RESUMO
Phenytoin (DFH), is an anticonvulsant widely used for the treatment of different types of seizures.(1) Therapeutic monitoring (TDM) is required for DFH due to its narrow therapeutic range and nonlinear pharmacokinetics, among other characteristics. Monitoring is frequently done on plasma or serum (total drug) through immunological methods. DFH can also be monitored in saliva, which shows a good correlation with plasma. The concentration of DFH in saliva reflects the concentration of free drug and due to the simplicity in its collection, it leads to a less stressful process for the patient. The aim of this study was to validate the immunological method of kinetic interaction of microparticles in solution (KIMS) for the determination of DFH using saliva as biological matrix. Linearity, precision, detection and quantification limit, accuracy and interference were analyzed. Infostat 8.0 student version software was used for statistical analysis. The method was linear in a range between 0.41 and 5ug/ml. The detection and quantification limits were 0.14 and 0.45ug/ml, respectively. The equation of the straight line obtained based on the method comparison between KIMS and HPLC-UV was DFHKIMS= 0,81* DFHHPLC 0,03. The KIMS method proved to have the necessary analytical characteristics to be applied as a useful and practical tool for the follow-up of those patients with difficult venous access and/or children with chronic DFH treatments.
La Fenitoína (DFH), es un anticonvulsivante ampliamente utilizado para el tratamiento de distintos tipos de convulsiones.(1) El monitoreo terapéutico (TDM) es requerido para la DFH debido a su estrecho rango terapéutico y farmacocinética no lineal, entre otras características. Los monitoreos se realizan frecuentemente en plasma o suero (droga total) a través de métodos inmunológicos. También se puede monitorear DFH en saliva, la cual presenta una buena correlación con el plasma. La concentración de DFH en saliva refleja la concentración de droga libre y debido a la simplicidad en su recolección, conlleva a un proceso menos estresante para el paciente. El objetivo del trabajo fue validar el método inmunológico de interacción cinética de micropartículas en solución (KIMS) para la determinación de DFH usando como matriz biológica saliva. Se analizó linealidad, precisión, límite de detección y cuantificación, exactitud e interferencia. Se utilizó el software Infostat 8.0 versión estudiantil para el análisis estadístico. El método fue lineal en un intervalo entre 0,41 y 5ug/ml. Los límites de detección y cuantificación fueron 0,14 y 0,45ug/ml respectivamente. La ecuación de la recta obtenida en base a la comparación de métodos entre KIMS y HPLC-UV fue DFHKIMS= 0,81* DFHHPLC - 0,03. El método KIMS demostró tener las características analíticas necesarias paran ser aplicada como herramienta útil y práctica para el seguimiento de aquellos pacientes de difícil acceso venoso y/o niños con tratamientos crónicos con DFH.
Assuntos
Fenitoína , Saliva , Criança , Humanos , Trinidad e Tobago , Anticonvulsivantes , Cromatografia Líquida de Alta Pressão , Monitoramento de Medicamentos/métodosRESUMO
O projeto de extensão "Acompanhamento Terapêutico em Saúde Mental: suporte para inclusão e (re)construção do cotidiano", advindo da parceria entre a Diretoria de Saúde Mental de Curitiba e os Departamentos de Psicologia, Terapia Ocupacional e Enfermagem da Universidade Federal do Paraná, visou oferecer Acompanhamento Terapêutico (AT) a usuários dos serviços de saúde mental do município, com uma vertente específica de atuação junto a acumuladores compulsivos. Este trabalho se destina a relatar a experiência desse projeto, aprofundando a estratégia da utilização do AT num caso de acumulação compulsiva de animais. Para prover suporte à compilação e análise dos dados, utilizou-se como técnica de coleta de dados os diários de campo das acompanhantes terapêuticas envolvidas no caso. As anotações foram realizadas com base nas descrições objetivas das situações vivenciadas, reflexões e impressões pessoais e grupais dos profissionais que acompanhavam o caso. Após análise e categorização, conclui-se que a abordagem da pessoa com transtorno de acumulação tem especificidades que ressaltam a importância do cuidado e do trabalho em rede. Ademais, o AT se apresenta como um importante recurso no manejo de casos de acumuladores compulsivos e potencializador do trabalho em rede, por meio de ações singulares e estratégicas.
