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Item Investigação da acalásia do esfíncter anal interno por meio da eletromanometria de pacientes chagásicos obstipados com e sem megacolo (Goiânia-Goiás-Brasil)(Universidade Federal de Goiás, 2012-02-02) ALMEIDA, Arminda Caetano de; MOREIRA, Marise Amaral Rebouças; http://lattes.cnpq.br/6390358577348486Chagas disease remains as an important public health challenge in South America. The Chagas colopathy is considered the second clinical digestive manifestation most common of the disease and constipation chronic, its main symptom. The general objective was to investigate the presence of achalasia, through electromanometry of the internal anal sphincter, in constipated chagasic patients with and without megacolon. This study evaluated clinical and electromanometry parameters of 64 patients with symptoms of constipation, attended on the service of coloproctologya on a university hospital in Brazil, central region. The achalasia was present in 91.3% (IC95% 74.13 to 98.52) of patients with megacolon and/or megarecto (Group 1), in 47.29% (IC95% 27.29 to 68.57) without megacolon and/or megarecto (Group2), and was not present in patients of the control group (Group 3). The rectal capacity was 309.1, 159.2 and 150.1 ml in the groups 1, 2 and 3 respectively. In conclusion the electromanometry detects achalasia of the internal anal sphincter in almost totality of patients with megacolon and/or megarecto. The megacolon presence in constipated patients with Chagas Disease alert to the possibility of occurrence of achalasia on the internal anal sphincter. In chronically constipated patients with positive serology for Chagas Disease, without megacolon the a finding of absence of the recto anal inhibitory reflex, by electromanometry, can definitively prove the Chagas colopathy, while the presence of reflection departs, at the time, this diagnosis, should these patients be followed and treated like other patients with constipation due to other causes The comparison of clinical manifestations in the three groups not evidenced differences that could distinguish patients with Chagas colopathy those with functional constipation, reaffirming the importance of holding the electromanometry in Chagasic and constipated patients.Item Desenvolvimento farmacotécnico e analítico de comprimidos revestidos de montelucaste: equivalência farmacêutica e bioequivalência(Universidade Federal de Goiás, 2011-03-18) ALVES, Carina Pimentel Itapema; LIMA, Eliana Martins; http://lattes.cnpq.br/7248774319455970Montelukast is a potent reversible selective inhibitor of cysteinilleukotrien- 1 receptor, avoiding that these mediators promote the asthmatic response. Its commercialization in Brazil, as a terminated product, is protected by patent up to 2010. Once the active ingredient Montelukast is recent in the pharmaceutical market and there is no methodology description in official compendiums capable to assure the quality of new formulations, the objective of this paper was the pharmaceutics of montelukast film coated tablets, the development and the validation of analytical and bioanalytical methodologies foreseeing the pharmaceutical equivalence and bioequivalence with the reference medication of the market. With this purpose, some physicalchemical parameters were characterized, assay and dissolution methodologies were developed and validated per high performance liquid chromatography with ultraviolet detection (HPLC-UV) for the quantification of montelukast present in 10.0mg film coated tablets. The quantification of montelukast sodium in human plasma was performed using Loratadine as internal standard and high performance liquid chromatography attached to mass detector (HPLC - MS / MS). The active ingredient was extracted from the human plasma using precipitation extraction. The results found for the parameters of specificity, linearity, accuracy, precision, quantification and detection limits and stability in the methodologies validation confirm they were adequate for the objective proposed. The analytical methodologies developed and validated were applied in the pharmaceutics of the tablets for the determination of the formulation similar to the market reference medication Singulair®. This formulation was submitted to stability assays to assure its quality and to allow the performance of pharmaceutical equivalence and bioequivalence with the purpose of registering as a generic medication.Item BEVACIZUMABE INTRA-VÍTREO: ANÁLISE DA TOXICIDADE RETINIANA APÓS 3 MESES EM OLHOS DE COELHOS NÃO ALBINOS(Universidade Federal de Goiás, 2009-06-19) ARRAES, João Carlos Diniz; ÁVILA, Marcos Pereira de; http://lattes.cnpq.br/3335187297522447Antiangiogenesis therapy has become a first-line treatment for neovascular age-related macular degeneration (AMD). Bevacizumab has proven to be efficient and cost effective, however its use in AMD is still off-label. PURPOSES: Evaluating the histological toxicity of bevacizumab on the neurosensorial retina (NSR) and the retinal pigmented epithelium (RPE) in pigmented rabbit eyes; evaluating if a fast increase in vitreous volume after a 0.1 ml balanced saline solution (BSS) intravitreal injection (IVI) in a rabbit eye will lead to histological damages in the NSR and RPE; and evaluating postoperative clinical complications after an IVI in rabbits eyes. METHODS: Eighteen pigmented rabbits (36 eyes) were divided into 4 groups a Control Group (3 rabbits - 6 eyes), which did not receive any IVI; the rabbits were sacrificed at the beginning of the study. Thirty eyes of the fifteen remaining rabbits were distributed to three groups: a sham group (S), that received a 0.1 ml balanced saline solution (BSS) IVI (ten eyes); group 1, that received a 1.25 mg (0.1 ml) bevacizumab IVI (ten eyes); and group 2, that received a 2.5 mg (0.1 ml) bevacizumab IVI (ten eyes). Postoperative clinical evaluation included inspection of the anterior segment and indirect binocular ophthalmoscopy. The rabbits were sacrificed 90 days after the procedure and both eyes of all the rabbits were enucleated. Histological examination of the NSR and RPE were performed and their morphological features and layer thickness were analyzed. RESULTS: No significant postoperative clinical complications were observed either in the neurossensorial retina or in the RPE. Histological morphology and thickness of the NSR and RPE layers did not differ significantly between BBS-injected eyes and bevacizumab-injected eyes. CONCLUSIONS: A rapid increase in vitreous volume, after 0.1 ml BSS IVI did not lead to any histological damage in the NSR and RPE in rabbit eyes. After a 90-day follow-up period, a single Bevacizumab 1.25 and 2.5 mg intravitreal injection did not lead any toxic damage in the NSR and RPE. No important postoperative complications in pigmented rabbit eyes were observed and it appears to be a safe procedure for the treatment of retinal neovascular diseasesItem Efeitos de um programa individualizado e supervisionado de exercícios para os músculos do assoalho pélvico em multíparas de parto vaginal(Universidade Federal de Goiás, 2012-04-16) ASSIS, Thaís Rocha; AMARAL, Waldemar Naves