Aplicación Intralesional de Antimoniales en el Tratamiento de Leishmaniasis Cutánea

Resumen Objetivo: evaluar la eficacia clínica de la aplicación intralesional de 3 versus, 6 inyecciones de Glucantime®, durante una o dos semanas en pacientes con leishmaniasis cutánea. Métodos: estudio de tipo cuasi experimental. Se incluyó a 41 pacientes con leishmaniasis cutánea del área endémica tropical de Cochabamba, Bolivia. Los pacientes, fueron distribuidos aleatoriamente para recibir tratamiento intralesional con Glucantime®, en tres o seis aplicaciones. Todos ellos firmaron un consentimiento escrito de aceptación voluntaria de participar del estudio, que cuenta con el aval del comité de ética de la facultad de medicina UMSS. Resultados: la evaluación realizada a la eficacia clínica, del empleo de tres o seis aplicaciones intralesionales de Glucantime® no encontró diferencias estadísticamente significativas entre ambas. Así mismo, tampoco se encontró diferencias significativas en cuanto a la cicatrización completa alcanzada al primer mes post tratamiento por ambos esquemas de aplicación. Conclusiones: la cicatrización de las úlceras observada en este estudio, se consiguió independiente del esquema de tres o seis aplicaciones intralesionales de Glucantime® y estos resultados son comparables al tratamiento sistémico. Se considera que tres aplicaciones de Glucantime® intralesional es el límite mínimo como tratamiento para leishmaniasis cutánea con una sola úlcera cuyo tamaño sea menor a tres por tres centímetros.

Abstract Objective: to evaluate the clinical efficacy of intralesional application of 3 versus 6 injections of Glucantime® for one or two weeks in patients with cutaneous leishmaniasis. Methods: quasi-experimental study. 41 patients with cutaneous leishmaniasis were included from the tropical endemic area of Cochabamba, Bolivia. Participants were randomly assigned to receive intralesional treatment with Glucantime®, in three or six applications. All patients signed a written consent to voluntarily participate in the study, approved by the ethics committee of the UMSS medical school. Results: evaluation of the clinical effectiveness of three or six intralesional applications of Glucantime® found no statistically significant differences between the two. Likewise, no significance differences were found regarding complete healing achieved at one month post-treatment by both application schemes. Conclusions: ulcer healing observed in this study was achieved independent of the scheme of either three or six intralesional applications of Glucantime® and these results are comparable to systemic treatment. Three intralesional Glucantime® applications are considered to be the minimal treatment limit for cutaneous leishmaniasis with a single ulcer smaller than three by three centimeters.

Esquema de manejo de COVID-19 en adultos / COVID-19 treatment guidelines in adults

RESUMEN Un nuevo coronavirus, denominado COVID-19, fue descubierto por el brote iniciado en China a finales de diciembre del año 2019. Los síntomas característicos son fiebre, tos seca, dificultad respiratoria y malestar general. Muchas investigaciones se están llevando a cabo ya que, si bien no es una enfermedad considerada mortal, tiene un índice de contagio muy alto. Sin embargo, junto a los cuidados hospitalarios y extrahospitalarios, existe un grupo de fármacos que se vienen utilizando para combatir esta enfermedad, tales como hidroxicloroquina, cloroquina, remdesivir, lopinavir/ritonavir, tocilizumab, interferón beta 1B, entre otros.

ABSTRACT A novel coronavirus disease called COVID-19 was discovered as a result of the outbreak that began in China at the end of December 2019. Common symptoms are fever, dry cough, shortness of breath and malaise. Several research are being conducted since the disease has high transmission rate even though it is not considered life-threatening. However, together with hospital and out-of-hospital care, there is a group of medications being used to fight this disease, such as hydroxychloroquine, chloroquine, remdesivir, lopinavir/ritonavir, tocilizumab, interferon beta-1b, among others.

Fatores associados à adesão ao tratamento medicamentoso em trabalhadores de universidade pública / Factors related to adherence to drug treatment in public university workers

RESUMO Objetivo analisar fatores associados à adesão medicamentosa entre trabalhadores de universidade pública que referiram uso de medicação contínua. Métodos estudo transversal, desenvolvido junto a 629 trabalhadores de instituição pública de ensino superior. Dados coletados mediante entrevistas com formulários adaptados do Ministério da Saúde brasileiro e analisados pelo teste qui-quadrado. Resultados verificou-se que 331 (52,6%) dos participantes utilizavam medicação contínua, destes, 175 (52,9%) apresentaram padrão de adesão parcialmente satisfatória e 156 (47,1%) totalmente satisfatória. Trabalhadores com problema crônico de coluna, depressão, fraqueza/cansaço, dispneia e dor no peito apresentaram significativamente menor adesão ao tratamento medicamentoso (p≤0,050). Características sociodemográficas e laborais, polifarmácia e tipo de medicamento não se mostraram associados à adesão medicamentosa (p>0,050). Conclusão observou-se adesão satisfatória entre os trabalhadores pesquisados em relação ao tratamento medicamentoso, estando a presença de alguns sintomas e as doenças crônicas específicas associados à adesão medicamentosa parcialmente satisfatória.

