children with Down’s syndrome have characteristic phenotypic appearance with high frequent congenital anomalies that preclude a normal life and are frequently the cause of their earlier death. AIM The aim of the four year long investigation was to confirm the importance of ultrasound screening by the analyses of the basic ultrasound parameters for the second trimester, the thickness of the nuchal fold and the length of the femur of the fetus in the prediction of Down’s syndrome and other chromosomal aberrations of the fetus, as well as to improve other existing ultrasonic screenings of the first and second trimester of pregnancy by ultrasonic examination and analyses of the cephalic index and intraorbital space and the length of the fronto-thalamic distance. MATERIAL AND METODS Retrospective investigation (2010. 2011) and prospective investigation (2012.2013) includes 4655 pregnant women. For all pregnant women the genetic investigation of the fetus was performed. A total of 68 were found with chromosomal aberrations, 38 with Down’s syndrome. The method of haphazard choice in retrospective study and in prospective study ultrasound markers are examined. In retrospective analyses of the nuchal fold (<6mm and the length of femur <0.6, that represent basic ultrasound screening of the second trimester and are analyzed as parametric signs of the second trimester, and are analyzed as parametric markers, and analyses of the circulation of fetal blood through ductus venosus of the fetus. In the retrospective study the length of the nuchal fold (>6mm in length, that represent a basic ultrasound screening of the second trimester, and are analyzed as parametric markers in the prediction of Down’s syndrome and other chromosomal aberrations. RESULTS AND DISCUSION Cytogenetic analyses revealed 66 (1, 49%) pathologic karyotypes and Down syndrome were present in 31 (0, 68%) cases. All pathologic karyotypes were obtained after ultrasound examinations of 4552 pregnant women. Ultrasound markers for period 14th-22nd GW were analyzed with descriptive statistical methods and importance of pregnancy in older women, thickness of nuchal fold and lengths frontal thalamic distance were proofed in case of Down syndrome. Femoral bone lengths, cephalic index and intraorbital distances were similar for both groups, normal and pathologic karyotypes. Student’s t test revealed statistical significance with p<0, 001 values for nuchal fold thickness, frontal thalamic distance and older ages.Three additional ultrasound markers (frontal thalamic distance, cephalic index, intraorbital distance) improve prediction of Down syndrome and other chromosomal aberrations between 14th and 22nd GW as well. Multifactorial logistic regressive analyses revealed 93% sensitivity with 7% false positive results. Corelation between nuchal fold thickness and frontal thalamic distance improve prenatal ultrasound screening sensitivity. Using both ultrasound and biochemical screening (triple test) is way to improve sensitivity of non invasive screening in prediction of Down syndrome and other chromosomal aberrations. CONCLUSIONS Importance of pregnant women ages and higher risk for Down syndrome and other chromosomal aberrations was proofed (p<0, 001).Importance of nuchal fold thickness above 6mm (p<0, 001) and shorter femoral bone marker in period from 14th to 22nd GW in prediction of Down syndrome and other chromosomal aberrations are proofed (p<0, 001). Hypothesses that frontal thalamic distance improve ultrasound screening sensitivity was proofed was proofed (p<0, 001) since it is significantly shorter in Down syndrome and other chromosomal aberrations in comparison with fetuses with normal karyotypes. Comparative analyses of frontothalamic distance, nuchal fold thickness and femoral bone length in period from 14th to 22nd GW can signifi cantly improve prenatal diagnostic testing in Down syndrome prediction. Correlation between frontothalamic distance and nuchal fold thickness improve ultrasound screening sensitivity on 93% that is proofed with multifactorial logistic regressive analyses. Significance of multidisciplinary approach is high in Down syndrome prediction. Cost-benefit: High sensitivity of non invasive prenatal screening in Down syndrome prediction reduces costs for families and government since it costs ten time less than cytogenetic analyses and risk with invasive procedures is avoided.
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Aleksandra, Patić. "Značaj molekularne dijagnostike u dokazivanju virusnog gastrointestinalnog sindroma u Vojvodini." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2018. https://www.cris.uns.ac.rs/record.jsf?recordId=106859&source=NDLTD&language=en.
Full textAbstract:
Uvod: Virusni gastrointestinalni sindrom je aktuelni zdravstveni problem u celom svetu. To važi kako u razvijenim zemljama, tako i u zemljama u razvoju, a posebno u nerazvijenim zemljama, gde je drugi po redu uzrok mortaliteta. Nagli početak bolesti, praćen pojavom velikog broja tečnih stolica, mukom, povraćanjem, bolovima u stomaku, temperaturom, malaksalošću, ima za posledicu dehidrataciju. U svim starosnim grupama obolelih, a naročito kod sasvim male dece, starih i imunodeficitarnih osoba može da dođe do smrtnog ishoda, ukoliko se brzo ne postavi tačna etiološka dijagnoza bolesti i ne pristupi se odmah nadoknadi vode i elektrolita, kao i primeni svih ostalih mera simptomatske terapije. Brzo postavljena tačna dijagnoza, što se najbolje postiže real-time PCR testom, sprečava pojavu komplikacija, pa i fatalnog ishoda bolesti. Istovremeno, omogućava primenu odgovarajućih epidemioloških mera da se spreči nastanak epidemija i njihovo širenje. Cilj ovog istraživanja bio je da se tačno utvrdi incidenca virusnog gastrointestinalnog sindroma u Vojvodini i učestalost pojave epidemijskog i sporadičnog javljanja ove bolesti. Cilj je bio i postavljanje algoritma za primenu real-time PCR testa u dijagnostici virusnog gastrointestinalnog sindroma u budućem radu. Isto tako, cilj je bio da se molekularnom analizom, sekvenciranjem delova genoma pozitivnih uzoraka stolice, izvrši genetska tipizacija i odredi filogenetska pripadnost virusa. Materijal i metode: Tokom petogodišnjeg istraživanja molekularnim real-time PCR testom pregledane su 1003 obolele osobe sa simptomima virusnog dijarealnog sindroma, starosti od mesec dana do preko 90 godina. Pregledani su na rota, noro, astro i enterične adenoviruse. Na osnovu podataka iz anketnih upitnika i istorija bolesti, detaljno su analizirani svi klinički pokazatelji (javljanje bolesti tokom godine, trajanje bolesti, simptomi). Procena težine kliničke slike vršena je prema Vesikari skali. Svi podaci su upoređivani prema vrsti virusnog uzročnika, prema starosti obolelih, godinama trajanja istraživanja i epidemijskom i sporadičnom javljanju oboljenja. Dobijeni podaci su statistički obrađeni, tabelarno i grafički prikazani. Rezultati: U petogodišnjem periodu real-time PCR testom pregledan je uzorak od 1003 obolele osobe različite starosti na 4 virusna uzročnika dijarealnog sindroma (rota, noro, astro i enterične adenoviruse). Virusni dijarealni sindrom dokazan je kod 709 obolelih (70,69%). Najčešće su dokazane rotavirusne infekcije u 28,81%. Statistički značajno najčešće rotavirusi su bili utvrđeni kod dece do 5 godina (38,90%), ali u visokom procentu i kod dece uzrasta 6 do 14 godina (24,83%). Deca mlađa od 5 godina imala su statistički značajno najtežu kliničku sliku, bila su češće hospitalizovana i imala su statistički značajno višu temperaturu. Pored više temperature kod obolelih od rotavirusa, klinička slika je kod ovih bolesnika bila teža i bolest je duže trajala nego kod obolelih od drugih virusa. Norovirusna infekcija je dokazana u 23,03% obolelih i to statistički značajno češće kod odraslih osoba, starijih od 20 godina. Od kliničkih simptoma kod ovih bolesnika statistički značajno češće su dokazani muka, povraćanje i bolovi u stomaku, nego kod obolelih od drugih virusa. Norovirusi su značajno češće bili uzročnici epidemijskog javljanja bolesti. Astrovirus je dokazan kod znatno manjeg broja obolelih (u 2,29%) i to samo kod dece do 5 godina i dece uzrasta 6 do 14 godina. Infekcija izazvana enteričnim adenovirusima dokazana je kod 13,36% bolesnika. Njačešće je utvrđena kod dece uzrsta do 5 godina i 6 do 14 godina. Oboleli od adenovirusa imali su statistički značajno blažu kliničku sliku bolesti. Dva virusna uzročnika u uzorku stolice dokazana su u 3,19% osoba, obično u toku epidemijskog javljanja bolesti. Ovi bolesnici su imali bitno težu kliničku sliku. Najviše obolelih od dijarealnog sindroma bilo je u hladnim mesecima, mada su dijagnostikovani i tokom cele godine. U petogodišnjem periodu utvrđene su 22 epidemije u kolektivima i 9 porodičnih epidemija. Epidemijsko javljanje bolesti bilo je statistički značajno najčešće kod najstarijih bolesnika (starijih od 50 godina), a sporadično javljanje bilo je statističko značajno najčešće kod dece. U cilju potvrde tačnosti dijagnostike virusa u ispitivanim uzorcima real-time PCR testom, genotipizacije, kao i detaljnije molekularne analize, izabrani su reprezentativni uzorci pozitivni na rota, noro, astro ili adenoviruse. Delovi genoma ovih uzoraka su amplifikovani, a zatim sekvencirani. Sekvencirani izolati rotavirusa pripadali su grupi A i tipovima G1P[8], G2P[4], G3P[8] i G9P[8]. Sekvencirani izolati norovirusa pripadali su genogrupi I tipu 2, zatim genogrupi II tipovima 1, 2, 4 i 17. Sekvencirani izolati astrovirusa pripadali su grupi klasičnih astrovirusa i tipovima 1, 4 i 5. Sekvencirani izolati adenovirusa pripadali su grupi F i tipovima 40 i 41, kao i grupi C tipu 2. Pripadnost dobijenih sekvenci u ovom istraživanju, dodatno je potvrđena izradom filogenetskog stabla za sekvence pozitivne na rota, noro, astro ili adenoviruse. Zaključak: Incidenca virusnog dijarealnog sindroma u Vojvodini (70,69%) vrlo je visoka i viša je nego što je bilo pretpostavljeno prilikom prijave teze (u hipotezi). Real-time PCR test treba da bude redovno korišćen u budućem dijagnostičkom radu, jer dovodi do brze dijagnostike, čak i ako su virusi prisutni u malom broju u uzorcima tečnih stolica, što je utvrđeno tokom ovog dijagnostičkog rada. Ispitivani virusi treba da budu redovno dijagnostikovani kod obolelih od dijarealnog sindroma i to u svim starosnim grupama, tokom epidemijskog i sporadičnog javljanja oboljenja.<br>Introduction: Viral gastrointestinal syndrome is a current ongoing health problem worldwide. This is true of both developed and developing countries, especially underdeveloped ones where it is the second leading cause of mortality. Sudden onset of the disease—accompanied by the occurrence of large numbers of liquid stools, nausea, vomiting, abdominal pain, fever, and exhaustion—leads to dehydration. A fatal outcome can occur in all age groups of patients, especially very young children, the elderly, and the immuno-deficient, unless an accurate etiological diagnosis of the disease is quickly established, followed by a prompt institution of fluid and electrolyte placement, and implementation of other symptomatic therapy measures. Quick establishment of an accurate diagnosis, which is best achieved using the real-time PCR test, prevents the onset of complications, including a potentially fatal outcome of the disease. Simultaneously, it enables the implementation of appropriate epidemiological measures to prevent epidemic outbreaks and their spread. The aim of this study was to accurately determine the incidence of viral gastrointestinal syndrome in Vojvodina and the frequency of epidemic and sporadic occurrence of this disease. The aim was also to set up an algorithm for the application of the real-time PCR test in diagnostics of viral gastrointestinal syndrome in future work. Likewise, the aim was to carry out genetic typing and determine phylogenetic affiliation of the virus using molecular analysis and sequencing of parts of genomes from positive stool samples. Material and Methods: During a five-year study, 1003 patients with symptoms of viral diarrheal syndrome, aged from one month to more than 90 years old, were examined using molecular real-time PCR test. They were screened for rota, noro, astro, and enteric adenoviruses. Based on the data from survey questionnaires and medical case history, all clinical indicators were meticulously analyzed (disease occurrence during the year, disease duration, symptoms). The assessment of the clinical severity was carried out according to the Vesikari Clinical Severity Scoring scale. All data were compared according to the type of the viral causing agent, age of the patients, duration of research in years, and epidemic and sporadic occurrence of the disease. Obtained data were statistically analyzed, tabulated, and graphically displayed. Results: In a five-year period, a sample of 1003 patients of different ages was screened for four different viral causing agents of diarrheal syndrome (rota, noro, astro, and enteric adenoviruses) using the real-time PCR test. Viral diarrheal syndrome was confirmed in 709 patients (70.69%). The most commonly found were rotavirus infections in 28.81% of the cases. Rotaviruses were statistically significantly most common in children younger than 5 years old (38.90%), but were also found in high percentage in children aged 6-14 years old (24.83%). Children under 5 years of age had statistically significantly highest clinical severity and fever, and were more frequently hospitalized. In addition to higher fever in patients with rotavirus, clinical severity in these patients was also higher, and the disease lasted longer than in patients with other viruses. Norovirus infections were reported in 23.03% of the subjects, statistically significantly more frequently in adults over 20 years of age. Regarding the clinical symptoms in these patients, nausea, vomiting, and abdominal pain were statistically significantly more common than in patients with other viruses. Noroviruses were significantly more common as causing agents of epidemic disease outbreaks. Astrovirus was found in a significantly smaller number of patients (in 2.29%), and only in children under 5 years of age and children aged 6-14 years old. Enteric adenovirus infections were reported in 13.36% of the subjects. They were most commonly found in children younger than 5, and those aged 6- 14 years old. Adenovirus sufferers had statistically significantly milder clinical disease. Two viral causing agents in the stool sample were found in 3.19% of the subjects, usually during an epidemic disease outbreak. These patients had a significantly more severe clinical disease. Highest numbers of sufferers from diarrheal syndrome occurred during the cold months, although they were diagnosed throughout the year. In a five-year period, 22epidemics in collective groups and 9 family epidemics were identified. Epidemic outbreaks of the disease were statistically significantly most frequent in the elderly patients (older than 50), while sporadic occurrences were statistically significantly most frequent in children. Representative samples positive for rota, noro, astro, or adenoviruses were selected in order to confirm the accuracy of virus diagnostics in samples tested by the real-time PCR test, and perform genotyping as well as more detailed molecular analyses. Parts of the genomes of these samples were amplified and then sequenced. Sequenced rotavirus isolates belonged to group A and types G1P[8], G2P[4], G3P[8], and G9P[8]. Sequenced norovirus isolates belonged to genogroup I type 2, and genogroup II types 1, 2, 4, and 17. Sequenced astrovirus isolates belonged to the group of classical astroviruses and types 1, 4, and 5. Sequenced adenovirus isolates belonged to group F and types 40 and 41, as well as group C type 2. The affiliation of the obtained sequences in this study was further confirmed by creating a phylogenetic tree for sequences positive for rota, noro, astro, or adenoviruses. Conclusion: The incidence of viral diarrheal syndrome in Vojvodina (70.69%) is very high—higher than what was assumed at the time of the thesis submission (in the hypothesis). The real-time PCR test should be regularly used in future diagnostic work, since it leads to rapid diagnostics even if viruses are present in small numbers in liquid stool samples, as determined in the course of this diagnostic study. The investigated viruses should be regularly tested in patients with diarrheal syndrome belonging to all age groups during both epidemic and sporadic occurrences of the disease.
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Dušan, Škrbić. "Metabolički sindrom kod pacijenata sa hroničnom opstruktivnom bolesti pluća i bronhiektazijama." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2015. http://www.cris.uns.ac.rs/record.jsf?recordId=94077&source=NDLTD&language=en.
Full textAbstract:
Hronične inflamatorne bolesti disajnih organa su jedan od vodećih uzroka morbiditeta i mortaliteta širom sveta. I pored stalnog napretka u naučnim istraživanjima, u otkrivanju molekularnih i ćelijskihmehanizama koji doprinose progresiji bolesti, uvođenju novih prognostičkih biomarkera, novim metodama detektovanja infektivnih uzročnika, primeni novih moćnih bronhodilatatornih, antiniflamatornih i antiinfektivnih lekova, hronične plućne bolesti i danas u dvadeset prvom veku beleže stalan porast broja obolelih i umrlih. Prema savremenom tumačenju HOBP je heterogena bolest koja je udružena sa brojnim komorbiditetima i sistemskim manifestacijama. Zajednički faktori rizika su osnova za javljanje udruženih hroničnih bolesti. Komorbiditeti i akutne egzacerbacije doprinose ukupnoj težini bolesti . S obzirom da se HOBP manifestuje i izvan pluća kod svakog pacijenta je potrebno proceniti postojanje sistemskih manifestacija i tragati za komorbiditetima. U reviziji „Globalne strategije za dijagnozu, lečenje i prevenciju hronične opstruktivne bolesti pluća H GOLD“ iz 2011. godine navedene sledeće pridružene bolesti za kojima je potrebno aktivno tragati: kardiovaskularne bolesti, disfunkcija skeletnih mišića, metabolički sindrom, osteoporoza, depresija i karcinom pluća. Bronhiektazije sepredstavljaju hronično oboljenje pluća koje se karakteriše abnormalnim proširenjem lumena bronha koje je uzrokovano slabljenjem ili destrukcijom mišićnih i elastičnih komponenti bronhijalnog zida, smanjenim klirensom mukusa i čestim infekcijama respiratornog trakta. Bronhiektazije se nekim svojim kliničkim karakteristikama preklapaju sa hroničnom opstruktivnom bolesti pluća. Metabolički sindrom predstavlja skup metaboličkih poremećaja koji povećavaju rizik za razvoj kardiovaskularnih bolesti i tipa 2 šećerne bolesti. Za naše istraživanje smo koristili definiciju NCEPHATPIII prema kojoj se metabolički sindrom zasniva na prisustvu tri od pet komponenti: Abdominalna gojaznost (obim struka preko 102 cm za muškarce i preko 88 cm za žene), povišene vrednosti triglicerida našte preko 1,7 mmol/l ili od ranije lečen poremećaj, snižen nivo HDL holesterola manje od 1,03 mmol/l za muškarce i manje od 1,29 mmol/l za žene ili već lečen poremećaj, povišen sistolni krvni pritisak preko 130 mmHg i/ili dijastolni preko 85 mmHg ili već lečena hipertenzija, povišen nivo glukoze našte preko 5,6 mmol/l ili već postojeći tip 2 šećerne bolesti. Istraživenje je sprovedeno u Institutu za plućne bolesti Vojvodine u Sremskoj Kamenici. Cilj je bio da se utvrdi učestalost metaboličkog sindroma i komponenti među bolesnicima sa HOBP i bronhiektazijama. Sledeći cilj je bio da analizira i uporedi zastupljenosti metaboličkog sindroma i pojedinih komponenti među ispitivanim grupama u odnosu na pol, starost bolesnika i dužinu lečenja HOBP. Bilo je uključeno ukupno 193 ispitanika. Od ovog broja 163 su činili bolesnici od HOBP i bronhiektazija koji su bili podeljeni u tri grupe: pacijenti oboleli od hronične opstruktivne bolesti pluća (n=55, grupa 1), pacijenti oboleli od bronhiektazija (n=50, grupa 2) i pacijenti sa udruženom hroničnom opstruktivnom bolesti pluća i bronhiektazijama (n=58, grupa 3). Kontrolna grupa, koja je označena kao grupa 4, formirana je od 30 ispitanika bez bronhiektazija i hronične opstruktivne bolesti pluća, tako da je ukupan broj ispitanika u istraživanju bio 193. Učestalost metaboličkog sindroma prema kriterijumuma NCEP/ATP III kod bolesnika hroničnim bolestima respiratornog sistema (hroničnom opstruktivnom bolesti pluća, bronhiektazijama i udružena ova dva oboljenja) je iznosila je kod 37,3 % . Metabolički sindrom je bio učestaliji kod ispitanika sa hroničnim opstruktivnombolesti pluća i/ili bronhiektazijama u odnosu na ispitanike iz kontrolne grupe bez hroničnih bolesti respiratornog trakta. Kod bolesnika sa hroničnom opstruktivnom bolesti pluća dokazano je prisustvo metaboličkog sindroma kod 38,2% ispitanika, kod bolesnika sa bronhiektazijama kod 54% ispitanika i IV kod pacijenata sa udruženom hroničnom opstruktivnom bolesti pluća i bronhiektazijama kod 36,2% ispitanika. Prosečan broj komponenti metaboličkog sindroma kod bolesnika sa hroničnom opstruktivnom bolesti pluća je iznosio 2,18, kod bolesnika sa bronhiektazijama je bio 2,56, a kod bolesnika sa udružena ova dva oboljenja 2,1.Komponente metaboličkog sindroma nisu učestalije i nisu statistički više kod bolesnika sa udruženom hroničnom opstruktivnom bolesti pluća i bronhiektazijama u odnosu na obolele sa HOBP i bronhiektazijama kao samostalnim oboljenjima.Razlika u pojedinačnim vrednostima komoponenti metaboličkog sindroma i učestalosti pojedinih komponenti među posmatranim grupama bolesnika sahroničnim plućnim bolestima nije statistički značajna. Učestalost metaboličkog sindroma kod bolesnika sa hroničnim bolestima respiratornog sistema nije u vezi sa polom i ne zavisi od starosti ispitanika. Nije dokazano da je metabolički sindrom učestaliji kod muškaraca i i nije dokazano da je učestaliji kod ispitanika koji imaju više od šesdeset i pet godina u odnosu na mlađe bolesnike među ispitivanim. Učestalost metaboličkog sindroma kod ispitanika sa hroničnom opstruktivnom bolesti pluća ne zavisi od dužine lečenja hronične opstruktivne bolesti pluća. Dokazano je da učestalost metaboličkog sindoma nije veća kod bolesnika kojima je dijagnoza bolesti postavljena pre više od pet godina i koji se od HOBP leče duže od pet godina. Na osnovu rezultata koje smo dobili u našem istraživanju zaključili smo da hronične plućne bolesti, bronhiektazije i hronična opstruktivna bolest pluća, predstavljaju stanja sa povišenim kardiometaboličkim rizikom. <br>Chronic inflammatory diseases of the respiratory organs are one of the leading morbidity and mortality causes all over the world. Despite the steady advance in scientific research, discovery of the disease-progression-contributing molecularand cellular mechanisms, introduction of novel prognostic biomarkers, new detection methods of infectious agents, application of new, potent bronchodilation, anti-inflammatory and anti-infectious drugs, a constant increase in the number of the affected and deceased from chronic pulmonary diseases has still been permanentlyevidenced in the 21st century. In a modern concept, the chronic obstructive pulmonarydisease (COPD) is understood as a heterogenous disorder associated with numerous comorbidities and systemic manifestations. Common risk factors represent the basis for concomitant chronic diseases to develop. Comorbidities and acute exacerbations contribute to the overall disease severity. As a COPD may develop extrapulmonary manifestations as well, each patient should be evaluated for systemic manifestations and comorbidities. The 2011 update of the „Global Strategy for Chronic Obstructive Lung Disease Diagnosis, Management, and Prevention –GOLD” lists the following comorbidities to be actively searched for: cardiovascular diseases, skeletal muscledysfunction, metabolic syndrome, osteoporosis, depression, and lung cancer. Bronchiectases represent a chronic lung disorder marked by VII excessively dilated bronchial lumen induced by weakened or destructed muscular and elastic components of the bronchial wall, reduced mucus clearance, and recurrent respiratory infections. Bronchiectases and COPD have some clinical features in common. The metabolic syndrome is a group of metabolic disorders which increase the risk of cardiovascular diseases and type 2 diabetes. In our investigation, we utilized the NCEP HATPIII definition of the metabolic syndrome based on the presence of three of five components: abdominal obesity (> 102 cm and >88 cm waist measure for males and females respectively), elevated (>1.7 mmol/l) triglyceride levels on an empty stomach, or a former history of the disorder treatment, reduced HDL cholesterol (< 1.03 mmol/l and <1.29 mmol/l for males and females respectively), or a former history of the disorder treatment, elevated systolic bloodpressure of >130 mmHg and/or diastolic blood pressure of > 85 mmHg, or a former history of treated hypertension, elevated glucose levels (>5.6 mmol/l), or already existing type 2 diabetes mellitus. The investigation has been carried out inthe Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, aimed at 1)establishing the frequency of the metabolic syndrome and its components among the patients with COPD and bronchiectases; 2) analyze and compare the frequency of metabolic syndrome and its components in the examined groups related to the patients’ sex, age, and COPD treatment length. The study included 193 subjects, 163 of whom suffered from COPD and bronchiectases, classified into three groups: COPD patients (n=55, Group 1), patients with bronchiectases (n=50, Group 2), and patients with concurrent COPD and bronchiectases (n=58, Group 3). The control group, designated as Group 4, included 30 subjects free of bronchiectases and COPD, so the total of 193 subjects were included in the investigation. The NCEP/ATP III criteriaestablished metabolic syndrome frequency among the patients with chronic respiratory diseases (COPD, bronchiectases, and concomitant COPD and bronchiectases) amounted to 37.3 % . The metabolic syndrome was more frequent in the patients with COPD and/or bronchiectases than in the control group patients free of any chronic respiratory disease. The metabolic syndrome was VIII confirmed in 38.2% of COPD patients, 54% of the patients with bronchiectases, and in 36.2% of thepatients with concomitant COPD and bronchiectases. The mean number of themetabolic syndrome components was 2.18 in COPD patients, 2.56 in patients withbronchiectases, and 2.1 in patients with concomitant COPD and bronchiectases. Themetabolic syndrome components were neither more frequent, nor statistically higher in the patients with concomitant COPD and bronchiectases as compared to the patients with a single presence of any of the two diseases. The difference in the single values of the metabolic syndrome components and the frequency of certain components in the examined groups of the patients with chronic pulmonary diseases was not statistically significant. Among the patients with chronic respiratory diseases, no correlation was observed between the metabolic syndrome frequency and the patients’ sex or age. The metabolic syndrome was not confirmed to be more frequent in males, or in >65 yr old patients, as compared to younger patients. Among COPDpatients, no correlation was registered between the metabolic syndrome frequency and COPD treatment duration. It was confirmed that the metabolic syndrome frequency was not higher in the patients with <5Hyear long COPD treatmentthan in those treated for COPD longer. On the basis of the results obtained in our investigation, we conclude that chronic respiratory diseases, COPD and bronchiectases, are the conditions with a higher cardiometobolic risk.
