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Incidence and predictors of severe liver fibrosis in HIV-infected patients with chronic hepatitis C in Brazil

MENDES-CORREA, Maria Cassia; WIDMAN, Azzo; BRUSSI, Maria Luiza Paes; GUASTINI, Cristina Fatima; GIANINI, Reinaldo Jose
Fonte: MARY ANN LIEBERT INC Publicador: MARY ANN LIEBERT INC
Tipo: Artigo de Revista Científica
ENG
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The aim of this study was to examine the incidence and factors associated with the severity of liver fibrosis in 234 coinfected patients in Brazil. Patients were cared for in our clinic, from 1996 to 2004. Eligible patients were defined as patients with documented HIV and hepatitis C virus (HCV) infections and had previously undergone a liver biopsy. Patients with persistently normal alanine aminotransferase (ALT) were also included. The variables selected for study were age, gender, risk category, history of high alcohol consumption, CD4(+) T cell count, antiretroviral therapy usage, HCV genotype and duration of HCV infection. Stage of fibrosis was scored as follows: F0, no fibrosis; F1, portal fibrosis with no septa; F2, portal fibrosis with few septa; F3, bridging fibrosis with many septa; and F4, cirrhosis. The liver fibrosis stage was F3 in 39 (16.6%) and F4 in 20(8.5%) patients. Among patients with normal ALT, the liver fibrosis stage was F3-F4 in three patients (5.6%). Predictors of severe liver fibrosis (17344) by multivariate analysis were age (older patients) and genotype 3 (genotype I odds ratio [OR], 0.28; 95% confidence interval [0], 0.12 0.65). In summary, in the present study severe liver fibrosis was found in 25% of our patients and was associated with an age of more than 38 years at the time of liver biopsy as well as...

Peginterferon alfa-2b and Ribavirin: Effective in Patients With Hepatitis C Who Failed Interferon alfa/Ribavirin Therapy

POYNARD, Thierry; COLOMBO, Massimo; BRUIX, Jordi; SCHIFF, Eugene; TERG, Ruben; FLAMM, Steven; MORENO-OTERO, Ricardo; CARRILHO, Flair; SCHMIDT, Warren; BERG, Thomas; MCGARRITY, Thomas; HEATHCOTE, E. Jenny; GONCALES, Fernando; DIAGO, Moises; CRAXI, Antonio;
Fonte: W B SAUNDERS CO-ELSEVIER INC Publicador: W B SAUNDERS CO-ELSEVIER INC
Tipo: Artigo de Revista Científica
ENG
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Background & Aims: Treatment with peginterferon alfa and ribavirin produces a sustained virologic response (SVR) in approximately 60% of hepatitis C virus (HCV)-infected patients. Alternate options are needed for patients who relapse or do not respond to therapy. Methods: This prospective, international, multicenter, open-label study evaluated efficacy and safety of peginterferon alfa-2b (1.5 mu g/kg/wk) plus weight-based ribavirin (800-1400 mg/day) in 2333 chronic HCV-infected patients with significant fibrosis/cirrhosis whose previous interferon alfa/ribavirin therapy failed. Patients with undetectable HCV-RNA at treatment week (TW) 12 received 48 weeks of therapy; patients with detectable HCV-RNA at TW12 could enter maintenance studies at TW18; 188 patients with low/detectable HCV-RNA at TW12 continued therapy at the investigator`s request. Results: Overall, 22% of the patients attained SVR (56% with undetectable HCV-RNA and 12% with low/detectable HCV-RNA at TW12). SVR was better in relapsers (38%) than nonresponders (14%), regardless of previous treatment, and in patients previously treated with interferon-alfa/ribavirin (25%) than peginterferon alfa-ribavirin (17%). Predictors of response in patients with undetectable HCV-RNA at TW12 were genotype (2/3 vs 1...

