Introdução: Reação Adversa a Medicamento (RAM) é qualquer resposta prejudicial ou indesejável e não intencional que ocorre com medicamentos em doses normalmente utilizadas no homem para profilaxia, diagnóstico, tratamento de doença ou para modificação de funções fisiológicas. Atualmente, representa uma das principais causas de morbidade e mortalidade na área da saúde. Objetivo: Analisar as reações adversas a medicamentos e fatores associados em pacientes ortopédicos tratados com antibióticos. Método: Coorte prospectiva conduzida com 273 pacientes ortopédicos internados no Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brasil. A coleta de dados ocorreu nos anos de 2012 e 2013, por meio de instrumento composto por variáveis demográficas-clínicas e terapia medicamentosa. Para identificação das RAMs realizou-se o monitoramento ativo, composto de: entrevista, análise de prontuários e exames laboratoriais. As RAMs consideradas graves foram analisadas por meio do formulário do Instituto Catalão de Farmacologia, Espanha. Na análise dos dados utilizaram-se os testes Mann-Whitney, Qui-Quadrado, exato de Fisher e regressão logística, com significância de p 0,05. Resultados: A incidência de RAM foi de 41%. O grupo com RAM apresentou maior média de idade (43,3; DP 10,9), tempo de internação (72,7; DP 40,9) e número de medicamentos concomitantes (13,2; DP 4,1). Os fatores associados foram número de medicamentos, uso de antimicobacteriano (OR 2,44; IC 1,3944,270) e carbapenêmicos (OR 2,38; IC 1,167 4,872). Identificaram-se 466 RAM, cuja maioria (67,1%) foi classificada como leve. No grupo de pacientes com RAMs graves identificaram-se leucopenia (46,6%), insuficiência renal aguda (40%) e hepatite medicamentosa (26,6%). Os antibióticos foram os principais medicamentos suspeitos de causar as RAMs graves (76,4%), sendo os mais frequentes (23,5%) formados pela tríade: amicacina + vancomicina + piperacilina com tazobactam. Conclusão: A incidência de RAM é maior quando se incorpora ao serviço de farmacovigilância a técnica de monitoramento contínuo dos pacientes hospitalizados e se utiliza a analise de exames laboratoriais como preditores para suspeitas de RAMs potencialmente graves / Introduction: Adverse Drug Reaction (ADR) is any noxious, undesired or unintended response which occurs in the use of normal dosages of drugs for prophylaxis, diagnosis, treatments or for modifying physiologic functions. Nowadays, ADR represents one of the main causes of morbidity and mortality in the health service area. Objective: To analyze the occurrence of adverse reaction to drugs and factors related to orthopedic patients treated with antibiotics. Method: The prospective cohort study was conducted in 273 orthopedic patients hospitalized at the Brazilian Institute of Traumatology and Orthopedics in Rio de Janeiro. The data collection was made during the years 2012 and 2013, using instruments composed by demographic-clinical variables and drug therapies. With the purpose of identifying occurrences of ADRs, during active monitoring, interviews were conducted, medical charts and exams were analyzed. In addition, the occurrence of ADRs considered harmful was analyzed by using a form provided by the Catalan Institute of Pharmacology, Spain. In the study of the data collected, was made use of Mann-Whitney tests, Chi-Squared test, Fishers exact test and logist regression, with p-value 0,05. Results: The occurrence of ADRs was of 41%. This group was composed by individuals with major age rage (43,3, SD 10,9), major time spent hospitalized (72,7; SD 40,9), and quantity of concurrent drugs used (13,2; SD 4,1). Also, the related factors were the number of drugs, the usage of Antimicobacterial agents (OR 2,44, CI 1,394-4,270) and Carbapenemases (OR 2,38; CI 1,167 4,872). During the study, there were identified 466 ADRs, and the majority (67,1%) was classified as low-grade. Additionally, in the group of patients with harm adverse reactions, it was possible to identify leukopenia (46,6%), acute kidney failure (40%) and drug-induced hepatitis (26,6%). The antibiotics were the main drugs suspected to be the cause of potentially harmful ADRs (76,4%), being the most frequent (23,5%) formed by the triad: amikacin + vancomycin + piperacillin-tazobactam. Conclusion: The occurrence of ADRs is higher when the practice of continuous monitoring of hospitalized patients is incorporated to the pharmacovigilance service, and the analyzes of lab exams are used as predictors for the suspicion of potentially harmful ADRs

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / Antibiotics are the most prescribed drugs at the Intensive Care Units. Bacteria has become more and more resistant to those drugs, which represents a threat of public health. Keeping eyes on the use of antimicrobic agents is one of the essential preconditions to control that resistance. In the period of November 1st 2005 to June 30th 2006, was verified an observational study, descriptive and prospective, where were evaluated the handbook of patients on Intensive Care Unit (ICU) of âSanta Casa de MisericÃrdia de Fortalezaâ. About 157 patients were observed and their handbook and structured forms. The social-demographic characteristics, the factors of risk associated to clinic evolution and the identification and profile of bacterial resistance were studied. The use of antimicrobic was evaluated with the objective to available subsidies to a good and rational use of drugs. The collected data were analyzed on the SPSS, version 10.0. The patients presented an average of 66 years old and the mortality between the elderly people was 60%. The most frequent diagnosed hypotheses were respiratory infection (28.7%) and sepses (15.9%), associated to 48.9% out of 80% of the total registered deaths. About half of those who made use of veinal or urinary catheters - 62.4% and 87.3%, respectively, came to die. It was found that the antibiotic therapy applied in those patients was not based on the microbiotic sensitiveness patterns, and the antibiotic consume was 182,8 DDD (daily dose definite) per bed a day. The most given antibiotic were the Ã-lactamics (107.8 DDD per 100 beds a day), such as ceftriaxone (31.9%), ciprofloxacin (16.9%) and clindamicin (14.4%). The highest dose of antibiotic given was ceftriaxone (50.3 DDD/100 beds a day). The Gram-negative bacilli were more often (71.1%), especially P. aeruginose (21.7%). The most predominant species was S. aureus (22.9%). 