Pablo de Moura Santos

Preditores da adesão ao tratamento em pacientes com asma grave atendidos em um centro de referência na Bahia

Objective: To determine the rate of adherence to treatment with inhaled corticosteroids in patients with severe asthma, to identify predictive factors for adherence and to evaluate the relationship between adherence to treatment and parameters of clinical and functional response. Methods: Prospective cohort study of patients enrolled in the Program for the Control of Asthma and Allergic Rhinitis in the state of Bahia, Brazil. The study comprised 160 patients with severe asthma, monitored for 180 days in order to evaluate adherence (dependent variable) to the prescribed inhaled corticosteroid. Independent variables were assessed at baseline and for a six-month follow-up period by means of interviews and the completion of a standardized questionnaire.Patients recorded the missed doses in a diary. Results: Of the 160 patients. 158 completed the study. Adherence rate was 83.8%. Of the 158 patients, 112 (70.9%) were considered adherent (cut-off point: 80% of prescribed doses administered). There was a significant association between asthma control and adherence to treatment.Predictors of poor adherence were adverse effects, living far from the referral center, limited resources to pay for transportation and dose schedule. Other factors, such as depressive symptoms, religion and economic status, were not associated with poor adherence. Conclusions: Adherence to asthma treatment was high and was associated with the clinical response to treatment, in a sample of patients with severe asthma enrolled in a public program that provides free medication and the assistance of a multiprofessional specialized team in a referral center

The Impact of a Program for Control of Asthma in a Low-Income Setting

The prevalence of asthma is increasing in developing countries and the burden of uncontrolled asthma affects patients, families, and the health system. This is to summarize, evaluate, and discuss previous reports on the impact of a targeted and comprehensive approach to the most severe cases of asthma in a low-income setting. A Program for Control of Asthma (ProAR) was developed in Salvador, Bahia, Brazil, prioritizing the control of severe asthma. By facilitating referrals from the public health system and providing proper multidisciplinary but simple management including education and medication, for free, the Program enrolled 2385 patients in 4 reference clinics. They are offered regular follow up and discharged back to primary health care only when asthma control can be maintained without requirement of a combination of an inhaled corticosteroid and a long-acting β2 agonist. ProAR has markedly reduced health resource utilization and decreased the rate of hospital admissions because of asthma in the entire City (2.8 million inhabitants) by 74%. Moderate to severe rhinitis was associated with lack of control of asthma. The average income of the families in the ProAR was US

Bisphosphonates: Pharmacokinetics, bioavailability, mechanisms of action, clinical applications in children, and effects on tooth development

2955 a year, and they spent 29% of all their income attempting to control the severe asthma of one member, a unbearable expenditure for a low-income family. The ProAR was shown to be cost-effective, reducing costs to the public health system (US

Adherence to Treatment in Severe Asthma: Predicting Factors in a Program for Asthma Control in Brazil

387 patient/year) and the families (US

La investigación clínica con medicamentos: una oportunidad práctica para el farmacéutico hospitalario

789 patient/year). In a low-income setting of Brazil, an intervention prioritizing the control of severe asthma was feasible, effective, and reduced costs.

Prevalência de admissão hospitalar por reação adversa a medicamentos em Salvador, BA

Bisphosphonates (BPs) avidly bind to calcium crystals and inhibit osteoclastic bone resorption, making them useful for treatment of skeletal disorders such as osteoporosis, Pagets disease, osteogenesis imperfecta and metastatic bone diseases. BPs therapeutically act by causing toxic effects on osteoclasts or interfering with specific intracellular pathways in those cells. BPs that possess nitrogen in their composition are called nitrogen-containing BPs (NBPs) and include alendronate, pamidronate, risedronate, ibandronate, and zoledronate. Simple BPs or non-NBPs do not have nitrogen in their composition, include etiodronate and clodronate, and were the first to be tested in animals and clinically used. Because BPs may be administered to pregnant women or children during deciduous and permanent teeth development, it is expected that they might disturb tooth eruption and development. A review of current literature on pharmacokinetics, bioavailability, mechanisms of action, and clinical applications of BPs in children, and their effects on tooth eruption and development is presented.

