Efavirenz versus Nevirapina : comparação da efectividade e do perfil de segurança, a longo prazo, no tratamento da infecção por vírus da imunodeficiência humana tipo 1

Tese de mestrado, Doenças Infecciosas Emergentes, Universidade de Lisboa, Faculdade de Medicina, 2016

Infeção humana por vírus do dengue no século XXI: causas e consequências

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

O vírus do papiloma humano e a vacinação contra o cancro do colo do útero

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas Moniz

EFICÁCIA ADAPTATIVA E SITUAÇÕES DE CRISE EM PORTADORES DO VÍRUS HIV IMUNODEFICIÊNCIA HUMANA / AIDS.

O objetivo desta pesquisa foi investigar a eficácia adaptativa e situações de crise de indivíduos portadores do vírus HIV do Programa Municipal DST/AIDS de Aparecida SP. O instrumento utilizado foi a Entrevista Clínica Preventiva - EDAO (Escala Diagnóstica Adaptativa Operacionalizada). Participaram do estudo 5 homens e 5 mulheres que freqüentavam o serviço de saúde. Os resultados do trabalho revelaram que ser portador de uma doença crônica carregada de estigmas como a AIDS é um fator desestruturante para o diagnóstico. Foi percebida na população estudada o comprometimento dos setores afetivo-relacional e produtividade, seguido do sóciocultural. Foram observados alguns aspectos importantes como: a crise do impacto diagnóstico como sendo algo marcante em todos os participantes, bem como o uso de drogas, comportamentos vulneráveis que possivelmente levaram à infecção pelo vírus HIV, dificuldades de resolução de conflitos e nas relações interpessoais, perdas vivenciadas durante toda a vida e também no decorrer da infecção e o fenômeno da feminização do vírus HIV através das mulheres entrevistadas, que foram infectadas por seus parceiros sexuais estáveis. No setor orgânico de funcionamento, a população estudada mostrou adesão ao tratamento A maioria da população estudada foi diagnosticada com adaptação ineficaz severa. Este estudo trouxe questionamentos importantes sobre a maneira com a qual o indivíduo portador do vírus HIV mantém seu equilíbrio psíquico e suas relações com o trabalho que executa, chamando atenção para a necessidade de outros estudos que contemplem diferentes instrumentos para a compreensão do tema.

O EFEITO DO CONTROLE RESPIRATÓRIO EM VARIÁVEIS ELETROFISIOLÓGICAS DA ATENÇÃO

A prática do ioga tem se tornado cada vez mais popular, não apenas pelos benefícios físicos, mas principalmente pelo bem-estar psicológico trazido pela sua prática. Um dos componentes do ioga é o Prãnãyama, ou controle da respiração. A atenção e a respiração são dois mecanismos fisiológicos e involuntários requeridos para a execução do Prãnãyama. O principal objetivo desse estudo foi verificar se variáveis contínuas do EEG (potência de diferentes faixas que o compõem) seriam moduladas pelo controle respiratório, comparando-se separadamente as duas fases do ciclo respiratório (inspiração e expiração), na situação de respiração espontânea e controlada. Fizeram parte do estudo 19 sujeitos (7 homens/12 mulheres, idade média de 36,89 e DP = ± 14,46) que foram convidados a participar da pesquisa nas dependências da Faculdade de Saúde da Universidade Metodista de São Paulo. Para o registro do eletroencefalograma foi utilizado um sistema de posicionamento de cinco eletrodos Ag AgCl (FPz, Fz, Cz, Pz e Oz) fixados a uma touca de posicionamento rápido (Quick-Cap, Neuromedical Supplies®), em sistema 10-20. Foram obtidos valores de máxima amplitude de potência (espectro de potência no domínio da frequência) nas frequências teta, alfa e beta e delta e calculada a razão teta/beta nas diferentes fases do ciclo respiratório (inspiração e expiração), separadamente, nas condições de respiração espontânea e de controle respiratório. Para o registro do ciclo respiratório, foi utilizada uma cinta de esforço respiratório M01 (Pletismógrafo). Os resultados mostram diferenças significativas entre as condições de respiração espontânea e de controle com valores das médias da razão teta/beta menores na respiração controlada do que na respiração espontânea e valores de média da potência alfa sempre maiores no controle respiratório. Diferenças significativas foram encontradas na comparação entre inspiração e expiração da respiração controlada com diminuição dos valores das médias da razão teta/beta na inspiração e aumento nos valores das médias da potência alfa, sobretudo na expiração. Os achados deste estudo trazem evidências de que o controle respiratório modula variáveis eletrofisiológicas relativas à atenção refletindo um estado de alerta, porém mais relaxado do que na situação de respiração espontânea.

