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1.
Braz. J. Pharm. Sci. (Online) ; 58: e18681, 2022. graf
Article in English | LILACS | ID: biblio-1360162

ABSTRACT

Abstract Vascular ulcers (VU) constitute a major cause of pain and disability, and significantly compromise quality of life. VU have a natural tendency to become chronic and in many cases exhibit anunsatisfactoryresponse to many of the standard therapeutic options.The case of a 73 year-old Caucasian female with severe pain and poorly-controlled pain (Visual Analogic Scale-VAS- of 8-9) due to three lower leg long-standing VUs is reported and discussed herein. The patient was treated with topical instillations of undiluted sevoflurane as per institutional off-label protocol (starting doses of 1mL/cm2 twice a day, and up-titrated according to response to a maximum of 7 mL twice daily). The VAS score dropped to 0-1 shortly after initiation of therapy and remained stable throughout treatment up until the closure of the observations. Subsequently, opioid therapy was gradually tapered down and ultimately abandoned.Sevoflurane application resulted on adequate and sustained pain management of refractory VU, with no significant side effects. On account of its beneficial effectivity and safety profiles, topical sevoflurane emerges as an add-on alternative for the long-term management of VU, and potentially other painful conditions.


Subject(s)
Humans , Female , Aged , Pain/drug therapy , Varicose Ulcer , Research Report , Sevoflurane/analysis , Drug Tapering/methods , Analgesics, Opioid/agonists , Patients/classification , Pain Management/classification
2.
Rev. medica electron ; 43(5): 1285-1296, 2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1352111

ABSTRACT

RESUMEN Introducción: el daño actínico crónico es un grupo de alteraciones en la estructura, función y apariencia de la piel como resultado de la exposición no controlada a las radiaciones ultravioletas. Puede provocar el cáncer de piel. Objetivo: caracterizar a los pacientes con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en el departamento de Cochabamba, Bolivia. Materiales y métodos: se realizó un estudio clínico descriptivo, prospectivo, en un universo de 1 833 pacientes diagnosticados con daño actínico crónico, atendidos en la consulta de Dermatología del Hospital Comunitario Valle Hermoso, en Cochabamba, entre septiembre de 2017 y septiembre de 2018. Se evaluaron las variables edad, sexo, color y fototipo de piel, ocupación, uso de medios de protección solar, exposición a otro tipo de radiaciones, manifestaciones clínicas de fotodaño y altitud del lugar de residencia. Resultados: predominaron el grupo de edad de 25 a 59 años, el sexo femenino, el color de piel mestizo (77,08 %), el fototipo de piel IV (76,98 %) y la ocupación comerciante (72,56 %). La mayoría de los pacientes (82,7 %) no utilizaron medios de protección solar, y el 99,8 % no tuvieron exposición a otro tipo de radiaciones. Las lesiones por fotodaño que prevalecieron fueron melasma (83,03 %) y lentigos (12,22 %). El 99,29 % vivían en zonas de gran altitud. Conclusiones: se caracterizaron los pacientes con daño actínico crónico, obteniendo en algunas variables estudiadas resultados similares a los mencionados por otros investigadores (AU).


ABSTRACT Introduction: chronic actinic damage is a group of alterations in the structure, function, and appearance of the skin as a result of uncontrolled exposure to ultraviolet radiation. It can cause skin cancer. Objective: to characterize the patients with chronic actinic damage, treated at the Dermatology consultation of Valle Hermoso Community Hospital, in the department of Cochabamba, Bolivia. Materials and methods: a descriptive, prospective clinical study was conducted in a universe of 1,833 patients diagnosed with chronic actinic damage, treated at the Dermatology clinic of the Valle Hermoso Community Hospital, Cochabamba, between September 2017 and September 2018. The variables age, sex, skin color, skin phototype, occupation, use of sun protectors, exposure to other types of radiation, clinical manifestations of photodamage and altitude of the place of residence were evaluated. Results: the age group from 25 to 59 years, the female sex, mestizo skin color (77.08 %), the IV skin phototype (76.98 %) and merchant occupation (72.56 %) predominated. Most patients (82.7 %) did not use sun protection means, and 99.8 % had no other radiation exposure. The prevailing photodamage lesions were melasma (83.03 %) and lentigo (12.22 %). 99.29 % lived in high altitude areas. Conclusions: the patients with chronic actinic damage were characterized, obtaining in some variables studied results similar to those mentioned by other researchers (AU).


