Navegando por Palavras-chave "Tratamento"

Agora exibindo 1 - 20 de 83
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Abordagem psicodinâmica no tratamento dos transtornos alimentares
    (Associação Brasileira de Psiquiatria - ABP, 2002-12-01) Gorgati, Soraia Bento [UNIFESP]; Holcberg, Alessandra S [UNIFESP]; Oliveira, Marilene Damaso De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The authors underwent a review of psychodinamic psychotherapy in the treatment of anorexia nervosa e bulimia nervosa. First, they defined the conceptual framework of this therapeutical approach. Then, they described the indications and contraindications and, also they discussed the studies about the efficacy of this psychotherapeutic intervention on this syndromes. At last, they pointed out and discussed many psychotherapeutical technical aspects in the treatment of patients with eating disorders.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Adesão ao tratamento para tuberculose: uma etnografia no Instituto Clemente Ferreira - São Paulo/SP
    (Universidade Federal de São Paulo (UNIFESP), 2015-09-18) Posses, Isabela Pellacani Pereira das [UNIFESP]; Pereira, Pedro Paulo Gomes [UNIFESP]; Matsue, Regina Yoshie [UNIFESP]; http://lattes.cnpq.br/0117573990594433; http://lattes.cnpq.br/1474930426841995; http://lattes.cnpq.br/2656572425835545; Universidade Federal de São Paulo (UNIFESP)
    Esta dissertação visa compreender a adesão ao tratamento da tuberculose sob o ponto de vista dos pacientes e profissionais de saúde por meio de uma aproximação etnográfica em um ambulatório de atenção terciária à pessoas com tuberculose da cidade de São Paulo/SP, o Instituto Clemente Ferreira. A pesquisa de campo desenvolveu-se de junho a dezembro de 2014 e foram utilizadas as técnicas da observação participante e entrevistas. O material empírico foi interpretado pela perspectiva das ciências socias aplicadas à saúde. Os resultados deste trabalho nos possibilitou compreender um pouco da concepção de doença que os pacientes possuem, qual o impacto que a tuberculose causa no cotidiano deles, como lidam com a necessidade de realizar um tratamento, quais elementos incentivam ou impedem a adesão ao tratamento e ainda como os profissionais de saúde dessa instituição prestam assistência a esses pacientes e suas atitudes e percepções sobre aqueles pacientes que descontinuam o tratamento. Destaca-se que o processo de adesão não diz respeito apenas a ingestão diária de medicação, mas, sobretudo, ao contexto socio-cultural onde o tratamento acontece e a postura de profissionais de saúde que desconsideram a complexidade desse fenômeno e assim rotulam e marginalizam aqueles pacientes que descontinuam o tratamento.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Adesão dos dependentes de drogas psicoativas ao tratamento em CAPSs AD
    (Universidade Federal de São Paulo (UNIFESP), 2016-04-12) Reis, Larissa Ferraz [UNIFESP]; Carlini, Elisaldo Luiz de Araujo [UNIFESP]; http://lattes.cnpq.br/5948335656347039; http://lattes.cnpq.br/4096854302752731; Universidade Federal de São Paulo (UNIFESP)
    Faced with so many and different treatments for substance dependents, it was our interested to give voice to patients in Psychosocial Care Centers Alcohol and Drugs / CAPS ad in Sao Paulo. This qualitative research with 40 users intended to analyze the reasons that led them to begin, to remain or to abandon treatment. The three listed units by the municipal coordination of mental health are managed by social organizations. The first phase of the collection at the entrance, with interviews content analysis indicates heterogeneous socio-demographic profile. More than 50% of the sample had previous treatments. The main drugs were cocaine / crack and alcohol. Most participants declared to follow total abstinence, and some of them incorporated harm reduction. The results showed that the search for treatment was motivated by guilt, loss and desire to restore the dignity and self-respect. In this regard, these reasons should be better explored by the team, because, beyond verifying the relationship that the patients establish with the psychoactive substances, it’s important to unveil the meanings they attach to treatment and then, use more efficient therapeutic approaches. Many patients declared need for medication in order to relieve withdrawal symptoms or to create aversion to drugs. Besides, it was expressive family participation in treatment, which appears as a source of support and challenging. Most of the patients did not know clearly the dynamics of CAPS ad. Many of them have shown a tendency to transfer the responsibilities of the treatment, but others have had the expectation to participate more actively in their process and they hoped to take new paths with the support offered to them. Thus, one should pay attention to the demands that the patient brings and encourage their autonomy. In the initial call, impressions were good, but