RESUMEN
RESUMO: Objetivo: Descrever indicadores de cuidado em saúde em adultos com hipertensão arterial autorreferida no Brasil, segundo características sociodemográficas. Métodos: Foram utilizados dados da Pesquisa Nacional de Saúde 2013, estudo transversal de base populacional, referentes ao cuidado em saúde com a hipertensão arterial autorreferida quanto ao uso de serviços de saúde. As prevalências e seus intervalos de confiança de 95% (IC95%) foram calculados segundo sexo, idade, raça/cor e escolaridade, representativos para Brasil e grandes regiões. Resultados: A hipertensão arterial foi referida por 21,4% (IC95% 20,8 - 22,0) dos entrevistados, sendo maior em mulheres e em pessoas sem instrução e com ensino fundamental incompleto. Dentre estes, 45,9% (IC95% 44,0 - 47,7) referiram ter recebido assistência médica pela última vez em uma Unidade Básica de Saúde; 81,4% (IC95% 80,1 - 82,7) referiram tomar medicamentos para a hipertensão; e 92,0% (IC95% 91,2 - 92,8) referiram ter realizado todos os exames complementares que foram solicitados. Conclusão: É importante conhecer a cobertura e o acesso aos serviços de saúde para o cuidado aos indivíduos com hipertensão arterial, de modo a avançar na qualidade da assistência prestada e reduzir as desigualdades identificadas.
ABSTRACT: Objective: To describe health care indicators in adults with self-reported hypertension in Brazil, according to socio-demographic characteristics. Methods: Data from the National Health Survey 2013, a cross-sectional population-based study, about health care of self-reported hypertension and health services were used. Prevalence and 95% confidence intervals (95%CI) were calculated for sex, age, race/color skin and schooling levels, representing Brazil and major regions. Results: Hypertension was reported by 21.4% (95%CI 20.8 - 22.0) of respondents, being higher in women and in people without instruction and incomplete middle school. Among these, 45.9% (95%CI 44.0 - 47.7) reported having received medical care for the last time in a basic health unit; 81.4% (95%CI 80.1 - 82.7) reported taking medication for high blood pressure; and 92.0% (95%CI 91.2 - 92.8) reported having taken all requested complementary examinations. Conclusion: It is important to know the coverage and access to health services for the care of patients with hypertension, in order to improve care quality and reduce identified inequalities.
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Animales , Ratones , Ratas , Barrera Hematoencefálica , Encéfalo/metabolismo , Nanotubos de Carbono , Técnicas de Cocultivo , Técnicas In Vitro , Microscopía Electrónica de Transmisión de Rastreo , Nanotubos de Carbono/toxicidad , Ácido Pentético/farmacocinética , Ratas Wistar , PorcinosRESUMEN
Synthetic somatostatin (SST) analogues have been used in the preparation of receptor-specific radiopharmaceuticals for diagnostic and therapy of neuroendocrine tumors. This work studied the labeling conditions with (99m)Tc and biological distribution in Swiss mice of two SST analogs (HYNIC-Tyr(3)-Octreotide and HYNIC-Tyr(3)-Octreotate) and compared the biodistribution pattern with (111)In-DTPA-Octreotide. Biological distribution studies were performed after injection of radiopharmaceuticals on Swiss mice. Labeling procedures resulted on high radiochemical yield for all three preparations and the labeled products presented high in vitro stability. Biological distribution studies evidenced similar general biodistribution of (99m)Tc-labeled peptides when compared with indium-labeled peptide with fast blood clearance and elimination by urinary tract. Kidneys uptake of (99m)Tc-HYNIC-TATE are similar to (111)In-DTPA-Octreotide, and both are significantly higher than (99m)Tc-HYNIC-OCT. All labeled peptides presented similar uptake on liver, but the retention in time at intestines, particularly at large intestine, was more expressive for (111)In-labeled peptide. The %ID of (99m)Tc-HYNIC-OCT and (99m)Tc-HYNIC-TATE in organs with high density of SST receptors like pancreas and adrenals were significant and similar to obtained for (111)In-DTPA-Octreotide, confirming the affinity of these radiopharmaceuticals for the receptors.
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Ácido Pentético/análogos & derivados , Somatostatina/química , Tecnecio/farmacocinética , Animales , Intestinos/diagnóstico por imagen , Riñón/efectos de los fármacos , Ligandos , Hígado/diagnóstico por imagen , Hígado/efectos de los fármacos , Ratones , Tumores Neuroendocrinos/diagnóstico por imagen , Octreótido/química , Ácido Pentético/farmacocinética , Péptidos/química , Control de Calidad , Cintigrafía , Radiofármacos/química , Factores de Tiempo , Distribución TisularRESUMEN
The aim of this work was to synthesize [166Dy]Dy/166Ho-DTPA-Biotin to evaluate its potential as a new radiopharmaceutical for targeted radiotherapy. Dysprosium-166 (166Dy) was obtained by neutron irradiation of enriched 164Dy(2)O(3) in a Triga Mark III reactor. The labeling was carried out in aqueous media at pH 8.0 by addition of [166Dy]DyCl(3) to diethylenetriaminepentaacetic-alpha,omega-bis(biocytinamide) (DTPA-Biotin). Radiochemical purity was determined by high-performance liquid chromatography (HPLC) and TLC. The biological integrity of labeled biotin was studied evaluating its avidity for avidin in an agarose column and by size-exclusion HPLC analysis of the radiolabeled DTPA-Biotin with and without the addition of avidin. Stability studies against dilution were carried out by diluting the radiocomplex solution with saline solution and with human serum at 37 degrees C for 24 h. The [166Dy]Dy/166Ho-labeled biotin was obtained with a 99.1+/-0.6% radiochemical purity. In vitro studies demonstrated that [166Dy]Dy/166Ho-DTPA-Biotin is stable after dilution in saline and in human serum and no translocation of the daughter nucleus occurs subsequent to beta(-) decay of 166Dy that could produce release of 166Ho(3+). Avidity of labeled biotin for avidin was not affected by the labeling procedure. Biodistribution studies in normal mice showed that the [166Dy]Dy/166Ho-DTPA-Biotin has a high renal clearance. In conclusion, the radiolabeled biotin prepared in this investigation has adequate properties to work as a stable in vivo generator system for targeted radiotherapy.
