Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-06-13T19:31:53Z No. of bitstreams: 1 DjaynaNunes.pdf: 1924249 bytes, checksum: 4f6ce9666f11c7db163db65abb60f729 (MD5) / Made available in DSpace on 2017-06-13T19:31:53Z (GMT). No. of bitstreams: 1 DjaynaNunes.pdf: 1924249 bytes, checksum: 4f6ce9666f11c7db163db65abb60f729 (MD5) Previous issue date: 2013-12-02 / The increase in life expectancy, access to treating erectile dysfunction, behavioral changes in the social and sexual and non-adherence to condoms has coincided with the increasing prevalence of HIV / AIDS in the elderly. The objective of the research was to identify the socio-economic and socio-demographic and knowledge about HIV/AIDS individuals aged 50or older. Developed a descriptive transversal study through qualitative research and quantitative. The study included people aged above 50years with a confirmed diagnosis of HIV/AIDS, registered in the Service of Specialized Health, in São Luís, Maranhão, Brazil. This investigation was evaluatedin49patientsaged 50to 74 years, 77.6% were female, 91.8% in the exposure category was heterosexual,52.1% had elementary education, 89.2% had family income1-3minimum wages, 63.0% had no prior information about HIV/AIDSand91.8% were receiving antiretroviral terapy. The found data can be inferred that he study group had limited knowledge about HIV/AIDS. / O aumento da expectativa de vida, o acesso a tratamento de disfunção erétil, as alterações de comportamento na esfera social e sexual e a não adesão ao uso de preservativos têm coincidido com aumento da incidência de HIV/AIDS em idosos. O objetivo da pesquisa foiidentificar o perfil sócio-econômico esócio-demográfico e de conhecimento sobre HIV/AIDS de indivíduos com 50 anos ou mais de idade.Desenvolveu-se um estudo descritivo, transversal, através de pesquisa de cunho qualitativo-quantitativo. Foram incluídas no estudo pessoas com idade igual ou acima de 50 anos, com diagnóstico confirmado de HIV/AIDS, cadastrados em um Serviço de Atendimento Especializado (SAE) em São Luís, Maranhão, Brasil. Nesta investigação foram avaliados 49 pacientes na faixa etária de 50 a 74 anos; 77,6% era do sexo feminino; em 91,8% a categoria de exposição foi heterossexual; 52,1% tinha ensino fundamental incompleto; 89,2% tinha renda familiar de 1 a 3 salários mínimos; 63,0% não tinha informação prévia sobre HIV/AIDS e 91,8% estava recebendo tratamento anti-retroviral. Os dados encontrados permitem inferir que o grupo estudado possuía conhecimento reduzido sobre o HIV/AIDS.

Apesar dos avanços tecnológicos e terapêuticos para o manejo do HIV/aids, os desfechos desfavoráveis da doença, como é o caso das internações, se mantém com um desafio para a saúde pública. Nesse sentido, objetivou-se analisar as internações hospitalares por aids ocorridas em 2013 em um hospital de grande porte de um município do interior de São Paulo. Trata-se de estudo descritivo, exploratório, do tipo levantamento, quantitativo. Foram incluídos indivíduos com idade igual ou superior a 18 anos, hospitalizados no período de janeiro a dezembro/2013, cujas causas de internação principal ou secundárias estivessem relacionadas ao HIV/aids, considerando os seguintes códigos, segundo a Classificação Internacional de Doenças (CID-10): B20.0 ao B24, Z20, Z20.6, Z21 e R75. Elaborou-se um formulário específico para a coleta de dados, cujas fontes secundárias de informação utilizadas foram: Sistema de Internação Hospitalar, prontuário clínico, Sistema de Informação de Agravos de Notificação, HygiaWeb, Sistema de Controle Logístico de Medicamentos. Os dados foram analisados por meio de técnicas exploratórias, incluindo proporções, medidas de tendência central e variabilidade. Foram identificadas 259 internações relacionadas a 179 pessoas que viviam com aids, com reinternações no período (42,5%). O perfil dos sujeitos constitui-se por homens (62,1%); faixa etária entre 40 e 50 anos (38%); cor branca (62,1%); solteiros (50,8%); baixa escolaridade (40,2%); alguma fonte de renda (36,3%); histórico de uso de álcool (49,2%), tabaco (63,1%) e outras drogas ilícitas (46,3%) e de má adesão à terapia antirretroviral (TARV) (49,7%). A duração média das internações foi de 14,1 dias (DP± 12,6) e o desfecho predominante foi a alta médica (83,4%. Na maioria dos casos havia alguma manifestação clínica no momento da internação (55,2%), bem como a presença de doenças oportunistas (71,8%) e condições crônicas associadas (55,2%). Das pessoas internadas, a maioria possuía baixa contagem de células T CD4+ (83,8%) e carga viral detectável (71%). Quanto aos antecedentes assistenciais, 49,7% dos sujeitos tinham algum histórico de tratamento em serviços de assistência especializada em HIV/aids (SAE) da rede pública municipal. Considerando o período de 12 meses antes da internação, 35,8% dos sujeitos passaram em pelo menos uma consulta no SAE municipal; 46,9% nunca utilizaram serviços de atenção básica; 64,8% utilizaram pronto atendimento; 