Darbas apie apsisaugojimo metodiką nuo injekcinių atakų naudojant Bekaus ir Nauro formą. Pasirinkta įvesties patikros strategija (blacklist), realizuotas reguliarių išraiškų transformacijos algoritmas. Sukurtas pradinis injekcinių atakų aprašas. Transformuojant aprašo sematiką į reguliarių išraiškų masyvus yra suformuojamos tikrinimo taisyklės. Pagal suformuotas taisyklės yra nustatoma, ar sistemos įvesties parametrai atitinka injekcinių atakų aprašą. Sukurtas saugos sistemos prototipas apsaugai nuo injekcinių atakų. / In this research the injection attack prevention method is introduced. Also the interactive security system prototype to protect against injections attacks is proposed. Security system prototype is using blacklist input validation strategy for checking input parameters. Each list item consists of a single type of injection attack description. Descriptions are written in Backus–Naur form.

The primary focus of this thesis is to establish the clinical utility of corticosteroid injections mixed with local anesthetics, when compared to only local anesthetics, for relief of pain in patients with chronic non-cancer pain. Chronic non-cancer pain is common and causes significant pain and suffering to patients, and economic burden to health care system. Injection of steroids is an option, either by targeting the painful structure or the associated neural elements. Steroids are commonly mixed with local anesthetics in the hope of prolonging the pain relief. Since there is no evident inflammation in most chronic pain conditions, and because existing clinical studies do not consistently support its effectiveness in various clinical conditions, the potential value of adding steroids is questionable. This clinical question has been addressed through a comprehensive systematic review and meta-analysis of randomized control trials comparing injections of steroid with local anesthetics against only local anesthetics for chronic non-cancer pain conditions. Our review found that there is paucity of good quality randomized controlled studies specifically addressing this comparison. Although a large numbers of studies were identified, there was a small effect favoring steroids in studies measuring pain relief by dichotomous outcomes. Overall confidence in the effect estimates were limited due to serious concerns of bias, significant heterogeneity and variability in studies, leading to low quality. A majority of the included studies did not aim to capture the full spectrum of adverse effects. Future studies addressing this clinical question should aim to be of optimum size, must aim to limit the threat of bias, and capture all patient important outcomes including pain relief. / Thesis / Master of Science (MSc)

Titre. Évaluation de la couverture vaccinale des jeunes enfants de la Montérégie au regard des facteurs sociodémographiques et impact de l'ajout des nouveaux vaccins. Contexte. En Montérégie comme ailleurs au Québec, les couvertures vaccinales des enfants de 2 ans selon les facteurs sociodémographiques sont peu connues. Avec l'ajout des nouveaux vaccins, le calendrier vaccinal des jeunes enfants se complexifie davantage ; récemment, le vaccin contre le pneumocoque, l'influenza et la varicelle ont été introduits pour la vaccination des nourrissons. On anticipait que cet ajout ait un impact sur le respect du calendrier à cause entre autres de l'administration de multiples injections lors d'une même visite. La présente étude vise à évaluer la couverture vaccinale des enfants de la Montérégie au regard des facteurs sociodémographiques et à explorer l'impact de l'ajout des nouveaux vaccins sur l'observance du calendrier de vaccination et l'opinion des parents. Méthodologie. Étude descriptive transversale par questionnaire postal auto-administré auprès d'un échantillon aléatoire stratifié de deux cohortes d'enfants tirés du Fichier des naissances de la Montérégie : 1) cohorte 2002-03 : enfants nés entre le 1er mai 2002 et le 30 avril 2003 (ancien calendrier) et 2) cohorte 2004-05 : enfants nés entre le 1er mai 2004 et le 30 avril 2005 (nouveau calendrier). Deux enquêtes ont été réalisées : Enquête 1 (automne 2005-hiver 2006) effectuée auprès des parents pour lesquels l'adresse a pu être validée par Canada 411 (taux de reponse=56 %) ; enquête 2 (automne 2006) effectuée auprès des parents dont l'adresse a été validée par la RAMQ (taux de réponse=57 %). Les données vaccinales incomplètes ou manquantes ont été complétées par vérification des dossiers vaccinaux chez le vaccinateur. Les variables dépendantes à l'étude sont le statut vaccinal, l'observance au calendrier et l'opinion des parents sur les injections