Subject(s)
Humans , Male , Female , Patients/classification , Photosensitivity Disorders/epidemiology , Photosensitivity Disorders/diagnosis , Radiation Effects , Clinical Diagnosis , Lentigo/diagnosis , Melanosis/diagnosis
3.
Braz. J. Pharm. Sci. (Online) ; 57: e18910, 2021. tab, graf
Article in English | LILACS | ID: biblio-1345454

ABSTRACT

Chemotherapy induced nausea and vomiting (CINV) is an issue, which usually occurs in cancer patient. Despite high bioavailability of oral and intravenous administration, these have some drawbacks. The oral route causes hepatic first pass metabolism and intravenous route is invasive in nature. Hence, antiemetic drug by means of transdermal route is necessary to administer in such cases. The aim of the present investigation is to develop suitable Transdermal Therapeutic System (TTS) with an objective to enhance solubility and skin permeability properties of metoclopramide base. Preformulation study begins with an approach to enhance solubility of 40 metoclopramide base by solid dispersion technique. transdermal films were prepared with 41 the solid dispersion as well as with pure drug. Phase solubility study at various temperatures reveals binding constants (Ka, 95-350 M-1 for PVP K30; 56-81 M-1 for HPßCD). Spontaneity of solubilization was justified by AL type linear profiles. The films showed satisfactory diffusion (%), permeation rate and flux after 8 h study. The transdermal patches as prepared were analyzed under FTIR, DSC and SEM. Both solubility and permeability rate in this investigation have been enhanced. So, it can be affirmed that this route would effectively enhance bioavailability


Subject(s)
Solubility , Metoclopramide/antagonists & inhibitors , Patients/classification , Pharmaceutical Preparations/administration & dosage , Biological Availability , Spectroscopy, Fourier Transform Infrared , Diffusion/drug effects , Drug Therapy , Administration, Intravenous/instrumentation , Motion Pictures , Neoplasms/pathology
4.
Braz. J. Pharm. Sci. (Online) ; 57: e19078, 2021. tab, graf
Article in English | LILACS | ID: biblio-1345449

ABSTRACT

1,5-Anhydroglucitol (1,5-AG) is a non-fasting glycemic marker that responds to hyperglycemia excursions. The reduction in serum levels of 1,5-AG is associated with an increase in postprandial glycemia and glycosuria, phenomena that increase the risk and severity of diabetic complications. The objective is to assess the ability of 1,5-AG to discriminate type 2 diabetes (T2D) patients without overt kidney disease, for screening or diagnostic purposes. The Human Research Ethics Committee of Universidade Federal do Paraná (UFPR) approved the project. Serum samples from 567 individuals classified as healthy subjects (n = 291) and T2D (n = 276) with moderate glycemic control (HbA1c of 7-8%), matched by gender, were analyzed. Serum 1,5-AG levels were measured using an automated enzymatic method (GlycoMark, Inc.). Receiver Operating Characteristic (ROC) curve analysis for 1,5-AG showed sensibility of 65.3% and specificity of 91.1% to detect T2D at cut-off point of 92 µmol/L. The results were similar to the groups' discrimination by glycemia (sensibility/specificity, 62.2%; 89.0%) at cut-off point of 6.3 mmol/L. HbA1c was the best discriminator (sensibility/specificity, 87.4%; 94.2%) at a cut-off point of 5.8% (40 mmol/mol). The serum 1,5-AG concentration was not able to discriminate T2D in the presence of moderate glycemic control with no overt nephropathy.


Subject(s)
Humans , Male , Female , Patients/classification , ROC Curve , Diabetes Mellitus, Type 2/pathology , Biomarkers , Diabetes Complications , Glycemic Control/instrumentation , Hyperglycemia/complications
5.
Braz. J. Pharm. Sci. (Online) ; 57: e18113, 2021. tab
Article in English | LILACS | ID: biblio-1339307

ABSTRACT

The effective insertion of the pharmacist into primary care is an important goal for health policies. The objective of this study was to describe and analyze pharmacists and Pharmaceutical Care in the primary health centers (UBS) of São Bernardo do Campo. Data were obtained through an interview applied to pharmacists. The instrument has three sections: (1) Pharmacist identification; (2) Pharmacist work; and (3) Pharmaceutical activities. Items in section 3 correspond to the guidelines of agencies that promote Pharmaceutical Care in the primary health system. All 24 pharmacists working in UBS in São Bernardo do Campo were interviewed. Every center dispensing medicines has a responsible pharmacist. These pharmacists are predominantly women and postgraduates. Activities of Pharmaceutical Care reported were: daily prescription analysis (75% of interviewees); monthly participation in patient groups (70.8%); monthly follow-up of pharmacotherapy adherence (58.3%); monthly participation in multiprofessional team meetings (54.2%); monthly home visits (12.5%); health education to the community (83.3%); and pharmacist consultation (37.5%). Frequency of prescription analysis and home visits was weakly associated with aspects of the pharmacist and the facility. This study showed that Pharmaceutical Services are structured in primary care in São Bernardo do Campo and many Pharmaceutical Care activities are offered in its UBS


