Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection

ABSTRACT Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors.

In vitro approaches to antioxidant screening for the development of a sunscreen formulation

Abstract The incorporation of antioxidants into sunscreens may provide additional skin photoprotection against the harmful photobiological effects of ultraviolet radiation. The present study evaluated the applicability of a screening approach to the assessment of the antioxidant and photoprotective properties of vitamin C, vitamin E, and coenzyme Q10 and then determined the performance of the most effective antioxidant in a sunscreen formulation. Antioxidant activity was assessed by the 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay, 2,2`-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS) assay, and oxygen radical absorbance capacity (ORAC) assay, and the photoprotective potential was investigated by the yeast photoprotection assay. The antioxidant with the best effect was incorporated into sunscreen formulations which were evaluated for 120 days regarding their in vitro photoprotective parameters. Vitamin C showed high antioxidant capacity as well as a photoprotective potential against simulated solar irradiation applied for times longer than 1 h. Although the Sun Protection Factor, UVA/UVB ratio and critical wavelength did not differed significantly (p<0.05) between the formulation blank and the formulations containing 0.5% or 1% vitamin C, formulations with vitamin C kept their photostability for 6 months. Consequently, the proposed screening approach seems to be promising for the development of an antisolar photostable formulation containing vitamin C as an antioxidant.

Development, physicochemical evaluation, and in vivo permeation studies of topical formulations containing 0.1% tacrolimus

Abstract The objective of this paper was to develop and evaluate two semi-solid pharmaceutical forms containing 0.1% tacrolimus: cream (CRT01) and gel (GLT01). For the evaluation of physicochemical stability, at times 0, 30, 60 and 90 days, at 23°C and at 40°C, High Performance Liquid Chromatography coupled with a Diode Array Detector (HPLC-DAD) was employed. This method was developed and validated for tacrolimus quantification. The occlusivity test and skin permeation assay were also performed, using an animal model (Wistar rats), and the CRT01 and GLT01 were compared to the 0.1% tacrolimus ointment (PFU01) obtained from the University Pharmacy, Federal University of Rio de Janeiro, Brazil. CRT01 and GLT01 presented a homogeneous aspect and consistency adequate for topical products, along with sensory characteristics above PFU01. They also presented adequate physicochemical stability for 90 days and a lower occlusive effect than PFU01 (p<0.05). CRT01 showed greater affinity for the skin when compared to PFU01 and GLT01, with low systemic absorption. The CRT01 semi-solid formulation was considered the most adequate one to treat patients with atopic dermatitis or other dermatologic inflammatory diseases, promoting rational use of tacrolimus

University Pharmacy: from the foundation to the Pandemic times of Covid-19

Abstract The University Pharmacy Program (FU), from the Federal University of Rio de Janeiro (UFRJ), was created based on the need to offer a curricular internship to students of the Undergraduate Course at the Faculty of Pharmacy. Currently, it is responsible for the care of about 200 patients/day, offering vacancies for curricular internships for students in the Pharmacy course, it has become a reference in the manipulation of many drugs neglected by the pharmaceutical industry and provides access to medicines for low-income users playing an important social function. Research is one of the pillars of FU-UFRJ and several master and doctoral students use the FU research laboratory in the development of dissertations and theses. As of 2002, the Pharmaceutical Care extension projects started to guarantee a rational and safe pharmacotherapy for the medicine users. From its beginning in 1982 until the current quarantine due to the COVID-19 pandemic, FU-UFRJ has been adapting to the new reality and continued to provide patient care services, maintaining its teaching, research, and extension activities. The FU plays a relevant social role in guaranteeing the low-income population access to special and neglected medicines, and to pharmaceutical and education services in health promotion.

Compounded medications for cardiovascular use in neonatology: an integrative review / Medicamentos manipulados de uso cardiovascular em neonatologia: uma revisão integrativa

ABSTRACT Objective: To analyze the profile of the compounded cardiovascular medicines prescribed in neonatology in Brazil. Data source: An integrative bibliographic review was carried out, including studies published in the last 20 years. The used descriptors were: Intensive Care Neonatal, Off-Label Use, Pharmaceutical Preparations, in the databases Virtual Health Library (VHL), PubMed, and Scientific Electronic Library Online (SciELO). Review articles and guidelines were excluded. The quality of the evidence was analyzed, and 10 articles were selected to integrate the study. Data synthesis: The profile of routine prescrption in the neonatal unit was evaluated. The main cardiovascular medications prescribed as compounding formulation were: Spironolactone, Captopril, Furosemide, Hydrochlorothiazide, Propranolol, Amiodarone, Nifedipine, Carvedilol, Digoxin, Enalapril, Epinephrine, and Hydralazine. The drugs were obtained from adaptations of dosage forms, through the transformation of capsules or tablets into liquid formulations, as a solution, suspension, or syrup, as well as in the form of solutions prepared from active pharmaceutical ingredients. The compounding of medications made drug therapy possible in neonatology, considering that such medications do not have registration of the oral liquid dosage form in the country, despite being part of the List of Essential Medicines for Children of the Word Health Organization. Conclusions: It was possible to analyze the profile of compounded cardiovascular medicines prescribed in neonatology in Brazil. The results showed the need for the development of medications suitable for the neonatal population, and the standardization of operational procedures for preparing extemporaneous formulations in neonatology to increase drug safety.