77.8% and 84.2% of ceps displayed tough toward cefalotin and penicillin, respectively. Most of patients (54.1%) died, though they were under antibiotic therapy. The broad profile of resistance at antibiotics shown in this research follows the recent patterns, which state that the most of the isolated patients are resistant to the Ã-lactamics, such as Pseudomonas and Staphylococcus. Scientists have become more concerned about the future, due to the high therapeutic limitation. The outcomes displayed in this essay aims to point out the necessity of monitoring the sue of antibiotics at Intensive Care Units, in order to minimize the causes of mortality due to the abuse of antibiotics. Educational actions, in order to promote a permanent guard on the use of antibiotics at hospitals, along with a rational politic to regulate the their use are very important measures to prevent and control such restless situation. / Perfil de utilizaÃÃo de antimicrobianos na unidade de terapia intensiva da Santa Casa de MisericÃrdia de Fortaleza Os antibiÃticos sÃo as drogas mais prescritas nas Unidades de Terapia Intensiva e o aumento constante da resistÃncia bacteriana a essas drogas à uma ameaÃa à saÃde pÃblica. A vigilÃncia do uso de antimicrobianos à um dos prÃ-requisitos essencial para a promoÃÃo do controle da resistÃncia. No perÃodo de 01 de Novembro de 2005 a 30 de junho de 2006, foi realizado um estudo observacional, descritivo e prospectivo, onde foram avaliados os prontuÃrios de pacientes internados na Unidade Terapia Intensiva (UTI) da Santa Casa de MisericÃrdia de Fortaleza. Foram observados 157 pacientes atravÃs de seus prontuÃrios e formulÃrios estruturados. As caracterÃsticas sÃcio-demogrÃficas, os fatores de riscos associados à evoluÃÃo clÃnica e a identificaÃÃo e perfil de resistÃncia bacteriano foram estudadas. A utilizaÃÃo de antimicrobianos foi avaliada com o objetivo de disponibilizar subsÃdios para o uso adequado e racional desses fÃrmacos. Os dados coletados foram analisados no SPSS versÃo 10.0. Os pacientes apresentaram uma media de 66 anos de idade e a mortalidade entre os maiores de 60 anos foi de 60,0%. As hipÃteses diagnÃsticas mais freqÃentes, infecÃÃo respiratÃria (28,7%) e sepse (15,9%), foram associadas a 48,9% e 80% dos Ãbitos, respectivamente. Cerca da metade dos pacientes que fizeram uso de cateter venoso central e ou de cateter urinÃrio, 62,4% e 87,3%, respectivamente, evoluÃram para Ãbito. A antibioticoterapia frequentemente nÃo foi baseada nos padrÃes de sensibilidade microbiana e o consumo de antibiÃticos foi de 182,8 Dose DiÃria Definida (DDD) por 100 leitos-dia. Predominou o uso de β-lactÃmicos (107,8 DDD por 100 leito-dias), os antimicrobianos mais consumidos foram ceftriaxona (31,9%), ciprofloxacina (16,9%) e clindamicina (14,4%) e o maior valor de DDD foi para ceftriaxona (50,3 DDD/100 leito-dias). A resistÃncia bacteriana foi elevada para a maioria dos antibiÃticos utilizados, especialmente aos β-lactÃmicos. Os bacilos Gram-negativos foram mais freqÃentes (71,1%), especialmente P. aeruginosa (21,7%). A espÃcie predominante foi S. aureus (22,9%). 77,8% e 84,2% das cepas de P. aeruginosa e S. aureus foram resistentes a cefalotina e à penicilina, respectivamente, e 47,4 % dos isolados de S. aureus apresentaram resistÃncia à Oxacilina e 0,6% à Vancomicina. A maioria dos pacientes (54,1%) foi a Ãbito. O amplo perfil de resistÃncia aos antimicrobianos constatado nesse estudo segue o padrÃo atual, onde a maioria dos isolados sÃo resistentes aos β-lactÃmicos e pertencem aos gÃneros Pseudomonas e Staphylococcus. A elevada resistÃncia das cepas de S. aureus à oxacilina à motivo de grande preocupaÃÃo, devido à limitaÃÃo terapÃutica que essa resistÃncia determina. Os resultados obtidos nesse trabalho mostram a necessidade de se monitorar o uso de antibacterianos e a ocorrÃncia de resistÃncia bacteriana em UTIâs, no sentido de minimizar os fatores que predispÃem ao aumento da morbidade e mortalidade. A promoÃÃo de aÃÃes educativas, da vigilÃncia permanente das cepas bacterianas hospitalares e de uma polÃtica racional para o uso de antimicrobianos sÃo medidas de imensa importÃncia na prevenÃÃo e no controle dessa situaÃÃo.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-05-02T17:44:50Z No. of bitstreams: 1 carolinamirandagasparetto.pdf: 2045445 bytes, checksum: b796bec99aa751194ab9ed2ad03867e6 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-06-03T15:35:17Z (GMT) No. of bitstreams: 1 carolinamirandagasparetto.pdf: 2045445 bytes, checksum: b796bec99aa751194ab9ed2ad03867e6 (MD5) / Made available in DSpace on 2016-06-03T15:35:17Z (GMT). No. of bitstreams: 1 carolinamirandagasparetto.pdf: 2045445 bytes, checksum: b796bec99aa751194ab9ed2ad03867e6 (MD5) Previous issue date: 2014-07-28 / Bauhinia forficata Link (Fabaceae), conhecida como pata-de-vaca, é uma planta medicinal nativa da América do Sul, tradicionalmente usada como hipoglicemiante, diurética, hipocolesterolêmica e no tratamento de cistite, parasitoses intestinais, elefantíase e outros distúrbios orgânicos. Essas disfunções estão associadas ao estresse oxidativo e dano celular. Os principais metabólitos especiais presentes nesta espécie são as substâncias fenólicas, em particular os flavonoides. Neste contexto, o objetivo do presente estudo foi avaliar as atividades antioxidante, antibacteriana e genotóxica das folhas de B. forficata, bem como determinar o conteúdo de fenóis e flavonoides totais. O material vegetal seco e pulverizado foi submetido à maceração estática em etanol, seguido de partição líquido/líquido para obtenção do extrato etanólico (EE) e das frações em hexano (FH), diclorometano (FD), acetato de etila (FA) e butanol (FB). Os teores de fenóis e flavonoides totais foram determinados por espectrofotometria utilizando as curvas de calibração do ácido gálico e da rutina, respectivamente. A atividade antioxidante foi avaliada pelos ensaios do sequestro do radical livre 2,2-difenil-1-picril-hicrazila (DPPH•), poder de redução do ferro e cooxidação do β- caroteno/ácido linoleico. A atividade antibacteriana foi investigada por meio da determinação da Concentração Inibitória Mínima 100% (CIM100) pelo método de microdiluição em caldo segundo recomendações do Clinical Laboratory Standards Institute (CLSI) frente a sete amostras de referência ATCC. Em