999 resultados para Tuberculose resistente a múltiplos medicamentos
Resumo:
Com o objetivo de avaliar as características do consumo de medicamentos na população urbana de Araraquara, SP, Brasil, foram coletados dados, por meio de entrevistas domiciliares, de uma amostra da população que consumiu pelo menos um medicamento nos quinze dias que antecederam a data da entrevista. O estudo foi realizado no período de agosto a setembro de 1985. Verificou-se que 42,1% dos medicamentos utilizados foram adquiridos sem prescrição médica. O consumo entre o sexo feminino foi maior que para o sexo masculino. Na automedicação o grupo que apresentou taxa mais elevada, segundo a faixa etária, foi o de 50 anos e mais, com 31,6%. Grande parte do consumo de medicamentos constituiu-se dos industrializados (97,6%). As prescrições médicas, feitas em consultas anteriores, e avalia das como bem sucedidas foram retomadas em situações diversas (12,0%), revelando o importante papel que o médico desempenha na formação dos critérios de escolha dos remédios utilizados nas práticas de automedicação. O farmacêutico e/ou balconista de farmácia contribui com 10,0% dos medicamentos usados que tiveram essa via de indicação. As orientações feitas por amigos, vizinhos e parentes (9,1%) revelaram intenso circuito de trocas de socializações quanto aos quadros móbidos e indicações terapêuticas.
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The inventory management in hospitals is of paramount importance, since the supply materials and drugs interruption can cause irreparable damage to human lives while excess inventories involves immobilization of capital. Hospitals should use techniques of inventory management to perform replenishment in shorter and shorter intervals, in order to reduce inventories and fixed assets and meet citizens requirements properly. The inventory management can be an even bigger problem for public hospitals, which have restrictions on the use of resources and decisionmaking structure more bureaucratized. Currently the University Hospital Onofre Lopes (HUOL) uses a periodic replacement policy for hospital medical supplies and medicines, which involves one moment surplus stock replenishment, the next out of stock items. This study aims to propose a system for continuous replenishment through order point for inventory of medical supplies and medicines to the hospital HUOL. Therefore, a literature review of Federal University Hospitals Management, Logistics, Inventory Management and Replenishment System in Hospitals was performed, emphasizing the demand forecast, classification or ABC curve and order point system. And also, policies of inventory management and the current proposal were described, dealing with profile of the mentioned institution, the current policy of inventory management and simulation for continuous replenishment order point. For the simulation, the sample consisted of 102 and 44 items of medical and hospital drugs, respectively, selected using the ABC classification of inventory, prioritizing items of Class A, which contains the most relevant items in added value, representing 80 % of the financial value in 2012 fiscal year. Considering that it is a public organization, subject to the laws, we performed two simulations: the first, following the signs for inventory management of Instruction No. 205 (IN 205 ), from Secretary of Public Administration of the Presidency ( SEDAP / PR ), and the second, based on the literature specializing in inventory management hospital. The results of two simulations were compared to the current policy of replenishment system. Among these results are: an indication that the system for continuous replenishment reorder point based on IN 205 provides lower levels of safety stock and maximum stock, enables a 17% reduction in the amount spent for the full replenishment of inventories, in other words, decreasing capital assets, as well as reduction in stock quantity, also the simulation made from the literature has indicated parameters that prevent the application of this technique to all items of the sample. Hence, a change in inventory management of HUOL, with the application of the continuous replenishment according to IN 205, provides a significant reduction in acquisition costs of medical and hospital medicine
