A xerostomia é um efeito adverso comum e frequentemente irreversível decorrente da radioterapia de neoplasias malignas da região de cabeça e pescoço, afetando, sobremaneira, a qualidade de vida dos pacientes. Diferentes métodos para solucionar tal problema são propostos, de resultados, todavia questionáveis. Este estudo avaliou a eficácia clínica da acupuntura como método de tratamento preventivo e curativo de tais condições. Os pacientes foram distribuídos, aleatoriamente, em três grupos: grupo preventivo, constituído de 12 indivíduos, sem queixa de secura bucal, tratados com 12 a 16 sessões de acupuntura, antes e durante a radioterapia; grupo curativo, constituído de 12 indivíduos, diagnosticados, clinicamente, com xerostomia severa, tratados com 12 aplicações de acupuntura após concluído o tratamento oncológico, e grupo controle, formado pelos mesmos indivíduos do grupo curativo no momento da primeira consulta, precedente à terapêutica com acupuntura. O tratamento foi conduzido de acordo com os princípios da medicina tradicional chinesa e medicina ocidental ortodoxa, realizado de forma padronizada para todos os pacientes, duas vezes por semana, por um período de 20 minutos cada sessão. A avaliação da eficácia terapêutica fundamentou-se na mensuração da xerostomia, conduzida sob duas formas: objetiva, através da sialometria, com o registro quantitativo dos índices de fluxo salivar em repouso e estimulado (IFSR e IFSE), e subjetiva, por intermédio dos questionários Xerostomia Inventory (XI) modificado, Escala Visual Analógica (EVA) e Treatment Emergent Symptom Scale (TESS), mensurando o grau de severidade dos sintomas. Os resultados obtidos no grupo preventivo foram estatisticamente significativos quanto as avaliações objetivas e subjetivas, evidenciados por índices de fluxo salivar mais elevados tanto para o IFSR (P<0.001) como para o IFSE (P<0.001) e pela menor intensidade dos sintomas (P<0.001), quando comparadas ao controle. Para o grupo curativo, resultados também significativos foram constatados em ambas as avaliações, demonstrados pelo aumento dos IFSR (P<0.05) e IFSE (P<0.05) e redução da sintomatologia (P<0.05), comparados aos valores iniciais. Constatamos também que houve efeito de grupo e os pacientes que se beneficiaram do método preventivo, obtiveram médias estatisticamente mais significativas (P<0.001), para ambas as respostas clínicas, objetivas e subjetivas. É lícito concluir que a acupuntura mostrou-se um importante método de tratamento de xerostomia decorrente da radioterapia, visto ter alcançado uma confiabilidade significativa de eficácia, que nos faz indicá-la e sugerir a disponibilização do método preventivo nos centros de tratamento. / Xerostomia is a common and usually irreversible radiotherapy side effect in patients with head and neck cancer, affecting the patients’ quality of life. Many attempts have been suggested to manage this condition nevertheless of questionable results. This study evaluated the acupuncture treatment efficacy as a preventive and curative method for radiation-induced xerostomia. The patients were randomly assigned in three groups: preventive, composed of 12 individuals, without complaints of dry mouth, treated with 12-16 acupuncture sessions, before and concomitant radiotherapy; curative, composed by 12 individuals, diagnosed with severe xerostomia, treated with 12 acupuncture sessions after radiation therapy, and control, comprised of the curative’s group patients at the moment of the first visit, preceding this therapy. Acupuncture treatment, according to traditional Chinese medicine and occidental orthodox medicine concepts was performed twice a week, lasting 20 minutes each session, following standardize techniques for all patients. Acupuncture efficacy was evaluated, based upon objective and subjective methods of xerostomia measurements, performed by sialometry, measuring the resting and stimulated salivary flow rates (RSFR and SSFR), and by means of questionnaires such as Xerostomia Inventory (XI) modified, Visual Analog Scale (VAS) and Treatment Emergent Symptom Scale (TESS), which evaluated referred symptoms. Results obtained in preventive group, evidenced RSFR (P<0.001) and SSFR (P<0.001) significantly increased, and improvement of symptoms (P<0.001), compared with control. Within curative group, after acupuncture treatment, the results showed statistically significant improved for both resting and stimulated salivary flow rates (P<0.05) and reduces of referred symptoms (P<0.05). There were statistically differences between groups, being the patients in preventive group those who evidenced the most significant improved of values (P<0.001) for objective and subjective evaluations. We concluded that acupuncture plays an important role in xerostomia’s treatment, as shown by the results, reaching a significant confiability of efficacy, indicating and suggesting the preventive method at oncology centers.

