Navegando por Autor "COSTA, Maria Heliana Alencar da"

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Acesso aberto (Open Access)
Estresse oxidativo na hepatotoxicidade aos medicamentos anti-tuberculose
(Universidade Federal do Pará, 2016-06-30) COSTA, Maria Heliana Alencar da; MACCHI, Barbarella de Matos; http://lattes.cnpq.br/5330351659478942; NASCIMENTO, José Luiz Martins do; http://lattes.cnpq.br/7216249286784978
Tuberculosis treatment involves a combination of drugs with possible interactions with each other and other drugs. The most common side effects are related to hepatotoxicity. The biotransformation of drugs may result in the formation of reactive metabolites that can produce cellular damage which has been considered as an important process in the pathogenesis of hepatotoxicity. Goals: Evaluate the role of oxidative stress in patients with hepatotoxicity that have used anti-TB drugs. Methodology: To reach the first goal a Review of hepatotoxicity as an adverse reaction to anti-TB drugs was performed. Such an review was done through a wide search in the Portal of the Virtual Library of Health that targeted Portuguese and English literature to find papers pub- lished until December 2014. On the other hand, a Case Control study was performed to reach the second goal. For the analysis of antioxidant enzymes, patients treated at HUJBB in Secondary Reference Clinic of Pulmonology Clinic and admitted in línica of Pulmonology, and the patients seen at the Basic Health Unit Guamá in Belém were included. Results: As for the literature review, it was found that hepatic impairment is among the highest incidence of adverse reactions associated with anti-tuberculosis drugs in the Brazilian scene and adverse reactions during treatment of tuberculosis are one of the main factors associated with therapy abandonment. Regarding the analysis of antioxidant enzymes, the analysis of glutathione in the control group with hepatotoxicity (PCH) and the group without hepatotoxicity with anti-TB drugs (PCT) achieved median glutathione levels of 221 nmol / ml, 227 nmol / ml, and 236 nmol / ml, respectively. The distribution of catalase in the control group with hepatotoxicity (PCH) and the group without hepatotoxicity with anti-TB drugs (PCT) showed medians of catalase activity with values of 213 nmol / ml, 319 nmol / ml and 2035 nmol / ml, respectively. The median levels of antioxidants glutathione to the PCT group was the largest. However, glutathione levels were not statistically significant when applying the ANOVA test. Distributions of catalase activity in the population of TB patients in the group who developed hepatotoxicity (PCH) and that evolved without hepatotoxicity (PCT) were larger when compared to healthy volunteers. In particular, there was a statistically significant difference in catalase activity in the group (PCT) compared to the remaining groups. Conclusion: The results suggest that hepatotoxicity is not only associated with antioxidants enzymes and further analysis with more explanatory variables should be made to better understand this phenomenon.
Acesso aberto (Open Access)
Impacto na incidência de infecção relacionada a cateter vascular central após medidas de educação na unidade de terapia intensiva do Hospital Universitário João de Barros Barreto
(Universidade Federal do Pará, 2007) COSTA, Maria Heliana Alencar da; SOUSA, Rita Catarina Medeiros; http://lattes.cnpq.br/3560941703812539
Central venous catheters are commonly employed in the management of critically ill patients in intensive care units (ICU). Primary bloodstream infections resulting from central venous catheterization (CVC-BSI) are a common cause of excess morbidity, mortality, and medicalcare costs associated in the ICU setting. Many strategies have been used to decrease the risk of CVC-BSI and educational initiatives aimed at improving CVC insertion and care has been demonstrated successful results. The purpose of the study was to determine the impact of an educational program targeted to specific points observed during CVC care practices on decreasing CVC-BSI rates in ICU setting. This was a preintervention and postintervention study. Barros Barreto Hospital is a 260-bed university urban teaching hospital located in Belém city, Pará, Brazil and its ICU is a 10-bed surgical-medical unit. In this ICU, reported CVC-BSI from January 2003 to December 2005 was 11.8 episodes of CVC-BSI per 1000 CVC-days. Between January 2006 and July 2007 this study was carried in this setting. An educational program based on CDC Guidelines for Prevention of Intravascular Catheter- Related Infection directed to nurses and physicians was developed by a multidisciplinary task force to highlight correct practices for CVC care. Posters concerning CVC-BSI pathogenesis and prevention, tips about importance of handwashing were available in the unit. BSI-CVC rates were monitored in the following 12-months period after educational intervention. Twenty episodes of catheter-associated bloodstream infections (11.8 per 1,000 catheter-days) occurred in the 36 months before the introduction of the education program. Following implementation of the intervention, the rate of catheter-associated bloodstream infection decreased to four episodes in 1667 catheter-days (2.4 per 1,000 catheter-days), a decrease of 78%. Behavior changes such as adherence to hand hygiene before manipulating CVC and CVC dressing was dramatically enhanced after the educational intervention (49.5% to 98.5% and 15.4% to 96.9%, respectively) [p < .0001]. A multiple approach included a focused educational strategy targeted to specific problems observed during a careful evaluation of CVC care practices, and policy changes can lead to decrease in the incidence of bloodstream infections associated to CVC. Educational programs directed to healthcare professionals may lead to decrease in cost, morbidity, and mortality associated to healthcare-related infections.