Djanilson Barbosa dos Santos

Reações adversas a medicamentos em pediatria: uma revisão sistemática de estudos prospectivos

The aim of this literature review is to explore and to compare information derived from prospective studies of adverse drug reactions (ADR) incidence in pediatrics. A systematic literature research was performed looking for studies involving outpatient and inpatient children as well hospitalizations due to ADR. The studies were identified in MEDLINE, IPA and LILACS databases from January 1966 to November 2003. Investigation focused on specific treatments or morbidities was not included in the review. Twenty prospective cohort studies were included in the analysis. In outpatient investigations ADR incidence varied from 0.75% to 11.1% between the studies; 0.6% to 4.3% of hospital admissions were related to ADR with ADR frequency during hospitalization varying from 4.4% to 18.1% of the children. The lack of definition standards and of methodological criteria hindered results comparison and could partly explain the different observations.

Drug use and associated factors in children living in poor areas

OBJETIVO: Descrever o perfil de uso de medicamentos entre criancas residentes em areas pobres e fatores associados. METODOS: Estudo transversal de base populacional que incluiu 1.382 criancas entre quatro e 11 anos de idade, selecionadas por amostragem aleatoria de 24 micro-areas representativas das zonas mais pobres da populacao residente no municipio de Salvador, BA, em 2006. A variavel dependente foi o consumo de medicamentos nos 15 dias anteriores a realizacao dos inqueritos. Foram considerados tres grupos de variaveis explanatorias: socioeconomicas, estado de saude da crianca e utilizacao dos servicos de saude. A analise ajustada utilizou regressao de Poisson seguindo um modelo conceitual hierarquizado. RESULTADOS: A prevalencia de consumo de medicamentos em criancas foi de 48%. As criancas do sexo feminino apresentaram prevalencia de utilizacao de medicamentos superior ao sexo masculino, 50,9% e 45,4%, respectivamente (p=0,004). A prevalencia de uso de medicamentos diminuiu significativamente com a idade (p<0,001) em ambos os sexos. Os grupos farmacologicos mais utilizados foram os analgesicos/antitermicos (25,5%), antibacterianos sistemicos (6,5%) e antitussigenos/expectorantes (6,2%). Na analise multivariada os fatores determinantes de maior utilizacao de medicamentos foram: idade (quatro a cinco, seis, sete a oito anos), sexo feminino, maes de cor da pele branca, pior percepcao de saude, interrupcao de atividades por problemas de saude e atendimento de saude independentemente de estar doente nos ultimos 15 dias, gasto com medicamentos no ultimo mes e realizacao de consultas ao medico nos ultimos tres meses. CONCLUSOES: A prevalencia de uso de medicamentos entre criancas pobres estudadas foi inferior a verificada em outros estudos populacionais no Brasil, mas semelhante a de adultos. A identificacao de grupos mais sujeitos ao uso excessivo de medicamentos pode embasar estrategias para promocao de seu uso racional.OBJECTIVE To describe drug use profile in children living in poor areas and associated factors. METHODS Population-based, cross-sectional study, including 1,382 children aged between four and 11 years. These children were selected by random sampling of 24 micro-areas, representative of the poorest segments of the population living in the city of Salvador, Northeastern Brazil, in 2006. The dependent variable was drug use in the 15 days preceding the surveys. A total of three groups of explanatory variables were considered: socioeconomic variables, child health status, and use of health services. Adjusted analysis used Poisson regression, following a hierarchical conceptual model. RESULTS Drug use prevalence in children was 48%. Female children showed higher drug use prevalence than males, 50.9% and 45.4%, respectively (p=0.004). Drug use prevalence decreased significantly with age (p<0.001) in both sexes. Most used pharmacological groups were: analgesics/antipyretics (25.5%), systemic antibiotics (6.5%), and anti-cough /expectorant drugs (6.2%). In the multivariate analysis, factors determining greater drug use were: age (four to five, six, seven to eight years); female sex; white mother; poorer health perception; interruption of activities due to health problems and health care, whether ill or not, in the last 15 days; drug spending in the last month; and medical visits in the last three months. CONCLUSIONS Drug use prevalence in the poor children studied was below that observed in other population-based studies in Brazil, yet similar to that of adults. The identification of groups most subject to excessive drug use may serve as the basis for strategies to promote their rational use.

