Diabetes mellitus är en av de vanligaste endokrina sjukdomarna och de vanligaste formerna är typ I och typ II. Idag har ca 350 000 personer i Sverige diabetes och av dessa har 85-90% diabetes typ II. Typ II diabetes börjar med insulinresistens och så småningom blir det avtagande funktion av β- cellerna vilket leder till nedsatt insulinkänslighet och främsta orsakerna till typ II diabetes är övervikt och fetma. Det finns olika behandlingsrekommendationer för att behandla typ II diabetiker för att minska att sena komplikationer uppstår. Främst genom livsstilsförändringar som kost och fysisk aktivitet, men då dessa inte räcker till kan perorala läkemedel komma i efterhand och om inte det heller ger tillräcklig effekt kan insulinbehandling sättas in. Ca 50 % av typ II diabetiker får insulin efter 10 års sjukdom. Syftet med arbetet är att undersöka om det finns en god implikation av att sätta in insulin tidigare än det som redan är rekommenderat. Denna litteraturstudie är baserad på artiklar hämtade från databasen PubMed. Sammanlagt har fem randomiserade kontrollerade studier granskats. Resultaten visar att en HbA1c-sänkning med ca 1,5 - 2,0 % kan erhållas samt också en bibehållen β- cellfunktion vid insättning av insulin. Insulinbehandlingen bör sättas in så snart HbA1c går över 7,5 % istället för att vänta en viss tid. Den kan sättas in hos behandlingsnaiva personer med framträdande symtom eftersom insulin fortfarande sänker HbA1c och det finns inget som tyder på att insulin inte kan sättas in tidigare än det som är rekommenderat. Slutsatsen som dras är att stödja intensiv behandling som gör att HbA1c hålls på en så låg nivå det är möjligt och när målvärden för HbA1c inte kan hållas kan insulin med fördel sättas in hos typ II diabetiker som behandlats med perorala antidiabetika.

In order for a medicinal product to produce a consistent and reliable therapeutic response, it is essential that the final composition of the product is invariable and that the active ingredient/s is/are present in appropriate, non-toxic amounts. However, due to the complexity involved in the standardization of natural products, quality control (QC) criteria and procedures for the registration and market approval of such products are conspicuously absent in most countries around the world. African Potato (AP) is of great medical interest and this particular plant has gained tremendous popularity following the endorsement by the South African Minister of Health as a remedy for HIV/ AIDS patients. Very little information has appeared in the literature to describe methods for the quantitative analysis of hypoxoside, an important component in AP. It has also been claimed that sterols and sterolins present in AP are responsible for its medicinal property but is yet to be proven scientifically. To-date, no QC methods have been reported for the simultaneous quantitative analysis of the combination, β- sitosterol (BSS)/ stigmasterol (STG)/ stigmastanol (STN), purported to be present in preparations containing AP. The effect of concomitant administration of AP and other herbal medicines on the safety and efficacy of conventional medicines has not yet been fully determined. Amongst the objectives of this study was to develop and validate quantitative analytical methods that are suitable for the assay and quality control of plant material, extracts and commercial formulations containing AP. Hypoxoside was isolated from AP and characterized for use as a reference standard for the quality control of AP products and a stability-indicating HPLC/ UV assay method for the quantitative determination of hypoxoside was developed. In addition, a quantitative capillary zone electrophoretic (CZE) method was developed to determine hypoxoside, specifically for its advantages over HPLC. A HPLC method was also developed and validated for the quantitative analysis of BSS, STG and STN in commercially available oral dosage forms containing AP material or extracts thereof. The antioxidant activity of an aqueous extract of lyophilized corms of AP along with hypoxoside and rooperol were investigated. In comparison with the AP extracts and also with hypoxoside, rooperol showed significant antioxidant activity. The capacity of AP, (extracts, formulations, hypoxoside and rooperol as well as sterols to inhibit in vitro metabolism of drug substrates by human cytochrome P450 (CYP) enzymes such as CYP 3A4, 3A5 and CYP19 were investigated. Samples were also assessed for their effect on drug transport proteins such as P-glycoprotein (P-gp). Various extracts of AP, AP formulations, stigmasterol and the norlignans, in particular the aglycone rooperol, exhibited inhibitory effects on CYP 3A4, 3A5 and CYP19 mediated metabolism.These results suggest that concurrent therapy with AP and other medicines, in particular antiretroviral drugs, can have important implications for safety and efficacy. Large discrepancies in marker content between AP products were found. Dissolution testing of AP products was investigated as a QC tool and the results also revealed inconsistencies between different AP products.