Clinical failure among children with nonsevere community-acquired pneumonia treated with amoxicillin

BackgroundIn Brazil, like many other low- to middle-income countries, most asthmatic patients cannot afford the medication necessary to prevent exacerbations. The reference clinic of the Programme for Asthma Control in Bahia (ProAR; Salvador-Bahia) offers free medical care, pharmaceutical assistance (inhaled medication) and patient education. The reference clinic is accessible to all the population of Salvador and the Programme is targeted on severe asthma.ObjectiveThe aim of the present study was to evaluate adherence to inhaled medication in severe asthmatics enrolled in ProAR.MethodsA sub-group of 160 consecutive severe asthmatics enrolled in ProAR were followed prospectively for 6 months. All patients were assessed by means the Asthma Control Questionnaire, the Beck Depression Inventory and spirometry. The rate of adherence to inhaled corticosteroid was checked monthly. A cut-off point of 80% of the doses prescribed in the period was used to define patients as adherent.ResultsOf the one hundred-sixty patients with severe asthma included, it was possible to objectively assess adherence to the use of the inhaled corticosteroid in 158. Among these, 112 (70.9%) were considered adherent according to the adopted cut-off point. The rate of adherence in the whole sample of subjects was 83.9% of the prescribed doses. There was a significant association between asthma control and adherence to treatment. Predictors of poor adherence were adverse effects, living far from the referral center, limited resources to pay for transportation and dose schedule.ConclusionIn the present study, adherence to treatment was high. In a sample of patients with severe asthma managed in a public program that provides free medication and multidisciplinary treatment at a referral center, adherence to treatment was found to be associated with favorable clinical outcomes.

Prevalence of hospital admission due to adverse drug reaction in Salvador, Bahia

Resumen Objetivo Describir el campo de accion del farmaceutico en ensayos clinicos con medicamentos Metodo Evaluacion no sistematica de la literatura cientifica disponible a traves de bases de datos internacionales consultadas en el periodo del 5 a 31 de mayo de 2005. Resultados Se rescataron 36 articulos relacionados con la participacion del farmaceutico hospitalario en el desarrollo de ensayos clinicos con medicamentos. Las actividades mas comunmente desarrolladas fueron la dispensacion, almacenamiento e inventario. La participacion en comites de etica y actividades de coordinacion de estudios representa una practica en expansion. Conclusiones La investigacion clinica con medicamentos constituye un excelente campo de practica para el farmaceutico de hospital. Las actividades de control de los medicamentos bajo investigacion tales como la dispensacion, gestion de los esquemas de aleatorizacion y el seguimiento de los pacientes son ejemplo de esta actuacion. En Brasil este escenario es nuevo pero en franco crecimiento.

Use of medicinal herbs by patients with severe asthma managed at a Referral Center

OBJECTIVE: To determine the prevalence of hospital admissions due to ADR in Salvador, Bahia and their outcomes. METHODS: All patients admitted in four Sentinel Hospital (ANVISA) in Salvador-Ba were evaluated and followed to determine the prevalence of admissions due to ADR and their outcomes from April to December 2007. Cases were validated by 03 algorithms. The drugs were classified by Anatomical-Therapeutic-Chemical Classification, organs and systems affected by the WHO criteria and severity seconds Pearson et al. Type of ADR was analyzed by Rawlins and Thompson. RESULTS: The prevalence of ADR admission was 0.5% and adjusted for exposed was 2.1%, with 316 cases. Average of hospitalization due to ADR was 12.3 days. Younger and older accounted for 28.8% and 31.1% of patients. Females and blacks were 60% of cases. Main pharmacologic groups were antineoplastics, antibiotics and diuretics, affecting skin, gastrointestinal and hematologic systems. Around 70% of the ADR was validated as defined. ADR of type A was 80% and 90% recovered, and one death (0.5%). CONCLUSION: The prevalence of ADR admission was similar to those described in the literature and only one patient died. As this is the first national study will form the basis for future investigations.

Evaluation of Landsat 8 and Sentinel-2A data on the correlation between geological mapping and NDVI

Objective: To estimate the clinical failure and adverse events in children with nonsevere pneumonia receiving amoxicillin, identifying risk factors. Research design/methods: 192 patients aged 2 – 59 months were prospectively followed up. Pneumonia diagnosis was based on respiratory complaints and radiographic pulmonary infiltrate or pleural effusion. Amoxicillin (50 mg/kg/day) was given. Demographic data and clinical findings on admission, daily evolution up to the 5th day of treatment and 2 – 4 weeks after enrollment were collected. Main outcome measures: Clinical failure included persistence of fever, difficulty breathing or tachypnea beyond the first 48 h of treatment or of cough beyond the first 96 h of treatment or sign of severe/very severe disease up to the 5th day of treatment. Results: Amoxicillin failed in 6 (3.1%) cases. By excluding one child diagnosed with cystic fibrosis after continued follow-up, the final clinical failure rate was 2.6%. The total adverse effect frequency was 14 (7.3%), but amoxicillin was discontinued only in 1 (0.5%) case. No relapse was identified at the 2 – 4-week interval evaluation. By multivariate analysis, age (OR = 1.1; 95% CI 1.01 – 1.19) was an independent risk factor for clinical failure which occurred in older children (47 ± 9 vs 31 ± 16 months; p = 0.01). Conclusions: Clinical failures were few, especially among those aged < 2 years. Amoxicillin discontinuation due to adverse reaction was rare.