Prevalence of Mycoplasma genitalium and Mycoplasma hominis in urogenital tract of Brazilian women

BackgroundThe role of Mycoplasma hominis and M. genitalium in urogenital tract infections remains unknown. Furthermore these mollicutes present a complex relationship with the host immune response. The role of inflammatory cytokines in infections also makes them good candidates to investigate bacterial vaginosis and mycoplasma genital infections. Therefore, the aim of this study was to detect the above-mentioned mollicutes by quantitative Polymerase Chain Reaction (qPCR) methodologies in vaginal swabs and dosage of cytokines.MethodsVaginal swabs and peripheral blood were collected from 302 women, including healthy individuals. The molecular findings were correlated with some individual behavioral variables, clinical and demographic characteristics, presence of other important microorganisms in vaginal swabs, and levels of interleukin (IL)-1β and IL-6.ResultsM. hominis and M. genitalium were detected in 31.8% and 28.1% of samples, respectively. The qPCR results were associated with clinical signs and symptoms of the infections studied. The frequency of Trichomonas vaginalis, Gardnerella vaginalis, Neisseria gonorrhoeae and Chlamydia trachomatis was 3.0%, 21.5%, 42.4%, and 1.7% respectively. Increased levels of IL-1β were associated with the presence of M. hominis and signs and/or symptoms of the genital infection of women studied.ConclusionIL-1β production was associated with the detection of M. hominis by qPCR. The sexual behavior of women studied was associated with the detection of mycoplasma and other agents of genital infections.

Utilização de medicamentos e fatores associados entre crianças residentes em áreas pobres

OBJETIVO: Descrever o perfil de uso de medicamentos entre criancas residentes em areas pobres e fatores associados. METODOS: Estudo transversal de base populacional que incluiu 1.382 criancas entre quatro e 11 anos de idade, selecionadas por amostragem aleatoria de 24 micro-areas representativas das zonas mais pobres da populacao residente no municipio de Salvador, BA, em 2006. A variavel dependente foi o consumo de medicamentos nos 15 dias anteriores a realizacao dos inqueritos. Foram considerados tres grupos de variaveis explanatorias: socioeconomicas, estado de saude da crianca e utilizacao dos servicos de saude. A analise ajustada utilizou regressao de Poisson seguindo um modelo conceitual hierarquizado. RESULTADOS: A prevalencia de consumo de medicamentos em criancas foi de 48%. As criancas do sexo feminino apresentaram prevalencia de utilizacao de medicamentos superior ao sexo masculino, 50,9% e 45,4%, respectivamente (p=0,004). A prevalencia de uso de medicamentos diminuiu significativamente com a idade (p<0,001) em ambos os sexos. Os grupos farmacologicos mais utilizados foram os analgesicos/antitermicos (25,5%), antibacterianos sistemicos (6,5%) e antitussigenos/expectorantes (6,2%). Na analise multivariada os fatores determinantes de maior utilizacao de medicamentos foram: idade (quatro a cinco, seis, sete a oito anos), sexo feminino, maes de cor da pele branca, pior percepcao de saude, interrupcao de atividades por problemas de saude e atendimento de saude independentemente de estar doente nos ultimos 15 dias, gasto com medicamentos no ultimo mes e realizacao de consultas ao medico nos ultimos tres meses. CONCLUSOES: A prevalencia de uso de medicamentos entre criancas pobres estudadas foi inferior a verificada em outros estudos populacionais no Brasil, mas semelhante a de adultos. A identificacao de grupos mais sujeitos ao uso excessivo de medicamentos pode embasar estrategias para promocao de seu uso racional.OBJECTIVE To describe drug use profile in children living in poor areas and associated factors. METHODS Population-based, cross-sectional study, including 1,382 children aged between four and 11 years. These children were selected by random sampling of 24 micro-areas, representative of the poorest segments of the population living in the city of Salvador, Northeastern Brazil, in 2006. The dependent variable was drug use in the 15 days preceding the surveys. A total of three groups of explanatory variables were considered: socioeconomic variables, child health status, and use of health services. Adjusted analysis used Poisson regression, following a hierarchical conceptual model. RESULTS Drug use prevalence in children was 48%. Female children showed higher drug use prevalence than males, 50.9% and 45.4%, respectively (p=0.004). Drug use prevalence decreased significantly with age (p<0.001) in both sexes. Most used pharmacological groups were: analgesics/antipyretics (25.5%), systemic antibiotics (6.5%), and anti-cough /expectorant drugs (6.2%). In the multivariate analysis, factors determining greater drug use were: age (four to five, six, seven to eight years); female sex; white mother; poorer health perception; interruption of activities due to health problems and health care, whether ill or not, in the last 15 days; drug spending in the last month; and medical visits in the last three months. CONCLUSIONS Drug use prevalence in the poor children studied was below that observed in other population-based studies in Brazil, yet similar to that of adults. The identification of groups most subject to excessive drug use may serve as the basis for strategies to promote their rational use.

