Avaliação do processo de reestruturação da assistência farmacêutica no município de Aracaju-SE / Assessment of the restructuring of pharmaceutical services in the city of Aracaju (SE, Brazil)

O objetivo do estudo é avaliar o efeito da reestruturação da Assistência Farmacêutica (AssistFar) no município de Aracaju-SE. Foi realizado um estudo retrospectivo longitudinal, de fevereiro a junho de 2011. Para avaliação da Assistência Farmacêutica foi utilizado um banco de dados documental, gerado pelo "Sistema de Controle de Administração de Materiais" e aplicaram-se os indicadores do Instrumento de Auto-Avaliação para o Planejamento da Assistência Farmacêutica (IAPAF) do ?Planejar é Preciso?, que aborda tópicos de acordo com o ?Ciclo da Assistência Farmacêutica?. A aplicação do instrumento foi realizada em três momentos na prática da AssistFar no município de Aracaju. Para análise de cada indicador levou-se em consideração os níveis de qualidade classificados de 1 a 3, sendo o nível 3 o melhor estágio. A maioria dos resultados evidenciou o fortalecimento da gestão após a criação de procedimentos e a inclusão de estratégias de monitoramento dos indicadores de avaliação no plano municipal de saúde. As etapas de institucionalização dos serviços perante a gestão foram as que apresentaram os melhores resultados. Enquanto que a etapa de prescrição foi considerada a mais crítica do processo. Os dados mostram que a falta de ações de desenvolvimento da AssistFar contribuíram para a presença de resultados insatisfatórios, principalmente nas etapas de prescrição e dispensação, sinalizando a necessidade de elaborar uma estratégia de gestão que vise sua reformulação. Neste cenário, é preciso incorporar às equipes de saúde mais farmacêuticos que atuem em todas as etapas da AssistFar, promovendo uma gestão racional de medicamentos...

The objective of the study was to evaluate the effect of the restructuring of Pharmaceutical Services (AssistFar) in the city of Aracaju (capital of Sergipe, Brazil). We conducted a retrospective, longitudinal survey, from February to June 2011. A document database generated by the "Materials Management Control System" was analyzed, to assess the pharmaceutical services, by applying the indicators of the Self-Assessment Instrument for Pharmaceutical Services Planning (IAPAF) that are defined in the government-proposed" Planning is Necessary" method, which covers topics referring to the various steps in the "Cycle of Pharmaceutical Services". This instrument was applied to three stages in the practice of AssistFar in the city of Aracaju, within the study period. For each indicator, the quality of each step was graded from 1 to 3, level 3 being the best. Most results showed a strengthening of management after the establishment of procedures and inclusion of strategies for monitoring the quality indicators, for the municipal health plan. Steps towards the institutionalization of management services showedthe best results. In contrast, the step of prescription was considered the most critical of the Cycle. The data showed that the lack of AssistFar development actions contributed to the unsatisfactory results, especially in the steps of prescribing and dispensing, signaling the need to develop a management strategy that aims to recast it. In this scenario, it will be necessary to involve the health teams, plus the pharmacists, in the work at all stages of AssistFar, promoting the rational management of medicines...

Down-regulation of the cardiac sarcoplasmic reticulum ryanodine channel in severely food-restricted rats

We have shown that myocardial dysfunction induced by food restriction is related to calcium handling. Although cardiac function is depressed in food-restricted animals, there is limited information about the molecular mechanisms that lead to this abnormality. The present study evaluated the effects of food restriction on calcium cycling, focusing on sarcoplasmic Ca2+-ATPase (SERCA2), phospholamban (PLB), and ryanodine channel (RYR2) mRNA expressions in rat myocardium. Male Wistar-Kyoto rats, 60 days old, were submitted to ad libitum feeding (control rats) or 50 percent diet restriction for 90 days. The levels of left ventricle SERCA2, PLB, and RYR2 were measured using semi-quantitative RT-PCR. Body and ventricular weights were reduced in 50 percent food-restricted animals. RYR2 mRNA was significantly decreased in the left ventricle of the food-restricted group (control = 5.92 ± 0.48 vs food-restricted group = 4.84 ± 0.33, P < 0.01). The levels of SERCA2 and PLB mRNA were similar between groups (control = 8.38 ± 0.44 vs food-restricted group = 7.96 ± 0.45, and control = 1.52 ± 0.06 vs food-restricted group = 1.53 ± 0.10, respectively). Down-regulation of RYR2 mRNA expressions suggests that chronic food restriction promotes abnormalities in sarcoplasmic reticulum Ca2+ release.

Additional markers to refine the World Health Organization algorithm for diagnosis of pneumonia.

INTRODUCTION: WHO guidelines for primary care of children with tachypnea indicate that all should receive antibiotics for presumed pneumonia. These guidelines have led to excessive antibiotic use. OBJECTIVE: To examine the value of history of previous respiratory distress, chest indrawing and fever, and response to bronchodilator(BD) to refine these guidelines. DESIGN: Prospective study. SETTING: Urban tertiary care hospital. SUBJECTS: Children, between the ages of 6 and 59 months, presenting with cough and tachypnea. METHODS: 182 children were enrolled. Each child had a chest X-ray that was read by two blinded, independent radiologists. Discordance between the two radiologists led to excluding 17 patients. The remaining 165 children were examined for fever and/or chest indrawing, and if they had a history of previous respiratory distress, challenge with a BD. The association of persistent tachypnea after BD and presence of pulmonary infiltrates was recorded. RESULTS: The median age was 22 months (mean 25.1 +- 14.5 mo) and 75.8% were aged greater than 1 year. There were 58.8% males. Previous respiratory distress occurred in 65.0% and 79.2% of children aged less than 1 year and 1 year, respectively. Pneumonia was radiologically diagnosed in 26/165 (15.8%). 2/40 (5 %) of children without a history of previous respiratory distress had pneumonia diagnosed. Of 125 children with history of previous respiratory distress, pneumonia was identified in 24 (19.2 %). Persistence of tachypnea after BD was associated with pulmonary infiltrate in 14/24 (58.3%), whereas, tachypnea persisted in 32/101 (31.7%) children without pulmonary infiltrates (P = 0.02). The negative predictive value of resolution of tachypnea was 87.3% (95% CI 77.5 93.4). BD non-response was most useful in children without fever and/or with chest indrawing to indicate pneumonia as the cause of the tachypnea. CONCLUSION: This study indicates that by adding the simple procedures of a history of previous respiratory distress, recording of fever and chest indrawing, and observing the response to bronchodilators, pneumonia can be reliably identified in children presenting with tachypnea and cough. It is probable that this approach to management of children with cough and tachypnea could reduce unnecessary use of antibiotics.

Extracapsular cataract extraction and intraocular lens implantation in leprosy patients: visual outcome and complications.

In Belo Horizonte, Brazil, 70 eyes of 53 leprosy patients had extracapsular cataract extraction and intraocular lens implantation done during a period of four years. The authors analyzed the outcome regarding restoration of vision and complications after this procedure. The visual acuity improved in 92.9% of the eyes and in 65.7% the acuity had improved by four lines or more on the Snellen chart. The post-operative complications could not be associated only to leprosy infiltration; in any case, they were not too serious and could be controlled.