INTRODUÇÃO: A mielopatia associada ao HTLV-1/paraparesia espástica tropical (HAM/TSP) é a manifestação neurológica mais descrita da infecção pelo HTLV-1. Embora o risco de seu desenvolvimento ao longo da vida do portador dessa retrovirose seja pequeno, 2% a 5%, tal afecção pode causar um importante comprometimento funcional e prejuízo na qualidade de vida. Dadas as exigências atuais por melhores cuidados de saúde, os profissionais de saúde frequentemente empregam diferentes terapêuticas disponíveis para tratar pacientes com HAM/TSP, dentre os quais se destacam as drogas imunomoduladoras, visando reduzir a incapacidade e melhorar a qualidade de vida dos pacientes acometidos. Porém, ainda não há consenso sobre qual seria a melhor intervenção e, quando indicado, qual o melhor imunomodulador para o tratamento da HAM/TSP. MÉTODOS: Com o propósito de buscar-se evidência da eficácia dos medicamentos imunomoduladores no tratamento da HAM/TSP, foi conduzida uma revisão sistemática de ensaios clínicos randomizados e controlados nas bases de dados MEDLINE, LILACS, Embase e Registro Cochrane de Ensaios Clínicos Controlados. Selecionaram-se estudos relevantes, sem restrição de idioma e publicados até em 31/01/13. Além disso, foi realizada busca manual das referências bibliográficas dos estudos selecionados. RESULTADOS: Três ensaios clínicos randomizados e controlados que preencheram os critérios de inclusão foram analisados: dois deles abordando a eficácia do interferon alfa e um de zidovudina associada à lamivudina. CONCLUSÕES: Os pacientes que receberam 3,0 milhões de UI de interferon alfa, pela via intramuscular, uma vez por dia, durante 28 dias consecutivos, apresentaram melhora temporária do comprometimento funcional e do distúrbio urinário, quando comparados aos que receberam 0,3 ou 1,0 milhão de UI de interferon alfa, e apresentaram efeitos adversos toleráveis e temporários. A intensidade da melhora e o tempo do benefício dependeram do grau de comprometimento funcional e urinário prévio ao estudo. Os pacientes que receberam 300 mg de zidovudina e 150 mg de lamivudina, pela via oral, duas vezes por dia, durante 24 semanas, não apresentaram melhora significativa do comprometimento funcional, da dor em membros inferiores ou do distúrbio urinário, quando comparados aos pacientes que receberam placebo. A literatura revisada mostrou-se escassa e heterogênea no que se refere às drogas utilizadas e à dosagem, bem como nos desfechos clínicos avaliados. Em função disso, não se realizou metanálise. Conclui-se que não há evidência definitiva de eficácia do uso de imunomoduladores para o tratamento da HAM/TSP / BACKGROUND: HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is the most frequently described neurological manifestation of this retroviral infection. Even through the lifetime risk of HTLV-1 carries developing HAM/TSP is low (2% to 5%) this condition may cause significant disability and compromise quality of life. Given current demands for better health care, health professionals often use different available therapies to treat patients with HAM/TSP, and, particularly, immunomodulating drugs to reduce disability and improve quality of life. However, so far there is no consensus about the best intervention, and, when recommended, the best immunomodulating drug for the treatment of HAM/TSP. METHODS: To establish whether there is evidence of the efficacy of immunomodulating drugs in the treatment of HAM/TSP. We conducted a systematic review of randomized, double-blind, controlled trials, searching MEDLINE, LILACS, EMBASE and the Cochrane Central Register of Controlled Trials. We selected relevant studies published until January 31st, 2013, regardless of language. In addition, a manual search of the references of selected studies was conducted. RESULTS: Three randomized controlled clinical trials that met our inclusion criteria were analyzed: two of them address the efficacy of interferon alfa and another of zidovudine plus lamivudine. CONCLUSIONS: Patients who received 3.0 million IU of interferon alfa, intramuscularly, once a day, for 28 consecutive days, showed temporary improvement of functional impairment and urinary disorder, as compared to those who received 0.3 or 1.0 million IU of interferon alfa, and exhibited with tolerable and temporary side effects. The intensity and duration of improvement depended on the degree of functional impairment and urinary disorder prior to the study. Patients who received 300 mg zidovudine plus 150 mg lamivudine, orally, twice a day, for 24 weeks showed no significant improvement in functional impairment, in lower limbs pain or in urinary disorder when compared to patients who received placebo. The literature we reviewed is scarce and heterogeneous in terms of used drugs and in evaluated clinical outcomes. Therefore, a meta-analysis was not performed. We concluded that there is no definitive evidence of the efficacy of imunnomodulating drugs in the treatment of HAM/TSP