nÃo hà / O controle da hansenÃase baseia-se no tratamento precoce dos doentes e na interrupÃÃo da cadeia de transmissÃo. Nos dias atuais, apresenta-se um novo desafio para este controle: a viabilidade de um esquema terapÃutico Ãnico para todas as formas clinicas da doenÃa, denominado multidrogaterapia uniforme (U-MDT), de curta duraÃÃo e eficaz, capaz de superar os seguintes problemas: erros na classificaÃÃo das formas clÃnicas, efeitos indesejÃveis dos fÃrmacos, abandono do tratamento e custos do mesmo. VÃrias doenÃas, tendo como exemplo principal a malÃria, apresentam diferenÃas na eficÃcia e efeitos indesejÃveis dos fÃrmacos, em funÃÃo dos diferentes agentes etiolÃgicos e formas clÃnicas. Isto se deve, entre outras possibilidades, a diferenÃas no metabolismo destes fÃrmacos. A hansenÃase, com formas clÃnicas espectrais e diferentes (indeterminada, tuberculÃide, bordeline tuberculÃide, bordeline bordeline, bordeline virchowiana e virchowiana), tambÃm apresenta, em funÃÃo destas, diferenÃas bacteriolÃgicas, histopatolÃgicas, imunolÃgicas e genÃticas. Neste sentido, possÃveis problemas a serem enfrentados pelo U-MDT seriam diferenÃas na eficÃcia terapÃutica e efeitos indesejÃveis dos fÃrmacos utilizados, conforme o espectro da doenÃa. Nesta tese, procuramos avaliar a incidÃncia dos efeitos indesejÃveis dos fÃrmacos dapsona, rifampicina e clofazimina, utilizados na terapÃutica da hansenÃase. Foram selecionados quarenta pacientes da forma tuberculÃide, dois quais 20 (vinte) fizeram uso do esquema padrÃo com dapsona e rifampicina e 20 (vinte) fizeram uso do esquema com dapsona, rifampicina e clofazimina, denominado U-MDT. TambÃm foram selecionados 20 (vinte) pacientes das formas clÃnicas bordeline virchowiana e virchowiana, os quais fizeram uso do esquema U-MDT. Todos os sujeitos receberam seis doses de tratamento. Em todos os pacientes tratados, nÃo evidenciamos efeitos indesejÃveis que levassem a interrupÃÃo do tratamento. Com exceÃÃo da anemia hemolÃtica, que se apresentou com incidÃncias elevadas em ambos os grupos de pacientes que fizeram uso do U-MDT os demais efeitos indesejÃveis apresentaram-se com baixas incidÃncias, compatÃveis com as evidencias cientÃficas, em todos os grupos de pacientes. NÃo evidenciamos diferenÃas nos achados da anemia hemolÃtica, bem como nos demais efeitos indesejÃveis, em funÃÃo das formas clinicas dos pacientes tuberculÃides (paucibacilares) e bordeline virchowianos ou virchowianos (multibacilares), que fizeram uso do esquema U-MDT. Tal dado sugere a inexistÃncia de influÃncias das formas clinicas da doenÃa nos efeitos indesejÃveis dos fÃrmacos. A verificaÃÃo de maiores incidÃncias de anemia hemolÃtica, atribuÃda à dapsona, nos grupos de pacientes tratados com U-MDT em relaÃÃo ao grupo de pacientes tratados com dapsona e rifampicina, parece sugerir alguma participaÃÃo da clofazimina na gÃnese de tal efeito indesejÃvel. / Leprosy control is based on early treatment of the patient and interruption of transmission. On current days, a new challenge for this control presents itself: the applicability of one single treatment regimen for all clinical forms of the disease, denominated Uniform Multidrug Therapy (U-MDT), an effective and short regimen, capable of overcoming the following issues: mistakes in the classification of clinical forms, drugs side effects, treatment abandon and its costs. Many diseases, malaria being the main example, present differences in effectiveness and side effects of drugs, according to the different pathological agents and clinical forms. This is due, amongst other possibilities, to differences in the metabolism of these drugs. Leprosy, with different and spectral clinical forms (indeterminate, tuberculoid, borderline tuberculoid, borderline borderline, borderline lepromatous, lepromatous), also presents, in function of those forms, bacteriological, histopathological, immunological and genetic differences. Possible issues to be faced by the U-MDT would be differences in the therapeutical effectiveness and pharmacological side effects, according to the spectrum of the disease. On this thesis, we try to evaluate the incidence of side effects of the drugs dapsone, rifampicin and clofazimine, used in the treatment of leprosy. Forty patients of the tuberculoid form were selected, from which 20 (twenty) used the standard regimen with dapsone and rifampicin and 20 (twenty) used the regimen with dapsone, rifampicin and clofazimine, denominated U-MDT. We also selected twenty patients of the borderline lepromatous and lepromatous forms, who used the U-MDT regimen. All patients received six doses of treatment. In all treated patients