bluuebunny/crossref_metadata_2025 huggingface dataset:
EVALUACION DE LA ADOPCION DEL MARKETING DIGITAL EN LAS MICRO PYMES Y PYMES DE SERVICIOS DE COLOMBIA
Authors: Pabon Lancheros Leandro Alberto
Published: March 2017

 

El propósito principal de este trabajo es evaluar la adopción de marketing digital en las Pymes de servicios de Colombia y la percepción de los resultados obtenidos de las herramientas digitales en actividades de mercadeo. Se ha realizado, en primera instancia, una revisión sistemática de literatura (Pérez-Rave, Álvarez-Jaramillo, & Henao-Velásquez, 2012) en la base de datos científica Scopus; en segunda, una validación del instrumento por parte de dos jueces; y en tercera, una prueba piloto del instrumento. Se prevé para la validación empírica un método de investigación descriptivo, no experimental, con un muestreo no probabilístico a partir base de datos de las Micro Pymes y Pymes de Servicios. El instrumento que se utilizará, será cuantitativo con la técnica de encuesta, a través de un cuestionario estructurado con ítems extraídos de las tres variables identificadas en la literatura: Conocimiento del Marketing Digital, Implementación del Marketing Digital y Precepción de resultados obtenidos.
PERCEPCIÓN DE MARCA DE MEDICAMENTOS GENÉRICOS FRENTE A LAS MARCAS ORIGINALES DE ALTO COSTO EN PACIENTES CON HIPERTENSIÓN ARTERIAL PULMONAR EN BOGOTÁ, COLOMBIA
Authors: Alfonso Iannini Silvana
Published: March 2017

Resumen
La presente investigación tiene como objetivo establecer percepción de marca presente en un grupo de pacientes con hipertensión arterial pulmonar, frente al uso de medicamentos de marcas genéricos y originales en el sector farmacéutico en la ciudad de Bogotá. Se buscará analizar las percepciones generales de esta población en torno al uso y tratamiento con medicamentos originales de marca frente a la eficacia de los medicamentos genéricos; evaluando el grado de confianza, utilización, elección y recomendación. La estrategia metodológica que se propondrá será de carácter cuantitativo y se implementará un análisis descriptivo transversal.
Effect of the ketoprofen on the preemptive analgesia in female cats undergoing to ovariohysterectomy
Authors: Lucena Dayvid Vianêis Farias de , Henrique Fernanda Vieira , Lima Amara Gyane Alves de , Souza Almir Pereira de , Nóbrega Neto Pedro Isidro da
Published: March 2017

ABSTRACT The objective of this study was to investigate the effect of the ketoprofen on the preemptive analgesia in female cats submitted to ovariohysterectomy. Sixteen healthy cats were distributed into two groups, with eight animals each, by means of a draw, in a preemptive group (PREG), in which the animal received ketoprofen (1 mg/kg) subcutaneously two hours before the surgery; and postsurgery group (POSG), in which ketoprofen (1 mg/kg) was administered subcutaneously immediately after surgery. In both groups, ketoprofen was given 24, 48 and 72 hours after the first adminstration. Heart and respiratory frequencies and glycemia were measured in all animals during the days first ten postsurgery. Analgesia was measured by assigning scores at zero, two, four, six, 12, 24, 48, 72, 96, 120, 144, 168, 192, 216 and 240 hours after the surgical procedure. Statistical analysis was performed using two-way analysis of variance followed by Tukey's test to compare the moments and Student's t-test for comparison between groups. Pain scores were evaluated using test of U-Mann-Withney or Kruskall-Wallis, all at the 5% level of significance. Pain scores were significantly lower in PREG in M0, M6, M72, M96 and M120. No significant difference was found in the levels of glycemia in comparison to baseline values. Ketoprofen promotes postsurgery analgesia in female cats submitted to ovariohysterectomy and preemptive and postsurgery administration provides an earlier reduction of pain scores when compared to postoperative administration, only.
Production and morphological components of sunflower on soil fertilized with cassava wastewater
Authors: Dantas Mara Suyane Marques , Rolim Mario Monteiro , Duarte Anamaria de Sousa , Lima Luiz Evandro de , Silva Manassés Mesquita da
Published: March 2017

ABSTRACT Agroindustrial residues, such as cassava wastewater, have been used as soil fertilizers, reducing environmental pollution and recovering nutrients. The objective of this work was to evaluate production and morphological components and oil yield of sunflower (Helianthus annuus), hybrid Helio-250, fertilized with cassava wastewater. The experiment was conducted at the Experimental Station of the Instituto Agronomico de Pernambuco, Vitória de Santo Antão, State of Pernambuco, Brazil. A randomized block experimental design was used, with six cassava wastewater rates (0, 8.5, 17.0, 34.0, 68.0 and 136 m3 ha-1) and four replications. The variables evaluated were shoot fresh and dry weight, capitulum fresh and dry weight, capitulum diameter, seed yield, oil yield and seed oil content. The use cassava wastewater as soil fertilizer improved the production and morphological variables evaluated, except the seed oil content, which decreased with application of cassava wastewater rates above 25 m3 ha-1.
Post-2008 Brazilian fiscal policy: an interpretation through the analysis of fiscal multipliers
Authors: Costa Junior Celso José , Cintado Alejandro C. García , Sampaio Armando Vaz
Published: March 2017

