Medicines Waste Policies And The Population Knowledge In Brazil

Objective: To investigate the degree of knowledge of the patients enrolled in the Unified Health System of the Medicine School of ABC (Faculdade de Medicina do ABC) regarding the proper use and disposal of medicaments. Methods: Participants were recruited for convenience, during their medical appointments at the clinic of the Medical School of ABC (Santo André, Sao Paulo, Brazil) in the period from 04 August to 30 September 2014. Data collection was conducted through a self-administered poll designed specifically for the purpose of this study, which consisted of 25 questions multiple choice about socioeconomic issues and the subject disposal of drugs, consumption and environmental pollution. Results: We selected the 140 patients’ polls. Most of them is of white ethnicity (58%) and female (58%). Level of education: 31% have completed secondary education (31%) or incomplete graduation (19%). Most of the participants (76%) buy drugs without a prescription, and most families (76%) seek understanding by reading the labels. 71.43% reported knowing that incorrect disposal of drugs could contaminate the environment, but 78% reported never having seen or received information about these. After using, 22.15% maintains the medication at home for future use, 55% of subjects reported improper disposal sites and 13% are delivered in health care institutions. Conclusion: Our study has showed that most participants inappropriately use and dispose of drugs, even though they know they can contaminate the environment.

Inquérito sorológico de Toxoplasma gondii em ovinos na microrregião Castanhal, Pará, Brasil / Serologic inquiry of Toxoplasma gondii in sheep in northern Brazil

A toxoplasmose é uma grave zoonose e uma das mais difundidas doenças parasitárias. Um inquérito sorológico realizado nos municípios de Santo Antônio do Tauá e Santa Izabel do Pará, Microrregião Castanhal do Estado do Pará, demonstrou uma elevada frequência (44,29%) de anticorpos anti-Toxoplasma gondii em amostras de soros de ovinos detectados pelo teste de hemaglutinação indireta, com a seguinte distribuição nos títulos 1:64, 1:128, 1:256, 1:512, 1:1024 e 1:2048, respectivamente: 50 (32,26%), 42 (27,10%), 29 (18,70), 11 (7,10%), 12 (7,74%) e 11(7,10%). Diferença estatística significativa foi observada entre as faixas etárias 0 a 2 e > 2 anos em ambos os sexos (?2 = 13,42, p = 0,0002) com maior freqüência, (58,71%), na faixa etária > 2 anos (58,71%), entre os sexos (?2 = 23,51, p = 0,0001), com maior freqüência de sororreagentes nas fêmeas (72,26%). Embora os municípios tenham apresentado freqüências semelhantes (49,33%, para Santa Izabel do Pará e 40,50% para Santo Antonio do Tauá), não foi observada associação entre eles (?2 = 2,71, p = 0,09). Medidas e ações de vigilância sanitária são recomendadas para prevenir riscos aos rebanhos e às populações humanas.

Toxoplasmosis is a serious zoonosis and widespread parasitic disease. A serologic inquiry in Santo Antonio do Tauá and Santa Izabel do Pará counties in the Castanhal Microregion, state of Pará, Northern Brazil, demonstratedahighfrequency,(44.29%) ofanti-Toxoplasmagondii antibodies detected by indirect hemaglutination test, with a distribution at titers 1:64, 1:128, 1:256, 1:512, 1:1024 and 1:2048 of, respectively, 50 (32.26%), 42 (27.10%), 29 (18.70%), 11 (7.10%), 12 (7.74%) and 11(7.10%). A statistically significant difference was observed between the 0 up to 2 and > 2 age groups in both sexes (?2 = 13.42, p = 0.0002) with a greater frequency in the > 2 years age group, (58.71%), and between the sexes (?2 = 23.51, p = 0.0001) with a greater frequency in females, (72.26%). Although the two counties presented similar frequencies (49.33% and 40.50% for Santa Izabel do Pará and Santo Antonio do Tauá, respectively) no association was observed between them. Sanitary surveillance measures are recommended to prevent health risks to humans and animals.

Frequência de anticorpos anti-Toxoplasma gondii em suínos abatidos sem inspeção em Belém / Serologic diagnosis of Toxoplasma gondii in swines slaughtered without inspection in Northern Brazil

To survey the occurrence of IgM and IgG anti-T. gondii antibodies in pigs slaughtered without inspection, 110 serum samples from different localities were submitted to indirect hemaglutination test. A frequency of 50.0% (confidence interval 40.7% /.../ 59.3%, 95% significance) of positive sera was detected, with a distribution of frequency of 1.83% and 1.83%, 6.36% and 15.45%, 20.0% and 25.4%, 17.3% and 7.3%, and 4.5% and 0.0% for IgM and IgG antibodies, respectively in 1:16, 1:64, 1:256, 1:1024, and 1:2048 serum dilutions. The toxoplasmic infection was present among pigs in the city of Belém.

