ABSTRACT
JUSTIFICATIVA E OBJETIVOS: A prevalência da hipertensão arterial sistêmica (HAS) é crescente no mundo e é o principal fator de risco para as doenças cardiovasculares e renais. Apesar de existirem tratamentos eficazes, as taxas de descontrole da doença oscilam de 35% a 80%. A baixa adesão ao tratamento está presente em 50% dos casos de pacientes hipertensos descompensados. O objetivo deste estudo foi descrever os principais aspectos relacionados à adesão ao tratamento da HAS. CONTEÚDO: Foram pesquisados artigos nas bases de dados Pubmed/Medline, LILACS, Scielo, Cochrane Embase e CINAHL,no período 2005 a 2010, em que foi proposto o uso de índices de adesão na prática clínica como elementos diferenciais em relação à hipertensão resistente e à inércia terapêutica. Foram descritos os principais métodos de mensuração da adesão com suas vantagens e desvantagens, as quais determinam a dificuldade em obter padrões uniformes de comparação entre os estudos. Discutiram-se os conceitos de adesão inicial e persistente, assim como os principais fatores intervenientes relacionados ao paciente,aos profissionais de saúde, à terapia e à estrutura dos sistemas de saúde. Finalmente, descreveram-se os resultados do emprego de estratégias promissoras mais recentemente utilizadas como acombinação de doses fixas de medicamentos, o auxílio de farmacêuticos, a automensuração domiciliar da pressão, a monitorização eletrônica de doses e os sistemas de suporte, monitoramento e apoio à decisão.CONCLUSÃO: A adesão ao tratamento é a chave para a redução das altas taxas de complicações cardiovasculares relacionadas à hipertensão.
BACKGROUND AND OBJECTIVES: The prevalence of systemic hypertension (SH) is increasing worldwide and is the main risk factor for cardiovascular and renal diseases. Though effective treatments exist, the rates of uncontrolled disease vary between 35% and 80%. The low compliance to treatment is present in 50% of decompensated hypertensive patients. The objective of this study was to describe main aspects of SH treatment compliance. CONTENTS: We have searched for the articles published between 2005 and 2010 in the following databases: PUBMED/Medline, LILACS, Scielo, EMBASE, Cochrane Library and CINAHL. We have proposed the use of rates of compliance in clinical practice as differential elements for resistant hypertension and therapeutic inertia. The main compliance measurement methods were described, with advantages and disadvantages, determining the difficulty in obtaining uniform standards of comparison among studies. The concepts of early and persistent compliance were discussed, as well as the main intervening factors related to patients, health professionals, therapy and the structure of health systems. Finally, the results of the use of most recent promising strategies were described, such as a fixed dose drug combination, help of pharmacists, home self-measurement of blood pressure, electronic dosages monitoring, and support systems, monitoring and support of decision making.CONCLUSION: Compliance to treatment is the key action to reduce the high rates of cardiovascular complications related to hypertension.
Subject(s)
Humans , Antihypertensive Agents , Hypertension/therapyABSTRACT
The authors compared demographic aspects and profile of mutations in 80 patients with subtypes B and F of human immunodeficiency type 1 (HIV-1). Genotyping of the pol region of the reverse transcriptase was performed using the ViroSeqTM Genotyping System. A total of 61 (76.2 percent) patients had subtype B and 19 (23.8 percent) subtype F of the HIV-1. Subtype F tended to be more frequent in heterosexuals and women with a low educational level, but without statistical significance. The frequency of mutations related to nucleoside reverse transcriptase inhibitors and protease inhibitors (PI) was the same in the two subtypes, but mutations related to PI at the codons 63, 77, and 71 were more frequent in subtype B, while mutations at the codons 36 and 20 predominated in subtype F. Sixty-two of the 80 patients infected with subtypes B and F were submitted to antiretroviral therapy for an average of 18-22 months. Undetectable viral loads at the end of follow-up were similar in the two groups, representing 63.8 percent of subtype B and 73.3 percent of subtype F (p = 0.715). CD4 lymphocyte counts before and after treatment were similar in the two groups. This study, despite pointing to possible epidemiological and genetic differences among subtypes B and F of HIV-1, suggests that the use of highly active antiretroviral therapy is equally effective against these subtypes.