Abstract According to the law patients have a right to good care and the care has to be of a high level, safe and evidence based. Medication has been found to be a nursing procedure that is associated with many risks. It has been documented that mistakes occur even in every fifth medication event. All Finnish nurses have been trained to carry out advanced medication and iv-therapy, and it is the nurses who are the main administrators of medication in the health care units. For these reasons nurses' medication competence is important. The constant development of medical treatment increases the demands of nurses' competence in medication. The aim of the study was to describe and to explain the medication competence of nurses assessed by themselves and according to theoretical and online exams. The aim was to describe the nurses' perceptions of the verification process of medication competence and e-learning as the method for verification. The quantitative data of the study consisted of 692 nurses´ self-assessment of medication competence and of 2479 nurses' results on theoretical and drug calculation exams. The qualitative data consisted of 342 nurses' perceptions of the verification and e-learning. In the theoretical exam the nurses had 84,9% correct answers while the required level to pass was 75%. The nurses themselves considered their medication competence to be good. Challenges were found most in the areas of anatomy, physiology and pharmacology, and in reading of professional and scholarly literature. About 5% of the nurses had persistent problems in the drug calculations. Diluting and solution calculations were the most challenging ones. The nurses who had taken the online course considered their medication competence better than the other nurses. The ones who regularly administer advanced medication and iv-therapy in their daily work considered their medication competence better than the other nurses. The nurses accepted the verification process of medication competence, and e-learning was considered a sound teaching method. Some of the nurses criticised the present model of verification and they wished for verification that is better targeted to their daily duties. In addition to e-learning they wished for other teaching methods. A nationally and even internationally standardised model needs to be developed for verification of nurses’ medication competence. / Tiivistelmä Potilailla on lain mukaan oikeus hyvään hoitoon, ja hoidon tulee olla korkeatasoista, turvallista ja näyttöön perustuvaa. Lääkehoito on todettu riskialttiiksi tehtäväksi. Jopa joka viidennessä lääkitystapahtumassa on havaittu tapahtuvan virheitä. Kaikki suomalaiset sairaanhoitajat ovat saaneet koulutuksen vaativan neste- ja lääkehoidon toteuttamiseen, ja sairaanhoitajat ovatkin terveydenhuollon toimintayksiköissä keskeisiä lääkehoidon toteuttajia. Näistä syistä sairaanhoitajien lääkehoidon osaaminen on tärkeää. Lääkehoidon jatkuva kehittyminen lisää sairaanhoitajien osaamisen vaatimuksia. Tämän tutkimuksen tarkoituksena oli kuvata ja selittää sairaanhoitajien lääkehoidon osaamista heidän itsensä arvioimana ja lääkehoidon teoria- ja lääkelaskutentin perusteella. Tutkimuksen tarkoituksena oli myös kuvata sairaanhoitajien käsityksiä lääkehoidon osaamisen varmistamisesta ja verkko-oppimisesta osaamisen varmistamisen menetelmänä. Tutkimuksen määrällinen aineisto koostui 692 sairaanhoitajan lääkehoidon osaamisen itsearvioinnista ja 2 479 sairaanhoitajan teoria- ja lääkelaskutentin tuloksista. Laadullinen aineisto perustui 342 sairaanhoitajan käsityksiin lääkehoidon osaamisen varmistamisesta ja verkko-oppimisesta. Teoriatentissä sairaanhoitajat saivat 84,9 % kysymyksistä oikein, kun hyväksyttyyn suoritukseen vaadittiin 75 % oikein. Sairaanhoitajat arvioivat lääkehoidon osaamisensa hyväksi. Anatomian, fysiologian ja farmakologian tiedoissa sekä ammatillisen ja tieteellisen tiedon lukemisessa oli eniten haasteita. Lääkelaskuissa toistuvia ongelmia oli n. 5 %:lla vastaajista. Haastavimpia olivat infuusioihin ja laimennoksiin liittyvät laskut. Lääkehoidon verkkokurssin käyneet arvioivat osaamisensa paremmaksi kuin muut vastaajat. Säännöllisesti työssään vaativaa neste- ja lääkehoitoa toteuttavat arvioivat lääkehoidon osaamisensa muita paremmiksi. Sairaanhoitajat hyväksyivät lääkehoidon osaamisen varmistamisen prosessin, ja verkkokurssi oli heidän käsitystensä mukaan toimiva opetusmenetelmä. Osa sairaanhoitajista kritisoi nykyistä osaamisen varmistamisen mallia ja he toivoivat enemmän työtehtäviin kohdennettua osaamisen varmistamista. Verkko-oppimisen rinnalle toivottiin muita opetusmenetelmiä. Lääkehoidon osaamisen varmistamisesta tulisi jatkossa kehittää kansallisesti yhtenäinen ja jopa kansainvälinen malli.