67,6% procederam a alguma retirada da TARV e 29% realizaram 80% ou mais das possíveis retiradas da TARV. Apesar do aprimoramento de testes diagnósticos e a disponibilização da TARV em larga escala, a hospitalização por HIV/aids mantém relação com grupos minoritários desfavorecidos, os quais possuem o status imunológico agravado em decorrência da ação viral no organismo, sugerindo disparidades que perpassam o acesso ao diagnóstico precoce, tratamento oportuno e profilaxia de infecções oportunistas. Urge a necessidade de ações intra e intersetoriais que visem a focalização de sujeitos mais vulneráveis para superar as barreiras assistenciais de modo que os benefícios da TARV sejam disponíveis a todas as pessoas que vivem com a doença / Despite technological and therapeutic advances in the HIV/ADS management unfavorable outcomes of the disease, as the case of hospitalization, remains a challenge to public health. In this sense, this study aimed to analyze hospital admissions due to AIDS in 2013 occurred in a large hospital in a city of São Paulo. This is a descriptive, exploratory study, type survey, quantitative. Were included individuals aged over 18 years, hospitalized in the period of January-December/2013 whose main or secondary causes of hospitalization were related to HIV/AIDS, considering the following codes according to the International Classification of Diseases (ICD 10) the B20.0 to B24, Z20, Z20.6, Z21 and R75. A specific form was elaborated for data collection, whose secondary sources of information were used: System Hospitalization, clinical record, System for Notifiable Diseases, HygiaWeb, Logistics Management System of Medicines. Data were analyzed using exploratory techniques, including proportions, measures of central tendency and variability. Were identified 259 hospitalizations related to 179 people living with AIDS, with readmissions in the period (42.5%). The profile of the individuals is constituted by men (62.1%); aged between 40 and 50 years (38%); white color skin (62.1%); single (50.8%); low education (40.2%); some source of income (36.3%); history of alcohol use (49.2%), tobacco (63.1%) and other illicit drugs (46.3%) and poor adherence to antiretroviral therapy (ART) (49.7%). The average length of hospitalization was 14.1 days (SD ± 12.6) and the predominant outcome was medical discharge (83.4%. In most cases there was any clinical signs at admission (55.2%) as well as the presence of opportunistic infections (71.8%) and chronic conditions associated (55.2%). of hospitalized persons, the majority had low CD4+ T cell count (83.8%) and detectable viral load (71 %). As for healthcare background, 49.7% of subjects had a history of treatment in specialized care services on HIV/AIDS (SHS) of the municipal public network. Considering the 12 months prior to admission, 35.8% the subjects passed in at least one visit in the municipal SHS; 46.9% never used primary care services; 64.8% used emergency care; 67.6% have carried out any withdrawal of antiretroviral therapy and 29% had 80% or more of possible withdrawn from ART. Despite the improvement of diagnostic tests and the availability of HAART on a large scale, hospitalization for HIV/AIDS remains relation to disadvantaged minority groups, which have the immune status worsened due to the viral action in the body, suggesting disparities that pervade the access to early diagnosis, timely treatment and prophylaxis of opportunistic infections. There is an urgent need for intra and inter-sectoral actions aimed at targeting vulnerable individuals to overcome barriers assistance so that the benefits of ART are available to all people living with the disease

O presente estudo teve como objetivo identificar áreas de risco para a co-infecção HIV/TB no município de Ribeirão Preto através da distribuição espacial dos casos notificados em 2006. Trata-se de um estudo de caráter ecológico em que a unidade de observação é um conjunto de indivíduos do município de Ribeirão Preto-SP. A população do estudo foi constituída por 48 casos novos de co-infecção HIV/TB notificados e residentes em Ribeirão Preto no ano de 2006. As informações sobre os doentes de TB co-infectados foram coletadas do sistema de notificação TB-WEB. Outra fonte de informação utilizada foi a base de dados dos setores censitários do município disponibilizada pelo Instituto Brasileiro de Geografia e Estatística (IBGE) referentes ao censo demográfico do ano 2000. Para caracterização dos doentes foram selecionadas variáveis sócio-demográficas (sexo, data de nascimento, escolaridade e endereço do doente) e clínico-epidemiológicas (tipo de caso, forma clínica, tipo de tratamento, encerramento de caso e local de atendimento). Para caracterizar os setores censitários foram selecionadas variáveis relacionadas a: renda média dos responsáveis pelos domicílios, média de anos de instrução das pessoas responsáveis pelos domicílios, renda média das mulheres chefes de família, média de anos de instrução das