Vanessa Terezinha Gubert de Matos

Caracterização das prescrições medicamentosas em unidade de terapia intensiva adulto

OBJECTIVE:To characterize drug prescriptions in a university hospital adult intensive care unit. METHODS: Single-center, observational, descriptive, cross-sectional study conducted at an adult general intensive care unit. The study population included all of the units inpatients from January to March 2011. The following characteristics for all prescriptions recorded during this period were examined: drug name (generic, brand name or abbreviation), dosage strength, pharmaceutical form, dose, route of administration, patient name, patient registration in the institution, clinic and hospital bed as well as the name, board license number, signature of the prescriber and date of the prescription. It was quantified the percentage of prescribed drugs included in the National List of Essential Drugs, the World Health Organization Model List of Essential Medicines and the University Hospital Center Pharmacotherapy Guide. The prescribed drugs were classified based on the Anatomical Therapeutic Chemical classification system (levels 1 and 2). RESULTS: Eight hundred forty-four prescriptions were reviewed from 72 patients (mean age: 59.04 ± 21.80), 54.92% of whom were female. The mean number of prescriptions per patient was 11.72 ± 11.68. The total number of drugs prescribed was 12,052 and 9,571 (79.41%) of the drugs were prescribed using the generic name. The most frequent absent information in the drug description was the pharmaceutical form of the drug (8,829/73.26%). The dosage strength was indicated in 7,231 (60%) of the prescriptions, and the prescriber and patient information were indicated in over 96% of the prescriptions. The prescribed drugs were classified in 13 therapeutic groups and 55 subgroups. Systemic antibacterials represented one of the most frequently prescribed subgroups. CONCLUSION: Most of the reviewed information was present in the prescriptions. However, the dosage strength and pharmaceutical form were absent in many prescriptions. The characterization of prescriptions at different hospital units is essential for the development of strategies that reduce drug utilization problems.

Transitioning through AIDS epidemics - gender and temporality

OBJECTIVE To understand the evolution of AIDS over time in Mato Grosso do Sul, Brazil, using incidence, lethality, and mortality coefficients. METHODS A descriptive epidemiological study based on time series analysis of secondary data from the Notifiable Diseases Information System reported between 1985 and 2012. RESULTS The prevalence of AIDS was higher among men, with evidence of feminization during the first 14 years of the epidemic. There was no statistically significant sex difference in AIDS lethality. Women were 1.3 times more likely to survive than men. CONCLUSIONS Gender differences must be considered when designing new HIV/AIDS prevention strategies.

Pertussis in the central-west region of Brazil: one decade study

In many parts of the world, numerous outbreaks of pertussis have been described despite high vaccination coverage. In this article we report the epidemiological characteristics of pertussis in Brazil using a Surveillance Worksheet. Secondary data of pertussis case investigations reported from January 1999 to December 2008 recorded in the Information System for Notifiable Diseases (SINAN) and the Central Laboratory for Public Health (LACEN-MS) were utilized. The total of 561 suspected cases were reported and 238 (42.4%) of these were confirmed, mainly in children under six months (61.8%) and with incomplete immunization (56.3%). Two outbreaks were detected. Mortality rate ranged from 2.56% to 11.11%. The occurrence of outbreaks and the poor performance of cultures for confirming diagnosis are problems which need to be addressed. High vaccination coverage is certainly a good strategy to reduce the number of cases and to reduce the impact of the disease in children younger than six months.

Potentially inappropriate medication use in institutionalized older adults according to the Beers Criteria

A exigencia de cuidados especificos, aliada aos novos arranjos familiares, tem contribuido para a crescente institucionalizacao dos idosos. O objetivo do presente trabalho foi avaliar o uso de medicamentos por idosos institucionalizados utilizando os Criterios de Beers. Este estudo longitudinal prospectivo foi realizado nas tres instituicoes de longa permanencia para idosos de Campo Grande, Centro-Oeste do Brasil. Todos os sujeitos com 60 anos ou mais foram incluidos em Novembro de 2011 e acompanhados ate Novembro de 2012. Dezoito idosos foram excluidos, sendo a amostra final composta por 133 sujeitos com idade entre 60 e 113 anos. O total de medicamentos utilizados foi 212 na instituicao A, 532 na B e 1329 na C. Foram identificados 34 medicamentos inapropriados, prescritos 89 vezes na instituicao A (41.98%), 49 prescritos 177 vezes na B (67.29%) e 90 prescritos 460 vezes na C (34.61%). Este estudo demonstrou diferenca estatistica na utilizacao de medicamentos inapropriados entre os generos (p=0.007). Os anti-histaminicos de 1a geracao foram os medicamentos potencialmente inapropriados para idosos mais utilizados (15.34%). Houve elevada frequencia no uso de MPI, os quais podem desencadear efeitos colaterais acentuados e comprometer mais a saude fragilizada do idoso institucionalizado. Ainda, a adocao dos Criterios de Beers na prescricao contribui para minimizar as reacoes adversas e interacoes medicamentosas.