not enough to keep people in treatment. Through the analysis of medical records, it was found that only 4 subjects joined. These data indicate that other aspects of the adherence must be investigated, such as the shortcomings of the service and the culture of the subjects “do not point out errors / not inform. It Should be a priority the continuation or the beginning of new research aimed to study the treatment in the institutions to consider new interventions, especially for the first month of treatment, during which there was the largest drop, as well as more efficient care strategies throughout the process; Finally, it is necessary to strengthen both contact with the community in order to stimulate a dialogue that reduces stigma and prejudice, as well as relations with other services, such as hostels that despite being very present in the life of the respondent public, cannot hold the individuals for the necessary time for their recovery. The second stage, after three months, could not be assessed mainly due to lack of contact and also by the refusal of the subjects.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Agentes indutores da síntese de hemoglobina fetal
    (Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular, 2007-09-01) Figueiredo, Maria Stella [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Sickle cell anemia is a heterogeneous disorder with variable severity. Initial observations showed that a high level of fetal hemoglobin (HbF) was associated with minor clinical manifestations, as HbF interferes with HbS polymerization. Hydroxyurea, a cytotoxic agent, has several effects on sickle cell patients, such as: increased HbF production, increased mean corpuscular volume, improved red blood cell hydration, improved hemoglobin, myelosuppression, production of nitric oxide and decreases in adhesion molecules. Till now, hydroxyurea is considered the most successful drug therapy for sickle cell anemia and its use is described in this article.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Ai Chi: efeitos do relaxamento aquático no desempenho funcional e qualidade de vida em idosos
    (Pontifícia Universidade Católica do Paraná, 2010-09-01) Cunha, Márcia Cristina Bauer [UNIFESP]; Alonso, Angélica Castilho; Mesquita E Silva, Tatiana [UNIFESP]; Raphael, Anna Carolina Britto De [UNIFESP]; Mota, Claudia Ferreira; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Universidade Ibirapuera
    OBJECTIVE: This study evaluated the effects of Ai Chi in one group of elderly people in relation to balance, quality of life and functionality. METHODS: We selected 20 elderly people, mean age 68,95 (±7,42) years, that were submitted to Ai Chi technique. The elderly were evaluation after and before exercises program, for 12 weeks, 45 minutes each section, twice a week, by the following scales: Independence Function Measure (IFM), Berg Scale (Brazilian version), and SF-36, for quality of life. The study was made at Ibirapuera University warm pool (33-34° C). RESULTS: There was increase in balance before and after Ai Chi application (p < 0,003), but there was not increase of measure of functional independence (p < 0,10) and quality of life (p < 0,38). CONCLUSION: The Ai Chi technique when applied to elderly people provided an increase on balance. The other evaluations did not show statistic results.
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Análise cefalométrica da imagem digital em uma telerradiografia frontal para diagnosticar a origem da assimetria mandibular em indivíduos com maloclusão de Classe II, subdivisão
    (Universidade Federal de São Paulo (UNIFESP), 2009-06-24) Cerqueira, Leandro Kfouri Martins [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: To investigate the mandibular asymmetry cause of an individual with Class II subdivision malocclusion, through a cephalometric analysis made on frontal digital teleradiography. The aim was also to provide, through the results of cephalometric analysis, subsidies to the professionals to a better diagnosis and treatment plan of patients with Class II subdivision malocclusion. Methods: The sample consisted of 30 individuals presenting Class II subdivision malocclusion. Frontal digital teleradiographies were performed and five main points were demarcated (17 - center point on top of the head of left condyle, 28 - center point on top of the head of right condyle, 23 - the deepest point in the right antegonial notch, 21 - deepest point on the left antegonial notch, and 22 - lower point in the mandibular symphysis). Sixteen secondary points were used in the cephalometric analysis. A digital system (Radiocef® 4.9) was used to point assessment, which determined the lines, plans and measures necessary to verify the origin of mandibular asymmetry present in an individual with a Class II subdivision malocclusion. Results: The results showed that there is a greater tendency of mandibular asymmetry of dental cause in