Prescribing errors intercepted by pharmacist intervention in care of patients hospitalised with breast and gynaecological cancer at a Brazilian teaching hospital.

Oncologic inpatients often require multiple drug therapy. They may be at higher risk of experiencing prescribing errors, which pharmacist interventions may help to avoid. This study aimed to evaluate the types of prescribing errors, pharmaceutical interventions and differences in clinical significance, in prescriptions for hospitalised patients with breast and gynaecological cancer. A cross-sectional, prospective study was conducted at the oncology ward of a clinic specialised in breast and gynaecology cancer. A clinical pharmacist analysed prescriptions, identified errors, performed interventions and classified clinical significance. A total of 1,874 prescriptions of 248 patients were evaluated; 11.5% prescriptions were involved at least in one prescribing error, totalising 283 errors. The most common error was unsafe medication due to drug interaction (89[31.4%]). Drugs for the alimentary tract and metabolism, and nervous system were the most involved in errors with statistical association (p = .0246 and p = .0002 respectively). Of the 294 interventions, 73.5% were accepted. The clinical significance of prescribing errors and interventions were classified as significant and very significant respectively. The pharmacist interventions obtained a good acceptance rate and impact significantly, avoiding prescribing errors classified as significant.

Can polyacrylic acid treat sexual dysfunction in women with breast cancer receiving tamoxifen?

OBJECTIVE: There is a lack of safety data supporting the use of hormone therapy in women who have had breast cancer and who have complained of genitourinary syndrome of menopause (GSM). The objective was to test the efficacy of two non-hormonal therapies for vaginal dryness. METHODS: This was a randomized trial with 52 women with breast cancer who were being treated with tamoxifen and who complained of vaginal dryness. The volunteers answered two questionnaires to evaluate sexual function (Female Sexual Function Index, FSFI) and a customized GSM questionnaire. The women were randomized into two groups: 25 (48.1%) in the polyacrylic acid group and 27 (51.9%) in the lubricant group, using either one of the treatments for 30 days, and after they were invited to answer the questionnaires again. RESULTS: There was improvement in the FSFI after both treatments. The polyacrylic acid group showed a decrease in sexual dysfunction from 96% to 24% (p < 0.0001) and the lubricant group showed a decrease from 88.9% to 55.6% (p = 0.0027). CONCLUSIONS: The results of this study showed that both treatments improved sexual function; however, polyacrylic acid was superior to the lubricant in treating sexual dysfunction.

Plant-based active photoprotectants for sunscreens.

Excessive exposure to the sun's radiation is the major exogenous mediator of skin damage, which accelerates skin ageing and increases the risk of developing skin cancer. Compounds with photoprotectant activity are extremely useful for decreasing the effect of ultraviolet (UV) radiation on the skin; however, numerous sun filters, especially organic sunscreens, are allergenic. Therefore, the development of formulations containing plant extracts, which may be potentially safer, is extensively being explored. Plant-based cosmetics are commonly used to avoid skin ageing because they contain antioxidant agents that minimize free radical activity, and numerous studies have investigated the skin-protectant effects of related plant species. In addition to their antioxidant properties, plant-based cosmetics protect the skin against solar radiation because they contain polyphenols such as flavonoids and carotenoids. Therefore, this study aims to present a review of plant species commonly used in sunscreens to protect the skin against damage due to sunlight exposure.

Evaluation of the enzymatic activity and stability of commercial bromelain incorporated in topical formulations.

BACKGROUND: Bromelain is a mixture of proteolytic enzymes found in various tissues of the pineapple plant (Ananas comosus) and other species of Bromeliaceae. Owing to its proteolytic activity, bromelain has been used in the food, medical, pharmaceutical and cosmetic industries, for its cell renewal, anti-ageing, whitening and anti-cellulite properties. OBJECTIVE: This study evaluated the stability of bromelain (commercial powder) incorporated in topical formulations. METHODS: Bromelain was incorporated at three concentrations, 0.5%, 1.0% and 2.0%, in oil-in-water emulsion and gel, and stored for six months at varying stress conditions. Stability was accessed by measuring the changes in the protein content, enzymatic activity, viscosity, rheology, pH and colour of the selected formulations. RESULTS: The colour of all the samples changed after 180 days of incubation, indicating the concentration-dependence and temperature-sensitive nature of these formulations. No relationship was observed between the changes in the pH, temperature and luminosity exposure in all the samples. Gels proved to be the least preferred base for incorporation of bromelain for use as a topical formulation, owing to its inability to maintain the integrity of bromelain, thereby affecting the formulation characteristics. CONCLUSION: The emulsion-based formulations at all the concentrations of bromelain were more stable than the gel-based formulation over 180 days of evaluation, at a temperature of 5°C, protected from light.