This thesis describes bioanalytical methods for drug determination in biological matrixes, with drugs in focus used against diseases largely affecting low-income countries. Solid-phase extraction is used for sample cleanup, and processed samples are analyzed by liquid chromatography. Developed bioanalytical methods are validated according to international guidelines. Eflornithine (DFMO) is a chiral drug, used for treating human African trypanosomiasis. A bioanalytical method for determination of DFMO enantiomers in plasma is presented. The enantiomers are detected by evaporative light-scattering detection. The method has been applied to determination of D-DFMO and L-DFMO in rats, after intravenous and oral administration of racemic DFMO. It is concluded that DFMO exhibits enantioselective absorption, with the more potent enantiomer L-DFMO being less favored. Sulfadoxine (SD) and sulfamethoxazole (SM) are sulfa-drugs used for malaria and pneumonia respectively. Two methods are described for simultaneous determination of SD and SM in capillary blood sampled on filter paper. The former method allows direct injection of extracts from dried blood spots (DBS), while for the latter method solid-phase extraction is added. Pre-analytical factors contributing to measurement uncertainty is also discussed, and it is concluded that it is of high importance that homogeneity in type of sampling paper and sampling volume is assured. Piperaquine (PQ) is an antimalarial, increasingly used in artemisinin combination therapy. A method for determination of piperaquine in DBS is presented. By using a monolithic LC column, a very short LC analysis of two minutes per sample is achieved. A method for simultaneous determination of three antiretroviral drugs i.e. lamivudine (3TC), zidovudine (AZT) and nevirapine (NVP), in DBS samples is described. The method is applied to drug determination in two subjects after receiving standard antiretroviral treatment. Conclusion is that the method is suitable for determination of 3TC and NVP, and to some extent for AZT.

INTRODUÇÃO: A mielopatia associada ao HTLV-1/paraparesia espástica tropical (HAM/TSP) é a manifestação neurológica mais descrita da infecção pelo HTLV-1. Embora o risco de seu desenvolvimento ao longo da vida do portador dessa retrovirose seja pequeno, 2% a 5%, tal afecção pode causar um importante comprometimento funcional e prejuízo na qualidade de vida. Dadas as exigências atuais por melhores cuidados de saúde, os profissionais de saúde frequentemente empregam diferentes terapêuticas disponíveis para tratar pacientes com HAM/TSP, dentre os quais se destacam as drogas imunomoduladoras, visando reduzir a incapacidade e melhorar a qualidade de vida dos pacientes acometidos. Porém, ainda não há consenso sobre qual seria a melhor intervenção e, quando indicado, qual o melhor imunomodulador para o tratamento da HAM/TSP. MÉTODOS: Com o propósito de buscar-se evidência da eficácia dos medicamentos imunomoduladores no tratamento da HAM/TSP, foi conduzida uma revisão sistemática de ensaios clínicos randomizados e controlados nas bases de dados MEDLINE, LILACS, Embase e Registro Cochrane de Ensaios Clínicos Controlados. Selecionaram-se estudos relevantes, sem restrição de idioma e publicados até em 31/01/13. Além disso, foi realizada busca manual das referências bibliográficas dos estudos selecionados. RESULTADOS: Três ensaios clínicos randomizados e controlados que preencheram os critérios de inclusão foram analisados: dois deles abordando a eficácia do interferon alfa e um de zidovudina associada à lamivudina. CONCLUSÕES: Os pacientes que receberam 3,0 milhões de UI de interferon alfa, pela via intramuscular, uma vez por dia, durante 28 dias consecutivos, apresentaram melhora temporária do comprometimento funcional e do distúrbio urinário, quando comparados aos que receberam 0,3 ou 1,0 milhão de UI de interferon alfa, e apresentaram efeitos adversos toleráveis e temporários. A intensidade da melhora e o tempo do benefício dependeram do grau de comprometimento funcional e urinário prévio ao estudo. Os pacientes que receberam 300 mg de zidovudina e 150 mg de lamivudina, pela via oral, duas vezes por dia, durante 24 semanas, não apresentaram melhora significativa do comprometimento funcional, da dor em membros inferiores