Gastroduodenal opportunistic infections and dyspepsia in HIV-infected patients in the era of Highly Active Antiretroviral Therapy

WERNECK-SILVA, Ana Luiza; PRADO, Ivete Bedin
Fonte: WILEY-BLACKWELL PUBLISHING, INC Publicador: WILEY-BLACKWELL PUBLISHING, INC
Tipo: Artigo de Revista Científica
ENG
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Background and Aim: Dyspeptic symptoms are frequently reported by human immuno-defficiency virus (HIV)-infected patients under highly active antiretroviral therapy. Whether opportunistic infections are a cause of dyspepsia is still unknown. In this study we prospectively compare the prevalence of gastrointestinal opportunistic infections in dyspeptic versus non-dyspeptic HIV-infected patients with advanced immunodeficiency. Patients and Methods: Six hundred and ninety HIV-infected patients under highly active antiretroviral therapy underwent esophagogastroduodenoscopy with mucosal biopsies from the stomach and duodenum. Group 1: 500 patients (161 women, 339 men; mean age 38.8 years; mean CD4 count 154.3 cells/mm(3) with dyspeptic symptoms such as epigastric pain, nausea, vomiting and fullness. Group 2: 190 patients (169 men, 21 women; mean age 40.7 years; mean CD4 count 171.6 cell/mm(3)) with no dyspeptic symptoms. Results: Group 1: Gastrointestinal opportunistic infections were observed in eight (1.6%), and non-opportunistic parasites in two (0.4%), patients. They were: Cytomegalovirus (four patients), Cryptosporidium sp. (two patients), Schistosoma mansoni sp. (one patient), Strongyloides stercoralis (one patient) and Giardia sp. (two patients). In five patients esophagogastroduodenoscopy showed no mucosal lesions. Group 2: Giardia sp. was detected in two patients (1.1%: P = 0.07947). Conclusion: Gastrointestinal opportunistic infections were shown in a small number of HIV-infected patients under highly active antiretroviral therapy with advanced immunodeficiency. Although gastrointestinal opportunistic infections were detected exclusively in the dyspeptic patient group...

A Sustained Virologic Response Is Durable in Patients With Chronic Hepatitis C Treated With Peginterferon Alfa-2a and Ribavirin

SWAIN, Mark G.; LAI, Ming-Yang; SHIFFMAN, Mitchell L.; COOKSLEY, W. Graham E.; ZEUZEM, Stefan; DIETERICH, Douglas T.; ABERGEL, Armand; PESSOA, Mario G.; LIN, Amy; TIETZ, Andreas; CONNELL, Edward V.; DIAGO, Moises
Fonte: W B SAUNDERS CO-ELSEVIER INC Publicador: W B SAUNDERS CO-ELSEVIER INC
Tipo: Artigo de Revista Científica
ENG
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BACKGROUND & AIMS: A sustained virologic response (SVR) to therapy for hepatitis C virus (HCV) infection is defined as the inability to detect HCV RNA 24 weeks after completion of treatment. Although small studies have reported that the SVR is durable and lasts for long periods, it has not been conclusively shown. METHODS: The durability of treatment responses was examined in patients originally enrolled in one of 9 randomized multicenter trials (n = 1343). The study included patients who received pegylated interferon (peginterferon) alfa-2a alone (n = 166) or in combination with ribavirin (n = 1077, including 79 patients with normal alanine aminotransferase levels and 100 patients who were coinfected with human immunodeficiency virus and HCV) and whose serum samples were negative for HCV RNA (<50 IU/mL) at their final assessment. Patients were assessed annually, from the date of last treatment, for a mean of 3.9 years (range, 0.8-7.1 years). RESULTS: Most patients (99.1%) who achieved an SVR had undetectable levels of HCV RNA in serum samples throughout the follow-up period. Serum samples from 0.9% of the patients contained HCV RNA a mean of 1.8 years (range, 1.1-2.9 years) after treatment ended. It is not clear if these patients were reinfected or experienced a relapse. CONCLUSIONS: In a large cohort of patients monitored for the durability of an SVR...

Severe novel influenza A (H1N1) infection in cancer patients

HAJJAR, L. A.; MAUAD, T.; GALAS, F. R. B. G.; KUMAR, A.; SILVA, L. F. F. da; DOLHNIKOFF, M.; TRIELLI, T.; ALMEIDA, J. P.; BORSATO, M. R. L.; Abdala, Edson; PIERROT, L.; KALIL FILHO, R.; AULER JR., J. O. C.; SALDIVA, Paulo H. N.; HOFF, P. M.
Fonte: OXFORD UNIV PRESS Publicador: OXFORD UNIV PRESS
Tipo: Artigo de Revista Científica
ENG
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Patients and methods: Clinical data from all patients admitted with acute respiratory failure due to novel viral H1N1 infection were reviewed. Lung tissue was submitted for viral and bacteriological analyses by real-time RT-PCR, and autopsy was conducted on all patients who died. Results: Eight patients were admitted, with ages ranging from 55 to 65 years old. There were five patients with solid organ tumors (62.5%) and three with hematological malignancies (37.5%). Five patients required mechanical ventilation and all died. Four patients had bacterial bronchopneumonia. All deaths occurred due to multiple organ failure. A milder form of lung disease was present in the three cases who survived. Lung tissue analysis was performed in all patients and showed diffuse alveolar damage in most patients. Other lung findings were necrotizing bronchiolitis or extensive hemorrhage. Conclusions: H1N1 viral infection in patients with cancer can cause severe illness, resulting in acute respiratory distress syndrome and death. More data are needed to identify predictors of unfavorable evolution in these patients.; Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq); Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

