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There are few studies on the personal view retrieved by patients in the spontaneous reports’ free-text section of suspected adverse drug reactions. We analysed the suspected adverse drug reactions (ADRs) spontaneous reports sent to the Catalan Centre of Pharmacovigilance between 2013 and 2017. The information provided in the free-text section was classified as (1) temporal sequence, (2) description of symptoms, (3) description of psychological impact, (4) withdrawal effects, (5) alternative causes, and (6) rechallenge. The concordance level between the perceived severity by the reporter and the pharmacovigilance team was assessed by the Kappa index (ƙ). Usual descriptive statistics were used to describe variables. Nationally, 190 spontaneous reports described 383 ADRs, which 28.6% were unknown or poorly known in the literature, and 52.1% were serious. The most frequent ADRs were gastrointestinal (19.3%) and neurological (19.1%), and among the most common 213 suspected medicines, there were those used for nervous system conditions (18.8%). The agreement on the perception of ADRs’ severity between citizens and centre’s technicians was ‘good’ (K = 0.62 (0.51–0.72)). An analysis of the free-text section of reports showed that one-quarter of the reports provided useful additional data, like the psychobiosocial impact, which could explain the discrepancy between patients and health professionals in the classification of the severity of some ADRs. Patients’ report free-text section provides relevant information, mainly about symptoms description, psychobiosocial impact and feelings. Therefore, it is a section to be enhanced and analysed. These findings should encourage the strengthening of citizens reporting.

The aim of this study is to analyze the quality of the information contained in the adverse drug reactions (ADR) reports and to describe the magnitude and characteristics of the lacking information. All reports of serious ADR received by the Catalan Center of Pharmacovigilance in 2014 were analyzed using the VigiGrade and a more clinical and qualitative approach. Up to 824 reports describing serious ADR were included in the study; of them, 503 (61.0%) were sent by health care professionals (HPs) and the remaining 321 (39.0%) came from pharmaceutical companies (PhC). More than 80% of missing variables such as ‘onset date’ or ‘time-to-onset’ of the ADR were from PhCs reports. ‘Onset of treatment date’ was not filled in 28 (22.2%) of the reports including an ‘additional monitoring’ medicine, and ‘end of treatment’ date was not completed in 53 of those reports (42.1%). In summary, 39% of the reports involving a black triangle medicine sent by PhCs lacked some essential information such as the onset date of treatment. More than one third of the reports coming from manufacturers did not include information that is considered a limiting factor to evaluate any causal relationship, and can be an issue for the detection of safety signals. To take advantage of this huge amount of potentially important information that is almost useless at present, data mining tools and new algorithms should be developed and tested with the aim of finding formulas to deal with a huge amount of low quality data without losing it, nor generating a number of false associations.

Objective To assess the prevalence of potential drug–drug interactions (DDIs) in bone marrow transplantation (BMT) patients at the time of pre-infusion (day −1), to describe the potential DDIs and assess their frequency and severity. Setting The study was developed in a tertiary care hospital in Sao Paulo, Brazil. Method Cross-sectional study based on examining the medical prescriptions from the pre-infusion day (day −1) of 70 BMT patients. Potential DDIs were analyzed using Drug-Reax® and categorized according to levels of severity, evidence, and onset (rapid and delayed). Only interactions of major or moderate severity were included in the potential DDI analysis. Main outcome measure: Prevalence of potential DDIs in patients during the preinfusion phase of BMT. Results Data were analysed for 70 BMT patients. The median age was 36.5 years; 52.9% (37) of the patients were male, and 65.7% (46) were undergoing autologous BMT. The patients received a median of 8 drugs each. Up to 128 potential DDIs were detected, 60.0% (42) of patients had at least 1 potential DDI and 21.4% (15) were exposed to at least 1 major potential DDI. The most commonly involved drugs were cyclosporine (9, 28.1%), phenytoin (8, 25%) and fluconazole (5, 15.6%). Most potential DDIs had moderate severity (110, 85.9%), a pharmacokinetic mechanism (67, 52.3%), and were classified as delayed onset (106, 82.8%). For major interactions, fluconazole + sulfamethoxazole/trimethoprim, diazepam + fentanyl, fluconazole + levofloxacin and fentanyl + fluconazole were the most frequent. Conclusions The prevalence of potential DDIs during the conditioning period of BMT was high as a consequence of the therapeutic complexity of the procedure. Most potential DDIs identified in the study may result in clinically relevant consequences as they could lead to nephrotoxicity, cardiotoxicity, and other undesirable adverse effects. Careful monitoring of clinical and laboratory parameters is essential to ensure a successful BMT and to avoid adverse drug events related to DDI.

