RESUMO
Epilepsy is a chronic neurological disease characterized by the presence of spontaneous seizures, with a higher incidence in the pediatric population. Anti-seizure medication (ASM) may produce adverse drug reactions (ADRs) with an elevated frequency and a high severity. Thus, the objective of the present study was to analyze, through intensive pharmacovigilance over 112 months, the ADRs produced by valproic acid (VPA), oxcarbazepine (OXC), phenytoin (PHT), and levetiracetam (LEV), among others, administered to monotherapy or polytherapy for Mexican hospitalized pediatric epilepsy patients. A total of 1034 patients were interviewed; 315 met the inclusion criteria, 211 patients presented ADRs, and 104 did not. A total of 548 ASM-ADRs were identified, and VPA, LEV, and PHT were the main culprit drugs. The most frequent ADRs were drowsiness, irritability, and thrombocytopenia, and the main systems affected were hematologic, nervous, and dermatologic. LEV and OXC caused more nonsevere ADRs, and PHT caused more severe ADRs. The risk analysis showed an association between belonging to the younger groups and polytherapy with ADR presence and between polytherapy and malnutrition with severe ADRs. In addition, most of the severe ADRs were preventable, and most of the nonsevere ADRs were nonpreventable.
RESUMO
Hospitals consume a large amount of water, so they also generate large amounts of wastewater, which contain a wide variety of contaminants. It is important to consider that hospital effluents are a mixture of pollutants that can interact with each other and have a negative impact on aquatic species of water bodies. The aim of this study was to evaluate the effects induced by a hospital effluent using Danio rerio embryos. In this study, Danio rerio embryos were exposed to different concentrations of the hospital effluent and a lethality test was evaluated and the malformations present in zebrafish embryos were evaluated. The lethal concentration of effluent 50% was 6.1% and the effective malformation concentration was of 2.5%. The teratogenic index was 2.45%. The main malformations identified were yolc sac malformation, pericardial edema, hatching abnormalities, hypopigmentation, tail deformation, chorda malformation, without fin, chorion deformation and craniofacial malformation. The risks that this type of water represents for the survival of living organisms, as well as the presence of malformations in them, are reference indicators for a future regulation focused on the adequate treatment of hospital effluents.
Assuntos
Poluentes Químicos da Água , Peixe-Zebra , Animais , Embrião não Mamífero , Desenvolvimento Embrionário , MéxicoRESUMO
Introducción: el panorama de los países de América Latina en la actualidad revela que a nivel hospitalario hay una adopción del concepto de atención farmacéutica, sin embargo, la práctica demuestra que se mantiene el centro de la actividad en el medicamento y su dispensación. El uso de indicadores fácilmente mensurables que permitan conocer las características de las funciones relacionadas con este ejercicio, puede constituirse en una forma de constatar esta realidad.Objetivo: caracterizar la práctica de la atención farmacéutica en instituciones hospitalarias.Métodos: se realizó una investigación retrospectiva que incluyó los años 2005-2007, en instituciones hospitalarias de Santiago de Cuba. Se establecieron indicadores a partir de los criterios normados para la actividad de atención farmacéutica en el Manual de normas y procedimientos de farmacias hospitalarias y criterios establecidos en la literatura internacional. Se partió de los registros informados de dicha actividad a la Dirección Provincial de Salud.Resultados: los indicadores reflejaron que se realizan más las actividades de seguimiento farmacoterapéutico (algunos indicadores relacionados superiores al 70 por ciento), que las de educación sanitaria (no alcanza nunca más del 5 por ciento) e información sobre medicamentos a pacientes y profesionales (no alcanza nunca más del 13 por ciento); pero no se desarrollan de forma normalizada, ni continua. Además, las intervenciones farmacéuticas son bien aceptadas por los equipos de salud (más del 70 por ciento de aceptación), sin embrago, no son suficientes en función del número de problemas relacionados con los medicamentos detectados.Conclusiones: el ejercicio de la atención farmacéutica no es una práctica habitual del profesional farmacéutico en las instituciones estudiadas y no se desarrolla de forma normalizada; esto indica la necesidad de establecer estrategias para el perfeccionamiento de este ejercicio profesional
Introduction: the panorama of the Latin American countries at present shows that at hospital setting, the concept of pharmaceutical care is adopted, but the practice proves that it continues being focused in drugs and dispensation. The use of easy-to-measure indications to find out the characteristics of the functions related to this exercise may represent the confirmation these realities. Objective: to characterize the practice of pharmaceutical care in hospital institutions. Methods: a retrospective research study was carried out and covered years 2005 through 2007 in hospital institutions of Santiago de Cuba. Some indicators were set on the basis of the criteria for the pharmaceutical care activity included in the Manual de normas y procedimientos de farmacias hospitalarias and of the criteria found in the international literature. The reported registers of pharmaceutical care sent to the provincial health division were also taken into consideration. Results: the indicators revealed that the pharmacotherapeutic follow-up activities (some indicators over 70 percent) exceeded those of health education (barely reaching 5 percent) and information about drugs for patients and health professionals (never over 13 percent); however, they are not either standardized or permanent. Additionally, the pharmaceutical interventions were well-accepted by the health teams (over 70 percent acceptance rate) but they are still insufficient to deal with the number of problems connected with the detected medications. Conclusions: the implementation of the pharmaceutical care is not a regular and standardized practice by the pharmaceutical professional in the studied institutions. The aforementioned points to the need of drawing up strategies to improve this professional endeavor