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Domingos, Manuel Carlos do Rosário. "Abordagem neuropsicológica das alterações na atenção e memória no sindroma de Burnout." Doctoral thesis, Universidade de Aveiro, 2011. http://hdl.handle.net/10773/7375.
Full textAbstract:
Doutoramento em Psicologia<br>O sindroma de Burnout, quadro psicofisio-patológico tem sido objecto de
investigação intensiva, desde o artigo de Freudenberger (1974) intitulado "Staff
Burnout", com dois objectivos: compreendê-lo melhor, através de meios de
diagnóstico, e criar técnicas de intervenção terapêutica. Na realidade, desde
essa altura, foram efectuados e publicados um número avultado de trabalhos
de investigação, nos campos do diagnóstico e caracterização do Burnout, e da
sua resolução terapêutica. O pensamento dominante, nessa altura e ainda
hoje, é de tendência analítica e/ou psico-social.
Este quadro, espoletado por uma sucessão de episódios emocionalmente
negativos em contexto ocupacional em indivíduos com provável predisposição
genética e sujeitos a situações de pressão laboral, dos mais diversos tipos
(podendo ir do “simples” stress por acumulação de tarefas até às situações de
mobbing), tem efeitos frequentemente dramáticos ao nível da dinâmica biopsico-
social, nos seus mais diversos aspectos. Estes estendem-se, quase
sempre, muito para lá das problemáticas laborais, prejudicando, de forma mais
ou menos grave, as interacções sociais com particular impacto ao nível da
dinâmica familiar. Por outro lado, o Burnout propicia o aparecimento de
patologias diversas, já que toda a estrutura psiconeuro-endocrino-imunulógica
estará posta em causa, potenciando situações de fragilidade sistémica.
No entanto, há aspectos correlacionáveis com este quadro disfuncional que
têm sido muito pouco abordados – alterações cognitivo-operativas ou
neuropsicológicas. Aliás os trabalhos que sobre eles incidem são em número
muito reduzido. Assim após termos registado queixas, acentuadas, ao nível da
capacidade de concentração e da memória em pessoas com burnout
observadas na clínica hospitalar e privada, decidimos investigar estas
situações, usando uma metodologia clínica de tipo qualitativo, e constatámos
que, na realidade, as queixas eram pertinentes. Posto isto, achámos que a
situação deveria ser aprofundada e partimos para um trabalho mais
sistematizado, este, com o objectivo de caracterizar melhor o tipo de
disfunções atencionais e mnésicas. Para isso, após uma selecção prévia, a
partir de um grupo de 192 enfermeiros que responderam à Escala de Maslach,
avaliámos uma amostra de risco constituída por 40 enfermeiros e enfermeiras,
de Instituições Psiquiátricas da Grande Lisboa, trabalhando em urgência e
enfermaria, que comparámos com uma amostra de igual número de
enfermeiros, desenvolvendo a sua actividade na consulta externa ou em
ambientes mais protegidos de stress ocupacional continuo.
Para o efeito, e após uma anamnese cuidada, aplicámos provas de atenção e
memória, sensíveis a qualquer tipo de compromisso encefálico seja ele
funcional ou patológico. Para a componente atenção/concentração e a
componente vísuo-grafo-espacial usámos a prova de Toulouse-Piéron, assim
como as séries de dígitos ou digit span, para a vertente audio-verbal. A
dinâmica mnésica foi avaliada através da prova de memória associativa
(Escala de Memória de Wechsler) para testar a variante áudio-verbal, e a
reprodução de figuras (Escala de Memória de Wechlser).
Os resultados, após uma dupla análise clínica e estatística, comprovaram
globalmente as hipóteses, indicando uma correlação significativa entre o grau
de Burnout e os défices neuropsicológicos detectados: alteração da
atenção/concentração e dismnésia, de natureza limitativa face às exigências
quotidianas dos indivíduos.
Finalmente, com base na revisão da literatura e os resultados deste estudo, foi
esquematizado um Modelo Neuropsicológico do sindroma de Burnout, que nos
parece espelhar as relações entre este quadro clínico, as alterações cognitivooperativas
encontradas e as principais estruturas encefálicas, que julgamos,
implicadas em toda a dinâmica do processo disfuncional.<br>The Burnout syndrome, introduced in the paper by Freudenberger (1974)
entitled "Staff Burnout", is a psycho-physio-pathological syndrome that has
been the subject of intensive investigation with two main goals: to better
understand the syndrome, by studying diagnosis techniques, as well as
intervention. In fact, since the paper by Freudenberger (1974), there has been
a vast number of published researches in the fields of diagnostic and
characterization of Burnout, and its therapeutic resolution. The dominant
theoretical mainstream at that time, and still today, is analytical and / or psychosocial.
This syndrome, present in patients with probable genetic predisposition and
subjected to pressure situations at work, is triggered by a succession of
emotionally negative episodes in the occupational setting. The episodes can
vary from 'simple' stress by accumulation of tasks to situations of mobbing.
These effects are extended almost always well beyond work issues, hurting
(more or less serious), and social interactions with particular impact on family
dynamics. Moreover, the Burnout allows the emergence of various diseases,
since the whole psico-neuro-endocrine-imunulogical structure will be impaired,
therefore enhancing systemic fragility.
However, there are aspects correlated with this dysfunctional disorder that
have been poorly addressed - neuropsychological or cognitive-operatives
disturbances. The studies concerning this correlation are scarce. In our clinical
activity at the hospital, we have been registering serious complaints in the
ability to concentrate and memory in people with burnout. Given our clinical
observation, we decided to investigate these cognitive impairments. We used a
qualitative clinical methodology, and found that, in fact, the complaints were
relevant and evident. We realized that the situation should be deepened
through a more systematic approach in order to better characterize the type of
attentional and memory dysfunctions. In order to do so, we made a preliminary
selection from a group of 192 nurses who responded to the Maslach Scale. We
assessed this population at risk of developing Burnout, by including fourty
nurses from Psychiatric Institutions of Lisbon, working in emergency and ward
and compared it to a sample of fourty nurses who were developing their activity
in the outpatient section and nurses working in a more protected occupational
environment.
With this aim, and after careful anamnesis, we assessed attention and memory,
cognitive functions that are very sensitive to any kind of functional or
pathological commitment. For assessing attention, concentration, and the
visuospatial component, we used the Toulouse –Piéron test, as well as the
Digit Span test, to evaluate the audio-verbal component. Memory was
assessed by using the Wechsler Memory Scale (associative memory) to test
the audio-verbal variant. We also used reproduction of figures of the same
Wechlser Memory Scale.
Results after a clinical and statistical analyses, confirmed the overall
hypothesis, indicating a significant correlation between the degree of burnout
and neuropsychological deficits: a change in attention / concentration and
dismnesia, highly dysfunctional given the daily demands faced by the
individuals.
Finally, based on the literature review and on the results of this study, we
outlined a neuropsychological model of burnout syndrome. This model shows
the relationship between the syndrome, the cognitive-operational changes
associated and the respective brain structures involved. All of these factors, we
believe, are involved in the dynamics of the dysfunctional process of Burnout
Syndrome.
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Arbelius, Karin. "För sakens skull : Det omöjliga mötet i Rut Hillarps roman Sindhia - en lacansk läsning." Thesis, Södertörn University College, School of Gender, Culture and History, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:sh:diva-475.
Full textAbstract:
<p>This essay examines the love affair between the two main characters of Rut Hillarp’s novel Sindhia. It draws attention to the schism between the Surrealist version of love as an extatic-religious fusion of the sexes – that in a way marks the relationship – and the yet remarkable coolness between the two lovers.</p><p>With the theories of French psychoanalyst Jacques Lacan, I will show how the man and the woman project their unrealistic individual fantasies on each other, thus rendering impossible the Surrealist Meeting, with its road to an absolute reality. The Surrealist "l’amour fou", I will argue, is trapped in the ritualized "l’amor interruptus"; a lacanian term for a certain kind of love that wishes to conceal the fact that desire will never find its object. It does so by pretending that the object would be found if only love had been consummated (thus the reason love is never consummated, since, as Lacan puts it, the object, or the Thing, is never to be found).</p><p>I will, in brief, argue that the love affair depicted in the novel in different ways tries to deal with the “lack-of-being” that marks the subject according to Lacan; the absolute distance to the desirable Thing.</p>
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Kucher, Sebastian Verfasser], Jan [Akademischer Betreuer] [Schwarzbauer, and Sven [Akademischer Betreuer] Sindern. "Environmental fate of DDT-related compounds in aquatic systems / Sebastian Kucher ; Jan Schwarzbauer, Sven Sindern." Aachen : Universitätsbibliothek der RWTH Aachen, 2018. http://d-nb.info/1180392124/34.
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Kucher, Sebastian [Verfasser], Jan [Akademischer Betreuer] Schwarzbauer, and Sven [Akademischer Betreuer] Sindern. "Environmental fate of DDT-related compounds in aquatic systems / Sebastian Kucher ; Jan Schwarzbauer, Sven Sindern." Aachen : Universitätsbibliothek der RWTH Aachen, 2018. http://d-nb.info/1180392124/34.
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Dibady, Mandendi Éric Gilles. "Étude du mythe de Tsamba et Magotsi sur la connaissance de la métallurgie du fer, dans la région de Sindara-Fougamou, au Gabon." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp02/NQ43060.pdf.
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Radmila, Velicki. "Utvrđivanje povezanosti mediteranskog načina ishrane i faktora rizika za nastanak akutnog koronarnog sindroma upotrebom „MedDiet” skora." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2018. https://www.cris.uns.ac.rs/record.jsf?recordId=106919&source=NDLTD&language=en.
Full textAbstract:
Uvod: Kardiovaskularne bolesti predstavljaju vodeći uzrok obolevanja i umiranja savremenog čoveka i vodeći su javno-zdravstveni problem u svetu i kod nas. Brojna istraživanja sugerišu da se mediteranski način ishrane povezuje sa smanjenjem rizika za nastanak i razvoj kardiovaskularnih bolesti i drugih masovnih nezaraznih bolesti kao i smanjenjem stope ukupnog mortaliteta. Cilj istraživanja: Utvrditi stepen pridržavanja mediteranskom načinu ishrane kod obolelih od akutnog koronarnog sindroma i kod osoba sa utvrđenim rizikom za nastanak kardiovaskularnih bolesti, upotrebom validovanog skora mediteranske ishrane – MedDiet skora. Takođe, cilj istraživanja je bio da se utvrdi da li postoji značajna razlika u vrednostima biohemijskih i kliničkih faktora rizika za razvoj kardiovaskularnih bolesti između dve posmatrane grupe ispitanika, kao i da se odredi granična vrednost MedDiet skora između poželjnog i rizičnog načina ishrane za nastanak akutnog koronarnog sindroma. Metod: Istraživanje je sprovedeno kao analitička studija preseka na uzorku od 294 ispitanika (146 žena i 148 muškaraca), starosti od 30 do 82 godine. Istraživanje je sprovedeno u vremenskom periodu od 07.02.2016. godine do 16.03.2017. godine. Prvu grupu činili su ispitanici kod kojih je dijagnostikovan akutni koronarni sindrom, koji su hospitalizovani u Institutu za kardiovaskularne bolesti Vojvodine u Sremskoj Kamenici, dok su drugu grupu činili ispitanici kod kojih je utvrđeno prisustvo najmanje jednog faktora rizika za nastanak kardiovaskularnih bolesti, bez klinički manifestne koronarne bolesti, koji su se javili na pregled u Savetovalište za pravilnu ishranu, Instituta za javno zdravlje Vojvodine u Novom Sadu. Kod svih učesnika u studiji izvršena su: antropometrijska merenja, merenje arterijskog krvnog pritiska, odgovarajuće biohemijske analize, EKG i anketiranje upotrebom posebno pripremljenog upitnika, u čijem sastavu se nalazio i MedDiet skor – validovan skor system za procenu stepena zastupljenosti mediteranskog načina ishrane kod pojedinca. Rezultati istraživanja: Srednja vrednost MedDiet skora ispitanika bez akutnog koronarnog sindroma bila je 27,48±6,59, dok je srednja vrednost MedDiet skora ispitanika sa akutnim koronarnim sindromom bila 20,53±4,01. Razlika srednjih vrednosti MedDiet skora između dve grupe ispitanika bila je statistički značajna (p=0,029). Ispitivanjem prediktivnih vrednosti pojedinih varijabli utvrđeno je da su MedDiet skor i glikemija našte odlični markeri za akutni koronarni sindrom (AUROC=0,815, p<0,0005 i AUROC=0,829, p<0,0005, respektivno). Rezultati istraživanja su pokazali da konzumiranje pojedinih namirnica iz kategorija definisanih MedDiet skorom (voće, povrće, živinsko meso i maslinovo ulje) može doprineti smanjenju rizika za nastanak akutnog koronarnog sindroma. Konzumiranje crvenog mesa i mesnih prerađevina povećava rizik od pojave akutnog koronarnog sindroma. Utvrđena granična vrednost MedDiet skora iznosila je 22,5. Vrednosti MedDiet skora ≤22,5 predstavljaju faktor rizika za nastanak akutnog koronarnog sindroma, dok vrednosti MedDiet skora >22,5 ukazuju na smanjen rizik za nastanak akutnog koronarnog sindroma. Multivarijantnom regresionom analizom pokazano je da na pojavu akutnog koronarnog sindroma utiču sledeći faktori rizika: godine starosti 1,063 (1,270-1,819), muški pol 4,071 (1,901-8,719), pušenje 3,067 (1,322-7,114), indeks telesne mase 0,902 (0,839-0,970), sistolni pritisak 1,020 (1,003-1,037), glikemija našte 1,520 (1,025-1,101) i MedDiet skor 0,783 (0,722-0,849). Zaključak: Akutni koronarni sindrom predstavlja značajan javno-zdravstveni problem odraslog stanovništva u Republici Srbiji na šta ukazuju visoke prevalencije u populaciji. Rezultati sprovedenog istraživanja pokazuju da je i diskretnim povećanjem unosa namirnica koje predstavljaju osnovu mediteranskog načina ishrane moguće postići značajne zdravstvene koristi. Ovi rezultati mogu predstavljati okvir za razvoj lokalnog skoring sistema ishrane prikladnog za nemediteransko područje, kao i modela za procenu rizika za nastanak akutnog koronarnog sindroma u našoj populaciji.<br>Introduction: Cardiovascular diseases are the leading cause of morbidity and mortality of a modern society and are major public health problem in our country and also worldwide. Numerous studies suggest that the Mediterranean diet is associated with a reduction in the risk of developing cardiovascular diseases and other non-communicable diseases, as well as reduction in the overall mortality rate. Aim: To determine the degree of Mediterranean diet complience in subjects with acute coronary syndrome and subjects with an established risk for developing cardiovascular diseases, using validated Mediterranean diet score - MedDiet. Also, the aim of the study was to determine whether there is a significant difference in the values of the biochemical and clinical risk factors for the development of cardiovascular diseases between the two observed groups of subjects, and to determine the cut-off value of the MedDiet score between the favorable and unfavorable dietaty pattern for the development of acute coronary syndrome. Method: The study was conducted as an analytical cross-sectional study with enrollment of 294 subjects (146 women and 148 men), 30 to 82 years of age. The research was conducted during the period from 02/07/2016 until 03/16/2017. The first group of subjects consisted of patients diagnosed with acute coronary syndrome who were hospitalized at the Institute for Cardiovascular Diseases Vojvodina in Sremska Kamenica. The second group was comprised of subjects with established at least one major risk factor for the development of cardiovascular diseases but without clinically manifest coronary artery disease, who came to the medical examination of the Counseling Center for Proper Nutrition, Institute of Public Health of Vojvodina in Novi Sad. Among all participants in the study the following examinations were conducted: anthropometric measurements, arterial blood pressure measurements, appropriate biochemical analysis, ECG and surveys using a specially prepared questionnaire, which included MedDiet score - validated score system for assessing the degree of compliance with Mediterranean dietary pattern among subjects. Results of the study: The average value of the MedDiet score among subjects without acute coronary syndrome was 27.48 ± 6.59, while the average value of MedDiet score among subjects with acute coronary syndrome was 20.53 ± 4.01. The difference in MedDiet average values between the two groups of subjects was statistically significant (p = 0.029). By examining the predictive values of individual variables, it was shown that MedDiet score and fasting blood sugar were excellent markers for acute coronary syndrome (AUROC = 0.815, p<0.0005 and AUROC = 0.829, p <0.0005, respectively). The results of the study showed that the consumption of certain foods in the categories defined by MedDiet score (fruits, vegetables, poultry, and olive oil) can contribute to reduction of the risk for developing acute coronary syndrome. On the other hand, consuming red meat and meat products increased the risk of acute coronary syndrome. The established cut-off value for MedDiet score was 22.5. MedDiet score ≤22.5 practicaly indicated greater risk for the development of acute coronary syndrome, while MedDiet score> 22.5 indicated reduced risk for the development of acute coronary syndrome. Multivariate regression analysis showed that acute coronary syndrome is affected by the following risk factors: age 1,063 (1,270-1,819), male gender 4,071 (1,901-8,719), smoking 3,067 (1,322-7,114), body mass index 0,902 (0.839-0.970 ), systolic blood pressure 1.020 (1.003-1.037), fasting blood sugar 1.520 (1.025-1.101) and MedDiet score 0.783 (0.722- 0.849). Conclusion: Acute coronary syndrome is a major public health problem in the adult population of the Republic of Serbia, as indicated by its high prevalence. The results of the conducted research show that discrete increase in food intakes of foods which represent the basis of the Mediterranean diet, can lead to significant health benefits. These results can represent a framework for the development of a local scoring system for a non-mediterranean area, and also for creation of risk assessment model for acute coronary syndrome in our population.
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Vollemaere, Benjamin. "Histoire politique des royaumes du Sud-Sindjar à l'époque amorrite (XIXe-XVIIe siècle avant notre ère)." Thesis, Lille 3, 2016. http://www.theses.fr/2016LIL30009/document.
