Factors Influencing the Magnitude and Clinical Significance of Drug Interactions Between Azole Antifungals and Select Immunosuppressants

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90188/1/phco.26.12.1730.pd

Bioethical education in physical therapy undergraduate course

Physical therapy recent expansion, along with changes in education and health, enhance physical therapists' role in patient care, while increasing both their autonomy and the ethical challenges they face in daily clinic. In addition to knowledge of the professional ethical code, notions of Bioethics are thought to be central to students training. This study analysed the ability to make ethical decisions among 100 physical therapy undergraduate students at two universities in São Paulo, of which only one offers the discipline Bioethics. Fifty students of each university answered a questionnaire of dilemmas related to items of the Physical Therapy Code of Ethics; for each question there was a choice between three answers, bioethical, in accordance with the ethical code, or non-ethical. Answers were statistically analysed. About half the students of both universities seemed to be satisfactorily prepared to act ethically, thus suggesting that both offer similar ethical training, regardless of curricula differences. However, students from the university that offers Bioethics had significantly better results in questions concerning the relationship with other health providers, thereby suggesting that this discipline may provide better student training for inter-professional relationship, which is important both to clinical practice and to raise physical therapy status.O desenvolvimento da Fisioterapia, aliado às mudanças na educação e na saúde, faz com que a autonomia e os dilemas éticos do fisioterapeuta sejam maiores a cada dia, expandindo seu papel no cuidado do paciente. Para além do Código de Ética, as noções de Bioética são centrais no preparo de graduandos para os desafios profissionais. Este estudo verificou a capacidade de tomar decisões éticas de alunos no último ano de Fisioterapia de duas universidades na cidade de São Paulo, das quais uma oferece no currículo a disciplina Bioética e a outra não. Cinqüenta alunos de cada universidade responderam a um questionário sobre dilemas éticos correspondentes a artigos do Código de Ética; cada questão oferecia três alternativas de resposta: uma bioética, outra referente ao Código e uma não-ética. As respostas foram analisadas estatisticamente. Os resultados mostraram um bom preparo ético em pouco mais de metade dos alunos das duas universidades, sugerindo que ambas oferecem preparo ético similar aos graduandos, independente da diferença curricular. No entanto, os alunos da universidade que oferece Bioética tiveram resultados significantemente melhores nos quesitos referentes à relação com outros profissionais da saúde, sugerindo que essa disciplina oferece melhores condições para o relacionamento interprofissional, fator importante tanto na prática clínica quanto para elevar o status da Fisioterapia.Universidade Nove de JulhoUniversidade São Judas TadeuUniversidade de São Paulo Escola de Educação Física e EsporteCentro Universitário São CamiloUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Carcinoma basocelular: tratamento com cirurgia de rotação de retalhos (CRR) / Basal cell carcinoma: treatment with flap rotation surgery (CRR)

A neoplasia de pele é uma doença multifatorial, com dois subtipos principais: melanoma e não melanoma. O carcinoma basocelular (CBC) é um tumor cutâneo não melanoma. Este artigo objetiva demonstrar uma opção de cirurgia para tratamento de CBC. A Cirurgia de Rotação de Retalho (CRR) é indicada quando o fechamento primário não terá resultado satisfatório. Nesse sentido, o enfoque é a rotação do retalho sobre o seu próprio eixo, em especial, a transposição, em que há a rotação lateral, em cima de um ponto pivô para cobrir uma área defeituosa adjacente. No caso do CBC em ponta de nariz, realiza-se a técnica de dupla translocação, para conseguir boa cobertura da região após exérese da lesão. Os retalhos são superiores aos enxertos no reparo da perda de substâncias, pois possuem maior semelhança de cor e textura de pele. Ademais, evitam a necessidade de remoção do tecido de outro sítio, sem gerar uma nova lesão operatória. Há exímio resultado estético, por utilizar pele da própria área e, ao transpor o tecido, também é transferido o pedículo vascular e realizada a anastomose. Quanto às complicações, ocorre certa alteração anatômica inicial, já que o retalho causa redistribuição não uniforme das linhas de tensão de fechamento primário. Conclui-se que o CBC tratado cirurgicamente com rotação se beneficia esteticamente, além de tratar de forma resolutiva o caso, proporcionando bem estar ao paciente e manutenção da sua autoestima.