do; http://lattes.cnpq.br/4092560599116579This study consists of two scientific papers. The first aimed at investigating the effects of an individualized and supervised exercise program to strengthen pelvic floor muscles (PFM) in the postpartum period of multiparous women, and verify the correlation between two methods used to assess muscle strength. The second paper aimed at verifying the perception that puerperal women have regarding the alterations to their vaginal area and sex life after childbirth and after a PFM exercise program. To achieve these goals, an open clinical trial was performed on the first study, while the second conducted an exploratory and descriptive study. The final sample consisted of 23 puerperal women divided into two groups: intervention group (IG, n=11) and control group (CG, n=12). In IG, the puerperal women participated in an eight-week PFM exercise program, twice a week. In CG, the puerperal women did not receive any recommendations regarding exercises. PFM strength was assessed by digital vaginal palpation using the modified Oxford Scale and perineometer. The statistical analysis of the first article was performed using the following tests: Fisher s Exact Test, Chi-squared Test, Student s t-test, Kolmogorov Smirnov test for the two samples, and Pearson s Correlation Coefficient. Significance was defined as p < 0.05. On the second paper, categories were established and content analysis was performed. The participants mean age in IG was 24 ± 4.56 years, and 25.33 ± 4.03 years in CG (p=0.465). By completing the PFM exercise program, a significant difference was observed between the groups in the two muscle strength assessments (p0.001). The two methods used to assess muscular strength showed significant correlation in both assessments (1st assessment: r = 0.889 with p <0.001; 2nd assessment: r = 0.925 with p <0.001). In terms of the participants perception regarding any vaginal alteration in the late postpartum period, the most frequent reports in both groups were those related to the category perception of low vaginal tonus . Fourteen weeks into the postpartum period, at the end of the exercise program, the participants in IG presented more reports in the category perception of increased vaginal tonus and greater control over the PFM and those in the CG, in the category feels that the vagina is back in the same condition as before pregnancy . Finally, the exercise program resulted in a significant increase in PFM strength in puerperal women and showed positive effects on the perineal area and in the sex life of the participants. Good correlation was observed between digital vaginal palpation and perineometer, which indicates that vaginal palpation can be used in clinical practice, considering it is an inexpensive method that demonstrated significant correlation with an objective method, i.e. perineometer.Item Prevalência de problemas de saúde mental em populações de crianças e adolescentes indígenas Karajá da Amazônia brasileira(Universidade Federal de Goiás, 2012-03-14) AZEVÊDO, Paulo Verlaine Borges e; CAIXETA, Leonardo Ferreira; http://lattes.cnpq.br/9536747113677509Objective: To determine the prevalence of mental disorders in children and adolescents from an indigenous population living in isolated tribes in the Brazilian Amazon. Methods: This is an analytical prevalence study in a sample of 192 indigenous children and adolescents from Karajá ethnicity, aged between 7 and 14 years old. The prevalence were determined using the syndrome scales of mental health problems according to the ASEBA questionnaires. The Child Behavior Checklist 6-18 (CBCL) and the Teacher Report Form 6-18 (TRF) were used for the screening of these problems. The difference among the prevalence found in the two questionnaires as well as the risk association between gender and schooling and mental health problems were evaluated. Results: A total prevalence of problems of 34.38% with the CBCL and of 23.44% with the TRF was found (p < 0.00). There was an association between the occurrence of these problems in the subjects attending the second phase of fundamental school (6th to 9th year of formal education). Conclusion: The prevalence of mental health problems found was high when compared to studies with other cultures around the world. It was observed that even in human populations who preserve the primordial cultural aspects of their ancestors who lived 10.000 years ago, psychiatric problems exist and have clinical presentations that are similar to those found in modern civilized societies, in which the cultural context may influence the manifestations of such problems.Item Composição corporal e antropometria de idosos:concordância entre métodos, desenvolvimento e validação de equações preditivas e pontos de corte(Universidade Federal de Goiás, 2011-05-09) BARBOSA, Larissa Silva; SILVEIRA, Erika Aparecida da; http://lattes.cnpq.br/3801865783333828The aim of this study was to assess body composition and anthropometry of the elderly with regard to agreement between methods, development and validation of predictive equations and cutoffs. We evaluated 132 elderly patients (52 men and 80 women) aged between 60 and 91 years, users of primary health care, not institutionalized and drawn at random in proportion to the nine health districts of Goiânia, GO. For collection of anthropometric measurements, bioelectrical impedance (BIA) and dual energy x-ray absorptiometry (DEXA), standardized procedures were used by trained examiners and equipment was calibrated regularly. Analyses were performed using STATA/SE. Descriptive analysis, tests for comparison of means, equation validation according to criteria suggested by Lohman, Bland-Altman and Lin graphic analysis and ROC (receiver operator characteristic curve) analysis were carried out. The project was approved by the Ethics Committee of the Federal University of Goias. The Durnin and Womersley equation showed the highest concordance correlation coefficient (CCC = 0.846) and the lowest mean differences (MD = - 2.335) for males. The equations of Lean et al. (for men) and Deurenberg et al. (for women) showed the highest correlation with and lowest mean differences from DEXA. Equations were proposed to estimate body fat percentage (BF%): (males: BF% = - 16.868 + 0.571TSF + 0.409WC and females: BF% = 8.634 + 0.601BMI + 0.321SISF + 0.234SSSF + 0.398TSF 0.467BSF). In both sexes, the equations are similar to DEXA in estimating BF% with high precision and accuracy. In males, the proposed body mass index (BMI) cutoff point was ≥ 25 kg/m2; the waist circumference (WC) cutoff point was ≥ 98.9 cm. In women, the BMI and WC values with the most sensitivity, specificity and accuracy were ≥ 26.6 kg/m2 and ≥ 90.5 cm. Since the currently available equations for predicting body composition of elderly have certain limitations, these newly developed and validated equations for the two sexes can be recommended for wide use. Accurate BMI and WC cutoff points for predicting BF% in older adults were also identified.Item Estudo comparativo randomizado do tratamento da bexiga hiperativa com eletroestimulação vaginal e eletroestimulação transcutânea do