ABSTRACT Objective to analyze factors associated with medication adherence among public university workers who reported use of continuous medication. Methods cross-sectional study carried out with 629 workers from a public university. Data were collected through interviews using forms adapted from the Brazilian Ministry of Health and analyzed using the chi-square test. Results three hundred thirty-one (52.6%) participants were users of continuous medication, of these, 175 (52.9%) had a partially satisfactory adherence pattern and 156 (47.1%) a totally satisfactory pattern. Workers with chronic back problems, depression, weakness/tiredness, dyspnea, and chest pain had significantly less adherence to drug treatment (p≤0.050). Sociodemographic and labor characteristics, polypharmacy, and type of medication were not associated with medication adherence (p>0.050). Conclusion satisfactory drug adherence was observed among the participants in relation to drug treatment, and the presence of some symptoms and specific chronic diseases was associated with partially satisfactory drug adherence.

Nuevas recomendaciones para el diagnóstico y tratamiento de la infección por Helicobacter pylori en niños / New recommendations for the diagnosis and treatment of Helicobacter pylori infection in children

RESUMEN Fundamento: Helicobacter pylori es una de las bacterias más prevalentes en el mundo. En población pediátrica la prevalencia varía del 10 al 80 %. En los últimos años la eficacia de los esquemas de tratamiento ha sido comprometida y se ha trazado un complejo escenario para la implementación de tratamientos erradicadores. Objetivo: profundizar y actualizar los aspectos más importantes sobre la infección por Helicobacter pylori en niños. Métodos: la búsqueda de la información se realizó en un periodo de cuatros meses (noviembre de 2018 a marzo de 2019) y fueron empleadas las palabras: Helicobacter pylori en niños, métodos diagnósticos, tratamientos actuales, cocoides. De 138 artículos en las bases de datos PubMed, Hinari, SciELO y LILACS mediante el gestor de búsqueda y administrador de referencias EndNote, se utilizaron 53 citas para realizar la revisión, de ellas 40 de los últimos cinco años, cuatro estudios de meta-análisis y cuatro estudios multicéntricos. Resultados: se describe características epidemiológicas, clínicas, las ventajas y desventajas de los diferentes métodos diagnósticos basados en la revisión de este tema, se proponen modificaciones en los esquemas de tratamientos al tener en cuenta variables dependientes de la bacteria y del individuo. Conclusiones: en la revisión se brinda una actualización de la infección en niños, así como esquemas de tratamientos actualizados según las guías actuales.

ABSTRACT Background: helicobacter pylori is one of the most prevalent bacteria in the world. In the pediatric population, the prevalence varies from 10 to 80 %. In recent years, the effectiveness of treatment schemes has been compromised and a complex scenario has been drawn up for the implementation of eradication treatments. Objective: to deepen and update the most important aspects of helicobacter pylori infection in children. Methods: the search for the information was made over a period of four months (November 2018 to March 2019) and the words: Helicobacter pylori in children, diagnostic methods, current treatments, coccoides were used. Of 138 articles in the PubMed, Hinari, SciELO and LILACS databases through the EndNote search manager and reference manager, 53 citations were used to perform the review, of which 40 were from the last five years, four meta-analysis studies and four multicenter studies. Results: epidemiological and clinical characteristics, the advantages and disadvantages of the different diagnostic methods and based on the revision of this topic are proposed, modifications are proposed in the treatment schemes taking into account variables dependent on the bacteria and the individual. Conclusions: this review provides an update of the infection in children, as well as updated treatment schedules.

Economic Burden Can Be the Major Determining Factor Resulting in Short-Term Intermittent and Repetitive Ustekinumab Treatment for Moderate-to-Severe Psoriasis

BACKGROUND: The continuous use of biologic agents in the treatment of psoriasis has been reported to result in successful and sustained therapeutic effects and safety. However, some patients choose intermittent and repetitive treatment. OBJECTIVE: To determine the factors for selecting intermittent and repetitive ustekinumab treatment for the management of psoriasis. METHODS: From January 2011 to October 2016, we enrolled 30 psoriasis patients who discontinued ustekinumab treatment and were followed up for psoriasis treatment. We reviewed data regarding patients' clinical characteristics and the treatment they received, and investigated the factors for selecting intermittent treatment. RESULTS: A total of 52 ustekinumab treatment periods were administered to the 30 patients. Of the 52 treatment periods, 34.6% were covered by insurance and 82.4% were discontinued after sufficient improvement had been made or at the patient's request. Further analysis comparing the first and second ustekinumab treatments revealed that the patients who used ustekinumab in second treatment were more likely to be insured. In addition, the rate of patients reaching psoriasis area and severity index (PASI)75 and PASI90 was similar between the first and subsequent ustekinumab treatments. CONCLUSION: We found that the patients who used ustekinumab intermittently were those who were satisfied with the outcome of ustekinumab treatment but could not afford the treatment. These results suggested that economic burden can be a factor for the patients' choice of short-term intermittent treatment. The expansion of insurance coverage can increase the effectiveness of, and patients' satisfaction with, the management of psoriasis.