were not evidenced side effects that could lead to the interruption of treatment. With the exception of hemolytic anemia, which occurred in high incidence in both groups of patients that used the U-MDT regimen, other side effects were present in low incidence, compatible with the scientific evidences, in all groups of patients. There was no difference in the findings of hemolytic anemia, or other side effects, according to the clinical forms of the tuberculoid patients (paucibacillary) and borderline lepromatous or lepromatous (multibacillary) patients who used the U-MDT regimen. Such data suggests the inexistence of influence of the clinical forms of the disease on pharmacological side effects. The verification of highest incidence of hemolytic anemia, attributed to dapsone, in the groups of patients treated with U-MDT in comparison to the group of patients treated with dapsone and rifampicin, seems to suggest some role of clofazimin in the genesis of such side effect.

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2016-08-04T18:44:24Z No. of bitstreams: 1 Dissertação - Ariane Borges Costa - 2016.pdf: 1654685 bytes, checksum: ff7560e112682ef85ece381d2dd5a833 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-08-05T12:46:57Z (GMT) No. of bitstreams: 1 Dissertação - Ariane Borges Costa - 2016.pdf: 1654685 bytes, checksum: ff7560e112682ef85ece381d2dd5a833 (MD5) / Made available in DSpace on 2016-08-05T12:46:57Z (GMT). No. of bitstreams: 1 Dissertação - Ariane Borges Costa - 2016.pdf: 1654685 bytes, checksum: ff7560e112682ef85ece381d2dd5a833 (MD5) Previous issue date: 2016-03-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The records on the use of plants for therapeutic purposes date back to the earliest civilizations. The medicinal therapy lasted for many decades, replaced by synthetic drugs that gained prominence after intensive research in the area. We note that at present the use of plants with possible biological properties is growing too for various reasons that discourage the use of allopathic as cost of allopathic medication and their side effects. As an example of such use, the plant popularly known as Noni, scientific name Morinda citrifolia Linn. The M.citrofolia stands out for its extensive use for therapeutic purposes, as an analgesic, anti-inflammatory, antibiotic, antifungal, antiviral, antineoplastic and slimming. However, due to lack of conclusive experimental studies, ANVISA banned the sale of the plant, based on the description of cases maintain that the plant has potentially hepatotoxic. However, no experimental studies confirmed this claim, and part of the work argue that the plant has hepatoprotective effect. In this sense, this study conducted an epidemiological survey, 75 interviews, on the consumption of Noni by individual inhabitants of the southwest region of Goiás who consume or have used the Noni plant. Of these, blood samples from 05 volunteers obtained for evaluation of hematologic and hepatic profile. Parse that Noni consumption profile differs from what was observed in the overall consumption of plants with therapeutic purposes, as it can’t be regarded as restricted to elderly and low-income population. We also analyzed the most part consumed is the fruit in combination with completely grape juice in an amount of 20 ml per intake. Despite the ban imposed by ANVISA, the plant is still marketed and voluntary claim has no knowledge of the decree, and testify about the real reasons used by the body to maintain the ban. Clinical analysis was not enough to claim the association of liver changes and consumption of Noni, since the individuals included in this study had stage of disease diagnosis and / or consumption of drugs that could promote this type of change. / Os registros quanto à utilização de plantas para fins terapêuticos datam desde as primeiras civilizações. A terapia medicinal perdurou por muitas décadas, sendo substituída pelos medicamentos sintéticos que ganharam destaque após intensas pesquisas na área. Observamos que na atualidade a utilização de plantas com possíveis propriedades biológicas vem crescendo demasiadamente por vários motivos que desencorajam o uso dos alopáticos como custo de medicação alopática e seus efeitos colaterais. Como exemplo dessa utilização, a planta conhecida popularmente como Noni, de nome científico Morinda citrifolia Linn. A M.citrofolia destaca-se por sua ampla utilização para fins terapêuticos, como analgésico, anti-inflamatório, antibiótico, antifúngico, antiviral, emagrecedor e antineoplásico. Porém, devido à falta de estudos experimentais conclusivos, a ANVISA proibiu a comercialização da