The extension project "Therapeutic Monitoring in Mental Health: support for inclusion and daily life (re)construction", resulting from a partnership between the Mental Health Directorship of Curitiba and the departments of Psychology, Occupational Therapy, and Nursing of the Federal University of Paraná, aimed to offer Therapeutic Monitoring to users of the mental health services of the city, with a specific application to compulsive hoarders. The present study aims to report on the experience of the therapeutic monitoring carried out in this project, in order to discuss the potential of this clinical device in the management of an animal hoarding case. For data collection, this study used field diaries kept by the therapeutic monitors involved in the case. The notes were taken as objective descriptions of the situations and personal and group reflections of the professionals that followed the case. After analyzing and categorizing the data, it was concluded that the approach of the person with hoarding disorder has distinct particularities that highlight the importance of care and networking. In addition, therapeutic monitoring may be an important resource in the management of hoarding cases and a catalyst for the networking, prompting singular and strategic actions.
El proyecto de extensión "Acompañamiento Terapéutico en Salud Mental: soporte para inclusión y (re)construcción de lo cotidiano", realizado por la asociación entre la Dirección de Salud Mental de Curitiba y los departamentos de Psicología, Terapia Ocupacional y Enfermería de la Universidad Federal de Paraná, tuvo como objetivo ofrecer Acompañamiento Terapéutico (AT) a usuarios de los servicios de salud mental del municipio, actuando junto a acumuladores compulsivos. El trabajo objetiva relatar la experiencia del proyecto, profundizando la estrategia de la utilización del AT junto a un caso de acumulación compulsiva de animales. Para la compilación de los datos, se utilizó los diarios de campo de las acompañantes terapéuticas involucradas en el caso. Las anotaciones se realizaron con base en las descripciones objetivas de las situaciones vividas, reflexiones e impresiones personales y grupales de los profesionales que acompañaban el caso. Después del análisis y categorización, se concluye que el abordaje de la persona con trastorno de acumulación posee especificidades que resaltan la importancia del cuidado y del trabajo en red. Además, el AT se presenta como un importante recurso en el manejo de casos de acumuladores compulsivos y potenciador del trabajo en red, por medio de acciones singulares y estratégicas.
RESUMO
The use of alternative blood sampling strategies in clozapine (CLZ) therapeutic drug monitoring (TDM) aims to facilitate collection and improve drug therapy and adherence. This study aimed to develop and validate two methods for the determination CLZ and norclozapine (NOR) in dried blood spots (DBS) and dried plasma spots (DPS) by high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). The analytes were extracted from one 10 microliter volumetric DBS disc punch and from one 6 mm DPS disc punch with methyl tert-butyl ether: methanol (1:9, v/v) and injected into the HPLC-MS/MS with Atmospheric pressure chemical ionization (APCI) source. Separation was performed in a phenyl column, with mobile phase ammonium formate 1 mM pH 4.0 with methanol in gradient mode. The method was linear from 50 to 1500 ng/ml (r > 0.99), with accuracy between 98% and 105% in DBS and 91-101% in DPS, and intra- and inter-assay CV% from 5.23% to 9.35% in DBS and 2.22-11.36% in DPS for both analytes. The matrix effect was compensated by the internal standard, between - 5.1-6.89% in DBS and - 2.45-5.74% in DPS. The average extraction efficiency was 63-67% for CLZ and 58-69% for NOR with no significant impact of hematocrit (HCT). The analytes were stable in the dried matrices stored up to 42 °C for 26 days. The method was applied in the evaluation of clozapine therapy in 13 schizophrenic patients with mean serum levels of 401 ng/ml (43-914 ng/ml). Only 38% were within the therapeutic range, 46% below and 23% above. CLZ and NOR concentrations in dried samples were highly correlated to serum levels, with greater accuracy for DPS compared to DBS (97 versus 89%, and 99 versus 131%, for CLZ and NOR, respectively). Our data support the use of DBS and DPS as alternative sampling strategies in CLZ therapeutic drug monitoring, with satisfactory performance and logistics advantages.
Assuntos
Clozapina , Cromatografia Líquida de Alta Pressão , Cromatografia Líquida , Clozapina/análogos & derivados , Teste em Amostras de Sangue Seco , Humanos , Reprodutibilidade dos Testes , Espectrometria de Massas em TandemRESUMO
Phosphodiesterase inhibitors (PDE5i) are considered the first line therapy for erectile dysfunction. All PDE5i available on the market are structurally related; their main differences relate to their pharmacokinetic parameters. For these treatments to be effective and safe, it is necessary that these drugs are in the appropriate doses and that they reach adequate concentrations in the plasma. For this purpose, it is essential to perform therapeutic monitoring using bioanalytical methods. In this way, the present work aimed to develop and validate a new bioanalytical method, based on LC-MS/MS, for the simultaneous quantification of six commercially available PDE5i (avanafil, lodenafil, sildenafil, tadalafil, udenafil, and vardenafil). For this purpose, the human plasma was extracted with diethyl ether and sulfaquinoxaline was established as an internal standard. Separation was achieved using an Xbridge C18 column at 40 °C as the stationary phase, using water and acetonitrile as the mobile phase (both with formic acid and ammonium formate) in gradient mode. The method was validated according to the current guidelines and was found to be selective, linear (from 1 to 200 ng.mL-1 for all drugs except for tadalafil which is from 5 to 200 ng.mL-1), precise, accurate, and free of residual and matrix effects. The drugs were considered stable in plasma and in solution under different conditions. The method was applied to volunteerssamples, demonstrating that the method can be used routinely and may be useful in future studies on pharmacokinetics and therapeutic monitoring.