Abstract The elderly use drugs more commonly than younger persons. Many studies about drug use have concentrated on institutionalized elders. Knowledge of drug use by the oldest old, aged 85 years or over, is scant. Psychotropics are among the drugs most commonly used by the elderly. Psychotropics have many adverse effects, such as balance impairment, sedation, reduced cognition, depression, and extrapyramidal symptoms. We do not know the extent of sedative drug use, including psychotropics and drugs prescribed for somatic disorders that have sedative properties. Withdrawal of unnecessary drugs appears to be beneficial and to improve the functional capacities of the elderly. The aim of this study was to describe the changes in prescription drug use, polypharmacy, and psychotropic use among home-dwelling elderly Finns in the 1990s by using two cross-sectional community surveys. The specific aim was to classify all drugs used in Finland into four groups based on their sedative properties. Drug use, polypharmacy, and, to some extent, psychotropic use increased within a decade. The oldest old used prescription drugs most commonly. Polypharmacy was independently associated with higher age, and in 1998-99, with at least 3 chronic diseases, poor self-perceived health, and the use of home nursing services. Most psychotropic users were on regular medication. The use of hypnotics and antidepressants increased most. Persons with polypharmacy used significantly more commonly psychotropics compared to other people. Over 84-year-olds used psychotropics more commonly than younger persons. Sedative use was common, as 40 % of drug users used them. Sedative use was significantly more common among persons with polypharmacy than others. According to logistic regression models, the use of many sedatives was independently associated with age 80 years or over, female gender, chronic morbidity, smoking, poor self-perceived health/life satisfaction, and the use of home nursing. Both polypharmacy and abundant sedative use were associated with impaired physical functional abilities. Prescribers need to be aware of the increasing polypharmacy and abundant sedative use. Regular assessment of indications is needed to avoid overuse of drugs. Geriatric knowledge is needed to support health centers and specialized units in this demanding task.

Malaria, caused by an intracellular Plasmodium parasite, remains a devastating disease, having claimed approximately 655 000 lives worldwide in 2010. The Medicines for Malaria Venture suggests a "single-dose radical cure" as the ideal malaria treatment since rapid clearance of blood-stage parasites and symptom relief improves patient compliance and limits drug resistance. Thus, novel antimalarials should be rapid-acting and assessing their rate of activity is critical to drug discovery. Traditional evaluation of this rate by morphological assessments is flawed by highly subjective, operator-specific interpretations, mainly due to heterogeneous parasite morphology under routine culture conditions. This study aimed to develop an alternative, quantitative assay. Energy is vital for the growth and maintenance of all living organisms. Commercially available kits allow rapid quantification of the cell's energy currency, ATP. Therefore, quantification of parasite ATP shows potential for diagnosing abnormal parasite metabolism and the kinetics of drug action. In this study, a rapid protocol for detecting ATP in Plasmodium falciparum parasites using a luminescence-based kit was developed and optimised. Furthermore, luciferase-expressing transgenic parasites, in which luciferase activity is detected using a similar kit, were acquired. The utility of both methods for evaluating the rate of drug-induced stress was explored using antimalarials with varying modes of action and, presumably, rates of activity. Results showed that parasite ATP remained unchanged, increased or decreased during drug exposure. Morphological examinations by light microscopy and a Recovery assay, aided interpretation of the drug-induced changes in parasite ATP. These investigations suggested that unchanged parasite ATP levels reflect poor drug action, increased ATP levels indicate a stress response and partially compromised