Alfredo Dias de Oliveira-Filho

Relação entre a Escala de Adesão Terapêutica de oito itens de Morisky (MMAS-8) e o controle da pressão arterial

BACKGROUND Non-adherence to treatment is an important and often unrecognized risk factor that contributes to reduced control of blood pressure (BP). OBJECTIVE To determine the association between treatment adherence measured by a validated version in Portuguese of the 8-item Morisky Medication Adherence Scale (MMAS-8) and BP control in hypertensive outpatients. METHODS A cross-sectional study was carried out with hypertensive patients older than 18 years, treated at six of the Family Health Strategy Units in Maceió (AL), through interviews and home blood pressure measurements, between January and April 2011. Adherence was determined by MMAS-8 version translated for this study. The patients were considered adherent when they had a score equal to 8 at the MMAS-8. RESULTS The prevalence of adherence among the 223 patients studied was 19.7%, while 34% had controlled BP (> 140/90 mmHg). The average adherence value according to the MMAS-8 was 5.8 (± 1.8). Adherent patients showed to be more prone (OR = 6.1, CI [95%] = 3.0 to 12.0) to have blood pressure control than those who reached mean (6 to <8) or low values (<6) at the adherence score. The Portuguese version of MMAS-8 was showed a significant association with BP control (p = 0.000). CONCLUSION The diagnosis of non-adherent behavior through the application of MMAS-8 in patients using of antihypertensive medications was predictive of elevated systolic and diastolic BP.

Risk factors for unintentional medication discrepancies at hospital admission: A matched case-control study

Unintentional medication discrepancies (UMD) are defined as erroneous and unjustified medication changes between the medication use history and the admission medication orders. UMD (e.g., medication omissions, incorrect doses, incorrect frequencies of administration, therapeutic duplications, among others) are distinguished from intentionalmedication discrepancies inwhich adjustments guided by the patients clinical condition are made at the time of admission [1]. Previous studies observed that 14.7% to 66.2% of identified UMD at admission or discharge are able to cause potential damage to patients [1–3]. Discrepancies between the medications patients taken before admission and those listed in their admission orders range from 50% to 70% [1,4–6]. Several studies have investigated the prevalence of UMD, but few have focused on its causes [4,6,7]. Until this date, there are no casecontrol or cohort studies of risk factors for UMD. Therefore, using a prospective case–control study design, we examined potential risk factors for unintended medication discrepancies (UMD) identified at admission among a random sample of hospitalized adult and children patients in the Federal University of Sergipe teaching hospital HU/UFS, in Aracaju, Brazil, betweenApril and July 2013. Patients with at least 1UMD identified at admission were recruited as the case group. Patients without UMD at admission were recruited as the control group. The two groups were matched in terms of age (±2 years, for children;±5years, for adults). At least 1 control patientwas selected for each case patient andmatched on day of hospital admission. Our study included only patients admitted fromMonday to Friday in the surgical, medical and pediatric wards, which remained hospitalized for longer than 24 h. We excluded patients for whom it was not possible to conduct the interview (e.g., the patient was in isolation or unattended) and those whose medical records were not available at the time of evaluation. In the study hospital there were no admissions on weekends. The information collected for each participant included sociodemographic characteristics, medication use and hospitalization related data. A clinical pharmacist and three pharmacy students analysed the data and assessed the presence of UMD. If necessary, a second clinical pharmacist analysed the case until consensus was reached. The evaluation was made in the first 36 h after admission. We did not perform the medication reconciliation process in our study, once it aimed to identify risk factors for UMD. A total of 514 patients were selected for the study, of whom 358 eligible subjects were analysed for this report (113 patients were discharged in b24 h; 30 patients it was not possible to interview and 13 patients there were no access to their medical records). There were

Adverse drug reactions in high-risk pregnant women: A prospective study

Background Because pregnant women are often excluded from clinical trials, there is still very limited information about the risk and safety of prescription drugs during pregnancy. Objective We aimed to determine the prevalence of Adverse Drug Reactions (ADRs) in high-risk pregnant women after hospital admission. A prospective study was carried out in a teaching maternity hospital in Brazil during six months. Causality of ADRs was assessed through the Naranjo Algorithm and Korean Algorithm for ADR Causality Assessment. Severity of ADRs was assessed using Hartwig’s Severity Assessment Scale. Results The prevalence of ADRs among the 294 inpatients studied was 8.8%. The mean age was 27.14 (±7.5) y.o. Patients age was related to the presence of ADRs, while the manifestation of these events was not associated with any adverse pregnancy outcome. 75.9% of the ADRs reported in the study were of mild severity and 24.1% were of moderate severity. No ADR was caused by drug-drug interaction; however, a significant increase in blood pressure was observed in all patients using concurrent methyldopa and ferrous sulfate. Conclusion Overall, ADRs were not common events among high-risk pregnant women and no adverse pregnancy outcomes following these events were observed.

