Effect of sodium diclofenac on the biovailability of amoxicillin

Orientadores: Francisco Carlos Groppo, Pedro Luiz RosalenDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: O objetivo deste estudo foi avaliar o efeito do diclofenaco sódico sobre a biodisponibilidade da amoxicilina. Vinte voluntários do gênero masculino foram avaliados em um estudo aberto, randomizado, cruzado, com dois períodos e intervalo de uma semana entre as colheitas das amostras de sangue. Os voluntários receberam dose única de 2g amoxicilina (Amoxil®) - Grupo 1 ou 2g de amoxicilina (Amoxil®) juntamente com 100mg de diclofenaco sódico (Voltaren®) - Grupo 2. Imediatamente antes e após 15min, 30min, 1h, 1h30min, 2h, 2h30min, 4h, 6h, 8h, 12h e 24h da administração dos fármacos, foram obtidas amostras de plasma. A cromatografia líquida de alta eficiência (CLAE) com detecção UV foi usada para quantificar a concentração plasmática de amoxicilina. O método microbiológico, usando Micrococcus luteus ATCC 9341 como microorganismo teste, foi realizado para verificar a eficácia antimicrobiana da amoxicilina in vitro. Os parâmetros farmacocinéticos concentração máxima (Cmax), área sob a curva de 0 ao infinito (ASC0-inf), área sob a curva de 0 a t (ASC0-24) e clearence renal (CL) foram submetidos à ANOVA, enquanto os parâmetros tempo necessário para a máxima concentração (Tmax) e volume de distribuição (VD) foram analisados pelo teste de Wilcoxon (p<0.05). Os valores observados de ASC0-24, Cmax e Tmax para o Grupo 1 foram 3391,8µg.min/ml (±1186,7), 17,3µg/ml (±6,5) e 121,5min (±20,6), respectivamente e para o Grupo 2 foram 2918,4µg.min/ml (±1024,8), 15,5µg/ml (±5,8) e 136,5min (±30,0), respectivamente. O Grupo 2 demonstrou redução nos parâmetros de ASC and Cmax (p<0.05). O CL da amoxicilina aumentou (p<0.05) em 18,5% no Grupo 2 , sugerindo uma possível interferência do diclofenaco sódico na excreção renal da amoxicilina. O diclofenaco sódico afetou significativamente a farmacocinética da amoxicilina, reduzindo sua biodisponibilidadeAbstract: The aim of this study was to evaluate the effect of sodium diclofenac on the bioavailability of amoxicillin. Twenty volunteers were evaluated in an open, randomized, two-period, crossover study with one-week of washout period. The study was designed in two groups: a 2-g oral dose of amoxicillin (Amoxil®) ¿ Group 1; or a 2-g oral dose of amoxicillin with 100mg of sodium diclofenac (Voltaren®) ¿ Group 2. Blood samples were collected at 0, 15min, 30min, 1h, h30min, 2h, 2h30min, 4h, 6h, 8h, 12h and 24h after drug administration. High-performance liquid chromatography (HPLC) with UV detection was used to quantify plasmatic amoxicillin concentrations. Bioassay (Micrococcus luteus ATCC9341) was performed to verify the antimicrobial efficacy of amoxicillin in vitro. The pharmacokinetic parameters AUC, Cmax and CL were analyzed by ANOVA and Tmax and VD by Wilcoxon test (p<0.05). For group 1, AUC0-24, Cmax and Tmax values were 3391.8µgmin/ ml (±1186.7), 17.3µg/ml (±6.5) and 121.5min (±20.6), respectively, and for Group 2, 2918.4µg-min/ml (± 1024.8), 15.5µg/ml (± 5.8) and 136.5min (± 30.0). Lower values of AUC and Cmax were obtained for Group 2 (p<0.05). The clearance of amoxicillin increased (p<0.05) 18.5% in Group 2, suggesting that sodium diclofenac might interfere with amoxicillin renal excretion. In conclusion, sodium diclofenac can reduce the bioavailability of amoxicillin significantlyMestradoFarmacologia, Anestesiologia e TerapeuticaMestre em Odontologi

Clinical evaluation of metronidazole in gel and tablet formulation in smokers with chronic periodontitis

