[Aspects related to the use of antiretrovirals in high complexity patients in the state of Rio de Janeiro]. / Aspectos relacionados à utilização de antirretrovirais em pacientes de alta complexidade no estado do Rio de Janeiro, Brasil.

Treatment of AIDS involves the use of the cocktail of drugs that make up the antiretroviral therapy. Its logistic control is monitored by a computerized national system of dispensation, the Logistic Control System of Medication (SICLOM). This study aimed to investigate, by means of SICLOM data, the use of antiretroviral therapy in patients treated at two University Hospitals in the state of Rio de Janeiro. A cross-sectional study was conducted with sociodemographic and dispensation data collected from SICLOM. The evaluation of drug ownership was done by calculating the Proportion of Days Covered (PDC). Five hundred and thirty-eight patients of both genders with active registration in SICLOM and over 18 years of age were included. The ART most used in both hospitals was lamivudine, considering the total of 58 different schemes identified. The mean of possession of groups was 88% (± 0,16). The factor associated with possession of drugs was the ART scheme, with PDC of 91% (p<0,001) for rescue schemes. This study confirmed that SICLOM was a reliable source to establish the profile of the population assisted.

O tratamento da aids implica a utilização de diversos medicamentos que compõem a terapia antirretroviral, sendo o controle logístico monitorado por um sistema nacional informatizado de dispensação, o Sistema de Controle Logístico de Medicamentos (SICLOM). O objetivo foi investigar a utilização da terapia antirretroviral de pacientes de dois hospitais universitários no Estado do Rio de Janeiro a partir do SICLOM. Foi realizado um estudo seccional com coleta de dados sociodemográficos e de dispensação, a partir do SICLOM. A avaliação da posse para estimativa de pacientes não aderidos foi realizada através do indicador de proporção de dias cobertos (PDC). Foram incluídos 538 pacientes com cadastro ativo no SICLOM, maiores de 18 anos de ambos os sexos. O ARV mais utilizado em ambos os hospitais foi lamivudina, dentre 58 esquemas diferentes identificados. A maior parte dos pacientes utilizava esquemas classificados como de primeira linha de tratamento. Em média, a proporção de dias cobertos (posse) pelo tratamento foi 88% (± 0,16). A linha de tratamento mostrou associação estatística com a posse, sendo observado melhor PDC 91% (p < 0,001) para os esquemas resgate. Este estudo corroborou o SICLOM como uma boa fonte para conhecimento do perfil de utilização de ARV.

Aspectos relacionados à utilização de antirretrovirais em pacientes de alta complexidade no estado do Rio de Janeiro, Brasil / Aspects related to the use of antiretrovirals in high complexity patients in the state of Rio de Janeiro

Resumo O tratamento da aids implica a utilização de diversos medicamentos que compõem a terapia antirretroviral, sendo o controle logístico monitorado por um sistema nacional informatizado de dispensação, o Sistema de Controle Logístico de Medicamentos (SICLOM). O objetivo foi investigar a utilização da terapia antirretroviral de pacientes de dois hospitais universitários no Estado do Rio de Janeiro a partir do SICLOM. Foi realizado um estudo seccional com coleta de dados sociodemográficos e de dispensação, a partir do SICLOM. A avaliação da posse para estimativa de pacientes não aderidos foi realizada através do indicador de proporção de dias cobertos (PDC). Foram incluídos 538 pacientes com cadastro ativo no SICLOM, maiores de 18 anos de ambos os sexos. O ARV mais utilizado em ambos os hospitais foi lamivudina, dentre 58 esquemas diferentes identificados. A maior parte dos pacientes utilizava esquemas classificados como de primeira linha de tratamento. Em média, a proporção de dias cobertos (posse) pelo tratamento foi 88% (± 0,16). A linha de tratamento mostrou associação estatística com a posse, sendo observado melhor PDC 91% (p < 0,001) para os esquemas resgate. Este estudo corroborou o SICLOM como uma boa fonte para conhecimento do perfil de utilização de ARV.