ou do distúrbio urinário, quando comparados aos pacientes que receberam placebo. A literatura revisada mostrou-se escassa e heterogênea no que se refere às drogas utilizadas e à dosagem, bem como nos desfechos clínicos avaliados. Em função disso, não se realizou metanálise. Conclui-se que não há evidência definitiva de eficácia do uso de imunomoduladores para o tratamento da HAM/TSP / BACKGROUND: HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is the most frequently described neurological manifestation of this retroviral infection. Even through the lifetime risk of HTLV-1 carries developing HAM/TSP is low (2% to 5%) this condition may cause significant disability and compromise quality of life. Given current demands for better health care, health professionals often use different available therapies to treat patients with HAM/TSP, and, particularly, immunomodulating drugs to reduce disability and improve quality of life. However, so far there is no consensus about the best intervention, and, when recommended, the best immunomodulating drug for the treatment of HAM/TSP. METHODS: To establish whether there is evidence of the efficacy of immunomodulating drugs in the treatment of HAM/TSP. We conducted a systematic review of randomized, double-blind, controlled trials, searching MEDLINE, LILACS, EMBASE and the Cochrane Central Register of Controlled Trials. We selected relevant studies published until January 31st, 2013, regardless of language. In addition, a manual search of the references of selected studies was conducted. RESULTS: Three randomized controlled clinical trials that met our inclusion criteria were analyzed: two of them address the efficacy of interferon alfa and another of zidovudine plus lamivudine. CONCLUSIONS: Patients who received 3.0 million IU of interferon alfa, intramuscularly, once a day, for 28 consecutive days, showed temporary improvement of functional impairment and urinary disorder, as compared to those who received 0.3 or 1.0 million IU of interferon alfa, and exhibited with tolerable and temporary side effects. The intensity and duration of improvement depended on the degree of functional impairment and urinary disorder prior to the study. Patients who received 300 mg zidovudine plus 150 mg lamivudine, orally, twice a day, for 24 weeks showed no significant improvement in functional impairment, in lower limbs pain or in urinary disorder when compared to patients who received placebo. The literature we reviewed is scarce and heterogeneous in terms of used drugs and in evaluated clinical outcomes. Therefore, a meta-analysis was not performed. We concluded that there is no definitive evidence of the efficacy of imunnomodulating drugs in the treatment of HAM/TSP

Lamivudina (3TC) e zidovudina (ZDV) são inibidores nucleosídeos da transcriptase reversa utilizados na terapêutica anti-HIV. Para avaliar a equivalência farmacêutica entre um medicamento teste contendo esta associação e o referência, foi desenvolvido um método para determinação cromatográfica simultânea de 3TC e ZDV em comprimidos. O método empregou coluna C8 Shim-pack®(150 x 4,6 mm, 5 µm), pré-coluna C18 Phenomenex® (50x4,6 mm 5um), água e metanol 60:40 (v:v) como fase móvel e detecção a 266nm. Este mostrou-se específico, com linearidade entre 45 a 5000 ng/mL, precisão demonstrada por CV% inferior a 5%, exatidão entre 90,0 e 110,0% com recuperação superior a 90% para ambos os fármacos. Os testes de dissolução apresentaram porcentagem de cedência média superior a 85% em 30 minutos. A biodisponibilidade relativa dos produtos Biovir® (referência) e Lamivudina + Zidovudina 150 + 300 mg (teste), foi avaliada por meio de um estudo quantitativo direto, cruzado e aberto. Para purificação das amostras biológicas contendo 3TC e ZDV foi realizada adição de acetato de amônio e dupla extração com acetato de etila. O método cromatográfico bioanalítico utilizou coluna C8 Shim-pack® (150 x 4,6 mm 5 µm) e pré-coluna C18 Phenomenex® (50 x 4,6 mm; 5 µm). Empregou-se sistema gradiente linear, combinando fase móvel A, tampão fosfato 0,01 M:acetonitrila (97:3 v/v) e fase móvel B, metanol, sob fluxo de 1,0 mL/min e detecção a 270 nm. Utilizou-se como padrão interno solução 10 µg/mL de estavudina. O método mostrou-se linear na faixa de concentração de 80 a 2500 ng/mL para 3TC e 80 a 5000 ng/mL para ZDV, com adequada precisão e exatidão intra-corridas e inter-corridas. As amostras plasmáticas mostraram-se estáveis a pelo menos três ciclos de congelamento e descongelamento e 48 horas à temperatura ambiente, após preparação. Os parâmetros farmacocinéticos calculados para 3TC foram: ASCo-t de 4936,10 ng.h/mL