ORAL MUCOSITIS PREVENTION BY LOW-LEVEL LASER THERAPY IN HEAD-AND-NECK CANCER PATIENTS UNDERGOING CONCURRENT CHEMORADIOTHERAPY: A PHASE III RANDOMIZED STUDY

de Lima, Aline Gouvea; Villar, Rosangela Correa; de Castro, Gilberto, Jr.; Antequera, Reynaldo; Gil, Erlon; Rosalmeda, Mauro Cabral; Honda Federico, Miriam Hatsue; Longo Snitcovsky, Igor Moises
Fonte: ELSEVIER SCIENCE INC; NEW YORK Publicador: ELSEVIER SCIENCE INC; NEW YORK
Tipo: Artigo de Revista Científica
ENG
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Purpose: Oral mucositis is a major complication of concurrent chemoradiotherapy (CRT) in head-and-neck cancer patients. Low-level laser (LLL) therapy is a promising preventive therapy. We aimed to evaluate the efficacy of LLL therapy to decrease severe oral mucositis and its effect on RT interruptions. Methods and Materials: In the present randomized, double-blind, Phase III study, patients received either gallium-aluminum-arsenide LLL therapy 2.5 J/cm(2) or placebo laser, before each radiation fraction. Eligible patients had to have been diagnosed with squamous cell carcinoma or undifferentiated carcinoma of the oral cavity, pharynx, larynx, or metastases to the neck with an unknown primary site. They were treated with adjuvant or definitive CRT, consisting of conventional RT 60-70 Gy (range, 1.8-2.0 Gy/d, 5 times/wk) and concurrent cisplatin. The primary endpoints were the oral mucositis severity in Weeks 2, 4, and 6 and the number of RT interruptions because of mucositis. The secondary endpoints included patient-reported pain scores. To detect a decrease in the incidence of Grade 3 or 4 oral mucositis from 80% to 50%, we planned to enroll 74 patients. Results: A total of 75 patients were included, and 37 patients received preventive LLL therapy. The mean delivered radiation dose was greater in the patients treated with LLL (69.4 vs. 67.9 Gy...

Epidemiology and predictors of a poor outcome in elderly patients with candidemia

Guimaraes, Thais; Nucci, Marcio; Mendonca, Joao S.; Martinez, Roberto; Brito, Ligia R.; Silva, Nivia; Moretti, Maria Luiza; Salomao, Reinaldo; Colombo, Arnaldo L.
Fonte: ELSEVIER SCI LTD; OXFORD Publicador: ELSEVIER SCI LTD; OXFORD
Tipo: Artigo de Revista Científica
ENG
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Background: Candidemia affects patient populations from neonates to the elderly. Despite this, little information is available about the epidemiology of candidemia in elderly patients. Methods: We performed a retrospective analysis of 987 episodes of candidemia in adults (>14 years of age) from the databases of three laboratory-based surveys of candidemia performed at 14 tertiary care hospitals. Patients aged >= 60 years were considered elderly (group 1, n = 455, 46%) and were compared to younger patients (group 2, n = 532, 54%) regarding demographics, underlying diseases, comorbidities, exposure to medical procedures, species, treatment, and outcome. Results: The median APACHE II score was significantly higher in the elderly patients (19 vs. 15, p = 0.03). Variables that were observed significantly more frequently in elderly patients included admission to an intensive care unit, diabetes mellitus, renal failure, cardiac disease, lung disease, receipt of antibiotics or H2 blockers, insertion of a central venous catheter, mechanical ventilation, and candidemia due to Candida tropicalis. The 30-day mortality of elderly patients was significantly higher than that of younger patients (70% vs. 45%, p < 0.001). Factors associated with higher mortality by multivariate analysis included APACHE II score and being in group 1 (elderly). Factors associated with mortality in elderly patients were lung disease and the receipt of mechanical ventilation. Conclusions: Elderly patients account for a substantial proportion of patients with candidemia and have a higher mortality compared to younger patients. (C) 2012 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

