Pharmaceutical care to patients treated with antidepressants.

Depression is considered one of the ten most disabling conditions on the planet, causing physical, personal and social limitations. Antidepressants are the most commonly used drug treatment for eliminating or controlling the symptoms of depression. A variety of factors can contribute to treatment abandonment, particularly severe side effects. The present article is aimed to provide information and guidelines on the development of a pharmacotherapy follow-up program for patients treated with antidepressant medication. According to this practice, the pharmacist evaluates whether the three following requirements of a proper pharmacotherapy are being observed: need, effectiveness and safety. If one of these requirements is not met, the pharmacist seeks to solve the problem, by intervening in the pharmacotherapy, within the scope of his/her skills. Pharmaceutical care is aimed to improve adherence to treatment and minimize side effects, as well as the occurrence of drug interactions. Thus, the present article presents and discusses the main strategies of pharmaceutical care to achieve the proposed objectives.

Trends in drug use among students in Brazil: analysis of four surveys in 1987, 1989, 1993 and 1997.

The consumption of psychotropic drugs among Brazilian secondary school students was examined by comparing data from four surveys using a questionnaire adapted from the WHO's Program on Research and Reporting on the Epidemiology of Drug Dependence. Students filled out the form in their classrooms without the presence of teachers. The target population consisted of 10-18-year-old students (on average, 15,000 students responded to each survey) in Brazil's ten largest state capitals: Belém, Belo Horizonte, Brasília, Curitiba, Fortaleza, Porto Alegre, Recife, Rio de Janeiro, Salvador, and São Paulo. Among the legal drugs, lifetime use (use at least once during life) of tobacco was increased in seven cities (the exceptions were Brasília, Porto Alegre and Rio de Janeiro). There was also a significant increase in frequent use of alcohol (six times or more per month) in 6 of the cities, from an average of 9.2% in 1987 to 15.0% in 1997. With respect to illegal drugs, there was a significant increase in lifetime use of marijuana (a 3-fold increase from 2.8% in 1987 to 7.6% in 1997). Cocaine use increased 4-fold over the survey period (0.5% in 1987 to 2.0% in 1997). Lifetime use of cocaine significantly increased in eight capitals (except Recife and Rio de Janeiro). However, frequent cocaine use increased in only three capitals (Belém, Fortaleza and Porto Alegre), from an average of 1.0% in 1987 to 3.6% in 1997. Lifetime use of medications such as anxiolytics and amphetamines increased 2-fold on average over the survey period. Comparing the four studies, the main conclusion is that there were significant increases in the frequencies for lifetime use, frequent use and heavy use of many drugs.

Trends in drug use among students in Brazil: analysis of four surveys in 1987, 1989, 1993 and 1997

The consumption of psychotropic drugs among Brazilian secondary school students was examined by comparing data from four surveys using a questionnaire adapted from the WHO's Program on Research and Reporting on the Epidemiology of Drug Dependence. Students filled out the form in their classrooms without the presence of teachers. The target population consisted of 10-18-year-old students (on average, 15,000 students responded to each survey) in Brazil's ten largest state capitals: Belém, Belo Horizonte, Brasília, Curitiba, Fortaleza, Porto Alegre, Recife, Rio de Janeiro, Salvador, and São Paulo. Among the legal drugs, lifetime use (use at least once during life) of tobacco was increased in seven cities (the exceptions were Brasília, Porto Alegre and Rio de Janeiro). There was also a significant increase in frequent use of alcohol (six times or more per month) in 6 of the cities, from an average of 9.2 percent in 1987 to 15.0 percent in 1997. With respect to illegal drugs, there was a significant increase in lifetime use of marijuana (a 3-fold increase from 2.8 percent in 1987 to 7.6 percent in 1997). Cocaine use increased 4-fold over the survey period (0.5 percent in 1987 to 2.0 percent in 1997). Lifetime use of cocaine significantly increased in eight capitals (except Recife and Rio de Janeiro). However, frequent cocaine use increased in only three capitals (Belém, Fortaleza and Porto Alegre), from an average of 1.0 percent in 1987 to 3.6 percent in 1997. Lifetime use of medications such as anxiolytics and amphetamines increased 2-fold on average over the survey period. Comparing the four studies, the main conclusion is that there were significant increases in the frequencies for lifetime use, frequent use and heavy use of many drugs.

