scholarly journals Incidência de Interações Medicamentosas e Avaliação Clínica nos Pacientes de um Hospital Público Brasileiro

Author(s):  
Fabiana Cristina Furquim ◽  
Cristina Eunice Okuyama ◽  
Sandro Rostelato-Ferreira ◽  
Carla Leticia Rivero-Wendt ◽  
Helder Oliveira ◽  
...  

Interações droga-droga (IDDs) são responsáveis por problemas terapêuticos e as principais causas de reações adversas a medicamentos que levam a hospitalização. O objetivo do trabalho foi analisar a incidência de IDDs em pacientes admitidos em hospital público no Brasil, em 2015. Em um estudo transversal, 351pacientes foram selecionados com IDDs utilizando-se o banco de dados da Micromedex®, e as interações foram classificadas de acordo com a severidade e documentação. Os potenciais IDDs foram avaliados durante o acompanhamento farmacoterapêutico diário por anamnese farmacêutica e a análise dos exames laboratoriais foi realizada. Um total de 2.937 potenciais IDDs foram identificados e 28,42% deles tinham sinais e sintomas clínicos confirmados em 87 pacientes (29%). Entre os pacientes que apresentaram interações, 62,07% tinham mais que 60 anos. Neste grupo de idade, 61,27% de todos os sinais e sintomas clínicos observados foram também identificados, demonstrando uma associação positiva entre interações clínicas e idade. Além disso, uma correlação positiva entre o número de drogas prescritas e a ocorrência de sinais clínicos também foram observados. Muitos IDDs observados foram de severidade moderada e estavam relacionados a alterações das pressões arteriais e níveis glicêmicos. Este estudo demonstrou que IDDs estão diretamente relacionados a idade e número de drogas prescritas. E a grande frequência de IDDs com documentação fraca alertam para a necessidade de se analisar esse tipo de interação. Sendo assim, este estudo mostrou que potenciais IDDs e sinais e sintomas clínicos significantes em pacientes só reforçam a necessidade de se apoiar a farmácia clínica.   Palavras-chave: Interação Droga-Droga (IDD). Pacientes Internados. Farmacoterapia, Poli Farmácia. Sinais e Sintomas.   Abstract Drug-drug interactions (DDIs) are responsible for therapeutic problems and the main causes of adverse drug reactions that require hospitalization. The aim of this study was to analyze the incidence of DDIs in patients admitted in a Public Hospital in Brazil, in 2015. In a cross-sectional study, DDIs were screened in 351 patients, using Micromedex® database, that classify interactions according to severity and documentary evidence. Potential DDIs were assessed at the daily pharmacotherapeutic follow-up through pharmaceutical anamnesis and analysis of laboratory tests were performed. A total of 2,937 potential DDIs were identified and 28.42% of these had confirmed signs and symptoms clinical in 87 patients (29%). Among the patients that presented interactions, 62.07% were older than 60 years. In this age group, 61.27% of all signs and symptoms clinical observed in the study were also identified, demonstrating a positive association between the occurrence of clinical interactions and age. In addition, a positive correlation between the number of drugs prescribed and the occurrence of signs clinicals was also observed. Most DDIs observed were of moderate severity and were related to imbalance of blood pressure and glycemic levels. This study demonstrated that DDIs are directly related to the age and number of drugs prescribed. And the greater frequency of DDIs with fair documentary evidence alerts to the need to consider all the possible interactions. Thereafter, this study showed that potential DDIs and sign and clinical symptoms  are significant in patients and reinforce the need to support Clinical Pharmacy.   Keywords: Drug-Drug Interaction (DDI). Inpatients. Pharmacotherapy. Poly Pharmacy. Sign and Symptom.    

