Administração de medicamentos por via intramuscular: caracterização dos vídeos brasileiros veiculados no YouTube® / Intramuscular drug administration: characterization of Brazilian videos on YouTube®

RESUMO Objetivo caracterizar os vídeos que contém a demonstração do procedimento de administração de medicamentos por via intramuscular em indivíduos adultos. Métodos estudo de corte transversal descritivo, foram selecionados 44 vídeos brasileiros disponíveis no YouTube® que abordavam o procedimento de administração de medicamentos por via intramuscular. Resultados a maioria dos vídeos selecionados é de origem pessoal (86,4%), tem como autor um técnico de Enfermagem (59,1%), adota a região dorsoglútea como local de injeção (54,5%), foi produzido em ambiente de saúde utilizando um paciente para a demonstração do procedimento (52,3%). Nenhum vídeo apresentou a completude do procedimento, sendo identificada grande frequência de erros em todas as etapas do procedimento. Observou-se uma diferença estatisticamente significante entre os testes de confiabilidade e popularidade dos vídeos (p=0,042). Conclusão os vídeos que abordam o procedimento de administração de medicamentos por via intramuscular disponíveis na plataforma YouTube® foram considerados atuais, de pouca relevância, elaborados por fontes não confiáveis, de baixa acurácia e frágil finalidade. Contribuições para a prática os vídeos disponíveis na plataforma YouTube® sobre a administração de medicamentos por via intramuscular não devem ser indicados como material educativo para a formação ou atualização profissional.

ABSTRACT Objective to characterize videos that contain a demonstration of the procedure for administering drugs intramuscularly to adults. Methods a descriptive cross-sectional study, 44 Brazilian videos available on YouTube® were selected which addressed the procedure of intramuscular drug administration. Results the majority of the videos selected are of personal origin (86.4%), were made by a Nursing technician (59.1%), used the dorsal gluteal region as the injection spot (54.5%), and were produced in a healthcare environment using a patient to demonstrate the procedure (52.3%). No video showed the completeness of the procedure, and a high frequency of errors was identified at all stages of the procedure. There was a statistically significant difference between the reliability and popularity tests of the videos (p=0.042). Conclusion the videos on intramuscular drug administration available on the YouTube® platform were considered to be up-to-date, of little relevance, produced by unreliable sources, of low accuracy, and with a weak purpose. Contributions to practice the videos available on the YouTube® platform on intramuscular drug administration should not be used as educational material for professional training or updating.

Transição de via de linezolida endovenosa para via oral: uma análise de custo-minimização / Switching from intravenous to oral linezolid therapy: a cost-minimization analysis

Objetivo: Comparar custos da terapia endovenosa exclusiva com linezolida com os custos da terapia iniciada por via endovenosa com transição para via oral após 72 horas, como estratégia de intervenção em programas de gestão de antimicrobianos. Métodos: Avaliação econômica de custo-minimização comparando custos diretos da terapia endovenosa exclusiva com linezolida com a terapia endovenosa seguida de transição para via oral em cenário simulado, sob a perspectiva do Sistema Único de Saúde (SUS), com árvore de decisão como modelo para tomada de decisão. Resultados: A alternativa englobando a transição de via mostrou-se a mais econômica em todos os cenários analisados. Para 28 dias de tratamento com linezolida, houve redução de 22% nos custos, considerando o paciente internado. Ao considerar alta após o sexto dia de tratamento, a redução de custos variou de 26%, com financiamento pelo SUS do restante do tratamento, a 84%, com financiamento do tratamento pós-alta pelo paciente. Conclusão: Conclui-se que a transição de via de linezolida é uma importante estratégia nos programas de gerenciamento de antimicrobianos, capaz de gerar economia significativa para a instituição. As avaliações econômicas de custo-minimização, nesse contexto, são uma importante ferramenta para demonstrar o aspecto econômico com potencial para sensibilizar gestores e tomadores de decisão.

Objective: To compare the direct costs of linezolid intravenous therapy with the costs of intravenous therapy switching to oral therapy after 72 hours as an intervention strategy in antimicrobial stewardship programs. Methods: Economic evaluation cost-minimization comparing direct costs of exclusive linezolid intravenous therapy with intravenous therapy for 72 hours and after switching to oral therapy in a simulated scenario, from the perspective of the National Health Service, with a decision tree as a decision modeling. Results: The alternative encompassing the therapy transition proved to be the most economical in all analyzed scenarios. For 28 days of treatment with linezolid, there was a 22% reduction in costs, considering the hospitalized patient. When considering discharge after the sixth day of treatment, the cost reduction ranged from 26%, with funding from the National Health Service for the rest of the treatment, to 84%, with funding for the post-discharge treatment by the patient. Conclusion: It was concluded that the linezolid therapy transition is an important strategy in antimicrobial management programs, capable of generating significant savings for the institution. In this context, economic cost-minimization assessments are an important tool to demonstrate the economic aspect with the potential to raise awareness among managers and decision-makers.

Efficacy of intratympanic injection versus intravenous drip of prednisolone acetate in the treatment of sudden hearing loss / 中国基层医药

