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ObjectiveBased on the integrated strategy of "empirical prescriptions in ancient books-medical cases by prestigious doctors-computational analysis"， this study aims to explore and analyze the prescriptions and medical cases for treating tremors in traditional Chinese medicine （TCM）， predict their efficacy， and obtain the core prescriptions for treating tremors in TCM， providing references for clinical application and new drug development. MethodThe Chinese Medicine Prescription Database and the China National Knowledge Infrastructure （CNKI） were searched for relevant prescriptions and medical cases for treating tremors in TCM to establish a database of prescriptions for tremors. The Traditional Chinese Medicine Inheritance Computer System （V3.0） was used to analyze and explore the medication rules including drug frequency， properties， flavor， meridian tropism， and pharmacological effects， as well as core drugs and formula associations. A multi-target drug efficacy prediction platform based on network robustness was used to evaluate the predicted efficacy of the core prescriptions obtained. Based on the integration of ancient prescriptions， prestigious doctors' medical cases， and network analysis results， the priority level of the developed prescriptions was determined through comprehensive evaluation. ResultA total of 81 ancient prescriptions were screened， involving 246 drugs， and 171 prescriptions were screened from prestigious doctors' medical cases， involving 278 drugs. The frequently used TCM drugs were mostly warm in nature and sweet in flavor， mainly acting on the liver， spleen， and kidney meridians. In terms of efficacy， they were mainly effective in tonifying deficiency， soothing liver and extinguishing wind， activating blood and resolving blood stasis， clearing heat， and resolving exterior. Through association rules and K-means clustering， the core prescriptions were composed of high-frequency drugs such as Glycyrrhizae Radix et Rhizoma， Ginseng Radix et Rhizoma， Astragali Radix， Atractylodis Macrocephalae Rhizoma， Angelicae Sinensis Radix， Poria， Gastrodiae Rhizoma， and Uncariae Ramulus Cum Uncis. Drug combinations mainly focused on tonifying Qi and nourishing blood， with the additional functions of calming wind and dredging collaterals. Clustering analysis of core prescriptions from ancient prescriptions and prestigious doctors' medical cases， as well as multi-target drug efficacy prediction， showed that Combination 1 had the highest disturbance score on the disease network. Furthermore， comparative analysis revealed consistent results with both the analysis of ancient prescriptions and prestigious doctors' medical cases， indicating its optimal development potential based on theoretical inheritance and empirical practice. In comparison， Combinations 3， 2， and 4 were less utilized in contemporary clinical practice， with lower rankings in network disturbance scores， suggesting that their development value still warranted further exploration. ConclusionTCM clinical treatment of tremors emphasizes the regulation of the liver， spleen， and kidney. In line of syndrome differentiation， drugs potent in soothing liver， extinguishing wind， activating blood， and resolving blood stasis are added based on deficiency-tonifying drugs. The core prescriptions based on Glycyrrhizae Radix et Rhizoma， Angelicae Sinensis Radix， Paeoniae Radix Alba， Astragali Radix， Poria， and Atractylodis Macrocephalae Rhizoma （combination 1） have the highest potential development value. The integrated strategy "empirical prescriptions in ancient books-medical cases by prestigious doctors-computational analysis" can be used for the screening of candidate prescriptions for new TCM drugs.
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Objective Data mining method was used to analyze the Chinese herbal prescriptions for oral use in treating venomous snake bites collected from the major domestic literature databases and the surgery volume of Zhong Hua Yi Fang(Chinese Medical Prescriptions),so as to explore their potential prescription and medication rules,and to provide references for the treatment of venomous snake bites in the primary hospitals.Methods The Chinese herbal prescriptions for oral use in treating venomous snake bites were retrieved from the CNKI,VIP and Wanfang databases,and the ancient formulas for treating venomous snake bites were screened in the surgery volume of Zhong Hua Yi Fang(Chinese Medical Prescriptions).Excel software was used to extract the relevant information of the formulas,and R language was used to analyze the medication frequency,properties,flavors and meridian tropism of the herbs as well as their association rules and clustering analysis.Results A total of 187 prescriptions for oral use in treating venomous snake bite were obtained,involving 284 Chinese herbal medicines.The top 15 Chinese herbal medicines in decreasing sequence of medication frequency were Lobeliae Chinensis Herba,Rhei Radix et Rhizoma,Angelicae Dahuricae Radix,Glycyrrhizae Radix et Rhizoma,Paridis Rhizoma,Rehmanniae Radix,Coptidis Rhizoma,Scutellariae Radix,Lonicerae Japonicae Flos,Paeoniae Radix Rubra,Moutan Cortex,Hedyotis Diffusae Herba,Imperatae Rhizoma,Plantaginis Herba,and Scutellariae Barbatae Herba.The flavor of herbs in the prescription for the treatment of venomous snakebite was usually bitter,pungent and sweet,and their property was relatively cold.Most of the herbs had the meridian tropism of the liver meridian and lung meridian.The core prescription mainly composed of Rhei Radix et Rhizoma,Lobeliae Chinensis Herba,and Paridis Rhizoma was obtained after association rule analysis and cluster analysis.Conclusion The herbs for the treatment of venomous snake bites often have the actions of clearing heat and removing toxins,and the prescription is usually composed of Rhei Radix et Rhizoma,Lobeliae Chinensis Herba,Paridis Rhizoma together with the compatibility of medicines for clearing heat and cooling blood,extinguishing wind and arresting convulsion,clearing heat and promoting urination.