HIV/AIDS: um perfil epidemiológico do vírus e uma análise das práticas seguras, conhecimento e percepção de mulheres

In recent decades, the debate surrounding the consequences of the HIV has passed by great changes. Earlier, prevention campaigns focused risk groups then risk behaviors and ultimately vulnerability. Furthermore, over the years, the dimensions of HIV that emerged in the social environment are these: internalization, heterosexualization, impoverishment and feminization. Based on these contexts, the composition of this study comprises two papers: the former has the overall objective to analyze the epidemiology and incidence of HIV in Brazilian regions in the period from 1980 to 2012; the latter, it aims to find out whether there is the relationship among safe practices, knowledge and perception of women residents in Manaus and Boa Vista cities on the infection by HIV. In paper 1, it was used information from the Health Ministry, as a data source. Besides, it was developed an exploratory and spatial analysis of incidence rates and relative proportion of notified cases. In paper 2, was used as a source of data, the research "Evaluating the process of spatial and epidemic diffusion of HIV in the federal units of Brazil-Northern Region" in 2008. Furthermore, Statistical Techniques of Cluster Analysis, Analysis of Variance, Chi-Square and Logistic Regression were applied. In this paper, it was found that, in Brazilian Regions, the prevalence of reported cases occurred among heterosexuals in men 20-40 year age group and residing in metropolitan areas. It was observed a significant spatial correlation of the incidence rate of reported cases of HIV. It was also noted by the results that have good knowledge and awareness about HIV does not imply, essentially, in a safe sexual intercourse. These results have shown the need public policies geared to the guiding of society, based in educational strategies aiming both information about the virus and its prevention, as well as public awareness for safe sex practices or in stable or not intercourses

Co-circulação dos vírus dengue tipo 1, 2 e 4 nos Estados do Rio Grande do Norte e Paraíba, 2013

Dengue is a viral disease transmitted by female mosquitoes from genus Aedes, the principal urban vector is Aedes aegypti. Actually dengue has caused, in global scale, substantial morbidity and mortality. Four serotypes (antigenically distinct) are known: DENV-1, DENV-2, DENV-3 and DENV-4. The objective of this study was described the epidemiological profile dengue in the states of Rio Grande do Norte (RN) and Paraíba (PB), 2013. For that, suspected cases of dengue were studied, received for Laboratory of Molecular Biology of infectious disease and cancer (LADIC-UFRN) from different Health Units from RN and PB between January and December of 2013. The viral RNA was obtained from serum samples of patient from health units from RN and PB. It were studied 478 suspected cases of dengue , 252 (52,7%) from Rio Grande do Norte and 226 (47,3%) from Paraíba, showeds a global rate of infection global prevalence of 29,7% (142/478). The co-circulation of three serotypes was observed: DENV-1 (9,8% [14/142]), DENV-2 (3,5% [5/142]) and DENV-4 (86,7% [123/142]). People between 21-30 years old were the most affected by the disease during all the period of the study, representing 63,7% of the cases in both states. The genus most affected was female, representing 63,3% of cases in both states. Pau dos Ferros, Rio Grande do Norte, had the highest circulation of disease, with 8,2% (8/97) of cases. In Paraíba, the city most affected was João Pessoa, with (80% (36/45) of cases. The months with the biggest viral circulation in RN and PB were March and August, respectively. These results are very important to understanding the dengue viral activity in RN and PB, providing data that can guide control actions of this disease in support to local control programs

Epidemiologia e caracterização molecular dos vírus Dengue circulantes no Rio Grande do Norte, 2013-2014

