Does L-carnitine prevent cadmium-induced damage in gastrointestinal contractility and histological changes in prepubertal rat / ¿La L-carnitina previene el daño inducido por cadmio en la contractilidad gastrointestinal y los cambios histológicos en ratas prepúberes?

SUMMARY: Cadmium (Cd) is the industrial and environmental toxic heavy metal which is found in air, water and soil. Cd, adversely affects many organs in humans such as kidney, intestine, liver, testis and lungs. L-carnitine (LC) is an important agent that plays essential role in energy metabolism. In our study, we aimed to work out whether LC application has any protective effect on intestinal contractility and morphologic damage of prepubertal rat duodenum on Cd-induced toxicity. Twenty eight prepubertal female Wistar rats were divided into four groups. The first group is control (C), second group; Cd group; Cadmium chloride was given 2 mg/kg 28 days with a one-day break by i.p. The third group; Cd+LC, which cadmium chloride was given 2 mg/kg i.p. and LC was given orally by gastric lavage. The LC dose was given as 75 mg/kg. The fourth group; LC, which only LC was given orally. The intestinal segments were isolated and suspended in tissue bath. Contractile responses were induced by acetylcholine (ACh) and relaxation was achieved with phenylephrine. Also the segments were examined for histological changes by light microscopy. Ach-induced contractions were higher in Cd+LC, LC, and control group compared to the Cd group in duodenal segments. The phenylephrine-induced relaxations were lower in Cd groups as compared with Control, Cd+LC and LC group in duodenal segments. In Cd group intestinal morphology was observed to be severely damaged whereas in Cd+LC group the damage was noticeably lower. Cd administration caused severe cellular damage and decreased gastrointestinal motility. Treatment with the LC has affected the gastrointestinal contractility and reduced the damage in intestinal morphology, which occured after Cd application.

El cadmio (Cd) es el metal pesado tóxico industrial y ambiental que se encuentra en el aire, el agua y el suelo. El Cd afecta negativamente a muchos órganos humanos, como los riñones, los intestinos, el hígado, los testículos y los pulmones. La L-carnitina (LC) es un agente importante que juega un rol esencial en el metabolismo energético. El objetivo de este estudio fue determinar si la aplicación de LC tiene algún efecto protector sobre la contractilidad intestinal y el daño morfológico del duodeno de rata prepuberal sobre la toxicidad inducida por Cd. Veintiocho ratas Wistar hembras prepúberes se dividieron en cuatro grupos. El primer grupo control (C), segundo grupo; grupo cd; Se administró cloruro de cadmio 2 mg/kg durante 28 días con un descanso de un día por vía i.p. El tercer grupo; Cd+LC, al que se administró cloruro de cadmio 2 mg/kg i.p. y LC se administró por vía oral mediante lavado gástrico. La dosis de LC se administró como 75 mg/kg. El cuarto grupo; LC, al cual solo LC se administraba por vía oral. Los segmentos intestinales fueron aislados y suspendieron en baño de tejido. Las respuestas contráctiles fueron inducidas por acetilcolina (ACh) y la relajación se logró con fenilefrina. También se examinaron los segmentos en busca de cambios histológicos mediante microscopía óptica. Las contracciones inducidas por Ach fueron mayores en Cd+LC, LC y el grupo control en comparación con el grupo Cd en los segmentos duodenales. Las relajaciones inducidas por fenilefrina fueron menores en los grupos Cd en comparación con el grupo Control, Cd+LC y LC en los segmentos duodenales. En el grupo Cd se observó que la morfología intestinal estaba severamente dañada mientras que en el grupo Cd+LC el daño fue notablemente menor. La administración de Cd causó daño celular severo y disminución de la motilidad gastrointestinal. El tratamiento con LC afectó la contractilidad gastrointestinal y redujo el daño en la morfología intestinal, que ocurría después de la aplicación de Cd.

Involvement of MT2 receptors in protective effects of melatonin against cisplatin-induced gastrointestinal damage in mice

Abstract Melatonin (MLT) reportedly reduces side effects associated with certain antineoplastic agents. Accordingly, we investigated the effect of MLT on cisplatin (CP)-induced gastric emptying (GE) delay. Mice were intraperitoneally pretreated with vehicle (ethanol 5%; control group), MLT (5, 10, or 20 mg/kg), or N-acetylcysteine (NAC; 150 mg/kg), followed by CP treatment (5 mg/kg). Pharmacological modulation was analyzed using relevant receptor antagonists (luzindole: non-selective MT1/MT2 antagonist; 5 mg/kg or 4-P-PDOT: selective MT2 antagonist; 4 mg/kg) before treatment with MLT plus CP. All treatments were performed once daily for three days. GE was assessed using phenol red. Gut morphology was examined using scanning electron microscopy and optical microscopy. Compared with the control, CP decreased GE. Pretreatment with NAC and MLT (5 and 10 mg/kg) did not prevent CP-induced gastric dysmotility; however, pretreatment with 20 mg/kg MLT prevented this effect. In addition, luzindole and 4-P-PDOT suppressed MLT-mediated gastroprotection against cytotoxic effects of CP. CP caused degeneration of the gut mucosa, which was attenuated by MLT treatment. Thus, 20 mg/kg MLT prevented the GE delay and decreased CP-induced adverse effects on the gut mucosa. In addition, the gastroprotective activity was mediated via the MT2 receptor.

