Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

The use of aminoglycosides in the treatment of the febrile neutropaenic patient with haematological disease is difficult and often suboptimal. This study reviews the available literature to establish therapeutic guidelines in this population and then reports the use of a Bayesian statistics based predictive model to implement and manage therapy in 10 patients. A review of the literature on aminoglycoside Pharmacology and clinical use is essential to determine therapeutic guidelines for this population. Aminoglycosides are amino sugars in glycosidic linkage and are polycations at physiological PH. The antibiotic effect is mediated through inhibition of protein synthesis and disruption of cell membrane integrity. Principal use is in treatment of Gram negative infection although aminoglycosides have activity against some Gram positive organisms including staphylococci. Aminoglycosides are inactive against anaerobes. Acquired resistance is mediated by bacterial enzymatic drug metabolism. Aminoglycosides are nephro- and ototoxic, this is the major constraint in clinical use.

A epidemia do HIV/AIDS vive o final de sua terceira década acompanhada de avanços importantes na terapia e na sobrevida dos pacientes infectados. Com o advento das drogas antiretrovirais altamente ativas transformou-se em uma condição crônica capaz de ser controlada por muito tempo. Com isso surgiram mudanças no quadro clínico geral e oral dos pacientes. Algumas comorbidades e alterações hematológicas passaram tornaram-se mais prevalentes nessa população, enquanto que as manifestações bucais oportunistas passaram a ser mais raras. Uma vez que o paciente HIV positivo hoje no Brasil vive mais tempo, espera-se que a demanda destes pacientes aumente nos consultórios odontológicos. Torna-se importante que o cirurgião dentista conheça o atual perfil do paciente HIV positivo, as condições bucais e as comorbidades mais freqüentes, especialmente as que exigem mudanças no manejo clínico odontológico. Desta forma, os objetivos deste trabalho foram determinar as prevalências de comorbidades, alterações hematológicas e manifestações bucais em pacientes HIV positivos atendidos no CAPE-FOUSP, correlacionando-as entre si na busca de marcadores bucais para alterações sistêmicas e verificar a correlação entre as prevalências encontradas com os dados demográficos e com o estado imunológico do paciente. Para tanto, estudamos prospectivamente 138 pacientes HIV positivos atendidos no Centro de Atendimento a Pacientes especiais da FOUSP. A presença de comorbidades foi relatada por 92% dos pacientes. O hemograma solicitado revelou alterações hematológicas, que muitas vezes eram desconhecidas por eles. Pelo menos uma manifestação orofacial relacionada com a infecção pelo HIV foi observada em 54% dos pacientes, sendo a mais freqüente o aumento de glândulas salivares, observado em 16,7% dos pacientes. Leucoplasia pilosa e candidíase bucal ainda podem ser considerados importantes marcadores da progressão da doença. Xerostomia e cáries pareceram ter relação com maiores prevalências de hipertensão e desordens psiquiátricas, respectivamente, sugerindo que possam ser marcadores bucais para estas comorbidades. / HIV/AIDS epidemic lives the end of its third decade followed by important advances in the therapy and life expetancy of the infected patients. With the advent of highly active antiretroviral therapy (HAART), HIV/AIDS was been transformed into a chronic condition that can be managed over time. Consequently, several changes in the general and oral clinical status were observed. Some comorbidities and hematological alterations became more prevalent in this population, while opportunist buccal manifestations had started to be rare. Once Brazilian HIV-positive patients are living more time, is expected that the demand of these patients increases in the dental office. Is important for the dentist to know the current profile of HIV-positive patient, which includes: the associated oral conditions and the most frequent comorbities, specially that ones that demand changes in the dental management. Based on this, the objectives of this research were to identify buccal alterations, comorbidities and hematological alterations, searching for correlation between them, to analize them according to demographic data and immunologic status. For this study, 138 HIV-positive patients of Special Care Dentistry Center of Sao Paulo University (CAPE-FOUSP) were analized prospectively. The presence of comorbidities was related by 92% of the patients. The requested hematological exams disclosed several hematologic alterations, many times unknown by them. At least one HIV-related orofacial manifestation was observed in 54% of the patients. Hairy leukoplakia and oral candidiasis still can be considered important markers of the progression of HIV infection. Xerostomia and dental caries was more often observed in patients with hypertension and psychiatric desorders, respectively, suggesting that they can be buccal markers for these comorbidities.