viability, while significantly reduced ATP reflects severely compromised viability. Concerning the Luciferase assay, parasite luciferase activity decreased during drug exposure, even in the presence of proteasome inhibitors. Changes in parasite ATP and luciferase activity occurred at rates which suggested that chloroquine is slow-acting, mefloquine has a moderate rate of activity and artemisinin is rapid-acting. These findings are compatible with the expected rates of activity of these established antimalarials. Hence, measurement of parasite ATP and/or luciferase activity may support assessments of parasite health and the kinetics of antimalarial action during drug discovery

Malaria poses the greatest threat of all parasites to human life. Current vaccines and efficacious drugs are available however their use is limited due to toxicity, emergence of drug resistance, and cost. The discovery of an alternative pathway of isoprenoid biosynthesis, the non-mevalonate pathway, within the malarial parasite has resulted in development of novel anti-malarial drugs. 1-Deoxy-D-xylulose-5-phosphate (DOXP) reductoisomerase, the second enzyme in this pathway, is responsible for the synthesis of 2-C-methyl-D-erythritol 4-phosphate (MEP) in an intramolecular rearrangement step followed by a reduction process involving NADPH as a hydrogen donor and divalent cations as co-factors. Fosmidomycin and FR900098 have been identified as inhibitors of DOXP reductoisomerase. However, they lack clinical efficacy. In this investigation recombinant DOXP reductoisomerase from Escherichia coli (EcDXR) and Plasmodium falciparum (pfDXR) were biochemically characterized as potential targets for inhibition. (His)6-EcDXR was successfully purified using nickel-chelate affinity chromatography with a specific activity of 1.77 μmoles/min/mg and Km value 282 μM. Utilizing multiple sequence alignment, previous structural data predictions and homology modeling approaches, critical active site amino acid residues were identified and their role in the catalytic activity investigated utilizing site-directed mutagenesis techniques. We have shown evidence that suggests that Trp212 and Met214 interact to maintain the active site architecture and hydrophobic interactions necessary for substrate binding, cofactor binding and enzyme activity. Replacement of Trp212 with Tyr, Phe, and Leu reduced specific activity relative to EcDXR. EcDXR(W212F) and EcDXR(W212Y) had an increased Km relative to EcDXR indicative of loss in affinity toward DOXP, whereas EcDXR(W212L) had a lower Km of ~8 μM indicative of increased affinity for DOXP. The W212L substitution possibly removed contacts necessary for full catalytic activity, but could be considered a non-disruptive substitution in that it maintained active site architecture sufficient for DOXP reductoisomerase activity. EcDXR(M214I) had 36-fold reduced enzyme activity relative to EcDXR, while its Km (~8 μM) was found to be lower than that of EcDXR. This suggested that the M214I substitution had maintained (perhaps improved) substrate and active site architecture, but may have perturbed interactions with NADPH. Rational drug design strategies and docking methods have been utilized in the development of furan derivatives as DOXP reductoisomerase inhibitors, and the synthesis of phosphorylated derivatives (5) and (6) has been achieved. Future inhibitor studies using these novel potential DOXP reductoisomerase inhibitors may lead to the development of effective anti-malarial drug candidates.

Diabetes mellitus has been associated with both clinical and experimental cardiac dysfunction. Diabetic cardiomyopathy which is characterized by depressed cardiac contractility is accompanied by a variety of biochemical changes in Ca⁺⁺ metabolism. This cardiomyopathy may occur in the presence of normal coronary arteries and normal blood pressure. However, some studies have shown that hypertension is more prevalent among diabetics and can aggravate the cardiovascular abnormalities associated with diabetes. To understand the mechanisms of diabetic cardiomyopathy and consequences of combined hypertension and diabetes, experiments were designed to measure cardiac tissue responses to various inotropic agents in experimental