Modelagem em análise de sobrevivencia com eventos recorrentes aplicada a dados da área médica

Pós-graduação em Biometria - IBB

Avaliação e manejo da oclusão trombótica de cateteres de longa permanência dos pacientes em hemodiálise

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Caracterização fenotípica e molecular das espécies fúngicas causadoras de peritonites em pacientes submetidos à diálise peritoneal ambulatorial continua do Hospital das Clínicas da UNESP, Botucatu

Pós-graduação em Biologia Geral e Aplicada - IBB

Avalição comparativa das intercorrências dialíticas de pacientes com lesão ranal aguda submetidos a sessões de hemodiálise prolongada de 6 e 10 horas

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

Efeito do treinamento físico na qualidade de vida, capacidade funcional e fatores de risco cardiovascular nos portadores de doença renal crônica em tratamento conservador

Pós-graduação em Fisiopatologia em Clínica Médica - FMB

O tratamento da doenca renal cronica pode afetar a audicao?

Introdução:Doença renal crônica (DRC) é definida pela presença de lesão renal levando à perda lenta e progressiva da função renal.Objetivo:Comparar testes auditivos entre pacientes com DRC submetidos a diferentes método de tratamento.Material e método:Estudo clínico transversal. Os grupos foram divididos de acordo com o método de tratamento: hemodiálise (n = 35), diálise peritoneal (n =15), conservador (n = 51) e 27 pacientes saudáveis (controle). Pacientes com idade superior a 60 anos, perda auditiva congênita, síndromes genéticas, infecções de orelha média e transplante renal foram excluídos da pesquisa. A avaliação audiológica incluiu audiometria tonal, emissões otoacústicas evocadas transientes e Potencial Evocado Auditivo de Tronco Encefálico (PEATE); e as variáveis avaliadas foram: sexo, idade, diagnóstico de hipertensão arterial e diabetes, estádio da DRC, tempo de diagnóstico do diabetes e da hipertensão arterial, duração da DRC e do tratamento.Resultados:A idade, presença de hipertensão arterial e tempo de DRC foram estatisticamente significantes e controlados. O grupo conservador apresentou piores limiares auditivos na audiometria tonal e o intervalo III-V do PEATE significativamente maior que o da hemodiálise.Conclusão:O tratamento conservador mostrou piores resultados na avaliação auditiva, independente de diabetes e de hipertensão, reforçando que os pacientes submetidos a tratamento para DRC devem realizar avaliação auditiva completa para melhor compreensão da doença e de seus efeitos sobre o sistema auditivo.

NOVEL PREDICTORS OF PERITONITIS-RELATED OUTCOMES IN THE BRAZPD COHORT

Introduction: Peritonitis remains the main cause of peritoneal dialysis (PD) technique failure worldwide, despite significant reductions in infection rates observed over the past decades. Several studies have described risk factors for peritonitis, technique failure and mortality. However, there are scarce data regarding predictors of complications during and after a peritonitis episode. The aim of our study was to analyze predictors of peritonitis-related outcome in the Brazilian Peritoneal Dialysis study (BRAZPD) cohort.Methods: All adult incident patients recruited in the BRAZPD Study between December 2004 and October 2007, who remained at least 90 days on PD and presented their first peritonitis episode (n = 474 patients) were included in the study. The endpoints analyzed were non-resolution, death due to a peritonitis episode and long-term technique survival after a peritonitis episode.Results: In the multivariable regression, non-resolution was independently associated with older age (odds ratio (OR) 1.02; p < 0.01), collagenosis as the primary renal disease (OR 4.6; p < 0.05) and Pseudomonas spp as etiological agent (OR 2.9; p < 0.05). Patients who were transferred from APD to CAPD during peritonitis therapy presented a higher risk of non-response (OR 2.5; p < 0.05). The only factor associated with death during a peritonitis episode was older age (OR 1.04; p < 0.05). Exposure to vancomycin and male gender were the independent predictors of long-term technique failure (OR 2.2; p < 0.01).Conclusion: Apart from confirming previous observations of the negative impact of older age and Pseudomonas spp peritonitis on outcomes, we observed that collagenosis may negatively impact response to treatment and exposure to vancomycin may possibly reduce long-term technique survival. It is important to emphasize that the association of vancomycin with technique failure does not prove causality. These findings shed light on new factors predicting outcome when peritonitis is diagnosed.

Experience with the sandwich technique in endovascular thoracoabdominal aortic aneurysm repair

Background: The sandwich technique is an endovascular off-the-shelf solution for patients with thoracoabdominal aortic aneurysms (TAAAs). In a sandwich configuration, the chimney stent runs in the middle of a space created by two or three aortic endografts.Methods: All patients with TAAAs who were treated with the sandwich technique were included in the study. Self-expanding Viabahn grafts (W. L. Gore and Associates Inc, Flagstaff, Ariz) were used as parallel grafts in the renal arteries and visceral vessels. Caudad-facing chimney grafts were used for the visceral arteries and cephalad-facing periscope grafts for the renal arteries.Results: During the study period, 32 patients with TAAAs were treated with sandwich grafts. Indication for the procedure in 43% was an acute onset of symptoms, including two patients with a rupture and a retroperitoneal hematoma. Three patients required an additional debranching procedure. A total of 104 chimney grafts were implanted. Two patients died postoperatively because of the operation. Major adverse events were recorded in five patients, including one patient with persistent paraplegia and two with permanent renal failure requiring dialysis. The incidence of chimney graft occlusion was higher in patients with three or four parallel grafts than in those with two chimney grafts only. Patients with chronic dissections had a 12-times higher incidence of chimney graft occlusion than aneurysm patients. The number of patients with type I or III endoleaks was higher in the group with three or four parallel grafts.Conclusions: The sandwich technique is an off-the-shelf endovascular alternative to treat patients with TAAAs in an emergent setting. The combination of chimney grafts with a periscope configuration enables a rapid endovascular aneurysm exclusion with acceptable midterm results.