multiples. Les variables indépendantes retenues sont les caractéristiques sociodémographiques. Résultats. Les résultats montrent que 77 % (IC 95 % : 74,8 % - 80,0 %) des enfants de la cohorte 2002-03 ont reçu tous les vaccins requis et 2 % n'ont jamais été vaccinés. La couverture vaccinale varie au palier local entre 73 % et 95 %. Parmi les facteurs sociodémographiques étudiés (âge du père et de la mère, scolarité du père et de la mère, statut marital, rang de l'enfant dans la fratrie, taille de la famille, poids à la naissance et statut socioéconomique), seul le rang de l'enfant dans la fratrie est associé significativement au statut vaccinal de l'enfant. Une plus forte proportion d'enfants à un statut vaccinal complet parmi les premiers nés de la famille (p=0,037). L'analyse de l'observance du calendrier par l'approche de survie de Kaplan-Meier montre un retard dans la réception de la deuxième et la troisième dose du vaccin pentavalent DCaT-P-Hib des enfants de la cohorte 2004-05 comparés à ceux de la cohorte 2002-03 (Nombre de jours médians de retard : 2 jours sur le 2e vaccin (p=0,013) et 4 jours sur le 3e vaccin (p<0,001)). La majorité des parents (76 %) préfèrent 2 à 3 injections lors d'une même visite pour leur enfant et 61 % craignent une augmentation du risque d'effets secondaires lorsque plusieurs vaccins sont administrés à la même visite. Conclusion. Bien que les retards de vaccination constatés semblent moins importants qu'anticipés, la couverture vaccinale observée en Montérégie s'écarte des objectifs provinciaux. Des efforts importants devront continuer à être effectués pour obtenir une meilleure couverture vaccinale. Une attention particulière devra être accordée aux enfants derniers nés de familles nombreuses et à la sensibilisation des parents pour réduire les fausses croyances notamment sur la crainte d'effets secondaires accrus.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Apesar dos avanÃos da ciÃncia, o medo e ansiedade, por razÃes odontolÃgicas, ainda acometem uma grande quantidade de pessoas, comprometendo a procura por tratamento e resultando, ocasionalmente, em baixos nÃveis de saÃde oral. A aparÃncia fÃsica dos instrumentos parece ser um dos principais causadores de medo e ansiedade no meio odontolÃgico, e a seringa anestÃsica à o instrumental que mais desencadeia estes sentimentos. Assim, diminuir a ansiedade e o medo do tratamento odontolÃgico deveria ser uma das prioridades do cirurgiÃo-dentista. Para tanto, a presente dissertaÃÃo teve por objetivo comparar as reaÃÃes apresentadas por crianÃas que foram anestesiadas com um dispositivo em formato lÃdico e com uma seringa tradicional, com a finalidade de analisar se uma mudanÃa no desenho externo da seringa anestÃsica seria capaz de influenciar os nÃveis de ansiedade, medo e dor dos pacientes. Sessenta e quatro crianÃas, com idade ente 4-10 anos, foram distribuÃdas aleatoriamente em dois grupos, de acordo com o dispositivo a ser utilizado na primeira sessÃo anestÃsica. G1 (Convencional) e G2 (Design modificado). Os participantes submeteram-se a duas sessÃes anestÃsicas, e cada paciente foi anestesiado com ambos dispositivos. Um Ãnico pesquisador, odontopediatra, realizou os procedimentos anestÃsicos que foram filmados e consistiram de anestesias terminais infiltrativas, na regiÃo posterior da maxila. Devido ao carÃter multidimensional do medo, ansiedade e dor, uma combinaÃÃo de testes foi utilizada para avaliÃ-los, como: O teste de medo da crianÃa (Child Fear Survey Schedule â Dental Subscale - CFSS-DS), escala de ansiedade facial (Facial Anxiety Scale- FAS), frequÃncia cardÃaca, escala som, olhos e movimento (Sound, Eyes and Motor-SEM), escala visual analÃga â Visual Analogue Scale (VAS) e escala Frankl. As escalas foram aplicadas em momentos predeterminados, como: sala de espera (SE), cadeira odontolÃgica (CO), inÃcio da anestesia (IA) e final da anestesia (FA). ApÃs a segunda sessÃo anestÃsica, as crianÃas escolheram o dispositivo que mais as agradou. Os resultados mostraram que 78% da amostra foi classificada como pouco ansiosa (CFSS-DS). Nenhuma diferenÃa estatisticamente significante pÃde ser observada nas diferentes escalas, ao comparar o dispositivo tradicional com o modificado. A seringa com mudanÃa no design foi a preferida por 57,8% das crianÃas. As crianÃas ansiosas relataram mais dor que as nÃo ansiosas (p=0,001) e o estado emocional variou nas diferentes situaÃÃes: SE, CO, IA e FA. (p<0,05). Assim, concluiu-se que a aparÃncia da seringa à importante, mas nÃo à fundamental no controle da ansiedade, medo e dor de crianÃas submetidas à anestesia odontolÃgica. / Despite advances in Odontology, fear and anxiety regarding