Use of GnRH analogs for functional protection of the ovary and preservation of fertility during cancer treatment in adolescents: a preliminary report.

OBJECTIVE: Recent success in polychemotherapy (PCT) in adolescent female cancer patients has become a source of concern for specialists who also strive to preserve fertility. We studied whether gonadotropin-releasing hormone (GnRH) analogs could prevent the early onset of ovarian insufficiency postchemotherapy and protect fertility. METHODS: The patients were divided into three groups: Control group 1 (Group A), premenarchal patients aged 3 to 7.5 years (n = 5), were not given GnRH analogs administered prior to PCT. Postmenarchal patients (Group B), aged 14.7 to 20 years (n = 12) with normal menstrual rhythm and ovulatory cycles, received treatment with GnRH analogs prior to PCT. Control group 2 (Group C), postmenarchal patients aged 15.9 to 20 years (n = 4), received PCT but no GnRH analog protection. All groups received the PCT regimens CAVPE, CVPP, ABVD, TAMO, ARA-C, and MTT. In group B, leuprolide acetate inhibition was obtained with a depot injection administered each month before and during treatment with PCT. To accelerate the timing of ovarian regression, a subcutaneous injection (0.2 mg) was administered simultaneously. RESULTS: In Group A, patients had spontaneous menarche between the ages of 12 and 17.9 years, followed by normal menstruation and ovulatory cycles. Three patients became pregnant. After GnRH analog withdrawal, Group B patients continued with normal ovulatory cycles. Two patients became pregnant. Group C patients presented hypergonadotrophic hypoestrogenic amenorrhea. CONCLUSION: GnRH analog treatment before and during PCT enhances ovarian function and preserves adolescent fertility. The results must be confirmed in a larger study.

Concepts of dependence among Brazilian alcohol- and drug-dependent patients.

Studies suggest that the concepts that drug dependent persons have about their problems could influence adherence to treatment and outcome. The objective of this study was to compare these concepts in different groups of patients. Three groups of drug-dependent patients (diagnosed according to DSM-III-R criteria) were compared: 64 dependent on alcohol only, 56 dependent only on other drugs and 39 dependent on both alcohol and drugs. They were asked: "What do you think about your problem?" and the responses were qualitatively analyzed and classified into themes. For the whole sample, the main themes mentioned were: the function of alcohol and drugs in their lives (50%), the etiology of dependence (32%) and reasons for initial use (21%). Patients dependent on alcohol associated their use with coping, while patients dependent on other drugs reported pleasure seeking. In regard to etiology, most patients classified their dependence as a habit. Patients dependent on alcohol tended to attribute an organic etiology to their problem, while those dependent on other drugs most frequently considered moral aspects as important. This study suggests that there are differences between these three groups in the appraisal of their problem. Professionals interested in treatment matching need to take these findings into account, as they may influence compliance and treatment outcome.

Evaluación diagnóstica mediante R. M. I. de las malformaciones müllerianas / Diagnostic evaluation of the müllerian malformations by means of nuclear magnetic resonance

Objetivos: Analizar el uso de la Resonancia Magnética Nuclear (N.M.R.) en la evaluación de las malformaciones Müllerianas, malformaciones total o parcialmente obstructivas, y en las patologías asociadas. Material y métodos: Se estudiaron diez adolescentes (edad promedio 16.5 años con un rango entre los 13 y 21) que consultaron al Programa de Adolescencia del Hospital de Clínicas en el período entre el 1 de junio de 1995 y 31 de mayo de 1998, con diagnóstico prsuntivo de malformación Mülleriana. Se le efectuó a cada paciente: anamnesis, exámen físico, ecografía ginecológica y renal, y N.M.R. pelviana sin contraste. En algunas situaciones se utilizó vaginoscopía así como tacto bajo anestesia y laparoscopía. Resultados: Utilizamos la modificación de J. Rock a la clasificación de la Sociedad Americana de Fertilidad (A.F.S.). 1) 3 pacientes con disgenesia del conducto de Müller (Síndrome de Mayer-Rokitansky-Kuster-Hauser). 2) 3 pacientes con anomalías de la fusión lateral del conducto de Müller. 3) 4 pacientes con anomalías de la fusión vertical del conducto de Müller. Las complicaciones asociadas fueron: 4 hematometras, 2 hematosalpinx, 1 piosalpinx, 1 piocolpos. También se diagnosticaron 6 agenesias renales unilaterales. Conclusiones: La N.M.R. fue muy útil para realizar diagnósticos diferenciales en los distintos tipos de malformaciones complejas del conducto de Müller

