Clinical and epidemiological profiles of individuals with drug-resistant tuberculosis

Drug-resistant tuberculosis (TB) is a growing global threat. Approximately 450,000 people developed multidrug-resistant TB worldwide in 2012 and an estimated 170,000 people died from the disease. This paper describes the sociodemographic, clinical-epidemiological and bacteriological aspects of TB and correlates these features with the distribution of anti-TB drug resistance. Mycobacterium tuberculosis (MT) cultures and drug susceptibility testing were performed according to the BACTEC MGIT 960 method. The results demonstrated that MT strains from individuals who received treatment for TB and people who were infected with human immunodeficiency virus were more resistant to TB drugs compared to other individuals (p < 0.05). Approximately half of the individuals received supervised treatment, but most drug-resistant cases were positive for pulmonary TB and exhibited positive acid-fast bacilli smears, which are complicating factors for TB control programs. Primary healthcare is the ideal level for early disease detection, but tertiary healthcare is the most common entry point for patients into the system. These factors require special attention from healthcare managers and professionals to effectively control and monitor the spread of TB drug-resistant cases.

Comprensibilidad de un prospecto de medicamento de venta libre / Comprehensibility of an over-the-counter medicine leaflet

INTRODUCCIÓN: El prospecto que acompaña a los medicamentos de venta libre contiene información importante, que no siempre es comprendida correctamente. OBJETIVOS: Explorar en qué medida se comprende la información incluida en los prospectos de especialidades medicinales de venta libre con paracetamol como principio activo. MÉTODOS: Se realizó un estudio cualitativo, con entrevistas semiestructuradas a 20 adultos a cargo de niños usuarios del medicamento. Se llevó a cabo con un equipo multidisciplinario: dos médicas, una psicóloga, una socióloga y una lingüista. Se utilizó el prospecto de un medicamento con paracetamol destinado a niños mayores de cuatro años. Se analizó cada respuesta como variable dicotómica (sí/no), de acuerdo con la comprensión de la información. Se identificaron las características discursivas de los prospectos y, a partir de ellas, se evaluaron los datos de las entrevistas. RESULTADOS: Ninguno de los entrevistados comprendió la posología, mientras que un 30% tuvo dificultades para entender las contraindicaciones. CONCLUSIONES: Es necesario seguir realizando estudios de comprensibilidad para identificar las dificultades que tienen los usuarios de medicamentos de venta libre para entender los prospecto

INTRODUCTION: Over-the-counter medicine leaflets include important information, which is not alway sunderstood by users. OBJECTIVES: To explore the level of understanding of information stated in over-the-countermedicine leaflets, containing paracetamol as active ingredient. METHODS: A qualitative study was conducted, with semi-structured interviews to 20 adults in charge of children using the medicine. The multidisciplinary team was composed by two physicians, one psychologist, one sociologist and one linguist. It used a leaflet of a medicine containing paracetamol for children older than four years. The study analyzed every response as a yes/no variable according to information comprehension. The leaflet speech features were identified, so as to evaluate the data collected by the interviews. RESULTS: None of the interviewed people understood the dosage, while 30% of them had difficulties regarding contraindications. CONCLUSIONS: It is necessary to perform further comprehensibility studies to identify the difficulties faced by over-the-counter medicine users while reading the leaflets

Automedicação em idosos residentes em Campinas, São Paulo, Brasil: prevalência e fatores associados / Self-medication in the elderly population of Campinas, São Paulo State, Brazil: prevalence and associated factors

The aim of this study was to evaluate the prevalence and causative factors associated with self-medication in the elderly and identify the main drugs consumed without prescription. A cross-sectional population-based study with stratified clustered two-stage sampling was performed in Campinas, São Paulo, Brazil in 2008 and 2009. Of the 1,515 elderly studied, 80.4 percent reported using at least one drug duringthe three days preceding the survey. Of these, 91.1 percent reported the use of prescription drugs only and the remainder (8.9 percent) reported simultaneous use of prescribed and non prescribed drugs. After adjustment, a negative association between age > 80 years, hypertension, chronic diseases, use of health services, dental consultations and adherence to a medical plan,and self-medication was found, whereas a positive association was found with per capita income. Dipyrone, acetylsalicylic acid, diclofenac, Ginkgo biloba, paracetamol and homeopathic medicines were among the most used non-prescribed drugs. Pharmaceutical assistance should be provided as a priority tothe elderly, to avoid the misuse of medicines and ensure access to the correct drugs.