RESUMO Objetivo: Analisar o perfil dos medicamentos cardiovasculares manipulados prescritos em neonatologia no Brasil. Fontes de dados: Foi realizada uma revisão bibliográfica integrativa, incluindo estudos publicados nos últimos 20 anos. As palavras-chave utilizadas foram: intensive care neonatal, off-label use, pharmaceutical preparations, nos bancos de dados da Biblioteca Virtual em Saúde (BVS), PubMed e Biblioteca Eletrônica Científica Online (SciELO). Os artigos de revisão e diretrizes foram excluídos. A qualidade da evidência foi analisada, e foram selecionados 10 artigos para integrar o estudo. Síntese dos dados: Todos os estudos possibilitaram a avaliação do perfil de prescrição na rotina da unidade. Os principais fármacos cardiovasculares, prescritos em formulação extemporânea, foram espironolactona, captopril, furosemida, hidroclorotiazida, propranolol, amiodarona, nifedipina, carvedilol, digoxina, enalapril, epinefrina e hidralazina. Os medicamentos foram obtidos mediante adaptações de formas farmacêuticas, por meio da transformação de cápsulas ou comprimidos em formulações líquidas, como solução, suspensão ou xarope, assim como também na forma de soluções preparadas com base nos insumos farmacêuticos ativos. A manipulação de medicamentos tornou possível o tratamento medicamentoso em neonatologia, uma vez que tais medicamentos não possuem registro da forma farmacêutica líquida oral no país, apesar de integrarem a lista de medicamentos essenciais em pediatria da Organização Mundial da Saúde. Conclusões: Foi possível analisar o perfil dos medicamentos cardiovasculares manipulados prescritos na neonatologia no Brasil. Os resultados evidenciaram a necessidade do desenvolvimento de medicamentos adequados à população neonatal e à padronização dos procedimentos operacionais do preparo de formulações extemporâneas na neonatologia, para aumentar a segurança dos medicamentos.

Development and clinical application of hydrogel formulations containing papain and urea for wound healing

Abstract Hydrogels are used for wound treatment, as they may contain one or more active components and protect the wound bed. Papain is one of the active substances that have been used with this purpose, alongside urea. In this paper, carboxypolymethylene hydrogels containing papain (2% and 10% concentrations) and urea (5% concentration) were produced. Physical-chemical stability was performed at 0, 7, 15 and 30 days at 2-8ºC, 25ºC and 40ºC, as well as the rheological aspects and proteolytic activity of papain by gel electrophoresis. Clinical efficacy of the formulations in patients with lower limb ulcers was also evaluated in a prospective, single-center, randomized, double-blind and comparative clinical trial. The results showed 7-day stability for the formulations under 25ºC, in addition to approximately 100% and 15% of protein activity for 10% and 2% papain hydrogel, respectively. The rheological profile was non-Newtonian for the 10% papain hydrogel tested. There were no significant differences regarding the mean time for healing of the lesions, although 10% papain presented a better approach to be used in all types of tissue present in the wound bed.

Thyroid Volume in Pregnancy is Associated with Parity, Gestational Age, and Body Mass Index in an Iodine-sufficient Area / O volume tireoidiano em gestantes está associado à paridade, idade gestacional e índice de massa corporal em uma área suficiente em iodo

Abstract Objective We compared thyroid volume (TV) and presence of nodular goiter (NG) in pregnant vs. non-pregnant women in an iodine-sufficient area. We also evaluated the relationship between gestational age, parity, and TV in the pregnant women group, and determined the 2.5th and 97.5th percentiles of normal TV in pregnancy. Methods This cross-sectional study included 299 healthy women (216 pregnant) without previous thyroid diseases. Thyroid ultrasounds were performed and compared between pregnant and non-pregnant women. The range of normal distribution of TV (2.5th and 97.5th percentiles) in pregnancy was determined after excluding individuals with positive thyroid antibodies, NG, and/or abnormal serum thyrotropin (TSH) or free thyroxine (FT4). Results Thyroid volume was larger among pregnant compared to non-pregnant women (8.6 vs 6.1 cm3; p< 0.001) and was positively correlated with gestational age (rs = 0.221; p= 0.001), body mass index (BMI, rs 0.165; p= 0.002), and FT4 levels (rs 0.118 p= 0.021). Nodular goiter frequency did not differ between the two groups. There was a negative correlation between TV and TSH (rs -0.13; p= 0.014). Thyroid volume was lower among primiparous compared to multiparous patients (7.8 vs 8.9; p< 0.001) and was positively correlated with parity (rs 0.161; p= 0.016). The 2.5th and 97.5th percentiles of TV were 4.23 and 16.47 cm3, respectively. Conclusion Thyroid volume was higher in pregnant compared to non-pregnant women and was positively related to parity, BMI, and gestational age in a normal iodine status population. Pregnancy did not interfere with the development of NG.

Resumo Objetivo Comparamos o volume tireoidiano (VT) e a presença de bócio nodular (BN) em mulheres grávidas e não grávidas em uma área suficiente em iodo. Também avaliamos a relação entre idade gestacional, paridade e VT no grupo de gestantes e determinamos os percentis 2,5 e 97,5 de VT normal na gestação. Métodos Este estudo transversal incluiu 299 mulheres saudáveis (216 grávidas) sem doenças tireoidianas prévias. Ultrassonografias de tireoide foram realizadas e comparadas entre mulheres grávidas e não grávidas. A faixa de distribuição normal de VT (percentis 2,5 e 97,5) na gestação foi determinada após a exclusão de indivíduos com anticorpos tireoidianos positivos, BN e/ou tireotropina sérica (TSH) ou tiroxina livre (T4L) anormais. Resultados O VT foi maior entre as gestantes em comparação com as mulheres não grávidas (8,6 vs 6,1 cm3; p< 0,001) e foi positivamente correlacionado com a idade gestacional (rs = 0,221; p= 0,001), índice de massa corporal (IMC, rs 0,165; p= 0,002) e níveis de T4L (rs 0,118 p= 0,021). A frequência de BN não diferiu entre os dois grupos. Houve correlação negativa entre VT e TSH (rs -0,13; p= 0,014). O VT foi menor entre as primíparas em comparação com as multíparas (7,8 vs 8,9; p< 0,001) e foi positivamente correlacionado com a paridade (rs 0,161; p= 0,016). Os percentis 2,5 e 97,5 de VT foram 4,23 e 16,47 cm3, respectivamente. Conclusão O VT foi maior em gestantes em comparação com mulheres não grávidas e foi positivamente relacionado à paridade, IMC e idade gestacional em uma população com status iódico normal. A gravidez não interferiu no desenvolvimento de BN.