2021 ◽  
Vol 9 (B) ◽  
pp. 1633-1636
Author(s):  
Afrida Aryani Nasution ◽  
Imam Budi Putra ◽  
Mutiara Indah Sari

Background: Scabies is a disease caused by the mite Sarcoptes scabiei var. hominis. In Indonesia, scabies ranks third out of the 12 most common skin diseases. In terms of disease screening, direct visualization of dermatitis from mites and microscopy of skin scrapings is less sensitive. PCR and dermoscopy examinations have a high sensitivity value to Sarcoptes mites. Aims: This study aims to identify Sarcoptes scabiei mites between clinical symptoms and supporting examinations, namely PCR and dermoscopy methods. Methods: This research is a cross-sectional study, with descriptive analytics. The number of samples of 50 people who met the inclusion criteria was examined by microscopic examination, dermoscopy, and PCR. We state it to be positive if we found scabies mites or their eggs on microscopy, delta wing sign, or jet wet contrail on dermoscopy and there is a 135bp DNA band on PCR. Results: 50 samples diagnosed with scabies based on cardinal sign of scabies, gender were 80% male and 20% female with an average age of 14 years. Based on the location of the rash, the most rashes were between the fingers and toes, each 26% and the least on the head as much as 2%. Based examination tools, no Sarcoptes scabiei mites were found through microscopic and dermoscopic examination, while the PCR examination found 12 positive samples of scabies. Conclusion: PCR examination is very sensitive and specific even in very small quantities, with the fore primer SSUDF and the reverse primer SSUDR. Further research is needed to assess the sensitivity and specificity of dermoscopy and PCR in diagnosing scabies.


2021 ◽  
Author(s):  
Iosief Abraha ◽  
Antonella Germani ◽  
Erica Pasquarelli ◽  
Sofia Pascolini ◽  
Rossana Antonietti ◽  
...  

Objectives To describe clinical characteristics and treatment used in subjects who had Sars-Cov-2 infection during the first pandemic and to assess the correlation between serological titers and clinical characteristics; to evaluate the persistence of anti-Sars-Cov-2 titers over a follow-up of 12. Design Cross-sectional study. Setting Residents in Azienda USL Umbria 2. Participants Consecutive subjects aged 15 to 75 who from February, 2020, to March 2021 were discharged with the diagnosis of Sars-Cov-2 from the hospitals of the AUSL Umbria 2, or resulted positive to a PCR test for Sars-Cov-2 infection with or without symptoms. Participants were classified according to clinical findings. SARS-CoV-2 serologic testing for antibodies targeting the Nucleocapside and Spike proteins were determined. Results Of 184 eligible subjects, 149 were available for evaluation: 17 were classified as Oligo/asymptomatic, 107 as Symptomatic (with no hospital admission), 25 as Hospital. While fever resulted common to all the groups, headache or musculoskeletal pain was common to symptomatic participants whereas cough and dyspnea was present in all the hospital admitted. Participants with significant signs and symptoms were more likely to use antibiotics, hydroxychloroquine, heparin and steroids. Compared to Oligo/asymptomatic participants, Symptomatic and Hospital admitted participants had higher levels of anti-S titers at every follow-up (median titer at 12 month follow-up: 29 vs 94 vs 116 respectively; P < 0.001). At 12 months follow-up, anti-S titers persisted above the threshold for at least 12 months in all Hospital admitted participants, in 90% of the Symptomatic participants and 83% in the oligo/asymptomatic participants; in 30% of participants the titer raised significantly probably due to reinfection. Anti-N antibody titer tended to decrease over time and in 62% of the entire cohort resulted negative. None of the participants reported clinical reinfection with Sars-Cov-2 virus. Conclusion - Anti-S and anti-N antibody titers correlates well with disease severity. While anti-N decline overtime, anti-S antibodies persist for at least one year and most probably provide protection from reinfection.


2010 ◽  
Vol 26 (10) ◽  
pp. 1912-1920 ◽  
Author(s):  
Samanta W. Madruga ◽  
Mario Renato de Azevedo ◽  
Cora Luiza Araújo ◽  
Ana M. B. Menezes ◽  
Pedro C. Hallal

Evidence has shown the negative effects of unsupervised diets and those with excessive calorie restriction. The aim of this study was to determine the proportion of adolescents engaging in weight loss dieting and associated factors. This was a cross-sectional study of 4,452 adolescents born in Pelotas, Rio Grande do Sul State, Brazil, in 1993. The outcome was defined as adolescents that reported having practiced some type of weight loss dieting in the previous 12 months. Prevalence of such dieting was 8.6% (95%CI: 7.7;9.4), and was higher in girls. Elevated maternal body mass index (BMI) was associated with dieting among girls. The adolescent's and parents' view of the adolescent's weight, excess weight, and consumption of diet or light soft drinks were associated with adolescent dieting. There was a positive association between dieting and socioeconomic status. The findings provide important backing for policies aimed at improving adolescents' diet, since they express a major concern over weight and thus a significant percentage of individuals with erroneous and unhealthy behaviors.