planta, com base em descrições de casos que alegam que a planta possui potencial hepatotóxico. Contudo, nenhum estudo experimental confirmou essa afirmação, sendo que parte dos trabalhos alegam que a planta possui efeito hepatoprotetor. Nesse sentido, este estudo realizou um levantamento epidemiológico, com um total de 75 entrevistas, sobre o consumo de Noni por indivíduos habitantes da região sudoeste de Goiás que consomem ou fizeram uso da planta Noni. Destes, foram obtidas amostras sanguíneas de 05 voluntários para avaliação de perfil hematológico e hepático. Foi possível analisar que o perfil do consumo de Noni difere do que foi observado no consumo geral de plantas com finalidades terapêuticas, visto que não pode ser considerada como restrito a idosos e a população de baixa renda. Analisamos ainda que a parte mais consumida é o fruto em associação com suco de uva integral em uma quantidade de 20 mL por ingesta. Apesar da proibição imposta pela ANVISA a planta é ainda comercializada e os voluntário afirmam não possuir conhecimento do decreto, e atestam ainda sobre os verdadeiros motivos utilizados pelo órgão para manter a proibição. A análise clínica não foi suficiente para alegar a associação de alterações hepáticas e consumo de Noni, posto que, os indivíduos inclusos nessa etapa da pesquisa possuíam diagnostico de doenças e/ou consumo de fármacos que poderiam promover este tipo de alteração.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-05-17T12:24:07Z No. of bitstreams: 1 tiagobaessomonteirodecastro.pdf: 1669524 bytes, checksum: 9a14116f51037cbccac895a4f9c011a8 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-06-28T14:04:30Z (GMT) No. of bitstreams: 1 tiagobaessomonteirodecastro.pdf: 1669524 bytes, checksum: 9a14116f51037cbccac895a4f9c011a8 (MD5) / Made available in DSpace on 2016-06-28T14:04:30Z (GMT). No. of bitstreams: 1 tiagobaessomonteirodecastro.pdf: 1669524 bytes, checksum: 9a14116f51037cbccac895a4f9c011a8 (MD5) Previous issue date: 2015-11-05 / Introdução: A maioria dos protocolos para o tratamento do mieloma múltiplo (MM) é composto pelo bortezomibe e/ou talidomida, associados a outras drogas, como agentes alquilantes e corticóides. A farmacovigilância mostra-se uma importante ferramenta durante o tratamento, pois é grande a chance dos pacientes apresentarem algum tipo de efeito adverso (EA). Objetivo: Avaliar as principais toxicidades dos protocolos que utilizam bortezomibe e/ou talidomida para o tratamento do MM. Materiais e Métodos: Foi realizado um estudo prospectivo de farmacovigilância, em que esta foi exercida através de entrevistas realizadas a cada retorno do paciente, observação clínica e consultas aos exames laboratoriais e prontuários. Os critérios National Cancer Institute versão 4.0 foram utilizados para identificação e graduação de EA. Os dados foram coletados em 3 instituições, no período de 28 meses. Resultados: Foram incluídos no estudo 59 pacientes (tendo sido avaliados 62 tratamentos). Houve uma predominância do sexo feminino, 36 (61%), versus 23 (39%) do sexo masculino, e de brancos, 49 (83,1%) versus 10 (16,9%) da raça negra. A idade dos pacientes variou de 40 a 94 anos, com mediana de 65 anos de idade (DP = 11,6). Em relação ao estadiamento ao diagnóstico, 27 (45,7%) pacientes se encontravam no estádio III-A, sendo 12 (20,3%) pacientes com creatinina ≥ 2. Os principais EA do grupo tratado com bortezomibe (n = 40) foram: neutropenia (42,5%), diarreia (47,5%) e neuropatia periférica (NP) em 60% dos casos, sem diferença (p = 0,343) da administração endovenosa do bortezomibe (n = 26) em relação a utilizacao subcutânea (n = 14). No grupo tratado com talidomida (n = 19), 31,6% apresentaram neutropenia, 47,4% constipação e 68,4% NP. A neutropenia esteve associada ao uso de alquilantes (p = 0,038). Dos 3 pacientes que receberam bortezomibe associado a talidomida apenas 1 apresentou NP (33,3%). Conclusão: A NP foi o principal EA dos protocolos que utilizaram bortezomibe ou talidomida, com maior risco de neutropenia naqueles que utilizaram agentes alquilantes. Aprimorar a identificação de EA é fundamental para o cuidado com o paciente portador de MM que apresenta melhoras progressivas no tratamento e requer um uso racional e seguro dos medicamentos. / Introduction: Most protocols for the treatment of multiple myeloma (MM) consist of bortezomib and/or thalidomide, combined with other drugs such as alkylating agents and corticosteroids. Pharmacovigilance proves to be an important tool during treatment, as there is a high likelihood of patients having some type of adverse effect (AE). Objective: To assess the major adverse effects of the protocols