Assuntos
Cromatografia Líquida/métodos , Nucleotídeo Cíclico Fosfodiesterase do Tipo 5/sangue , Espectrometria de Massas em Tandem/métodos , Adulto , Monitoramento de Medicamentos , Humanos , Limite de Detecção , Modelos Lineares , Masculino , Reprodutibilidade dos TestesRESUMO
INTRODUCCIÓN: La monitorización de antimicrobianos mediante sus concentraciones plasmáticas permite determinar la posología óptima de éstos, conducta esencial en pediatría. OBJETIVOS: Describir la monitorización de concentraciones plasmáticas de antimicrobianos y el ajuste de dosis en población pediátrica para determinar si las dosis utilizadas alcanzan rangos terapéuticos. PACIENTES Y MÉTODOS: Estudio descriptivo, retrospectivo, utilizando una base de datos con medición de concentraciones plasmáticas de amikacina y vancomicina en pacientes pediátricos del Hospital San Borja Arriarán, entre 2015-2018. Se determinó el número de pacientes que alcanzó rango terapéutico con dosis inicial, cuántos requirieron ajuste y sus características. RESULTADOS: Se monitorizó 104 concentraciones totales. Para vancomicina 65 concentraciones plasmáticas eran basales encontrándose fuera de rango terapéutico 56,5%; de los que requirieron ajuste, 25% fueron neonatos con mayor probabilidad de estar fuera de rango versus otros (p = 0,022). Para amikacina la Cpeak estuvo en rango en 60% de mediciones; 15,4% requirió ajuste incluyendo pacientes con fibrosis quística y oncológicos. No fue necesario efectuar ajustes en pacientes sin co-morbilidad. CONCLUSIÓN: La medición de concentraciones plasmáticas es necesaria para ajustar de forma individualizada la dosis, especialmente en pacientes pediátricos con fibrosis quística, oncológicos y en neonatología, donde es más probable no alcanzar rango terapéutico con las dosis iniciales.
BACKGROUND: The monitoring of antimicrobial therapy through plasma levels makes it possible to determine the optimal dosage of antimicrobials, an essential approach in pediatrics. AIM: To describe the monitoring of plasma antimicrobial levels and dose adjustment in the pediatric population to determine if the doses used reach therapeutic ranges. METHODS: Retrospective, descriptive study using a database with measurement of plasma levels of amikacin and vancomycin in pediatric patients at San Borja Arriarán Hospital between 2015-2018. The number of patients who reached the therapeutic range with the initial dose, how many required adjustment and their characteristics were determined. RESULTS: 104 total levels were monitored. For vancomycin 65 plasmatic levels were baseline, being outside the therapeutic range 56.5%; 25% of those requiring adjustment were neonates with a higher probability of being out of range versus others (p = 0.022). For amikacin, Cpeak was in range in 60% of measurements; 15.4% required adjustment, including patients with cystic fibrosis and cancer, without adjustments in patients without comorbidity. CONCLUSION: Measurement of plasma levels is necessary to individually adjust the dose, especially in pediatric patients with cystic fibrosis, oncology and in neonatology where it is more likely not to reach a therapeutic range with initial doses.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Pediatria , Amicacina/administração & dosagem , Vancomicina/administração & dosagem , Estudos Retrospectivos , Monitoramento de Medicamentos , Antibacterianos/administração & dosagemRESUMO
BACKGROUND: Frontal fibrosing alopecia (FFA) is a scarring alopecia that mainly affects postmenopausal women characterized by recession of the frontotemporal hairline and eyebrow loss. Current techniques to assess FFA activity are limited and involve noninvasive tools that assess disease progression or an invasive technique such as scalp biopsies. However, since progression of FFA is very slow, it is very important to develop a noninvasive technique to assess disease activity to monitor treatment response. OBJECTIVES: To provide a standardized and objective method to assess FFA activity. METHODS: We evaluated the correlation between trichoscopy and pathological features (degree of lymphocytic infiltration) in 20 dermoscopy-guided biopsies of FFA. At trichoscopy, we divided the severity of peripilar casts into 3 grades according to their thickness. To validate the trichoscopic visual scale, we showed the images to 7 dermatologists with interest in hair diseases. Concordance was assessed using the Kendall Tau-b concordance test. RESULTS: A strong correlation between severity of peripilar casts at trichoscopy and degree of lymphocytic infiltrate was observed by the Kendall Tau-b test. Validation showed very good inter- and intraobserver agreement. CONCLUSION: The trichoscopic visual scale allows noninvasive assessment of scalp inflammation in FFA in different scalp regions and therefore provides optimal guidance for treatment.