Orientador: Francisco Carlos GroppoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Foram objetivos deste estudo: 1) comparar o efeito das formulações (gel e comprimido) de metronidazol (Mtz) sobre o debridamento periodontal (DP) em pacientes fumantes; 2) comparar as concentrações plasmáticas (CP) e salivares (CS) destas formulações; 3) determinar a farmacocinética do Mtz em comprimido; e 4) avaliar o efeito do fumo na biodisponibilidade do Mtz comprimido. Cada objetivo constituiu um capítulo do estudo. Capítulo 1: 30 fumantes com periodontite crônica foram aleatoriamente divididos em 3 grupos: DP associado com 3 g de gel placebo; DP associado com aplicação tópica diária de 3 g de gel de benzoato de Mtz e; DP associado com dose oral única diária de 750 mg de Mtz (Flagyl®). Foram avaliados: Índice de Placa (IP), Índice de Sangramento Gengival (ISG), Profundidade à Sondagem (PS) e Nível Clínico de Inserção relativo (NIC); nos tempos: pré-operatório, baseline, e após 30, 90 e 180 dias do tratamento periodontal. Nenhuma diferença significante foi observada entre os grupos para todos os parâmetros e tempos avaliados. Houve uma significante redução no ISG, PS e NIC em todos os tempos comparados ao baseline (p0,05). Capítulo 3: 13 fumantes (F) e 13 nãofumantes (NF) receberam dose oral única de 750mg Mtz. Amostras de plasma e saliva foram colhidas em diferentes tempos após administração. A CLAE foi usada para quantificar as CP e CS do Mtz. Os parâmetros farmacocinéticos AUC, Cmax, Tmax, VD e CL foram determinados. Foram observadas redução significante nas concentrações plasmáticas no grupo F comparada ao NF em 1, 1,5 e 2 horas após a administração e na Cmax plasmática (p0,05). Conclusão geral: 1) Não houve vantagem clínica no uso do Mtz associado ao DP; 2) A formulação em gel produziu igual disponibilidade de Mtz no plasma e na saliva; 3) Alguns dos parâmetros farmacocinéticos do Mtz foram maiores no plasma que na saliva para o comprimido; 4) O fumo interferiu apenas na biodisponibilidade plasmática do Mtz.Abstract: The aim of this study were 1) to compare the effect of metronidazole (Mtz) gel and tablet on debridement periodontal (DP) in smokers; 2) to compare Mtz gel and tablet concentrations in both blood plasma and saliva; 3) to determine the pharmacokinetic profile of Mtz tablet; and 4) to verify the effect of cigarette smoking on bioavailability of Mtz tablet. This study was divided in three chapters. Chapter 1: 30 patients smokers with chronic periodontitis were randomly assigned into 3 groups: PD combined with 3 g placebo gel; PD combined with daily topical application of 3 g Mtz benzoate gel (15%); and PD combined with a daily single dose of 750 mg Mtz (Flagyl®). Clinical parameters evaluated were visible plaque index (VPI), gingival bleeding index (GBI), probing pocket depth (PPD) and relative attachment level (RAL) which were assessed preoperatively, baseline, and after 1, 3 and 6 months after PD. No significant difference was observed among the groups, considering all parameters tested (p>0.05). In all groups was observed a significant reduction in GBI, PPD and RAL, at all times compared to baseline (p0.05). Chapter 3: 13 smokers (S) and 13 non-smokers (NS) received a single oral dose of 750 mg Mtz tablet. Blood and saliva samples were collected in different times after oral administration of Mtz. HPLC was used to quantify plasmatic and salivary Mtz concentrations. Pharmacokinetic parameters (ASC, Cmax, Tmax, VD and CL) were determined. A significant reduction in plasmatic Mtz concentration was observed in S compared to NS at 1, 1.5 and 2 hours after administration and in Cmax to plasma (p0.05). Conclusions: 1) Mtz did not improve the clinical outcomes provided by PD alone; 2) Gel and tablet formulations had similar Mtz bioavailability in plasma and saliva; 3) Some pharmacokinetic parameters were higher in plasma than in saliva concerning Mtz tablet. 4) Smoking interfered with the plasmatic Mtz bioavailability but not the salivary.DoutoradoFarmacologia, Anestesiologia e TerapeuticaDoutor em Odontologi

Pharmacokinetic profile of liposome-encapsulated ropivacaine after maxillary infiltration anaesthesia