Frequência de anticorpos anti-Toxoplasma gondii em suínos abatidos sem inspeção em Belém / Serologic diagnosis of Toxoplasma gondii in swines slaughtered without inspection in Northern Brazil

To survey the occurrence of IgM and IgG anti-T. gondii antibodies in pigs slaughtered without inspection, 110 serum samples from different localities were submitted to indirect hemaglutination test. A frequency of 50.0% (confidence interval 40.7% -...- 59.3%, 95% significance) of positive sera was detected, with a distribution of frequency of 1.83% and 1.83%, 6.36% and 15.45%, 20.0% and 25.4%, 17.3% and 7.3%, and 4.5% and 0.0% for IgM and IgG antibodies, respectively in 1:16, 1:64, 1:256, 1:1024, and 1:2048 serum dilutions. The toxoplasmic infection was present among pigs in the city of Belém.

Early remodeling of rat cardiac muscle induced by swimming training

The aim of the present investigation was to study the effect of acute swimming training with an anaerobic component on matrix metallopeptidase (MMP) activity and myosin heavy chain gene expression in the rat myocardium. Animals (male Wistar rats, weighing approximately 180 g) were trained for 6 h/day in 3 sessions of 2 h each for 1 to 5 consecutive days (N = 5 rats per group). Rats swam in basins 47 cm in diameter and 60 cm deep filled with water at 33 to 35°C. After the training period a significant increase (P < 0.05) was observed in the heart weight normalized to body weight by about 22 and 35 percent in the groups that trained for 96 and 120 h, respectively. Blood lactate levels were significantly increased (P < 0.05) in all groups after all training sessions, confirming an anaerobic component. However, lactate levels decreased (P < 0.05) with days of training, suggesting that the animals became adapted to this protocol. Myosin heavy chain-ß gene expression, analyzed by real time PCR and normalized with GAPDH gene expression, showed a significant two-fold increase (P < 0.01) after 5 days of training. Zymography analysis of myocardium extracts indicated a single ~60-kDa activity band that was significantly increased (P < 0.05) after 72, 96, and 120 h, indicating an increased expression of MMP-2 and suggesting precocious remodeling. Furthermore, the presence of MMP-2 was confirmed by Western blot analysis, but not the presence of MMP-1 and MMP-3. Taken together, our results indicate that in these training conditions, the rat heart undergoes early biochemical and functional changes required for the adaptation to the new physiological condition by tissue remodeling.

Evaluación nutricional de pacientes pediátricos críticos: estudio preliminar / Nutritional evaluation of critical pediatric patients: Preliminary study

El objetivo del trabajo es evaluar el estado nutricional con respecto a hierro en un grupo de niños con diferentes patologías, al ingreso en terapia intensiva, a través de la determinación de hematocrito, concentración de hemoglobina, protoporfirinas eritrocitarias libres y analizar los niveles de fracciones séricas específicas: transferrina, proteína C reactiva y ceruloplasmina. En treinta y un pacientes (entre tres y cuarenta y ocho meses de edad) internados en la Unidad de Cuidados Intensivos Pediátricos con diferentes patologías, se determina hematocrito (Hto), la concentración de hemoglobina (g/dL) (Hb) por colorimetría, FEP por método Piomelli expresándose los resultados como FEP/Hto y FEP/Hb y transferrina, ceruloplasmina y preoteína C reactiva sérica (mg/dL) por inmunodifusión radial cuantitativa sobre placas...

Identification of metalloprotease gene families in sugarcane

Metaloproteases exercem papéis importantes em muitos processos fisiológicos em mamíferos tais como migraçäo celular, remodelamento tecidual e processamento de fatores de crescimento. Estas enzimas estäo envolvidas também na pato-fisiologia de um grande número de doenças humanas como hipertensäo e câncer. Muitas bactérias patogênicas dependem de proteases para infectar o hospedeiro. Diversas classes de metaloproteases foram descritas em seres humanos, bactérias, venenos de serpentes e insetos. No entanto, a presença e a caracterizaçäo de metaloproteases em plantas estäo pouco descritas na literatura. Neste trabalho, foi pesquisada a biblioteca de cDNA de etiquetas de seqüências expressas da cana-de-açúcar (SUCEST) para identificar, por homologia com seqüências depositadas em outros bancos de dados, famílias gênicas de metaloproteases expressas em diferentes condições. Foram utilizadas seqüências protéicas de Arabidopis thaliana e Glycine max e seqüências de nucleotídeos de Sorghum bicolor. Regiões conservadas correspondentes aos diferentes domínios e motivos de seqüência de metaloproteases foram identificadas nos cDNAs de cana-de-açúcar para caracterizar cada grupo de enzimas. Pelo menos quatro classes de metaloproteases foram identificadas na cana-de-açúcar, a saber, metaloproteases de matriz extracelular, zincinas, inverzincinas e metaloproteases dependentes de ATP. Cada uma destas classes foi analisada quanto a sua expressäo nas diferentes condições e tecidos utilizados na construçäo das bibliotecas de cDNA.