Adaptación transcultural del componente de síntomas gastrointestinales de la escala CTCAE versión 4. 02 / Transcultural adaptation of the component of gastrointestinal symptoms of the CTCAE scale version 4. 02

Resumen Objetivo: Realizar la traducción y adaptación transcultural del componente de síntomas gastrointestinales (SGI) de la escala CTCAE versión 4.02 en pacientes ambulatorios tratados con quimioterapia en el Instituto Nacional de Cancerología en Bogotá. Métodos: Se realizó una búsqueda manual en medios electrónicos de escalas en idioma inglés o español que evaluarán la presencia, frecuencia o intensidad de SGI en pacientes oncológicos. La selección de los ítems fue efectuada por consenso informal de un comité técnico, el cual verificó la concordancia entre los principales SGI descritos en la literatura y los incluidos en la escala, ya que estos podrían afectar el estado nutricional. Posteriormente, para la adaptación transcultural, se siguieron los pasos y recomendaciones del manual ISPOR y del grupo de calidad de vida EORTC. La prueba piloto se efectuó en 30 pacientes seleccionados por conveniencia, quienes cumplieron los criterios de inclusión. Resultados: El 52% eran hombres; la edad promedio fue de 54,2 años (+/- 15,3 años). Los cánceres más frecuentes fueron: colorrectal (28%), estómago (16%) y mama (12%). Los 14 SGI incluidos en la escala fueron experimentados por todos los pacientes, por lo cual se conservaron, y no se requirió adicionar ningún otro. El tiempo promedio de aplicación del instrumento fue de 5 minutos y el 90% de los participantes lo consideró adecuado. Conclusiones: Se generó un instrumento de 14 ítems para medir SGI en pacientes oncológicos ambulatorios sometidos a quimioterapia, el cual es de rápida aplicación y utiliza lenguaje de fácil comprensión para el paciente. Aunque todavía quedan por definir sus propiedades clinimétricas.

Abstract Objective: To carry out the translation and transcultural adaptation of the gastrointestinal symptoms component (GIS) of the CTCAE, scale version 4.02, in outpatient patients treated with chemotherapy at the National Cancer Institute, Bogotá (Colombia). Methods: It was performed a manual search of scales on electronic media, in English or Spanish languages, which will evaluate the presence and intensity of GIS in oncological patients. The selection of the items was made by an informal consensus of a technical committee, which verified the concordance between the main GIS described in the literature and those included in the scale, all of which could affect the nutritional status. For transcultural adaptation, there were followed the steps and recommendations of the ISPOR Handbook, as well as those of the EORTC quality of life group. The pilot test was conducted in 30 patients selected for convenience, who met the inclusion criteria. Results: 52% were men; the average age was 54.2 years (+/-15.3 years). The most frequent cancers were: colorectal (28%), stomach (16%) and breast (12%). The 14 GIS included in the scale were experienced by all patients, so they were retained, and no other addition was required. The average time of application of the instrument was 5 minutes, and 90% of the participants considered it appropriate. Conclusions: A 14-item instrument was generated to measure GIS in cancer patients who undergo outpatient chemotherapy, which is of fast application and uses a language that is easily understood by patients. Its clinimetrics properties remain to be defined.

Quality of life domains affected in women with breast cancer / Los dominios afectados en la calidad de vida de mujeres con neoplasia mamaria / Os domínios afetados na qualidade de vida de mulheres com neoplasia mamária

OBJECTIVE: This study aimed to investigate the quality of life of women suffering from breast cancer undergoing chemotherapy in public and private health care systems. METHOD: It is an observational, prospective study with 64 women suffering from breast cancer. Data was collected with two instruments: Quality of Life Questionnaire C30 and Breast Cancer Module BR23. By applying Mann Whitney and Friedman's statistical tests, p values < 0.05 were considered statistically significant. RESULTS: The significant results in public health care systems were: physical functions, pain symptom, body image, systemic effects and outlook for the future. In private health care systems, the results were sexual, social functions and body image. Women's quality of life was harmed by chemotherapy in both institutions. CONCLUSION: The quality of life of women has been harmed as a result of the chemotherapy treatment in both institutions, but in different domains, indicating the type of nursing care that should be provided according to the characteristics of each group. .