malocclusion subdivision Class II conditions, however the orthodontist should give special attention to the sides of the base of the mandible, since the results found in this cephalometric study showed a greater linear difference comparing one against another attempting to a possible skeletal cause of mandibular asymmetry. Conclusions: The cephalometric analysis used in this study confirmed the clinical need for diagnosis and orthodontic treatment plan for individuals with Class II subdivision malocclusion, it is a simplified method that induces the professional to use complementary tests (clinical and photographic examination, analysis of models and CT) in cases where the cephalometric results showed a trend of a mandibular asymmetry of skeletal cause, since in most cases of malocclusion division Class II the individual is treated as if the mandibular asymmetry was always of dental cause.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Análises farmacogenômica e funcional do efeito do biperideno nas interações das vias colinérgicas e dopaminérgicas nos transtornos por uso de etanol e cocaína
    (Universidade Federal de São Paulo, 2022-04-20) Palombo, Paola [UNIFESP]; Santos, Paulo Caleb Junior de Lima [UNIFESP]; Cruz, Fábio Cardoso [UNIFESP]; Galduroz, José Carlos Fernandes [UNIFESP]; http://lattes.cnpq.br/8366139801463833; http://lattes.cnpq.br/4804337113083801; http://lattes.cnpq.br/7270343730265469; http://lattes.cnpq.br/2519982739467859
    Os transtornos por uso de cocaína e de etanol são grandes problemas de saúde pública no Brasil e no mundo. Os fármacos utilizados para o tratamento destes transtornos são escassos e ineficazes para evitar a recaída ao uso destas drogas. Os sistemas dopaminérgico e colinérgico estão envolvidos nos mecanismos relacionados aos transtornos por uso de substâncias (TUS). Assim, fármacos que atuem no equilíbrio entre esses sistemas de neurotransmissão, podem ser promissores para o tratamento dos TUS. Estudos sugerem que o biperideno, um antagonista muscarínico M1pode ser uma nova ferramenta farmacológica para esse tratamento. Dessa forma, o objetivo do presente estudo foi avaliar a participação dos sistemas dopaminérgico e muscarínico, assim como os efeitos do tratamento com o biperideno sobre comportamentos relacionados ao transtorno por uso de cocaína e etanol, em roedores. Para isso, investigamos o efeito do biperideno sobre: a) a autoadministração intravenosa de cocaína; b) nas concentrações de dopamina e de seus metabólitos em ratos submetidos ao teste de reexposição ao contexto associado a autoadministração de cocaína; c) na preferência condicionada por lugar (PCL) induzida por etanol em camundongos; d) no número de células Fos positivas, da borda e centro do núcleo acumbens em camundongos submetidos ao teste de expressão da PCL, induzida por etanol; e) nas concentrações teciduais de dopamina e de seus metabólitos em camundongos submetidos ao teste da PCL induzida pelo etanol; f) no consumo de etanol no paradigma de livre escolha de etanol ou água; g) no teste de reconhecimento de objetos de camundongos e h) na função motora de camundongos. Por fim, avaliamos, a expressão dos genes que codificam os receptores dopaminérgicos D1 (DrD1) e D2 (DrD2), muscarínicos M1 (mAChR M1) e M4 (mAChR M4), e da enzima Catecol O-Metiltransferase (COMT) em ratos submetidos a um protocolo de exposição prolongada ao etanol (câmara de vapor) ou à cocaína (acesso estendido a autoadministração de cocaína por 6 horas). Em resumo, nossos resultados demonstraram que a administração de biperideno, na dose de 10 mg/Kg, atenuou a motivação e a reexposição ao contexto associado a autoadministração de cocaína; porém não afetou o consumo em binge dessa substância. Em relação ao etanol, observamos que esse fármaco, nas doses de 1, 5 e 10 mg/kg, atenuou a expressão da PCL de etanol. Esse efeito foi acompanhado pelo aumento no número de células positivas para a proteína Fos e na taxa de utilização de dopamina no núcleo acumbens. Evidenciamos, também, que a administração de biperideno promoveu prejuízo nos testes de reconhecimento de objetos, uma e vinte e quatro horas após o treino, porém não causou déficit motor e nem alteração na quantidade consumida de etanol no protocolo de livre escolha. Por fim, o protocolo de acesso estendido da autoadministração de cocaína, promoveu aumento na expressão dos genes do receptor D1 e M1, enquanto o protocolo de acesso restrito promoveu aumento apenas na expressão do gene D1. Já o protocolo de exposição à câmara de vapor, promoveu aumento apenas na expressão do gene do receptor M1. Dessa forma, nossos resultados sugerem que o biperideno possui potencial terapêutico para o tratamento do transtorno por uso de cocaína e etanol e pode estar relacionado a diminuição na expressão gênica do receptor muscarínico M1.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Aripiprazole in the treatment of posttraumatic stress disorder: an open-label trial
