ABSTRACT
Understanding the factors associated with pre-exposure prophylaxis (PrEP) adherence may help in the development of strategies to support, motivate and sustain PrEP use. This study estimated self-reported adherence, described perceived barriers and facilitators and investigated factors associated with adherence to daily oral PrEP among men who have sex with man (MSM) and transgender women after 1 year of PrEP use in Brazil. PrEP Brasil was a prospective, multicentre, open-label demonstration study with MSM and transgender women at high risk for HIV infection. We used logistic regression to evaluate factors associated with complete adherence (not forgetting to take any pills in the past 30 days) at week 48. Of 338 participants included in this analysis, 60% reported complete adherence to daily oral PrEP at week 48. Perceived barriers and facilitators to daily oral PrEP were reported by 38.2% and 98.5%, respectively. The most reported barrier and facilitator were 'I forgot to take my pills' (19.2%) and 'Associate PrEP with a daily activity/task' (58.6%), respectively. In final multivariable analysis, living in Rio de Janeiro (aOR: 0.38; 95% CI: 0.20-0.73), being transgender women (aOR: 0.22; 95% CI: 0.07-0.73), reporting stimulant use (a OR: 0.40; 95% CI: 0.20-0.80) and having any perceived barriers to daily oral PrEP (aOR: 0.12; 95% CI: 0.07-0.23) were associated with decreased odds of complete adherence. Our findings provide information for developing the best practices to promote PrEP adherence in the Brazilian context.
Subject(s)
Anti-HIV Agents , HIV Infections , Pre-Exposure Prophylaxis , Sexual and Gender Minorities , Transgender Persons , Anti-HIV Agents/therapeutic use , Brazil , Female , HIV Infections/drug therapy , HIV Infections/prevention & control , Homosexuality, Male , Humans , Male , Medication Adherence , Prospective Studies , Self ReportABSTRACT
Oral Mucositis is a frequent and debilitating inflammatory complication in patients with head and neck malignancies and may lead to unplanned treatment interruptions due to intense pain and dysphagia. This systematic review with meta-analysis was performed to determine the effectiveness of low-level laser therapy in preventing oral mucositis in this context. The following databases were searched through September 2018, with last search performed on May 2019, for clinical trials: MEDLINE via PubMed, Cochrane Central, Scopus, Lilacs, ISI Web of Science and SIGLE via Open Grey. From 14,525 records, 4 studies were included in the review and 3 studies were included in meta-analysis. Data from 500 patients (mean age of 53.595 and 54.14 for intervention and control groups, respectively) were analysed. Meta-analysis showed that laser therapy prevents oral mucositis incidence in 28% and 23% of cases during the third and fourth follow-up week, respectively, in comparison to a placebo-treated control group. There was no statistically significant difference the prevention of pain; dysphagia and quality of life were not analysed due to missing. Laser therapy was effective in preventing oral mucositis from the 15th to the 45th days of chemoradiotherapy. However, new primary studies with low risk of bias are needed so a higher scientific evidence can be obtained.
Subject(s)
Chemoradiotherapy/adverse effects , Head and Neck Neoplasms/therapy , Low-Level Light Therapy , Stomatitis/prevention & control , Bias , Data Analysis , Deglutition Disorders/etiology , Deglutition Disorders/prevention & control , Female , Humans , Male , Middle Aged , Pain/prevention & control , Stomatitis/etiology , Treatment OutcomeABSTRACT
This study aimed to evaluate the effect of rosuvastatin upon structural and ultrastructural aortic remodeling in a rat model of hypertension induced by NO synthase blockade. Wistar rats were divided into 4 groups: Control group (C); control treated with rosuvastatin 20mg/kg/day (CR); L-NAME group 40 mg/kg/day (LN) and L-NAME treated with rosuvastatin (LNR) (same doses). Body mass and blood pressure were measured weekly; the experiment lasted 5 weeks. L-NAME administration augmented blood pressure (BP) in the LN group in comparison to the C group (123.3 vs. 180.5 mm Hg at week 5). In LNR rats, rosuvastatin slightly attenuated BP rise, but it had no effect on the BP of CR group. Intima and media thickening of the thoracic aorta were observed in the LN group, and increased elastic fiber content as well. Rosuvastatin prevented all these alterations as seen in the LNR group. Ultrastructural changes due to L-NAME intake (intracellular vesicles and altered membrane morphology in endothelial cells, extracellular matrix deposition, and cytoplasmatic projections from smooth muscle cells toward the internal elastic lamina) were also prevented by rosuvastatin. All in all, rosuvastatin administration is capable of attenuating ultrastructural aortic wall remodeling in NO-deficient rats despite small changes in blood pressure.
Subject(s)
Aorta, Thoracic/drug effects , Fluorobenzenes/pharmacology , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Hypertension/pathology , Nitric Oxide/deficiency , Pyrimidines/pharmacology , Sulfonamides/pharmacology , Animals , Aorta, Thoracic/metabolism , Aorta, Thoracic/ultrastructure , Blood Pressure/drug effects , Disease Models, Animal , Endothelial Cells/drug effects , Endothelial Cells/metabolism , Endothelial Cells/ultrastructure , Fluorobenzenes/therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hypertension/drug therapy , Hypertension/metabolism , Immunohistochemistry , Lipids/blood , Microscopy, Electron, Transmission , NG-Nitroarginine Methyl Ester/pharmacology , Nitric Oxide Synthase Type III/antagonists & inhibitors , Pyrimidines/therapeutic use , Rats , Rats, Wistar , Rosuvastatin Calcium , Sulfonamides/therapeutic use , Tunica Intima/drug effects , Tunica Intima/metabolism , Tunica Intima/ultrastructureABSTRACT
Con el objetivo de aportar datos anatómicos, que posibiliten el acceso a la región pre-auricular, con menor riesgo de lesión del nervio auriculotemporal en procedimientos quirúrgicos, fue realizada esta investigación, sobre las relaciones topográficas y biométricas de este nervio con la arteria y vena temporales superficiales y el trago. Fueron disecadas 24 hemicaras de cadáveres fijados con formaldehído al 10 por ciento, disponibles en el Laboratorio de Anatomía del Departamento de Morfología Humana de la Universidad Federal de Alagoas, Brasil. En siete casos (29,2 por ciento) el nervio subía posteriormente a los vasos temporales superficiales, y en otros siete (29,2 por ciento), subía junto a la vena. En tres casos (12,5 por ciento) el nervio emergía junto con la arteria. En dos casos (8,3 por ciento), el nervio estaba en posición intermedia. En cinco casos (20,8 por ciento), el nervio subía junto con ambos vasos. La menor distancia del nervio auriculotemporal a la línea pre-auricular fue de 0,3 mm, y la mayor fue de 11,5 mm, con media de 1,89 mm. La menor distancia del nervio con la arteria temporal superficial fue de 0,1 mm, y la mayor fue de 14,6 mm, con media de 8,66 mm, situándose la arteria anterior. Cuando la vena era anterior al nervio, la menor distancia entre sí, fue de 0,2 mm y la mayor, 10,9 mm, con media de 2,91 mm. Cuando la vena estaba en posición posterior, la distancia mínima fue de 0,1 mm, y la máxima de 9,4 mm, siendo la media de 2,54 mm. Concluimos que el nervio auriculotemporal presenta posición variable en la región pre-auricular y es la estructura más próxima a la línea pre-auricular.