Abstract The global crisis that erupted in 2007 led many countries to embark on countercyclical fiscal policies as a way to cushion the blow of a depressed aggregate demand. Advocates of discretionary measures emphasize that fiscal policy can indeed stimulate the economy. The main goal of this work is to assess whether the fiscal policies pursued by the Brazilian government in the aftermath of the 2008 crisis, succeeded in bringing the economy back on track in a sustainable fashion. To this end, the fiscal multipliers of five different shocks are studied in a small open-economy New Keynesian framework. Our results point to the government spending and public investment as the most effective fiscal tools for combating the crisis. However, the highest fiscal multiplier turned out to be the one associated with excise tax reductions.
Inovação aberta no processo de pesquisa e desenvolvimento: uma análise da cooperação entre empresas automotivas e universidades
Authors: Lopes Ana Paula Vilas Boas Viveiros , Ferrarese André , Carvalho Marly Monteiro de
Published: March 2017

Resumo: A crescente demanda por inovação e a necessidade de reduzir o tempo e o custo do desenvolvimento de novos produtos têm mudado o cenário automotivo nacional, o qual foi por muito tempo caracterizado por um modelo fechado de inovação. A tecnologia flex fuel tem sido um desafio para as empresas desse setor e é o fator motivador deste estudo, cujo principal objetivo foi compreender o processo de inovação aberta no contexto de Fuzzy Front End, identificando as principais motivações e os principais gargalos para implementação. Para atingir esse objetivo foi realizado um estudo de caso longitudinal em um consórcio composto por 9 empresas e 2 universidades. A metodologia envolveu pesquisa qualitativa e quantitativa. A principal contribuição teórica desta pesquisa é justamente o pioneirismo no que diz respeito às empresas montadoras automotivas trabalhando de forma colaborativa. Esta pesquisa também tem implicações gerenciais importantes. Ela indica as peculiaridades que devem ser consideradas quando em um ambiente de coopetição, bem como sugere aos gestores de que forma trabalhar as fases iniciais da inovação. A pesquisa retrata bem o papel das universidades nesse contexto.
Diet of two syntopic species of Crenuchidae (Ostariophysi: Characiformes) in an Amazonian rocky stream
Authors: Fernandes Suzanne , Leitão Rafael Pereira , Dary Eurizângela Pereira , Guerreiro Ana Isabel Camacho , Zuanon Jansen , Bührnheim Cristina Motta
Published: March 2017

Abstract This study assessed the diet of two poorly known syntopic fish species of the family Crenuchidae, Characidium aff. declivirostre and Leptocharacidium omospilus, in a Presidente Figueiredo´ rocky stream, Amazonas, Brazil. The stomach contents were analyzed and their Frequency of Occurrence (FO %) and Relative Volume (Vol %) were combined in a Feeding Index (IAi). We examined 20 individuals of C. aff. declivirostre and 23 of L. omospilus. The Morisita-Horn Index was used to estimate the overlap between the diets of these species. Immature insects were the most valuable items consumed by both fish species. The diet of C. aff. declivirostre was mainly composed of larvae and pupae of Chironomidae, while L. omospilus predominantly consumed larvae of Hydroptilidae, Hydropyschidae and Pyralidae. Thus, both species were classified as autochthonous insectivorous. Characidium aff. declivirostre was considered a more specialized species, probably reflecting lower feeding plasticity or the use of more restricted microhabitats compared to L. omospilus. When the food items were analyzed at the family taxonomic level, the diet overlap between these species was considered moderate (Morisita-Horn Index = 0.4). However, a more thorough analysis, at the genus level, indicates a very low diet overlap. Therefore, we conclude that the feeding segregation between C. aff. declivirostre and L. omospilus may favor their co-existence, despite their high phylogenetic closeness.
Relação de dispersão para os plásmon-poláritons de superfície em uma interface plana metal/dielétrico
Authors: Andrade-Neto A. V. , Ribeiro Neto Aroldo , Jorio Ado
Published: March 2017

A plasmônica é uma disciplina emergente que investiga a interação entre a luz e os elétrons quase livres em sistemas metálicos em uma interface metal/dielétrico. Esta interação dá origem aos denominados Plásmon-Poláritons de Superfície SPPs (da sigla em inglês Surface Plasmon-Polaritons), que são um tipo de quasipartícula resultante do acoplamento entre o fóton e o plásmon de superfície. A relação de dispersão dos SPPs é um conceito chave no entendimento da interação da luz com a matéria em estruturas nanométricas, com aplicações diversas nos campos da fotônica e da bioengenharia. Neste trabalho apresentamos em detalhes a dedução da relação de dispersão para o plásmon-poláriton de superfície para uma interface plana metal/dielétrico. Para as partes real e imaginária do vetor de onda ao longo da interface, deduzimos expressões gerais cujos casos particulares reproduzem resultados conhecidos na literatura. Em seguida é realizada uma discussão sobre o significado físico dos resultados obtidos. Por fim, utilizando o modelo de Drude, apresentamos uma expressão explícita para a relação de dispersão na forma frequência versus vetor de onda.
O armazenamento atmosférico de vapor dágua sobre a região Amazônica
Authors: Marques José , Santos Jesus Marden dos , Salati Eneas
Published: March 2017

Resumo Foram estimados, a partir dos dados de radiossondagens, os valores da umidade específica bem como são apresentadas as variações em altitude e espacial da água precipitável sobre a região Amazônica, utilizados como parâmetros representativos do vapor dágua armazenado na atmosfera. De um modo genérico a maior concentração de vapor dágua atmosférico ocorre entre Manaus e Iquitos. Estimou-se em 35mm o valor médio da água precipitável sobre a bacia Amazônica bem como ser de 18,2% o valor da "eficiência da precipitação" para a região e um tempo de reciclagem ao vapor dágua de. aproximadamente, 5,5 dias. São apresentados os valores mensais da umidade específica em Belém e Manaus comparados com os obtidos para Brasília. São de 44.2, 41,9 e 25,1 mm os valores médios da água precipitável em Manaus, Belém e Brasília, respectivamente.
Símbolos na arte rupestre sob o olhar da Arqueologia Cognitiva: considerações analíticas sobre o sítio Conjunto da Falha, Cidade de Pedra, Rondonópolis, Mato Grosso
Authors: Guedes Carolina , Vialou Denis
Published: March 2017