O objetivo foi avaliar a prevalência e fatores associados à automedicação em idosos e identificar os principais fármacos consumidos sem prescrição. Estudo transversal de base populacional, com amostra estratificada por conglomerados e em dois estágios realizado em Campinas, São Paulo, Brasil, em 2008-2009. Dos 1.515 idosos, 80,4 por cento referiram uso de ao menos um medicamento nos três dias anteriores à pesquisa. Desses, 91,1 por cento relataram consumo exclusivo de medicamentos prescritos e o restante (8,9 por cento), uso simultâneo de prescritos e não prescritos. Após ajuste, idade > 80 anos, hipertensão arterial, presença de doenças crônicas, uso de serviços de saúde, realização de consultas odontológicas e filiação a plano médico de saúde estiveram associadas negativamente, e renda per capita, positivamente à automedicação. Os fármacos sem prescrição mais consumidos foram dipirona, AAS, diclofenaco, Ginkgo biloba, paracetamol e homeopáticos. Sobretudo entre idosos, a assistência farmacêutica deve ser priorizada para evitar o uso incorreto de medicamentos e garantir o acesso aos fármacos necessários ao tratamento.

Trends of home drug storage and use in different regions across the northern United Arab Emirates

To investigate the habits of use and home storage of over-the-counter [OTC] and prescription drugs. A pretested questionnaire was distributed to university students who represented 300 household units in different regions of the northern United Arab Emirates. Household chairs [parents] answered questions on various aspects of home use and storage of OTC and prescription medicines. The number of drugs stored at home was collapsed into 5 unequal groups [1-3, 4-6, 7-10, 11-15 and 16-20]. The response rate was 300 [100%]. The average number of drugs per household unit was 6 items. Almost 40% of the participants stored between 16 and 20 drugs. More than half [56%] of the household units stored medicines in a home pharmacy kept either in the bedroom [n=66; 39%] or in the kitchen [n=71; 42%]. No correlation was found between the level of education and the number of family members [r=0.29] or drugs stored at home [r=-0.35]. Only 2 [0.7%] of the participants did not keep drugs at home. There was a clear discrepancy in either OTC or prescription drugs stored, and the variation in the utilization and preference of drugs was obvious among the pooled sample. Various problems related to the use and storage at home of OTC and prescription drugs were revealed. Discussing the results of this survey with students who participated as members of the household units that took part in the study may prove to be a helpful intervention. The need for public educational efforts on the rational use of medicines at home is urgent to foster awareness of the proper use of drugs

Over-the-counter whitening agents: a concise review

Tooth discoloration is commonly found in the dental clinic and tooth bleaching has been considered the preferred esthetic alternative, being more conservative, safe and with predictable results. Supervised home-use of 10 percent Carbamide Peroxide (CP) bleaching with custom-trays is the most common bleaching procedure dispensed by dentists to their patients. The good results obtained with this technique stimulated the flourishing of new products and techniques. Over-the-counter (OTC) bleaching products appeared as a low-cost alternative to bleach discolored teeth without dentist supervision. Different OTC products are available in supermarkets, drug stores or on the Internet, including rinses, paint-on brushes, toothpastes, chewing guns, dental floss, and whitening strips. There is lack of clinical evidence regarding the safety and effectiveness of these products, being most of the studies supported by the manufacturers'. Basically, toothpastes, chewing gums, and dental floss are removal agents of superficial stains. Rinses and paint-on brushes with low levels of hydrogen peroxide have some whitening effect, but without clinical relevance. Strips present similar esthetic results and side-effects, compared to bleaching with 10 percent CP using trays; however, the studies have financial support from the manufacturers and were based on short term evaluations. Legislation varies widely in different countries regarding OTC dental bleaching. Concerns have appeared due to the potential abusive use of these self-medication agents, especially in young patients, with potential harmful results. Dentists should be acquainted with this kind of products to be able to inform their patients. In conclusion, there is a need for independent clinical trials to provide sufficient evidence regarding the use of OTC bleaching products.