Update on ultraviolet A and B radiation generated by the sun and artificial lamps and their effects on skin.

Solar radiation, especially ultraviolet A (UVA) and ultraviolet B (UVB), can cause damage to the human body, and exposure to the radiation may vary according to the geographical location, time of year and other factors. The effects of UVA and UVB radiation on organisms range from erythema formation, through tanning and reduced synthesis of macromolecules such as collagen and elastin, to carcinogenic DNA mutations. Some studies suggest that, in addition to the radiation emitted by the sun, artificial sources of radiation, such as commercial lamps, can also generate small amounts of UVA and UVB radiation. Depending on the source intensity and on the distance from the source, this radiation can be harmful to photosensitive individuals. In healthy subjects, the evidence on the danger of this radiation is still far from conclusive.

Impact of drug formulation and free platinum/cisplatin ratio on hypersensitivity reactions to cisplatin: formulation matters.

WHAT IS KNOWN AND OBJECTIVE: Use of cisplatin can induce type I hypersensitivity reactions that may also be linked to the quality of the drug utilized. We observed cases of hypersensitivity that appeared to be associated with the brand of cisplatin used. The aim of this study was to compare two different brands of cisplatin in relation to type I hypersensitivity reactions. METHODS: Brand A was used in a tertiary care teaching hospital until 2012, and use of brand B started from January 2013, when the first hypersensitivity cases were observed. Patients were categorized based on symptom. Cisplatin of both brands was analysed by high-performance liquid chromatography (HPLC) and high-resolution electrospray ionization mass spectrometry (ESI-(+)-MS) and characterized according to US Pharmacopeia. RESULTS AND DISCUSSION: There were no cases of hypersensitivity associated with the use of cisplatin brand A, whereas four of 127 outpatients that used cisplatin brand B were affected. The two brands were in accordance with the US Pharmacopeia parameters, and there was no significant difference in the total platinum levels between the two brands when analysed by HPLC. However, high-resolution ESI-(+)-MS analyses show that brand B contains approximately 2.7 times more hydrolysed cisplatin than brand A. WHAT IS NEW AND CONCLUSION: The increase in the hydrolysed form of cisplatin found in brand B may be the cause of the hypersensitivity reaction observed in a subset of patients. We present the first study of the quality of drugs by high-resolution ESI-(+)-MS. Drug regulatory agencies and manufacturers should consider including measurement of hydrolysed cisplatin as a quality criterion for cisplatin formulations.

Evaluation of antimicrobial effectiveness of C-8 xylitol monoester as an alternative preservative for cosmetic products.

Xylitol is a natural sugar derived from plants, fruits and vegetables, whose antimicrobial properties are described in the literature. This study aimed to evaluate the antimicrobial effectiveness of C-8 xylitol monoester, for its use as a preservative in cosmetic formulations. The minimum inhibitory concentration (MIC) was determined by the broth macrodilution method, and the antimicrobial effectiveness of C-8 xylitol monoester was determined by using challenge test method. The results obtained in the determination of minimum inhibitory concentration are between 1.0% and 1.25% for Staphylococcus aureus, Escherichia coli and Candida albicans and between 1.0% and 1.5% for Pseudomonas aeruginosa and Aspergillus niger. The amount of 1% of C-8 xylitol monoester was added to the lotion used in the challenge test, observing a rapid decline in the number of CFU g(-1) in stages of evaluation after contamination of the product by all bacteria. The same occurs in relation to C. albicans, which shows a 90% reduction in the number of CFU g(-1). Regarding A. niger, similar reduction is observed when pH value of the lotion is adjusted from 5.5 to 7.0. The results indicate that under the tests conditions, C-8 xylitol monoester has antimicrobial activity and could be considered as an alternative preservative for cosmetic formulations.

Avaliação de potenciais interações medicamentosas em prescrições de pacientes internadas, em hospital público universitário especializado em saúde da mulher, em Campinas-SP / Potential drug interaction evaluation in medical prescriptions in a public hospital specialized in women care, in Campinas, SP