diabetes. Six weeks following streptozotocin (STZ) administration, Wistar, spontaneously hypertensive (SHR) and Wistar Kyoto (WKY) rats exhibited the 'classical signs' of diabetes which included: hyperglycemia, hypoinsulinemia, hyperlipidemia (except in WKY), and hypothyroidism. Decreased basal atrial rate and increased basal developed force (BDF) suggest a depressed SA node function and an alteration of Ca⁺⁺ utilization by diabetic ventricles. Decreased post quiescent potentiation (PQP) values (except in WKY) in ventricular tissues suggest a diminished amount of releasable Ca⁺⁺ from sarcoplasmic reticulum (SR). Decreased post stimulation potentiation (PSP) values in SHR papillary muscles (PM) are probably suggestive of a depressed sarcolemmal Na⁺-Ca⁺⁺ exchange function in this tissue. Diabetic rats show subsensitivity to β-adrenergic stimulation in ventricular tissues, supersensitivity and hyperresponsiveness to Ca⁺⁺ and α-adrenergic stimulation (except in WKY) in ventricular tissues and left atria (LA) and supersensitivity to BAY K 8644 in SHR LA and hyperresponsiveness to verapamil in ventricular strips. These alterations may be attributed to a change in receptor number and/or a post receptor alteration. Ryanodine decreased the PQP of Wistar and SHR PM and SHR LA in both controls and diabetics. It especially abolished PQP in SHR diabetic tissues, but had no effect on WKY tissues, which may suggest a difference in the SR function in these tissues. SR with impaired Ca⁺⁺ uptake may contribute to these phenomena in diabetic rats. Ryanodine also diminished (PQP + BDF) of SHR LA and (PQP/BDF) of Wistar and SHR PM, ˙but had no effects on control and other diabetic tissues. It appears that ryanodine has some influence on the Na⁺-Ca⁺⁺ exchange generated by sarcolemma (SL) of certain diabetic tissues. Further experiments are required to clarify this. SHR diabetic rats had greater changes in most of the measurements such as hyperlipidemia, depressed PQP and PSP values, and altered drug responses. This model exhibited very high mortality as compared to Wistar and WKY diabetic rats. As has been shown previously, the combination of hypertension and diabetes exerts a synergistic effect on the cardiac dysfunction in this model, and that altered lipid metabolism, SL and SR function are all involved in the development of cardiomyopathy. WKY diabetic rats, on the other hand, exhibited no significant changes in blood lipids, or in response to phenylephrine or to Ca⁺⁺ (LA) stimulation. Lack of change in these factors may explain the relatively normal cardiac function of this model as measured previously. / Pharmaceutical Sciences, Faculty of / Graduate

Orientador: Simone dos Santos Aguiar / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T11:47:25Z (GMT). No. of bitstreams: 1 Nobrega_VirginiaTafas_M.pdf: 3339539 bytes, checksum: c286b90582a441ee1bb2f4b87b025ed0 (MD5) Previous issue date: 2014 / Resumo: Introdução: As taxas de sobrevida para leucemia linfoblástica aguda (LLA) na infância vêm apresentando aumento significativo nos últimos anos. Em decorrência disso, o número de adultos jovens sobreviventes se eleva a cada ano, tendo muitos deles uma série de complicações decorrentes do tratamento. O objetivo deste estudo é investigar a incidência e prevalência dos efeitos adversos tardios do tratamento antineoplásico, em sobreviventes de leucemia linfocítica aguda. Pacientes e Métodos: Desenho do estudo de coorte retrospectivo. Foram selecionados sobreviventes de LLA, que foram diagnosticados com menos de 18 anos, e estejam fora de tratamento há, pelo menos, dois anos. Os dados deste estudo foram coletados dos prontuários dos pacientes que foram submetidos a avaliação médica e exames complementares. Os efeitos adversos apresentados foram avaliados através desta revisão. Resultados obtidos: Dos 38 sobreviventes analisados, 55% (n=21) apresentaram algum tipo de comorbidade e 13,5% foram afetados por mais de uma alteração. A dislipidemia acometeu 18,4% (n=7) da população estudada, sendo a comorbidade mais prevalente com 35%. A baixa densidade óssea também apareceu com bastante frequência, acometendo 15% dos casos estudados. O tempo fora de terapia teve uma média de 7,92 anos (variação 2-16 anos). Conclusão: A necessidade de realizar o acompanhamento desses pacientes, não só através do exame físico, mas também de exames de imagem e laboratoriais foi evidente no nosso estudo. É possível que o acompanhamento regular, desde o término da terapia, até 20 ou 30 anos depois, leve à redução da intensidade e prevalência de comorbidades nessa população / Abstract: Background: Survival rates for acute lymphocytic leukemia in childhood have shown significant increase in recent years. Consequently, the number of young adult survivors rises each year, and some of those has a set of complications resulting from therapy. The aim of this study is to investigate the incidence and prevalence of late adverse effects of antineoplastic treatment in survivors of acute lymphoblastic leukemia. Patients and Methods: Retrospective cohort study. Survivors of acute lymphoblastic leukemia, younger than 18 years old at diagnosis, and off treatment for at least two years, have been selected. These were following-up at outpatient¿s clinic, where the information was collected and examinations performed. Adverse effects presented were evaluated by reviewing medical records. Results: Of the 38 survivors studied, 55,2% (n = 21) had some type of comorbidity and 13.5% were affected by more than one change. Dyslipidemia struck 18.4% (n = 7) of the population studied, and the most prevalent comorbidity with 35%. Low bone mineral density also appeared quite frequently, affecting approximately 16% of the group. The time off therapy had an average of 7.92 years (range 2-16 years). Conclusion: The necessity of follow-up of these patients, but only by physical examination, but imaging and laboratory was evident in our study. It is possible that with regular monitoring, since the completion of therapy, up to 20 or 30 years, leading to the reduction of the intensity and prevalence of comorbidities in this population / Mestrado / Saude da Criança e do Adolescente / Mestra em Ciências

O câncer de mama é uma preocupação de saúde pública por sua grande incidência na população. A quimioterapia é a estratégia de tratamento mais empregada e dentre as formas de ser administrada, a mais comum é a intravenosa. A maioria das drogas citotóxicas é irritante ou vesicante, passível de promover trauma vascular. A pesquisa teve como objetivos: verificar a ocorrência de trauma vascular, oriundo do procedimento de punção venosa periférica, em pessoas submetidas à quimioterapia ambulatorial no tratamento do câncer de mama; identificar as manifestações clínicas de trauma vascular no local de punção venosa periférica para quimioterapia; verificar a existência de associação entre a ocorrência do trauma vascular e as variáveis estudadas; descrever a evolução temporal da ocorrência e continuidade do trauma vascular. Foram observadas 30 pacientes, durante 188 sessões. Quanto à caracterização da amostra, 93,3% das pacientes apresentaram o diagnóstico Carcinoma Ductal Invasivo, 3,3% Carcinoma Lobular Invasivo e 3,3% carcinoma metaplásico condróide; quanto ao estadiamento clínico os de maior porcentagem foram IIIA e IIIB com 26,7% cada um. Quanto ao programa de quimioterapia, 36,6% fizeram uso de Fluorouracil, Epirrubicina e Ciclofosfamida e 56,67% de uma combinação quatro Ciclos de Epirrubicina e Ciclofosfamida e quatro ciclos de Docetaxel associado ou não ao Trastuzumab. Outra característica, a presença de dor antes do inicio da quimioterapia, foi observada no ciclo 1 (10%), ciclo 2 (26,7%), ciclo 3 (36,7%), ciclo 4 (23,3%), ciclo 5 (26,67%), ciclo 6 (40%), ciclo 7 (14,3%) e ciclo 8 (14%); dentre as pacientes que apresentaram dor, os locais predominantes foram os membros superiores e inferiores. As características principais identificadas em relação aos acessos venosos foram visibilidade, em mais de 50% dos acessos escolhidos; palpabilidade, presente em 100% dos acessos; mobilidade, sendo que mais de 50% das veias eram fixas; alem de a maioria apresentar trajetória retilínea e com elasticidade preservada. Quanto ao local de inserção, predominou (>60%) o dorso da mão. Houve também um aumento de repetidas punções para se conseguir um acesso ao longo dos ciclos. Quanto ao material, identificou-se preferência pelos materiais flexíveis - vialon ou tefon - de calibre