Evaluación in vitro de linezolid frente a staphylococcus aureus meticilina resistentes aislados de infecciones osteo-articulares / In vitro evaluation of linezolid against methicillin-resistant staphylococcus aureus isolated from osteoarticular infections

En este trabajo se analiza la susceptibilidad in vitro de 64 cepas de Staphylococcus aureus meticilina resistentes (SAMR), aisladas de procesos infecciosos osteo-articulares frente a linezolid y se compara con la de teicoplanina. El 100 por ciento de las cepas analizadas fue inhibido por linezoid entre 0,25 y 3 µg/ml y por teicoplanina entre 0,38 y 2 µg/ml. La CIM de linezolid fue 0,75 µg/ml y la de teicoplanina fue 1 µg/ml. La CIM para ambos antimicrobianos fue 1,5 µg/ml. La buena evaluación in vitro de linezolid frente a SAMR y su excelente biodisponibilidad por vía oral, lo hacen una atractiva opción terapéutica en el manejo de las infecciones osteoarticulares causadas por SAMR. Sin embargo, su uso para esta indicación aún no ha sido aprobado por Food and Drug Administration

Intima-media thickness evaluation by B-mode ultrasound: Correlation with blood pressure levels and cardiac structures

The aim of this study was to analyze the thickness of the intima-media complex (IMC) using a noninvasive method. The carotid and femoral common arteries were evaluated by noninvasive B-mode ultrasound in 63 normotensive and in 52 hypertensive subjects and the thickness of the IMC was tested for correlation with blood pressure, cardiac structures and several clinical and biological parameters. The IMC was thicker in hypertensive than in normotensive subjects (0.67 ± 0.13 and 0.62 ± 0.16 vs 0.54 ± 0.09 and 0.52 ± 0.11 mm, respectively, P<0.0001). In normotensive patients, the simple linear regression showed significant correlations between IMC and age, body mass index and 24-h systolic blood pressure for both the carotid and femoral arteries. In hypertensives the carotid IMC was correlated with age and 24-h systolic blood pressure while femoral IMC was correlated only with 24-h diastolic blood pressure. Forward stepwise regression showed that age, body mass index and 24-h systolic blood pressure influenced the carotid IMC relationship (r2 = 0.39) in normotensives. On the other hand, the femoral IMC relationship was influenced by 24-h systolic blood pressure and age (r2 = 0.40). In hypertensives, age and 24-h systolic blood pressure were the most important determinants of carotid IMC (r2 = 0.37), while femoral IMC was influenced only by 24-h diastolic blood pressure (r2 = 0.10). There was an association between carotid IMC and echocardiographic findings in normotensives, while in hypertensives only the left posterior wall and interventricular septum were associated with femoral IMC. We conclude that age and blood pressure influence the intima-media thickness, while echocardiographic changes are associated with the IMC

Acesso ao tratamento dialítico crônico: deficiente e desigual / Access to chronic dialysis treatment: deficient and unequal

OBJETIVO. Determinar a fraçao de pacientes com insuficiência renal crônica (IRCT) tratada por meio de diálise no Município de Sao Paulo e investigar a influência da idade em relaçao ao acesso a diálise. MATERIAL E MÉTODOS. Foram estudados todos os pacientes que receberam diálise para IRCT durante o ano de 1991, registrados junto à Secretaria de Saúde do Estado. No mesmo ano, foram também coletadas informaçoes dos indivíduos que morreram tendo com causa básica de óbito doença relacionada a insuficiência renal crônica. Estes últimos dados foram obtidos do Serviço Funerário da Prefeitura de Sao Paulo. Cruzando-se os dados destes bancos de dados foi possível descobrir os pacientes que morreram de IRCT sem ter realizado diálise e calcular a fraçao tratada nas diversas faixas etárias. RESULTADOS. De forma global, 25,6 por cento dos pacientes com IRCT nao receberam tratamento. A partir da idade de 40 anos, houve reduçao progressiva e significante (p<0,001) da fraçao de pacientes tratados conforme aumentou a idade. Até os nove anos de idade a percentagem de tratamento também foi reduzida (29 por cento). Indivíduos nas faixas etárias de 60-69 e 70-79 anos apresentaram chance cerca de 5 e 11 vezes maior, respectivamente, de morrer sem receber tratamento dialítico do que aqueles no grupo etário de 20-29 anos. CONCLUSOES. Os autores estimam que pelo menos um quarto dos pacientes com IRCT morreram em Sao Paulo, em 1991, sem ter recebido tratamento dialítico. Idade é um fator importante de discriminaçao para aceitaçao em programas de diálise crônica.