mulheres chefes de família, proporção de pessoas analfabetas, proporção de mulheres analfabetas, porcentagem de domicílios com 5 ou mais moradores. Os casos novos de co-infecção selecionadas foram então georreferenciados utilizando-se o software ArcGIS 9.1, da Esri. A Unidade espacial de análise considerada foi a de setor censitário e a análise estatística realizada foi a de componentes principais. Após o cálculo dos fatores socioeconômicos, foi escolhido o responsável pela maior variação (83%) que foi chamado de fator socioeconômico. Dos setores que permaneceram para análise (633), estes foram ordenados de forma decrescente e divididos em tercis. Assim, os tercis foram classificados em 3 faixas socioeconômicas: superior (condições socioeconômicas mais favoráveis), intermediária e inferior (condições socioeconômicas desfavoráveis). Em 2006, no período da coleta, 190 casos de TB estavam notificados no TB-WEB, sendo 58 (30,5%) casos de co-infecção. Foram considerados para este estudo 48 casos novos de co-infecção. Os resultados mostraram que: 68,7% dos casos eram do sexo masculino, faixa etária de 20 a 39 anos (47,9%), 4 a 7 anos de escolaridade (58,3%), forma clínica pulmonar (75%), sob o tratamento supervisionado (48%), 48% foram curados e 31% em tratamento no HCFMRPUSP. A distribuição espacial mostrou uma concentração dos casos de co-infecção nas regiões oeste e norte do município (58,3%) e 52,1% dos casos localizam-se na faixa socioeconômica inferior, seguido da faixa intermediária. O estudo evidenciou a forte ligação entre o aparecimento da TB e aspectos sociais entre os casos de AIDS. O conhecimento de alguns determinantes sociais e mesmo a desigualdade que permeia um espaço geográfico pode favorecer um planejamento mais adequado de ações para controle dessas doenças. / This ecological study aimed to identify the risk areas for HIV/TB (Human Immunodeficiency Virus, HIV/tuberculosis) co-infection in the city of Ribeirão Preto, state of São Paulo, through the spatial distribution of the cases registered in 2006. The unit of observation was a set of individuals from Ribeirão Preto. The study population consisted of 48 new cases of HIV/TB co-infection, registered and of patients living in Ribeirão Preto in 2006. The information about co-infected TB patients was collected in the TB-WEB register system. Another source of information used was the database of the census sectors of the city, published by the Brazilian Institute for Geography and Statistics (IBGE) regarding the demographic census of the year 2000. Sociodemographic variables (gender, birth date, educational level and address) and clinical-epidemiological variables (type of case, clinical form, type of treatment, case closing and venue of care) were selected for patients\' characterization. To characterize the census sectors, variables related to the following topics were selected: average income of the individuals responsible for the households, average years of education of the individuals responsible for the households, average income of the women head of families, average years of education of the women head of families, proportion of illiterate people, proportion of illiterate women, percentage of households with 5 or more residents. The selected new coinfection cases were then georeferentiated using the ArcGIS 9.1 software, by Esri. The census sector was considered the spatial analysis unit and the statistical analysis was carried out with the main components. After the calculation of the socioeconomic factors, the responsible for the main variation (83%) was chosen, and it was entitled socioeconomic factor. The sectors remaining for analysis (633) were ordered decreasingly and divided into tertiles. Thus, the tertiles were classified in socioeconomic bands: upper (more favorable socioeconomic conditions), intermediate and lower (unfavorable socioeconomic conditions). In 2006, during the data collection period, 190 TB cases were registered in the TB-WEB, of which 58 (30.5%) were cases of co-infection. In this study, 48 new cases of co-infection were considered. The results showed that: 68.7% of the cases were of male subjects, aged between 20 and 39 years of age (47.9%), having studied between 4 to 7 years (58.3%), pulmonary clinical form (75%), under supervised treatment (48%), 48% had been cured and 31% were under treatment at HCFMRP-USP (Hospital das Clinicas of the University of São Paulo at Ribeirao Preto Medical School). The spatial distribution showed the concentration of the cases of coinfection in the West and North regions of the city (58.3%) and 52.1% of the cases were located in the lower socioeconomic band, followed by the intermediate band. The study evidenced a strong relation between the outcome of TB and social aspects among the cases of AIDS. The knowledge of certain social determinants and even the inequality that permeates a geographic space can favor a more appropriate planning of actions for the control of these diseases.