nervo tibial posterior(PTNS)(Universidade Federal de Goiás, 2012-02-15) BERQUÓ, Marcela Souza; AMARAL, Waldemar Naves do; http://lattes.cnpq.br/4092560599116579INTRODUCTION: The overactive bladder syndrome (OAB) is a lower urinary tract pathology that negatively affects the quality of life (QOL) of women whose main symptom is your definition for urinary urgency, with or without incontinence usually accompanied by urinary frequency and nocturia in the absence of metabolic, infectious or local. The diagnosis of BH is defined from the clinical symptoms, but the voiding diary and urodynamic studies are good tools for objective evaluation of this pathology. There are several forms of treatment for OAB, are the main pharmacological and physical therapy, physical therapy has been being considered an important option in a clinical setting. OBJECTIVES: to do a systematic review article about physical therapy in the treatment of female miccional urgency, to evaluate and compare the effects, discomfort and improvement in quality of life (QOL) of vaginal electrostimulation and percutaneous tibial nerve stimulation (PTNS) in women with overactive bladder. METHODS: We conducted a comparative, prospective, randomized trial of physiotherapy in the sector of the Hospital Materno Infantil (HMI) in Goiânia-GO, from march 2010 to august 2011. We randomized 40 women with urodynamic diagnosis of detrusor overactivity, mixed incontinence with predominant symptoms of overactive bladder or urinary urgency only in two groups: vaginal electrical stimulation (n=20) and PTNS (n=20), being held 10 sessions in each group. We used urodynamic studies, voiding diary and QoL questionnaire of King's Health Questionnaire (KHQ) before and after the two procedures, and then visual analog scale. Statistical analysis used: Fisher exact tests, chi quadratic, U Mann Whitney and Wilcoxon tests with a significance level of 0.05. RESULTS: In voiding diary was a reduction in urinary frequency, urge incontinence, nocturia and urgency in both groups. The urgency was present in all women and disappeared in 90% in the PTNS group (p<0.001) and 80% in vaginal electrical stimulation (p<0.001). According to urodynamic evaluation, the group of vaginal electrostimulation showed disappearance of detrusor overactivity in 60% (p=0.005) and PTNS in 75% (p= 0.002). The urodynamics showed significant differences in some parameters analyzed within each specific group and to compare the two groups was not observed differences. The scale and the KHQ domains of the two procedures had similar results as physical therapy to improve QOL, but no significant difference between them. In relation to the discomfort of procedures, PTNS in 80% of women reported no discomfort and 80% reported vaginal electrostimulation mild to moderate discomfort (p<0.001). CONCLUSION: There was no significant difference in the effects and QOL between the vaginal electrical stimulation and PTNS. The PTNS promoted less discomfort for women.Item Estudo da Relação entre Hiperatividade dos Músculos Esfenomandibulares e dor ocular(Universidade Federal de Goiás, 2010-07-13) BORGES, Raulino Naves; ÁVILA, Marcos; http://lattes.cnpq.br/3335187297522447study was based on the hypothesis that a TMD can be the etiological factor in ocular pain and to test it the authors performed a clinical evaluation in TMD patients presenting with sphenomandibular muscle hyperactivity. The hypothesis is based on the fact that the muscle originates in the lateral aspect of the orbit, with a point of insertion in the mandible. It is an observational and descriptive study, characterized by: 1) an anatomical investigation performed in cadavers and 2) a clinical interpretation of the physiological relationship between sphenomandibular muscle functions and symptoms involving temporomandibular disorders presenting with ocular pain. Ten anatomical specimens (five cadavers) from the Anatomy Department of the School of Medicine of the Catholic University of Goiás were examined. One hundred three patients with temporomandibular disorders (TMD) were treated and followed in the Outpatient Clinic of the School of Dentistry of the Federal University of Goiás for the purpose of studying the interrelationship between cervical and craniofacial pain symptoms and craniomandibular disorders. The work was carried out in the Outpatient Clinic of the School of Dentistry of the Federal University of Goiás, between April 2006 and December 2008. Inclusion criteria, used to form Group I, totaling 58 patients, included temporomandibular disorders, referred ocular pain and sphenomandibular muscle hyperactivity. Group II comprised 45 patients who did not present with sphenomandibular muscle hyperactivity. All the patients received treatment for Temporomandibular Disorder (Groups I and II) and were followed for two years, with biannual evaluation visits. Response to treatment was evaluated by means of an opinion-based questionnaire that served to stratify the level of ocular pain, which was reported as eliminated in 46 of the 58 patients in Group I (79.3%) and in eight Group II patients (17.8%). This evaluation has made it possible for the authors to affirm that the sphenomandibular muscle is independent from the temporal muscle and is closely related to the orbit; the clinical examinations conducted along the study enabled the evaluation of sphenomandibular muscle hyperactivity in temporomandibular disorder episodes; and this hyperactivity is significantly associated to the presence of referred ocular pain.Item Adesão de pessoas adoecidas de AIDS (Síndrome da Imunodeficiência Adquirida) à terapia antiretroviral: estudo clínico e laboratorial à partir da orientação de Enfermagem(Universidade Federal de Goiás, 2011-02-21) BRASILEIRO, Marislei de Sousa Espíndula; CUNHA, Luiz Carlos da; http://lattes.cnpq.br/6349547031976679Adherence to antiretroviral therapy reduces the risk of treatment failure, toxicity and resistance, so the therapeutic monitoring is necessary in the treatment of infection by human immunodeficiency virus. The aim of this study was to determine, through clinical and laboratory studies, the compliance of individuals sickened by HIV / AIDS with antiretroviral therapy before and after three nursing interventions. The study design was analytical, descriptive, prospective and quantitative, using data from medical records, interviews and blood sampling for plasma levels of efavirenz by HPLC analysis, including subjects with a diagnosis of HIV / AIDS, attended at the Hospital for Diseases Tropical Goiânia - Goiás and treated with zidovudine/ lamivudine and efavirenz. The results of analysis of data from 15 subjects indicate a socio-demographic profile, predominantly male, young, heterosexual. After nursing intervention, there was a change in 48% of the diagnoses. We also noticed a positive change in the rates of CD4, corresponding to 14%. As viral count, an increase of subjects with undetectable loads of 1 st to 2 nd nursing intervention (20%, or 73.3% to 93.3%). Chromatographic analysis of plasma of the subjects indicated that 60% of them had adequate medication adherence, and 40% increased adhesion between the 