11 resultados para refusal of treatment

em Instituto Politécnico do Porto, Portugal


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We develop a new a coinfection model for hepatitis C virus (HCV) and the human immunodeficiency virus (HIV). We consider treatment for both diseases, screening, unawareness and awareness of HIV infection, and the use of condoms. We study the local stability of the disease-free equilibria for the full model and for the two submodels (HCV only and HIV only submodels). We sketch bifurcation diagrams for different parameters, such as the probabilities that a contact will result in a HIV or an HCV infection. We present numerical simulations of the full model where the HIV, HCV and double endemic equilibria can be observed. We also show numerically the qualitative changes of the dynamical behavior of the full model for variation of relevant parameters. We extrapolate the results from the model for actual measures that could be implemented in order to reduce the number of infected individuals.

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Atualmente, o álcool tem um papel importante na saúde pública e surge como um dos principais problemas sociais no mundo, dado que é a droga mais viciante aceite em encontros sociais. Provavelmente, por essa razão, os riscos do consumo abusivo do álcool são subestimados pelos jovens, mulheres grávidas e idosos. O álcool, quando ingerido em altas proporções, pode afetar todos os órgãos e desencadear inúmeras doenças, tais como a doença cardíaca coronariana, doença neurodegenerativa, as doenças crónicas e câncer. O álcool afeta ainda o estado psicológico, induzindo a violência, o estado antissocial e situações de risco de comportamentos. Por estas razões, o álcool tornou-se um foco principal da investigação, avaliando os seus efeitos sobre o corpo humano. Nesta pesquisa, foram suscitadas amostras de sangue de um grupo de pacientes em tratamento psicológico e/ou farmacêutico que serão analisadas com quatro métodos: Teste de Radicais Livres do Oxigénio (FORT), Defesa contra Radicais Livres do Oxigénio (FORD), cromatografia gasosa (GC) e cromatografia líquida de alta pressão (HPLC). Ambos os métodos FORT e FORD avaliam o stress oxidativo pela quantificação de radicais livres e a capacidade de antioxidantes em eliminar esses radicais livres, respetivamente. O stress oxidativo é o efeito do excesso de consumo de álcool, que é reduzido pela capacidade de ação dos antioxidantes. A boa reprodutibilidade, precisão e exatidão de ambos os métodos indicam que estes podem ser aplicados em rápidos diagnósticos. Para o método FORT e considerando o início do tratamento, os pacientes alcoólicos apresentaram uma média de 3,59±1.01mmol/LH2O2 e o grupo de controlo uma média de 1,42±0.53mmol/LH2O2, o que mostra uma diferença significativa entre os dois grupos (P=0,0006). Para o método FORD, pacientes alcoólicos apresentam uma média de 1,07±0.53mmol/LH2O2 e o grupo de controlo, uma média de 2,81±0.46mmol/LH2O2, mostrando também uma média significativa (P=0,0075). Após 15 dias de tratamento observou-se que há uma diferença entre os dois grupos de pacientes alcoólicos, mas não há nenhum melhoramento em relação ao grupo de pacientes em tratamento. No método FORT os grupos mostram uma diferença significativa (P=0,0073), tendo os pacientes sem tratamento farmacêutico melhores resultados (2.37±0.44mmol/LH2O2) do que os pacientes com tratamento (3.72±1,04mmol/LH2O2). O oposto ocorre no método FORD, os pacientes em tratamento farmacêutico presentam melhores resultados (1.16±0.65mmol/LH2O2) do que o outro grupo (0.75±0.22mmol/LH2O2), não sendo, no entanto, uma diferença significativa entre os dois grupos (P=0.16). Os resultados obtidos para a concentração de MDA pelo método de HPLC mostraram que o grupo de controlo tem valores mais baixos do que os pacientes alcoólicos, embora a diferença não seja muito significativa (P = 0,084), mas é ainda elevada. Além disso, os dois grupos de pacientes não apresentaram uma diferença significativa entre os seus resultados no início (P=0,77) e no fim (P=0,79) do tratamento. De acrescentar ainda que, os resultados da concentração de álcool no sangue determinados pelo método de CG mostraram que só alguns pacientes sem tratamento consumiram álcool durante o período de tratamento, o que influencia negativamente a conclusão sobre o efeito do tratamento. Contudo, outros fatores externos podem ainda influenciar os resultados finais, tais como o estado nutricional e estado psicológico dos pacientes, se o paciente continua a beber durante o tempo de tratamento ou até mesmo se o paciente é exposto a outros tipos de substâncias nocivas. Existe ainda a possibilidade de o tempo de aplicação do tratamento não ser suficiente para apresentar um efeito positivo em relação ao stress oxidativo e este é um outro fator que contribui para a impossibilidade de confirmar sobre o efeito, quer seja positivo ou negativo, do tratamento antioxidante.