Embora a velhice seja uma realidade biológica, os significados que lhe são atribuídos são construções sociais e históricas e se constitui em categoria de análise complexa e heterogênea. O aumento de casos de HIV/Aids entre pessoas acima de 60 anos e adultos tem sido reportado por pesquisadores e tido ampla repercussão na mídia, pois os dados mostram o aumento de casos proporcionais de HIV/Aids entre idosos e adultos comparado as outras faixas de idade. Entre as razões para esse aumento figuram a maior oferta de fármacos contra disfunção erétil, o baixo uso de preservativos nessa geração e o atraso no diagnóstico. A velhice é cercada por uma série de preconceitos e estereótipos (ageism) em razão da idade ou geração e o HIV/Aids nessa fase da vida gera perplexidade, pois rompe com o estereótipo da velhice como uma fase marcada pela assexualidade, recolhimento e passividade. O objetivo deste trabalho foi o de apresentar experiências de pessoas acima de 60 anos convivendo com HIV/Aids em uma cidade histórica de Minas Gerais, colocando em cena dois aspectos pouco estudados, que iluminam duas dinâmicas importantes da epidemia: a interiorização e o aumento dos casos em pessoas nessa faixa etária. A pesquisa foi realizada principalmente a partir de entrevistas com mulheres e homens, acima de 60 anos que eram acompanhados no Centro de Testagem e Aconselhamento em DST/aids (CTA) e com diagnóstico sorológico positivo para o HIV/aids. Participaram da pesquisa três mulheres e um homem, com idades variando entre 60 e 76 anos, com pouca escolaridade, renda e com um tempo de diagnóstico variando de 5 a 9 anos. As entrevistas foram gravadas e transcritas e os conteúdos foram submetidos à análise de conteúdo. A análise dos resultados mostra diferentes estratégias adotadas para o enfrentamento da questão do viver com HIV/Aids, sendo a principal delas a tática do silêncio, do segredo e da ocultação da condição de pessoa convivendo com HIV/Aids, como forma de evitar ainda mais as situações de estigma e discriminação que ocorrem de maneira mais evidente nas relações familiares e na vida cotidiana por meio de diversos constrangimentos. Um aspecto específico do conviver com HIV/Aids nessa fase da vida é o agravamento da diminuição gradual da rede de relações sociais freqüente entre os idosos. Este trabalho mostra que as dimensões sociais de vulnerabilidade, especialmente a pobreza, as desigualdades de gênero, o estigma e a discriminação marcam a experiência de conviver com HIV/Aids na velhice. A superação de tais dimensões constitui-se em processo histórico de transformações amplas nas estruturas sociais, políticas e econômicas, nas relações sociais de gênero e na desconstrução de preconceitos e estigmas. / Although old age is a biological reality, the meanings ascribed to it are social and historical constructions and constitute a complex and heterogeneous analysis category. Increase in HIV/AIDS cases among people over 60 years old and adults has been reported by researchers, gaining wide repercussion in media, since data show a proportional increase in HIV/AIDS cases among elders and adults compared to other age brackets. Amongst the reasons for such increase are: a greater supply of medicines for erectile dysfunction, low use of condoms in such generation, and delayed diagnosis. Old age is surrounded by a number of prejudices and stereotypes (ageism) because of age or generation and HIV/AIDS in such period of life causes perplexity, since it breaks with the stereotype of old age as a period characterized by asexuality, withdrawal, and passiveness. The purpose of this project was to present experiences of people over 60 years old who live with HIV/AIDS in a historical city in Minas Gerais, drawing the attention to two aspects that have little investigation, lighting up two important dynamics of epidemic: internalization and increase in cases of people in such age bracket. The research has been carried out mainly from interviews with women and men over 60 years old who were followed up at DST/AIDS Testing and Counseling Center (CTA) and had HIV/AIDS-positive serological diagnosis. Three women and one man aged between 60 and 76 years old, with little education, income, and diagnosis time varying from 5 to 9 years have participated in the research. The interviews have been recorded and transcribed, and the contents have been submitted to analysis. The analysis of the results shows different strategies used for confrontation of the matter of living with HIV/AIDS, and the main one is the tactic of silence, secrecy and concealment of the condition of persons living with HIV/AIDS as a way to avoid even more stigma and discrimination situations that occur more evidently in family relationships and daily life through several constraints. A specific aspect of living with HIV/AIDS in such period of life is the aggravation of social relationships network fading, often among elders. This project demonstrates that the social dimensions of vulnerability, especially poverty, gender inequalities, stigma and discrimination define the experience of living with HIV/AIDS in old age. Overcoming these dimensions is a historical process of wide transformations in social, political, and economic structures, in gender social relationships, and in the deconstruction of prejudices and stigmas.