1st and 2nd visits by nurses, 10% between the 1st and 3rd and 10% between the 2nd and 3rd queries. The factor that was associated with high concentration rate after adjustment in nursing diagnoses and prescriptions was having difficulty using the antiretroviral in the same time. It was also demonstrated significant difference between mean plasma concentrations of efavirenz from the 1st, 2nd and 3rd interventions. Considering the reference measurement of plasma concentrations of efavirenz, the method of accession had a sensitivity and specificity, with high proportion of agreement between the rate of CD4, nursing diagnosis and analysis of the plasma of subjects. Conclusions: the systematization of nursing care and determination of plasma concentrations should be incorporated into the routine outpatient care, for better monitoring of adherence to antiretroviral therapy of individuals sickened by HIV / AIDS.Item Aspectos Inflamatórios e Imunológicos de Pulpites Dentárias Humanas(Universidade Federal de Goiás, 2009-09-18) BRUNO, Kely Firmino; ESTRELA, Carlos; http://lattes.cnpq.br/3611967334176683Immune and inflammatory cells may contribute to host defense and microenvironmental changes during the pathogenesis of dental pulpitis. This study evaluated the microscopic characteristics and densities (per mm2) of tryptase+ mast cells, CD4+ T helper lymphocytes, CD45RO+ memory T lymphocytes, foxp3+ T regulatory lymphocytes, CD20+ B lymphocytes, CD68+ macrophages, and CD31+ blood vessels in human dental pulpitis (n = 38). Methods: Tryptase, CD4, CD45RO, foxp3, CD20, CD68, and CD31 expressions were analyzed using immunohistochemistry; other microscopic features, such as intensity of inflammatory infiltrate and collagen deposition, were evaluated after staining with hematoxylin and eosin. Results: Two microscopic patterns of dental pulpitis were found: group 1 (G1) (n = 15) showed intense inflammatory infiltrate and mild collagen deposition; conversely, group 2 (G2) (n = 23) showed scarce inflammatory infiltrate and intense collagen deposition. The numbers of CD68+ and CD20+ cells and the density of blood vessels were higher in G1 than in G2. However, there were no differences in CD4+ and CD45RO+ cell densities between groups. When present, mast cells were equally distributed in G1 and G2, whereas foxp3+ cells were detected in 58.82% and 14.28% of the samples of G1 and G2. Conclusions: Immune and inflammatory cell infiltration have different patterns in human dental pulpitis, which might reflect distinct microscopic characteristics and particular local defense capabilities.Item Avaliação de citocinas na secreção endocervico-vaginal de pacientes com vaginose bacteriana e papilomavírus humano(Universidade Federal de Goiás, 2011-03-09) CAMPOS, Ana Claudia Camargo; REIS, Cleomenes; http://lattes.cnpq.br/5103786277121402The vagina and the cervix are the first immune and physical line of defense against sexually transmitted pathogens. However infectious process in the vagina, caused by potentially pathogenic microorganism such as bacterial vaginosis (BV), are very often. This may be associated with a morbid entity as Human Papillomavirus (HPV). It was evaluated the association between the presence of BV and HPV in the lower female genital tract, identifying the clinical and lab aspects in women who received medical attention at emergency rooms in the city of Goiânia-GO and observed the production of cytokines in endocervical secretions in cases with VB associated with HPV. This study included 173 sexually active women, between 16 and 48 years old, divided into groups: control, with BV and with high and low risk of HPV. A survey was conducted to collect the intrinsic and extrinsic factors associated with the patients. Microbial cultures, vaginal pH, identification of high and low risk of HPV by PCR, and the concentration of cytokines were performed. The result of the research data was submitted to a statistical analysis, calculating the oods ratio, confidence intervals and p of 0,05. Forty seven cases of BV were diagnosed. Besides, the presence of a vaginal pH > 4.5, showed a result statistically significant for the presence of HPV, p = 0.001 was also observed. When analyzing the multivariate logistic regression, the independent risk factors for the presence of VB were: having more than one sexual partner in the last 5 years p<0,001 and have more than 3 sexual intercourses per week p=0,002. But in HPV infection the independent risk factors were: being married p=0,029 and pH ≤ 4.5 p<0,001 and in the case of high-risk HPV the only independent factor considered was the pH ≤ 4.5 p= 0,006. Relating HPV infections with high and low risk and the presence of VB with some immune factors by the strength of local cytokines, it was found that, IL-2 and IL-12 were significantly elevated in cases of BV and HPV. The IL-6 was high only for HPV, followed by IFN-gamma and IL-10 although the last two showed a trend towards statistical significance in HPV cases. It was concluded through the univariate analysis that the factors, having more than one sexual partner in the last 5 years, a failure in the use of condoms and the presence of leucorrhoea and dyspaurenia were related to the presence of BV and level of alkaline in the vagina which could possibly predispose to infections HPV, and the immune response Th1-type cytokines in vaginal secretions in the presence of BV and/or HPV may also be similar.Item Efeito da dextrina de trigo na sensibilidade à insulina e estado nutricional de indivíduos com Diabetes Mellitus tipo 2(Universidade Federal de Goiás, 2012-02-27) CARVALHO, Ana Clara Martins e Silva; SILVA, Maria Sebastiana; http://lattes.cnpq.br/1329422634395496Introduction: The dietary fiber, particularly soluble, are assigned the physiological effects that are important for the treatment of patients with type 2 diabetes mellitus. Objective: To evaluate the effect of supplementing wheat dextrin in insulin sensitivity, glycemic control and lipid, and nutritional status of patients with type 2 diabetes mellitus. Methodology: This is a trial blind, randomized, lasting 12 weeks.The sample consisted of 27 type 2 diabetic subjects of both sexes with a BMI ≥ 25.00 kg/m2 and sedentary. These subjects were randomized into two groups, test (n = 14) and placebo (n = 13). The test group was supplemented daily with 200 ml of orange flavor beverage without the addition of sugar and added 10 g of wheat dextrin, 30 minutes before the lunch. The control group received the same drink daily, but without the addition of fiber. Participants were instructed to maintain their lifestyle (diet and physical activity). Fasting plasma glucose, glycated hemoglobin (A1c), insulin sensitivity, lipid profile, the level of physical activity, intestinal function, food intake, and anthropometric indicators were assessed at baseline, 45 and 90 days intervention. Results: The A1c, fasting glucose and lipid profile showed no significant differences within and between groups. There was an increase in the values of HOMA-IR (p = 0.0163) and fasting insulin (p = 0.0406) at 45 days in the placebo group, with significant difference. The increase in