seguida, procedeu-se ao estabelecimento do efeito farmacológico bactericida ou bacteriostático e à determinação da Concentração Bactericida Mínima (CBM). O potencial genotóxico foi avaliado pelo ensaio do cometa utilizando células HepG2. As análises foram realizadas em triplicata e os resultados apresentados como média ± desvio-padrão, quando pertinente. Os dados foram submetidos à Análise de Variância seguida do pós-teste de Tukey (p < 0,05). Os teores de fenóis e flavonoides totais variaram de 9,20 ± 0,87 a 87,35 ± 0,92 mg/g em equivalentes de ácido gálico e de 2,51 ± 0,06 a 56,76 ± 0,81 mg/g em equivalentes de rutina, respectivamente. Os valores das Concentrações Efetivas 50% obtidos nos ensaios do DPPH• e poder de redução do ferro foram de 27,95 ± 0,33 a 193,62 ± 1,12 μg/mL e de 21,12 ± 0,52 a 328,45 ± 3,23 μg/mL, respectivamente. A porcentagem de inibição da peroxidação lipídica obtida pelo ensaio do β-caroteno/ácido linoleico variou de 26,80 ± 2,26 a 67,07 ± 1,48, de 36,30 ± 5,38 a 73,66 ± 3,91 e de 48,70 ± 5,08 a 81,93 ± 3,45 nas concentrações de 250, 500 e 1000 μg/mL, nessa ordem. A FA foi ativa frente à Staphylococcus aureus ATCC 29213 e ATCC 6538 testadas, com valores de CIM100 e CBM de 2,5 mg/mL e 5 mg/mL, e de 5 mg/mL e > 5 mg/mL, respectivamente, revelando efeito bacteriostático. O EE induziu dano genético significativo às células HepG2 pelo ensaio do cometa nas concentrações de 125 e 250 μg/mL. Os resultados desse estudo indicam que B. forficata possui substâncias fenólicas, incluindo flavonoides, demonstrando atividades antioxidante e antibacteriana. O dano genético revelado pelo EE requer estudos adicionais para a confirmação de seu potencial genotóxico. / Bauhinia forficata Link (Fabaceae), known as "pata-de-vaca", is a medicinal plant native in South America, traditionally used as hypoglycemic, diuretic, hypocholesterolemic, and in the treatment of cystitis, intestinal parasites, elephantiasis and other organic disturbs. These disorders are associated with oxidative stress and cellular damage. The major secondary metabolites present in this species are phenolic compounds, particularly flavonoids. In this context, the aims of this study were to evaluate the antioxidant, antibacterial and genotoxic activities of B. forficata leaves and to determine the total phenols and flavonoids contents. Dried and powdered plant material was subjected to static maceration in ethanol followed by liquid/liquid partition to obtain the ethanol extract (EE) and the hexane (HF), dichloromethane (DF), ethyl acetate (EF) and butanol (BF) fractions. The total phenols and flavonoids contents were determined by spectrophotometry using gallic acid and rutin calibration curves, respectively. The antioxidant activity was evaluated by the 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radical scavenging, the ferric reducing power and the β-carotene bleaching assays. The antibacterial activity was investigated by determining the 100% Minimal Inhibitory Concentration (MIC100) using the broth microdilution according to Clinical Laboratory Standards Institute (CLSI) recommendations against seven ATCC reference strains. After that, the bactericidal or bacteriostatic pharmacological effect was established and the Minimal Bactericidal Concentration (MBC) was also determined. The genotoxic potential was assessed by the comet assay using HepG2 cells. Analyses were performed in triplicate and the results presented as mean ± standard deviation, when appropriate. Data were statistically analyzed by one-way ANOVA followed by Tukey’s post-test (p < 0.05). The total phenolic and flavonoid contents ranged from 9.20 ± 0.87 to 87.35 ± 0.92 mg/g gallic acid equivalents, and from 2.51 ± 0.06 to 56.76 ± 0.81 mg/g rutin equivalents, respectively. The Effective Concentration 50% values in the DPPH and ferric reducing power assays were 27.95 ± 0.33 to 193.62 ± 1.12 μg/mL, and 21.12 ± 0.52 to 328.45 ± 3.23 μg/mL, respectively. The percentage inhibition of lipid peroxidation obtained by β-carotene bleaching method ranged from 26.80 ± 2.26 to 67.07 ± 1.48, 36.30 ± 5.38 to 73.66 ± 3.91 and 48.70 ± 5.08 to 81.93 ± 3.45 at 250, 500 and 1000 μg/mL concentrations, in that order. The EF was active against Staphylococcus aureus ATCC 29213 and ATCC 6538, with MIC100 and MBC values of 2.5 mg/mL and 5 mg/mL, and 5 mg/mL and > 5 mg/mL, respectively, showing bacteriostatic effect. The EE induced significant genetic damage to HepG2 cells by the comet assay at concentrations of 125 and 250 μg/mL. The results of this study indicate that B. forficata contains phenolic compounds, including flavonoids, possessing antioxidant and antibacterial effects. The genetic damage revealed by EE requires additional studies to confirm its genotoxic potential.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-07-04T14:51:48Z No. of bitstreams: 1 jordanadamascenogitiranadesantana.pdf: 3160925 bytes, checksum: 910c9f83a7dacd60918a4704f0d0fdeb (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-08T13:39:58Z (GMT) No. of bitstreams: 1 jordanadamascenogitiranadesantana.pdf: 3160925 bytes, checksum: 910c9f83a7dacd60918a4704f0d0fdeb (MD5) / Made available in DSpace on 2017-08-08T13:39:58Z (GMT). No. of bitstreams: 1 jordanadamascenogitiranadesantana.pdf: 3160925 bytes, checksum: 910c9f83a7dacd60918a4704f0d0fdeb (MD5) Previous issue date: 2015-07-30 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / Vernonia polyanthes Less. (Asteraceae), popularmente conhecida como assa-peixe, é uma espécie vegetal nativa da América do Sul, principalmente do Brasil. Esta planta medicinal é tradicionalmente utilizada em casos de gripes, resfriados, tosses, febre, bronquite, contusões, hemorroidas, infecções do útero e no tratamento de malária. Farmacologicamente, V. polyanthes tem sido relatada como detentora de propriedades anti-hipertensiva, antinociceptiva, anti-ulcerogênica, anti-inflamatória, leishmanicida e antimicrobiana. Estudos fitoquímicos focando esta espécie, disponibilizados na literatura, relatam a presença de metabólitos secundários pertencentes, principalmente, às classes dos flavonoides e terpenos, especialmente lactonas sesquiterpênicas. O presente estudo descreve a avaliação da atividade antibacteriana do extrato de lavagem foliar (extrato VP) e da lactona sesquiterpênica glaucolídeo A isolada de V. polyanthes, no intuito de corroborar cientificamente com o uso