e 4760,07 ng.h/mL, ASCo-∞ de 5305,76 ng.h/mL e 5069,16 ng.h/mL; Cmax de 1526,33 ng/mL e 1585,61 ng/mL e tmax 1,04 h e 0,97 h, respectivamente, para os produtos referência e teste. Para ZDV os valores obtidos foram ASCo-t de 2341,32 ng.h/mL e 2538,17 ng.h/mL, ASCo-∞ de 2561,68 ng.h/mL e 2770,21 ng.h/mL e Cmax de 2406,56 ng/mL e 2652,80 ng/mL e tmax 0,60 h e 0,55 h, respectivamente, para os produtos referência e teste. Os intervalos de confiança 90% para as relações entre os parâmetros Cmax, ASCo-t e ASCo-∞ em escala logarítmica obtidos para ambos os fármacos após administração dos produtos referência e teste a 24 voluntários sadios, estiveram compreendidos entre os limites de 80 a 125% exceto pelo Cmax para ZDV. O coeficiente de variação intra-sujeito de 47% demonstrou a alta variabilidade da ZDV em relação ao Cmax. Estudos de permeabilidade indicaram que a ZDV tem alta permeabilidade e alta solubilidade (Classe I) e a 3TC apresenta moderada permeabilidade e alta solubilidade (Classe III) . A absorção destes não é afetada significativamente pelas glicoproteínas-P, o que não pode explicar a alta variabilidade in vivo da absorção de ZDV. / Lamivudine (3TC) and zidovudine (ZDV) are the nucleoside reverse transcriptase inhibitors, They are used in combinations of antiretroviral therapy. The switchability between one test product and reference could be proved if they are pharmaceutically equivalents and bioequivalents. This research beginning with development and validation of chromatographic method to 3TC and ZDV simultaneous determination in tablet. The HPLC system were used to assay and 266nm wavelength ultraviolet detector. Separation was performed using a C8 column (150 x 4,6 mm, 5 µm) Shim-pack®protected by a C18 column (50 x 4,6 mm, 5 µm) Phenomenex®. The mobile phase is composed of water and methanol 60:40 (v:v). This method was successfully applied to simultaneous determination to 3TC and ZDV without interference. It was validated over the range of 45 a 5000 ng/mL for both drugs with accurate from 90 to 110% and precision with variation lower than 5%. Extraction recoveries of the analytes were higher than 90%. The mean dissolution data about 3TC and ZDV were above than 85% in 30 minutes of dissolution test. The relative bioavailability between Biovir® (brand-name product) and Lamivudina + Zidovudina 150 + 300 mg (test product), was conducted for one direct quantitative, open and crossover study. The serial plasma sample of 3TC and ZDV collected after oral administration of brand-name product and test product, were analyzed using a validated high-performance liquid chromatography assay with UV detection in wavelength of 270 nm. The double liquid-liquid extraction was realized with additions of amonio acetat. A CLC-C8 (M) column (150 x 4,6 mm 5 µm) Shim-pack®and C18 column (50 x 4,6mm 5 µm) Phenomenex®, was eluted with two mobile phase in a linear gradient system at a flow-rate of 1 mL/min. The mobile phase A was composed by 0,01 M phosphate bufer:acetonitrile (97:3 v/v) and mobile phase B composed by methanol. A methanolic solution containing 10 µ g/mL of stavudine was used as internai standard. The method was linear over the range of 80 a 2500 ng/mL for 3TC and 80 a 5000 ng/mL for ZDV. It was shown adequate intra-day accuracy; inter-day accuracy and precision. The sample have been stable in three cycle of freezing and thawing and 48 hours in room temperature after thawing, purified and with mobile phase. The pharmacokinetic parameter estimates for 3TC, were: ASCo-t de 4936,10 ng.h/mL e 4760,07 ng.h/mL, ASCo-C/) de 5305,76 ng.h/mL e 5069,16 ng.h/mL; Cmax de 1526,33 ng/mL e 1585,61 ng/mL e tmax 1,04 h e 0,97 h, respectively for brand-name product and test product. The obtained values for ZDV were: ASCo-t de 2341 ,32 ng.h/mL e 2538,17 ng.h/mL, ASCo-if.l de 2561,68 ng.h/mL e 2770,21 ng.h/mL e Cmax de 2406,56 ng/mL e 2652,80 ng/mL e tmax 0,60 h e 0,55 h respectively for for brand-name product and test product. The 90% confidence intervals for Cmax, ASCo-t e ASCo-∞ for log¬transformed results for 3TC and ZDV after oral administration of brand-name product and test product to 24 health volunteers was between 80 to 125% except for Cmax of ZDV. The high variability of Cmax this was displayed by intra-individual coefficient of variation of 47%. Permeability results suggest that ZDV has a high permeability and high solubility (Class I) and Lamivudine presents moderate permeability and high solubility. (Class III). These results assume that P-gp do not affect significantly lamivudine and zidovudine absorption and can not explain the high variability of zidovudine absorption.