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Aminocarb is a widely applied carbamate insecticide with action of controlling pests such as Lepidoptera and Coleoptera. In this study, subchronic effects on Wistar rats were investigated using hematological, biochemical, and histological techniques. Rats were exposed orally at sublethal levels of 10, 20, or 40 mg/kg body weight (groups A, B, and C, respectively) for 14 d. Hematological results revealed no statistical differences after 1 d of exposure but significant reduction in white blood cells detected after 7 d of exposure in group C, as well as, in all treated groups after 14 d of exposure. Biochemical data showed a decrease of acetylcholinesterase activity in all groups after 1 d of exposure with a return to normal after 7 and 14 d. Significant increase in alkaline phosphatase activity of rats exposed to aminocarb was noted after 7 d of treatment. The levels of triglycerides were also significantly decreased. The present investigation also showed a significant increase in content of serum urea and creatinine in animals from group A (14 d), and from groups B and C (7 and 14 d). Histological results demonstrated hemorrhagic focus on hepatic and renal parenchyma in all exposed groups. Taken together, the attained results were dose dependent and indicated adverse effects of aminocarb on hepatic and renal functions, as well as on immune responsiveness at sublethal tested doses.

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The most effective therapeutic option for managing nonmuscle invasive bladder cancer (NMIBC), over the last 30 years, consists of intravesical instillations with the attenuated strain Bacillus Calmette-Gu´erin (the BCG vaccine). This has been performed as an adjuvant therapeutic to transurethral resection of bladder tumour (TURBT) and mostly directed towards patients with highgrade tumours, T1 tumours, and in situ carcinomas. However, from 20% to 40% of the patients do not respond and frequently present tumour progression. Since BCG effectiveness is unpredictable, it is important to find consistent biomarkers that can aid either in the prediction of the outcome and/or side effects development. Accordingly, we conducted a systematic critical review to identify themost preeminent predictive molecular markers associated with BCG response. To the best of our knowledge, this is the first review exclusively focusing on predictive biomarkers for BCG treatment outcome. Using a specific query, 1324 abstracts were gathered, then inclusion/exclusion criteria were applied, and finally 87 manuscripts were included. Several molecules, including CD68 and genetic polymorphisms, have been identified as promising surrogate biomarkers. Combinatory analysis of the candidate predictive markers is a crucial step to create a predictive profile of treatment response.

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Atualmente, o álcool tem um papel importante na saúde pública e surge como um dos principais problemas sociais no mundo, dado que é a droga mais viciante aceite em encontros sociais. Provavelmente, por essa razão, os riscos do consumo abusivo do álcool são subestimados pelos jovens, mulheres grávidas e idosos. O álcool, quando ingerido em altas proporções, pode afetar todos os órgãos e desencadear inúmeras doenças, tais como a doença cardíaca coronariana, doença neurodegenerativa, as doenças crónicas e câncer. O álcool afeta ainda o estado psicológico, induzindo a violência, o estado antissocial e situações de risco de comportamentos. Por estas razões, o álcool tornou-se um foco principal da investigação, avaliando os seus efeitos sobre o corpo humano. Nesta pesquisa, foram suscitadas amostras de sangue de um grupo de pacientes em tratamento psicológico e/ou farmacêutico que serão analisadas com quatro métodos: Teste de Radicais Livres do Oxigénio (FORT), Defesa contra Radicais Livres do Oxigénio (FORD), cromatografia gasosa (GC) e cromatografia líquida de alta pressão (HPLC). Ambos os métodos FORT e FORD avaliam o stress oxidativo pela quantificação de radicais livres e a capacidade de antioxidantes em eliminar esses radicais livres, respetivamente. O stress oxidativo é o efeito do excesso de consumo de álcool, que é reduzido pela capacidade de ação dos antioxidantes. A boa reprodutibilidade, precisão e exatidão de ambos os métodos indicam que estes podem ser aplicados em rápidos diagnósticos. Para o método FORT e considerando o início do tratamento, os pacientes alcoólicos apresentaram uma média de 3,59±1.01mmol/LH2O2 e o grupo de controlo uma média de 1,42±0.53mmol/LH2O2, o que mostra uma diferença significativa entre os dois grupos (P=0,0006). Para o método FORD, pacientes alcoólicos apresentam uma média de 1,07±0.53mmol/LH2O2 e o grupo de controlo, uma média de 2,81±0.46mmol/LH2O2, mostrando também uma média significativa (P=0,0075). Após 15 dias de tratamento observou-se que há uma diferença entre os dois grupos de pacientes alcoólicos, mas não há nenhum melhoramento em relação ao grupo de pacientes em tratamento. No método FORT os grupos mostram uma diferença significativa (P=0,0073), tendo os pacientes sem tratamento farmacêutico melhores resultados (2.37±0.44mmol/LH2O2) do que os pacientes com tratamento (3.72±1,04mmol/LH2O2). O oposto ocorre no método FORD, os pacientes em tratamento farmacêutico presentam melhores resultados (1.16±0.65mmol/LH2O2) do que o outro grupo (0.75±0.22mmol/LH2O2), não sendo, no entanto, uma diferença significativa entre os dois grupos (P=0.16). Os resultados obtidos para a concentração de MDA pelo método de HPLC mostraram que o grupo de controlo tem valores mais baixos do que os pacientes alcoólicos, embora a diferença não seja muito significativa (P = 0,084), mas é ainda elevada. Além disso, os dois grupos de pacientes não apresentaram uma diferença significativa entre os seus resultados no início (P=0,77) e no fim (P=0,79) do tratamento. De acrescentar ainda que, os resultados da concentração de álcool no sangue determinados pelo método de CG mostraram que só alguns pacientes sem tratamento consumiram álcool durante o período de tratamento, o que influencia negativamente a conclusão sobre o efeito do tratamento. Contudo, outros fatores externos podem ainda influenciar os resultados finais, tais como o estado nutricional e estado psicológico dos pacientes, se o paciente continua a beber durante o tempo de tratamento ou até mesmo se o paciente é exposto a outros tipos de substâncias nocivas. Existe ainda a possibilidade de o tempo de aplicação do tratamento não ser suficiente para apresentar um efeito positivo em relação ao stress oxidativo e este é um outro fator que contribui para a impossibilidade de confirmar sobre o efeito, quer seja positivo ou negativo, do tratamento antioxidante.