OBJETIVO: Se objetivó investigar la calidad de vida de las mujeres con neoplasia mamaria sometidas a quimioterapia, en el seguro médico público y privado. MÉTODO: Se trata de un estudio observacional, de cohorte, prospectivo, realizado con 64 mujeres con neoplasia mamaria. Los datos fueron recolectados mediante dos instrumentos Quality of Life Questionnaire C30 y Breast Cancer Module BR23. Para el análisis los datos se utilizaron pruebas estadísticas de Mann Whitney y Friedman, con valores estadísticamente significativas para p <005. RESULTADOS: Fueron verificadas diferencias estadísticamente significativas en el seguro médico público: la función física, síntoma dolor, la imagen corporal, los efectos sistémicos en las perspectivas de futuro, en el seguro médico privado fueron la función sexual, la imagen social y el cuerpo. CONCLUSIÓN: La calidad de vida de las mujeres se ha visto comprometida como consecuencia de la quimioterapia en ambas instituciones, pero en diferentes dominios que subsidia la atención de enfermería dirigida según las características de cada grupo. .

OBJETIVO: O objetivo deste estudo foi investigar a qualidade de vida das mulheres com neoplasia mamária submetidas à quimioterapia nos convênios público e privado. MÉTODO: Trata-se de estudo observacional, de coorte prospectivo, realizado com 64 mulheres portadoras de neoplasia mamária. Os dados foram coletados com a utilização dos instrumentos Quality of Life Questionnaire C30 e Breast Cancer Module BR23. Para análise dos dados, foram utilizados os testes estatísticos de Mann Whitney e Friedman, com valores estatisticamente significantes para p<005. RESULTADOS: Os resultados significantes no convênio público foram: função física, dor, imagem corporal, efeitos sistêmicos e perspectivas futuras. No convênio privado, foram: função sexual, social e imagem corporal. CONCLUSÃO: A qualidade de vida das mulheres foi comprometida em decorrência do tratamento quimioterápico em ambas as instituições, porém em domínios diferentes, o que subsidia um cuidado de enfermagem direcionado de acordo com as características de cada grupo. .

Adverse drug reactions associated with the use of disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis / Reacciones adversas a medicamentos asociadas con el uso de fármacos antirreumáticos modificadores de la enfermedad en pacientes con artritis reumatoide

This study describes the adverse drug reactions (ADRs) and their incidence in patients with rheumatoid arthritis who were treated in the Colombian health system. A retrospective cohort study was conducted using information from all patients who were diagnosed with rheumatoid arthritis and attended specialized health care centers in the cities of Bogotá, Cali, Manizales, Medellin, and Pereira between 1 December 2009 and 30 August 2013. The ADRs were obtained from medical records and the pharmacovigilance system registry and sorted by frequency and affected tissue according to World Health Organization Adverse Reaction Terminology (WHO-ART). A total of 949 reports of ADRs were obtained from 419 patients (32.8 ADRs per 100 patient-years); these patients were from a cohort of 1 364 patients being treated for rheumatoid arthritis and followed up for an average of 23.8 months (± 12.9). The cohort was mostly female (366, 87.4%) and had a mean age of 52.7 years (± 13.1). The highest numbers of ADRs were reported following the use of tocilizumab, rituximab, and infliximab (28.8, 23.1, and 13.3 reports per 100 patient-years respectively). The most frequently reported ADRs were elevated transaminase levels and dyspepsia. Overall, 87.7% of ADRs were classified as type A, 36.6% as mild, 40.7% as moderate, and 22.7% as severe. As a result, 73.2% of patients who experienced an ADR stopped taking their drugs. The occurrence of ADRs in patients treated for rheumatoid arthritis is common, especially in those associated with the use of biotechnologically produced anti-rheumatic drugs. This outcome should be studied in future research and monitoring is needed to reduce the risks in these patients.

Este estudio describe las reacciones adversas a medicamentos (RAM) y su incidencia en pacientes con artritis reumatoide y tratados en el sistema de salud colombiano. Se llevó a cabo un estudio retrospectivo de cohortes utilizando la información correspondiente a todos los pacientes con diagnóstico de artritis reumatoide que acudieron a centros especializados de atención de salud de las ciudades de Bogotá, Cali, Manizales, Medellín y Pereira entre el 1 de diciembre del 2009 y el 30 de agosto del 2013. Los casos de RAM se obtuvieron de las historias clínicas y del registro del sistema de farmacovigilancia, y se clasificaron por su frecuencia y el tejido afectado, según la Terminología de Reacciones Adversas de la Organización Mundial de la Salud ­ (WHO-ART). Se obtuvo un total de 949 informes de RAM en 419 pacientes (32,8 RAM por 100 pacientes-año); estos pacientes correspondían a una cohorte de 1 364 pacientes tratados por artritis reumatoide y seguidos durante un promedio de 23,8 meses (± 12,9). La cohorte estaba compuesta principalmente por mujeres (366, 87,4%) y la media de edad era de 52,7 años (± 13,1). El mayor número de casos de RAM se notificó tras el uso de tocilizumab, rituximab e infliximab (28,8, 23,1 y 13,3 notificaciones por 100 pacientes-año, respectivamente). Las RAM notificadas con mayor frecuencia fueron la elevación de los niveles de transaminasas y la dispepsia. En términos generales, 87,7% de las RAM se clasificaron como de tipo A, 36,6% como leves, 40,7% como moderadas y 22,7% como graves. Como consecuencia, 73,2% de los pacientes que presentaron una RAM dejaron de tomar sus medicamentos. La aparición de RAM en pacientes tratados por artritis reumatoide es frecuente, especialmente cuando se utilizan fármacos antirreumáticos de producción biotecnológica. Estos resultados deben ser objeto de estudio en futuras investigaciones y señalan la necesidad de actividades de vigilancia para reducir los riesgos en estos pacientes.