Evaluación diagnóstica mediante R. M. I. de las malformaciones m³llerianas / Diagnostic evaluation of the m³llerian malformations by means of nuclear magnetic resonance

Objetivos: Analizar el uso de la Resonancia Magnética Nuclear (N.M.R.) en la evaluación de las malformaciones M³llerianas, malformaciones total o parcialmente obstructivas, y en las patologías asociadas. Material y métodos: Se estudiaron diez adolescentes (edad promedio 16.5 años con un rango entre los 13 y 21) que consultaron al Programa de Adolescencia del Hospital de Clínicas en el período entre el 1 de junio de 1995 y 31 de mayo de 1998, con diagnóstico prsuntivo de malformación M³lleriana. Se le efectuó a cada paciente: anamnesis, exámen físico, ecografía ginecológica y renal, y N.M.R. pelviana sin contraste. En algunas situaciones se utilizó vaginoscopía así como tacto bajo anestesia y laparoscopía. Resultados: Utilizamos la modificación de J. Rock a la clasificación de la Sociedad Americana de Fertilidad (A.F.S.). 1) 3 pacientes con disgenesia del conducto de M³ller (Síndrome de Mayer-Rokitansky-Kuster-Hauser). 2) 3 pacientes con anomalías de la fusión lateral del conducto de M³ller. 3) 4 pacientes con anomalías de la fusión vertical del conducto de M³ller. Las complicaciones asociadas fueron: 4 hematometras, 2 hematosalpinx, 1 piosalpinx, 1 piocolpos. También se diagnosticaron 6 agenesias renales unilaterales. Conclusiones: La N.M.R. fue muy útil para realizar diagnósticos diferenciales en los distintos tipos de malformaciones complejas del conducto de M³ller (AU)

Two cases of breast lymphoma mimicking juvenile hypertrophy.

Two cases of mammary lymphosarcoma in adolescents, a secondary localization of a systemic process, are described. These cases clinically presented as bilateral virginal hypertrophies. One patient died while being treated with chemotherapy; the tumoral mass in the other patient had been reduced at the end of treatment.

Protección funcional ovárica con análogos de GnRH y preservación de la fertilidad en adolescentes durante la terapéutica oncológica / Protection of the ovarian function with GnRH analogs and preservation of fertility during cancer therapy

Objetivos: Investigar si los análogos de GnRH pueden evitar la falla ovárica precoz post-quimioterapia antineoplásica y tener así un efecto protector de la fertilidad. Diseño del Estudio: Veintiún pacientes oncológicas fueron divididas en dos grupos y seguidas a lo largo de 18 años. A: premenarca, 3-7,5 años (n:5) recibió poliquimioterapia (PCT). B: post-menarca, 14,7 - 20 años (N:12), ciclos menstruales ovulatorios normales, recibieron análogos de GnRH antes de la PCT.B1 (n:5) trasplante de médula ósea previo (BMT) a la PCY.B2 (n:7) recibió PCT y cobaltoterapia supradiafragmática. C: post-menarca, 15,9 - 20 años (n:4) recibió PCT y fue sometida a BMT. La inhibición se obtuvo mediante la administración de acetato de Leuprolide de depósito en dosis mensuales antes y durante la poliquimioterapia. Resultados: A: menarca espontánea (12.17.8 años), ciclos menstruales ovulatorios normales, cinco embarazos normales. B: ciclos ovulatorios normales desde la supresión del análogo de GnRH, tres embarazos. C: amenorrea hipergonadotrófica hipoestrogénica. Conclusiones: El seguimiento de estas pacientes demostró que la administración de análogos de GnRH antes y durante la poliquimioterapia protege la función ovárica y preserva la fertilidad futura de las adolescentes