Interação medicamentosa (IM) é um evento clínico em que os efeitos de um fármaco são alterados pelo uso concomitante ou anterior à ingestão de outro fármaco, alimento ou bebida. O estudo teve como objetivo identificar IM em prescrições da Unidade de Terapia Intensiva (UTI) e do Alojamento Conjunto (AC). Foram avaliadas 36 prescrições da UTI e 274 do AC e as IM foram listadas como "maiores", "moderadas" e "menores", tendo por base o site Drugs.com. Na UTI, foram identificadas 105 interações maiores, 171 moderadas e 18 menores. Na AC, foram identificadas 64 interações maiores, 64 interações moderadas e 4 interações menores. Para as IM classificadas como "maiores", realizou-se estudo comparativo com a base DrugDex/Micromedex® e com o software OPharmacêutico®, constatando-se que a IM de metoclopramida com tramadol, que representava 63,16% das IM da UTI e 100% das IM do AC, não são classificadas como "maiores". A identificação de IM, de relevância clínica, e o seu monitoramento permitem tratamentos mais efetivos com o menor número possível de complicações causadas por IM, diminuindo o tempo de internação e, consequentemente, os custos do hospital.

Drug interaction (DI) is a common clinical occurrence, in which the effects of one drug are altered by the simultaneous or previous use of another drug, food or drink. The aim of this study was to identify DI in medical prescriptions issued in the intensive care unit (ICU) and common shelter (CS) at a public women?s hospital in Brazil. Thirty-six prescriptions from the ICU and 271 prescriptions from the CS were analyzed and the DIs classified as "major", "moderate" and "minor", based on the database at the website Drugs.com. At the ICU, 105 "major", 171 "moderate" and 18 "minor" DIs were identified, while at the CS, the numbers found were 64, 64 and 4, respectively. For major DIs, a comparative analysis was carried out with another database, DrugDex/MicromedexTM, and the program OPharmaceuticoTM, revealing a lack of standardization and conflicting information in the different databases. Pharmacosurveillance in the wards, carried out by a pharmacist to identify the clinically relevant DIs and monitor their clinical manifestations, would enable more effective treatments to be given, with the smallest possible number of complications due to DIs, thus reducing lengths of stay and hospital costs.

Liquid-liquid extraction of commercial and biosynthesized nisin by aqueous two-phase micellar systems.

Nisin is a natural additive for conservation of food, and can also be used as a therapeutic agent. Nisin inhibits the outgrowth of spores, the growth of a variety of Gram-positive and Gram-negative bacteria. In this paper we present a potentially scalable and cost-effective way to purify commercial and biosynthesized in bioreactor nisin, including simultaneously removal of impurities and contaminants, increasing nisin activity. Aqueous two-phase micellar systems (ATPMS) are considered promising for bioseparation and purification purposes. Triton X-114 was chosen as the as phase-forming surfactant because it is relatively mild to proteins and it also forms two coexisting phases within a convenient temperature range. Nisin activity was determined by the agar diffusion assay utilizing Lactobacillus sake as a sensitive indicator microorganism. Results indicated that nisin partitions preferentially to the micelle rich-phase, despite the surfactant concentration tested, and its antimicrobial activity increases. The successful implementation of this peptide partitioning, from a suspension containing other compounds, represents an important step towards developing a separation method for nisin, and more generally, for other biomolecules of interest.

The efficacy of chemical agents in cleaning and disinfection programs.

BACKGROUND: Due to the growing number of outbreaks of infection in hospital nurseries, it becomes essential to set up a sanitation program that indicates that the appropriate chemical agent was chosen for application in the most effective way. METHOD: For the purpose of evaluating the efficacy of a chemical agent, the minimum inhibitory concentration (MIC) was reached by the classic method of successive broth dilutions. The reference bacteria utilized were Bacillus subtilis var. globigii ATCC 9372, Bacillus stearothermophilus ATCC 7953, Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 25923. The strains of Enterobacter cloacae IAL 1976 (Adolfo Lutz Institute), Serratia marcescens IAL 1478 and Acinetobactev calcoaceticus IAL 124 (ATCC 19606), were isolated from material collected from babies involved in outbreaks of infection in hospital nurseries. RESULTS: The MIC intervals, which reduced bacteria populations over 08 log10, were: 59 to 156 mg/L of quaternarium ammonium compounds (QACs); 63 to 10000 mg/L of chlorhexidine digluconate; 1375 to 3250 mg/L of glutaraldehyde; 39 to 246 mg/L of formaldehyde; 43750 to 87500 mg/L of isopropanol or ethanol; 1250 to 6250 mg/L of iodine in polyvinyl-pyrolidone complexes, 150 to 4491 mg/L of chlorine-releasing-agents (CRAs); 469 to 2500 mg/L of hydrogen peroxide; and, 2310 to 18500 mg/L of peracetic acid. CONCLUSIONS: Chlorhexidine showed non inhibitory activity over germinating spores. A. calcoaceticus, was observed to show resistance to the majority of the agents tested, followed by E. cloacae and S. marcescens.