RESUMEN

Objetivo: avaliar a capacidade institucional de cuidado ao paciente hipertenso nos serviços de saúde destinados aos idosos, a partir da percepção das equipes de saúde. Método: estudo transversal, com 53 profissionais de saúde das instituições ambulatoriais especializadas no cuidado ao idoso na cidade de Manaus, Amazonas, Brasil. Aplicou-se a Avaliação da Capacidade Institucional para Atenção às Condições Crônicas (ACIC). Os dados são apresentados em valores de média. Resultados: as potencialidades foram nas dimensões: autocuidado apoiado (6,1 ± 2,7), organização da atenção à saúde (5,5 ± 2,1) e desenho do sistema de prestação de serviços (5,1 ± 2,6). As fragilidades foram: sistema de informação clínica (3,9 ± 2,7), recursos da comunidade (4,0 ± 2,9), integração dos componentes do modelo de atenção (4,1 ± 2,7) e suporte às decisões (4,4 ± 2,9). Conclusão: de acordo com o ACIC, as instituições apresentaram capacidade básica na prestação de cuidado ao paciente hipertenso.

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Objective: To evaluate the institutional capacity to care for hypertensive patients in health services for older adults, based on the perception of health teams. Method: A cross-sectional study with 53 health professionals from outpatient institutions specializing in the care of older adults in the city of Manaus, Amazonas, Brazil. The Institutional Capacity Assessment for Attention to Chronic Conditions (ACIC) was applied. Data are presented in mean values. Results: The strengths were in the dimensions: supported self-care (6.1 ± 2.7), organization of health care (5.5 ± 2.1), and design of the service delivery system (5.1 ± 2.6). The weaknesses were: clinical information system (3.9 ± 2.7), community resources (4.0 ± 2.9), integration of the components of the care model (4.1 ± 2.7), and support for decisions (4.4 ± 2.9). Conclusion: According to the ACIC, the institutions presented a basic capacity to provide care to hypertensive patients.

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Objetivo: evaluar la capacidad institucional para la atención de hipertensos en los servicios de salud del anciano, a partir de la percepción de los equipos de salud. Método: estudio transversal, con 53 profesionales de la salud de instituciones ambulatorias especializadas en el cuidado de ancianos en la ciudad de Manaus, Amazonas, Brasil. Se aplicó la Evaluación de la Capacidad Institucional para la Atención de Condiciones Crónicas (ACIC). Los datos se presentan como valores medios. Resultados: las potencialidades estuvieron en las dimensiones: autocuidado apoyado (6,1 ± 2,7), organización de la atención en salud (5,5 ± 2,1) y diseño del sistema de prestación de servicios (5,1 ± 2,6). Las debilidades fueron: sistema de información clínica (3,9 ± 2,7), recursos comunitarios (4,0 ± 2,9), integración de los componentes del modelo de atención (4,1 ± 2,7) y apoyo a las decisiones (4,4 ± 2,9). Conclusión: según la ACIC, las instituciones tenían una capacidad básica para brindar atención a los pacientes hipertensos.

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Grupo de Atención al Paciente , Servicios de Salud para Ancianos , Investigación sobre Servicios de Salud , Hipertensión/terapia , Estudios Transversales

RESUMEN

Crotamine is a single-chain polypeptide with cell-penetrating properties, which is considered a promising molecule for clinical use. Nevertheless, its biosafety data are still scarce. Herein, we assessed the in vivo proinflammatory properties of crotamine, including its local effect and systemic serum parameters. Sixty male Wistar rats were intradermically injected with 200, 400 and 800 µg crotamine and analyzed after 1, 3 and 7 days. Local effect of crotamine was assessed by determination of MPO and NAG activities, NO levels and angiogenesis. Systemic inflammatory response was assessed by determination of IL-10, TNF-α, CRP, NO, TBARS and SH groups. Crotamine induced macrophages and neutrophils chemotaxis as evidenced by the upregulation of both NAG (0.5⁻0.6 OD/mg) and MPO (0.1⁻0.2 OD/mg) activities, on the first and third day of analysis, respectively. High levels of NO were observed for all concentrations and time-points. Moreover, 800 µg crotamine resulted in serum NO (64.7 µM) and local tissue NO (58.5 µM) levels higher or equivalent to those recorded for their respective histamine controls (55.7 µM and 59.0 µM). Crotamine also induced a significant angiogenic response compared to histamine. Systemically, crotamine induced a progressive increase in serum CRP levels up to the third day of analysis (22.4⁻45.8 mg/mL), which was significantly greater than control values. Crotamine (400 µg) also caused an increase in serum TNF-α, in the first day of analysis (1095.4 pg/mL), however a significant increase in IL-10 (122.2 pg/mL) was also recorded for the same time-point, suggesting the induction of an anti-inflammatory effect. Finally, crotamine changed the systemic redox state by inducing gradual increase in serum levels of TBARS (1.0⁻1.8 µM/mL) and decrease in SH levels (124.7⁻19.5 µM/mL) throughout the experimental period of analysis. In summary, rats intradermally injected with crotamine presented local and systemic acute inflammatory responses similarly to histamine, which limits crotamine therapeutic use on its original form.

