Medication adherence in patients with juvenile idiopathic arthritis / Adesão ao tratamento farmacológico em pacientes com artrite idiopática juvenil por meio de questionários

ABSTRACT Objective: The aim of this study was to investigate pharmacological treatment adherence of patients with juvenile idiopathic arthritis, attended in an outpatient pharmacy at a tertiary hospital in northeastern Brazil. Methods: The analysis of adherence was performed along with caregivers, through a structured questionnaire based on Morisky, Green and Levine, which enabled the categorization of adherence in “highest”, “moderate” or “low” grades, and through evaluating medication dispensing registers, which classified the act of getting medications at the pharmacy as “regular” or “irregular”. Drug Related Problems (DRP) were identified through the narrative of caregivers and classified according to the Second Granada Consensus. Then, a pharmaceutical orientation chart with information about the therapeutic regimen was applied, in order to function as a guide for issues that influenced adherence. Results: A total of 43 patients was included, with a mean age of 11.12 years, and 65.1% (n = 28) were female. Applying the questionnaire, it was found “highest” adherence in 46.5% (n = 20) patients, “moderate” adherence in 48.8% (n = 21), and “low” adherence in 4.7% (n = 2). Through an analysis of the medication dispensing registers, a lower level of adherence was observed: only 25.6% (n = 11) of the participants received “regularly” the medications. Twenty-six DRP was identified, and 84.6% (n = 22) were classified as real. There were no significant associations between socio-demographic variables and adherence, although some caregivers have reported difficulty in accessing the medicines and in understanding the treatment. Conclusion: Our findings showed problems in the adherence process related to inattention, forgetfulness and irregularity in getting medicines, reinforcing the need for the development of strategies to facilitate a better understanding of treatment and to ensure adherence.

RESUMO Objetivo: Investigar a adesão ao tratamento farmacológico de pacientes com artrite idiopática juvenil, atendidos na farmácia ambulatorial de hospital terciário do Nordeste do Brasil. Métodos: A análise da adesão foi feita junto aos cuidadores, por meio de questionário estruturado com base no teste de Morisky, Green e Levine, que viabilizou a categorização da adesão em “máxima”, “moderada” ou “baixa”, e da avaliação dos registros de dispensação dos medicamentos, que classificou a retirada de medicamentos na farmácia como “regular” ou “irregular”. Os problemas relacionados com medicamentos (PRM) foram identificados por meio da narrativa dos cuidadores e classificados conforme o Segundo Consenso de Granada. Em seguida, aplicou-se uma tabela de orientação farmacêutica, que contém informações sobre o esquema terapêutico, de forma a esclarecer questões que influenciavam a adesão. Resultados: Participaram 43 pacientes, com média de 11,12 anos, 65,1%, (n = 28) do sexo feminino. Por meio do questionário, verificou-se adesão “máxima” em 46,5% (n = 20) dos pacientes, “moderada” em 48,8% (n = 21) e “baixa” em 4,7% (n = 2). Pelo registro de dispensação, observou-se um nível de adesão menor: apenas 25,6% (n = 11) dos participantes receberam os medicamentos “regularmente”. Identificaram-se 26 PRM, 84,6% (n = 22) classificados como “reais”. Não foram observadas associações significativas entre as variáveis sociodemográficas e a adesão, embora alguns cuidadores tenham relatado dificuldade de acesso ao medicamento e de compreensão do tratamento. Conclusão: Nossos achados demonstraram falhas no processo de adesão, relacionadas ao descuido, esquecimento e à irregularidade para receber os medicamentos, o que reforça a necessidade de estratégias para facilitar a compreensão do tratamento e garantir a adesão

Medication adherence in patients with juvenile idiopathic arthritis. / Adesão ao tratamento farmacológico em pacientes com artrite idiopática juvenil por meio de questionários.

