Uso de lopinavir/ritonavir associado com ergotamina resultando em amputação de pé: comunicação breve

Mulher de 32 anos infectada pelo HIV 1, vinha utilizando zidovudina/lamivudina 300/150 mg um comprimido duas vezes ao dia e lopinavir/ritonavir 200/50 mg dois comprimidos duas vezes ao dia e profilaxia com sulfametoxazol-trimetoprim 800/160 mg uma vez ao dia, sem profilaxia com macrolídeos. A paciente apresentou enxaqueca severa com prescrição da associação tartarato de ergotamina 1 mg, cafeína 100 mg, paracetamol 220 mg, sulfato de hiosciamina 87,5 mcg, sulfato de atropina 12,5 mcg, dois comprimidos na crise, seguido de um comprimido a cada 30 minutos, com no máximo seis comprimidos ao dia. A paciente ingeriu seis comprimidos em um dia, surgindo uma dor em tornozelo esquerdo três dias depois, que evoluiu para ergotismo e amputação do pé.A 32-year-old female, was diagnosed in 2004 with a C1 HIV1 infection, using zidovudine/lamivudine 300/150 mg BID and lopinavir/ritonavir 400/100 mg BID, in addition to prophylaxis with trimethoprim-sulfamethoxazole 800/160 mg QD, but no prophylaxis with macrolide antibiotics. The patient presented with a severe headache and was prescribed two capsules of the anti-migraine drug Ormigrein™, which contained ergotamine tartrate 1 mg, caffeine 100 mg, paracetamol 220 mg, hyoscyamine sulfate 87.5 mcg, and atropine sulfate 12.5 mcg. Afterwards she was prescribed one capsule of Ormigrein every 30 minutes for a total of six capsules a day. The patient took the medication as prescribed but developed a pain in her left ankle three days later, which evolved to the need for amputation

Latex allergy: an emerging

Objectives: The current review presents the pathogenic mechanisms, diagnostic and therapeutic and preventive measures to avoid the development of complications related to latex allergy. Method: Literature search electronically from articles already published on the basis of the NCBI / PUBMED / MEDLINE. Results: Manifestations of latex allergy are related to immediate hypersensitivity such as urticaria, angioedema, asthma or even anaphylaxis, or delayed hypersensitivity by a mechanism such as allergic contact dermatitis or primary irritation. Conclusion: Prevention of exposure, replacement and use of latex-free products such as synthetic gloves are essential for those affected. Adjustments in the workplace should be done with gloves without talc, low in allergens or synthetic gloves. These preventive measures significantly reduce the prevalence of allergic reactions

UNIVERSITY HOSPITAL CRISIS IN BRAZIL

RESUMO: Introdução: Indústria da saúde chegou aos Hospitais Universitários(HU) no Brasil, com o contencioso entre o que o paciente quer e o que o Sistema Único de Saúde pode oferecer; HUs são instituições de ensino com a missão de transformar estudantes em profissionais de saúde competentes, desenvolver programas de pesquisa, prática assistencial  na rotina hospitalar diária, além de garantir direitos formais à comunicação, decência, cortesia e respeito.Realidade e Modelo: Há tendência a transformação de instituições de ensino (HUs) em sistemas de assistência à saúde fornecedoras de atendimento médico à população utilizando a prática da medicina baseada em evidência.Política Atual:O Governo Brasileiro estabeleceu nos HU Fundações de Apoio, através das quais os recursos necessários aos HU são transferidos para cobrir suas demandas bem como facilita a possibilidade de receita de planos para seus serviços médicos.Conclusão: É necessária avaliação crítica da situação nos HUs, fortalecendo estas instituições de ensino/pesquisa como instituições completas sociais de atenção à saúde, mas que além de prover saúde, fornece serviços médicos de excelência, contribuem na formação de recursos humanos, em tecnologia e infraestrutura. Descritores:Hospital Universitário,Hospital de Ensino, Crise no Hospital Universitário