2020 ◽  
Vol 26 (1) ◽  
pp. 31-36
Author(s):  
Md Zakaria Sarkar ◽  
AHM Ferdows Nur ◽  
Utpal Kumar Dutta ◽  
Muhammad Rafiqul Islam ◽  
Debabrota Roy ◽  
...  

Objective: The aim of this study was to evaluate hearing outcome after stapedotomy in patients with Otosclerosis. Methods: This cross sectional study was carried out from July 2017 to January 2019 in National Institute of ENT, Unit V. About 22 patients with Otosclerosis were included in this study. Diagnosis of Otosclerosis was based on the history, medical status with Otoscopy, Tuning fork tests and Audiometric tests. We compiled data on the pre and post operative air-bone gap (ABG) at 0.5, 1, 2 KHZ. The ABG was Calculated using AC and BC thresholds on the same audiogram. Post operative hearing gain was then Calculated from the ABG before the operation minus the ABG of the last follow up examination Results: In this study most of the cases were age group 14-30 years (72.7%), female (54.5%). Most common symptoms was progressive hearing loss, tinnitus (77.8%).The average preoperative hearing loss in this study was (AC) was 48.31±7.68. The average post opt. hearing (AC) at follow up was 28.95±10.30 with an average hearing gain of 15.40±8.53 dB which was significant. The average pre-operative ABG was 28.99 dB ± 8.10. The average post opt. ABG was analyzed at 1 follow up showed ABG 13.18±8.09 dB which was found to be significant. Conclusion: Stapedotomy is an effective surgical procedure for the treatment of otosclerosis which leads to improvement in patient’s quality of life. A favorable hearing outcome can be obtained by the combination of experienced hands with minimal surgical trauma and appropriate surgical technique. Bangladesh J Otorhinolaryngol; April 2020; 26(1): 31-36


2011 ◽  
pp. 122-129
Author(s):  
Quang Di Bui ◽  
Phuoc Lam Nguyen

Objectives: The aim of study is to evaluate the efficacy, tolerability and adverse effects of a standard triple therapy including Rabeprazole, Clarithromycin and Amoxicilline at Sai gon Hoan My hospital in order to consider treatment H.pylori for patients who have not yet eradicated before or need to be undertaked by alternative regimens. Methods: By descriptive cross-sectional study, the authors have examined 116 patients sufferring from peptic ulcer received 10-day therapy including Rabe (20mg b.d) plus Clari(500mg b.d) plus Amoxi(1g b.d). Eradication is confirmed with endoscopy after 4 weeks from completing of treatment. Results and Discussion: 100% of patients were initially included and noboby was dropped out of the follow-up satges. The mean age was 49 in which 62% was male, 73(62,9%) presented duodenal ulcer, 28(24,1%) gastric ulcer and 15(13%) simultaneous gastric and duodenal ulcers. All patients took medications correctly. Per-protocol and intention to treat eradication rates were both 75%(95% CI=73,4-78,3). Additionally, 62(53,4%) patients had at least one risky factor for peptic ulcer disease, smoking being the most common one 44(37,9%).The adverse effects were reported overall in 67% of the patients, mainly including changed taste, very bitter, tired 49%, trouble sleeping 12% and diarrhea 5%. Conclusion: this ten-day standard triple therapy used in this study is ineffective with high adverse effects.The first line eradication with new regimens should be alternative.


