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Background: Cardiovascular disease (CVD) is one of the major causes of morbidity and mortality worldwide. Clinical guidelines, based on the results of randomised controlled trials, state that effective secondary prevention therapies should be prescribed following a diagnosis of particular CVD unless there are contraindications. Although evidence shows that use of evidence based pharmacotherapies after diagnosis of CVD reduces mortality and disease progression, many inequalities exist in prescribing practice. Many studies have documented that women and the elderly are less likely to receive evidence based therapies than men and the young, respectively. Greater socioeconomic deprivation has also been shown to be associated with lower rates of prescribing of therapies. However, prior studies have all focussed on one particular CVD or failed to adjust for confounders. Also, few studies have examined trends in the prescribing of evidence based pharmacotherapies over time and documented whether prescribing inequalities are static, narrowing or widening. This project aims to describe the pharmacotherapy received by patients with CVD in Scotland, and to describe the factors associated with prescribing of evidence based pharmacotherapy. Methods: In this retrospective cohort study I examined a linked database of primary care records (Continuous Morbidity Records) and secondary care records (Scottish Morbidity Records) covering 238064 individuals in Scotland (approximately 6% of the total population) from 1997 to 2005. Patients with a first diagnosis (defined as a first hospitalisation or first recording of the diagnosis in primary or secondary care) of myocardial infarction (MI), angina, and peripheral arterial disease (PAD) were identified. Patients who died within the first 30 days of diagnosis/first hospitalisation were excluded from further analysis. Data on prescribing of evidence based therapies (angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARBs), β-blockers, statins and antiplatelet agents [aspirin or clopidogrel]) within 30 days of diagnosis was obtained from primary care database records. Multivariable logistic regression was conducted to examine the association between prescribing of evidence based pharmacotherapies and age, sex, socioeconomic status, comorbidities and year of diagnosis. Results: Between 1997 and 2005, 4305 (83.4%) patients with a first diagnosis of MI, 7210 (98.6%) with angina, and 3385 (95.8%) with PAD had survived to 30 days after their first diagnosis. Increasing age was associated with lower odds of being prescribed evidence based therapies. This association persisted after adjustment for sex, socioeconomic status, year of diagnosis, and comorbidities. In general, older patients ≥ 85 were significantly less commonly prescribed evidence based therapy (EBTs), however they were significantly prescribed nitrates (OR 1.29; 95% CI 1.05-1.59, P < 0.01) for angina. Generally men were more likely to be prescribed evidence based therapies than women. After adjustment, prescribing of evidence based therapies was significantly higher in men with a MI for β-blockers (OR 1.18; 95% CI1.04-1.33, P < 0.01), ACEI/ARBs (OR1.26; 95% CI1.05-1.47, P < 0.01) in angina, and statins in men (OR 1.39; 95% CI1.01-1.93, P < 0.04) with PAD and coronary heart disease (CHD). In contrast, men diagnosed with isolated PAD were significantly less commonly prescribed statins than women (OR 0.73; 95% CI0.59-0.91, P < 0.004). Prescribing of evidence based therapies varied negligibly between the most deprived and least deprived patients. These minor differences disappeared after adjustment except for β-blockers which were significantly less likely to be prescribed for patients who had been diagnosed with angina and were residing in quintile 9 compared to the least deprived area (OR 0.76, 95% CI 0.58-1.00, p= 0.05). Prescribing of evidence based therapies increased between 1997 and 2005, particularly for ACEIs/ARBs, β-blockers, statins and antiplatelet agents. Generally the presence of comorbidities was associated with lower odds of being prescribed evidence based therapies. When comparing prescribing rates between the different diagnoses, patients with a first MI were more likely to be prescribed ACEI/ARBs, β-blockers, statins, aspirin and clopidogrel compared to angina. All evidence based therapies were less likely to be prescribed for those with PAD compared to patients with a MI or angina. Conclusion: In conclusion, I have shown that prescribing of evidence based therapies has improved over time, though rates remain low. Prescribing evidence based therapies is inequitable, though not always significant, for age, sex, and socioeconomic status. Concomitant disease decreased the odds of being prescribed evidence based therapies. More studies are needed to identify the reasons for the prescribing inequalities and low rates observed. Further studies are needed to examine the existence of other inequalities in using evidence based therapies such as dosing and to find strategies to improve prescribing rates.

