Study to determine the cardiovascular risk ofthe population of Guimarães/Vizela, includingthe prevalence of arterial stiffness and early vascular aging syndrome

Tese de Doutoramento em Medicina.

Indicadores chave de sustentabilidade para edifícios residenciais em estrutura metálica

Dissertação de mestrado integrado em Engenharia Civil

The impact of depression on survival of Parkinson's disease patients: a five-year study

OBJECTIVE: The aim of this study is to evaluate the survival rate in a cohort of Parkinson's disease patients with and without depression. METHODS: A total of 53 Parkinson's disease subjects were followed up from 2003-2008 and 21 were diagnosed as depressed. Mean time of follow up was 3.8 (SD 95% = 1.5) years for all the sample and there was no significant difference in mean time of follow up between depressed and nondepressed Parkinson's disease patients. Survival curves rates were fitted using the Kaplan-Meier method. In order to compare survival probabilities according to the selected covariables the Log-Rank test was used. Multivariate analysis with Cox regression was performed aiming at estimating the effect of predictive covariables on the survival. RESULTS: The cumulative global survival of this sample was 83% with nine deaths at the end of the study - five in the depressed and four in the nondepressed group, and 55.6% died in the first year of observation, and none died at the fourth and fifth year of follow up. CONCLUSION: Our finding point toward incremental death risk in depressed Parkinson's disease patients.

Prevalence of thyroiditis and immunohistochemistry study searching for a morphologic consensus in morphology of autoimmune thyroiditis in a 4613 autopsies series

We sought to verify the prevalence of lymphocytic thyroiditis (LT) and Hashimoto's thyroiditis (HT) in autopsy materials. Cases examined between 2003 and 2007 at the Department of Pathology of Faculty of Medicine of São Paulo University were studied. Immunohistochemical analyses were conducted in selected cases to characterize the type of infiltrating mononuclear cells; in addition, we evaluated the frequency of apoptosis by TUNEL assay technique and caspase-3 immunostaining. Significant increase in overall thyroiditis frequency was observed in the present series when compared with the previous report (2.2978% vs. 0.0392%). Thyroiditis was more prevalent among older people. Selected cases of LT and HT (5 cases each) had their infiltrating lymphocytes characterized by immunohistochemical analyses. Both LT and HT showed similar immunostaining patterns for CD4, CD8, CD68, thus supporting a common pathophysiology mechanism and indicating that LT and HT should be considered different presentations of a same condition, that is, autoimmune thyroiditis. Moreover, apoptosis markers strongly evidenced that apoptosis was present in all studied cases. Our results demonstrated an impressive increase in the prevalence of thyroiditis during recent years and our data support that the terminology of autoimmune thyroiditis should be used to designate both LT and HT. This classification would facilitate comparison of prevalence data from different series and studies.

Structural and enzymatic characterization of ABgp46, a novel phage endolysin with broad anti-Gram-negative bacterial activity

The present study demonstrates the antibacterial potential of a phage endolysin against Gram-negative pathogens, particularly against multidrug resistant strains of Acinetobacter baumannii. We have cloned, heterologously expressed and characterized a novel endolysin (ABgp46) from Acinetobacter phage vb_AbaP_CEB1 and tested its antibacterial activity against several multidrug-resistant A. baumannii strains. LC-MS revealed that ABgp46 is an N-acetylmuramidase, that is also active over a broad pH range (4.0-10.0) and temperatures up to 50°C. Interestingly, ABgp46 has intrinsic and specific anti-A. baumannii activity, reducing multidrug resistant strains by up to 2 logs within 2 hours. By combining ABgp46 with several organic acids that act as outer membrane permeabilizing agents, it is possible to increase and broaden antibacterial activity to include other Gram-negative bacterial pathogens. In the presence of citric and malic acid, ABgp46 reduces A. baumannii below the detection limit (> 5 log) and more than 4 logs P. aeruginosa and Salmonella Typhimurium strains. Overall, this globular endolysin exhibits a broad and high activity against Gram-negative pathogens, that can be enhanced in presence of citric and malic acid, and be used in human and veterinary medicine.

