Adesão à terapêutica em diabéticos do tipo 2

Antecedentes/Objetivos: Atualmente regista-se um aumento significativo dos casos de Diabetes mellitus tipo 2 a nível mundial e em idades cada vez mais precoces (WHO, 2003; SPD, 2012). Segundo a SPD (2012), a prevalência desta patologia, em Portugal, em 2011, foi de 7,0%. Esta doença carateriza-se pelo aumento dos níveis de glicose no sangue, a hiperglicemia, que se deve, à insuficiente produção de insulina e/ou, à ação insuficiente da mesma (WHO, 2003; Nogueira et al, 2006; SPD, 2012). Na literatura a adesão terapêutica é retratada como o grau de concordância do comportamento do doente face às indicações do médico ou outro profissional de saúde, ao nível do cumprimento da prescrição médica e ao nível das indicações relativas ao estilo de vida e comportamentos saudáveis (WHO, 2003). Foram objetivos desta investigação determinar a adesão à terapêutica em diabéticos do tipo 2, utentes de uma farmácia comunitária localizada no concelho de Bragança, e identificar os motivos que mais contribuíram para a não adesão à terapêutica. Métodos: Estudo quantitativo transversal e analítico. A recolha de dados foi feita no período de janeiro a março de 2012 usando uma técnica de amostragem não probabilística acidental. Os utentes da farmácia foram abordados e convidados a participar, voluntariamente, no presente estudo aquando da dispensa de antidiabéticos orais (ADO). Na recolha de dados foi utilizado o teste de adesão ao tratamento (MAT), desenvolvido e validado para Portugal por Delgado & Lima (2001) e adaptado por Gimenes et al (2009). Participaram neste estudo 35 indivíduos com idades compreendidas entre os 48 e os 90 anos, sendo a maioria do género feminino (57,1%). Resultados: Relativamente à terapêutica medicamentosa, 91,4% dos utentes utilizam apenas antidiabéticos orais, 2,9% associam os antidiabéticos orais à insulina e 2,9% apenas utilizam insulina. Os resultados revelam que a esmagadora maioria (97,1%) adere à terapêutica medicamentosa. A hora da toma, seguido do esquecimento e do abandono da toma sem indicação médica foram os fatores que mais contribuíram para uma menor adesão à terapêutica. A dieta, o exercício físico e a toma de medicamentos associada a outras patologias mostram ser diferenciadoras do grau de adesão. Conclusiones: Esta investigação aponta para a necessidade do reforço das informações prestadas aos utentes com recurso a ferramentas que auxiliem o cumprimento das dosagens e horários. O uso de pictogramas, de informação escrita nas embalagens, a utilização de caixas multidose, entre outras medidas, são contributos, pouco dispendiosos e úteis, que ajudam a melhorar o grau de adesão à terapêutica medicamentosa

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Treatment adherence in type 2 diabetics

Atualmente regista-se um aumento significativo dos casos de Diabetes mellitus tipo 2 a nível mundial e em idades cada vez mais precoces (WHO, 2003; SPD, 2012). Segundo a SPD (2012), a prevalência desta patologia, em Portugal, em 2011, foi de 7,0%. Esta doença carateriza-se pelo aumento dos níveis de glicose no sangue, a hiperglicemia, que se deve, à insuficiente produção de insulina e/ou, à ação insuficiente da mesma (WHO, 2003; Nogueira et al, 2006; SPD, 2012). Na literatura a adesão terapêutica é retratada como o grau de concordância do comportamento do doente face às indicações do médico ou outro profissional de saúde, ao nível do cumprimento da prescrição médica e ao nível das indicações relativas ao estilo de vida e comportamentos saudáveis (WHO, 2003). Foram objetivos desta investigação determinar a adesão à terapêutica em diabéticos do tipo 2, utentes de uma farmácia comunitária localizada no concelho de Bragança, e identificar os motivos que mais contribuíram para a não adesão à terapêutica. Este estudo é quantitativo, transversal. A recolha de dados foi feita de janeiro a março de 2012 usando uma técnica de amostragem não probabilística acidental. Os utentes da farmácia foram abordados e convidados a participar, voluntariamente aquando da dispensa de antidiabéticos orais (ADO). Na recolha de dados foi utilizado o teste de adesão ao tratamento (MAT), desenvolvido e validado para Portugal por Delgado & Lima (2001) e adaptado por Gimenes et al (2009). Participaram neste estudo 35 indivíduos com idades compreendidas entre os 48 e os 90 anos, sendo a maioria do género feminino (57,1%) Relativamente à terapêutica medicamentosa, 91,4% dos utentes utilizam apenas antidiabéticos orais, 2,9% associam os antidiabéticos orais à insulina e 2,9% apenas utilizam insulina. Os resultados revelam que a esmagadora maioria (97,1%) adere à terapêutica medicamentosa. A hora da toma, seguido do esquecimento e do abandono da toma sem indicação médica foram os fatores que mais contribuíram para uma menor adesão à terapêutica. Esta investigação aponta para a necessidade do reforço das informações prestadas aos utentes com recurso a ferramentas que auxiliem o cumprimento das dosagens e horários. O uso de pictogramas, de informação escrita nas embalagens, a utilização de caixas multidose, entre outras medidas, são contributos, pouco dispendiosos e úteis, que ajudam a melhorar o grau de adesão à terapêutica medicamentosa