A pessoa com distúrbios hematológicos demonstra desarranjos físicos, emocionais e sociais. Assim, atuar nesta área é estar disposta a cuidar do indivíduo, percebendo e intervindo precocemente nas alterações manifestadas. Os tratamentos para as patologias hematológicas podem ser feitos pela radioterapia, quimioterapia e o transplante de células tronco hematopoéticas (TCTH). Na maioria dos casos, a combinação destas modalidades terapêuticas faz-se necessária para o alcance do controle da doença. Após ser submetido à quimioterapia e/ou radioterapia o paciente é encaminhado para o TCTH almejando-se a cura. Estes tratamentos são altamente agressivos, acarretando prejuízos em todas as dimensões da vida do doente. A compreensão da trajetória da pessoa acometida por uma doença, desde o início dos sinais e sintomas até as perspectivas para o futuro, identificando suas idéias e condutas na luta pela sobrevivência, parte do entendimento do contexto sociocultural em que está inserida. Nessa perspectiva, o objetivo deste estudo foi identificar os modelos explicativos (MEs) para o TCTH alogênico aparentado, na visão de um grupo de pacientes. Para o seu alcance, estabelecemos como base teórica a antropologia médica, o método do estudo de caso qualitativo e a técnica de análise de conteúdo indutivo. Participaram deste estudo 11 pacientes, sendo três com leucemia mielóide aguda, quatro com leucemia mielóide crônica, dois com leucemia linfóide aguda e dois com anemia aplástica grave. As seis mulheres e os cinco homens formam um grupo de adultos em idade produtiva e suas características sociais mostram que são pessoas oriundas da classe social popular. Realizamos entrevistas semi-estruturadas, norteada por questões que integram a construção dos modelos explicativos. Posteriormente compilamos cada uma das entrevistas e seguimos para a análise de dados que se realizou em duas etapas. Reunimos as entrevistas e após várias leituras elencamos as categorias temáticas: da trajetória da doença ao tratamento especializado, os sentidos dados à doença e aos tratamentos, o lidar com a doença e os tratamentos e a vida após os tratamentos. Por estas categorias apreendemos os diversos elementos constitutivos dos modelos explicativos do adoecer e do submeter-se ao TCTH alogênico, onde evidenciamos a influência da cultura em que estão inseridos os participantes. Os entrevistados retrataram os sinais e sintomas da doença, a percepção do estar doente e suas causas, a difícil busca pela assistência à saúde, os tratamentos caseiros, a necessidade das terapêuticas, a existência de um doador compatível, as complicações e suas consequências, as dificuldades financeiras, os cuidados e as mudanças no modo de vida após os tratamentos e as perspectivas de futuro. Concluímos que a cultura é um sistema de referência para as pessoas de um grupo social, que fornece formas de pensar e agir sobre uma determinada situação ou evento. Evidenciamos exemplos da trajetória percorrida pelos participantes em busca da cura, almejando instigar os profissionais da saúde, em especial à equipe de enfermagem, que cuidam destes pacientes a olhá-los em todas as suas dimensões da vida, desejando um cuidado integral e diferenciado, integrando conhecimentos culturais ao modelo biomédico. / People with hematologic disorders face physical, emotional and social alterations. Thus, acting in this area means to be willing to care for the individual, precociously perceiving and intervening in the revealed changes. Hematologic pathologies can be treated by radiotherapy, chemotherapy and hematopoietic stem cell transplantation (HSCT). In most cases, the combination of these types of therapy is needed to control the disease. After undergoing chemotherapy and/or radiotherapy the patient is subject to HSCT, aiming the cure. These treatments are highly aggressive, causing damages in all dimensions of patients lives. Understanding patients sociocultural context is necessary to comprehend the trajectory of someone affected by a disease, since the beginning of the signs and symptoms up to the perspectives for the future, identifying their ideas and behaviors in the fight for survival. In this way, this study aimed to identify the explanatory models (EMs) for allogeneic HSCT of related donors, in the view of a group of patients. In order to achieve this, the medical anthropology, the qualitative case study method and the inductive content analysis technique were established as theoretical bases. Eleven patients participated in the study, three with acute myeloid leukemia, four with chronic myeloid leukemia, two with acute lymphoid leukemia and two with severe aplastic anemia. The six women and five men are adults at reproductive age and their social characteristics show they are from the lower social class. Semi-structured interviews guided by questions that are part of the construction of the explanatory models were carried. Afterwards the interviews were compiled and analyzed in a two-phase data analysis. Interviews were gathered and after several readings, the following thematic categories were listed: from the trajectory of the disease to specialized treatment, the meanings given to the disease and treatments, dealing with the disease and treatments, and life after treatments. Different elements of the explanatory models of becoming ill and undergoing allogeneic HSCT emerged from these categories. The influence of participants cultural context was evidenced. Interviewed subjects reported the signs and symptoms of the disease, the perception of being ill and its causes, the difficult search for health care, home treatments, the need of medications, the existence of a compatible donor, complications and their consequences, the financial difficulties, care and changes in the lifestyle after treatments and the perspectives of future. It is concluded culture is a reference system to people from a social group, which provides ways of thinking and acting about a certain situation or event. Examples of the trajectory followed by the participants in the search for care is evidenced, aiming to motivate health professionals, specially from the nursing team, who delivery care to these patients, to look them in all dimensions of their lives, to provide a comprehensive and differentiated care, integrating cultural knowledge to the biomedical model.