that use bortezomib and/or thalidomide for the treatment of MM. Materials and methods: A prospective study of pharmacovigilance, carried out through interviews at each appointment with the patient, clinical observation, and by consulting laboratory tests and medical records. The National Cancer Institute criteria, version 4.0, were used for the identification and grading of AEs. Data were collected at three institutions, over 28 months. Results: A total of 59 patients (with 62 treatments being evaluated) were included in the study. There was a predominance of females, 36 (61%), versus 23 (39%) males, and Whites, 49 (83.1%), versus Blacks, 10 (16.9%). Patient age ranged from 40 to 94 years, with a median of 65 years (SD = 11.6). Regarding staging at diagnosis, 27 (45.7%) of the patients were in stage III-A, with 12 (20.3%) patients having creatinine ≥ 2. The main AEs for the bortezomib treatment group (n = 40) were: neutropenia (42.5%), diarrhea (47.5%), and peripheral neuropathy (PN) in 60% of cases, with no difference (p = 0.343) between intravenous administration of bortezomib (n = 26) and subcutaneous use (n = 14). In the group treated with thalidomide (n = 19), 31.6% had neutropenia, 47.4% constipation, and 68.4% PN. Neutropenia was associated with the use of alkylating agents (p = .038). Of the 3 patients who received bortezomib combined with thalidomide, only 1 presented NP (33.3%). Conclusion: NP was the main AE of the protocols that used bortezomib or thalidomide, with increased risk of neutropenia in those using alkylating agents. Improving the identification AEs is critical in caring for the patient with MM, which shows progressive improvements in treatment, and requires a rational and safe use of medicines.

Bakgrund: Bröstcancer är den vanligaste cancerformen hos kvinnor i Sverige idag. Cancerbehandling består ofta av kombinerade behandlingsmetoder och kan ha omfattande biverkningar. Bröstcancerbehandling kan försätta kvinnan i menopaus, leda till fatigue, håravfall och innebära kroppsliga förändringar. Detta kan påverka kvinnans självbild och sexuella hälsa. Syfte: Syftet med denna litteraturöversikt var att beskriva kvinnors upplevelse av sin sexuella hälsa under- och efter bröstcancerbehandling. Metod: Den metod som valdes var en litteraturöversikt som baserats på kvalitativa studier. Data har sammanställts från tidigare, redan genomförda studier för att skapa en samlad bild kring området. Resultat: Det framkom fyra centrala teman kring hur kvinnors sexuella hälsa påverkades till följd av bröstcancerbehandling. Dessa var behandlingens påverkan på samlivet, kvinnans relation till sig och sin kropp, intimitet och nära relationers betydelse och kommunikation med hälso- och sjukvård. Slutsats: Majoriteten av kvinnorna upplevde försämrad sexuell hälsa och svårigheter att identifiera sig i sin förändrade kropp till följd av bröstcancerbehandling. De ställdes inför en fysisk och psykisk utmaning. Det är viktigt att sjuksköterskor bemöter patienter med ett personcentrerat förhållningssätt för att bemöta kvinnors individuella behov. Hälso- och sjukvården brister i sin kommunikation kring sexuell hälsa vilket bör förbättras för att minska patienters lidande. / Background: Breast cancer is the most common cancer form in women in Sweden today. Cancer treatment often consists of combined treatment methods and can have extensive side effects. Breast cancer treatment can put the woman into menopause, lead to fatigue, hairloss and involve bodily changes. This can affect the woman's self-image and sexual health. Aim: The aim of this literature review was to describe the women's experience of their sexual health during and after breast cancer treatment. Method: The method chosen was a literature review based on qualitative studies. Data has been compiled from previous, already completed studies to create a combined image around the area. Results: Four main themes were identified about how women's sexual health was affected by breast cancer treatment. These were: The impact of treatment on sexual intercourse, the relationship of the woman with herself and her body, intimacy and the importance of close relationships and communication with health care. Conclusion: The majority of women experienced impaired sexual health and difficulty identifying themselves in their changed body as a result of breast cancer treatment. They faced a physical and mental challenge. It is important that nurses meet patients with a person-centered approach to respond to women's individual needs. Healthcare is lacking in communication about sexual health which should be improved to reduce patient suffering.