RESUMO
Esta pesquisa buscou conhecer as mudanças no comportamento alimentar do paciente bariátrico, analisando a função desse repertório antes e depois da cirurgia. Investigou-se também o processo de avaliação psicológica préoperatória, o acompanhamento terapêutico realizado nesse contexto bem como a existência ou não de repertórios alternativos ao comportamento alimentar que auxiliem no manejo do pós-cirúrgico. Os dados foram coletados em entrevistas semiestruturadas com 15 pessoas que realizaram a cirurgia. Os resultados indicaram que, antes do procedimento, o alimentarse era primordialmente mantido por reforço negativo, mas também por reforço positivo. Contudo o relato do pós-cirúrgico mostrou poucas alterações na função desse comportamento bem como a inexistência de repertórios alternativos, indicando probabilidade aumentada de, em longo prazo, de os sujeitos retornarem ao seu padrão nutricional anterior e viverem a reengorda. Em relação à avaliação psicológica e ao acompanhamento terapêutico, verificaram-se esses processos como pouco efetivos entre os procedimentos pré e pós-operatórios.
This research aimed to know the changes in a bariatric patients feeding behavior, analyzing the function of this repertoire before and after surgery. It also investigated the process of preoperative psychological evaluation, therapeutic monitoring conducted in this context, and the existence or lack of existence of alternative options for eating behavior which help to assist in the management of post-surgical period. Data were collected from semistructured interviews with fifteen people who underwent the surgery. The results indicated that before the procedure, the food itself was primarily maintained by both, negative and positive reinforcement. However, the reporting on post-surgical stage showed little change in the function of this behavior, as well as the absence of alternative options, indicating increasing likelihood of subjects returning, in a long run, to their previous nutritional status, and regaining lost weight. Psychological assessment and therapeutic monitoring processes proved to be ineffective in between preoperative and postoperative procedures.
Esta investigación tuvo como objetivo conocer los cambios en el comportamiento alimentario del paciente bariátrico, analizando la función de este repertorio antes y después de la cirugía. También se investigó el proceso de evaluación psicológica preoperatoria, el seguimiento terapéutico realizado en este contexto, así como la existencia de repertorios alternativos para la conducta alimentaria que ayuden en el acompañamiento post quirúrgico. Los datos se obtuvieron de entrevistas semi-estructuradas con quince personas que se sometieron a cirugía. Los resultados indicaron que antes del procedimiento, el hecho de alimentarse se mantuvo principalmente por el refuerzo negativo, pero también por el refuerzo positivo. Sin embargo, el informe post quirúrgico mostró pocos cambios en la función de este comportamiento, y la ausencia de repertorios alternativos, lo que indica una mayor probabilidad de que a largo plazo, los sujetos vuelvan a su estado nutricional previo y experimenten aumento de peso. En cuanto a la evaluación psicológica y al seguimiento terapéutico, se observaron estos procesos como ineficaces entre el pre y el post-operatorio.
Assuntos
Terapêutica , Dieta , Cirurgia BariátricaRESUMO
BACKGROUND: Therapeutic drug monitoring (TDM) of the widely prescribed antidepressant fluoxetine (FLU) is recommended in certain situations, such as occurrence of toxicity, inadequate response or suspect of poor adherence. Dried blood spot (DBS) sampling is an increasingly studied alternative for TDM, particularly for outpatients, due to its ease of collection and inherent stability. OBJECTIVES: The aim of this study was to develop and validate an LC-MS/MS assay for the simultaneous quantification of FLU and norfluoxetine (NFLU) in DBS. DESIGN AND METHODS: The assay is based on a liquid extraction of single DBS with 8mm of diameter, using FLU-D6 as the internal standard, followed by reversed phase separation in an Accucore® C18 column (100×2.1mm, 2.6µm). Mobile phase was composed of water and acetonitrile (gradient from 80:20 to 50:50, v/v), both containing formic acid 0.1%. The assay was validated and applied to 30 patients under FLU pharmacotherapy. RESULTS: The assay was linear in the range 10-750ngmL-1. Precision assays presented CV% of 3.13-9.61 and 3.54-7.99 for FLU and NFLU, respectively, and accuracy in the range of 97.98-110.44% and 100.25-105.8%. FLU and NFLU were stable at 25 and 45°C for 7days. The assay was evaluated in 30 patients under FLU treatment. Concentrations of both compounds were higher in DBS than in plasma, and the use of the multiplying factors 0.71 and 0.68 for FLU and NFLU, respectively, allowed acceptable estimation of plasma concentrations, with median prediction bias of -0.55 to 0.55% and mean differences of 0.4 to 2.2ngmL-1. CONCLUSIONS: The presented data support the clinical use of DBS for therapeutic drug monitoring of FLU.