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With reference to Xin Diao Sun Zhen Ren Qian Jin Fang,the Xindiao's edition of Bei Ji Qian Jin Yao Fang(Invaluable Prescriptions for Emergencies)which was the popular edition before official block printing of the Northern Song Dynasty),we analyzed the collation for proof-reading method in Song's edition of Bei Ji Qian Jin Yao Fang(Invaluable Prescriptions for Emergencies)printed by Bureau of Correcting Medical Books in Northern Song Dynasty.The results showed that there are many omissions and erroneous annotations in the collation records of the Song's edition,indicating that the judgment of the scholarly value of textual difference and the criteria of selecting and omitting the annotations of textual difference in the Song's edition require further studies.Some of the collation records in the Song's edition were consistent with those of the Xindiao's edition,suggesting that the Xindiao's edition was referenced during the collation by the officials of the Song Dynasty.In compiling Bei Ji Qian Jin Yao Fang,the original edition and the collated edition were not defined by the officials of the Song Dynasty,multiple hand copies in Tang Dynasty were collected for reference,and multiple medical records in Tang Dynasty and before Tang Dynasty were referenced.For the proofreading work of the Bureau for Revising Medical Books was in charge by scholars and Confucian ministers,we proposed that the complexity during compiling the book and the uncertainty of the text should be paid more attention.It is necessary to further clarify the basic issues such as the origin,basic structure,references and citation methods of the Song's edition,so as to provide reference for understanding the characteristics of the edition correctly and making effective use of the literature.
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[Objective]To explore the role of vinegar in ancient prescriptions,inherit and explore the unique value of vinegar in traditional Chinese medicine,and provide reference for modern clinic.[Methods]Based on the records of the efficacy of vinegar in traditional Chinese medicines and medical records from various dynasties,this paper classifies and sorts out the ancient literature on the vinegar in prescriptions.Combining the Qi and taste of vinegar,the theory of reinforcing and reducing about viscera,and the idea of visceral-Qi corresponding to nature rhythms,this paper explores the role of vinegar in prescriptions from five aspects:promoting Qi and blood circulation,promoting blood circulation and stopping bleeding,healing sores and relieving swelling,clearing heat and detoxicating,and calming endogenous wind and blooming the sprit.[Results]The sour taste of vinegar acting on the liver helps to regulate activities of Qi,tonifies the lungs to help regulate water passages,fragrance and warm of vinegar promote Qi,bitter and warm of vinegar eliminate dampness,thus eliminating the concretions and gatherings,and resolving phlegm-dampness.Vinegar fragrance acts on the spleen and sour acts on the liver,vinegar can achieve the effect of promoting blood circulation and stopping bleeding by regulating the liver and spleen.The main reason for its application in skin diseases is that vinegar tonifies the lungs with the sour taste,and lungs govern skin and hair,and vinegar has astringent properties.The sour taste of vinegar acting on the liver can help the liver detoxify,while the bitter taste can clear heat and detoxicate.Therefore,vinegar is often used in prescriptions such as detoxification of drugs,food and insects,etc.Sour acts on the liver to control conveyance and dispersion,while the fragrance of vinegar acts on the spleen to refresh the mind,so it is also used to treat symptoms such as stroke and fainting.[Conclusion]Vinegar tastes sour,bitter,fragrant and warm.It is the main reason why vinegar is used as a necessary medicine in promoting Qi and blood circulation,promoting blood circulation and stopping bleeding,healing sores and relieving swelling,clearing heat and detoxicating,and calming endogenous wind and blooming the spirit.According to the theory of reinforcing and discharging viscera,sour acts on the liver;According to the theory of visceral-Qi corresponding to nature rhythms,sour can regulate the heart,liver and lung.By combing the application of vinegar in ancient prescriptions systematically,it helps to provide literature support and theoretical reference for further improving the clinical application of vinegar in prescription.
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[Objective]To summarize the academic experience of Director ZHAO Hongli in the treatment of male infertility with six meridians syndrome differentiation.[Methods]By summarizing the clinical cases of male infertility treated by Director ZHAO and combining his interpretation of the six meridians syndrome differentiation,this paper summarizes Director ZHAO's experience in treating this disease with six meridians syndrome differentiation,fully elaborates the characteristics of the disease and the diagnosis and treatment ideas,and verifies and analyzes it with a typical medical case.[Results]Director ZHAO believes that male infertility has many clinical symptoms and can be treated with six meridians syndrome differentiation.The first step in syndrome differentiation is to distinguish between deficiency and excess.Those who belong to the excess category are based on the disease of the six Fu organs and Yang meridians,which are mostly three Yang disease patterns.Those who belong to the deficiency category are based on the disease of the five Zang organs and Yin meridians,which are mostly three Yin disease patterns.Director ZHAO carefully observes the pathogenesis and also establishes cold-heat complex type of male infertility,using Banxia Xiexin Decoction to communicate Yin and Yang.In terms of drug application,attention should be paid to patients'innate physique,combining Chinese and western medicine according to the characteristics of laboratory tests,advocating food therapy at the same time as medication,and paying attention to psychological counseling.In the case presented,the patient experienced erectile dysfunction after marriage,symptoms differentiation was of Yangming Channel syndrome.Treatment involved modified Gegen Qinlian Decoction to clear the Yangming heat,combined with Simiao Powder to clear damp-heat in lower-Jiao.After more than three months of comprehensive treatment based on the evolving symptoms,the patient's wife was successfully conceived.[Conclusion]Director ZHAO deeply verses in the classics,applies the six meridians syndrome differentiation to the treatment of male infertility innovatively,emphasizing individualized treatment based on syndrome differentiation,receiving remarkable efficacy,which offers a new perspective for both the clinical application of classical prescriptions and the treatment of male infertility.