Eficacia y seguridad del uso de medicamentos para la cesación de la adicción al tabaco: revisión de guías de práctica clínica / Efficacy and safety of medication use for the cessation of tobacco addiction: Are view of Clinical Practice Guidelines

Objetivo Revisar la eficacia y seguridad de medicamentos para cesación del tabaquismo en el contexto de construcción de guías de práctica clínica (GPC). Métodos Revisión sistemática de GPC para adaptación mediante ADAPTE. Los desenlaces fueron cesación ≥6 meses y seguridad de las intervenciones. Las GPC se calificaron por pares con DELBI. Se extrajeron resultados de estudios agregativos incluidos en las guías seleccionadas. Resultados Los fármacos duplican la cesación comparados con placebo (tasas de 25,0 % hasta 27,0 % al combinarse con consejería). Los mayores incrementos en cesación se obtienen con ansiolíticos y antidepresivos (8,7% a 19,4%), y los menores con terapia de reemplazo nicotínico -TRN- (5,2% a 12,9%). La nortriptilina tiene eficacia similar al bupropion (aproximadamente 10,0 %). Con limitadas excepciones (parche e inhalador, tabletas y bupropion), las combinaciones de medicamentos no incrementan la abstinencia. Conclusiones TRN, vareniclina, bupropion y nortriptilina son eficaces para dejar de fumar. Las combinaciones de medicamentos requieren más evidencia y deberían restringirse a personas con alta dependencia o con falla terapéutica inicial. Serían deseables análisis de costo-efectividad para valorar implementación de programas en países en desarrollo.

Objective To review the efficacy and safety of pharmacotherapy for smoking cessation in the context of clinical practice guidelines (CPG). Methods A systematic review of CPGs was conducted, aimed at adapting recommendations for Colombia following the ADAPTE methodology. Outcomes comprised 6-months or higher smoking cessation rates and intervention safety. CPGs were peer-assessed based on DELBI. Results from aggregative studies included in selected CPGs were obtained. Results Pharmacotherapy doubles smoking cessation rates as compared with placebos (rates @25% and up to 27 % when combined with counseling). The highest efficacy was observed for ansyolitic and antidepressive drugs (8.7 % to 19.4 %), and the lowest for nicotine replacement therapy -NRT- (5.2 % to 12.9 %). Nortriptiline shows an efficacy similar to that of bupropion (@10%). With limited exceptions, combined pharmacotherapy for smoking cessation has shown no significant increase in cessation rates. Conclusions NRT, varenicline, bupropion and nortriptiline are effective treatments for smoking cessation. Combination of drugs deserves further clinical evidence and should be restricted to highly dependent smokers or initial therapeutic failure. Cost-effectiveness analyses might help to introduce smoking cessation programs in low and middle income countries.

Use of sanitizing products: safety practices and risk situations / Uso de produtos saneantes: práticas de segurança e situações de risco

OBJECTIVES: to evaluate the handling and risk factors for poisoning and/or digestive tract injuries associated with the use of sanitizing products at home. METHODS: interviews were conducted in 419 households from different regions, collecting epidemiological data from residents and risk habits related to the use and storage of cleaning products. RESULTS: sanitizing products considered to be a health risk were found in 98% of the households where the research was conducted, and in 54% of cases, they were stored in places easily accessible to children. Lye was found in 19%, followed by illicit products in 39% of homes. In 13% of households, people produced soap, and in 12% they stored products in non-original containers. The use of illicit products and the manufacture of handmade soap were associated with lower educational level of the household owners and with the regions and socioeconomic classes with lower purchasing power. CONCLUSIONS: risk practices such as inadequate storage, manufacturing, and use of sanitizing products by the population evidence the need for public health policies, including educational measures, as a means of preventing accidents. .

OBJETIVOS: avaliar a forma de utilização e os fatores de risco para intoxicações e/ou lesões do trato digestório associados ao uso dos produtos saneantes no domicílio. MÉTODOS: foram realizadas entrevistas em 419 domicílios de diferentes regiões, estabelecendo-se dados epidemiológicos dos moradores e hábitos de risco relacionados à utilização e armazenamento dos produtos de limpeza. RESULTADOS: dos domicílios onde foi realizada a pesquisa, havia produtos saneantes considerados de risco em 98%, sendo que em 54% dos casos, eles estavam armazenados em locais de fácil acesso para crianças. A soda cáustica estava disponível em 19% e os produtos "clandestinos" em 39% das moradias. Em 13% dos domicílios havia o hábito de fazer sabão e em 12% de armazenar os produtos fora da embalagem original. O uso de produtos clandestinos e a fabricação artesanal de sabão estavam associados à baixa escolaridade das donas das casas e às regiões e às classes econômicas de poder aquisitivo mais baixo. CONCLUSÕES: práticas de risco como armazenamento, fabricação e utilização inadequados de produtos saneantes pela população estudada apontam para a necessidade de políticas de saúde pública, incluindo medidas educacionais, como forma de prevenção de acidentes. .