UNIVERSITY HOSPITAL CRISIS IN BRAZIL

RESUMO:Introdução: Indústria da saúde chegou aos Hospitais Universitários(HU) no Brasil, com o contencioso entre o que o paciente quer e o que o Sistema Único de Saúde pode oferecer; HUs são instituições de ensino com a missão de transformar estudantes em profissionais de saúde competentes, desenvolver programas de pesquisa, prática assistencial  na rotina hospitalar diária, além de garantir direitos formais à comunicação, decência, cortesia e respeito.Realidade e Modelo: Há tendência a transformação de instituições de ensino (HUs) em sistemas de assistência à saúde fornecedoras de atendimento médico à população utilizando a prática da medicina baseada em evidência.Política Atual:O Governo Brasileiro estabeleceu nos HU Fundações de Apoio, através das quais os recursos necessários aos HU são transferidos para cobrir suas demandas bem como facilita a possibilidade de receita de planos para seus serviços médicos.Conclusão: É necessária avaliação crítica da situação nos HUs, fortalecendo estas instituições de ensino/pesquisa como instituições completas sociais de atenção à saúde, mas que além de prover saúde, fornece serviços médicos de excelência, contribuem na formação de recursos humanos, em tecnologia e infraestrutura. Descritores:Hospital Universitário,Hospital de Ensino, Crise no Hospital Universitário

HIPPOCRATES IS CARE: HISTORY AND SOME BIOLOGICAL PATHWAYS ON CAREGIVER

Abstract Hippocrates is the mainstay of care. Plato and Aristotle state humoralism as the way that Hippocrates understands human health disorders. He closely observed patients to restore humoral equilibrium, relying on healing power of nature to recover health, rejecting drugs or any kind of procedure that could harm the individual. The development of a common ground of understanding is desirable as a process of negotiating treatment goals and methods which may create an atmosphere of support and solidarity. The concept of supportive care was formalized in Belgium in 1992 with attention to multicultural aspect of our population. The biological basis on care are backed on cortical circuitries, association of pathways, existence of several neurotransmitters, which mediates integrative process promoting behavior, emotion and cognitive. Care may influence favorably all these biological systems and help to improve quality of live or even cure the patient. Descriptors: Hippocrates is Care, Biological Basis on Care, Pathways of Care

HIPPOCRATES IS CARE: HISTORY AND SOME BIOLOGICAL PATHWAYS ON CAREGIVER

AbstractHippocrates is the mainstay of care. Plato and Aristotle state humoralism as the way that Hippocrates understands human health disorders. He closely observed patients to restore humoral equilibrium, relying on healing power of nature to recover health, rejecting drugs or any kind of procedure that could harm the individual. The development of a common ground of understanding is desirable as a process of negotiating treatment goals and methods which may create an atmosphere of support and solidarity. The concept of supportive care was formalized in Belgium in 1992 with attention to multicultural aspect of our population. The biological basis on care are backed on cortical circuitries, association of pathways, existence of several neurotransmitters, which mediates integrative process promoting behavior, emotion and cognitive. Care may influence favorably all these biological systems and help to improve quality of live or even cure the patient. Descriptors: Hippocrates is Care, Biological Basis on Care, Pathways of Care

150 YEARS ON CANCER CHALLENGING: WHAT DOES IT MEAN, WHERE ARE WE?

Abstract: Introduction: Cancer comes from Latin language where it means crab. Onco comes from Greek language meaning mass, bulk or tumor. Tumors are classified on biological features as low-grade, intermediate or high-grade malignancy according to tumor cell differentiation. There have been about three hundred thousands of new cancer cases reported per year in Brazil. Tumorigenesis mechanisms, complexity and conflicts: Cancer has been considered a genetic disease caused by mutations in genes governing cell growth or chromosomal events as amplifications, deletions, inversions or translocations. Single nucleotide polymorphisms (SNPs) have been considered associated with cancer. It has been identified 1.42 million polymorphisms in the human genome. Epigenetic gene modulation may be a key mechanism in cancer development and metastasis. Chromatin-histone complex may be modified by phosphorylation, acetylation, methylation and/or ADP-ribosylation. MicroRNAs may be incorporated in mRNA targets and influence several biological processes as development, differentiation and apoptosis. Apoptosis is a way cells undergo programm deaths by activation of extrinsic cell surface death-mediating receptor, activation of mitochondrial mediated intrinsic pathway or non-apoptotic forms of cell death. In cancer there seems be failure, loss or absence of forms of cell death and overactivation of kinase growth factor receptors. Treatment and Prevention: Surgery is the better method to cure patients with solid tumors confined to local disease. Ionizing radiation may be administered as an isolated local form of cure, but also to extend limits of a treated region. Prevention depends on educational strategies, chemopreventive agents or early diagnosis for solid tumors. Advanced forms of cancer presentation are rarely cured and depend on combination of surgery, irradiation, chemotherapy and biological agents. Conclusion: At 150 years on cancer challenging, we do not know what it does really mean, nor even cure, effective treatment or prevention has been achieved. Descriptors: Cancer a non solved problem. Tumorigenesis complex and conflicts mechanisms. Cancer treatment and prevention