Transtorno de Déficit de Atenção/Hiperatividade: prevalência e uso de psicofármacos em crianças de um ambulatório no sul de Santa Catarina / Attention Deficit Disorder/Hyperactivity: prevalence and psychotropic drugs use in children in an ambulatory in south Santa Catarina

Objetivos: Verificar a prevalência de Transtorno de Déficit de Atenção/Hiperatividade (TDAH) em crianças atendidas em nível ambulatorial. Estudar a utilização de psicofármacos e a adesão ao tratamento entre as crianças com o transtorno. Métodos: Estudo epidemiológico de delineamento transversal baseado na análise de prontuários para caracterizar o perfil das crianças com TDAH e em entrevista com cuidadores das crianças, para avaliar a adesão ao tratamento através do teste de Morisky. O trabalho foi desenvolvido em um ambulatório de uma cidade do sul do Brasil entre os meses de agosto a outubro de 2011. A população foi constituída por crianças atendidas em nível ambulatorial. A amostra foi constituída de todos os prontuários das crianças atendidas no setor de neuropediatria do Ambulatório Materno Infantil (AMI) da Universidade do Sul de Santa Catarina. Resultados: De 623 crianças cujos prontuários foram analisados, 127 apresentaram diagnóstico de TDAH. A prevalência encontrada foi de 20,4%. A idade das crianças com TDAH variou de 3 a 16 anos e a maioria era do sexo masculino (79,5%). O fármaco mais utilizado foi o metilfenidato (92,6%). Encontrou-se ainda o uso de antidepressivos, antipsicóticos e antiepiléticos. O transtorno associado ao TDAH mais frequente foi o de aprendizagem (20,6%). Foram entrevistados 24 cuidadores de crianças com TDAH, das quais apenas 25,0% aderem ao tratamento, observando-se uma menor adesão para o sexo masculino (p=0,043). Conclusões: Encontrou-se uma prevalência de TDAH superior àquelas relatadas na literatura. O grau de adesão ao tratamento encontrado foi considerado baixo e houve predomínio do comportamento não-intencional.

Objectives: To investigate the Attention Deficit Disorder/Hyperactivity (ADHD) prevalence among children on an outpatient care. Study of psychotropic drugs use and compliance in children with ADHD treated at outpatient care. Methods: Cross-sectional study based on analysis of medical records to check the children profile with ADHD and in an interview with children`s caregivers, to assess compliance through the Morisky test. The study was conducted at a outpatient clinic in a southern Brazil city and time between August and October 2011. The sample consisted of all medical records of children treated in the neuropediatric sector at outpatient clinic. Results: Of 623 records, 127 were diagnosed with ADHD. The prevalence was 20.4%. The children's ages ranged from 3 until 16 years and most of them were male (79,5%). The medicines used most frequency was methylphenidate (92,6%). It was also found the use of antidepressants, antipsychotics and antiepileptics. Among the comorbidities with ADHD, the most common was Learning Disorder (20,6%). We interviewed 24 caregivers of children with ADHD, of which only 25,0% were compliance to treatment, and this lower rates was associated with boys (p=0,043). Conclusions: We found a high prevalence of ADHD than those reported in the literature. The degree of compliance to treatment was found to be low and there was a predominance of unintentional behavior.

Dose issue of novel oral anticoagulants to prevent stroke in patients with atrial fibrillation / 国际脑血管病杂志

Oral anticoagulants are important for preventing stroke in patients with atrial fibrillation.Compared with the traditional oral anticoagulant warfarin,the novel oral anticoagulants (NOACs) have the characteristics of high efficiency,safety,and no need to monitor coagulation function.However,current clinical reports have showed that the dose is usually low when NOACs were used for preventing stroke in patients with atrial fibrillation.Its main reason may be associated with the risk avoidance and the difference in doctor and patient preferences.The analysis from the aspects of safety and effectiveness,the risk of ischemic stroke or systemic embolism is lower when the dose of NOACs is relatively high,and the risk of hemorrhage is lower when the dose of NOACs is relatively lower.Given the differences between the incidences of different events,the disability rate and the mortality rate,the patient with atrial fibrillation are more suitable for using high-dose drug.When choosing a specific dose,taking into account the specificity,the appropriate dose,intensity,and dosing regimen should be given according to the guideline recommendations,appropriate reference to renal function and patient preferences,and individual differences in order to obtain the best clinical efficacy..

Effect of taking L-T4 in bedtime vs morning on changes of serum thyroid hormone concentration in patients with hypothyroidism / 中华核医学与分子影像杂志