    (Associação Brasileira de Psiquiatria - ABP, 2008-12-01) Mello, Marcelo Feijó de [UNIFESP]; Costa, Mariana Cadrobbi Pupo [UNIFESP]; Schoedl, Aline Ferri [UNIFESP]; Fiks, Jose Paulo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: Post traumatic stress disorder is frequent in the general population (7.8%-lifetime-USA). The selective serotonin reuptake inhibitors are the first choice of treatment but result in low remission rates. This study aims to evaluate the effect of aripiprazole monotherapy for the treatment of post traumatic stress disorder. METHOD: Thirty-two patients diagnosed with post traumatic stress disorder were included in a 16-week open label trial of aripiprazole. They were evaluated at baseline, week 8, and 16 with the Clinician-Administered PTSD Scale, Beck Depression Inventory, Beck Anxiety Inventory, Medical Outcome Study Short Form 36, and Social Adjustment Scale. Statistical analysis were performed with an intention-to-treat approach and last observation carried forward. A general linear model for repeated measures comparing the factor with 3 continuous measures from baseline, 8 and 16 weeks was used. A between-subject factor was included RESULTS: Nine patients discontinued the treatment. The mean aripiprazole dose was 9.6 (± 4.3) mg/day. The mean scores at baseline and endpoint for all measures were: Clinician-Administered PTSD Scale - 82.7 (± 23.1) and 51.4 (± 31.4) (F = 11.247, p = 0.001); Beck Anxiety Inventory - 31.7 (± 13.4) and 25.4 (± 18.2) (F = 8.931, p = 0.011); Social Adjustment Scale - 2.4 (± 0.45) and 2.27 (± 0.57) (F = 8.633, p = 0.012); Medical Outcome Study Short Form 36 - 76.6 (± 14.11) and 94.01 (± 25.06) (F = 10.127 p = 0.007); and Beck Depression Inventory - 26.06 (± 11.6) and 21.35 (± 12.6) (F = 1.580, p = 0.042). In all measurements, the differences were statistically significant. CONCLUSIONS: Patients achieved a good response to treatment with aripiprazole, but placebo-controlled studies are needed for more accurate results.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Arte e loucura: Jung e arte na abordagem da saúde mental
    (Universidade Federal de São Paulo, 2016-11-29) Nogueira, Juliana Rebecca Cappelletti Imperatore [UNIFESP]; Silveira, Fernando de Almeida [UNIFESP]; http://lattes.cnpq.br/4032075843318626; http://lattes.cnpq.br/2085812746741322; Universidade Federal de São Paulo (UNIFESP)
    Este trabalho consiste na apresentação da contribuição histórica das artes plásticas no que tange a elaboração do homem consigo mesmo e com o mundo externo. Tal análise foi baseada na Psicologia Analítica, de Carl Gustav Jung e trazendo conceitos importantes desta linha teórica. Após esta primeira análise o trabalho foi debruçado sobre a experiência de tratamento Psiquiátrico de Nise da Silveira no Hospital Pedro II para clientes psiquiátricos e seu estudo sobre a melhora clínica dos mesmos através do tratamento artístico.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Avaliação da adesão dos pacientes com doença pulmonar obstrutiva crônica (DPOC) às recomendações de prevenção contra covid-19
    (Universidade Federal de São Paulo, 2023-08-07) Almeida, Raquel Emanuela Lima de; Nascimento, Oliver Augusto [UNIFESP]; http://lattes.cnpq.br/2225674564595145; http://lattes.cnpq.br/1688476159498705
    Objetivo: Verificar se os pacientes com Doença Pulmonar Obstrutiva Crônica (DPOC) seguiram as recomendações de prevenção à Covid-19. Associar a adesão dos participantes às medidas de prevenção diante da pandemia do novo coronavírus com: gravidade da DPOC, escolaridade, nível socioeconômico e as comorbidades dos pacientes. Métodos: Estudo observacional e transversal, com amostragem de conveniência. Foi realizada aplicação de um questionário por meio de entrevista telefônica contendo perguntas sobre classificação socioeconômica tratamento medicamentoso da DPOC, adesão ao tratamento, presença de sintomas da Covid-19 e se cumpriram as medidas de prevenção contra o novo coronavírus. Resultados: 434 participantes participaram do estudo, a média de idade foi 69,7 + 9,9 anos, 53,2% eram do sexo feminino. Em geral, os participantes seguiram as recomendações. Houve uma associação significativa (p < 0,01) quando observado a frequência com que os participantes saiam de casa e a gravidade da doença, além disso, também houve resultado significativo (p = 0,03) ao associar a quantidade de visitas que eles recebiam em suas casas com as classes socioeconômicas. Ademais, identificou-se que indivíduos com idade mais avançada tinham 2,9% maior chance de seguir o protocolo, além disso, sexo feminino e aqueles que usavam oxigênio tendiam a seguir mais as recomendações de prevenção à nova doença em 2,7 e 3,1 mais chance, respectivamente. Conclusão: Os pacientes apresentaram uma boa aderência às medidas preventivas contra Covid-19. Indivíduos com idade mais avançada, do sexo feminino e que faziam usam de oxigênio suplementar domiciliar seguiram mais as recomendações.