Perfil de utilização de medicamentos em idosos da zona urbana de Santa Rosa, Rio Grande do Sul, Brasil / Use of medicines by the elderly in Santa Rosa, Rio Grande do Sul State, Brazil

Os medicamentos representam um dos itens mais importantes da atenção à saúde do idoso. Estes particularmente utilizam múltiplos medicamentos apresentando mais reações adversas. O estudo objetivou avaliar o perfil do consumo de medicamentos por idosos. Desenvolveu-se um estudo epidemiológico transversal mediante entrevistas domiciliares, numa amostra aleatória de 294 idosos, residentes em Santa Rosa, Rio Grande do Sul, Brasil. Os idosos representam 9 por cento da população. Os resultados evidenciaram consumo médio de 2,79 medicamentos por idoso. O coeficiente de prevalência do uso de medicamentos na última semana foi de 82 por cento, dos 827 medicamentos utilizados pelos idosos 794 (96 por cento), foram prescritos. As classes farmacológicas mais utilizadas foram os anti-hipertensivos (21,3 por cento) e diuréticos (11,3 por cento). A prevalência do uso de medicamentos foi comparável ao encontrado em outros estudos, confirmando a importância dos medicamentos na atenção à saúde do idoso. A porcentagem de medicamentos utilizados sem prescrição médica foi baixa. Os medicamentos e forma de apresentação mais freqüentemente relatados foram os usualmente prescritos e dispensados gratuitamente na rede básica de saúde do município que está estruturada há mais de 10 anos com quase 100 por cento de cobertura.

Medicines are one of the most important health care items for the elderly, who are particularly prone to use multiple drugs with a higher number of adverse reactions. The current study aimed to assess the profile of pharmaceutical consumption by the elderly. A cross-sectional epidemiological study used household interviews in a random sample of 294 elderly living in Santa Rosa, Rio Grande do Sul State, Brazil. The elderly represent 9 percent of the local population. The results showed a mean consumption of 2.79 medicines per individual. The prevalence rate for use of medicines in the previous week was 82 percent, and of the 827 medicines used by the elderly, 794 (96 percent) had been prescribed. The most widely used pharmacological classes were anti-hypertensives (21.3 percent) and diuretics (11.3 percent). Prevalence of pharmaceutical use was comparable to the results from other studies, thus confirming the importance of medicines in the health of the elderly. The percentage of medicines used without a medical prescription was low. The most frequently reported medicines and formulations were those usually prescribed and dispensed free of cost in the municipal basic health care system, which has been organized for more than 10 years, with coverage of nearly 100 percent.

Nuevas etiquetas de medicamentos para apoyar la automedicación en México: el caso de un analgésico pediátrico / New medicine label to support self-medication in Mexico: the case of a children’s analgesic

OBJETIVO: Se presenta el método para diseñar etiquetas de medicamentos centrados en el usuario, aplicado a un analgésico pediátrico. MATERIAL Y MÉTODOS: El Communication Research Institute (CRI) de Australia desarrolló este método, consistente en seis etapas que cubren todos los aspectos relacionados con el diseño de una etiqueta. Para aplicarlo por primera vez al analgésico pediátrico en México, y en sociedad con el CRI, el Centro de Estudios Avanzados de Diseño realizó diversos ajustes, como la modificación del nivel de desempeño o la inclusión de preguntas al protocolo. RESULTADOS: La aplicación de este método a la etiqueta del analgésico mejoró sustancialmente la localización y comprensión de la información del medicamento en "usuarios en riesgo", lo cual garantiza que el público general obtendrá la información adecuada para automedicarse correctamente. CONCLUSIONES: La aplicación del método llevó a firmar, en 2005, las Guías de etiquetado para medicamentos de libre acceso en México.