Interleukin-6 c.-174G>C Polymorphism and Periodontitis in a Brazilian Population.

Aim. Periodontitis is an inflammatory disease that affects the teeth supporting structures, triggered by periodontal pathogens, and is influenced by environmental and genetic factors. Genes encoding molecules related to the immune response, such as cytokine, are the main candidates for polymorphisms analysis and may be possibly associated with this pathology. A G/C promoter polymorphism on the IL6 gene has been shown to affect basal IL-6 levels. The aim of this study was to investigate the association between the IL6 c.-174G>C polymorphism and periodontitis in individuals from Vitória da Conquista, Bahia, Brazil. Material and Methods. Three hundred and thirty individuals (134 cases, 196 controls) were genotyped for the IL6 c.-174G>C by MS-PCR technique. Concentrations of salivary IL-6 were determined by ELISA method. Results. The IL6 c.-174G>C polymorphism was associated with periodontitis when comparing the distribution of genotypes between patients with periodontitis and control subjects. The GC genotype appeared as a protective factor for periodontitis. Results showed increased levels of salivary IL-6 in periodontitis patients. Nevertheless, there was no relationship between the concentrations of IL-6 and genotypes when comparing the case and control groups. Conclusions. Our data indicate an association between IL6 c.-174G>C polymorphism and periodontitis and showed that IL-6 may be considered an important marker for periodontitis.

Produtos naturais utilizados para tratamento de asma em crianças residentes na cidade de Salvador-BA, Brasil

O conhecimento popular e o passo inicial para a investigacao cientifica de atividades terapeuticas de remedios caseiros. Diversas patologias podem ser tratadas ou amenizadas atraves de preparacoes de origem natural e muitos farmacos disponiveis sao oriundos de fontes naturais. Este trabalho tem como objetivo avaliar o uso de remedios caseiros derivados de plantas para tratamento de asma em criancas residentes no municipio de Salvador. Os dados foram obtidos a partir de estudo realizado em Salvador sobre fatores de risco, uso de medicacoes e vias imunologicas relacionadas a asma em criancas. Foram calculadas as frequencias de uso de preparacoes caseiras para tratamento de asma por esta populacao e realizado uma revisao bibliografica sobre os efeitos das plantas mais usadas. Dentre as especies mais citadas, destacam-se o Allium sativum (alho) que teve a maior frequencia de utilizacao na preparacao dos remedios caseiros (25%), seguido da Allium cepa (cebola, 19,74%). Apos a revisao critica de literatura, constatou-se que a maioria das especies e utilizada com base em relatos fundamentados no saber popular, sendo assim carente de evidencias cientificas para as atividades farmacoterapeuticas esperadas. Neste sentido, ha necessidade de mais estudos farmacologicos para comprovacao das atividades terapeuticas peculiares a cada produto de origem natural bem como para avaliar possiveis efeitos toxicos destes produtos.

Use of prescribed and non-prescribed medications among children living in poor areas in the city of Salvador, Bahia State, Brazil

A cross-sectional study of children living in poor areas in the city of Salvador, Bahia State, Brazil, was carried out in 2006 to investigate the prevalence of use of prescribed and non-prescribed medication. This population-based study included 1,382 children aged 4-11 years. The use prescribed and non-prescribed medication during the 15 day period preceding the interview was adopted as the dependent variable. Of the 1,382 children, 663 (48%) had used at least one type of medication in the 15 days prior to the interview: in 267 cases (40.3%), mothers reported that the child had taken prescribed medication, while in 396 cases (59.7%), the child had taken medication that had not been prescribed by a physician. The most commonly prescribed drugs were analgesics (42.3%), systemic antibiotics (21.3%) and antiasthmatic (16.5%). With respect to non-prescribed drugs, the most common were analgesics (65.2%), antitussives (15.7%) and vitamins (9.3%). The results show a high prevalence of the use of non-prescription drugs among poor children, and large drug purchases of drugs by the head of household, highlighting deficiencies in coverage of the health system.

