RESUMO
Objetivo: Determinar la necesidad de aperturas de farmacias sociales bien establecida para pacientes ambulatorios de escasos recursos como base del ente nacional responsable del cuidado de la salud poblacional. El estudio se realizó mediante encuesta a aquellas personas que presenten epidemiología frecuentes y de tratamientos básicos del Barrio Barcequillo de la ciudad de San Lorenzo del Departamento Central. El 82% de los pobladores no cuentan con algún tipo de cobertura para su salud y la de sus familiares. Las enfermedades de mayor preponderancia fueron: hipertensión 36%, enfermedades respiratorias 22%. El 40% de la población reciben sus haberes mensualmente, el 60% no tiene ingreso fijo (obtiene de manera diaria, semanal o quincenalmente). Los lugares donde acuden con mayor frecuencia en caso de padecer alguna enfermedad: centro de salud 78%, sanatorios 4%, médicos naturalistas 10%. En esta ciudad la distribución de farmacias sociales o dispensarios de salud social son nulos, la gran mayoría de los pobladores encuestados no poseen seguro de salud y tampoco cuentan con capital suficiente para cubrir los costos de medicamentos para tratamientos de sus afecciones.
Assuntos
Serviços de Saúde Comunitária , Serviços Comunitários de Farmácia , Licenciamento em Farmácia/legislação & jurisprudência , Serviço Social , Paraguai , FarmáciasRESUMO
BACKGROUND: Loop diuretics are beneficial in heart failure in the short term because they eliminate fluid retention, but in the long-term, they could adversely influence prognosis due to activation of neurohumoral mechanisms. AIMS: To explore the changes induced by diuretic withdrawal in chronic nonadvanced heart failure. METHODS: Diuretics were withdrawn in 26 stabilized heart failure patients with systolic dysfunction (ejection fraction [EF]<45%). Clinical status was evaluated by physical exam, exercise capacity (corridor test) and New York Heart Association (NYHA) class. Biochemical and neurohumoral determinations were performed at baseline and at 3 months. RESULTS: At 3 months, 17 out of 26 patients (65%) were able to tolerate diuretic interruption without a deterioration in exercise capacity or New York Heart Association functional class. Renal function parameters improved (baseline urea 46.2+/-10.8 to 39.2+/-10.1 mg/dl at 3 months, p=0.014; creatinine 1.1+/-0.23 to 0.98+/-0.2 mg/dl, p=0.013). Glucose metabolism also improved (fasting glucose 151+/-91 to 122+/-14 mg/dl, p=0.035). Heart rate and systolic blood pressure did not significantly change, while diastolic blood pressure increased (from 80+/-10 to 87+/-13 mm Hg, p=0.006). Neurohumoral determinations showed a decrease in plasma renin activity (4.19+/-5.96 to 2.88+/-4.98 ng/ml, p=0.026), with no changes in aldosterone, arginine-vasopressin, endothelin-1 and norepinephrine. In contrast, atrial natriuretic peptide significantly increased (115+/-87 to 168+/-155 pg/ml, p=0.004). CONCLUSION: Diuretic withdrawal in stabilized heart failure with systolic dysfunction is associated with an improvement in renal function parameters, glucose metabolism and some neurohumoral parameters, such as plasma renin activity; however, atrial natriuretic peptide levels increased.