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The present study aimed to evaluate the inclusion of the principles of the National Medicines Policy - PNM and the Pharmaceutical assistance - PNAF in the prosecution of lawsuits involving medicines. To fulfill this necessity , data collection was performed on the website by the Tribunal Rio Grande do Norte - TJ RN ( Rio Grande do Norte Court) , in 2012 . It was obtained 115 judgments, which were analyzed in order to generate Monitoring Indicators from lawsuits and conduct content analysis proposed by Bardin (2006). The results showed that : a) 100 % of the decisions were favorable to the author , b) 76 % of decisions were requests by the trade name of the drug , c) only one drug (eculizumabe) had not granted by ANVISA , d) 36 % of drugs were present in the list of standard medicines in SUS , 16 % of primary care block and 20 % of specialized component , e) 76 % of the decisions presented the request of at least 01 non-standard medicine. With regard to decentralization of PNM and PNAF we observed a commitment to this principle at judicial decisions, to see that municipalities and states are often forced to buy medicines of responsibility from another federal entity or other tertiary units as CACONs and UNACONS. The content analysis revealed that the argument from the judges used when you utter their decisions was that the right to health is recognized by Brazilian law as a fundamental right and should be guaranteed by the State for all its citizens. So, health is more than budgetary constraints of federal entities, which are severally liable for lawsuits , regardless the medication requested belongs or not to a particular block of a pharmaceutical assistance funding. Given these data, it is observed that there are gaps in the judgment when it comes to the insertion of the words and principles of PNM and PNAF, creating then the need for greater dialogue between the executive and judicial, so that they may consider relevant the effectiveness and application of such principles to minimize the negative consequences of the phenomenon of health judicialisation. Keywords: Judicialisation, Medicines, Public Policy, Pharmaceutical Care
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This work was concerned to investigate the meaning attributed to anxiolytic drugs by women, in public health service. It proposes a joint analysis through a link between three dimensions: the woman, the drug, and public health service itself, in an hegemonic medical assistance model. It is observed that the relation between these elements has a great influence over the use and construction of a particular meaning, by the user. The medication is analysed as a consumption merchandise and as an health symbol. In this way, it reflects a biologized vision, which believes the drug as a solution for all health problems. It tries to analyse the generalized medical prescription for anxiolythics and it s consequences. It focalizes also the production and utilization of public health services by patients, mainly women. The question related to the use of anxiolytics and the meaning construted by women is analysed focusing the way that relations of masculine/feminine gender are organized in our society. At this point of view, it tries to understand the dimension that these questions have in subjectivity production, and how it acts in the health/disease process. Finally, this work tries to understand, in a broad sense, the use of anxiolytics looking at the problem not only as a biological question, but also as a cultural matter. The research was done over seventeen women, all of them anxiolytic users. It was used, as research instrument, semi-structured interview associated with methodological analysis of user s speeches
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This study aimed to apply, thermogravimetriy /derivative Thermogravimetriy (TG/DTG), differential scanning calorimetry (DSC), Differential Thermal Analysis (DTA), to conduct a comparative study on drug reference, generic and whose active principles are similar captopril hydrochlorothiazide, ampicillin, paracetamol, aspirin and mebendazole sold in local pharmacies. Samples of the active ingredients and dosage forms were also characterized by absorption infrared spectroscopy (IR), X-ray diffraction (XRD) and microscopy scanning electron (SEM). The TG / DTG curves showed a general similarity in the thermal behavior of the samples, but also showed the influence of excipients on the thermal stability. The DSC curve of the generic base hydrochlorothiazide showed no peak on the fusion of the drug due to interference of lactose as a diluent, which causes interaction with the active principle causing their degradation before the merger. The DSC curves of the drugs consisting of paracetamol showed reproducibility at the melting point of the active and the other thermal events. The DSC result of binary mixtures involving captopril / magnesium stearate and mebendazole/magnesium stearate showed possible interactions or incompatibilities evidenced by the displacement of the melting point of both drugs. The other mixtures showed no change. The infrared spectra presented were very similar, indicating the presence of functional groups characteristic of the constituents of the samples. The X-ray diffraction showed peaks indicative of crystalline structure of the active ingredients as well as some of the ingredients in the formulation of the drug and the micrographs indicate a general heterogeneity in the size distribution of particles in the samples