A evasão no ensino superior privado: um estudo de caso em uma instituição de ensino brasileira

O objetivo deste estudo foi analisar a contribuição do marketing de relacionamento na redução da evasão discente do curso de administração de uma instituição de ensino superior privada do estado de São Paulo. Considerando o aumento da competitividade no setor educacional privado, as instituições de ensino superior começam a identificar a necessidade de estabelecer relacionamentos mais duradouros com os alunos-clientes, focando esforços desde o ingresso do estudante na faculdad

Blomia tropicalis Blo t 5 and Blo t 21 recombinant allergens might confer higher specificity to serodiagnostic assays than whole mite extract.

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2014-08-25T17:06:11Z No. of bitstreams: 1 CArvalho KA Blomia tropicalis....pdf: 663542 bytes, checksum: 347309bf124c30836985962ab870eb34 (MD5)Made available in DSpace on 2014-08-25T17:06:12Z (GMT). No. of bitstreams: 1 CArvalho KA Blomia tropicalis....pdf: 663542 bytes, checksum: 347309bf124c30836985962ab870eb34 (MD5) Previous issue date: 2013Universidade Federal da Bahia. ProAR Núcleo de Excelência em Asma. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Aggeu Magalhães. Recife, PE, Brasil.Associação Caruaruense de Ensino Superior. Caruaru, PE, Brasil.Universidade Federal da Bahia. Instituto de Ciências da Saúde. Laboratório de Alergia e Acarologia. Salvador, BA, Brasil.Universidade Federal da Bahia. Instituto de Ciências da Saúde. Laboratório de Alergia e Acarologia. Salvador, BA, BrasilUniversidade Federal da Bahia. Instituto de Matemática. Salvador, BA, Brasil.Centro Estudos de Alergias Respiratórias. Salvador, BA, Brasil.Centro Estudos de Alergias Respiratórias. Salvador, BA, Brasil / Universidade Federal da Bahia. ProAR Núcleo de Excelência em Asma. Salvador, BA, Brasil.Universidade Federal da Bahia. ProAR Núcleo de Excelência em Asma. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil.Universidade Federal da Bahia. ProAR Núcleo de Excelência em Asma. Salvador, BA, Brasil.BACKGROUND: Blomia tropicalis is a dust mite and an important source of allergens in tropical regions. Up to now, the assays to diagnose atopy to this mite use whole body extract as antigens. However, anti-B. tropicalis IgE antibodies cross-react with Ascaris lumbricoides antigens, hindering the diagnosis of allergy to this mite. In this study, B. tropicalis recombinant allergens were evaluated with the purpose of developing an immunodiagnostic assay for allergy to this mite with greater specificity than those commercially available. METHODS: Two B. tropicalis allergens (Blo t 5 and Blo t 21) were cloned into a plasmidial expression vector, expressed in Escherichia coli and purified by affinity chromatography. Sixty-three sera containing anti-B. tropicalis extract (BtE) IgE antibodies were used to investigate IgE reactivity to the recombinant Blot 5 and 21 allergens. Inhibition assays with 20 sera pre-adsorbed with A. lumbricoides extract were performed using rBlo t 5, rBlo t 21, and BtE as antigens. All the assays were carried using indirect ELISA. RESULTS: Eighty-two point nine percent and 80.0% of the sera with anti-BtE antibodies from 35 children reacted with rBlo t 5 and rBlo t 21, respectively, whereas 92.8% and 89.3% of the 28 sera with anti-BtE antibodies from adult asthma patients reacted with the same allergens, and 96.4% of these sera reacted with a mixture of rBlo t 5 and rBlo t 21. In an inhibition ELISA, the absorption of sera by A. lumbricoides extract affected less the reaction with rBlo t 5 and rBlo t 21 than with BtE. CONCLUSIONS: The rBlo t 5 and rBlo t 21 allergens contain important epitopes recognized by IgE antibodies of individuals allergic to B. tropicalis antigens. Moreover, the assays using the recombinant allergens had lower IgE cross-reactivity with A. lumbricoides antigens, a fact which would confers higher specificity to serodiagnostic assays than the crude mite extract. However, additional recombinant allergens should be evaluated in order to reach the same sensitivity of the commercially available assays based on mite extrac