Pouco mais de 20 anos marcam a disseminação da infecção pelo vírus da imunodeficiência humana (HIV) em todo o mundo. Durante este período, avanços reais no diagnóstico, na clínica e na terapêutica podem ser observados como, por exemplo, a disponibilidade de 14 fármacos potencialmente ativos no combate direto ao vírus. Embora, nos últimos anos, os progressos no tratamento de pacientes infectados pelo HIV e/ou doentes com a síndrome da imunodeficiência adquirida (AIDS) tenham sido significativos, novos estudos mostram-se importantes na área de Fármacos e Medicamentos. Este trabalho tem como objetivo aplicar a tecnologia farmacêutica à produção e controle de fármacos e medicamentos anti-HIV/AIDS, em especial a zidovudina (AZT). A utilização de diversas técnicas físico-químicas e analíticas possibilitou o desenvolvimento de estudos relacionados à avaliação da estabilidade e decomposição térmica do AZT, de excipientes e de misturas físicas utilizadas para a obtenção de formas farmacêuticas sólidas; caracterização dos produtos sólidos e voláteis do processo de degradação térmica do AZT; determinação do grau de pureza, faixa de fusão e variação dos valores de entalpia de fusão de princípios ativos de AZT de diferentes procedências; síntese e caracterização de compostos de inclusão de AZT com ciclodextrinas e com sais de lantanídeos caracteristicamente luminescentes; avaliação da estabilidade acelerada e a longo prazo de cápsulas de AZT disponíveis no mercado brasileiro; determinação dos parâmetros cinéticos da decomposição térmica do conteúdo das cápsulas de AZT. O método de planejamento fatorial foi utilizado na avaliação estatística dos dados de cinética obtidos por termogravimetria (TG) não-isotérmica. Os estudos de pré-formulação indicaram que não há interação entre o AZT e a maioria dos excipientes testados. Algumas alterações nos perfis termoanalíticos foram observadas em relação aos excipientes PEG 4000, 6000 e 20000, PVP, sorbitol e polióxido de etileno (polyox30®). No processo de decomposição térmica do AZT destaca-se a formação de timina. A utilização do sistema simultâneo e acoplado TG/DTA-GC/MS viabilizou a identificação de furano e 2-furanometanol como produtos voláteis. Os ensaios de calorimetria exploratória diferencial (DSC) permitiram a determinação da temperatura de fusão (118,0 a 122,9°C), do ΔHfusão (valor médio 30 kJ.min-1) e da percentagem de pureza (97,5 a 99,8%) para seis amostras comerciais do fármaco. O complexo de inclusão com β-ciclodextrina pode ser formado pela solubilização das espécies em meio aquoso e posterior obtenção do produto sólido por liofilização ou secagem à pressão reduzida. A interação não ocorre pela simples mistura mecânica das espécies. Foram preparados complexos de tenoiltrifluoracetonatos (TTA) de terras raras (Eu3+ e Sm3+) com AZT que apresentam alta luminescência. Os dados de absorção na região do infravermelho (IV) do complexo [RE(TTA)3·(AZT)2] sugerem que o ligante está coordenado ao íon de terra rara pelo átomo de nitrogênio do grupo azido. Os dados de difração de raios X (DRX) indicaram que o complexo [Eu(TTA)3·(AZT)2] mostra-se não cristalino, diferentemente do AZT livre, do sal precursor hidratado [RE(TTA)3·2H2O] e da mistura física. O estudo da variabilidade de condições experimentais em TG, empregando o planejamento fatorial, mostrou que nenhum dos efeitos avaliados é significativo. Os valores de energia de ativação para as amostras comerciais de AZT variaram entre 120 a 142 kJ.mol-1, para o método não-isotérmico e, de 100 a 112 kJ.mol-1, para o método isotérmico. Os resultados obtidos no estudo cinético se mostraram reprodutíveis configurando-se assim como um parâmetro importante, por exemplo, para avaliação da equivalência farmacêutica juntamente com os testes farmacopêicos. / For over twenty years the dissemination of the human immunodeficiency virus (HIV) appeared in the world. Since then, considerable advances in the diagnosis, clinic and therapy have been observed currently three classes of drugs 14 agents are in use for HIV infection. Therefore, the long-term effectiveness of potent three-drug antiretroviral regimens for the treatment of HIV infected patients and/or patients with adquired immunodeficiency syndrome (SIDA) is limited by problems related to compliance and tolerability. The aim of this work to apply the pharmaceutical technology to the production and control of anti-HIV/SIDA drugs and medicines, especially for zidovudine (AZT). The use of different physico-chemical and analytical techniques rnade it possible to develop some related studies for the stability evaluation and thermal decomposition of AZT, excipients and physical mixtures used for obtaining solid dosage forms; characterization of the solid and volatiles products of the thermal degradation process of AZT; determination of the purity, melting point and enthalpy variation of AZT obtained from different laboratories; synthesis and characterization of AZT inclusion compounds with cyclodextrins and with lanthanides salts characteristically luminescent; evaluation of the accelerated stability and the long-time of AZT capsules available in the Brazilian Market; determination of the degradation kinetics parameters of the different AZT samples. The factorial design method was used in the statistical evaluation of the kinetic