Widespread use of combined antiretroviral therapy (cART) increased HIV patients' life expectancy, however, favored the development of kidney and cardiovascular diseases. The aim of this study was to investigate endothelial glycocalyx (eGC) damage and its association with renal function in HIV patients receiving cART. This is a cross-sectional study with HIV-infected patients with no renal and cardiovascular disease, recruited in public health centers in Brazil. Clinical and laboratory parameters of HIV patients were compared according to cART use and with a healthy control group. Blood ICAM-1 and syndecan-1 levels were quantified by ELISA kit. Estimated glomerular filtration rate (eGFR) was evaluated. A total of 69 HIV patients were included, with mean age of 33.4 ± 8.9 years, and 77.3% were male. Serum urea, creatinine, and eGFR were similar in all groups. No HIV patient had decreased GFR <60 ml/min. All HIV patients had higher systemic syndecan-1 compared with healthy controls (71.8 ± 25.4 ng/ml vs. 36.5 ± 14.3 ng/ml, p < .001). Syndecan-1 showed a significant positive correlation with serum creatinine (r = 0.437, p = .001), serum urea levels (r = 0.352, p = .006), and a negative correlation with eGFR (r = -0.315, p = .015) in HIV patients. Syndecan-1 remained independently associated with serum creatinine and reduced GFR even after we forced variables related with HIV infection status, tenofovir use, treatment time, dyslipidemia, and others in a multivariate analysis. HIV patients using cART with no clinical renal and cardiovascular disease presented eGC damage and it is associated with clinical markers of kidney dysfunction. Syndecan-1 may be a useful early biomarker to monitoring renal dysfunction in HIV patients in chronic use of cART. Further research is needed to evaluate this applicability.

Introduction:The Brazilian HIV/AIDS management and treatment guideline (PCDT), published in 2013, recommends and standardizes the use of highly active antiretroviral therapy (HAART) in all adult patients, in spite of LTCD 4 count. This study aimed to analyze the first year of HAART use in patients from a reference center on HIV/AIDS management in Fortaleza, Ceará. Method: This descriptive study reviewed all prescription forms of antiretroviral regimens initiation and changes from January to July 2014. All antiretroviral regimen changes that occurred during the first year of therapy were evaluated. Data were analyzed with SPSS version 20. Mean, standard deviation and frequency, Student's t and Mann-Whitney tests calculations were used, with significance at p<0.05. Results: From 527 patients initiating HAART, 16.5% (n=87) had a regimen change in the first year. These patients were mostly male (59.8%; n=52), aged 20 to 39 years, with only one HAART change (72.4%; n=63). Efavirenz was the most often changed drug, followed by tenofovir, zidovudine and lopinavir/ritonavir. Mean time of HAART changes was 120 days, with adverse reactions as the most prevalent cause. HAART was effective in decreasing viral load since second month of treatment (p=0.003) and increasing LTCD 4 lymphocytes since fifth month (p<0.001). Conclusion:The main cause of initial HAART changes was adverse reaction and most patients had only one change in the HAART regimen. HAART prescription was in accordance to the PCDT from 2013.

A automedicação é a prática de consumir medicamentos por conta própria, visto que há uma série de fatores que a leva a ser praticada tão comumente. O presente estudo teve como objetivo analisar a prevalência da automedicação em acadêmicos do curso de Farmácia em uma instituição privada de Fortaleza, identificando os principais grupos terapêuticos envolvidos. É um estudo prospectivo com uma abordagem quantitativa baseado em um roteiro estruturado. A pesquisa foi realizada em uma faculdade particular do município de Fortaleza, de agosto a dezembro de 2017. Foram entrevistados 205 acadêmicos, com faixa etária predominante entre 18 e 28 anos 65,37% (n= 134), sendo o gênero feminino predominante 72,68% (n= 149). Ao analisar a prática da automedicação 99,51% (n= 204) foram adeptos do qual o motivo principal a cefaleia 35,27% (n= 149) e a classe farmacológica mais utilizada foram os analgésicos com 41,96% (n= 141). Cerca de 61,35% (n= 154) realizam a automedicação por conta própria e baseado em conhecimentos teóricos como conseguinte (50,00%; n= 94). Conclui-se que a automedicação entre os alunos é alto e há necessidade de uma maior conscientização da comunidade acadêmica, evitando que essa consciência seja propagada à população.

Dentre o universo de substâncias tóxicas, os medicamentos são os mais envolvidos em intoxicações. Em 2016, eles representaram 34% das intoxicações no Brasil. O objetivo foi analisar as intoxicações medicamentosas registradas entre os anos de 2012 a 2016, identificando as possíveis causas. Trata-se de um estudo documental realizado por meio de dados secundários disponíveis no sinitox e de informações contidas em bases de dados. As variáveis analisadas foram a frequência por região, a zona de ocorrência, o sexo, a faixa etária, a circunstância, a evolução dos casos e a frequência de óbitos. Os resultados mostraram que o Sudeste foi a região mais prevalente; o grupo mais atingido foi as mulheres de 20 a 49 anos, seguido de crianças de um a quatro anos; e a tentativa de suicídio como a principal circunstância. Pretende-se direcionar gestores e profissionais de saúde no planejamento de ações preventivas, amenizando esses incidentes e promovendo melhor qualidade de vida para a população.

SUMMARYBackground: The aim of this study is to describe clinical characteristics, outcomes and risk factors for death among patients with HIV-related acute kidney injury (AKI) admitted to an intensive care unit (ICU). Methods: A retrospective study was conducted with HIV-infected AKI patients admitted to the ICU of an infectious diseases hospital in Fortaleza, Brazil. All the patients with confirmed diagnosis of HIV and AKI admitted from January 2004 to December 2011 were included. A comparison between survivors and non-survivors was performed. Risk factors for death were investigated. Results: Among 256 AKI patients admitted to the ICU in the study period, 73 were identified as HIV-infected, with a predominance of male patients (83.6%), and the mean age was 41.2 ± 10.4 years. Non-survivor patients presented higher APACHE II scores (61.4 ± 19 vs. 38.6 ± 18, p = 0.004), used more vasoconstrictors (70.9 vs. 37.5%, p = 0.02) and needed more mechanical ventilation - MV (81.1 vs. 35.3%, p = 0.001). There were 55 deaths (75.3%), most of them (53.4%) due to septic shock. Independent risk factors for mortality were septic shock (OR = 14.2, 95% CI = 2.0-96.9, p = 0.007) and respiratory insufficiency with need of MV (OR = 27.6, 95% CI = 5.0-153.0, p < 0.001). Conclusion: Non-survivor HIV-infected patients with AKI admitted to the ICU presented higher severity APACHE II scores, more respiratory damage and hemodynamic impairment than survivors. Septic shock and respiratory insufficiency were independently associated to death.