Objective:To investigate the efficacy of intratympanic injection versus intravenous drip of prednisolone acetate in the treatment of sudden hearing loss. Methods:A total of 120 patients with sudden hearing loss who received treatment in the Department of Otolaryngology, Mingzhou Hospital between January 2017 and January 2020 were included in this study. They were divided into intratympanic injection group (intratympanic injection of prednisolone acetate, n = 60) and intravenous injection group (intravenous injection of prednisolone acetate, n = 60) according to route of drug administration. After 8 days of treatment, clinical efficacy was compared between the two groups. The hearing thresholds at 500 Hz and 1 000 Hz in both groups were detected using pure tone audiometry. The levels of procalcitonin and high-sensitivity C-reactive protein and adverse drug reactions were compared between the two groups. Results:After treatment, total response rate in the intratympanic injection group was significantly higher than that in the intravenous injection group (93.33% vs. 80.00%, χ2 = 4.61, P < 0.05). The hearing threshold at 500 Hz in the intratympanic injection group was significantly lower than that in the intravenous injection group [(38.69 ± 3.56) vs. (42.36 ± 4.36), t = 5.05, P < 0.001). The hearing threshold at 1 000 Hz in the intratympanic injection group was significantly lower than that in the intravenous injection group [(32.36 ± 3.36) vs. (40.15 ± 4.12), t = 11.35, P < 0.001). After treatment, procalcitonin level in the intratympanic injection group was significantly lower than that in the intravenous injection group [(0.65 ± 0.12) μg/L vs. (0.98 ± 0.15) μg/L, t = 13.30, P < 0.001)]. High-sensitivity C-reactive protein level in the intratympanic injection group was significantly lower than that in the intravenous injection group [(3.28 ± 0.36) mg/L vs. (5.26 ± 0.56) mg/L, t = 23.03, P < 0.001]. There was no significant difference in incidence of adverse reactions between intratympanic injection and intravenous injection groups (8.33% vs. 10.00%, χ2 = 0.10, P > 0.05). Conclusion:Compared with intravenous drip of prednisolone acetate, intratympanic injection of prednisolone acetate can improve the clinical symptoms of patients with sudden hearing loss and enhance clinical efficacy.

mRNA cancer vaccines: Advances, trends and challenges

Patients exhibit good tolerance to messenger ribonucleic acid (mRNA) vaccines, and the choice of encoded molecules is flexible and diverse. These vaccines can be engineered to express full-length antigens containing multiple epitopes without major histocompatibility complex (MHC) restriction, are relatively easy to control and can be rapidly mass produced. In 2021, the U.S. Food and Drug Administration (FDA) approved the first mRNA-based coronavirus disease 2019 (COVID-19) vaccine produced by Pfizer and BioNTech, which has generated enthusiasm for mRNA vaccine research and development. Based on the above characteristics and the development of mRNA vaccines, mRNA cancer vaccines have become a research hotspot and have undergone rapid development, especially in the last five years. This review analyzes the advances in mRNA cancer vaccines from various perspectives, including the selection and expression of antigens/targets, the application of vectors and adjuvants, different administration routes, and preclinical evaluation, to reflect the trends and challenges associated with these vaccines.

Fatores associados com a escolha da terapia nos pacientes com doença inflamatória intestinal no Brasil / Factors associated with patient´s preference in choosing their therapy for inflammatory bowel disease in brazil

BACKGROUND: Biological therapy and new drugs have revolutionized the treatment of inflammatory bowel disease. Ideally, the choice of medication should be a shared decision with the patient, aiming at greater satisfaction, compliance, and consequently, favorable clinical outcome. OBJECTIVE: This study aims to evaluate patient's preferences in the choice of their therapy and the factors that influence this choice. METHODS: This cross-sectional study enrolled 101 outpatients with Crohn's disease or ulcerative colitis. The inclusion criteria were age ≥18 years and no previous exposure to biological therapy. Patients' preferences were assessed through questions that addressed the preferred mode of administration (oral, subcutaneous, or intravenous) and the factors that determined the choice of medication (efficacy, medical indication, fear of medication, convenience, mode of application, and personal doctors' indication). RESULTS: The mean age was 43.6±13.5 years, 75.3% were female, and 81.2% were cases of ulcerative colitis. Regarding the mode of administration, the majority of patients preferred oral (87.1%), followed by intravenous (6.93%) and subcutaneous (5.94%) medications. The reasons were "I prefer to take it at home" (42.57%), "I have more freedom" (36.63%), "I don't like self-application" (29.70%), and "I believe it works better" (19.80%). Younger patients and patients in clinical disease activity preferred intravenous mode compared to the oral route (P<0.05). Doctor's opinion (98%) was an important factor associated with the medication choice. CONCLUSION: Oral route was the preferred mode of administration and most patients took their physician's opinion into account in their choice of medication.

RESUMO CONTEXTO: A terapia biológica e os novos medicamentos revolucionaram o tratamento da doença inflamatória intestinal. A escolha do medicamento deve ser compartilhada com o paciente, visando maior satisfação, adesão e, consequentemente, desfecho clínico favorável. OBJETIVO: Este estudo teve como objetivo avaliar as preferências do paciente na escolha de sua terapia e os fatores que influenciaram essa escolha. MÉTODOS: Este estudo transversal incluiu 101 pacientes ambulatoriais com doença de Crohn ou retocolite ulcerativa. Os critérios de inclusão foram idade ≥18 anos e nenhuma exposição prévia à terapia biológica. A preferência dos pacientes foi avaliada por meio de perguntas que abordaram o modo de administração preferido (oral, subcutâneo ou intravenoso) e os fatores que determinaram a escolha do medicamento (eficácia, indicação médica, medo da injeção, conveniência, modo de aplicação e opinião pessoal do médico). RESULTADOS: A idade média foi de 43,6±13,5 anos, 75,3% eram mulheres e 81,2% eram portadores de retocolite ulcerativa. Em relação ao modo de administração, a maioria dos pacientes preferiu os medicamentos orais (87,1%), seguidos dos endovenosos (6,93%) e subcutâneos (5,94%). Os motivos foram "prefiro aplicar em casa" (42,57%), "tenho mais liberdade com essa medicação" (36,63%), "não gosto de autoaplicação" (29,70%) e "acredito que funcione melhor" (19,80%). Pacientes jovens e pacientes em atividade clínica preferiram a via intravenosa em comparação com a via oral (P<0,05). A opinião do médico (98%) foi um fator importante associado à escolha do medicamento. CONCLUSÃO: A via oral foi preferida e a maioria dos pacientes levou em consideração a opinião do seu médico na escolha do medicamento.