Resumo O grande número de sítios existentes na região da Cidade de Pedra, localizada no município de Rondonópolis, Mato Grosso, aliado à variedade formal, temática e de técnicas aplicadas nas construções dos painéis rupestres, marcam fortemente a paisagem da região. Neste artigo, será analisado, mais detalhadamente, o sítio rupestre da Falha sob o viés da Arqueologia Cognitiva, reforçando a importância da relação estrutural entre suporte/registro gráfico na construção de uma linguagem simbólica. Unindo a materialidade do sítio da Falha com as propostas teóricas das ciências do conhecimento, será apresentada uma discussão sobre os registros rupestres socialmente organizados, que refletem as crenças e escolhas culturais do grupo pretérito responsável pela sua organização, em estreita relação com o suporte, como parte essencial da construção da mensagem, tornando-se uma categoria semântica em conjunto com os grafismos.
Do Folclorismo à História da Cultura na Amazônia: o percurso construído por Vicente Salles
Authors: Ricci Magda Maria de Oliveira , Mafra Alessandra Regina e Souza
Published: March 2017

Resumo Este artigo tem como objetivo analisar parte da trajetória intelectual do pesquisador e folclorista paraense Vicente Salles (1931-2013), nos estudos sobre o folclore. Examina-se como surgiu e se intensificou o interesse de Salles pelo folclore amazônico (em especial, o paraense), as suas primeiras pesquisas de campo, como o autor interpretou os conceitos de folclore e de cultura popular e a presença do folclore em algumas de suas principais obras.
Desafios e Dificuldades na Implementação do Programa Mais Educação: percepção dos atores das escolas
Authors: Soares Antonio Jorge Gonçalves , Brandolin Fabio , Amaral Daniela Patti do
Published: March 2017

Resumo: O presente artigo tem o objetivo de investigar a implementação do Programa Mais Educação (PME) a partir da percepção dos atores que tomam decisões cotidianas nas escolas para dar corpo aos objetivos dessa política indutora do governo federal. A pesquisa foi conduzida em 6 escolas da rede municipal de Petrópolis-RJ e contou com a participação de 33 entrevistados. Os resultados indicam que as escolas enfrentam dificuldades de estabelecer parcerias com outras instituições para o desenvolvimento das atividades do programa, os gestores valorizam o PME por seu caráter de assistência e apoio às famílias e os monitores, apresentam frágeis vínculos com o programa por conta do baixo valor da ajuda de custo, colocando em xeque o caráter voluntário da participação.
A influência de sintomas da disfunção temporomandibular na força máxima de mordida em indivíduos com deformidade dentofacial
Authors: Passos Dannyelle Christina Bezerra de Oliveira Freitas , Prado Daniela Galvão de Almeida , Nary-Filho Hugo , Berretin-Felix Giédre
Published: March 2017

RESUMO Introdução Indivíduos com deformidade dentofacial (DDF) apresentam comprometimento na oclusão, que pode alterar o desempenho mastigatório e, consequentemente, a força de mordida, não tendo sido encontrados estudos que considerassem a relação entre disfunção temporomandibular (DTM) e força de mordida, nessa população. Objetivo Verificar se a presença de sintomas de DTM influencia a força máxima de mordida (FMM) em indivíduos com DDF. Métodos Participaram do estudo 60 indivíduos, 30 com DDF (GDDF) e 30 com oclusão normal (GC). Para avaliação da DTM, foi aplicado um questionário anamnésico (QA), contendo 10 questões que permitem a classificação quanto à presença e grau de sintomas da DTM. A FMM foi avaliada utilizando-se um transdutor de força mandibular, integrado ao eletromiógrafo EMG System 810c. Foram realizados três registros da força de mordida, com duração de 10 segundos cada. Foi aplicado o coeficiente de correlação de Spearman, com nível de significância de 5%. Resultados Os resultados do QA demonstraram que, no GDDF, houve maior ocorrência de sintomas de DTM, em relação ao GC. Foi observado menor FMM em indivíduos com DDF, comparativamente ao GC. Além disso, foram constatadas correlações negativas e significantes entre os escores obtidos na aplicação do QA e a FMM, ou seja, quanto maior a gravidade dos sintomas da DTM, menor o valor da força de mordida. Conclusão A presença e gravidade dos sintomas da DTM influenciaram a FFM nos individuos com DDF, demonstrando a necessidade de atuação interdisciplinar durante todas as fases do tratamento ortocirúrgico.
Principle of maximum entropy in the estimation of suspended sediment concentration
Authors: Martins Patrícia Diniz , Poleto Cristiano
Published: March 2017

ABSTRACT The concern with water quality has been promoting development of better monitoring and control techniques every day. As sediments transport most of water contaminants, their study is fundamental. Given the large number of variables for estimating sediment concentration and high costs of monitoring campaigns, it becomes necessary to develop more accessible methods which bring satisfactory practical results. Therefore, this work deals with application of the principle of maximum entropy, a probabilistic method to determine concentration of sediments in river channels with various concentrations and particle sizes. For this purpose, it was proposed a relationship between the theory of entropy parameters in order to reduce the computational effort. The results were satisfactory at concentrations above 10 g/L with R2 greater than 0.88. The calculated squared errors in this study were lower than those found when using the theory of entropy by Tsallis and the equation of Rouse, classic models for determining the sediment concentration profile. The applicability of the proposed model and the ease of using the probabilistic method, since it reduces the amount of data needed to perform the estimate, makes it feasible on a global scale.
Dispositivos de informação: arquivos, memórias e informação
Authors: TAVARES Derek Warwick da Silva , LOUREIRO José Mauro Matheus
Published: March 2017

