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GUSTAVO FERNANDO DE FRAZÃO LIMA
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Leader : JOSE AUGUSTO FERREIRA PEREZ VILLAR
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MEMBRES DE LA BANQUE :
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JOSE AUGUSTO FERREIRA PEREZ VILLAR
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JEFFERSON LUIZ PRINCIVAL
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RAFAEL AUGUSTO SOLDI
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Data: 4 févr. 2022
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Afficher le Résumé
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2
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DENNER HENRIQUE ISAIAS SOUZA
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Analysis of the quality of evidenceon the effectiveness of direct oral anticoagulants
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Leader : DANYELLE ROMANA ALVES RIOS
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MEMBRES DE LA BANQUE :
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DANYELLE ROMANA ALVES RIOS
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LEILISMARA SOUSA NOGUEIRA
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MARIA AUXILIADORA PARREIRAS MARTINS
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NAYARA RAGI BALDONI COUTO
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Data: 7 févr. 2022
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Afficher le Résumé
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Introduction: Direct oral anticoagulants (DOACs) have been presented as a new anticoagulant front in the prevention of thromboembolism. Imprecisions in design, conduct, and analysis may bias the effect of the intervention to be underestimated or overestimated. Objective: To analyze the quality of scientific evidence on the efficacy of DOACs available in package leaflets. Method: To achieve the objective, the study was divided into two stages: (i) identification and analysis of the availability of bibliographic references contained in the package leaflets of DOACs consulted through the electronic bularium of the Agência Nacional de Vigilância Sanitária (ANVISA); and (ii) analysis of the quality of the studies contained in the package leaflets using. In this step the Cochrane Risk of Bias tool was used. This tool has seven domains, and each domain was classified as high, uncertain, or low risk of bias according to the authors' assessment. The analysis was performed by two independent authors. In case of disagreement, a third reviewer was consulted. After evaluation, graphs of the analyses were generated using Revman 5.4 software. Results: Twenty-five studies were evaluated. The results showed that the clinical trials used as references in the professional package leaflets of DOACs have great methodological uncertainties. Conclusion: Therefore, the present study evidenced that the quality of clinical trials used as references for DOACs' package inserts showed many uncertain domains in their clinical trials and should be analyzed with caution. It is suggested the need for strict protocols that establish the description of the methods in a clear and cohesive way.
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3
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MARLON SILVA TINOCO
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DEPRESCRIPTION OF BENZODIAZEPINES IN THE ELDERLY: ANALYSIS OF PACKAGE INSERTS AND VALIDATION OF INSTRUMENTS FOR IDENTIFICATION OF SIGNS AND SYMPTOMS OF WITHDRAWAL
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Leader : ANDRE DE OLIVEIRA BALDONI
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MEMBRES DE LA BANQUE :
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ANDRE DE OLIVEIRA BALDONI
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CAMILO MOLINO GUIDONI
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LORENA ROCHA AYRES
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Data: 10 févr. 2022
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With population aging and the irrational use of benzodiazepines by society, health professionals need quality evidence to perform the deprescription of these drugs, as well as instruments for this process to occur effectively and safely for the elderly. That said, this study has been divided into two chapters.
Chapter 1: Objective: To analyze the presence and quality of content on drug deprescribing in Brazilian package inserts for benzodiazepine drugs Methodology: A documentary study was carried out, in which data contained in Brazilian package inserts for benzodiazepines (BZDs) were analyzed. The keywords “reduction”, “withdrawal” and “non-prescription” were sought. Furthermore, information relevant to the topic (directly related to the describing process) was verified, such as the maximum time of use, the risks of prolonged use and adverse reactions. For purposes of comparison of information, explicit and systematic guidelines for describing and warning of adverse reactions found in the literature were considered. Results: Twelve BZD inserts were found with valid registration and the inserts (100%) address the topic of descrip- tion through the suggestion of gradual dose reduction. Only one (8.33%) presented explicit and systematic guidance for dose reduction. As for the maximum time of use, different information according to each drug, and a package insert (8.33%) did not present this information. Regarding the risks of prolonged use of the drug, 11 (91.67%) package inserts reported a risk of dependence and/or tolerance and one (8.33%) stated that the data available in the literature do not provide a true estimate of the risk. 33.33% package inserts did not address the risk of falls and five (41.67%) did not address the risk of fractures in the elderly. The risk of cognitive impairment was not reported in six (50.00%) package inserts. The risk of a car accident is included in the 12 (100%) package inserts analyzed. Conclusion: The package inserts do not provide detailed or schematic descriptions. It is extremely important that health professionals are guided in their conduct and, therefore, there is a great need to update the package inserts.