Cambios clínicos, bioquímicos e inmunológicos obtenidos en pacientes tratados con insulina porcina biobras / Clinical, biochemical and immunological changes in patientstreated with porcine insulin Biobras

Se estudiaron los cambios ocurridos a nivel clínico, bioquímico e inmunológico en pacientes diabéticos insulinodependientes (adultos y niños) tratados con insulina NPH de origen porcino (Biobras) durante 90 días y se loscomparó con los obtenidos previamente en esos mismos pacientes tratados con otras insulinas disponibles en el mercado nacional. Los resultados obtenidos no mostraron cambios importantes en el corto plazo en ninguno de los parámetros estudiados, lo que sugiere que la insulina Biobras presenta características apropiadas para el tratamiento del diabético insulinodependiente. Ello brinda al paciente, junto con una correcta alimentación, una actividad física apropiada y el permanente soporte educativo, otra alternativa de elección para el tratamiento insulínico de esta enfermedad metabólica

Euthanasia and relief of suffering: attitudes of medical students

Medical students, from the first, second and third year classes of the University of Puerto Rico School of Medicine, answered a questionnaire which included testing knowledge and attitudes about euthanasia and the relief of suffering. More than 60 of each class participated, a total of two hundred. Ninety three percent of the students knew the definition of euthanasia but 50 percent could not tell the difference between active and passive euthanasia. Students in the first year were better oriented than their counterparts in the third year (58 percent versus 44 percent). Seventy percent of the 100 students who could differentiate between active and passive euthanasia thought that active euthanasia should not be considered murder, but 69 percent were cognizant it was so considered in Puerto Rico. Eighty-three percent of first year students but only 61 percent of third year students thought that physicians should alleviate suffering of terminally ill patients. Medical schools should provide a serious, unprejudiced and complete discussion of euthanasia and other life and death issues in their curricula. A humane orientation of medical students should be given as much emphasis as other aspects of professional training

ß2 microglobulina (ß2M) sérica na monitorizaçäo do transplante renal / Serum ß2 microglobulin (ß2M) following renal transplantation

Apesar da melhora na sobrevida do enxerto em pacientes transplantados renais, ocorrida nos últimos dez anos, a rejeiçäo continua sendo uma causa importante de perda de enxerto. Vários testes laboratoriais têm sido estudados na tentativa de se identificar um método näo invasivo que possibilite o diagnóstico precoce de rejeiçäo em pacientes transplantados renais. OBJETIVO. Avaliar a utilidade da monitorizaçäo da ß2 microglobulina sérica no período inicial pós-transplante. Métodos. foram estudados em 20 receptores de transplante renal (10 doadores vivos relacionados e 10 doadores cadáveres), o comportamento diário dos níveis séricos da ß2M e correlacionados com a sua evoluçäo clínica e laboratorial. RESULTADOS. Pacientes que apresentaram boa funçäo renal no pós-operatório imediato e näo mostraram rejeiçäo aguda, precocemente, evoluíram com queda dos níveis de ß2M que se estabilizaram em níveis de 3,7 mg/L no 4§ dia pós-transplante. A sensibilidade de ß2M para o diagnóstico de rejeiçäo aguda foi muito boa (87,5 por cento), mas sua especificidade foi baixa (46 por cento). Nos oito pacientes que näo apresentaram boa funçäo renal, inicialmente, a monitorizaçäo dos níveis de ß2M mostrou-se capaz de diferenciar pacientes com necrose tubular aguda (NTA) sem complicaçöes, de portadores de NTA evoluindo com rejeiçäo ou nefrotoxicidade por CSA. Conclusäo. A monitorizaçäo dos níveis séricos de ß2M näo acrescenta benefício nítido para o diagnóstico de rejeiçäo aguda em pacientes com boa funçäo renal inicial. Contudo, em pacientes evoluindo para NTA, esta monitorizaçäo mostrou-se útil para identificar episódios de rejeiçäo aguda e nefrotoxicidade por CSA