Dengue is an acute infectious disease, usually transmitted by Aedes aegypti mosquitoes. The etiologic agents belong to the family Flaviviridae, genus Flavivirus, and occur as four antigenically related but distinct serotypes designated DENV-1, 2, 3, and 4. In Brazil, the disease represents a national public health problem. The purpose of the present study was to describe epidemiological aspects of dengue in the State of Rio Grande do Norte, from 2013 to 2014. A total of 483 blood or serum samples, collected from January 2013 to December 2014, were studied by RT-PCR for viral detection and typing. The infection was confirmed in 36.44% (176/483) of the cases studied. This study detected the circulation of three serotypes of dengue virus in Rio Grande do Norte, DENV-1, 2, and 4. The predominant serotype in 2013-2014 was the DENV-4, representing 83.51% (81/97) and 68.35% (54/79) of the positive cases, respectively. Regarding the spatial distribution, most of the cases occurred in Natal and Caicó, with 9.28% (9/97) and 18.99% (15/79), respectively. The months with the biggest viral circulation in RN were March 2013 and May 2014. The female gender was the most affected, representing 69.07% (67/97) in 2013 and 54.43% (43/79) in 2014. The most affected age groups were 21-30 years (2013) and 11-20 years (2014) with 25.77% (25/97) and 20.25% (16/79) positive cases, respectively. Phylogenetic analysis indicated that genotype V (DENV-1) and genotype II (DENV-4) circulated in the State. Our results provide information about the dynamics of DENV in the Rio Grande do Norte, important for the development of disease control strategies.

Desenvolvimento de métodos para quantificação de benzilpenicilina em medicamentos veterinários e seus resíduos em leite bovino e caprino por UFLC-DAD

The Benzylpenicillin (PENG) have been as the active ingredient in veterinary medicinal products, to increase productivity, due to its therapeutic properties. However, one of unfortunate quality and used indiscriminately, resulting in residues in foods exposed to human consumption, especially in milk that is essential to the diet of children and the ageing. Thus, it is indispensable to develop new methods able to detect this waste food, at levels that are toxic to human health, in order to contribute to the food security of consumers and collaborate with regulatory agencies in an efficient inspection. In this work, were developed methods for the quality control of veterinary drugs based on Benzylpenicillin (PENG) that are used in livestock production. Additionally, were validated methodologies for identifying and quantifying the antibiotic residues in milk bovine and caprine. For this, the analytical control was performed two steps. At first, the groups of samples of medicinal products I, II, III, IV and V, individually, were characterized by medium infrared spectroscopy (4000 – 600 cm-1). Besides, 37 samples, distributed in these groups, were analyzed by spectroscopy in the ultraviolet and near infrared region (UV VIS NIR) and Ultra Fast Liquid Chromatograph coupled to linear arrangement photodiodes (UFLC-DAD). The results of the characterization indicated similarities, between PENG and reference standard samples, primarily in regions of 1818 to 1724 cm-1 of ν C=O that shows primary amides features of PENG. The method by UFLC-DAD presented R on 0.9991. LOD of 7.384 × 10-4 μg mL-1. LOQ of 2.049 × 10-3 μg mL-1. The analysis shows that 62.16% the samples presented purity ≥ 81.21%. The method by spectroscopy in the UV VIS NIR presented medium error ≤ 8 – 12% between the reference and experimental criteria, indicating is a secure choice for rapid determination of PENG. In the second stage, was acquiring a method for the extraction and isolation of PENG by the addition of buffer McIlvaine, used for precipitation of proteins total, at pH 4.0. The results showed excellent recovery values PENG, being close to 92.05% of samples of bovine milk (method 1). While samples of milk goats (method 2) the recovery of PENG were 95.83%. The methods for UFLC-DAD have been validated in accordance with the maximum residue limit (LMR) of 4 μg Kg-1 standardized by CAC/GL16. Validation of the method 1 indicated R by 0.9975. LOD of 7.246 × 10-4 μg mL-1. LOQ de 2.196 × 10-3 μg mL-1. The application of the method 1 showed that 12% the samples presented concentration of residues of PENG > LMR. The method 2 indicated R by 0.9995. LOD 8.251 × 10-4 μg mL-1. LOQ de 2.5270 × 10-3 μg mL-1. The application of the method showed that 15% of the samples were above the tolerable. The comparative analysis between the methods pointed better validation for LCP samples, because the reduction of the matrix effect, on this account the tcalculs < ttable, caused by the increase of recovery of the PENG. In this mode, all the operations developed to deliver simplicity, speed, selectivity, reduced analysis time and reagent use and toxic solvents, particularly if compared to the established methodologies.