Chapter 2: Objective: to develop and carry out the validation of an adequate instrument to assess the signs and symptoms of withdrawal from the benzodiazepine deprescription process in Brazilian elderly. Methodology: a two-step methodological study was carried out, the first being the preparation of an instrument to identify signs and symptoms arising from the gradual descrip- tion of benzodiazepines in elderly Brazilians. A second stage consisted of the validation of the instrument using the delphi technique by experts in the area of health and specialists in elderly health. Results: A systematized elaboration and validation was carried out with 36 experienced reviewers in elderly care, making it possible to build an instrument for the proper identification of withdrawal signs and symptoms present during the process of describing benzodiazepines in elderly Brazilians. The agreement percentage found was higher than the minimum awarded rate of 80% and the critical evaluation of the evaluators updated the improvement of the questionnaire. Conclusion: The instrument elaborated understood the signs and common to the process of describing BZD in the elderly, validated by a reviewer to be applicable in the Brazilian health context.
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4
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ADRIANO LOPES DA SILVA
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CHEMICAL COMPOSITION AND EVALUATION OF THE ANTIOXIDANT AND LARVICIDE ACTVITIES OF THE EXTRACTS, FATTY ACIDS AND METHYL ESTERS OF THE PERICARP OF Tecoma stans (L.) Juss. Ex Kunth (BIGNONIACEAE).
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Leader : LUCIANA ALVES RODRIGUES DOS SANTOS LIMA
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MEMBRES DE LA BANQUE :
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LUCIANA ALVES RODRIGUES DOS SANTOS LIMA
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MAIRON CESAR COIMBRA
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NATHÁLIA LUCCA SILVA
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Data: 29 avr. 2022
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Afficher le Résumé
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Currently, there is a growing interest in antioxidants and insecticides from plant extracts from aromatic and medicinal plants, cereals, fruits, considered sources of natural antioxidants and bioinsecticides, and this is also economically interesting. The control of insects with synthetic insecticides causes a great impact on the environment and, consequently, on public health, as they are not biodegradable and because they are bioaccumulative. In this context, the ipê-mirim, guarã-guarã, ipê-de-jardim, amarelinho and yellow caroba, some of the names by which the species Tecoma stans (L.) Juss. Ex Kunth (Bignoniaceae) is known, it becomes interesting. Thus, this study aimed to evaluate the antioxidant activities and larvicidal potential of the T. stans pericarp from hexane extracts (HE), methanol extract (ME) and their fatty acids (FA) and methyl esters (FAMES). The extracts were obtained with hexane and methanol in a Soxhlet apparatus, hydrolyzed and esterified to obtain AG and FAME, respectively, and analyzed by Gas Chromatography and Mass Spectrometry (GC-MS) to determine their composition. In the phytochemical screening, the presence of steroids, triterpenes, alkaloids and coumarins was detected for HE, whereas for ME only the presence of alkaloids and coumarins was verified. In the analysis by GC-MS, the nonacosane hydrocarbon was identified as the major compound (81.69%) in the hexane extract. In FAME (EH), the major compounds were methyl hexadecanoate or palmitate (C16:0), methyl 9, 12-octadecadienoate or linoleate (C18:2) and methyl 9, 12, 15-octadecatrienoate or linolenate (C18:3), whereas in FAME (ME), the major compound was methyl hexacosanoate (C26:0). In the evaluation of antioxidant activity, the samples were effective at all concentrations tested (1, 10, 100, 250 and 500 µg/mL) by the DPPH method, with antioxidant potential, with percentages of inhibition ranging from 63.70 to 96.10% at a concentration of 500 µg/mL. The samples were more effective than BHT in capturing DPPH radicals, because they had lower EC50 values. In the FRAP test, the samples showed a lower antioxidant potential. By this methodology, the highlight was for the methanolic extract that had an activity like that of BHT. The results for lethality in A. salina showed that the FAME of the hexane extract and the FAME of the methanolic extract can be considered toxic with LD50 < 1000 µg/mL. In the susceptibility test in Culex quinquefasciatus larvae, it was possible to observe that the hexane extract and its fatty acids have larvicidal activity, because they promoted larval mortality. However, this effect is considered ineffective according to the literature. Thus, it can be concluded that this work is unprecedented and important because it contributed to the identification of compounds present in the pericarp of T. stans, as well as to the evaluation of the biological activities of this species.