Asunto(s)

Venenos de Crotálidos/toxicidad , Inflamación/inducido químicamente , Animales , Proteína C-Reactiva/inmunología , Inflamación/inmunología , Inyecciones Intradérmicas , Interleucina-10/inmunología , Masculino , Neovascularización Fisiológica , Óxido Nítrico/inmunología , Ratas Wistar , Factor de Necrosis Tumoral alfa/inmunología

RESUMEN

The consumption of psychoactive pharmaceuticals has increased worldwide, and wastewater treatment plants are not able to eliminate them from the effluent. An extensive review was carried out to assess the environmental risk (ERA model) based on secondary data about potential impacts on non-target organisms of seven psychoactive drugs consumed worldwide (alprazolam, bromazepam, citalopram, clonazepam, diazepam, lorazepam, and oxazepam). Risk quotients (RQs) were calculated according to the European Medicines Agency (EMA) on ERA of Medicinal Products For Human Use based on (i) the predicted and measured environmental concentrations (PEC and MEC, respectively) of the psychoactive drug in surface water, groundwater, and wastewater effluent and (ii) the predicted no-effect concentration (PNEC) derived from ecotoxicological assays or ECOSAR software. Furthermore, this study reviews and discusses non-standardized ecotoxicity assays, such as sublethal and behavioral effects on different organisms. In total, 903 MEC entries of psychoactive drugs and 162 data on ecotoxicological assays were gathered from the literature survey addressing behavioral effects (115), acute/chronic effects (35), and sublethal effects (12). Citalopram and diazepam were the only substances that are likely to pose an environmental risk (RQ > 1) to surface waters. Even though there is considerable amount of data on behavioral effects of psychoactive drugs to aquatic species, results are currently not integrated into the EMA risk assessment framework. The large amount of data on psychoactive drug concentrations and effects on non-target organisms collected, interpreted, and discussed in the present study should be used as a baseline for future improvement of ERA strategies.

Asunto(s)

Monitoreo del Ambiente/métodos , Agua Subterránea/química , Psicotrópicos/análisis , Aguas Residuales/química , Contaminantes Químicos del Agua/análisis , Ecotoxicología , Humanos , Medición de Riesgo

RESUMEN

Connexins (Cx) and cadherins are responsible for cell homeostasis. The Cx activity is directly related to cholesterol. The present work investigates whether vitamin E, with or without caloric restriction (CR), alters the mRNA expression of Cx26, Cx32, Cx43, N-cadherins (N-cads), E-cadherins (E-cads) and alpha-smooth muscle actin (α-SMA), and evaluates their relation to cholesterol metabolism in rat liver. Animals were divided into different groups: control with ad libitum diet (C), control+vitamin E (CV), aloric restriction with intake to 60% of group C (CR), and the intake of group CR+vitamin E (RV). There were increases of manganese superoxide dismutase (Mn-SOD) and glutathione S-transferase mu 1, indicating antioxidant effects of CR and vitamin E. An increase of nitric oxide in the CR group was in agreement with the Mn-SOD data. Supplementation with vitamin E, with or without CR, upregulated the expression of Cx26 mRNA and increased low-density lipoprotein cholesterol (LDL-c) in the CV group. Reductions of Cx32 and Cx43 were associated with lower LDL-c. Increases in Hmgcr and low-density lipoprotein receptor (LDLr) in the CV and RV groups could be explained by the effect of vitamin E. A reduction of LDLr in the CR group was due to the reduced dietary intake. Increases in cadherins in the CV, CR and RV groups were indicative of tissue maintenance, which was also supported by increases of α-SMA in groups CV and RV. Finally, vitamin E, with or without CR, increased Cx26, probably modulated by expression of the Hmgcr and LDLr genes. This suggests important relationship of Cxs and cholesterol metabolism genes.

Asunto(s)

Cadherinas/metabolismo , Restricción Calórica , Conexinas/metabolismo , Hígado/efectos de los fármacos , Proteínas del Tejido Nervioso/metabolismo , Vitamina E/farmacología , Animales , Cadherinas/genética , LDL-Colesterol/sangre , Conexina 26 , Conexina 43/genética , Conexina 43/metabolismo , Conexinas/genética , Dieta , Glutatión Transferasa/genética , Glutatión Transferasa/metabolismo , Homeostasis , Metabolismo de los Lípidos/genética , Hígado/metabolismo , Masculino , Proteínas del Tejido Nervioso/genética , ARN Mensajero/genética , ARN Mensajero/metabolismo , Ratas , Ratas Wistar , Superóxido Dismutasa/genética , Superóxido Dismutasa/metabolismo , Proteína beta1 de Unión Comunicante