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- ItemSomente MetadadadosThe fundamental frequency of voice and its correlations with the five sounds of the traditional Chinese Medicine(Cognizant Communication Corp, 2007-01-01) Barros, Fernando Cesar Dotta de [UNIFESP]; Barros, Soraia Elias de; Universidade Federal de São Paulo (UNIFESP)The Fundamental Frequency of Voice (F-0) is one of the patterns of voice evaluation, where the sound of a prolonged vowel spoken is measured by a chromatic tuner, and the result is obtained in a musical tone. We investigated the correlations of the Fundamental Frequency of Voice and the 5 sounds of Traditional Chinese Medicine. We determined the tones corresponding to the sounds related in the ancient book Ling Shu, which are Zhi (), Yu(), Gong (), Shang () and Jue (), using the Bi-Digital O-Ring Test and histological slides of the following human organs: heart, kidney, pancreas, lung and liver. We also investigated the F-0 in interned patients with the following western medicine diagnosis: schizophrenia, kidney failure and hepatic failure. The results are discussed, and suggest that the Fo can be used as a complementary diagnostic tool in Chinese Medicine and Acupuncture.
- ItemAcesso aberto (Open Access)Hiperhomocisteinemia na insuficiência renal crônica(Pontifícia Universidade Católica de Campinas, 2005-04-01) Nerbass, Fabiana Baggio [UNIFESP]; Draibe, Sergio Antonio [UNIFESP]; Cuppari, Lilian [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Homocysteine is a sulfur-containing amino acid derived from the metabolism of methionine, whose abnormal accumulation in plasma is a risk factor for vascular disease in the general population and in patients with chronic renal disease. In these patients, the prevalence of individuals with hyperhomocysteinemia is very high, even in the pre-dialysis stage of the disease. The main factor that seems to be implicated on the elevation of homocysteine levels in this population is the renal mass loss, considering that the kidney has an important role in the metabolism of such amino acid. The treatment of hyperhomocysteinemia consists on supplementation of the vitamins that are involved in the homocysteine metabolism (folate, B6 and B12.). However, for chronic renal disease patients, this treatment is not completely effective, because although it promotes reduction of homocysteine levels, the normalization is not reached in the majority of the patients. This study reviews the hyperhomocysteinemia etiology on chronic renal disease, its main determinants, its relationship with vascular diseases, and the modes of treatment.
- ItemAcesso aberto (Open Access)Microangiopatias trombóticas: púrpura trombocitopênica trombótica e síndrome hemolítico-urêmica(Sociedade Brasileira de Nefrologia, 2010-09-01) Polito, Maria Goretti [UNIFESP]; Mastroianni Kirsztajn, Gianna [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Thrombotic microangiopathies (TMAs) are pathological conditions characterized by generalized microvascular occlusion by platelet thrombi, thrombocytopenia, and microangiopathic hemolytic anemia. Two typical phenotypes of TMAs are hemolytic- uremic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP). Other disorders occasionally present with similar manifestations. Depending on whether renal or brain lesions prevail, two pathologically indistinguishable but somehow clinically different disorders have been described: HUS and TTP. Injury to the endothelial cell is the central and likely inciting factor in the sequence of events leading to TMA. Loss of physiological thromboresistance, leukocyte adhesion to damaged endothelium, complement consumption, abnormal von Willebrand factor release and fragmentation, and increased vascular shear stress may then sustain and amplify the microangiopathic process. Intrinsic abnormalities of the complement system and of the von Willebrand factor pathway may account for a genetic predisposition to the disease that may play a paramount role in particular in familial and recurrent forms. In the case of diarrhea-associated HUS (D+HUS), renal endothelial damage is mediated (at least in large part) by the bacterial agent Shigatoxin (Stx), which is actually a family of toxins elaborated by certain strains of Escherichia coli and Shigella dysenteriae. Outcome is usually good in childhood, Shiga toxin-associated HUS, whereas renal and neurological sequelae are more frequently reported in adult, atypical, and familial forms of HUS and in TTP. Recent studies have demonstrated that deficiency in the von Willebrand factor cleaving protease ADAMTS13, due to deficiency of ADAMTS13 can be genetic or more common, acquired, resulting from autoimmune production of inhibitory anti-ADAMTS13 antibodies, that causes TTP. During the last decade, atypical HUS (aHUS) has been demonstrated to be a disorder of the complement alternative pathway dysregulation, as there is a growing list of mutations and polymorphisms in the genes encoding the complement regulatory proteins that alone or in combination may lead to aHUS. Approximately 60% of aHUS patients have so-called 'loss-of-function' mutations in the genes encoding the complement regulatory proteins, which normally protect host cells from complement activation: complement factor H (CFH), factor I (CFI) and membrane cofactor protein (MCP or CD46), or have 'gain-of-function' mutations in the genes encoding the complement factor B or C3. In addition, approximately 10% of aHUS patients have a functional CFH deficiency due to anti-CFH antibodies. Although TMAs are highly heterogeneous pathological conditions, one-third of TMA patients have severe deficiency of ADAMTS13. Platelet transfusions are contraindicated. Plasma infusion or exchange (PE) is the only treatment of proven efficacy.
- ItemAcesso aberto (Open Access)Relatorio do Censo Brasileiro de Dialise Cronica 2012(Sociedade Brasileira de Nefrologia, 2014-03-01) Sesso, Ricardo de Castro Cintra [UNIFESP]; Lopes, Antonio Alberto; Thome, Fernando Saldanha; Lugon, Jocemir Ronaldo; Watanabe, Yoshimi; Santos, Daniel Rinaldi dos; Universidade Federal de São Paulo (UNIFESP); Universidade Federal da Bahia; Universidade Federal do Rio Grande do Sul; Universidade Federal Fluminense; Hospital Sao Joao de Deus; Faculdade de Medicina do ABCIntroduction:National chronic dialysis data are fundamental for treatment planning.Objective:To report data of the annual survey of the Brazilian Society of Nephrology about chronic kidney disease patients on dialysis in July 2012.Methods:A survey based on data of dialysis units from the whole country. The data collection was performed by using a questionnaire filled out on-line by the dialysis units in Brazil.Results:255 (31.9%) of the dialysis units in the country answered the questionnaire. In July 2012, the total estimated number of patients on dialysis in the country was 97,586. The estimated prevalence and incidence rates of chronic kidney disease on maintenance dialysis were 503 and 177 patients per million population, respectively. The estimated number of new patients starting dialysis in 2012 was 34,366. The annual gross mortality rate was 18.8%. For prevalent patients, 31.9% were aged 65 years or older, 91.6% were on hemodialysis and 8.4% on peritoneal dialysis, 30,447 (31.2%) were on a waiting list of renal transplant, 28.5% were diabetics, 36.6% had serum phosphorus > 5.5 mg/dl and 34.4% hemoglobin < 11 g/dl. A venous catheter was the vascular access for 14.5% of the hemodialysis patients.Conclusion:The prevalence and incidence rates of chronic kidney disease patients on dialysis increased, while the mortality rate tended to decrease compared with 2011. The indicators of the quality of maintenance dialysis remained stable with a trend towards decrease in levels of anemia. The data highlight the importance of the census to guide chronic dialysis therapy.