Subject(s)
Humans , Male , Female , Pharmaceutical Services/classification , Primary Health Care/standards , Health Centers , Patients/classification , Pharmacists/ethics , Referral and Consultation/classification , Health Systems/organization & administration , Prescriptions/standards , House Calls/trends
6.
Braz. J. Pharm. Sci. (Online) ; 57: e18064, 2021. tab, graf
Article in English | LILACS | ID: biblio-1339301

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Pharmacists/ethics , Drug Prescriptions/standards , Health Care Costs , Medication Reconciliation/ethics , Medication Errors/adverse effects , Patients/classification , Pharmaceutical Preparations , Medical Records/statistics & numerical data , Patient Safety , Drug Misuse/statistics & numerical data , Hospitals/supply & distribution
7.
Braz. J. Pharm. Sci. (Online) ; 57: e19048, 2021. tab, graf
Article in English | LILACS | ID: biblio-1345460

ABSTRACT

Drug-resistant Acinetobacter baumannii is a frightening reality. The aim of this study is to examine the expression profiles of blaOXA-51 gene in carbapenemases producing A. baumannii treated with imipenem/sulbactam combination. Carbapenemases producing A. baumannii was identified among clinical isolates of A. baumannii obtained from patients at Shahid Rajaee hospital, Gachsaran, Iran, from January to June 2018. Synergism testing of imipenem/sulbactam on carbapenemases producing A. baumannii was carried out by broth microdilution method. Eventually, the expression of blaOXA-51 gene was carried out to investigate the inhibitory properties of imipenem/sulbactam combination against carbapenemases producing A. baumannii using quantitative real time RT-PCR. Among A. baumannii isolates, 24% were carbapenemases producing A. baumannii. Imipenem/sulbactam combination revealed synergistic and partial synergistic effect for all tested isolates (FIC= 0.313-0.75). Finally, imipenem/sulbactam combination displayed significant down-regulation of blaOXA-51 gene in carbapenemases producing A. baumannii. Imipenem synergizes with sulbactam against carbapenemases producing A. baumannii by targeting of the blaOXA-51 gene.


Subject(s)
Sulbactam/agonists , Imipenem/agonists , Acinetobacter baumannii/drug effects , Patients/classification , In Vitro Techniques/instrumentation , Pharmaceutical Preparations/analysis , Hospitals/classification , Methods
8.
Rev. medica electron ; 42(5): 2181-2192, sept.-oct. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1144726

ABSTRACT

RESUMEN Introducción: el síndrome compartimental abdominal es una entidad clínica sistémica desencadenada por incremento en la presión intraabdominal, caracterizada clínicamente por distensión abdominal y alteraciones de las funciones respiratoria, cardiovascular, neurológica y renal. Objetivo: caracterizar el comportamiento del síndrome compartimental abdominal en los pacientes críticos que ingresaron en la unidad de cuidados intensivos del Hospital Provincial "José Ramón López Tabrane". Materiales y método: se realizó un estudio prospectivo, descriptivo, y longitudinal que tuvo como universo los pacientes adultos con factores de riesgo conocidos para síndrome compartimental abdominal, tratados entre enero de 2014 a diciembre de 2015. Se le realizó medición sistemática de la presión intraabdominal transvesical y fueron sometidos a descompresión quirúrgica en caso de hipertensión intraabdominal grados III y IV. Resultados: los valores de presión intraabdominal sostenidamente elevados, son directamente proporcionales al desarrollo del síndrome compartimental abdominal y trae aparejado disfunciones en los diferentes sistemas de órganos; en estos casos apareció complicaciones, las cuales se presentaron combinadas para todos los pacientes, y fueron mayoritarias para el grupo con presión intraabdominal grado IV. La mortalidad se comportó en un número bastante elevado lo cual estuvo relacionado con los niveles de presión intraabdominal, así como la posibilidad de que fueran reintervenidos quirúrgicamente estos pacientes. Conclusiones: se debe protocolizar en todo paciente con sospecha de desarrollar un síndrome compartimental abdominal la medición periódica de la presión intraabdominal (AU).


