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A síndrome de Stevens-Johnson é uma condição que pode ser considerada rara, porém de gravidade severa, podendo ser induzida por medicamentos, sendo os antimicrobianos destacados como principais causadores. Apresentamos um caso de uma pessoa idosa que desenvolveu a síndrome, com sobreposição para Necrólise Epidérmica Tóxica, provavelmente devido ao uso do fármaco ciprofloxacino. Durante sua hospitalização, o caso foi gerenciado pelo setor de farmacovigilância (I. Sistematização de evidências científicas em saúde; II. Realização de investigação aprofundada do caso vivenciado, confrontando os dados com as informações científicas; III. Estudo da causalidade da reação adversa; IV. Desenvolvimento de um protocolo de práticas a serem seguidas, capacitação da equipe e acompanhamento das etapas; V. Organização da notificação e encaminhamento para as agências reguladoras responsáveis) e por equipe multidisciplinar. Foi realizado tratamento com base em evidências de saúde, no entanto, houve refratariedade às medidas clínicas, e a paciente progrediu com agravamento da descamação, infecção, parada cardíaca e óbito após o protocolo de ressuscitação. Além dos fatores mencionados anteriormente, adicionam-se outros aspectos que contribuíram para a gravidade do episódio: presença de multimorbidade, idade avançada, busca tardia por assistência à saúde e continuação do uso do medicamento que induziu a reação, mesmo após os sintomas iniciais. A ANVISA categorizou o evento como grave e reportável para o Uppsala Monitoring Centre. O Serviço de farmacovigilância hospitalar atuou em conjunto com a equipe multidisciplinar, contribuiu para o pronto e adequado manejo do evento, gerenciamento de risco e educação em saúde. Este estudo oferece conteúdo para aprendizado multiprofissional, estratégias para a segurança e cuidado centrado na pessoa.

BackgroundBenzodiazepines are frequently prescribed to treat anxiety and insomnia, but long-term use has been associated with the development of dependence, tolerance, and cognitive decline, especially among older adults. This study aimed to investigate the pattern of consumption and factors associated with inappropriate prescribing of benzodiazepines in primary health care.MethodsThis is a cross-sectional analytical study, using dispensing records of diazepam, clonazepam, and nitrazepam from public pharmacies in a Brazilian municipality between 2018 and 2022. Metrics for benzodiazepine consumption were DDD (Defined Daily Dose) and DDD/1000PD (per 1000 population per day). Long-term/prolonged benzodiazepine use was defined as consuming at least 90 DDD and at least 2 dispensations per year. To ascertain associations between long-term use and predictor variables, a multivariate logistic regression model was utilized.FindingsA total of 40402 participants were included, with an average age of 55 years (SD = 0.30), 38.5% were older aged. Diazepam and nitrazepam exceeded the daily dose recommended. There was a reduction in diazepam consumption during the study period, as calculated by DDD/1.000PD, while the consumption of other benzodiazepines remained stable. However, a significant increase in diazepam consumption is noted when considering the last decade. Prolonged use was observed in 29.1% of participants, with a significant prevalence among the older people (34.8% of them were long-term users) and advancing age was identified as a risk factor for long-term use. Higher PDDs were also associated with long-term use and aging. Participants who used different benzodiazepines during the period had a higher risk of prolonged use.ConclusionsThese results provide insights into the prevalence of problematic utilization of benzodiazepines in primary health care. Authorities and health care providers must take steps to encourage gradual cessation of prolonged benzodiazepine prescriptions and the embrace of suitable strategies for addressing anxiety and insomnia within primary health care settings.

Stevens-Johnson syndrome is a condition that is considered rare but of severe intensity, potentially induced by medications, with antimicrobials being highlighted as the main culprits. We present a case of an older individual who developed the syndrome, overlapping with Toxic Epidermal Necrolysis, likely due to the use of the drug ciprofloxacin. During hospitalization, the case was managed by the pharmacovigilance sector (I. Systematization of scientific evidence in health; II. Conducting an in-depth investigation of the experienced case, comparing data with scientific information; III. Studying the causality of the adverse reaction; IV. Developing a protocol of practices to be followed, team training, and monitoring of the steps; V. Organizing notification and referral to responsible regulatory agencies) and a multidisciplinary team. Treatment was based on health evidence; however, there was refractoriness to clinical measures, and the patient progressed with worsening skin shedding, infection, cardiac arrest, and death after the resuscitation protocol. In addition to the factors mentioned above, other aspects contributed to the severity of the episode: presence of multimorbidity, advanced age, late seeking of healthcare assistance, and continued use of the drug that induced the reaction, even after the initial symptoms. ANVISA categorized the event as severe and reportable to the Uppsala Monitoring Centre. The hospital pharmacovigilance service collaborated with the multidisciplinary team, contributing to the prompt and appropriate management of the event, risk management, and Health education. This study provides content for multiprofessional learning, strategies for safety, and person-centered care.

Background: Pharmaceutical care is considered an important pillar for promoting the rational and safe use of medicines. Consequently, it constitutes actions of practices capable of reducing morbidity and mortality induced by pharmacotherapy. On the other hand, pharmaceutical services may face several barriers related to the implementation of these practices. These difficulties are associated with management, availability of an appropriate physical environment, integration with the multidisciplinary team, and acceptance of pharmaceutical interventions by health professionals. Objectives: This study aims to map and summarize the scientific evidence on the experiences and strategies used to implement pharmaceutical services in hospital geriatric units. Methods: The scoping review will be based on three electronic databases (PubMed, EMBASE, and Web of Science). Studies that met the inclusion criteria and are published by December 2022 will be selected. The screening, eligibility, extraction, and assessment of studies will be carried out by two independent researchers. Experimental and observational studies will be eligible for inclusion. Discussion: The experiences of incorporating pharmaceutical care into geriatric hospital units need to be better disseminated. Our review could support the performance of pharmaceutical care in other geriatric wards and has the potential to be a reference for multidisciplinary training. In addition, the study is related to the global challenge of the World Alliance for Patient Safety as it is a survey that will demonstrate strategies for safety in the use of medicines.

