Pharmaceutical care as a strategy to improve the safety and effectiveness of patients? pharmacotherapy at a pharmacy school: a practical proposal

Several patients experience at least one drug-related problem and Pharmaceutical Care can change this reality. This work describes a model for structuring the pharmaceutical care service at a pharmacy training unit of the Brazilian Public Health System based on pharmacotherapy follow-up program of Parkinson’s disease patients’ results. From the follow-up results (phase 1), a Therapy Management Scheme was designed (phase 2). Of the 57 patients followed-up, 30 presented at least one drug-related problem and 42% were non-adherent to treatment, which supported the need of pharmacotherapy management. The Pharmacotherapy Management Scheme was proposed as a pharmaceutical care service model, which presents 6 steps: first, the pharmacist fills out the dispensing form and assesses patient´s pharmacotherapy, if there is a suspect problem, he is invited to the follow-up (steps 1 and 2) and they agree the first appointment. After that, pharmacist studies the patient’s case (study phase, steps 3 and 4). At the second meeting, the pharmacist proposes the intervention needed, and at the third, assesses the intervention results and new problems (steps 5 and 6, respectively). The process ends when all therapeutics outcomes are reached. This practical model can significantly contributed to the development and organization of pharmaceutical care services

Cefalea de elevada altitud y mal de altura

Resumen: Introducción: La cefalea es la complicación más frecuente de la exposición a la altitud y puede aparecer de forma aislada o bien asociada al mal de altura (MA). El objetivo de este artículo es revisar los aspectos relacionados con el diagnóstico y tratamiento de la cefalea de elevada altitud (CEA). Desarrollo: El 80% de las personas presentan CEA por encima de los 3.000 m de altitud. La segunda versión de la Internacional Classification of Headache Disorders (ICHD-II) incluye la CEA en el capítulo «Cefalea atribuida a trastornos de la homeostasia». La hipoxia desencadena una respuesta neurohumoral y hemodinámica que provoca un aumento de la presión capilar y edema. La vasodilatación cerebral inducida por hipoxia es una causa probable de CEA. El síntoma cardinal del MA es la cefalea, que se suele asociar con trastornos del sueño, fatiga, mareo e inestabilidad, náuseas y anorexia. Parece existir una cierta susceptibilidad así como una gran variación interindividual. La forma más grave es el edema cerebral de altitud y puede suceder por encima de los 2.500 m. Estudios de resonancia de encéfalo han mostrado la presencia de edema en sustancia blanca y esplenio del cuerpo calloso. La CEA puede tratarse con paracetamol e ibuprofeno. El tratamiento farmacológico del MA tiene la finalidad de incrementar la respuesta ventilatoria, mediante fármacos como la acetazolamida, y reducir los procesos inflamatorios y de liberación de citocinas, mediante el empleo de esteroides. Conclusiones: Parece haber una progresión en la expresión de los síntomas entre la CEA, el MA y el edema cerebral de altitud. Abstract: Introduction: Headache is the most common complication associated with exposure to high altitude, and can appear as an isolated high-altitude headache (HAH) or in conjunction with acute mountain sickness (AMS). The purpose of this article is to review several aspects related to diagnosis and treatment of HAH. Development: HAH occurs in 80% of all individuals at altitudes higher than 3000 meters. The second edition of ICHD-II includes HAH in the chapter entitled “Headaches attributed to disorder of homeostasis”. Hypoxia elicits a neurohumoral and haemodynamic response that may provoke increased capillary pressure and oedema. Hypoxia-induced cerebral vasodilation is a probable cause of HAH. The main symptom of AMS is headache, frequently accompanied by sleep disorders, fatigue, dizziness and instability, nausea and anorexia. Some degree of individual susceptibility and considerable inter-individual variability seem to be present in AMS. High-altitude cerebral oedema is the most severe form of AMS, and may occur above 2500 meters. Brain MRI studies have found variable degrees of oedema in subcortical white matter and the splenium of the corpus callosum. HAH can be treated with paracetamol or ibuprofen. Pharmacological treatment of AMS is intended to increase ventilatory drive with drugs such as acetazolamide, and reduce inflammation and cytokine release by means of steroids. Conclusions: Symptom escalation seems to be present along the continuum containing HAH, AMS, and high-altitude cerebral oedema. Palabras clave: Altitud, Acetazolamida, Cefalea, Cuestionario Lago Louise, Edema cerebral de altitud, Mal de altura, Keywords: Altitude, Acetazolamide, Headache, Lake Louise Questionnaire, Cerebral oedema, Acute mountain sicknes