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En quelques décennies, entre le XXIe et le XIXe siècle, le visage de la Mésopotamie fut profondément bouleversé par l'immigration massive de populations amorrites qui se sédentarisèrent et investirent les centres urbains laissés vacants au tournant du millénaire précédent. Le phénomène toucha particulièrement la Haute‑Mésopotamie dans laquelle s'insère un petit ensemble rendu singulier par sa topographie : le sud du Djebel Sindjar.Si cette région n'a encore livré que peu de vestiges archéologiques, la documentation écrite exhumée sur plusieurs sites dans ou à l'extérieur du Sud-Sindjar (Tell Hariri, Tell Leilan et Tell al‑Rimah principalement), apporte de nombreuses informations sur sa géographie, sur ses habitants et leur mode de vie mais également et surtout sur les événements politiques qui la touchèrent entre le XIXe et le XVIIe siècle avant notre ère. C'est l'enjeu de cette thèse que de dater, d'ordonner et d'analyser ces informations dans une optique qui se veut double. Dans un premier temps, il s'agit de reconstituer le paléo-environnement et la géographie historique de cette région, avec comme l'un des principaux points de mire la localisation des villes évoquées dans ces textes. L'autre approche tient à la découverte de son histoire politique en premier lieu par la description des ensembles politiques et humains qui s'y constituèrent, royaumes et groupes tribaux, mais également par l'analyse des rapports que ces entités entretinrent entre elles. Enfin, il s'agit de considérer les enjeux que la région revêt et qui expliquent autant les choix politiques de ces royaumes que les interventions étrangères dans la région<br>In a few decades, between the XXIst and the XIXth century, the appearance of Mesopotamia deeply changed because of the immigration on a massive scale of amorite populations which settled down and flooded upon the cities left unoccupied at the end of the previous century. The phenomenon particularly struck the Upper Mesopotamia in which there is a small area made singular owing to its topography : the plains south of the Jebel-Sinjar. This area has revealed only a few archaeological vestiges but the written documentation which was found in several sites inside or outside South-Sinjar (especially in Tell Hariri, Tell Leilan and Tell al-Rimah) brought many pieces of information about its geography, its inhabitants and their way of life, but also, and most importantly, about the political events which occurred there between the XIXth and the XVIIth century before our era. The issue of this thesis is to date, to order and to analyze these pieces of information in a double perspective. On one hand, it is about rebuilding the old environment and the historical geography of this area, aiming especially the location of the cities mentioned in these texts. Secondly, its political history will be studied, first of all throughout the description of the political and human groups which appeared there, kingdoms and tribal groups, and secondly through the analysis of the relationships between these entities. Finally, we will consider the issues represented in the area which explain the political decisions made by those kingdoms as well as the foreign interventions in the region
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Wluka, Ann-Kathrin [Verfasser], Jan [Akademischer Betreuer] Schwarzbauer, and Sven [Akademischer Betreuer] Sindern. "Screening analyses and selective quantification of organic pollutants in various matrices / Ann-Kathrin Wluka ; Jan Schwarzbauer, Sven Sindern." Aachen : Universitätsbibliothek der RWTH Aachen, 2017. http://d-nb.info/1162499133/34.
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Ruggeri, Luca Santo. "Tromboembolismo venoso e cancro: rischi e conseguenze." Doctoral thesis, Università di Catania, 2012. http://hdl.handle.net/10761/1124.
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Il Tromboembolismo venoso è una complicanza frequente nei tumori maligni, molto frequente nei pazienti anziani associata o meno a comorbidità, che fu segnalata per primo da Armand Trousseau nel 1865, e la combinazione delle due condizioni viene spesso ancora chiamata sindrome di Trousseau. (1). Comunque, nonostante l'accumulo, nel corso degli anni, di un considerevole volume di dati epidemiologici la fisiopatologia rimane ancora poco conosciuta. I pazienti sottoposti ad intervento chirurgico per neoplasia maligna presentano un rischio più alto di trombosi venosa profonda postoperatoria (TVP) rispetto a quelli operati per patologia non neoplastica (1) Studi autoptici hanno riportato percentuali più alte di embolia polmonare (PE) in pazienti con cancro comparati con pazienti senza neoplasia maligna (2). Inoltre, il rischio di recidiva dopo un primo episodio di TVP è più alto nei pazienti con cancro rispetto a quelli senza patologia maligna (3) Infine individui che presentano un episodio non spiegabile di TVP è più probabile che presentino un cancro occulto, rispetto a quelli con un fattori di rischio identificabili per trombosi, nei sei mesi successivi dopo l episodio acuto. (4,5) In questa revisione, viene discussa in 6 sezioni l epidemiologia della trombosi e cancro: (1) l'incidenza di TVP in pazienti con cancro con o senza trattamento antineoplastico; (2) i tumori associati più frequentemente con la trombosi; (3) l'associazione tra TVP e la malignità occulta; (4) gestione della TVP nei pazienti con cancro; (5) l'associazione inversa tra terapia anticoagulante e sopravvivenza al cancro, e (6) la prognosi dei pazienti di cancro con trombosi venosa.
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Trarbach, Ericka Barbosa. "Estudo citogenetico e molecular em pacientes com hipogonadismo hipogonadotrofico com e sem anosmia : sindorme de Kallmann e hipogonadismo hipogonadotropico." [s.n.], 2004. http://repositorio.unicamp.br/jspui/handle/REPOSIP/316605.
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Previous issue date: 2004<br>Resumo: A síndrome de Kallmann (SK) é uma afecção relativamente rara, caracterizada pela associação de hipogonadismo hipogonadotrófico (HH) e anosmia/hiposmia. Embora a maioria dos casos de SK seja esporádica, diferentes padrões de herança, recessivo ligado ao X, autossômico dominante e autossômico recessivo têm sido descritos, sendo que a forma ligada ao X da síndrome (SKX) encontra-se genotípica e fenotipicamente melhor definida. O gene KAL-1 localizado em Xp22.3 escapa à inativação e codifica uma proteína, a anosmina, cujo papel tem sido relacionado ao processo de migração de neurônios produtores de GnRH que ocorre durante a embriogênese humana. No entanto, muitos casos de hipogonadismo hipogonadotrófico não podem ser relacionados a qualquer alteração olfativa, sendo estes classificados como hipogonadismo hipogonadotrófico normósmicos (HHn). Mutações no gene do receptor do hormônio liberador de gonadotrofinas (GnRH-R) têm sido descritas numa parcela desses casos. Além disso, os genes NELF (fator nasal embrionário do hormônio liberador de hormônio luteinizante) e EBF2 (¿early B-cell factor¿) têm sido relacionados ao processo de migração de neurônios produtores de GnRH, sendo considerados possivelmente envolvidos na gênese do HH. O presente trabalho foi elaborado com o objetivo de se investigar a base genética das diferentes formas do HH. Para tal, foram avaliados 31 indivíduos com hipogonadismo hipogonadotrófico (pertencentes a 26 famílias), 22 com anosmia e nove com olfação normal, mediante a análise do cariótipo pela técnica de bandamento GTG seguida da análise molecular dos genes KAL-1 e GnRH-R, por PCR e seqüenciamento. Todos os pacientes estudados apresentaram cariótipo normal, à exceção de um caso esporádico de SK com microdeleção do locus KAL-1 detectada somente por FISH em estudo anteriormente realizado. Entre os pacientes com SK, foram detectadas mutações na região codificante do gene KAL-1 nas três famílias com herança recessiva ligada ao X e em um caso esporádico. Duas famílias apresentaram duas deleções intragênicas similares envolvendo os éxons 5-10; na terceira família detectou-se uma mutação 721C>T no éxon 5 levando a um códon de parada prematuro. Esta mutação ainda não se encontra descrita na literatura. No caso esporádico identificou-se uma mutação ¿frameshift¿ 1956delC no éxon 12. Em relação aos pacientes com HHn, não foram identificadas mutações nos genes GnRH-R e KAL-1. Nesses casos, e nos pacientes com SK cuja etiologia não pôde ser esclarecida, foram ainda analisados os genes NELF e EBF2. Contudo, nenhuma alteração nas seqüências desses genes foi identificada entre os pacientes da nossa casuística. Em conclusão, não foram encontradas evidências cromossômicas da localização de outros genes candidatos responsáveis pelo surgimento do HH. Duas mutações novas e duas deleções intragênicas semelhantes foram identificadas no gene KAL-1 entre os casos esporádicos e familiais da SK, observando-se que essas mutações ocorreram numa freqüência relativamente elevada em nossa casuística. Os pacientes com HHn não apresentaram mutações nos genes KAL-1 e GnRH-R. Não foram observadas anomalias nas seqüências codificantes dos genes NELF e EBF2 em nenhuma das formas de HH<br>Abstract: Kallmann syndrome (KS) is a relatively rare disorder characterized by the association of hypogonadotropic hypogonadism (HH) with anosmia or hyposmia. Although the majority of KS cases are sporadic, the syndrome may be transmitted as an autosomal dominant, autosomal recessive and X-linked modes of inheritance. The KAL-1 gene responsible for the X linked form of KS (X-KS) was mapped in Xp22.3 and encodes a protein called anosmin, that could function in the migration of GnRH-secreting neurons during embryonic development. However, many cases of hypogonadotropic hypogonadism do not have olfactory alterations, and are referred as normosmic hypogonadotropic hypogonadism (nHH). Mutations in the GnRH-R gene have been described in some of these cases. In addition, the NELF and EBF2 genes have been implicated in the neuronal GnRH migration and are considered promising candidate to HH manifestation. The aim of the present study was to investigate the genetic basis of different forms of HH. Thirty-one patients with HH (belonging to 26 families), 22 affected by KS and nine with normal olfaction, were evaluated by karyotype analysis using GTG banding technique followed by molecular analysis of the KAL-1 and GnRH-R genes, by PCR and sequencing techniques. All patients exhibited normal karyotypes, with exception of a previously studied KS sporadic case, where a microdeletion of the KAL-1 locus was detected only by FISH. Mutations were identified in the coding region of the KAL-1 gene in the three familial cases with X-linked inheritance and in one of the sporadic cases of KS. Two similar intragenic deletions involving exons 5-10 were observed in two families. In the third, a new point mutation on exon 5 (721C>T) leading to a premature stop codon was found, while a frameshift mutation caused by one nucleotide deletion (1956delC) within exon 12 was identified in the sporadic case. Mutations in the KAL-1 and GnRH-R genes were not observed in the patients with nHH. In these cases and in the KS patients without KAL-1 abnormalities, the coding sequences of genes NELF and EBF2 were analyzed. However, no mutation was detected in these genes in our sample. In conclusion, no chromosomal rearrangements or deletions that could be useful for the localization of other candidate genes responsible for HH were detected. Two new point mutations and two similar intragenic deletions of the KAL-1 gene were identified among sporadic and familial KS cases, with a relative high frequency in our sample. In the HHn patients, neither KAL-1 nor GnRH-R mutations were detected. No sequence abnormalities were demonstrated for the coding regions of the NELF and EBF2 genes in both forms of HH<br>Doutorado<br>Genetica Humana e Medica<br>Doutor em Genetica e Biologia Molecular
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Ryan, Peter J. "Computer simulation of a two-phase Capillary Pumped Loop (CPL) using SINDA/FLUINT." Monterey, Calif. : Springfield, Va. : Naval Postgraduate School ; Available from National Technical Information Service, 1997. http://handle.dtic.mil/100.2/ADA343672.
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Thesis (M.S. in Mechanical Engineering) Naval Postgraduate School, December 1997.<br>"December 1997." Thesis advisor(s): Matthew D. Kelleher. Includes bibliographical references (p. 123-124). Also available online.
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Ghassal, Bandar Ismail Hassan Verfasser], Ralf [Akademischer Betreuer] [Littke, and Sven [Akademischer Betreuer] Sindern. "Source rock depositional processes in different marine settings: examples from North African basins / Bandar Ismail Hassan Ghassal ; Ralf Littke, Sven Sindern." Aachen : Universitätsbibliothek der RWTH Aachen, 2017. http://d-nb.info/1171323581/34.
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Ghassal, Bandar Ismail Hassan [Verfasser], Ralf [Akademischer Betreuer] Littke, and Sven [Akademischer Betreuer] Sindern. "Source rock depositional processes in different marine settings: examples from North African basins / Bandar Ismail Hassan Ghassal ; Ralf Littke, Sven Sindern." Aachen : Universitätsbibliothek der RWTH Aachen, 2017. http://d-nb.info/1171323581/34.
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Cardoso, Maria Leila. "Polimorfismos do gene MSX1 e a fenda labio e/ou palatina n?o-sindr?mica." Universidade Federal do Rio Grande do Norte, 2012. http://repositorio.ufrn.br:8080/jspui/handle/123456789/13277.
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Previous issue date: 2012-12-04<br>Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior<br>O objetivo deste estudo foi investigar a contribui??o de 6 polimorfismos do gene MSX1 em pacientes com fenda l?bio e/ou palatina n?o-sindr?mica. Avaliou-se tamb?m a contribui??o materna, de forma qualitativa, do etilismo e tabagismo durante a gesta??o como fatores etiol?gicos, bem como iniciou-se a pesquisa de novas variantes no gene MSX1. Este estudo foi realizado com a colabora??o de uma equipe multidisciplinar que atende os pacientes fissurados. Foram estudados 358 indiv?duos dos quais 158 s?o pacientes com fendas orais e 200 s?o crian?as saud?veis constituindo o grupo controle. Todos os indiv?duos e/ou respons?veis legais responderam ao question?rio com informa??es sobre h?bitos de vida e hist?rico familiar. Para a pesquisa de polimorfismos foram utilizados ensaios pr?-desenhados (TaqMan?) empregando t?cnica de discrimina??o al?lica e para novas variantes foi aplicada a t?cnica High Resolution Melt Curve (HRM), ambos pela PCR em Tempo Real (ABI Prism 7500 Fast Real Time). O sequenciamento foi realizado em parceria com o Centro de Estudos do Genoma Humano (CEGH USP; ABI 3730 DNA Analyser - Applied Biosystems - Foster City, CA, USA) para confirma??o das variantes. Observou-se que, em rela??o ao g?nero, 60% dos pacientes eram do g?nero masculino e 40% do g?nero feminino. O etilismo materno durante a gravidez aumentou o risco de fendas orais em crian?as 3,37 vezes (IC95%: 1,56-7,28, p=0,002). Os resultados demonstraram que nenhum dos 6 polimorfismos estudados demonstraram associa??es significantes com a fenda l?bio e/ou palatina n?o-sindr?mica (p>0,05). Na pesquisa de novas variantes foi aplicada a t?cnica (HRM) para as regi?es 3 UTR e 5? pr?xima do gene MSX-1, dois polimorfimos foram identificados e caracterizados para a regi?o 3`UTR (rs1095, rs2229262) e um polimorfismo para regi?o 5? (rs3821949). N?o foram identificadas novas muta??es. Os resultados obtidos pelo HRM n?o mostraram relev?ncia estat?stica dos polimorfismos encontrados com a etiologia das fendas orais. Conclui-se que, o presente estudo n?o mostra associa??o significativa dos polimorfismos estudados do gene MSX1 com o desenvolvimento das fendas l?bio e/ou palatina n?o-sindr?micas, mas a an?lise de fatores ambientais sugere que o etilismo materno durante a gesta??o ? um importante fator de risco na etiologia das fendas orais. Al?m disso, este estudo possui uma abordagem in?dita do gene MSX-1 em pacientes com fendas orais no Rio Grande do Norte contribuindo para o esclarecimento da etiologia das fendas orais n?o-sindr?micas
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Sindern, Sven [Verfasser]. "Mineralogical, geochemical and geochronological studies in the Uralides and Variscides : contributions to the understanding of dynamic processes in collisional orogens / Sven Sindern." Aachen : Universitätsbibliothek der RWTH Aachen, 2014. http://d-nb.info/1133201571/34.
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Xavier, Lu?za Ara?jo da Costa. "Avalia??o da instabilidade do genoma em crian?as com fendas labiopalatinas n?o-sindr?micas." Universidade Federal do Rio Grande do Norte, 2015. http://repositorio.ufrn.br/handle/123456789/20330.
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Previous issue date: 2015-07-31<br>As fendas labiopalatinas n?o-sindr?micas (FL/PNS) s?o defeitos cong?nitos
comuns em humanos, caracterizadas pelo desenvolvimento incompleto de
estruturas que separam a cavidade nasal da cavidade oral, e s?o causadas devido a
uma intera??o entre fatores gen?ticos e ambientais. Dados obtidos de estudos de
caso-controle e interven??o diet?tica indicam que a suplementa??o materna com
multivitaminas contendo ?cido f?lico previne o surgimento das fissuras orais. ?
conhecido que o ?cido f?lico participa de fun??es celulares essenciais, como a
s?ntese de nucleot?deos para o reparo do DNA, as quais contribuem para a prote??o
da integridade do genoma contra eventos de danos gerados por fatores end?genos
e/ou ex?genos. Inclusive, estudos revelam que a defici?ncia desta vitamina aumenta
a forma??o de micron?cleos, estruturas citogen?ticas indicadoras de danos no DNA.
Al?m disso, esta defici?ncia ? modulada pelos polimorfismos gen?ticos associados
ao metabolismo do ?cido f?lico, comprometendo o desempenho das fun??es de
estabilidade do genoma e, portanto, est?o sendo associados com o desenvolvimento
de v?rios dist?rbios, dentre eles as fissuras orais. A partir deste contexto, foi
conduzido um estudo transversal do tipo caso-controle n?o pareado com o objetivo
de avaliar a frequ?ncia de biomarcadores de instabilidade gen?mica, sua rela??o
com polimorfismos gen?ticos do metabolismo do folato, e se essas vari?veis est?o
associadas com o desenvolvimento das FL/PNS em crian?as do Rio Grande do
Norte, Brasil.
Foram recrutados 48 pacientes fissurados e 18 crian?as controles,
respectivamente, no Hospital de Pediatria Professor Heriberto Ferreira Bezerra
(HOSPED)/UFRN e em escolas estaduais da cidade de Natal, RN. Com o devido
consentimento dos participantes, realizou-se uma entrevista com os respons?veis
para obten??o de dados epidemiol?gicos, como tamb?m procedeu-se a coleta
sangu?nea das crian?as para a realiza??o dos testes. Foi executado o ensaio do
micron?cleo com bloqueio da citocinese para calcular a frequ?ncia de micron?cleos
(MN), pontes nucleoplasm?ticas (PN) e brotos nucleares (BN). A partir da extra??o
do DNA gen?mico, avaliou-se os polimorfismos da metilenotetrahidrofolato redutase
C677T e A1298C, metionina sintase A2756G, metionina sintase redutase A66G e do
receptor de folato reduzido A80G pela t?cnica de rea??o em cadeia da polimerase
associada ao polimorfismo de tamanho do fragmento de restri??o (PCR-RFLP).
As crian?as com FL/PNS apresentaram maior frequ?ncia basal de MN, PN e
BN que o grupo de crian?as controle (p < 0,001), e nenhum dos polimorfismos
avaliados modificaram significativamente a frequ?ncia destes biomarcadores. Al?m
disso, crian?as com FL/PNS apresentaram 2,3 vezes mais risco de exibir altas
frequ?ncias de MN (p = 0,043) segundo modelo de regress?o log?stica bin?ria. A alta
instabilidade do genoma nas crian?as com fissuras orais sugere que os eventos
genot?xicos, em particular os que promovem quebras na dupla fita do DNA e n?o
s?o devidamente reparados formando micron?cleos, representam fatores relevantes
no desenvolvimento das fendas labiopalatinas n?o-sindr?micas.<br>The non-syndromic clefts of the lip and/or palate (NSCL/P) are common birth
defects in humans characterized by an incomplete development of cellular structures
that separate the nasal cavity from the oral cavity, and they are caused due to an
interaction between genetic and environmental factors. Data from case-control and
dietary intervention studies indicates that maternal supplementation with
multivitamins containing folic acid prevents the formation of oral clefts. It is known
that folic acid plays a role in essential cellular functions, such as nucleotides
synthesis for DNA repair, which contribute to the protection of genome integrity from
damage events generated by endogenous and/or exogenous factors. In fact, studies
show that a deficiency in this vitamin increases micronuclei formation, a cytogenetic
structure that indicates misrepair of damaged DNA. Furthermore, this deficiency is
modulated by genetic polymorphisms associated with folic acid metabolism, affecting
the performance of genome stability functions and therefore, it has been associated
with the development of various disorders, including oral clefts.
From this context, it was planned a unpaired case-control cross-sectional
study in order to assess the frequency of genome instability biomarkers, their
relationship with genetic polymorphisms in folate metabolism, and if these variables
are associated with the development of NSCL/P in children from a Northeast region
at Brazil.
For this research, it was recruited 48 NSCL/P patients and 18 control children,
respectively, at the Pediatric Hospital Professor Heriberto Ferreira Bezerra
(HOSPED)/ UFRN and at schools in Natal city. With the participants consent, they
were interviewed with a standard questionnaire to obtain epidemiological data, and
the children underwent a blood sampling for the tests. It was performed the
cytokinesis-block micronucleus assay to estimate the frequency of micronuclei (MN),
nucleoplasmic bridges (NPB) and nuclear buds (NB). Also, from the genomic DNA
extraction, it was evaluated by PCR-RFLP the polymorphisms of
methylenetetrahydrofolate reductase C677T and A1298C, methionine synthase
A2756G, methionine synthase reductase A66G and reduced folate carrier A80G.
Children with NSCL/P had higher baseline frequency of MN, NPB and NB than
the control group (p < 0.001), and none of the evaluated polymorphisms significantly
modified the frequency of these biomarkers. In addition, children with clefts had 2.3
times more risk of displaying high frequency of MN (p = 0.043) according to the
binary logistic regression model. The high genomic instability in children with oral
clefts suggests that genotoxic events that promote double strand breaks on DNA and
are not properly repaired, thus originating micronuclei, represent significant factors in
the development of non-syndromic cleft lip/ palate.
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Bezerra, Jo?o Felipe. "Associa??o de polimorfismos do gene IRF6 em pacientes com fendas orais n?o sindr?mica." PROGRAMA DE P?S-GRADUA??O EM CI?NCIAS DA SA?DE, 2017. https://repositorio.ufrn.br/jspui/handle/123456789/23747.