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5
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AMANDA MARIA DE PAIVA
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Use of medicines in pediatrics: an analysis of the technical and legal aspects of package inserts
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Leader : ANDRE DE OLIVEIRA BALDONI
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MEMBRES DE LA BANQUE :
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ADRIANO MAX MOREIRA REIS
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ANDRE DE OLIVEIRA BALDONI
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MARCIA CHRISTINA CAETANO ROMANO
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Data: 29 avr. 2022
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Afficher le Résumé
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Background: The use of medication in pediatrics should be performed with caution. The shortage of studies in the area and of specific medicines formulated for children and adolescents that address the physiological needs of this population make the occurrence of adverse drugrelated events more common in this population when they’re compared to adults. The medication package inserts are legal documents that provide information about the use of medicines to patients and health professionals and must contain data that guide the administration and inform the potential risks associated with medicines. Based on the above, this study aims to perform the technical and legal analysis of package inserts for medicines used in pediatrics, verifying whether the package inserts include technical and legal aspects and corroborate the recommendations of clinical protocols and legal provisions. Methods: A documental study of medication package inserts analysis was carried out, divided into two substudies. The search of the medication package inserts was carried out through the electronic portal of the National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária – ANVISA). Substudy 1 consists of the technical and legal analysis of drug inserts commonly used via continuous infusion (CI) pump in neopediatric intensive care units (ICU). Thirteen drugs used via IC were selected and information on the use in neonatal and pediatric patients was searched in the package inserts. In order to compare the technical information, the Micromedex Neofax®, Micromedex Pediatrics® and Lexicomp® databases were consulted. To analyze the legal aspects, ANVISA's Resolution of the Collegiate Board (Resolução da diretoria colegiada - RDC)47/2009 was used. Substudy 2 consists of the search for recommendations on adverse drug reactions (ADR) in pediatrics contained in the Guideline Key Potentially Inappropriate Drugs in Pediatrics: The KIDs List in the package inserts of drugs sold in Brazil. Results: substudy 1 showed that of the 13 drugs analyzed, 46% (n=6) showed some non-compliance with RDC 47/2009. Only 46% (n=6) of the drugs are indicated for pediatric use and only the midazolam package insert (7.7%) contained information considered essential for use via CI in pediatrics. Substudy 2 showed that, of the drugs indicated for pediatric use, only 26% (n=6) presented the risks of ADRs similar to the Guideline KIDs List and the same recommendations on the package inserts. The others (74%) showed some disagreement. Conclusions: The package inserts are technical and legal documents that provide essential information for the safe use of medications and, as noted, they have deficiencies that can compromise the safety of medication use, especially when dealing with neonatal and pediatric patients.
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6
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MARA LUIZA DE PAIVA DOMINGUES
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Assessment of the risk of bias of clinical trials referenced in the Technical Notes for Ordering Direct Oral Anticoagulants
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Leader : ANDRE DE OLIVEIRA BALDONI
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MEMBRES DE LA BANQUE :
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ANDRE DE OLIVEIRA BALDONI
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CARINA CARVALHO SILVESTRE
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KÉRILIN STANCINE SANTOS ROCHA
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LEILISMARA SOUSA NOGUEIRA
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Data: 4 mai 2022
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Introduction: Started in the 1990s, the judicialization of health care in Brazil contemplates direct oral anticoagulants (DOAC). The increase in demand resulted in the creation of the “eNatJus” system, which stores Technical Notes (NTs) that assist in the decisions of health processes. Thus, studies to evaluate the quality of clinical trials used in the elaboration of NTs are necessary and allow greater security in decisions. Objective: To evaluate the clinical trials that make up the NTs referring to the DOAC by classifying the risk of bias. Methods: The NTs related to apixaban, dabigatran, edoxaban and rivaroxaban DOAC requests were selected on the e-NatJus website and, after excluding duplicate bibliographic references, an analysis of the clinical trials used for their writing was performed. The risk of bias of clinical trials (low, high or uncertain bias) was assessed using the Cochrane Risk of Bias tool and the results of the analyzes were added in Review Manager 5.4 (Revman 5.4) for graphing. Results: 181 NTs were selected, 236 articles were analyzed and after applying the inclusion criteria, 28 clinical trials were analyzed in full. None of the clinical trials were free from bias. The majority of clinical trials, 71% (20/28) showed low risk of bias with respect to attrition bias and reporting bias. On the other hand, 61% (17/28) of the trials did not control for selection, performance and detection bias, since they present uncertainties and high risk of bias. In addition, it was observed that 21% (6/28) of clinical trials had risk of bias for conflict of interest. Conclusion: The biases present in the clinical trials cited as a bibliographic reference of the NT referring to the DOAC request are significant and compromise their quality.