HOMA-IR and fasting insulin resulted in decreased insulin sensitivity in the placebo group. In the test group showed no changes in insulin sensitivity. The test group showed improvement in bowel function. The fiber intake was below the recommendation for the diabetic.Food intake, body weight, BMI and waist circumference (WC) also showed no significant change. The percentage of body fat increased in the placebo group at 45 days (p = 0.0342) and decreased in the test group compared to placebo (p = 0.0216 and 0.0285). The basal metabolic rate (BMR) increased in the test group and decreased in placebo (p = 0.0198 and 0.005). Conclusion: Wheat dextrin in 10g/dia dosage did not improve insulin sensitivity, glycemic control and lipid, did not reduce body weight and WC and does not cause changes in the consumption of energy and macronutrients. There was increased consumption of fiber for the minimum of the recommendation, regulate bowel function, reduced body fat and increased the BMR.Item Encontro clínico no modelo biopsicossocial: autopercepção dos acadêmicos de medicina da Pontifícia Universidade Católica de Goiás(Universidade Federal de Goiás, 2010-11-30) CARVALHO, Gélcio Sisteroli de; CHAVES, Sandramara Matias; http://lattes.cnpq.br/8215617614854729; PORTO, Celmo Celeno; http://lattes.cnpq.br/9673684282497548Introduction: The Pontifical Catholic University of Goiás pedagogical project for its medical course has stemmed from a thirty year long dream. It came into existence in 2005 following the authorization granted by the National Council of Education after the homologation of the National Curricular Guidelines. The present study shows the need to further investigate the development of assessment processes which are used to identify, follow and materialize changes in medical training. The theory used lies on the possibility of quantifying the medical performance in the patient-physician encounter. Objective: to evaluate some components of the patient-physician encounter based on biopsychosocial model; to create an assessment tool to measure the self-perception of this encounter; to test the effectiveness of this tool in this scenario; and to quantify the category variables of the research in a Pontifical Catholic University of Goiás medical course. Materials and Methods: This was a quantitative, longitudinal and cohort study. The study group presented 39 medical students from 5th Class of the Pontifical Catholic University of Goiás Medical School Course and the investigation was divided into two stages with a year interval between the application of the required academic protocols preceded by a medical semiological conclusion. The dimensions under observation were the following: biomedical, cognitive, ecosystemic, psychological and bioethical. The assessment tool was designed to present 5 dimensions,18 facets and 72 indicators, divided into groups of four alternatives per facet, scaled in degrees 0,1,2 or 3. The higher the degree, the higher the complexity of the biopsychosocial model represented by the software program developed by the researcher called Project 2. Introduction: The Pontifical Catholic University of Goiás pedagogical project for its medical course has stemmed from a thirty year long dream. It came into existence in 2005 following the authorization granted by the National Council of Education after the homologation of the National Curricular Guidelines. The present study shows the need to further investigate the development of assessment processes which are used to identify, follow and materialize changes in medical training. The theory used lies on the possibility of quantifying the medical performance in the patient-physician encounter. Objective: to evaluate some components of the patient-physician encounter based on biopsychosocial model; to create an assessment tool to measure the self-perception of this encounter; to test the effectiveness of this tool in this scenario; and to quantify the category variables of the research in a Pontifical Catholic University of Goiás medical course. Materials and Methods: This was a quantitative, longitudinal and cohort study. The study group presented 39 medical students from 5th Class of the Pontifical Catholic University of Goiás Medical School Course and the investigation was divided into two stages with a year interval between the application of the required academic protocols preceded by a medical semiological conclusion. The dimensions under observation were the following: biomedical, cognitive, ecosystemic, psychological and bioethical. The assessment tool was designed to present 5 dimensions,18 facets and 72 indicators, divided into groups of four alternatives per facet, scaled in degrees 0,1,2 or 3. The higher the degree, the higher the complexity of the biopsychosocial model represented by the software program developed by the researcher called Project 2.Results: Through a circular radial profile with a central point and three areas with crescent spirals graded by differing shades of colors, we have been able to represent the clinical encounter, using the individuals self-perception. The results showed the effectiveness of the software, following a quality control process across all responses. We have used descriptive statistics to mathematically analyze the increase in the study group performance, and compare the responses in percentages in the two stages of the study. We have found a weak association between the category variables (facets) using the Chi-square ratio with the Cramer s-V Coefficient, except for the following facets: Critical Analysis(p 2 = 0,002); Social Health Indicators (p 2 = 0,007); e Health Promotion (p 2 = 0,049). As for individual self-perception, having the facet responses as a reference, 26 subjects (66,7%) showed growth in the formation process; 6 (15,4%) showed decrease and 7 (17,9%) remained unaltered. Conclusion: Through the use of the academic protocol and the biopsychosociallybased patient-physician self-perception assessment tool we have been able to quantitatively assess the academic performance as to knowledge, skills and medical attitudes displayed in the interaction of the physician with the patient. The selfperception assessment tool designed to graphically represent such encounters was put to test and has fulfilled all its objectives. The evaluation of the study group evidentiated some biopsychosocially practices in the pedagogical process used by the Pontifical Catholic University of Goiás Medical School. After a year interval between the stages of the study, an increase was observed in the self-perception of the individuals performance 2,9 times as high as the decrease responses. A long-term application of our findings include opportunities to use this methodology for an on-going self-evaluation of the medical students, provide insights about individual performance in the different stages of the medical training, create a new scenario in the academic portfolios as an evaluation and curricular history resource, and finally adjust the assessment tool so that it could be used by other courses and professionals in the health area working in clinical settings.Item Qualidade