The aim of this study was to determine the pharmacokinetic parameters of liposomal ropivacaine after dental anesthesia in 14 healthy volunteers. In this randomized, double-blind and crossover study, the volunteers received maxillary infiltration of liposome-encapsulated 0.5% ropivacaine and, 0.5% ropivacaine with 1:200,000 epinephrine in two different sessions. Blood samples were collected before and after (from 15 to 1440 min) the administration of either ropivacaine formulation. HPLC with UV detection was used to quantify plasma ropivacaine concentrations. The pharmacokinetic parameters AUC(0-24) (area under the plasma concentration x time curve from baseline to 24 h), AUC(0-infinity) (area under the plasma concentration-time curve from baseline to infinity), C-max (maximum drug concentration), CL (renal clearance), T-max (maximum drug concentration time), t(1/2) (elimination half-life) and Vd (volume of distribution) were analyzed using the Wilcoxon signed-rank test. No differences (p > 0.05) were observed between both formulations for any of the pharmacokinetic parameters evaluated and plasma ropivacaine concentrations, considering each period of time. Both formulations showed similar pharmacokinetic profiles, indicating that the liposomal formulation could be a safer option for use of this local anesthetic, due to the absence of a vasoconstrictor

Preemptive use of anti-inflammatories and analgesics in oral surgery: a review of systematic reviews

Objectives: This review of systematic reviews evaluated the effectiveness and safety of the preemptive use of anti-inflammatory and analgesic drugs in the management of postoperative pain, edema, and trismus in oral surgery.Materials and methods: The databases searched included the Cochrane Library, MEDLINE, EMBASE, Epistemonikos, Scopus, Web of Science, and Virtual Health Library, up to March 2023. Pairs of reviewers independently selected the studies, extracted the data, and rated their methodological quality using the AMSTAR-2 tool.Results: All of the 19 studies reviewed had at least two critical methodological flaws. Third molar surgery was the most common procedure (n = 15) and the oral route the most frequent approach (n = 14). The use of betamethasone (10, 20, and 60 mg), dexamethasone (4 and 8 mg), methylprednisolone (16, 20, 40, 60, 80, and 125 mg), and prednisolone (10 and 20 mg) by different routes and likewise of celecoxib (200 mg), diclofenac (25, 30, 50, 75, and 100 mg), etoricoxib (120 mg), ibuprofen (400 and 600 mg), ketorolac (30 mg), meloxicam (7.5, 10, and 15 mg), nimesulide (100 mg), and rofecoxib (50 mg) administered by oral, intramuscular, and intravenous routes were found to reduce pain, edema, and trismus in patients undergoing third molar surgery. Data on adverse effects were poorly reported.Conclusion: Further randomized clinical trials should be conducted to confirm these findings, given the wide variety of drugs, doses, and routes of administration used

Pharmacokinetic Profile of Liposome-Encapsulated Ropivacaine after Maxillary Infiltration Anaesthesia