Submitted by Luanna Matias (lua_matias@yahoo.com.br) on 2015-02-04T16:18:28Z No. of bitstreams: 2 Dissertação - Viviane Lopes Rocha - 2014.pdf: 3025545 bytes, checksum: 8144fc57a9ecf1ebc51b1286fa161d44 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-02-05T10:07:09Z (GMT) No. of bitstreams: 2 Dissertação - Viviane Lopes Rocha - 2014.pdf: 3025545 bytes, checksum: 8144fc57a9ecf1ebc51b1286fa161d44 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-02-05T10:07:09Z (GMT). No. of bitstreams: 2 Dissertação - Viviane Lopes Rocha - 2014.pdf: 3025545 bytes, checksum: 8144fc57a9ecf1ebc51b1286fa161d44 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-05-21 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / Mycobacterium massiliense (MM) has been associated as the causative agent of many nosocomial outbreaks related to laparoscopy, arthroscopic and wound infections. Several outbreaks have been reported in Brazil. The cities of Goiânia, Rio de Janeiro and Belem reported a high number of cases in 2006 and 2007. The iron ion (Fe) is extremely important for many biochemical processes in all organisms and, in the case of microorganisms, the success of the infection. Microorganisms synthesize molecules called siderophores (SD) to aid Fe uptake. Micobactin and carboximicobactin are the SDs that has been described in mycobacteria. One of the genes responsible for the assembly of these SD in M. tuberculosis is the mbtb. A MM strain, which belongs to the outbreak that happened in Goiânia (MM GO06) had its genome sequenced and the analysis revealed that the species has a putative gene with high similarity to M. tuberculosismbtb, which could be an indication that MM also synthesizes a siderophore molecule and that this can be helping this mycobacteria to install the infection in the host. It is known that in the absence of mbtb gene M. tuberculosis do not synthesize their SD. To estimate whether a gene similar to mbtb and with the same function is present in MM (smbtb) will assist in the understanding of the infection mechanisms of MM and discover new drug targets for treating infections with this microorganism. Total RNA was obtained from cultures grown at different concentrations of Fe. Real time PCR was performed targeting the smbtb to evaluate the expression of this gene during bacterial growth in each condition. The expression of smbtb was higher with the increase of the availability of iron. In vivo studies with mice supplemented with or chelated fromiron showed expression profile of smbtb different from those obtained in in vitro studies. In mice, M. massiliense smbtb expressed at higher levels when the animal were treated for iron depletion. Thus, we have evidence that smbtb is involved in iron uptake both for subsequent storage, when this ion is available, and for prompt use in the metabolism of the bacteria when it is not in an environment where there is availability of this ion. / Mycobacterium massiliense (MM) tem sido associado como agente causador de vários surtos nosocomiais relacionados à laparoscopia, artroscopia e infecções de feridas. Inúmeros surtos têm sido reportados no Brasil. As cidades de Goiânia, Rio de Janeiro e Belém apresentaram um alto número de casos em 2006 e 2007. O íon ferro é extremamente importante para vários processos bioquímicos em todos os organismos e, no caso dos microrganismos, para o sucesso da infecção. Para auxiliar a captação de Fe durante este processo, os microrganismos sintetizam moléculas chamadas sideróforos, que desempenham esta função. Micobactina e carboximicobactina são os sideróforos que já foram descritos em micobactérias. Um dos genes responsáveis pela síntese dos sideróforos em M. tuberculosis é o mbtb. Um isolado de MM, com origem no surto que aconteceu em Goiânia (MM GO06) teve seu genoma sequenciado e sua análise revelou que esta espécie possui um gene putativo com alta similaridade com o mbtb de M. tuberculosis, o que poderia indicar que MM também sintetiza sideróforos e que está molécula poderia estar auxiliando esta micobactéria a instalar a infecção no hospedeiro. Sabemos que a ausência do gene mbtb em M. uberculosis torna esta micobactéria incapaz de sintetizar sideróforos. Avaliar se um gene similar ao mbtb e com a mesma função está presente em MM (smbtb) irá auxiliar o entendimento dos mecanismos de infecção de MM e a descoberta de novos alvos para drogas para o tratamento de infecções causadas por MM. RNA total foi obtido de culturas onde MM foi crescido em diferentes concentrações de ferro. Realizou-se Real Time PCR para o gene smbtb a fim de avaliar a expressão deste gene durante o crescimento bacteriano em cada condição. A expressão do sbmtb aumentou com o aumento da disponibilidade de ferro. Estudos in vivo com camundongos suplementados ou privados do íon ferro apresentaram um perfil de expressão diferente daquele obtido nos estudos in vitro. Em camundongos, MM expressou smbtb em altos níveis nos animais que foram tratados com quelante para o íon ferro. Evidenciamos então, que smbtb pode estar envolvido na captação de ferro tanto para armazenamento deste íon, quando o mesmo está isponível, quanto para a utilização imediata no metabolismo da bactéria, quando há uma baixa disponibilidade de ferro no ambiente que MM se encontra.