Resumo O artigo aborda as dinâmicas do fenômeno informação como instrumento de desenvolvimento das lógicas e dos valores presentes nos quadros da memória, construídos e geridos no interior dos espaços arquivísticos. Para tanto, este estudo privilegia a noção de “dispositivo” tal como elaborada na obra de Michel Foucault e uma de suas derivações como os “dispositivos de informação”, além ainda das concepções filosóficas e sociológicas sobre a memória social e o arquivo. Os conceitos e as noções empregadas são desenvolvidos em uma perspectiva privilegiada da inter-relação entre Ciência da Informação, Filosofia e Ciências Sociais, permitindo perceber que o movimento entre a informação, os arquivos e as memórias, quando ativado no interior desses “dispositivos”, delineia tipos específicos de saber, poder e sujeitos submetidos a contextos sociais, políticos e econômicos específicos. Conclui-se ao fim que a memória coletiva constitui-se como um “dispositivo” composto de discursos de verdade, apresentado na condição de arquivo, isto é, como conjunto de regras que facultam o emergir, em uma determinada época, de um tipo de discurso capaz de agir sobre os homens, tornando-os sujeitos de certo conjunto de memórias.
Do Génio ao jogo. O papel da Técnica na Transformação dos Valores Estéticos em Walter Benjamin
Authors: Conceição Nélio Rodrigues
Published: March 2017

Resumo: Analisando o papel desempenhado pela questão da técnica no pensamento de Walter Benjamin, o artigo debruça-se sobre a transformação dos valores estéticos, na modernidade. As técnicas de reprodução/registo inventadas nos séculos XIX e XX, como a fotografia e o cinema, obrigaram a uma revisão das articulações entre arte, técnica e história, articulações que Benjamin desenvolveu em diversos sentidos. Contudo, não encontramos, nos seus textos, uma filosofia da técnica de princípios claramente estabelecidos. Portanto, o presente artigo visa estabelecer uma constelação de temas, os quais, brotando dos seus textos, nos permitem clarificar como a técnica influencia a transformação e a criação de valores estéticos, sendo estes entendidos como eixos em torno dos quais se dão a produção e a crítica dos fenómenos estéticos. A fotografia, constituindo um momento de viragem incisivamente estudado pelo autor, é o fio condutor das diferentes leituras. Historicidade da percepção; dimensão política da arte; sua relação com a memória; elemento de jogo: são estes os quatro eixos em torno dos quais se procura clarificar e, sempre que possível, prolongar a proposta benjaminiana.
Proposal of nursing care plan in people hospitalized with AIDS
Authors: Souza Neto Vinicius Lino de , Silva Richardson Augusto Rosendo da , Silva Cristiane da Costa , Negreiros Rosangela Vidal de , Rocha Cintia Capistrano Teixeira , Nóbrega Maria Miriam Lima da
Published: March 2017

Abstract OBJECTIVE to elaborate and validate a proposal for a nursing care plan in people hospitalized with AIDS, in an infectious disease unit, using ICNP® version 2015. METHODS A cross-sectional study, followed by validation of content, performed with 20 nurses and 120 people, living with AIDS in an infectious disease unit of a hospital of infectious diseases in Northeast Brazil. The methodological trajectory was carried out in the following stages: elaboration of the diagnosis, nursing outcomes; Initial proposal of nursing interventions; Preparation of a care plan; And validation of the plan by field experts. RESULTS 42 diagnoses were elaborated and validated, 33 presented CVI > 0.80 (55.42%) among field experts. From this quantitative, 228 interventions were elaborated and 41 obtained a CVI > 0.80 (44.78%), considered validated. CONCLUSION The study allowed us to identify and validate nursing diagnoses, outcomes and interventions for the use in clinical practice, aiming to subsidize the process of care for people with AIDS.
A estiva se diverte: organizações recreativas dos trabalhadores do porto carioca nas primeiras décadas do século XX
Authors: Arantes Erika Bastos
Published: March 2017

Resumo Os primeiros anos do século são marcados por uma intensa atividade associativa dos trabalhadores. Essas associações, que podiam ser as mais diversas, certamente contribuíram de alguma forma para que os trabalhadores se identificassem como parte de um mesmo mundo e se reconhecessem como trabalhadores. No entanto, até bem pouco tempo a historiografia tendeu a observar apenas as associações que previam a luta operária, como os sindicatos. Analisando o caso dos trabalhadores do porto do Rio de janeiro, este artigo tem por objetivo investigar outras formas de organização operária, mais especificamente, as de cunho recreativo, como as sociedades carnavalescas, os clubes dançantes, ranchos etc. Buscarei aqui demonstrar a diversidade associativa daqueles trabalhadores, chamando a atenção para o fato de que identidades múltiplas - percebidas na diversidade das organizações - não impediam uma identidade de classe.
A Prospective Observational Study on Effect of Short-Term Periodic Steroid Premedication on Bone Metabolism in Gastrointestinal Cancer (ESPRESSO-01)
Authors: Nakamura Michio , Ishiguro Atsushi , Muranaka Tetsuhito , Fukushima Hiraku , Yuki Satoshi , Ono Kota , Murai Taichi , Matsuda Chika , Oba Ayane , Itaya Kazufumi , Sone Takayuki , Yagisawa Masataka , Koike Yuta , Endo Ayana , Tsukuda Yoko , Ono Yuji , Kudo Takahiko , Nagasaka Atsushi , Nishikawa Shuji , Komatsu Yoshito
Published: March 2017

Background

A multicenter prospective observational study evaluated the effect of gastrointestinal cancer chemotherapy with short-term periodic steroid premedication on bone metabolism.