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7
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Jéssica Spínola Silva
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EVALUATION OF THE PERFORMANCE OF A SEROLOGICAL METHOD BY FLOW CYTOMETRY FOR THE GENOTYPE-SPECIFIC DIAGNOSIS OF CHAGAS DISEASE
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Leader : MELINA DE BARROS PINHEIRO INACIO
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MEMBRES DE LA BANQUE :
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MELINA DE BARROS PINHEIRO INACIO
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GUSTAVO MACHADO ROCHA
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GLAUCIA DINIZ ALESSIO
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LEILISMARA SOUSA NOGUEIRA
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Data: 12 mai 2022
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Afficher le Résumé
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Trypanosoma cruzi was subdivided into six distinct genetic groups, called Discrete Typing Units (DTUs), from TcI to TcVI. The genetic variability of T. cruzi can influence the biological characteristics of the parasite, the epidemiology and clinical features of Chagas disease (DCh). Furthermore, individuals infected with different T. cruzi genotypes may present a distinct therapeutic response to the treatment of DCh. Therefore, the development of new methods for the genotype-specific diagnosis of DCh is of great importance for clinical, epidemiological and post-therapeutic monitoring studies. Some molecular methods used for this proposal have limitations, such as: the need for previous isolation of the parasite from the blood by low-sensitivity techniques (blood culture and xenodiagnosis) that can select T. cruzi DTUs, in addition to the need to use multiple targets of the parasite's genome for the correct identification of the genetic groups that infect the host. The serological methods developed for the genotype-specific diagnosis of DCh were not able to recognize all T. cruzi DTUs present in samples of individuals from different geographic regions. In this sense, the technique of investigation of anti-amastigote (A), trypomastigote (T) and epimastigote (E) antibodies of T. cruzi by flow cytometry (Chagas-Flow ATE) for the diagnosis of DCh was standardized. Initially, Chagas-Flow ATE was developed for the genotype-specific diagnosis of experimental infection by T. cruzi, showing a good performance to discriminate the different DTUs of the parasite that infect mice. Therefore, continuing these studies, the objective of this project was to evaluate the performance of Chagas-Flow ATE in the universal and genotype-specific diagnosis of DCh, using human serum samples. 102 sera from patients with Chagas disease (CH) in the chronic phase, infected with TcI, TcVI or TcII of T. cruzi DTUs, using the Chagas-Flow ATE, were evaluated. The results showed that this new methodology showed excellent accuracy (100%) in the universal diagnosis of DCh, being able to segregate all serum samples from CH patients from those not infected with T. cruzi (NI), using certain sets of attributes (target antigens, serum dilutions and cut-off points). Furthermore, analysis by decision trees, using selected sets of attributes, indicated an excellent performance of Chagas-Flow ATE in the genotype-specific diagnosis of DCh, with an accuracy of 92% and 97% to discriminate infections by “TcI vs TcVI vs TcII” and “TcI vs TcII”, respectively. The data obtained suggest the use of Chagas-Flow ATE in the universal and genotype-specific diagnosis of DCh. Thus, through this new method, it will be possible to interfere with the T.cruzi genotypes that infect the patient, having a practical impact on the epidemiological surveillance of this disease, in the clinic and in the post-therapeutic monitoring of individuals with Chagas disease.
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8
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Magda Cesar Raposo
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Drug-Food Interactions in Brazilian Drug Data Sheets: Is There Concordance With The Literature?
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Leader : DANYELLE ROMANA ALVES RIOS
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MEMBRES DE LA BANQUE :
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DANYELLE ROMANA ALVES RIOS
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RAFAEL SANTOS SANTANA
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RENATA ADRIANA LABANCA
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Data: 19 juil. 2022
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Objective: To analyze the existence of information about drug-food interactions in Brazilian drug package inserts and whether there is agreement with the literature. Methodology: Electronic package inserts for patients and health professionals, made available by Anvisa, were analyzed. We identified 144 drugs with food interactions, of these 15 were excluded, because they were registered as expired/canceled or non- existent in Anvisa's files. After identifying all package inserts, a comparative analysis was performed between the information contained in the Interactions Manual, the health care professional's package insert, and the patient's package insert, and then we categorized these results. For data analysis and interpretation, a database was constructed in spreadsheet form using Microsoft Office Excel 2016. Results: Of the 129 package leaflets analyzed, in 66 (51.2%), the information contained in the professional and patient leaflets agreed with each other, in 45 (34.9%) there was no information about interactions between drugs with food in both the professional and patient leaflets, in 13 (10.0%) the data contained in the professional and patient leaflets partially agreed, and in 05 (3.9%) there was information that did not agree between the two information sheets. In addition, there is no information on interactions between drugs and food in the professional package leaflet. In the comparison between the patient package insert and the Interactions Manual, in 45 (34.9%) there was no data on drug-food interactions in the patient package insert. In 36 (27.9%) the information agreed with each other, in 30 (23.3%) the information in the patient package leaflet partially agreed with the Interactions Manual, and in 18 (13.9%) there was no agreement between the two sources of information. Partial Considerations: We found considerable divergence and absence of information, both in professional and patient package leaflets, about drug- food interactions. The absence or poor quality of information about drug-food interactions in package leaflets reduces their value as informational/educational material for the health care professional and patient. These factors may lead to risk exposure related to changes in drug response and patient safety.