Prescription Pattern of NSAIDs and the Prevalence of NSAID-induced Gastrointestinal Risk Factors of Orthopaedic Patients in Clinical Practice in Korea

This is a cross-sectional observational study undertaken to explore the current prescription pattern of non-steroidal anti-inflammatory drugs (NSAIDs) and the prevalence of NSAID-induced gastrointestinal (GI) risk factors of orthopaedic patients in real clinical practice in Korea. Study cohort included 3,140 orthopaedic outpatients at 131 hospitals and clinics between January 2008 and August 2008. A self-administered questionnaire was completed by each patient and physician. A simplified risk scoring scale (the Standardized Calculator of Risk for Events; SCORE) was used to measure patients' risk for GI complications. The pattern of NSAIDs prescription was identified from medical recordings. Forty-five percents of the patients belonged to high risk or very high risk groups for GI complications. The cyclooxygenase-2 enzyme (COX-2) selective NSAID showed a propensity to be prescribed more commonly for high/very high GI risk groups, but the rate was still as low as 51%. In conclusion, physician's considerate prescription of NSAIDs with well-understanding of each patient's GI risk factors is strongly encouraged in order to maximize cost effectiveness and to prevent serious GI complications in Korea. Other strategic efforts such as medical association-led education programs and application of Korean electronic SCORE system to hospital order communication system (OCS) should also be accompanied in a way to promote physician's attention.

Antibiotics-associated Diarrhea and Other Gastrointestinal Abnormal Responses Regarding Helicobacter pylori Eradication / 대한소화기학회지

BACKGROUND/AIMS: Helicobacter pylori (H. pylori) is closely related with a wide range of gastrointestinal disease. One-week triple therapy is currently considered as the golden standard for the treatment of H. pylori infection. However, gastrointestinal abnormal responses are major pitfalls in such regimen. The aim of this study was to identify symptoms, frequency and severity of antibiotics-associated gastrointestinal abnormal responses during H. pylori eradication therapy. METHODS: Sixty-seven patients with H. pylori infection between September 2005 and March 2006 were included. After 1 week of H. pylori eradication triple therapy (rabeprazol 10 mg, clarithromycin 500 mg, amoxicillin 1 g bid), we evaluated gastrointestinal abnormal responses (diarrhea, bloating, constipation, abdominal pain, borborygmus, flatulence, stool frequency, belching, and nausea) and severities every week for 4 weeks. RESULTS: The incidence of diarrhea was the highest in week 1, which was 41.28% (n=28) and the lowest in week 4, which was 9.52% (n=6) and decreased from week 1 to week 4 with statistical significance (p<0.0001). The most common gastrointestinal abnormal responses were associated with flatulence in week 1 (n=21, 31.34%), week 2 (n=21, 33.33%) and abdominal distention in week 3 (n=16, 25.40%), week 4 (n=15, 23.81%). Most of gastrointestinal abnormal responses were mild, and the most common symptom with higher than moderate grade was abdominal pain (n=4, 40.00%) in week 1. Alcohol consumption and coexisting medical illness were not associated with diarrhea (p=0.0852, 0.9009 respectively). CONCLUSIONS: H. pylori eradication therapy is commonly associated with antibiotics-associated gastrointestinal abnormal responses, which may result in antibiotics intolerance and H. pylori eradication failure. Even though those symptoms are not so severe, we have to consider the gastrointestinal abnormal responses associated with H. pylori eradication, especially diarrhea.

Improved Gastrointestinal Symptoms and Quality of Life after Conversion from Mycophenolate Mofetil to Enteric-Coated Mycophenolate Sodium in Renal Transplant Patients Receiving Tacrolimus

It is reported that a conversion from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) relieves gastrointestinal (GI) symptom burden and improves health-related quality of life (HRQoL). However, it is unclear whether renal transplant recipients using tacrolimus receive the same benefit from the conversion. In this prospective, multi-center, open-label trial, patients were categorized into two groups by their GI symptom screening. Equimolar EC-MPS (n=175) was prescribed for patients with GI burdens; those with no complaints remained on MMF (n=83). Gastrointestinal Symptom Rating Scale (GSRS) and Gastrointestinal Quality of Life Index (GIQLI) were evaluated at baseline and after one month. Patients and physicians completed Overall Treatment Effect (OTE) at one month. EC-MPS-converted patients had worse GSRS and GIQLI scores at baseline than MMF-continued patients (all P<0.001). Significant improvements in GSRS and GIQLI scores were observed for EC-MPS-converted patients at one month, but MMF-continued patients showed worsened GSRS scores (all P<0.05). OTE scale indicated that EC-MPS patients improved in overall GI symptoms and HRQoL more than MMF patients did (P<0.001). In tacrolimus-treated renal transplant recipients with GI burdens, a conversion from MMF to EC-MPS improves GI-related symptoms and HRQoL.