Clinical and pathological assessment of 82 patients with cardiovascular diseases undergoing autopsy at the Hospital das Clínicas of the Faculdade de Medicina de Botucatu from 1988 to 1993

OBJECTIVE: To evaluated the clinical diagnostic, efficiency for basic death causes in patients dying of circulatory disease and de relative frequency of those diseases. METHODS: Analysis of medical record data of 82 patients, ages from 16 to 84 years old (68 over 40 years old), whose died of circulatory disease and had undergone necropsy in the period from 1988 to 1993 years in the University Hospital of Medicine Faculty of Botucatu-UNESP, Br. RESULTS: The functional class of patients were III or IV, in 78%, and 81.7% needed urgent hospitalization. By the clinical judgment the death were by ischemic heart disease in 32 (21 acute myocardial infarction), Chagas'disease in 12, valvopathy in 11, cardiomyopathy in 7, heart failure with no specification of cardiopathy in 11 and other causes in 9. At the necropsy the death cause was ischemic heart disease in 34 patients, valvopathy in 10, Chagas'disease in 10, cardiomyopathy in 5, and heart failure with no specification of cardiopathy in 2.The concordance taxes were in thhe same order: 94,6%, 90,0%, 83.3%, 71.4% and 28.5%. CONCLUSION: There was a great efficiency of clinical diagnosis for death cause in a general university hospital. The ischemic heart disease were the main causes of death.

Some predictors of cardiovascular mortality among the elderly population of Botucatu (SP)

OBJECTIVE: To detect factors associated with cardiovascular mortality in the elderly of Botucatu. METHODS: We evaluated 29 variables of interest in a cohort of patients aged ³60 using data from a survey conducted between 1983/84. The elderly cohort was analyzed in 1992 to detect the occurrence of cardiovascular deaths. Survival analysis was performed using the Kaplan-Meier method, the log-rank test, and Cox regression analysis. Three models were adapted for each group of variables, and a final model was chosen from those variables selected from each group. RESULTS: We identified predictor for cardiovascular death according to age for elderly males not supporting the family, not possessing a vehicle, and previous cardiovascular disease. In elderly females, the predictor variables were previous cardiovascular disease and diabetes mellitus. CONCLUSION: Socioeconomic indicators (family heading and vehicle ownerrship) may be added to well stabilished medical factors (diabete mellitus and hypertension to select target groups for programs intended to reduce deaths due to cardiovascular diseases in elderly people.

Does a Role Exist for Tilting-Guided Therapy in the Management of Neurocardiogenic Syncope?

PURPOSE: Upright tilt-table testing (UTT) is an useful method for identifying patients with neurocardiogenic syncope, but its role in the evaluation of therapeutic efficacy is controversial. The aim of this study was to determine the correlation between negative UTT after therapy introduction (acute efficacy) and symptom recurrence during follow-up (chronic efficacy). METHODS: We studied 56 severely symptomatic patients (age 27±19 years) with recurrent (7±12 episodes) neurocardiogenic syncope (positive UTT). Once empirical pharmacological therapy was initiated, all patients underwent another UTT (therapeutic evaluation test - TET). Therapy was not modified after TET results. The probability of symptom recurrence was analyzed with the Kaplan-Meier method and compared by log-rank test in patients with negative and positive TET. RESULTS: Negative UTT after therapy was related to a significantly lower probability of recurrence during follow-up (4.9 versus 52.4% in 12 months, P<0.0001). CONCLUSION: A good correlation exists between acute and long-term efficacy of pharmacological therapy for neurocardiogenic syncope, so that serial UTT may be considered a good method for identifying an effective therapeutic strategy.

The Need for Pedagogical Qualifications for Teaching Cardiology to Undergraduate Students

OBJECTIVE: To report a training program in cardiology emphasizing changes in its pedagogical practice. These changes were put into practice by some teachers at the Medical School of Porto Alegre of the University of Rio Grande do Sul (FAMED/UFRGS) aiming to make faculty and student activities more dynamic and to promote more efficacious learning. The training program is directed at 5th semester medical students and aims at a behavioral change in teachers and students to promote more interaction, to favor exchanges, and to make the teaching-learning process easier, always maintaining the patient in the center of the medical activity. METHODS: The program emphasizes the definition of general and specific objectives for each activity to be developed by the students, with training in the area of admission to the cardiology service, with special emphasis on behavioral change in the cognitive, motor, affective, and attitudinal areas. Knowledge was developed by means of interactive seminars with initial and final assessment tests to identify students' and teachers' performance. The students were evaluated in an immediate, continuous, and progressive way in their daily activities and through comparison of the results of 2 tests, one applied at the beginning of the training and the other at its end. These 2 tests contained the same questions. RESULTS: We systematically assessed 560 students over 4 years. The mean grades of the tests performed prior to and after the 244 seminars were 7.38±1.66 and 9.17± 0.82, respectively (p<0.0001). For the tests applied at the beginning and at the end of the training, the mean grades were 5.61±1.61 and 9.37±0.90, respectively (p<0.0001). CONCLUSION: The program proved to be efficient both for the students' learning and for assessing their performance in a systematic and objective way.

