Discussion and consideration on pharmacology and toxicology of Areca catechu and its rational application / 中草药

Areca catechu ranks the first of China's precious "four southern medicines", with a history of more than 1 800 years of medicinal use and extensive clinical application. The pharmacological effects of A. catechu mainly focus on insect repellent, anti-tumor, anti-aging, anti-atherosclerosis and the effects on digestive system and nervous system. In recent years, safety problems such as oral cancer caused by consumption of A. catechu have been frequently reported, and the main chemical components of both medicinal and edible A. catechu are arecoline, so the clinical safety of medicinal A. catechu has been questioned. Based on the chemical composition, this paper analyzes the pharmacological and toxicological characteristics of A. catechu, discusses the points for attention in clinical application, in order to provide a reference basis for the clinical safe and rational use of A. catechu.

Current situation and principles of off-label drug uses / 中国小儿急救医学

Drug instructions are medical documents with legal effect. Off-label drug use exists widely worldwide,especially in cancer patients,children,pregnant women and the elderly,including unlabeled indica-tions,populations,usage and dosage. However,the government should formulate relevant laws and regulations to carry out scientific and standardized administration. To ensure the rights and interests of both doctors and patients,off-label uses should follow the corresponding principles in clinical practice.

Albumina humana prescrita para casos de desnutrição em hospitais do Rio de Janeiro / Human albumin prescribed for malnutrition in hospitals of Rio de Janeiro

OBJETIVO: Este estudo descreve e analisa a adequação da prescrição da AH, para reposição nutricional, nos hospitais da região metropolitana do Estado do Rio de Janeiro, e explora o uso do SIH/SUS para avaliar o perfil e a qualidade da prescrição de medicamentos. MÉTODOS: As informações foram extraídas do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS), entre 1999 e 2001. RESULTADOS: Houve registro de utilização de AH para reposição nutricional em 121 internações de maiores de um ano, nas quais a justificativa mais freqüente foi a desnutrição protéico-calórica (93 por cento). O uso da AH foi classificado como inadequado em 91 por cento dos casos. Em 51 por cento dos casos ocorreu o óbito e a clínica médica foi responsável 87 por cento das internações. A inadequação de prescrição esteve associada positivamente à duração da internação, com RP 1,14 (IC95 por cento 1,01-1,28). O óbito mostrou associação positiva com a idade do paciente, com RP 1,72 (IC 95 por cento 1,19-2,48). A ausência de parâmetros laboratoriais e a insuficiência de informações clínicas no banco limitaram a análise dos dados. O sub-registro no SIH das internações no âmbito do SUS foi outro importante fator limitante para o conhecimento do problema. CONCLUSÃO: Apesar das limitações, o estudo mostrou o elevado nível de inadequação de utilização da AH para reposição nutricional e as possibilidades de uso do banco do SIH/SUS na avaliação da qualidade da prescrição de medicamentos como a AH incluídos entre os procedimentos especiais.

OBJECTIVE:This study describes and analyzes the adequacy of HA prescription, for nutritional replacement, in hospitals of the Rio de Janeiro Metropolitan Area and explores the use of SIH/SUS to evaluate the profile and quality of drug prescription. METHODS: The information was collected from the Hospital Information System of the "Sistema Único de Saúde" SIH/SUS from 1999 to 2001. RESULTS: The use of HA for nutritional replacement was recorded in 121 admittances of subjects during 1 year, the most frequent justification being protein-caloric malnutrition (93 percent). HA use was classified as inadequate in 91 percent of cases. In 51 percent of the cases death occurred and the Clinical Practice Unit was responsible for 87 percent of the admittances. Inadequacy of the prescription was positively associated to length of hospital stay, with RP 1. 14 (IC95 percent 1.01-1.28). Death showed positive association with the patient's age, with RP 1.72 (IC 95 percent 1.19-2.48). The absence of laboratory parameters and lack of clinical databank information have limited data analysis. The SIH sub-registration of admittances, within the SUS ambit was another important restriction for more precise identification of the problem. CONCLUSION: In spite of the limitations, the study disclosed the high level of inappropriate utilization of HA for nutritional replacement and the possibilities of using the SIH/SUS databank to evaluate the quality of prescribing drugs such as HA included in the special procedures.