La radiothérapie constitue l’un des principaux traitements pour l’éradication des cancers. Cependant, elle présente un risque d’effets secondaires aux tissus sains environnant la tumeur. Dans ce processus, le système vasculaire et plus particulièrement l’endothélium jouent un rôle clé. Les cellules endothéliales activées favorisent le recrutement chronique des thrombocytes et des leucocytes, contribuant ainsi aux effets secondaires. D’autre part, dans les maladies inflammatoires, les glycanes exprimés à la surface des cellules endothéliales sont modifiés et influencent le recrutement des cellules immunitaires. Dans cette étude, nous avons évalué la modification des glycanes endothéliaux en réponse à une irradiation à forte dose, et étudié les effets fonctionnels de ces modifications sur le recrutement des leucocytes en utilisant un modèle de cellules endothéliales (HUVECs) in vitro. Nos résultats apportent les premières preuves d’une modification du glycome des cellules endothéliales en réponse à l’irradiation. Les N-glycanes hautement mannosylés, les O-glycanes et les motifs sialylées sont surexprimés. Parallèlement, le glycocalyx endothélial semble subir une dégradation. Nous avons évalué l’effet fonctionnel des modifications glycanique des cellules endothéliales irradiées sur l’adhésion d’une lignée de monocyte (THP-1). Nos résultats montrent que l’adhésion radio-induite est en partie due à la surexpression endothéliale des N-glycanes hautement mannosylés. Nous avons aussi évalué le glycome sur un modèle de souris irradiées et sur des pièces opératoires de patients traités par radiothérapies. Nos résultats de transcriptomiques sur la souris suggèrent l’existence de modifications glycaniques radio-induites in vivo. L’intégration de la composante glycanique permet de porter un regard nouveau sur le continuum d’évènement qui conduit aux lésions tissulaires radio-induites. A l’avenir, l’étude du glycome pourrait ouvrir de nouvelles pistes thérapeutiques pour une meilleure prise en charge des effets secondaires de la radiothérapie. / Radiotherapy is one of the main treatments against cancers. However, it presents a risk of adverse effects for the normal tissues surrounding the tumors. The vascular network and especially the endothelium are considered as main targets to limit normal tissue damages and prevent side effects of radiotherapy. Activated endothelial cells are involved in the chronic recruitment of thrombocytes and leukocytes, resulting in tissue complications. On the other hand, in inflammatory diseases, the glycans expressed on the surface of endothelial cells are modified and lead to immune cells recruitment. We sought to evaluate changes in endothelial glycome in a context of exposure to high dose of radiation, and studied the functional consequences on the recruitment of leukocytes. In vitro, the characterization of the glycome was performed on a primary endothelial cell model (HUVEC). Our results provide the first evidences of an endothelial modification of the glycome after exposure to ionizing radiation. We report an overexpression of high mannose N-glycans, O-glycans and syalilated motifs. At the same time, endothelial glycocalyx appeared to be damaged by exposure to radiation. Next, we evaluated these radiation-induced modifications of endothelial glycans on monocyte adhesion. We show that the radiation induced adhesion was mediated by overexpression of high mannose N-glycans. We also investigated changes in glycome in an irradiated mouse model of enteropathy and in resections of patients treated with radiotherapy. In mice, a transcriptomic study suggests changes in glycans following radiation exposure. Collectively, these findings on glycome changes provide a new perspective of the continuum of events leading to normal tissue complications. In the future, the study of the glycome should open new therapeutics opportunities for better management of tissue damages induced by radiation.