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Previous issue date: 2017-04-03<br>Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico (CNPq)<br>As fendas orais constituem um problema de sa?de publica atingindo cerca de 15% de todas as malforma??es, caracterizando-se pela forma??o incompleta das estruturas que separam a cavidade nasal e a cavidade oral com fatores gen?ticos e ambientais que contribuem para sua etiologia. Atualmente, estudos de microarray, utilizando pacientes fissurados identificaram diversas regi?es de susceptibilidade para o desenvolvimento das fendas orais n?o-sindr?micas, dentre essas alguns estudos demonstraram a regi?o do gene Interferon Regulatory Factor 6 (IRF6) associado ao aumento de risco para o desenvolvimento das fendas. O objetivo do presente trabalho ? pesquisar polimorfismos do gene IRF6 e as poss?veis associa??es com o desenvolvimento das fendas orais n?o-sindr?micas. Para isso, um total de 368 individuos (186 pacientes FL/P e 182 controles) foram selecionados no Servi?o de Atendimento ao Paciente Fissurado - HUOL/UFRN. Amostras de sangue foram coletadas para extra??o do DNA e an?lise dos polimorfismos do gene IRF6 (rs2235371, rs642961, rs2236907, rs861019, e rs1044516) por PCR em tempo real. Os pacientes foram classificados nos grupos Fenda L?bio-palatina (CLP), Fenda labial (CL) e Fenda Palatina (CP) e foi observada uma associa??o significativa de rs2235371 (OR: 11,24, 95% CI: 1.97-64.22, p = 0,016) no grupo com a fendas palatinas isoladas (CP). Al?m disso, a an?lise da combina??o al?lica mostrou um aumento do risco de fendas associado aos polimorfismos rs1044516 e rs2236907, uma vez que estavam presentes em todas as combina??es significativas. Assim, a associa??o do rs2235371 com pacientes do grupo CP mostra-se como um fator de risco para CP em nossa popula??o. A an?lise das combina??es al?licas mostram a influ?ncia de polimorfismos do IRF6 combinadas, principalmente (rs1044516 e rs2236907) sugerem que cada polimorfismo pode contribuir minimamente para aumentar o risco de desenvolver fendas orais n?o-sindr?micas em uma popula??o brasileira de Rio Grande do Norte.<br>Orofacial clefts are a public health problem accounting for approximately 15% of all malformations, characterized by the incomplete formation of structures that separate the nasal cavity and oral cavity with genetic and environmental factors that contribute to its etiology. Currently, microarray studies using fissured patients have identified several regions of susceptibility to the development of non-syndromic orofacial clefts among which some studies have demonstrated the region of the Interferon Regulatory Factor 6 (IRF6) gene associated with increased risk for non-syndromic orofacial clefts development. The aim of the present study is to investigate polymorphisms of the IRF6 gene and the possible correlations with the development of non-syndromic orofacial clefts. For this, a total of 368 individuals (186 FL / P patients and 182 controls) were selected in the Service of the Fissured Patient - HUOL / UFRN. Blood samples were collected for DNA extraction and analysis of the polymorphisms of the IRF6 gene (rs2235371, rs642961, rs2236907, rs861019, and rs1044516) by real-time PCR. Patients were classified into the CLP, CL and CP groups and a significant association of rs2235371 (OR: 11.24, 95% CI: 1.97-64.22, p = 0.016) was observed in the group with isolated palate clefts (CP). In addition, the analysis of the allelic combination showed an increased risk orofacial clefts associated with the polymorphisms rs1044516 and rs2236907, since they were present in all significant combinations. Thus, the association of rs2235371 with patients in the CP group is shown as a risk factor for CP in our population. The analysis of allelic combinations show the influence of combined IRF6 polymorphisms mainly (rs1044516 and rs2236907) suggest that each polymorphism may contribute minimally to increase the risk of developing non-syndromic orofacial clefts in a Brazilian population of Rio Grande do Norte.
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Suresh, Sinduja [Verfasser], Birgit [Akademischer Betreuer] Glasmacher, Robert [Akademischer Betreuer] Zweigerdt, and Sotirios [Akademischer Betreuer] Korossis. "Improving cell infiltration in electrospun scaffolds for soft tissue engineering / Sinduja Suresh ; Akademische Betreuer: Birgit Glasmacher, Robert Zweigerdt, Sotirios Korossis ; Institute for Multiphase Processes, Leibniz University Hannover." Hannover : Bibliothek der Medizinischen Hochschule Hannover, 2020. http://d-nb.info/1212544544/34.
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Slobodan, Pantelinac. "Uticaj biopsihosocijalnih faktora na ishod rehabilitacije pacijenata nakon lumbalne mikrodiskektomije." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2014. http://www.cris.uns.ac.rs/record.jsf?recordId=89984&source=NDLTD&language=en.
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Uvod: Mikrodiskektomija je jedan od savremenih hirurških metoda u lečenju osoba sa lumbalnim sindromom, čiji je uzrok hernijacija intervertebralnog diska. Na postoperativni oporavak, ishod rehabilitacije i funkcionalno stanje, veliki uticaj imaju i biopsihosocijalni faktori. Cilj: Glavni cilj istraživanja je bio procena uticaja biopsihosocijalnih faktora na ishod lečenja i funkcionalni status bolesnika sa lumbalnim sindromom nakon mikrodiskektomije i sprovedenog rehabilitacionog tretmana. Materijal i metode: Sprovedena je prospektivna studija na 200 pacijenata (96 muškaraca i 104 žene), različitih profesija, prosečne životne dobi 50.20 ± 10.26 godina (raspon 29–69 godina). U istraživanje su uključeni pacijenti nakon operativnog lečenja hernijacije diska, putem mikrodiskektomije, premešteni sa Klinike za neurohirurgiju na Kliniku za medicinsku rehabilitaciju, Kliničkog centra Vojvodine u Novom Sadu. Stratifikacija ispitanika je izvršena prema njihovim biološko-demografskim, socio-ekonomskim, psihološkim i funkcionalnim obeležjima, uz korišćenje podataka iz anamneze, kliničkog pregleda, raspoložive medicinske dokumentacije i odgovarajućih upitnika i testova. Korišćeni su sledeći upitnici: za procenu bola-vizuelna analogna skala (VAS), upitnik o bolu (Pain Detect Test), za procenu psiholoških karakteristika Spilbergerovi testovi za trenutnu i opštu anksioznost (Spielberger Anxiety Inventory-State and Trait Test), Bekova skala depresije (BDI), upitnik za procenu prisustva straha od fizičke aktivnosti i posla i njihovog izbegavanja (The Fear-Avoidance Beliefs Questionnaire - Physical activity and Work), a za procenu funkcionalnog statusa Osvestrijev upitnik o onesposobljenosti (ODI) i Kvebek skala onesposobljenosti osoba sa lumbalnim sindromom. Fleksibilnost i indeks pokretljivosti lumbalnog segmenta kičme su procenjivani pomoću Šoberovog i Tomajerovog testa. Navedena ispitivanja su obavljena postoperativno pre početka sprovođenja rehabilitacionog tretmana (0. mesec), potom posle mesec dana i zatim 3 i 6 meseci posle mikrodiskektomije. Rezultati: Na doživljavanje bola i na funkcionalnu sposobnost imali su signifikantnog uticaja sledeći navedeni činioci. Pol: subjektivno doživljavanje bola je bilo jače kod žena nego kod muškaraca, ali je stepen funkcionalne onesposobljenosti (prema ODI i Kvebek skali) bio signifikantno veći (p<0.01) kod muškaraca. Životna dob: Stepen oporavka pacijenata nakon mikrodiskektomije je tokom vremena u pojedinim starosnim grupama bio promenljiv, ali je u celini bio lošiji kod starijih osoba. Navika pušenja: intenzitet bola (VAS) i stepen funkcionalne onesposobljenosti (prema ODI i Kvebek skali ) su bili veći kod pušača nego kod nepušača (p<0.01). Mehaničko opterećenje kičme: manji stepen oporavka su imali ispitanici čije zanimanje je povezano sa većim dinamičkim i statičkim opterećenjem kičmenog stuba. Socijalni faktori: redovno zaposlenje i novčana primanja su povezani sa boljim funkcionalnim oporavkom. Psihološki status i stepen optimizma: anksioznost i strahovi od fizičke aktivnosti i posla, strah od gubitka posla, depresija, negativni stavovi i pesimizam su signifikantno češće prisutni kod ispitanika koji su imali manji stepen funkcionalnog oporavka tokom praćenog perioda. Zaključci: Na doživljavanje bola i na funkcionalnu sposobnost i oporavak pacijenata nakon mikrodiskektomije imali su signifikantnog uticaja sledeći biopsihosocijalni faktori: pol, životna dob, navika pušenja, mehaničko opterećenje kičme, socijalno-ekonomski faktori, psihološki status i stepen optimizma pacijenta. Primenom odgovarajućih upitnika i registrovanjem ovih faktora, može se kreirati model za predviđanje stepena funkcionalnog oporavka i za primenu dopunskih terapijskih postupaka posle načinjene mikrodiskektomije.<br>Introduction: Microdiscectomy is one of the modern surgical methods for the treatment of people with low back pain, caused by a herniated intervertebral disc. On postoperative recovery, rehabilitation outcome and functional status, among others, great influence have also biopsychosocial factors. Goal: The main goal of the research was to assess which biopsychosocial factors have a significant impact on treatment outcome and functional status of patients with low back pain after lumbar microdiscectomy and the subsequent physical therapy. Material and methods: The research was conducted as a prospective study on 200 patients (96 men and 104 women), of various professions and mean age 50.20 ± 26.10 years (range 29-69 years). The study involved patients after surgical treatment of disc herniation by microdiscectomy, who were transferred from the Clinic for neurosurgery to the Clinic for medical rehabilitation, in Clinical center of Vojvodina, Novi Sad, in order to perform physical therapy and rehabilitation. Stratification of patients was performed according to their biological, demographic, socio-economic, psychological and functional characteristics, using data from the health history, clinical examination, the available medical records and appropriate questionnaires and tests. Among the questionnaires were those that are used for assessment of pain, psychological and psychosocial characteristics and functional status of patients with low back pain, including a visual analogue scale, Pain Detect Test, Spielberger Anxiety Inventory-State and Trait, Beck Depression Inventory, The Fear-Avoidance Beliefs Questionnaire (Physical activity and Work), Oswestry Low Back Pain Disability Questionnaire (ODI) and Quebec Back Pain Disability Scale. The flexibility of the lumbar segment of the spine and its movement index were assessed by Schober's and Thomayer's tests. All of these above mentioned assessments were carried out just before the start of the rehabilitation treatment (month 0), at the beginning of physical therapy (month 0), one month later and then 3 and 6 months after microdiscectomy. Results: On the pain and functional ability / disability the significant influences had following listed factors. Gender: subjective perception of pain was stronger among women than among men, but the degree of functional disability (ODI and Quebec Scale) was significant higher in the group of men (p<0.01). Age: The degree of recovery among patients after microdiscectomy over time in different age groups was varying, but in general was worse in the group of older people. Smoking habits: pain intensity and degree of functional disability were higher among smokers than nonsmokers (p<0.01). Mechanical loading of the spine: lower degree of recovery had subjects whose job is associated with a higher dynamic and static loading of the spine. Social factors: regular employment and cash income are associated with better functional recovery. Psychological status and the degree of optimism: anxiety and fear of physical activity and work as well as the possibility of job loss, depression, negative attitudes and pessimism, were significantly more often present in the group of patients who had a lower degree of functional recovery during the studied period. Conclusions: On the experience of pain, on functional ability and recovery of patients after microdisectomy, significant influences have the following biopsychosocial factors: gender, age, smoking habits, the mechanical loading of the spine, socio-economic factors, psychological status and the degree of optimism of the patient. Using the appropriate questionnaires and registering mentioned factors, it is possible to create a model for predicting the degree of functional recovery and for the application of additional therapeutic procedures after microdisectomy.
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Sinder, Anne-Christin [Verfasser]. "Untersuchungen zum Einfluss des Renin-Angiotensin-Systems auf die exokrine und endokrine Pankreasfunktion bei chronischer Pankreatitis, Diabetes mellitus Typ 1 und Typ 2 / Anne-Christin Sinder." Gießen : Universitätsbibliothek, 2013. http://d-nb.info/1065462506/34.
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Belde, Johannes Verfasser], Stefan [Akademischer Betreuer] [Back, Gösta Akademischer Betreuer] Hoffmann, and Sven [Akademischer Betreuer] [Sindern. "Controls on depositional processes on the Australian Northwest Shelf: the Oligocene to recent carbonate succession analyzed on 2D/3D seismic reflection and borehole data / Johannes Belde ; Stefan Back, Gösta Hoffmann, Sven Sindern." Aachen : Universitätsbibliothek der RWTH Aachen, 2017. http://d-nb.info/1162499532/34.
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Milica, Jeremić Knežević. "Utvrđivanje validnosti kliničkog nalaza temporomandibularnih disfunkcija pomoću magnetne rezonance." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2015. https://www.cris.uns.ac.rs/record.jsf?recordId=95365&source=NDLTD&language=en.
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Uvod: Termin - temporomandibularne disfunkcije (TMD) obuhvata veći broj oboljenja TMZ, mastikatorne muskulature i okolnih struktura. Epidemiološke studije pokazuju da 50-75% osoba u toku života ima neki znak poremećaja funkcije mastikatornog sistema. TMD se najčešće javljaju između 20-40 godine života. Najznačajniji znaci i simptomi TMD su bol u predelu maseteričnog mišića, TMZ, regiona temporalnog mišića, ograničeno otvaranje usta i zvučne pojave (kliktaji i krepitacije). Bol u predelu TMZ je najčešći razlog javljanja pacijenta lekaru. Cilj Utvrđivanje validnosti kliničkog nalaza TMD dobijenog korišćenjem RDC/TMD (engl. Research Diagnostic Criteria/ Temporomandibular Disorders) i nalaza na MR pregledu radi utvrđivanja prisustva disfunkcije u cilju blagovremenog i adekvatnog kliničkog zbrinjavanja. Istraživanje je sprovedeno kao prospektivna studija u Centru za Imidžing dijagnostiku, Institutu za Onkologiju Vojvodine u Sremskoj Kamenici, u periodu od januara 2011. do maja 2013. godine. Istraživanjem je obuhvaćeno 200 ispitanica (400TMZ) koje su došle na zakazani MR pregled endokranijuma nevezano za eventualnu patologiju TMZ tj. zbog neurološke simptomatologije. Ispitanicama je prvo snimljen MR endokranijuma zbog osnovnog oboljenja a zatim je pregled nastavljen snimanjem oba TMZ. Snimanje je izvedeno na aparatu Siemens (Erlangen, SR Nemačka) jačine magnetnog polja 3Tesla – Siemens AVANTO 3T, istog dana, nakon obavljenog kliničkog pregleda. Svakoj ispitanici urađen je parasagitalni (Slika 8) i koronalni presek TMZ kroz oba kondila sa sledećim parametrima snimanja: proton density sekvenca, vreme repeticije (TR) 1850 ms, vreme ehoa (TE) 15 ms, vidno polje (FOV) 13 cm, kao i matrica 128 x 256. Debljina preseka prilikom snimanja MR bila je manja od 2 mm. Prilikom snimanja svakoj ispitanici je bio stavljen osmokanalni zapreminski kalem (engl. head matrix coil) da bi signal u antero-posteriornom pravcu na dobijenim snimcima bio ujednačen. Ukupno vreme snimanja oba TMZ iznosilo je 4 minuta. Na osnovu MR pregleda, najveći broj TMZ je bio bez patoloških promena, njih 198 (49,5%). Prednja dislokacija diska sa redukcijom je ustanovljena kod 46 TMZ (11,5%), sledili su prednja dislokacija diska bez redukcije (18 TMZ (4,5%)), zadnja dislokacija 4 TMZ (1%) I osteoartritis kod 100 TMZ (25%)). Kombinacija poremećaja dislokacije diska sa redukcijom i osteoartritisa ustanovljena je kod 20 TMZ (5%), dislokacije diska bez redukcije i osteoartritisa kod 6 TMZ (1,5%), dok je kombinacija zadnje dislokacije i osteoartritisa detektovana kod 8 TMZ (2%). Rezultati Najčešći oblik diska bio je bikonkavan i identifikovan je kod 278 (69,5%) TMZ, slede biplanaran kod 76 (19%), hemikonveksan kod 20 (5%) i bikonveksan kod 14 TMZ (3,5%). Zaključak Na osnovu MR pregleda 51 % TMZ je imalo patološki nalaz. Korelacija dijagnoza postavljenih na osnovu RDC/TMD i MR pregleda pokazala je umereno dobro slaganje dijagnoza. MR pregled je detektovao dislokaciju diska kod 18% ispitanica koje nisu imale tegobe. Korelacija dijagnoza dislokacije diska postavljenih na osnovu RDC/TMD i MR pregleda je pokazala umereno dobro slaganje. Dijagnoza dislokacije diska sa i bez redukcije, na RDC/TMD ima visoku specifičnost i nisku senzitivnost u poređenju sa dijagnozom postavljenom na MR pregledu. Primenom RDC/TMD, postoji mala verovatnoća za postavljanje lažno pozitivne dijagnoza dislokacije diska sa i bez redukcije. Korelacija dijagnoza degenerativnih promena postavljenih na osnovu RDC/TMD i MR pregleda pokazala je slabo slaganje dijagnoza. RDC/TMD nije optimalna metoda za dijagnostiku degenerativnih promena temporomandibularnih zglobova.<br>Introduction The term temporomandibular disorders (TMD) encompasses a large number of diseases of TMJ, masticatory musculature and surrounding structures. Epidemiological studies show that 50-75% of people have some type of impaired function of the masticatory system in the course of their lives. TMJ most commonly occurs between the ages of 20 to 40. The most important signs and symptoms of TMD are the pains in the area of masseter muscle; TMJ; temporal muscle; with limited mouth opening and sound phenomena (clicking and crepitus). Pain in the TMJ is the most common reason for a patient’s visit to a doctor. The aim To determine the validity of the clinical findings of TMD obtained by using RDC / TMD (Research Diagnostic Criteria / Temporomandibular Disorders) and MRI examination findings which could determine the presence of a disorder and therefore provide prompt and adequate clinical care. Materials and Methods The research was conducted as a prospective study at the Diagnostic Imaging Center, Oncology Institute of Vojvodina in Sremska Kamenica in the period from January 2011 to May 2013. The study included 200 subjects (400 TMJs) who came for a scheduled MRI of endocranium not related to potential TMJ pathology i.e. having neurological symptoms. Firstly, the subjects underwent the MRI of the endocranium due to their underlying diseases and then the examination continued with MRI of both TMJs. The imaging was performed using Siemens device (Erlangen, Germany) with the magnetic field strength 3Tesla - Siemens Avanto 3T the same day after theirclinical examination. Each subject underwent a parasagital and coronal cross section of TMJ through both condyles with the following imaging parameters: proton density sequence, repetition time (TR) 1850 ms, echo time (TE) 15 ms, field of view (FOV) 13 cm and a matrix of 128 x 256. The section thickness during MRI was less than 2 mm. During imaging, 8-channel head matrix coil was placed on each subject so that the signal in antero-posterior direction at the obtained images was uniform. Total imaging time for both TMJs was 4 minutes.Results Based on the MRI examination, the largest number of TMJs had no pathological changes - 198 of them (49.5%). Anterior disc displacement with reduction was found in 46 TMJs (11.5%), followed by the anterior disc displacement without reduction (18 TMJs (4.5%)), posterior displacement of TMJ 4 (1%) and osteoarthritis in 100 TMJs (25 %)). The combination of disorders of disc displacement with reduction and osteoarthritis was found in 20 TMJs (5%), disc displacement without reduction and osteoarthritis in 6 TMJs (1.5%), while the combination of the posterior displacement and osteoarthritis was found in 8 TMJs (2%). The most common shape of a disc was biconcave and was identified in 278 (69.5%) TMJs, followed by biplanar in 76 (19%), hemiconvex 20 (5%) and biconvex in 14 TMJs (3.5%).Conclusion Based on the MRI examination, 51% of TMJs had pathological findings. Correlation of diagnoses which was determined based on RDC / TMD and MRI examination was moderately present. MRI examination detected disc displacement in 18% of subjects who did not have any problems. Correlation of diagnoses of disc displacement which was determined based on RDC / TMD and MRI examination showed moderately good results. The diagnosis of disc displacement with andwithout reduction on the RDC / TMD has a high specificity and low sensitivity compared with the diagnosis from the MRI examination. When applying the RDC / TMD there is little chance of setting a false positive diagnosis of disc displacement with and without reduction. The correlation of the degenerative changes diagnoses which were set based on the RDC / TMD and MRI examination showed poor results. RDC / TMD is not an optimal method for the diagnosing the degenerative changes of temporomandibular joints.
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Bertoja, ?ngela Ehlers. "Estudo de alelos do l?cus TGFA envolvidos na etiologia das fissuras labiopalatinas em amostra de pacientes n?o-sindr?micos do Rio Grande do Sul." Pontif?cia Universidade Cat?lica do Rio Grande do Sul, 2006. http://tede2.pucrs.br/tede2/handle/tede/1156.
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Previous issue date: 2006-07-05<br>As fissuras labiopalatinas (FLP) s?o as malforma??es craniofaciais mais comuns em seres humanos. Sua etiologia ? complexa, envolvendo tanto fatores gen?ticos quanto ambientais. As fissuras labiopalatinas em pacientes n?o-sindr?micos (FLP-NS) parecem ter uma etiologia distinta das FLP associadas a alguma s?ndrome. Desde o final da d?cada de 1980, s?o realizadas pesquisas com o objetivo de testar genes que atuem na etiologia das FLP-NS, entre eles o TGFA
(fator transformador de crescimento epitelial alfa). O objetivo deste trabalho foi testar o polimorfismo TGFA/Taq I em pacientes portadores de FLP-NS, comparando os resultados obtidos com uma amostra controle de indiv?duos sem fissuras para averiguar a aus?ncia ou a presen?a da muta??o g?nica nesse l?cus. Al?m disso, foi feita a compara??o entre as t?cnicas de extra??o de DNA obtidas atrav?s de sangue perif?rico e swab bucal. A extra??o de DNA a partir de swab bucal se mostrou eficaz na determina??o genot?pica do l?cus TGFA e prop?cia para a coleta em popula??es com FLP.
Muta??es no gene TGFA n?o est?o associadas ? FLP-NS na amostra da popula??o do Rio Grande do Sul estudada n?o sendo, ent?o, poss?vel concluir qual seria o papel do TGFA na express?o da FLP-NS.
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Bezerra, Jo?o Felipe. "Estudo de polimorfismos em genes relacionados ao metabolismo do ?cido f?lico e sua associa??o com o desenvolvimento de fendas orais n?o-sindr?micas." Universidade Federal do Rio Grande do Norte, 2010. http://repositorio.ufrn.br:8080/jspui/handle/123456789/13483.