OBJECTIVE: This study presents the application of a method to design medicine labels centred in the user and applied to a Mexican children's analgesic. MATERIAL AND METHODS: The method was developed by the Communication Research Institute (CRI) of Australia and consists of six stages that thoroughly consider all aspects related to medicine labels. This method was applied for the first time in Mexico by CRI and by the Centre for Advanced Studies in Design (CEAD), but it required a number of modifications to adjust it, like modifying the label's performance requirements and incorporating different questions to the protocol. RESULTS: The application of this method to the children's analgesic improved significantly the localization and comprehension of the information by "users at risk", which guarantees that the general public will get adequate information for correct self-medication. CONCLUSIONS: The application of this method led to sign the Guides for OTC labels in Mexico in 2006.

Implementación y Evaluación del Sistema de Suministro de Medicamentos en el Centro de Salud 2 de Quito / Implementation and Evaluation of the System of Supply of Medications in the Center of Health 2 of Quito

La presente investigación se centra en el manejo de medicamentos en el Centro de Salud 2 de Quito, unidad de atención primaria del Ministerio de Salud y tiene tres momentos: un diagnóstico de base, un proceso de implementación del Sistema integrado de manejo de medicamentos y una evaluación final.La investigación inicial reveló que el manejo de medicamentos en el Centro de Salud era ineficiente, no satisfacía a los clientes externos, y no propiciaba las buenas prácticas de prescripción ni el uso racional de los medicamentos.En la fase de intervención, que duró diecisiete meses, se implementó y monitorizó cada componente del Sistema integrado de manejo de medicamentos se planificó y ejecutó un proceso de educación continua dirigido a prescriptores

Influencia de los padres en la prescripción de antibióticos hecha por los pediatras / Influence of the parents in the prescription of antibiotic opinions for the pediatrics

La aparición de resistencia bacteriana ha promovido investigaciones sobre la prescripción de antibióticos. Se estudió si existe relación entre la prescripción de antibióticos por los pediatras, la presión para ello ejercida por los padres y las opiniones sobre este tema de los pediatras y padres a través de encuestas tipo entrevista en 100 padres y 100 pediatras de medio público y privado de Caracas. Los padres describen sobre-expectativas acerca de uso de antibióticos, y reconocieron, en al menos una oportunidad: haber automedicado a sus hijos (52 por ciento), haber solicitado antibióticos a su pediatra (48 por ciento) y haberlo obtenido (33 por ciento) y los pediatras expresaron haber percibido presión por parte de los padres para indicar antibióticos (87 por ciento), y haber accedido a la petición al menos en una ocasión (38 por ciento), siendo más frecuente en consultas numerosas (P=0,038). Consideramos que existe relación entre la presión de los padres y la prescripción de antibióticos por los pediatras; los padres manejan conceptos y actitudes erróneos sobre los antibióticos. Asimismo, los pediatras opinan que la educación a los padres es necesaria para promover el uso racional de los antibióticos

Pharmacy distribution of advice, symptomatic treatment and antimicrobial drugs to patients with cough