predominantemente 24G, fixados com adesivo micropore. Quanto ao sistema utilizado para infusão foi utilizado o frasco de plástico flexível e colabável, com equipo simples e com sistema extensor de duas vias. Nos 188 ciclos observados foram identificados como trauma vascular tardio: diminuição da elasticidade do vaso (63); hiperpigmentação (69); endurecimento (46); engurgitamento (10) e cordão venoso (30). Como manifestações imediatas: infiltração em 1,59% dos ciclos, flebite durante a infusão (35) e queixas de dor durante a infusão (9). Ao se comparar as médias de problemas (trauma vascular) apresentados pelas pacientes que fizeram uso de Fluorouracil, Epirrubicina e Ciclofosfamida e as que fizeram uso de Epirrubicina, Ciclofosfamida, e Docetaxel, foi identificado maior índice para as do primeiro grupo; a análise estatística Mann-whitney, (,062) aponta que a diferença entre os protocolos é significante. O trauma vascular, como eventual diagnóstico de enfermagem, possibilita ao enfermeiro, no âmbito de sua competência, intervir para minimizá-lo ou extingui-lo. / Breast cancer is a public health concern due to its high incidence in population. Chemotherapy is the most applied treatment strategy, and intravenous administration is the most common form. Most cytotoxic drugs are irritant or vesicant, and can cause vascular trauma. This research aimed to verify the occurrence of vascular trauma, caused by the peripheral venous puncture procedure, in patients subject to ambulatory chemotherapy in breast cancer treatment; to identify the clinical manifestations of vascular trauma in the site of peripheral venous puncture for chemotherapy; to verify the existence of association between the occurrence of vascular trauma and the studied variables; to describe the time evolution of the occurrence and the continuity of vascular trauma. In total, 30 patients were observed during 188 chemotherapy sessions. Regarding the characterization of the sample, 93.3% of the patients presented diagnosis of Invasive Ductal Carcinoma, 3.3% Invasive Lobular Carcinoma and 3.3% Carcinoma with Chondroid Metaplasia; as to the clinical staging, the ones with highest percentage where IIIA and IIIB with 26.7% each one. Regarding the chemotherapy program, 36.6% used Fluorouracil, Epirubicin and Cyclophosphamide and 56.67% used a combination of four cycles of Epirubicin and Cyclophosphamide and four cycles of Docetaxel associated or not to Trastuzumab. Presence of pain before the start of chemotherapy was observed at cycle 1 (10%), cycle 2 (26.7%), cycle 3 (36.7%), cycle 4 (23.3%), cycle 5 (26.67%), cycle 6 (40%), cycle 7 (14.3%) and cycle 8 (14%); among patients who presented pain, the main sites were lower and upper extremities. The main characteristics identified in relation to venous accesses were visibility, in more than 50% of the chosen accesses, palpability, present in 100% of the accesses, mobility, being more than 50% of the veins fixed, and most presented straight path and preserved elasticity. Regarding the insertion site, most (60%) were in the dorsum of the hand. There was also an increase in repetitive punctures to succeed in accessing throughout the cycles. Preference for flexible materials vialon or teflon - was identified, mainly with 24G gauge, fixed with Micropore tape. Plastic, flexible and collapsible flask was used for infusion, with simple gadget and two-ways extended system. In the 188 observed cycles, the following were identified as late vascular trauma: decrease in vascular elasticity (63); hyperpigmentation (69); hardening (46); ingurgitation (10) and venous cord (30). As immediate manifestations: infiltration in 1.59% of the cycles, phlebitis during infusion (35) and complaint of pain during the infusion (9). Comparing the average of problems (vascular trauma) presented by the patients who used Fluorouracil, Epirubicin and Cyclophosphamide and the ones who used Epirubicin, Cyclophosphamide and Docetaxel, higher rates were identified for the patients of the first group; Mann-Whitneys statistical analysis (.062) shows significant difference between the protocols. Vascular trauma, as an occasional nursing diagnosis, enables nurses, under their competencies, to intervene to minimize or extinguish it.