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[Objective]To explore the specificity and effectiveness of Medical Records Integration of Palace in Qing Dynasty for the treatment of diseases,and to provide a reference for the modern clinical external therapy.[Methods]Taking 117 fumigating and washing decoctions in Medical Records Integration of Palace in Qing Dynasty as the research object,using Excel software,the formulas,dosage,medicinal properties,and efficacy of Qinggong fumigating and washing decoctions were organized and counted.Combining with the relevant medical cases and the commentaries in the book,the use of the fumigating and washing decoctions in the Qing Palace was systematically organized.[Results]The 117 fumigating and washing decoctions in Medical Records Integration of Palace in Qing Dynasty show many features such as there are many kinds of formula,the quality of the formula is refined;the effect is strength and special focus,formula with modification according to symptoms,flexible usage of medicine,treatment first,independent use of the amount of medicine,good use of the wind-extinguishing medicinal,filling in the poisonous features when needed.It also has other advantages such as a wide range of audiences,a unique approach,sophisticated instruments,and a meticulous process of preparation of the liquid.[Conclusion]The use of the fumigating and washing decoctions in Medical Records Integration of Palace in Qing Dynasty has palace characteristics and advantages,exploring its use can gain unique insights and revelations,which helps to carry forward the characteristics of court medication and promotes the development of external therapeutic methods of traditional Chinese medicine as high research value.
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Objective Based on the theory of"lung governs the skin and hair"in"Yellow Emperor's Inner Classic",this paper analyzes the medication rules of whitening and freckle-removing.The aim of this study is to provide reference for the clinical practice of traditional Chinese medicine(TCM)theory and the medication in TCM cosmetics.Methods"Chinese Medical Classics"was used to search the records of whitening and freckle-related drugs.The frequency,nature,flavor,meridian tropism and compatibility laws of TCM for whitening and freckle-removal were analyzed by statistics and association rules.The network pharmacology research was used to analyze the whitening and freckle-removing effects and mechanisms of high-frequency drugs.Then,the potential active ingredients were analyzed.The whitening and anti-freckle effect was verified through cytotoxicity experiments and melanin content detection.Results A total of 171 external prescriptions were selected in eligible articles,including 261 Chinese medicinals,most of which were pungent and belong to the lung meridian.The most frequently used Chinese medicinals was"Erbai Yixin"(EBYX,Angelicae Dahuricae Radix,Typhonii Rhizoma,Asari Radix et Rhizoma).Network pharmacological analysis showed that the core targets of EBYX for whitening and removing freckles are TP53,EGFR,ALB,etc.,which are mainly involved in oxygen perception and response,skin immune regulation,skin cell growth,differentiation,stress,inflammatory response,and other biological processes.Based on the results of molecular docking,biological analysis proved that the active ingredients of EBYX are chrysophanol,gallic acid and caffeic acid,which have inhibitory effects on the proliferation of melanoma cells and melanin production.Conclusion Most of the ancient prescriptions for whitening and removing freckles are pungent and belong to the lung meridian,which embodies the theory of"lung governs the skin and hair".The high-frequency drug EBYX may play a role by regulating skin redox,immunity and inflammation.The active ingredients of EBYX have an inhibitory effect on melanin formation.This study enriches the scientific connotation of TCM whitening and freckle-removing prescriptions based on the theory of"lung governs the skin and hair",realizes interdisciplinary integration and provides support for the modernization of TCM.
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The dosage， dose and administration method of decoctions are important factors affecting the efficacy of prescriptions. By analyzing 35 decoction formulas from the Ming and Qing dynasties within the Catalogue of Ancient Classic Famous Formulas （First Batch）， it was found that the average dosage was equivalent to about 65 g， of which 71.4% （25/35） of the prescriptions had a dosage ≤60 g. And among them， the dosage of decoctions in the Ming dynasty was significantly smaller than that in the Qing dynasty. Considering the characteristics of formulas in Song dynasty， it is believed that decoctions in Ming and Qing dynasties were influenced by the popular use of decoctions during the Song， Jin， and Yuan dynasties. Some decoctions recorded a dosage of one dose instead of one day， which was more evident in the Ming dynasty. However， by the Qing dynasty， the usage of prescriptions with a dosage of one day gradually became more common. Therefore， in the practical research and application of classic famous formulas from the Ming and Qing dynasties， it is advised to pay attention to the difference between the dosage， one dose and the daily dosage. It is necessary to determine whether to double the dosage of the original formula based on the actual use， in order to ensure the clinical efficacy.