O objetivo do presente estudo foi determinar os parâmetros farmacocinéticos da ropivacaína encapsulada em lipossomas após anestesia local em 14 voluntários sadios. Neste estudo randomizado, cruzado e duplo-cego, os voluntários receberam anestesia infiltrativa na maxila de ropivacaína a 0,5% encapsulada em lipossomas e ropivacaína 0,5% com epinefrina a 1:200.000 em duas sessões distintas. Amostras de sangue foram coletadas antes e após (de 15 a 1440 min) a administração das formulações de ropivacaína. A quantificação da concentração plasmática de ropivacaína foi feita por meio de HPLC com detecção por UV. Os parâmetros farmacocinéticos AUC 0-24 (área sob a curva de concentração × tempo do tempo 0 até 24 horas) , AUC 0-∞ (área sob a curva de concentração x tempo do tempo 0 até o infinito), C max (concentração máxima da droga), CL (clearance renal), T max (tempo em que ocorre a concentração máxima); t 1/2 (meia vida de eliminação) e V d (volume de distribuição) foram analisados pelo teste de Wilcoxon. Nenhuma diferença (p &gt; 0,05) foi observada entre as duas formulações em cada parâmetro farmacocinético avaliado e as concentrações plasmáticas de ropivacaína, considerando cada período de tempo. Ambas as formulações apresentaram perfil farmacocinético semelhante, indicando que a formulação lipossomal poderia ser uma opção mais segura para o uso deste anestésico local, devido à ausência de vasoconstritor. The aim of this study was to determine the pharmacokinetic parameters of liposomal ropivacaine after dental anesthesia in 14 healthy volunteers. In this randomized, double-blind and crossover study, the volunteers received maxillary infiltration of liposome-encapsulated 0.5% ropivacaine and, 0.5% ropivacaine with 1:200,000 epinephrine in two different sessions. Blood samples were collected before and after (from 15 to 1440 min) the administration of either ropivacaine formulation. HPLC with UV detection was used to quantify plasma ropivacaine concentrations. The pharmacokinetic parameters AUC 0-24 (area under the plasma concentration × time curve from baseline to 24 h), AUC 0-∞ (area under the plasma concentration-time curve from baseline to infinity), C max (maximum drug concentration), CL (renal clearance), T max (maximum drug concentration time), t 1/2 (elimination half-life) and Vd (volume of distribution) were analyzed using the Wilcoxon signed-rank test. No differences (p &gt; 0.05) were observed between both formulations for any of the pharmacokinetic parameters evaluated and plasma ropivacaine concentrations, considering each period of time. Both formulations showed similar pharmacokinetic profiles, indicating that the liposomal formulation could be a safer option for use of this local anesthetic, due to the absence of a vasoconstrictor. Keywords: ropivacaine, local anesthesia, dentistry, liposome, pharmacokinetic Pharmacokinetic Profile of Liposome-encapsulated Ropivacaine after Maxillary Infiltration Anaesthesia J. Braz. Chem. Soc. 1946 Introduction Prolonged-action local anesthetic is required when postoperative pain and discomfort are expected, especially after major surgical procedures. 1 In many countries, bupivacaine, the racemic mixture of S-and D-bupivacaine, is the only long-acting local anesthetic available in dental practice. Ropivacaine (RVC), another long-acting local anesthetic of the cyclic aminoamide family, is synthesized in the S-enantiomer form and presents lower toxicity to the cardiovascular and central nervous systems, compared to bupivacaine. 2 Traditionally, most of local anesthetic formulations are administered together with a vasoconstrictor in order to increase anesthesia duration and to reduce systemic absorption rate. 3 It was recently demonstrated that the use of these formulations increased, especially those containing epinephrine 1:100.000. 5 Alternative drug delivery systems, such as liposomes, have been used to prolong the duration of action of many drugs, including local anesthetics. 6-10 These vesicles are nontoxic and nonimmunogenic because their components (phosphatidyl choline and cholesterol) are also found in biological membranes. 17 Previous authors have shown that liposomal encapsulation of bupivacaine altered its pharmacokinetic profile after extradural injection in rabbits, resulting in lower concentrations of the drug in plasma, liver and myocardium. 18 Grant and co-workers 16 observed that when encapsulated in liposomes, bupivacaine remained at the injection site for a significantly longer period of time after subcutaneous injection in mice. Attempting to simulate an accidental intravascular injection of a local anesthetic, Boogaerts and coworkers 8 assessed the acute CNS (central nervous system) and cardiac toxicities induced by intravenous infusion in rabbits of 0.25% bupivacaine, with and without epinephrine (1:200,000), compared to liposomeencapsulated bupivacaine. They demonstrated a reduction of CNS and cardiac toxicities using liposome-encapsulated bupivacaine. The addition of epinephrine to the plain solution did not decrease the CNS and cardiac toxicities induced by bupivacaine. It was recently demonstrated in animal studies, which used sciatic and infraorbital nerve blockades, that encapsulation of ropivacaine into unilamellar vesicles increased the duration and the intensity of analgesic effects. 