ABSTRACT BACKGROUND: Despite the several options available for supplements containing vitamins C and E, evidence regarding the prevalence of deficiency or insufficiency of these vitamins is weak. OBJECTIVES: To estimate the prevalence of deficiency or insufficiency of vitamins C and E and associated factors among women of childbearing age, in Brazil. DESIGN AND SETTING: Systematic review and meta-analysis conducted at a Brazilian public university. METHODS: A search from index inception until May 2020 was conducted. Meta-analyses were performed using inverse variance for fixed models, with summary proportions calculation using Freeman-Tukey double arcsine (base case). Reporting and methodological quality were assessed using the Joanna Briggs Institute tool for prevalence studies. RESULTS: Our review identified 12 studies, comprising 1,316 participants, especially breastfeeding women. There was at least one quality weakness in all studies, mainly regarding sampling method (i.e. convenience sampling) and small sample size. The prevalence of vitamin C deficiency ranged from 0% to 40%. Only vitamin E deficiency was synthetized in meta-analyses, with mean prevalences of 6% regardless of the alpha-tocopherol cutoff in plasma, and 5% and 16% for cutoffs of < 1.6-12.0 mmol/l and < 16.2 mmol/l, respectively. The cumulative meta-analysis suggested that a trend to lower prevalence of vitamin E deficiency occurred in recent studies. CONCLUSIONS: Although the studies identified in this systematic review had poor methodological and reporting quality, mild-moderate vitamin C and E deficiencies were identified, especially in breastfeeding women. Thus, designing and implementing policies does not seem to be a priority, because the need has not been properly dimensioned among women of childbearing age in Brazil. REGISTRATION NUMBER IN PROSPERO: CRD42020221605.

Background: Prescription of calcium polystyrene sulfonate (CPS) has been considered a trigger with good performance to detect hyperkalemia related to adverse drug events (ADE). However, CPS prescription may underestimate the rate of ADE. Objective: To compare the performance of the serum potassium level (SPL) >5.0mEq/L and CPS triggers in detecting hyperkalemia related to ADE. Design and setting: A six-month cross-sectional study was conducted in a Brazilian medium-complexity public hospital. Methods: SPL Tests with results >5.0mEq/L and the prescriptions of CPS of all patients hospitalized in the internal medicine and infectious diseases wards were used as trigger tools to detect potential ADE. Primary outcome: patients with hyperkalemia related to ADE. Secondary outcomes: effectiveness of treatments and ADE. Variables analyzed were SPL tests, CPS prescriptions, treatments of hyperkalemia and comorbidities. Positive predictive values (PPV) of CPS and SPL triggers were calculated and compared. Results: In total 2,466 SPL tests were assessed, of which 513 were triggered (>5.0mEq/L). The tests triggered 198 patients with hyperkalemia, of whom 121 had hyperkalemia related to ADE (PPV=0.61). In total, 101 CPS prescriptions triggered tests in 35 patients with hyperkalemia, among whom 21 cases were related to ADE (PPV=0.60). SPL detected 204 ADE (PPV=0.40), while CPS prescription detected 22 (PPV=0.21). Seven pharmacological and four non-pharmacological treatments were identified. CPS showed the lowest effectiveness (PPV=0.71). Conclusion: SPL>5.0mEq/L increased the detection of ADE by 9.3-fold, the number of patients tracked with hyperkalemia related to ADE by 5.8-fold, and doubled the performance in detection of ADE in comparison with the prescription of the CPS trigger.

Background: Despite current policies of salt iodination, iodine deficiency is still a global public health problem, especially in women. So far, conflicting evidence has been suggested for the prevalence of iodine deficiency in Brazil. Objective: To estimate the prevalence of iodine deficiency and associated factors in women of childbearing age in Brazil. Methods: A systematic review was conducted using databases (PubMed, LILACS, WHO, Scopus, and Capes’ dissertation and thesis), from inception to May 2020. Meta-analyses of proportions were performed using the variance inverse for the fixed model. Reporting and methodological quality were assessed using the Joanna Briggs Institute tool to prevalence studies. Results: Our review identified seven studies published between 2002 e 2017, including 1354 participants, especially pregnant women. All studies presented at least one quality limitation, mainly regarding the sampling method (i.e., convenience) and small sample size. The prevalence of iodine deficiency ranged among studies from 16% to 62%. In contrast, the meta-analysis identified a mean prevalence of 40% (95% confidence interval, CI 37%-43%) for pregnant women and 13% (95% CI 4%-24%) for non-pregnant women. Cumulative meta-analysis suggests a tendency of higher iodine deficiency prevalence from 2018 in pregnant women. Conclusions: Although this systematic review identified studies with poor methodological and reporting quality, a high prevalence of iodine deficiency was identified in pregnant women, reinforcing the importance of national nutritional policies for monitoring iodine status in this population. Future studies should consider random probabilistic sampling, appropriate sample size, and pre-defined subgroup analysis to adequately inform the prevalence of iodine deficiency and associated factors in women of childbearing age and support health policies.