Glomerular hemodynamics during abortion induced by RU 486 and sepsis in rats

1. Acute renal failure is a very common consequence of septic abortion. Whole kidney and glomerular hemodynamics were evaluated in virgin (V), pregnant (PREG) and aborted (ABOR) euvolemic Munich-Wistar rats before and after E. coli (0111-B4) endotoxin (LPS) infusion in order to evaluate the effect of septic abortion on the renal microcirculation. 2. Abortion induced by RU 486 blunted the increase in glomerular filtration rate (GFR) induced by normal pregnancy (0.86 +/- 0.03 vs 0.63 +/- 0.07 ml/min, P < 0.05). In virgin rats, RU 486 did not modify the parameters of renal function. Significant alterations occurred in whole kidney and single nephron function. However, the changes in whole kidney function in the ABOR group were significantly higher than those observed for the V group (reductions in GFR were 42 in V and 80 in ABOR, RPF decreased 34 in V and 76 in ABOR, TRVR increased 82 in V and 400 in ABOR). 3. Mean single nephron glomerular filtration rate (SNGFR) was reduced in all groups after LPS (44 in V, 43 in V+RU, 55 in PREG, 60 in ABOR), due to significant decreases in glomerular plasma flow rate, QA (42 in V, 55 in V+RU, 53 in PREG, 57 in ABOR) and in glomerular ultrafiltration coefficient, Kf (46 in V, 47 in V+RU, 45 in PREG, 67 in ABOR). 4. These data show that LPS induced significant alterations in renal function in all groups. However, aborted rats were more sensitive to the effects of LPS than V rats. These results indicate that abortion may potentiate the effects of endotoxemia on renal function elevating the extent of acute renal failure and thus the mortality rate.

Metabolic factors for urolithiasis in acromegalic patients

Acromegaly is associated with metabolic disturbances of calcium and phosphorus which can also contribute to renal lithogenesis. In order to characterize these disturbances more precisely, an oral calcium load test was performed on 14 active acromegalic patients. Serum and urinary levels of calcium, phosphorus, uric acid, creatinine and urinary cyclic AMP were determined. Of the 14 patients, 5 (36%) presented hypercalciuria, 5 (36%) presented intestinal calciumhyperabsorption and 6 (43%) had uric acid hyperexcretion. Two patients (14%) presented nephrolithiasis. The medical records of 32 additional acromegalic patients with or without active disease were reviewed for a history of previous stones, which was observed in three cases (9.5%). The present data suggest that nephrolithiasis occurs more frequently among acromegalic patients because of the underlying metabolic disturbances of calcium presented by this population

Stress and hypertension: studies in three experimental models

The effects of three models of stress upon blood pressure and central responsiveness to angiotensin II (AII) and noradrenaline (NA) were assessed in rats. Considering general parameters of stress efficacy, all models were effective to induce stress but hypertension only occurred in animals submitted to rapid eye movement sleep deprivation (REM-sd) and electric shock (ES). An increased central pressor effect of AII and NA was observed in these groups. On the other hand, restriction (R) did not increase blood pressure or central responsiveness to AII or NA. Instead of hypertension, R induced gastric ulcers and testis atrophy. Thus, hypertension occurs only in some models of stress and may be due to increased central responsiveness to AII and NA.

Renal disease in the elderly: etiology and evolution of 24 cases

We retrospectively analyzed the histological data, clinical presentations, and outcome of 24 patients aged 60 years or older at the initial evaluation for renal disease. The study setting was a referral-based nephrology clinic at a tertiary care center. Twenty-three out of the 24 patients had a mean follow-up of 16 months (range 3-48). Their mean age was 65 years (range 60-75). The most common histological diagnoses were crescentic glomerulonephritis (GN) (n = 4), membranoproliferative GN (n = 4), diffuse endocapillary proliferative GN (n = 3), and minimal change (n = 3). Clinical presentation included renal insufficiency in 16 patients, the nephrotic syndrome in 8 patients (associated in 4 with decreased renal function), and hematuria with subnephrotic rang proteinuria in 4 cases. Ten out of the 23 patients developed end-stage renal disease (ESRD). Median serum creatinine at presentation in the group that developed ESRD was significantly higher than in the group that did not develop ESRD (490 vs 270 mumol/l; p < 0.05). Seven patients died, 5 of whom had developed ESRD. A variety of renal diseases affect the kidneys of the elderly; prognosis was unfavorable in about half of the patients in this series. Larger prospective studies are needed to clarify the natural history of GN in the elderly.