tradicional dessa espécie vegetal e de verificar a potencialidade do extrato VP e desta molécula como prováveis fitoterápico e protótipo de um agente antibacteriano, respectivamente. O extrato VP foi obtido por meio da lavagem das folhas íntegras e secas de V. polyanthes com diclorometano e o glaucolídeo A isolado a partir do fracionamento desse extrato por métodos de cromatografia em coluna. A atividade antibacteriana foi investigada por meio da determinação da Concentração Inibitória Mínima (CIM) pelo método de microdiluição em caldo, segundo recomendações do Clinical Laboratory Standards Institute (CLSI). Em seguida, procedeu-se ao estabelecimento da Concentração Bactericida Mínima (CBM) e à classificação do efeito farmacológico bactericida ou bacteriostático. Staphylococcus aureus ATCC® 6538™/ATCC® 29213™, Escherichia coli ATCC® 10536™/ ATCC® 25922™, Salmonella enterica subsp. enterica serovar Choleraesuis ATCC® 10708™, Salmonella enterica subsp. enterica serovar Thyphimurium ATCC®13311™ e Pseudomonas aeruginosa ATCC® 9027™/ATCC® 27853™ foram usadas como cepas de referência. O extrato VP revelou atividade antibacteriana frente a 5 das 8 cepas testadas, sendo mais ativo contra S. aureus ATCC® 6538™ e ATCC® 29213, com valores de CIM iguais a 0,625 mg/mL, refletindo efeito bacteriostático e CBM de 2,5 mg/mL e 1,25 mg/mL, respectivamente. O glaucolídeo A apresentou atividade antibacteriana frente às referidas cepas de S. aureus, com valores de CIM de 250 µg/mL e 500 µg/mL, efeito bacteriostático e CBM de 500 µg/mL e > 500 µg/mL, nessa ordem, sendo inativo contra as demais cepas nas concentrações testadas. Os resultados do presente estudo sugerem que V. polyanthes e glaucolídeo A apresentam potencial antibacteriano, especialmente frente à S. aureus, sendo a atividade do extrato VP resultante, provavelmente, de um sinergismo entre essa lactona sesquiterpênica e outros metabólitos secundários presentes nessa planta medicinal. / Vernonia polyanthes Less. (Asteraceae), popularly known as "assa-peixe", is a native species of South America, especially in Brazil. This medicinal plant is traditionally used in cases of cold, flu, cough, fever, bronchitis, bruise, hemorrhoid, uterus infection and malaria's treatment. Pharmacologically, V. polyanthes has been reported as anti-hypertensive, antinociceptive, anti-ulcerogenic, anti-inflammatory, leishmanicidal and antimicrobial. Phytochemical studies focusing this plant, available in the literature, report the presence of secondary metabolites mainly belonging to the flavonoids and terpene classes, especially sesquiterpene lactones. The present study investigated the antibacterial activity of the leaf rinse extract (VP extract) and the sesquiterpene lactone glaucolide A isolated from V. polyanthes in order to scientifically corroborate with the traditional use of this plant species and to verify the potential of VP extract and this molecule as probable herbal and an antibacterial agent prototype, respectively. VP extract was obtained by washing the dried intact leaves of V. polyanthes with dichloromethane and the glaucolide A, isolated from the VP extract fractionation by column chromatography methods. Antibacterial activity was established by the determination of the Minimal Inhibitory Concentration (MIC) using the microdilution method according to the Clinical Laboratory Standards Institute (CLSI) guidelines followed by the Minimal Bactericidal Concentration (MBC), classifying the pharmacological effect as bacteriostatic or bactericidal. Staphylococcus aureus ATCC® 6538™/ATCC® 29213™, Escherichia coli ATCC® 10536™/ATCC® 25922™, Salmonella enterica subsp. enterica serovar Choleraesuis ATCC® 10708™, Salmonella enterica subsp. enterica serovar Thyphimurium ATCC® 13311™ and Pseudomonas aeruginosa ATCC® 9027™/ATCC® 27853™ were used as reference bacterial strains. The VP extract revealed antibacterial activity against 5 of 8 tested strains, being more active against S. aureus ATCC® 6538™ and ATCC® 29213™ with MIC values of 0.625 mg/mL, demonstrating bacteriostatic effect and MBC of 2.5 mg/mL and 1.25 mg/mL, respectively. Glaucolide A showed antibacterial activity against S. aureus with MIC values of 250 µg/mL and 500 µg/mL and, revealing bacteriostatic effect and CBM of 500 µg/mL and > 500 µg/mL, in this order, being inactive against the other strains at the concentrations tested. Our results suggest the antimicrobial potential of V. polyanthes and glaucolide A, notably against S. aureus, and the VP extract activity is probably due to the synergism between this sesquiterpene lactone and other secondary metabolites of this medicinal plant.

Low concentrations (1-10mg/mL) of double antibiotic paste (DAP) have demonstrated antibacterial properties in regenerative endodontics. The aim of this study was to evaluate if DAP made radiopaque (RoDAP) with barium sulfate has antibacterial effects against bacterial isolates from a mature and immature tooth with necrotic pulp. Clinical bacterial isolates were obtained from the canals of mature and immature teeth with necrotic pulps during root canal therapy or a regenerative procedure, respectively. Bacterial isolates were grown anaerobically for three weeks on 4x4mm dentin specimens prepared from extracted human teeth (n=48 per biofilm type). The dentin specimens were allocated into six groups and treated as follows: 1mg/mL RoDAP, 10mg/mL RoDAP, calcium hydroxide (UltraCal), placebo (barium sulfate in methylcellulose), no treatment, and no bacteria or treatment (sterile control). After one week of treatment the biofilm was detached and biofilm disruption assays were conducted to determine the bacterial numbers (CFUs/mL). The data was analyzed using Wilcoxon Rank Sum tests followed by pairwise comparisons. 1 and 10 mg/mL RoDAP as well as calcium hydroxide demonstrated significant antibacterial effects against the tested bacterial isolates. The placebo paste did not demonstrate any significant antibacterial effects. No significant difference in antibacterial effects was found against isolates from both mature and immature teeth regardless of the type of treatment. Both 1 and 10 mg/mL RoDAP demonstrated significant antibacterial effects against bacterial isolates from mature and immature teeth with necrotic pulps. RoDAP can be beneficial clinically since its adequate placement within the canal system can be confirmed radiographically.