data obtained from non-isothermal thermogravimetry (TG). The pre-formulation studies by thermal analysis indicated that there were no interaction between the AZT and the majority of the tested excipients. Some changes in the thermoanalytical profiles were observed in relation to PEG 4000, 6000 and 20000, PVP, sorbitol and ethylene polyoxide (polyox 30®) excipients. In the thermal decomposition process of AZT was observed the formation of thymine. The use of simultaneous and coupled system TG/DTA-GC/MS made it possible to identify of furan and 2-furanmethanol as volatiles products. The differential scanning calorimetry experiments permitted the determination of the melting point (118,0 to 122,9°C), ΔHmelting (medium value 30 kJ.min-1) and purity percentage (97,5 a 99,8%) for six commercial samples of the drug. The inclusion complex of AZT/β-cyclodextrin was obtained by the dissolution of the species in water and the mixture was dried by lyophilization or under vacuum at room temperature. The interaction between the species do not occur in the simple physical mixture. In this work, thenoyltrifluoroacetonate complexes with trivalent europium and samarium were prepared using AZT as a ligand. The complex presented high luminescence. According to the results of IR spectroscopy of the complexes [RE(TTA)3·(AZT)2], it was suggested that the metal ion be coordinated through the nitrogen of the azide group. The powder X-ray diffractometry (DRX) indicated that the complexes [Eu(TTA)3·(AZT)2] are not crystalline while free AZT, hydrate precursor salt [RE(TTA)3·2H2O] and physical mixture are. The variability study of the influence of different experimental conditions from TG, using Factorial Design, showed that none of the effects are significative. The kinetic energy values for the commercial AZT samples varied between 120 to 142 kJ.mol-1, by non-isothermal conditions, and 100 to 112 kJ.mol-1, by dynamic method. The results obtained in the kinetic studies are reproducible. These parameters are important for the evaluation of pharmaceutical equivalence together with bioequivalence studies.

A mudança no perfil epidemiológico do HIV/aids favorece a desconstrução da ideia de morte iminente, sendo este agravo, hoje, considerado como uma doença crônica, na qual a qualidade da assistência configura-se como um importante determinante do sucesso dos programas no controle da epidemia, gerando impactos positivos nas condições de vida e de saúde dos indivíduos. Este estudo objetivou analisar a oferta das ações e serviços de saúde na assistência prestada às pessoas que vivem com Aids (PVHA) no município de Ribeirão Preto-SP. Trata-se de um estudo exploratório, do tipo inquérito, com abordagem quantitativa. Participaram 301 PVHA em acompanhamento nos cinco Serviços de Assistência Especializada (SAE) em HIV/aids sob gestão municipal, considerando-se os seguintes critérios de inclusão: indivíduos maiores de 18 anos, com terapia antirretroviral instituída há mais de 6 meses, residentes no próprio município e não pertencentes ao sistema prisional. A coleta de dados foi realizada no período de julho/2011 a fevereiro/2012, por meio de entrevistas com apoio de um instrumento específico. Os dados foram analisados por meio da estatística descritiva. Quanto ao perfil dos sujeitos, identificou-se paridade entre os sexos, cor branca, envelhecimento populacional, indivíduos casados/união estável, heterossexuais, baixa escolaridade, predomínio da classe econômica C. Dentre os motivos que levaram ao diagnóstico doença, destacam-se o aparecimento de sinais e sintomas e o diagnóstico do parceiro, sendo a via sexual a principal forma de transmissão. A oferta de ações e serviços de saúde às PVHA pelos SAE do município, de modo geral, foi avaliada como regular, porém houve heterogeneidade entre os serviços. O SAE \"D\" foi o melhor avaliado pelas PVHA, e o SAE \"C\" obteve média significativamente menor do que os outros serviços. Houve predomínio de atividades clínico-biológicas, sendo os indicadores referentes ao manejo clínico da doença classificados como satisfatórios. Já a oferta de ações e serviços envolvendo outras necessidades e demandas de saúde dos usuários foram classificadas como regular e insatisfatória. O estudo apontou que a equipe especializada atende às recomendações e diretrizes clínicas para o tratamento das PVHA, contudo a dimensão do cuidar possui potencial de ampliação quando se considera os demais profissionais e recursos da rede de atenção à saúde. Apesar dos avanços científicos e tecnológicos, desafios são lançados à rede de atenção à saúde para a ampliação e sustentabilidade de um elenco de ações que se articulem na promoção do cuidado às PVHA, desde a prevenção, a assistência, inclusive a farmacêutica, a formação profissional, avançando, assim, na construção de um cuidado integral, integrado e resolutivo, compatível com as necessidades dos indivíduos, dada a complexidade da doença e sua configuração enquanto condição crônica / The changing epidemiology of HIV/AIDS allows the deconstruction of the idea of imminent death. This disease, today considered as a chronic disease, lies on the the quality of care that appears as an important determinant of the success of programs in both controll ing the epidemic and generating positive impacts on health and living conditions of