Abstract INTRODUCTION This systematic review aimed to assess antibiotic use in Brazilian hospitals in the 21st century, as well as to understand the different drug utilization metrics adopted to assess the consumption of these drugs. METHODS We systematically reviewed five databases (MEDLINE [Medical Literature Analysis and Retrieval System Online], CENTRAL [The Cochrane Central Register of Controlled Trials], EMBASE® [Excerpta Medica Database], Scopus [Elsevier’s abstract and citation database], and LILACS [Literatura Latino-Americana e do Caribe em Ciências da Saúde]) for observational or experimental studies that assessed antibiotic utilization in Brazilian hospitals. The main outcomes were the drug utilization metrics and the consumption of antibiotics. RESULTS We included 23 studies, of which 43.5% were carried out in adult and pediatric care units, 39.1% in adult units, and 17.4% in pediatric units. Regarding the complexity of healthcare, 26.1% of the studies were performed in intensive care units. Two drug utilization metrics were used in these studies: the defined daily dose (DDD) and the percentage of antibiotic prescriptions. The most commonly used antibiotic classes were third-generation cephalosporins, carbapenems, fluoroquinolones, and combinations of penicillins when the DDD was the adopted drug utilization metric. CONCLUSIONS Although few studies have been conducted, existing data indicate a high use of broad-spectrum antibiotics. We found that the lack of standardized antibiotic utilization metrics impaired the mapping of drug consumption at the national level.

O consumo de psicofármacos é considerado um problema de saúde pública devido ao potencial de dependência e ocorrência de eventos adversos. Nesse contexto, o presente estudo teve como objetivo caracterizar o consumo de psicofármacos dispensados em unidades básicas de saúde de Ribeirão Preto, São Paulo, Brasil. Conduziu-se um estudo ecológico, com consulta à base de dados Hygia de 2008 a 2012. Foram extraídas as variáveis: psicofármaco dispensado, quantidade dispensada no ano, sexo e faixa etária dos pacientes. Para cada psicofármaco foi calculada a dose diária definida por 1.000 habitantes/dia (DDD/1.000PD), a dose diária definida por 1.000 habitantes/dia considerando-se 75% da população (DDD75%/1.000PD) que retiraram medicamento pelo Sistema Único de Saúde (SUS) e a dose diária prescrita (DDP). Comparou-se a taxa de crescimento populacional com a de crescimento do consumo dos medicamentos. Foram identificados 1.577.241 pacientes que retiraram medicamentos no período avaliado, dos quais 287.373 (18,2%) utilizaram pelo menos um sujeito a controle especial. Houve aumento do consumo total dos psicofármacos (DDD/1.000PD), porém, após a comparação com a taxa de crescimento populacional, apenas a da sertralina (p = 0,021), risperidona (p = 0,034) e do clonazepam (p = 0,043) foram superiores. As DDP de sete fármacos estavam maiores que a DDD da Organização Mundial da Saúde (OMS). As discrepâncias entre DDD e DDP podem ser úteis como estratégia para triar pacientes elegíveis ao cuidado farmacêutico, pois podem contribuir na prevenção de morbimortalidade relacionada ao uso de medicamentos.

Introduzione. Il ruolo dell’italiano L2 nel processo di internazionalizzazione delle università Sergio Lubello e Fabiana Rosi

ABSTRACT Objective The purpose was to identify the barriers of underreporting, the factors that promote motivation of health professionals to report, and strategies to enhance incidents reporting. Method Group conversations were carried out within a hospital multidisciplinary team. A mediator stimulated reflection among the subjects about the theme. Sixty-five health professionals were enrolled. Results Complacency and ambition were barriers exceeded. Lack of responsibility about culture of reporting was the new barrier observed. There is a belief only nurses should report incidents. The strategies related to motivation reported were: feedback; educational intervention with hospital staff; and simplified tools for reporting (electronic or manual), which allow filling critical information and traceability of management risk team to improve the quality of report. Conclusion Ordinary and practical strategies should be developed to optimize incidents reporting, to make people aware about their responsibilities about the culture of reporting and to improve the risk communication and the quality of healthcare and patient safety.

Modelo do estudo: Revisão Sistemática da Literatura e discussão com profissionais especialistas. Objetivo: Propor a lista de medicações, diluente e volume de diluição, para o uso por hipodermóclise, a pacientes acima de 18 anos Método: Com base em diretrizes Prisma, foi realizado um levantamento bibliográfico na base de dados MEDLINE através do portal Pubmed e pela biblioteca virtual SCIELO, utilizando os descritores: infusions; subcutaneous; palliative care; hospice; palliative care nursing e as palavra-chave hypodermoclysis e off-label use, seus correspondentes em português e seus cruzamentos. Os artigos encontrados foram analisados a partir do instrumento AMSTAR, seguido de discussão com profissionais de formação avançada em CP. Resultados: Dos artigos foram extraídas as seguintes variáveis: medicamentos administrados por hipodermóclise, veículo e volume de diluição, tempo de infusão, forma de administração (continua e em bolus), além de observações referentes à administração em sítio único e concentração máxima. A partir destas variáveis elaborou-se síntese em relação às medicações a serem utilizadas. Conclusões: Chegou-se a uma lista de medicações, dosagem, volume de diluição e diluente. Os resultados encontrados na literatura foram discutidos em processo dialógico e convergente, pelos profissionais de enfermagem, medicina e farmácia. Sendo assim, esta lista possui perfil replicável para outros serviços com cuidados paliativos ou que utilizam a via hipodermóclise.

INTRODUÇÃO: A vigilância pós-comercialização de medicamentos visa à detecção de problemas de segurança, qualidade e efetividade. A identificação de eventos adversos a medicamentos (EAM) é realizada, principalmente pela notificação espontânea por profissionais da saúde. Este método permite a comunicação dos riscos em farmacovigilância e contribui para a regulamentação do mercado. OBJETIVO: Estimar a prevalência de reações adversas a medicamentos (RAM) e as suspeitas de inefetividade terapêutica (IT) notificadas por profissionais da saúde; verificar os fármacos e o tipo medicamentos envolvidos, a gravidade, a causalidade, o mecanismo de produção e as manifestações clínicas dos eventos. MÉTODOS: Estudo transversal foi conduzido em um hospital de ensino, de alta complexidade, integrante da Rede Sentinela, no ano de 2008. A gravidade das RAM foi classificada quanto à intensidade (leve, moderada, grave e letal), os medicamentos associados aos EAM foram categorizados segundo o tipo (referência ou similar); o grau de causalidade foi imputado com o algoritmo de Naranjo e o mecanismo de ocorrência da RAM foi analisado segundo a definição de Rawlins e Thompson (A e B). RESULTADOS: No período, houve 103 notificações, sendo 39 de IT e 64 de RAM. As prevalências de EAM/paciente e EAM/leito foram, respectivamente, 0,3% e 11,9%. O enfermeiro foi o principal notificador (53,4%). A maioria das RAM foi classificada como sendo do tipo A (82,8%), leve (81,3%), de causalidade possível (57,8%) e relacionada aos medicamentos referência (20/35). Imunoglobulina humana, docetaxel e paclitaxel foram os fármacos comumente associados à RAM. As IT relacionaram-se ao uso de medicamentos similares (26/29), principalmente dos fármacos midazolam e ganciclovir. CONCLUSÕES Os resultados das notificações contribuíram para a proposição de rastreadores de monitoramento da segurança dos medicamentos e na qualificação de fornecedores para a instituição.