<p>Uvod: U na&scaron;oj zemlji nema smernica za lečenje bakterijskih infekcija u tercijarnim zdravstvenim ustanovama. Odabir antibakterijskih lekova je empirijski, &scaron;to nije uvek u skladu sa preporučenom terapijom prema međunarodnim smernicama. Zbog toga su na Klinici za infektivne bolesti Kliničkog centra Vojvodine u januaru 2013. godine usvojeni međunarodni protokoli i primenjivani za lečenje infektivnih bolesti bakterijske etiologije. Cilj istraživanja bio je da se ispita i uporedi efikasnost lečenja pojedinih antibiotskih tretmana za lečenja infektivnih bolesti bakterijske etiologije prema kliničkom iskustvu ordinirajućeg lekara, prema međunarodno prihvaćenim protokolima i prema modifikovanim međunarodnim protokolima na osnovu stanja lokalne rezistencije. Materijal i metode: Ispitivanje je bilo retrospektivno-prospektivno u trajanju od tri godine od&nbsp; 01.01.2012-31.12.2014.godine, sprovedeno je na Klinici za infektivne bolesti Kliničkog centra Vojvodine. U studiju je uključeno 1147 pacijenata sa dijagnozom infektivne bolesti bakterijske etiologije (sepsa, infekcija urinarnog trakta, bakterijski meningitis, infekcije kože i mekih tkiva, bakterijski tonzilofaringitisi, pneumonija, febrilni gastroenteritis i spondilodiscitis). U retrospektivnom delu, tokom 2012. godine ustanovljena je efikasnost lečenja prema kliničkom iskustvu ordinirajućeg lekara, kod 459 pacijenata. U drugom delu ispitivanja koje je bilo prospektivno, tokom 2013. godine, kod 487 pacijenata, ustanovljena je efikasnost lečenja prema međunarodnim protokolima i upoređena sa lečenjem prema kliničkom iskustvu ordinirajućeg lekara. Tokom 2012. i 2013. godine, ustanovljena je struktura uzročnika i rezistencija na antimikrobne lekove, i prema stanju lokalne rezistencija modifikovani su međunarodni protkoli i primenjivani su tokom 2014. godine. U trećem delu ispitivanja koje je bilo prospektivno, tokom 2014. godine, kod 201 pacijenta ustanovljena je efikasnost lečenja prema modifikovanim međunarodnim protokolima i upoređena sa lečenjem prema usvojenim međunarodnim protokolima. Efikasnost lečenja praćena je na osnovu vrednosti telesne temperature i na osnovu laboratorijskih parametara (leukocita, C reaktivnog proteina, fibrinogena, sedimentacije eritrocita i prokalcitonina), prvog i sedmog dana hospitalizacije. Za upoređivanje efikasnosti terapijskih režima napravljen je sistem skorovanja telesne temperature i laboratorijskih parametara. Za statističku obradu podataka kori&scaron;ćen je programski paket Statistical Package for Social Sciences - SPSS 21. Statistički značajnim se smatraju vrednosti nivoa značajnosti p&lt;0.05. Rezultati: Praćenjem rezistencija bakterija u na&scaron;oj sredini modifikovani su međunarodni protokoli za lečenje infekcija izazvanih E.coli i S aureus-om. Rezistencija E. coli iz urinokultura tokom 2012. i 2013. godine na ciprofloksacin (koji je preporučen prema međunarodnim protokolima za lečenje infekcija urinarnog trakta) je bila u 2012. godini 38,8% i u 2013. godini 57,1%, a na levofloksacin 27,7% u 2012. godini i u 2013. godini 28,6%. Rezistencija S. aureus-a izolovanog iz brisa rana na cefazolin (koji je preporučen prema međunarodnim protokolima za lečenje infekcija kože i mekih tkiva) u prve dve godine ispitivanja bila je 25% a na klindamicin nije zabeležena rezistencija. Rezistencija S. aureus-a na cefazolin (koji je preporučen prema međunarodnim protokolima za lečenje bakterijskih tonzilofaringitisa) iz brisa grla bila je u 2012. godini 18,1%, u 2013. godini 14,2% a na klindamicin u ovom periodu nije zabeležena rezistencija. Tako da je preporuka u modifikovanom kliničkom protokolu za lečenje infekcija urinarnog trakta levofloksacin, za lečenje bakterijskih tonzilofaringitisa i lečenje infekcija kože i mekih tkiva izazvanih S aureus-om klindamicin.Poredeći ukupan skor kliničkih i laboratorijskih parametara, lečenje pacijenata prema usvojenim međunarodnim protokolima, statistički značajno je efikasnije u odnosu na lečenje prema kliničkom iskustvu lekara kod lečenja pacijenata sa infekcijom urinarnog trakta (p=0,034) i infekcijom kože i mekih tkiva (p=0,032). U lečenju ostalih ispitivanih bakterijskih infekcija prema kliničkom iskustvu lekara i usvojenim međunarodnim protokolima nema statički značajne razlike (p&gt;0,05). Lečenje pacijenata sa infekcijom urinarnog trakta, prema modifikovanim međunarodnim protokolima je statistički značajno efikasnije u odnosu na efikasnost lečenja prema usvojenim međunarodnim protokolima (p=0,025) poredeći ukupan skor kliničkih i laboratorijskih parametara. Lečenje pacijenata sa tonzilofaringitisima i infekcijama kože i mekih tkiva prema modifikovanim međunarodnim protokolima podjednako je efikasno u odnosu na lečenje prema usvojenim međunarodnim protokolima (p=0,100) poredeći ukupan skor kliničkih i laboratorijskih parametara. Zaključak: Upoređivanjem dobijenih rezultata, omogućeno je određivanje najoptimalnijeg načina lečenja bolesti bakterijske etiologije, uvažavajući preporuke prema međunarodnim smernicama. Dobijeni rezultati ukazuju na to da je praćenjem lokalne strukture uzročnika i stanja lokalne rezistencije omogućeno određivanje optimalnijeg načina lečenja infekcija urinarnog trakta i infekcije kože i mekih tkiva, uvažavajući međunarodne preporuke i modifikaciju međunarodnih smernica prema stanju rezistencija bakterija na antimikrobne lekove u na&scaron;oj sredini</p> / <p>Introduction:In our country,there are noguidelines for the treatment of bacterial infections in tertiary health institutions. The choice of antibiotic is empirical and it does not always comply with the recommended treatment according to international guidelines. For this reason, international protocols were adopted at the Clinic for infectious diseases of the Clinical Center of Vojvodinain January 2013. and implemented in therapy of infectious diseases caused by bacteria. The aim of the study was to compare different regimens and to evaluate their effectiveness in therapy of the bacterial infections: one based on the clinical experience of the prescribing physician, another based on international guidelines and the third, modified international protocoladapted to comply with the local antibacterial resistance. Material and methods: Thisretrospective-prospective study was conducted at the Clinic for Infectious Diseases of the Clinical Center of Vojvodina and it covered the period of three years, from 01.01.2012.-31.12.2014. 