Assuntos
Cromatografia Líquida de Alta Pressão/métodos , Fluoxetina/análogos & derivados , Fluoxetina/análise , Espectrometria de Massas em Tandem/métodos , Cromatografia Líquida/métodos , Teste em Amostras de Sangue Seco/métodos , Monitoramento de Medicamentos/métodos , Fluoxetina/sangue , Hematócrito , Humanos , Reprodutibilidade dos TestesRESUMO
Resumen La presente revisión resume la evidencia sobre la monitorización terapéutica de tres antimicrobianos basada en datos regionales: vancomicina, amikacina y voriconazol en la población pediátrica. Estos datos coinciden con la literatura internacional en relación al requerimiento de dosis mayores que 40 mg/kg/día de vancomicina, la posibilidad de usar monodosis diarias de amikacina y el requerimiento de dosis mayores de voriconazol en relación a las iniciales recomendadas de 8 mg/kg/día. Contar con datos locales sobre el comportamiento farmacocinético/farmacodinámico de diversos antimicrobianos en la pediatría es de gran valor para adecuar la dosificación de los mismos en nuestra población. Se deberían incrementar los estudios de monitorización terapéutica en el uso de antimicrobianos en pediatría que permitan generar pautas de tratamiento adecuadas para este grupo etario.
This review summarizes recommendations of therapeutic monitoring of three antimicrobials based in regional data: vancomycin, amikacin and voriconazole in pediatric population. Regional evidence agrees with international literature regarding the requirement of higher daily doses than 40 mg/kg/day of vancomycin, as well as with the possibility of use one daily doses of amikacin and to recommend higher doses of voriconazole compared to the initially recommended doses of 8 mg/kg/day. Local data on the pharmacokinetic/pharmacodynamic behavior of various antimicrobials in pediatrics are of great value for dosing adjustment in our pediatric population. More studies in therapeutic monitoring in the use of antimicrobials in pediatrics should be performed in order to allow the generation of adequate treatment guidelines for this age group.
Assuntos
Humanos , Amicacina/administração & dosagem , Amicacina/farmacocinética , Vancomicina/administração & dosagem , Vancomicina/farmacocinética , Monitoramento de Medicamentos/tendências , Voriconazol/administração & dosagem , Voriconazol/farmacocinética , Antibacterianos/administração & dosagem , Antibacterianos/farmacocinética , Antifúngicos/administração & dosagem , Antifúngicos/farmacocinética , Relação Dose-Resposta a Droga , América LatinaRESUMO
Despite recent advances in the development of new therapeutic agents and diagnostic imaging modalities, cancer is still one of the main causes of death worldwide. A better understanding of the molecular signature of cancer has promoted the development of a new generation of anti-cancer drugs and diagnostic agents that specifically target molecular components such as genes, ligands, receptors and signaling pathways. However, intrinsic heterogeneity of tumors has hampered the overall success of target therapies even among patients with similar tumor types but unpredictable different responses to therapy. In this sense, post-treatment response monitoring becomes indispensable and nuclear medicine imaging modalities could provide the tools for an early indication of therapeutic efficacy. Herein, we briefly discuss the current role of PET and SPECT imaging in monitoring cancer therapy together with an update on the current radiolabeled probes that are currently investigated for tumor therapy response assessment.
Assuntos
Antineoplásicos/uso terapêutico , Compostos Radiofarmacêuticos/química , Animais , Diagnóstico por Imagem , Humanos , Neoplasias/diagnóstico por imagem , Neoplasias/tratamento farmacológico , Resultado do TratamentoRESUMO
A partir de um breve histórico de dispositivos clínicos utilizados no campo da saúde mental, discute-se a prática do Acompanhamento Terapêutico. Tal discussão se instrumentaliza da transferência, como conceito psicanalítico. Levantamos as hipóteses de que nesse trabalho realizado cotidianamente fora dos moldes do consultório, a fala de um usuário instiga a uma articulação entre teoria e prática e que a própria psicanálise pode dela adquirir um novo saber fazer clínico.
We discuss therapeutic monitoring based on a brief history of clinical tools used in the mental health field. This discussion is based on transference as a psychoanalytical concept. We hypothesize that, in everyday work carried out outside doctors’ offices’ models, users’ words instigate us to establish a connection between theory and practice — and that psychoanalysis itself can gain from it new knowledge for its clinical practices.