Patients and Methods

Seventy-four patients undergoing chemotherapy for gastrointestinal cancer were studied. The primary endpoints were changes in bone mineral densities (BMDs) and metabolic bone turnover 16 weeks after initiation of chemotherapy. BMDs, measured by dual-energy x-ray absorptiometry, and serum cross-linked N-telopeptides of type I collagen (sNTX), and bone alkaline phosphatase (sBAP) were assessed for evaluation of bone resorption and formation, respectively.

Results

In 74.3% (55/74) of the patients, BMDs were significantly reduced at 16 weeks relative to baseline. The percent changes of BMD were −1.89% (95% confidence interval [CI], −2.67% to −1.11%: p < .0001) in the lumbar spine, −2.24% (95% CI, −3.59% to −0.89%: p = .002) in the total hip, and −2.05% (95% CI, −3.11% to −0.99%: p < .0001) in the femoral neck. Although there was no significant difference in sNTX levels during 16 weeks (p = .136), there was a significant increase in sBAP levels (p = .010). Decreased BMD was significantly linked to number of chemotherapy cycles (p = .02). There were no significant correlations between changes in BMDs and the primary site of malignancy, chemotherapy regimens, total cumulative steroid dose, steroid dose intensity, and additive steroid usage.

Conclusion

Gastrointestinal cancer chemotherapy with periodic glucocorticoid premedication was associated with reduced BMD and increased sBAP levels, which were linked to number of chemotherapy cycles but independent of primary site, chemotherapy regimen, duration, and additive steroid usage.
Cardiac Safety of Dual Anti-HER2 Therapy in the Neoadjuvant Setting for Treatment of HER2-Positive Breast Cancer
Authors: Yu Anthony F. , Singh Jasmeet C. , Wang Rui , Liu Jennifer E. , Eaton Anne , Oeffinger Kevin C. , Steingart Richard M. , Hudis Clifford A. , Dang Chau T.
Published: March 2017

Background

Trastuzumab and pertuzumab are approved for the neoadjuvant treatment of human epidermal growth receptor 2 (HER2)-positive breast cancer, but cardiac safety data is limited. We report the cardiac safety of dose-dense doxorubicin and cyclophosphamide (AC) followed by paclitaxel, trastuzumab, and pertuzumab (THP) in the neoadjuvant setting followed by adjuvant trastuzumab-based therapy.

Methods

Fifty-seven patients treated with neoadjuvant dose-dense AC-THP followed by adjuvant trastuzumab-based therapy between September 1, 2013, and March 1, 2015, were identified. The primary outcome was cardiac event rate, defined by heart failure (New York Heart Association [NYHA] class III/IV) or cardiac death. Patients underwent left ventricular ejection fraction (LVEF) monitoring at baseline, after AC, and serially during 1 year of anti-HER2 therapy.

Results

The median age was 46 years (range 26–68). Two (3.5%) patients developed NYHA class III/IV heart failure 5 and 9 months after initiation of trastuzumab-based therapy, leading to permanent discontinuation of anti-HER2 treatment. Seven (12.3%) patients developed a significant LVEF decline (without NYHA class III/IV symptoms). The median LVEF was 65% (range 55%–75%) at baseline and 64% (range 53%–72%) after AC, and decreased to 60% (range 35%–70%), 60% (range 23%–73%), 61% (range 25%–73%), and 58% (range 28%–66%) after 3, 6, 9, and 12 months (± 6 weeks) of trastuzumab-based therapy.

Conclusion

The incidence of NYHA class III/IV heart failure after neoadjuvant AC-THP (followed by adjuvant trastuzumab-based therapy) is comparable to rates reported in trials of sequential doxorubicin and trastuzumab. Our findings do not suggest an increased risk of cardiotoxicity from trastuzumab plus pertuzumab following a doxorubicin-based regimen.
A Phase Ib Study of Sorafenib (BAY 43-9006) in Patients with Kaposi Sarcoma
Authors: Uldrick Thomas S. , Gonçalves Priscila H. , Wyvill Kathleen M. , Peer Cody J. , Bernstein Wendy , Aleman Karen , Polizzotto Mark N. , Venzon David , Steinberg Seth M. , Marshall Vickie , Whitby Denise , Little Richard F. , Wright John J. , Rudek Michelle A. , Figg William D. , Yarchoan Robert
Published: March 2017

Lessons Learned

Oral targeted agents are desirable for treatment of Kaposi sarcoma (KS); however, in patients with HIV, drug–drug interactions must be considered. In this study to treat KS, sorafenib was poorly tolerated at doses less than those approved by the U.S. Food and Drug Administration for hepatocellular carcinoma and other cancers, and showed only modest activity. Sorafenib's metabolism occurs via the CYP3A4 pathway, which is inhibited by ritonavir, a commonly used antiretroviral agent used by most patients in this study. Strong CYP3A4 inhibition by ritonavir may contribute to the observed sorafenib toxicity. Alternate antiretroviral agents without predicted interactions are preferred for co-administration in patients with HIV and cancers for which sorafenib is indicated.

Background

We conducted a phase Ib study of sorafenib, a vascular epithelial growth factor receptor (VEGFR), c-kit, and platelet derived growth factor receptor (PDGFR)-targeted treatment in Kaposi sarcoma (KS). We evaluated drug–drug interactions between sorafenib and ritonavir, an HIV medication with strong CYP3A4 inhibitory activity.