BMC Immunology

p. 1-9Background: Blomia tropicalis is a dust mite and an important source of allergens in tropical regions. Up to now, the assays to diagnose atopy to this mite use whole body extract as antigens. However, anti-B. tropicalis IgE antibodies cross-react with Ascaris lumbricoides antigens, hindering the diagnosis of allergy to this mite. In this study, B. tropicalis recombinant allergens were evaluated with the purpose of developing an immunodiagnostic assay for allergy to this mite with greater specificity than those commercially available. Methods: Two B. tropicalis allergens (Blo t 5 and Blo t 21) were cloned into a plasmidial expression vector, expressed in Escherichia coli and purified by affinity chromatography. Sixty-three sera containing anti-B. tropicalis extract (BtE) IgE antibodies were used to investigate IgE reactivity to the recombinant Blot 5 and 21 allergens. Inhibition assays with 20 sera pre-adsorbed with A. lumbricoides extract were performed using rBlo t 5, rBlo t 21, and BtE as antigens. All the assays were carried using indirect ELISA. Results: Eighty-two point nine percent and 80.0% of the sera with anti-BtE antibodies from 35 children reacted with rBlo t 5 and rBlo t 21, respectively, whereas 92.8% and 89.3% of the 28 sera with anti-BtE antibodies from adult asthma patients reacted with the same allergens, and 96.4% of these sera reacted with a mixture of rBlo t 5 and rBlo t 21. In an inhibition ELISA, the absorption of sera by A. lumbricoides extract affected less the reaction with rBlo t 5 and rBlo t 21 than with BtE. Conclusions: The rBlo t 5 and rBlo t 21 allergens contain important epitopes recognized by IgE antibodies of individuals allergic to B. tropicalis antigens. Moreover, the assays using the recombinant allergens had lower IgE cross-reactivity with A. lumbricoides antigens, a fact which would confers higher specificity to serodiagnostic assays than the crude mite extract. However, additional recombinant allergens should be evaluated in order to reach the same sensitivity of the commercially available assays based on mite extract

Genome-wide annotation of the soybean WRKY family and functional characterization of genes involved in response to Phakopsora pachyrhizi infection

Background: Many previous studies have shown that soybean WRKY transcription factors are involved in the plant response to biotic and abiotic stresses. Phakopsora pachyrhizi is the causal agent of Asian Soybean Rust, one of the most important soybean diseases. There are evidences that WRKYs are involved in the resistance of some soybean genotypes against that fungus. The number of WRKY genes already annotated in soybean genome was underrepresented. In the present study, a genome-wide annotation of the soybean WRKY family was carried out and members involved in the response to P. pachyrhizi were identified. Results: As a result of a soybean genomic databases search, 182 WRKY-encoding genes were annotated and 33 putative pseudogenes identified. Genes involved in the response to P. pachyrhizi infection were identified using superSAGE, RNA-Seq of microdissected lesions and microarray experiments. Seventy-five genes were differentially expressed during fungal infection. The expression of eight WRKY genes was validated by RT-qPCR. The expression of these genes in a resistant genotype was earlier and/or stronger compared with a susceptible genotype in response to P. pachyrhizi infection. Soybean somatic embryos were transformed in order to overexpress or silence WRKY genes. Embryos overexpressing a WRKY gene were obtained, but they were unable to convert into plants. When infected with P. pachyrhizi, the leaves of the silenced transgenic line showed a higher number of lesions than the wild-type plants. Conclusions: The present study reports a genome-wide annotation of soybean WRKY family. The participation of some members in response to P. pachyrhizi infection was demonstrated. The results contribute to the elucidation of gene function and suggest the manipulation of WRKYs as a strategy to increase fungal resistance in soybean plants