SUMMARY Introduction: the abdominal compartment syndrome is a systemic clinical entity triggered by an increase of the intra abdominal pressure, clinically characterized by abdominal distension and the alteration of the renal, neurological, cardiovascular and respiratory functions. Objective: to characterize the behavior of the abdominal compartment syndrome in critical patients from the intensive care unit of the provincial hospital "Jose Ramon Lopez Tabrane". Materials and methods: a longitudinal, descriptive and prospective study was carried out in a universe of adult patients with risk factors known as abdominal compartment syndrome, treated in the period of time from January 2014 to December 2015. Their transvesical intraabdominal pressure was systematically measured and they underwent surgical decompression in cases of intraabdominal hypertension grades iii and iv. Results: the values of intraabdominal pressure steadily increased are directly proportional to the development of the abdominal compartment syndrome and entails dysfunctions in the different systems of organs; in these cases complications were found, that were combined for all patients and mainly in the group with intraabdominal pressure grade iv. Mortality was present in a certainly increased group, and was related to the levels of intraabdominal pressure, and also to the possibility these patients undergoing surgical treatments again. Conclusions: it should be standardized the periodical measure of the intraabdominal pressure in any patient suspected of developing an abdominal compartment syndrome (AU).


Subject(s)
Humans , Male , Female , Patients/classification , Intra-Abdominal Hypertension/epidemiology , Surgical Procedures, Operative/methods , Critical Care/methods , Intra-Abdominal Hypertension/classification , Intra-Abdominal Hypertension/diagnosis , Patient Acuity , Intensive Care Units/standards
9.
Guatemala; MSPAS. Coordinación de Hospitales; 22 may 2020. 18 p. graf.
Non-conventional in Spanish | LILACS, LIGCSA | ID: biblio-1102036

ABSTRACT

Fecha de actualización: 22 de mayo 2020. Documento de orientación provisional procura fortalecer la respuesta de los servicios hospitalarios ante la posibilidad de tener casos en el país de COVID-19, especialmente en la de la atención clínica de los pacientes sin dejar de lado la prevención de la transmisión a través del fortalecimiento de las precauciones estándar en la prevención y control de infecciones, con énfasis en el lavado de manos y el uso de equipo protección personal por parte del personal de salud. El objetivo es proveer lineamientos para una respuesta oportna ante el Nuevo Coronavirus - COVID-19. Garantizar el acceso a los servicios de salud, con provisión de insumos, medicamentos, y recurso humano calificado para atención de IRAG priorizando los hospitales fronterizos de atención de primera línea. Investigar clínicamente y toma de muestra de laboratorio de todo caso sospechoso de Nuevo Coronavirus.


Subject(s)
Humans , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Guidelines as Topic , Betacoronavirus , Patients/classification , Public Health Surveillance , Guatemala
10.
Rev. medica electron ; 42(1): 1607-1621, ene.-feb. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1127018

ABSTRACT

RESUMEN Introducción: en febrero de 2010 se introdujo la técnica colangiopancreatografía retrógrada endoscópica en la provincia de Matanzas, dando cobertura a los casos con esta indicación, y atendiendo a un importante grupo de pacientes en edad geriátrica. Objetivo: describir los resultados después de ocho años de trabajo. Material y Métodos: se realizó un estudio descriptivo, transversal, en pacientes mayores de 65 años, quienes se realizaron el estudio en el servicio de Cirugía de Mínimo Acceso del Hospital Universitario Clínico Quirúrgico "Comandante Faustino Pérez Hernández", en el período de enero 2010 a enero de 2018. La población de estudio quedó conformada por 698 pacientes, que cumplieron con los criterios de inclusión con 713 informes de colangiopancreatografía retrógrada endoscópica. Resultados: predominó el sexo femenino y la canulación del conducto deseado, se utilizó como técnica complementaria el pre corte, en cuanto a los diagnósticos realizados la litiasis coledociana resultó ser el más frecuente, y la colangiopancreatografía retrógrada endoscópica con acción terapéutica fue la más realizada con la pancreatitis como complicación más encontrada, fallecieron en el período estudiado cuatro pacientes como consecuencia de colangitis aguda grave. Conclusiones: los resultados obtenidos son similares a los realizados, en poblaciones sometidas al proceder en general, independientemente a la edad de los pacientes, resultando ser un proceder seguro en edades geriátricas, siendo la colangiopancreatografía retrógrada endoscópica en este medio un arma con gran utilidad diagnóstica y terapéutica con una frecuencia de morbi-mortalidad que lo garantiza (AU).