Objective To compare the effect of L-T4 taken in the morning vs bedtime on serum thyroid hormone in patients with hypothyroidism.Methods Seventeen patients with primary hypothyroidism were prospectively included.They took L-T4 in the morning for 2 months followed by L-T4 taken during the bedtime for 2 months.Thyroid hormone levels and cholesterol,triglyceride,albumin,creatinine and heart rate were measured.Wilcoxon test and paired t test were used to compare the data.The correlation between the changes of TSH and FT3,FT4 was analyzed respectively by Pearson correlation analysis.Results TSH,FT3,FT4 were:(12.10±7.19) vs (3.90±3.47) mU/L,(4.14±0.86) vs (5.24±1.11) pmol/L,(12.72± 4.40) vs (18.48±2.87) pmoL/L for L-T4 taken in the morning and during the bedtime respectively (t value:6.371,-3.166,-5.435,all P＜0.01).There was no correlation between the changes of TSH and FT3,FT4(r=O.12,0.22,both P＞0.05),respectively.The averaged changes were (8.20±5.31) mU/L,(1.09± 1.42) pmol/L and (5.76±4.37) pmol/L.Triglyceride,cholesterol,albumin,creatinine levels and heart rate were not significantly different with L-T4 taken in the morning and during bedtime (t=0.240,0.017;z=0;t=-0.610,1.588,all P＞0.05).Conclusions L-T4 taken during the bedtime by patients with hypothyroidism would reduce TSH and increase FT3,FT4 levels.This method can maintain the stability of TSH level with no need to increase the dose.

Administration of four different doses of gabapentin reduces awakening from breakthrough pain and adverse effects in outpatients with neuropathic pain during the initial titration / 대한마취과학회지

BACKGROUND: Gabapentin is a safe and well-tolerated anticonvulsant with a wide therapeutic index, and it is used for neuropathic pain. The aim of this study was to compare previous dosing methods with the administration of four different doses of gabapentin while maintaining the same maximum daily dose for the safe administration of high doses of the medication. METHODS: The subjects were outpatients with various neuropathic pain syndromes, with at least two of the following symptoms: allodynia, burning pain, shooting pain, or hyperalgesia. The TID group received equal doses of gabapentin 3 times per day, while the QID group received 4 different doses of gabapentin per day. The pain score, frequency of breakthrough pain (BTP), severity and the duration of pain, sleep disturbance due to nocturnal pain, and adverse effects were recorded each day. RESULTS: The average daily pain score and sleep disturbance were significantly reduced in the QID group between days 3 and 10 of the experiment. The adverse effects of the medication were also reduced in the QID group. However, the frequency of BTP and severity and duration of pain were not significantly different between two groups. CONCLUSIONS: Administration of 4 different doses of gabapentin during the initial titration in outpatients with neuropathic pain resulted in a significant reduction in awakening from breakthrough pain and a reduction in the adverse effects of the medication.

Secondary infiltration of the central nervous system in patients with diffuse large B-cell lymphoma

OBJECTIVE: To investigate the incidence and risk factors of infiltration of the central nervous system after the initial treatment of diffuse large B-cell lymphoma in patients treated at Santa Casa de Misericórdia de São Paulo. METHODS: A total of 133 patients treated for diffuse large B-cell lymphoma from January 2001 to April 2008 were retrospectively analyzed in respect to the incidence and risk factors of secondary central nervous system involvement of lymphoma. Intrathecal prophylaxis was not a standard procedure for patients considered to be at risk. This analysis includes patients whether they received rituximab as first-line treatment or not. RESULTS: Nine of 133 (6.7%) patients developed central nervous system disease after a mean observation time of 29 months. The median time to relapse or progression was 7.9 months after diagnosis and all but one patient died despite the treatment administered. Twenty-six (19.5%) patients of this cohort received rituximab as first-line treatment and nine (7.1%) received intrathecal chemoprophylaxis. Of the nine patients that relapsed, seven (77.7%) had parenchymal central nervous system involvement; seven (77.7%) had stage III or IV disease; one (11.1%) had bone marrow involvement; two (22.2%) had received intrathecal chemoprophylaxis; and 3 (33.3%) had taken rituximab. In a multivariate analysis, the risk factors for this infiltration were being male, previous use of intrathecal chemotherapy and patients that were refractory to initial treatment. ...

Attaching great importance to polypharmacy in elderly patients / 中华老年医学杂志

Based on the ongoing clinical experiences at our outpatient pharmacy and geriatrics multidisciplinary inpatient and outpatient services,we believe that polypharmacy among elderly patients is serious and pervasive in China.This observation is supported by the findings from literature review.To help address this serious issue in senior care,we recommend to gain better understanding of age-related physiological changes of the elderly as well as those in pharmacokinetics and pharmacodynamics,and to conduct prescription review and medication reconciliation.The multi-and interdisciplinary approach employed by modern geriatrics care model,involving doctors,pharmacists and nurses,should further help address this issue and promote rational use of pharmaceuticals in the elderly patients.

Esquizofrenia: adesão ao tratamento e crenças sobre o transtorno e terapêutica medicamentosa / Schizophrenia: adherence to treatment and beliefs about the disorder and the drug treatment / Esquizofrenia: adhesión al tratamiento y creencias sobre el transtorno y terapéutica medicamentosa

Este estudo verificou a adesão de pessoas com esquizofrenia à medicação, identificou e comparou as crenças sobre transtorno e medicamento entre pacientes aderentes e não aderentes. Participaram do estudo 14 pacientes de um ambulatório de psiquiatria. Foi realizada entrevista semi-estruturada e aplicação do Teste de Morisky-Green. Os dados foram analisados com abordagem quali-quantitativa. Os resultados revelaram que 64,3 por cento dos pacientes não aderem ao medicamento. A maioria dos entrevistados considerou a medicação capaz de reduzir a seriedade e severidade do transtorno. Entretanto, entre pacientes não aderentes, as barreiras no seguimento da terapêutica foram mais expressivas. Efeitos colaterais foram razão para descontinuidade do tratamento em 80 por cento dos pacientes não aderentes intencionalmente. Observou-se conhecimento insuficiente sobre a esquizofrenia e tratamento medicamentoso. A fé foi mencionada pelos pacientes como estratégia para enfrentamento do processo vivenciado. Este estudo aponta para a necessidade de estratégias direcionadas à promoção da adesão ao medicamento entre pessoas com esquizofrenia.