Association of hypertension with coronary artery disease onset in the Lebanese population

The onset of coronary artery disease (CAD) is influenced by cardiovascular risk factors that often occur in clusters and may build on one another. The objective of this study is to examine the relationship between hypertension and CAD age of onset in the Lebanese population. This retrospective analysis was performed on data extracted from Lebanese patients (n = 3,753). Logistic regression examined the association of hypertension with the age at CAD diagnosis after controlling for other traditional risk factors. The effect of antihypertensive drugs and lifestyle changes on the onset of CAD was also investigated. Results showed that hypertension is associated with late onset CAD (OR=0.656, 95% CI=0.504-0.853, p=0.001). Use of antihypertensive drugs showed a similar association with delayed CAD onset. When comparing age of onset in CAD patients with traditional risk factors such as hypertension, diabetes, hyperlipidemia, obesity, smoking and family history of CAD, the age of onset was significantly higher for patients with hypertension compared to those with any of the other risk factors studied (p < 0.001). In conclusion, hypertension and its treatment are associated with late coronary atherosclerotic manifestations in Lebanese population. This observation is currently under investigation to clarify its genetic and/or environmental mechanisms

Responding to health needs of women, children and adolescents within Syria during conflict: intervention coverage, challenges and adaptations.

BACKGROUND: Women and children suffer disproportionately in armed-conflicts. Since 2011, the protracted Syrian crisis has fragmented the pre-existing healthcare system. Despite the massive health needs of women and children, the delivery of key reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) interventions, and its underlying factors are not well-understood in Syria. Our objective was to document intervention coverage indicators and their implementation challenges inside Syria during conflict. METHODS: We conducted 1) a desk review to extract RMNCAH&N intervention coverage indicators inside Syria during the conflict; and 2) qualitative interviews with decision makers and health program implementers to explore reasons behind provision/non-provision of RMNCAH&N interventions, and the rationale informing decisions, priorities, collaborations and implementation. We attempt to validate findings by triangulating data from both sources. RESULTS: Key findings showed that humanitarian organisations operating in Syria adopted a complex multi-hub structure, and some resorted to remote management to improve accessibility to certain geographic areas. The emergency response prioritised trauma care and infectious disease control. Yet, with time, humanitarian organisations successfully advocated for prioritising maternal and child health and nutrition interventions given evident needs. The volatile security context had implications on populations' healthcare seeking behaviors, such as women reportedly preferring home births, or requesting Caesarean-sections to reduce insecurity risks. Additional findings were glaring data gaps and geographic variations in the availability of data on RMNCAH&N indicators. Adaptations of the humanitarian response included task-shifting to overcome shortage in skilled healthcare workers following their exodus, outreach activities to enhance access to RMNCAH&N services, and operating in 'underground' facilities to avoid risk of attacks. CONCLUSION: The case of Syria provides a unique perspective on creative ways of managing the humanitarian response and delivering RMNCAH&N interventions, mainly in the multi-hub structure and use of remote management, despite encountered challenges. The scarcity of RMNCAH&N data is a tremendous challenge for both researchers and implementing agencies, as it limits accountability and monitoring, thus hindering the evaluation of delivered interventions

MEDIDOR DE CONSISTÊNCIA DA GRAXA

O presente projeto desenvolvido na disciplina de Projeto Integrador I, se refere a um medidor de consistência da graxa, ou penetrômetro de graxa manual, tal qual pode ser encontrado no mercado nos formatos analógico e digital. Nosso projeto foi baseado no formato analógico, respeitando as regras pré-estabelecidas pela norma D 217 - 02.Sua função é estabelecer qual o tipo de graxa testado pela sua consistência, e com a ajuda da tabela NLGI - tal qual expressa a dureza relativa de uma graxa usada para lubrificação - estabelecer qual o melhor uso para a mesma, seja ele em engrenagens, rolamentos, etc

Replacing wheat bran by corn gluten feed without steep water in complete dog food