Epidemiology of healthcare-associated infections among patients from a hemodialysis unit in southeastern Brazil

Patients submitted to hemodialysis are at a high risk for healthcare-associated infections (HAI). Presently there are scarce data to allow benchmarking of HAI rates in developing countries. Also, most studies focus only on bloodstream infections (BSI) or local access infections (LAI). Our study aimed to provide a wide overview of HAT epidemiology in a hemodialysis unit in southeastern Brazil. We present data from prospective surveillance carried out from March 2010 through May 2012. Rates were compared (mid-p exact test) and temporally analyzed in Shewhart control charts for Poisson distributions. The overall incidence of BSI was 1.12 per 1000 access-days. The rate was higher for patients performing dialysis through central venous catheters (CVC), either temporary (RR = 13.35, 95% CI = 6.68-26.95) or permanent (RR = 2.10,95% CI = 1.09-4.13), as compared to those with arteriovenous fistula. Control charts identified a BSI outbreak caused by Pseudomonas aeruginosa in April 2010. LAI incidence was 3.80 per 1000 access-days. Incidence rates for other HAI (per 1000 patients-day) were as follows: upper respiratory infections, 1.72; pneumonia, 1.35; urinary tract infections, 1.25; skin/soft tissues infections, 0.93. The data point out to the usefulness of applying methods commonly used in hospital-based surveillance for hemodialysis units. (C) 2013 Elsevier Editora Ltda. All rights reserved.

Efeito da aldosterona e da espironolactona na hipertrofia ventricular esquerda em pacientes com doença renal crônica em hemodiálise

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Different outcomes of peritoneal catheter percutaneous placement by nephrologists using a trocar versus the Seldinger technique: the experience of two Brazilian centers

A good catheter implantation technique is important to allow effective peritoneal access function and long-term technique survival. Studies regarding results obtained by nephrologists in comparison with different techniques have been limited. The aim of this study was to investigate the rate of early catheter-related complications and catheter survival in two Brazilian centers, according to two different percutaneous methods of catheter implantation performed by nephrologist team. Adult incident patients recruited from January 2006 to July 2013 having undergone first peritoneal dialysis (PD) catheter implantation were included in the analysis. Mechanical and infectious early complication rates were defined as time to the first event occurring up to 3 months. Four hundred and forty-five consecutive Tenckhoff catheters were implanted by nephrologist team percutaneously after antibiotic prophylaxis in an operating room: trocar was used in 349 (78.4 %) and Seldinger technique (ST) in 99 (21.6 %). The ST was significantly associated with a lower rate of leak (16.3 vs 3 %, p = 0.03) and outflow failure due to tip catheter migration (22.6 vs 10.1 %, p = 0.04), while early infectious complication rates were similar between the two groups (p = 0.59). Long-term catheter survival was higher in Seldinger group (log-rank, p = 0.031). By Cox multivariate analysis, adjusted for age, sex, and diabetes, the ST remained independently associated with better catheter survival [HR 0.681 (0.462-0.910), p = 0.04]. As conclusion, our experience showed better PD outcomes with the ST than trocar method of catheter implantation by nephrologist.

Metabolic Syndrome Criteria As Predictors of Insulin Resistance, Inflammation and Mortality in Chronic Hemodialysis Patients

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Infância, sexualidade e educação através dos desenhos animados

This article discusses the import o clock work and child sexuality for the overall development of children. To them as individuals socially and historically constitutional. Of that uses this instrument to express vivences and sensation. Es often unnoticed by adults look. We seek to ensnare a set of reflex. It’s fundamental about the multiples management possibilities you Rich and practical knowledge of the obvious sexuality analyzing brands present in the cartoons that are part of everyday life and education. The child to speak about the body of knowledge that the child to have, and what their relations with the same body, weaving some notes on sexuality and space the discovery, demonstrating the sensitivity surrounding the object of our study. During the course of this research, we remain based on studies of the reference you? Rich presented by: Freud (1997), Camargo and Ribeiro (1999), La Taille (2002) and Souza (1997). Where the main purpose for analyze the educational development of children having as a basis for an Dialysis cartoon that can serve as subside s difficulties in practice teacher, immersing ourselves in the gap left by the way deficit of educators regarding spec. I now proposed to issue, contributing, at least in part, to the improvement of Education and the professionals who work in it.

Participação da família no tratamento de paciente em diálise peritoneal

Dramatic changes occur in the lives of patients on peritoneal dialysis and his family life, changing lifestyle, professional and social activities. Considering the important role of family in treatment, is crucial for nurses to know how these families perceive their role as caregivers and their difficulties and needs, in the process of peritoneal dialysis. The approach chosen for the study was the phenomenological method, based on Merleau-Ponty, who proposes to understand the human experience, from the description of those who lived it. The study findings show that in the beginning of treatment, family members, feel impacted with the disease severity and eager to become responsible for maintenance treatment, fearing not match the expectations.Guided by staff, appear confident in taking care and deal with the difficulties and complications of treatment, supported by professionals. However, resent the great changes in their social activities and work, his life turns out to be quite limited, due to the dedication to a sick family member. Many feel overwhelmed because they are not supported by other family members. Some envision a future outlook for renal transplant, others seem skeptical, given the long waiting list, especially when advanced age of the sick family member. These results suggest the need for individualized attention to family caregivers, and to encourage the family to organize itself and develop a joint work. In this sense, the design of health care, taking care with the focus of the family, it seems highly appropriate in preparing the plan of family orientation, this is defined as a dynamic unity, which, working in harmony, can contribute positively in the treatment of health a sick member