Erros na administração de medicamentos via parenteral: Perspectiva dos técnicos de enfermagem / Errores en la administración de medicamentos por vía parenteral: perspectiva de los técnicos de enfermería / Errors in parenteral medication administration: nursing technicians perspective

Resumo Objetivo: Analisar a compreensão dos técnicos de enfermagem sobre os erros e eventos adversos relacionados a administração de medicamentos via parenteral. Métodos: Estudo de abordagem qualitativa, descritivo e exploratório. Realizado com 25 técnicos de enfermagem em um hospital universitário do Nordeste no período de março a junho de 2017. Para coleta dos dados, utilizou-se um roteiro de entrevista com perguntas abertas. Na análise de dados utilizou-se o método da Classificação Hierárquica Descendente através do software IRAMUTEQ e para análise de conteúdo optou-se pela técnica de análise temática de Minayo. Resultados: Na análise da Classificação Hierárquica Descendente foram obtidas cinco classes, a partir delas emergiram as categorias: Compreensão dos técnicos de enfermagem sobre erros de medicação; Compreensão dos técnicos de enfermagem sobre eventos adversos; Fatores associados e estratégias de prevenção de erros e eventos adversos; e Conduta diante da ocorrência de erros e eventos adversos. Conclusão: Os técnicos de enfermagem mostraram que sua compreensão sobre eventos adversos é limitada ao conceito de reações adversas, entendem que a sua ocorrência está atrelada não somente a falta de atenção, mas também a fatores extrínsecos como sobrecarga de trabalho, número considerável de pacientes e dimensionamento inadequado, e reconhecem a importância da comunicação e notificação nesse processo para a melhoria da segurança do paciente.

Resumen Objetivo: Analizar la comprensión de los técnicos de enfermería sobre los errores y eventos adversos relacionados con la administración de medicamentos por vía parenteral. Métodos: Estudio de enfoque cualitativo, descriptivo y exploratorio. Realizado con 25 técnicos de enfermería en un hospital universitario del Nordeste de Brasil en el período de marzo a junio de 2017. Para la recolección de datos se utilizó una entrevista con preguntas abiertas. En el análisis de datos se utilizó el método de clasificación jerárquica descendente a través del software IRAMUTEQ, y para el análisis de contenido se optó por la técnica de análisis temático de Minayo. Resultados: En el análisis de la clasificación jerárquica descendente se obtuvieron cinco clases, de las cuales surgieron las siguientes categorías: Comprensión de los técnicos de enfermería sobre errores de medicación, Comprensión de los técnicos de enfermería sobre eventos adversos, Factores asociados y estrategias de prevención de errores y eventos adversos, y Conducta ante episodios de errores y eventos adversos. Conclusión: Los técnicos de enfermería demostraron que su comprensión sobre eventos adversos está limitada al concepto de reacciones adversas, entienden que los incidentes están vinculados no solo a la falta de atención, sino también a factores extrínsecos como sobrecarga de trabajo, número considerable de pacientes y dimensionamiento inadecuado, y reconocen la importancia de la comunicación y notificación en este proceso para mejorar la seguridad del paciente.

Abstract Objective: To analyze the nursing technicians' understanding of errors and adverse events related to parenteral medication administration. Methods: This is a qualitative, descriptive and exploratory study conducted with 25 nursing technicians at a university hospital in Northeastern Brazil, between March and June 2017. An interview script with open questions was used for data collection. In the data analysis, the Descending Hierarchical Classification method was used through the IRAMUTEQ software. Minayo's thematic analysis technique was chosen for content analysis. Results: In the analysis of the Descending Hierarchical Classification, five classes were obtained, from which the following categories emerged: Nursing technicians' understanding of medication errors; Nursing technicians' understanding of adverse events; Associated factors and strategies for preventing errors and adverse events; and Conduct before the occurrence of errors and adverse events. Conclusion: Nursing technicians showed that their understanding of adverse events is limited to the concept of adverse reactions. They understand that its occurrence is linked not only to lack of attention but also to extrinsic factors such as work overload, a considerable number of patients and inadequate dimensioning. They recognize the importance of communication and notification in this process for improving patient safety.

Qualification of palliative nursing assistance in the use of the subcutaneous route / Cualificación de la asistencia de enfermería paliativa en el uso de la vía subcutánea / Qualificação da assistência de enfermagem paliativista no uso da via subcutânea

ABSTRACT Objectives: to describe the experience of conducting workshops for teaching the subcutaneous fluid infusion therapy in palliative care patients. Methods: experience report based on four workshops with a workload of nine hours each, addressing the teaching, implementation of the technique, and management in the use of subcutaneous fluid infusion therapy in patients in palliative care. The host institution was a private hospital, which had two care units in the state of Rio de Janeiro. Results: we identified little knowledge about the theme. Due to the dynamics used, the workshops made it possible to qualify the participants to perform and manage the subcutaneous route in palliative care environments. Conclusions: the workshops were an important means of training, qualification, and dissemination of nursing care in a palliative care environment. The resources used to enable the qualification in the execution and management of the presented technique.

RESUMEN Objetivos: describir la experiencia de la realización de talleres para la enseñanza de la terapia de infusión de fluidos por vía subcutánea en pacientes en cuidados paliativos. Métodos: relato de experiencia basado en cuatro talleres con carga horaria de nueve horas cada, abordando la enseñanza, la ejecución de la técnica y el manejo en la utilización de la terapia de infusión de fluidos por vía subcutánea en pacientes en cuidados paliativos. La institución acogedora ha sido un hospital privado, que ha contado con dos unidades asistenciales en el estado de Rio de Janeiro. Resultados: se identificó poco conocimiento acerca de la temática. Por la dinámica utilizada, los talleres posibilitaron calificar los participantes a ejecutaren y a manejaren la vía subcutánea en ambientes de cuidados paliativos. Conclusiones: Los talleres han sido importante medio de formación, cualificación y divulgación del cuidado de enfermería en ambiente de cuidados paliativos. Los recursos utilizados posibilitan la cualificación en la ejecución y en el manejo de la técnica presentada.