6 Although long-acting local anesthetics are normally used in low doses in dentistry, high doses may be required for removal of four impacted third molars in a single session. The present study is the first attempt to measure the pharmacokinetic parameters of ropivacaine after maxillary infiltration anesthesia using a liposome-encapsulated formulation in healthy volunteers. The pharmacokinetic parameters of an RVC formulation containing epinephrine (vasoconstrictor) were also assessed for comparison. Experimental Materials RVC hydrochloride was donated by Cristalia Prod. Quim. Farm. Ltda (Itapira, SP, Brazil). Egg phosphatidylcholine (EPC), cholesterol (Ch) and α-tocopherol (α-T) were purchased from Sigma Chemical Company (St Louis, MO). All other reagents used were of analytical grade. RVC-liposome formulation The liposomal RVC formulations were prepared as described by Araújo and co-workers. 10 The following liposomal characterization was previously determined by Araújo and co-workers. Subjects This research was approved by the Ethical Committee of Piracicaba Dental School, University of Campinas (approval #164/2006). Fourteen healthy volunteers (seven males and seven females) aged 24 (± 3.1) years old were selected, and signed a written informed consent. The volunteers presented no systemic or oral disorders, had no history of allergy to any of the local anesthetics used, and were not taking any medication, as determined by oral questioning and by their documented health histories. Prior to the beginning and right after the end of the study, all the subjects were submitted to laboratory tests to confirm that they were in good health and that the females were not pregnant. The same tests were performed at the end of the study to ensure that all results previously obtained were not altered by the anesthetic formulations tested. These tests included cross-reactive protein, blood-hemoglobin, lymphocyte count, platelet count, erythrocyte sedimentation rate, serum (S)-sodium, S-potassium, S-chloride, S-albumin, S-alkaline phosphate, S-gamma-glutamyl-transferase, S-aspartate transaminase, S-alanine transaminase, S-creatine, plasma glucose, urea, cholinesterase, total protein, bilirubin, uric acid, urine glucose, urine leukocyte count, urine protein, and urine hemoglobin. Serology tests for human immunodeficiency virus and hepatitis B and C were also performed. Female subjects underwent a urine bHCG pregnancy test. Ambulatory procedures Anesthetic procedures In this double-blind and crossover study, the volunteers randomly received 1.8 mL of 0.5% ropivacaine with 1:200,000 epinephrine, and liposome-encapsulated 0.5% ropivacaine, for infiltration anesthesia at the apex of the right maxillary canine, in two different sessions spaced one week apart. Ropivacaine with 1:200,000 epinephrine was obtained by simple dilution of the commercially available solution of ropivacaine (Naropin ® 10 mg mL -1 , AstraZeneca, São Paulo, Brazil) immediately before application. Under sterile conditions, 5 mL of 1% ropivacaine was diluted with 5 mL of 1:100,000 (v/v) epinephrine (Drenalin ® , Ariston Ind. Quim. Farm. Ltda, São Paulo, SP, Brazil). The local anesthetics (1.8 mL) were placed into coded sterile 3 mL Luer-Lok syringes (Becton Dickinson, Curitiba, Brazil) fitted with disposable needles (30G, one-inch, Becton-Dickinson Company, Franklin Lakes, NJ, USA). After topical anesthesia on the injection site with 20% benzocaine, the formulations were injected at the maxillary buccal fold of the right-canine region at an injection rate of 1 mL min -1 . The same operator performed the maxillary infiltration anesthesia in all the subjects. Blood sampling and drug analysis Blood samples (4.5 mL) from a forearm vein were collected with a heparinized cannula before and 15, Pharmacokinetic and statistical analyses The following pharmacokinetic parameters were evaluated by computer software (PK Solutions, noncompartmental pharmacokinetics data analysis, 2001; Summit Research Services, Montrose, CO, USA): C max (maximum drug concentration); T max (maximum drug concentration time); AUC 0-24 , (area under the plasma concentration-time curve from baseline to 24 h); AUC 0-∞ (area under the plasma concentration-time curve from baseline to infinity); CL (renal clearance); t 1/2 (elimination half-life) and Vd (volume of distribution). Statistical analysis was performed using the Student&apos;s t-test in order to compare the ropivacaine concentrations between the groups at each time interval. Pharmacokinetic parameters were compared using the Wilcoxon signed-rank test. The significance level was set at 5%, and the tests were performed with BioEstat 5.0 (Fundação Mamirauá, Belém, PA, Brazil) Results and Discussion In an earlier study, Araújo and co-workers 6 demonstrated that the size distribution of liposomal formulations containing RVC presented two modes, one with a maximum at 371 nm (85%), and another with a peak at 128 nm (15%). The efficiency of encapsulation was around 24%, which was sufficient to modify the release profile of the pharmaceutical, with a reduction of the release rate over a one-hour period from 76 to 58%. In the same study it was also shown that, compared to RVC alone, the liposomal RVC formulation increased the duration and intensity of analgesic effects in sciatic and infraorbital nerve blocking experiments. Extending the earlier work of Araújo and co-workers 6 here we report on the first attempt to assess the pharmacokinetic parameters of ropivacaine after maxillary infiltration anesthesia using a liposome-encapsulated ropivacaine formulation in healthy volunteers, comparing the results with a commercial RVC formulation containing epinephrine vasoconstrictor. The calibration curve for determination of plasma ropivacaine ( 22 The detection limit for ropivacaine observed in our study (30 ng mL -1 ) was close to the limit observed by those authors (25 ng mL -1 )