Desenvolvimento de métodos para quantificação de benzilpenicilina em medicamentos veterinários e seus resíduos em leite bovino e caprino por UFLC-DAD

The Benzylpenicillin (PENG) have been as the active ingredient in veterinary medicinal products, to increase productivity, due to its therapeutic properties. However, one of unfortunate quality and used indiscriminately, resulting in residues in foods exposed to human consumption, especially in milk that is essential to the diet of children and the ageing. Thus, it is indispensable to develop new methods able to detect this waste food, at levels that are toxic to human health, in order to contribute to the food security of consumers and collaborate with regulatory agencies in an efficient inspection. In this work, were developed methods for the quality control of veterinary drugs based on Benzylpenicillin (PENG) that are used in livestock production. Additionally, were validated methodologies for identifying and quantifying the antibiotic residues in milk bovine and caprine. For this, the analytical control was performed two steps. At first, the groups of samples of medicinal products I, II, III, IV and V, individually, were characterized by medium infrared spectroscopy (4000 – 600 cm-1). Besides, 37 samples, distributed in these groups, were analyzed by spectroscopy in the ultraviolet and near infrared region (UV VIS NIR) and Ultra Fast Liquid Chromatograph coupled to linear arrangement photodiodes (UFLC-DAD). The results of the characterization indicated similarities, between PENG and reference standard samples, primarily in regions of 1818 to 1724 cm-1 of ν C=O that shows primary amides features of PENG. The method by UFLC-DAD presented R on 0.9991. LOD of 7.384 × 10-4 μg mL-1. LOQ of 2.049 × 10-3 μg mL-1. The analysis shows that 62.16% the samples presented purity ≥ 81.21%. The method by spectroscopy in the UV VIS NIR presented medium error ≤ 8 – 12% between the reference and experimental criteria, indicating is a secure choice for rapid determination of PENG. In the second stage, was acquiring a method for the extraction and isolation of PENG by the addition of buffer McIlvaine, used for precipitation of proteins total, at pH 4.0. The results showed excellent recovery values PENG, being close to 92.05% of samples of bovine milk (method 1). While samples of milk goats (method 2) the recovery of PENG were 95.83%. The methods for UFLC-DAD have been validated in accordance with the maximum residue limit (LMR) of 4 μg Kg-1 standardized by CAC/GL16. Validation of the method 1 indicated R by 0.9975. LOD of 7.246 × 10-4 μg mL-1. LOQ de 2.196 × 10-3 μg mL-1. The application of the method 1 showed that 12% the samples presented concentration of residues of PENG > LMR. The method 2 indicated R by 0.9995. LOD 8.251 × 10-4 μg mL-1. LOQ de 2.5270 × 10-3 μg mL-1. The application of the method showed that 15% of the samples were above the tolerable. The comparative analysis between the methods pointed better validation for LCP samples, because the reduction of the matrix effect, on this account the tcalculs < ttable, caused by the increase of recovery of the PENG. In this mode, all the operations developed to deliver simplicity, speed, selectivity, reduced analysis time and reagent use and toxic solvents, particularly if compared to the established methodologies.

Infecção pelo vírus zika na gestação e microcefalia em recém-nascidos: revisão integrativa de literatura

v. 18, n. 1, jan./mar. 2016.