Farmacovigilância de medicamentos manipulados - Parte 1: perfil das notificações no Brasil / Pharmacovigilance of compounded drugs - Part 1: profile of Brazilian notifications

Introdução: Medicamentos manipulados são preparações farmacêuticas extemporâneas, em sua maioria utilizadas para viabilizar a farmacoterapia de populações especiais por meio de formulações personalizadas. Desta forma, não são submetidos a testes clínicos anteriores a sua utilização, sendo as ações de farmacovigilância fundamentais para a garantia de sua segurança. Objetivo: Descrever o perfil dos medicamentos manipulados registrados nas notificações de queixas técnicas reportadas ao Sistema Nacional de Notificação em Vigilância Sanitária (Notivisa). Método: Estudo exploratório descritivo, retrospectivo ao período de 2006-2016 das notificações de medicamentos manipulados reportadas ao Notivisa. Resultados: Foram analisadas 303 notificações de queixas técnicas referentes a 26 medicamentos oficinais, 268 magistrais e nove não classificadas. Foram identificados 107 diferentes ativos. Os de ação no aparelho digestivo e metabolismo foram os mais frequentes (42,00%), seguidos daqueles com ação no sangue e órgãos hematopoiéticos (10,00%), dermatológicos (10,00%) e aparelho cardiovascular (9,70%). Os principais desvios de qualidade notificados foram relacionados às formas farmacêuticas líquidas, sendo a presença de corpo estranho, partículas ou precipitados, a mais frequente (22,40%), seguida de alterações na embalagem e rotulagem (18,60%). Conclusões: Foi possível descrever os principais medicamentos manipulados notificados ao Notivisa, suas características e substâncias ativas veiculadas nas formulações, o que pode contribuir para as ações de vigilância sanitária no âmbito magistral, tão incipiente ainda no Brasil.

Introduction: Compounded drugs are extemporaneous pharmaceutical preparations, mostly used to enable the pharmacotherapy of special populations through personalized formulations. In this way, they are not subjected to clinical tests prior to their use, and pharmacovigilance actions are fundamental to guarantee their safety. Objective: to describe the profile of compounded drugs registered in the notifications of technical complaints reported to the National Health Surveillance Notification System (NOTIVISA). Method: Descriptive exploratory study, retrospective to the period 2006-2016, of the notifications of compounded drugs reported to Notivisa. Results: 303 notifications of technical complaints regarding 26 officinal, 268 magistral and 09 unclassified medicines were analyzed. 107 different assets were identified. Those with action on the Digestive System and Metabolism were the most frequent (42.00%), followed by those with action on the Blood and Hematopoietic Organs (10.00%), Dermatological (10.00%) and Cardiovascular System (9.70%). The main quality deviations reported were related to liquid dosage forms, with the presence of foreign bodies, particles or precipitates being the most frequent (22.40%), followed by changes in packaging and labeling (18.60%). Conclusions: It was possible to describe the main compounded drugs notified to Notivisa, their characteristics and active substances conveyed in the formulations, which can contribute to the actions of Health Surveillance in the masterful scope, which is still incipient in Brazil.

Farmacovigilância de medicamentos manipulados - Parte 2: notificações de eventos adversos e queixas técnicas no Brasil / Pharmacovigilance of compounded drugs - Part 2: Adverse event notifications and technical complaints in Brazil

Introdução: Medicamento manipulado é a preparação farmacêutica obtido por procedimento farmacotécnico a partir de uma prescrição de profissional habilitado destinada a um paciente individualizado ou cuja fórmula esteja inscrita no Formulário Nacional ou Internacional. Objetivo: Descrever o perfil das notificações relacionadas aos medicamentos manipulados, reportadas ao Sistema Nacional de Notificação em Vigilância Sanitária (Notivisa). Método: Estudo exploratório descritivo, retrospectivo ao período de 2006-2016 das notificações de medicamentos manipulados reportadas ao Notivisa. Os dados foram registrados e analisados no programa Excel versão para Windows 3.5.4. Resultados: De um total de 108.400 notificações referentes a medicamentos no período estudado, 335 (0,32%) foram relacionadas a notificações de medicamentos manipulados. As queixas técnicas (QT) obtiveram 90,40% das notificações, enquanto os eventos adversos (EA) obtiveram 9,60%. A Região Sudeste foi a principal notificadora (66,00%) e o estado de São Paulo, responsável por 54,00% do total das notificações. Os hospitais foram as instituições com maior frequência de notificação (81,00%). Foi possível avaliar os motivos que geraram as notificações, das quais as alterações relacionadas ao aspecto da preparação farmacêutica foram as predominantes dentre as QT, enquanto para os EA destacaram-se as reações adversas a medicamentos. Conclusões: As ocorrências observadas na farmacovigilância de medicamentos manipulados são próprias de cada produto com suas particularidades, embora o que se busque seja um padrão. Desta forma, tal observação poderá prevenir a ocorrência de danos à população exposta a situações semelhantes, se for devidamente notificada e amplamente divulgada.

Introduction: Compounded drug is a pharmaceutical preparation obtained by a pharmacotechnical procedure from a prescription of a qualified professional intended for an individualized patient, or whose formula is registered in the National or International Form. Objective: To describe the profile of notifications related to compounded drugs, reported to the National Health Surveillance Notification System (Notivisa). Method: Descriptive exploratory study, retrospective to the period 2006-2016, of the notifications of compounded drugs reported to Notivisa. Data were recorded and analyzed using the Excel program, version for Windows 3.5.4. Results: Of a total of 108,400 notifications referring to medicines in the studied period, 335 (0.32%) were related to reports of compounded drugs. Technical complaints (QT) obtained 90.40% of the notifications, while adverse events (AE) obtained 9.60%. The Southeast region was the main notifier (66.00%), and the state of São Paulo was responsible for 54.00% of the total notifications. Hospitals were the institutions with the highest frequency of notification (81.00%). It was possible to evaluate the reasons that generated the notifications, of which the changes related to the aspect of the pharmaceutical preparation were the predominant among the QT, while for the AEs, the adverse drug reactions stood out. Conclusions: The occurrences observed in the pharmacovigilance of compounded drugs are specific to each product with its particularities, although, what is sought is a pattern. In this way, such observation can prevent the occurrence of damages to the population exposed to similar situations, if it is duly notified and widely disseminated.