"Efeitos da visita médica nos pacientes da enfermaria da clínica geral do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo" ; Effects of the medical visit in patients of the infirmary of the general clinic of the Hospital of the Clinics of the College of Medicine of the University of São Paulo

Sancovski, Ana Rosa Kisielewski
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 29/05/2002 PT
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A forma de tratar os pacientes pode ser ensinada não somente pela teoria e prática formais, mas principalmente pelas atitudes do mestre e pela relação médico paciente que ele estabelece. O principal objetivo deste trabalho é avaliar os efeitos positivos ou deletérios da visita médica em grupo ao leito dos pacientes da Enfermaria da Clínica Médica Geral pois ela pode melhorar ou piorar a ansiedade e a depressão já contidas e instaladas no paciente e testar um modelo de visita médica hospitalar que priorize o paciente enquanto sujeito. Estudaram-se 95 pacientes com idades entre 16 e 65 anos, divididos em três grupos: um com 36 pacientes chamado G0 que passa visita na enfermaria mas não discute à beira do leito; outro com 34 pacientes chamado G1 que passa visita na enfermaria e discute à beira do leito e um novo, experimental, com 25 pacientes chamado G2, com visita na enfermaria e nova forma de discutir ao leito, com participação ativa do paciente em seu processo de recuperação . O Método utilizado foi: todos os pacientes, na véspera da visita, foram submetidos à escala HAD para medir ansiedade e depressão e à parte pré-visita do Questionário de Avaliação da Internação do Paciente da Clínica Médica Geral (QAIPCMG). No dia da visita...

Tradução para o português e validação de instrumento para triagem de pacientes em serviço de emergência: Canadian Triage and Acuity Scale (CTAS).; Translation into Portuguese and validation of a triage tool to be applied to patients in emergency department: Canadian Triage and Acuity Scale (CTAS).

Pires, Patrícia da Silva
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 10/02/2004 PT
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A triagem de pacientes em serviços de emergência constitui um campo de atuação para o enfermeiro, entretanto faltam instrumentos que possam ser utilizados para classificar a gravidade do paciente e a adequação de recursos ao seu atendimento. A finalidade deste estudo é obter um instrumento confiável que possa classificar as condições do paciente, melhorando a qualidade da assistência e diminuindo os riscos decorrentes da espera para o atendimento.O presente estudo teve como objetivo validar a escala de classificação de pacientes “Canadian Triage and Acuity Scale” (CTAS). Esta escala classifica o paciente em cinco níveis (1 a 5), respectivamente: situações de risco de vida, emergência, urgência, semi-urgência, não urgência. O instrumento foi submetido à tradução, versão à língua de origem, avaliação semântica, idiomática , cultural e conceitual. Após esta fase de validação, realizou-se a fase de confiabilidade interobservadores, entre a pesquisadora e duas enfermeiras voluntárias. A concordância expressa pelo índice kappa, foi de 0,739. Após esta etapa a pesquisadora avaliou 127 pacientes atendidos em um serviço privado, utilizando a CTAS. Houve predominância de pacientes classificados como nível 4 (46...

A evolução da lesão renal aguda em pacientes de terapia intensiva e o Neutrophil Gelatinese Associated Lipocalin (NGAL); The evolution of the acute kidney injury in critical care patients and the Neutrophil Gelatinase Associated Lipocalin (NGAL)

Silva, Gabriela Fulan e
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 19/12/2011 PT
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Introdução: A lesão renal aguda (LRA) ocorre em unidades de terapia intensiva (UTI), com incidência de 30%, enquanto que a incidência hospitalar é 3-5%. A mortalidade nestes pacientes, inalterada nas últimas décadas, varia entre 50 e 70%. O padrão clínico para diagnóstico da LRA é a dosagem da creatinina sérica, que é um método pouco sensível, tardio e incapaz de discriminar a gravidade da lesão. Esse fato compromete o uso de terapias efetivas em tempo hábil e não permite vislumbrar a evolução pós LRA. O reconhecimento da lesão renal precoce contribui para a prevenção de danos renais maiores. O NGAL, proteína presente no sangue e na urina proveniente da lesão de células tubulares renais, é capaz de detectar a LRA antes do aumento da creatinina, estabelece medidas de prevenção e tratamento logo após o insulto, indica o grau de severidade da lesão e sugere o início da terapia de substituição renal (TSR). Objetivo: Esse estudo visa caracterizar a evolução da função renal de pacientes com LRA baseados na classificação AKIN (Acute Kidney Injury Network) e no NGAL. Material e método: Estudo de coorte prospectivo consistindo de 83 pacientes internados em UTI, avaliados em relação ao fluxo urinário...