Assuntos
Assistência Farmacêutica , Assistência Farmacêutica , Serviço de Farmácia HospitalarRESUMO
Introducción: el panorama de los países de América Latina en la actualidad revela que a nivel hospitalario hay una adopción del concepto de atención farmacéutica, sin embargo, la práctica demuestra que se mantiene el centro de la actividad en el medicamento y su dispensación. El uso de indicadores fácilmente mensurables que permitan conocer las características de las funciones relacionadas con este ejercicio, puede constituirse en una forma de constatar esta realidad.Objetivo: caracterizar la práctica de la atención farmacéutica en instituciones hospitalarias.Métodos: se realizó una investigación retrospectiva que incluyó los años 2005-2007, en instituciones hospitalarias de Santiago de Cuba. Se establecieron indicadores a partir de los criterios normados para la actividad de atención farmacéutica en el Manual de normas y procedimientos de farmacias hospitalarias y criterios establecidos en la literatura internacional. Se partió de los registros informados de dicha actividad a la Dirección Provincial de Salud.Resultados: los indicadores reflejaron que se realizan más las actividades de seguimiento farmacoterapéutico (algunos indicadores relacionados superiores al 70 por ciento), que las de educación sanitaria (no alcanza nunca más del 5 por ciento) e información sobre medicamentos a pacientes y profesionales (no alcanza nunca más del 13 por ciento); pero no se desarrollan de forma normalizada, ni continua. Además, las intervenciones farmacéuticas son bien aceptadas por los equipos de salud (más del 70 por ciento de aceptación), sin embrago, no son suficientes en función del número de problemas relacionados con los medicamentos detectados.Conclusiones: el ejercicio de la atención farmacéutica no es una práctica habitual del profesional farmacéutico en las instituciones estudiadas y no se desarrolla de forma normalizada; esto indica la necesidad de establecer estrategias para el perfeccionamiento de este ejercicio profesional(AU)
Introduction: the panorama of the Latin American countries at present shows that at hospital setting, the concept of pharmaceutical care is adopted, but the practice proves that it continues being focused in drugs and dispensation. The use of easy-to-measure indications to find out the characteristics of the functions related to this exercise may represent the confirmation these realities. Objective: to characterize the practice of pharmaceutical care in hospital institutions. Methods: a retrospective research study was carried out and covered years 2005 through 2007 in hospital institutions of Santiago de Cuba. Some indicators were set on the basis of the criteria for the pharmaceutical care activity included in the Manual de normas y procedimientos de farmacias hospitalarias and of the criteria found in the international literature. The reported registers of pharmaceutical care sent to the provincial health division were also taken into consideration. Results: the indicators revealed that the pharmacotherapeutic follow-up activities (some indicators over 70 percent) exceeded those of health education (barely reaching 5 percent) and information about drugs for patients and health professionals (never over 13 percent); however, they are not either standardized or permanent. Additionally, the pharmaceutical interventions were well-accepted by the health teams (over 70 percent acceptance rate) but they are still insufficient to deal with the number of problems connected with the detected medications. Conclusions: the implementation of the pharmaceutical care is not a regular and standardized practice by the pharmaceutical professional in the studied institutions. The aforementioned points to the need of drawing up strategies to improve this professional endeavor(AU)
Assuntos
Assistência Farmacêutica , Serviço de Farmácia Hospitalar , Assistência FarmacêuticaRESUMO
The purpose of this study was to assess prescription rationality and most common prescription errors at the primary care clinic of a Mexican university.A retrospective drug utilization review of indication-prescription type was carried out. A random sample of 370 medical records of patients assisted over a year period, were reviewed. Prescription appropriateness was evaluated according to the variables: indication, dosage regimen, administration route, contraindications, interactions, medication duplicity, unnecessary or missing medications. Prescriptions were rated as appropriate (no prescription errors found) or inappropriate (at least one prescription error found). The benefit-risk ratio was calculated for each prescription. This study revealed a 58 percent of inappropriate prescriptions in the Mexican primary care university clinic, mostly due to errors on dosage regimen and innapropiate drug selection. As a result of chi2 analysis, it was found that the pharmacotherapeutic variables chosen for the prescription assessment in this study, were determinant in prescription appropriateness rating. Nimesulide, ciprofloxacin, ranitidine, ketorolac and paracetamol were the most prescribed drugs as well as the most common cause of errors found. The prescription error rate revealed by this study addresses the need for strategies to improve prescription's quality. Introducing pharmacists as a key part of health care team is a mean proposed to prevent medication errors and to solve the urgency of pharmaceutical care implementation in all primary care facilities in Mexico.