Efeitos adversos no tratamento da tuberculose: experiência em serviço ambulatorial de um hospital-escola na cidade de São Paulo / Adverse effects of tuberculosis treatment: experience at an outpatient clinic of a teaching hospital in the city of São Paulo, Brazil

OBJETIVOS: Verificar a freqüência de efeitos adversos com o uso do Esquema I para tratamento da tuberculose e a necessidade de alterações no tratamento devido a esses efeitos. MÉTODOS: Foi feita uma análise retrospectiva de 329 prontuários de pacientes que foram tratados com o Esquema I e receberam alta por cura entre março de 2000 e abril de 2006 no Ambulatório de Tuberculose da Clínica de Pneumologia da Santa Casa de Misericórdia de São Paulo. Foram analisados os dados referentes aos efeitos adversos, época de seu aparecimento e modificações do esquema de tratamento subseqüentes. RESULTADOS: Foram incluídos 297 pacientes, e 146 (49,1 por cento) apresentaram um ou mais efeitos adversos relacionados às drogas antituberculose. A freqüência dos efeitos colaterais menores foi de 41,1 por cento, e a dos efeitos maiores foi de 12,8 por cento. Os efeitos relacionados ao trato gastrointestinal (40,3 por cento) e pele (22,1 por cento) foram os mais freqüentes. Os efeitos adversos foram mais freqüentes nos primeiros dois meses de tratamento (58,4 por cento). Houve necessidade de modificação do esquema de tratamento em 11 casos (3,7 por cento do total). A hepatite induzida por medicamentos foi o efeito colateral que mais exigiu modificações. CONCLUSÕES: A freqüência de efeitos adversos relacionados ao tratamento da tuberculose com o Esquema I foi de 49,1 por cento neste grupo de pacientes. Entretanto, na maioria dos casos, não houve necessidade da modificação do esquema de tratamento devido aos efeitos adversos.

OBJECTIVES: To determine the frequency of adverse effects related to the use of the tuberculosis treatment regimen designated Regimen I and the need for regimen alterations due to these effects. METHODS: A retrospective analysis of 329 medical charts of patients who were treated with Regimen I and discharged after cure between March 2000 and April 2006 was carried out at the Tuberculosis Outpatient Clinic, Department of Pulmonology of the Santa Casa de Misericórdia de São Paulo Hospital in the city of São Paulo, Brazil. Adverse effects and the timing of their appearance, as well as subsequent modifications in the treatment regimen, were investigated. RESULTS: We included 297 patients, 146 (49.1 percent) of whom presented one or more adverse effects related to antituberculosis medications. The frequency of minor side effects was 41.1 percent, and that of major side effects was 12.8 percent. The most common reactions were those involving the gastrointestinal tract (40.3 percent) and the skin (22.1 percent). Adverse effects were more common in the first and second months of treatment (58.4 percent). Modification of the treatment regimen was necessary in 11 cases (3.7 percent of the total sample). Drug-induced hepatitis was the adverse effect that demanded the most regimen changes. CONCLUSIONS: In this group of patients, the frequency of adverse effects related to treatment with Regimen I was 49.1 percent. However, in most of the cases, it was not necessary to modify the treatment regimen due to side effects.

Corticoides sistémicos: uso racional en dermatología / Systemic glucocorticoids: rational use in dermatology

Los glucocorticoides (GC) son potentes agentes inmunosupresores y antiinflamatorios ampliamente utilizados en el tratamiento de enfermedades dermatológicas. Las complicaciones asociadas a la terapia esteroidal sistémica aumentan con dosis mayores, tratamientos prolongados y administración fraccionada. Para maximizar la eficacia de la terapia esteroidal minimizando el riesgo de efectos adversos, es necesario conocer su farmacocinética y función a nivel de distintos órganos blanco. En esta revisión damos una visión general del mecanismo de acción de los GC y sus efectos adversos, junto con algunas recomendaciones prácticas para su uso clínico efectivo y seguro, disminuyendo el riesgo de desarrollar complicaciones.

(GC) are potent immunosuppressive and anti-inflammatory agents widely used in the treatment of many dermatologic diseases. Complications associated with systemic GC increase with higher doses, prolonged therapies, and divided administration. In order to maximize the effectiveness of steroidal therapy, minimizing the risk of adverse effects, it is necessary to know their pharmacokinetics and function on different target organs. In this review, we take general look at the mechanism of action and side effects of GC, along with some practical recommendations for their safe and effective use in order to decrease the risk of complications.