Avaliação dos efeitos da dexametasona sobre a incidência de disfunção cognitiva pós-operatória em idosos submetidos à anestesia geral; Evaluation of the effects of dexamethasone on the incidence of postoperative cognitive dysfunction in elderly patients undergoing general anesthesia

Valentin, Livia Stocco Sanches
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 12/01/2015 PT
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Introdução: Disfunção cognitiva pós-operatória (POCD) é um evento adverso multifatorial mais frequente em pessoas com idade superior a 60 anos ou doenças neurológicas e psiquiátricas. Este estudo avaliou o efeito da dexametasona sobre a incidência de POCD em idosos após cirurgia não cardíaca sob anestesia geral. Métodos: Cento e quarenta pacientes (ASA I-II, idade 60-87 anos) participaram deste estudo prospectivo, randomizado, envolvendo a administração ou não de 8 mg de dexametasona IV antes da indução anestésica para anestesia geral profunda ou superficial de acordo com o índice bispectral. Os testes neuropsicológicos foram aplicados no pré-operatório e em 3, 7, 21, 90 e 180 dias após a cirurgia e comparados com os dados normativos. Enolase específica do neurônio e S100beta foram avaliados antes e 12 horas após a indução da anestesia. A regressão linear com inferência baseada no método de equações de estimação generalizadas (GEE) foi aplicado, seguido pelo teste post-hoc de Bonferroni, considerando P <0,05 como significativo. Resultados: No terceiro dia pós-operatório, POCD foi diagnosticada em 25,2% dos pacientes que receberam a dose de dexametasona e anestesia profunda, 15,3% nos pacientes que receberam a dose da dexametasona e anestesia superficial...

The impact of a history of psychotic symptoms on cognitive function in euthymic bipolar patients : a comparison with schizophrenic patients and healthy controls; O impacto da história de sintomas psicóticos na função cognitiva de doentes bipolares eutímicos : comparação com doentes esquizofrênicos e controles saudáveis

Brissos, Sofia; Dias, Vasco Videira; Soeiro-de-Souza, Márcio Gerhardt; Martínez, Vicent Balanzá; Kapczinski, Flávio Pereira
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Artigo de Revista Científica Formato: application/pdf
ENG
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Introducao: Cerca de dois tercos dos pacientes com Transtorno Bipolar (TB) apresentam sintomas psicoticos ao longo da vida. Objetivo: Comparar o desempenho neurocognitivo de quatro grupos: pacientes com TB, com e sem historico de sintomas psicoticos (HPS+ ou HPS-, respectivamente); pacientes esquizofrenicos; e grupo controle (GC) com individuos saudaveis. Metodos: Estudo transversal no qual 35 pacientes com esquizofrenia (EZ), 79 pacientes com TB na fase eutimica (44 HPS+ e 35 HPS-) e 50 GC foram submetidos a extensa avaliacao neuropsicologica. Resultados: Observou-se pior funcionamento neurocognitivo em pacientes com TB e com EZ quando comparados ao GC. Os dois grupos de pacientes TB nao diferiram em dados demograficos, clinicos ou variaveis neurocognitivas. Entretanto o grupo HPS+ teve mais sintomas negativos mensurados pela Positive and Negative Syndrome Scale (PANSS) e apresentou uma tendencia a pior performance nas funcoes executivas comparativamente aos pacientes HPS-. Alem disso ambos os grupos de pacientes TB tiveram melhor desempenho em todos testes neurocognitivos quando comparados aos pacientes com EZ. Conclusoes: A disfuncao neurocognitiva e mais marcada nos pacientes com EZ do que com TB, apesar de ser qualitativamente similar. Um historico de sintomas psicoticos no TB nao associou esta amostra de pacientes eutimicos a um maior prejuizo neurocognitivo. Assim sendo...