de vida de pacientes hipertensos de um centro de referência no tratamento de hipertensão arterial(Universidade Federal de Goiás, 2012-04-11) CARVALHO, Maria Virgínia de; SOUSA, Ana Luiza Lima; http://lattes.cnpq.br/6578713509935374; JARDIM, Paulo César Brandão Veiga; http://lattes.cnpq.br/2292209583823133INTRODUCTION: Systemic Arterial Hypertension (SAH) is one of the main cardiovascular risk factors, with high prevalence in almost every country. Studies have shown the negative effect of SAH on health-related quality of life (HRQL). OBJECTIVES: To evaluate the quality of life of hypertensive patients compared to the general population. METHODS: The study included patients of both sexes over 18 years of age. The EG, consisting of medicated patients enrolled in a multi-disciplinary SAH treatment service, responded to two HRQL evaluation instruments: one, the SF-36, was generic, and the other, MINICHAI-Brasil, was specificSAH treatment service, responded to two HRQL evaluation instruments: one, the SF-36, was generic, and the other, MINICHAI-Brasil, was specific. In the CG, consisting of normotensive individuals from the community, only the SF-36 was administered. For statistical analysis, the chi-square, Komogorov-Smirnov, Mann Whitney and Kruskal-Wallis tests and multivariate analysis were used. SPSS was used to analyze the data and p values <0.05 were considered significant. RESULTS: The groups were homogeneous with regard to age, sex, ethnic group, education level and marital status. Normotensive individuals had higher HRQL scores than hypertensives on the SF-36 in all domains. There was no significant difference between the study and control groups in regard to the emotional aspect EA (p=0.36). On the MICHAL-Brasil, SAH significantly affected HRQL in the mental state (MS) domain and least affected younger individuals with more schooling and higher income living with a partner. CONCLUSION: Although SAH is considered to be a silent and asymptomatic disease, it affects HRQL and is apparently associated with psycho-social factors and conditions.Item Avaliação da eficácia da dilatação com cateter-balão (dacrioplastia) para o tratamento das obstruções congênitas do ducto lacrimonasal(Universidade Federal de Goiás, 2010-06-29) CARVALHO, Roberto Murillo Limongi de Souza; ÁVILA, Marcos; http://lattes.cnpq.br/3335187297522447The most common etiology for congenital epiphora is the obstruction of the lacrimonasal duct. Congenital obstruction of the lacrimonasal duct (CLNDO) is the most frequent abnormality of the lacrimal sac of the child. It s incidence varies from 1.8% to 20%. The purpose of this study was to evaluate the efficacy of lacrimonasal duct dilatation using balloon-catheter for treatment of CLNDO in children between two and six years old. Besides, to evaluate the anatomical findings of lower lacrimal system of children with CLNDO using multi-detectors computerized tomography dacryocystography (MD-CT-DCG) with three dimension (3D) reconstruction, before and after the balloon-catheter dilatation. This was a prospective interventional case series study, performed with children treated at the Centro de Referência em Oftalmologia (CEROF) from the Universidade Federal de Goiás, with CLNDO. The cases were selected consecutively accordingly with the demand of the service. Thirthy-eight lacrimal systems from 29 children with CLNDO were included and treated with balloon-catheter dilatation. The age varied from 24 to 64 months, with average of 38.13 ± 11.26 months. Among the 38 lacrimal systems treated, 33 had complete resolution of the signs and symptoms of epiphora (success rate of 86.84%). A radiological study from the last 18 operated lacrimal systems was performed before and five minutes after balloon-catheter dacrioplasty. The circumference of the largest portion of lacrimal system, measured before the procedure, varied from 0.64 to 2cm with an average of 1.30 ± 0.45cm. The amount of contrast prior to the procedure varied from 0.01 to 0.38cm3, with an average of 0.12 ± 0.08cm3. The amount of contrast after the procedure varied from 0.01 to 0.20cm3, with an average of 0.07 ± 0.06cm3 (p = 0.01). The multivariate logistic regression analysis ( backward" model) showed that the difference in the amount of contrast before and after the procedure (p=0,04) and the largest portion of lacrimal sac (p=0,01) were the variables determining for the success of the procedure. There were no complications with the procedure. In conclusion, the balloon-catheter dilatation was proved to be effective as the first procedure in the vast majority of children with CLNDO. The technique of MD-CT-DCG-3D provides detailed information about the anatomy of the lacrimal system, including the lacrimal flow immediately after the dilatation. The difference in the amount of contrast before and after the procedure and the largest portion of lacrimal sac were the variables determining for the success of the procedure.Item Qualidade de vida das pessoas surdas que se comunicam pela língua de sinais: construção da versão em libras dos instrumentos WHOQOL-BREF e WHOQOL-DIS(Universidade Federal de Goiás, 2011-11-29) CHAVEIRO, Neuma; BARBOSA, Maria Alves; http://lattes.cnpq.br/5025797873585225; PORTO, Celmo Celeno; http://lattes.cnpq.br/9673684282497548Introduction: The evaluation of the quality of life of the deaf community is limited by the difficulties of communication in the oral and written language, thence the necessity of developing reliable instruments in sign language with methodological strictness that includes particular characteristics of the deaf people. Among the cultural lines of the deaf community, sign language is the most emphasized one: besides being a linguistical system, it is an element of constitution of the deaf person identity. In Brazil, it is legally assured the deaf the right to communicate in his natural language, that is, Brazilian Sign Language (LIBRAS), with no imposition of the usage of the majority language of the country. This doctoring thesis is part of the WHOQOL-LIBRAS project, a result of a partnership between Federal University of Goiás, World Health Organization and Brazil´s WHOQOL group in Federal University of Rio Grande Do Sul. In order to perform the WHOQOL-LIBRAS project, it was divided into two sub-projects with distinct but interdependent stages: Project 1 - Construction of the WHOQOL-BREF and WHOQOL-DIS versions in LIBRAS; Project 2 - Application/validation of the WHOQOL-BREF and WHOQOL-DIS instruments in the LIBRAS version. This thesis comprises Project 1. General Objective: Build the LIBRAS version of the WHOQOL-BREF and WHOQOL-DIS instruments to evaluate the brazilian deaf community quality of life. Methods: A transversal and exploratory study, designing based in the Methodological Research. The methodology proposed by the World Health Organization was used and adapted to the deaf community, and in accordance with the criteria established with Brazil WHOQOL group, the accomplishment of the project was divided into 13 phases: 1. creation of the QUALITY OF LIFE sign; 2. development of the answer scales in LIBRAS; 3. translation by a bilingual group; 4. recouncilling