Efectos de los procesos de ultrafiltración y de hidrólisis enzimática sobre las propiedades funcionales del plasma bovino deshidratado

En la Argentina la sangre obtenida del faenado del ganado bovino es considerada un subproducto de menor valor, a pesar de su alto contenido de proteínas de gran calidad. A diferencia de lo que ocurre en algunos países, en los cuales la sangre (o alguno de sus componentes) se utiliza como complemento alimenticio humano, en nuestro país sólo una pequeña fracción de la sangre recolectada es aprovechada, destinándola principalmente a consumo animal. En este trabajo de Tesis se evaluó el potencial como aditivo alimentario humano del plasma bovino deshidratado, un derivado de la sangre bovina que se utiliza únicamente como complemento nutricional animal. En la Primera Parte de este trabajo se obtuvo Plasma Desmineralizado mediante un proceso de diafiltración y se evaluaron algunas de sus propiedades funcionales (Solubilidad, Capacidad de Retención de Agua, capacidad de Retención de Aceite, Capacidad Emulsionante, Capacidad Espumante y Capacidad Antioxidante), comparándolas con las del plasma sin diafiltrar. Como resultado de las tareas llevadas a cabo en esta Primera Parte, se lograron establecer las condiciones operativas para efectuar el proceso de diafiltración de manera eficaz y se pudo evaluar el efecto de dicho proceso sobre las Propiedades Funcionales del plasma consideradas. La Solubilidad del plasma resultó alta en un amplio rango de pH, e incluso mejoró luego del proceso de diafiltración en algunos valores de pH. Los procesos realizados al plasma aumentaron su Capacidad de Retención de Agua; en cambio, su Capacidad de Retención de Aceite disminuyó. El plasma mostró una Capacidad Emulsionante acorde a lo descripto en la bibliografía; la diafiltración y la posterior deshidratación no la afectaron, pero sí aumentaron la estabilidad de las emulsiones formadas. El plasma mostró una gran capacidad para formar espumas estables, las cuales no resultaron afectadas por los procesos efectuados sobre el mismo. El plasma deshidratado original mostró una Capacidad Antioxidante similar a la descripta en la bibliografía. El efecto del proceso de diafiltración sobre la misma no pudo ser establecido. En la Segunda Parte de este trabajo se obtuvieron dos hidrolizados enzimáticos a partir del plasma, utilizando la enzima Alcalase, con diferentes grados de hidrólisis. Se evaluaron las propiedades funcionales de los hidrolizados, comparándolas entre sí y con las del plasma original. Como resultado de estas tareas se definieron las condiciones del proceso de hidrólisis, comprobándose la obtención de fragmentos proteicos y péptidos de distinto tamaño molecular. Con respecto a las Propiedades Funcionales, los hidrolizados obtenidos resultaron ligeramente más solubles que el plasma deshidratado original, y la hidrólisis con Alcalase afectó notoriamente a las propiedades surfactantes de las proteínas plasmáticas, tanto a la Capacidad Emulsionante como a la Capacidad Espumante. En cambio, la hidrólisis enzimática aumentó marcadamente la Capacidad Antioxidante del plasma deshidratado. Los hidrolizados obtenidos presentaron una actividad de secuestro de radicales libres significativamente mayor que la del plasma original, y esa mayor actividad antioxidante resultó asociada al menor tamaño de los péptidos obtenidos. En virtud de los resultados obtenidos, se concluye que el plasma bovino deshidratado, tanto en su forma original como desmineralizado, tiene potenciales aplicaciones como aditivo alimentario para mejorar algunas propiedades funcionales de los alimentos, y que los hidrolizados que se obtuvieron de él con la enzima Alcalase poseen una alta capacidad antioxidante, que los haría viables para ser utilizados como aditivos conservantes para prolongar la vida útil de los alimentos. De ser viable su uso en alimentos humanos, esto aumentaría el valor agregado de este subproducto de la industria cárnica. Por último, se discuten algunas líneas de trabajo que deberían realizarse para completar su posible implementación en la industria alimenticia humana.

Reaproveitamento da lactose presente em permeado de soro de leite bovino em pó para estudo da síntese de lactulose

Dissertação composta por 2 artigos.

Conceções alternativas sobre o sistema respiratório humano: da sua identificação à sua mudança

Relatório de Estágio apresentado à Escola Superior de Educação de Lisboa para obtenção de grau de mestre em Ensino do 1.º e 2.º Ciclos do Ensino Básico