Nitrogen-doped titanium dioxide (TiO2) thin films were synthesized on glass substrates by reactive pulsed laser deposition technique (PLD). A frequency quadrupled Nd:YAG (λ = 266 nm, τFWHM ≅ 5 ns, ν = 10 Hz) laser source was used for the irradiations of TiO2 targets. The experiments were performed in controlled reactive atmosphere consisting of mixtures of oxygen and nitrogen gases. We demonstrated that there exists the possibility for the accurate control of the nitrogen incorporation through the growth parameters, i.e., the nitrogen partial pressure in the reaction enclosure. The substitutional nitrogen doping of the anatase phase TiO2 thin films allows for the continuous shift of the optical absorption edge towards the visible spectral range. When a threshold value of the nitrogen dopant level is surpassed the crystallization structure of the TiO2 anatase phase thin films changes, and the onset of a stable titanium-oxinitride phase formation takes place.

Adverse drug reactions (ADRs) represent a major public health problem in the aged. In order to better evaluate this problem in Brazil, this study was designed to assess the prevalence of ADRs in an elderly hospitalised population, identify the most common ADRs and the principal medications involved, evaluate the appropriateness of use of these drugs in elderly people and determine the risk factors implicated in the appearance of such ADRs.The study population was comprised of 186 elderly patients (or =60 years of age) admitted to the internal medicine service of a teaching hospital. The patients were assessed by a single observer using an intensive drug surveillance method to identify and report ADRs. The degree of probability for each adverse reaction was determined using the Naranjo algorithm.The mean (+/- SD) age of the patients studied was 73.6 +/- 9.1 years. Up to 115 patients (61.8%) of the study population presented at least one ADR. A total of 199 ADRs were found, at an average of 1.7 per patient. The ADRs appeared during hospitalisation in 46.2% of the study population, were present at the time of the admission but did not cause hospitalisation in 17.2% of patients, and were the cause of admission in 11.3% of patients. The most frequent ADR that caused hospitalisation was digitalis toxicity (22.7% of such ADRs). Hypokalaemia as a result of diuretics was the most prevalent ADR both during hospitalisation (11.8%) and at the time of admission without being the cause (12.1%). Captopril was the most frequently prescribed drug (138 prescriptions), and led to an ADR in 18.1% of patients who received the drug. Almost a quarter of the patients presenting an ADR were prescribed drugs considered inappropriate for the elderly. By means of a multiple logistic regression model, the following were considered to be significant risk factors for the appearance of ADRs: number of diagnoses (odds ratio [OR] 1.40; 95% CI 1.06, 1.86), number of drugs (OR 1.07; 95% CI 1.01, 1.13) and use of drug that is inappropriate for the elderly (OR 2.32; 95% CI 1.17, 4.59).The main contribution of the present study was identification of use of drugs that are considered inappropriate for elderly populations as a major risk factor for presenting an ADR. This finding is useful for continuous education programmes, therapeutic committees and policy makers, because adverse effects complicate the course of diseases in aged patients, cause hospitalisation and/or require the prescription of additional drugs. In addition to contributing to a reduction in healthcare costs, continuous efforts to promote rational drug use could also benefit elderly patients by preventing some avoidable drug toxicity.A significant prevalence of ADRs was found among hospitalised elderly people. The risk factors associated with ADRs in this population included use of drugs considered to be inappropriate for that population, number of previous diagnoses and number of administered drugs. More appropriate drug prescription could avoid part of this burden of disease by minimising preventable ADRs.

Prescribing is a complex decision-making process influencednot only by patients’ needs, but also by other factors, such asavailable resources, priorities of national healthcare policies,and market pressures [1]. The information on medicines andtherapeutics that reaches prescribers is also one of thesefactors. The need for continuous updating of this informationis vital for both healthcare professionals and healthcaresystems, although keeping up with therapeutic advances inhealth care is challenging [2].In the last two decades, access to scientific publicationsand other sources of medical information has changeddramatically, from the need to gain access to information tothe need to select it. More than ever, genuine data and newsare diluted in an ocean of banalities. For example, it took20 years, hundreds of studies, and millions of treatedpatients to realize that the so-called second-generationantipsychotics are actually no better than the older drugsin terms of efficacy and side-effect profiles [3].New information and communication technologies giveusers the opportunity to retrieve a wealth of information[4, 5]. Nevertheless, the reliability, quality, and relevanceof the information retrieved to clinical and public healthvary, and the information overload carries an inevitablerisk of “infoxication”.Too often commercial interests—rather than clinical ortherapeutic needs—drive the conception, design, analysis,interpretation, and dissemination of clinical research [6, 7].In addition, recent cases of fraud, suppression of negativeresults, and selectivity in terms of publication, such asthose on selective COX-2 inhibitors [8], selective serotoninre-uptake inhibitors, antidepressants [9], and rosiglitazone[10], have shown that peer-reviewed medical literaturecannot always be regarded as a valid and reliable source ofinformation [11, 12]. The design of pre-marketing trials, theconduct of post-marketing surveillance, and communicationtoprescribersaredrivenbytheneedtosell.Table 1 summarizesthe main problems associated with the dissemination ofinformation on medicines.The real meaning of words: is it possible to define“essential information” in therapeutics?More than 30 years ago, a World Health Organization(WHO) expert committee noted that despite the fact thatthousands of medicines had been marketed in previousyears, their public health impact was uncertain. WHOdefined essential medicines as those that satisfy thehealthcare needs of the majority of the population [13].The WHO concept of essential medicines, launched in1977, helped to establish that some medicines are morehelpful than others and that essential medicines shouldtherefore be available at all times in adequate amounts andin the appropriate dosage forms—and at a price thatindividuals and the community can afford [14].Similarly, in order to promote a healthy and cost-effectiveuse of medicines, prescribers, other healthcare professionals

