Background This paper intends to check whether and how a hypothetical dengue vaccine could contribute to issue of evolution of bacteria resistance against antibiotics by reducing the number of patients that would inappropriately being treated with antibiotics. Methods We use a new mathematical model that combines, in a novel way, two previously published papers, one on the evolution of resistance against antibiotics and one classical Ross-Macdonald model for dengue transmission. Results The model is simulated numerically and reproduces a real case of evolution of resistance against antibiotics. In addition the model shows that the use of a hypothetical dengue vaccine could help to curb the evolution of resistance against an antibiotic inappropriately used in dengue patients. Both the increase in the proportion of resistant bacteria due to the misuse of antibiotics in dengue cases as a function of the fraction of treated patients and the reduction of that proportion as a function of vaccination coverage occur in a highly non-linear fashion. Conclusion The use of a dengue vaccine is helpful in reducing the rate of evolution of antibiotic resistance in a scenario of misuse of the antibiotics in dengue patients.
O médico residente, por ser profissional já graduado, responde a ações de responsabilidade civil em conformidade à legislação civilista ou consumerista de acordo com o âmbito do serviço prestado, se público ou privado, respectivamente. Este trabalho levantou a jurisprudência do Tribunal de Justiça de São Paulo em que residentes atuaram no polo passivo de lides sobre erro médico no estado de São Paulo, entre janeiro de 1998 e dezembro de 2016. As decisões indicaram que nas ações em que o residente respondeu com superiores hierárquicos acadêmicos eles não tiveram sua culpa apreciada e, sim, a dos seus supervisores, exceto em casos de erro grosseiro. Quando participaram do feito junto à equipe do hospital, sem que houvesse vinculação acadêmica, foram condenados em todas as ações, mediante verificação de culpa pessoal sobre o dano. Nas lides em que responderam sozinhos apenas com o hospital, foram condenados em apenas 2 casos (14,3%). Muito embora várias das instituições privadas que compuseram a amostra fossem prestadoras de serviço público, tanto seus médicos quanto os residentes não deveriam ter participado das lides por terem atuado como agentes públicos, porém a ilegitimidade não foi suscitada nas ações tempestivamente. O dever do médico de prover informação aos pacientes mereceu destaque nos acórdãos, já que a conduta esclarece quais procedimentos serão realizados e seus possíveis efeitos adversos. A falta de documentação neste sentido pode suscitar o entendimento de que houve dano indenizável pelos magistrados.
Deus. Agradeço a oportunidade de enredar por caminhos tão diferentes daqueles que considerei para mina vida. Foi desafiardor. Ao Professor Dr. Eduardo Massad, que mais do que orientador, amigo conduzindo com calma para que pudesse estar concluindo mais este desafio.Ao meu esposo, Mario, que me incentivou a desenvolver este trabalho.Aos meus filhos Martim e Andrew por acreditarem que ainda é possível. À minha amiga Prof. Dra. Leuda Oliveira que além de aconselhar ofereceu inúmeras sugestões que foram essenciais para o trabalho. Ao Prof. Dr. Marcos Amaku que ensinou a modelagem matemática. Ao Prof. Dr. Paulo Cesar dos Santos pelo incentivo e orientações. À Vilma, Iracene, Thiago e Ângela que ajudaram solucionar os trâmites burocráticos. Aos colegas Hélio e Tereza que estiveram comigo no novo objetivo. Às Professoras Dras. Anna Sara Levin e Izabel Marcílio que facilitaram o manuseio dos prontuários levantados e estudados. À Prof. Dra. Mara Massad pelo incentivo constante para não esmorecer e terminar o trabalho.A todos que direta ou indiretamente fizeram parte deste momento de retorno à vida acadêmica.
Optimizing a strategy for Dengue control based on vaccination is very challenging, since the dynamics of Dengue can be influenced by the coexistence of more than one serotype (DENV-1, DENV-2, DENV-3 and DENV-4), allowing the appearance of heterologous infections. In addition, although the effect of cross-immunity lasts a short period, the real protective power of the immune response is still not entirely clear. The aim of this study is to develop an optimization model to control Dengue transmission considering a multi-strain model. In order to evaluate such optimization, the vaccination was considered the control strategy. The Dengue dynamics was modeled according to that one developed by [1]. This model considered a human population, which can be infected by two strains of Dengue virus (strain 1 and 2). Both strains are simultaneously present in the system and they determine 10 categories in human population: susceptible to strains 1 and 2 (); primarily infected with strain 1 () or strain 2 (); recovered from the first infection with strain 1 () or strain 2 (); susceptible with a previous infection with strain 1 () or strain 2 (); secondarily infected with strain 1, when the first infection was caused by strain 2 () or for second time infected with strain 2 when the first infection was caused by strain 1 (); recovered from the secondary infection (). Initially, with the purpose of understand the Dengue dynamics in such conditions, the model was simulated without the introduction of vaccination. Following, the vaccination was introduced in this model. Although the vaccination was distributed to whole population, the vaccination effects occurs only on individual of category (the vaccinated individuals from move to category). Once in this category, individuals can become infected due to vaccination, moving to category. Otherwise, they become successfully protected (). Once the same individual cannot become infected by two different serotypes at the same time, there will be a competition between serotypes 1 and 2. However, the vaccination does not decrease the serotype 1 infected individuals, because there would be more susceptible individual's available to be infected by serotype 1. In other words, the serotype 1 would prevail in this population.
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