Subject(s)
Female , Humans , Male , Anti-HIV Agents/therapeutic use , HIV Infections/virology , HIV Protease/genetics , HIV Reverse Transcriptase/genetics , HIV-1 , Mutation , Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , HIV-1 , RNA, Viral/genetics , Viral LoadABSTRACT
To assess the prevalence of primary resistance of human immunodeficiency virus type 1 (HIV-1) to antiretrovirals, 84 patients chronically infected with HIV without prior antiretroviral treatment from Northeast Brazil were studied. Genotyping was performed using the ViroSeqTM Genotyping System. Thimidine analog mutations occurred in 3 (3.6 percent) patients. Accessory mutations related to NRTI occurred in 6 (7.1 percent) and related to PI in 67 (79.8 percent). Subtypes B (72.6 percent), F (22.6 percent), B/F 3 (3.6 percent), and C (1.2 percent) were detected. A low prevalence of major mutations related to NRTI in patients chronically infected by HIV was observed.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Anti-HIV Agents/therapeutic use , Drug Resistance, Viral/genetics , HIV Infections/virology , HIV-1 , Brazil , Chronic Disease , Genotype , HIV Infections/drug therapy , HIV Protease/genetics , HIV Reverse Transcriptase , HIV-1 , Mutation , Polymerase Chain Reaction , Prevalence , Thymidine/geneticsABSTRACT
Os autores trataram 70 pacientes portadores de estrongiloidíase, ascaríase, tricuríase e ancilostomíase com dose única de ivermectina (200 ug/kg). A cura parasitológica obtida foi de 95 porcento para estrongiloidíase, de 100 poecento para ascaríase e tricuríase e de 60 porcento para ancilostomíase. As reaçöes adversas foram observadas em 3 porcento dos pacientes - cefaléia, náuseas e vômitos.(au)
Subject(s)
Humans , Male , Female , Ancylostomiasis/drug therapy , Ascariasis/drug therapy , Strongyloidiasis/drug therapy , Intestinal Diseases, Parasitic , Ivermectin , Trichuriasis/drug therapyABSTRACT
Os autores atualizam os aspectos mais importantes das parasitoses intestinais que ocorrem na infância, subdividindo-as em dois grandes grupos: helmintíases e protozooses. Em cada caso discorre sobre o agente etiológico, quadro clínico e diagnóstico, detendo-se particularmente no estudo da terapêutica, em que säo relacionados os medicamentos utilizados em cada uma das parasitoses, pela denominaçäo genérica do sal e as denominaçöes comerciais dos produtos correspondentes disponíveis no mercado farmacêutico.
Subject(s)
Humans , Parasitic Diseases , Intestinal Diseases, Parasitic , Helminthiasis , Protozoan Infections , Eukaryota , Anthelmintics/administration & dosage , Anthelmintics/therapeutic use , Parasitic Diseases/complications , Parasitic Diseases/diagnosis , Parasitic Diseases/drug therapy , Intestinal Diseases, Parasitic/diagnosis , Intestinal Diseases, Parasitic/drug therapy , Protozoan Infections/complications , Protozoan Infections/diagnosis , Protozoan Infections/drug therapyABSTRACT
Os autores procedem a uma revisäo minunciosa do tatamento das helmintíases e protozooses intestinais prevalentes na infância, apresentando os mais recentes avanços no campo do diagnóstico e da terapêutica
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Infant , Anthelmintics/administration & dosage , Anthelmintics/therapeutic use , Antiprotozoal Agents/administration & dosage , Antiprotozoal Agents/therapeutic use , Helminthiasis/complications , Helminthiasis/etiology , Helminthiasis/drug therapy , Protozoan Infections/complications , Protozoan Infections/etiology , Protozoan Infections/drug therapyABSTRACT
Os autores fazem uma revisäo sobre os protozários digestivos näo-patogênicos, abordando os principais aspectos de sua epidemiologia e clínica
Subject(s)
Humans , Digestive System/parasitology , Eukaryota/classification , Eukaryota/parasitology , Gastrointestinal Diseases/parasitology , Intestines/parasitology , Parasites , Protozoan Infections/epidemiologySubject(s)
Humans , Male , Female , Child , Helminthiasis/etiology , Hymenolepiasis , Albendazole/therapeutic use , Ancylostomiasis , Ascariasis/complications , Helminthiasis/diagnosis , Helminthiasis/epidemiology , Helminthiasis/parasitology , Helminthiasis/drug therapy , Oxyuriasis , Strongyloidiasis , TaeniasisABSTRACT
Os autores realizaram uma atualizaçäo clínica, laboratorial e terapêutica sobre a himenolepíase e em seguida apresentam sua prevalência no Hospital das Clínicas da UFPE, Brasil
Subject(s)
Biology , Prevalence , Biological Evolution , Hymenolepiasis/diagnosis , Hymenolepiasis/etiology , Hymenolepiasis/therapy , Praziquantel , Cestoda , Helminthiasis/diagnosis , Helminthiasis/etiology , Helminthiasis/therapy , Cestode InfectionsABSTRACT
Os autores fazem uma atualizaçäo sobre isosporíase humana e abordam os principais aspectos da parasitose: epidemiologia, quadro clínico, diagnóstico laboratorial e terapêutica clínica
Subject(s)
Sulfamethoxazole , Coccidiosis/diagnosis , Coccidiosis/therapy , Furazolidone , Isospora/classification , Isospora/growth & development , Isospora/pathogenicity , Metronidazole , Sulfathiazoles , Pyrimethamine , Asthenia , Sulfadiazine , Sulfadoxine , Vomiting , Weight Loss , Anorexia , Abdominal Pain , Diarrhea , Eukaryota , Antimalarials , Protozoan Infections , Trimethoprim, Sulfamethoxazole Drug CombinationABSTRACT
Os autores realizam uma atualizaçäo sobre as principais helmintíases que acometem o trato digestivo humano. Abordam principalmente a sua epidemiologia, ciclo biológico, patogenia, quadro clínico, complicaçöes, diagnóstico e terapêutica, dando ênfase as principais drogas atualmente administradas