Bakgrund: Cancer är en sjukdom med över 200 olika former och cellgiftsbehandling är en vanlig behandling där cancerceller angrips, men även kroppens friska celler påverkas. Detta resulterar i biverkningar hos patienter som kan påverka livskvaliteten negativt trots att många av biverkningarna är lindriga. Sjuksköterskans primära roll är att arbeta för att främja hälsa och välbefinnande hos patienter. Syfte: Syftet med studien är att beskriva patienters upplevelser av ha biverkningar vid cellgiftsbehandling. Metod: Arbetet har genomförts genom en kvalitativ metod där självbiografier med en narrativ karaktär har studerats. Resultat:  I resultatet framkommer fyra teman. (1) Att orka fortsätta leva; innefattar upplevelser av att orka genomgå biverkningar. (2) Kroppens begränsningar; innefattar upplevelser av hur biverkningar begränsar patienternas liv. (3) Att pendla mellan olika känslor: innefattar upplevelser om hur känslor till biverkningarna är olika från dag till dag. (4) Behovet av stöd: innefattar vikten av stöd vid biverkningar. Resultatet visar upplevelsen av att ha biverkningar vid cellgiftsbehandling. Konklusion: Genom en inblick i upplevelserna kan sjuksköterskan möta och förstå patientens individuella behov av stöd och genom detta förebygga lidande av biverkningar vid cellgiftsbehandling. / Background: Cancer is a disease with over 200 different types. Treatment with cytostatics is common, cancer cells are attacked, but the healthy cells can also be affected. This result in different side effects that can affect the life quality in a negative way, although many of the side effects are minor.  The primary role as a nurse is to work for the protection of health and wellbeing in the patient care. Purpose: The purpose was to describe patient experiences of having side effects in chemotherapy. Method: The study was based on a qualitative method where autobiographies with a narrative quality has been studied. Result: The result show four themes that include experiences about having side effects in chemotherapy. The result also show the experiences about how side effects give limitations in life, experiences about how the feelings to the side effects are different from day to day and the importance of support through side effects. The themes presented in the result together show the experiences of having side effects in chemotherapy. Conclusion: Through an insight into the experiences, the nurse can meet and understand the patient's individual need for support and thereby prevent suffering of side effects during chemotherapy.

Charles University, Faculty of Pharmacy in Hradec Králové Department of Pharmacognosy Supervisor: doc. PharmDr. Lenka Tůmová, CSc. Student: Vendula Rapiová Title of Thesis: Natural substances with toxic and allergic activity Keywords: medicinal plant, allergy, side effects, toxicity The connection between herbs and mankind dates to early ages and without discussion herbal remedies were the first one to put in use. We observe significant increase of herbal remedies used in paediatric patients in last decades. The goal of this work was set to examine available information about herbal safety. The list of herbs that are dangerous or inappropriate to use in children age was made. The herbs were grouped into simple classification system of herbal safety. In addition to chapters describing herbal safety the work contains knowledge about their general use in paediatrics phytotherapy, the pros and cons of their use. To gather the data of web research and scientific literature were employed. The analysed data were published between 1968-2017 and were collected using PubMed, ScienceDirect and Google Scholar. The rate of herbal safety is classified into five specific groups - A, B, C, S and X. The analysis of results shows that the biggest group with the most represented samples in class was the class C with...

A energia ultra-sônica é um dos recursos físicos amplamente utilizado e pesquisado nos tratamentos de fisioterapia e diagnósticos médicos. Sabe-se que diante de uma escassa literatura dos efeitos do ultra-som em tecidos sadios, muitos profissionais fisioterapeutas acabam realizando aplicações infundadas de métodos e parâmetros. O objetivo desta pesquisa foi avaliar possíveis alterações do tecido sadio in vivo de ratos Wistar irradiados com diferentes intensidades, analisando a histologia e morfometria. Foram utilizados 30 ratos da linhagem Wistar, distribuídos aleatoriamente em 5 grupos de 6 animais cada. Foi escolhida a região dorsal do lado direito para tratamento com área de 4 \'CM POT.2\'. O lado esquerdo serviu como controle em todos os grupos. O tratamento foi feito durante 4 dias com 2 minutos de irradiação. Para verificar a intensidade de saída, utilizou-se o dosímetro de precisão antes da aplicação do ultra-som em cada animal. Foi realizada uma análise histológica descritiva e morfometria por meio do software Image Tool. Como resultado pode-se observar um discreto infiltrado inflamatório e adelgaçamento das fibras da derme, principalmente dos grupos irradiados com 1.5 e 2 W/\'CM POT.2\'. Notou-se também um aumento na espessura da epiderme