Pseudoresistant hypertension attributed to poor adherence and inappropriate antihypertensive therapy

T French regulatory system strongly encourages strict regulation of health products’ production and distribution, especially concerning risk management and economic aspects. An ICU is an unusual environment for a local pharmacy practice (a nurse for every 2.5 patients, continuous adaptation of therapeutics...). However, a literature review reports interesting data concerning risk management and economics. This article aims to relate the experience of pharmacist integration in a French teaching hospital ICU (half-time position).T present study reports the antischistosomal activity of a molecular entity of synthetic origin and derived from diminazene in an experimental in vitromodel against Schistosomamansoni.This derivative of diminazene is an aromatic diamide that at concentrations of 125, 250 and 500 μg/ml induced a significant reduction in the motor activity and high mortality rates of S.mansoni adult worms of both sexes. At concentrations of 125, 250 and 500 μg/ml, the derivative of diminazene caused the death of 100% of adult parasites of S. mansoni of both sexes at the time of 48 hours.Confocal laser scanning microscopyanalysis following flaking and disintegration of tubers studies revealed morphological changes in the tegumental surface of maleS. mansoni worms treated with the aromatic diamide resulting in the disappearance of swollen buttons.Also, it was observed that the derivative of diminazene at concentrations of 62.5, 125 and 250 μg/ml has the capability of reducing by 100% theoviposition when compared with the number of eggs produced by S. mansoni worms ofthe control group.Thus, the present studydescribed thein vitroantischistosomal activity of a compound derived from the diminazene through observations in the mortality rate, reduction in motor activity, alterations in the tegument and oviposition of adultS. mansoni worms.In vivo studies are needed usingthis derivative of diminazene to elucidate its mechanisms of action and to determine its full potential to develop a newantiesquistossomose drug.Methods: The study was performed as a “between-patient” three level RSP trial in single dose finding and “within-patient” RSP in duration of the dose. Reduction in lice was the outcome variable. The study consisted of 15 net pens (3.6 mill. salmon incl. control) with minimum 4 lice/fish. The study was conducted to determine the minimum efficient dose (MED) of a new treatment procedure. Adjustment of the dose from one design level to the next and duration between treatments within net pens was based on k-adjustment factors estimated to ensure coverage of the entire two predefined windows. Three net pens were included on the first dose/design level, five on the second and seven on the third. In order to obtain the “between patient” RSP in the dose arm, a randomization procedure was introduced.A biosimilar is a successor to a biologic medicine that has lost patent protection or exclusivity. Due to their relative complexity, biosimilars represent a separate regulatory class of medicines to small-molecule generics. Biosimilars are biologics, and are approved via stringently defined regulatory pathways on the basis that they have demonstrated comparability (high similarity) to their reference product. The introduction of biosimilars in the EU has already led to significant savings for patients and payers. With many more such products at various stages of the development pipeline, the number of therapeutic areas catered for by biosimilars will increase steadily over the next decade. The real benefit of biosimilars is the introduction of genuine competition into an area that has historically been unhealthily short of it. Competition not only reduces prices; it also frees up public funds to broaden overall access to healthcare. In addition, it provides a further incentive for the producers of patent-protected medicines to come up with fresh ideas and genuinely original new products – driving the ‘virtuous circle’ of innovation. Biosimilar development requires substantial time and investment. A typical biosimilar takes 7-8 years to develop, at a cost of between USD 75 and 250 million, with clinical trials that may involve about 500 patients. That compares to 8-10 years for a new drug application, at a cost of USD 800 million, including up to 1000 patients in clinical trials. For a smallmolecule generic, by comparison, development may be completed in 2-3 years, at a cost of USD 2-3 million.Objectives: Due to the lack of new antibiotics for the treatment of critically ill patients with multidrug-resistant bacteria, interest on “old” antibiotics like Colistin re-emerged. Dosing of Colistin in critically ill patients undergoing renal replacement therapy is based on scarce data. We aimed to perform a prospective clinical study on dosing of intravenous Colistin in critically ill patients with AKI undergoing extended dialysis to develop dosing recommendations for this patient cohort.O of the worlds population is infected with tuberculosis (TB), a disease caused by Mycobacterium tuberculosis that survives and replicates within human macrophages. TB is characterized by a long chronic stage of infection and progressive pathology that mainly compromises (90% of cases) the respiratory system (World Health Organization, 2012). The current recommended TB chemotherapy includes: Isoniazid, rifampicin, ethambutol and pyrazinamide. However, patients non-compliance, several side effects and multi-drug resistant TB infections, often make ineffective the therapy.M conjugates of platinum(II) complexes have been designed and evaluated in vitro as drug delivery systems. The polymer component has multiple functions – through conjugation to decrease the toxicity of the bioactive complex, to protect it against binding and degradation by plasma proteins, to prolong blood circulation and to assist the passive drug targeting. On engineering the conjugates, the choice of the polymer