O tratamento do câncer infanto-juvenil é prolongado e demanda frequentes internações hospitalares, as quais expõem a criança a procedimentos invasivos e a separam das pessoas, objetos e ambientes de seu convívio habitual. A quimioterapia é uma das terapêuticas mais utilizadas no tratamento do câncer e, embora eficaz, provoca inúmeros efeitos colaterais e exige uma reestruturação do cotidiano da criança adoecida. Desta forma, o cuidado oferecido a ela deve ser pensado de uma maneira integral, considerando-se não apenas os aspectos biológicos da patologia e seu tratamento, mas também suas repercussões emocionais, espirituais, escolares, sociais, no brincar e lazer. Visando a amenizar as experiências estressoras e facilitar a adaptação da criança ao novo cotidiano, esta deve ser auxiliada a desenvolver estratégias de enfrentamento da situação. Assim, este trabalho teve por objetivo identificar e compreender as estratégias de enfrentamento da terapêutica quimioterápica, utilizadas por crianças com câncer, durante a hospitalização. Tratou-se de um estudo exploratório, com análise de dados qualitativa, realizado com dez crianças entre sete e 12 anos, diagnosticadas com câncer, que se encontravam em quimioterapia, há pelo menos três meses, e hospitalizadas na unidade de internação pediátrica de um hospital universitário no momento da coleta de dados. A pesquisa foi aprovada pelo comitê de ética da referida instituição. Para a coleta dos dados foram realizadas entrevistas semiestruturadas, utilizando-se fantoches como recurso lúdico facilitador da interação e comunicação. Como técnica complementar, realizaram-se anotações em diário de campo e colheram-se dados relativos à patologia e histórico do tratamento nos prontuários. Realizou-se análise temática, indutiva, dos dados. Os resultados evidenciaram estratégias de enfrentamento dos efeitos colaterais da quimioterapia; da dor e procedimentos invasivos; da ociosidade e da incerteza quanto ao sucesso do tratamento. Tais estratégias incluem: conhecimento e a compreensão do diagnóstico e seu tratamento; vínculo afetivo entre a equipe de saúde e a criança; medidas farmacológicas e não farmacológicas para o alívio de náuseas, vômitos, alopecia e dor; alimentação - o prazer proporcionado pelo controle da situação; distração e brincadeiras - a melhor parte da hospitalização; a religião e a esperança de cura. Este estudo identificou que, apesar do sofrimento vivido durante as hospitalizações para realização do tratamento quimioterápico do câncer infantil, as crianças demonstraram construir vínculos positivos com a equipe de saúde e manter o desejo e disposição para realizar brincadeiras, as quais aproximam as vivências da internação ao cotidiano anterior à doença, evidenciando a manutenção de aspectos saudáveis, apesar do adoecimento. As crianças desenvolveram estratégias para lidar com as adversidades da terapêutica quimioterápica no hospital, as quais podem ser úteis quando compartilhadas com outras crianças que se encontram na mesma condição. Por fim, conhecer e compreender as estratégias válidas para o enfrentamento da quimioterapia, na perspectiva da criança com câncer, hospitalizada, auxiliam os profissionais de saúde a mobilizar recursos institucionais, da própria criança e da equipe de saúde, visando a potencializar o uso destas estratégias, tornando o tratamento o menos traumático possível. / Child-juvenile cancer treatment is extensive and demands frequent hospitalizations, which expose the children to invasive procedures and separate them from the people, objects and environments they are used to. Chemotherapy is one of the most used treatments in cancer management and, although effective, it provokes countless collateral effects and demands the restructuring of the sick children\"s daily life. Therefore, care delivery should be considered comprehensively, taking into account not only the biological aspects of the disease and its treatment, but also its emotional, spiritual, school, social, play and leisure repercussions. With a view to mitigating the stressful experiences and facilitating the children\"s adaptation to the new daily life, they should be helped to develop strategies to cope with the situation. Thus, this research aimed to identify and understand the strategies for coping with chemotherapy among children with cancer during hospitalization. An exploratory research with qualitative data analysis was developed, involving 10 children between seven and 12 years of age, diagnosed with cancer, who had been undergoing chemotherapy for at least three months and were hospitalized at the pediatric hospitalization unit of a teaching hospital during data collection. Approval was obtained from the hospital\"s institutional review board. For data collection, semistructured interviews were held, using puppets as a plaything to facilitate interaction and communication. As a complementary technique, field notes were made and data were collected on the disease and treatment history from the files. Data were subject to inductive thematic analysis. The results evidenced strategies to cope with the collateral effects of chemotherapy; with the pain and invasive procedures; with the lack of activity and uncertainty on treatment success. These strategies include: knowledge and understanding of the diagnosis and its treatment; affective bond between the health team and the child; pharmacological and non-pharmacological measures to relieve the nausea, vomiting, baldness and pain; food - the pleasure control of the situation grants; distraction and games - the best part of hospitalization; religion and the hope of cure. This study identified that, despite the suffering during hospitalizations to undergo chemotherapy, the children demonstrated that they construct positive bonds with the health team and continue wanting and willing to play, which approach the hospitalization experiences to the daily life before the illness, disclosing that healthy aspects are maintained despite the disease. The children developed strategies to cope with the adversities of chemotherapy in hospital, which can be useful when shared with other children in the same condition. Finally, knowing and understanding valid strategies to cope with chemotherapy, from the perspective of hospitalized children with cancer, help health professionals to mobilize resources from the institution itself, the children themselves and the health team, with a view to enhancing the use of these strategies, making treatment as less traumatic as possible.