Twenty-four adult Beagles were utilised to evaluate the partial replacement of wheat bran with corn gluten feed without steep water on digestibility and characteristics of faeces. The treatments were 0 (no substitution), 30, 60 or 90 g/kg of corn gluten without steep water. There was no effect (p > .05) on the digestibility coefficients (g/kg) of dry matter (0.771), organic matter (0.806), crude protein (0.813), ether extract (0.798), crude fibre (0.393), neutral detergent fibre (0.425), acid detergent fibre (0.286) and crude energy (0.812), whilst there was effect (p  .05) was found on the remaining faecal characteristics: excretion for 100 g of food (56.77 g), excretion (129.6 g/day and 49.0 g dry matter/day), score (3.90), dry matter excretion for 100 g of food (22.86 g), buffering capacity (BC) at pH 5 (57.81), ammonia nitrogen (1.46 g/kg of faecal dry matter) and water balance (333.25 mL/day), in vivo and in situ gas production (p > .05). Corn gluten feed without steep water can be utilised to replace up to 90 g/kg of wheat bran without causing negative effect on the digestibility and characteristics of faeces

Intestinal microsporidiosis: a hidden risk in rheumatic disease patients undergoing anti-tumor necrosis factor therapy combined with disease-modifying anti-rheumatic drugs?

OBJECTIVE: Immunosuppressed patients are at risk of microsporidiosis, and this parasitosis has an increased rate of dissemination in this population. Our objective was to evaluate the presence of microsporidiosis and other intestinal parasites in rheumatic disease patients undergoing anti-tumor necrosis factor/disease-modifying anti-rheumatic drug treatment. METHODS: Ninety-eight patients (47 with rheumatoid arthritis, 31 with ankylosing spondylitis and 11 with psoriatic arthritis) and 92 healthy control patients were enrolled in the study. Three stool samples and cultures were collected from each subject. RESULTS: The frequency of microsporidia was significantly higher in rheumatic disease patients than in control subjects (36 vs. 4%, respectively; p<0.0001), as well as in those with rheumatic diseases (32 vs. 4%, respectively; p<0.0001), ankylosing spondylitis (45 vs. 4%, respectively; p<0.0001) and psoriatic arthritis (40 vs. 4%, respectively; p<0.0001), despite a similar social-economic class distribution in both the patient and control groups (p = 0.1153). Of note, concomitant fecal leukocytes were observed in the majority of the microsporidia-positive patients (79.5%). Approximately 80% of the patients had gastrointestinal symptoms, such as diarrhea (26%), abdominal pain (31%) and weight loss (5%), although the frequencies of these symptoms were comparable in patients with and without this infection (p&gt;0.05). Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis disease activity parameters were comparable in both groups (p&gt;0.05). The duration of anti-tumor necrosis factor/disease-modifying anti-rheumatic drugs and glucocorticoid use were also similar in both groups. CONCLUSION: We have documented that microsporidiosis with intestinal mucosa disruption is frequent in patients undergoing concomitant anti-tumor necrosis factor/disease-modifying anti-rheumatic drug therapy. Impaired host defenses due to the combination of the underlying disease and the immunosuppressive therapy is the most likely explanation for this finding, and this increased susceptibility reinforces the need for the investigation of microsporidia and implementation of treatment strategies in this population.FAPESPCNPQFederico FoundationWyet

A mudança comportamental da população após a conscientização dos riscos do câncer do tipo melanoma

O câncer de pele é o crescimento descontrolado e autônomo de células presentes neste tecido. É causado pela exposição intensa e intermitente a radiação ultravioleta da luz solar ou camas de bronzeamento, o que desencadeia mutações, ou defeitos genéticos, que levam as células da pele a se multiplicarem rapidamente e formar tumores malignos. Sabendo-se do papel da exposição solar no desencadeamento de neoplasias de pele, este estudo tem como objetivo apresentar a mudança de conduta da população após a conscientização sobre riscos do câncer de pele do tipo melanoma. Trata-se de um mini revisão, a partir de 5 artigos selecionados nas bases de dados PubMed e Scielo, utilizando os descritores: prevention, melanoma, comportamento, sendo selecionados artigos publicados entre 2015 e 2018. Concluiu-se que após a intervenção por meio de medidas promotoras de conhecimento sobre os riscos de câncer de pele tipo melanoma os indivíduos mudaram a conduta em relação aos fatores que podem ocasionar o melanoma