This study verified the adherence of people with schizophrenia to the medication, identified and compared their beliefs about the disorder and the drug among patients who adhered and those who did not. Participants were 14 patients of a psychiatric outpatient clinic. Semi-structured interviews and the Morisky-Green test were performed. The data was analyzed using a quali-quantitative approach. Results showed that 64.3 percent of patients do not adhere to treatment. Most participants considered the drug capable of reducing the seriousness and severity of the disorder. However, the drawbacks for patients that did not adhere to the treatment were more expressive. Side effects were the cause for interrupting the treatment for 80 percent of patients who intentionally did not adhere to treatment. It was observed there is insufficient knowledge about schizophrenia and the drug treatment. Patients referred to faith as a strategy to cope with the process they were experiencing. This study points at the need for strategies directed towards the promotion of drug treatment adherence among people with schizophrenia.

Estudio que verificó adhesión de personas esquizofrénicas a la medicación, identificó y comparó las creencias sobre transtorno y medicamento entre pacientes adherentes y no adherentes. Participaron 14 pacientes de ambulatorio de psiquiatría. Se realizó entrevista semiestructurada y aplicación de Test de Morisky-Green. Los datos se analizaron con abordaje cuali-cuantitativo. Los resultados revelaron que 64,3 por ciento de pacientes no adhieren a medicación. La mayoría de entrevistados consideró a la medicación capaz de reducir la seriedad y severidad del transtorno. Entretanto, en pacientes no adherentes, las barreras en el seguimiento de la terapéutica fueron más expresivas. La razón para descontinuar el tratamiento en 80 por ciento de pacientes no adherentes intencionalmente fueron los efectos colaterales. Se observó conocimiento insuficiente sobre esquizofrenia y tratamiento medicamentoso. La fe fue mencionada por los pacientes como estrategia de enfrentamiento del proceso experimentado. El estudio determina necesidad de estrategias dirigidas a promoción de adhesión a medicamentos en pacientes esquizofrénicos.

Transtorno afetivo bipolar e a ambivalência em relação à terapia medicamentosa: analisando as condições causais / Affective bipolar disorder and ambivalence in relation to the drug treatment: analyzing the causal conditions / Transtorno afectivo bipolar y la ambivalencia en relación a la terapia medicamentosa: analizando las condiciones causales

Este estudo buscou compreender as condições causais da ambivalência da pessoa com transtorno afetivo bipolar (TAB) em relação ao seguimento da terapêutica medicamentosa. Foi utilizada a abordagem qualitativa, tendo como referencial metodológico a Teoria Fundamentada nos Dados, à luz do Interacionismo Simbólico. Participaram do estudo 14 pessoas com TAB que estavam em acompanhamento em um Ambulatório de Transtornos do Humor de um hospital universitário e 14 familiares indicados pelas mesmas. A entrevista e observação foram as principais formas de obtenção de dados. Os resultados revelaram três categorias que descrevem as referidas condições causais: vivendo as crises do transtorno; tendo necessidade do medicamento e convivendo com os efeitos colaterais dos medicamentos. Este estudo aponta para necessidade de mudança de atitude dos profissionais de saúde de culpabilizar o paciente pela interrupção do tratamento para aquela de escuta, de valorização do seu universo simbólico e afetivo bem como de parceria no tratamento.

This study was performed with an aim to understand the conditions causing the ambivalence of the person with bipolar affective disorder (BAD) regarding following the drug treatment. A qualitative approach was used, with the Grounded Theory as the methodology framework, under the light of Symbolic Interactionism. Participants were 14 individuals with BAD who were being followed at an Outpatient Clinic for Mood Disorders of a university hospital and 14 relatives they indicated. Interviews and observation were the main forms of obtaining data. Results revealed three categories that described the referred causal conditions: experiencing the crises of the disorder; needing the drug; and living with the side effects of the drugs. It was found that there is a need to change the attitude of some health professionals from blaming the patient for interrupting the treatment to one of listening, valuing their symbolic and affective universe as well as the partnership in the treatment.