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / O Streptococcus (S.) pneumoniae à considerado como o principal agente causador de morbidade e mortalidade em crianÃas menores de cinco anos de idade. Todas as doenÃas pneumocÃcicas comeÃam com o estabelecimento da colonizaÃÃo do S. pneumoniae na nasofaringe, podendo progredir para doenÃa invasiva se as barreiras naturais forem cruzadas. Nas Ãltimas dÃcadas, o aumento do nÃmero de cepas de S. pneumoniae resistentes à antibiÃticos &#946;-lactÃmicos e a outras classes de antimicrobianos tem dificultado o tratamento da infecÃÃo pneumocÃcica. Atualmente cerca de 13 sorotipos de S. pneumoniae respondem por mais de 85% dos isolados invasivos. A vacina pneumocÃcica polissacarÃdica conjugada 7-valente tem sido amplamente recomendada para crianÃas menores de cinco anos. Os objetivos desse estudo foram determinar a prevalÃncia de S. pneumoniae em crianÃas portadoras, a frequÃncia de isolados de S. pneumoniae de indivÃduos com infecÃÃo sistÃmica, o perfil de sensibilidade a antimicrobianos e os sorotipos mais comuns, em Fortaleza, Brasil. Os isolados de portadores foram recuperados a partir de swabs de nasofaringe de crianÃas usuÃrias de creches, enquanto que os isolados de infecÃÃo sistÃmica foram cedidos pelo LACEN-CE. Foram realizadas as ConcentraÃÃes InibitÃrias MÃnimas (CIM) para penicilina e ceftriaxona para todos os isolados, e levofloxacina apenas para os isolados de nasofaringe. Os pontos de corte das CIM foram determinados de acordo com o CLSI (2007). As sorotipagens dos isolados sistÃmicos foram realizadas pela reaÃÃo de Quellung, enquanto que a genotipagem capsular dos isolados de portadores foi realizada pela tÃcnica de multiplex PCR. De 215 crianÃas usuÃrias de creches, foram isolados S. pneumoniae em 152 (71%). As CIM de 137 isolados de portadores mostraram uma taxa resistÃncia de 71% para penicilina e de 21% para ceftriaxona. NÃo houve resistÃncia nos testes com levofloxacina. Comparado a um estudo similar, realizado hà 10 anos, em Fortaleza, nossos resultados apresentaram um aumento significativo nas taxas de resistÃncia à penicilina e ceftriaxona. De 26 isolados de nasofaringe que apresentaram resistÃncia plena, apenas, seis isolados (23%) tiveram a genotipagem capsular identificada por multiplex PCR. A incidÃncia de isolados invasivos neste estudo por ano, foi de, aproximadamente, 1 caso/100.000 hab. Dos 52 isolados, 42% apresentaram resistÃncia à penicilina e 13,5% à ceftriaxona. Os sorotipos mais comuns dos isolados sistÃmicos foram 19F (12%), 14, 3, 6A (8% cada), 4, 18C e 9V (6% cada), com cobertura estimada, tanto para vacina pneumocÃcica conjugada 7-valente quanto para a 10-valente, de 31,8%. / Streptococcus (S.) pneumoniae is considered the principal causative agent of morbidity and mortality in children younger than five years of age. All pneumococcal diseases are initiated by establishing a S. pneumoniae colonization in nasopharynx, the disease progressing to systemic disease if natural barrier are crossed. During the last decades, the increasing amount of resistant S. pneumoniae strains to beta-lactams and other classes of antimicrobials has modified the treatment of pneumococcal infection. At present, nearly 13 serotypes respond for more than 85% of invasive isolates. The 7-valent polysaccharide-conjugated pneumococcal vaccine has been widely recommended for use in children younger than five years. The aims of this study were to determine the S. pneumoniae carrier in children, the frequence of serotypes from systemic infection patients, the susceptibility profile to antimicrobials in Fortaleza, Brazil. Carrier state isolates were recovered from nasopharyngeal swabs from children attending day-care center facilities, while the isolates from systemic infection fournished by LACEN-CE. Minimal Inhibitory Concentrations (MIC) to penicillin and ceftriaxone were assessed for all isolates, and levofloxacin MIC only from nasopharyngeal isolates. MIC cut-offs were determined according to CLSI standards (2007). Serotyping of systemic isolates was performed by Quellung reaction, while