Non-polarized cytokine profile of a long-term non-progressor HIV infected patient

The HIV-1 initial viral infection may present diverse clinical and laboratory course and lead to rapid, intermediate, or long-term progression. Among the group of non-progressors, the elite controllers are those who control the infection most effectively, in the absence of antiretroviral therapy (ART). In this paper, the TH1, TH2 and TH17 cytokines profiles are described, as well as clinical and laboratory aspects of an HIV-infected patient with undetectable viral load without antiretroviral therapy. Production of IL-6, IL-10, TNF-α, IFN-γ, and IL-17 was detected; in contrast IL-4 was identified. Host-related factors could help explain such a level of infection control, namely the differentiated modulation of the cellular immune response and a non-polarized cytokine response of the TH1 and TH2 profiles.

High vertical HIV transmission rate in the Midwest region of Brazil

OBJECTIVES To estimate vertical HIV transmission rate in a capital city of the Midwest region of Brazil and describe the factors related to transmission. METHODS A descriptive epidemiological study based on the analysis of secondary data from the Notifiable Diseases Information System (SINAN). The analysis considered all HIV-infected pregnant women with delivery in Campo Grande-MS in the years 2007-2013 and their HIV-exposed infants. RESULTS A total of 218 births of 176 HIV-infected pregnant women were identified during the study period, of which 187 infants were exposed and uninfected, 19 seroconverted, and 12 were still inconclusive in July 2015. Therefore, the overall vertical HIV transmission rate in the period was 8.7%. Most (71.6%) of HIV-infected pregnant women were less than 30 years at delivery, housewives (63.6%) and studied up to primary level (61.9%). Prenatal information was described in 75.3% of the notification forms and approximately 80% of pregnant women received antiretroviral prophylaxis. Among infants, 86.2% received prophylaxis, but little more than half received it during the whole period recommended by the Brazilian Ministry of Health. Among the exposed children, 11.3% were breastfed. CONCLUSION The vertical HIV transmission rate has increased over the years and the recommended interventions have not been fully adopted. HIV-infected pregnant women need adequate prophylactic measures in prenatal, intrapartum and postpartum, requiring greater integration among health professionals.

Missed opportunities for prevention of perinatal HIV infection

The increment of HIV transmission involving the female population of childbearing age favors HIV vertical transmission.1 Programs for the prevention of mother-to-child-transmission (PMTCT) of HIV are part of the solution to eliminate new pediatric HIV infections and that can reduce the risk of MTCT to fewer than 2%.2 Herein we report missed opportunities for preventing perinatal HIV infection abstracted from medical records of a cohort of patients. Vertically HIV-infected infants followed up from birth or from the time of diagnosis receiving care at the referral services of Campo Grande city, in Midwest Brazil, between 1993 and 2014 were included. Patients who died during the study period were excluded from the analysis due to insufficient information in the medical records. One hundred forty-one patients were identified until 2014, 99 were eligible for inclusion and 42 died during the study period. Most of the children were diagnosed owing to their parents’ HIV diagnoses (p < 0.001), including one patient diagnosed at 127 months old. One teenager was diagnosed at 144 months because of the death his older brother. Seventy-six mothers (96.2%) had not received ARV prophylaxis during pregnancy, while 74 (92.5%) had not used prophylaxis during labor, including two women who had received ARVT during pregnancy. Moreover, 91 (91.9%) children had not received prophylaxis ARV. Although 66.0% of HIV infections in the women had been diagnosed before delivery (Table 1), 82.4% of the newborns were breastfed. Despite lack of ARV prophylaxis, most of the patients (52.5%) were between 16 and 24 years old in 2014. Since 1997, voluntary prenatal HIV testing ought to be offered in Brazil. The fact that 43% of the children in this cohort were born before 1997 contributed to the majority of pregnant women having been diagnosed after delivery. On the other hand, 57% of the children were born after 1997 and their HIV-infected mothers could have been diagnosed during pregnancy. Furthermore, women who were receiving ARVT during pregnancy and did not use prophylaxis during labor, as well as women who were aware of their HIV status before pregnancy and had not undergone Cesarean delivery raises the Table 1 – Characteristics of HIV-positive mothers of infants infected by vertical transmission, Campo Grande, Brazil.

Drug Interaction Exposures in an Intensive Care Unit: Population Under Antihypertensive Use

Many of these interactions have slow onset clinical manifestations that can be diagnosed as new diseases and handled wrongly (Correr et al., 2007). Drug interactions are estimated to occur between 3% and 5% in patients to whom few drugs are prescribed and 20% among those who use 10 to 20 drugs simultaneously (Ferreira Sobrinho et al., 2006). The incidence of drug interactions is directly proportional to the increase in the number of drugs prescribed (Matos et al., 2009). It is known that a prescription containing eight or more drugs will present at least one interaction (Almeida et al., 2007).