Mandibular fractures: a comparative analysis between young and adult patients in the southeast region of Turkey

Atilgan,Serhat; Erol,Behçet; Yaman,Ferhan; Yilmaz,Nezih; Ucan,Musa Can
Fonte: Faculdade De Odontologia De Bauru - USP Publicador: Faculdade De Odontologia De Bauru - USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2010 EN
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OBJECTIVE: The purpose of this study was to review and compare the differences between mandibular fractures in young and adult patients. MATERIAL AND METHODS: Patients treated at the Oral and Maxillofacial Department of Dicle University during a five-year period between 2000 and 2005 were retrospectively evaluated with respect to age groups, gender, etiology, localization and type of fractures, treatment methods and complications. RESULTS: 532 patients were included in the study, 370 (70%) males and 162 (30%) females, with a total of 744 mandibular fractures. The mean age of young patients was 10, with a male-female ratio of 2:1. The mean age of adult patients was 28, with a male-female ratio of 3:1. The most common causes of injury were falls (65%) in young patients and traffic accidents (38%) in adults. The most common fracture sites were the symphysis (35%) and condyle (36%) in young patients, and the symphysis in adults (36%). Mandibular fractures were generally treated by arch bar and maxillomandibular fixation in both young (67%) and adult (39%) patients, and 43% of the adult patients were treated by open reduction and internal fixation. CONCLUSION: There was a similar gender, monthly and type of treatment distribution in both young and adult patients in the southeast region of Turkey. However...

O uso de imunossupressores e alterações menstruais em pacientes lúpicas; O uso de imunossupressores e alterações menstruais em pacientes lúpicas; The use of immunosuppressants and menstrual disorders in patients with lupus; The use of immunosuppressants and menstrual disorders in patients with lupus

NONATO, Dejan Rodrigues
Fonte: Universidade Federal de Goiás; BR; UFG; Mestrado em Ciências da Saúde; Ciências da Saúde - Medicina Publicador: Universidade Federal de Goiás; BR; UFG; Mestrado em Ciências da Saúde; Ciências da Saúde - Medicina
Tipo: Dissertação Formato: application/pdf
POR
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BACKGROUND: The Systemic Lupus Erythematosus (SLE) is an autoimmune disease that affects mainly women, and studies have shown that the use of immunosuppressants (IS) during SLE treatment may affect ovarian function. OBJECTIVES: This study aimed at the determination of possible associations in various IS therapeutic schemes and disturb in the ovarian function, through evaluation of menstrual cycle disturb and detection of premature ovarian failure in women with SLE. METHODS: A cross sectional study was conducted in 87 women, aged less than 40 years old that use IS in therapeutic scheme, as follows: prednisone, azathioprine, cyclophosphamide or methrotrexate, either alone or in a combination regime. The ovarian dysfunction was evaluated by the occurrence of menstrual disturbances such as hypermenorrhea, polymenorrhea, menorrhagia, oligomenorrhea, hypomenorrhea and amenorrhea and those diagnosed with premature ovarian failure. RESULTS: The values obtained by the study are expressed in years, mean and standard deviation. The age of the patients varied from 14 to 38 years old, with a mean age of 28.01 ± 5.81 years. The patients reached menarche between 10 and 19 years of age, with a mean age of 13.12 ± 1.77 years. The SLE diagnosis was established when the patients had between 10 and 35 years of age...

Aspects méthodologiques, mesure et facteurs associés à l’autonomie des patients utilisant les technologies de dialyse péritonéale à domicile

Moqadem, Khalil
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
FR
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La dialyse péritonéale (DP) est une thérapie d’épuration extra-rénale qui peut se réaliser à domicile par l’entremise d’une technologie. Elle exige, du patient certaines aptitudes, (motivation et compétence) et de l’équipe de soins, une organisation particulière pour arriver à une autonomie d’exécution de l’épuration. Dans un contexte de thérapie à domicile, comme celui de la dialyse péritonéale, le niveau d’autonomie des patients ainsi que les facteurs qui y sont associés n’ont pas été examinés auparavant. C’est l’objet de cette thèse. En se fondant sur la théorie de l’autodétermination et sur une revue de la littérature, un cadre conceptuel a été développé et fait l’hypothèse que trois types de facteurs essentiels pourraient influencer l’autonomie. Il s’agit de facteurs individuels, technologiques et organisationnels. Pour tester ces hypothèses, un devis mixte séquentiel, composé de deux volets, a été réalisé. Un premier volet qualitatif - opérationnalisé par des entrevues auprès de 12 patients et de 11 infirmières - a permis, d’une part, d’explorer et de mieux définir les dimensions de l’autonomie pertinente dans le cadre de la DP; d’autre part de bonifier le développement d’un questionnaire. Après validation...