SUMMARY Introduction: the endoscopic retrograde cholangiopancreatography technique was introduced in the province of Matanzas in February 2010, for the treatment of the cases with this indication and attending an important group of patients in geriatric age. Objective: to describe the results of this technique after eight years of use. Method: a descriptive, cross-sectional study was carried out in patients aged more than 65 years, who were attended in the service of Minimal Access Surgery of the Clinical Surgical University Hospital "Comandante Faustino Pérez Hernández", in the period January 2010-January 2018. The studied population was 698 patients who fulfilled the inclusion criteria for 713 reports of endoscopic retrograde cholangiopancreatography. Results: female sex and cannulation of the desired duct predominated; pre-cut was used as complementary technique. Choledocholithiasis was the most frequent diagnosis; the most used therapeutic action was endoscopic retrograde cholangiopancreatography, and pancreatitis was the most commonly found complication. In the studied period, four patients died as a consequence of severe acute cholangitis. Conclusions: the obtained results are similar to those obtained in populations undergoing the procedure in general, patients´ age-independent. It is a safe procedure in geriatric ages. The endoscopic retrograde cholangiopancreatography is a tool of a great diagnosis and therapeutic usefulness in our midst, with a morbid-mortality frequency guarantying it (AU).


Subject(s)
Humans , Male , Female , Aged , Cholangiopancreatography, Endoscopic Retrograde/methods , Patients/classification , Minor Surgical Procedures/methods , Cholangiopancreatography, Endoscopic Retrograde/standards , Methods
11.
Braz. J. Pharm. Sci. (Online) ; 56: e18551, 2020. tab, graf
Article in English | LILACS | ID: biblio-1142487

ABSTRACT

We performed this study to measure the Tumor Necrosis Factor-alpha (TNF-α) plasma level and to survey its correlation with disease activity in the newly diagnosed Rheumatoid Arthritis (RA) patients and those who were under treatment with the combination of Disease-Modifying Anti-Rheumatic Drug (DMARD) plus Prednisolone (PSL).We enrolled 30 newly diagnosed RA patients who received no treatment regarding their disease, 30 patients under treatment with the combination of Methotrexate (MTX) + Hydroxychloroquine (HCQ) + PSL and 30 healthy subjects in this case-control study from September 2017 to December 2017. The level of plasma TNF-α was measured by enzyme-linked immunosorbent assay (ELISA) in each group. For assessment of disease severity, we used Disease Activity Score-28 (DAS-28) formula, and regarding DAS-28, we divided patients into four groups, including remission, low, moderate and high disease activity. There were no significant differences in the plasma level of TNF-α between the newly diagnosed RA patients and subjects who received MTX + HCQ + PSL, as well as healthy controls (p>0.05). There was a significant correlation between plasma levels of TNF-α and DAS-28 in the newly diagnosed patients with RA (r = 0.594, P = 0.001). Targeting TNF-α at the early stage of RA could have more beneficial effects on the amelioration of disease activity


Subject(s)
Patients/classification , Arthritis, Rheumatoid/pathology , Lymphotoxin-alpha/pharmacology , Antirheumatic Agents/administration & dosage , Enzyme-Linked Immunosorbent Assay , Tumor Necrosis Factor-alpha/pharmacology , Antirheumatic Agents
12.
Braz. J. Pharm. Sci. (Online) ; 56: e18715, 2020. tab
Article in English | LILACS | ID: biblio-1285511

ABSTRACT

This study was aimed to calculate in detail the costs of a medication dispensing service in community pharmacy in Brazil. Descriptive and retrospective analysis with a cost analysis based on mixed costing; absorption costing and time-driven activity based-costing, considering year 2018 and both public and private health system perspectives within a one-year time horizon to estimates costs related to implement and to deploy the service, costs per patient and costs per activity of process (US$ 1 = R$ 3.8310 in October, 2018). Total costs of dispensing service ranged from US$ 24,451.61 to US$ 37,914.48. Costs per patient ranged from US$ 2.43 to US$ 3.77. Costs per activity of the process ranged from US$ 0.39 in pharmacotherapy assessment to US$ 2.46 in pharmaceutical interview. This provides evidence to deploy and implement a structured medication dispensing service in community pharmacy in Brazil with a view to optimize the usage of medicines.


Subject(s)
Humans , Male , Female , Pharmaceutical Preparations/classification , Costs and Cost Analysis/statistics & numerical data , Products Commerce , Patients/classification , Pharmacies/statistics & numerical data , Health Systems/organization & administration , Drug Therapy/classification
13.
Braz. J. Pharm. Sci. (Online) ; 56: e18028, 2020. tab, graf
Article in English | LILACS | ID: biblio-1249168

ABSTRACT

Pharmaceutical care (PC) is in the implementation process in Brazil and Latin America. Synthesis of evidence has been requested for monitoring and evaluating the process regarding the treatment effect. The objective is to build and disseminate a systematic review protocol to make a standard for updating results from pharmaceutical care for hypertension and for other diseases. This is a protocol for systematic review studies regarding a real example of a protocol reasoned in pharmaceutical care for hypertension in primary care. This protocol was delineated grounded in the Cochrane Handbook. Descriptors and words were defined using MeSH (Medical Subject Headings), DeCS (Descriptors in Health Sciences) and Emtree thesaurus, and the search was performed in English, Spanish and Portuguese, without filters, up to March, 27th, 2017. The results were structured in the PRISMA flowchart. Results found from all databases were: the Cochrane Library (n= 202); PubMed (n= 2608); LILACs (n= 909); Embase (n= 1653); Scopus (n=1298); IPA (n=967); and Web of Sciences (n=435). From these, 1688 were duplicate articles. The content of this paper can aid the constant monitoring of pharmaceutical care implementation and contribute to the improvement of the quality and evidence levels of published studies.