Methods

Two cohorts were enrolled: HIV-related KS on ritonavir (Cohort R) and HIV-related or classical KS not receiving ritonavir (Cohort NR). Sorafenib dose level 1 in cohort R (R1) was 200 mg daily and 200 mg every 12 hours in cohort NR (NR1). Steady-state pharmacokinetics were evaluated at cycle 1, day 8. KS responses and correlative factors were assessed.

Results

Ten patients (nine HIV+) were enrolled: R1 (eight), NR1 (two). Median CD4+ count (HIV+) was 500 cells/µL. Dose-limiting toxicities (DLTs) were grade 3 elevated lipase (R1), grade 4 thrombocytopenia (R1), and grade 3 hand-foot syndrome (NR1). Two of seven evaluable patients had a partial response (PR; 29%; 95% CI 4%–71%). Steady-state area under the curve of the dosing interval (AUCTAU) of sorafenib was not significantly affected by ritonavir; however, a trend for decreased AUCTAU of the CYP3A4 metabolite sorafenib-N-oxide (3.8-fold decrease; p = .08) suggests other metabolites may be increased.

Conclusion

Sorafenib was poorly tolerated, and anti-KS activity was modest. Strong CYP3A4 inhibitors may contribute to sorafenib toxicity, and ritonavir has previously been shown to be a CYP3A4 inhibitor. Alternate antiretroviral agents without predicted interactions should be used when possible for concurrent administration with sorafenib.
Flecha, R.; García, R.; Ortega, S.; Racionero, S. (2012). Aprendiendo contigo. Barcelona: Hipatia.
Authors: Gairal Casadó Regina
Published: March 2017

Los/las autores/as del libro narran las vivencias de niños y niñas con casuísticas diferentes pero con un denominador común, todos ellos han sido receptores en sus escuelas de actuaciones educativas que están avaladas por la comunidad científica internacional y que por lo tanto son de éxito.
Editorial
Authors: Gisbert Cervera Mercè , Esteve Mon Francesc M.
Published: March 2017

Editorial
Authors: Frochoso Sánchez Manuel
Published: March 2017

Sin resumen.
Authors: Castañón Álvarez Juan Carlos
Published: March 2017

Sin resumen.
Inappropriate prescribing in hospitalized elderly patients
Authors: Massoud Lina K. , AlAgha Hala Z. , Taleb Mahmoud H.
Published: March 2017

Inappropriate prescribing (IP) is a major healthcare problem in elderly patients. The risk of this problem increases during hospitalization. This is due to increase morbidity and thus increases the use of medications by the inpatients. This study will clarify the problem of IP for elderly people during hospitalization and will identify the different types of it. It also will highlight some tools that are used to assess the different types of IP and the prevalence of it in elderly patients during hospitalization. Finally, the study will address the consequences of IP in the elderly inpatients and the risks associated with the use of some potentially inappropriate medications (PIMs) in the elderly.
Study of antihypertensive effect of ramipril alone and in combination with telmisartan
Authors: Raja Mustafa , Shukla Ajay Kumar , Agnihotri Astha
Published: March 2017

Background: Hypertension is one of the leading causes of the global burden of disease. Hypertension has been associated with increased risk of cardiovascular diseases, including coronary heart disease (CHD), congestive heart failure (CHF), ischemic and hemorrhagic stroke, renal failure, and peripheral arterial disease. Majority of the hypertensive population are still either untreated or inadequately treated. Aims and objectives of the study were to compare ramipril alone and in combination with telmisartan as an antihypertensive in mild to moderate hypertension.Methods: This study was a hospital based prospective, comparative randomized, observational study conducted over a period of one year. The subjects of this study had mild to moderate hypertension selected from outpatient department of department of General Medicine of a tertiary care hospital. For the purpose of this study, equal numbers of subjects were randomly allocated equally between two groups: one group on ramipril alone and the other group on combination of ramipril and telmisartan. Patients were assessed for the blood pressure (BP) reduction during follow-up period of 6-months.Results: Ramipril alone and in combination with telmisartan, both were associated with significant reduction of systolic BP (SBP), diastolic BP (DBP), and mean BP (MBP) from beginning to the end of study. Combination of ramipril with telmisartan was more effective than ramipril in lowering SBP during 4 to 12 weeks but at the end of study both drug groups were found to be equally effective antihypertensive. Both ramipril alone and in combination with telmisartan were equally effective in lowering DBP and MBP from beginning to end of study.Conclusions: There was a significant reduction of SBP, DBP, and MBP from beginning to the end of study with both ramipril alone and in combination with telmisartan. Ramipril alone and in combination with telmisartan, both were equally effective antihypertensive for mild to moderate hypertension.
Prescribing pattern of drugs in sick newborn care unit in a tertiary care hospital, Haldwani, Uttarakhand, India
Authors: Agrawal Pooja , Srivastava Bhavana , Gaur Sanjay , Khanchandani Renu , Basumatary Bithorai
Published: March 2017