Mobilidade social, identidade e valores: o regresso de emigrantes no Minho

Dissertação de mestrado em Sociologia (área de especialização em Políticas Comunitárias e Cooperação Territorial)

Significado clínico das dissecções coronarianas não complicadas após o implante de "stents"

OBJETIVO: Analisar a influência de dissecções coronarianas não complicadas na incidência de revascularização do vaso alvo e eventos cardiovasculares maiores, em um ano. MÉTODO: Pacientes tratados de junho/1996 a dezembro/2000, sendo os dados coletados, prospectivamente, e comparadas dissecções não complicadas (G1, n=36) às sem dissecções (G2, n=871). Os dados foram analisados com programa estatístico SPSS 8,0, os desfechos comparados com curvas de Kaplan-Meier e o nível de significância avaliado pelo teste do log rank. RESULTADOS: As características clínicas foram semelhantes nos dois grupos: O G1 apresentou diâmetro de referência médio menor (p<0,0001), mais pacientes com lesões tipo C (p=0,01), menores diâmetros luminais ao final do procedimento (p=0,003) e maiores relações balão/artéria (p<0,0001). Por análise multivariada, somente diâmetro de referência e relação balão-artéria foram independentemente associados à presença de dissecções residuais. Não houve diferença estatisticamente significativa nas incidências de revascularização do vaso alvo e eventos cardiovasculares maiores, no seguimento clínico em um ano, entre os grupos de pacientes com ou sem dissecções. Os preditores de eventos clínicos adversos em um ano foram diâmetro de referência, extensão da lesão e estenose residual, mas não a presença de dissecção residual. CONCLUSÃO: Dissecções residuais não complicadas após o implante de "stents" coronarianos estão associadas a artérias de menor calibre e maiores relações balão/artéria, mas não com piores desfechos no seguimento clínico em um ano.

A influência do plano de saúde na evolução a longo prazo de pacientes com infarto agudo do miocárdio

FUNDAMENTO: Pouco se sabe, principalmente em nosso meio, sobre a influência dos planos de saúde na evolução a longo prazo pós-infarto agudo do miocárdio (IAM). OBJETIVO: Avaliar a evolução de pacientes com IAM usuários do SUS ou de outros convênios. MÉTODOS: Foram analisados 1588 pacientes com IAM (idade média de 63,3 ± 12,9 anos, 71,7% homens), incluídos de forma prospectiva em banco de dados específico, e seguidos por até 7,55 anos. Deste total, 1003 foram alocados no "grupo SUS" e 585 no "outros convênios". Qui-quadrado, log-rank e Cox ("stepwise") foram aplicados nas diferentes análises estatísticas. O modelo multivariado a longo prazo, com mortalidade como variável dependente, incluiu 18 variáveis independentes. RESULTADOS: As mortalidades hospitalares nos grupos "outros convênios" e "SUS" foram de 11,4% e 10,3%, respectivamente (P=0,5); a longo prazo, as chances de sobrevivência nos grupos foram, respectivamente, de 70,4% ± 2,9 e 56,4% ± 4,0 (P=0,001, "hazard-ratio"=1,43, ou 43% a mais de chance de óbito no grupo "SUS"). No modelo ajustado, o grupo "SUS" permaneceu com probabilidade significativamente maior de óbito (36% a mais de chance, P=0,005), demonstrando-se ainda que cirurgia de revascularização miocárdica e angioplastia melhoraram o prognóstico dos pacientes, ao passo que idade e história de infarto prévio, diabete ou insuficiência cardíaca, pioraram o prognóstico dos mesmos. CONCLUSÃO: Em relação a usuários de outros convênios, o usuário SUS apresenta mortalidade similar durante a fase hospitalar, porém tem pior prognóstico a longo prazo, reforçando a necessidade de esforços adicionais no sentido de melhorar o nível de atendimento destes pacientes após a alta hospitalar.