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Previous issue date: 2010-02-23<br>Funda??o de Amparo a Pesquisa do Estado de S?o Paulo<br>The congenital facial clefts are characterized by incomplete formation of
the structures that separate the oral and nasal cavity. It is known that several
environmental and genetic factors are involved in its development, among these,
polymorphisms associated with folic acid metabolism have been investigated. In this
sense, the objective was to observe the frequency of polymorphisms C677T and
A1298C methylenetetrahydrofolate reductase gene (MTHFR), methionine synthase
A2756G of (MTR), A66G of methionine synthase reductase (MTRR) A80G and the
reduced folate carrier (RFC1) in patients with non-syndromic oral clefts, trying to match
them with their development. Methods: We studied 140 patients with non-syndromic
oral clefts and their mothers and 175 control subjects with their mothers, who
underwent a questionnaire to obtain family information. Were collecting blood for DNA
extraction from patients and their mothers to identify the genotypes of both by PCRRFLP,
in addition to carrying out the determination of glucose, AST, ALT and serum
creatinine, folic acid and vitamin B12 Serum and plasma homocysteine, and the
hemogram. Results: Most patients have cleft lip and palate (55.8%), followed by
isolated cleft palate (24.2%) and cleft lip (20%). Regarding gender, 62% of patients
were male and 48% female and, after subdivision of the type of screwdriver according
to sex was found a prevalence of males in the cracks of the type lip and palate (69 %)
and lip (69.2%) and in the case of cleft palate was a female predominance (59%). The
average concentration of serum folate in the group of mothers of cleft patients was
significantly lower (13.8 ? 2.4 ng / mL) compared with the group of mothers of control
subjects (18.8 ? 3.4 ng / mL) This was also observed for the group of cleft children as
compared to controls, the dosage of folic acid had a significant difference with values of
15.6 ? 0.6 (ng / mL) and 17.9 ? 0.6 (ng / mL), respectively. For the biochemical
measurements of glucose, AST, ALT and creatinine were not statistically different, nor
was observed for haematological parameters performed. In assessing the frequency of
polymorphisms C677T and A1298C MTHFR, A2756G MTR, MTRR A66G and A80G
of the RFC1 there was no statistically significant difference in genotype distribution
between cases and controls both for mothers and in the cleft. Conclusion: Although not
observed association of polymorphisms with the development of cracks, the decrease in
serum folate in the group of cleft patients and their mothers may reflect a disturbance in
the metabolism of this metabolite, necessitating further studies such as studies
methylation and expression to further elucidate the involvement of folate in the
development of oral clefts<br>As fendas orais s?o malforma??es caracterizadas pela forma??o
incompleta das estruturas que separam a cavidade nasal e oral. Sabe-se que v?rios
fatores ambientais e gen?ticos est?o envolvidos no seu desenvolvimento, dentre esses,
polimorfismos associados ao metabolismo do ?cido f?lico t?m sido alvo de estudos.
Neste sentido, o objetivo deste trabalho foi observar a freq??ncia dos polimorfismos
C677T e o A1298C do gene da Metilenotetrahidrofolato redutase (MTHFR), A2756G
da Metionina Sintase (MTR), A66G da Metionina Sintase Redutase (MTRR) e A80G
do Transportador de folato reduzido (RFC1) em pacientes portadores de fendas orais
n?o-sindr?micas, buscando associ?-los ao desenvolvimento das mesmas. Casu?stica e
M?todos: Foram avaliados 140 portadores de fendas orais n?o-sindr?micas e suas m?es
e 175 indiv?duos controles com suas m?es, que foram submetidos a um question?rio
familiar para obten??o de informa??es. Foi realizada a coleta de sangue para extra??o
do DNA dos pacientes e de suas m?es para identifica??o dos gen?tipos de ambos
atrav?s de PCR-RFLP, al?m da realiza??o das dosagens de glicose, AST, ALT e
creatinina s?ricos, dosagens de ?cido f?lico e vitamina B12 s?ricos e homociste?na
plasm?tica, al?m da realiza??o de hemograma. Resultados: A maioria dos pacientes s?o
portadores de fenda l?bio-palatina (55,8%), seguida da fenda palatina isolada (24,2%) e
da fenda labial (20%). Em rela??o ao sexo, 62% dos pacientes e s?o do sexo masculino
e 48% do sexo feminino e, ap?s subdivis?o do tipo de fenda de acordo com o sexo
constatou-se uma preval?ncia do sexo masculino nas fendas do tipo l?bio-palatina
(69%) e labial (69,2%) e no caso das fendas palatinas isoladas houve uma
predomin?ncia do sexo feminino (59%). A concentra??o m?dia de ?cido f?lico s?rico no
grupo das m?es de pacientes fissurados foi significativamente inferior (13,8?2,4ng/mL)
quando comparada com o grupo das m?es dos indiv?duos controles (18,8?3,4ng/mL), o
que tamb?m foi observado para o grupo dos pacientes fissurados quando comparado aos
filhos controles, a dosagem de ?cido f?lico apresentou diferen?a significante com
valores de 15,6?0,6(ng/mL) e 17,9?0,6(ng/mL), respectivamente. Para as dosagens
bioqu?micas de glicose, AST, ALT e creatinina n?o foram observadas diferen?as
estat?sticas, assim como n?o foi observado para os par?metros hematol?gicos
realizados. Na avalia??o da freq??ncia dos polimorfismos C677T e A1298C da
MTHFR, A2756G da MTR, A66G da MTRR e A80G do RFC1 n?o foi observada
diferen?a estatisticamente significante na distribui??o dos gen?tipos entre caso e
controle tanto em rela??o as m?es quanto nos pacientes fissurados. Conclus?o: Apesar
de n?o ter sido observada associa??o dos polimorfismos estudados com o
desenvolvimento das fendas, a diminui??o na concentra??o s?rica de ?cido f?lico no
grupo dos pacientes fissurados e de suas m?es pode refletir algum dist?rbio no
metabolismo desse metab?lito, sendo necess?rio mais estudos como estudos de
metila??o e express?o para melhor elucidar o envolvimento do ?cido f?lico no
desenvolvimento das fendas orais
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Erceg, Ivan P. "Mathematical Analysis of a Geothermal System." Cleveland State University / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=csu1225138202.
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GUERREIRO, Hélia Lourenço. "Do genótipo ao fenótipo na síndrome de Marfan: um estudo de associação numa amostra de pacientes portugueses." Master's thesis, Instituto de Higiene e Medicina Tropical, 2015. http://hdl.handle.net/10362/20077.
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A síndrome de Marfan (MFS) é uma doença hereditária do tecido conjuntivo, com manifestações multissistémicas, envolvendo os sistemas esqueléticos (grande crescimento dos ossos e laxidez articular). As estimativas mais recentes apontam para uma prevalência de 1:5000. Os critérios clínicos usados no diagnóstico, designados de
Ghent, recaem mais sobre manifestações cardiovasculares, sendo que o aneurisma da raiz da aorta e a ectopia lentis são as características fundamentais. Na ausência de qualquer história familiar, a presença destas duas características são suficientes para o diagnóstico inequívoco de MFS; no entanto, na ausência de uma destas características, é necessária a presença de uma mutação no gene FBN1.
A MFS (OMIM #154700 - Online Mendelian Inheritance in Man) apresenta um padrão de hereditariedade autossómica dominante, sendo causada por mutações no gene FBN1.
O teste genético assume uma grande importância, visto que a esperança média de vida dos doentes com MFS quando não tratados é de 32 anos podendo, no entanto, atingir valores de 60 anos quando adequadamente tratados.
Este projeto visa a identificação e descrição de novas mutações no gene FBN1 e assim: aumentar o conhecimento sobre a base genética da doença; analisar a patogenicidade de novas mutações com programas informáticos in silico (predições) e ainda realizar estudos de correlação fenótipo-genótipo, que irão fornecer informações sobre o espectro da variação fenotípica da doença e que serão usados como base de ajuste das diretrizes mundiais à população portuguesa.
Os doentes foram clinicamente avaliados pelo departamento de cardiologia de hospitais portugueses. Foram analisados 43 doentes com MFS, realizando o estudo genético através da pesquisa de mutações no gene FBN1 por PCR e sequenciação direta. A
patogenicidade das mutações encontradas foi estudada utilizando 7 programas diferentes de análise por simulação computacional.
Foram encontradas mutações em 12 doentes, 5 das quais não se encontram descritas na literatura. A maioria dos programas de análise por simulação computacional classificou como patogénicas as novas mutações encontradas.
Estes resultados realçam a importância do teste genético em pacientes com MFS, permitindo um diagnóstico específico e influenciando as opções terapêuticas. As análises por simulação computacional, em relação à patogenicidade das mutações, permitem uma simples e fiável avaliação das novas variantes. Estes resultados podem contribuir para estudos de correlação genótipo-fenótipo.<br>Marfan syndrome (MFS) is an inherited connective tissue disease with multisystem manifestations involving the skeletal systems (large bone growth and joint hyperlaxity).
The most recent estimates suggest a prevalence of 1:5000. The clinical criteria used in the diagnosis, called Ghent criteria, focus more on cardiovascular manifestations wherein the aneurysm aortic root and ectopia lentis are the fundamental characteristics.
In absence of any family history, the presence of these two features is enough for unambiguous diagnosis of MFS; however, in the absence of one these features, the presence of a mutation in the FBN1 gene is required.
MFS (OMIM #154700 - Online Mendelian Inheritance in Man) shows a pattern of autossomal dominant inheritance, and is caused by mutations in the FBN1 gene.
Genetic testing assumes a major importance, given that the average life expectancy of patients with MFS when untreated is 32 years old, and when properly treated may achieve 60 years old.
This project aims at the identification and description of new mutations in the FBN1 gene, and thus: increase knowledge about the disease genetic basis; analyze the pathogenicity of new mutations with in silico software (predictions) and also conduct studies of phenotype-genotype correlations, which will provide information about the spectrum of phenotypic variation of the disease and that will be used as an adjustment basis of global guidelines to the Portuguese population.
Patients were clinically diagnosed by the cardiology department of Portuguese hospitals. 43 patients with MFS were subject to genetic studies, through screening of mutations in the FBN1 gene by PCR and direct sequencing. The pathogenicity of the mutations found was assessed using 7 different programs of analysis by computer
simulation.
Mutations were found in 12 patients, 5 of which are not described in the literature. Most of the computational simulation analysis programs classified the new mutations found as pathogenic.
These results highlight the importance of genetic testing in patients with MFS, allowing specific diagnosis and influencing the treatment options. The analysis by computer simulation, in relation to the pathogenicity of mutations, allows a simple and reliable evaluation of new variants. These results can contribute to genotype-phenotype correlation.
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Moreira, Carla Costa. "Estudo do gene IRF6 em uma amostra de pacientes portadores de fissuras labiopalatinas n?o-sindr?micas por meio da triagem de muta??o por sequenciamento autom?tico." Pontif?cia Universidade Cat?lica do Rio Grande do Sul, 2007. http://tede2.pucrs.br/tede2/handle/tede/1293.
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Previous issue date: 2007-04-20<br>As fissuras labiais com ou sem fissura palatina (FL/P) e as fissuras palatinas (FP) s?o anomalias orofaciais comuns. As fissuras quando constituem a ?nica malforma??o s?o classificadas como n?o sindr?micas (FL/PNS ou FPNS) e em sindr?micas, quando associadas a outros sinais cl?nicos. T?m-se postulado um modelo de heran?a multifatorial para as FL/P e FP n?o sindr?micas. Nestes casos, o risco de repeti??o de um segundo caso na genealogia ? baixo, estimado em 4%. J? as fissuras sindr?micas podem ser causadas por aberra??es cromoss?micas, muta??es g?nicas ou ter origem teratog?nica. Entre as formas sindr?micas, se destaca a s?ndrome de Van der Woude (SVW), que ? uma condi??o mendeliana de heran?a autoss?mica dominante. Muta??es no gene IRF6 s?o respons?veis pela maioria dos casos desta s?ndrome. Esta s?ndrome se caracteriza pela presen?a de comissuras ( pits ) no l?bio inferior, fissura labial e palatina. Sendo o espectro de variabilidade cl?nica destas altera??es muito amplo, torna-se dif?cil distinguir clinicamente os pacientes com a SVW que n?o apresentam pits daqueles portadores das formas de FL/P ou FP n?o sindr?mica. A distin??o cl?nica entre estas duas formas ? extremamente importante, pois o risco de recorr?ncia ? muito diferente entre os casos de fissura n?o sindr?mica (4%) e SVW (50%). A ?nica maneira de se distinguir os casos de SVW sem pits daqueles com fissuras n?o sindr?micas ? por meio da an?lise do gene IRF6. Estima-se que 2% dos casos de fissurados n?o-sindr?micos representem casos de SVW. Assim sendo, este trabalho teve como objetivo principal verificar qual a propor??o de casos com muta??o patog?nica em IRF6, que s?o portadores da SVW, entre pacientes diagnosticados com fissura l?bio-palatino ou fissura palatina n?o-sindr?mica (FL/PNS e FPNS, respectivamente). Os ?xons com maior freq??ncia de muta??o entre os pacientes com SVW foram analisados por sequenciamento direto em 37 pacientes com fissura n?o sindr?mica. N?o encontramos nenhuma muta??o patog?nica nesses [?xons entre estes pacientes, por?m, foi verificada qualquer presen?a dos SNPs e suas freq??ncias, rs225371 de 2.2% (1 alelo/ 44 cromossomos); rs2235373 de 6.8% (3 alelos/44 chromossomos). Nossos resultados mostraram que numa amostra obtida de um banco de DNA de fissurados n?o sindr?micos de uma popula??o brasileira espec?fica n?o se observou nenhum caso de SVW dada pela an?lise do gene IRF6. A fim de melhor caracterizar a SVW numa popula??o brasileira representativa deverse-? aumentar o n?mero de indiv?duos analisados e expandir o estudo a popula??es de fissurados de outras regi?es no Brasil.
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Milana, Ivkov Simić. "Kliničke i dermoskopske karakteristike displastičnih nevusa." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2015. http://www.cris.uns.ac.rs/record.jsf?recordId=90291&source=NDLTD&language=en.
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Uvod: Od kada je prvi put opisan pre 30 godina, kod porodica obolelih od melanomakože, displastični nevus je predmet debate. Klinički najznačajnija kontroverza je da sedisplastični nevus klinički često smatra sumnjivim i da se teško razlikuje od ranogmelnoma kože. Ovakav klinički izgled displastičnog nevusa je razlog čestih nepotrebnihekscizija, jednog od najčešćih nevusa čoveka. Ciljevi: Ispitati kliničke i dermoskopske karakteristike patohistološki potvrđenih displastičnih nevusa, i utvrditi učestalost displastičnih nevusa među sumnjivim melanocitnim lezijama koje su odabrane kliničko-dermoskopskim pregledom. Metode: U analitičkoj kliničkoj studiji, u prospektivnom delu, koristili smo kliničko-dermoskospki pristup po predloženom protokolu za selekciju sumnjivih melanocitnih lezija za eksciziju. Ekscidirano je 279 lezija. Od ukunog broja, 83 su bile lezije veoma sumnive na melanom kože, kod 116 lezija melanom nije mogao biti isključen u diferencijalnoj dijagnozi, a 80 lezija su imponovale dobroćudne i ekscidirane su zbog smetnji koje su pričinjavale pacijentu. Klinički su lezije opisivane prema ABCD akronimu (A za asimetriju, B za nepravilnost ivica, C za nepravilnu prebojenost i D za veličinu preko 5 mm). Za dermoskopski opis lezija su korisćeni algoritmi Analiza struktura i Lista od sedam tačaka. Rezultati: Nakon histopatološkog pregleda ekscidiranih 279 lezija, 242 lezije su bile nevusi, od kojih 131 displastični nevus, koji je analiziran posebno za potrebe ove studije, dok su 47 lezija činili melanomi kože. Histopatološki potvrđeni displastični nevusi su proistekli dominantno iz grupa lezija kliničko-dermoskospki upućenih kao sumnjive na melanom ili iz grupe gde melanom nije mogao biti isključen u diferencijalnoj dijagnozi OR 2,49 (95%CI 1,51-4,11) p=0,0003. Svako ispitano kliničko obeležje ponaosob i u svim mogućim kombinacijama, je bilo od značaja samo za melanoma kože p<0,0001. Nije bilo značajnih razlika u grupi displastičnih nevusa i ostalih nevusa. Displastične nevuse su činile sumnivim njihove dermoskopske karakteristike. Kod ovih nevusa je bila češća multikomponentna struktura OR 4,84 (95%CI 2,87-8,16) p<0,0001 i nepravilne globule OR 7,32 (95%CI 3,35-15,99) p<0,0001. Nepravilne mrlje su uočene kod 90/96 displastičnih nevusa i kod 41/47 melanoma bez značajne razlike. Zaključak: Klinički displastični nevusi nisu imali kliničke karakteristike koje se obično koriste za njihov opis, te klinički nisu imali znake sumnjivih lezija. Klinički su izgledali poput banalnih nevusa. Kombinovani kliničko-dermoskospki pristup za odabir sumnjivih lezija je ukazao na značaj nekih dermoskospkih obeležja. Multikomponentna struktura i nepravilne globule su se više javljale kod displastičnih nevusa. Poseban je značaj nepravilnih mrlja koje su podjednako često bile uočavane i kod displastičnih nevusa i tankih melanoma.<br>Background: Dysplastic nevus, a benign melanocytic lesion has been a matter of debate over the last thirty years, since its first description in families with melanoma. The most important controversy is that dysplastic nevus is usually considered to be suspicious, not easily distinguishable from early melanoma by its clinical appearance. This is followed by numerous unnecessary excisions of a nevus that is considered to be one of the most common in humans. Objectives: To describe the clinical and dermoscopic characteristics of dysplastic nevus, and to investigate its proportion in suspicious melanocytic lesions using clinicodermoscopic approach. Methods: In an analytical clinical study, in the prospective part of the study, we used a combined clinicodermoscopic approach according to a proposed protocol, to select lesions for excision. A total of 279 lesions were excised. Of the total number, 83 were very suspicious for melanoma, 116 where melanoma could not be excluded, and eighty were considered to be benign. Still they were excised because they were a burden for patients. Clinical appearance was studied using ABCD acronym (A for assimetry, B for border irregularity, C for color variegation, and D for diameter of more than 5mm). Dermoscopic description of lesions was performed according to algorithms Pattern Analysis and Seven-point Checklist. Results: After histopathological analysis of the 279 lesions, 242 lesions were nevi, among them 131 dysplastic nevi that were analyzed separately for the purpose of this study and 47 lesions were skin melanoma. Histopathologicaly proven dysplastic nevus originated mainly from a group of lesions clinicodermoscopily recognized as suspicious of melanoma, or a group where melanoma could not be excluded OR 2.49 (95%CI 1.51-4.11) p=0.0003. Each examined clinical feature alone or in any possible combination of features was important only for melanoma p<0.0001. There were no significant differences between dysplastic nevus group and a group of nevi. Dermoscopic features were more important for the overall suspicious appearance. Multicomponent structure OR 4.84 (95%CI 2.87-8,16) p<0.0001 and irregular globules OR 7.32 (95%CI 3.35-15.99) p<0.0001 were frequent. Irregular blotches were found in 90/96 and 41/47, dysplastic nevus and melanoma respectively, without significant differences. Conclusion: Clinically dysplastic nevi did not show clinical characteristics that were usually used to describe them, and did not show signs of suspicious lesions. Clinically, they looked more like banal nevi. The commbined clinicodermoscopic approach to select suspicious melanocytic lesions, revealed some dermoscopic features that were often seen in dysplastic nevi, like the multicomponent structure and the irregular globules, while the irregular blotches were a feature shared both by dysplastic nevi and melanoma.
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Jelena, Sente. "МЕТАБОЛИЧКИ СИНДРОМ И ПРОГРАМИРАНО ФИЗИЧКО ВЕЖБАЊЕ КОД ЈУВЕНИЛНЕ ГОЈАЗНОСТИ". Phd thesis, Univerzitet u Novom Sadu, Fakultet sporta i fizičkog vaspitanja u Novom Sadu, 2020. https://www.cris.uns.ac.rs/record.jsf?recordId=112590&source=NDLTD&language=en.
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Преваленца гојазности и метаболичког синдрома у јувенилној популацији једраматично у порасту и представља јавно-здравствени проблем у целом свету.Гојазност, нарочито висцералног типа, је кључни аспект за појаву метаболичкогсиндрома или појединих његових компоненти у млађој популацији. Оваква патолошкастања доводе до појаве низ компликација као и фактора ризика за настанаккардиоваскуларних обољења и дијабетеса типа II, касније у адултној доби. Циљ овестудије био је да се утврде ефекти програма физичке активности и хипокалоријскеисхране на антропометријске, конституционалне, метаболичке и кардиоваскуларнепараметре код гојазне деце, имајући у виду да је за настанак гојазности управоодговоран животни стил у смислу неадекватне исхране и хипокинезије код младих. Уту сврху креиран је упитник на основу ког смо дoбили увид о животним навикамаиспитаника и закључили да се ради о гојазној јувенилној популацији, са врло малоквалитативног уноса хранљивих материја и физички неактивном у великој мери.Такође присутна је и генетска предиспонираност за кардиоваскуларне и метаболичкеболести, на шта нам указује породична анамнеза. Програм физичке активности идијететског режима, прилагођен узрасној групи испитаника од 11-14 година ± 0.5 год,био је краткорочног карактера у трајању од три месеца. У циљу провере ефектамултидисциплинарног третмана, сви испитивани параметри су мерени у три временскетачке (иницијално, трансверзално и финално мерење). Дескриптивне резултати у светри групе испитиваних параметара показују статистички значајне промене код свихиспитаника у све три временске, као и резултати једнофакторске униваријантне анализеваријансе (ANOVA) за поновљена мерења (one-way repeated measures ANOVA) за Sig.<0,05. Телесна маса и обими трбуха су значајно редуковани као и сви остали параметрициркуларне димензионалности и поткожног масног ткива, исхрањености иконституције. Код физиолошких показатеља метаболичког синдрома такође је дошлодо редукције и позитивних промена. Потврда је добијена мултиваријатном анализомваријансе за поновљена мерења (One-way repeated measures MANOVA) за Sig.<0,05,дате тестом Wilk’s Lambda, чиме смо потврдили значајан ефекат спроведеног третманавежбања и редуковане исхране, који је изазвао значајне промене у свим посматранимпросторима.<br>Prevalenca gojaznosti i metaboličkog sindroma u juvenilnoj populaciji jedramatično u porastu i predstavlja javno-zdravstveni problem u celom svetu.Gojaznost, naročito visceralnog tipa, je ključni aspekt za pojavu metaboličkogsindroma ili pojedinih njegovih komponenti u mlađoj populaciji. Ovakva patološkastanja dovode do pojave niz komplikacija kao i faktora rizika za nastanakkardiovaskularnih oboljenja i dijabetesa tipa II, kasnije u adultnoj dobi. Cilj ovestudije bio je da se utvrde efekti programa fizičke aktivnosti i hipokalorijskeishrane na antropometrijske, konstitucionalne, metaboličke i kardiovaskularneparametre kod gojazne dece, imajući u vidu da je za nastanak gojaznosti upravoodgovoran životni stil u smislu neadekvatne ishrane i hipokinezije kod mladih. Utu svrhu kreiran je upitnik na osnovu kog smo dobili uvid o životnim navikamaispitanika i zaključili da se radi o gojaznoj juvenilnoj populaciji, sa vrlo malokvalitativnog unosa hranljivih materija i fizički neaktivnom u velikoj meri.Takođe prisutna je i genetska predisponiranost za kardiovaskularne i metaboličkebolesti, na šta nam ukazuje porodična anamneza. Program fizičke aktivnosti idijetetskog režima, prilagođen uzrasnoj grupi ispitanika od 11-14 godina ± 0.5 god,bio je kratkoročnog karaktera u trajanju od tri meseca. U cilju provere efektamultidisciplinarnog tretmana, svi ispitivani parametri su mereni u tri vremensketačke (inicijalno, transverzalno i finalno merenje). Deskriptivne rezultati u svetri grupe ispitivanih parametara pokazuju statistički značajne promene kod svihispitanika u sve tri vremenske, kao i rezultati jednofaktorske univarijantne analizevarijanse (ANOVA) za ponovljena merenja (one-way repeated measures ANOVA) za Sig.<0,05. Telesna masa i obimi trbuha su značajno redukovani kao i svi ostali parametricirkularne dimenzionalnosti i potkožnog masnog tkiva, ishranjenosti ikonstitucije. Kod fizioloških pokazatelja metaboličkog sindroma takođe je došlodo redukcije i pozitivnih promena. Potvrda je dobijena multivarijatnom analizomvarijanse za ponovljena merenja (One-way repeated measures MANOVA) za Sig.<0,05,date testom Wilk’s Lambda, čime smo potvrdili značajan efekat sprovedenog tretmanavežbanja i redukovane ishrane, koji je izazvao značajne promene u svim posmatranimprostorima.<br>Prevalence of obesity and metabolic syndrome in juvenile population is increasingdramatically and presents a worldwide public health problem. Obesity, the visceral type inparticular, is the key aspect for emergence of metabolic syndrome or some of its individualcomponents in the younger population. Pathological states of this kind lead to development ofa range of complications, as well as, risk factors for emergence of cardiovascular diseases anddiabetes type II, later in adult age. The aim of this study was to determine effects of a programof physical activity and hypocaloric diet on anthropometric, constitutional, metabolic andcardiovascular parameters in obese children, considering that it is lifestyle, namely inadequatediet and lack of movement, which is responsible for emergence of obesity in children. Withthis in mind, we have created a questionnaire which has given us an insight into living habitsof the participants, and we have determined that we are dealing with an obese juvenilepopulation which consumes very little of quality nutritious foods, and which is, to a greatextent, physically inactive. Also, there is a presence of genetic predisposition forcardiovascular and metabolic diseases, which was indicated in family anamnesis. Thephysical activity and diet regime program, adapted to the age group of the participants (11 to14-year-olds ± 0.5 year) was short term in character and it lasted for three months. With theaim of checking the effect of the multidisciplinary treatment, all the tested parameters weremeasured at three points in time (initial, transversal and final measurements). Descriptiveresults in all three groups of the measured parameters indicate statistically significant changesin all the participants, at all three time points, as do the results of one-way repeated measuresANOVA for Sig.< 0,05. Body mass and abdominal circumferences were reducedsignificantly, as were all the other parameters of circulatory dimensions and subcutaneous fat,nourishment and constitution. Reduction and positive changes were also measured inphysiological indicators for metabolic syndrome. The results were confirmed by one-wayrepeated measures MANOVA for Sig.< 0.05, using the Wilk’s Lambda test, through whichwe have confirmed a significant effect of the applied treatment which has caused significantchanges in all the measured parameters.