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9
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LIVIAN RABELO LOPES
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Drug repositioning: evaluation of the anti-inflammatory and antinociceptive activity of nitazoxanide
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Leader : ADRIANA CRISTINA SOARES DE SOUZA
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MEMBRES DE LA BANQUE :
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ADRIANA CRISTINA SOARES DE SOUZA
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ALINE APARECIDA SALDANHA RAFANTE
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GLAUCIA MARIA LOPES REIS
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MELISSA GRAZIELLE MORAIS
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PRISCILA TOTARELLI MONTEFORTE
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Data: 5 sept. 2022
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Afficher le Résumé
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Nitazoxanide (NTZ) is a drug widely used for the treatment of a wide variety of parasitic diseases. Some recent discoveries suggest new therapeutic functions of this drug, a process called drug repositioning. New drug development is a slow and costly process, so drug repositioning is an effective alternative approach. Inflammatory processes are part of the pathogenesis of several very prevalent diseases. Inflammation is a complex biological process and its chronicity can lead to deleterious effects in the body. The treatment of inflammation involves the use of non-steroidal anti-inflammatory drugs, glucocorticoids and opioids, but the prolonged use of these drugs can cause serious adverse effects. Therefore, the search for new safer drugs is necessary. The objectives of this work were to evaluate the anti-inflammatory and antinociceptive activities of NTZ; using experimental models of paw edema induced by carrageenan (Cg), model of abdominal writhing induced by acetic acid, formalin test and rota rod for analysis of motor impairment and balance. The oral (po) treatment of the animals with NTZ induced a significant inhibition of paw edema of 60% and 68% at doses of 10 and 30 mg/Kg, respectively, already in the first hour after Cg injection. There was also a significant inhibition 3 and 4 hours after the inflammatory stimulus at doses of 10 mg/Kg (57.14% and 21.27%) and 30 mg/Kg (69.25% and 61.70%) and 6 hours after stimulation at a dose of 30 mg/kg (40.47%). Histological analysis of the footpads of animals treated with NTZ 30 mg/Kg (4 hours after Cg stimulation) showed a reduction in the migration of inflammatory cells by 65.77%. Likewise, treatment with NTZ 30 mg/Kg reduced tumor necrosis factor-α (TNF-α) levels in the footpad 2 hours after Cg-induced inflammation. NTZ showed antinociceptive activity, significantly inhibiting the number of abdominal contortions induced by acetic acid at doses of 30 and 90 mg/kg by 54.14% and 56.21%, respectively. In the formalin test, doses of 10 and 30 mg/Kg did not present an antinociceptive effect; and the dose of 90 mg/Kg had an effect in both phases of the test (55.88% and 57.99%). Finally, the treatment of animals with NTZ, at doses of 10, 30 and 90 mg/Kg, did not cause any motor or balance alteration in the rota rod test. This result suggests that the antinociceptive effect of NTZ may be related to the reduction of inflammatory pain by inhibiting inflammation. The results suggest an anti-inflammatory effect, possibly related to the decrease in TNF-α.
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10
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PAULA LAMOUNIER LIMA
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EPIDEMIOLOGICAL PROFILE OF THE SEIZURE OF MARIHUANA, COCAINE AND CRACK IN MUNICIPALITIES IN THE CENTRAL-WEST REGION OF MINAS GERAIS
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Leader : JOAQUIM MAURICIO DUARTE ALMEIDA
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MEMBRES DE LA BANQUE :
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DANYELLE ROMANA ALVES RIOS
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FARAH MARIA DRUMOND CHEQUER BALDONI
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JOAQUIM MAURICIO DUARTE ALMEIDA
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YURI MACHADO
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Data: 28 sept. 2022
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Drug use and abuse is a serious public health problem, having a strong relationship with conditions of social vulnerability and crimes in general, such as trafficking and violence. The objective of the present study was to describe the profile of arrests of marijuana, cocaine and crack, carried out by the Civil Police, in the Central-West region of Minas Gerais. This is a descriptive observational study designed according to the guidelines proposed by the Declaration of Strengthening Reports of Observational Studies in Epidemiology (STROBE), carried out on a documentary basis from January 2017 to December 2019. Data collection took place on the 1st Regional Civil Police Department of the 7th Civil Police Department, based in Divinópolis, with cases selected from the municipalities of Divinópolis, Itaúna, Cláudio, Carmo do Cajuru and Itatiaiuçu. The number of arrests per municipality, the nature of the crimes related to these arrests, the number of perpetrators involved in the arrests, the sociodemographic profile of the individuals arrested, the type and forms of the drugs arrested were determined. The database was created using the Questionnaire Development System (QDS) version 2.6.1.1 program, and later, the data were exported to the Statistical Package for the Social Sciences (SPSS) version 21 for statistical analysis. A total of 5,903 documents related to drug arrests were analyzed during the study period. The city that anchors the largest number of drug arrests is the municipality of Divinópolis (64%). Regarding the nature of the fact, the crime most correlated with these apprehensions belongs to illicit drug trafficking (59.2%), and which mostly involved more than one perpetrator (57.8%). The profile of individuals arrested for involvement with drugs was mostly male (90.8%), with a median age of 22 years, literate (32.8%) and single (67%). Among the drugs arrested, marijuana ranked first (63.9%), followed by cocaine (18.5%) and crack (17.7%). The form that most appears in the apprehensions is the loofah for marijuana (31%), paper bags for cocaine (82.3%) and rocks for crack (81.6%). Knowledge about the profile of drug arrests in the Central-West region of Minas Gerais becomes an important reference to assist in the planning of public policies for prevention and awareness according to the real demand, against the trade and consumption of drugs.