FOOD CONSUMPTION PATTERNS DURING PREGNANCY: A LONGITUDINAL STUDY IN A REGION OF THE NORTH EAST OF BRAZIL.

INTRODUCTION the nutritional panorama in Brazil indicates that the dietary patterns of the population is characterized by the increasing inclusion of saturated and trans fats, sodium, sugars, soft drinks. This epidemiological and nutritional challenges reflects in the patterns of illness and death. OBJECTIVE this study aims to identify patterns of food consumption and dietary changes in the first and third trimester of pregnancy. METHODOLOGY this is a prospective cohort study involving 185 pregnant women in the State of Bahia, from 2012 to 2013. We used a food frequency questionnaire to assess dietary intakes. To identify the dietary pattern, the principal components factor analysis was adopted. We used the Pearson correlation test to identify the correlation between the patterns extracted in each trimester. RESULTS four patterns of food consumption during pregnancy were identified. We observed changes in the eating patterns over the trimesters evaluated, especially for the food groups of fruit, coffee, fats, fried snacks, sugar and sweets. DISCUSSION these dietary changes throughout the pregnancy accompany the physiological changes of each period of the pregnancy. In the first trimester, symptoms of nausea and vomiting are common, whereas in the same period cravings is reported, which may justify the consumption of a larger quantity of food deemed unhealthy. CONCLUSION it was observed that there were changes in the adoption of dietary pattern throughout the evaluated trimesters of pregnancy, especially for the groups of fruit, coffee, fats, fried snacks and sugar and sweets.

Use of an indicator to evaluate physician adherence to prescription guidelines for the treatment of heart failure

The aim of this study was to use indicators to evaluate physician adherence to prescription guidelines for heart failure treatment in a university hospital. This was a prospective cohort study conducted in a university hospital. The information collected at the time of patient admission, including therapeutic indication, absolute contra indications and intolerance, was utilised for the formulation of a guideline adherence indicator (GAI). This indicator was calculated as follows: (the number of patients who used the medication/the number of eligible patients) x 100. The percentage of eligible patients was calculated using the following formula: (the number of eligible patients/the total number patients) x 100. The GAI was applied to a population of 53 patients. Inhibitors of angiotensin-converting enzyme/angiotensin receptor blocker (ACE-I/ARB) combination therapy were used in the greatest percentage of eligible patients (92.4%) and demonstrated the largest GAI value (73.5%). The percentages of patients who were eligible for beta-blockers, spironolactone and digitalis treatments were 81.1%, 52.8% and 60.4%, respectively. The GAI values for the use of beta-blockers, spironolactone and digitalis were 60.4%, 57.1% and 56.2%, respectively. For the studied patient population, the GAI was consistent with the proportion of patients who were eligible to receive digitalis and spironolactone.

Epidemiology of vitamin D insufficiency and deficiency in a population in a sunny country: geospatial meta-analysis in Brazil.

ABSTRACT Studies conducted among populations of tropical countries have reported high prevalences of vitamin D deficiency and insufficiency. Information resulting from meta-analyses on the spatial distribution of vitamin D deficiency and insufficiency in tropical countries is still rare. The aim of this review was investigated the prevalence of vitamin D deficiency and insufficiency among the Brazilian population. Observational studies were searched in eight electronically databases. Additionally, theses and dissertations and abstracts were screened. Details on study design, methods, population, mean and data on serum concentrations of vitamin D in different age groups in Brazil were extracted. Data were pooled using a random-effects model and choropleth maps were created based on the geopolitical regions of the country. 72 published paper met the inclusion criteria. The mean vitamin D concentration among the Brazilian population between 2000 and 2017 of 67.65 nmol/L (95% CI: 65.91, 69.38 nmol/L).The prevalences of vitamin D deficiency and insufficiency were 28.16% (95% CI: 23.90, 32.40) and 45.26% (95% CI: 35.82, 54.71), respectively, for the Brazilian population. The highest prevalence of deficiency were observed in the southern and southeastern regions and the highest occurrence of vitamin D insufficiency was among the populations of the southeastern and northeastern regions. Finally, there are high prevalence of inadequate vitamin D concentrations among the population, regardless of age group in Brazil. The development of vitamin D food fortification policies in needs to be cautious and carefully planned.