Entre la ejecución y la representación: intersecciones de lo real en la construcción escénica. Between the execution and the representation: intersections of the real thing in the scenic construction.

Esta propuesta de investigación se enmarca en los encuentros y discusiones que se están realizando en la Escuela de Artes de la Facultad de Filosofía y Humanidades (CEPIA, CIFFyH y SeCyT, de la U.N.C), en relación a las problemáticas de la investigación en Artes. Los encuentros llevados a cabo en diversas ocasiones y a lo largo de 2009, demuestran la necesidad de establecer un campo particular de la investigación y su relación con la práctica artística. Este proyecto nace de estas inquietudes y establece ciertos ejes de trabajo que permiten poner en práctica ciertos esbozos imaginados. En este sentido, nuestra propuesta se centra en definir la misma construcción escénica como objeto de estudio, delimitando sobre éste la problemática de lo real en el trabajo de la ficción, proponiendo además un equipo que permita investigar en su propio desarrollo creativo las diversas variables que entran en juego. De este modo, se trabajará en una propuesta de laboratorio escénico donde los planteos de orden teórico atraviesen la práctica y, a su vez, la observación de ésta permita una reelaboración y profundización del pensamiento contemporáneo sobre la problemática ejecución/representación, desde los diversos órdenes en que ésta interviene. La idea de representación teatral que planteaba Aristóteles señala que las acciones devienen necesariamente en la definición del carácter de los personajes. Este concepto es clave en el desarrollo del teatro occidental y por ende en las diferentes concepciones de actor. La definición de acción dada por Aristóteles es problemática para parte del teatro contemporáneo ya que supone que toda acción es mimética. También da por supuesto que en el teatro se conforman personajes, y que la unidad narrativa está dada por una programática, que es definida por la acción.La presente investigación se propone indagar en la relación entre la ejecución de la acción y su representación en el desarrollo de un laboratorio teatral. Esto implica que necesariamente es aplicada al trabajo escénico. Nuestra hipótesis de partida es que la relación conflictiva entre acción, ejecución de la misma y representación, se produce a partir de la operación material sobre lo real . Estas intersecciones podrían ser pensadas como una teoría del montaje donde la corporalidad es el principio necesario e irreductible de la construcción. La intersección de lo real es una problemática que permite ahondar sobre los procedimientos por los cuales se construye la escena. La idea de un teatro material, obliga a pensar con qué procedimientos se construye ficción. Un teatro que intenta recalar en lo “real” como modo de señalar la cosa misma, se propone, desde la perspectiva de la realización, indagar en los mecanismos de su construcción (procedimientos), por lo cual supone que la actividad teatral puede dar cuenta de los procesos por los cuales se realiza. La realización de una acción, puede remitir a sí misma y genera una relación “extraña” y ambigua con el mundo de referencia. La acción en sí misma, pone en cuestión la idea de modelo y da cuenta de una crisis en la representación. La teoría ha intentado dividir y sistematizar de manera binaria la manifestación teatral: Teatro de Representación/ Teatro Performático, para distinguir un teatro vinculado a la creación de personajes o para relacionarlo a un teatro de ejecución. Sin embargo, pensamos que es posible encontrar en la producción escénica, intersecciones de lo real que median el mundo de la representación y el de la performance para la construcción de ficción. Nuestra hipótesis de base es que si intervenimos el plano de la ejecución en el actor, la representación varía sustancialmente sus mecanismos de producción de sentido. Este primer planteo no es conflictivo hasta que se pone de manifiesto lo real. This research’s proposal is framed into the meetings and discussions that have been taking place in the School of Arts of the Faculty of Philosophy and Humanities (CEPIA, CIFFyH y SeCyT, of the National University of Cordoba), concerning the difficulties of research in Arts. The meetings carried out along 2009, demonstrate the need to establish a particular field of research and its relation to the practice of arts. This project is born from these concerns and it establishes central axis for the work, that enables us to put on practice some sketches imagined. In this regard, our proposal focuses on defining the construction of the scene as object of study, in itself, delimiting the issue of “the real” in the work of fiction. Proposing, furthermore, a team for researching the many variables that comes into play, in their own creative development. Consequently, the work will be developed in the method of a scenic laboratory, where the theoretical proposals cross over the practice and, in turn, these observations allow a reworking and deepen of contemporary thinking about the problematic of performance / representation, from the diverse orders in which it intervene. The idea of theatrical performance proposed by Aristotle, indicate that actions necessarily turn into the definition of the nature of the characters. This concept is key to the development of Western theaterand consequently on the different conceptions of actor. The definition of action given by Aristotle is problematic for a part of the contemporary theater, because it assumes that every action is mimetic. Also presumes that in the theatre the characters are formed, and narrative unit is given by a programmatic, which is defined by the action. This research proposes to explore the relationship between implementation of the action and its representation in the development of a theatrical laboratory. This implies that it is applied necessarily to the scenic practice. Our preliminary hypothesis is that the co.