A epidemia do HIV/AIDS vive o final de sua terceira década acompanhada de avanços importantes na terapia e na sobrevida dos pacientes infectados. Com o advento das drogas antiretrovirais altamente ativas transformou-se em uma condição crônica capaz de ser controlada por muito tempo. Com isso surgiram mudanças no quadro clínico geral e oral dos pacientes. Algumas comorbidades e alterações hematológicas passaram tornaram-se mais prevalentes nessa população, enquanto que as manifestações bucais oportunistas passaram a ser mais raras. Uma vez que o paciente HIV positivo hoje no Brasil vive mais tempo, espera-se que a demanda destes pacientes aumente nos consultórios odontológicos. Torna-se importante que o cirurgião dentista conheça o atual perfil do paciente HIV positivo, as condições bucais e as comorbidades mais freqüentes, especialmente as que exigem mudanças no manejo clínico odontológico. Desta forma, os objetivos deste trabalho foram determinar as prevalências de comorbidades, alterações hematológicas e manifestações bucais em pacientes HIV positivos atendidos no CAPE-FOUSP, correlacionando-as entre si na busca de marcadores bucais para alterações sistêmicas e verificar a correlação entre as prevalências encontradas com os dados demográficos e com o estado imunológico do paciente. Para tanto, estudamos prospectivamente 138 pacientes HIV positivos atendidos no Centro de Atendimento a Pacientes especiais da FOUSP. A presença de comorbidades foi relatada por 92% dos pacientes. O hemograma solicitado revelou alterações hematológicas, que muitas vezes eram desconhecidas por eles. Pelo menos uma manifestação orofacial relacionada com a infecção pelo HIV foi observada em 54% dos pacientes, sendo a mais freqüente o aumento de glândulas salivares, observado em 16,7% dos pacientes. Leucoplasia pilosa e candidíase bucal ainda podem ser considerados importantes marcadores da progressão da doença. Xerostomia e cáries pareceram ter relação com maiores prevalências de hipertensão e desordens psiquiátricas, respectivamente, sugerindo que possam ser marcadores bucais para estas comorbidades. / HIV/AIDS epidemic lives the end of its third decade followed by important advances in the therapy and life expetancy of the infected patients. With the advent of highly active antiretroviral therapy (HAART), HIV/AIDS was been transformed into a chronic condition that can be managed over time. Consequently, several changes in the general and oral clinical status were observed. Some comorbidities and hematological alterations became more prevalent in this population, while opportunist buccal manifestations had started to be rare. Once Brazilian HIV-positive patients are living more time, is expected that the demand of these patients increases in the dental office. Is important for the dentist to know the current profile of HIV-positive patient, which includes: the associated oral conditions and the most frequent comorbities, specially that ones that demand changes in the dental management. Based on this, the objectives of this research were to identify buccal alterations, comorbidities and hematological alterations, searching for correlation between them, to analize them according to demographic data and immunologic status. For this study, 138 HIV-positive patients of Special Care Dentistry Center of Sao Paulo University (CAPE-FOUSP) were analized prospectively. The presence of comorbidities was related by 92% of the patients. The requested hematological exams disclosed several hematologic alterations, many times unknown by them. At least one HIV-related orofacial manifestation was observed in 54% of the patients. Hairy leukoplakia and oral candidiasis still can be considered important markers of the progression of HIV infection. Xerostomia and dental caries was more often observed in patients with hypertension and psychiatric desorders, respectively, suggesting that they can be buccal markers for these comorbidities.