Laboratory variables as predictors of progression in gastroenteropancreatic neuroendocrine tumors in different lines of antineoplastic treatments

ABSTRACT Objective: To determine the association of red cell blood counts, and liver panel tests to predict outcomes in patients with gastroenteropancreatic neuroendocrine tumors who underwent systemic antineoplastic treatments. Methods: Patients with gastroenteropancreatic neuroendocrine tumors in systemic treatment were assessed according to laboratory tests within the same period. Progression free survival was determined by the period between the beginning of treatment and the date of progression. We used conditional models (PWP model) to verify the association between laboratory tests and tumor progression. The level of significance used was 5%. Results: A total of 30 treatments given to 17 patients in the intention-to-treat population were evaluated. Treatment included octreotide, lanreotide, everolimus, lutetium, and chemotherapy. We had statistically significant results in chromogranin A, neutrophils and platelets-to-lymphocyte ratio. The risk of progression increases by 2% with the addition of 100ng/mL of chromogranin A (p=0.034), 4% with the increase of 100 neutrophil units (p=0.006), and 21% with the addition of 10 units in platelets-to-lymphocyte ratio (p=0.002). Conclusion: Chromogranin A, neutrophils and platelets-to-lymphocyte ratio were associated with disease progression during systemic treatment in gastroenteropancreatic neuroendocrine tumors. Further prospective studies with larger cohorts are necessary to validate our findings.

Medication Errors in Compounding Pharmacy / Erros de Medicação em Farmácia de Manipulação

Abstract The traditional role of compounding pharmacies is to make drugs prescribed by physicians for patients with needs that cannot be met by commercially available drugs. Medication errors have attracted attention of health authorities since they compromise the patient's assistance, enhance morbidity rates and increase the healthcare costs. This study analyzed medication errors that occurred in a compounding pharmacy school in order to identify types and periodicity and to outline strategies in the service delivery process to mitigate such errors. This is a retrospective descriptive study carried out from March to June of 2018 and based on the analysis of occurrences recorded by the service sector of a magistral pharmacy school in Rio de Janeiro. The errors were classified according to the stage in the pharmaceutical assistance process and reached 124 records, with an average of 1.03 occurrence/day. The main causes were prescription errors (95 occurrences or 76.60%), administering (12 occurrences or 9.68%), labeling (7 occurrences or 5.65%), dispensing (7 occurrences or 5.65%) and handling (3 occurrences or 2.42%). The errors in the prescription stage, the most frequent ones, were potential but intercepted and cleared before they resulted in a harmful outcome. This study identified medication errors in a magistral pharmacy. The errors were potential but intercepted and resolved before they resulted in a harmful outcome. The results points to the need for systematic surveillance of adverse events in a more active way and for standardizing the procedures throughout the process, from assessing the medical prescription to guiding the patient for proper administration and storage. (AU)

Resumo O papel tradicional das farmácias de manipulação é manipular medicamentos prescritos por médicos para pacientes com necessidades que não podem ser atendidas pelos medicamentos disponíveis no mercado. Os erros de medicação são eventos que vêm recebendo grande destaque entre autoridades sanitárias por contribuírem com o aumento das taxas de morbidade e dos custos do sistema de saúde, comprometendo a qualidade da assistência prestada ao paciente. as it involves legal and ethical aspects of impact on professional practice. Errors in the administration of medications point out the responsibility of the nursing category. An adequate performance of this role enables the prevention of real errors. The purpose of this study was to analyze nursing responsibilities in the administration of medications through a bibliographical research in the Medline and Lilacs data bases (1997/1999O presente estudo teve por objetivo analisar os principais erros de medicação observados em uma Farmácia Escola magistral localizada no sudeste do Brasil. Foi desenvolvido um estudo descritivo retrospectivo no período de março a junho de 2018, baseado na análise das ocorrências de erros de medicação registradas no período. Os erros foram classificados de acordo com as etapas da assistência farmacêutica. Um total de 124 registros foram verificados no período, com média diária de 1,03 ocorrências/dia. As principais causas destes registros foram em 95 (76,60%) devido a erros de prescrição, 3 (2,42%) referentes à erros de manipulação dos medicamentos, 7 (5,65%) erros de rotulagem, 7 (5,65%) erros de dispensação, e 12 (9,68%) referentes à erros de administração do medicamento pelo paciente. Os erros de maior frequência foram relacionados à escrituração da prescrição. Os erros verificados eram potenciais e foram interceptados e resolvidos antes que resultassem em um desfecho danoso. Os resultados indicaram a necessidade de avançar para uma vigilância sistemática de eventos adversos de forma mais ativa e padronização das condutas relacionadas aos processos desde a avaliação da qualidade da prescrição até a orientação para administração e guarda adequada do medicamento pelo paciente. (AU)

High prevalence of HIV-associated neurocognitive disorders (HAND) in São Paulo City, Brazil / Alta prevalência de desordem neurocognitiva associada ao HIV (HAND) na Cidade de São Paulo, Brazil

INTRODUCTION: HIV-associated neurocognitive disorders (HAND) are the subject of many studies, some of them reporting a prevalence of up to 50 percent. OBJECTIVES: To determine the prevalence and factors associated with HIV neurocognitive disorders (HAND) in a cohort of HIV-1-infected patients in São Paulo city, Brazil. METHODOLOGY: Descriptive cross-sectional study including 106 HIV-1-infected patients, employing direct interview and neuropsychological tests, applied by trained neuro-psychologists with expertise in the tests. Other, similar assessment tools we used were Brief Neurocognitive Questionnaire, International HIV Dementia Scale, Lawton Instrumental Activities of Daily Living, Hospital Anxiety and Depression Scale, Social Support Scale for People with HIV/Aids, Assessment of Adherence to Antiretroviral Therapy Questionnaire, and a complex neuropsychological assessment. RESULTS: We included 106 patients from May 2015 to April 2018. We found a high prevalence of HAND in our patients (45%), with 27.5% presenting asymptomatic neurological impairment (ANI) and 17.5% mild neurological dysfunction (MND); only one patient presented HIV-associated dementia (HAD) (0.9%). Women were more likely to have MND (52.9%) and the only case of HAD was also female. The high prevalence of neurocognitive disorders was independent of the immunological status, use of efavirenz, or virological control. CONCLUSIONS: This study may mirror the national and international scenarios, showing a high prevalence of HAND (45%) and the prevalence of some risk factors, in special among women