individuals. This study aimed to analyze the offering of actions and availability of health services in assisting people living with AIDS (PLWHA) in Ribeirão Preto - SP. This is an exploratory study of the survey type, with a quantitative approach, with 301 PLWHA monitoring the five HIV/AIDS Specialized Assistance Services (SAS) under municipal management. We considered the following inclusion criteria: patients over 18 years on antiretroviral therapy for more than six months, residing in the county and outside the prison system. Data collection was performed in February 2011 to July 2012 through interviews by applying a specific instrument. Data were analyzed using descriptive statistics. Regarding the profile of the subjects, we identified parity between sexes, white color, aging population, individuals who were married/ in common-law marriage, heterosexuals, with low education, predominance of economic class C. Among the reasons leading to disease diagnosis, we highlight the onset of signs and symptoms and the diagnosis of the partner, being the main transmission form the sexual one. The offering of actions and availability of health services to PLWHA by the SAS was evaluated as a regular, but there was heterogeneity among the services. SAS \"D\" was rated best by PVHA and SAS \"C\" achieved significantly lower rates than the other services. There was a predominance of clinical and biological activities, and the indicators for the clinical management of the disease were classified as satisfactory. In turn, range of services involving other health needs and demands of the users were classified as regular and unsatisfactory. The study found that the expert team meets clinical recommendations and guidelines for the treatment of PLWHA, however, the dimension of care has the potential for expansion when considering other professionals and resources of the health care network. Despite scientific and technological advances, challenges are thrown at health care for the expansion and sustainability of an articulated set of actions capable of promoting care for PLWHA, from prevention to care, -including pharmaceutical care - and perpassing professional training, thereby improving the development of a comprehensive, resolutive and integrated care, consistent with the needs of individuals, given the complexity of the disease and its configuration as a chronic condition

Transmissions based precautions are measures implemented in various clinical health care settings as a means to prevent the transmission of infectious diseases and decrease instances of healthcare acquired infections (HAI). HAI’s result in increased cost to hospitals, longer hospitalization for patients, increased patient suffering, and fatal patient outcomes. While staff member adherence to transmissions based precautions are mandated through various organizations and hospital policies, a review of literature indicates little research has been conducted regarding visitor compliance with transmission-based precautions. The potential implications in healthcare from visitor non-adherence acquired infections are unknown; revealing a gap in literature and supporting the need for further research to describe the phenomenon. Through utilization of a descriptive online survey instrument, the purpose of this descriptive study is to gain insight into why nurses believe visitors may or may not be compliant with transmission-based precautions. To collect the data, an online descriptive survey instrument was developed and distributed via email to all graduate students’ enrolled East Tennessee State University’s College of Nursing. Only ten participants met the eligibility requirements to participate in this study. Data was analyzed though a predictive analytics software and grouping responses into themes. Responses suggest that nurses feel visitors are not complying with transmission-based precautions because of a lack in education, not perceiving the infection as a threat, prior exposure to loved one at home, and inconvenience.

Damage to the ventromedial prefrontal cortex (vmPFC) can lead to disturbances in personality, emotional dysregulation, impairments in social conduct, and difficulties in decision-making. Many researchers have likened the conduct of individuals with vmPFC lesions to that of criminal psychopaths, labeling the effects of vmPFC damage “pseudopsychopathy” or “acquired sociopathy.” However, although psychopathy—a condition marked by a distinct mosaic of antisocial personality traits and behaviors—has been studied and characterized as a psychological and behavioral disorder by many researchers, the overlap between acquired sociopathy and psychopathy remains ambiguous. This study assessed the severity of psychopathic personality traits in neurological patients with acquired damage to the vmPFC using both informant-report and self-report measures. On both informant-report and self-report measures, individuals with vmPFC damage showed no significant elevations across a wide range of psychopathic traits relative to demographically-matched neurologically healthy comparison participants and patients with damage outside of the vmPFC. The results showed only one trait, Fearlessness, that was significantly higher in patients with vmPFC lesions relative to the neurologically-healthy comparison group.