version; 5. first retrotranslation; 6. production of the version in LIBRAS to be provided to the focal groups; 7. realization of the Focal Groups; 8. review by a monolingual group; 9. revision by the bilingual group; 10. semantic/syntactic analysis and second retrotranslation; 11. re-evaluation of the retrotranslation by the bilingual group; 12. recording the final version into the software in studio; 13. software development of the WHOQOL-BREF and WHOQOL-DIS instruments into the LIBRAS version. Results: Peculiar characteristics of the deaf people culture pointed to the necessity of adaptations in the application methodology of focal groups when it is compound by deaf people. The writing conventions of the signed languages are yet not consolidated, thus, some difficulties were faced in graphically register the translation phases of Portuguese into LIBRAS. Linguistics structures that caused major problems in translation were those that included portuguese idiomatic expressions, for many of them are no equivalent concepts between Portuguese and LIBRAS. In the end, it was possible to build up a WHOQOL-BREF and WHOQOL-DIS software in LIBRAS. Conclusion: The WHOQOL-BREF and the WHOQOL-DIS in LIBRAS will allow the deaf to express about the quality of life in an autonomous way, and this will make possible to investigate more accurately the issues of deaf people quality of live. Besides, the WHOQOL-BREF and the WHOQOL-DIS in LIBRAS will be part of the World Health Organization instruments for evaluating quality of life.Item Mamografia: infraestrutura, cobertura, qualidade e risco do câncer radionduzido em rastreamento oportunístico no estado de Goiás(Universidade Federal de Goiás, 2012-04-10) CORRÊA, Rosangela da Silveira; PEIXOTO, João Emilio; http://lattes.cnpq.br/9897171879507189; FREITAS JÚNIOR, Ruffo de; http://lattes.cnpq.br/7343840830786566Among the available methods for the diagnosis and early detection of breast cancer, the most indicated for mass screening is the mammography. To guarantee its effectiveness, this exam needs to be performed using high quality standards and the lowest radiation dose possible. Therefore, the present research aimed to assess the infrastructure and performance of the equipments available at the mammography services in the state of Goiás, regarding coverage, quality, and radiological protection (dose) of patients, in order to provide early detection of breast cancer by an opportunistic screening. A prospective study was carried out, from 2007 to 2010, to observe the diagnostic imaging services which perform mammography, initially for the Brazilian Unified National Health System (SUS) and, in 2010, the services of the private system were included. Data collection was divided into two phases: the first, to collect information on infrastructure and the second, to apply tests in order to evaluate the performance characteristics of equipment and materials used. We calculated the conformity of the assessed items in terms of quality of image and equipment performance and estimated the average dose in glandular tissue and the risk of radioinduced carcinogenesis, as well as the risk of mortality by radioinduced tumors. The results were presented in four articles. In the first, we showed that mammography coverage in the state of Goiás in 2008 was 66% among women in the 50 69-year age group, considering biennial mammography. In the second article, we concluded that the implementation of the Mammography Quality Control Program was effective to achieve better quality mammography in SUS services. In the beginning of our research, only 2.9% of SUS services were within the desired range of quality and, after two interventions (2008 and 2009), 20% of them reached it. The results of the third article, in which we verified the infrastructure and quality of services performing mammography, both for SUS and private systems, showed no difference in quality of exams between them. However, the evaluation between types of technology used showed difference between radiation doses (p < 0.001) applied during mammography. In the fourth article, we estimated the benefit risk balance of screening mammography carried out in the state of Goiás in 2010. The excess absolute risk of radioinduced cancer and the lifetime risk presented significant difference for types of technology (p < 0.001) and types of health system (p < 0.019) according to the age group of screening. The ratio lives saved/lives lost was 75.5/1 for screening at the 40 70-year age group and 166.5/1 at the 50 70-year age group. The results showed that coverage of the 50 69-year age group in the state of Goiás is near the recommended standards for the beginning of organized screenings. However, when assessed per regional health unit, coverage was non-uniform, presenting high concentration of equipments and exames at the Central Regional. The initial evaluation of equipment performance indicated the need to implant actions for controlling mammography quality and risk. The actions of the Mammography Quality Control Program proved to be effective to enhance the quality of mammography, although the same does not remain true for the radiation dose used in mammography. These doses are lower in conventional mammography equipments than in those coupled to image digitization systems. Regarding radiological protection, screening women who are 50 70 years old, when performed biennially using conventional mammography equipments, presented more benefit.Item Influência da alimentação no ganho de peso materno e fetal(Universidade Federal de Goiás, 2012-05-14) COSTA, Bárbara Miranda Ferreira; PAULINELLI, Régis Resende; http://lattes.cnpq.br/8580274630880562; BARBOSA, Maria Alves; http://lattes.cnpq.br/5025797873585225Introduction: The excessive gestational weight gain can cause harmful consequences for both the mother and for the fetus. The feeding of the pregnant women may be responsible for this weight gain above the recommendations. Objectives: to evaluate the techniques for control of the weight gain during pregnancy, the food groups related to an increased weight gain during pregnancy and the association between gestational weight gain and fetal birth weight. Methods: Article 1: a systematic review of the techniques used to control weight gain. The Medline, Scielo, Pubmed and Cochrane databases were evaluated between November and December 2011 for the selection of randomized trials on the control of maternal weight gain in healthy pregnant women. Articles 2 and 3: case-control and cohort studies that included 200 low-risk pregnant women in two public obstetric hospitals in Goiás, Brazil. The women that agreed to this study were divided in two groups: cases with excessive weight gain (> 16Kg) and controls within the recommended weight gain for eutrophic pregnant (11.50 < a < 16Kg), matched on age. The women were inquired about their food intake during the gestational period, by means of a quantitative and qualitative food-frequency questionnaire validated and adapted to the low income regional people. The software for statistical analyze were the SPSS version 17.0. Were used the folowing tests: Kolmogorov-Smirnov, Fisher, Student´s