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Avaliação da eficácia de doses repetidas de nitroprussiato de sódio no tratamento da esquizofrenia resistente: um estudo duplo-cego, randomizado, controlado por placebo
    (Universidade Federal de São Paulo (UNIFESP), 2020-08-21) Adelino, Marcelo Pinheiro Machado [UNIFESP]; Lacerda, Acioly Luiz Tavares De [UNIFESP]; Universidade Federal de São Paulo
    In present study, we evaluated the efficacy of repeated-dose sodium nitroprusside (SNP) in treatment-resistant schizophrenia. Methods: This was a double-blind, randomized, placebo-controlled trial. Twenty DSM-IV schizophrenia subjects, aged 18-60 years, with a history of nonresponse to ≥2 trials of antipsychotics used in adequate dose and duration (≥6 weeks) were enrolled. Subjects received SNP or placebo 4-hour infusions at 0.5 μg/kg/min. A total of 4 infusions and 4 follow-up evaluations, with an interval of 2 weeks, were performed. Severity of symptoms was assessed by using Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS-18) and Clinical Global Impression (CGI) scales. Results: SNP and placebo groups did not differ at baseline or in change from baseline for PANSS-total F3.597, 64.748=0.398; p=0.790), PANSS-positive (F2.898, 52.167=0.509; p=0.672), PANSS general (F3.302, 59.431=0.243; p=0.983), BPRS (F4.312, 77.615=0.143; p=0.946), or CGI (F3.841, 69.131=1.096; p=0.364) scores. SNP was well tolerated and showed a good safety profile. Conclusion: Although preliminary, the present findings suggest that SNP is not efficacious in TRS, reinforcing previous studies that have not demonstrated symptom improvement in chronic schizophrenia subjects. At this time, it is conceivable to speculate that efficacy of SNP might be restricted to early stages of disease.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Avaliação de intervenções terapêuticas em pacientes com cicatrizes hipertróficas e queloides: revisão sistemática
    (Universidade Federal de São Paulo (UNIFESP), 2021) Rebelo, Fabrizio Ricardo Cevallos [UNIFESP]; Sabino Neto, Miguel [UNIFESP]; Universidade Federal de São Paulo
    Introduction: The treatment of hypertrophic scars and keloids has been a challenge for medicine for decades, given that until now one has not yet found a treatment considered “Gold standard” due to the variety of therapies. Objective: The aim of the study was to analyze the different therapeutic interventions, whether single or associated, for the treatment of hypertrophic scars and keloids, from a systematic review. Method: PubMed, Web of Science, Scopus, EMBASE, Cochrane Library and Lilacs were searched, from January 1992 to April 2020, for randomized clinical trials of hypertrophic and keloid scar treatments, without restrictions of age, sex, race, or language limitation, which evaluated their effects with regard to height, erythema, flexibility, pigmentation, and Vancouver Scale. The review followed the recommendations of the PRISMA protocol, the tool to assess the risk of bias of the Cochrane was used, and the GRADE protocol. Mean differences (MDs), odds ratios (ORs) were calculated with 95% confidence intervals (CI), and a meta-analysis was performed. Results: Twenty-three studies were selected from 796, with a total of 1342 scars. Twelve studies included keloid and hypertrophic scars, while 11 only keloid scars. The analyzed interventions were the ones with use of Triamcinolone, Triamcinolone + 5-Fluorouracil, Verapamilo and Laser. There was no statistically significant difference in the effectiveness of any of the interventions in comparison to other therapies. Conclusions: This review demonstrated that there is no therapy more effective than another, be it individual or in association.
  • Nenhuma Miniatura disponível
    Item
    Somente Metadadados
    Avaliação do grau de fibrose hepática pelo método da elastografia por ARFI (acoustic radiation force impulse) antes e após sucessivos tratamentos da hepatite crônica C
    (Universidade Federal de São Paulo (UNIFESP), 2020-05-25) Xavier, Joao Batista Gonzaga [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; Universidade Federal de São Paulo
    Introduction: Liver biopsy (LB) is still considered the gold standard for assessing the degree of hepatic fibrosis (HF), as well as to investigate associated diseases and the degree of inflammation. However, there are some conditions that make it difficult to perform LB, such as the need for hospitalization and increased likelihood of complications. As a result, noninvasive methods have been developed to facilitate the assessment of HF for both patients and healthcare professionals. Acoustic radiation force impulse (ARFI) elastography is one of these methods but many doubts still remain when evaluations are made after HCV treatment. Objective: The aim of the study was to evaluate hepatic fibrosis using ARFI technology before and after successive treatments for chronic hepatitis c virus infection. Methods: We prospectively included 50 adult patients with chronic hepatitis c with genotype. 