Clostridium difficile (C. difficile) is a gram positive, anaerobic, spore forming bacterium. C. difficile infections are triggered by dysbiosis of the intestinal microbiome linked to age, immune status, and medication; particularly use of antibiotics and proton pump inhibitors (PPI). The spore forming nature of the bacteria gives it the ability to persist in the environment for long periods of time and makes it impervious to many commonly-used hospital cleaning and disinfection products. C. difficile, along with Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus (VRE) are some of the leading multi-drug resistant hospital acquired infections in the United States. Environmental contamination and patient susceptibility are hypothesized as major contributors to infection transmission in a healthcare setting. We conducted a cross-sectional pilot study aimed at determining the bioaerosol concentration of C. difficile present in the toilet plume of C. difficile infected patients’ rooms. Patient rooms within the University of Iowa Hospital and Clinics (UIHC) were sampled using a customized bioaerosol air impactor device. Environmental samples were collected before and after flushing the toilet to determine the pre-flush and post-flush levels of aerosolized bacteria. Particle density was collected during both pre and post-flush sampling. Activity levels in the rooms were recorded as a potential confounding variable. A total of 144 environmental samples were collected in 24 rooms. Clostridium difficile was detected in two of the twenty-four rooms (8%). There was a 12% (9/72) positive culture rate pre-flush compared to 23% (19/72) post-flush. Wilcoxon rank sum tests revealed a significant increase in particle concentration at the 5.0µm and 10.0µm size between rooms that produced a bacterial culture compared to rooms that did not (p-values 0.0095 and 0.0082 respectively). There was no significant association between the amount of activity in the room and detectable bioaerosol production (p-value=0.605). Next, we performed a randomized control trial of hospital privacy curtains with antimicrobial properties to determine their ability to resist pathogenic bacterial contamination in an intensive care unit setting. Rooms within the surgical and neurological intensive care unit at UIHC were randomized to receive impregnated curtains, impregnated curtains plus Fuzion hypochlorite spray, or standard control curtains. MRSA, VRE, Pseudomonas spp. and Acinetobacter spp. were the four most frequently cultured pathogenic species. Time to event (contamination) analysis identified a significant difference in time to pathogenic contamination between the control curtains and the impregnated curtains post spray (p-value<0.001). The impregnated curtains post Fuzion spray also grew significantly less colonies of bacteria compared to the control curtains (p-value<0.001). After evaluating environmental risk factors that contribute to Clostridium difficile infection, patient related risk factors for infection were evaluated. Proton pump inhibitors are a class of gastric acid reducers that work by reducing the amount of hydrogen ions produced in the stomach. Recent evidence suggests that prolonged use could negatively affect the intestinal microbiome making it more susceptible to enteric pathogens. A nested case control study was done to determine the association between PPI medication duration and C. difficile infection. Fecal microbiome diversity was analyzed via logistic regression in relation to the development of Clostridium difficile infection. A co-morbidity score was created to adjust for other microbiome altering conditions. PPI duration remained a significant predictor of infection after adjusting for the microbiome influence (p-value=0.0123). Environmental contamination remains a significant risk factor for the transmission of hospital acquired infections including C. difficile. Toilets flushing has been shown to produce pathogenic bioaerosols in the healthcare setting. Hospital privacy curtains have been shown to routinely be contaminated with pathogenic bacteria including other gastrointestinal bacteria that could increase susceptibility to C. difficile infection. PPI medication, which is frequently prescribed in the hospital, has been shown to increase the risk of C. difficile infection, although specific microbiome changes could not be identified.

Systemic acquired resistance (SAR) is a type of plant defense mechanism that is induced after a localized infection and confers broad-spectrum immunity against related or unrelated pathogens. During SAR, a number of chemical signals and proteins generated at the site of primary infection travel to the uninfected tissues and are thought to alert the distal sites against secondary infections. Glycerol-3-phosphate (G3P) is one of the chemical signals that play an important role in SAR. G3P is synthesized in the cytosol and chloroplasts via the enzymatic activities of G3P Dehydrogenase (G3Pdh) or Glycerol Kinase (GK). Interestingly, a mutation in three of the five G3Pdh isoforms or GK impairs SAR by lowering the pathogen induced G3P pool. This suggests that total cellular pool of G3P is critical for SAR. To determine factors contributing to G3P flux between various subcellular compartments I analyzed the role of putative G3P transporters in G3P flux and SAR. The Arabidopsis genome encodes five isoforms of G3P Permeases (G3Pp) and these transmembrane proteins are predicted to localize to plasma membrane, chloroplast or mitochondria. At least two G3Pp isoforms (G3Pp1 and G3Pp3) were able to complement the Escherichia coli mutant impaired in the uptake of G3P into the cytoplasm. Characterization of Arabidopsis G3Pp mutants showed that a mutation in G3Pp2, G3Pp3 and G3Pp4 compromised SAR but not local resistance. Furthermore, this SAR defect could only be complemented by exogenous application of G3P. The G3Pp mutants accumulated wild-type-like levels of G3P suggesting that the subcellular compartmentalization of G3P might contribute to the induction of SAR.