INTRODUÇÃO: As doenças neurocognitivas associadas ao HIV (HAND), são o assunto de muitos estudos, alguns deles relatando uma prevalência de até 50 por cento. OBJETIVOS: Determinar a prevalência e os fatores associados aos distúrbios neurocognitivos do HIV (HAND) em uma coorte de pacientes infectados pelo HIV-1 na cidade de São Paulo, Brasil. METODOLOGIA: Estudo transversal descritivo incluindo 106 pacientes infectados pelo HIV-1, utilizando entrevista direta e testes neuropsicológicos, aplicados por neuropsicólogos treinados com experiência nos testes. Foram utilizados também: Questionário Neurocognitivo Breve, Escala Internacional de Demência do HIV, Atividades Instrumentais de Vida Diária de Lawton, Escala Hospitalar de Ansiedade e Depressão, Escala de Apoio Social para Pessoas com HIV / Aids, Avaliação da Adesão à Terapia Antiretroviral Questionário e uma bateria de avaliação neuropsicológica complexa. RESULTADOS: Foram avalaidos 106 pacientes de maio de 2015 a abril de 2018. Foi observado uma alta prevalência de HAND em nossos pacientes (45%), com 27,5% apresentando comprometimento neurológico assintomático (ANI) e 17,5% comprometimento cognitive leve (MND); apenas um paciente apresentou demência associada ao HIV (DAH) (0,9%). As mulheres eram mais propensas a ter MND (52,9%) e o único caso de HAD também era do sexo feminino. A alta prevalência de distúrbios neurocognitivos foi independente do estado imunológico, uso de efavirenz ou controle virológico. CONCLUSÕES: Este estudo pode espelhar o cenário nacional e internacional, mostrando uma alta prevalência de HAND (45%) e a prevalência de alguns fatores de risco, em especial entre as mulheres

Prevalence of canine atopic dermatitis at the Veterinary Hospital of the "Universidade Federal Rural da Amazônia" in Belém/Pará, Brazil / Prevalência de dermatite atópica canina no Hospital Veterinário da Universidade Federal Rural da Amazônia em Belém/Pará, Brasil

Canine atopic dermatitis (CAD) is a pruritic, chronic inflammatory disease, recurrent and genetically predisposed, which is the second most frequent allergic skin disorder, and ranks second among all the causes of pruritus in dogs worldwide. Given the absence of data on the occurrence of CAD in the northern region of Brazil, the aim of the current study was to conduct a survey to define the prevalence of canine atopic dermatitis attended at the Dermatology Department of the Mário Dias Teixeira Veterinary Hospital of the "Universidade Federal Rural da Amazônia" (HOVET-UFRA). To determine the prevalence of CAD, a retrospective survey was carried out of clinical records and results of dermatological examinations conducted at the Dermatology Department of HOVET-UFRA Belém, Pará from October 2018 to October 2019. During this period, 456 dogs were examined, of which 25.65% (117) were diagnosed with atopic dermatitis. Among the animals diagnosed, 62.4% (73) were females and 51.7% (29) were of the Shih-tzu breed. This level of atopic dermatitis is considered high. There are still no exact data on the incidence and prevalence of this dermatopathy, with described occurrence ranging from 3 to 15% of the canine population, a geographical relationship may be present. Although a sex-related predisposition has not been proven, a higher incidence of atopy in females is described, which indicated this may be the case. The most commonly diagnosed dogs in this study were the Shih-tzu breed. It is suspected that the regional popularity of some breeds, or the different genetic backgrounds in different geographical areas, may affect the predominance of CAD in some breeds. The results of the present study demonstrate the need for more research on the prevalence of canine atopic dermatitis, and better means of characterizing the population of atopic dogs in the region, so that it is possible to obtain a reliable epidemiological profile.(AU)

A dermatite atópica canina (DAC) é uma doença inflamatória crônica e pruriginosa recorrente e geneticamente predisposta, que se destaca como o segundo transtorno cutâneo alérgico mais frequente e ocupa o segundo lugar entre todas as causas de prurido em cães. Diante da ausência de dados da ocorrência de DAC na região Norte do Brasil, objetivou-se realizar um levantamento de dados para definir a prevalência de dermatite atópica canina atendida no Serviço de Dermatologia do Hospital Veterinário Mário Dias Teixeira da Universidade Federal Rural da Amazônia (HOVET-UFRA). Foi realizado um levantamento retrospectivo através dos registros clínicos e dos resultados de exames dermatológicos com base nos atendimentos dermatológicos no setor de Dermatologia do HOVET-UFRA Belém/Pará, de outubro de 2018 a outubro de 2019 para determinar a prevalência de DAC. Nesse período, foram atendidos 456 cães e destes, 25,65% (117) foram diagnosticados com dermatite atópica. Dentre os animais diagnosticados, 62,4% (73) eram fêmeas e 51,7% (29) eram da raça Shih-tzu. Neste estudo houve uma alta prevalência de cães com Dermatite atópica. Ainda não existem dados exatos sobre a incidência e a prevalência desta dermatopatia, com ocorrência descrita variando de 3 a 15% da população canina, podendo ter relação geográfica. Embora a predisposição sexual não tenha sido comprovada, descreve-se maior incidência de atopia em fêmeas, concordando com esta pesquisa. Os cães mais acometidos neste estudo foram da raça Shih-tzu. Suspeita-se que a popularidade regional de algumas raças ou os diferentes antecedentes genéticos em diferentes áreas geográficas afetam a predominância de algumas raças. Estes resultados mostraram que a prevalência de DAC em cães é a mais frequentemente diagnosticada no setor de Dermatologia do HOVET-UFRA, sendo mais prevalente em fêmeas e na raça Shih-tzu, podendo refletir um aspecto regional desta dermatopatia. Os resultados do presente estudo contribuíram para demonstrar a importância de mais pesquisas sobre a prevalência da Dermatite atópica canina e melhor caracterizar a população de cães atópicos na região, para que seja possível obter um perfil epidemiológico confiável.(AU)