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Recent advances in psychosocial treatments for schizophrenia have targeted social cognitive deficits. A critical literature review and effect-size (ES) analysis was conducted to investigate the efficacy of comprehensive programs of social cognitive training in schizophrenia. Results revealed 16 controlled studies consisting of seven models of comprehensive treatment with only three of these treatment models investigated in more than one study. The effects of social cognitive training were reported in 11/15 studies that included facial affect recognition skills (ES=.84) and 10/13 studies that included theory-of-mind (ES=.70) as outcomes. Less than half (4/9) of studies that measured attributional style as an outcome reported effects of treatment, but effect sizes across studies were significant (ESs=.30-.52). The effect sizes for symptoms were modest, but, with the exception of positive symptoms, significant (ESs=.32-.40). The majority of trials were randomized (13/16), selected active control conditions (11/16) and included at least 30 participants (12/16). Concerns for this area of research include the absence of blinded outcome raters in more than 50% of trials and low rates of utilization of procedures for maintaining treatment fidelity. These findings provide preliminary support for the broader use of comprehensive social cognitive training procedures as a psychosocial intervention for schizophrenia.

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Background Hippocampal neurogenesis has been suggested as a downstream event of antidepressants (AD) mechanism of action and might explain the lag time between AD administration and the therapeutic effect. Despite the widespread use of AD in the context of Major Depressive Disorder (MDD) there are no reliable biomarkers of treatment response phenotypes, and a significant proportion of patients display Treatment Resistant Depression (TRD). Fas/FasL system is one of the best-known death-receptor mediated cell signaling systems and is recognized to regulate cell proliferation and tumor cell growth. Recently this pathway has been described to be involved in neurogenesis and neuroplasticity. Methods Since FAS -670A>G and FASL -844T>C functional polymorphisms never been evaluated in the context of depression and antidepressant therapy, we genotyped FAS -670A>G and FASL -844T>C in a subset of 80 MDD patients to evaluate their role in antidepressant treatment response phenotypes. Results We found that the presence of FAS -670G allele was associated with antidepressant bad prognosis (relapse or TRD: OR=6.200; 95% CI: [1.875–20.499]; p=0.001), and we observed that patients carrying this allele have a higher risk to develop TRD (OR=10.895; 95% CI: [1.362–87.135]; p=0.008).Moreover, multivariate analysis adjusted to potentials confounders showed that patients carrying G allele have higher risk of early relapse (HR=3.827; 95% CI: [1.072–13.659]; p=0.039). FAS mRNA levels were down-regulated among G carriers, whose genotypes were more common in TRD patients. No association was found between FASL-844T>C genetic polymorphism and any treatment phenotypes. Limitations Small sample size. Patients used antidepressants with different mechanisms of action. Conclusion To the best of our knowledge this is the first study to evaluate the role of FAS functional polymorphism in the outcome of antidepressant therapy. This preliminary report associates FAS -670A>G genetic polymorphism with Treatment Resistant Depression and with time to relapse. The current results may possibly be given to the recent recognized role of Fas in neurogenesis and/or neuroplasticity.

