Analysis of notified drug poisoning among children in Santa Catarina state, 2016-2020 / Análise das intoxicações medicamentosas notificadas em crianças no estado de Santa Catarina, 2016-2020

ABSTRACT Objective: The aim of this study was to analyze the incidence of drug poisoning in children registered in the Santa Catarina Information and Toxicological Assistance Center between 2016 and 2020. Methods: This observational epidemiological study, with a historical cohort design, was carried out from reported cases of drug poisoning in children aged 0-12 years. Census sampling was used to collect data. Results: There were 4839 reported cases of drug poisoning among children in the State of Santa Catarina in the surveyed period, with an average annual incidence rate of 6 cases/1000 live births. The median age was 3 years. Most cases of poisoning occurred among girls aged 0-3 years by accidental ingestion of drugs at home. There was a predominance of signs and symptoms affecting the nervous system; only a small portion required hospitalization. Most cases were considered mild poisoning with a favorable outcome. No deaths were recorded. There was a tendency of increasing cases over time, however not significant. There is a predominance of incident cases in the Great West of the state, followed by the Midwest and Serra Catarinense regions. Conclusions: Drug poisoning in children is predominant in early childhood, mainly caused by accidental ingestion of drugs at home. These findings highlight the importance of preventive and educational measures among family members and caregivers.

RESUMO Objetivo: Analisar a incidência das intoxicações medicamentosas em crianças registradas no Centro de Informação e Assistência Toxicológica de Santa Catarina entre os anos de 2016 e 2020. Métodos: Estudo epidemiológico observacional, com delineamento de coorte histórica. Foi realizado com base nos casos notificados de intoxicação por medicamentos em crianças de zero a 12 anos. A amostra foi do tipo censo. Resultados: Foram notificadas 4.839 intoxicações medicamentosas em crianças no Estado de Santa Catarina no período, com taxa de incidência média anual de 6 casos/mil nascidos vivos. A idade apresentou mediana de três anos. A maioria (51,5%) dos casos de intoxicação ocorreu entre meninas, até os três anos de idade, de causa acidental, por exposição oral e no domicílio. Houve predomínio de sinais e sintomas que afetaram o sistema nervoso e apenas uma pequena parcela (6,2%) necessitou de hospitalização. A maioria dos casos (65,6%) foi considerada intoxicação leve com evolução favorável. Nenhum óbito foi registrado. Houve tendência de aumento dos casos ao longo do tempo, porém não significativo. Observa-se predomínio de casos incidentes no Grande Oeste, seguido do Meio-Oeste e Serra Catarinense. Conclusões: As intoxicações medicamentosas em crianças predominam na primeira infância, de forma acidental, sendo o ambiente doméstico o principal local. Esses achados destacam a importância de intensificar medidas preventivas e educativas entre familiares e cuidadores de crianças.

Medication discrepancies in a hospital in Southern Brazil: the importance of medication reconciliation for patient safety

Medication discrepancies are of great concern in hospitals because they pose risks to patients and increase health care costs. The aim of this study was to estimate the prevalence of inconsistent medication prescriptions to adult patients admitted to a hospital in southern Santa Catarina, Brazil. This was a patient safety study on patients recruited between November 2015 and June 2016. The participants were interviewed and had their medical records reviewed. Discrepant medications were considered those that did not match between the list of medicines taken at home and the prescribed drugs for treatment in a hospital setting. Of the 394 patients included, 98.5% took continuous-use medications at home, with an average of 5.5 medications per patient. Discrepancies totaled 80.2%, The independent variables associated with the discrepancies were systemic arterial hypertension, hypercholesterolemia, vascular disease, number of medications taken at home, and poor documentation of the medications in the medical record. Findings from this study allowed us to conclude there was a high rate of prescription medication misuse. Medication reconciliation is crucial in reducing these errors. Pharmacists can help reduce these medication-related errors and the associated risks and complications.