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Tomi, Kovačević. "Синдром сагоревања код здравствених радника који се баве лечењем болесника оболелих од респираторних болести". Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2020. https://www.cris.uns.ac.rs/record.jsf?recordId=114778&source=NDLTD&language=en.
Full textAbstract:
Sindrom sagorevanja, eng. Burnout Syndrome (BOS) je oblik profesionalnog stresa koji se najčešće javlja u zanimanjima koja podrazumevaju direktan kontakt sa ljudima, a nastaje kao odgovor na hroničan stres. Ogleda se kroz aspekte: emocionalne iscrpljenosti eng. Emotional Exhaustion (EE), depersonalizacije eng. Depersonalisation (DP) i osećaja smanjenog ličnog postignića eng. Personal Accomplishment (PA). Sprovedena istraživanja ukazuju na visoku zastupljenost BOS-a kod zdravstvenih radnika i njegovu zavisnost ne samo od ličnih karakteristika nego i od mnogobrojnih faktora na poslu. Dokazano je da BOS dovodi do posledica kako na individualnom, tako i na organizacionom nivou. Usled oštećenja fizičkog i psihičkog zdravlja lekara i medicinskih sestara/tehničara indirektno dolazi i do smanjenja nivoa zdravstvene usluge sa svim svojim posledicama po zdravstveni sistem i zdravlje pacijenata. Ovo istraživanje imalo je za cilj da ispita zastupljenost BOS-a kod zdravstvenih radnika koji se bave lečenjem obolelih od respiratornih bolesti, utvrdi da li postoji razlika u zastupljenosti BOS-a u odnosu na nivo edukacije (lekari i medicinske sestre/tehničari) i u odnosu na radno mesto (zbrinjavanje bolesnika koji boluju od neizlečivih (terminalnih) u odnosu na zbrinjavanje bolesnika koji boluju od izlečivih (kurabilnih). plućnih bolesti. Istraživanje je sprovedeno među zaposlenim zdravstvenim radnicima u Institutu za plućne bolesti Vojvodine u Sremskoj Кamenici u periodu april-jun 2019. godine kao studija poprečnog preseka. Podaci istraživanja su prikupljeni pomoću sledećih upitnika: Upitnik o socio-demografskim karakteristikama ispitanika, Maslač inventar izgaranja (MBI), Skala izgaranja izvedene iz Kopenhagen inventara izgaranja – srpska verzija (SI), Upitnik opšteg zdravlja (UOZ-12) i Upitnik o stresorima na radnom mestu, zadovoljstvu na poslu i motivaciji i opuštanju nakon posla. Istraživanjem je obuhvaćeno 165 zdravstvena radnika: 64 (38.8%) lekara i 101 (61.2%) medicinskih sestara/tehničara. BOS je utvrđen kod 47% ispitanika. Visoki stepen EE potvrđen je kod 43.0%, visok stepen DP kod 21.8%, a nizak stepen PA kod 32.1% ispitanih. Statistički značajna razlika u zastupljenosti nije dokazana u odnosu na stepen stručne spreme (40.6% vs. 51.5%) niti u odnosu na radno mesto (45.3% vs. 48.2%). Nema statistički značajne razlike u zastupljenosti BOS-a u odnosu na socio-demografske karakteristike ispitanika. Psihički distres prisutan je kod 30.8% zdravstvenih radnika sa potvrđenim BOS-om. Pokazana je statistički značajna razlika u povezanosti BOS-a i psihičkog distresa i u odnosu na stepen stručne spreme (p=0.000) i u odnosu na radno mesto (p=0.000), a ova povezanost je izraženija kod medicinskih sestara/tehničara (p=0.000). Značajna korelacija nije nađena samo između dva pretpostavljena stresora i BOS-a: prekovremenog rada i nedostatka odgovarajuće kontinuirane edukacije. Statistički značajna je i korelacija između svih domena BOS-a i ukupnog zadovoljstva radnim okruženjem. (EE p=0.000, DP p=0.000 i PA p=0.000). Trećina ispitanika sa potvrđenim BOS-om razmišlja o promeni zanimanja, a njih 41% o promeni radnog mesta. Sindrom sagorevanja kod zdravstvenih zdravstvenih radnika koji se bave lečenjem obolelih od respiratornih bolesti zastupljen je u visokom procentu. BOS značajno korelira sa psihičkim distresom, a ova povezanost je izraženija u populaciji medicinskih sestara. Nema statistički značajne razlike u zastupljenosti BOS-a u odnosu na nivo edukacije, niti u odnosu na radno mesto. Izražena je kompleksnost, varijabilnost i različitost u zastupljenosti pretpostavljenih stresora na poslu. Neophodnost otkrivanja stresogenih faktora i donošenje mera sa ciljem njihovog sprečavanja i/ili ublažavanja je nesumnjiva. Unapređenje edukacije radi prepoznavanja BOS-a i prevazilaženju stresogenih faktora kao i iznalaženje novih organizacionih šema u cilju eliminacije stresora na poslu trebalo bi da budu jedni od prioriteta svake zdravstvene institucije.<br>Sindrom sagorevanja, eng. Burnout Syndrome (BOS) je oblik profesionalnog stresa koji se najčešće javlja u zanimanjima koja podrazumevaju direktan kontakt sa ljudima, a nastaje kao odgovor na hroničan stres. Ogleda se kroz aspekte: emocionalne iscrpljenosti eng. Emotional Exhaustion (EE), depersonalizacije eng. Depersonalisation (DP) i osećaja smanjenog ličnog postignića eng. Personal Accomplishment (PA). Sprovedena istraživanja ukazuju na visoku zastupljenost BOS-a kod zdravstvenih radnika i njegovu zavisnost ne samo od ličnih karakteristika nego i od mnogobrojnih faktora na poslu. Dokazano je da BOS dovodi do posledica kako na individualnom, tako i na organizacionom nivou. Usled oštećenja fizičkog i psihičkog zdravlja lekara i medicinskih sestara/tehničara indirektno dolazi i do smanjenja nivoa zdravstvene usluge sa svim svojim posledicama po zdravstveni sistem i zdravlje pacijenata. Ovo istraživanje imalo je za cilj da ispita zastupljenost BOS-a kod zdravstvenih radnika koji se bave lečenjem obolelih od respiratornih bolesti, utvrdi da li postoji razlika u zastupljenosti BOS-a u odnosu na nivo edukacije (lekari i medicinske sestre/tehničari) i u odnosu na radno mesto (zbrinjavanje bolesnika koji boluju od neizlečivih (terminalnih) u odnosu na zbrinjavanje bolesnika koji boluju od izlečivih (kurabilnih). plućnih bolesti. Istraživanje je sprovedeno među zaposlenim zdravstvenim radnicima u Institutu za plućne bolesti Vojvodine u Sremskoj Kamenici u periodu april-jun 2019. godine kao studija poprečnog preseka. Podaci istraživanja su prikupljeni pomoću sledećih upitnika: Upitnik o socio-demografskim karakteristikama ispitanika, Maslač inventar izgaranja (MBI), Skala izgaranja izvedene iz Kopenhagen inventara izgaranja – srpska verzija (SI), Upitnik opšteg zdravlja (UOZ-12) i Upitnik o stresorima na radnom mestu, zadovoljstvu na poslu i motivaciji i opuštanju nakon posla. Istraživanjem je obuhvaćeno 165 zdravstvena radnika: 64 (38.8%) lekara i 101 (61.2%) medicinskih sestara/tehničara. BOS je utvrđen kod 47% ispitanika. Visoki stepen EE potvrđen je kod 43.0%, visok stepen DP kod 21.8%, a nizak stepen PA kod 32.1% ispitanih. Statistički značajna razlika u zastupljenosti nije dokazana u odnosu na stepen stručne spreme (40.6% vs. 51.5%) niti u odnosu na radno mesto (45.3% vs. 48.2%). Nema statistički značajne razlike u zastupljenosti BOS-a u odnosu na socio-demografske karakteristike ispitanika. Psihički distres prisutan je kod 30.8% zdravstvenih radnika sa potvrđenim BOS-om. Pokazana je statistički značajna razlika u povezanosti BOS-a i psihičkog distresa i u odnosu na stepen stručne spreme (p=0.000) i u odnosu na radno mesto (p=0.000), a ova povezanost je izraženija kod medicinskih sestara/tehničara (p=0.000). Značajna korelacija nije nađena samo između dva pretpostavljena stresora i BOS-a: prekovremenog rada i nedostatka odgovarajuće kontinuirane edukacije. Statistički značajna je i korelacija između svih domena BOS-a i ukupnog zadovoljstva radnim okruženjem. (EE p=0.000, DP p=0.000 i PA p=0.000). Trećina ispitanika sa potvrđenim BOS-om razmišlja o promeni zanimanja, a njih 41% o promeni radnog mesta. Sindrom sagorevanja kod zdravstvenih zdravstvenih radnika koji se bave lečenjem obolelih od respiratornih bolesti zastupljen je u visokom procentu. BOS značajno korelira sa psihičkim distresom, a ova povezanost je izraženija u populaciji medicinskih sestara. Nema statistički značajne razlike u zastupljenosti BOS-a u odnosu na nivo edukacije, niti u odnosu na radno mesto. Izražena je kompleksnost, varijabilnost i različitost u zastupljenosti pretpostavljenih stresora na poslu. Neophodnost otkrivanja stresogenih faktora i donošenje mera sa ciljem njihovog sprečavanja i/ili ublažavanja je nesumnjiva. Unapređenje edukacije radi prepoznavanja BOS-a i prevazilaženju stresogenih faktora kao i iznalaženje novih organizacionih šema u cilju eliminacije stresora na poslu trebalo bi da budu jedni od prioriteta svake zdravstvene institucije.<br>Burnout syndrome (BOS) is a form of occupational stress as a response to chronic stress. It occures most commonly in occupations that involve direct contact with people and manifests as: emotional exhaustion (EE), depersonalization (DP) and feelings of diminished personal achievement (PA). Large numbers of research indicates a high prevalence of BOS in healthcare professionals and its dependence on work related stressors. BOS has been proven to lead to consequences on individual and organizational levels. The level of health care can be reduced due to the decreased physical and mental health of helathcare providers caused by BOS. It is possible consequences on the patient health and healthcare system raises the need for further investigation. The aim of this research was to examine the prevalence of BOS among healthcare providers treating patients with respiratory diseases, to determine difference in the prevalnce of BOS regarding to education level (physicians vs. nurses), and regarding workplace (terminal vs. curable respiratory diseases). This exploratory study was conducted among healthcare providers at the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica in the period April-June 2019 as a cross-sectional study Quantitative and qualitative data were collectedtrough survey using the following questionnaires: Questionnaire on sociodemographic characteristics, Maslach burnout inventory (MBI), Work burnout scale from the Copenhagen burnout inventory – serbian version (SI), General health questionnaire (GHQ-12) and Questionnaire on workplace stressors, job satisfaction, motivation and after work relaxation. Out of total 165 healthcare professionals 64 (38.8%) were physicians and 101 (61.2%) nurses. Prevalence of BOS was 47%. High level of EE was confirmed in 43.0%, of DP in 21.8%, and low level of PA in 32.1%. No statistically significant difference was observed in relation to the education (40.6% vs. 51.5%) nor the workplace (45.3% vs. 48.2%). There were no statistically significant difference in socio-demographic characteristics. Psychological distress was present in 30.8% of healthcare professionals with BOS. Statistically significant difference was observed between BOS and psychological distress in terms of educational level (p = 0.000) and workplace (p = 0.000) This correlation was more accentuated in nurses (p = 0.000). Significant correlation was not confirmed only between two perceived stressors and BOS: job overtime and lack of appropriate education. A statistically significant correlation was observed between all domains of BOS and overall job satisfaction. (EE p = 0.000, DP p = 0.000 and PA p = 0.000). One third of respondents with observed BOS are thinking about changing occupation, and 41% of them changing workplace. Prevalence of burnout syndrome among physicians and nurses caring for patients with respiratory diseases is high regardless of education level or workplace. It significantly correlates with level of psychological distress which is is more accentuated among nurses. There is no diference in BOS prevalence regarding neither educational level nor workplace. The complexity, variability and diversity of assumed work stressors is undoubtley related to BOS. The need for determination of job stressor and actions in order to prevent and/or mitigate them is beyond doubt. Improvement of recognition and overcoming stress factors and finding new organizational charts to eliminate potential stressors at work should be one of the priorities of any healthcare institution.
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Đorđe, Popović. "Značaj adiponektina u proceni kardiometaboličkog profila i rizika za razvoj tipa 2 šećerne bolesti kod gojaznih osoba." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2016. http://www.cris.uns.ac.rs/record.jsf?recordId=101774&source=NDLTD&language=en.
Full textAbstract:
Gojaznost se najčešće definiše kao uvećanje udela masne mase u ukupnoj telesnoj masi. Danas gojaznost poprima pandemijske razmere i karakter globalnog zdravstveno-socijalnog problema jer predstavlja faktor rizika za razvoj masovnih nezaraznih bolesti, pre svega tipa 2 šećerne bolesti (T2DM) i kardiovaskularnih bolesti. Adipokini su molekule koje luči masno tkivo i koji imaju značajnu ulogu u regulaciji mnogobrojnih procesa u ljudskom organizmu. Adiponektin (ADN) je adipokin sa antidijabetogenim, antiinflamatornim i antiaterogenim dejstvom. Tokom razvoja, pre svega, centralnog tipa gojaznosti dolazi do poremećaja u sekretornom profilu masnog tkiva, nastaje pad serumske koncentracije ADN i dolazi do razvoja mnogobrojnih kardiometaboličkih poremećaja. Cilj rada je ispitivanje značaja određivanja serumskog ADN u proceni kardiometaboličkog profila i utvrđivanje povezanosti njegovog nivoa sa procenjenim desetogodišnjim rizikom za razvoj T2DM kod gojaznih osoba. Studija preseka sprovedena na Klinici za endokrinologiju, dijabetes i bolesti metabolizma, Kliničkog centra Vojvodine je obuhvatila 65 ispitanika sa hiperalimentacionim tipom gojaznosti. Kod ispitanika je procenjen desetogodišnji rizik za razvoj T2DM i sprovedena su odgovarajuća antropometrijska, laboratorijska i morfološka ispitivanja. Ispitanici sa sniženim serumskim ADN su imali nepovoljniji kardiometabolički profil u odnosu na ispitanike sa normalnom vrednošću serumskog ADN dok nije bilo razlike u nivou desetogodišnjeg rizika za razvoj T2DM između navedenih grupa. Takođe, ispitanici sa metaboličkim sindromom (MS) i ispitanici sa nealkoholnom masnom bolešću jetre (NAFLD) su imali niži serumski ADN u odnosu na osobe bez MS i osobe bez NAFLD. Kod gojaznih osoba postoji značajna povezanost serumskog ADN sa većim brojem pokazatelja kardometaboličkog profila ali ne i sa procenjenim desetogodišnjim rizikom za razvoj T2DM.<br>Obesity is often defined as the significant increase in proportion of fat mass in total body mass. Nowadays, obesity exhibits pandemic proportions and acquires character of the global health and social problem, as it represents the risk factor for the development of non-communicable diseases, especially type 2 diabetes mellitus (T2DM) and cardiovascular diseases. Adipokines are molecules secreted by adipose tissue which play an important role in the regulation of various processes in the human organism. Adiponectin (ADN) is an adipokine with anti-diabetic, anti-inflammatory and anti-atherogenic effects. During development of, above all, central obesity, disorders in the secretory profile of adipose tissue are arising, decline in serum concentrations of ADN advents, which leads to occurrence of numerous cardiometabolic disorders. The aim of study is to examine the significance of determining serum ADN in assessing the cardiometabolic profile, and determining its association with the estimated ten-year risk of developing T2DM in obese persons. Cross-sectional study conducted at the Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center of Vojvodina, included 65 persons with hyperalimentation type of obesity. Ten-year risk of developing T2DM was assessed and appropriate anthropometric, laboratory and morphological evaluations were performed. Persons with lower serum ADN had worse cardiometabolic profile compared to those with normal serum ADN value, while there was no difference in the level of ten-year risk of developing T2DM between two groups. Also, subjects with metabolic syndrome (MS) and subjects with nonalcoholic fatty liver disease (NAFLD) had lower serum ADN compared to persons without MS and to those without NAFLD. There is a significant association of serum ADN with a larger number of cardiometabolic profile indicators but not with the estimated ten-year risk of developing T2DM.
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Marija, Bjelobrk. "Uticaj sveobuhvatne kardijalne rehabilitacije na dijastolnu disfunkciju i funkcionalni status pacijenata lečenih perkutanom koronarnom intervencijom nakon akutnog koronarnog događaja." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2019. https://www.cris.uns.ac.rs/record.jsf?recordId=110082&source=NDLTD&language=en.