carrier was also consistent with the functionality and structure of the platinum complex and the possibility to obtain stable nanocolloidal aqueous solutions.P plays an increasing role in disease prevention, and therapy. While substantial adverse reactions and insufficient efficacy continue to limit significantly the benefits of drug therapy, an understanding of the underlying causes of varying drug response has the potential to improve outcomes substantially. Much evidence supports the hypothesis that genetic factors play a critical role in determining treatment outcomes. Numerous pharmacogenetic studies have revealed genetic variants that can serve as clinical biomarkers guiding therapy; yet predictive value often remains uncertain, and implementation in clinical practice is slow in part because the genetics of drug response, or of any complex phenotype, remains poorly understood. Likely, multiple genes and their interactions contribute to any complex phenotype, but most current pharmacogenetic markers fail to consider the combined actions of more than 1 or 2 genes. To develop genetic markers with compelling clinical utility, broad genomics approaches are needed. Stunning advances in biomedical technologies, ultra-rapid DNA sequencing among them, reveal ever more details of human genomics, including the epigenome the latter reflecting dynamic influence exerted by the environment. This presentation will assess strategies for developing clinically useful biomarker panels that require an understanding of dynamic gene-gene-environment interactions.Study: Hypoglycemia (hG) affects up to 26% of inpatients with diabetes mellitus (DM) and is responsible for an increase in cardiovascular morbidity and mortality. Objective: The goal of this pilot project (PP) was to decrease inpatient hG. Methods: A hospital wide PP was implemented by giving the basal insulin in the morning, bolus insulin postprandial, using lower doses of corrective insulin and withholding of prandial insulin if food intake was less than 50%. The frequency rate of hG, as reported in the Patient Safety Network, was compared between patients on standard insulin regimens (control group) and patients enrolled in the PP (intervention group). Results: A total of 46 type 2 DM patients, were reported to experience hG during the 8 month study period. Among these patients, 36/46 (78%) of hypoglycemic episodes occurred in the control group ( incidence rate - 0.16 episodes per patient per year). In contrast, only 10/46 (22%) of patients experienced hG in the intervention group (incidence rate - 0.04 episodes per patient per year). The risk of hG was 3.66 times higher among the patients in the control group (standard insulin users) vs intervention group (modified insulin regimens), p< 0.05. The utilization of D50%, as rescue treatment for severe hG, decreased by 70% in the intervention group. Conclusion: The modification of standard timing of insulin administration, significantly decreased the frequency rate of hypoglycemia in our study population. Since prevention of hypoglycemia is a safety issue in the management of diabetes, additional studies are needed to assess if the above changes and intervention consistently reduce the risks of hypoglycemia in a larger inpatient and outpatient diabetic populations.T protective effect of L-Carnitine on the gentamicin nephrotoxicity was investigated in experimental animal model. Male Wister 200-300 g rats were distributed randomly into four groups, control group, L-Carnitine treated group, Gentamicin treated group, and L-Carnitine + Gentamicin treated group. The result showed that gentamicin nephrotoxicity in rats is detected by significant plasma creatinine, urea and zinc changes in serum and renal tissue. L-Carnitine is able to ameliorate the renal functions and restore the zinc status. Zinc serum level in the gentamicin treated group is 115 μg/dl, while it is 129 μg/ dl in the Gentamicin + L-Carnitine treated group, and Zinc tissue level in the Gentamicin treated group is 14.6 μg/dl, while it is 17.89 μg/dl in the Gentamicin + L-Carnitine treated group. The possibility of scavenging property of L-Carnitine against peroxy radical is via restoring zinc status implicated.Background: Pulmonary arterial hypertension (PAH) is a disabling chronic disorder of the pulmonary vasculature, which is characterized by increased pulmonary artery pressure (PAP) as a result of increased pulmonary vascular resistance (PVR). The most accepted hemodynamic definition of PH is a mean PAP >25 mmHg. It is accidentally discovered preoperatively through performing an echocardiogram in patients suspected of having PH, as these patients suffer from dyspnea which is the most frequently presenting symptom. Additional symptoms include fatigue, weakness, angina, syncope, and lower limb edema. The aim of the study was to evaluate the efficacy and safety of preoperative oral sildenafil administration in the management of pulmonary hypertensive patients scheduled for non-cardiac surgery. Patients and methods: 30 Patients, (ASA II–III), suffering from pulmonary hypertension and scheduled for non-cardiac surgery were randomly assigned to one of two groups. Group I received 25 mg sildenafil twice daily for one week before surgery. Group II received placebo in the same way. PAP, LVEF and RVEF (through echocardiogram), heart rate, mean arterial blood pressure, SpO2 (oxygen saturation), functional class and 6-min walk distance were measured and recorded at baseline and one week after treatment in both groups. Results: Sildenafil significantly reduced PAP and improved exercise tolerance, functional class, 6- min walk distance and SpO2 without significant alteration of heart rate and mean arterial blood pressure. Conclusion: The study showed effective and safe administration of preoperative oral sildenafil in the management of pulmonary hypertensive patients scheduled for non-cardiac surgery. a 2014 Alexandria University Faculty of Medicine. Production and hosting by Elsevier B.V. All rights reserved.