Perfil e adequação do uso de antibacterianos em crianças internadas em hospital geral no sul do brasil / Profile and appropriate use of antibiotics among children in a general hospital in southern brazil

RESUMO Objetivo: Verificar o perfil e a adequabilidade do uso de antibacterianos em crianças hospitalizadas. Métodos: Estudo transversal. Foi feita a análise de todas as crianças que utilizaram antibacterianos durante a internação de janeiro a dezembro de 2015, em um hospital filantrópico de direito privado de grande porte no sul do Brasil. As informações foram obtidas por revisão dos prontuários e incluíram dados demográficos (idade, sexo, raça e peso corporal) e clínicos (motivo da internação, uso deantibacterianos e desfecho clínico). Utilizou-se estatística descritiva. Resultados: Dos 318 pacientes incluídos, 61,3% eram do sexo masculino. A faixa etária variou de 2 a 11 anos (média: 5,8±2,9 anos de idade). A prevalência do uso de antibacterianos foi de 24,4% considerando o total de 1.346 crianças que foram hospitalizadas. O tempo de internação apresentou mediana de quatro dias. O principal motivo de internação foi clínico e o antibacteriano mais prescrito foi a cefazolina, sendo a via intravenosa predominante. Em relação ao uso de antibacterianos, 62,2% apresentaram prescrições de antibacterianos consideradas adequadas. A subdosagem e a superdosagem tiveram, respectivamente, os valores de 11,7 e 14,6% dos pacientes incluídos. Quanto aos intervalos de administração, 8% foram caracterizados com intervalos longos e 3,5%, curtos. Conclusões: Apesar de a prevalência encontrada do uso de antibacterianos nas crianças hospitalizadas não ser tão elevada, parte considerável da amostra apresentou inadequabilidade quanto ao uso desse tipo de medicamento, se considerados a dose e o intervalo de utilização. Esses dados são motivo de preocupação para o desenvolvimento de resistência bacteriana e ocorrência de reações adversas.

ABSTRACT Objective: To examine the profile and appropriate use of antibiotics among hospitalized children. Methods: A cross-sectional study was conducted with children who had taken antibiotics during hospitalization in a private philanthropic hospital in Southern Brazil, from January to December 2015. The data were obtained by reviewing medical records, encompassing demographic data (age, gender, ethnicity, and body weight) and clinical data (causes of hospitalization, use of antibiotics, and clinical outcome). Descriptive statistics was used to present the data. Results: Of the 318 participants included in the study, 61.3% were male patients. The age range varied between 2 and 11 years, with mean age of 5.8±2.9 years. The prevalence of antibiotics was 24.4% out of the 1,346 hospitalized children. Median hospital stay was four days. The main cause of hospitalization was clinical instability, and the most commonly prescribed antibiotics was Cefazolin, mostly administered intravenously. Regarding the administration of antibiotics, 62.2% were adequately prescribed, even though underdose was 11.7%, and overdose was 14.6% in the studied patients. Antibiotic administration intervals were characterized as long in 8% of cases, and short in 3.5% of cases. Conclusions: Although the prevalence of antibiotics among hospitalized children was not that high, a considerable part of the sample presented inadequacy regarding the dosage and range of use. These data raise concerns about bacterial resistance and adverse reactions.

Assessing the overall medication use by elderly people in a Brazilian hospital using the start/stopp criteria version 2

To estimate the frequency of the use of medicines listed in the Screening Tool to Alert Doctors to the Right Treatment (START) and Screening Tool of Older Person's Prescriptions (STOPP) criteria version 2 among the elderly. A cross-sectional study was conducted on elderly who were attended in medical clinic and cardiology sectors in a hospital in southern Brazil attended at a hospital from February through September 2016. A data-collection tool was used to obtain information on variables, such as demographic and clinical data, and medications used before and during the hospitalization period. The adequacy of the medicines taken was examined with regard to omission (START) or inappropriate use (STOPP). This study was approved by the Research Ethics Committee of the University of Southern Santa Catarina. A total of 307 subjects were included in the final sample. The mean age was 75.2 years (SD = 8; range 65-102). Of the total, 93.5% had had at least one potential prescribing omission (PPO) listed in the START criteria, whereas 95.4% used at least one medicine of the STOPP criteria. PPO was significantly associated with lower mean age (74.9 years, SD = 7.9 versus 79.0 years, SD = 8.8) among the elderly who did not have PPOs detected by the START criteria (p-value=0.03). Furthermore, PPO was associated with longer hospital stay (18 versus 9 days; p-value=0.03). This study revealed inadequate prescription affecting 99.3% of the participating patients. To the best of our knowledge, this was the first to use the START and STOPP criteria, version 2, in Brazil.