2016 ◽  
pp. 66-71
Author(s):  
Van Mao Nguyen ◽  
Huyen Quynh Trang Pham

Background: The cytology and the support of clinical symptoms, biochemistry for diagnosis of the cases of effusions are very important. Objectives: - To describe some of clinical symptoms and biochemistry of effusions. - To compare the results between cytology and biochemistry by the causes of pleural, peritoneal fluids. Material & Method: A cross-sectional study to describe all of 47 patients with pleural, peritoneal effusions examinated by cytology in the Hospital of Hue University of Medicine and Pharmacy from April 2013 to January 2014. Results: In 47 cases with effusions, pleural effusion accounting for 55.32%, following peritoneal effusions 29.79% and 14.89% with both of them. The most common symptoms in patients with pleural effusions were diminished or absent tactile fremitus, dull percussion, diminished or absent breath sounds (100%), in patients with peritoneal effusions was ascites (95.24%). 100% cases with pleural effusions, 50% cases with peritoneal effusions and 80% cases with pleural and peritoneal effusions were exudates. The percentage of malignant cells in patients with pleural effusions was 26.92%, in peritoneal effusions was 28.57%, in pleural and peritoneal effusions was 42.86%. The percentage of detecting the malignant cells in patients with suspected cancer in the first test was 57.14%, in the second was 9.53% and 33.33% undetectable. Most of cases which had malignant cells and inflammatory were exudates, all of the cases which had a few cells were transudates. Besides, 7.5% cases which had high neutrophil leukocytes were transudates. Conclusion: Cytology should be carry out adding to the clinical examinations and biochemistry tests to have an exact diagnosis, especially for the malignant ones. For the case with suspected cancer, we should repeat cytology test one more time to increase the ability to detect malignant cells. Key words: Effusion, pleural effusion, peritoneal effusion, cytology, biochemistry


2020 ◽  
Vol 18 (5) ◽  
pp. 373-380 ◽  
Author(s):  
SeyedAhmad SeyedAlinaghi ◽  
Maryam Ghadimi ◽  
Mahboubeh Hajiabdolbaghi ◽  
Mehrnaz Rasoolinejad ◽  
Ladan Abbasian ◽  
...  

Background: COVID-19 has spread globally with remarkable speed, and currently, there is limited data available exploring any aspect of the intersection between HIV and SARSCoV- 2 co-infection. Objective: To estimate the prevalence of clinical symptoms associated with COVID-19 among people living with HIV (PLWH) in Tehran, Iran. Design: Cross-sectional study. Methods: A total of 200 PLWH were recruited through the positive club via sampling, and completed the symptom-based questionnaire for COVID-19, which was delivered by trained peers. Results: Of 200 participants, respiratory symptoms, including cough, sputum, and shortness of breath, were the most prevalent among participants, but only one person developed symptoms collectively suggested COVID-19 and sought treatments. Conclusions: It appears that existing infection with HIV or receiving antiretroviral treatment (ART) might reduce the susceptibility to the infection with SARS-CoV-2 or decrease the severity of the infection acquired. Further research is needed to understand causal mechanisms.


2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Ahmad Aliyu ◽  
Babatunde Adelekan ◽  
Nifarta Andrew ◽  
Eunice Ekong ◽  
Stephen Dapiap ◽  
...  

Abstract Background Expanded access to antiretroviral therapy (ART) leads to improved HIV/AIDS treatment outcomes in Nigeria, however, increasing rates of loss to follow-up among those on ART is threatening optimal standard achievement. Therefore, this retrospective cross-sectional study is aimed at identifying correlates and predictors of loss to follow-up in patients commencing ART in a large HIV program in Nigeria. Methods Records of all patients from 432 US CDC Presidents Emergency Plan for AIDS Relief (PEPFAR) supported facilities across 10 States and FCT who started ART from 2004 to 2017 were used for this study. Bivariate and multivariate analysis of the demographic and clinical parameters of all patients was conducted using STATA version 14 to determine correlates and predictors of loss to follow-up. Results Within the review period, 245,257 patients were ever enrolled on anti-retroviral therapy. 150,191 (61.2%) remained on treatment, 10,960 (4.5%) were transferred out to other facilities, 6926 (2.8%) died, 2139 (0.9%) self-terminated treatment and 75,041 (30.6%) had a loss to follow-up event captured. Males (OR: 1.16), Non-pregnant female (OR: 4.55), Patients on ≥ 3-monthly ARV refills (OR: 1.32), Patients with un-suppressed viral loads on ART (OR: 4.52), patients on adult 2nd line regimen (OR: 1.23) or pediatric on 1st line regimen (OR: 1.70) were significantly more likely to be lost to follow-up. Conclusion Despite increasing access to anti-retroviral therapy, loss to follow-up is still a challenge in the HIV program in Nigeria. Differentiated care approaches that will focus on males, non-pregnant females and paediatrics is encouraged. Reducing months of Anti-retroviral drug refill to less than 3 months is advocated for increased patient adherence.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mugove G. Madziyire ◽  
Thulani L. Magwali ◽  
Vasco Chikwasha ◽  
Tinovimba Mhlanga