The preparation of titanium oxide powders has been the subject of many studies in recent years. Titania has many industrial applications as a white pigment, catalyst support, etc. Its use in semiconductor-sensitized photomineralization of organic compounds by oxygen is a common topic of research. Numerous studies have been devoted to investigate the synthesis of titania powders with improved photoactivity [1–3]. The TiO2-sensitized photodegradation of organic compounds has been proposed as an alternative advanced oxidation process (AOP) for the decontamination of water and air [4]. The process is initiated by the generation of hole/electron pairs upon absorption of UV light with energy equal to or higher than the band gap. In titania the threshold energy is ∼3.2 eV (anatase). Electrons and holes are photogenerated in the bulk of the semiconductor, and move within the particle. When the charges reach the particle surface, electrons are able to reduce an electron acceptor (i.e. oxygen) and positive holes can oxidize an electron donor (i.e. organic compounds). The electron/hole recombination is a competitive process that decreases the activity of the TiO2. Crystal defects or impurities may also act as photoactivity-quenching traps. The properties of titania powder, like crystal structure, surface area, morphology, particle size, surface chemistry, etc. are determined by the preparation conditions of the different synthetic routes used in their preparation and strongly influence their photoactivity. Materials with high surface area can adsorb a large amount of organic molecules. For this reason, the preparation of titania powders with high surface area has been extensively studied. Unfortunately, high surface area powders are usually associated with a large amount of crystalline defects that favors the recombination of electrons and positive holes leading to a poor performance in photoactivity. Recently, it has been reported that the photocatalytic activity of amorphous TiO2 is negligible or very poor indicating that crystallinity is an important requirement [5]. Then, finding a compromise between surface area and crystallinity must be attained. The most convenient TiO2 crystalline structure, either anatase or rutile, that could lead to a higher photoactivity is also a point of controversy. Some authors point out that the anatase structure is the more convenient, although a combination of anatase and rutile, or even pure rutile has proven to be favorable for the treatment of some contaminants [3, 6]. The preparation of titania powders was carried out in a cold-wall-type plasma enhanced chemical vapor deposition (PECVD) reactor with an external radiofrequency electrode [7]. The excitation frequency employed was 40 kHz. Titanium tetraisopropoxide (TTIP, supplied by Aldrich) was used as the precursor and oxygen as the carrier gas. The oxygen flow rate was controlled by a mass flowmeter and maintained at 50 sccm. The experiments were carried out under reduced pressure conditions at 30 Pa (measured by a capacitive gauge coupled to a throttle valve). The powder was deposited on the cold areas of the reactor at temperatures not higher than 90 ◦C. The titania powder was formed by vapor phase decomposition of the plasma-activated TTIP precursor in an oxygen atmosphere. The time of synthesis was 90 min. Structural characterization of powders was carried out by powder X-ray diffraction (XRD) in a Rigaku Rotaflex RU-200B. Measurements of powder specific surface area (SBET) were performed by using N2 adsorption/desorption isotherms following the Brunauer– Emmett–Teller (BET) method in a Micromeritics ASAP 2000 apparatus. Morphological characterization was performed by scanning electron microscopy (SEM) and transmission electron microscopy (TEM) at 300 kV. The as-grown powder presented a snow flake shape and was amorphous. Scanning electron microscopy (SEM) showed that the particles were spherical with a uniform size. The powder was hydrophobic, probably due to the presence of traces of organic species from the TTIP decomposition which still remain at the powder surface. This was confirmed by an IR spectrum.