capsular genotyping of carrier isolates was performed by multiplex PCR assay. OF 215 children attending day-care centers, 152 S. pneumoniae isolates were identified (71%). Penicillin MIC showed 71% of resistance, and for ceftriaxone, 21% of resistance. No resistance was found for levofloxacin MIC testing. When compared to a 10-year old similar study in Fortaleza, our results have shown a significant increase of penicillin and ceftriaxone resistance rates. Of 26 isolates tested, only six nasopharyngeal isolates (23%) were positively genotyped by multiplex PCR. The incidence of invasive isolates was 1/100,000 inhab. per year. Of 52 systemic isolates serotyped, 42% were penicillin-resistant, and 13.5% were ceftriaxone-resistant. Systemic serotypes identified were 19F, 3, 6A, 4, 18C and 9V, with a estimated coverage by the 7-valent and 10-v pneumococcal polysaccharide conjugated vaccines of 31.8%.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / As infecÃÃes respiratÃrias agudas (IRA) sÃo importantes causas de morbidade e mortalidade em todo o mundo, acometendo principalmente crianÃas menores de cinco anos de idade. Essas infecÃÃes podem ser causadas por diferentes microrganismos, porÃm os vÃrus sÃo os mais frequentes. Esse estudo teve como objetivo descrever aspectos clÃnicos e epidemiolÃgicos de IRA de etiologia viral em crianÃas de zero a 12 anos de idade atendidas em serviÃo de emergÃncia de um hospital terciÃrio da cidade de Fortaleza-CE, no perÃodo de janeiro de 2007 a dezembro de 2008. Para tanto foram coletadas 1318 amostras de secreÃÃo de nasofaringe das crianÃas. As amostras foram submetidas à tÃcnica de imunofluorescÃncia indireta para detecÃÃo dos seguintes vÃrus respiratÃrios: vÃrus sincicial respiratÃrio (VSR), metapneumovÃrus humano (MPVh), adenovÃrus, influenza A e B e parainfluenza 1, 2 e 3. Os resultados desse estudo mostraram que pelo menos um vÃrus respiratÃrio foi detectado em 383 (29,1%) amostras. O vÃrus mais prevalente foi o VSR (44,4%), tendo o mesmo apresentado um padrÃo de sazonalidade definido, com associaÃÃo a estaÃÃo chuvosa. A co-infecÃÃo ocorreu em 12 (3,1%) amostras e o VSR foi o mais frequentemente associado. A mÃdia de idade dos pacientes foi de 23 meses e nÃo houve associaÃÃo entre o gÃnero desses pacientes e a positividade dos exames, apesar da maioria das crianÃas serem do sexo masculino. Entre os diagnÃsticos clÃnicos de etiologia viral, houve predomÃnio de infecÃÃo da via aÃrea superior (IVAS) (51,2%), e em relaÃÃo ao diagnÃstico especÃfico das infecÃÃes da via aÃrea inferior (IVAI), destacou-se a pneumonia. Portanto, os resultados desse estudo ressaltam a importÃncia dos vÃrus como causadores de IRA em crianÃas na cidade de Fortaleza, com as maiores taxas ocorrendo entre os meses de marÃo a junho, diferenciando-se da regiÃo Sul do paÃs, onde as maiores taxas sÃo encontradas nos meses de julho a outubro. / Acute respiratory infections (ARI) are important causes of morbidity and mortality worldwide, affecting mainly children under five years old. These infections can be caused by different organisms, but viruses are the most frequent. This study aimed to describe clinical and epidemiological aspects of viral ARI in children 0-12 years of age treated in the emergency department of a tertiary hospital in the city of Fortaleza, from January 2007 to December 2008. Therefore, we collected 1318 samples of nasopharyngeal secretions of children. The samples were subjected to indirect immunofluorescence for detection of the following respiratory viruses: respiratory syncytial virus (RSV), human metapneumovirus (hMPV), adenovirus, influenza A and B and parainfluenza 1, 2 and 3. The results of this study showed that at least one respiratory virus was detected in 383 (29.1%) samples. The most prevalent virus was RSV (44.4%), and presented the same seasonal pattern of a defined association with the rainy season. Co-infection occurred in 12 (3.1%) samples and RSV was the most frequently associated. The average age of patients was 23 months and there was no association between gender of these patients and positivity of the tests, although most children were male. Among the clinical diagnoses of viral etiology, there was predominance of upper respiratory infection diseases (URID) (51.2%), and in relation to the specific diagnosis of the lower respiratory infections diseases (LRID), stood out pneumonia. Therefore, the results of this study highlight the importance of viruses as causes of ARI in children in Fortaleza, with the highest rates occurring between the months March to June, differing from the southern region, where the highest rates are found in the months from July to October.