1,147 patients diagnosed with infectious diseases of bacterial etiology (sepsis, urinary tract infections, bacterial meningitis, skin and soft tissue infections, bacterial tonsillopharyngitis, pneumonia, febrile gastroenteritis and spondylodiscitis) were included in the study. In the first, retrospective part of the study, the efficacy of therapy based on the clinical experience of the prescribing physician was analyzed from medical records of 459 patients treated in 2012. In 2013, during the second, prospective part of the study, the efficacy of treatment according to the international guidelines was evaluated in 487 patients and the results were compared to the data obtained from the patients treated according to the clinical experience of the prescribing physician. The types of organism isolated in 2012/2013 were analyzed as well as their resistance to antimicrobials, the international protocols were subsequently modified according to the state of local resistance and implemented during 2014. In 2014, during the third, prospective part of the study, the efficacy of therapy according to modified international protocols was established in 201 patients, and the results were compared to the ones obtained by therapy according to original international protocols. The efficacy of the treatment was estimated by body temperature measurements and laboratory parameters (leukocytes, C-reactive protein, fibrinogen, erythrocyte sedimentation rate and procalcitonin) on day 1 and day 7 of hospitalization. The scoring system for body temperature and laboratory parameters was designed to compare therapeutic regimes efficiency. For statistical analysis, we used a software package Statistical Package for Social Sciences- SPSS 21. The values of p&lt;0.05were considered statistically significant. Results.Monitoring of antibiotic resistance patterns in our community led to modification international protocols for treating infections caused by E. coli and S aureus. Resistance of E.coli to ciprofloxacin (recommended for the treatment of urinary tract infectionsby international protocols) from urine culture in 2012 and 2013 was 38.8% and 57.1% respectively, while resistance to levofloxacin in 2012 and 2013 was 27.7% and 28.6%, respectively. Resistance of S. aureus to cefazolin (recommended by international protocols for the treatment of the skin and soft tissue infections) from wound cultures in 2012 and 2013 was 25% while the resistance to&nbsp; clindamycin was not present. Resistance to cefazolin (recommended for the treatment of bacterial tonsillopharyngitisby international protocols) from throat culture in 2012 and 2013 was 18,1% and 14,2%, respectively,and the resistance to clindamycin was not present in the same period. Accordingly, clinical therapeutic protocols were modified, levofloxacin was recommended for urinary tract infections and clindamycin was recommended for treatment of tonsillopharyngitis and skin and soft tissues infections caused by S. aureus. Comparing the total score of clinical and laboratory parameters, the treatment of patients according to the adopted international protocols was statistically significantly more effective compared to the one based on clinical experience of physicianin urinary tract infections (p = 0.034) and skin and soft tissue infections(p = 0.032). No statically significant difference (p&gt;0.05) was observed in efficiency of treatment options for other studied bacterial infections. In therapy of urinary tract infections, modified international protocols proved to be significantly more efficient than the adopted international protocols (p = 0.025) when the total score of clinical and laboratory parameters was compared.&nbsp; Comparing the total score of clinical and laboratory parameters, both adopted international protocols and modified international protocols proved to be equally efficient (p=0,100) in therapy of bacterial tonsillopharyngitis and skin and soft tissue infections. Conclusion:Comparison of the obtained results made possible to develop the optimal way of treating diseases of bacterial etiology, taking into account recommendations by international guidelines.The results suggest that the monitoring of the local structure of pathogens and their resistance pattern enabled the determination of optimal treatment options for urinary tract infections and skin and soft tissue infections, respecting international recommendations and modifying the international guidelines to match bacterial resistance pattern in our community.</p>

The development of drugs and therapeutic agents for combating infections and human malignancies continues to be a forefront area in both academic and industrial research. This is driven by the rapid emergence of multi-drug resistant bacterial strains and accumulating mutations in cancer targets that is quickly rendering our current arsenal of drugs ineffective for these therapies. Unless new drugs with novel mechanisms of action are identified and developed at a faster pace, we face a losing battle in managing these diseases. The first part of this work concerns with the natural product Simocyclinone D8 (SD8). Simocyclinone D8 is an angucyclinone antibiotic that inhibits DNA gyrase with a novel mechanism of action that has been termed competitive inhibition. Simocyclinone D8 was found to inhibit the growth of both Gram-(+ve) and Gram-(–ve) organisms and also inhibit a fluoroquinolone resistant mutant of DNA gyrase. Inspired by the structure and novel mechanism of action that SD8 displays, we synthesized analogues based on the co-crystal structure of SD8 with DNA gyrase. These compounds were found to inhibit DNA gyrase, albeit by a different mechanism of action than that of SD8. We also conducted studies towards the total chemical synthesis of SD8 and made three out of the four fragments in SD8 in decent yields. The second part of this work is focused on the development of a substrate-competitive covalent inhibitor for protein kinase B (AKT). AKT is a valid target for cancer research with two compounds currently in late stage clinical trials. Developing substrate- competitive inhibitors for kinases is a novel approach in targeting them, with very few examples in the literature. This mechanism has been postulated to overcome common resistance mutations that cancer targets harbor. A major drawback in this approach is the low binding affinity for peptide substrates by kinases. We circumvented this problem of affinity by utilizing a covalent mode of binding and synthesized a potent non-peptide active-site directed irreversible compound that inhibits AKT. Further studies on this compound are underway and are expected to yield a compound that can be used as a therapeutic agent or as a probe for AKT.