Subject(s)
Pharmaceutical Services/organization & administration , Primary Health Care/standards , Systematic Reviews as Topic , Hypertension/drug therapy , Patients/classification , Evidence-Based Medicine/statistics & numerical data , Medical Subject Headings
14.
Braz. J. Pharm. Sci. (Online) ; 56: e18567, 2020. tab, graf
Article in English | LILACS | ID: biblio-1249167

ABSTRACT

Microbial translocation is associated with the increased risk of cardiovascular disease in HIV-infected individuals. There is scarce information regarding the possible associations between the biomarkers of microbial translocation, inflammation and cardiovascular risk that can be evaluated in clinical laboratories using plasma or serum samples. This systematic review was conducted according to the PRISMA protocol in order to verify the most used soluble biomarkers of microbial translocation, inflammation and cardiovascular risk, as well as possible associations between them, in HIV-infected individuals. A search was performed using the Medline, Scopus and Web of Science databases to identify existing studies regarding the relationship between microbial translocation biomarkers, inflammation and cardiovascular risk in HIV-infected patients. Eleven articles that presented soluble biomarkers of microbial translocation (LPS, rDNA, sCD14, LBP and EndoCAb) were selected. The most frequently evaluated soluble biomarker was sCD14, followed by LPS; the latter were associated with some lipid profile parameters. This systematic review considered soluble blood biomarkers that can be utilized in laboratory diagnosis. The aim was to identify the interconnection between microbial translocation, inflammation and cardiovascular risk. Despite the fact that a large number of inflammation and cardiovascular risk biomarkers have been previously reported, it was noted that important markers involved in the pathophysiology of cardiovascular diseases need to be included in future research.


Subject(s)
Patients/classification , Biomarkers/analysis , Cardiovascular Diseases/physiopathology , HIV/pathogenicity , Systematic Review , Heart Disease Risk Factors , Inflammation/physiopathology , Blood , Risk , Lipopolysaccharide Receptors , Clinical Laboratory Techniques/instrumentation
15.
Braz. J. Pharm. Sci. (Online) ; 56: e18600, 2020. tab, graf
Article in English | LILACS | ID: biblio-1249141

ABSTRACT

To find the predictors of High Dose Methotrexate toxicities in childhood Acute Lymphoblastic Leukemia Patients. This study included 198 Childhood Acute Lymphoblastic Leukemia patients (303 infusions) who were treated with High Dose Methotrexate. Methotrexate levels at different time point were measured by modified enzyme multiplied immunoassay technique assay. The correlation between Methotrexate levels and toxicity was evaluated by Receiver Operating Characteristic curve. When the Methotrexate level at 42 h was lower than 0.76 µmol/L, the sensitivity for predicting thorough clearance at 66 h was 90.78%. When the Methotrexate level at 42 h was higher than1.5 µmol/L, the sensitivity for predicting delayed clearance was 82.17%. When the Methotrexate level at 66 h was higher than 0.5 µmol/L, the sensitivity for predicting Methotrexate toxicity was 89.09%. When the Methotrexate level at 66 h was lower than 0.1 µmol/L, the sensitivity for predicting Methotrexate nontoxicity was 92.73%. The Methotrexate level at 42 h could be predictor for delayed clearance. The Methotrexate level at 66 h could be predictor for toxicity.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Patients/classification , Methotrexate/administration & dosage , Methotrexate/analysis , Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology , Forecasting , ROC Curve , Enzyme Multiplied Immunoassay Technique/instrumentation , Dosage/adverse effects
16.
Braz. J. Pharm. Sci. (Online) ; 56: e17184, 2020. tab
Article in English | LILACS | ID: biblio-1132039