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Part of the optical clearing study in biological tissues concerns the determination of the diffusion characteristics of water and optical clearing agents in the subject tissue. Such information is sufficient to characterize the time dependence of the optical clearing mechanisms—tissue dehydration and refractive index (RI) matching. We have used a simple method based on collimated optical transmittance measurements made from muscle samples under treatment with aqueous solutions containing different concentrations of ethylene glycol (EG), to determine the diffusion time values of water and EG in skeletal muscle. By representing the estimated mean diffusion time values from each treatment as a function of agent concentration in solution, we could identify the real diffusion times for water and agent. These values allowed for the calculation of the correspondent diffusion coefficients for those fluids. With these results, we have demonstrated that the dehydration mechanism is the one that dominates optical clearing in the first minute of treatment, while the RI matching takes over the optical clearing operations after that and remains for a longer time of treatment up to about 10 min, as we could see for EG and thin tissue samples of 0.5 mm.

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Background Musicians are frequently affected by playing-related musculoskeletal disorders (PRMD). Common solutions used by Western medicine to treat musculoskeletal pain include rehabilitation programs and drugs, but their results are sometimes disappointing. Objective To study the effects of self-administered exercises based on Tuina techniques on the pain intensity caused by PRMD of professional orchestra musicians, using numeric visual scale (NVS). Design, setting, participants and interventions We performed a prospective, controlled, single-blinded, randomized study with musicians suffering from PRMD. Participating musicians were randomly distributed into the experimental (n = 39) and the control (n = 30) groups. After an individual diagnostic assessment, specific Tuina self-administered exercises were developed and taught to the participants. Musicians were instructed to repeat the exercises every day for 3 weeks. Main outcome measures Pain intensity was measured by NVS before the intervention and after 1, 3, 5, 10, 15 and 20 d of treatment. The procedure was the same for the control group, however the Tuina exercises were executed in points away from the commonly-used acupuncture points. Results In the treatment group, but not the control group, pain intensity was significantly reduced on days 1, 3, 5, 10, 15 and 20. Conclusion The results obtained are consistent with the hypothesis that self-administered exercises based on Tuina techniques could help professional musicians controlling the pain caused by PRMD. Although our results are very promising, further studies are needed employing a larger sample size and double blinding designs.

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Pyrethroids are pesticides very used in agriculture, which tend to replace organophosfate and carbamate insecticides. These pesticides have shown to exhibit cardiotoxicity. The aim of this study was to assess if cardiotoxicity is due to direct or indirect effects (metabolites) of permethrin on hearts. There were studies 8 rats; three of them were sacrificed after 24 of the end of treatment with permethrin and the other four were sacrificed after 14 days of the end of treatment. Afterwards hearts and urines were collected. The amounts of permethrin and its main metabolite (3-PBA) were evaluated on hearts and urines of female rats which were treated with permethrin and sacrificed the day after and 14 days after the treatment. Moreover has been highlighted the difference of amount of permethrin and its metabolite between rats sacrificed immediately at the end of treatment and those sacrificed after 14 days. The study of permethrin was accomplished by liquid-liquid extraction and GC-ECD. The evaluation of 3-PBA was performed by SPE procedure with 2-PBA as internal standard and gas-chromatography GC-MS. The concentration of permethrin in hearts is basically the same in 24h and 14 days. The 3-PBA concentration in urines decreased 50 times from 24h to 14 days. In hearts the 3-PBA level also decrease but only 2.24 times and a high variation of results were achieved in rats after 14 days.

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Synthetic pyrethroids are pesticides derived from naturally occurring pyrethrins, taken from pyrethrum of dried Chrysanthemum flowers. Pyrethroid insecticides are one of the most commonly used residential and agricultural insecticides. Many pyrethroids can significantly harm the nervous system. Permethrin could be one of the factors involved in the onset of neurodegenerative diseases. The present study aims to evaluate in brain, the effect that can induce the exposure to permethrin, during early life of female rats (from 6 to 21 days of life). Therefore, have been examined the concentrations of permethrin and its main metabolite (3-PBA) in the brain and urine in female rats sacrificed the day after and 14 days after treating. The different concentrations of permethrin and 3-PBA (after 24h and after 14 days in the end of treatment) were obtained using two different methods. The evaluation of permethrin by liquid-liquid extraction and GC-ECD was performed. The levels of the 3-PBA (in urine and brains) were obtained by SPE procedure and GC-MS using the 2- PBA as internal standard.