病原體感染是包括植物的高等生物的主要健康危害之一。為抵禦入侵者，大多數植物會製造防禦蛋白，包括凝集素、蛋白酶抑製劑、抗真菌蛋白、核糖核酸酶和核糖體失活蛋白，並分佈在不同的器官，如葉、根、種子和塊莖。一些植物防禦蛋白被發現能表現出多種生物活性，如抗腫瘤活性、抗細菌活性和抗病毒活性，能抵抗多種植物病原菌和人類病原體。因此，一些植物防禦蛋白可能有潛力用於治療人類疾病，或保護農作物免受感染。 / 我們在研究中從不同的植物來源成功純化出各種防禦蛋白，包括：小芋頭塊莖中的血凝素、日本長芋中的凝集素、東北紅豆中的血凝素和抗真菌多肽、棕色芸豆中的凝集素、抗真菌多肽和胰蛋白酶抑製劑，玉豆一號中的凝集素以及小斑豆中的胰蛋白酶抑製劑。小芋頭血凝素被發現能誘導脾細胞的有絲分裂反應。日本長芋凝集素和東北紅豆血凝素被發現能對一些腫瘤細胞株（如乳腺癌MCF7細胞及鼻咽癌CNE2細胞）發揮抗增殖的作用。棕色芸豆凝集素能誘導脾臟細胞的有絲分裂反應以及抑制腫瘤細胞株（如乳腺癌MCF7細胞、肝癌HepG2及鼻咽癌CNE1和 CNE2細胞）的生長，而棕色芸豆抗真菌蛋白能抑制數種病原真菌物種的生長。研究這些防禦蛋白的生物活性有助找出其潛在應用價值，如藥用前景。 / Infection from pathogens is one of the major health hazards in higher organisms including plants. To defend against harmful invaders, most plants produce a variety of defense proteins including lectins, protease inhibitors, antifungal proteins, ribonucleases and ribosome-inactivating proteins. They may be present in different organs of the plants, such as leaves, roots, seeds and tubers. Some of the plant defense proteins were found to exhibit a variety of biological activities such as anti-tumor activity, anti-bacterial activity and anti-viral activity that act against various plant pathogens and also some human pathogens. Therefore, some plant defense proteins may have potential for therapeutic applications in human diseases, or protecting the crops from infections. / This study involved purification of defense proteins from different plant sources. The proteins that were successfully isolated included a hemagglutinin from small taro tubers, a lectin from Japanese yam tubers, a lectin and an antifungal peptide from northeast red beans, a lectin, an antifungal peptide and a trypsin inhibitor from brown kidney beans, a lectin from French bean cultivar no. 1 and a trypsin inhibitor from mini pinto beans. The small taro hemagglutinin was found to induce mitogenic response in splenocytes. The Japanese yam lectin and northeast red bean hemagglutinin were found to exert anti-proliferative activity toward some tumor cell lines including MCF7 and CNE2 cells. The brown kidney bean lectin induced a mitogenic response from murine splenocytes as well as inhibited the growth of tumor cell lines including MCF7, HepG2, CNE1 and CNE2 cells, while the brown kidney bean antifungal protein inhibited the growth of several pathogenic fungal species including M. arachidicola, S. turcica and B. maydis. Studying the biological activities of these defense proteins helps to find out their potential applications like therapeutic uses. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Chan, Yau Sang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves i-xvii). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract --- p.i-ii / 論文摘要 --- p.iii / Acknowledgements --- p.iv / List of Publications --- p.v / Table of Contents --- p.vi-vii / List of Figures --- p.viii-ix / List of Tables --- p.x / List of Abbreviations --- p.xi / Chapter Chapter 1 --- Introduction on plant defense proteins / Chapter 1.1 --- General introduction to plant defense proteins --- p.1-2 / Chapter 1.2 --- An overview on lectins --- p.3-18 / Chapter 1.2.1 --- History of lectins --- p.3-6 / Chapter 1.2.2 --- Classification of lectins --- p.7-11 / Chapter 1.2.3 --- Biological activities of lectins --- p.12-16 / Chapter 1.2.4 --- Applications of plant lectins --- p.16-18 / Chapter 1.3 --- An overview on defensins --- p.18-25 / Chapter 1.3.1 --- Types of defensins --- p.18-21 / Chapter 1.3.2 --- Mechanism of anti-microbial activity of defensins --- p.22-23 / Chapter 1.3.3 --- Application of defensins --- p.23-25 / Chapter 1.4 --- An overview on trypsin inhibitors --- p.25-38 / Chapter 1.4.1 --- Serpins --- p.26-28 / Chapter 1.4.2 --- Kunitz-type protease inhibitors --- p.29-31 / Chapter 1.4.3 --- Bowman-Birk protease inhibitors --- p.32-34 / Chapter 1.4.4 --- Physiological functions of protease inhibitors --- p.35-38 / Chapter 1.5 --- Aim of study --- p.38-41 / Chapter Chapter 2 --- Isolation and characterization of a hemagglutinin from small taros and a lectin from yam tubers / Chapter 2.1 --- Introduction --- p.42-45 / Chapter 2.2 --- Materials and Methods --- p.46-55 / Chapter 2.3 --- Results --- p.56-78 / Chapter 2.4 --- Discussion --- p.79-84 / Chapter Chapter 3 --- Isolation and characterization of two defense proteins from seeds of Phaseolus vulgaris cv. “northeast red bean“ / Chapter 3.1 --- Introduction --- p.85-86 / Chapter 3.2 --- Materials and Methods --- p.87-93 / Chapter 3.3 --- Results --- p.93-119 / Chapter 3.4 --- Discussion --- p.120-129 / Chapter Chapter 4 --- Isolation and characterization of three defense proteins from seeds of Phaseolus vulgaris cv. “brown kidney bean“ / Chapter 4.1 --- Introduction --- p.130-131 / Chapter 4.2 --- Materials and Methods --- p.131-136 / Chapter 4.3 --- Results --- p.136-175 / Chapter 4.4 --- Discussion --- p.176-189 / Chapter Chapter 5 --- Isolation and characterization of a lectin from French bean cultivar no. 1 beans and a trypsin inhibitor from mini pinto beans / Chapter 5.1 --- Introduction --- p.190-191 / Chapter 5.2 --- Materials and Methods --- p.191-194 / Chapter 5.3 --- Results --- p.195-212 / Chapter 5.4 --- Discussion --- p.213-221 / Chapter Chapter 6 --- General discussion / Chapter 6.1 --- Summary on purification protocols of the defense proteins in the study --- p.222-228 / Chapter 6.2 --- Chemical properties of the defense proteins in the study --- p.228-232 / Chapter 6.3 --- Biological activities of the defense proteins in the study --- p.232-238 / Chapter 6.4 --- Potential application of these defense proteins and future perspectives --- p.238-242 / References --- p.i-xvi