REPRODUCCIÓN CAPRINA. EFECTO DE LA ADICIÓN DE LÍPIDOS DIETARIOS SOBRE LA MODULACIÓN DEL ESTADO METABÓLICO Y LA CALIDAD DEL SEMEN CRIOPRESERVADO.

Adding Omega fatty acids (ω) 3 to the diet of stud bucks, the quality of sperm and their resistance to cryopreservation could increase. The aim of this study is to determine the effect of supplementation with ω3 on the metabolic state, sperm quality and resistance to freezing, in bucks kept in confinement under natural photoperiod. The experiment will be conducted in the facilities of the Faculty of Agronomy and Veterinary, UNRC (National University of Río Cuarto). Ten Anglo Nubian adult bucks, trained for semen collection with artificial vagina will be used. Males will be randomly allocated into 2 groups (5 animals each): control (C) and treatment (T). During the breeding season, group C will be fed with a ration of alfalfa and ground corn, according to the requirements for each category and sex (NRC, 2007). Group T will receive the same diet with the addition of linseeds. Both will have free access to water. Every week, semen of each buck, will be collected, evaluated and frozen. Sperm quality “in vitro” after thawing will be studied with a digital image analyzer. To assess oxidative stress in fresh and cryopreserved semen, levels of thiobarbituric acid reactive substances (TBARS) and quantification of the activity of superoxide dismutase (SOD) and catalase (CAT) will be determined. To establish the metabolic state, blood samples will be collected every two weeks. The statistical analysis will include an exploratory data analysis, multivariate analysis of multiple correspondences on a completely randomized design, analysis of variance and Fisher post-test. The level of significance will be set at P <0.05 and all results will be expressed as means ± SEM.

Prevalência e impacto prognóstico da disfunção diastólica na doença renal crônica em hemodiálise

FUNDAMENTO: Disfunção diastólica é frequente em pacientes de hemodiálise, mas seu impacto na evolução clínica é incerto. OBJETIVO: Avaliar a prevalência e o impacto prognóstico da disfunção diastólica (DD) avançada (DDA) do ventrículo esquerdo (VE) em pacientes de hemodiálise. MÉTODOS: Ecocardiogramas foram realizados em pacientes no primeiro ano de hemodiálise, em ritmo sinusal, sem doença cardiovascular manifestada, excluindo-se aqueles com valvopatia significativa ou derrame pericárdico. Pela avaliação integrada dos dados ecodopplercardiográficos, a função diastólica foi classificada como: 1) normal, 2) DD discreta (alteração do relaxamento) e 3) DDA (pseudonormalização e fluxo restritivo). Os desfechos pesquisados foram mortalidade geral e eventos cardiovasculares. RESULTADOS: Foram incluídos 129 pacientes (78 homens), com idade 52 ± 16 anos e prevalência de DD de 73% (50% com DD discreta e 23% com DDA). No grupo com DDA, demonstrou-se maior idade (p < 0,01), pressão arterial sistólica (p < 0,01) e diastólica (p = 0,043), massa do VE (p < 0,01), índice do volume do átrio esquerdo (p < 0,01) e proporção de diabéticos (p = 0,019), além de menor fração de ejeção (p < 0,01). Após 17 ± 7 meses, a mortalidade geral foi significativamente maior naqueles com DDA, em comparação aos normais e com DD discreta (p = 0,012, log rank test). Na análise multivariada de Cox, a DDA foi preditiva de eventos cardiovasculares (hazard ratio 2,2, intervalo de confiança 1,1-4,3, p = 0,021) após ajuste para idade, gênero, diabete, massa do VE e fração de ejeção. CONCLUSÃO: A DDA subclínica foi encontrada em aproximadamente um quarto dos pacientes de hemodiálise e acarretou impacto prognóstico, independente de outros dados clínicos e ecocardiográficos.