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Neurodegenerative diseases are a group of diseases caused by degeneration and dysfunction of the cells and tissues of the central nervous system， mainly including Alzheimer's disease （AD）， Parkinson's disease （PD）， and epilepsy. A common clinical manifestation of these diseases is cognitive decline. Neurodegenerative diseases are more common in the elderly. As population aging is aggravating， neurodegenerative diseases have aroused increasing concern since they seriously affect human health and quality of life. The pathogenesis of neurodegenerative diseases is complex， mainly related to mitochondrial dysfunction， apoptosis， neurotoxin， neurotransmitter abnormalities， oxidative stress， and inflammation. Although western drugs on the market can attenuate the symptoms of neurodegenerative diseases， they may induce severe adverse reactions and are thus not conducive to long-term use by the patients. The Chinese herbal medicine Angelicae Sinensis Radix was first recorded in the Shennong's Classic of Materia Medica （Shen Nong Ben Cao Jing）. It has the functions of activating blood， tonifying blood， modulating the immune system， regulating menstruation， and relieving pain. This paper summarizes the research progress in the effects of Angelicae Sinensis Radix and the prescriptions containing this medicine on neurodegenerative diseases in recent 10 years， aiming to provide a reference for the future application and research of Angelicae Sinensis Radix in the treatment of neurodegenerative diseases.
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The efficacy of traditional Chinese medicine （TCM） and compound prescriptions is confirmed based on practical experience. It is a highly generalized expression of the clinical characteristics and scope of prescriptions and a unique expression of the medical effects of TCM. Network pharmacology， as a cross-disciplinary field based on the theory of systems biology and multi-level analysis of biological systems， has become a common virtual screening tool in TCM research and gradually developed with the progress in big data and artificial intelligence. In the context of modern medicine， the efficacy of TCM compound prescriptions has a vague concept and lacks scientific evidence. Elucidating the connotation of TCM efficacy and guiding TCM theoretical research has become one of the hotspots and difficulties in TCM research. This article explores the feasibility of using network pharmacology for the research on the efficacy of TCM compound prescriptions and investigates whether the research results can represent part of the efficacy of prescriptions. Furthermore， the research platforms and algorithms in this field are summarized. The research ideas and existing problems in this field are proposed from the aspects of efficacy concept embodiment， target screening， result verification， efficacy network building， and homogenization avoiding of network pharmacology research results. Finally， the future development directions are prospected. This article is expected to provide a reference for exploring the modern biological basis of the efficacy of TCM and compound prescriptions and for the clinical application and theoretical research of TCM.
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ObjectiveThis study explored the application of Yiqi Zengmian prescription as a vaccine adjuvant， aiming to provide a new scheme for the prevention and control of corona virus disease 2019（COVID-19） with traditional Chinese medicine （TCM）. By analyzing the compatibility and efficacy， this paper examines the compatibility effect of Yiqi Zengmian prescription， which is modified from the classic tonifying agent Si Junzitang， as a vaccine adjuvant. MethodUsing the Database of Ancient Classical Prescriptions， this paper analyzed the composition of Yiqi Zengmian prescription and probed into the theoretical basis for the compatibility of this prescription from the properties， medicine combination， and efficacy. Furthermore， the compatibility effect of this prescription with vaccines was analyzed. ResultAs a TCM prescription， Yiqi Zengmian prescription focuses on the lung and spleen and enhances the Qi in the two organs. The lung governs Qi movement. The body breathes fresh air through the lungs and exchanges the turbid gas in the lungs， and the gas circulates alternately in the lungs to ensure the normal breathing of the human body. The spleen governing transportation and transformation is the hub for Qi movement， and Qi is the embodiment of metabolic function. By regulating qi movement and enhancing the functions of Qi and blood， Yiqi Zengmian prescription can enhance the immunogenicity of the vaccine， which provides a theoretical basis for enhancing the immune effects of vaccines. ConclusionYiqi Zengmian prescription has the effects of replenishing Qi and invigorating spleen， regulating Qi and drying dampness， and enhancing immunity. The in-depth analysis of the TCM theory of Yiqi Zengmian prescription as a vaccine adjuvant and the results of clinical and laboratory studies suggest that Yiqi Zengmian prescription may enhance the induction of immune response after vaccination and maintain the immune memory. However， the mechanism of Yiqi Zengmian prescription in regulating the complex immune network remains to be elucidated.
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According to the World Health Organization's world report on hearing, nearly 2.5 billion people worldwide will suffer from hearing loss by 2050, which may contribute to a severe impact on individual life quality and national economies. Sensorineural hearing loss (SNHL) occurs commonly as a result of noise exposure, aging, and ototoxic drugs, and is pathologically characterized by the impairment of mechanosensory hair cells of the inner ear, which is mainly triggered by reactive oxygen species accumulation, inflammation, and mitochondrial dysfunction. Though recent advances have been made in understanding the ability of cochlear repair and regeneration, there are still no effective therapeutic drugs for SNHL. Chinese herbal medicine which is widely distributed and easily accessible in China has demonstrated a unique curative effect against SNHL with higher safety and lower cost compared with Western medicine. Herein we present trends in research for Chinese herbal medicine for the treatment of SNHL, and elucidate their molecular mechanisms of action, to pave the way for further research and development of novel effective drugs in this field.