The aim of this study was to assess the extent on how effective was the prevention of mother-to-child transmission of Human Immunodeficiency Virus (HIV) infection at Oshakati District Health Centre. Explanatory survey was used to conduct the research. A total of 160 nurses experienced in prevention of mother-to-child transmission and women who attended antenatal care and post natal care services participated in the study. Respondents expressed unsatisfactory with the promoting involvement of male partners, high quality voluntary counselling and testing services, couple counselling and testing, integration of Highly Active Antiretroviral Therapy services, administration of short course of Zidovudine to pregnant mothers and the provision of antiretroviral drugs to infants. Therefore, promoting involvement of male partners, couple counselling and testing, administration of short course of Zidovudine to pregnant mothers and educating women about exclusive breastfeeding prior to delivery are some of recommendations for effective prevention of mother-to-child transmission of HIV infections. / Health Studies / (M.A. (Public Health))

The aim of this study was to assess the extent on how effective was the prevention of mother-to-child transmission of Human Immunodeficiency Virus (HIV) infection at Oshakati District Health Centre. Explanatory survey was used to conduct the research. A total of 160 nurses experienced in prevention of mother-to-child transmission and women who attended antenatal care and post natal care services participated in the study. Respondents expressed unsatisfactory with the promoting involvement of male partners, high quality voluntary counselling and testing services, couple counselling and testing, integration of Highly Active Antiretroviral Therapy services, administration of short course of Zidovudine to pregnant mothers and the provision of antiretroviral drugs to infants. Therefore, promoting involvement of male partners, couple counselling and testing, administration of short course of Zidovudine to pregnant mothers and educating women about exclusive breastfeeding prior to delivery are some of recommendations for effective prevention of mother-to-child transmission of HIV infections. / Health Studies / M.A. (Public Health)

This dissertation is a challenge to the Pentecostal churches, particularly, the Apostolic Faith Mission Church in Tumahole, to take an action in meeting the challenges posed by HIV/AIDS. This disease, HIV/AIDS, is the latest enemy to human life that the nations are faced with. In the newspapers like Sowetan, there is an article almost daily about HIV and AIDS. In this dissertation, I have tried to show shocking figures of how this disease is spreading in Africa. The seriousness of the disease, unlike other diseases, is its in curability. The secular organisations are far ahead of the churches in as far as the relevant programmes on combating HIV/AIDS are concerned. Despite these massive programmes, the disease is spreading like the wild fire. Deducing from this background, it is no longer the question of whether the Pentecostal churches have any role to play, but what specific role should the church play in this challenge. In this challenging times, many people look at the church as one of the most important institute that would play a positive role in bringing hope to the hopeless. / Christian Spirituality, Church History and Missiology / M. Th. (Missiology (Urban Ministry))

This dissertation is a challenge to the Pentecostal churches, particularly, the Apostolic Faith Mission Church in Tumahole, to take an action in meeting the challenges posed by HIV/AIDS. This disease, HIV/AIDS, is the latest enemy to human life that the nations are faced with. In the newspapers like Sowetan, there is an article almost daily about HIV and AIDS. In this dissertation, I have tried to show shocking figures of how this disease is spreading in Africa. The seriousness of the disease, unlike other diseases, is its in curability. The secular organisations are far ahead of the churches in as far as the relevant programmes on combating HIV/AIDS are concerned. Despite these massive programmes, the disease is spreading like the wild fire. Deducing from this background, it is no longer the question of whether the Pentecostal churches have any role to play, but what specific role should the church play in this challenge. In this challenging times, many people look at the church as one of the most important institute that would play a positive role in bringing hope to the hopeless. / Christian Spirituality, Church History and Missiology / M. Th. (Missiology (Urban Ministry))