Submitted by Patricia Rocha de Araújo (patriciarocha39@hotmail.com) on 2018-10-15T01:56:34Z No. of bitstreams: 1 Dissertação Patricia Rocha out 2018.pdf: 3514360 bytes, checksum: 9b0fea77694a33ed0ae69da788c5a4a2 (MD5) / Approved for entry into archive by Maria Irani Coito (irani@fcfar.unesp.br) on 2018-10-16T20:37:01Z (GMT) No. of bitstreams: 1 araujo_pr_me_arafcf.pdf: 3514379 bytes, checksum: dffaf731be630bbca5063c79b406b6ae (MD5) / Made available in DSpace on 2018-10-16T20:37:01Z (GMT). No. of bitstreams: 1 araujo_pr_me_arafcf.pdf: 3514379 bytes, checksum: dffaf731be630bbca5063c79b406b6ae (MD5) Previous issue date: 2018-09-20 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A candidíase vulvovaginal (CVV) é uma doença causada por espécies do gênero Candida spp. no trato genital inferior feminino que afeta um grande número de mulheres em todo mundo. Porém o uso sistêmico de fármacos causa muitas reações adversas e as formulações tópicas possuem um baixo tempo de retenção na mucosa vaginal devido à diluição dos sistemas na cavidade vaginal. Esse estudo propõe uma terapia antifúngica alternativa empregando sistemas precursores de cristais líquidos mucoadesivos (SPCLM) para a liberação de hipericina (HIP), um potente fotossensibilizador isolado de plantas do gênero Hipericum com e sem o emprego da terapia fotodinâmica (TFD). O sistema visa aumentar o tempo de permanência da formulação, bem como reduzir o número de aplicações e a quantidade de fármaco empregada. O emprego da TFD, por sua vez, se faz como uma forma de diminuir a resistência pelos microrganismos. Observou-se a formação de sistemas isotrópicos no sistema constituído por 30% da fase oleosa constituída por ácido oleico e colesterol na razão de 7:1, 40% de Procetyl AWS como tensoativo e 30% de uma dispersão de poloxamer à 16% empregando as técnicas de microscopia de luz polarizada e espalhamento de raios-X a baixo ângulo. Após a introdução de três diferentes concentrações de fluido vaginal simulado FVS (30, 50 e 100%), as formulações resultantes passaram a apresentar anisotropia e picos característicos de fase lamelar. Análises das propriedades mecânicas, reológicas e mucoadesivas das formulações indicaram que a organização e a mucoadesão dos sistemas aumentaram à medida que a quantidade de FVS aumentou. Os ensaios de validação da metodologia analítica para quantificação de HIP indicaram que o método é aceitável segundo agências regulatórias. Os testes de liberação in vitro demonstraram perfil de liberação sustentada da HIP provavelmente devido à sua alta afinidade pelos componentes da fase oleosa dos sistemas de liberação. Além disso, os SPCLM causaram aumento da retenção e baixa permeação da HIP em mucosa suína. Ensaios microbiológicos indicaram que a HIP é um agente eficaz para inativação das leveduras de Candida albicas com emprego da TFD, porém os SPCLM com HIP não potencializaram a ação antifúngica deste composto, possivelmente devido ao longo período necessário para sua liberação. Os testes de citotoxicidade indicaram que todas as formulações apresentam baixa toxicidade, porém os sistemas com hipericina incorporada apresentaram maior toxicidade para células tumorais L292. Ensaios in vivo do sistema em modelo de CVV são necessários para comprovar a viabilidade do sistema desenvolvido. / Vulvovaginal candidosis (VVC) is a disease induced by Candida strains in the female genital tract that affects a great number of women worldwide. However, systemic drugs cause many adverse reactions. Also, currently employed topical dosage forms present low retention times due to their dilution in vaginal fluids. This study proposes an alternative antifungal therapy through the development of liquid crystalline precursor systems (LCPS) for hypericin release, a potent photosensitizer isolated from Hipericum plants with and without photodynamic inactivation (PDI). The developed system aims to increase the residence time of the formulations, as well as decrease the number of applications and the amount of drug. Photodynamic therapy was used to reduce microorganism resistance. Polarized light microscopy and Small-Angle X-Ray Scattering confirmed the formation of an isotropic system composed of 30% of oil phase containing oleic acid and cholesterol in (ratio of 7:1). After addition of three different concentrations of simulated vaginal fluid -SVF (30, 50 and 100%), the resultant formulations presented anisotropy and characteristic peaks of lamellar phases. Mechanical, rheological and mucoadhesive assays indicated the formation of long-range ordering systems as the amount of SVF increased. Drug validation assays indicated that the method is aceptable for hypericin quantification according to regulatory agencies. In vitro drug release assays exhibited a sustained release profile probably due to the high affinity between HIP and the oily phase components. In addition, the LCPS lead to poor permeability and enhanced retention of HIP in the porcine mucosa. Microbiological assays pointed out that HIP effectively inactivated Candida albicans yeasts with PTD, however the HIP loaded LCPS did not potentiate the antifungal activity of HIP, probably due to the long period for HIP release. Cytotoxic tests indicated that all formulations presented low toxicity, however the HIP loaded presented higher toxicity to L292 tumor cells. In vivo assays should be performed to confirm the viability of the developed system. / 001