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Objective To analyze the acupoint compatibility law and the application characteristics of acupuncture moxibustion treatment for depression based on complex network technology;To provide a basis and ideas for formulating prescriptions of acupuncture antidepressant therapy.Methods Related clinical literature about acupuncture for the treatment of depression was retrieved from CNKI,Wanfang Data,VIP,CBM,PubMed,Embase,Cochrane Library,and Web of Science from the establishment of the databases to 21st,Sep.2022.According to the inclusion and exclusion criteria,the literature was screened,and the clinical literature database of acupuncture in anti-depression was established.Excel 2010 was used for frequency analysis of acupoints.SPSS Modeler 18.0 was used for association rule analysis,and Gephi 0.9.5 was used for complex network analysis.Results Totally 579 articles were included,involving 172 acupoints,with a total frequency of 3 222.The results of descriptive analysis showed that the main meridians of acupoints were Governor Vessel,bladder meridian and liver meridian,and the specific acupoints such as Yuan-primary point,Shu-stream point,Back-shu point,Luo-connecting point,Eight confluence points,Front-mu point,He-sea point were frequently used.Association rules analysis showed that the combination of the highest correlation acupoints were"Yintang(GV29)-Baihui(GV20)".Through the complex network k-core analytic hierarchy process and community analysis,two core acupoint groups were finally obtained.The acupuncture angle,depth and direction were based on safety and meridian circulation direction,the tonifying and reducing method was based on syndrome differentiation,and the prescription was based on syndrome differentiation and symptomatic selection.Conclusion Acupuncture for depression has the following characteristics:the principle of acupoint selection is based on meridian selection and specific acupoints,the selection of core acupoints focuses on the treatment of spirit and the regulation of viscera,channels and functions,and the emphasis on syndrome differentiation and symptomatic acupoint selection in clinical treatment.While,it was important to pay more attention to the specificity of acupuncture and moxibustion.
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ABSTRACT Objective: To analyze the prevalence of off-label and unlicensed prescriptions for a population of neonates admitted to the Neonatal Intensive Care Unit in a hospital in southern Santa Catarina. Methods: Observational study with a cross-sectional design. All neonates admitted to the Intensive Care Unit during the period from March 2020 to March 2021 were included. Data collection was performed through a questionnaire made by the authors and the classification of drugs based on the Electronic Drug Description (Bulário Eletrônico) of the Brazilian Health Regulatory Agency and Drug Dex-Micromedex. Results: Data from 296 neonates were evaluated. The prevalence was 50,7% for prescribing off-label medications and 37,2% for unlicensed medications. The use of drugs was higher in preterm neonates, with low birth weight, 1st minute Apgar between 6-8, 5th minute Apgar between 7-8, and in need of invasive procedures. The most used off-label drugs were ampicillin, gentamicin and fentanyl (92.6, 92.0 and 26.6%, respectively), whereas the most used unlicensed drugs were caffeine, phenobarbital and bromopride (78.1, 16.3 and 10.9%, respectively). Conclusions: This study showed a large percentage of prescriptions made in the off-label (50.7%) and unlicensed (37.2%) form in the Neonatal Intensive Care Unit, corroborating the worrying world scenario. The most exposed neonates were precisely the most vulnerable ones and, among the most commonly prescribed medications, ampicillin and gentamicin stood out in off-label form and caffeine in unlicensed form.
RESUMO Objetivo: Analisar a prevalência de prescrições off-label e não licenciadas uma população de neonatos internados na Unidade de Terapia Intensiva Neonatal em um hospital ao sul de Santa Catarina. Métodos: Estudo observacional com delineamento transversal. Foram incluídos todos os neonatos admitidos na Unidade de Terapia Intensiva durante o período de março de 2020 a março de 2021. A coleta de dados foi realizada a partir de questionário elaborado pelos autores, e a classificação dos medicamentos, com base no Bulário Eletrônico da Agência Nacional de Vigilância Sanitária e no Drug Dex-Micromedex. Resultados: Foram avaliados dados de 296 neonatos. A prevalência foi de 50,7% para prescrição de medicações off-label e 37,2% para medicações não licenciadas. O uso dos fármacos foi maior em neonatos pré-termo, com baixo peso ao nascer, Apgar de 1o minuto entre 6-8, Apgar de 5o minuto entre 7-8, e com necessidade de procedimentos invasivos. Os fármacos off-label mais utilizados foram a ampicilina, gentamicina e fentanil (92,6, 92 e 26,6%, respectivamente), já os fármacos não licenciados mais utilizados foram a cafeína, fenobarbital e bromoprida (78,1, 16,3 e 10,9%, respectivamente). Conclusões: O estudo demonstrou grande porcentagem de prescrições realizadas de forma off-label (50,7%) e não licenciada (37,2%) na Unidade de Terapia Intensiva Neonatal de análise, corroborando o preocupante cenário mundial. Os neonatos mais expostos foram justamente aqueles mais vulneráveis e, entre as medicações mais utilizadas, destacam-se a ampicilina e a gentamicina de modo off-label e a cafeína de modo não licenciado.
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Resumo: Os antidepressivos são a terceira classe medicamentosa mais prescrita, sendo que a maioria das prescrições não é realizada por especialistas. O objetivo do estudo é avaliar a autopercepção de confiança na prescrição de antidepressivos por médicos da atenção primária à saúde (APS). Foi realizado estudo de corte transversal de médicos atuantes na APS da cidade de Salvador, Bahia, Brasil. Foram excluídos psiquiatras ou residentes de psiquiatria. A autoavaliação da confiança, assim como a coleta de características dos participantes foi realizada por meio de questionário online. Variáveis categóricas foram descritas em termos de frequência absoluta e relativa. Variáveis contínuas foram descritas como média ou mediana, conforme distribuição de normalidade. No contexto total de 447 médicos, a amostra foi composta por 55 participantes. A média de idade foi de 37,2 (±12,8) anos. A maioria dos médicos (75%) reconheceu-se confiante na prescrição de antidepressivos. A autopercepção de confiança manteve-se predominante em cenários de pacientes idosos (69,2%) e portadores de comorbidades gerais (65,4%). A minoria mostrou confiança para prescrever antidepressivos a crianças/adolescentes (19,2%) e gestantes (26,9%). Para 80,4% dos participantes, os inibidores seletivos da recaptação de serotonina foram a classe farmacológica de maior confiança. O encaminhamento para o Centro de Atenção Psicossocial foi a estratégia mais referida em casos de insegurança na prescrição (32%). Até onde se sabe, esse é o primeiro estudo a abordar tal questão. Por essa razão, ele pode contribuir para a construção de ações de educação em saúde mais assertivas voltadas a médicos da APS.