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11
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Patricia Costa Souza de Sá
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EVALUATION OF HEMATOLOGICAL PARAMETERS IN PREGNANT WOMEN WITH AND WITHOUT PERIODONTAL DISEASE
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Leader : MELINA DE BARROS PINHEIRO INACIO
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MEMBRES DE LA BANQUE :
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MELINA DE BARROS PINHEIRO INACIO
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DANYELLE ROMANA ALVES RIOS
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MARIA DAS GRACAS CARVALHO
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MAURO HENRIQUE NOGUEIRA GUIMARAES DE ABREU
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Data: 30 sept. 2022
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Afficher le Résumé
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Prenatal care is of fundamental importance and, therefore, must be carried out by a multidisciplinary health team, since numerous physiological, physical, psychological and even pathological changes can be perceived in this period. In addition to medical follow-up, imaging and laboratory tests, it is important to have specific dental care, as several changes and complications can occur during pregnancy with repercussions on the oral cavity. Therefore, the present study aims to analyze the hematological profile of pregnant women with and without periodontal disease (PD). This is a cross-sectional study developed in the city of Divinópolis/MG, Brasil. Data on pregnant women in the second and third trimesters were obtained by consulting medical and dental records, which were stratified into two subgroups: pregnant women with PD (n=107) and pregnant women without PD (n=42). Study variables were related to PD, sociodemographic, clinical and laboratory characteristics. Data were collected from the complete blood count of all participants and the indices derived from blood count parameters were calculated: NLR (neutrophils/lymphocytes ratio); PLR (platelet/lymphocyte ratio); LMR (lymphocyte/monocyte ratio); dNLR (derived NLR); SIRI (systemic inflammation response index); AISI (aggregate index of systemic inflammation) and SII (systemic immune-inflammation index). Data were analyzed using conventional statistical analysis using the Statistical Package for the Social Sciences® software (version 19.0), with a significance level of p<0.05. Regarding the results, the mean age in both subgroups was 27 years. As expected, pregnant women with less education had more PD. As for the hematological changes in the red blood cells, the mean corpuscular volume of erythrocytes (MCV) was significantly higher in pregnant women with PD, probably a reflection of folate deficiency. Regarding the alterations in the white blood cells, the global number of leukocytes and lymphocytes was significantly higher in pregnant women with periodontitis, possibly reflecting an inflammatory process caused by bacterial invasion of the periodontium, with systemic repercussions. Our study reinforces the need for a multidisciplinary team, including a dentist, in prenatal care, given that pregnancy is known to be a period subject to many physical, psychological and even pathological changes, bringing security to pregnant women in relation to their health. and the baby.
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12
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13
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Natália Ribeiro Nunes
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EVALUATION OF THE INFLAMMATORY PROFILE OF PATIENTS VICTIMS OF OPHIDIC ACCIDENTS SEEN AT THE JOÃO XXIII ER HOSPITAL, BELO HORIZONTE/MG
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Leader : MELINA DE BARROS PINHEIRO INACIO
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MEMBRES DE LA BANQUE :
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MELINA DE BARROS PINHEIRO INACIO
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FARAH MARIA DRUMOND CHEQUER BALDONI
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LUCI MARIA SANT ANA DUSSE
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RITA CAROLINA FIGUEIREDO DUARTE
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Data: 28 oct. 2022
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Afficher le Résumé
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Among the species present in the Brazilian fauna, snakes of the Bothrops and Crotalus genera are responsible for the highest frequency of snakebites in our country. Such accidents, although still neglected, constitute a serious public health problem. Snake venom is a complex mixture of toxins, enzymes, activators and growth factor inhibitors that have deleterious effects on cells. Among such harmful effects, hematological abnormalities emerge as the most common of snake envenomation, with consumption coagulopathy being the most frequent and important. Given the above and due to the frequency and potential severity of snakebites, in addition to the difficulties encountered in their management, the present study aimed to survey the literature on the main snakebites (Bothrops and Crotalus) in our country, in addition to know the laboratory profile of victims of such accidents treated at Hospital de Pronto Socorro XXIII (HPS XXIII), in Belo Horizonte - MG, before and after antivenom use. Clinical and routine laboratory data were obtained from the patients' medical records. From the blood count data, the following ratios/indices were calculated, namely: NLR, PLR, RML, dNLR, SIRI, AISI and SII. Data analysis revealed that the vast majority of victims were male for both genders of snakes, with Crotalus accidents being the most serious. As for routine laboratory parameters, in bothropic accidents, the PT/INR showed an increased value before the antivenom serum, reflecting hemostatic disorders. Likewise, PT/RNI was also shown to be increased in crotalic accidents before antivenom serum, possibly reflecting low fibrinogen levels. As for the number of platelets, a drop in their number was observed after the antivenom serum. Before the serum, a reduction in MCH was also observed, which increased after the antivenom use. Ratios/indices derived from complete blood count parameters showed inconsistent results, not adding value to routine data. The data analyzed together allowed us to conclude that snakebites, Bothrops or Crotalus, are associated with several laboratory disorders, particularly hemostatic, of varying severity, but potentially fatal; Crotalus accidents, as expected, were more severe compared to bothrops; and the use of antivenom sérumtends to normalize the results of laboratory tests, indicating an evident benefit to patients. In view of the above, rapid admission to a specialized service for appropriate treatment on an urgent basis is mandatory.