Abstract Treatment of AIDS involves the use of the cocktail of drugs that make up the antiretroviral therapy. Its logistic control is monitored by a computerized national system of dispensation, the Logistic Control System of Medication (SICLOM). This study aimed to investigate, by means of SICLOM data, the use of antiretroviral therapy in patients treated at two University Hospitals in the state of Rio de Janeiro. A cross-sectional study was conducted with sociodemographic and dispensation data collected from SICLOM. The evaluation of drug ownership was done by calculating the Proportion of Days Covered (PDC). Five hundred and thirty-eight patients of both genders with active registration in SICLOM and over 18 years of age were included. The ART most used in both hospitals was lamivudine, considering the total of 58 different schemes identified. The mean of possession of groups was 88% (± 0,16). The factor associated with possession of drugs was the ART scheme, with PDC of 91% (p<0,001) for rescue schemes. This study confirmed that SICLOM was a reliable source to establish the profile of the population assisted.

Assessment of pharmaceutical services in HIV/AIDS health units in the city of Niterói, Brazil

ABSTRACT This study aimed to conduct an assessment of pharmaceutical services in HIV/AIDS in the city of Niteroi, Brazil, with emphasis on management. It was done a descriptive cross-sectional study, and the approach used was a normative assessment focused on quality. The indicators used were analyzed individually or grouped according to the components of pharmaceutical services. The assessment identified some good points, especially regarding the good availability of ARVs, and good guide patients in the use of these drugs, and also some problems such as low levels of compliance in relation to good dispensing practices criteria and storage and a high time for the distribution of medicines. The result was a degree of 50.3% compliance with the quality criteria, considered only regular in accordance with trial made. Proposals were suggested for actions and interventions, especially in relation to the improvement of structural conditions of pharmacies of health facilities in the city, and increased training of professionals involved in the services.

ACOMPANHAMENTO TERAPÊUTICO: A PERCEPÇÃO DA FAMÍLIA / THERAPEUTIC MONITORING: THE PERCEPTION OF THE FAMILY

Este estudo, configurado em um modelo de relato de experiência, tem como objetivo investigar a percepção da família acerca das práticas de Acompanhamento Terapêutico (AT), através de uma abordagem qualitativa, que possibilitou a discussão dos aspectos relevantes dentro das categorias construídas. Verificou-se, ao longo da análise das informações obtidas, que a prática do AT tem beneficiado famílias e sujeitos em sofrimento psíquico, portanto, sendo este um estudo valoroso e que deve ser ampliado a fim de contemplar outros estratos populacionais.(AU)

This study, set in an experience report model, aims to investigate the perception of the family about the Therapeutic Monitoring practices, through a qualitative approach that allowed the discussion of the relevant aspects within the constructed categories. It was found, along the data analysis and results, that the practice of Therapeutic Monitoring has benefited families and individuals in psychological distress, therefore, which is a valuable study and should be expanded to include other sections of the population.(AU)

Hologram quantitative structure-activity relationship and comparative molecular field analysis studies within a series of tricyclic phthalimide HIV-1 integrase inhibitors.

Acquired immunodeficiency syndrome is a public health problem worldwide caused by the Human immunodeficiency virus (HIV). Treatment with antiretroviral drugs is the best option for viral suppression, reducing morbidity and mortality. However, viral resistance in HIV-1 therapy has been reported. HIV-1 integrase (IN) is an essential enzyme for effective viral replication and an attractive target for the development of new inhibitors. In the study reported here, two- and three-dimensional quantitative structure-activity relationship (2D/3D-QSAR) studies, applying hologram quantitative structure-activity relationship (HQSAR) and comparative molecular field analysis (CoMFA) methods, respectively, were performed on a series of tricyclic phthalimide HIV-1 IN inhibitors. The best HQSAR model (q (2) = 0.802, r (2) = 0.972) was obtained using atoms, bonds, and connectivity as the fragment distinction, a fragment size of 2-5 atoms, hologram length of 61 bins, and six components. The best CoMFA model (q (2) = 0.748, r (2) = 0.974) was obtained with alignment of all atoms of the tricyclic phthalimide moiety (alignment II). The HQSAR contribution map identified that the carbonyl-hydroxy-aromatic nitrogen motif made a positive contribution to the activity of the compounds. Furthermore, CoMFA contour maps suggested that bulky groups in meta and para positions in the phenyl ring would increase the biological activity of this class. The conclusions of this work may lead to a better understanding of HIV-1 IN inhibition and contribute to the design of new and more potent derivatives.