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The present study utilized the thermogravimetry (TG) and optical emission spectroscopy with inductively coupled plasma - ICP / OES to determine the calcium content in tablets of carbonate, citrate and calcium lactate used in the treatment of osteoporosis. The samples were characterized by IR, SEM, TG / DTG, DTA, DSC and XRD. The thermal analysis evaluated the thermal stability and physical-chemical events and showed that the excipients influence the decomposition of active ingredients. The results of thermogravimetry indicated that the decomposition temperature of the active CaCO3 (T = 630.2 °C) is lower compared to that obtained in samples of the tablets (633.4 to 655.2 °C) except for sample AM 2 (Ti = 613.8 oC). In 500.0 °C in the samples of citrate and calcium lactate, as well as their respective active principles had already been formed calcium carbonate. The use of N2 atmosphere resulted in shifting the initial and final temperature related to the decomposition of CaCO3. In the DTA and DSC curves were observed endo and exothermic events for the samples of tablets and active ingredients studied. The infrared spectra identified the main functional groups in all samples of active ingredients, excipients and tablets studied, such as symmetric and asymmetric stretches of the groups OH, CH, C = O. Analysis by X-ray diffraction showed that all samples are crystalline and that the final residue showed peaks indicative of the presence of calcium hydroxide by the reaction of calcium oxide with moisture of the air. Although the samples AM 1, AM 2, AM 3 and AM 6 in their formulations have TiO2 and SiO2 peaks were not observed in X-ray diffractograms of these compounds. The results obtained by TGA to determine the calcium content of the drugs studied were satisfactory when compared with those obtained by ICP-OES. In the AM 1 tablet was obtained the content of 35.37% and 32.62% for TG by ICP-OES, at 6 AM a percentage of 17.77% and 16.82% and for AM 7 results obtained were 8.93% for both techniques, showing that the thermogravimetry can be used to determine the percentage of calcium in tablets. The technique offers speed, economy in the use of samples and procedures eliminating the use of acid reagents in the process of the sample and efficiency results.
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The camera motion estimation represents one of the fundamental problems in Computer Vision and it may be solved by several methods. Preemptive RANSAC is one of them, which in spite of its robustness and speed possesses a lack of flexibility related to the requirements of applications and hardware platforms using it. In this work, we propose an improvement to the structure of Preemptive RANSAC in order to overcome such limitations and make it feasible to execute on devices with heterogeneous resources (specially low budget systems) under tighter time and accuracy constraints. We derived a function called BRUMA from Preemptive RANSAC, which is able to generalize several preemption schemes, allowing previously fixed parameters (block size and elimination factor) to be changed according the applications constraints. We also propose the Generalized Preemptive RANSAC method, which allows to determine the maximum number of hipotheses an algorithm may generate. The experiments performed show the superiority of our method in the expected scenarios. Moreover, additional experiments show that the multimethod hypotheses generation achieved more robust results related to the variability in the set of evaluated motion directions
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OBJETIVO: Verificar a proporção de pacientes com baciloscopia negativa no pré-operatório e que apresentaram TB ativa na peça cirúrgica. MÉTODOS: Estudo retrospectivo de pacientes com diagnóstico histopatológico de TB ativa ou sequelar e operados entre os anos de 2003 e 2006 em um hospital universitário. Foram pesquisados antecedentes e aspectos clínicos relativos à doença, pesquisa de bacilos álcool-ácido resistentes (BAAR), tipo de cirurgia realizada e exame histopatológico da peça cirúrgica. RESULTADOS: Foram incluídos 43 pacientes, com média de idade de 44 ± 19 anos, sendo 27 do sexo masculino. Apresentavam história prévia de TB com tratamento adequado 28 pacientes, e 15 não referiam antecedentes para TB. O principal motivo da procura pelo serviço foi infecção de repetição, seguida por achados em exames de imagem. Dos 43 pacientes, foi pesquisado BAAR no pré-operatório em 35: 32 apresentaram resultados negativos e 3, resultados positivos. Dos 35 pacientes pesquisados, 26 apresentavam diagnóstico histopatológico de TB ativa e 9 de TB sequelar na peça cirúrgica; os outros 8 também foram diagnosticados com TB sequelar. A proporção de TB ativa em doentes com baciloscopia negativa foi de 72% (23/32), e o de baciloscopia negativa em TB ativa foi de 88% (23/26), sendo a pesquisa de BAAR positiva somente em 11,5% (3/26). CONCLUSÕES: A baciloscopia direta tem rendimento muito baixo, e muitos pacientes mesmo já tratados podem permanecer com TB em atividade com baciloscopia negativa. A TB ativa pode ser confundida com infecções secundárias ou com câncer.