Vaginose bacteriana – avaliação da atividade antimicrobiana seletiva de gel de Schinus terebinthifolia raddi

O microbioma vaginal sofre contínua flutuação durante o ciclo menstrual e após a menopausa. Albert Döderlein foi o primeiro a descrever sobre bactérias produtoras de ácido láctico na cavidade vaginal. Tais bactérias são capazes de inibir o crescimento de microrganismos anaeróbios e patogênicos. Quando há a redução desses lactobacilos, há proliferação de bactérias oportunistas como as do gênero Gardnerella. A vaginose bacteriana (VB) é uma patologia não sexualmente transmissível, caracterizada pelo aumento do número de bactérias anaeróbias e do pH vaginal, ocasionando um corrimento vaginal acinzentado e de odor fétido. A prevalência estimada é alta, no entanto a cura efetiva e duradoura é ainda incerta. Essa falha em tratar adequadamente tem motivado a busca de alternativas terapêuticas, que consigam tratar e prevenir as possíveis recidivas da patologia1. No Brasil, a espécie Schinus terebinthifolia Raddi (aroeira-da-praia) é bem conhecida, e um ensaio clínico mostrou sua atuação de forma eficaz no tratamento da VB, bem como a recomposição da microbiota vaginal. O presente estudo tem por objetivo determinar a capacidade do gel de Schinus terebinthifolia Raddi em inibir o crescimento dos microrganismos Lactobacillus gasseri ATCC 19992 e Gardnerella vaginalis ATCC 14018. Foram usados Lactobacillus gasseri ATCC 19992 e Gardnerella vaginalis ATCC 14018. As culturas de trabalho foram produzidas com incubação a 36°±1°C por 24 horas. Foram efetuados pequenos poços nas placas com meio de cultura, onde a amostra teste foi inoculada. As placas foram incubadas por 48 horas a temperatura de 30°C. Não foi observado halo de inibição contra L. gasseri, enquanto que foi observado halo de inibição contra G. vaginalis. Tais dados, demonstram que o gel de Schinus terebinthifolia Raddi tem ação anaerobicida contra um dos principais microrganismos causadores da VB e, ao mesmo tempo, não apresenta nenhuma alteração na formação das colônias de L. gasseri, um dos lactobacilos da microbiota vaginal

150 YEARS ON CANCER CHALLENGING: WHAT DOES IT MEAN, WHERE ARE WE?

Abstract: Introduction: Cancer comes from Latin language where it means crab. Onco comes from Greek language meaning mass, bulk or tumor. Tumors are classified on biological features as low-grade, intermediate or high-grade malignancy according to tumor cell differentiation. There have been about three hundred thousands of new cancer cases reported per year in Brazil. Tumorigenesis mechanisms, complexity and conflicts: Cancer has been considered a genetic disease caused by mutations in genes governing cell growth or chromosomal events as amplifications, deletions, inversions or translocations. Single nucleotide polymorphisms (SNPs) have been considered associated with cancer. It has been identified 1.42 million polymorphisms in the human genome. Epigenetic gene modulation may be a key mechanism in cancer development and metastasis. Chromatin-histone complex may be modified by phosphorylation, acetylation, methylation and/or ADP-ribosylation. MicroRNAs may be incorporated in mRNA targets and influence several biological processes as development, differentiation and apoptosis. Apoptosis is a way cells undergo programm deaths by activation of extrinsic cell surface death-mediating receptor, activation of mitochondrial mediated intrinsic pathway or non-apoptotic forms of cell death. In cancer there seems be failure, loss or absence of forms of cell death and overactivation of kinase growth factor receptors. Treatment and Prevention: Surgery is the better method to cure patients with solid tumors confined to local disease. Ionizing radiation may be administered as an isolated local form of cure, but also to extend limits of a treated region. Prevention depends on educational strategies, chemopreventive agents or early diagnosis for solid tumors. Advanced forms of cancer presentation are rarely cured and depend on combination of surgery, irradiation, chemotherapy and biological agents. Conclusion: At 150 years on cancer challenging, we do not know what it does really mean, nor even cure, effective treatment or prevention has been achieved. Descriptors: Cancer a non solved problem. Tumorigenesis complex and conflicts mechanisms. Cancer treatment and prevention