O objetivo deste trabalho foi avaliar a racionalidade das prescrições como também os erros mais comuns nas prescrições emitidas pelo Centro de Saúde de uma Universidade no México. Foi realizado um estudo retrospectivo de utilização de medicamentos que requeria prescrição médica. 370 expedientes médicos foram aleatoriamente selecionados e revisados, obtendo uma mostra estatísticamente representativa do total de consultas médicas realizadas no período de um ano. A validade da prescrição médica foi feita utilizando as seguintes variáveis: indicação, doses recomendada, via de administração, contra-indicações, interações, duplicação de medicamentos, medicamentos desnecessários ou faltantes. As prescrições médicas foram classificadas como: apropriada (se não foram encontrados erros nas prescrições) ou inapropriada (se foram encontradas ao menos um erro na prescrição). A razão risco-beneficio foi calculada para cada prescrição médica. O estudo revelou alta incidência de prescrições inapropriadas no Centro de Saúde da Universidade do México (58 por cento), causada pelos erros nas doses recomendadas e na seleção do medicamento relacionado com a necessidade do paciente. Como resultado da análise chi2 , foi encontrado que as variáveis fármaco-terapêuticas escolhidas neste estudo para avaliar a prescrição médica, foram determinantes para classificar as prescrições como apropriadas. Nimesulide, ciprofloxacin, ranitidine, ketorolac e paracetamol representaram o maior número de medicamentos prescritos assim como a maior causa de erros encontradas nas prescrições. É importante que um farmacêutico valide os medicamentos prescritos no Centro de Saúde. Este estudo justifica o papel que os farmacêuticos mexicanos deveriam desempenhar para evitar erros na prescrição, como parte importante da equipe médica, assim como a urgência de implementar os cuidados farmacêuticos em todos os estabelecimentos dos Centros de Saúde no México.
Assuntos
Humanos , Centros de Saúde , Erros de Medicação , Assistência Farmacêutica , Atenção Primária à Saúde , México , Medição de RiscoRESUMO
The purpose of this study was to assess prescription rationality and most common prescription errors at the primary care clinic of a Mexican university.A retrospective drug utilization review of indication-prescription type was carried out. A random sample of 370 medical records of patients assisted over a year period, were reviewed. Prescription appropriateness was evaluated according to the variables: indication, dosage regimen, administration route, contraindications, interactions, medication duplicity, unnecessary or missing medications. Prescriptions were rated as appropriate (no prescription errors found) or inappropriate (at least one prescription error found). The benefit-risk ratio was calculated for each prescription. This study revealed a 58 percent of inappropriate prescriptions in the Mexican primary care university clinic, mostly due to errors on dosage regimen and innapropiate drug selection. As a result of chi2 analysis, it was found that the pharmacotherapeutic variables chosen for the prescription assessment in this study, were determinant in prescription appropriateness rating. Nimesulide, ciprofloxacin, ranitidine, ketorolac and paracetamol were the most prescribed drugs as well as the most common cause of errors found. The prescription error rate revealed by this study addresses the need for strategies to improve prescription's quality. Introducing pharmacists as a key part of health care team is a mean proposed to prevent medication errors and to solve the urgency of pharmaceutical care implementation in all primary care facilities in Mexico(AU)
O objetivo deste trabalho foi avaliar a racionalidade das prescrições como também os erros mais comuns nas prescrições emitidas pelo Centro de Saúde de uma Universidade no México. Foi realizado um estudo retrospectivo de utilização de medicamentos que requeria prescrição médica. 370 expedientes médicos foram aleatoriamente selecionados e revisados, obtendo uma mostra estatísticamente representativa do total de consultas médicas realizadas no período de um ano. A validade da prescrição médica foi feita utilizando as seguintes variáveis: indicação, doses recomendada, via de administração, contra-indicações, interações, duplicação de medicamentos, medicamentos desnecessários ou faltantes. As prescrições médicas foram classificadas como: apropriada (se não foram encontrados erros nas prescrições) ou inapropriada (se foram encontradas ao menos um erro na prescrição). A razão risco-beneficio foi calculada para cada prescrição médica. O estudo revelou alta incidência de prescrições inapropriadas no Centro de Saúde da Universidade do México (58 por cento), causada pelos erros nas doses recomendadas e na seleção do medicamento relacionado com a necessidade do paciente. Como resultado da análise chi2 , foi encontrado que as variáveis fármaco-terapêuticas escolhidas neste estudo para avaliar a prescrição médica, foram determinantes para classificar as prescrições como apropriadas. Nimesulide, ciprofloxacin, ranitidine, ketorolac e paracetamol representaram o maior número de medicamentos prescritos assim como a maior causa de erros encontradas nas prescrições. É importante que um farmacêutico valide os medicamentos prescritos no Centro de Saúde. Este estudo justifica o papel que os farmacêuticos mexicanos deveriam desempenhar para evitar erros na prescrição, como parte importante da equipe médica, assim como a urgência de implementar os cuidados farmacêuticos em todos os estabelecimentos dos Centros de Saúde no México(AU)