Abstract Background Infertility affects 48.5 million couples globally. It is defined clinically as failure to conceive after 12 months or more of regular unprotected sexual intercourse. The contribution of various aetiological factors to infertility differs per population. The causes of infertility have not been assessed in Zimbabwe. Our objectives were to determine the reproductive characteristics, causes and outcomes of women presenting for infertility care. Methods A retrospective and prospective study of women who had not conceived within a year of having unprotected intercourse presenting in private and public facilities in Harare was done. A diagnosis was made based on the history, examination and results whenever these were deemed sufficient. Data was analysed using STATA SE/15. A total of 216 women were recruited. Results Of the 216 women recruited, two thirds (144) of them had primary infertility. The overall period of infertility ranged from 1 to 21 years with an average of 5.6 ± 4.7 years whilst 98 (45.4%) of the couples had experienced 2–4 years of infertility and 94 (43.5%) had experience 5 or more years of infertility. About 1 in 5 of the women had irregular menstrual cycles with 10 of them having experienced amenorrhoea of at least 1 year. Almost half of the participants (49%) were overweight or obese. The most common cause for infertility was ‘unexplained’ in 22% of the women followed by tubal blockage in 20%, male factor in 19% and anovulation in 16%. Of the 49 (22.7%) women who conceived 21(9.7%) had a live birth while 23 (10.7%) had an ongoing pregnancy at the end of follow up. Thirty-seven (17.1%) had Assisted Reproduction Techniques (ART) in the form of Invitro-fertilisation/Intracytoplasmic Sperm Injection (IVF/ICSI) or Intra-Uterine Insemination (IUI). Assisted Reproduction was significantly associated with conception. Conclusion Most women present when chances of natural spontaneous conception are considerably reduced. This study shows an almost equal contribution between tubal blockage, male factor and unexplained infertility. Almost half of the causes are female factors constituted by tubal blockage, anovulation and a mixture of the two. Improved access to ART will result in improved pregnancy rates. Programs should target comprehensive assessment of both partners and offer ART.


Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 616
Author(s):  
Avril Beirne ◽  
Kevin McCarroll ◽  
James Bernard Walsh ◽  
Miriam Casey ◽  
Eamon Laird ◽  
...  

The health effects of vitamin D are well documented, with increasing evidence of its roles beyond bone. There is, however, little evidence of the effects of vitamin D on hospitalisation among older adults. This study aimed to prospectively determine the relationship of vitamin D status in older adults with hospital admission and emergency department (ED) attendance. Trinity University of Ulster Department of Agriculture (TUDA) is a large cross-sectional study of older adults with a community population from three disease-defined cohorts (cognitive dysfunction, hypertension, and osteoporosis). Participants included in this analysis were recruited between 2008 and 2012. ED and hospital admission data were gathered from the date of TUDA participation until June 2013, with a mean follow up of 3.6 years. Of the 3093 participants, 1577 (50.9%) attended the ED during the period of follow-up. Attendees had lower mean serum 25(OH)D concentrations than non-attendees (59.1 vs. 70.6 nmol/L). Fully adjusted models showed an inverse association between vitamin D and ED attendance (Hazard Ratio (HR) 0.996; 95% Confidence Interval (CI) 0.995–0.998; p < 0.001). A total of 1269 participants (41%) were admitted to hospital during the follow-up. Those admitted had lower mean vitamin D concentrations (58.4 vs. 69.3 nmol/L, p < 0.001). In fully adjusted models, higher vitamin D was inversely associated with hospital admission (HR 0.996; 95% CI 0.994–0.998; p < 0.001) and length of stay (LOS) (β = −0.95, p = 0.006). This study showed independent prospective associations between vitamin D deficiency and increased hospitalisation by older adults. The need for further evaluation of current recommendations in relation to vitamin D supplementation, with consideration beyond bone health, is warranted and should focus on randomised controlled trials.


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