Prevalence of undiagnosed hypertensive young people of dental policlinics of University of Amazonas State

Objetivo: avaliar a prevalência de jovens hipertensos não diagnosticados que procuraram atendimento na policlínica odontológica da Universidade do Estado do Amazonas (UEA) quanto a sexo, raça, idade e índices antropométricos.Metodologia: foi entregue um questionário de perguntas fechadas e realizadas duas aferições de pressão arterial com intervalo de 10 minutos entre elas para diagnóstico da hipertensão em 124 sujeitos. Em seguida, os pacientes foram pesados e medidos para obtenção do índice de massa corporal (IMC) e foi obtida a medida da circunferência abdominal (CA). Os dados foram analisados pelos testes Exato de Fisher e t de Student, com nível de significância de 5%. Resultados:a prevalência de jovens hipertensos não diagnosticados foi de 4,8% (n=6) e a média de idade encontrada foi de 19,3 ± 1,9 anos. O sexo feminino apresentou 8,0% (n=4) e o masculino 2,5% (n=2) de hipertensos. Houve predominância da raça parda (n=4; 5,0%). A prevalência de sobrepeso/obeso foi superior nos jovens hipertensos em comparação aos valores de IMC normal (p foi observada associação entre hipertensão e CA, em ambos os sexos (p0,05). Conclusão: a prevalência de hipertensos jovens foi baixa, sendo que a maioria destes era de mulheres de raça parda, sendo associada a indivíduos em sobrepeso ou obesos.   Aim: to evaluate the prevalence of non-diagnosed hypertensive young-adults searching for dental treatment at dentistry policlinics of Amazonas State University in function of gender, race, age and anthropometric indexes.   Metodology: a survey with non-open questions was applied along with two measurements of arterial pressure toke 10 minutes apart between them in 124 subjects. The patients were weighed and their height was measured to obtain the body-mass index (BMI). The abdominal circumference (AC) was also obtained. Data were analyzed by Fisher’s exact and Student t tests (alpha=5%). Results: the prevalence of hypertensive young-adults, aging 19.3 ± 1.9 years, was 4.8% (n=6), being 8% (n=4) females and 2.5 % (n=2) males. The predominant race was brown (5%, n=4). Overweighed/obese hypertensive subjects were prevalent when compared to normal BMI subjects (p0.05).Conclusion: the prevalence of hypertensive young-adults was low, being the majority of them brown females, being associated with overweigh or obesity.

Data sources for drug utilization research in Latin American countries—A cross-national study: DASDUR-LATAM study