It i an accepted fact that, in many countries, pharmacies are the predominat source of medical advice over-the-counter drugs, and supplies of "prescription-only" drugs for sale without a prescription. To assess the activities conducted by pharmacists or pharmacy counter assistants in response to a common health problem, a cross-sectional study was done at 114 pharmacies in Porto Alegre, Brazil. A fictitious case-history of cough was used by trained personnel entering the pharmacy and the subsequent activities by the pharmacist or pharmacy counter assistant were analyzed. Some kind of medication was provided in 101 (88.5 percent)of the pharmacies. Pharmacists gave medication in 80 percent of pharmacies, and pharmacy assistants in 95.5 percent (p<0.03). The class of medication most frequently dispensed was the expectorants (97 times, 92.4 percent), however, systemic antibiotics were provided in 11 pharmacies (10.5 percent). Of note, the pharmacists provided antibiotics more frequently than did pharmacy assistants (p=0.016). We conclude that pharmacy advice and symptomatic medical care (expectorants) are very common and that pharmacy assistants are more likely than pharmacists to provide medication. Of concern, when pharmacists were the drug dispensers of antibiotics which should be provided by prescription only, drugs were provided without proper diagnosis, and often incorrect dosages. This reflects a pontentially dangerous practice in need of careful evaluation, education and supervision.

Tratamiento de la Amibiasis Intestinal Aguda: estudio comparativo Tinidazol/Teclozan Vs Secnidazol/Teclozán / Treatment of the acute intestinal ameobiasis: comparative study Teclozan/Tinidazol Vs Teclozan/Secnidazol

Se realizó un estudio controlado comparativo entre Tinidazol/Teclozan vs Secnidazol/Teclozan en el Estado Carabobo. El estudio fue efectuado en 160 pacientes del barrio El Carmen y de la Urbanización Alianza. Los resultados revelan que la combinación Secnidazol/Teclozan fue más efectiva que la combinación Tinidazol/Teclozan

Prescripcion y acceso inadeciado de medicamentos en Caranavi / Prescription and access of medicines in Caranavi

La adquisicion de medicamentos, como una parte importante del proceso de resolucion de los problemas de salud en poblacion de zonas rurales, guarda bastantes particularidades en paises de america latina como boliva. El presente estudio se ralizo en Caranavi, capital de la Provincia Caranavi, Departamento de la Paz; mediante encuestas a pacientes que accedieron a consulta externa del hospital de referencia y a las personas encargadas del comercio de medicamentos en dicha zona. Se concluye que el uso irracional de medicamntos es el principal problema, siendo causado por varias razones. Se sugiere la elaboracion de conductas y legislaciones pertinentes que beneficien y protejan la salud de la poblacion, previniendo el uso irracional de medicamntos

La importancia de la medicina popular en el sistema de salud de la provincia de Vallegrande (Santa Cruz-Bolivia) / Importance of popular medicine in the health system in the province of Vallegrande (Santa Cruz - Bolivia)

En general los profesionales de la salud ignoran los conocimientos populares que tienen las personas en relacion con la salud y las enfermedades. la ideologia dominate de desarrollo de salud esta siempre relacionada con la presencia de medicos, enfermeras, hospitales y equipos de diagnostico. El sistema de salud de la provincia de Vallegrande esta integrado por los 3 sectores: popular, tradicional y profesional. La poblacion de vallegrande utiliza 115 plantas medicinales y 104 medicamentos para automedicarse (medicina casera). La capacidad de la automedicacion esta estrechamente relacionada con el nivel de escolaridad, nivel socioeconomico y el domicilio de las personas. Los curanderos de Vallegrande utilizan en su tratamiento productos farmeceuticos, (tonicos, antibioticos y vitaminas) Existe una prescripcion excesiva de sueros, corticoides y antibioticos por el personal de salud e la ciudad de Vallegrande. El 80 por ciento de las prescripciones medicas se realizan bajo nombre comercial

Medicamentos caseros inocuos / Inocuos domestic medicaments

El presente trabajo demostró las diversas colonias de bacterias y hongos encontrados en los medicamentos caseros inocuos preparados en forma empírica y recetados por médicos inclusive oftalmólogos. Se cultivaron bacterias gram (-), un coco gram (+) y hongos, la recomendación final eliminar de la práctica médica cotidina la utilización de estos medicamentos caseros inocuos