1, first submitted to triple therapy with first generation protease inhibitors (boceprevir and telaprevir), attended at the hepatitis division of the Gastroenterology Department of the Federal University of São Paulo, from August 2013 to July 2014. The non responders underwent retreatment with Interferon free direct acting antivirals (sofosbuvir associated with daclatasvir or simeprevir) in 2017 and 2018. Assessment of hepatic stiffness by ARFI was performed before and after the first treatment and the retreatment. Results: ARFI values decreased significantly after treatments. In patients on first generation protease inhibitor therapy and achieving SVR, the ARFI ranged from 2.41 ± 0.58 m/seg pre treatment to 2.39 ± 0.63 m/seg (p <0.042) post treatment. In patients who did not obtain SVR, that is, were non responders, there was also a significant reduction. The ARFI was 2,02 ± 0,58 m/seg in the pretreatment and went to 2.03 ± 0.54 m/seg (p <0.001). Non responders patients, before starting the retreatment, again showed higher ARFI values, which suffered a sharp drop after SVR (from 2.46 ± 0.57 m/seg to 1.45 ± 0.68 m/seg, p <0.004). Laboratory parameters such as AST and ALT followed the fall in elastography values by the ARFI method. Conclusion: The evaluation of hepatic stiffness by the ARFI method before and after successive treatment of hepatitis C in responders and non responders, and performed early (within 6 to 9 months after the end of therapy), led to the conclusion that the reduction of elastographic parameters seems to be more closely related to the reduction of hepatic inflammation, more than as a consequence of fibrosis regression.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Avaliação do impacto da terapia tripla para Hepatite C sobre a qualidade de vida relacionada à saúde de pacientes cronicamente infectados
    (Universidade Federal de São Paulo (UNIFESP), 2016-10-25) Souza, Samara Ercolin de [UNIFESP]; Ferraz, Maria Lucia Cardoso Gomes [UNIFESP]; http://lattes.cnpq.br/1870810357457710; http://lattes.cnpq.br/1015287527131946; Universidade Federal de São Paulo (UNIFESP)
    ims: To evaluate the impact of triple therapy with Boceprevir and Telaprevir on the health-related quality of life (HRQOL) of patients chronically infected with hepatitis C. To compare the HRQOL of the patients before treatment with the HRQOL of different moments during the therapy. To associate HRQOL with epidemiological, clinical and histological variables. Methods: Descriptive, observational longitudinal study conducted in Hepatitis Sector of Gastroenterology Discipline of the Universidade Federal São Paulo. Coinfected with HIV and HBV were excluded. A standard questionnaire was applied to investigate sociodemographic, clinical and histological aspects. Survey forms to assess of HRQOL - Short Form 36 (SF-36), Liver Disease Quality of life (LDQOL) - were applied in four moments: pre-treatment, 1º month, 3º month and 6º month of therapy. In the comparative analysis the relation between HRQOL and clinical and therapeutic variables was evaluated. Results: 38 patients were included, the majority of women (55%) with a mean age of 52±10 years. Most part was cirrhotic (61%), in retreatment (66%) and used telaprevir (61%). During the course of therapy 16 patients discontinued treatment, most due to adverse events. Pre-treatment moment had the highest HRQOL average. The 3º month of treatment showed the lowest average quality of life related to health. For the SF-36 the differences were in the domains: physical limitation, functioning, pain, vitality, social and mental health aspects. In accord with LDQOL, the differences were in the domains: symptoms of liver disease, effects of liver disease, concentration and sleep. The domain hope presented the highest score over all moments of the study; on the other hand the domains with lower scores, which had stayed low during the hole treatment were related to sexual sphere. In the comparative analysis men had lower HRQOL scores, as well as patients with less than 52 years, with higher education, naives and not submitted to lead-in.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Avaliação dos efeitos de um programa de exercícios funcionais no tratamento de pacientes com fibromialgia: um estudo controlado e randomizado.
    (Universidade Federal de São Paulo (UNIFESP), 2019-10-31) Fernandes, Giovana [UNIFESP]; Natour, Jamil [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: Fibromyalgia (FM) is a syndrome characterized mainly by chronic generalized pain that affects the physical fitness and functional capacity of patients. There is increasing evidence of the benefits of physical exercise in improving FM symptoms, making these interventions part of therapeutic arsenal. Objective: To evaluate the effectiveness of a program of functional exercises in reducing pain, improving functional capacity, increasing muscle strength, improving flexibility, balance and quality of life of patients with FM. Methods: It is a controlled and randomized study, with blind evaluator. A total of 82 female patients with FM were included, with age between 18 and 65 years, randomized into two groups, intervention and control. The intervention group (FEG) performed functional exercise training for 45 minutes twice a week for 14 weeks. The control group (SEG) performed stretching exercises with the same duration and frequency. Evaluation instruments were: VAS - Visual Analogue Scale for pain assessment; FIQ- Fibromyalgia Impact Questionnaire, for assessing healthrelated quality of life; Time-up and go test for functional performance evaluation; 1RM, for evaluation of muscle strength; Bank of Welss, for the assessment of flexibility; Berg Balance Scale, to evaluate balance; and SF- 36 to evaluate general quality of life. Also, the amount of analgesics used during the intervention period was assessed.Results:41 patients were randomized to the FEG and 41 patients to the SEG. After intervention, the FEG presented a reduction in pain and an improvement in the quality of life related to the disease, which was statistically significant compared to SEG. Regarding general quality of life, functional capacity, muscle strength, flexibility and balance, there was no difference between the groups. Conclusion: Functional exercise training proved to be effective in reducing pain and improving the health-related quality of life of patients with FM when compared to stretching exercises.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Balanced scorecard como ferramenta de gestão estratégica no tratamento da fasciíte plantar