S’étayant sur un bref historique des dispositifs cliniques utilisés dans le domaine de la santé mentale, cet article discute la pratique du suivi thérapeutique. Cette discussion s’instrumentalise du transfert en tant que notion psychanalytique. Il émet les hypothèses que dans ce travail effectué quotidiennement en dehors du domaine des cabinets, la parole d’un utilisateur suggère un lien entre la théorie et la pratique et que la psychanalyse elle-même acquiert ainsi un nouveau savoir faire clinique.
A partir de un breve historial de los dispositivos clínicos utilizados en el campo de la salud mental, se analiza la práctica del monitoreo terapéutico. Esta discusión se instrumentaliza por la transferencia, como concepto psicoanalítico. Surgen entonces las hipótesis de que en ese trabajo realizado diariamente, por fuera del molde de los consultorios, el discurso de un usuario nos instiga a un enlace entre la teoría y la práctica y el propio psicoanálisis adquiere un nuevo saber-hacer clínico.
Basierend auf einem kurzen historischen Rückblick von klinischen Methoden im Bereich der psychischen Gesundheit, diskutiert der vorliegende Artikel die Praxis der therapeutischen Begleitung. Diese Diskussion leitet sich von der Übertragung ab, in Sinne des psychoanalytischen Konzepts. Wir erstellen die folgenden Hypothesen: 1. In dieser täglichen Arbeit, die außerhalb des Praxismodells stattfindet, unterstützt die Sprache des Benutzers die Verbindung zwischen Theorie und Praxis und 2. die Psychoanalyse kann dadurch neue Erkenntnisse für die klinische Arbeit erwerben.
RESUMO
Resumo Este trabalho é baseado em uma tese de doutorado que pretende refletir sobre a relação terapêutica entre acompanhante e acompanhado e suas possíveis aproximações com a relação de amizade. Utilizamos como intercessores, por um lado, o conceito de amizade dos filósofos Nietzsche, Montaigne e Blanchot e a técnica da análise mútua desenvolvida pelo psicanalista Sándor Ferenczi, para problematizar os movimentos de proximidade e distância que ocorrem no acompanhamento terapêutico. Por outro lado, dialogamos com os conceitos de políticas de amizade em Foucault, agir político em Arendt e especialmente conceitos como o Fora, o devir, a transversalidade e outros criados por Deleuze e Guattari, fundamentais para a reflexão sobre a dimensão ética, estética e política da clínica do Acompanhamento Terapêutico.(AU)
Abstract This work is based on a doctoral thesis that aims to reflect on the therapeutic relationship between companion and accompanied and possible approaches to the budding relationship. We use as intercessors, first, the concept of friendship of the philosophers Nietzsche, Montaigne and Blanchot and mutual analysis technique developed by psychoanalyst Sándor Ferenczi, to discuss the movements of proximity and distance that occur in therapeutic monitoring. Moreover, we use the concepts of political friendship in Foucault, Arendt in political action and especially concepts such as Outside, becoming and transversal created by Deleuze and Guattari, fundamental for reflection on the ethical, aesthetic and political dimension of clinic the Therapeutic Accompaniment.(AU)
Assuntos
Humanos , Amigos , Psicologia ClínicaRESUMO
O objetivo do artigo é relatar uma experiência de acompanhamento terapêutico escolar com uma criança autista, realizado durante três anos e meio em uma escola particular de Salvador. Os dados foram registrados em um diário de campo e analisados a partir da abordagem psicanalítica. Observaram-se avanços significativos relacionados à emergência do sujeito, como mudanças na fala, no reconhecimento de si, do corpo e no brincar simbólico. A prática mostra-se como um recurso importante para a inclusão e para o desenvolvimento de crianças autistas.(AU)
This paper aims to report a therapeutic monitoring experience at school with an autistic child, carried out for three and a half years in a private school in Salvador. Data were recorded in a diary and analyzed from the psychoanalytic approach. There were significant developments about the emergence of the subject, such as changes in speech, recognition of himself, of his body and at symbolic playing. This practice shows up as an important resource for the inclusion and development of autistic children.(AU)
Este texto tiene el propósito de informar sobre una experiencia de acompañamiento terapéutico en una escuela con un niño autista, realizada durante tres años y medio en un colegio privado de Salvador, Brasil. Se registraron los datos en un diario y se los analizaron desde el enfoque psicoanalítico. Se produjeron avances significativos relacionados con la emergencia del sujeto, tales como, cambios en el habla, reconocimiento de sí mismo, del cuerpo y del juego simbólico. La práctica muestra como un recurso importante para la inclusión y el desarrollo de niños autistas.(AU)
Assuntos
Humanos , Masculino , Criança , Transtorno Autístico/psicologia , Inclusão EscolarRESUMO
O objetivo do artigo é relatar uma experiência de acompanhamento terapêutico escolar com uma criança autista, realizado durante três anos e meio em uma escola particular de Salvador. Os dados foram registrados em um diário de campo e analisados a partir da abordagem psicanalítica. Observaram-se avanços significativos relacionados à emergência do sujeito, como mudanças na fala, no reconhecimento de si, do corpo e no brincar simbólico. A prática mostra-se como um recurso importante para a inclusão e para o desenvolvimento de crianças autistas.