Molecular characterization of the first fluoroquinolone resistant strains of Streptococcus agalactiae isolated in Brazil.

Three isolates of Streptococcus agalactiae, recovered from residents of the metropolitan area of Rio de Janeiro with significant bacteriuria, were found to be resistant to levofloxacin. Determination of the minimal inhibitory concentration (MIC) confirmed one isolate as intermediate and two as resistant to levofloxacin. No reduction in levofloxacin MIC was observed with reserpine, indicating that resistance was not caused by an efflux mechanism. Typical point mutations were observed in the quinolone resistance determinant region of gyrA and parC. Other point mutations in parC generated novel altered codons: Ser80→Pro in the intermediate resistance isolate, and Gly128→Asp in a resistant isolate. Through molecular modeling, it was possible to observe that these novel substitutions might not play a role in resistance, since these amino acids were not involved in the antibiotic binding site. Pulsed field gel electrophoresis profiles revealed a non-clonal trend among these isolates. This is the first report of genetic characterization of levofloxacin-resistant S. agalactiae strains in Brazil.

Necessidade de novos antibióticos: [Carta ao Leitor] / The need of new antibiotics: [Letters to the Editor]

Os antibióticos são uma classe de fármacos indispensável; sem eles haveria perdas na expectativa de vida que conquistamos ao longo de décadas. Mas a potência dos antibióticos está ameaçada pela resistência bacteriana. Há uma explosão de casos reportados na literatura. De fato, o aumento da resistência bacteriana, principalmente entre patógenos potencialmente perigosos, tem levado ao aumento na necessidade de novos fármacos e novas classes de antibióticos, tanto para infecções adquiridas em hospitais quanto na comunidade. Entretanto, a despeito dessa necessidade, somente duas novas classes de antibióticos foram introduzidas na medicina desde 1963, quando o ácido nalidíxico foi aprovado: uma em 2000 e uma em 2003. O artigo discute um pouco esta questão.

Antibiotics are a important class of drugs, without them there would be losses in life expectancy achieved over decades. But the power of antibiotics is threatened by bacterial resistance. There is an explosion of cases reported in the literature. In fact, the increase in bacterial resistance, particularly among potentially dangerous pathogens, has led to an increased need for new drugs and new classes of antibiotics for both infections acquired in hospitals and in the community. However, despite this need, only two new classes of antibiotics have been introduced in medicine since 1963, when nalidixic acid was approved: one in 2000 and one in 2003. The article discusses this issue.

Pharmacokinetic study with computational tools in the medicinal chemistry course

To improve the teaching-learning process in the Medicinal Chemistry course, new strategies have been incorporated into practical classes of this fundamental discipline of the pharmaceutical curriculum. Many changes and improvements have been made in the area of medicinal chemistry so far, and students should be prepared for these new approaches with the use of technological resources in this field. Practical activities using computational techniques have been directed to the evaluation of chemical and physicochemical properties that affect the pharmacokinetics of drugs. Their objectives were to allow students to know these tools, to learn how to access them, to search for the structures of drugs and to analyze results. To the best of our knowledge, this is the first study in Brazil to demonstrate the use of computational practices in teaching pharmacokinetics. Practical classes using Osiris and Molinspiration were attractive to students, who developed the activities easily and acquired better theoretical knowledge.