t, chi-square (x²), Mann-Whitney and Spearman´s correlation coefficient. Results: Article 1: among the techniques applied by the authors highlight individualized dietary prescription, general dietary guidelines, frequent consultations with a nutritionist or doctor, and physical activity. Article 2: the median age was 25.00 (22.00-29.00) years-old for cases and 24.00 (22.00-28.00) years-old for controls (p=0.52). The educational level was quite similar in the studied sample, and the median in the case group was 10.50 (9.00 to 12.00) years and 11.00 in controls (9.00 to 12.00) years (p=0.77). The median per capita income was 0.85 (0.56 1.20) for the cases and 0.80 (0.48 1.18) for controls (p=0.37). The group of sugar and sweets (p=0.04) was associated with greater weight gain during pregnancy. Conclusion: The articles analyzed recommend the association of different control techniques to gain weight satisfactorily and still gets early prenatal care and the introduction of these measures. Among the food groups studied, the excessive consumption of sweets was associated with greater weight gain among pregnant women. There is a direct association between excessive maternal weight gain and the fetal birth weight and a high incidence of macrosomia.Item Fatores de virulência de isolados de Candida de pacientes imunocomprometidos. Caracterização molecular de Candida albicans suscetíveis e resistentes ao fluconazol(Universidade Federal de Goiás, 2009-06-02) COSTA, Carolina Rodrigues; SILVA, Maria do Rosário Rodrigues; http://lattes.cnpq.br/7119226630434725Adhesion to host tissues, production of hydrolytic enzymes, the resistance to antifungals and ability to production hyphal interfere in the infectious process caused by Candida. Resistance to azole antifungal agents, used to treatment of candidiasis, has been observed to immunocompromised patients. Molecular typing based on RAPD-PCR has been used to discriminate between susceptible and resistant isolates to antifungal agents. In this work, were evaluated the virulence factors and molecular characteristics of Candida isolates obtained of samples from blood, catheter of nosocomial patients and from oral cavity of HIV positive patients. The isolates were identified as: Candida albicans (59) Candida parapsilosis (22), Candida tropicalis (14) Candida guilliermondii (07), Candida. famata (05), Candida krusei (03), Candid. lusitaniae (01) and Candida kefyr (01). The proteinase and phospholipase production and the adherence ability were determined for these yeasts. The effect of fluconazole and itraconazole antifungal agents on hyphal formation were studied to 5 isolates previously classified as either susceptible or resistant. The characterization genotypic of resistant and susceptible isolates to fluconazole was carried out for 13 isolates of C. albicans by RAPD-PCR method. The results showed that proteinase activity was detected in 88.1% of C. albicans isolates and in 69.8% of non C. albicans, while phospholipase was produced in 55.9% of C. albicans isolates and in 37.7% of non C. albicans. Isolates of blood were more proteolitic than catheter and oral cavity, while for phospholipase, there was more production of this enzyme in the oral cavity. The ability of adherence to buccal epithelial cell was higher in C. albicans than non C. albicans, however there was not behavior difference between the isolates from different sources studied. The hyphal formation was higher in resistant isolates than susceptible isolates when used the both drugs. In RAPD-PCR method the formation of two different groups was verified for susceptible and resistant isolates being that only one resistant isolate was clustered in the susceptible group. Thus, in this work, it was verified that the exoenzymes activity and adherence ability depend not only of the specie of Candida, but too of the source from host; the resistant isolates produced more hyphal than susceptible isolates under the antifungal action and the molecular characteristics of the resistant isolates did not suggest unique DNA fingerprints did not predicting their susceptibility to fluconazoleItem Metabolização da quercetina e produção de quercetina 2,3-dioxigenase por Beauverias bassianas isoladas da região Centro-Oeste do Brasil(Universidade Federal de Goiás, 2009-03-25) COSTA, Eula Maria de Melo Barcelos; OLIVEIRA, Valeria de; http://lattes.cnpq.br/6300240031300604Considering the vast biotechnological applicability described for Beauveria bassiana, the versatility microbial biotransformation exhibits, the important biological activities attributed to the flavonoid quercetin, the therapeutic perspectives of its use, and the activity the enzyme quercetin 2,3-dioxygenase has on quercetin, we intended to evaluate quercetin biotransformation by B. bassiana ATCC 7159 and isolates of B. bassiana collected in the Midwestern Region of Brazil. The objectives of this study were: evaluate the potential of B. bassiana isolates and B. bassiana ATCC 7159 to produce metabolites of quercetin; investigate quercetin 2,3-dioxygenase production by the isolates and B. bassiana ATCC 7159; determine the genetic variability among the isolates of B. bassiana and establish possible correlations between molecular data and quercetin 2,3-dioxygenase production. All isolates and B. bassiana ATCC 7159 were capable of metabolizing quercetin and form compounds described in mammalian quercetin biotransformation studies and isolate IP 94 produced a higher number of metabolites compared with the others. B. bassiana ATCC 7159 and isolates IP 94, IP 98, IP 129, IP 147 produced methylated metabolites, while isolates IP 8, IP 11, and IP 94 produced glucuronidated metabolites. All the isolates produced sulphated metabolites and methylated and glucuronidated metabolites simultaneously and were capable to synthesize quercetin 2,3-dioxygenase. Quercetin 2,3-dioxygenase synthesis on PDSM, used in its biotransformation process was higher than on basic medium. B. bassiana ATCC 7159 and the isolates IP 11 and IP 132 presented the highest quercetin 2,3-dioxigenase activity, whereas the isolates IP 153 and IP 3a presented the lowest ones. Quercetin metabolites formation and quercetin 2,3-dioxygenase production were not correlated with the geographic origin of the isolates. Genetic variability analysis by RAPD allowed the separation of the isolates into three distinct groups and showed high genetic diversity among them; however, the RFLP-PCR of ITS region did not provide characteristic markers to differentiate the isolates. The ITS region sequencing confirmed the identity of the isolates as B. bassiana. The results obtained can lead to the following conclusions: B. bassiana constitutes an interesting alternative to the use of chemical methods and biological systems to produce quercetin metabolites, but is necessary to optimize the biotransformation process in order to obtain a more expressive amount of metabolites; B. bassiana is able to produce quercetin 2,3-dioxygenase, although more detailed studies are needed to explain its production pathway, regulation, and mechanism of action.
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