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This work presents an User Interface (UI) prototypes generation process to the softwares that has a Web browser as a plataform. This process uses UI components more complex than HTML elements. To described this components more complex this work suggest to use the XICL (eXtensinble User Interface Components Language). XICL is a language, based on XML syntax, to describe UI Components and IUs. XICL promotes extensibility and reusability in the User Interface development process. We have developed two compiler. The first one compiles IMML (Interactive Message Modeling Language) code and generates XICL code. The second one compiles XICL code and generates DHTML code
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The northeastern semiarid is a region that presents a serious picture stagnation or slowness of the economic growth, beyond the presence of social pointers below of the averages national and regional. The half-dryness conditions become the improper region for many agricultural cultures, what it affects the local populations directly, as well as the economy that is based mainly on agriculture. Cnidoscolus quercifolius Pohl, popularly know as favelone is a native species of the semiarid region that withholds great potential for the development of the region in virtue of its multiple uses. Being an oleaginous, its production in familiar farmings makes with that biodiesel either for the misery an important alternative eradication for the possibility of occupation of enormous contingents of people. The present study it aims at to evaluate the germination of the faveleira without thorns under conditions of water and saline stresses, main stresses which the vegetal species of the semiarid one are submitted; beyond verifying the acceptance of the species for agriculturists of a cooperative in the city of Apodi/RN. The methodology used for germination corresponds to using treatments with polyethylene glycol and sodium chloride to assess water and salt stress respectively, being held in rolo. O system approach used for the verification of acceptance of faveleira was the use of interview with farmers cooperative in the study area determined. In this direction it was verified that the faveleira is a resistant species the conditions of drought and salinity of the ground, factor of great relevance, since one is about a species with high added value, making possible the development for the semiarid region. It was verified that the agriculturists are favorable the introduction of the faveleira and reveal receptive the idea to cultivate a species with potential for production of biodiesel
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Considering that osteopenia and osteoporosis are diabetes mellitus complications, and that tamoxifen (TAM) is an anti-estrogenic drug used in breast cancer treatment, this drug may have a beneficial action preventing accentuaded bone loss associated to diabetes. Female Wistar rats (n=60) weighting 180-250g were divided in four groups: Group C, control animals (n=5); Group T, animals treated with TAM (n=5); Group D, diabetic animals (n=5); and Group DT, diabetic animals treated with TAM (n=5). Oestrus cycle was evaluated before the beggining of experimental period to select the animals with regular cycle. This evaluation continued throughout the study period and for all studied groups. Diabetes was induced by a intra perithoneal injection of streptozotocin (STZ) in a concentration of 45 mg/Kg of body weight. Those animals with serum glicose levels 250 mg/dL were considered diabetics. Animals were sacrificed in the periods of 30, 60 and 90 days after diabetes onset. Left femur histomorphometric measurements and serum biochemical analysis (glycemia, alkaline phosphatase, tartaric-resistant acid phosphatase, calcium, phosphorous, magnesium, total proteins, albumin, globulins, urea and creatinine) were done. Histomorphometric results showed a progressive bone loss in Group D animals when compared to those from Group C all over the experimental period, becoming accentuaded in the 90 days period. In relation to Groups T and DT, values approcimated to those obtained for control group were found during the whole period of study. Those data may indicate a bone mass recovery or a diminished bone loss due to diabetes when animals were treated with TAM. During the whole experimental period animals of groups D and DT maintained glycemic levels above 250 mg/dL whereas animals of groups C and T maintained those levels below 150mg/dL. Alkaline phosphatase activity was increased in all study