ABSTRACT

To evaluate the clinical outcomes of daptomycin therapy and adherence to treatment recommendations, a retrospective cohort study was conducted with patients that received daptomycin during the period of the study. The adherence and nonadherence to clinical guidelines were assessed through organism identification, dose and time of treatment, management of bacteremia, and vancomycin treatment failure. A multiple logistic regression model analyzed the association between independent variables and clinical success (dependent variable), considering 5% of statistical significance. The study presented 52 patients who received daptomycin for the treatment of bacteremia (21.1%) or infections (osteomyelitis [63.5%], synovial fluid [15.4%]). Most patients (86.5%) received daptomycin as the second line of treatment, and 51.9% achieved clinical success. The patients had a better chance of clinical success when they followed the guideline indications (OR = 16.86; 95% CI = 1.45-195.88) and the medication was prescribed by a specialist in infectious diseases (OR = 4.84; 95% CI = 1.11-21.09). The study demonstrated lower clinical success than that described in the literature because of patients who were not eligible according to the clinical guidelines. Adherence to recommendations and appropriate prescription of reserve antibiotics is important in limiting early resistance, and avoiding clinical failure and unnecessary expenditure.


Subject(s)
Cohort Studies , Treatment Failure , Daptomycin/analysis , Anti-Bacterial Agents/adverse effects , Patients/classification , Product Surveillance, Postmarketing , World Health Organization , Communicable Diseases/complications , Gram-Positive Bacterial Infections/classification , Dosage/adverse effects
17.
Braz. J. Pharm. Sci. (Online) ; 55: e17536, 2019. tab, graf
Article in English | LILACS | ID: biblio-1055294

ABSTRACT

Tadalafil, a long-acting PED-5 inhibitor, is commonly used for the treatment of pulmonary arterial hypertension (PAH). However, its efficacy and clinical application are severely limited by the poor water solubility, low bioavailability and a series adverse effects (e.g. headaches, indigestion). In this study, tadalafil was prepared and loaded into biodegradable PLGA (poly(lactic-co-glycolic acid)) microspheres (TDF-PLGA-MS) via emulsification-solvent evaporation. The resulting microspheres were processed into pulmonary inhalant by freeze drying. The TDF-PLGA-MS was spherical and uniform, with an average particle diameter ~10.29 µm. The encapsulation efficiency and drug loading yield of TDF-PLGA-MS were 81.68% and 8.52%, respectively. The investigation of micromeritics showed that the TDF-PLGA-MS had low moisture content. The fluidity of powders was relatively good. The aerodynamic diameter and emptying rate of microspheres powders were 3.92 µm and 95.41%, respectively. Therefore, the microspheres powders were easy to be atomized, and can meet the requirements of pulmonary administration. In vitro release results showed that the microspheres group released slowly. The cumulative release in 24 h and 10 d was 46.87% and 84.06%, respectively. The in vitro release profile of TDF-PLGA-MS was in accordance with the Weibull model. The results of Pharmacokinetics showed that tadalafil from microspheres slowly released into the blood after intratracheal instillation. The pulmonary drug residue in 0.5 h was 3.5 times compared with solution group. The residual concentration in lung after 10d was still higher than that of solution group in 48 h. The t1/2β and MRT0-∞ were 3.10 times and 3.96 times that of solution group, respectively. Moreover, the Cmax and AUC of drug residues in lung ​​were 3.48 times and 16.36 times that of solution group, respectively. The results of tissue distribution showed that the Re in lung was 16.358, which indicated the lung targeting. In conclusion, the TDF-PLGA-MS for pulmonary administration in this study can significantly improve the pulmonary targeting, increase efficacy of tadalafil and reduce other non-target organs toxicity. This study will have an important clinical significance for PAH patients who need long-term drug therapy.


Subject(s)
Pharmacokinetics , Tadalafil/adverse effects , Pulmonary Arterial Hypertension/drug therapy , Microspheres , Patients/classification , Solubility/drug effects , In Vitro Techniques/instrumentation , Pharmaceutical Preparations/administration & dosage , Drug Therapy , Lung
19.
Rev. gaúch. enferm ; 39: e20170107, 2018. tab, graf
Article in Portuguese | LILACS, BDENF | ID: biblio-960805

ABSTRACT

Resumo OBJETIVO Aplicar recursos da tecnologia PRAXIS® para classificação de pacientes e dimensionamento de profissionais de enfermagem em unidade de internação de hospital universitário. METODO Pesquisa Convergente Assistencial seguindo as fases de concepção e instrumentação - definidos tema e objetivo da pesquisa, realização em uma unidade hospitalar de clínica médica envolvendo 633 participantes; perscrutação - classificação dos pacientes durante 30 dias de junho de 2016, seguido de dimensionamento; análise e interpretação dos resultados-elaborada com suporte da teorização de gestão em enfermagem hospitalar. RESULTADOS Realizadas 633 classificações e encontrados 29,38% pacientes em cuidados mínimos, 35,71% cuidados intermediários, 33,02% alta dependência, 1,42% semi-intensivos e 0,47% cuidados intensivos. Para realização do dimensionamento utilizou-se duas referências; em ambas a equipe disponibilizada mostrou-se deficitária. CONCLUSÃO Classificação de pacientes e dimensionamento de profissionais de enfermagem estão diretamente relacionados, são indispensáveis para gestão em enfermagem e de difícil realização cotidiana. Tecnologias informatizadas são úteis para realização destas atividades.