nÃo hà / O aumento nos Ãltimos anos de indivÃduos imunocomprometidos, como portadores da SÃndrome da ImunodeficiÃncia Adquirida, de doenÃas malignas, transplantados e outros usuÃrios de terapias imunossupressoras, favorece o surgimento de infecÃÃes oportunistas, principalmente as de teor fÃngico, como a candidÃase e a criptococose. Apesar de a terapia antifÃngica atual ser eficiente na maioria dos casos, algumas vezes fazem-se necessÃrias novas drogas que atuem como alternativa ou como coadjuvantes no tratamento para potencializar o efeito dos antifÃngicos utilizados. As estatinas sÃo fÃrmacos hipolipemiantes mais prescritos mundialmente para doenÃas cardiovasculares. Entretanto, recentemente, tem sido descritos outros efeitos benÃficos destas drogas, como, por exemplo, o controle de infecÃÃes. Este trabalho teve como objetivo determinar a atividade antifÃngica in vitro das estatinas ante 51 cepas de Candida, sendo 16 de C. albicans, 11 de C. krusei, 12 de C. tropicalis e 12 de C. parapsilosis, e 25 cepas de Cryptococcus, sendo 12 de C. gattii e 13 de C. neoformans, por meio de testes de microdiluiÃÃo em caldo, segundo documento M27-A3 padronizado pelo CLSI. O intervalo de concentraÃÃo testado para pravastatina foi de 50 a 0,0977 mg/mL, para sinvastatina, 1 a 0,0020 mg/mL e para atorvastatina, 10 a 0,0200 mg/mL. Pravastatina inibiu 37 leveduras do gÃnero Candida apresentando concentraÃÃo inibitÃria mÃnima (CIM) na faixa de 1,56 a 6,25 mg /mL e as cepas restantes nÃo foram inibidas mesmo na maior concentraÃÃo testada (50 mg /mL), enquanto que sinvastatina e atorvastatina apresentaram atividade antifÃngica sobre todas as 51 cepas avaliadas, apresentando CIMs de 0,02 a 1 mg / mL e 0,04 a 5,00 mg / mL, respectivamente. Para o gÃnero Cryptococcus, apenas 4 cepas foram inibidas ante a pravastatina (CIM = 25 mg / mL), por outro lado, sinvastatina inibiu todas as 25 cepas (CIM = 0,06 a 1 mg / mL), e atorvastatina apenas 8 cepas (CIM = 0,62 a 2,5 mg / mL), sendo que as 17 restantes nÃo foram inibidas mesmo na maior concentraÃÃo testada ( &#8805; 10 mg / mL). Foi determinada concentraÃÃo fungicida mÃnima (CFM) de pravastatina sobre 15 cepas do gÃnero Candida (CFM = 3,12 a 25 mg / mL), de sinvastatina sobre 34 cepas (CFM = 0,03 a 1 mg / mL), e de atorvastatina sobre 16 cepas (CFM = 0,04 a 0,31 mg / mL). Para o gÃnero Cryptococcus, das 25 cepas testadas, pravastatina exibiu CFM sobre apenas 3 cepas (CFM = 50 mg / mL), sinvastatina sobre 21 cepas (CFM = 0,12 a 1 mg / mL), e atorvastatina sobre 1 cepa (CFM = 1 mg / mL). Esta atividade inibitÃria in vitro de estatinas sobre espÃcies de Candida e Cryptococcus, abre uma perspectiva importante para a investigaÃÃo do possÃvel uso destas drogas com finalidade antifÃngica in vivo. / In the past years, fungal opportunistic infections, especially, candidiasis and cryptococcosis, have become more frequent because of the increase in the number of immunocompromised individuals, such as AIDS, transplant and cancer patients and those that are on immunosuppressive therapy. In spite of being effective, sometimes it is necessary to use new drugs as alternatives or as adjuvants in order to potentiate the effect of the classical antifungal therapy. Statins are the most prescribed hypolipemiant drugs worldwide for preventing cardiovascular diseases. However, other benefic effects for these drugs have been described, such as the control of infections. This work aimed at determining the antifungal activity of statins against Candida spp. and Cryptococcus spp. The minimum inhibitory concentrations (MICs) for three different statins (pravastatin, simvastatin and atorvastatin) were determined against 51 strains of Candida spp. (16 C. albicans, 11 C.krusei, 12 C. tropicalis and 12 C. parapsilosis) and 25 strains of Cryptococcus spp. (12 C. gattii and 13 C. neoformans), through broth microdilution assay, according to the Clinical Laboratory Standards Institute (CLSI - Document M27-A3). The concentration tested for pravastatin ranged from 50 to 0.0977 mg/mL, for simvastatin, it ranged from 1 to 0.0020 mg/mL and, for atorvastatin, it varied from 10 to 0.0200 mg/mL. Pravastatin inhibited 37 Candida strains, with MICs varying from 1.56 to 6.25 mg/mL and the remaining strains were not inhibited, even at the highest concentration tested (50 mg/mL). Simvastatin and atorvastatin, on the other hand, inhibited all 51 Candida strains evaluated, presenting MICs ranging from 0.02 to 1 mg/mL and from 0.04 to 5 mg/mL, respectively. Concerning Cryptococcus spp., only four strains were inhibited by pravastatin (MIC=25 mg/mL), while all 25 strains were inhibited by simvastatin (0.06&#8804;MIC&#8804;1 mg/mL) and eight were inhibited by atorvastatin (0.62&#8804;MIC&#8804;2.5 mg/mL) and the remaining 17 were not susceptible to the highest atorvastatin concentration tested (10 mg/mL). The minimum fungicidal concentrations (MFCs) for the tested statins were also determined. The MFC for pravastatin against Candida spp. was determined against 15 strains (3.12&#8804;MIC&#8804;25 mg/mL). The MFC values for simvastatin were determined for 34 strains of Candida spp. (0.03&#8804;MFC&#8804;1 mg/mL), while those for atorvastatin were determined against 16 strains (0.04&#8804;MFC&#8804;0,31 mg/mL). Concerning Cryptococcus spp., the 25 strains tested, MFC values for pravastatin were found against three strains (MFC=50 mg/mL), while those for simvastatin were determined against 21 strains (0.12&#8804;MFC&#8804;1 mg/mL) and those for atorvastatin were determined against one single strain (MFC=1 mg/mL). This in vitro inhibitory activity of statins against Candida spp. and Cryptococcus spp. creates an important perspective for the use of these drugs in vivo in order to control fungal infections.