dentistry still affect a large number of people who, because of their fears, fail to seek treatment; this can result in low levels of oral health. The physical appearance of the instruments used by dentists seems to be a major cause of such fear and anxiety with regard to dentistry. The anesthetic syringe is the instrument that causes the strongest feelings of fear. So, the prevention of dental anxiety and patients fear should be one of the dentistâs highest priorities, this study aims to compare the reactions shown when children were anesthetized with a modified device and when they were anesthetized with a traditional syringe, and examine the results to see if a change in the external design of the anesthetic syringe can influence the levels of anxiety, fear and pain of patients. Sixty-four children aged 4-10 years were randomly assigned into two groups according to the device to be used in the first session of anesthesia. G1 (Traditional Syringe) and G2 (Modified syringe). Participants underwent two sessions and each patient was anesthetized with both devices. A single researcher performed anesthetic procedures, which were videotaped and the procedure consisted of infiltrative anesthesia in the posterior area of the maxilla. Due to the multidimensional nature of fear, anxiety and pain, a combination of tests was used to access them: Child Fear Survey Schedule - Dental Subscale - CFSS-DS, Facial Anxiety Scale-FAS, heart rate, the SEM scale Sound, Eyes and Motor, the Visual Analogue Scale (VAS) and the Frankl scale. These tests were applied in predefined situations as the waiting room (WR), the dental chair (DC), during the onset of anesthesia (OA) and end of anesthesia (EA). After the second session of anesthesia, children chose the device that they preferred. The results showed that most 78% children were classified as having a low level of anxiety (CFSS-DS). No significant difference was observed when comparing the traditional and modified devices. The syringe with a change in design was preferred by (57.8%) of the children. The anxious children reported more pain than non-anxious (p = 0.001) and their emotional state varied in different situations: WR, DC, OA and EA. (P <0.05). Thus, it was concluded that the appearance of the syringe is important, but not essential in order to control the anxiety, fear and pain which children suffer when undergoing dental anesthesia.

Bibliography: leaves 107-109.

Purpose: To develop an approach to formulating an injectable solution containing both hydrophilic and lipophilic drugs for subcutaneous administration. Based on the literature survey, isotropic medium chain mono-and diglyceride (MCMDG) systems were chosen for study. For this purpose, analytical methods were developed and validated. In vitro assessments of the MCMDG systems, and in vitro release and in vivo studies were conducted. Methods: The phase diagrams of the isotropic MCMDG systems were constructed with systems comprising two and three components. The isotropic region was examined by visual inspection and confirmed using polarized light microscopy. Viscosities of formulations were measured. The validated HPLC assay methods were developed for determination of levamisole and abamectin in liquid formulations and in sheep plasma. The HPLC assay was capable of evaluating stability of abamectin and levamisole in liquid formulations. Solubilities of levamisole hydrochloride or levamisole phosphate and abamectin were determined in the isotropic MCMDG formulations using a HPLC assay method. Stabilities of levamisole phosphate and abamectin were conducted in the isotropic MCMDG formulations at 60�C for 10 days. In vitro release studies for levamisole phosphate were carried out for selected formulations using modified Franz diffusion cells. Based on stability and in vitro release studies, one formulation (MCMDG/propylene glycol (PG):glycerol formal (GF), 20/20:60 % w/w) was selected for a preliminary in vivo study. The selected MCMDG/PG:GF (20/20:60) formulation containing both levamisole phosphate and abamectin was injected subcutaneously into sheep, and the injection site was examined after subcutaneous injection. Pharmacokinetic profiles were determined. A correlation between in vitro fraction released (FR) and in vivo fraction absorbed (FA) for levamisole phosphate from the MCMDG/PG:GF (20/20:60) formulation was assessed. Results: The isotropic systems of the MCMDG systems containing two or three components were characterized through phase diagrams and viscosity. The solubility of the levamisole hydrochloride in the isotropic MCMDG/sesame oil/water formulations was higher in the absence of abamectin than