Trajetória, avanços e perspectivas da pós-graduação no Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro / History, advances, and perspectives of graduate studies at Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro

O Instituto de Nutrição Josué de Castro (INJC), da Universidade Federal do Rio de Janeiro (UFRJ), foi criado em 1946 como instituição de ensino e pesquisa na área de Nutrição. Este trabalho, submetido na categoria "Perspectivas", descreve a trajetória do ensino de Pós-Graduação (PG) no INJC, no ano do jubileu dos 75 anos do INJC. Para elaborar este relato, foram consultados artigos, livros, documentos, relatórios, atas e anotações do INJC e da UFRJ. O ensino de PG no INJC teve início no final da década de 1970, com a oferta de dois cursos de especialização. Em 1985, foi implantado o mestrado em Nutrição Humana. Atualmente, o INJC é a única instituição da área de Nutrição no Brasil que abriga um programa acadêmico de mestrado e doutorado, o Programa de Pós-Graduação em Nutrição, e um programa de mestrado profissional, o Programa de Pós-Graduação em Nutrição Clínica. A instituição oferece, ainda, seis cursos de especialização e integra quatro programas de residência multiprofissional da UFRJ. Indicadores favoráveis consistentes expressam o sucesso do esforço coordenado de docentes e discentes dos Programas de PG em iniciativas que privilegiam a obtenção de financiamento, o desenvolvimento de projetos interdisciplinares intra e interinstitucionais e o incentivo à produção acadêmica de qualidade. A pós-graduação no INJC articula-se com o ensino de graduação e com a extensão, contribuindo para a formação qualificada de recursos humanos no campo da Alimentação e Nutrição. Aos 75 anos, o INJC, por meio do ensino de PG, reitera o papel social e acadêmico da universidade pública brasileira. (AU)

The Instituto de Nutrição Josué de Castro (Josué de Castro Nutrition Institute - INJC), at the Universidade Federal do Rio de Janeiro (Federal University of Rio de Janeiro - UFRJ) was created in 1946 as an education and research institution in the field of nutrition. This work, presented in the Perspectives modality, describes the history of graduate education (GE) at INJC, in the year of INJC's 75th anniversary. This work is based on articles, books, documents, reports, minutes, and notes from UFRJ and INJC's Graduate Programs. GE at INJC began in the late 1970s, with the offer of specialization courses. In 1985, the Master's Degree Program in Human Nutrition was implemented. Currently, INJC is the only institution in the field of Nutrition in Brazil that hosts academic master's and doctoral programs, the Graduate Program in Nutrition, and a professional master's program, the Graduate Program in Clinical Nutrition. The institution also offers six specialization courses and integrates four multi-professional internship programs within UFRJ. Consistent favorable indicators express the success of the coordinated efforts of faculty and students of GE Programs in initiatives that prioritize attraction of funding, the implementation of intra- and inter-institutional interdisciplinary projects, and qualified academic production. Graduate education at INJC is linked to undergraduate education and to university outreach programs, contributing to high-quality education and training of human resources in the field of food and nutrition. After 75 years, INJC, through graduate education, reaffirms the social and academic role of Brazilian public universities. (AU)

Efficacy of vitamin D supplementation among persons living with HIV/AIDS in São Paulo city, Brazil

ABSTRACT Hypovitaminosis D is now considered a pandemic, especially among more vulnerable populations and in HIV-infected subjects, with 80% presenting levels below 30 ng/mL. As there is no consensus on the more adequate dosage needed to correct such deficiency, the objective of this study was to evaluate 25 (OH) vitamin D supplementation in HIV-1 patients deficient of vitamin D. A total of 73 HIV-1-infected patients were included, drawn from a cohort of 435 patients; 37 patients were randomized to the active group, supplemented once a week with 50,000 UI vitamin D by mouth (group 1) and 36 to the placebo group (group 2). The study period ranged from June 2016 to September 2017. Variables involved in vitamin D metabolism and risk factors associated with hypovitaminosis were evaluated. The mean age was 45 years and 31.5 % were women. Vitamin D supplementation was effective in normalizing serum levels after six months in group 1 (mean 35 ng/mL compared to 21 ng/mL for the placebo group; p= 0.04). No patient reached blood levels considered toxic (>100 UI). Efavirenz use can negatively influence vitamin D levels and supplementation is necessary as a likely adjunct to improving CD4+ T cells, resulting in greater effectiveness of the treatment. A weekly oral dose of 50,000 IU of vitamin D was sufficient to normalize the vitamin deficiency, safely and with good adherence among persons living with HIV/AIDS in Brazil.