Purpose: Drug utilization research (DUR) contributes to inform policymaking and to strengthen health systems. The availability of data sources is the first step for conducting DUR. However, documents that systematize these data sources in Latin American (LatAm) countries are not known. We compiled the potential data sources for DUR in the LatAm region. Methods: A network of DUR experts from nine LatAm countries was assembled and experts conducted: (i) a website search of the government, academic, and private health institutions; (ii) screening of eligible data sources, and (iii) liaising with national experts in pharmacoepidemiology (via an online survey). The data sources were characterized by accessibility, geographic granularity, setting, sector of the data, sources and type of the data. Descriptive analyses were performed. Results: We identified 125 data sources for DUR in nine LatAm countries. Thirty-eight (30%) of them were publicly and conveniently available; 89 (71%) were accessible with limitations, and 18 (14%) were not accessible or lacked clear rules for data access. From the 125 data sources, 76 (61%) were from the public sector only; 46 (37%) were from pharmacy records; 43 (34%) came from ambulatory settings and; 85 (68%) gave access to individual patient-level data. Conclusions: Although multiple sources for DUR are available in LatAm countries, the accessibility is a major challenge. The procedures for accessing DUR data should be transparent, feasible, affordable, and protocol-driven. This inventory could permit a comparison of drug utilization between countries identifying potential medication-related problems that need further exploration.Fil: Lopes, Luciane C.. University Of Sorocaba; BrasilFil: Salas, Daiana Maribel. University of Pennsylvania; Estados UnidosFil: Osorio de Castro, Claudia Garcia Serpa. Fundación Oswaldo Cruz; BrasilFil: Freitas Leal, Lisiane. McGill University; CanadáFil: Doubova, Svetlana V.. Mexican Institute of Social Security; MéxicoFil: Cañás, Martín. Universidad Nacional Arturo Jauretche; Argentina. Federación Médica de la Provincia de Buenos Aires; ArgentinaFil: Dreser, Anahi. Instituto Nacional de Salud Pública; MéxicoFil: Acosta, Angela. Universidad ICESI; ColombiaFil: Oliveira Baldoni, Andre. Federal University of São João Del-Rei; BrasilFil: de Cássia Bergamaschi, Cristiane. University of Sorocaba; BrasilFil: Marques Mota, Daniel. Brazilian Health Regulatory Agency; BrasilFil: Gómez Galicia, Diana L.. Universidad Autónoma del Estado de Morelos; MéxicoFil: Sepúlveda Viveros, Dino. Universidad de Chile; ChileFil: Narvaez Delgado, Edgard. No especifíca;Fil: da Costa Lima, Elisangela. Universidade Federal do Rio de Janeiro; BrasilFil: Chandia, Felipe Vera. Pontificia Universidad Católica de Chile; ChileFil: Ferre, Felipe. Universidade Federal de Minas Gerais; BrasilFil: Marin, Gustavo Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata; ArgentinaFil: Olmos, Ismael. State Health Services Administration; UruguayFil: Zimmermann, Ivan R.. Universidade do Brasília; BrasilFil: Fulone, Izabela. University of Sorocaba; BrasilFil: Roldán Saelzer, Juan. Instituto de Salud Pública; ChileFil: Sánchez Salgado, Juan Carlos. No especifíca;Fil: Castro Pastrana, Lucila I.. Universidad de Las Américas de Puebla; MéxicoFil: de Souza, Luiz Jupiter Carneiro. Fundación Oswaldo Cruz; BrasilFil: Machado Beltrán, Manuel. Universidad Nacional de Colombia; ColombiaFil: Tolentino Silva, Marcus. University of Sorocaba; BrasilFil: Mena, María Belén. Universidad Central del Ecuador; EcuadorFil: de França Fonteles, Marta Maria. Universidade Federal do Ceara; BrasilFil: Urtasun, Martín Alejandro. Universidad Nacional Arturo Jauretche; Argentina. Federación Médica de la Provincia de Buenos Aires; Argentin

Association between diabetes mellitus and depressive symptoms in the Brazilian population

ABSTRACT OBJECTIVE To determine the prevalence of current depressive symptoms in people with diabetes mellitus and their association with the disease. METHODS Data were collected from the Brazilian National Health Survey (Pesquisa Nacional de Saúde - PNS), a cross-sectional, population-based study conducted in 2013. Study participants were selected by simple random cluster sampling in three stages: census tracts, households, and residents aged ≥ 18 years. The presence of diabetes was self-reported, whereas the presence of current depressive symptoms was determined by the Patient Health Questionnaire-9 (PHQ-9) and mean scores of this questionnaire were calculated for the variables assessed. Tobit regression was used to evaluate variation in these individuals. RESULTS Of the 60,202 interviewees, 6.03% (n = 3,636) reported diabetes mellitus. The disease was more frequent in female, older, widowed, obese and with incomplete elementary education. Depression symptoms were mild-to-moderately severe in 22% of the diabetics. The severity of current depressive symptoms was higher in individuals that were female (PHQ-9 mean = 3.35), older adults (PHQ-9 mean = 3.01), indigenous (PHQ-9 mean = 3.46), separated/divorced (PHQ-9 mean = 3.13), widowed (PHQ-9 mean = 3.39), obese (PHQ-9 mean = 3.13) and with incomplete primary education (PHQ-9 mean = 3.21). Higher severity of depressive symptoms was associated with the use of insulin and with coma (PHQ-9 mean = 8.32), limb amputation (PHQ-9 mean = 7.55), circulatory problems (PHQ-9 mean = 6.94), infarction (PHQ-9 mean = 6.83), diabetic foot (PHQ-9 mean = 6.62), and kidney problems (PHQ-9 mean = 6.68). The severity of current depressive symptoms was associated with diabetes severity and degree of limitation in activities of daily living (PHQ-9 mean = 10.62). CONCLUSIONS Interventions to improve depressive symptoms should be prioritized in people with diabetes are female, older adults, indigenous, widowed, separated/divorced, obese and with incomplete elementary education