Abstract: Antidepressants are the third most prescribed drug class, and most prescriptions are not performed by specialists. This study aimed to evaluate primary health care (PHC) physicians' self-perceived confidence in prescribing antidepressants. This is a cross-sectional study with PHC physicians in the municipality of Salvador, Bahia State, Brazil. Psychiatrists or psychiatry residents were excluded. The self-assessment of confidence and the collection of participants' characteristics was carried out by an online questionnaire. Categorical variables were presented in absolute and relative frequencies. Continuous variables were described as means or medians according to their normality distribution. Of 447 physicians, the sample consisted of 55 participants. Their mean age was 37.2 ± 12.8 years. Most physicians (75%) claimed confidence in prescribing antidepressants. Self-perceived confidence remained predominant in scenarios with older adults (69.2%) and patients with general comorbidities (65.4%). A minority showed confidence to prescribe antidepressants to children/adolescents (19.2%) and pregnant women (26.9%). For 80.4% of participants, selective serotonin reuptake inhibitors were the most trusted pharmacological class. Referral to the Psychosocial Care Center was the most reported strategy in cases of insecure prescription (32%). To the best of our knowledge, this is the first study to address such an issue. Thus, it can contribute to more assertive health education actions for PHC physicians.
Resumen: Los antidepresivos son la tercera clase de medicamentos más prescritos, y la mayoría de las prescripciones no son realizadas por especialistas. El objetivo del estudio es evaluar la autopercepción de confianza en la prescripción de antidepresivos por parte de los médicos de atención primaria de salud (APS). Corte transversal de médicos que trabajan en la APS de la ciudad de Salvador, Bahia, Brasil. Se excluyeron a los psiquiatras o residentes de psiquiatría. La autoevaluación de la confianza, así como la recolección de las características de los participantes, fue realizada a través de un cuestionario online. Las variables categóricas se describieron en términos de frecuencia absoluta y relativa. Las variables continuas se describieron como media o mediana, según la distribución de normalidad. En el contexto total de 447 médicos, la muestra estaba formada por 55 participantes. La edad promedio fue de 37,2 (±12,8) años. La mayoría de los médicos (75%) se reconocieron confiados en la prescripción de antidepresivos. La autopercepción de confianza se mantuvo predominante en los escenarios de pacientes ancianos (69,2%) y portadores de comorbilidades generales (65,4%). La minoría mostró confianza para prescribir antidepresivos a niños/adolescentes (19,2%) y mujeres embarazadas (26,9%). Para el 80,4% de los participantes, los inhibidores selectivos de la recaptación de serotonina eran la clase farmacológica de mayor confianza. El encaminamiento para el Centro de Atención Psicosocial fue la estrategia más mencionada en los casos de inseguridad en la prescripción (32%). Hasta donde se sabe, este es el primer estudio que aborda este tema. Por esa razón, puede contribuir para la construcción de acciones de educación en salud más asertivas dirigidas a los médicos de la APS.
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Introducción: La diabetes es una enfermedad de carácter crónico, que se origina cuando el organismo pierde su capacidad de producir insulina necesaria para utilizarla de manera eficaz. La diabetes mellitus tipo 1 se caracteriza por la destrucción autoinmune de las células beta del páncreas, que conlleva a una deficiente producción de insulina. Mientras que, la diabetes mellitus tipo 2 resulta de la combinación de resistencia a la insulina junto con inadecuada secreción de la misma. En ambos casos, se utiliza el medicamento insulina para garantizar un control de la enfermedad. Objetivo: Caracterizar la prescripción del medicamento insulina Neutral Protamine Hagedorn bulbo, en una farmacia comunitaria perteneciente a la Atención Primaria de Salud del municipio Santa Clara. Métodos: Se realizó una investigación observacional, descriptiva y transversal, que se corresponde con un estudio de uso de medicamentos del tipo prescripción-indicación del medicamento insulina Neutral Protamine Hagedorn bulbo en septiembre 2023. El universo estuvo conformado por 852 pacientes, que tenían prescripción por certificado para medicamentos controlados vigentes. La muestra no probabilística quedó conformada por 26 pacientes. El tipo de muestreo fue aleatorio simple y los resultados se presentaron en tablas mediante números absolutos y porcentaje. Se respetó el principio a la confidencialidad de la información revisada y los certificados para medicamentos controlados. Resultados: Predominaron los pacientes del sexo femenino (76,92 %), mayores de 50 años (84,62 %), hipertensión arterial como comorbilidad (76,92 %), presentaban cuatro o más medicamentos (61,54 %) y la combinación con glibenclamida, metformina, enalapril, captopril, carvedilol, ácido acetilsalicílico, hidroclorotiazida y levotiroxina sódica fueron las interacciones medicamentosas de mayor importancia clínica. Conclusiones: La frecuencia en la prescripción de insulina Neutral Protamine Hagedorn bulbo, es similar a la encontrada en algunos estudios previos, es más representativa a partir de la quinta década de la vida y más frecuente en el sexo femenino.