RESUMO Objetivos: descrever a experiência da realização de oficinas para o ensino da terapia de infusão de fluidos por via subcutânea em pacientes em cuidados paliativos. Métodos: relato de experiência baseado em quatro oficinas com carga horária de nove horas cada, abordando o ensino, a execução da técnica e o manejo na utilização da terapia de infusão de fluidos por via subcutânea em pacientes em cuidados paliativos. A instituição sediadora foi um hospital privado, que contava com duas unidades assistenciais no estado do Rio de Janeiro. Resultados: identificou-se pouco conhecimento acerca da temática. Pela dinâmica utilizada, as oficinas possibilitaram qualificar os participantes a executarem e a manejarem a via subcutânea em ambientes de cuidados paliativos. Conclusões: as oficinas foram importante meio de formação, qualificação e divulgação do cuidado de enfermagem em ambiente de cuidados paliativos. Os recursos utilizados possibilitam a qualificação na execução e no manejo da técnica apresentada.

Meta-analysis of the Efficacy and Safety of Different Administration Routes of Bevacizumab in the Treatment of Malignant Pleural Effusion / 中国药房

OBJECTIVE：To evaluate the efficacy and s afety of different administration routes of bevacizumab in the treatment of malignant pleural effusion （MPE），and to provide evidence-based reference for rational use of drugs in clinic. METHODS ： Retrieved from Cochrane L ibrary，PubMed，Embase，VIP，CNKI，Wanfang database and CBM ，clinical studies were collected ， about bevacizumab combined with or without chemotherap eutic drugs （trial group ）versus chemotherap eutic drugs （control group ） in the treatment of MPE under different administration routes. After literature screening and data extraction ，the quality of RCTs was evaluated by using bias risk evaluation tool recommended by Cochrane Systematic Evaluator Manual 5.3. Newcastle-Ottawa scale was used to evaluate the quality of the retrospective study. Meta-analysis was performed by using Rev Man 5.3 software， network Meta-analysis was performed by using Stata 13.0 software and intervention measures were ranked by using R 3.6.1 software. RESULTS ：A total of 29 studies were included ，involving 21 RCTs and 8 retrospective studies ，including 2 254 patients. The studies involved 5 intervention measures ，such as bevacizumab+chemotherap eutic drugs （thoracic perfusion ），bevacizumab+ chemotherapeutic drugs （ivgtt），bevacizumab（thoracic perfusion ），chemotherapeutic drugs （thoracic perfusion ），chemotherapeutic drugs（ivgtt）. Network Meta-analysis showed there was no statistical significance in bevacizumab+chemotherap eutic drugs （thoracic perfusion）and bevacizumab+chemotherap eutic drugs （ivgtt）[OR＝0.81，95％CI（0.13，4.60），P＞0.05]，chemotherapeutic drugs （thoracic perfusion ）and chemo therapeutic drugs （ivgtt）[OR＝ 0.47， 95％ CI （0.07，3.10）， P＞0.05]， bevacizumab + Z19SCHX202） chemotherapeutic drugs （ivgtt） and chemotherap eutic drugs （ivgtt） [OR＝0.56，95％ CI（0.27，1.20），P＞0.05]. Total 、 response rate of bevacizumab + chemotherap eutic drugs （thoracic perfusion ） [OR＝3.10，95％ CI（2.10，4.50），P＜ 0.05]，bevacizumab（thoracic perfusion ）[OR＝1.90，95％CI （0.99，3.90），P＜0.05] were significantly higher than chemotherapeutic drugs （thoracic perfusion ）. Network Meta-analysis ranking showed that bevacizumab + chemotherapeutic drugs （ivgtt）＞ bevacizumab + chemotherapeutic drugs （thoracic perfusion ）＞ bevacizumab（thoracic perfusion ）＞chemotherapeutic drugs （ivgtt）＞chemotherapeutic drugs （thoracic perfusion ）. The incidence of elevated blood pressure [RR= 2.64，95％CI（1.56，4.43），P＝0.000 3] and proteinuria [RR ＝3.24，95％CI（1.79，5.86），P＝0.000 1] in trial group were significantly higher than control group. There was no statistical significance in the incidence of granulo- cytopenia [RR ＝0.94，95％CI（0.81，1.09），P＝0.41] or nausea and vomiting [RR ＝0.87，95％CI（0.73，1.03），P＝0.10] between 2 groups. Compared with chemotherapy alone ，bevacizumab combined chemotherapy could not prolong the total survival time of patients，but can improve the progression-free survival time. CONCLUSIONS ：Bevacizumab combined with chemotherapy can improve the efficacy of MPE patients ，but thoracic perfusion can increase the risk of proteinuria and elevated blood pressure.

Tratamento da hipomelanose gutata idiopática com laser Er:YAG 2940nm isolado ou combinado ao drug delivery de piperina: um estudo-piloto comparativo / Treatment of idiopathic guttate hypomelanosis with Er:YAG 2940nm laser alone or combined to piperine drug delivery: a pilot and comparative study

Introdução: Introdução: A hipomelanose gutata idiopática constitui uma leucodermia adquirida, cujas opções terapêuticas disponíveis apresentam resultados inconsistentes. Objetivos: Avaliar o efeito do laser fracionado ablativo isolado ou combinado ao drug delivery de piperina para tratamento de hipomelanose gutata idiopática. Materiais e métodos: Em um estudo prospectivo e comparativo, sete pacientes apresentando HGI nas pernas foram selecionadas, sendo escolhidas cinco lesões em cada perna de cada uma. Ambas as pernas de cada paciente foram submetidas a duas sessões de laser Er:- YAG 2940nm, seguido de drug delivery de piperina 20% somente na perna direita. A avaliação foi feita por avaliadores cegos por meio de fotografias e medidas comparativas das lesões. Resultados: O tamanho das lesões variou de 0,2cm a 1,5cm. Ambos os tratamentos reduziram significativamente o tamanho das lesões (p<0,00008 perna direita e p<0,002 perna esquerda). O método de equações de estimativas generalizadas demonstrou que não houve diferença estatística entre os grupos em relação à redução do tamanho das lesões. A avaliação atingiu melhores escores para a perna direita (laser + piperina) (p=0,126). Conclusão: Embora diferenças estatisticamente significativas não tenham sido encontradas entre o lado tratado com laser e drug delivery versus o lado tratado somente com laser, acreditamos que a técnica possa representar uma opção no arsenal terapêutico.