nas amostras dos animais irradiados quando comparado com o controle. Para avaliar os resultados quantitativos, utilizou-se como análise estatística ANOVA \"one way\" e o teste \"pos hoc\" de Tukey com nível de significância p < 0,01. Em 120 medidas da espessura da epiderme obtiveram-se diferenças significativas do grupo controle com os grupos irradiados com (1.0, 1.5 e 2.0 W/\'CM POT.2\'). Concluímos diante dos resultados que houve alterações no tecido sob ação do US nas doses maiores, o que nos alerta para possíveis implicações do uso do US em estética. / The ultrasound (US) energy is one of the resources widely used and researched in both physio-therapist treatment and in medical diagnosis. In front of a scarce literature about the US effects in healthy tissues, many professionals have carried out unfounded applications of methods and parameters. So, the aim of this research was evaluate, through the histology, possible alternations in healthy tissues of Wistar rats in vivo irradiated with different intensity, analyzing the qualitative and quantitative histological slides. We used 30 Wistar rats randomly distributed in 5 groups of animals each. The local chosen for receiving the treatment was the dorsal right side, whose area was 4 \'CM POT.2\'. The left side was used as control of the animal itself for all the groups. The rats underwent the treatment during 4 days exposed to 2 minutes of irradiation. In order to check the energy output, the precision dosimeter was used before US application in each animal. The histological slides were evaluated qualitatively in the microscope and quantitatively through the image tool software. The qualitative result shows a discrete inflammatory process with infiltration and atrophy dermis fibers, mainly in the groups with higher US dosage. In the quantitative aspect, we found epidermis thickness increased in the 1.5 and 2 W/\'CM POT.2\' of US, with statistical difference (ANOVA) compared to control. We conclude that US therapy can be dangerous with high dosage applied in the intact skin.

Bakgrund: Bröstcancer är den vanligaste förekommande cancerformen bland kvinnor i västvärlden och behandlingsalternativen vid bröstcancer ser olika ut. En av de vanligaste behandlingarna är cytostatikabehandling. Cytostatikabehandlingen för med sig en rad biverkningar som anses vara plågsamma både fysiskt och psykiskt, dessa upplevs inte sällan mer påfrestande än själva cancern. För att kunna stödja patienten under sjukdomsförloppet och för att kunna lindra lidandet är information och råd från sjukvården av största vikt. Tidigare studier visar att det dominerande omvårdnadsbehovet hos kvinnor med bröstcancer är information och råd från sjukvården för att kunna hantera biverkningarna som cytostatikager upphov till samt psykologisk hjälp för att hantera rädsla och ångest. Syfte: Syftet med denna litteraturstudie är att sammanställa kvinnors upplevelse av cytostatikabehandling i samband med bröstcancer. Metod: En litteraturstudie som baseras på elva vetenskapliga artiklar från databaserna PubMed och Cinahl. Resultat: Resultatet visade att kvinnors psykosociala liv begränsas av biverkningar under cytostatikabehandling och vardagen karaktäriseras av anpassning och hantering, detta utmynnade i tre huvudkategorier; De fysiska biverkningarnas psykosociala påverkan, stöd av familj och anhöriga och brister i vården. Konklusion: Resultatet av litteraturstudien och tidigare forskning visade att cytostatikabehandling upplevs ha en stor påverkan på kvinnors dagliga liv där de fysiska biverkningarna har stor inverkan på det psykosociala livet. / Background: Breast cancer is the most commonly occurring form of cancer among women in the western world, and the treatment options for breast cancer looks different. One of the most common treatment methods is chemotherapy. The chemotherapy treatment carries a host of side effects and these are seen as quite exhausting both physically and mentally, they are commonly seen as testing out the overall effects of the cancer itself. In order to be able to support the patient during the course of the disease and to relieve suffering, information and advice from the healthcare system is of the utmost importance. Previous studies show that the main care needs of women with breast cancer is information and advice from healthcare to handle the side effects of the cytostatics cause, as well as psychological help to combat the fear and anxiety. Purpose: The purpose of this literature study was to compile the experiences of women receiving chemotherapy to combat breast cancer. Results: The results show that women’s psychosocial life is limited by the side-effects during the chemotherapy treatment, and their everyday lives are characterized by adapting to, and managing. The findings are presented as three main categories; The psychosocial impact of physical side effects, support from family and relatives and deficiencies in care. Conclusion: The results ofthe literature study, and earlier research, show that chemotherapy has a major impact on women's daily life, where the physical side effects have a great impact on the psychosocial life.