Background: Sick Newborn Care Unit (SNCU) is meant to reduce the case fatality among sick newborns. Although it has been shown that patterns of drug utilization in SNCU are changing dynamically, current data on drug utilization patterns in SNCU is limited. This study was done to find out drug utilization pattern in newborn admitted at SNCU.Methods: This prospective observational drug utilization study was carried out in SNCU of Government Medical College and Hospital, Haldwani (Uttrakhand). The pattern of drug use in 206 sick newborn admitted at SNCU was assessed.Results: 75.25% sick newborns were in early neonatal period and 63.11% sick newborns were male. 33.98% sick newborn were preterm and mean±SD of weight of sick newborn was 2.16±0.6kg. Neonatal sepsis was commonest reason for admission followed by birth asphyxia . Three or more drugs (average 2.35drug/ Range 3-9 drug) were given to 52.91% new born and two drugs were given to 40.78% new born. Commonest route of drug administration was intravenous (97.08%), followed by intramuscular (72.82%), followed by orally (13.59%) and 11.65% new born received drug by inhalation. Most frequently used drugs in SNCU were antibiotics (Ampicillin, Gentamicin, Amikacin, Cefotaxime). Only two adverse drug reactions (mild rash by ampicillin and fever) were reported during study period. Out of 206 sick newborn, 18.93% died. Most common causes for death were respiratory distress syndrome (41.03%) followed by sepsis (23.08%) and hypoxic ischemic encephalopathy (17.95%).Conclusions: Antibiotics were of major concern in SNCU. The uncertainty regarding the choice of antibiotic can be minimized by periodic survey of etiological agent and their antibiotic susceptibility pattern.
A prospective study to evaluate oral iron preparations in antenatal women at a tertiary care hospital
Authors: V. Satyanarayana , D. Shabeer , Jayaram Suma , Bhandare Basavaraj
Published: March 2017

Background: Iron deficiency is the most common cause of anemia in pregnancy worldwide. It can be mild, moderate or severe. Severe anemia can have very serious consequences for mothers and babies. Pregnant women requiring medication represent a challenge to healthcare providers to avoid any teratogenic risk to foetus. The purpose of this study was to provide information about the most effective iron preparations prescribed to pregnant women and to evaluate the haemoglobin status before and after oral iron therapy.Methods: This was a Prospective observational study conducted in the Department of Obstetrics and Gynaecology, Rajarajeswari Medical College and Hospital, between October 2013 and March 2014.This study was conducted by reviewing the antenatal care Outpatient department case papers of 200 pregnant women who were anaemic.Results: Demographic profile, detailed medical history and drug intake in current pregnancy was noted. The prescription pattern was assessed. Of the three common iron preparations prescribed, Ferrous sulphate was the most common preparation. Findings of our study showed that all pregnant anaemic women included in the study were provided with iron and folic acid therapy and the most effective oral iron preparation was Ferrous sulphate.Conclusions: Present study shows that ferrous sulphate is the most common iron preparation prescribed. Ferrous sulphate and ferrous fumarate preparations showed better improvement in Hb levels. Anaemia is common among all pregnant women and therefore it raises the concern about high morbidity and mortality associated with pregnancy outcome. This can be minimized by educating pregnant women about importance of balanced diet and utilization of antenatal facilities even during early pregnancy.
Study of drug utilization pattern in emergency medicine ward at a tertiary care teaching hospital
Authors: V. Mamatha , B. M. Parashivamurthy , D. K. Suneetha
Published: March 2017

Background: The emergency department represents an important platform for conducting drug utilization studies as patients present with a wide spectrum of diseases in acute form. An irrational prescription adversely affects the prognosis and recovery of patients. Hence, the objective of our study was to evaluate the drug utilization pattern and to determine the rationality of prescription using WHO prescribing indicators in emergency medicine ward.Methods: After obtaining Institutional Ethical Committee approval, a prospective observational study was conducted over 2 months. The case records of 150 patients admitted to the emergency medicine ward, with a hospital stay of more than 24hrs were reviewed to analyze the prescription pattern during the initial 48hrs of admission. Case records of patients irrespective of age, sex and diagnosis were included in the study. Descriptive statistics were used to analyze the results (SPSS version 20).Results: A total of 1014 drugs were prescribed from 150 case records with a mean age of 47±18 years. An average of 6.76 drugs was prescribed per prescription; percentage of encounters with at least an antimicrobial was 115 (76.66%). Injections were prescribed in all patients (100%) and only 416 (41.02%) drugs were prescribed by generic name and 657 (64.79%) drugs abided to the WHO essential drug list. Majority of patients received anti-ulcerogenic drugs followed by antimicrobials.Conclusions: There was a tendency of polypharmacy with overuse of PPIs and antimicrobials. There is need to rationalize the drug therapy in terms of increasing prescription of drugs from essential drug list by generic name.
Evaluation of antimicrobial sensitivity pattern of chronic suppurative otitis media in a tertiary care hospital of West Bengal, India
Authors: Mondal Shirsendu , Banerjee Manasi , Das Sudip
Published: March 2017

Background: Chronic suppurative otitis media is a common infectious disease in our country. The micro-organisms commonly causing the disease and their antibiotic sensitivity pattern is important for treatment. This study was conducted to evaluate the antimicrobial sensitivity pattern of the common microorganisms in patients with chronic suppurative otitis media in our tertiary care hospital.Methods: The study was carried out from July 2013 to December 2013 at the ENT out-patient department of a tertiary care hospital in West Bengal. 100 patients aged 18 to 60 years of either sex, with unilateral or bilateral active chronic suppurative otitis media attending the out- patient clinic were included in the study. Pus samples were collected from the discharging ears and sent for isolating the organisms and susceptibility testing.Results: A total number of 108 ear swabs were collected from the 100 recruited patients of which 15 (13.88%) were sterile and 93 (86.11%) showed presence of organisms. Pseudomonas aeruginosa 41(38%) was the commonest organism isolated, followed by Staphylococcus aureus 25(23.15%). The antimicrobial profile of the microorganisms reveals maximum sensitivity of the isolated organisms to piperacillin and levofloxacin.Conclusions: In our study, Pseudomonas aeruginosa (38%) and Staphylococcus aureus (23.15%) are the major pathogens involved in the etiology of CSOM. The isolates showed maximum sensitivity to piperacillin (41%) and levofloxacin (41%). As piperacillin is available only in parenteral form and is also costly, topical levofloxacin can be recommended in empirical treatment of CSOM.
A study to assess awareness amongst pregnant women about the effects of drugs on the fetus and self-medication
Authors: Banzal Neeta , Saxena Kirti , Dalal Malti , Srivastava S. K.
Published: March 2017

