Low-dose adrenocorticotropin test in patients with the Acquired Immunodeficiency Syndrome

Adrenocortical insufficiency is a serious complication of AIDS. Usually, integrity of the hypothalamo-pituitary-adrenal (HPA) axis in AIDS patients is assessed by measuring basal cortisol levels and cortisol response to 250 µg of ACTH. Recent studies suggest that a lower ACTH dose increases the sensitivity of the procedure. In the present study, we investigated the prevalence of adrenal hypofunction in AIDS patients using a low-dose ACTH test (1 µg), evaluated the clinical characteristics that might suggeest this diagnosis, and the diseases and/or drugs that could be associated with it. We prospectively evaluated 63 very ill AIDS patients and 16 normal controls. A standard examination assessed the presence of signs and symptoms of adrenal insufficiency. Blood samples were colleted before and 30 and 40 minutes after an injection of 1 µg 1-24 ACTH. No opportunistic disease, signs, symptoms or drugs were associated with an abnormal cortisol response to ACTH. The lowest stimulated cortisol level in the contol group was 18.5 µg/dL; cortisol level (greather or equal) 18 µg/dL were taken to indicate a normal HPA axis. Test results revealed that 12/63 AIDS patients (19 percent) had an abnormal HPA axis. With these data in mind, we suggest a prospective adrenal function evaluation of all severely ill AIDS patients.

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

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