L'évaluation médico-économique (EME) joue un rôle de plus en plus important dans le développement des recommandations cliniques et les décisions de prix et remboursement des produits de santé, notamment des vaccins. L'EME des vaccins fait l'objet de procédures et de recommandations méthodologiques spécifiques, distinctes des médicaments, dans de nombreux pays. Cette thèse illustre et répertorie les différentes questions méthodologiques concernant l'EME des programmes de vaccination sur la base de six études : estimation de la morbidité, mortalité et coûts liés aux infections à cytomégalovirus chez les receveurs de greffe d'organe solide ; description de l'état de santé subjectif et qualité de vie liée à la santé chez les femmes atteintes de candidose vulvovaginale récurrente (CVVR) ; revue critique des EME de la vaccination de rappel contre la coqueluche ; revue critique des EME de la vaccination contre le rotavirus ; analyse coût-efficacité de la vaccination antigrippale chez les personnes de 50 à 64 ans ; analyse coût-efficacité d'un vaccin antigrippal quadrivalent en Ontario. L'EME des programmes de vaccination nécessite de prédire l'effet d'un vaccin dans la vie réelle à partir d'essais cliniques, ce qui est particulièrement difficile pour plusieurs raisons : l'épidémiologie d'une infection peut varier dans le temps et l'espace, la réduction du risque d'infection après vaccination est différente de celle du risque de maladie, et la vaccination peut conduire à une augmentation ou diminution du risque chez les personnes non-vaccinées. De plus, la mesure et la valorisation des effets sur la qualité de vie soulèvent des questions méthodologiques et requièrent des choix normatifs liés aux faits que de nombreux vaccins ciblent les enfants, et que la réduction du risque peut améliorer la qualité de vie en dehors des périodes de maladie. Nous établissons finalement des recommandations pour les futures EME de programmes de vaccination, concernant la définition des stratégies à comparer, le choix de structure de modèle, l'estimation des paramètres cliniques et épidémiologiques, et la mesure et la valorisation de la qualité de vie et des coûts / Economic evaluation plays an increasingly important role in the development of clinical recommendations and pricing and reimbursement decisions for healthcare interventions, and particularly for vaccination. Specific processes and methodological recommendations have been developed for the economic evaluation of vaccines in many countries. This thesis identifies and illustrates different methodological questions about the economic evaluation of vaccination programs based on six studies: estimation of morbidity, mortality and costs associated with cytomegalovirus infections among receivers of solid organ transplant; description of subjective health state and quality of life among women with recurrent vulvovaginal candidosis; critical review of economic evaluations of pertussis booster vaccination; critical review of economic evaluations of rotavirus vaccination; cost-effectiveness analysis of influenza vaccination for people aged 50 to 64 years; cost-effectiveness analysis of a quadrivalent influenza vaccine in Ontario. The economic evaluation of vaccines requires predicting the effectiveness of vaccination based on clinical trial data, which is particularly difficult for several reasons: the epidemiology of an infection may vary over time and space, the effectiveness against infection may differ from effectiveness against disease, and vaccination may lead to an increase or decrease in the burden of disease among non-vaccinated persons. In addition, the measurement and valuation of effects of vaccination on quality of life raises methodological questions and requires normative choices related to the facts that many vaccines target children and that the reduction in risk may improve quality of life outside illness periods. We finally establish recommendations for future economic evaluations of vaccination programs, related to the definition of vaccination strategies to compare, the choice of model structure, the estimation of clinical and epidemiological parameters, and the measure and valuation of quality of life and costs