OBJECTIVE: The aim of this study was to investigate pharmacological treatment adherence of patients with juvenile idiopathic arthritis, attended in an outpatient pharmacy at a tertiary hospital in northeastern Brazil. METHODS: The analysis of adherence was performed along with caregivers, through a structured questionnaire based on Morisky, Green and Levine, which enabled the categorization of adherence in "highest", "moderate" or "low" grades, and through evaluating medication dispensing registers, which classified the act of getting medications at the pharmacy as "regular" or "irregular". Drug Related Problems (DRP) were identified through the narrative of caregivers and classified according to the Second Granada Consensus. Then, a pharmaceutical orientation chart with information about the therapeutic regimen was applied, in order to function as a guide for issues that influenced adherence. RESULTS: A total of 43 patients was included, with a mean age of 11.12 years, and 65.1% (n=28) were female. Applying the questionnaire, it was found "highest" adherence in 46.5% (n=20) patients, "moderate" adherence in 48.8% (n=21), and "low" adherence in 4.7% (n=2). Through an analysis of the medication dispensing registers, a lower level of adherence was observed: only 25.6% (n=11) of the participants received "regularly" the medications. Twenty-six DRP was identified, and 84.6% (n=22) were classified as real. There were no significant associations between socio-demographic variables and adherence, although some caregivers have reported difficulty in accessing the medicines and in understanding the treatment. CONCLUSION: Our findings showed problems in the adherence process related to inattention, forgetfulness and irregularity in getting medicines, reinforcing the need for the development of strategies to facilitate a better understanding of treatment and to ensure adherence.

Preeclampsia is associated with increased maternal body weight in a northeastern Brazilian population.

BACKGROUND: Preeclampsia is a disease with great variability in incidence across the world. The mortality is higher in lower income countries, where it is the leading cause of maternal mortality. This study aimed to determine the frequency of and risk factors for preeclampsia in a low income population from an urban area of Brazil. METHODS: A prospective case control study of 242 women of which 30 developed preeclampsia, 4 had gestational hypertension, 2 had superimposed hypertension, 11 had spontaneous abortion, 13 were lost to follow up and 192 had normal pregnancy. This latter group was considered the normotensive controls. The rate of preeclampsia and the risk of cardiovascular disease, after onset of preeclampsia, were determined. RESULTS: Of the 218 women who completed the study, the frequency of hypertensive disorder of pregnancy was 16.5% (36 of 218) and of preeclampsia was 13.8% (30 of 218). Women with preeclampsia had a higher body mass index (BMI), mean of 25.3 ± 4.8 compared to 23.5 ± 3.7 for the normotensive controls, p = 0.02. The risk of preeclampsia increased with BMI [Odds ratio (OR) 1.12, 95% Confidence Interval (CI = 1.02;1.24, p-value = 0.023)]. Women with preeclampsia developed chronic hypertension more often than normotensive controls (p = 0.043) and their systolic and ambulatory blood pressure monitoring was elevated (p = 0.034). Women with preeclampsia had higher BMI even 5 years post-pregnancy (p = 0.008). CONCLUSIONS: Women who are overweight or older have an increased risk of preeclampsia. Previous history of preeclampsia increases the risk of early onset of chronic hypertension. Therefore, effective preventive measures are needed, particularly women at lower social economic stratum who have less access to proper medical care and adequate nutrition.

Padrão de respiração em crianças asmáticas / Breathing patterns in children with asthma

Objetivo: avaliar o padrão respiratório de crianças asmáticas. Material e métodos: foi realizado um estudo do tipo transversal com 111 pacientes asmáticos de 09 a 12 anos de idade e de ambos os sexos. O diagnóstico da respiração foi realizado por meio de dois testes; Teste 1 - espelho de Glatzel (vapor) para verificação da presença de vapor decorrente da respiração e o Teste 2: tempo de permanência de água na boca, com cronometragem de três minutos. O grau de concordância interexaminadores quanto ao diagnóstico da respiração foi avaliado pelo teste Kappa (0,83). A análise estatística consistiu de distribuições absolutas e percentuais e o teste estatístico Exato de Fisher. Resultados: o percentual de respiração oral foi de 45%. Verificou-se que 30,6% das crianças apresentaram asma persistente leve, 48,6% asma persistente moderada, 4,5% asma persistente grave e 16,2% asma intermitente. Conclusão: as crianças portadoras de asma apresentaram um padrão de respiração oral elevado.

Aim: to evaluate the breathing pattern of asthmatic children. Material e methods: this was a kind of cross-sectional study a sample of 111 children from 09 to 12 years of age and both sexes. The diagnosis of respiration was performed by means of two tests, Test 1 - metal plate of Glatzel (steam) and Test 2 - The residence time of water in the mouth. The degree of interexaminer agreement on the diagnosis of breathing was evaluated by Kappa test (0,83). Statistical analysis consisted of absolute and percentage distributions and statistical analysis Fisher’s exact. Results: the percentage of mouth breathing was 45%. It was found that 30.6% of children had mild persistent asthma, 48.6% moderate persistent asthma, severe persistent asthma 4.5% and 16.2% intermittent asthma. Conclusion: the children with asthma showed a pattern of mouth breathing.