NSAID-induced Gastroenteropathy / 대한소화기학회지

Non-steroidal anti-inflammatory drugs (NSAIDs) are used for the management of various conditions, such as pain, fever, inflammation, cancer, or cardiovascular diseases. These drugs may induce injury throughout the gastrointestinal tract. NSAIDs are associated with diverse upper gastrointestinal adverse effects, including dyspepsia, erosions, peptic ulcer diseases and complications such as bleeding perforation. Established risk factors for these adverse effects include age, prior ulcer, types, doses and duration of NSAIDs, concurrent other NSAIDs administration, and the concomitant uses of corticosteroids or anticoagulants. Misoprostol, proton pump inhibitors, and cyclooxygenase-2 selective inhibitors have been used to reduce the risk of NSAID-associated upper gastrointestinal events. NSAID-induced enteropathy is more common than complications of the stomach and duodenum and is usually manifested by occult blood loss or hypoalbuminemia. Furthermore, NSAIDs induce small intestinal injuries causing gut barrier damage, and bacterial translocation that have been proposed to be associated with the burden of illness in decompensated chronic heart failure. However, the risk factors for NSAID-induced enteropathy and bacterial translocation, as well as its preventive measures, are not well documented.

Conocimiento básico de los riesgos del uso de analgésicos no opioides en pacientes ambulatorios / Basic knowledge of risks for non-opioid analgesics (NOA) in ambulatory patients

OBJETIVO: Evaluar el conocimiento básico de los pacientes acerca de los analgésicos no opioides (ANOP) e identificar los posibles factores relacionados con la falta de información sobre este tipo de analgésicos. MATERIAL Y MÉTODOS: Participaron 629 pacientes >50 años con síndrome doloroso de origen no oncológico y que recibieron ANOP. Se analizaron sus características generales, la información recibida y su conocimiento sobre ANOP. La variable dependiente fue la falta de conocimiento básico (FCB) sobre ANOP. Se realizó análisis descriptivo y bivariado. RESULTADOS: Del total de participantes, 64.2 por ciento tuvo FCB; 28 por ciento desconocía la forma correcta de tomar ANOP y 48 por ciento sabía que ocasionan trastornos gastrointestinales. Factores asociados con la FCB: no recibir información sobre ANOP (RM= 2.22; IC95 por ciento 1.32-3.70), escolaridad < 7 años (RM= 1.87; IC95 por ciento 1.33-2.63) y duración del dolor < 4 años (RM=1.70; IC95 por ciento 1.22-2.37). CONCLUSIONES: Los pacientes carecen de conocimiento y reciben poca información acerca de ANOP. Es indispensable promover acciones para solucionar este problema.

OBJECTIVE: To describe patients’ knowledge of non-opioid analgesics (NOA) and to identify factors associated with patients’ lack of basic knowledge (LBN) on this type of medication. MATERIAL AND METHODS: A total of 629 ambulatory patients older than 50 years of age, with non-malignant pain syndrome, attended to two family medicine clinics and received seven day prescriptions for NOA. The data on patients’ general characteristics, the information they received and their actual knowledge of NOA were analyzed using descriptive statistics and bivariate analysis. RESULTS: A total of 64.2 percent had LBN; 28 percent did not know how to take NOA properly, and 48 percent knew that these drugs cause gastrointestinal adverse effects. The factors significantly associated with LBN on NOA included: failure to receive information on NOA (OR:2.22, 95 percentCI 1.32-3.70), education <7 years (OR:1.87, 95 percentCI 1.33-2.63) and pain duration <4 years (OR:1.70, 95 percentCI 1.22-2.37). CONCLUSION: Patients lack knowledge and receive little information on NOA. It is important to encourage actions to tackle this problem.

Retinoides orales en niños y adolescentes / Oral retinoids in children and adolescent

Los retinoides son muy eficaces en el tratamiento de diversas enfermedades cutáneas que se presentan en niños, como psoriasis, acné e ictiosis. Sus efectos adversos potenciales limitan su uso, especialmente en la población pediátrica. Revisamos la eficacia y riesgos de la terapia con retinoides orales en niños y adolescentes. La toxicidad mucocutánea es el efecto adverso más frecuente, siendo generalmente bien tolerada, fácilmente tratable y reversible al discontinuar el tratamiento. Los efectos adversos sistémicos más graves incluyen la teratogenicidad y los efectos musculoesqueléticos, neurológicos y del sistema gastrointestinal. La educación y control de los pacientes pueden minimizar la ocurrencia de complicaciones.

Anti-inflamatorios no esteroideos: situación 2005 / Non-steroidal anti-inflammatory drugs: update 2005