    (Universidade Federal de São Paulo, 2019-02-18) Pazetti, José Augusto Theodosio [UNIFESP]; Yi, Liu Chiao [UNIFESP]; http://lattes.cnpq.br/6106154677645509; http://lattes.cnpq.br/8445469805205594; Universidade Federal de São Paulo (UNIFESP)
    Os modelos de gestão empresarial têm influenciado, globalmente, mudanças em todas as áreas de negócio. Assim, as ações dos profissionais estão baseadas cada vez mais em informações confiáveis oriundas de sistemas de gerenciamento integrados. A Fasciíte Plantar (FP) é uma das lesões mais comuns que acometem o pé, sendo seu tratamento demorado e oneroso. Utilizar uma ferramenta de gestão como o Balanced Scorecard (BSC) poderá auxiliar no diagnóstico e tratamento da FP. Participaram do estudo 42 pacientes de ambos os sexos, com FP unilateral ou bilateral, com duração mínima dos sintomas de quatro meses e idades entre 35 e 65 anos. O modelo BSC para análise das cinco etapas do projeto, foi definido a partir de quatro perspectivas: (i) os resultados; (ii) o paciente; (iii) processo interno; (iv) aprendizagem e crescimento. Sendo a etapa 1 responsável pela identificação dos níveis da FP, a etapa 2 por associação entre o nível da FP e o melhor tratamento, a etapa 3 pela associação entre os níveis da FP com o perfil do paciente e o melhor tratamento, a etapa 4 responsável pela associação dos níveis da FP com o perfil do paciente e a etapa 5 com a análise de evasão ao tratamento. Desta forma, o presente estudo propõe contribuir no gerenciamento do tratamento da FP, fornecendo assistência na escolha do melhor tratamento por nível de lesão e perfil do paciente, na redução do tempo de tratamento, na evasão e reincidência da doença por meio da construção e da implementação de um modelo BSC.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Bruxismo do sono: possibilidades terapêuticas baseadas em evidências
    (Dental Press International, 2011-04-01) Machado, Eduardo; Machado, Patricia; Cunali, Paulo Afonso [UNIFESP]; Dal Fabbro, Cibele [UNIFESP]; UFPR; UFSM; PUC; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); CFO
    INTRODUCTION: Sleep bruxism (SB) is defined as a stereotyped and periodic movement disorder, characterized by tooth grinding and/or clenching occurring during sleep, associated with rhythmic masticatory muscle activity. This condition isn't a disease, but when exacerbated may cause an unbalance and changing of orofacial structures. Thus, it is necessary to obtain effective and safe treatments for the control and management of the bruxist patient. The treatment alternatives ranges from oral devices to pharmacological and cognitive-behavioral techniques. OBJECTIVES: This study, through a systematic literature review, having as research bases MEDLINE, Cochrane, EMBASE, Pubmed, Lilacs and BBO, between the years of 1990 and 2008, with focus in randomized and quasi-randomized clinical trials, systematic reviews and meta-analysis, had as objective to analyze and discuss possibilities of treatment for sleep bruxism. RESULTS: According to the analysis of literature there are a lot of treatment options for the SB, but many of the therapies have no scientific support. Thus, the chosen therapy should be based on scientific evidences and in clinical common sense, to an improvement in quality of life of the bruxist patient.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Características clínicas de uma população com migrânea e tontura e resposta ao tratamento profilático após três e seis meses
    (Universidade Federal de São Paulo (UNIFESP), 2019-01-31) Costa, Aline Turbino Neves Martins Da [UNIFESP]; Ferraz, Henrique Ballalai [UNIFESP]; http://lattes.cnpq.br/6405640945393510; http://lattes.cnpq.br/7356157635063797; Universidade Federal de São Paulo (UNIFESP)
    A retrospective study carried out in the headache sector at the Migraine Clinic and University of the Federal University of São Paulo, through the review of patient charts from the outpatient clinic, attended from January 2014 to June 2016, in order to evaluate the clinical characteristics of patients, an aura presence associated with vertigo and / or non-vertiginous dizziness, as well as the efficacy of treatment at 3 months 6 months. In patients with a diagnosis of migrânea associated with vestibular symptoms, a presence of aura for the most prevalent subtype, being an average frequency of days of headache / month compatible with chronic migraine (pain more than 15 days in the month). Patients with migraine presented mostly vertigo, but an occurrence of dizziness combined with non-vertigo dizziness was also found verified. It was possible to observe that some otovestibular symptoms such as tinnitus, aural fullness, dizziness associated with dizziness, phonophobia, nausea, vomiting, osmophobia and kinesiophobia had a higher relative risk of occurrence in migraine with aura. Therapeutic therapies for vestibular migrans (MV), the outlets are direct from the treatment of migration, through studies comparing patients with MV, with the treatment with profile. In this group of patients with health problems, intensity and frequency of episodic dizziness / vertigo, as well as their associated characteristics, with time effect (the longer the treatment time the greater the improvement of symptoms) for improvement of pain and vestibular symptoms and without statistical classification of response between classes of medications choices for their treatment.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Características clínicas, laboratoriais e histológicas de pacientes com glomerulopatia membranosa após o transplante renal