Background: The use of herbal medicines is justified empirically using ethnopharmacological knowledge, which has limitations. Reports of adverse events (AE) may contribute for safety, quality, and effectiveness assessment. Objectives: This study aimed to develop an instrument to allow detection and evaluation of the causal likelihood of AE related to herbal medicines. Methods: A quantitative methodological development research intervention was performed with primary care health professionals. Two cases were distributed in an interval of one week in order to allow for completion of the proposal form. The within-rater reliability was calculated and classified into satisfactory, regular, and unsatisfactory, according to essential, necessary, and recommended items reported. Results: Fifty-seven professionals were enrolled. A high degree of the within-rater reliability was observed for the most essential, necessary, and recommended fields. The instrument contributed to assessment of definite causal association, once the duration of reactions including evolution, withdrawal, and reposition items showed high reliability. Most fields poor and weak filled were related to quality defects, such as popular name and appearance. Conclusions: Data suggest the instrument is adequate to report AE arising from herbal medicines. Owing to information regarding to organoleptic characteristics, the instrument is different from drug instruments. Therefore, it is intended to improve AE reports related to herbal medicines and contribute for appropriate use.

BACKGROUND & OBJECTIVES:Different algorithms have been developed to standardize the causality assessment of adverse drug reactions (ADR). Although most share common characteristics, the results of the causality assessment are variable depending on the algorithm used. Therefore, using 10 different algorithms, the study aimed to compare inter-rater and multi-rater agreement for ADR causality assessment and identify the most consistent to hospitals. METHODS:Using ten causality algorithms, four judges independently assessed the first 44 cases of ADRs reported during the first year of implementation of a risk management service in a medium complexity hospital in the state of Sao Paulo (Brazil). Owing to variations in the terminology used for causality, the equivalent imputation terms were grouped into four categories: definite, probable, possible and unlikely. Inter-rater and multi-rater agreement analysis was performed by calculating the Cohen´s and Light´s kappa coefficients, respectively. RESULTS:None of the algorithms showed 100% reproducibility in the causal imputation. Fair inter-rater and multi-rater agreement was found. Emanuele (1984) and WHO-UMC (2010) algorithms showed a fair rate of agreement between the judges (k = 0.36). INTERPRETATION & CONCLUSIONS:Although the ADR causality assessment algorithms were poorly reproducible, our data suggest that WHO-UMC algorithm is the most consistent for imputation in hospitals, since it allows evaluating the quality of the report. However, to improve the ability of assessing the causality using algorithms, it is necessary to include criteria for the evaluation of drug-related problems, which may be related to confounding variables that underestimate the causal association.

Objective: Identifying the main causes for underreporting of Adverse Drug Reaction (ADR) by health professionals. Method: A systematic review carried out in the following databases: LILACS, PAHO, SciELO, EMBASE and PubMed in the period between 1992 and 2012. Descriptors were used in the search for articles, and the identified causes of underreporting were analyzed according to the classification of Inman. Results: In total, were identified 149 articles, among which 29 were selected. Most studies were carried out in hospitals (24/29) for physicians (22/29), and pharmacists (10/29). The main causes related to underreporting were ignorance (24/29), insecurity (24/29) and indifference (23/29). Conclusion: The data show the eighth sin in underreporting, which is the lack of training in pharmacovigilance. Therefore, continuing education can increase adherence of professionals to the service and improve knowledge and communication of risks due to drug use.

Certain medicines are considered potentially inappropriate (PIM) for elderly people as they increase the risk of adverse drug events (ADE) and because safer alternative therapies are available on the market. In this context, in order to identify the instruments that assess the quality of medical prescriptions for elderly and to determine which drugs are considered PIM, a bibliographic survey was conducted in PUBMED, LILACS and PAHO databases, in February and March/2010. The search strategy included the use of health descriptors and a manual search in the references cited by selected papers. During the period of data collection, 15 instruments were identified. In 2012, with the publication of the update of Beers criteria, this instrument was included in the study. We identified 163 PIM of 25 therapeutic classes, of which 125 (76.7%) are marketed in Brazil. Of these, 31 (24.8%) are essential medicines (RENAME 2012), of which 13 have safer therapeutic equivalents and 19 (15.2%) are over-the-counter drugs. Data suggest the need for inclusion of safer alternatives for the elderly in the national list of essential medicines and the pharmaceutical care for early detection of ADE in this age group, in order to contribute to the safe use of medicines.