Introduction: Idiopathic guttate hypomelanosis is an acquired leukoderma, whose available therapeutic options have inconsistent results. Objectives: To evaluate the effect of isolated or combined ablative fractionated laser to drug delivery of piperine for treatment of idiopathic guttate hypomelanosis. Materials and methods: In a prospective and comparative study, seven patients with idiopathic guttate hypomelanosis in the legs were elected, and five lesions were selected on each leg of each. Both legs of each patient were submitted to two Er:YAG 2940nm laser sessions, followed by drug delivery of piperine 20% only in the right leg. Blind evaluators conducted the assessment through photographs and comparative measurements of the lesions. Results: The lesion size ranged from 0.2cm to 1.5 cm. Both treatments significantly reduced lesion size (p< 0.00008, right leg; p< 0.002, left leg). The generalized estimating equation method showed that there was no statistical difference between the groups regarding the reduction of lesion size. The evaluation achieved better scores for the right leg (laser + piperine) (p=0.126). Conclusion: Although statistically significant differences were not found between the side treated with laser and drug delivery versus the side treated only with laser, we believe that the technique may represent an option in the therapeutic arsenal.

Sérum anidro fluido como veículo para formulações de drug delivery: resultados do teste de esterilidade para crescimento bacteriano e fúngico / Anhydrous fluid serum as vehicle for drug delivery formulations: sterility test results for bacterial and fungal growth

Introdução: A entrega tópica de medicamentos é essencial na Dermatologia. Devido à dificuldade de permeação do estrato córneo, as técnicas de drug delivery vêm recebendo destaque. O uso de formulações não específicas para este fim nos faz atentar para possíveis efeitos adversos e para a segurança microbiológica destas formulações. Objetivo: Avaliar crescimento bacteriano e fúngico no sérum anidro fluido por meio do teste de esterilidade simples. Materiais e métodos: O teste de esterilidade simples foi realizado em um sérum anidro contendo ativos lipofílicos e hidrofílicos. Este teste foi realizado três meses após a manufatura do produto. Resultados: A formulação estudada foi aprovada no teste de esterilidade simples realizado três meses após a manufatura do produto, mesmo sem uso de conservantes na formulação. A formulação em estudo foi aprovada no teste de esterilidade possivelmente devido ao fato de o veículo sérum ser de origem mineral e anidra, características que não favorecem a proliferação de micro-organismos. Conclusões: Embora somente o veículo contando ativos específicos tenha sido testado, os resultados deste estudo são promissores e demonstram a necessidade de estudos futuros que englobem de forma mais ampla o assunto.

Introduction: Topical delivery of drugs is essential in Dermatology. Due to the difficulty of permeation of the stratum corneum, drug delivery techniques have been highlighted. The use of non-specific formulations for this purpose makes raises the concern of possible adverse events and the microbiological safety of these formulations. Objective: To assess bacterial and fungal growth in anhydrous fluid serum through simple sterility test. Materials and methods: The simple sterility test was performed on an anhydrous serum containing lipophilic and hydrophilic active substances. This test was performed three months after the manufacture of the product. Results: The formulation studied was approved in the simple sterility test conducted three months after the manufacture of the product, even without the use of preservatives in the formulation. Discussion: The assessed formulation was approved in the sterility test possibly due to the fact that the serum vehicle has mineral and anhydrous origin, characteristics that do not favor the proliferation of microorganisms. Conclusions: Although only the vehicle counting specific assets has been tested, the results of this study are promising and demonstrate the need for future studies broadly encompassing this subject.

(Re)discutindo a técnica de administração de medicamentos pela via intramuscular: revisão sistemática / (Re)discussing the drug administration technique by the intramuscular route: a systematic review / (Re)discutir la técnica de administración de fármacos por vía intramuscular: revisión sistemática

Objetivo: Identificar la producción del conocimiento en enfermería junto la técnica de administración de medicamentos por vía intramuscular, describa las diferencias, congruencias, y la ocurrencia de las complicaciones de la técnica y analizar las recomendaciones formuladas en la literatura con las mejores prácticas y las actualizaciones clínicas en enfermería. Método: Revisión sistemática sin meta-análisis. Búsqueda realizada en las bases de datos LILACS, PUBMED, MEDLINE, DEDALUS, Portal de Evidencia en Salud y Bibliotecas SciELO y Cochrane, en el período de 1993-2012, por un total de 16 estudios. Resultados: Estúdios mostraron diferencias en las variaciones en la demarcación de la región ventral glútea, la realización de la antisepsia y la aplicación de presión antes de la administración intramuscular. Consonancia en la aspiración del contenido de la jeringa después de la inserción de la aguja en el músculo, de ricino secuencias del sitio de aplicación para inyección IM, entre otras. Conclusión: La incorporación de la mejor evidencia permite la ejecución segura de la técnica intramuscular, proporcionando comodidad y la excelencia en la atención al paciente

Objective: The study's purpose has been to identify the production of nursing knowledge related to the medication administration technique by the intramuscular route. It was also aimed to describe the differences, similarities, and occurrence of complications of the technique and to analyze the recommendations described in literature with best practice and clinical updates in the nursing research field. Methods: This is a systematic review without meta-analysis. The research was performed through the following electronic databases, LILACS, PUBMED, MEDLINE, DEDALUS, Health Evidence Portal and Libraries SciELO and Cochrane, during the period from 1993 to 2012, then totaling 16 studies. Results: The findings have shown the different variations in the limit of the ventrogluteal region, conducting antisepsis, and applying pressure before intramuscular administration. They also showed consonances in the aspiration of the contents of the syringe after insertion of needle into the muscle, caster application site during sequences IM injections, among others. Conclusion: The incorporation of best evidence allows safe execution of intramuscular technique, providing comfort and excellence towards the patient care