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Biotina/análogos & derivados , Biotina/química , Disprosio/química , Holmio/química , Ácido Pentético/análogos & derivados , Ácido Pentético/química , Radiofármacos/química , Animales , Biotina/sangre , Biotina/farmacocinética , Cromatografía Líquida de Alta Presión , Cromatografía en Capa Delgada , Estabilidad de Medicamentos , Femenino , Inyecciones Intravenosas , Marcaje Isotópico , Ratones , Ratones Endogámicos BALB C , Ácido Pentético/sangre , Ácido Pentético/farmacocinética , Radioisótopos/química , Radiofármacos/sangre , Radiofármacos/farmacocinética , Distribución TisularRESUMEN
Labeled biotin has been used mainly for pretargeted therapy, an approach for increasing the amount of radioactivity delivered to a cancer cell. The aim of this investigation was to prepare (153)Sm-DTPA-bis-biotin and (99m)Tc-DTPA-bis-biotin in order to study their in vitro and in vivo uptake in rat AS-30D hepatoma cells found in ascites and in implanted tumor. DTPA-bis-biotin (pH 8) was (153)Sm labeled with (153)SmCl(3) and (99m)Tc-DTPA-bis-biotin was prepared via SnCl(2) reduction. Radiochemical purity was >98% in both cases. AS-30D hepatoma cells were obtained from ascites of a rat with hepatoma and were propagated in the peritoneum cavity of normal rats. In vitro ascites cell (153)Sm-DTPA-bis-biotin uptake was compared with (153)SmCl(3) cell uptake. The ratio cell (153)Sm-DTPA-bis-biotin/(153) SmCl(3) was 39.6 and when avidin was added it increased to 50. The ratio (99m)Tc-DTPA-bis-biotin/TcO(4)Na was 8.7. Concentration of (153)Sm-DTPA-bis-biotin in tumor 2, 3 and 24 h after administration, was 5, 15 and 3 times higher than in normal muscle (T/nT). Biodistribution in a 0.083-24 h time period showed that (153)Sm-DTPA-bis-biotin was taken up only by ascites tumor cells and hepatoma cells. Two and 3 h ratio ascites/liver (As/Lv) was 6.4 and 6.0. For (99m)Tc-DTPA-bis-biotin 2 and 3 h T/nT was 15.7 and 4.7 and 2 h As/Lv was 1.4. In conclusion, both radiopharmaceuticals show high uptake in rat AS-30D hepatoma cells in ascites and in implanted tumor. Since lung, thyroid, kidney, liver or pancreas carcinomas are ascites producing cancers (153)Sm-DTPA-bis-biotin would be an adequate therapeutic radiopharmaceutical for these patients whose life quality would be enhanced with control of ascites, and a reduction of the primary tumor and its metastases.
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Biotina/análogos & derivados , Biotina/farmacocinética , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/metabolismo , Compuestos de Organotecnecio/farmacocinética , Ácido Pentético/análogos & derivados , Ácido Pentético/farmacocinética , Animales , Carcinoma Hepatocelular/patología , Femenino , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patología , Trasplante de Neoplasias , Especificidad de Órganos , Cintigrafía , Radiofármacos/síntesis química , Radiofármacos/farmacocinética , Ratas , Ratas Wistar , Valores de Referencia , Distribución Tisular , Células Tumorales CultivadasRESUMEN
To study whether acute or chronic hyponatremia alters blood-brain barrier (BBB) permeability, rats made hyponatremic by constant desmopressin acetate infusion were studied by NMR spectroscopy and imaging. On constant volume ventilation and nitrous oxide, acute (1- and 2-day) and chronic (7- and 14-day) hyponatremic and normonatremic controls were infused with 0.25 M HCl. Despite reducing blood pH by at least 0.35 in < 50 min, brain pH, measured by 31P NMR, was unaffected in any group. As a second test of BBB function, gadolinium-DTPA (Gd-DTPA) was injected intravenously in these five groups. Coronal slice 1H NMR images obtained before and after Gd-DTPA showed image intensity changes in multiple areas outside brain, but neither control nor hyponatremic rats showed any differences in cortex, white matter or cerebellum. To ascertain whether the threshold for BBB disruption was altered, hypertonic mannitol (1.5, 2.0 or 3.0 mL) was injected rapidly into one internal carotid artery and pre- and post-Gd-DTPA images obtained. In both control and hyponatremic rats only the largest dose caused detectable Gd-DTPA leakage into brain. Thus, BBB function appears intact in both acute and chronic hyponatremia since neither H+ nor GD-DTPA penetrated the barrier and resistance to mannitol disruption was unaffected by hyponatremia.