Introduction: Diabetes is a disease of a chronic nature which occurs when the body loses its ability to produce the insulin needed to use it effectively. Type 1 diabetes mellitus is characterized by destruction of pancreatic beta cells in genetically predisposed individuals and the consequent deficiency in insulin production while type 2 diabetes mellitus results from the combination of insulin resistance along with inadequate secretion of it. In both cases, the insulin medication is used to ensure control of the disease. Objective: To characterize the prescription profile of Neutral Protamine Hagedorn insulin vial in Santa Clara Community Pharmacy. Methods: An observational, retrospective, descriptive and cross-sectional investigation was conducted that corresponded with a medications use study, of prescription-indication type of the medication Neutral Protamine Hagedorn insulin vial in September 2023. The universe was 852 patients and the sample was 26 patients with NPH insulin vial prescription, the sampling was simple random and the results were presented in tables using absolute numbers and percentages. The principle of confidentiality of the reviewed information and certificates for controlled medications was respected. Results: The female sex predominated (76.92 %), older than 50 years (84.62 %), arterial hypertension as a comorbidity (76.92 %), 4 or more medications (61.54 %) and the combination with glibenclamide, metformin, enalapril, captopril, carvedilol, acetylsalicylic acid, hydrochlorothiazide and levothyroxine sodium were the most clinically important drug interactions. Conclusions: The prevalence in the prescription of Neutral Protamine Hagedorn insulin vial is similar to that found in some previous studies, being more representative from the 5th decade of life and more frequent in the female sex.
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ABSTRACT Objective: The quality of care and safety for Telemedicine-discharged patients with suspected respiratory infections are closely related to low rates of prescriptions of unjustified and high-risk medications. This retrospective study aimed to assess adherence to the current COVID-19 guidelines in direct-to-consumer telemedicine encounters at a large center using multidrug stewardship protocols. Methods: A quarterly electronic survey utilizing medical records of individual physician care assessed various quality indicators. Physicians received ongoing adaptive feedback based on personal metrics, with Telemedicine Center recommendations derived from the 2020 Infectious Diseases Society of America guidelines. The study included all consecutive adults with new respiratory symptoms in the last 14 days who sought spontaneous Telemedicine consultations between March 2020 and August 2021. This study analyzed patients with suspected or confirmed COVID-19 and other airway infections. Results: Of the 221,128 evaluated patients, 42,042 (19%) had confirmed COVID-19; 104,021 (47%) were suspected to have COVID-19; and, 75,065 (33%) had other diagnoses. Patients with suspected or confirmed COVID-19 had a mean (+DP) age of 35±12 years. A total of 125,107 (85.65%) patients were managed at home, 2,552 (1.74%) were referred for non-urgent in-office reassessment, and 17,185 (11.7%) were referred to the emergency department for whom there was no further treatment recommendation. The antibiotic rate in confirmed or suspected COVID-19 cases was 0.46%/0.65% and that for non-evidence-based prescriptions was 0.01%/0.005%. Conclusion: Guideline training and Telemedicine consultation feedback may lead to lower antibiotic and antimicrobial prescriptions in suspected and confirmed COVID-19 cases. Multidrug stewardship protocols may improve guideline adherence and reinforce the quality of care and safety in Telemedicine encounters.
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Resumo A prescrição farmacêutica avança no mundo, com diferentes países regulando a prática. No Brasil, essa regulação ocorreu em 2013, porém são escassas as informações sobre sua inserção no cotidiano do exercício farmacêutico. Este estudo objetivou analisar a prescrição farmacêutica no município de Vitória-ES, Brasil, e os fatores que influenciam na adesão da prática. Trata-se de um estudo qualitativo com 20 farmacêuticos e 10 gestores de farmácias comunitárias públicas e privadas, realizado a partir de entrevistas, com posterior análise de conteúdo temática para apreender percepções e opiniões. Os farmacêuticos desta pesquisa não prescreviam. Farmacêuticos e gestores identificaram facilitadores para a implementação da atividade, com destaque para os fatores: infraestrutura; fácil acesso ao farmacêutico; e boa receptividade à prescrição. Como barreiras, os fatores foram: número insuficiente de recursos humanos; falta de estímulo institucional à prescrição; e fatores individuais. Além da observação da não execução da prescrição farmacêutica, este estudo trouxe uma oportunidade para identificar elementos que podem estar contribuindo para que o exercício dessa atividade não seja realizado nas farmácias comunitárias. Adaptar rotinas ou contratar pessoal se mostraram as principais modificações necessárias. Paralelamente, ações destinadas a qualificar a formação por meio da educação permanente também se apresentam como necessárias.
Abstract Pharmacist prescribing advances in the world with different countries regulating this activity. In Brazil, this regulation took place in 2013, but there is little information about its insertion in the routine of pharmacist practice. This study aimed to analyze the pharmacist prescribing in the city of Vitória, Espírito Santo state, Brazil, and the factors that influence adherence to the practice. This is a qualitative study based on interviews with 20 pharmacists and 10 managers of public and private community drugstores with subsequent content analysis to apprehend perceptions and opinions. The pharmacists in this research did not prescribe. Pharmacists and managers identified facilitators for the implementation of the activity, highlighting the following factors: infrastructure; easy access to the pharmacist; and good receptivity to the prescription. As barriers, the factors were insufficient number of human resources; lack of institutional stimulus to prescribing; and individual factors. In addition to the observation of non-execution of pharmacist prescribing, this study provided an opportunity to identify elements that may contribute to the non-existence of this activity in community drugstores. Adapting routines or hiring staff were the main necessary changes. At the same time, actions aimed at qualifying training through permanent education are also necessary.