Objetivo: Identificar a produção do conhecimento da enfermagem atrelado à técnica de administração de medicamentos pela via intramuscular; descrever as divergências, congruências e ocorrência de complicações acerca da técnica; e analisar as recomendações descritas na literatura com as melhores práticas e atualizações clínicas na enfermagem. Método: Revisão sistemática sem meta-análise. Realizada busca nas bases de dados LILACS, PUBMED, MEDLINE, DEDALUS, Portal de Evidência em Saúde e Bibliotecas SciELO e Cochrane, no período de 1993 a 2012, totalizando 16 estudos. Resultados: Os estudos evidenciaram divergências na variações de demarcação da região ventroglútea; realização de antissepsia; e aplicação de pressão antes da administração intramuscular. Consonâncias na aspiração do conteúdo da seringa após inserção da agulha na massa muscular, rodízio do local de aplicação durante sequências de injeções IM, dentre outros. Conclusão: A incorporação das melhores evidências permite a execução segura da técnica intramuscular, gerando conforto ao paciente e excelência na assistência

The Effects of Menopausal Hormone Therapy on Serum Level of C-reactive Protein in Postmenopausal Korean Women

OBJECTIVES: Inflammation is a major mechanism underlying coronary heart disease (CHD) and C-reactive protein (CRP) is a marker of inflammation. When administered soon after menopause, menopausal hormone therapy (MHT) prevents CHD. This study was conducted to examine the impact of estrogen by administration route on CRP in postmenopausal Korean women using micronized progesterone (MP4) for endometrial protection. METHODS: This retrospective cohort study included 129 healthy women without CHD risk factors. Eighty-nine women took oral estrogen (conjugated equine estrogen, 0.625 mg/day or equivalent), and 40 women applied a 1.5-mg/day 0.1% percutaneous estradiol gel. MP4 was added in 82 women with an intact uterus. The CRP level was measured at baseline and three and six months after initiation of MHT. RESULTS: The baseline characteristics were comparable between the MHT groups except current age and age at menopause. After controlling for age, menopausal age, body mass index, and basal CRP, no significant change in CRP was observed in the oral estrogen group (n = 29). Follow-up CRP levels were also similar to the baseline in the percutaneous estrogen group (n = 18). However, three-month CRP was significantly lower than six-month CRP, and there was a significant time trend within the percutaneous estrogen group. However, the group difference did not reach statistical significance. CRP also did not differ by addition of MP4 in either group. CONCLUSIONS: In postmenopausal Korean women, no change in CRP was observed with oral estrogen, while percutaneous estrogen might decrease CRP. The estrogenic impacts were not influenced by adding MP4.

Comparison of therapeutic effect of dibutyryl cyclic adenosine monophosphate calcium on chronic heart failure between different administration route／ / 心血管康复医学杂志

To compare therapeutic effect of dibutyryl cyclic adenosine monophosphate calcium (DCAMC) on chronic heart failure (CHF) between different administration route .Methods :The 98 CHF patients were ran‐ domly and equally divided into intravenous drip (i .v.gtt) group and intramuscular injection group (i.m .) group , both groups received DCAMC via corresponding administration route based on routine anti heart failure treatment for 10d.Plasma level of N terminal pro brain natriuretic peptide (NT‐proBNP) ,left ventricular end diastolic dimen‐sion (LVEDd) ,LVEF before and after treatment ,and incidence of adverse reactions were observed and compared between two groups .Results :Compared with before treatment , there were significant reductions in plasma NT‐proBNP level [i.v.gtt group :(6846.23 ± 3856. 01)pg／ml vs.(2285.69 ± 2023.79)pg／ml ,i .m .group :(6151. 50 ± 5160.09) pg／ml vs.(2568.37 ± 2488.51)pg／ml] and LVEDd [i.v.gtt group :(4.78 ± 0.44 )cm vs.(4. 69 ± 0.43) cm ,i.m .group :(4.97 ± 0.64)cm vs .(4. 88 ± 0.62) cm] ,and significant rise in LVEF [i.v.gtt group :(59.49 ± 4.64)% vs.(60. 67 ± 4. 52)%,i.m.group :(57.67 ± 7.19)% vs.(58.94 ± 7.05)%] in two groups after treatment , P＝0.001 all.There were no significant difference in above indexes between two groups before and after treatment , P＞0. 05 all.There was no significant difference in incidence rate of adverse reactions between two groups , P＝1.000. Conclusion :DCAMC can improve cardiac function in CHF patients .Therapeutic effect of local intramuscular injection is equal with that of intravenous drip .

Preferencias de Reumatólogos del Ecuador sobre el tratamiento de la artritis reumatoide

RESUMEN Introducción: los medicamentos para el manejo de la artritis reumatoide (AR), especialmente los biológicos y los aprobados recientemente, están en un proceso de disminuir la invasividad de su vía de administración. La investigación terapéutica avanza cada día en el desarrollo de nuevas fórmulas que se basan en mayor efectividad y seguridad, sin embargo, también se están haciendo esfuerzos en vías de administración menos invasivas y menos requirentes de servicios de salud (autoadministrables) por lo tanto, es necesario conocer la opinión de los especialistas. Objetivo: Determinar las preferencias sobre la vía de administración de medicamentos para el tratamiento de AR por parte de médicos reumatólogos. Metodología: se realizó un estudio de corte transversal en reumatólogos del Ecuador en 2017. La información fue recolectada a través de una encuesta diseñada para esta investigación. Resultados: el 61,5% de los médicos prefieren la vía subcutánea, principalmente la autoadministrada. El 73% de los médicos cree que el paciente está preparado para la autoadministración sin embargo perciben que el nivel educativo puede ser un factor importante en su contra. La mayoría de profesionales basa su preferencia en el confort y seguridad del paciente. Conclusiones: la percepción de los médicos en general se baja en la disminución de la invasividad y el incremento de la seguridad, la percepción de los profesionales sobre las vías autoadministrables se centra en la preparación de los pacientes como una barrera, la vía oral es un objetivo importante y esperable por los profesionales.