Resumen OBJETIVO aplicar recursos de la tecnología PRAXIS® para la clasificación y dimensionamiento de profesionales de enfermería en una unidad de internación de un hospital universitario. MÉTODO investigación convergente asistencial, siguiendo las etapas de concepción e instrumentación - definidos el tema y objetivo de la investigación, realización en una unidad hospitalaria de clínica médica involucrando a 633 participantes; escrutación - clasificación de los pacientes durante 30 días de junio de 2016, seguida de dimensionamiento. Análisis e interpretación de los resultados elaborados con soporte de la teorización de gestión en enfermería hospitalaria. RESULTADOS se realizaron 633 puntuaciones y se encontraron 29,38% pacientes en cuidados básicos, 35,71% en cuidados intermedios, 33,02% en alta dependencia, 1,42% en semi-intensivos, y 0,47% en cuidados intensivos. Para realizar el dimensionamiento, se utilizaron dos referencias. En ambos el equipo disponible se mostró deficiente. CONCLUSIÓN la clasificación de pacientes y el dimensionamiento de los profesionales de enfermería están directamente vinculados, son indispensables para la gestión en enfermería y de difícil realización cotidiana. Las tecnologías informatizadas son útiles para realizar estas actividades.


Abstract OBJECTIVE Applying PRAXIS® technology resources for patient classification and nursing professional sizing in university hospital inpatient unit. METHOD Convergent Care Research following the design and instrumentation phases - defined the research theme and purpose, performed in a medical clinic hospital unit involving 633 participants; scrutiny - classification of patients during 30 days of June 2016, followed by sizing, analysis and interpretation of the results - elaborated with the support of the management theorization in hospital nursing. RESULTS Amongst the total of 633 classifications made, 29.38% were patients in minimal care, 35.71% were intermediate care patients, 33.02% were highly dependent, 1.42% were semi-intensive and 0.47% were in intensive care. Two references were used to carry out the sizing; in both the available team showed to be in deficit. CONCLUSION The classification of patients and the sizing of nursing professionals are directly related, they are indispensable for management in nursing and difficult to perform daily. Computerized technologies are useful for performing these activities.


Subject(s)
Humans , Patients/classification , Nursing Staff, Hospital/supply & distribution , Patients/statistics & numerical data , Personnel Administration, Hospital/methods , Quality of Health Care , Software , Brazil , Patient Acuity , Hospital Bed Capacity , Hospital Units/statistics & numerical data , Intensive Care Units/statistics & numerical data , Nursing Assistants/organization & administration , Nursing Assistants/supply & distribution , Nursing Staff, Hospital/organization & administration , Nursing Staff, Hospital/statistics & numerical data
20.
Braz. J. Pharm. Sci. (Online) ; 53(2): e16089, 2017. tab, graf
Article in English | LILACS | ID: biblio-839488

ABSTRACT

ABSTRACT Metabolic syndrome (MetS) is a group of different risk factors that raises the chances of develop several health problems such, as cardiovascular disease and diabetes. There are few cases in literature of studies that specifically address the use of pharmaceutical care in MetS. The aim of study was to evaluate the effectiveness of home pharmaceutical interventions in patients with this syndrome. The randomized clinical trial was conducted in subjects with diagnosis of MetS treated in a basic unit of health from Cuité, Paraíba. The patients were randomized in a 1:1 ratio to two groups: intervention (IG) and control (CG). The IG received monthly individual pharmaceutical interventions, while the CG did not. The effectiveness of the intervention protocol was measured after six months, comparing the hemodynamic values, anthropometric, biochemistry, cardiovascular risk, medication adherence, drug related problems (DRP) and quality of life. The sample consisted of 63 individuals (33 IG and 30 CG) and older than 60 years. The majority of pharmaceutical interventions were educational and/or behavioral. In the intervention group, significant differences were observed in the parameters systolic and diastolic blood pressure, triglycerides, medication adherence and DRP. The pharmaceutical interventions at home were effective in improving medication adherence, decreasing DRPs and helping to control components of the metabolic syndrome.


Subject(s)
Humans , Male , Female , Infant , Adult , Middle Aged , Aged , Aged, 80 and over , Randomized Controlled Trial , Metabolic Syndrome/prevention & control , /statistics & numerical data , Evaluation of the Efficacy-Effectiveness of Interventions , Patients/classification , Drug Storage
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