periods for groups D and DT when compared to group C animals over the 90 days period. Tartarate-resistant acid phosphatase activity was showed unaltered in all periods of study and for all groups. Calcium and magnesium results were also unaltered, maintaining reference levels for all groups in all experimental periods. Phosphorous levels were increased in groups D and DT when compared to groups C and T in the 30 days period. However no difference was found in the periods of 60 and 90 days for this test. No difference was found for total proteins levels for groups C, T, D and DT over the study period. Albumin levels were reduced in DT group in the 60 days period and in D and DT groups in the 90 days period. Urea levels were significantly increased in the 30, 60 and 90 days study periods in groups D and DT when compared to groups C and T. Creatinine results showed a significantly increase in the 90 days period for groups D and DT when compared to groups C and T, and maintaining unaltered in the 30 and 60 days periods. These results suggest that the treatment with TAM may reduce bone loss caused by diabetes mellitus
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OBJETIVO: Analisar o padrão de citocinas pró- e antiinflamatórias e da resposta de fase aguda (RFA) como marcadores de resposta ao tratamento da tuberculose pulmonar. MÉTODOS: Determinação dos níveis de interferon-gama (IFN-γ), tumor necrosis factor-alpha (TNF-α, fator de necrose tumoral-alfa), interleucina-10 (IL-10) e transforming growth factor-beta (TGF-β, fator transformador de crescimento-beta), pelo método ELISA, em sobrenadante de cultura de células mononucleares do sangue periférico e monócitos, assim como dos níveis de proteínas totais, albumina, globulinas, alfa-1-glicoproteína ácida (AGA), proteína C reativa (PCR) e velocidade de hemossedimentação (VHS) em 28 doentes com tuberculose pulmonar, em três tempos: antes (T0), aos três meses (T3) e aos seis meses (T6) de tratamento, em relação aos controles saudáveis, em um único tempo. RESULTADOS: Os pacientes apresentaram valores maiores de citocinas e RFA que os controles em T0, com diminuição em T3 e diminuição (TNF-α, IL-10, TGF-β, AGA e VHS) ou normalização (IFN-γ e PCR) em T6. CONCLUSÕES: PCR, AGA e VHS são possíveis marcadores para auxiliar no diagnóstico de tuberculose pulmonar e na indicação de tratamento de indivíduos com baciloscopia negativa; PCR (T0 > T3 > T6 = referência) pode também ser marcador de resposta ao tratamento. Antes do tratamento, o perfil Th0 (IFN-γ, IL-10, TNF-α e TGF-β), indutor de e protetor contra inflamação, prevaleceu nos pacientes; em T6, prevaleceu o perfil Th2 (IL-10, TNF-α e TGF-β), protetor contra efeito nocivo pró-inflamatório do TNF-α ainda presente. O comportamento do IFN-γ (T0 > T3 > T6 = controle) sugere sua utilização como marcador de resposta ao tratamento.
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Entre 6.316 necropsias realizadas, no período de 1969 a 2000, no Departamento de Patologia da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista (FMB/UNESP), foram encontradas 240 necropsias com diagnóstico de tuberculose, sendo 117 registradas como doença principal (grupo tuberculose/doença principal) e 123, como doença associada (grupo tuberculose/doença associada). No grupo tuberculose/doença principal, 100% apresentavam tuberculose ativa, com 80 ocorrências em homens e 37 em mulheres e média de idade de 47,7 anos. Caquexia (37,2%) e cor pulmonale (23,7%) foram as co-morbidades mais prevalentes nesse grupo. Os pulmões estavam comprometidos em 95,7% dos casos, seguido pelos linfonodos (38,9%) e pleuras (27,1%). Os padrões morfológicos das lesões pulmonares foram: 1. miliar, 58,4%; 2. cavernas, 56,6%; 3. fibrose, 41,5%; 4. bronquiectasias, 26,5%; 5. enfisema, 19,4%; e 6. cistos, 1,7%. Cavernas foram observadas em diferentes áreas, com discreto predomínio no pulmão direito, sendo a localização apical preferencial (100%) e quase sempre bilaterais (94%). Lesões miliares, bronquiectasias e fibrose estavam distribuídas, de forma difusa e aleatória, nos pulmões. No grupo tuberculose/doença associada também houve predomínio de homens (70,8%). Nesses casos, a AIDS e o alcoolismo crônico foram as doenças principais mais freqüentes, representando 22% e 16,3%, respectivamente. Os pulmões estavam acometidos em 85,2% dessas necropsias (100% nos casos de AIDS), seguidos pelos linfonodos (31,9%) e baço (28,6%). Nossos dados corroboram a importância da necropsia no estudo e no conhecimento da tuberculose, fornecendo subsídios para uma melhor abordagem clínica e epidemiológica dessa doença em nossa região.