in combination with abamectin. Solubility of levamisole phosphate was higher in the MCMDG system containing GF or PG compared to the MCMDG/SO/water system. The isotropic MCMDG/PG:GF systems allowed preparations of levamisole phosphate/abamectin solution dose forms containing more than the usual dosage of levamisole. Stability of both levamisole phosphate and abamectin in MCMDG/PG:GF formulations was higher compared with MCMDG/PG:GF/water formulations. Levamisole phosphate degraded in the presence or absence of abamectin in the MCMDG/PG:GF (20/20:60) formulation at 60�C for 10 days. Abamectin alone was found to be stable in the formulation at 60�C for 10 days. In vitro release of levamisole phosphate from water and the MCMDG formulations tested displayed first-order kinetics. Water from the receptor compartment was observed to pass through the membrane into the donor compartment. Therefore, an advancing layer of turbidity occurred in the donor phase. A highly significant decrease in release rate of levamisole phosphate was obtained in MCMDG/GP:GF (20/20:60) formulation compared to water and the other formulations. Pharmacokinetic studies of subcutaneous injection of MCMDG/PG:GF 20/20:60) formulation showed the tmax values of 2.2 h and 4.2 days for levamisole phosphate and abamectin, respectively. The Cmax was 0.94 [mu]g/ml for levamisole phosphate and 6.24 ng/ml for abamectin while the formulation displayed the AUC value was 5.2 [mu]g�h�ml⁻1 for levamisole phosphate and 84.7 ng�day�ml⁻1 for abamectin. No inflammatory reaction was observed at the injection site. Linear regression analysis showed that a significant relationship between the FR (in vitro) and FA for the subcutaneously injected formulation. Conclusion: The study carried out in this thesis introduces a new approach to formulating an injectable solution of the isotropic MCMDG/PG:GF systems containing both levamisole (hydrophilic drug) and abamectin (lipophilic drug) for subcutaneous administration, and presents the development of the HPLC assay methods for determination of levamisole and abamectin in liquid MCMDG formulations and plasma, in order to investigate in vitro and in vivo release from the isotropic MCMDG/PG:GF formulations. The MCMDG/PG:GF formulations may represent an alternative to the more traditional formulations for both lipophilic and hydrophilic drugs.

Tennis elbow (TE) is a relatively common painful condition affecting the upper extremity. The aetiology is not known, but TE is most often seen in middle aged individuals using repetitive and forceful gripping at work or recreational activities, and is referred to overuse injuries. The pathogenesis is not known, but there are so-called degenerative changes in the wrist- and finger-extensor muscle origin (common extensor origin - CEO). The pain mechanisms involved have not been scientifically clarified. The studies in the present thesis aimed to 1) evaluate the structure and blood flow using ultrasound (US) and colour Doppler (CD) examinations of the CEO in patients with TE, and in pain-free elbows, 2) evaluate the clinical effects of US- and CD-guided intratendinous injection treatment with the sclerosing substance polidocanol, 3) evaluate the long term (2 years) effects of injection treatment on the tendon structure and blood flow, and 4) investigate if there is a local production of sympathetic and parasympathetic signal substances in non-neural cells in the CEO. Structural tendon changes and high blood flow was found in the CEO in patients with TE, but not in pain-free controls. Remaining structural changes and additional bone spur formation at the lateral epicondyle, but not high blood flow, were seen 2 years after successful injection treatment. In a randomised double-blind study, US- and CD-guided intratendinous injection treatment with sclerosing polidocanol or the local anaesthetic lidocaine combined with epinephrine, targeting the region with high blood flow, was found to reduce pain and increase grip strength in patients with TE. There were no differences in the outcome between the two treatment groups. A local production of catecholamines, but not acetylcholine, was found in fibroblasts in the CEO, in patients with TE. This thesis presents results showing US and CD examinations to be useful methods to diagnose TE, and to evaluate structure and blood flow in the CEO after treatment. US- and CD-guided injection treatment targeting high blood flow in the region with structural changes can reduce pain symptoms in patients with TE. The localised high blood flow, and local production of catecholamines in the tendon cells in the CEO, might be involved in the pain mechanisms.

Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2007. / Titre provenant de l'écran-titre. 103 f. ill. Bibliogr. f. 94-103.

published_or_final_version / Dental Surgery / Master / Master of Dental Surgery

Purpose: To develop an approach to formulating an injectable solution containing both hydrophilic and lipophilic drugs for subcutaneous administration. Based on the literature survey, isotropic medium chain mono-and diglyceride (MCMDG) systems were chosen for study. For this purpose, analytical methods were developed and validated. In vitro assessments of the MCMDG systems, and in vitro release and in vivo studies were conducted. Methods: The phase diagrams of the isotropic MCMDG systems were constructed with systems comprising two and three components. The isotropic region was examined by visual inspection and confirmed using polarized light microscopy. Viscosities of formulations were measured. The validated HPLC assay methods were developed for determination of levamisole and abamectin in liquid formulations and in sheep plasma. The HPLC assay was capable of evaluating stability of abamectin and levamisole in liquid formulations. Solubilities of levamisole hydrochloride or levamisole phosphate and abamectin were determined in the isotropic MCMDG formulations using a HPLC assay method. Stabilities of levamisole phosphate and abamectin were conducted in the isotropic MCMDG formulations at 60�C for 10 days. In vitro release studies for levamisole phosphate were carried out for selected formulations using modified Franz diffusion cells. Based on stability and in vitro release studies, one formulation (MCMDG/propylene glycol (PG):glycerol formal (GF), 20/20:60 % w/w) was selected for a preliminary in vivo study. The selected MCMDG/PG:GF (20/20:60) formulation containing both levamisole phosphate and abamectin was injected subcutaneously into sheep, and the injection site was examined after subcutaneous injection. Pharmacokinetic profiles were determined. A correlation between in vitro fraction released (FR) and in vivo fraction absorbed (FA) for levamisole phosphate from the MCMDG/PG:GF (20/20:60) formulation was assessed. Results: The isotropic systems of the MCMDG systems containing two or three components were characterized through phase diagrams and viscosity. The solubility of the levamisole hydrochloride in the isotropic MCMDG/sesame oil/water formulations was higher in the absence of abamectin than in combination with abamectin. Solubility of levamisole phosphate was higher in the MCMDG system containing GF or PG compared to the MCMDG/SO/water system. The isotropic MCMDG/PG:GF systems allowed preparations of levamisole phosphate/abamectin solution dose forms containing more than the usual dosage of levamisole. Stability of both levamisole phosphate and abamectin in MCMDG/PG:GF formulations was higher compared with MCMDG/PG:GF/water formulations. Levamisole phosphate degraded in the presence or absence of abamectin in the MCMDG/PG:GF (20/20:60) formulation at 60�C for 10 days. Abamectin alone was found to be stable in the formulation at 60�C for 10 days. In vitro release of levamisole phosphate from water and the MCMDG formulations tested displayed first-order kinetics. Water from the receptor compartment was observed to pass through the membrane into the donor compartment. Therefore, an advancing layer of turbidity occurred in the donor phase. A highly significant decrease in release rate of levamisole phosphate was obtained in MCMDG/GP:GF (20/20:60) formulation compared to water and the other formulations. Pharmacokinetic studies of subcutaneous injection of MCMDG/PG:GF 20/20:60) formulation showed the tmax values of 2.2 h and 4.2 days for levamisole phosphate and abamectin, respectively. The Cmax was 0.94 [mu]g/ml for levamisole phosphate and 6.24 ng/ml for abamectin while the formulation displayed the AUC value was 5.2 [mu]g�h�ml⁻1 for levamisole phosphate and 84.7 ng�day�ml⁻1 for abamectin. No inflammatory reaction was observed at the injection site. Linear regression analysis showed that a significant relationship between the FR (in vitro) and FA for the subcutaneously injected formulation. Conclusion: The study carried out in this thesis introduces a new approach to formulating an injectable solution of the isotropic MCMDG/PG:GF systems containing both levamisole (hydrophilic drug) and abamectin (lipophilic drug) for subcutaneous administration, and presents the development of the HPLC assay methods for determination of levamisole and abamectin in liquid MCMDG formulations and plasma, in order to investigate in vitro and in vivo release from the isotropic MCMDG/PG:GF formulations. The MCMDG/PG:GF formulations may represent an alternative to the more traditional formulations for both lipophilic and hydrophilic drugs.