Submitted by Cássia Santos (cassia.bcufg@gmail.com) on 2014-10-16T15:13:44Z No. of bitstreams: 2 Dissertacao Ely Rodrigues de Almeida - 2013.pdf: 1560361 bytes, checksum: 153a2514b81e70d5b31e01a1cc0d09b6 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Jaqueline Silva (jtas29@gmail.com) on 2014-10-20T20:06:38Z (GMT) No. of bitstreams: 2 Dissertacao Ely Rodrigues de Almeida - 2013.pdf: 1560361 bytes, checksum: 153a2514b81e70d5b31e01a1cc0d09b6 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-10-20T20:06:38Z (GMT). No. of bitstreams: 2 Dissertacao Ely Rodrigues de Almeida - 2013.pdf: 1560361 bytes, checksum: 153a2514b81e70d5b31e01a1cc0d09b6 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-10-15 / INTRODUCTION: Anticoagulation with warfarin is used in the presence of hypercoagulability and as prophylaxis for thromboembolism. Prothrombin time and activity and the international normalized ratio (PTA/INR) are the standard tests for laboratory follow up of the anticoagulation rate. Hemorrhage is one complication of this therapy. Therefore, one speculates on the possibility of diagnosing cases in which there is excess anticoagulation, by means of the analysis of hematuria in urinalysis and the association with PTA/INR. OBJECTIVE: Analyze the existence of a correlation between hematuria in urinalysis and high PTA/INR, among users of warfarin. METHODOLOGY: This is a descriptive, analytical, primary, quantitative and cross-sectional investigation. The study included 128 patients, 63 of whom were being treated with warfarin, and formed the group of anticoagulated patients (ACG). The remaining 65 patients who were not using anticoagulants formed the non anticoagulated group (NACG). For this study, 152 blood and urine samples were collected; 24 patients of the ACG contributed twice for the PTA/INR and urinalysis, at two different times. All the participants of the NACG also had the PTA/INR and urinalysis tests done. Patients with a clinical suspicion of conditions that might cause hematuria were excluded. The social and demographic data of these individuals were analyzed and the numerical variables of hematuria and of other urinalysis and INR parameters were measured and analyzed. The prevalence and the correlation between hematuria and PTA/INR levels were calculated. Data from the tests, medical appointments and the records of patients recruited in the collection room of the Clinical Laboratory of the HC-UFG were evaluated statistically, and emphasis was placed on the Spearman's correlation for hematuria and PTA/INR (IC 95%; p< 0.05). The study was approved by the Committee on Ethics and Human Research of the HC-UFG, protocol No. 016/2012. RESULTS: The amount of warfarin given on a weekly basis ranged from 10 to 65 mg. If one considers the INR between 2 and 3.9 acceptable for adequate anticoagulation, 59.77% of the individuals were adequately anticoagulated, 35% were insufficiently anticoagulated and 5.75% were excessively anticoagulated. The prevalence of hematuria among the ACG members was 26.44 % (CI 95% 17.98 – 36.43) and among NACG members, 29.23 % (CI 95% 19.16 – 41.11). The correlation coefficient between hematuria and INR was 0.012 (p=0.887). CONCLUSIONS: The most of the patients (59.7%) were within the recommended therapeutic range for controlling patients. There was no correlation between hematuria as measured by urinalysis and anticoagulation levels measured by the INR. / INTRODUÇÃO: A anticoagulação com varfarina é usada na hipercoagubilidade e como profilaxia para o tromboembolismo. O tempo e atividade de protrombina e a relação normatizada internacional (TAP/RNI) são os exames padrões para acompanhamento laboratorial da taxa de anticoagulação. A hemorragia é uma complicação desta terapia. Dessa forma, especula-se a possibilidade de diagnosticar casos em que haja excesso de anticoagulação, por meio da análise da hematúria no exame dos elementos anormais e sedimentoscopia da urina (EAS) e a associação com