Alucinógenos en las culturas precolombinas mesoamericanas

Resumen: Introducción: El continente americano es rico en hongos y plantas psicoactivas, y numerosas culturas precolombinas mesoamericanas las emplearon con fines mágicos, terapéuticos y religiosos. Objetivos: Se revisan las evidencias arqueológicas, etnohistóricas y etnográficas del uso de sustancias alucinógenas en Mesoamérica. Resultados: Cactus, plantas y hongos alucinógenos se utilizaron para provocar estados alterados del nivel de conciencia en ceremonias rituales y curativas. Los mayas ingerían el balché (hidromiel y extracto de Lonchocarpus) en ceremonias grupales para lograr la embriaguez. También emplearon enemas rituales con sustancias psicoactivas para inducir estados de trance. Olmecas, zapotecas, mayas y aztecas usaron el peyote, los hongos alucinógenos (teonanacatl: Psylocibe spp.) y las semillas de ololiuhqui (Turbina corymbosa), que contienen mescalina, psilocibina y amida del ácido lisérgico, respectivamente. La piel del sapo Bufo spp. contiene bufotoxinas, con propiedades alucinógenas y fue usado desde el periodo olmeca. El toloache (Datura estramonio), el tabaco silvestre (Nicotiana rustica), el lirio de agua (Nymphaea ampla) y la hoja de la pastora (Salvia divinorum) se utilizaron por sus efectos psicotropos. Piedra fúngicas de 3.000 años de antigüedad se han encontrado en contextos rituales en Mesoamérica. Las evidencias arqueológicas del uso del peyote se remontan a más de 5.000 años. Diversos cronistas, entre ellos Fray Bernardino de Sahagún, relataron sus efectos en el siglo xvi. Conclusiones: El empleo de sustancias psicotrópicas fue muy común en las sociedades precolombinas mesoamericanas. En la actualidad chamanes y curanderos locales las siguen usando en ceremonias rituales. Abstract: Introduction: The American continent is very rich in psychoactive plants and fungi, and many pre-Columbian Mesoamerican cultures used them for magical, therapeutic and religious purposes. Objectives: The archaeological, ethno-historical and ethnographic evidence of the use of hallucinogenic substances in Mesoamerica is reviewed. Results: Hallucinogenic cactus, plants and mushrooms were used to induce altered states of consciousness in healing rituals and religious ceremonies. The Maya drank balché (a mixture of honey and extracts of Lonchocarpus) in group ceremonies to achieve intoxication. Ritual enemas and other psychoactive substances were also used to induce states of trance. Olmec, Zapotec, Maya and Aztec used peyote, hallucinogenic mushrooms (teonanacatl: Psilocybe spp) and the seeds of ololiuhqui (Turbina corymbosa), that contain mescaline, psilocybin and lysergic acid amide, respectively. The skin of the toad Bufo spp contains bufotoxins with hallucinogenic properties, and was used since the Olmec period. Jimson weed (Datura stramonium), wild tobacco (Nicotiana rustica), water lily (Nymphaea ampla) and Salvia divinorum were used for their psychoactive effects. Mushroom stones dating from 3000 BC have been found in ritual contexts in Mesoamerica. Archaeological evidence of peyote use dates back to over 5000 years. Several chroniclers, mainly Fray Bernardino de Sahagún, described their effects in the sixteenth century. Conclusions: The use of psychoactive substances was common in pre-Columbian Mesoamerican societies. Today, local shamans and healers still use them in ritual ceremonies in Mesoamerica. Palabras clave: Alucinógenos, Culturas precolombinas, Hongos, Peyote, Psilocybe spp., Turbina corymbosa, Keywords: Hallucinogens, Hallucinogenic fungi, Peyote, Pre-Columbian cultures, Psilocybe spp., Turbina corymbos