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Aline Michelle Silveira Silva
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Relationship between drug trafficking and/or consumption and homicides in a region in the Midwest of Minas Gerais
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Leader : FARAH MARIA DRUMOND CHEQUER BALDONI
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MEMBRES DE LA BANQUE :
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CRISTINA SANCHES
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DANYELLE ROMANA ALVES RIOS
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FARAH MARIA DRUMOND CHEQUER BALDONI
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JOAQUIM MAURICIO DUARTE ALMEIDA
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LEILISMARA SOUSA NOGUEIRA
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Data: 30 nov. 2022
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Introduction: Homicide is a heinous crime that has increased throughout the national context, making it a concern mainly for public entities. In 2016 homicides in Brazil represented 13% of the world total for the year. Drug use and markets can act as facilitators for violence. It was assumed that crimes related to consumption and/or drug trafficking increase the risk of the arrested individual committing a homicide or being a victim of this crime. Objectives: To assess the risk of individuals apprehended for drug consumption and/or trafficking committing homicide or being a victim of this crime, analyze the profile of the individual apprehended for trafficking and/or consumption of marijuana, cocaine/crack, describe the seized illicit drug and identify the rates of illegal drug trade in the cities of Divinópolis, Itaúna, Itatiaiuçu, Carmo do Cajuru and Cláudio. Methodology: This is an observational retrospective cohort study based on documents from 01/01/2017 to 12/31/2019. Data were collected at the Regional Civil Police Station and at the Regional Technical Session of Criminalistics in Divinópolis. Data processing and storage were carried out in a database, created using QDS™ Version 2.6.1 software and Microsoft Office Excel. To characterize the epidemiological profile, a descriptive statistical analysis of the variables was performed. This project was approved by the Research Ethics Committee involving human beings (CAAE: 30655120.3.0000.5545). Results: A total of 3,994 documents were selected from among those analysed, these being preliminary and definitive toxicological expert reports of seized illicit drugs and Social Defense Event Records - REDS. Divinópolis had the highest rate of registrations (63.32%), and marijuana was the most common drug (64.52%). 5944 individuals were identified in drug trafficking and/or consumption, 90.723% male, more frequent in the 18-40 age range in both genders (72.17% men and 71.87% women). Of the 194 homicides registered in the region during the studied period, 146 were involved with drugs, thus presenting a Relative Risk of 10.10 (p<0.0001). Conclusion: Divinópolis has the highest rate of drug seizures in the region, with marijuana being the most learned drug, following national and global standards. Young males prevail both in drug trafficking and/or consumption and in homicides. It can be seen that in this region studied, an individual inserted in the drug market and consumption increases the risk of committing or being the victim of a homicide.
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15
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SABRINA PAULA PEREIRA
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Infection caused by carbapenem-resistant gram-negative bacteria in patients with chronic kidney disease: a systematic review
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Leader : CAROLINE PEREIRA DOMINGUETI
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MEMBRES DE LA BANQUE :
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CAROLINE PEREIRA DOMINGUETI
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CLÁUDIA NATÁLIA FERREIRA
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MAGNA CRISTINA DE PAIVA
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WILLIAM GUSTAVO DE LIMA
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Data: 2 déc. 2022
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Introduction: Chronic kidney disease is characterized by the progressive and irreversible loss of kidney function. About 144,7779 patients are on dialysis in Brazil. Infections caused by carbapenem-resistant Gram-negative bacteria are associated with higher mortality, longer hospital stay and greater economic burden. The increased resistance of Gram-negative bacteria to carbapenem antimicrobials is particularly relevant for patients with chronic kidney disease (CKD) who are vulnerable to these infections. General objective: To evaluate the prevalence of infections caused by gram-negative bacteria resistant to carbapenems in patients with chronic kidney disease and in kidney transplant patients. In addition, discuss the epidemiology of these infections, prevention and treatment strategies, as well as future directions in combating antimicrobial resistance. Method: This is a systematic review carried out according to Cochrane guidelines with extraction of data of interest and analysis of results carried out in accordance with the PRISMA statement (2022), seeking to assess the presence or development of infection caused by bacteria Carbapenem-resistant gram-negatives in patients with chronic kidney disease or patients on dialysis or kidney transplant patients. Results: After analysis, a total of 13 articles were included in