The minimization of blood loss represents a significant clinical need in the arena of surgery, trauma, and emergency response medicine. Fibrinogen is our body's native polymer system activated in response to tissue and vasculature injury, and forms the foundation of the most widely employed surgical sealant and hemostatic agent. Non-covalent knob:hole interactions are central to the assembly of fibrin that leads to network and clot formation. This project exploits these affinity interactions as a strategy to direct fibrin polymerization dynamics and network structure so as to develop a temperature-triggered polymerizing fibrin mixture for surgical applications. Short peptides modeled after fibrin knob sequences have been shown to alter fibrin matrix structure by competing with native fibrin knobs for binding to the available holes on fibrinogen and fibrin. The fusion of such knob peptides to a non-native component should facilitate binding of the fused component to fibrinogen/fibrin, and may permit the concomitant modification of the fibrin matrix. We examined this hypothesis in a three-step approach involving (a) analyzing the ability of tetrapeptide knob sequences to confer fibrin(ogen) affinity on a non-fibrin protein, (b) investigating the effect of knob display architecture on fibrin(ogen) structure, and (c) designing a temperature-responsive knob-displaying construct to modulate fibrin(ogen) affinity at different temperature regimes, thus altering fibrin(ogen) structure.

Aim: The overall aim of this thesis was to describe and explore how sexuality, body image and HRQoL were affected in patients treated for hematologic malignancies, and their need for support. A further aim was to describe nurses’ conceptions of dialogues about sexuality. Methods: Ten nurses in cancer care (I) and twelve patients were interviewed (II). Data were analysed according to phenomenography (I-II). Data were also collected from patients (≥45 years) included consecutively: at baseline (n=32), one month (n=25; III-IV) and six months (n=20; IV) after treatment. Three instruments were used: SAQ-S, BIS and EORTC QLQ-C30. The data were analysed statistically. Main findings: The nurses (I) conceived that they should talk about sexuality with cancer patients, but usually did not due to their own attitudes, lack of knowledge about sexuality, communication skills and environmental conditions. The patients (II) experienced negative effects on sexual function and sexual relationship due to affected strength and sexual desire. The patients’ sexuality, body image and HRQoL were affected during (II-III) and one month after treatment (III-IV). Patients recovered with regard to these issues within six months, except for sexual relationship (IV). However, when the disease and side effects were experienced as severe, thoughts about and interest in sexuality were overshadowed, and the need or wish for support related to this issue was low (II). Sexuality and body image seemed to influence changes in HRQoL (IV). Conclusion: Patients above the age of 45 treated for hematologic malignancies with chemoimmunotherapy experienced problems related to sexuality, body image and HRQoL. However, as sexuality was found to be of low priority due to concerns for life when the disease and side effects were severe, support must be timely and individualized. Patient-centered care, with patients continuously meeting a nurse guided by the idea of holistic individual nursing care throughout the care trajectory, is suggested. / Sexuality is to a large extent seen as a private and sensitive topic by both patients and nurses in cancer care. The patients in this thesis were above the age of 45 and treated with chemo- or chemoimmunotherapy for hematologic malignancies. They experienced affected sexuality, body image and HRQoL during and after treatment. The importance of sexuality was low and sexuality seemed to be overshadowed when the disease and side effects were experienced as severe. Few patients described that information might have been helpful.  In order to avoid violating patients’ integrity, one challenge is to identify patients who ascribe importance to sexuality and who also want support regarding sexuality. One way is to organize care in a patient-centered way, with patients continuously meeting a nurse guided by the idea of holistic individual nursing care throughout the care trajectory. Furthermore, nurse educators’ need to acknowledge this area and the health care leaders should provide nurses opportunities to discuss attitudes and personal barriers to sensitive issues such as sexuality

Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 5 uppsatser.