Submitted by Angela Maria de Oliveira (amolivei@uepg.br) on 2018-05-22T12:11:55Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Giselle Ariana.pdf: 971489 bytes, checksum: 5abfc7a704112e83f259ad38f6544f1e (MD5) / Made available in DSpace on 2018-05-22T12:11:55Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Giselle Ariana.pdf: 971489 bytes, checksum: 5abfc7a704112e83f259ad38f6544f1e (MD5) Previous issue date: 2018-03-26 / A prescrição de anti-inflamatórios e antibióticos é uma prática comum na Odontologia. Interações medicamentosas podem ocorrer quando diferentes fármacos são administrados ao mesmo tempo. O objetivo desta pesquisa foi avaliar a influência do ibuprofeno, sobre a concentração da amoxicilina no plasma e no tecido periapical de ratos com periodontite apical induzida. Foram utilizados 28 ratos Wistar, machos, com 45 dias, divididos em 4 grupos: PL: placebo (salina); AM: amoxicilina (100 mg/kg); IB: ibuprofeno (100 mg/kg); e AM+IB: amoxicilina (100 mg/kg) + ibuprofeno (100 mg/kg). Os animais foram submetidos à exposição pulpar do primeiro molar inferior esquerdo que permaneceu aberto por 15 dias e, então, fechado com resina composta, permanecendo por mais 07 dias. Os animais foram tratados com dose única dos medicamentos (gavagem) conforme o grupo ao qual pertenciam, 01 hora antes da eutanásia. Foram coletados 2 mL de sangue da artéria aorta para a obtenção do plasma sanguíneo e amostras do tecido periapical que foram homogeneizadas para a obtenção do sobrenadante. A partir das amostras (plasma e sobrenadante do tecido periapical) realizou-se o antibiograma para análise da concentração plasmática e tecidual de amoxicilina. Os resultados mostraram no plasma do grupo AM maiores concentrações da droga que os demais grupos (p<0,05, ANOVA com Tukey). O ibuprofeno interferiu na concentração plasmática de amoxicilina, no entanto, a concentração de amoxicilina no grupo AM+IB foi maior que nos grupos PL e IB (p<0,05, ANOVA com Tukey). A análise do sobrenadante do tecido periapical não mostrou diferença significativa entre os grupos (p>0,05, Kruskal-Wallis). A partir dos resultados é possível concluir que o ibuprofeno interfere com a concentração plasmática de amoxicilina, porém não interferiu na concentração da amoxicilina no tecido periapical. / The prescription of anti-inflammatories and antibiotics is a common practice in dentistry. Drug interactions can occur when medicines are administered at the same time. The objective of this present research was to evaluate the influence of ibuprofen on plasma and periapical tissue amoxycillin concentration in induced apical periodontitis in rats. 28 Wistar male rats (45 days) were divided into 4 groups: PL: placebo (saline); AM: amoxycillin (100 mg / kg); IB ibuprofen (100 mg / kg); and AM+IB amoxycillin (100 mg / kg) + ibuprofen (100 mg / kg). The animals were submitted to pulp exposure in the first lower left molar, which remained open for 15 days and then closed with composite resin, maintained for more 07 days. The rats were treated with a single dose (gavage) according to each group, 01 hour before euthanasia.Two milliliters of blood was collected from the aorta to obtain blood plasma samples and the periapical tissue were homogenised to obtain the supernatant. From the samples (plasma and the supernatant periapical tissue) was carried out antibiogram for analysis of plasma and tissue amoxycillin levels. Results showed that AM group showed plasma higher amoxycillin concentrations than the other groups (p <0.05, ANOVA with Tukey). Ibuprofen interferes with the amoxycillin plasma concentration, however, AM+IB group had a higher amoxycillin concentration than the PL and IB groups (p<0.05, ANOVA with Tukey test). The analysis of the periapical tissue supernatant showed no significant difference among groups (p> 0.05, Kruskal-Wallis). In conclusion, ibuprofen can interfere with amoxycillin plasm concentration, but had noinfluence on amoxycillin periapical tissue concentration.

INTRODUÇÃO: A Faringotonsilite é doença comum nos consultórios e prontosocorros de pediatria. OBJETIVOS: Avaliar o impacto da realização rotineira da prova rápida para pesquisa de estreptococo do grupo A (PRE) no diagnóstico e tratamento da faringotonsilite aguda em crianças e adolescentes atendidos em um Hospital Geral. MÉTODOS: Trata-se de um estudo prospectivo, observacional, de protocolo de atendimento, instituído no Pronto-Socorro do Hospital Universitário da Universidade de São Paulo para o atendimento de crianças e adolescentes com diagnóstico de faringotonsilite aguda. RESULTADOS: Foram estudadas 1039 crianças e adolescentes. Com base no quadro clínico, antibiótico seria prescrito em 530 pacientes (51%), e com o uso da PRE e/ou cultura de orofaringe foi prescrito em 268 (25,8%) pacientes. Das 509 crianças que não receberiam antibiótico pelo quadro clínico, 157 tiveram PRE e/ou cultura de orofaringe positiva. O diagnóstico baseado no quadro clínico apresentou sensibilidade de 63,06% (IC-95%:62,95-63,17%); especificidade de 57,33% (IC-95%:57,25-57,41%); valor preditivo positivo de 50,57% (IC-95%:50,47-50,66%) e valor preditivo negativo de 69,16% (IC-95%: 50,47-50,66%). CONCLUSÕES: Neste estudo o diagnóstico clínico da faringotonsilite estreptocócica mostrou baixa sensibilidade e especificidade. O uso rotineiro da prova rápida para pesquisa de estreptococo permitiu uma redução do uso de antibiótico e a identificação de crianças e adolescentes com faringotonsilite estreptocócicas que não receberiam antibiótico e estariam sob o risco das complicações da infecção estreptocócica / BACKGROUND: Sore throat is a common disease in the pediatric emergency room. OBJECTIVES: The objective of this study was to evaluate the impact of routine performance of rapid antigen detection test (RADT) in the diagnosis and treatment of acute pharyngitis in children treated at an academic hospital. METHODS: This is a prospective, observational, protocol compliance, established at the Emergency of Hospital Universitário - Universidade de São Paulo for the care of children and adolescents diagnosed with acute pharyngitis. RESULTS: We studied 1039 children and adolescents. Based on clinical findings, antibiotic would be prescribed in 530 patients (51%) and using the RADT or sore throat culture was prescribed in 268 patients. Of the 509 children who did not receive antibiotics for the clinical, 157 had positive RADT or sore throat culture. The diagnosis based on clinical sensitivity was 63,06% (IC 95% 62,95- 63,17%), specificity 57,3% (IC 95% 57,25-57,41%), positive predictive value of 50,57% (IC 95% 50,47-50,66%) and negative predictive value of 69,16% (IC 95% 50,47-50,66%). CONCLUSIONS: In this study the clinical diagnosis of streptococcal pharyngitis had low sensitivity and specificity. The routine use of rapid test for streptococcal research led to a reduction of antibiotic use and the identification of a risk group for complication of streptococcal infection