Background: The present study was conducted with an objective to assess the awareness of drug use in pregnancy, to assess the knowledge of pregnant women on effect of drugs on foetus and to assess the self-medication among pregnant women.Methods: This was a prospective, observational, cross-sectional study conducted on randomly selected 200 pregnant women attending a tertiary care hospital in Surat, Gujarat, India. Data was collected by means of a pre-designed semi-structured questionnaire composed of 26 questions on self-medication during pregnancy and knowledge about that. The data was collected by interview technique in which each participant was asked questions in the language of her understanding in a separate room.Results: The average age of the participants was 23.7±3.68 years. About 91% were not aware about the effect of medication on the health of foetus and did not even enquire about it.  At the time of survey, 74% pregnant women were on some kind of medication. More than 80% were not aware about the duration of medication. About 51% were taking medication on regular basis. The proportion of self-medication among pregnant women was 8.5% (includes 5.5% by themselves and 3% by advice of chemists).Conclusions: There is a lack of awareness amongst the pregnant women regarding the effect of the drugs on the health of foetus. More than half of the women take medication on regular basis. However, low proportion of self-medication during pregnancy suggests that during pregnancy women preferred to take advise of physician for medication rather than taking self-medication.
Monitoring of adverse drug reactions to antidepressant drugs in a teaching hospital
Authors: Munoli Swetha , Patil Soumya B.
Published: March 2017

Background: Adverse drug reactions (ADRs) are considered among the leading causes of morbidity and mortality. Adverse drug reactions are important determinants of non-adherence to antidepressant treatment, but their assessment is complicated by overlap with depressive symptoms and lack of reliable self-report measures The present study was therefore undertaken to monitor the ADRs of the antidepressant in the psychiatric outpatient unit of Raichur Institute of Medical Sciences, Raichur, Karnataka, IndiaMethods: Study was conducted from December 2012 to November 2013, the   patients on antidepressant drugs from psychiatry out- patient department (OPD) of Raichur Institute of Medical Sciences were considered for analysis. The patients were diagnosed by consultant psychiatrist. Data was collected in standard questionnaire format. All patients diagnosed with psychiatric disorder as per ICD 10 criteria and receiving treatment with antidepressant were included. Assessment of causality and severity of recorded adverse events was done using WHO assessment scale and modified Siegel and Hartwig Scale respectively.Results: In our study 74 adverse drug reactions(ADRs) were seen among 52 cases, total 263 cases were screened.CNS and Anticholinergic side effects were most common adverse drug reactions noted. Tricyclic antidepressants (TCA) and Selective serotonin reuptake inhibitors (SSRIs) were the drugs causing maximum ADRs. Assessment of causality and severity of recorded adverse events showed possible to probable and mild to moderate severity respectively.Conclusions: CNS and Anticholinergic side effects were most common adverse drug reactions noted. Tricyclic antidepressants (TCA) were most commonly prescribed drugs followed by Selective serotonin reuptake inhibitors (SSRIs). Tricyclic antidepressants (TCA) and Selective serotonin reuptake inhibitors (SSRIs) accounted for most of ADRs (87.8%). Assessment of causality of recorded adverse events showed no certain cause and assessment of severity of recorded adverse events showed no severe cases.
Effect of nicotine on serotonin (5-HT) levels in brain of depressed rats
Authors: Bhalsinge Rahul R. , Barde Anita A. , Worlikar Pratibha S. , Limaye Manasi V. , Dhole Mrunal P. , Tilak Abhijeet V.
Published: March 2017

Background: Reduction in brain serotonin (5-HT) levels contributes to depression. Nicotine may have antidepressant properties and smokers self-medicate underlying depression. Epidemiological findings suggest that smokers more often demonstrate depressive symptoms than non-smokers and depressed patients are less likely to cease smoking. Therefore, the study was planned to evaluate the effect of nicotine on serotonin levels in brain of depressed rats.Methods: Antidepressant action of study drugs was evaluated using isolation induced hyperactivity model in rats. Rats were divided into five groups with six rats in each group. Study groups: Vehicle in normal rats 1 ml/kg (subcutaneous); vehicle after isolation 1ml/kg (subcutaneous); imipramine 10 mg/kg (intraperitoneal) for 7 consecutive days; single dose of nicotine 0.4 mg/kg (subcutaneous); single dose of nicotine 0.2 mg/kg (inhalational). Brain serotonin assay was carried out. The statistical significance was determined by ANOVA followed by Tukey test (p<0.05).Results: Serotonin levels (55.93ng/g of brain tissue) in rats after isolation were significantly less than in normal rats (335.87ng/g) (p<0.001). In imipramine treated group, serotonin levels (301.4ng/g) after isolation were highly significant as compared to serotonin levels in vehicle treated group after isolation (p<0.001). Nicotine administered by subcutaneous and inhalational route showed significantly higher brain serotonin levels, i.e. 175ng/g and 254.62ng/g respectively as compared to vehicle treated rats after isolation (p<0.001).Conclusions: Single dose nicotine (inhalational) produced significant antidepressant action comparable to that of seven days’ treatment of standard antidepressant drug imipramine in rats. In rats, nicotine by both routes i.e. subcutaneous and inhalational increased serotonergic activity.