ABSTRACT Introduction: Drugs for the management of rheumatoid arthritis (RA), especially the biological and recently approved, are in a process of reducing the invasiveness of its route of administration. Therapeutic research advances every day in the development of new formulas that are based on greater effectiveness and safety, however, efforts are also being made in less invasive administration routes and less demanding of health services (self-administered). Therefore, it is necessary to know the opinion of the specialists. Objective: To determine the preferences on the route of administration of medications for the treatment of RA by rheumatologists. Methodology: A cross-sectional study was carried out in rheumatologists from Ecuador in 2017. The information was collected through a survey designed for this research. Results: The subcutaneous route was preferred by 61.5% of doctors, mainly self-administered. Seventy three percent of doctors believe that the patient is prepared for self-administration, however, they perceive that the educational level can be an important factor against it. Most professionals base their preference on patient comfort and safety. Conclusions: The perception of physicians in general is based on the decrease of invasiveness and the increase of safety. The perception of professionals on self-administered routes is focused on the preparation of patients as a barrier while the oral route is a important and expected objective of the professionals.

Nursing knowledge and practices regarding subcutaneous fluid administration / Conocimientos y prácticas de enfermería en la administración de fluidos por vía subcutánea / Conhecimentos e práticas da enfermagem na administração de fluidos por via subcutânea

ABSTRACT Objective: To describe the evidence in the literature regarding the knowledge and practices of the nursing team about subcutaneous administration of drugs and fluids in adults. Method: Integrative review of the literature using the descriptors "nursing", "hypodermoclysis", "drug administration routes", "adult health," and "knowledge," in English, Spanish, and Portuguese, with no publication deadline. Of the 569 articles found, eight made up the sample. Results: A predominance of international journals (75%) with more than five years of publication (62.5%). The analysis of the methodological characteristics showed a predominance of literature reviews (25%), quantitative studies (62.5%), cross-sectional studies (50%), and non-experimental studies (50%). Conclusion: Although it is an old technique with proven efficacy, hypodermoclysis is still little used, a puzzling fact due to its advantages and indications for any age.

RESUMEN Objetivo: Describir las evidencias, en la literatura, acerca de los conocimientos y prácticas del equipo de enfermería sobre administración de medicamentos y fluidos por vía subcutánea en adultos. Método: Revisión integrativa de la literatura, utilizando los descriptores: enfermería, hipodermoclisis, vías de administración de medicamentos, salud del adulto y conocimiento; en idiomas inglés, español y portugués, sin fecha límite de publicación. Fueron encontrados 569 artículos, de los cuales 8 integraron la muestra. Resultados: Predominio de revistas internacionales (75%), y con más de cinco años de publicación (62,5%). Al analizarse las características metodológicas, predominaron: revisiones de literatura (25%), estudios cuantitativos (62,5%), estudios transversales (50%) y no experimentales (50%). Conclusión: A pesar de tratarse de una técnica antigua de comprobada eficacia, la hipodermoclisis es aún poco utilizada, hecho inexplicable, dadas sus ventajas e indicaciones para cualquier edad.

RESUMO Objetivo: descrever as evidências, na literatura, sobre os conhecimentos e as práticas da equipe de enfermagem na administração de medicamentos e de fluidos por via subcutânea no adulto. Método: revisão integrativa da literatura utilizando os descritores enfermagem, hipodermóclise, vias de administração de medicamentos, saúde do adulto e conhecimento; nos idiomas inglês, espanhol e português, sem data limite de publicação. Dos 569 artigos encontrados, oito compuseram a amostra. Resultados: predomínio de revistas internacionais (75%) e com mais de cinco anos de publicação (62,5%). Ao analisarem-se as características metodológicas, predominaram: revisões de literatura (25%), estudos quantitativos (62,5%), estudos transversais (50%) e não-experimentais (50%). Conclusão: apesar de se tratar de uma técnica antiga com eficácia comprovada, a hipodermóclise ainda é pouco utilizada, fato incoerente pelas suas vantagens e suas indicações para qualquer idade.

Comparing the Rates of Dopamine Hemodynamic Effect Onset after Infusion through Peripheral Veins in Three Regions / 대한중환자의학회지

BACKGROUND: Dopamine is an inotropic agent that is often selected for continuous infusion. For hemodynamic stability, the rate of infusion is controlled in the range of 5-15 µg/kg/min. This study aimed to compare the time intervals from the administration of dopamine to the onset of its hemodynamic effects when dopamine was administered through three different peripheral veins (the cephalic vein [CV], the great saphenous vein [GSV], and the external jugular vein [EJV]). METHODS: Patients in group 1, group 2, and group 3 received dopamine infusions in the CV, GSV, and EJV, respectively. A noninvasive continuous cardiac output monitor (NICCOMO™, Medis, Ilmenau, Germany) was used to assess cardiac output (CO) and systemic vascular resistance (SVR). Six minutes after intubation, baseline heart rate (HR), systolic blood pressure (BP), diastolic BP, mean arterial pressure (MAP), CO, and SVR values were recorded and dopamine infusion was initiated at a dose of 10 µg/kg/min. Hemodynamic changes at 0, 4, 8, 12, and 15 minutes postinfusion were recorded. RESULTS: No statistically significant differences were observed among the three groups with respect to the rate of hemodynamic change. In all groups, systolic BP, diastolic BP, MAP, and SVR tended to increase after decreasing for the first 4 minutes; in contrast, HR and CO decreased until 8 minutes, after which they tended to reach a plateau. CONCLUSIONS: For patients under general anesthesia receiving dopamine at 10 µg/kg/min, there were no clinical differences in the effect of dopamine administered through three different peripheral veins.