This paper aims to report a therapeutic monitoring experience at school with an autistic child, carried out for three and a half years in a private school in Salvador. Data were recorded in a diary and analyzed from the psychoanalytic approach. There were significant developments about the emergence of the subject, such as changes in speech, recognition of himself, of his body and at symbolic playing. This practice shows up as an important resource for the inclusion and development of autistic children.
Este texto tiene el propósito de informar sobre una experiencia de acompañamiento terapéutico en una escuela con un niño autista, realizada durante tres años y medio en un colegio privado de Salvador, Brasil. Se registraron los datos en un diario y se los analizaron desde el enfoque psicoanalítico. Se produjeron avances significativos relacionados con la emergencia del sujeto, tales como, cambios en el habla, reconocimiento de sí mismo, del cuerpo y del juego simbólico. La práctica muestra como un recurso importante para la inclusión y el desarrollo de niños autistas.
Assuntos
Humanos , Masculino , Criança , Inclusão Escolar , Transtorno Autístico/psicologiaRESUMO
Levetiracetam (LEV), an antiepileptic drug (AED) with favorable pharmacokinetic profile, is increasingly being used in clinical practice, although information on its metabolism and disposition are still being generated. Therefore a simple, robust and fast liquid-liquid extraction (LLE) followed by high-performance liquid chromatography method is described that could be used for both pharmacokinetic and therapeutic drug monitoring (TDM) purposes. Moreover, recovery rates of LEV in plasma were compared among LLE, stir bar-sorptive extraction (SBSE), and solid-phase extraction (SPE). Solvent extraction with dichloromethane yielded a plasma residue free from usual interferences such as commonly co-prescribed AEDs, and recoveries around 90% (LLE), 60% (SPE) and 10% (SBSE). Separation was obtained using reverse phase Select B column with ultraviolet detection (235 nm). Mobile phase consisted of methanol:sodium acetate buffer 0.125 M pH 4.4 (20:80, v/v). The method was linear over a range of 2.8-220.0 µg mL-1. The intra- and inter-assay precision and accuracy were studied at three concentrations; relative standard deviation was less than 10%. The limit of quantification was 2.8 µg mL-1. This robust method was successfully applied to analyze plasma samples from patients with epilepsy and therefore might be used for pharmacokinetic and TDM purposes...
Levetiracetam, fármaco antiepiléptico com perfil farmacocinético favorável, tem sido cada vez mais utilizado na prática clínica, embora informações sobre seu metabolismo e disposição cinética ainda estejam sendo geradas. Um método simples, robusto e rápido de extração líquido-líquido seguido por análise por cromatografia líquida de alta eficiência é aqui descrito para servir tanto a investigações farmacocinéticas quanto à monitorização terapêutica. Além disso, as taxas de recuperação do levetiracetam em plasma foram comparadas entre a extração líquido-líquido, a extração sortiva em barra de agitação e a extração em fase sólida. Extração com o solvente diclorometano resultou em plasma livre de interferentes, tais como fármacos antiepilépticos co-prescritos, e apresentou taxas de recuperação em torno de 90% (extração líquido-líquido), 60% (extração em fase sólida) e 10% (extração sortiva em barra de agitação). A separação foi obtida utilizando-se coluna de fase reversa Select B e detecção ultravioleta (235 nm). A fase móvel foi composta por metanol:tampão acetato de sódio 0,125 M pH 4,4 (20:80, v/v). O método mostrou-se linear para o intervalo de 2,8 a 220,0 µg mL-1. Precisão intra- e interdias e a exatidão foram avaliadas em três concentrações; o desvio padrão relativo foi inferior a 10%. O limite de quantificação foi 2.8 µg mL-1. Este método foi aplicado para análise de amostras de plasma de pacientes com epilepsia e, desta forma, pode ser utilizado satisfatoriamente tanto para fins de farmacocinética quanto de monitorização terapêutica...