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O diagnóstico da situação da tuberculose pulmonar nos Municípios de Botucatu, Conchas, São Manuel e Avaré, SP, Brasil, baseou-se na prevalência e risco de infecção em escolares de lª série, em 1972, e em dados de morbidade e mortalidade específica, de 1963 a 1972. Realizou-se inquérito tuberculínico em 2.913 escolares, com PPD 23 RT-2UT; foram analisados os prontuários de 718 casos inscritos no CSI de Botucatu e os atestados de óbito de residentes, incluindo-se os ocorridos em hospitais especializados. As taxas de prevalência de infecção para os quatro Municípios foram respectivamente 2,4%; 6,8%; 1,9% e 4,5%. Para a idade de 7,5 anos, os riscos de infecção foram: 0,27%; 0,32; 0,20% e 0,34%. O nível de infecção apurado caracterizou o conjunto como área de média prevalência da tuberculose pulmonar. Os índices de prevalência de infecção relacionaram-se diretamente à incidência de casos bacilíferos de cada Município. em 530 casos com baciloscopia, houve 62,0% de positividade. As formas radiológicas moderada e avançada predominaram principalmente em adultos jovens do sexo masculino. Foram registradas alta taxa de abandono (39,5%}, baixo percentual de cura (17,9%) e 3,4% de óbitos; ao redor de 32,0% estava em tratamento. Não houve diferenças estatisticamente significativas das proporções de abandono, segundo procedência por Município ou formas da doença. Invocaram-se razões técnico-administrativas do sistema vigente para explicar esses achados. A incidência média de casos confirmados, no período, foi de 35,4 em Conchas, 33,1 em Avaré, 23,7 em Botucatu e 18,5 em São Manuel (por 100.000). Com casos confirmados e suspeitos os índices foram: 57,6; 48,8; 43,8 e 35,3. Os índices médio-anuais de mortalidade, foram: 7,6 em Botucatu, 12,14 em Conchas, 5,0 em São Manuel e 18,7 em Avaré (por 100.000). Apenas em Botucatu registrou-se declínio das taxas de mortalidade de 1963 a 1972. A mortalidade específica em adultos jovens ainda era elevada, predominando no sexo masculino, principalmente em Conchas. Sublinhou-se a necessidade de descentralizar as atividades antituberculose para atingir um controle eficiente.
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OBJETIVO: Analisar o consumo de medicamentos e os principais grupos terapêuticos consumidos por pessoas com deficiências físicas, auditivas ou visuais. MÉTODOS: Estudo transversal em que foram analisados dados do Inquérito Multicêntrico de Saúde no Estado de São Paulo (ISA-SP) em 2002 e do Inquérito de Saúde no Município de São Paulo (ISA-Capital), realizado em 2003. Os entrevistados que referiram deficiências foram estudados segundo as variáveis que compõem o banco de dados: área, sexo, renda, faixa etária, raça, consumo de medicamentos e tipos de medicamentos consumidos. RESULTADOS: A percentagem de consumo entre as pessoas com deficiência foi de: 62,8% entre os visuais; 60,2% entre os auditivos e 70,1% entre os físicos. As pessoas com deficiência física consumiram 20% mais medicamentos que os não-deficientes. Entre as pessoas com deficiência visual, os medicamentos mais consumidos foram os diuréticos, agentes do sistema renina-angiotensina e analgésicos. Pessoas com deficiência auditiva utilizaram mais analgésicos e agentes do sistema renina-angiotensina. Entre indivíduos com deficiência física, analgésicos, antitrombóticos e agentes do sistema renina-angiotensina foram os medicamentos mais consumidos. CONCLUSÕES: Houve maior consumo de medicamentos entre as pessoas com deficiências quando comparados com os não-deficientes, sendo os indivíduos com deficiência física os que mais consumiram fármacos, seguidos de deficientes visuais e auditivos.