OBJECTIVES: Drug safety problems can lead to hospital admission. In Brazil, the prevalence of hospitalization due to adverse drug events is unknown. This study aims to estimate the prevalence of hospitalization due to adverse drug events and to identify the drugs, the adverse drug events, and the risk factors associated with hospital admissions. METHOD: A cross-sectional study was performed in the internal medicine ward of a teaching hospital in São Paulo State, Brazil, from August to December 2008. All patients aged ≥18 years with a length of stay ≥24 hours were interviewed about the drugs used prior to hospital admission and their symptoms/complaints/causes of hospitalization. RESULTS: In total, 248 patients were considered eligible. The prevalence of hospitalization due to potential adverse drug events in the ward was 46.4%. Overprescribed drugs and those indicated for prophylactic treatments were frequently associated with possible adverse drug events. Frequently reported symptoms were breathlessness (15.2%), fatigue (12.3%), and chest pain (9.0%). Polypharmacy was a risk factor for the occurrence of possible adverse drug events. CONCLUSION: Possible adverse drug events led to hospitalization in a high-complexity hospital, mainly in polymedicated patients. The clinical outcomes of adverse drug events are nonspecific, which delays treatment, hinders causality analysis, and contributes to the underreporting of cases.

O presente trabalho teve como objetivo desenvolver uma alternativa de produto sem glúten, como a massa de macarrão, com a utilização de misturas de farinhas contendo fécula de batata, amido de milho, farinha de arroz, farinha de feijão e farinha de banana verde. Também se objetivou avaliar o valor nutricional das formulações e o efeito do tratamento térmico sobre a capacidade antioxidante total, fenólicos totais e peroxidação lipídica. Foram elaboradas três massas de macarrão constituídas de ingredientes básicos, farinha de banana verde e farinha de feijão e determinados os teores de umidade, lipídios, cinzas, proteínas, carboidratos e fibra alimentar conforme metodologia da AOAC. A análise do potencial antioxidante foi baseada no teste do DPPH, o conteúdo de fenólicos totais foi determinado utilizando-se o reagente de Folin-Ciocalteau e para determinação da taxa de peroxidação utilizou-se o reagente TBARS. Foi utilizado o delineamento inteiramente casualizado com 2 tratamentos (cru e cozido) e 3 repeti- ções. Utilizou-se o teste t pareado (α=5%) para avaliação dos fenólicos totais e da peroxidação lipídica e a análise de variância (ANOVA) e teste de Duncan (α=5%) para comparação de médias entre amostras de macarrões crus e cozidos, separadamente. As massas de macarrão mostraram-se fontes de carboidratos, proteínas e fibra. O potencial antioxidante e o conteúdo de fenólicos totais mostraram- -se maiores nas massas alimentícias cozidas, ao contrário da peroxidação lipídica, o que é um resultado positivo. Os produtos elaborados podem, assim, ser considerados como alternativas viáveis a portadores de doença celíaca, visto suas importantes características tecnológicas e nutricionais.

As interações medicamentosas (IM) são consideradas um problema de saúde pública, pois podem causar resultados negativos à saúde dos usuários de medicamentos. Portanto o referido trabalho teve como objetivos: estimar a prevalência de internações hospitalares relacionadas a Potenciais IM (PIM); identificar os sinais e sintomas, e os fatores de risco para a hospitalização relacionados à PIM. Metodologia: Realizou-se estudo transversal na clínica geral de um hospital privado do interior de São Paulo (Brasil), em maio de 2006, com pacientes acima de 18 anos, com tempo de hospitalização superior a 24horas, sendo os mesmos entrevistados sobre os sintomas/motivos de internação e os medicamentos que haviam utilizado previamente à hospitalização. Calculou-se Odds-ratio para identificar fatores de risco, sendo encontrado os seguintes resultados: 168 pacientes utilizando mais de um medicamento, dos quais 57 apresentaram PIM, sendo que em 17(10,1%), os sinais e sintomas da PIM possivelmente foram a causa da hospitalização. A maioria das manifestações clínicas das PIM foram sintomas cardiovasculares (44,3%), gastrintestinais (17,2%) e musculoesqueléticos (13,8%) e 10% das PIM foram consideradas potencialmente perigosas. Não foram detectados fatores de risco relacionados ao gênero, idade, uso de medicamentos de estreita faixa terapêutica para hospitalização por PIM. A polimedicação foi fator de risco para ocorrência de PIM (p

O presente estudo analisou o valor nutricional e realizou a caracterização física e físico-química de jenipapo, espécie frutífera encontrada no Cerrado de Minas Gerais. Os frutos foram selecionados e caracterizados fisicamente quanto ao comprimento, diâmetro, massa e rendimento. Foram investigados os conteúdos de acidez total titulável (ATT), sólidos solúveis totais (SST), relação SST/ ATT, pH, umidade, cinzas, proteínas, lipídios, fibra alimentar total (FAT), carboidratos na polpa in natura. Utilizou- -se o delineamento inteiramente casualizado, com três repetições. Os frutos apresentaram formato oval, com casca fina, rugosa e murcha, polpa marrom clara com sementes pardas, peso médio de 283,42 g e rendimento de polpa de 48,00%. A polpa do fruto apresentou ATT igual a 3,33 g ácido cítrico/100g, SST de 11,40 0 Brix, relação SST/ATT de 3,43, pH igual a 3,87, umidade de 80,42%, 1,59g/100g de proteínas, 1,60g/100g de lipídios, 0,74g/100g de cinzas, 1,09g/100g de FAT, 14,57g/100g de carboidratos e valor energético total de 76,92kcal/100g. A polpa apresentou teor reduzido de SST e elevado conteúdo de ATT e pH, o que pode contribuir para uma menor aceitação do seu consumo in natura. O percentual de umidade foi elevado e juntamente com sua casca frágil, pode contribuir na deterioração do fruto. O jenipapo não se destacou quanto ao valor nutricional, considerando sua composição em macronutrientes. No entanto, apesar de pouco apreciado em sua forma in natura, o jenipapo pode ser processado, consumido e comercializado contribuindo para o aumento de renda e para o aporte nutricional das populações nativas.

The prevalence of hospital admissions because of possible adverse drug events (ADEs) vary from 0.56% to 54.5% in Brazil. In addition, nearly 43% of inpatients may develop adverse drug reactions (ADRs) during their hospital stays. Clinical outcomes arising from drug-related problems are almost never identified by health professionals because the signs and symptoms are nonspecific and may mimic pathologies.