An exploratory study for the discovery of non-invasive hepatocellular carcinoma biomarkers among high-risk hepatitis C virus infected patients

Abdalla, Moemen.
Fonte: Brock University Publicador: Brock University
Tipo: Electronic Thesis or Dissertation
ENG
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Hepatocellular Carcinoma (HCC) is a major healthcare problem, representing the third most common cause of cancer-related mortality worldwide. Chronic infections with Hepatitis B virus (HBV) and/or Hepatitis C virus (HCV) are the major risk factors for the development of HCC. The incidence of HBV -associated HCC is in decline as a result of an effective HBV vaccine; however, since an equally effective HCV vaccine has not yet been developed, there are 130 million HCV infected patients worldwide who are at a high-risk for developing HCC. Because reliable parameters and/or tools for the early detection of HCC among high-risk individuals are severely lacking, HCC patients are always diagnosed at a late stage where surgical solutions or effective treatment are not possible. Using urine as a non-invasive sample source, two different approaches (proteomic-based and genomic-based approaches) were pursued with the common goal of discovering potential biomarker candidates for the early detection of HCC among high-risk chronic HCV infected patients. Urine was collected from 106 HCV infected Egyptian patients, 32 of whom had already developed HCC and 74 patients who were diagnosed as HCC-free at the time of initial sample collection. In addition to these patients...

Chronic pain management in non-oncologic patients: multicentric study on adult patients referring to the centers for pain management in the Lazio Region (Italy); LA GESTIONE DEL DOLORE CRONICO NON ONCOLOGICO: STUDIO MULTICENTRICO SULLA POPOLAZIONE ADULTA AFFERENTE AI CENTRI DI TERAPIA DEL DOLORE NELLA REGIONE LAZIO

LATINA, ROBERTO
Fonte: La Sapienza Universidade de Roma Publicador: La Sapienza Universidade de Roma
Tipo: Tese de Doutorado
IT
Relevância na Pesquisa
35.85%
Introduction Chronic pain is a complex phenomenon usually associated with psychological stress, which implies falling back on the National Health Service and reducing work capacities, indeed affecting Activities of Daily Living. Studies based on efficacy have identified the multidisciplinary approach as the most effective means to obtain therapeutic results. These programs can be provided by the Centers for Pain Management (CPMs), where multidisciplinary teams are likely to provide the necessary expertise to outline the best treatments for the diagnosis and management of chronic pain. To date, very little information is available on the kind of assistance and support these centers can provide, as well as on the clinical and socio-demographic characteristics of patients who refer to these facilities. Aims The present investigation has the following objectives: • to describe what kind of assistance the centers for pain management (CPMs) in the Lazio Region are able to provide; • to describe the clinical and socio-demographic characteristics of the population referring to the CPMs; • to describe the type of pharmacologic, complementary and intervention treatments; • to describe the clinical characteristics of patients who turn to the two different levels of available assistance (hub and spoke system). Methods In 2011 a non-profit...

Die Versorgung Polytraumatisierter und Schädel-Hirn-Verletzter unter besonderer Berücksichtigung mund-, kiefer- und gesichtschirurgischer Verletzungen im Zeitraum vom 1. Juli 1998 bis 30. Juni 1999; Treatment of Polytrauma-Patients and patients with cranial and brain injuries especially maxillary mandibular injuries during the period from July 1st 1998 until June 30th 1999.

Jalil Sales, Mohammadreza
Fonte: Universidade de Tubinga Publicador: Universidade de Tubinga
Tipo: Dissertação
DE_DE
Relevância na Pesquisa
35.83%
Abstract Titel der Arbeit: Die Versorgung Polytraumatisierter und Schädel-Hirn-Verletzter unter besonderer Berücksichtigung Mund-, Kiefer- und Gesichtschirurgischen Verletzungen im Zeitraum vom 1. Juli 1998 bis 30. Juni 1999. Einleitung: Die vorliegende Arbeit soll eine Aussage darüber machen, wie die Versorgung polytraumatisierter Patienten mit zusätzlichen Mund-, Kiefer- und Gesichtschirurgischen Verletzungen an der Chirurgischen Klinik in Tübingen abläuft. Der Schwerpunkt lag auf der Klassifizierung von Verletzten unter besonderer Berücksichtigung der interdisziplinären Zusammenarbeit mit der Fachrichtung Mund-, Kiefer- und Gesichtschirurgie am Universitätsklinikum Tübingen. Material und Methodik: Im Zeitraum von 07/1998 bis 06/1999 wurden die Akten aller polytraumatisierten Patienten, die in die Chirurgische Universitätsklinik Tübingen transportiert wurden, analysiert. Von 104 erfassten Patienten zeigten 34 Mund-, Kiefer- und Gesichtsverletzungen. Insgesamt wurden 104 Patienten untersucht. Das durchschnittliche Alter betrug 36,4 Jahre. Ergebnisse: Von 34 Patienten mit Zahn-, Mund- und Kieferverletzungen hatten 16 Patienten Mittelgesichtsverletzungen, 4 Patienten Unterkieferverletzungen und drei dieser Gruppe eine Kombinationsverletzung von Mittelgesicht und Unterkiefer. 76 Patienten waren männlich (73%) und 28 weiblich (27%). Die meisten Unfälle passierten am Wochenende (19...