Influência do gênero nos efeitos adversos provocados por antineoplásicos em pacientes oncológicos atendidos em um hospital do sul catarinense / Gender influence on the adverse effects caused by antineoplastics in oncological patients of a hospital in the south of santa catarina

OBJETIVO: Verificar a ocorrência de efeitos adversos causados pelo uso de antineoplásicos e sua relação com o gênero. MÉTODOS: Estudo transversal de análise das evoluções médicas descritas em prontuários de pacientes em uso de antineoplásicos (n=200) na unidade de oncologia de um hospital da região sul do país, no ano de 2015. A análise dos prontuários foi feita através da utilização do algoritmo de Naranjo, algoritmo esse que determina a causalidade das Reações Adversas a Medicamentos (RAM). RESULTADOS: No sexo feminino, a maioria das pesquisadas apresentou a doença na faixa etária de 31-60 anos (56,25%), já no sexo masculino houve predominância do aparecimento na faixa etária maior do que 60 anos (73,86%). Com relação às reações adversas descritas nos prontuários, o sexo feminino apresentou uma prevalência 30% maior (p=0,025). Em relação à frequência de RAM, no sexo feminino houve uma maior prevalência de reações no sistema gastrointestinal (73,6%), enquanto o sexo masculino apresentou maior prevalência no sistema tegumentar (19,7%). DISCUSSÃO: Foram observadas diferenças entre os gêneros quanto às reações adversas relacionadas ao uso de antineoplásicos, com maior prevalência no sexo feminino e relacionadas ao sistema gastrointestinal.

OBJECTIVE: To verify the occurrence of adverse effects caused by the use of antineoplastic agents and their relationship with the gender. METHODS: A cross-sectional study of the medical evolution through of the use of the Naranjo algorithm, which determines the causality of Adverse Drug Reactions (ADRs). RESULTS: In the female sex, the majority of those surveyed presented the disease in the age group of 31-60 years (56.25%), whereas in the male sex there was a higher frequency in the age group over 60 years old (73.86%). With regard to the adverse reactions described in the charts, the female sex presented a 30% higher prevalence (p = 0.025). Regarding to the frequency of ADRs, in females there was a higher prevalence of reactions in the gastrointestinal system (73.6%), while males had a higher prevalence in the tegumentary system (19.7%). DISCUSSION: It was observed differences between genders regarding the adverse reactions related to the antineoplastics use, with more prevalence in female and related to gastrointestinal system.

Avaliação da qualidade de comprimidos de propranolol e enalapril distribuídos no sistema público de saúde em uma cidade do sul do Brasil / Evaluation of the quality of propranolol and enalapril tablets supplied in the public health system in a southern Brazilian city

A aquisição de medicamentos no serviço público de saúde brasileiro através de licitação com critério de menor preço gera preocupação com a qualidade dos produtos distribuídos à população. O objetivo deste trabalho foi avaliar a qualidade dos comprimidos de Enalapril 10 mg e Propranolol 40 mg adquiridos através de processo licitatório e distribuídos na rede pública de saúde de um município catarinense durante o período de um ano. Foram analisados: o aspecto visual, o peso médio, a friabilidade, o teor de fármaco e o tempo de dissolução. De um total de sete lotes, cinco apresentaram desvio da qualidade. Encontraram-se irregularidades no aspecto visual, peso médio, friabilidade e teor de princípio ativo. A avaliação dos medicamentos além de assegurar que os medicamentos dispensados na rede pública possuem qualidade e que podem ser utilizados com segurança pelos pacientes é também uma ferramenta para a qualificação de fornecedores e um subsídio para o aprimoramento do processo licitatório. Sugere-se a implantação de um sistema de gestão da qualidade que inclua a qualificação de fornecedores, o aperfeiçoamento do processo de licitação, incluindo especificações claras sobre a qualidade dos medicamentos adquiridos, bem como o monitoramento da qualidade integrado a ações de farmacovigilância.

The acquisition of medication by the Brazilian public health service through bidding processes based on the lowest price criterion is a source of concern with respect to the quality of the products offered to the population. The scope of this work was to evaluate the quality of Enalapril 10 mg and Propranolol 40 mg tablets bought via the bidding process and supplied by the public health system in a city in the state of Santa Catarina, Brasil, over the course of a year. The visual aspect, weight variation, friability, drug content and dissolving time were analyzed. Out of seven lots, five presented quality deviation. Irregularities were found in the visual aspect, weight variation, friability and active ingredient. The evaluation of the quality of medication, besides ensuring the quality of the products supplied by the health system and safe usage by patients, is also a tool to evaluate medical supply companies and ensure the enhancement of the bidding process. The implementation of a management system that includes the evaluation of medical supply companies, improvement of the bidding process with clear specifications about the quality of the medicines bought are all recommended to ensure product safety.