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ABSTRACT Objective: To assess prescription patterns for short-acting b2 agonists (SABAs) and other asthma medications in asthma patients treated by specialists and participating in the SABA use IN Asthma (SABINA) study in Brazil. Methods: This was an observational, cross-sectional study conducted at five sites in different regions of Brazil. The primary endpoints were to record SABA prescriptions and obtain data on over-the-counter (OTC) SABA purchases at the pharmacy. Results: Data on 218 asthma patients were analyzed. Of those 218 patients, 80.3% were prescribed SABAs in addition to their maintenance therapy, with a mean of 11.2 SABA canisters in the previous 12 months. Of those patients, 71.4% were prescribed ≥ 3 canisters and 42.2% were prescribed ≥ 10 canisters. None of the patients were prescribed SABA monotherapy. A total of 14.2% of the patients reported purchasing SABAs OTC at a pharmacy without a prescription. Of those, 48.4% purchased ≥ 3 SABA canisters. A fixed-dose combination of an inhaled corticosteroid and a long-acting b2 agonist was prescribed to 95.0% of the patients. In the year before the study visit, 45.0% of the patients received at least one course of oral corticosteroid burst treatment. Asthma was well controlled in 43.1% of the patients, partly controlled in 34.9%, and uncontrolled in 22.0%. Patients reported a mean of 1.1 severe asthma exacerbations, with 49.1% experiencing 1 or more severe exacerbations. Conclusions: Overprescription and OTC purchases of SABAs are common in Brazil, possibly leading to the need for courses of oral corticosteroids. The health care community should collaborate to implement evidence-based recommendations and promote health education to improve asthma management in Brazil.
RESUMO Objetivo: Avaliar os padrões de prescrição de short-acting b2 agonists (SABAs, b2-agonistas de curta duração) e outros medicamentos para asma em pacientes tratados por especialistas e participantes do estudo SABA use IN Asthma (SABINA) no Brasil. Métodos: Trata-se de um estudo transversal observacional realizado em cinco locais em diferentes regiões do Brasil. Os desfechos primários foram registrar as prescrições de SABAs e obter dados a respeito da compra de SABAs sem receita médica na farmácia. Resultados: Foram analisados dados a respeito de 218 pacientes com asma. Dos 218 pacientes, 80,3% receberam prescrição de SABA além da terapia de manutenção, com uma média de 11,2 frascos de SABA nos 12 meses anteriores. Destes, 71,4% receberam prescrição de ≥ 3 frascos e 42,2% receberam prescrição de ≥ 10 frascos. Nenhum dos pacientes recebeu prescrição de monoterapia com SABA. Do total de pacientes, 14,2% relataram que compraram SABAs sem receita médica na farmácia. Destes, 48,4% compraram ≥ 3 frascos de SABA. Foram prescritas doses fixas combinadas de corticosteroide inalatório e b2-agonista de longa duração para 95,0% dos pacientes. No ano anterior à visita do estudo, 45,0% dos pacientes receberam pelo menos um ciclo de tratamento de curta duração com corticosteroide oral. A asma estava bem controlada em 43,1% dos pacientes, parcialmente controlada em 34,9% e não controlada em 22,0%. Os pacientes relataram uma média de 1,1 exacerbações graves da asma, sendo que 49,1% apresentaram uma ou mais exacerbações graves. Conclusões: A prescrição excessiva e a compra de SABAs sem receita médica são comuns no Brasil e possivelmente levam à necessidade de uso de corticosteroides orais. A comunidade de profissionais de saúde deve colaborar para implantar recomendações baseadas em evidências e promover a educação em saúde para melhorar o manejo da asma no Brasil.
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SUMMARY OBJECTIVE: The aim of this study was to analyze the prescription of packed red blood cells performed by emergency physicians for adults with sickle cell anemia. METHODS: Transfusions performed in adults with sickle cell anemia treated at an emergency service in São Bernardo do Campo, São Paulo Brazil, between January 2018 and January 2022 were evaluated. For data comparison, the chi-square2 test was used. The significance level adopted was 5%. RESULTS: A total of 114 transfusions were performed. The mean age was 41.8±16.4 years, and pretransfusion hemoglobin was 6.1±1.23 g/dL. Regarding the indication, the adequacy of transfusions performed in symptomatic individuals was significantly higher compared to asymptomatic individuals (100% vs. 3.9%, p<0.001). Symptomatic individuals received excessive volumes of packed red blood cells less frequently than asymptomatic individuals (17.5% vs. 56.9%, p<0.001). The filtered subtype, indicated for sickle cell anemia, was prescribed in only a quarter of the patients. However, non-indicated subtypes were frequently prescribed. CONCLUSION: This study found low adequacy in the indication and calculation of the transfusion volume of packed red blood cells in asymptomatic individuals. Few patients received filtered red blood cells, resulting in increased risks of transfusion reactions. On the contrary, non-indicated subtypes were prescribed in a quarter of transfusions, which resulted in higher costs and delay in receiving packed red blood cells.