Para melhorar o processo ensino-aprendizagem no curso de Química Medicinal novas estratégias estão sendo incorporadas às aulas práticas desta disciplina fundamental do currículo farmacêutico. Muitas mudanças e melhorias vêm marcando a área de química medicinal e por isso é importante que os alunos sejam colocados nestas novas abordagens na área, com a utilização de recursos tecnológicos. As atividades práticas foram direcionadas para a avaliação dos dados químicos e físico-químicos de fármacos que influenciam as propriedades farmacocinéticas com o auxílio de técnicas computacionais. Os objetivos foram permitir aos alunos conhecer essas ferramentas, saber como acessá-las, procurar as estruturas de fármacos e analisar os resultados. Este é o primeiro estudo publicado no Brasil que apresenta aula prática computacional sobre o tema farmacocinética. As aulas práticas utilizando os servidores Osiris e Molinspiration foram atraentes para os alunos, que desenvolveram as atividades com maior facilidade e sedimentaram o conhecimento teórico adquirido em sala de aula.

Contornando as grades do manicômio: histórias de resistências esculpidas na instituição total / Circumventing the asylum metal bars: resistance stories molded in the total institution

Esse trabalho trata de uma experiência de estágio em um hospital psiquiátrico. O manicômio é uma instituição total, isto é, instituições fechadas em regime de confinamento, responsáveis pela gestão total da vida de seus pacientes. Nossa proposta objetivou olhar através dessa instituição total e buscar possíveis linhas de fuga que atravessam esse espaço. Apresentamos aqui os resultados dessa imersão no manicômio e algumas histórias de resistências esculpidas na instituição total. Os contatos diários foram o campo privilegiado de observação dos movimentos, da tensão entre diferentes forças, dos afetos que circulavam, enfim, do plano micropolítico em operação. Buscamos conhecer como se estabeleciam as relações e identificar os aspectos instituídos, cristalizados e segregadores aí presentes, bem como a forma como lidavam com isso, as vias de escape dessa estrutura, por meio de observações e conversas informais com profissionais e pacientes do hospital(AU)

The study deals with the practicum experience at a psychiatric hospital. The asylum is a total institution, that is, a closed institution with a confinement regime that is responsible for the total life management of its patients. We proposed to look at the total institution and to search for the possible avoidance axes that cut cross that space. We present the results of that asylum immersion and the stories of resistance formed. The daily contacts were observed for movements, force-tensions and the surrounding affections, that is, for the micro-political plan in operation. Through observation and informal conversations with the patients and hospital staff, we managed to understand how relations are molded and the segregate aspects that are established in the institution, as well as the means by which they deal with them and escape from the structure(AU)

Contornando as grades do manicômio: histórias de resistências esculpidas na instituição total / Circumventing the asylum metal bars: resistance stories molded in the total institution

Esse trabalho trata de uma experiência de estágio em um hospital psiquiátrico. O manicômio é uma instituição total, isto é, instituições fechadas em regime de confinamento, responsáveis pela gestão total da vida de seus pacientes. Nossa proposta objetivou olhar através dessa instituição total e buscar possíveis linhas de fuga que atravessam esse espaço. Apresentamos aqui os resultados dessa imersão no manicômio e algumas histórias de resistências esculpidas na instituição total. Os contatos diários foram o campo privilegiado de observação dos movimentos, da tensão entre diferentes forças, dos afetos que circulavam, enfim, do plano micropolítico em operação. Buscamos conhecer como se estabeleciam as relações e identificar os aspectos instituídos, cristalizados e segregadores aí presentes, bem como a forma como lidavam com isso, as vias de escape dessa estrutura, por meio de observações e conversas informais com profissionais e pacientes do hospital.

The study deals with the practicum experience at a psychiatric hospital. The asylum is a total institution, that is, a closed institution with a confinement regime that is responsible for the total life management of its patients. We proposed to look at the total institution and to search for the possible avoidance axes that cut cross that space. We present the results of that asylum immersion and the stories of resistance formed. The daily contacts were observed for movements, force-tensions and the surrounding affections, that is, for the micro-political plan in operation. Through observation and informal conversations with the patients and hospital staff, we managed to understand how relations are molded and the segregate aspects that are established in the institution, as well as the means by which they deal with them and escape from the structure.