El proceso de envejecimiento puede alterar los parámetros farmacocinéticos y farmacodinámicos. De este modo, algunos de los medicamentos se consideran potencialmente inadecuados (MPI) para los ancianos, ya que aumentan la probabilidad de eventos adversos del fármaco. Los objectivos son estimar la frecuencia de personas mayores en el uso de MPI, con interacciones farmacológicas potencialmente peligrosas (IMPP), y evaluar el impacto de la intervención farmacéutica (IF) para la prescripción de terapias más seguras. Se realizó un estudio transversal en dos unidades de la Estrategia Salud de la Familia (ESF) de un municipio de la región de Araraquara (SP) en enero y febrero de 2012. Las fichas médicas de los ancianos ? 60 años, que utilizaban al menos un fármaco, fueron examinadas para identificar MPI y IMPP, de acuerdo con los criterios de Beers y de la Organización Mundial de la Salud. Los MPI identificados fueron clasificados según el sistema de clasificación anatómica-terapéutica- Química (ATC) y la esencialidad (criterios de seguridad, calidad, eficacia y costo.) La IF consistió en una carta de orientación a la institución médica, con propuestas de equivalentes terapéuticos más seguros para el grupo de edad estudiado. 358 ancianos contemplados según los criterios de inclusión, de los cuales 93 de ellos (26%) utilizaron al menos un MPI. De los 114 medicamentos recetados a los mayores, diez se clasificaron como MPI, cuatro de los cuales actúan sobre el sistema nervioso central, cuatro sobre el sistema cardiovascular y dos en el tracto digestivo. Siete MPI están presentes en la lista de medicamentos esenciales (RENAME-2010). Se identificaron 14 interacciones farmacológicas diferentes, dos de los cuales son IMPP (fluoxetina / amitriptilina y digoxina / hidroclorotiazida). Después de la IF, no hubo cambios en la prescripción de los fármacos evaluados. La prescripción médica para los ancianos asistidos en las ESF estudiadas presenta problemas de seguridad, los cuales pueden ser responsables de los problemas de salud de este grupo etario. Aunque la intervención por carta no haya sido efectiva, pues los médicos no adhirieron a las alternativas propuestas de fármacos más seguros, es necesario difundir los MPI y las IMPP entre los profesionales prescriptores, así como también lo es la inclusión de alternativas más seguras para las personas mayores en la RENAME con el fin de contribuir a la promoción del uso racional de los medicamentos.

The present study aimed to estimate the prevalence of elderly using potentially inappropriate medications (PIM) and with occurrence of potentially hazardous drug interactions (PHDI); to identify the risk factors for the prescription of PIM and to evaluate the impact of pharmaceutical intervention (PI) for the prescription of safer therapeutic alternatives. Therefore, a cross-sectional study was performed in a long-term care facility in São Paulo State, between December/2010 and January/2011. The medical records of the patients >60 years old who took any drugs were consulted to assess the pharmacotherapeutic safety of the medical prescriptions, in order to identify PIM and PHDI, according to the Beers (2003) and World Health Organization criteria, respectively. PI consisted of a guidance letter to the physician responsible for the institution, with the suggestions of safer equivalent therapeutics. Approximately 88% of the elderly took at least one drug, and for 30% of them the PIM had been prescribed. Most of the PIM identified (53.4%) act on the central nervous system. Among the 13 different DI detected, 6 are considered PHDI. Polypharmacy was detected as a risk factor for PIM prescription. After the PI there was no change in medical prescriptions of patients who had been prescribed PIM or PHDI. The data suggests that PI performed by letter, as the only interventional, method was ineffective. To contribute it a wide dissemination of PIM and PHDI among prescriber professionals is necessary for the selection of safer treatment for elderly. Additionally, a pharmacist should be part of the health care team in order to help promote rational use of medicines.O presente estudo teve como objetivos estimar a prevalência de idosos em uso de medicamentos potencialmente impróprios (MPI) e com ocorrência de interações medicamentosas potencialmente perigosas (IMPP); identificar os fatores de risco para a prescrição de MPI e avaliar o impacto de intervenção farmacêutica (IF) para a prescrição de alternativas terapêuticas mais seguras. Para tanto, realizou-se estudo transversal em instituição de longa permanência do interior de São Paulo, de dezembro/2010 a janeiro/ 2011. Os prontuários médicos dos pacientes >60 anos e que utilizavam pelo menos um medicamento foram consultados para avaliar a segurança farmacoterapêutica das prescrições médicas, identificando-se os MPI e as IMPP, segundo critérios de Beers (2003) e o critério da Organização Mundial da Saúde, respectivamente. A IF constou de carta de orientação ao médico da instituição, com sugestão de equivalentes terapêuticos mais seguros. Aproximadamente 88% dos idosos haviam utilizado pelo menos um medicamento e, para 30% deles, havia pelo menos um MPI prescrito. A maioria dos MPI identificados (53,4%) age no sistema nervoso central. Entre as 13 interações medicamentosas detectadas, 6 são consideradas IMPP. A polimedicação foi detectada como fator de risco para a prescrição de MPI. Após a IF, não houve alterações nas prescrições médicas dos pacientes que apresentavam MPI e IMPP prescritos. Os dados sugerem que IF realizadas por cartas, como único método interventivo, não são efetivas. Para contribuir com a seleção de farmacoterapia mais segura para idosos é necessária ampla divulgação dos MPI e IMPP entre os profissionais prescritores. Além disso, o farmacêutico deve fazer parte das equipes de saúde para auxiliar na promoção do uso racional de medicamentos.