Comparing the Rates of Dopamine Hemodynamic Effect Onset after Infusion through Peripheral Veins in Three Regions / 대한구급학회지

BACKGROUND: Dopamine is an inotropic agent that is often selected for continuous infusion. For hemodynamic stability, the rate of infusion is controlled in the range of 5-15 µg/kg/min. This study aimed to compare the time intervals from the administration of dopamine to the onset of its hemodynamic effects when dopamine was administered through three different peripheral veins (the cephalic vein [CV], the great saphenous vein [GSV], and the external jugular vein [EJV]). METHODS: Patients in group 1, group 2, and group 3 received dopamine infusions in the CV, GSV, and EJV, respectively. A noninvasive continuous cardiac output monitor (NICCOMO™, Medis, Ilmenau, Germany) was used to assess cardiac output (CO) and systemic vascular resistance (SVR). Six minutes after intubation, baseline heart rate (HR), systolic blood pressure (BP), diastolic BP, mean arterial pressure (MAP), CO, and SVR values were recorded and dopamine infusion was initiated at a dose of 10 µg/kg/min. Hemodynamic changes at 0, 4, 8, 12, and 15 minutes postinfusion were recorded. RESULTS: No statistically significant differences were observed among the three groups with respect to the rate of hemodynamic change. In all groups, systolic BP, diastolic BP, MAP, and SVR tended to increase after decreasing for the first 4 minutes; in contrast, HR and CO decreased until 8 minutes, after which they tended to reach a plateau. CONCLUSIONS: For patients under general anesthesia receiving dopamine at 10 µg/kg/min, there were no clinical differences in the effect of dopamine administered through three different peripheral veins.

Pharmacokinetics and drug therapy in neonates

Neonates include both full term and preterm infants up to 28 days of age. The heterogeneity and rapid physiologic change of neonates affect all aspects of pharmacokinetics such as absorption, distribution, metabolism, and elimination. This feature should be considered in determining the dose and regimen of drug therapy in neonates. However, the research on the safety and efficacy of specific drugs is limited due to ethical and technical issues. This review article focuses on the neonatal pharmacokinetics and the rationales of drug therapy in neonates based on findings of previous studies and empirical evidence.

Effect of two administration routes of Shenmai Injection () on pulmonary gas exchange function after tourniquet-induced ischemia-reperfusion / 中国结合医学杂志

<p><b>OBJECTIVE</b>To compare the effect between nebulized and intravenous administration of Shenmai Injection () on pulmonary gas exchange function of patients following tourniquet-induced lower limb ischemia-reperfusion.</p><p><b>METHODS</b>Thirty-eight patients scheduled for lower extremity surgery were randomized into three groups using the closed envelop method: Shenmai Injection was administered 30 min before tourniquet inflflation by nebulization [0.6 mL/kg in 10 mL normal saline (NS)] in the nebulization group or by intravenous drip (0.6 mL/kg dissolved in 250 mL of 10% glucose) in the intravenous drip group, and equal volume of NS was given intravenously in the NS group; 15 in each group. Arterial blood gases were analyzed, serum levels of malonaldehyde (MDA) and interleukine-6 (IL-6) and interleukine-8 (IL-8) were determined using the method of thiobarbituric acid reaction and enzyme-linked immuno sorbent assay respectively just before tourniquet inflflation (T0), and at 0.5 h (T1), 2 h (T2), 6 h (T3) after tourniquet deflflation.</p><p><b>RESULTS</b>Compared with baselines at T0, MDA levels signifificantly increased at T2, T3 in the NS group and at T3 in the nebulization group, and IL-6 and IL-8 levels were signifificantly increased at T2, T3 in NS, the intravenous drip and the nebulization groups (P <0.05). Arterial pressure of oxygen (PaO) at T3 was decreased, while alveolararterial oxygen tension showed difference (PA-aDO) at T3 in the NS group; RI at T3 in both intravenous drip and the nebulization groups were enhanced (P <0.05). Compared with the NS group, MDA and IL-8 levels at T2, T3, IL-6 at T3 in the intravenous drip group, and IL-8 at T3 in the nebulization group were all remarkably increased (P <0.05). Additionally, MDA level at T3 in the nebulization group was higher than that in the intravenous drip group (P <0.05).</p><p><b>CONCLUSIONS</b>Intravenous administration of Shenmai Injection provided a better protective effect than nebulization in mitigating pulmonary gas exchange dysfunction in patients following tourniquet-induced limb ischemia-reperfusion.</p>

Drug delevery assistido por lasers: revisão / Drug delevery assistido por lasers: revisão

A via tópica de entrega de medicamentos é essencial na dermatologia. O drug delivery otimiza a penetração de medicamentos e, realizado por lasers, ocorre de forma uniforme e controlada. O grau de evidência do drug delivery está em investigação para diversos medicamentos. Além disso, a técnica é excelente associação com a atuação dos lasers para rejuvenescimento e para tratamento de doenças dermatológicas. Conclusão: O uso de lasers para drug delivery é promissor: enquanto algumas substâncias possuem estudos clínicos que permitem indicar sua realização, outras necessitam de estudos controlados e com maior tempo de seguimento para sua avaliação.

The topical route for the delivery of drugs is essential in dermatology: it optimizes the penetration of medicaments, and when performed with the assistance of lasers, it takes place in a uniform and controlled manner. The degree of evidence of drug delivery is being investigated for many drugs. Moreover, the technique combines outstandingly with lasers for rejuvenation and treatment of skin diseases. It is therefore possible to conclude that the use of lasers for drug delivery is promising. While there are clinical studies on some substances that allow their indication and use, others require further controlled analyses, with longer follow-up periods, aimed at allowing thorough evaluations.