Estudio que buscó comprender las condiciones causales de ambivalencia de persona con transtorno afectivo bipolar (TAB) relacionadas al seguimiento de terapéutica medicamentosa. Utilizó abordaje cualitativa, con referencial metodológico de Teoría Fundamentada en los Datos, a la luz del Internacionalismo Simbólico. Participaron del estudio 14 personas con TAB en seguimiento en un Ambulatorio de Transtornos de Humor de un hospital universitario y 14 familiares según su indicación. Entrevista y observaciones fueron las principales fuentes de recolección de datos. Los resultados revelaron tres categorías que describen las referidas condiciones causales: viviendo las crisis del transtorno, teniendo la necesidad del medicamento y conviviendo con los efectos colaterales del medicamento. Este estudio resalta la necesidad de cambio de actitud de los profesionales de salud de culpar al paciente por la interrupción del tratamiento por la de escucha, de valorización de su universo simbólico y afectivo, así como de asociación en el tratamiento.

Interação entre paciente com transtorno afetivo bipolar e equipe ambulatorial quanto à terapêutica medicamentosa / Interacción entre el paciente con trastorno afectivo bipolar y el equipo de consulta externa en relación a la terapéutica medicamentosa / Interaction between the patients with bipolar affective disorder and the outpatient team regarding medication therapy

OBJETIVO: Identificar, na perspectiva da pessoa com transtorno afetivo bipolar (TAB) e de seu familiar, como ocorre a interação paciente-equipe de saúde relacionada à terapêutica medicamentosa. MÉTODOS: Foi utilizada a abordagem qualitativa, com referencial metodológico da Teoria Fundamentada nos Dados, à luz do Interacionismo Simbólico. Participaram do estudo 14 pessoas com TAB de um serviço ambulatorial e 14 familiares. Para obtenção dos dados utilizou-se a entrevista e observação. RESULTADOS: Os resultados revelaram três categorias que descrevem o referido processo de interação: identificando falhas nas orientações sobre medicamentos, sentindo necessidade de acolhimento pela equipe de saúde e julgando que o paciente deve ser avaliado na sua individualidade. CONCLUSÃO: Evidenciou-se a necessidade de implementação, nos serviços de saúde, de espaços de acolhimento como forma do paciente enfrentar seu processo saúde-doença.

OBJECTIVE: To understand the interaction between the patients with bipolar affective disorder (BAD) and the outpatient health care team regarding medication therapy from the perspective of the patients and their family members. METHODS: This was a grounded theory qualitative study using symbolic interactionism method. Fourteen patients with BAD from an outpatient clinic and 14 family members participated in the study. Interviews and participant observation were used to collect the data. RESULTS: Three categories emerged from the data: identifying inaccuracy in the medication orientation, feeling the need of being welcomed by the health care team, and perceiving the need for individualize care. CONCLUSION: There is a need for the implementation of health care services that welcome patients and provide individualized care to facilitate coping strategies with the disease process.

OBJETIVO: Identificar, en la perspectiva de la persona con trastorno afectivo bipolar (TAB) y de su familiar, cómo ocurre la interacción paciente - equipo de salud relacionada a la terapéutica medicamentosa. MÉTODOS: Fue utilizado el abordaje cualitativo, con referencial metodológico de la Teoría Fundamentada en los Datos, a la luz del Interaccionismo Simbólico. Participaron del estudio 14 personas con TAB de un servicio de consulta externa y 14 familiares. Para la obtención de los datos se utilizó la entrevista y la observación. RESULTADOS: Los resultados revelaron tres categorías que describen el referido proceso de interacción: identificando fallas en las orientaciones sobre medicamentos, sintiendo necesidad de acogida por parte del equipo de salud y juzgando que el paciente debe ser evaluado en su individualidad. CONCLUSIÓN: Fue evidenciada la necesidad de implementación, en los servicios de salud, de espacios de acogida como forma de que el paciente enfrente su proceso salud-enfermedad.

Não-adesão ao tratamento em pacientes com doença de Crohn: prevalência e fatores de risco / Non-adherence to the therapy in Crohn's disease patients: prevalence and risk factors

CONTEXTO: A não-adesão ao tratamento medicamentoso, em algum grau, ocorre universalmente. É uma das principais causas de insucesso no tratamento das doenças crônicas, tal como a doença de Crohn. OBJETIVO: Em doentes com doença de Crohn, avaliar a prevalência e os fatores de risco associados à baixa adesão ao tratamento medicamentoso. MÉTODOS: No período entre julho de 2006 e julho de 2007 foram incluídos prospectivamente, para avaliação da não-adesão ao tratamento, 100 doentes com doença de Crohn em seguimento clínico no ambulatório de doenças inflamatórias intestinais. Os pacientes responderam ao Teste de Medida de Adesão a Tratamentos de Morisky e Green, modificado. De acordo com este teste, os pacientes foram classificados em dois grupos, conforme o grau de adesão: adesão e não-adesão. A não-adesão foi subdividida em intencional e não-intencional. Variáveis clínicas, psicológicas e farmacoterapêuticas foram pesquisadas na busca de possíveis fatores associados à não-adesão. RESULTADOS: Entre os pacientes avaliados, 64 por cento apresentaram escore compatível com não-adesão. O perfil mais frequente de não-adesão foi o do tipo não-intencional, e os pacientes mostraram ter conhecimento e motivação para o tratamento. Na comparação entre os dois grupos observou-se somente uma tendência a não-adesão entre os pacientes mais jovens (P = 0,07) e de raça não-branca (P = 0,06). Não houve correlação significativa entre o grau de adesão e as variáveis psicológicas e farmacoterapêuticas. CONCLUSÕES: Em pacientes com doença de Crohn, a prevalência de não-adesão ao tratamento medicamentoso é elevada (64 por cento). Indivíduos jovens e aqueles não-brancos parecem ser os mais predispostos à não-adesão. Portanto, é preciso estar alerta para sua ocorrência e, caso necessário, implementar medidas que busquem aumentar o grau de adesão destes pacientes.