Prevalence of canine atopic dermatitis at the Veterinary Hospital of the Universidade Federal Rural da Amazônia in Belém/Pará, Brazil

ABSTRACT: Canine atopic dermatitis (CAD) is a pruritic, chronic inflammatory disease, recurrent and genetically predisposed, which is the second most frequent allergic skin disorder, and ranks second among all the causes of pruritus in dogs worldwide. Given the absence of data on the occurrence of CAD in the northern region of Brazil, the aim of the current study was to conduct a survey to define the prevalence of canine atopic dermatitis attended at the Dermatology Department of the Mário Dias Teixeira Veterinary Hospital of the Universidade Federal Rural da Amazônia (HOVET-UFRA). To determine the prevalence of CAD, a retrospective survey was carried out of clinical records and results of dermatological examinations conducted at the Dermatology Department of HOVET-UFRA Belém, Pará from October 2018 to October 2019. During this period, 456 dogs were examined, of which 25.65% (117) were diagnosed with atopic dermatitis. Among the animals diagnosed, 62.4% (73) were females and 51.7% (29) were of the Shih-tzu breed. This level of atopic dermatitis is considered high. There are still no exact data on the incidence and prevalence of this dermatopathy, with described occurrence ranging from 3 to 15% of the canine population, a geographical relationship may be present. Although a sex-related predisposition has not been proven, a higher incidence of atopy in females is described, which indicated this may be the case. The most commonly diagnosed dogs in this study were the Shih-tzu breed. It is suspected that the regional popularity of some breeds, or the different genetic backgrounds in different geographical areas, may affect the predominance of CAD in some breeds. The results of the present study demonstrate the need for more research on the prevalence of canine atopic dermatitis, and better means of characterizing the population of atopic dogs in the region, so that it is possible to obtain a reliable epidemiological profile.

RESUMO: A dermatite atópica canina (DAC) é uma doença inflamatória crônica e pruriginosa recorrente e geneticamente predisposta, que se destaca como o segundo transtorno cutâneo alérgico mais frequente e ocupa o segundo lugar entre todas as causas de prurido em cães. Diante da ausência de dados da ocorrência de DAC na região Norte do Brasil, objetivou-se realizar um levantamento de dados para definir a prevalência de dermatite atópica canina atendida no Serviço de Dermatologia do Hospital Veterinário Mário Dias Teixeira da Universidade Federal Rural da Amazônia (HOVET-UFRA). Foi realizado um levantamento retrospectivo através dos registros clínicos e dos resultados de exames dermatológicos com base nos atendimentos dermatológicos no setor de Dermatologia do HOVET-UFRA Belém/Pará, de outubro de 2018 a outubro de 2019 para determinar a prevalência de DAC. Nesse período, foram atendidos 456 cães e destes, 25,65% (117) foram diagnosticados com dermatite atópica. Dentre os animais diagnosticados, 62,4% (73) eram fêmeas e 51,7% (29) eram da raça Shih-tzu. Neste estudo houve uma alta prevalência de cães com Dermatite atópica. Ainda não existem dados exatos sobre a incidência e a prevalência desta dermatopatia, com ocorrência descrita variando de 3 a 15% da população canina, podendo ter relação geográfica. Embora a predisposição sexual não tenha sido comprovada, descreve-se maior incidência de atopia em fêmeas, concordando com esta pesquisa. Os cães mais acometidos neste estudo foram da raça Shih-tzu. Suspeita-se que a popularidade regional de algumas raças ou os diferentes antecedentes genéticos em diferentes áreas geográficas afetam a predominância de algumas raças. Estes resultados mostraram que a prevalência de DAC em cães é a mais frequentemente diagnosticada no setor de Dermatologia do HOVET-UFRA, sendo mais prevalente em fêmeas e na raça Shih-tzu, podendo refletir um aspecto regional desta dermatopatia. Os resultados do presente estudo contribuíram para demonstrar a importância de mais pesquisas sobre a prevalência da Dermatite atópica canina e melhor caracterizar a população de cães atópicos na região, para que seja possível obter um perfil epidemiológico confiável.

Development and characterization of photoprotective formulations containing keratin particles

This work deals with development and evaluation of MFQ protective formulation, which contains two organic filters, namely: octyl-p-methoxycinnamate (OMC) and benzophenone-3 (BP-3); a photostabilizing agent called ethylhexylmethoxycrylene (EHMCR) and keratin particles. The MFQ formulation was evaluated in order to measure its pH, spin-spin lattice relaxation time (T2H), occlusivity factor, formulation efficacy, photostability and skin permeation, as well as keratin particle properties. Keratin particle size increased when incorporated to formulation, however, it did not affect pH. The MFQ formulation was found to be photostable and photoprotective, as evidenced by sunlight photostability test, sun protection factor (SPF), UVA/UVB ratio and critical wavelength. Interaction between keratin particles and active substances (OMC, BP-3 and EHMCR) was evidenced by T2H measurements. Evidences suggest that keratin reduces the permeation of both UV filters employed along this study, therefore, it can be stated that keratin has a promising potential for use in sunscreen formulations.

Caso clínico: Diagnóstico de alergia a relajantes musculares y opiáceos / Case report: Diagnosis of allergy to muscle relaxants and opiates

The anesthesiologist is the specialist who most often faces allergic reactions due to the number of drugs and substances that are exposed to the patient during the course of an intervention. Although they are rare, they have a mortality rate between 3% and 10%. We present a clinical case of a 42-year-old woman with a history of anaphylactic reaction grade 2 that is coordinated for a Werthein-Meigs surgery, for which it is decided to test her with skin tests. The results were positive for morphine, fentanil, remifentanil and atracurium, which directly affected the perioperative management.

El anestesiólogo es el especialista que con mayor frecuencia se enfrenta a reacciones alérgicas por el número de fármacos y sustancias a las que se expone al paciente en el transcurso de una intervención. Si bien son poco frecuentes presentan una mortalidad entre 3 a 10%. Presentamos un caso clínico de una mujer de 42 años con un antecedente de reaccion anafiláctica grado 2 que se coordina para una cirugía de Werthein- Meigs, por lo cual se decide testearla con pruebas cutáneas. Los rsultados fueron positivos para morfina, fentani, remifentanil y atracurio, lo cual incidió directamente en el manejo perioperatorio.