Los anti-inflamatorios no esteroideos (AINEs) constituyen una de las drogas más usadas en el mundo, ya sean prescriptascomo de venta libre. Son efectivas para controlar la inflamación, pero frecuentemente son utilizadas solamente paracontrolar el dolor o la fiebre. La prescripción en gerontes es casi cuatro veces mayor que en la población joven, siendo laprimera una población de mayor riesgo.De acuerdo a datos de EE.UU., se estima que alrededor del 5% de todas lasinternaciones se debe a efectos adversosproducidos por drogas, de las cuales un 30% se deberían a AINEs, cuyos efectos adversos son bien conocidos.El descubrimiento de las isoenzimas 1 y 2 de la ciclooxigenasa (COX-1 y 2) y la aparición de AINEs COX-2 selectivosha resultado en una mayor seguridad sobre el tracto gastrointestinal. La percepción inicial de que también podría habermenos efectos sobre el filtrado glomerular desapareció rápidamente, confirmándose que los COX-2 selectivos teníanefectos similares a los AINEs clásicos. Progresivamente apareció evidencia de que la inhibición selectiva de la COX-2podría generar una situación pro trombótica con mayor riesgo de accidentes cardiovasculares y cerebrales en pacientespredispuestos. Esto ha llevado al retiro del mercado de por lo menos dos de estas drogas.En otras áreas, el rol de la COX-2 ha abierto puertas interesantes en enfermedad de Alzheimer y cáncer de colon, pormencionar sólo dos. El rol de la COX-2 en otros tejidos es sumamente interesante, probablemente muy relevante, pero noestá aún completamente comprendido.El aumento del riesgo cardiovascular obliga a ser muy selectivos en la indicación de estas drogas. Esta situación generaproblemas en los pacientes con enfermedad reumática que deben tomarlos durante períodos prolongados.

Anti-inflamatorios no esteroideos: Situación 2005: [revisión] / Non-Steroidal Anti-Inflammatory Drugs: Update 2005: [revision]

Los anti-inflamatorios no esteroideos (AINEs) constituyen una de las drogas más usadas en el mundo, ya sean prescriptas como de venta libre. Son efectivas para controlar la inflamación, pero frecuentemente son utilizadas solamente para controlar el dolor o la fiebre. La prescripción en gerontes es casi cuatro veces mayor que en la población joven, siendo la primera una población de mayor riesgo. De acuerdo a datos de EE.UU., se estima que alrededor del 5% de todas las internaciones se debe a efectos adversosproducidos por drogas, de las cuales un 30% se deberían a AINEs, cuyos efectos adversos son bien conocidos. El descubrimiento de las isoenzimas 1 y 2 de la ciclooxigenasa (COX-1 y 2) y la aparición de AINEs COX-2 selectivosha resultado en una mayor seguridad sobre el tracto gastrointestinal. La percepción inicial de que también podría haber menos efectos sobre el filtrado glomerular desapareció rápidamente, confirmándose que los COX-2 selectivos tenían efectos similares a los AINEs clásicos. Progresivamente apareció evidencia de que la inhibición selectiva de la COX-2 podría generar una situación pro-trombótica con mayor riesgo de accidentes cardiovasculares y cerebrales en pacientes predispuestos. Esto ha llevado al retiro del mercado de por lo menos dos de estas drogas. En otras áreas, el rol de la COX-2 ha abierto puertas interesantes en enfermedad de Alzheimer y cáncer de colon, por mencionar sólo dos. El rol de la COX-2 en otros tejidos es sumamente interesante, probablemente muy relevante, pero no está aún completamente comprendido.El aumento del riesgo cardiovascular obliga a ser muy selectivos en la indicación de estas drogas. Esta situación genera problemas en los pacientes con enfermedad reumática que deben tomarlos durante períodos prolongados.

Non-steroidal anti-inflammatory drugs (NSAID) are one of the most commonly used medications throughout the world,both prescribed and over the counter. Although effective in controlling inflammation, they are frequently used just to treat fever or pain. Prescription in elder patients, a higher risk group, is almost four times that in younger people. Side effects are well known and it is estimated that in the USA around 5% of hospital admissions are related to drugs. Of these, NSAID side effects would account for 30%. The discovery of COX-2 iso-enzymes and of COX-2 selective NSAID has provided for a better gastrointestinal safety profile when compared with traditional NSAID. The initial perception that they may have less effect on renal blood flowwas quickly proved incorrect confirming that COX-2 selective NSAID and non-selective NSAID have similar renal sideeffects. Selective COX-2 inhibition appears to generate a pro-thrombotic state which has been shown to increase cardiovascular side effects in predisposed patients. This has resulted in the discontinuation of two drugs from the market. In other areas, such as Alzheimer´s disease and colon cancer, to name but two, the role of COX-2 has opened interesting pathways. The role of COX-2 in other tissues is interesting and may be very relevant, but it is yet not completely understood. Increased cardiovascular risk determines that we should be very careful when prescribing these drugs. This situation is problematic in patients with rheumatic diseases who need to take these medications over prolonged periods of time.

Therapeutic potentials of bovine colostrums.

Colostrum is the first milk produced by mammals for their young ones. This transfers the passive immunity gained by the mother to the baby. The bovine colostrum (BC) can be obtained in large quantity and has properties similar to human colostrum. It has been used for various disorders of the body. It has properties to stimulate immune system, contains growth factors and many bioactive substances needed for the body to combat with wear and tear. The BC has been used for various gastrointestinal disorders, respiratory tract infection, rheumatoid arthritis, healing injured tissues of body etc. There are not much double blind placebo-controlled trials to prove its efficacy, though a lot of experience about its good effects in various disorders is available in the literature. The dosage and duration of therapy need to be worked up. The BC has potential to treat as well to prevent certain diseases in the body. In future this will prove to be a very useful product to treat and control diseases in a natural way.