CONTEXT: Non-adherence to therapy, in any degree is a common event and occurs in several circumstances. It is one of most common cause of fail in therapy of chronic diseases and Crohn's disease is not an exception. OBJECTIVE: To evaluate in patients with Crohn's disease the prevalence and the risk factors to non-adherence to therapy. METHODS: From July 2006, for 12 months, were included prospectively, for non-adhesion to therapy 100 patients with Crohn's disease that were assisted in a Center for Inflammatory Bowel Diseases of Universitary Hospital of Federal University of Juiz de Fora, MG, in Brazil. A modified Morisky & Green Test for Measure of Adherence to Therapy was answered by all of them. According to test the patients were classified in two groups defined as adherence and non-adherence, respectively, and the last one was separated in intentional and non-intentional adhesion. Clinical, psychological and pharmacotherapeutics variables were sought to find the factors related to non-adherence. RESULTS: Sixty four percent of total group were noticed to have a score of non-adherence to therapy according to used test and non-intentional was the most common type of behavior in such patients, and they demonstrated to be conscious of therapy. The comparison of adherent and non-adherent patients displayed a significant tendency to occurrence of non-adherence in younger (P = 0,07) and in non-white patients (P = 0,06). No correlation was observed in comparison of psychological and pharmacotherapeutics variables and non-adherence. CONCLUSIONS: In patients with Crohn's disease the prevalence of non-adherence to therapy is high (64 percent). The younger and non-white patients have higher propensity to non-adherence. In such circumstances efforts should be made to look for strategies to deal with this sort of people suffering from Crohn's disease, trying to increase the degree of adherence in this sort of patients.

Bipolar affective disorder: medication adherence and satisfaction with treatment and guidance by the health team in a mental health service / El trastorno afectivo bipolar: adhesión al medicamento y satisfacción con el tratamiento y orientaciones del equipo de salud de un núcleo de salud mental / Transtorno afetivo bipolar: adesão ao medicamento e satisfação com o tratamento e orientações da equipe de saúde de um núcleo de saúde mental

Bipolar Affective Disorder (BAD) is a chronic disease and requires medication treatment. This study verified the adherence of people with BAD to medication and compared, among adherent and non-adherent patients, satisfaction with the health team and treatment. Twenty-one patients with BAD receiving care in a mental health unit participated in the study. The Morisky-Green test and another instrument elaborated by the researchers were used for interviews. Data were analyzed with qualitative and quantitative approaches. Results showed that the majority of patients did not adhere to the medication treatment due to "non-intentional behavior" (negligence or forgetfulness). The majority reports satisfaction with information received regarding the medication and its effectiveness, though there were reports of collateral effects, doubts and lack of motivation to keep up the treatment. This research shows the need for strategies directed at promoting adherence to medication therapy in patients with BAD.

El trastorno afectivo bipolar (TAB) es crónico y requiere tratamiento medicamentoso para su control. Este estudio verificó la adhesión de personas con TAB a la medicación y comparó, entre adherentes y no adherentes, la satisfación en cuanto al equipo de salud y al tratamiento. Participaron del estudio 21 pacientes con TAB atendidos en un Núcleo de Salud Mental. Fue realizada una entrevista con aplicación de la prueba de Morisky-Gren y de un instrumento elaborado por las investigadoras. Los datos fueron analizados con un abordaje cualitativo y cuantitativo. Los resultados mostraron que la mayor parte de los pacientes no adhiere al tratamiento medicamentoso por "comportamiento no intencional". La mayoría de ellos afirma tener satisfación con la efectividad del medicamento y con las informaciones recibidas sobre este, sin embargo fueron identidificados relatos de efectos colaterales, dudas y falta de motivación para seguir el tratamiento. Esta investigación apunta para la necesidad de elaborar estrategias dirigidas a la promoción de la adhesión a la terapia medicamentosa en pacientes con TAB.

O transtorno afetivo bipolar (TAB) é crônico e requer tratamento medicamentoso para seu controle. Este estudo verificou a adesão de pessoas com TAB à medicação e comparou, entre aderentes e não aderentes, a satisfação quanto à equipe de saúde e tratamento. Participaram do estudo 21 pacientes com TAB atendidos em um Núcleo de Saúde Mental. Foi realizada entrevista com aplicação do teste de Morisky-Green e de um instrumento elaborado pelas pesquisadoras. Os dados foram analisados com abordagem quali-quantitativa. Os resultados mostraram que a maior parte dos pacientes não adere ao tratamento medicamentoso por "comportamento não intencional". A maioria deles afirma satisfação com a efetividade do medicamento e com as informações recebidas sobre o mesmo, mas foram identidificados relatos de efeitos colaterais, dúvidas e falta de motivação para seguir o tratamento. Esta pesquisa aponta para a necessidade de estratégias direcionadas à promoção da adesão à terapia medicamentosa em pacientes com TAB.