Full textAbstract:
Uvod: U savremenom svetu koronarna arterijska bolest srca (KABS) je vodeći uzrok obolevanja i umiranja, a akutni koronarni sindrom (AKS) je jedna od njenih najčešćih i najopasnijih kliničkih manifestacija. Dijastolna disfunckija leve komore često prati KABS i mogući je doprinosni faktor za loš klinički tok i ishod. Postavlja se pitanje u kom obimu je dijastolna disfunkcija leve komore udružena sa koronarnom arterijskom bolešću i da li savremeni programi ambulantne sveobuhvatne kardijalne rehabilitacije (ASKR) imaju uticaja na bolju prognozu ove grupe kardioloških bolesnika. Uprkos širokoj primeni revaskularizacionih procedura u svakodnevnoj kardiološkoj praksi i brojnih studija koje su ukazale na pozitivne efekte programa SKR na funkcionalni status pacijenata nakon AKS, još uvek postoji mnogo kontroverzi o efektima fizičkog treninga, na srčanu funkciju i poboljšanje funkcionalnog kapaciteta kod pacijenata sa KABS i pridruženom dijastolnom disfunkcijom. Cilj istraživanja: bio je da ispita uticaj superviziranih vežbi fizičkim opterećenjem (VFO) u okviru programa ambulantne sveobuhvatne kardijalne rehabilitacije (ASKR), na dijastolnu disfunkciju leve komore (DDLK) i funkcionalni status pacijenata (FS), nakon AKS, rešenog perkutanom koronarnom intervencijom (PCI), kao i da li, s druge strane, prisustvo i stepen dijastolne disfunkcije na početku istraživanja, utiče na funkcionalni status i pojavu neželjenih kardijalnih događaja, kod ove grupe pacijenata u okviru programa ASKR i van njega Materijal i metode: Istraživanjem je bilo obuhvaćeno ukupno 85 ispitanika, oba pola, starosti od 18-65 godina, koji su tokom indeksne hospitalizacije lečeni kao klinički dokazani AKS (APNS; NSTEMI; STEMI) i kod kojih je urađena neka od interventnih koronarnih procedura (pPCI; PCI; PTCA). Nakon 4 nedelje od otpusta sa hospitalizacije, zbog NSTEMI ili APNS, odnosno nakon 6 nedelja od otpusta sa hospitalizacije zbog STEMI, pacijenti sa EFLK ≥ 45%, bez značajnih valvularnih i drugih mana i sa nekim od poremećaja dijastolne funkcije, bili su kandidati za učešće u istraživanju. Svi ispitanici su podvrgavani „ulaznom“ehokardiografskom pregledu (EHO) u cilju procene sistolne funkcije i stepena dijastolne disfunkcije leve komore, kao i „ulaznom“ spiroergometrijskom testu (CPET) u cilju procene funkcionalnog statusa, na osnovu kojeg je vršena preskripcija vežbi fizičkim opterećenjem (VFO) u okviru programa ASKR. Program ASKR odvijao se u ukupnom trajanju od 12 nedelja, odnosno 36 pojedinačnih sesija VFO, 3 puta nedeljno u trajanju od po 30 minuta. Kontrolna grupa obuhvatila je grupu pacijenata koja nije živela u blizini IKVBV i koja nije bila u mogućnosti da dolazi redovno na VFO u sklopu ASKR. Njima je bilo pušteno na volju da na osnovu urađenog EHO pregleda i CPET, određuju stepen VFO po sopstvenom nahođenju, uz primenu optimalnog medikamentnog lečenja i ostalih mera sekundarne prevencije. Nakon 3 meseca obe grupe pacijenata bile su podrvrgnute novom –“izlaznom” ehokardiografskom i CPET pregledu u cilju komparacije sa rezultatima na početku istraživanja. Rezultati:Istraživanje je pokazalo da nakon 3 meseca superviziranog treninga VFO, u okviru programa ASKR, kod bolesnika nakon AKS, lečenih perkutanom koronarnom intervencijom, dolazi do poboljšanja stepena dijastolne disfunkcije leve komore, naročito kroz promene vrednosti ehokardiografskih parametara e’l i E/e’ l. U kontrolnoj grupi e’l se smanjio za (0,003 ± 0,025), a u osnovnoj se povećao za (0,011 ± 0,021). U kontrolnoj grupi e’l se nije značajno promenio (p = 0,515), a u osnovnoj grupi se značajno povećao (p < 0,0005). Na početku istraživanja u osnovnoj grupi e’l je bio (0,097 ± 0,027 m/sec), a na kraju (0,108 ± 0,031 m/sec). E/e’l se nije značajno promenio u kontrolnoj grupi (p = 0,226), a u osnovnoj grupi se značajno smanjio (p = 0,002). Na početku istraživanja u osnovnoj grupi E/e’l je bio (8,02 ± 2,98), a na kraju (6,97 ± 2,17). Takođe je utvrđeno da nakon 3 meseca superviziranog treninga u okviru programa ASKR, dolazi do poboljšanja funkcionalnog kapaciteta pacijenata sa KABS i dijastolnom disfunkcijom leve komore, kroz povećanje CPET parametara: peak VO2, VO2 predict i METs. U kontrolnoj grupi peak VO2 se smanjio za (1,79 ± 3,84), a u osnovnoj se povećao za (1,67 ± 4,29). U kontrolnoj grupi peak VO2 se značajno smanjio (p = 0,018), a u osnovnoj grupi se značajno povećao (p = 0,005).Na početku istraživanja u kontrolnoj grupi srednja vrednost peak VO2 iznosila je (23,01 ± 3,99 ml/kgTT/min), a u osnovnoj grupi je iznosila (23,15 ± 4,99 ml/kgTT/min). Na kraju istraživanja u osnovnoj grupi srednja vrednost peak VO2 iznosila (24,82 ± 5,77 ml/kgTT/min), dok je kod kontrolne grupe iznosila (21,21 ± 4,05 ml/kgTT/min). U kontrolnoj grupi ppVO2(%) se smanjio za (5,28 ± 14,39), a u ispitivanoj se povećao za (7,16 ± 18,51). U kontrolnoj grupi ppVO2(%) se nije značajno promenio (p = 0,058), dok se u osnovnoj grupi statistički značajno povećao (p = 0,005). Razlika srednjih vrednosti promena METs između osnovne i kontrolne grupe je bila statistički značajna (p < 0,0005). U kontrolnoj grupi METs se smanjio za (0,55 ± 1,12), a u osnovnoj se povećao za (0,58 ± 1,12). U kontrolnoj grupi METs se značajno smanjio (p = 0,013), a u osnovnoj grupi se značajno povećao (p < 0,0005). Zaključak: Program ambulantne sveobuhvatne kardijalne rehabilitacije, kod bolesnika nakon akutnog koronarnog sindroma, lečenih perkutanom koronarnom intervencijom, utiče na poboljšanje faktora rizika kardiovaskularnih bolesti, značajno utiče na poboljšanje stepena dijastolne disfunkcije leve komore i na poboljšanje funkcionalnog statusa pacijenata, u odnosu na početak istraživanja.<br><b>Background: </b>In modern world, coronary artery disease (CAD) is one of the leading cause of morbidity and mortality, and acute coronary syndrome (ACS) is one of its most common and most dangerous clinical manifestations. Left ventricle diastolic dysfunction (LVDD) is often associated with CAD and is possibly a contributing factor for poor clinical course and outcome. The question arises as to the extent to which the left ventricle diastolic dysfunction is associated with CAD and whether modern ambulatory comprehensive cardiac rehabilitation programs (ACCR) have an impact on a better prognosis of this group of cardiac patients. Despite the wide use of revascularization procedures in everyday clinical practice and numerous trials that have indicated the positive effects of the ACCR on the functional status of patients after ACS, there is still much controversy about the effects of physical training, and its impact on cardiac function and the improvement of functional capacity in patients with CAD and associated diastolic dysfunction<b>. Objective: </b>to examine the influence of supervised physical training programe as a part of ambulatory comprehensive cardiac rehabilitation (ACCR), on diastolic dysfunction and the functional capacity of patients after ACS resolved by percutaneous coronary intervention (PCI), and whether, on the other hand, the presence and the degree of diastolic dysfunction at the beginning of the study, affects the functional capacity and occurrence of unwanted cardiac events (MACE), in this group of patients within the ACCR program and without it. <b>Methods: </b>The study include a total of 85 subjects, both sexes, ages 18-65, who were treated as clinically proven ACS during the index hospitalization and in which some of the interventional coronary procedures were performed (pPCI; PCI; PTCA). After 4 weeks of hospitalization due to NSTEMI or APNS, or after 6 weeks of hospitalization due to STEMI, patients with LVEF ≥ 45%, without significant valvular and other disorders and with some degree of lef ventricle diastolic dysfunction, were candidates for participation in the study. All patients were subjected to an initial, “entrance”, echocardiographic examination (ECHO) in order to evaluate the left ventricle systolic function and the degree of diastolic dysfunction, as well as the initial, “entrance”, spiroergometry test (CPET) in orther to asses the functional capacity. The ACCR program include a total duration of 12 weeks, or 36 individual exercise training sessions, 3 times a week, with the duration of 30 minutes. The control group included a group of patients who did not live near ICVDV and who was not able to come regularly to the exercise training sessions as a part of ACCR. They determine the degree of exercise trainig on their own will after they performed initial EHO and the CPET examination, using the optimal medical treatment and other secondary prevention measures. After 3 months, both groups of patients were subjected to a new, "exit", ECHO and CPET examinations in order to compare with the results at the start of the study. <b>Results: </b>The study showed that after 3 months of supervised exercise training program, as a part of the ACCR, in patients following ACS treated with percutaneous coronary intervention, there is an improvement in the degree of left ventricular diastolic dysfunction, especially through changes in the echocardiographic parameters e'l and E / e 'l . In the control group e'l decreased by (0,003 ± 0,025), and in the base group it increased by (0,011 ± 0,021). In the control group, e'l did not change significantly (p = 0,515), while in the base group significantly increased (p <0,0005). At the beginning of the study in the base group e'l was (0,097 ± 0,027 m/sec), and at the end (0,108 ± 0,031 m/sec). E / e'l did not change significantly in the control group (p = 0,226), and in the base group significantly decreased (p = 0,002). At the beginning of the study in the base group E / e'l was (8,02 ± 2,98), and at the end (6,97 ± 2,17). It has also been established that after 3 months of supervised training within the ACCR program, the functional capacity of patients with CAD and left ventricular diastolic dysfunction is improved, by increasing in peak VO2, VO2 predict and METs. In the control group, peak VO2 decreased by (1,79 ± 3,84), and in the base group it increased by (1,67 ± 4,29). In the control group, peak VO2 decreased significantly (p = 0,018) and significantly increased in the base group (p = 0,005). At the start of the study in the control group, the mean peak VO2 was (23,01 ± 3,99 ml/ kgTT / min), and in the base group it was (23,15 ± 4,99 ml / kgTT / min). At the end of the study in the base group, the mean peak VO2 was (24,82 ± 5,77 ml/ kgTT / min), while the control group was (21,21 ± 4,05 ml / kgTT / min). In the control group ppVO2 (%) it decreased by (5,28 ± 14,39), and in the examined it increased by (7,16 ± 18,51). The control group ppVO2 (%) did not significantly change (p = 0,058), while in the base group it increased significantly (p = 0,005). The difference in mean values of MET changes between base and control group was statistically significant (p <0,0005). In the control group METs decreased by (0,55 ± 1,12), and in the base group it increased by (0,58 ± 1,12). METs significantly decreased in the control group (p = 0,013), while in the base group significantly increased (p <0,0005). <b>Conclusions: </b>The program of ambulatory comprehensive cardiac rehabilitation in patients following acute coronary syndrome, treated with percutaneous coronary intervention, has an positive effect on the improvement of the risk factors for cardiovascular diseases, significantly influencing the improvement of the degree of left ventricle diastolic dysfunction and the improvement of the functional capacity of patients.
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Jelena, Zvekić-Svorcan. "Povezanost funkcijskog stanja šake u osteoartrozi i koštane mase merene centralnom dvostrukom apsorpciometrijom X-zraka kosti kod žena u postmenopauzi." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2019. https://www.cris.uns.ac.rs/record.jsf?recordId=109650&source=NDLTD&language=en.
Full textAbstract:
UVOD: Artroza šaka predstavlja jednu od najčešćih mišićno-skeletnih bolesti. Manifestuje se bolom, nekada otokom, deformacijom i gubitkom funkcije šaka. Postoje različita mišljenja o povezanosti osteoartroze (OA) i osteoporoze (OP) kao dva najčeša skeletna poremećaja. CILJ: istraživanja je da se utvrde faktori rizika za nastanak OA šaka, uporedi mineralna koštana gustina kod pacijenata sa OA šaka sa kontrolnom grupom i utvrdi značaj metaboličkog sindroma kod pacijenata sa OA šaka. MATERIJAL I METODE: Istraživanje je obavljeno u periodu od jedne godine kod bolesnika sa OA šaka – eksperimentalna grupa, i u kontrolnoj grupi bez OA. OA šaka je definisana na osnovu bola, klinički prisutnih deformiteta šaka kod žena u postmenopauzi starosne dobi od 60-70 godina i radiografskih promena ( drugog do četvrtog stepena prema Kellgren-Lowrencovoj skali). Analizirani su faktori rizika odgovorni za nastanak OA šaka, povezanost OA šaka sa snagom stiska šake, mineralnom koštanom gustinom i metaboličkim sindromom. Analazirirana je i funkcija šake pomoću tri validirana upitnika: Michigan Hand Outcomes Questionnaire (MHQ, Duruoz Hand Indeks (DHI), Health Assessment Questionnaire (PROMIS HAQ). Statistička obrada podataka rađena je u programu SPSS verzija 25. REZULTATI: Prosečna starost pacijentkinja je bila 65,89±3,67 godina. Eksperimentalna i kontrola grupa se statistički razlikuju prema porodičnoj anamnezi o strukturnim promenama zglobova šaka, prema bolnosti šaka u miru, bolnosti šaka pri palpaciji, uzdržavanju od pokreta prstiju šaka, snage stiska šake, metaboličkom sindromu( p<0,001). Kao značajni prediktori za nastanak osteoartroze šaka su se izdvojili pozitivna porodična anamneza o strukturnim promenama za zglobovima šaka i metabolički sindrom ( p<0,001). Utvrđen je veći broj ispitanica sa normalnom koštanom gustinom u kontrolnoj grupi. Eksperimentalna grupa bolesnica imala je lošiju funkciju šake, odnosno lošiji skor primenom validiranih upitnika ( p <0,001). ZAKLJUČAK: Pacijentkinje sa izraženom osteoartrozom šaka imaju smanjenu funkciju šake, češći metabolički sindrom u odnosu na kontrolnu grupu, ali ne i značajno nižu koštanu gustinu.<br>INTRODUCTION: Arthritis of the hand is one of the most common musculoskeletal disorders. It manifests as pain, sometimes accompanied by swelling and deformities, which may lead to the loss of hand function. However, there is no consensus on the relationship between osteoarthritis (OA) and osteoporosis (OP) as the two most common skeletal disorders. AIMS: The study aim was to determine the risk factors related to the development of OA in the hand, as well as compare the bone density in patients with hand OA (HOA) with that measured in the control group and establish the significance of metabolic syndrome in the HOA group. MATERIAL AND METHODS: The study was conducted over a 12-month period and included a sample comprising of the experimental (patients affected by HOA) and the control (individuals with no evidence of HOA) group. HOA was diagnosed based on the reported pain, clinical evidence of hand deformities in postmenopausal women aged 60−70, and radiological evidence of physiological changes (Grade II to IV, based on the Kellgren-Lowrence scale). The risk factors for the development of HOA were analyzed, along with the link between HOA and hand grip strength, bone mineral density and metabolic syndrome. Analyses also included had function, as determined by three validated questionnaires: Michigan Hand Outcomes Questionnaire (MHQ), Duruoz Hand Index (DHI), and Health Assessment Questionnaire (PROMIS HAQ). Statistical analyses were performed using the SPSS version 25 computer software. RESULTS: The average age of the sample was 65.89±3.67 years. There were statically significant differences between the experimental and the control group with respect to the family history of structural changes in the hand joints, perceived hand pain at rest and when palpated, reluctance to utilize fingers, hand grip strength, and metabolic syndrome (p < 0.001). Family history of structural changes to the hand joints and metabolic syndrome emerged as the strongest predictors of the osteoarthritis of the hand development (p < 0.001). A greater number of the control group members had normal bone mineral density, while the patients assigned to the experimental group had inferior hand function, as determined by the score on the aforementioned validated questionnaires (p < 0.001). CONCLUSION: Postmenopausal women with pronounced osteoarthritis of the hand have reduced hand function, and are more likely to suffer from a metabolic syndrome relative to the control group, while the differences in bone mineral density are not statistically significant.
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MALOBERTI, ALESSANDRO. "RUOLO DELL’ACIDO URICO NELLA CARDIOPATIA ISCHEMICA ACUTA: RISULTATI DALLA COORTE DEI PAZIENTI CON SINDROME CORONARICA ACUTA DELL’OSPEDALE NIGUARDA." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2020. http://hdl.handle.net/10281/262315.
Full textAbstract:
Background: l’acido urico (AU) nei pazienti che si presentano con SCA è stato riconosciuto come fattore determinante la mortalità intra-ospedaliera. Inoltre esso è anche correlato con le complicanze intraospedaliere in termini di recidiva precoce di altri eventi cardiovascolari non fatali e altri outcome intermedi interpretabili come segni di decorso intra-ospedaliero complicato (l’utilizzo di contropulsatore aortico o di ventilazione non invasiva, un maggior tempo di degenza ed una maggior frequenza di sanguinamenti ma anche la presentazione con un quadro di scompenso cardiaco acuto o con FA all’ingresso in unità coronarica).
Scopo dello studio: scopo principale del nostro studio è quello di valutare il ruolo dell’AU misurato in acuto come possibile determinante di mortalità intraospedaliera (outcome primario) e di complicanze durante la degenza (outcomes secondari). Scopo secondario è stato anche quello di individuare il miglior cut-off per tale associazione. Oltre all’individuazione di uno specifico cut-off è stata anche valutata la performance diagnostica, in termini di sensibilità e specificità, del cut-off classico oggi utilizzato per definire l’iperuricemia (> 6 mg/dL nelle femmine e 7 mg/dL nei maschi) e di un cut-off più basso individuato dalla letteratura più recente (5.26 mg/dL per le femmine e 5.49 mg/dL per i maschi).
Metodi: Per fare questo sono stati analizzati i dati di 563 pazienti ricoverati presso l’Unità di Cure Intensive Cardiologiche (UCIC) dell’ospedale Niguarda Ca’ Granda. Gli outcome considerati sono la mortalità intraospedaliera per tutte le cause, il re-infarto, la trombosi intrastent, la nuova rivascolarizzazione non programmata, i sanguinamenti, gli stroke, la presentazione con scompenso cardiaco, la presentazione con FA, l’utilizzo di inotropi, contropulsatore aortico e ventilazione non invasiva, l’evidenza di coronaropatia trivasale alla coronarografia e la FE in ingresso ed in dimissione dall’UCIC.
Risultati: i pazienti presentavano un’età media di 66.5 ± 12.3 anni, nel 79.2% dei casi erano maschi e nel 49.9% dei casi accedevano per STEMI. Con entrambi i cut-off i soggetti iperuricemici erano più anziani e presentavano più frequentemente FRCV e pregresso infarto miocardico. Essi morivano più frequentemente durante la degenza, giungevano al ricovero in FA o con scompenso cardiaco, presentavano con maggior frequenza coronaropatia trivasale ed utilizzavano più frequentemente contropulsatore aortico e NIV. Infine i valori di FE sia all’ingresso che in dimissione dall’UCIC erano più bassi rispetto al gruppo dei non iperuricemici.
All’analisi multivariata l’AU resisteva come determinante significativo di tutti gli outcomes (esclusa la coronaropatia trivasale) in un modello contenente età, genere, precedente infarto miocardico, anamnesi positiva per ipertensione arteriosa, Charlson Comorbidity Index e creatinina.
Entrambi i cut-off erano in grado di discriminare in modo statisticamente significativo l’incrementata mortalità dei pazienti iperuricemici anche se in entrambi i casi la performance in termini di Sensibilità (Sn) e Specificità (Sp) presentava alcuni problemi.
Abbiamo infine provato ad individuare un cut-off ideale per questa specifica popolazione che è stato di 6.35 mg/dL con un’area sotto la curva complessiva di 0.772 e con una Sn ed una Sp di 70.3% ed 81.8%.
Conclusioni: in conclusione AU risulta determinante indipendente della mortalità intraospedaliera per tutte le cause e di variabili indicative di peggior presentazione al momento dei ricovero (scompenso cardiaco, FA ed FE all'ingresso), di complicanze intra-ricovero (utilizzo di contropulsatore aortico e NIV) e di un peggior risultato sulla ripresa della funzione ventricolare sinistra (FE in dimissione). Ulteriori studi con valutazione longitudinale dell'andamento dell'AU sono necessari per chiarire definitivamente la direzionalità delle relazioni individuate.<br>Background: Uric acid (UA) has been related to in-hospital mortality in ACS patients. Furthermore, it has been related to early relapse of non-fatal cardiovascular events and to intermediate outcome such as use of intra-aortic balloon pump, noninvasive ventilation, longer inward stay, bleeding but also clinical presentation with AF or heart failure.
Aim of the study: principal aim of our study was to evaluate the role of UA as a possible determinants of in-hospital mortality (primary outcome) and in hospital complications (secondary outcomes). Secondary aim was to identify the best cut-off and to evaluate diagnostic performance of already used cut-off (the classic one of > 6 mg/dL in female and 7 mg/dL in males, and a recently described one with 5.26 mg/dL in females and 5.49 mg/dL in males).
Methods: we analyze data of 563 patients admitted for ACS at the Cardiological Intensive Care Unit of the Niguarda Ca’ Granda Hospital. We consider as outcome in-hospital mortality, inward myocardial infarction, instent thrombosys, bleeding, stroke, clinical presentation with heart failure of AF, inotropes, intra-aortic balloon pump and non-invasive ventilation uses during hospital stay, three vessels coronaric involvement at the coronary angiogram and EF both at admission and at discharge.
Results: mean age was 66.5 ± 12.3 years, 79.2% of the patients were males and 49.9% of the ACS were STEMI. With both cut-off hyperuricemic subjects were older, with more prominent cardiovascular risk factor and previous myocardial infarction. Furthermore, they more frequently died during hospital stay, they present more frequently heart failure and AF as clinical presentation, have more commonly three vessels disease and use more frequently intra-aortic balloon pump and non-invasive ventilation. Finally, also EF at admission and discharge were lower in hyperuricemic patients.
At multivariate analysis UA was a significant determinants of primary and secondary outcomes (except for three vessels coronaric disease) in a model with age, gender, previous myocardial infarction, arterial hypertension, Charlson Comorbidity Index and creatinine as covariates.
Both cut-off can significantly discriminate in-hospital mortality but with only fair results in term of Sensibility (Sn) and Specificity (Sp). Finally, we identify 6.35 mg/dL as the best cut-off for this specific population with an area under the curve of 0.772, Sn 70.3% and Sp 81.8%.
Conclusions: in conclusion UA was an independent determinants of in-hospital mortality and of variables suggestive of worst clinical presentation (heart failure, AF and admission EF), in-hospital complications (intra-aortic balloon pump and non-invasive ventilation uses) and worst recovery (discharge EF). Further study with longitudinal evaluation of UA during ACS are needed in order to better clarify directionality of detected relationship.
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Nevena, Eremić Kojić. "Odnos između pojedinih markera aterosklerotske bolesti i debljine intima-medija kompleksa karotidne arterije kod bolesnika sa metaboličkim sindromom." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2019. https://www.cris.uns.ac.rs/record.jsf?recordId=110198&source=NDLTD&language=en.