Assuntos
Humanos , Anticonvulsivantes/análise , Anticonvulsivantes/farmacocinética , Monitoramento Ambiental , Cromatografia Líquida de Alta Pressão , Epilepsia/tratamento farmacológico , Epilepsia/terapiaRESUMO
This study developed a remarkable methodological innovation (FC-ATE) which enables simultaneous detection of antibodies specific to the three evolutive forms of Trypanosoma cruzi: live amastigote (AMA), live trypomastigote (TRYPO), and fixed epimastigote (EPI) using a differential fluorescence staining as low (AMA), intermediate (TRYPO), and high (EPI). An outstanding performance (100%) was observed in the discrimination of the chagasic (CH) and non-chagasic (NCH) patients. In the applicability of FC-ATE in the diagnosis of Chagas disease, 100% of the CH samples presented positivity in the percentage of positive fluorescent parasites (PPFP) for all the three forms of T. cruzi. Moreover, 94% of the samples of NCH presented negative values of PPFP with AMA and TRYPO, and 88% with EPI. Samples from the NCH group with false-positive results were those belonging to the leishmaniasis patients. Considering the applicability of this technique in post-therapeutic monitoring of Chagas disease, 100% of non-treated (NT) and treated non-cured (TNC) samples were positive with the three T. cruzi evolutive forms, while a percentage of 100% from samples of the treated cured (TC) patients were negative with AMA, 93% with TRYPO and 96% with EPI. The comparison between FC-ATE and two other flow cytometric tests using the same samples of patients NT, TNC and TC showed that the three techniques presented different reactivities, although categorical correlation between the methodologies was observed. Taken together, the results obtained with the novel FC-ATE method have shown an outstanding performance in the diagnosis and post-therapeutic monitoring of Chagas disease.
Assuntos
Anticorpos Antiprotozoários/sangue , Antígenos de Protozoários/sangue , Doença de Chagas/diagnóstico , Imunoglobulina G/sangue , Estágios do Ciclo de Vida/imunologia , Trypanosoma cruzi/imunologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Doença de Chagas/tratamento farmacológico , Doença de Chagas/imunologia , Doença de Chagas/parasitologia , Criança , Pré-Escolar , Feminino , Citometria de Fluxo/métodos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prognóstico , Sensibilidade e Especificidade , Tripanossomicidas/uso terapêutico , Trypanosoma cruzi/crescimento & desenvolvimentoRESUMO
Sickle cell anemia (SCA) is a recessively inherited disease characterized by chronic hemolytic anemia, chronic inflammation, and acute episodes of hemolysis. Hydroxyurea (HU) is widely used to increase the levels of fetal hemoglobin (HbF). The objective of this study was to standardize and validate a method for the quantification of HU in human plasma by using ultra high performance liquid chromatography (UPLC) in order to determine the plasma HU levels in adult patients with SCA who had been treated with HU. We used an analytical reverse phase column (Nucleosil C18) with a mobile phase consisting of acetonitrile/water (16.7/83.3). The retention times of HU, urea, and methylurea were 6.7, 7.7, and 11.4 min, respectively. All parameters of the validation process were defined. To determine the precision and accuracy of quality controls, HU in plasma was used at concentrations of 100, 740, and 1600 µM, with methylurea as the internal standard. Linearity was assessed in the range of 50-1600 µM HU in plasma, obtaining a correlation coefficient of 0.99. The method was accurate and precise and can be used for the quantitative determination of HU for therapeutic monitoring of patients with SCA treated with HU.
A anemia falciforme (AF) é uma doença hereditária recessiva caracterizada por anemia hemolítica crônica, inflamação crônica e episódios agudos de hemólise. Hidroxiureia (HU) é amplamente utilizada para aumentar os níveis de hemoglobina fetal (Hb F). O objetivo consiste em padronizar e validar um método para a quantificação de HU no plasma humano utilizando Cromatografia Líquida de Ultra Alta Eficiência (UPLC), a fim de determinar os níveis de HU em pacientes adultos com AF, tratados com HU. Utilizou-se coluna analítica de fase inversa (Nucleosil C18), fase móvel constituída por acetonitrila/água (16,7/83,3). Os tempos de retenção da HU, uréia e metiluréia foram respectivamente de 6,7, 7,7 e 11,4 minutos. Definiram-se todos os parâmetros do processo de validação. Para determinar a precisão e exatidão dos controles de qualidade utilizaram-se concentrações de 100, 740 e 1600 mM de HU no plasma, empregando como padrão interno a metiluréia. A linearidade foi avaliada no intervalo de 50 1600 mM de HU no plasma, obtendo-se coeficiente de correlação de 0,99. O método foi considerado exato e preciso e pode ser realizado com o propósito de determinação quantitativa de HU para monitorização terapêutica de pacientes com AF tratados com esse fármaco.