Potenciais interações de drogas em pacientes de terapia antirretroviral: uma revisão integrativa: Potential drug interactions in antiretroviral therapy patients: an integrative review

Possíveis interações medicamentosas devem ser levadas em consideração ao selecionar um regime antirretroviral. Uma revisão detalhada dos medicamentos concomitantes pode ajudar na criação de um regime que minimize as interações indesejáveis. O potencial para interações medicamentosas deve ser avaliado quando qualquer novo medicamento (incluindo agentes de venda livre) é adicionado a um regime antirretroviral existente. A maioria das interações medicamentosas com medicamentos antirretroviral é mediada por inibição ou indução do metabolismo hepático de medicamentos. Este estudo trata-se de uma revisão integrativa, cujo objetivo foi compreender as possíveis interações de drogas em pacientes com infecção pelo HIV em processo de terapia antirretroviral. Após análise dos dados, concluiu-se que há riscos reais de interações medicamentosas a partir do uso de 5 ou mais medicamentos, por um tempo superior a seis anos. Os principais riscos apontados nesse sentido foram interferência na resposta terapêutica, aumento de reações adversas toxidade nos sistemas cardiovascular e nervoso central e dificuldades para detecção de resistência do HIV aos medicamentos antirretrovirais

Application of magnetic resonance spectroscopy in the differentiation of high-grade brain neoplasm and inflammatory brain lesions Aplicação da espectroscopia por ressonância magnética na diferenciação de lesões expansivas encefálicas neoplásicas e inflamatórias

This study aims at evaluating the application of magnetic resonance spectroscopy (MRS) in the differential diagnosis of brain tumors and inflammatory brain lesions. The examinations of 81 individuals, who performed brain MRS and were retrospectively analyzed. The patients with ages between 10 and 80 years old, were divided into two groups. Group A consisted of 42 individuals with diagnoses of cerebral toxoplasmosis and Group B was formed of 39 individuals with diagnosis of glial neoplasms. On analyzing the ROC curve, the discriminatory boundary for the Cho/Cr ratio between inflammatory lesions and tumors was 1.97 and for the NAA/Cr ratio it was 1.12. RMS is an important method useful in the distinction of inflammatory brain lesions and high-degree tumors when the Cho/Cr ratio is greater than 1.97 and the NAA/Cr ratio is less than 1.12. And so this method is important in the planning of treatment and monitoring of the therapeutic efficiency.O presente estudo tem como objetivo avaliar a aplicação da espectroscopia por ressonância magnética (ERM) no diagnóstico diferencial entre lesões expansivas encefálicas inflamatórias e neoplásicas. Foram analisados retrospectivamente 81 indivíduos que realizaram exames de ERM com idade entre 10 a 18 anos, divididos em dois grupos. O grupo A foi formado por 42 indivíduos com diagnóstico de neurotoxoplasmose e o grupo B foi formado por 39 indivíduos com diagnóstico de neoplasias gliais. Após análise da curva ROC observou-se que o valor discriminatório da relação Co/Cr entre lesões inflamatórias e neoplásicas foi de 1,97 e da relação Naa/Cr foi de 1,12. A espectroscopia por RM é um método útil na distinção de lesões expansivas inflamatórias e neoplasias de alto grau quando a relação Co/Cr é maior que 1,97 e a relação Naa/Cr é menor que 1,12, o que torna este método importante no planejamento do tratamento e monitorização da eficácia terapêutica

The role of dynamic susceptibility contrast-enhanced perfusion MR imaging in differentiating between infectious and neoplastic focal brain lesions: results from a cohort of 100 consecutive patients.

BACKGROUND AND PURPOSE: Differentiating between infectious and neoplastic focal brain lesions that are detected by conventional structural magnetic resonance imaging (MRI) may be a challenge in routine practice. Brain perfusion-weighted MRI (PWI) may be employed as a complementary non-invasive tool, providing relevant data on hemodynamic parameters, such as the degree of angiogenesis of lesions. We aimed to employ dynamic susceptibility contrast-enhanced perfusion MR imaging (DSC-MRI) to differentiate between infectious and neoplastic brain lesions by investigating brain microcirculation changes. MATERIALS AND METHODS: DSC-MRI perfusion studies of one hundred consecutive patients with non-cortical neoplastic (n = 54) and infectious (n = 46) lesions were retrospectively assessed. MRI examinations were performed using a 1.5-T scanner. A preload of paramagnetic contrast agent (gadolinium) was administered 30 seconds before acquisition of dynamic images, followed by a standard dose 10 seconds after starting imaging acquisitions. The relative cerebral blood volume (rCBV) values were determined by calculating the regional cerebral blood volume in the solid areas of lesions, normalized to that of the contralateral normal-appearing white matter. Discriminant analyses were performed to determine the cutoff point of rCBV values that would allow the differentiation of neoplastic from infectious lesions and to assess the corresponding diagnostic performance of rCBV when using this cutoff value. RESULTS: Neoplastic lesions had higher rCBV values (4.28±2.11) than infectious lesions (0.63±0.49) (p<0.001). When using an rCBV value <1.3 as the parameter to define infectious lesions, the sensitivity of the method was 97.8% and the specificity was 92.6%, with a positive predictive value of 91.8%, a negative predictive value of 98.0%, and an accuracy of 95.0%. CONCLUSION: PWI is a useful complementary tool in distinguishing between infectious and neoplastic brain lesions; an elevated discriminatory value for diagnosis of infectious brain lesions was observed in this sample of patients when the rCBV cutoff value was set to 1.3

Examples of rCBV maps of neoplastic and infectious lesions.

<p>Glioblastoma multiforme in a 49-year-old man (A,B,C). Axial FLAIR image shows a mass lesion in the right parietal lobe surrounded by infiltrating and vasogenic edema (A), with irregular peripheral enhancement on axial contrast-enhanced T1-W image (B) and increased vascularity on the color-coded rCBV map (C). Metastatic melanoma in an 18-year-old man (D,E,F). Axial FLAIR image depicts a mass lesion in the left parietal lobe with perilesional vasogenic edema (D), irregular peripheral rim enhancement on the axial post-contrast T1-W image (E) and increased vascularity on the color-coded rCBV map (F). Cerebral toxoplasmosis in a 54-year-old woman (G,H,I). Axial FLAIR image shows a mass lesion in the left parietal lobe with surrounding vasogenic edema (G), irregular peripheral rim enhancement on the axial post-contrast T1-W image (H) and hypovascularity on the color-coded rCBV map (I).</p

Mean rCBV values according to type of lesion.

*<p>Results are presented as mean ± SD, except for the cases of tuberculoma and paracoccidioidomycosis (one patient in each category), which are presented as single values.</p

A cutoff point for rCBV values (<i>x-</i>axis) of 1.3 allows the correct classification (black dots) of all but one infectious lesions and almost all neoplastic lesions; four cases of neoplastic lesions were misclassified as being infectious (red dots).

<p><i>I = infectious; N = neoplastic</i>.</p

Diagnostic performance of rCBV for the diagnosis of infectious lesions with a cutoff point of 1.3.

<p>PPV: positive predictive value; NPV: negative predictive value; CI: confidence interval.</p