Uso de la Dexmedetomidina en la Neurocirugía con el paciente despierto. A propósito de un caso clínico / Use of Dexmedetomidine in Neurosurgery with the patient awake. About a clinical case

Presentamos el caso de un paciente de 58 años, coordinado para resección de tumor temporo insular izquierdo mediante una craneotomía despierto. Se analiza en este trabajo, a partir de la descripción del caso clínico, las ventajas de la resección de este tipo de lesiones con el paciente despierto. La posibilidades de abordaje, despierto durante todo el procedimiento (awake), dormido-despierto-dormido (asleep-awake-asleep), dormido-despierto (asleep-awake). A su vez se analiza la técnica anestésica, la combinación de fármacos y especialmente las características de la Dexmedetomidina. Conclusiones: la neurocirugía con el paciente despierto, determina una serie de características y desafíos para el equipo anestésico tratante y la interacción con un equipo mulitidisciplinario (neurocirujanos, neurofisiologos, anestesiologos). Existen diferentes combinaciones de fármacos; siendo la Dexmedetomidina una opción que mejorar la satisfacción de los pacientes durante la etapa de despertar, así como las condiciones quirúrgicas con mínimas interferencia en la monitorización neurofisiológica.

We present the case of a 58-year-old patient, scheduled to resection of left insular tumor by an awake craniotomy. In this paper, from the description of the clinical case, we analyzed the advantages of a resection of this type of lesion with an awake patient. We discuss the surgical approach, and options of an awake patient all throughout the procedure, asleep-awake-asleep and asleep-awake. Also, the anesthetic technique, the combination of drugs and especially the characteristics of Dexmedetomidine are analyzed. Conclusions: neurosurgery with an awake patient, determines a series of characteristics and challenges for the anesthetic and multidisciplinary team (neurosurgeons, neurophysiologists, anesthesiologists). There are different combinations of drugs, with Dexmedetomidine being an option that would improve patient satisfaction during the awakening stage, as well as surgical conditions with minimal interference in neurophysiological monitoring.

Efeito de exercícios físicos e de lazer sobre os níveis de cortisol plasmático em pacientes com Aids / Effect of physical exercises and leisure on cortisol levels in Aids patients / Efecto del ejercicio físico y el ocio en los niveles de cortisol plasmático en pacientes con sida

Resumo O advento dos antiretrovirais para o tratamento dos indivíduos com Aids proporcionou aumento no tempo de sobrevida, porém o paciente, apesar de apresentar-se muitas vezes assintomático, pode apresentar importantes transtornos na esfera psicossocial, dentre eles o enfraquecimento das relações sociais, as quais se perdem com a descoberta da contaminação. A prática regular de exercícios físicos pode ser uma estratégia interessante de combate a problemas psicológicos associados à infecção pelo HIV. Indivíduos engajados em um programa de treinamento físico podem apresentar melhoria do bem-estar, elevação da autoestima e diminuição dos sintomas de depressão e ansiedade, que proporcionam maior interação social. Pacientes infectados com o HIV geralmente têm maior cortisol basal sérico e alguns estudos apontam que altos níveis de cortisol podem comprometer a função do sistema imune e atuar como aceleradores da progressão viral e do desenvolvimento da Aids. O objetivo deste trabalho foi avaliar o efeito de exercícios físicos e de lazer sobre os níveis de cortisol plasmático em pacientes com Aids. Pacientes selecionados foram divididos em dois grupos: Grupo I participou de atividades de exercício físico e Grupo II participou de atividades de lazer, ambos por 16 semanas. A avaliação consistiu da dosagem do cortisol plasmático antes do início das atividades e após 16 semanas: 57% dos pacientes apresentaram melhoria nos níveis do cortisol plasmático após o programa aplicado. Este trabalho sugere que o exercício físico e o lazer induzem uma melhoria fisiológica da resposta do cortisol em pacientes com Aids.

Abstract The advent of antiretroviral drugs for the treatment of AIDS individuals provided an increase in survival time, however, despite having the patient is often asymptomatic, can present significant disturbances in psychosocial sphere, among them, the weakening of social relations, which are lose with the discovery of the contamination. Regular physical exercise can be an interesting strategy to combat the psychological problems associated with HIV infection. Individuals engaged in a physical training program may have improved well -being, increased self-esteem, decrease in symptoms of depression and anxiety, but also provide greater social interaction. Patients infected with HIV generally have higher baseline serum cortisol and some studies suggest that high levels of cortisol can impair the function of the immune system, acting as accelerators of viral progression and development of AIDS. The objective of this study was to evaluate the effect of physical exercise and leisure on plasma cortisol levels in patients with AIDS. Selected patients were divided into two groups: Group I participated in physical activity and exercise Group II participated in leisure activities, both for a period of 16 weeks. The evaluation consisted of measurement of plasma cortisol before the start of activities and after 16 weeks. 57% of patients showed improvement in the levels of plasma cortisol after the program applied. This work suggests that physical exercise and leisure induce a physiological improvement cortisol response in patients with AIDS.

Resumen La llegada de los medicamentos antirretrovirales para el tratamiento de las personas con sida aumentó el tiempo de supervivencia. Sin embargo, a pesar de que el paciente permanece a menudo asintomático, puede presentar alteraciones significativas en la esfera psicosocial y, entre ellas, el debilitamiento de las relaciones sociales, que se pierden con el descubrimiento de la infección. El ejercicio físico regular puede ser una estrategia interesante para combatir los problemas psicológicos asociados con la infección por VIH. Las personas que participan en un programa de entrenamiento físico pueden mejorar el bienestar, el aumento de la autoestima, la disminución de los síntomas de depresión y ansiedad, y éste también proporciona mayor interacción social. Los pacientes infectados con el VIH tienen generalmente mayores niveles de cortisol basal sérico y algunos estudios sugieren que los niveles elevados de cortisol pueden perjudicar la función del sistema inmunitario al actuar como aceleradores de la progresión vírica y el desarrollo del sida. El objetivo de este estudio fue evaluar el efecto del ejercicio físico y el ocio en los niveles de cortisol en plasma en pacientes con sida. Los pacientes seleccionados se dividieron en dos grupos: el grupo I participó en actividades físicas mientras que el grupo II participó en actividades de ocio, ambos por un período de 16 semanas. La evaluación consistió en la medición de cortisol en plasma antes del inicio de las actividades y después de las 16 semanas. El 57% de los pacientes mostró una mejora en los niveles de cortisol en plasma después de la aplicación del programa. Este trabajo sugiere que el ejercicio físico y el ocio provocan una mejora fisiológica de la respuesta de cortisol en pacientes con sida.