Prevalência de Mycobacterium tuberculosis resistente em pacientes sob tratamento parcialmente intermitente ou sob tratamento diário / Prevalence of drug-resistant Mycobacterium tuberculosis in patients under intermittent or daily treatment

OBJETIVO: Comparar as taxas de prevalência de Mycobacterium tuberculosis resistentes entre pacientes sob tratamento parcialmente intermitente e daqueles sob tratamento diário. MÉTODOS: Foram utilizados dados da Organização Mundial de Saúde de 5.138 pacientes com TB pulmonar bacilífera no Brasil, que foram separados em dois grupos: um grupo de pacientes do Distrito Federal submetidos a um regime intermitente de três tomadas semanais após o primeiro mês de regime diário, e um grupo de pacientes dos estados brasileiras, submetidos somente a um regime diário. O padrão de resistência foi categorizado em resistência primária ou adquirida, conforme a existência de tratamento anterior. Além disso, multirresistência foi definida como a resistência simultânea à isoniazida e à rifampicina, enquanto monorresistência como a resistência a uma única droga. RESULTADOS: A prevalência da resistência primária como um todo no Distrito Federal e no restante do Brasil foi de 9,2 por cento e 9,3 por cento (p = 0,94), respectivamente. A prevalência de monorresistência foi de 6,6 por cento e 6,9 por cento (p = 0,89), respectivamente, e a de multirresistência, 1,0 por cento e 1,2 por cento (p = 0,85), respectivamente. A prevalência de resistência adquirida como um todo no Distrito Federal e no restante do Brasil foi de 15,8 por cento e 26,8 por cento (p = 0,39), respectivamente. A prevalência de monorresistência adquirida foi de 5,3 por cento e 13,7 por cento (p = 0,33), respectivamente, e a de multirresistência, 0,0 por cento e 10,2 por cento (p = 0,16), respectivamente. CONCLUSÕES: Não houve diferença significativa entre os índices de resistência observados na comunidade usuária do esquema parcialmente intermitente e do diário.

OBJECTIVE: To compare the prevalence rates of drug-resistant Mycobacterium tuberculosis in patients under intermittent treatment with those observed in patients under daily treatment. METHODS: We used World Health Organization data regarding 5,138 patients with active pulmonary TB in Brazil, separated into two groups: patients in the Federal District of Brasília, treated with a one-month daily regimen followed by an intermittent thrice-weekly regimen; and patients in other parts of Brazil, treated with a daily regimen only. The resistance pattern was categorized as primary or acquired, based on the history of previous treatment. Multidrug resistance was defined as resistance to at least isoniazid and rifampin, whereas monoresistance was defined as resistance to only one drug. RESULTS: The prevalence of primary resistance in the Federal District of Brasília and in the other parts of Brazil, respectively, was as follows: overall, 9.2 percent and 9.3 percent (p = 0.94); monoresistance, 6.6 percent and 6.9 percent (p = 0.89); and multidrug resistance, 1.0 percent and 1.2 percent (p = 0.85). The prevalence of acquired resistance in the Federal District of Brasília and in the other parts of Brazil, respectively, was as follows: overall, 15.8 percent and 26.8 percent (p = 0.39); monoresistance, 5.3 percent and 13.7 percent (p = 0.33); and multidrug resistance, 0.0 percent and 10.2 percent (p = 0.16). CONCLUSIONS: No significant differences were found between patients treated with an intermittent regimen and those treated with a daily regimen in term of resistance rates.

Comparison of two dosing regimens of aminoglycosides for the development of nephrotoxicity: once versus multiple daily dosing / 대한내과학회지

BACKGROUND: Aminoglycosides are useful for the treatment of aerobic gram-negative infections, and this is despite the narrow therapeutic index and the potential nephrotoxicity and ototoxicity. Once daily dosing of aminoglycosides has recently been suggested as an alternative method to multiple daily dosing. We compared the two dosing regimens of aminoglycosides for the development of nephrotoxicity. METHODS: This study was conducted as part of an ongoing quality improvement program. For the administration of aminoglycosides in adult patients with suspected or documented gram-negative infection, multiple daily dosing was used until April 2005 and thereafter once daily dosing was recommended. RESULTS: A total of 85 patients who received aminoglycoside for more than 3 days from March to August 2005 were available for analysis (40 in the once daily dosing group and 45 in the multiple daily dosing group). The mean duration of administration was 7.7 (range: 3-19) days in the once daily dosing group and 8.0 (range: 3-31) days in the multiple daily dosing group (p=0.83). Aminoglycoside-associated nephrotoxicity was observed in a patient in the once daily dosing group (2.5% vs 0%, respectively, p=0.48). CONCLUSIONS: No significant difference in the development of nephrotoxicity was found between the two dosing regimens for aminoglycosides, but this finding had low statistical power. This may be due to underdosing of aminoglycosides in the multiple daily dosing group.