TAP/RNI. OBJETIVO: Analisar a existência de correlação entre hematúria no EAS e TAP /RNI elevados, nos usuários do anticoagulante varfarina. METODOLOGIA: Estudo descritivo, analítico, primário, quantitativo e transversal. Incluíram-se 128 pacientes, sendo 63 tratados com varfarina, formando um grupo anticoagulado (GAC) e 65 que não faziam uso de anticoagulantes, grupo não anticoagulado (GNAC). Colheram-se 152 amostras de sangue e urina; das quais 24 pacientes do GAC contribuíram duas vezes para exames TAP/RNI e EAS, em dois momentos distintos. Todos os participantes do GNAC também se submeteram aos exames TAP/RNI e EAS. Excluíram-se pacientes com suspeita clínica de condições que causassem hematúria. Analisaram-se os dados sociodemográficos e fez-se a mensuração e a análise das variáveis numéricas hematúria e de outros parâmetros do EAS e RNI. Calculou-se a prevalência e a correlação entre hematúria e níveis de TAP/RNI. Os dados oriundos de exames, consultas médicas e dos prontuários dos pacientes recrutados na sala de coleta do Laboratório Clinico do HC-UFG, foram avaliados estatisticamente, com ênfase na correlação de Spearman para hematúria e TAP/RNI (IC 95%; p<0,05). O projeto foi aprovado pelo Comitê de Ética e Pesquisa Humana do HC-UFG sob o nº 016/2012. RESULTADOS: A quantidade de varfarina semanal variou de 10 a 65 mg. Considerando-se o valor de RNI entre 2 e 3,9, como valor aceitável para adequada anticoagulação, 59,77% estavam adequadamente anticoagulados, 35% insuficientemente e, com efeito anticoagulante excessivo, 5,75%. A prevalência de hematúria no GAC foi de 26,44 % (IC 95% 17,98 – 36,43) e no GNAC, foi de 29,23 % (IC 95% 19,16 – 41,11). O coeficiente de correlação entre hematúria e RNI foi de 0,012 (p=0,887). CONCLUSÕES: A maioria dos pacientes (59,7%) tinha a RNI na faixa terapêutica preconizada para anticoagulação. Não houve correlação entre hematúria ao exame EAS e os níveis de anticoagulação medidos pela RNI.

Submitted by Cristiane Chim (cristiane.chim@ucpel.edu.br) on 2018-10-08T12:04:48Z No. of bitstreams: 1 Felipe Simões Lopes Quintana.pdf: 77300691 bytes, checksum: ee08226cb6940ec6c50e71b9ec852ebe (MD5) / Made available in DSpace on 2018-10-08T12:04:48Z (GMT). No. of bitstreams: 1 Felipe Simões Lopes Quintana.pdf: 77300691 bytes, checksum: ee08226cb6940ec6c50e71b9ec852ebe (MD5) Previous issue date: 2017-10-10 / . / Descrever dois dermatofibromas, analisando seus aspectos clínicos, histológicos e ultraestruturais. 3.2 ESPECÍFICOS a) Descrever os achados da microscopia óptica com a coloração com hematoxicilina e eosina. b) Descrever os achados da microscopia óptica com a coloração Weigert. c) Descrever aspectos ultraestruturais tridimensionais com microscopia eletrônica de varredura. d) Descrever os aspectos clínicos do dermatofibroma.

Lee, Kit Lin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 95-105). / Abstracts in English and Chinese. / Abstract --- p.i / 撮要 --- p.iii / Acknowledgements --- p.v / Table of contents --- p.vii / List of Tables --- p.x / List of Figures --- p.xi / List of Abbreviations --- p.xiii / Chapter Chapter 1: --- Literature Review --- p.1 / Chapter 1.1 --- Introduction --- p.1 / Chapter 1.1.1 --- History of Botanical Studies in Hong Kong --- p.1 / Chapter 1.1.2 --- Plant Species Named after Hong Kong --- p.2 / Chapter 1.2 --- Botanical Background of Asarum Plants --- p.5 / Chapter 1.2.1 --- Plant Species under the Family of Aristolochiaceae --- p.5 / Chapter 1.2.2 --- Herba Asari --- p.6 / Chapter 1.2.3 --- Classification of Asarum hongkongense --- p.8 / Chapter 1.2.4 --- Growing Habitat of Asarum hongkongense --- p.8 / Chapter 1.3 --- Medicinal Properties of Asari --- p.10 / Chapter 1.4 --- Chemical Constituents of Asari --- p.10 / Chapter 1.5 --- Aristolochic acid and Health Issues --- p.12 / Chapter 1.5.1 --- Aristolochic Acid Intoxication --- p.12 / Chapter 1.5.2 --- Description of Aristolochic Acid --- p.13 / Chapter 1.5.3 --- Toxicities of Aristolochic Acid --- p.13 / Chapter 1.5.4 --- Aristolochic Acid-Containing Plants --- p.15 / Chapter 1.5.5 --- Control of Aristolochic Acid-Containing Products --- p.17 / Chapter 1.5.6 --- Control of Aristolochic Acid-Containing Products in Hong Kong --- p.18 / Chapter 1.6 --- Objectives of Study --- p.19 / Chapter Chapter 2: --- Macroscopic Features of Asarum hongkongense --- p.20 / Chapter 2.1 --- Introduction --- p.20 / Chapter 2.2 --- Plant Material --- p.20 / Chapter 2.2.1 --- Asarum hongkongense --- p.20 / Chapter 2.2.2 --- Herba Asari --- p.23 / Chapter 2.3 --- Macroscopic Characteristics of Aarum hongkongense --- p.23 / Chapter 2.3.1 --- Leaf --- p.23 / Chapter 2.3.2 --- Root and Rhizome --- p.25 / Chapter 2.3.3 --- Flower --- p.27 / Chapter 2.4 --- Macroscopic Characteristics of Herba Asari heterotropoidis (Liaoxixin) --- p.31 / Chapter 2.4.1 --- Leaf --- p.31 / Chapter 2.4.2 --- Root and Rhizome --- p.31 / Chapter 2.4.3 --- Flower --- p.34 / Chapter 2.5 --- Discussion --- p.36 / Chapter Chapter 3: --- Microscopic Features of Asarum hongkongense --- p.38 / Chapter 3.1 --- Introduction --- p.38 / Chapter 3.2 --- Plant Materials --- p.39 / Chapter 3.3 --- "Chemical,Reagents and Instrumentation" --- p.39 / Chapter 3.4 --- Methods --- p.39 / Chapter 3.5 --- Microscopic Characteristics of Asarum hongkongense --- p.40 / Chapter 3.5.1 --- Transverse Section of Leaf --- p.40 / Chapter 3.5.2 --- Surface View of Leaf --- p.40 / Chapter 3.5.3 --- Transverse Section of Root --- p.43 / Chapter 3.5.4 --- Transverse Section of Rhizome --- p.43 / Chapter 3.5.5 --- Powder --- p.47 / Chapter 3.5.5.1 --- Pollens --- p.47 / Chapter 3.5.5.2 --- Vessels --- p.47 / Chapter 3.5.5.3 --- Starch Grains --- p.47 / Chapter 3.6 --- Microscopic Characteristics of Herba Asari heterotropoidis (Liaoxixin) --- p.49 / Chapter 3.6.1 --- Transverse Section of Leaf --- p.49 / Chapter 3.6.2 --- Surface View of Leaf --- p.49 / Chapter 3.6.3 --- Transverse Section of Root --- p.53 / Chapter 3.6.4 --- Transverse Section of Rhizome --- p.53 / Chapter 3.6.5 --- Powder --- p.56 / Chapter 3.6.5.1 --- Starch Grains --- p.56 / Chapter 3.6.5.2 --- Vessels --- p.56 / Chapter 3.7 --- Discussion --- p.58 / Chapter Chapter 4: --- Molecular DNA Sequencing of Asarum hongkongense --- p.61 / Chapter 4.1 --- Introduction --- p.61 / Chapter 4.2 --- Sample Preparation --- p.64 / Chapter 4.3 --- Method --- p.64 / Chapter 4.3.1 --- Extraction of Total DNA --- p.64 / Chapter 4.3.2 --- PCR Amplification of ITS1 and ITS2 Regions of rRNA Gene --- p.65 / Chapter 4.3.3 --- Purification of PCR Products --- p.65 / Chapter 4.3.4 --- Sequencing of ITS Regions --- p.66 / Chapter 4.3.4.1 --- Cycle Sequencing Reaction --- p.66 / Chapter 4.3.4.2 --- Purification of Sequencing Extension Products --- p.67 / Chapter 4.3.4.3 --- Electrophoresis by Genetic Analyzer --- p.67 / Chapter 4.3.4.4 --- Sequence Analysis and Alignment --- p.67 / Chapter 4.4 --- Results and Discussion --- p.68 / Chapter 4.4.1 --- Extraction of Total DNA --- p.68 / Chapter 4.4.2 --- PCR Amplification of ITS1 and ITS2 Regions of rRNA Gene --- p.68 / Chapter 4.4.3 --- Sequence Analyses --- p.68 / Chapter Chapter 5: --- Determination of Aristolochic Acid of Asarum hongkongense --- p.80 / Chapter 5.1 --- Introduction --- p.80 / Chapter 5.2 --- Sample Preparation --- p.81 / Chapter 5.3 --- Standard Preparation --- p.81 / Chapter 5.4 --- Experimental --- p.83 / Chapter 5.4.1 --- Chemical and Reagents --- p.83 / Chapter 5.4.2 --- Methods --- p.83 / Chapter 5.4.2.1 --- High-Performance Liquid Chromatography --- p.83 / Chapter 5.4.2.2 --- Mass Spectrometry --- p.85 / Chapter 5.4.3 --- Other Instrumentation --- p.85 / Chapter 5.5 --- Method Validation --- p.85 / Chapter 5.5.1 --- Calibration --- p.85 / Chapter 5.5.2 --- Precision --- p.87 / Chapter 5.5.3 --- Recovery Test --- p.88 / Chapter 5.5.4 --- Limit of Detection --- p.89 / Chapter 5.6 --- Results and Discussion --- p.90 / Chapter Chapter 6: --- Conclusion --- p.92 / References --- p.94