This study aimed assess the physical characteristics (mass, length and width) of tamarind fruit (Tamarindus indica L.) and the physical-chemical characteristics (moisture, ash, proteins, lipids, dietary fiber, titratable acidity, soluble solids and pH) of the pulp and jellies of tamarind. The jelly formulations were prepared containing different concentrations of tamarind juice (40 and 50%) and pectin (1.0 and 1.2%). The formulations were subjected to preference and acceptance tests. The tamarind presented a high pulp yield (50.3%) as well as high contents of carbohydrates (68.60g 100g-1), fiber (5.55g 100g-1) and titratable acidity (18.56g tartaric acid 100g-1). There were no significant differences in the chemical composition and acceptance of the jellies. The acceptance of the formulations was higher than 5 (I liked) for all parameters evaluated (appearance, color, odor, texture, flavor and overall evaluation). In conclusion, the tamarind was rich in carbohydrates, fiber and organic acids. The jellies were well accepted by the panelists. The tamarind jelly production was feasible and represents an effective option for the better utilization and conservation of the fruit.

As Reações Adversas a Medicamentos (RAM) podem ser responsáveis por 2,4% a 11,5% das admissões hospitalares. O estudo objetivou conhecer o perfil demográfico dos pacientes internados por possíveis RAM, identificar os medicamentos e as queixas mais freqüentemente relacionadas e estimar a incidência de admissão hospitalar pelo uso de medicamentos. Durante um mês, os pacientes internados em um hospital geral foram entrevistados quanto ao uso de medicamentos antes da internação e as queixas que o levaram ao hospital; as informações foram analisadas, usando-se a base de dados MICROMEDEX® e outras bases oficiais. Observou-se que as admissões por uso de medicamentos ocorreram predominantemente em idosos [47,5% (66/139)] e mulheres [62% (87/139)]. Os medicamentos mais freqüentes foram: omeprazol (16), analgésicos (31), antihipertensivos (31), sinvastatina (7) e formoterol (6); e normalmente os sintomas associados foram do sistema digestório (20,5%), circulatório (20,2%), respiratório (18,2%) e SNC (13,9%). Estima-se que em 15,5% (139/897) das internações, possivelmente, a razão foi o uso de medicamentos. Os dados sugerem medidas de prevenção, como o acompanhamento farmacoterapêutico dos pacientes no âmbito da assistência primária à saúde, principalmente aos idosos, aos portadores de doenças crônicas e aos polimedicados, além da orientação farmacêutica na compra e dispensação de medicamentos, principalmente os isentos de prescrição.According to the Word Health Organization, adverse drug reactions (ADR) are any harmful and non intentional answer which occurred in doses normally used in human beings. The ADR can be responsible for 2.4% to 11.5% of hospital admissions. Therefore, this study aimed at knowing the admitted patient´s demographic profile due to possible ADR, identifying the most frequent drugs and complaints, and evaluating the incidence of hospital admission related to drug use. Patients who were 18 years old or more and were admitted during a period of one month to a medical clinical of a general hospital were interviewed for one month about drug use before being admitted, as well as regarding to the complaint which led them to hospital. These information were analyzed according to official data, like MICROMEDEX® and WHO criteria as well. It was observed that the admission due to drug use occurred in most part of the cases in elderly [47.5% (66/139)] and women [62% (87/139)]. The most frequent drugs used were: omeprazole (16), analgesics (31), antihypertensive (31), simvastatin (7) and formoterol fumarate (6), and the symptoms were normally associated to the digestive (20.5%), circulatory (20.2%), respiratory (18.2%) and central nervous systems (13.9%). It was estimated that 15.5% (139/897) of the hospital admission occurred possibly due to the drug use. The data found by present study suggests some strategies in order to prevent ADR in the context of primary health care services, such as monitoring drug therapy, manly for patients with chronic diseases, elderly and polimedicated people; and pharmaceutical care including dispensation and purchasing of the drugs, a lot of them dispensed over the counter (OTC).

O presente estudo buscou descrever a situação de segurança alimentar vivenciada por famílias residentes na comunidade rural de Galheiros do município de Diamantina, situada no Alto Vale do Jequitinhonha, no Estado de Minas Gerais, Brasil. Foi utilizada a Escala Brasileira de Insegurança Alimentar - EBIA - com 15 questões que refletem a insegurança alimentar em diferentes níveis de intensidade. Foram investigadas 28 famílias, e obtidas informações sobre renda familiar, renda per capita, condição sócio econômica, de moradia, de saneamento básico e consumo alimentar. A prevalência de insegurança alimentar encontrada na comunidade foi de 46,4%, sendo 32,14% leve, 3,6% moderada e 10,7% grave. Mais da metade das famílias (57,2%) viviam com o equivalente a ½ do salário mínimo por mês. A maioria das famílias (75,0%) relatou gastar com alimentação valores inferiores a R$ 350,00, e 53,6% relataram receber da união e/ou Estado algum tipo de benefício. Estes resultados demonstram que apesar de existir no Brasil políticas públicas de combate à fome, grande parte das famílias residentes em Galheiros, vive em vulnerabilidade social, assim sendo, são necessárias ações estruturantes para reverter tal quadro, tanto no que se refere à produção de alimentos, quanto ao acesso a alimentos em qualidade e quantidade suficiente.

A comprehensive assessment of the patient’s drug related needs allows identifying health problems drug-induced. It has been demonstrated that each dollar spent on clinical pharmacy services reduces the pooled median cost of health by 4.81 dollars. Jaw stiffness (bruxism) can be a serotonergic manifestation related to drugs with serotonin reuptake inhibition activity. Clinical manifestations also include: agitation, tachycardia, high blood pressure, tremor, fever, dyspnea, diarrhea, mental confusion and insomnia.

Depression associated with fibromyalgia can be treated with selective serotonin reuptake inhibitors (SSRI) as fluoxetine, paroxetine or citalopram; or with serotonin–norepinephrine reuptake inhibitors (duloxetine or milnacipran). In patients with fibromyalgia, several meta-analyses have demonstrated the effectiveness of antidepressants, particularly the tricyclic antidepressant (TCA) amitriptyline, which reduce the pain, fatigue, depression, and sleep disturbances. Additionally, tramadol, pregabalin, and gabapentin are other treatment options.