The prevalence of thyroid dysfunction in elderly cardiology patients with mild excessive iodine intake in the urban area of São Paulo

Duarte,Glaucia C.; Tomimori,Eduardo K.; Camargo,Rosalinda Y. A.; Rubio,Ileana G.S.; Wajngarten,Mauricio; Rodrigues,Amanda G.; Knobel,Meyer; Medeiros-Neto,Geraldo
Fonte: Faculdade de Medicina / USP Publicador: Faculdade de Medicina / USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2009 EN
Relevância na Pesquisa
35.82%
OBJECTIVES: To evaluate the prevalence of thyroid dysfunction in elderly cardiac patients in an outpatient setting. SUBJECTS AND METHODS: A total of 399 consecutive patients (268 women, age range 60-92 years) who were followed at Heart Institute were evaluated for thyroid dysfunction with serum free T4, TSH, anti-Peroxidase antibodies, urinary iodine excretion measurements and thyroid ultrasound. RESULTS: Hyperthyroidism (overt and subclinical) was present in 29 patients (6.5%), whereas hypothyroidism (overt and subclinical) was found in 32 individuals (8.1%). Cysts were detected in 11 patients (2.8%), single nodules were detected in 102 (25.6%), and multinodular goiters were detected in 34 (8.5%). Hashimoto's thyroiditis was present in 16.8% patients, most of whom were women (83.6%). The serum TSH increased with age and was significantly higher (p= <0.01) in patients, compared to the normal control group. No significant differences in serum TSH and free T4 values were observed when patients with atrial fibrillation (AF) where compared with those without arrhythmia. The median urinary iodine levels were 210 µg/L (40-856 µg/L), and iodine levels were higher in men than in women (p<0.01). Excessive iodine intake (urinary iodine >300 µg/L) was observed in one-third of patients (30.8%). CONCLUSIONS: Elderly patients have a higher prevalence of both hypo- and hyperthyroidism as well as thyroid nodules when compared with the general population. About one-third of the older patients had elevated urinary secretion of iodine and a higher prevalence of chronic Hashimoto's thyroiditis. It is recommended that ultrasonographic studies...

Mandibular fractures: a comparative analysis between young and adult patients in the southeast region of Turkey

Atilgan, Serhat; Erol, Behçet; Yaman, Ferhan; Yilmaz, Nezih; Ucan, Musa Can
Fonte: Universidade de São Paulo. Faculdade de Odontologia de Bauru Publicador: Universidade de São Paulo. Faculdade de Odontologia de Bauru
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; Formato: application/pdf
Publicado em 01/02/2010 ENG
Relevância na Pesquisa
35.82%
OBJECTIVE: The purpose of this study was to review and compare the differences between mandibular fractures in young and adult patients. MATERIAL AND METHODS: Patients treated at the Oral and Maxillofacial Department of Dicle University during a five-year period between 2000 and 2005 were retrospectively evaluated with respect to age groups, gender, etiology, localization and type of fractures, treatment methods and complications. RESULTS: 532 patients were included in the study, 370 (70%) males and 162 (30%) females, with a total of 744 mandibular fractures. The mean age of young patients was 10, with a male-female ratio of 2:1. The mean age of adult patients was 28, with a male-female ratio of 3:1. The most common causes of injury were falls (65%) in young patients and traffic accidents (38%) in adults. The most common fracture sites were the symphysis (35%) and condyle (36%) in young patients, and the symphysis in adults (36%). Mandibular fractures were generally treated by arch bar and maxillomandibular fixation in both young (67%) and adult (39%) patients, and 43% of the adult patients were treated by open reduction and internal fixation. CONCLUSION: There was a similar gender, monthly and type of treatment distribution in both young and adult patients in the southeast region of Turkey. However...