Full textAbstract:
S obzirom na visoku prevalencu metaboličkog sindroma (10-40% u svetskoj populaciji) i na činjenicu da prisustvo metaboličkog sindroma duplira rizik od nastanka aterosklerotske bolesti kardiovaskularnog sistema jasna je potreba za identifikacijom indivudualnih parametara koji doprinose njenom razvoju. Metabolički sindrom je klaster faktora rizika metaboličkog porekla koji je udružen sa povećanim rizikom za nastanak aterosklerotske bolesti kardiovaskularnog sistema i dijabetes melitusa tipa 2. Insulinska rezistencija, abdominalna gojaznost, aterogena dislipidemija, hipertenzija, proinflamatorno i protrombotično stanje su faktori koji su u osnovi metaboličkog sindroma a često su i praćeni nagomilavanjem masti u jetri. Cilj rada je bio da se utvrdi odnos između markera disfunkcije hepatocita (AST, ALT, GGT), serumskog nivoa inflamatornih biomarkera (broj leukocita, elektroforeza serumskih proteina, CRP, fibrinogen, TNF-α), biomarkera endotelne disfunkcije (ADMA i homocistein), kao i nivoa serumskih adipokina (leptin i adiponektin) i debljine intima-medija kompleksa (IMT) karotidne arterije kao pokazatelja prisustva aterosklerotskog procesa. Ispitivanje je dizajnirano kao studija preseka. U ispitivanje je uključeno 58 ispitanika oba pola sa karakteristikama metaboličkom sindroma (NCEP:ATP III kriterijumi). Odabir ispitanika je vršen u Odeljenju za pravilnu ishranu i zdravstvenu bezbednost hrane, Instituta za javno zdravlje Vojvodine. Kontrolnu grupu su sačinjavale 30 klinički i biohemijski zdravih ispitanika nepušača koji su prema polnoj i dobnoj strukturi odgovarali ispitivanim grupama bolesnika. Iz ispitivanja su isključene osobe koje konzumiraju više od 20g/dan alkohola, pušači, koji imaju dijagnostikovan virusni hepatitis B ili C ili pozitivan Hbs antigen, anti-Hbs antitela i anti-HCV antitela, osobe koje imaju verifikovana oboljenja kardiovaskularnog sistema, bubrega, CNS-a, infektivna, maligna i autoimuna oboljenja kao i druga oboljenja jetre i žučnih puteva, osobe koje su pod medikamentoznom terapijom koja može uticati na nivo serumskih biomarkera endotelne disfunckije, lipidni i lipoproteinski status, glikoregulaciju kao i menstruacioni ciklus. Sve laboratorijske analize su urađene u Centru za laboratorijsku medicinu, Kliničkog centra Vojvodine. Doppler ultrasonografski pregled karotidnih arterija i ultrazvuk abdomena i jetre je urađen u Centru za radiologiju Kliničkog centra Vojvodine. Signifikantna pozitivna korelacija niskog stepena je utvrđena između IMT zajedničke karotidne arterije i serumskih koncentracija GGT, hsCRP i leptina kao i odnosa neutrofili/limfociti. Prema prvom konstruisanom regresionom modelu u kojem je zavisna varijabla bila IMT preko 0,09 cm statistički značajan uticaj na predviđanje debljine IMT zajedničke karotidne arterije imaju hsCRP (Exp (B) 1,112 i glikemija (Exp (B) 1,973). Prema modelu neuronske mreže sa istom zavisnom varijablom najveću mogućnost predviđanja IMT imaju glikemija, AST i fibrinogen. Prema drugom konstruisanom regresionom modelu gde su zavisne varijable bile IMT zajedničke karotidne arterije preko 0,09 cm i prisutnost hepatične steatoze najveću mogućnost predviđanja imaju leptin Exp (B) 1,1022 i ALT Exp (B) 1,053. Prema modelu neuronske mreže sa istom zavisnom varijablom najveću mogućnost predviđanja IMT imaju ALT, ADMA i leptin.<br>Given the high prevalence of metabolic syndrome (10-40% in the world population) and the fact that the presence of metabolic syndrome doubles the risk of atherosclerotic disease of the cardiovascular system, there is a clear need to identify individual parameters that contribute to its development. Metabolic syndrome is a cluster of the risk factors of metabolic origin that is associated with an increased risk for the onset of atherosclerotic disease of the cardiovascular system and type 2 diabetes mellitus. Insulin resistance, abdominal obesity, atherogenic dyslipidemia, hypertension, proinflammatory and prothrombotic conditions are the factors at the base of the metabolic syndrome and are often accompanied by fat accumulation in the liver. The aim of this work was to determine the relation between markers of hepatic dysfunction (AST, ALT and GGT), serum levels of inflammatory biomarkers (white blood cell count, electrophoresis of serum proteins, CRP, fibrinogen, TNF-α), biomarkers of endothelial dysfunction (ADMA and homocysteine) as well as levels of serum adipokines (leptin and adiponectin) and intima-media thickness of carotid artery as indicators of atherosclerotic process in the patients with metabolic syndrome. Study was cross-sectional. It included 58 participants with metabolic syndrome (NCEP:ATP III criteria) as well as 30 clinically and biochemically healthy nonsmokers, age and gender matched controls. Participants were selected in the Department for Nutrition and Food Safety, Center of Hygiene and Human Ecology Institute of Public Health of Vojvodina. Patients that consumed alcohol more than 20g/day were excluded. Participants with positive HBsAg, anti-HBs-antibodies or anti- HCV antibodies were excluded also. Smokers were also excluded. Patients with cardiovascular diseases, renal diseases, infective, hepatic, malignant and autoimmune diseases were excluded from this study. Subjects which used drugs that could affect biomarker levels of endothelial dysfunction, lipid metabolism, glucose metabolism and menstrual cycle were also excluded. All laboratory analyzes were done in Centre for Laboratory Medicine, Clinical Centre of Vojvodina. Doppler ultrasonography of carotid arteries and ultrasound of abdomen and liver were done in Centre for Radiology, Clinical Centre of Vojvodina. Significant positive correlation of low degree was determined between IMT of common carotid artery and serum concentrations between GGT, hsCRP and leptin and relationship neutrophils/lymphocytes. According to the first constructed regression model where dependent variable was IMT of common carotid artery above 0.09 cm statistically significant influence on foreseeing IMT of common carotid artery have hsCRP (Exp (B) 1.112 and glycaemia (Exp (B) 1.973). According to the neuronal network with the same dependent variable greatest probability for foreseeing IMT have glycaemia, AST and fibrinogen. According to the second constructed regression model where dependent variable was IMT above 0.09 cm and present hepatic steatosis greatest probability for foreseeing IMT have leptin Exp (B) 1.1022 and ALT Exp (B) 1.053. According to the neuronal network with the same dependent variable greatest probability for foreseeing IMT have ALT, ADMA and leptin.
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Vesna, Mijatović. "Procena kardiološke bezbednosti pri primeni metadona u supstitucionoj terapiji zavisnika od opijata." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2014. http://www.cris.uns.ac.rs/record.jsf?recordId=87273&source=NDLTD&language=en.
Full textAbstract:
Metadon je sintetski agonist opijatnih receptora koji se primenjuje u sklopu supstitucione terapije opijatnih zavisnika metadonom (STM) i u terapiji hroničnog bola. Dugoročna primena STM je praćena blagim, uglavnom prolaznim, neželjenim delovanjima. Međutim, metadon pripada grupi lekova koji mogu da prouzrokuju prolongaciju korigovanog QT intervala (QTc) u elektrokardiogramu (EKG-u) i povećaju rizik za nastanak potencijalno fatalnih aritmija tipa torsades de pointes. Opijatni zavisnici metadon najčešće koriste u kombinaciji sa benzodiazepinima, i ova kombinacija lekova predstavlja faktor rizika za nastanak smrtnog ishoda. Iako je najveći broj lekara upoznat sa rizikom za razvoj respiratorne depresije prilikom primene opijata u kombinacji sa benzodiazepinima, velika studija otkriva da su ventrikularne aritmije i srčani zastoj najčešće prijavljivana neželjena delovanja metadona, primenjenog u kombinaciji sa benzodiazepinima. Ciljevi ovoga radu su da se analizom smrtnih slučajeva povezanih sa upotrebom metadona (MRDs) tokom desetogodišnjeg perioda na teritoriji Vojvodine i sprovođenjem kliničkog ispitivanja kod opijatnih zavisnika na STM proceni kardiološka bezbednost primene metadona, posebno u kombinaciji sa benzodiazepinima. Sprovedena je retrospektivna studija za određivanje karakteristika MRDs na teritoriji Vojvodine, kao i kliničko ispitivanje u kome su učestvovali opijatni zavisnici koji počinju sa STM. Snimanje EKG-a (za izračunavanje QTc intervala) i uzorkovanje krvi (za određivanje koncentracije metadona i diazepama i vrednosti troponina) je sprovedeno kod svih učesnika istraživanja u 5 vremenskih tačaka (pre početka primene STM, 8. i 15. dana i nakon 1. i 6. meseca primene STM). Koncentracije metadona i diazepama u serumu su određivane metodom tečne hromatografije sa masenom spektrometrijom (LC-MS). U Vojvodini je zapažena rastuća tendencija MRDs, ali ni jedan od umrlih nije bio na STM, i najverovatnije su samoinicijativno koristili metadon i benzodiazepine. Patohistološki nalaz na srcu može govoriti u prilog kardiotoksičnosti metadona i njegove kombinacije sa benzodiazepinima, pogotovo kod slučajeva sa pronađenim akutnim miokardijalnim oštećenjem. Što se tiče hroničnih promena na srcu, ne postoji mogućnosti da se potvrdi niti opovrgne uloga psihostimulanasa. Detektovane koncentracije metadona i diazepama kod MRDs su bile u opsegu terapijskih (<1 μg/ml). Poredeći socio-demografske karakteristike opijatnih zavisnika koji su počeli sa STM u ovom istraživanju sa podacima iz sličnih studija sprovedenih širom sveta, zapažena je sličnost u pogledu velikog broja karakteristika. Srednje doze metadona 8., 15. dana i nakon 1. i 6. meseca primene STM su bile 40,23±17,11 mg, 47,11±16,79 mg, 50,00±17,55 mg i 78,63±18,14 mg, dok su srednje doze diazepama u istim vremenskim tačkama bile 35,92±10,47 mg, 33,89±9,23 mg, 28,33±11,55 mg i 28,12±11,67 mg. Srednje koncentracije metadona su u posmatranim tačkama ispitivanja iznosile 153,44±111,51 ng/ml, 157,43±112,39 ng/ml, 176,77±118,56 ng/ml i 342,86±181,54 ng/ml, dok su srednje koncentracije diazepama bile 923,00±537,89 ng/ml, 923,76±739,96 ng/ml, 560,74±436,72 ng/ml i 1045,32±932,72 ng/ml. Dužina QTc intervala pre primene STM je bila 411,87±27,22 ms, tj. 414,64±29,38 ms 8. dana STM, 416,97±26,39 15. dana, i 425,20±17,71 ms nakon 1. meseca tj. 423,50±14,72 ms nakon 6. meseca primene STM. Pokazan je statistički značajan porast dužine QTc intervala nakon 1. i nakon 6. meseca primene STM u odnosu na vrednost pre primene STM, kako u grupi svih ispitanika, tako i u podgrupi muškog pola. Pokazano je postojanje statistički značajne korelacije između koncentracije metadona i dužine QTc intervala nakon 15. dana, 1. i 6. meseca primene STM, kako kod svih ispitanika, tako i u podgrupi muškog pola. Ova korelacija ostaje statistički značajna i ukoliko se uključe i drugi faktori – koncentracija diazepama i dužina perioda upotrebe heroina, kod svih ispitanika i u podgrupi muškog pola nakon 15 dana i mesec dana primene STM, kao i u podgrupi muškog pola nakon 6. meseca STM. Iako nijedan pacijent nije prijavio neko neželjeno delovanje metadona na nivou kardiovaskularnog sistema, najveći broj pacijenata oba pola se nakon prvog meseca primene STM žalio na pojačano znojenje i opstipaciju. Koncentracije metadona i diazepama u uzorcima krvi kod MRDs se nalaze u rasponu koncentracija ovih lekova u krvi ispitanika koji su učestvovali u prospektivnoj studiji. Trećina umrlih je imala samo znake akutnog oštećenja srca, dok do porasta troponina i vrednosti QTc intervala preko 500 ms nije došlo ni kod jednog ispitanika iz prospektivne studije. Potrebno je sprovesti dalja istraživanja sa ciljem razjašnjenja moguće uloge benzodiazepina u povećanju kardiotoksičnosti metadona kod opijatnih zavisnika na STM.<br>Methadone is a synthetic agonist of opioid receptors which is used in methadone maintenance tratment (MMT) of opiate addicts as well as in the treatment of chronic pain. A long-term use of MMT is followed by mild, mostly transient, adverse effects. However, methadone belongs to a group of medicines which can provoke a prolongation of QTc (corrected QT) interval in electrocardiogram (ECG) and thus increase the risk from the development of potentially fatal arrhythmias – torsades de pointes. Moreover, methadone is widely associated with benzodiazepines use in heroin addicts, and this combination is considered as a risk factor for lethal outcome. Despite the fact that most of health care professionals are aware of possible respiratory depressant effect of methadone and benzodiazepines co-administration, recently published data reveal that ventricular arrhythmia and cardiac arrest are currently the most frequent adverse event attributed to methadone and benzodiazepine co-medication. The aim of this study is to assess cardiac safety of methadone use, especially in combination with benzodiazepines, by analyzing characteristics of methadone-related deaths (MRDs) during 10-year period as well as by conducting a clinical trial among opiate addicts in MMT. A retrospective study to determine the characteristics of MRDs in Vojvodina, as well as a clinical trial in which participated opiate addicts at the start of MMT were performed. ECG (to calculate QTc interval) and blood sampling (to determine methadone and diazepam concentrations and troponin values) were performed in all study participants at five time points (before the introduction of MMT, on 8th, on 15th day, after 1 and 6 months of MMT). Methadone and diazepam concentrations in serum were determined by using liquid chromatography-mass spectrometry (LC-MS). An increasing tendency of MRDs was observed in the region of Vojvodina, but none of the victims were under healthcare professionals’ control, and, most commonly, they used methadone and benzodiazepines, on their own initiative. Pathohistological findings in the heart in MRDs might support cardiac adverse effects of methadone and its combination with benzodiazepines, especially in cases with acute myocardial damage. As for the chronic heart changes, we can neither confirm nor exclude the role of psychostimulants. Detected concentrations of methadone and diazepam were in therapeutic range (<1 μg/ml). Comparing socio-demographic characteristics of opiate addicts who started with MMT in this study with data from similar studies conducted worldwide, the similarity in terms of large number of features was observed. The mean methadone dose on the 8th, 15th days, and after 1 and 6 months of MMT was 40.23±17.11 mg, 47.11±16.79 mg, 50.00±17.55 mg and 78.63±18.14 mg, respectively, while the mean diazepam dose at the same time points was 35.92±10.47 mg, 33.89±9.23 mg, 28.33±11.55 mg and 28.12±11.67 mg, respectively. The mean methadone concentration at observed time points was 153.44±111.51 ng/ml, 157.43±112.39 ng/ml, 176.77±118.56 ng/ml and 342.86±181.54 ng/ml, respectively, while the mean diazepam concentration was 923.00±537.89 ng/ml, 923.76±739.96 ng/ml, 560.74±436.72 ng/ml and 1045.32±932.72 ng/ml, respectively. The length of QTc interval before the introduction of MMT was 411.87±27.22 ms, 414.64±29.38 ms on the 8th day of MMT, 416.97±26.39 on the 15th day of MMT, after 1 month of MMT 425.20±17.71 ms and after 6 months of MMT 423.50±14.72 ms. There was a statistically significant increase in the length of QTc interval after 1 and 6 months of MMT in comparison to the value before the application of MMT, within the whole group of patients and in the subgroup of men. A statistically significant correlation between the concentration of methadone and QTc interval length after 15 days, 1 and 6 months of MMT, both in the whole group and in the subroup of men was observed. The correlation remained statistically significant if the other factors, such as concentration of diazepam and the length of heroin use, were included, in all patients and in the subgroup of men after 15 days and one month of MMT as well as in the subgroup of men after 6 months of MMT. Although none of the patients reported any cardiac adverse effect of methadone, the majority of them complained of sweating and constipation after the first month of MMT. Concentrations of methadone and diazepam in blood samples in MRDs were within the range of concentrations of these drugs in blood of patients who participated in the prospective study. In one third of MRDs only signs of acute myocardial damage were detected, while an increase in troponin values and the length of QTc interval over 500 ms did not occur in any patient in the prospective study. Further studies could clarify the possible role of benzodiazepines in the increasing cardiotoxicity of methadone in opiate addicts in MMT.
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Mladen, Karan. "Korelacija kliničkog i radiološkog nalaza sa prisustvom neuropsiholoških posledica kod povređenih sa blagim traumatskim oštećenjem mozga." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2016. http://www.cris.uns.ac.rs/record.jsf?recordId=101551&source=NDLTD&language=en.
Full textAbstract:
Uvod: Traumatsko oštećenje mozga (TOM) nastaje usled dejstva spoljašnje mehničke sile na kranijum i endokranijalni sadržaj, koje se karakteriše privremenim ili trajnim neurološkim oštećenjem, funkcionalnom onesposobljenošću ili psihosocijalnom neprilagođenošću. Blago TOM je najčešće i čini između 70% i 90% svih povređenih sa TOM. Postoji veliki broj definicija ovog kliničkog entiteta, ali gotovo sve sadrže Glazgov koma skor 13-15, poremećaj stanja svesti u različitom trajanju, te posttraumatsku amneziju kao odrednice koje definišu blago TOM. Najveći broj povređenih sa blagim TOM ima dobru prognozu i potpunu rezoluciju tegoba u kratkom vremenskom periodu nakon povređivanja, bez medicinski relevantnih posledica. Međutim, jedna grupa povređenih koja navodi naglašenije i dugotrajnije tegobe koje mogu imati uticaja na ukupno zdravstveno stanje i kvalitet života. U savremenom naučnoistraživačkom radu aktuelni su pokušaji da se primenom novih dijagnostičkih metoda, detaljnim praćenjem povređenih i primenom neuropsiholoških testova objektivizuju ove tvrdnje, kako bi se pacijenti sa povišenim rizikom od nastanka dugotrajnih tegoba pravovremeno identifikovali i kako bi se mogao sprovesti adekvatan tretman. Cilj: Cilj ove studije je da se utvrditi da li postoji korelacija između kliničkih i radioloških simptoma i znakova i rezultata neuropsihološkog testiranja kod povređenih sa blagim traumatskim oštećenjem mozga, kao i da se utvrdi da li neki od od kliničkih simptoma i znakova mogu biti pouzdan prediktor pojave perzistentnih neuropsiholoških posledica, i koja je priroda moždanih oštećenja koja mogu biti u njihovoj osnovi. Materijal i metode: Sprovedeno istraživanje je u celosti bilo kliničko, prospektivno, i obuhvatilo je 64 povređena sa blagim TOM koji su u periodu od 2012. do 2015. godine hospitalizovani na Klinici za neurohirurgiju Kliničkog centra Vojvodine u Novom Sadu. Pre prijema je svim ispitanicima načinjen pregled endokranijuma kompjuterizovanom tomografijom (CT) koji nije prikazivao znakove traumatskih oštećenja kranijuma niti endokranijalnog sadržaja. U toku hospitalizacije kod povređenih su praćeni i beleženi relevantni klinički parametri. U prvih 72 sata od povređivanja je kod 37 ispitanika načinjen pregled endokranijuma magnetnom rezonancom (MRI). Kod 25 ispitanika je načinjeno neuropsihološko ispitivanje baterijom neuropsiholoških testova mesec dana nakon povređivanja i 6-9 meseci nakon povređivanja. Rezultati su unošeni u bazu podataka i nakon toga statistički analizirani. Rezultati: U analiziranoj grupi od 64 povređena sa blagim TOM kod 37 ispitanika (58%) je načinjen MRI pregled endokranijuma, a pozitivan nalaz u smislu postojanja traumom izazvanih oštećenja moždanog parenhima pronađen je kod 17 ispitanika (46%). Najsenzitivnije MRI sekvence su SWI i T2* kojima se otkrivaju veoma diskretni depoziti razgradnih produkata krvi. Povređeni sa pozitivnim MRI nalazom imaju lošije postignuće na rekogniciji liste B Rejovog testa verbalnog učenja u odnosu na povređene iz grupe bez intrakranijalne traumatske lezije. Rezultati neuropsiholoških testova ukazuju na poboljšanje rezultata između prvog i drugog testiranja u pogledu egzekutivnih i govornih funkcija u ispitivanoj grupi. U ostalim ispitivanim kognitivnim aspektima nije pronađena značajna razlika među navedenim grupama Zaključak: TOM predstavlja jedan od najvećih savremenih medicinskih izazova koji se nameće zbog svoje visoke incidence, dijagnostičkih i terapijskih problema, ali i potencijalno lošeg ishoda i visokih troškova rehabilitacije i resocijalizacije povređenih. Rezultati studije se mogu iskoristiti za bolje razumevanje blagog TOM u smislu lakšeg rešavanja dijagnostičkih dilema, kreiranje efikasnijih dijagnostičkih protokola i preciznije procene ishoda nakon povređivanja ove vrste.<br>Introduction: Traumatic brain injury (TBI) is a result of the influence of external mechanical forces on scull and endocranial structures which can produce temporarily or permanent neurological impairment, functional disability or psychosocial unconformity. Mild TBI is the most frequent form of TBI and represent between 70% and 90% of all TBI cases. There are several different definitions of mild TBI, but almost all of them contain Glasgow Coma Scale score 13-15, altered state of consciousness and different forms of amnesia as criteria for mild TBI diagnosis. Largest number of patients suffered mild TBI have good prognosis and complete resolution of symptoms in short period of time after injury, with out of any kind of sequeles. However, small group of patients report various symptoms and complaints which can last longer than is usual and seriously affect quality of life of this patients. Numerous researches has been conducted applying novel imaging technologies, long follow-up periods and neuropsychological testing in order to make these non-specific self-reported complaints as much objective as possible. The other reason is necessity of timely identification of patients in risk of developing long term complaints so they can be treated in a proper manner. Objective: The aim of this study was to determine is there correlation between clinical and radiological signs and symptoms and results of neuropsychological testing in patients with mild TBI. The aim also was to determine are there some clinical signs which can be reliable predictor of appearance of neuropsychological consequences and what is the nature of cerebral lesion suspected to be a cause of this consequences. Materials and methods: The research was clinical, completely prospective and included total of 64 patients with mild TBI who were hospitalized between 2012 and 2015 at Clinic for neurosurgery, Clinical Centre of Vojvodina in Novi Sad. All patients had computed tomography scan (CT) at the admission which failed to show any signs of trauma of cranial bones or endocranial content. During the first 72 hours after injury the magnetic resonance imaging (MRI) has been performed in 37 patients. 25 patients had neuropsychological testing one month and 6-9 months after injury. We entered results in database and after completion we performed statistical analysis. Results: In 37 of 64 patients (58%) MRI examination has been performed and in 46% of patients we found trauma induced small haemorrhagic and oedematous brain lesions. The most sensitive sequences in our protocol were SWI and T2* confirmed superb sensitivity in detection of small foci of blood. Patients with detected MRI abnormalities showed poorer accomplishment at recognition of list B of Ray Auditory Verbal Learning Test in comparison with group with no intracranial lesions. The results of neuropsychological testing showed significant improvement of executive and speech functions between two periods in time when tests have been administered. We found no other significant differences between analysed cognitive functions in this period in our group of patients. Conclusion: TBI is one of the most important contemporary medical problems due to his high incidence, diagnostics and therapy related issues, but also potentially poor outcome and high costs of rehabilitation. Results of this study can be used for better understanding of mild TBI in order to solve some diagnostic dilemma, create more efficient diagnostic protocols and facilitate more precise outcome assessment after mild TBI.