Berardinelli syndrome. A case report with fatal outcome.

The aim of this paper is to present the main clinical findings and evolution of a fatal case of Berardinelli Syndrome (congenital generalized lipodystrophy). A 15-year-old girl, followed since the age of three months in the Genetic outpatients' clinic, developed insulin resistance when she was eight years old. She had hyperchloremic metabolic acidosis, bilateral retinopathy, proteinuria and hydronephrosis. She was hospitalized several times due to urinary infections. In her last admission she had fever, abdominal pain and was diagnosed urinary sepsis. She presented hemodynamic instability and died, despite all therapeutic measures adopted. Considering the rarity of this syndrome it is important to describe the clinical presentation and evolution of this patient with Berardinelli Syndrome, which developed renal dysfunction and had a fatal outcome.

Berardinello syndrome: a case report with fatal outcome

El objetivo de este trabajo fue relatar las principales manifestaciones observadas en un caso de evolución fatal de Síndrome de Berardinelli (Lipodistrofía congénita generalizada). Una niña de 15 años, con seguimiento clínico desde los tres meses de edad en el Servicio de Genética, desarrolló resistencia insulínica cuando tenía ocho años de edad. Presentaba además acidosis metabólica hiperclorémica, retinopatía bilateral, proteinuria e hidronefrosis. Habia sido hospitalizada varias veces debido a infecciones urinarias a repetición. En su última hospitalización presentó sepsis urinaria. Evolucionó con inestabilidad hemodinámica y falleció, a pesar de todas las medidas terapéuticas adoptadas. Considerando la poca frecuencia de este síndrome se hace importante el reporte de la presentación clínica y de la evolución de esta paciente con Síndrome de Berardinelli, que desarrolló disfunción renal y tuvo una evolución fatal.

Cephalometric characteristics and dentofacial abnormalities of pycnodysostosis: report of four cases from Brazil.

Pycnodysostosis (PKND) is a human autosomal recessive genetic disorder characterized mainly by osteosclerosis of the skeleton, severe bone fragility, and short stature. This syndrome usually presents very typical craniofacial deformities, such as beaked nose, micrognathia, hypoplastic midface, open mouth posture, grooved palate, anterior cross-bite, dental crowding, and over-retained deciduous teeth. Early diagnosis and intervention are of the utmost importance. Four cases from the northeast of Brazil are reported including 2 siblings. Features included maxillary retrusion, reduced facial height, open bite, and bone fracture history. Very poor oral hygiene, severe dental caries, and periodontal disease were also present.

Alternativas ao uso de transfusöes de sangue alogênico em cirurgia ginecológica / Alternative use of allogenic blood transfusion in gynecologic surgery

Os autores realizaram estudo prospectivo de 154 pacientes submetidas a cirurgias ginecológicas provenientes de clínica privada e da Clínica Ginecológica do Hospital Universitário do Norte do Paraná, da Universidade Estadual de Londrina, durante os anos de 1998 e 1999, avaliando-se o tipo de cirurgia, cuidados perioperatórios, índices hematimétricos e necessidades transfusionais. Nas pacientes cujo teor de hemoglobina era inferior a 10g/dl no pré-operatório e 8g/dl no pós-operatório, administrou-se eritropoetina recombinante humana (Hu-Epo) na dose diária de 150-300UI/Kg, via subcutânea; hidróxido de ferro 100 mg, via endovenosa; ácido folínico 3mg, via intramuscular; Vitamina B12 5.000UI, via intramuscular. Houve rigoroso controle hemostático e hemodinâmico no intra-operatório, através de rigorosa hemostasia mecânica, da utilização de drogas e de produtos hemostáticos, além da utilização de expansores cristalóides e colóides. A média de perda de sangue operatória foi 2,13g/dl, fato que dispensou o uso de hemotransfusões em todos os casos. Concluem os autores que as cirurgias ginecológicas são possíveis sem o uso de transfusões de sangue alogênico, todavia a fim de que possa utilizar, adequadamente, alternativas pertinentes, práticas e viáveis