Purpose: Potentially Inappropriate Medications (PIM) use in elderly people may be responsible for the development of Adverse Drug Reaction (ADR) which, when severe, leads to hospital admissions. Objectives: to estimate the prevalence of elderly who had used PIM before being admitted to hospital admission and to identify the risk factors and the hospitalizations related to ADR arising from PIM. Methods: A descriptive and cross-sectional study was performed in the internal medicine ward of a teaching hospital (Brazil), in 2008. With the aid of a validated form, patients aged ≥ 60 years, with length of hospital stay ≥ 24 hours, were interviewed about drugs taken prior to the hospital admission and the complaints/reasons for hospitalization. Results: 19.1% (59/308) of older patients had taken PIM before hospital admission and in 4.9%; there were a causal relation between the PIM taken and the complaint reported. PIM responsible for admissions were: amiodarone, amitriptyline, cimetidine, clonidine, diazepam, digoxin, estrogen, fluoxetine, lorazepam, short-acting nifedipine and propranolol. 47.0% of the clinical manifestations of PIM-related ADR were: dizziness, fatigue, digoxin toxicity and erythema. Only polypharmacy was detected as a risk factor for the occurrence of ADR of PIM (p = 0.02). Conclusion: PIM use in elderly people is not a risk factor for ADR-related hospital admission. Probably, severe ADR, which lead to hospitalizations of older people, can be explained by idiosyncratic response or the predisposition of these patients to develop adverse drug events, whether or not drugs are classed as PIM. Key-words: potentially inappropriate medication (PIM), older people, adverse drug reaction (ADR), hospital admission, pharmacovigilance

Abstract: Background: The use of herbal medicines is justified empirically using ethnopharmacological knowledge, which has limitations. Reports of adverse events (AE) may contribute for safety, quality, and effectiveness assessment. Objectives: This study aimed to develop an instrument to allow detection and evaluation of the causal likelihood of AE related to herbal medicines. Methods: A quantitative methodological development research intervention was performed with primary care health professionals. Two cases were distributed in an interval of one week in order to allow for completion of the proposal form. The within-rater reliability was calculated and classified into satisfactory, regular, and unsatisfactory, according to essential, necessary, and recommended items reported. Results: Fifty-seven professionals were enrolled. A high degree of the within-rater reliability was observed for the most essential, necessary, and recommended fields. The instrument contributed to assessment of definite causal association, once the duration of reactions including evolution, withdrawal, and reposition items showed high reliability. Most fields poor and weak filled were related to quality defects, such as popular name and appearance. Conclusions: Data suggest the instrument is adequate to report AE arising from herbal medicines. Owing to information regarding to organoleptic characteristics, the instrument is different from drug instruments. Therefore, it is intended to improve AE reports related to herbal medicines and contribute for appropriate use.

OBJECTIVES: Most educational interventions in pharmacovigilance are designed to encourage physicians to report adverse drug reactions. However, multidisciplinary teams may play an important role in reporting drug-related problems. This study assessed the impact of a multifaceted educational intervention in pharmacovigilance on the knowledge, skills and attitudes of hospital professionals. METHOD: This prospective, open-label, non-randomized study was performed in a medium-complexity hospital in São Paulo, Brazil. The intervention involved four activities: 1) an interactive lecture, 2) a practical class, 3) a pre-post questionnaire administered to professionals on a multidisciplinary team, and 4) educational material. The intervention’s impact on the professionals’ knowledge and skills was assessed using the World Health Organization’s definitions. The intervention’s effect on the professionals’ attitudes was analysed by the prevalence of adverse drug event reports (adverse drug reactions, medication errors, therapeutic failure and drug quality deviations) and the relevance (seriousness and expectancy) of the events. RESULTS: One hundred seventy-three professionals were enrolled. A 70-fold increase in the number of adverse drug event reports was observed during the 12 months post-intervention. The intervention improved the professionals’ form-completion skills (p

Background: Benzodiazepines are frequently prescribed to treat anxiety and insomnia, but long-term use has been associated with the development of dependence, tolerance, and cognitive decline, especially among older adults. This study aimed to investigate the pattern of consumption and factors associated with inappropriate prescribing of benzodiazepines in primary health care. Methods: This is a cross-sectional analytical study, using dispensing records of diazepam, clonazepam, and nitrazepam from public pharmacies in a Brazilian municipality between 2018 and 2022. Metrics for benzodiazepine consumption were DDD (Defined Daily Dose) and DDD/1000PD (per 1000 population per day). Long-term/prolonged benzodiazepine use was defined as consuming at least 90 DDD and at least 2 dispensations per year. To ascertain associations between long-term use and predictor variables, a multivariate logistic regression model was utilized. Findings: A total of 40402 participants were included, with an average age of 55 years (SD = 0.30), 38.5% were older aged. Diazepam and nitrazepam exceeded the daily dose recommended. There was a reduction in diazepam consumption during the study period, as calculated by DDD/1.000PD, while the consumption of other benzodiazepines remained stable. However, a significant increase in diazepam consumption is noted when considering the last decade. Prolonged use was observed in 29.1% of participants, with a significant prevalence among the older people (34.8% of them were long-term users) and advancing age was identified as a risk factor for long-term use. Higher PDDs were also associated with long-term use and aging. Participants who used different benzodiazepines during the period had a higher risk of prolonged use. Conclusions: These results provide insights into the prevalence of problematic utilization of benzodiazepines in primary health care. Authorities and health care providers must take steps to encourage gradual cessation of prolonged benzodiazepine prescriptions and the embrace of suitable strategies for addressing anxiety and insomnia within primary health care settings. [ABSTRACT FROM AUTHOR]