    (Universidade Federal de São Paulo (UNIFESP), 2016-10-31) Silva, Artur Quintiliano Bezerra da [UNIFESP]; Kirsztajn, Gianna Mastroianni [UNIFESP]; http://lattes.cnpq.br/5744106277657588; http://lattes.cnpq.br/5375961194708676; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Membranous nephropathy (MN) is one of the most common causes of nephrotic syndrome in the adult population, accounting for about 20% of cases. MN may occur in the transplanted kidney, either as a recurrent or de novo disease. Objetives: This study has the purpose to describe clinical, laboratorial and immunological characteristics of patients submitted to kidney transplantation that developed MN, and evaluate graft and patient survival in patients with post-transplant MN, as well as survival associated factors. Methods: In a retrospective cohort study of patients who were transplanted between 1983 and 2015 and had the diagnosis of MN in the graft, clinical, laboratorial and histopathological kidney parameters were evaluated. Results: 41 patients with post-transplant MN were identified. Men were predominant (58.5%), in the fourth or fifth decade of life. The etiology of end-stage renal disease (ESRD) was MN in 36.6% of the cases, the median for onset of the first proteinuria was 40 months, for diagnosis of MN was 41.5 months and the average post-transplant follow-up was 108.2 ± 52.8 months. Complete remission was achieved in 31.3% patients and partial remission in 43.9%, recurrence was confirmed in 36.6% and the main cause of graft loss was chronic nephropathy (50%) followed by post transplant MN. A secondary cause of MN was identified in 24%, half of them from malignancies. In renal biopsy, there was a positive but non significant correlation between C3 deposits intensity and proteinuria levels. Death-censored graft survival (DCGV) at 10 years was 58.6%. Conclusion: Post-transplant MN has varied clinical presentation, as well as in the native kidney, but usually presented with subnephrotic proteinuria and progressive graft dysfunction, although it has observed complete remission of proteinuria in about ¼ of the cases in this population. Kidney and patient survivals at 10 years were 53.1% and 88.3%,, respectively, and they were not different of that of the general population transplanted at the same service. The remission of the post-transplant MN occurred either in patients undergoing additional immunosuppressive treatment as in those for whom only renoprotection was introduced or optimized. The remission, even if only partial, was associated with a better renal outcome. The 4 main cause of graft loss in this group was chronic graft nephropathy and not post transplant MN. It was not possible to assess the direct benefit or risk of therapeutic interventions (renoprotection and/or immunosuppression) in transplanted kidney, possibly because of the limitations of the present study design.
  • Imagem de Miniatura
    Item
    Acesso aberto (Open Access)
    Caracterização molecular de amostras de Pseudomonas aeruginosa resistentes a Amicacina e Meropenem
    (Universidade Federal de São Paulo (UNIFESP), 2019-02-20) Santos, Paulo Henrique Dantas Dos [UNIFESP]; Pignatari, Antonio Carlos Campos [UNIFESP]; http://lattes.cnpq.br/9461346610553865; http://lattes.cnpq.br/7071042329034394; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Pseudomonas aeruginosa infections in the hospital environment present high morbidity and mortality, particularly in immunocompromised patients, with high rates of multiresistance to antimicrobials including carbapenens and aminoglycosides. This study retrospectively analyzed isolates of P. aeruginosa resistant to amikacin and meropenem from nosocomial infections of the bloodstream and respiratory tract diagnosed in the participating medical centers of SCOPE Brazil and Hospital São Paulo. Methods: The sensitivity profile to amikacin and meropenem of 96 P. aeruginosa samples, identified by MALDI-TOF, was determined by dilution in agar. The presence of genes encoding enzyme resistance to meropenem and amikacin was evaluated by real-time PCR (qPCR) and the clonality profile by Pulsed Field Gel Electrophoresis (PFGE). Four samples with different minimum inhibitory concentrations (MIC) for amikacin were submitted to new generation sequencing (SNG). Results: Resistance to both antibiotics, amikacin and meropenem, was observed in 42 (43.75%) with very high MICs for amikacin (> 4,096 μg / ml). The blaSPM, rmtD, blaGES resistance genes were detected by the qPCR methodology. An association of samples with higher MICs for amikacin was observed when the detection of genes coding for the metalloenzyme blaSPM and the methylase rmtD was observed. The analysis of the clonality profile of the isolates resistant to amikacin by PFGE revealed 10 profiles, and the majority of isolates resistant to amikacin and meropenem are found in the same profile. The SNG analyzed by the online platforms Center for Genomic Epidemiology and MLST-Pasteur Database enabled the detection of resistance genes for β-lactams, aminoglycosides and fluoroquinolones, as well as ST of three isolates, especially ST 277 for international dissemination.