this review: Pubmed (2), Web Of Science (5), ,Scopus (1) (7.7%) and Embase (5). published in the United States (30.7%), followed by Brazil (15%), South Korea, (7.7%) Israel, (7.7%) China, (7.7%) Spain, (7, 7%) Italy, (7.7%) Colombia (7.7%) and Greece (7.7%). Regarding the study design, 9 were retrospective cohorts, (69%), 3 were case control (23%) and 1 cross-sectional study (7.7%). The age range of the individuals ranged from 18 to 75 years (mean 46.5) and the follow-up time ranged from 6 months to 10 years. The bacterial identification methodology that prevailed among the analyzed articles was the automated VITEk2R (8 studies, 61.5%) and the most prevalent Gram-negative bacteria species were: Klebsiella pneumoniae (11/84.6%), Escherichia coli (6/46%), Pseudomonas aeruginosa 2 (15.4%), Citrobacter sp 2 (15.4%). ,Enterobacter sp 2 (15.4%), Morganella Morganii 1 (7.7%), Proteus mirabiliis 1 (7.7%) and Providência stuarti 1 (7.7%). The predominant sites of infection were the urinary tract 10 (77%) bronchoalveolar lavage, blood and feces with 1 (7.7%) site each and surveillance cultures were also reported (38.4%). For the detection of resistance to carbapenems, the molecular method (PCR 38.4%), modified Hodge method (23%), Kirby Bauer (15.4%) and CarbaNP (7.7%) were used in the studies, considering as reference the protocols of the Clinical and Laboratory Standards Institute (CLSI) (69%) and the European Committee on Antimicrobial Susceptibility Testing (Eucast) (7.7%). The bacterial resistance mechanisms found in bacterial isolates were production of inactivating enzymes: KPC (53.8%), NDM (7.7%) and VIM (7.7%), ESBL (15.4%) were also detected. As a clinical outcome, it was possible to observe that diabetic patients or those with a history of colonization by multidrug-resistant Gram-negative bacteria had a worse prognosis. The mortality rate ranged from 41.9% to 79% at 30 days, while in transplant patients infected with KPC-producing bacteria, the median survival was one month.
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ANGELO ELIAS MERI JUNIOR
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RELATIONSHIP BETWEEN THE USE OF DIFFERENT PHARMACEUTICAL PRESENTATIONS OF METFORMIN
HYDROCHLORIDE AND THE OCCURRENCE OF GASTROINTESTINAL ADVERSE EVENTS: A BIOPHARMACEUTICAL
AND USER PERCEPTION STUDY
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Leader : WHOCELY VICTOR DE CASTRO
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MEMBRES DE LA BANQUE :
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WHOCELY VICTOR DE CASTRO
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ANDRE DE OLIVEIRA BALDONI
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ANA JULIA PEREIRA SANTINHO GOMES
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JOSÉ EDUARDO GONÇALVES
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MAIRON CESAR COIMBRA
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Data: 15 déc. 2022
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Introduction: Metformin hydrochloride (MET) is a hypoglycemic agent of oral administration, considered the drug of choice for the treatment of type 2 diabetes mellitus (DM2). The main adverse effects (AEs) related to the use of MET are gastrointestinal disorders. A hypothesis associated with the occurrence of these AEs due to the use of MET is related to the speed of drug release from its pharmaceutical form, since the higher the release rate, the higher its concentration in the intestine. It is relevant to investigate whether there is a difference in the perception of gastrointestinal AEs, as well as the correlation with the quality and the rate of drug release among the different commercial products containing MET. Methods: This is a prospective observational cohort study, in which diarrhea was related by patients with DM2 who started treatment with extended-release (XR) formulations of MET at doses of 500 mg. Additionally, at this stage of the study, the assay of MET and the test of uniformity of dosage units of different formulations of MET were conducted as described in the monographs of the American Pharmacopoeia. The dissolution profiles of the different MET brands were also performed in order to verify the percentage of the drug dissolved as a function of time. Results: Considering the patients eligible for study participation (n= 27) nineteen (66.7%) used the reference drug (R) and eight (33.3%) used the generic drug (G) of MET 500 mg XR. A lower frequency of gastrointestinal AEs was observed in patients who used the reference formulation when compared to those who used the generic. In both groups (R and G) the AEs did not affect the social and family life, as well as the quality of life of the patients. In the G4 sample, the assay test revealed that the content of MET was below the limit specified by the America Pharmacopoeia, being therefore considered an unsatisfactory result. The G2 sample presented the maximum amount of MET dissolved in the time of 10 minutes (97.69%), remaining constant subsequently. In G3, the amount of dissolved MET was gradual, reaching a maximum concentration in 25 minutes (92.07%), remaining constant afterward. The results obtained so far suggest that the AEs and the rate of drug release may be associated with the type of formulation, however, additional studies involving the evaluation of quality, dissolution profile, and the perception of AEs are still being performed in order to better support the hypothesis raised. It is expected that this work can contribute to the optimization of the pharmacotherapy of patients intolerant to gastrointestinal AEs resulting from the use of MET.
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