Protección funcional ovárica con análogos de GnRH y preservación de la fertilidad en adolescentes durante la terapéutica oncológica / Protection of the ovarian function with GnRH analogs and preservation of fertility during cancer therapy

Objetivos: Investigar si los análogos de GnRH pueden evitar la falla ovárica precoz post-quimioterapia antineoplásica y tener así un efecto protector de la fertilidad. Diseño del Estudio: Veintiún pacientes oncológicas fueron divididas en dos grupos y seguidas a lo largo de 18 años. A: premenarca, 3-7,5 años (n:5) recibió poliquimioterapia (PCT). B: post-menarca, 14,7 - 20 años (N:12), ciclos menstruales ovulatorios normales, recibieron análogos de GnRH antes de la PCT.B1 (n:5) trasplante de médula ósea previo (BMT) a la PCY.B2 (n:7) recibió PCT y cobaltoterapia supradiafragmática. C: post-menarca, 15,9 - 20 años (n:4) recibió PCT y fue sometida a BMT. La inhibición se obtuvo mediante la administración de acetato de Leuprolide de depósito en dosis mensuales antes y durante la poliquimioterapia. Resultados: A: menarca espontánea (12.17.8 años), ciclos menstruales ovulatorios normales, cinco embarazos normales. B: ciclos ovulatorios normales desde la supresión del análogo de GnRH, tres embarazos. C: amenorrea hipergonadotrófica hipoestrogénica. Conclusiones: El seguimiento de estas pacientes demostró que la administración de análogos de GnRH antes y durante la poliquimioterapia protege la función ovárica y preserva la fertilidad futura de las adolescentes (AU)

Use of drugs among street children in Brazil.

The purpose of this study has been to assess drug consumption among children in five Brazilian state capitals during 1993. The sample was composed of street children who were given assistance in institutions, and data was collected by means of anonymous individual interviews. Five hundred sixty five boys and girls were interviewed: 74.3% reported having used drugs (not including alcohol and tobacco) at least once in their life. Solvents, followed by marijuana, were the most cited drugs. Important regional differences were observed concerning other drugs. Consumption of cocaine, including crack, seems restricted to the southeast region, whereas psychotropic medication was consumed more in the northeast of the country. Drug initiation among these children seems to be a consequence of street life and is part of their group lifestyle.

Linfosarcoma secundario de mama en adolescentes: consideraciones acerca de 2 casos / Mammary lympho sarcoma in adolescents: considerations about two cases

A partir de la observación clínica de la discordancia entre conocimiento y uso de métodos anticonceptivos, hemos evaluado con diferencia de una década distintos parámetros relacionados a este tema. La implementación de métodos anticonceptivos no se logra solamente dando informaicón y proveyendo anticonceptivos. Se deberá brindar una correcta educación sobre sexualidad teniendo en cuenta la conflictiva propia de esta edad que surge de la asincronía madurativa bio - psico - social

Linfosarcoma secundario de mama en adolescentes: consideraciones acerca de 2 casos / Mammary lympho sarcoma in adolescents: considerations about two cases

A partir de la observación clínica de la discordancia entre conocimiento y uso de métodos anticonceptivos, hemos evaluado con diferencia de una década distintos parámetros relacionados a este tema. La implementación de métodos anticonceptivos no se logra solamente dando informaicón y proveyendo anticonceptivos. Se deberá brindar una correcta educación sobre sexualidad teniendo en cuenta la conflictiva propia de esta edad que surge de la asincronía madurativa bio - psico - social

Linfosarcoma secundario de mama en adolescentes: consideraciones acerca de 2 casos / Mammary lympho sarcoma in adolescents: two cases

Se publican 2 casos de linfosarcoma mamario en adolescentes. Se trató de una localización secundaria de un proceso sistémico. Clínicamente se presentaron como una hipertrofia virginal bilateral. Una paciente falleció durante el tratamiento quimioterápico y la otra redujo la masa tumoral al fin de la terapéutica