Hallucinogenic drugs in pre-Columbian Mesoamerican cultures

Objectives: The archaeological, ethno-historical and ethnographic evidence of the use of hallucinogenic substances in Mesoamerica is reviewed. Results: Hallucinogenic cactus, plants and mushrooms were used to induce altered states of consciousness in healing rituals and religious ceremonies. The Maya drank balché (a mixture of honey and extracts of Lonchocarpus) in group ceremonies to achieve intoxication. Ritual enemas and other psychoactive substances were also used to induce states of trance. Olmec, Zapotec, Maya and Aztec used peyote, hallucinogenic mushrooms (teonanacatl: Psilocybe spp.) and the seeds of ololiuhqui (Turbina corymbosa), that contain mescaline, psilocybin and lysergic acid amide, respectively. The skin of the toad Bufo spp. contains bufotoxins with hallucinogenic properties, and was used during the Olmec period. Jimson weed (Datura stramonium), wild tobacco (Nicotiana rustica), water lily (Nymphaea ampla) and Salvia divinorum were used for their psychoactive effects. Mushroom stones dating from 3000 BC have been found in ritual contexts in Mesoamerica. Archaeological evidence of peyote use dates back to over 5000 years. Several chroniclers, mainly Fray Bernardino de Sahagún, described their effects in the sixteenth century. Conclusions: The use of psychoactive substances was common in pre-Columbian Mesoamerican societies. Today, local shamans and healers still use them in ritual ceremonies in Mesoamerica. Resumen: Introducción: El continente americano es rico en hongos y plantas psicoactivas, y numero-sas culturas precolombinas mesoamericanas las emplearon con fines mágicos, terapéuticos y religiosos. Objetivos: Se revisan las evidencias arqueológicas, etnohistóricas y etnográficas del uso de sustancias alucinógenas en Mesoamérica. Resultados: Cactus, plantas y hongos alucinógenos se utilizaron para provocar estados altera-dos del nivel de conciencia en ceremonias rituales y curativas. Los mayas ingerían el balché (hidromiel y extracto de Lonchocarpus) en ceremonias grupales para lograr la embriaguez. También emplearon enemas rituales con sustancias psicoactivas para inducir estados de trance. Olmecas, zapotecas, mayas y aztecas usaron el peyote, los hongos alucinógenos (teonanacatl: Psilocybe spp.) y las semillas de ololiuhqui (Turbina corymbosa), que contienen mescalina, psilocibina y amida del ácido lisérgico, respectivamente. La piel del sapo Bufo spp. contiene bufotoxinas, con propiedades alucinógenas y fue usado desde el periodo olmeca. El toloache (Datura estramonio), el tabaco silvestre (Nicotiana rustica), el lirio de agua (Nymphaea ampla) y la hoja de la pastora (Salvia divinorum) se utilizaron por sus efectos psicotropos. Piedra fún-gicas de 3.000 ãnos de antigüedad se han encontrado en contextos rituales en Mesoamérica. Las evidencias arqueológicas del uso del peyote se remontan a más de 5.000 ãnos. Diversos cronistas, entre ellos Fray Bernardino de Sahagún, relataron sus efectos en el siglo xvi. Conclusiones: El empleo de sustancias psicotrópicas fue muy común en las sociedades preco-lombinas mesoamericanas. En la actualidad chamanes y curanderos locales las siguen usando en ceremonias rituales. Keywords: Hallucinogens, Hallucinogenic fungi, Peyote, Pre-Columbian culture, Psilocybe spp., Turbina corymbosa, Palabras clave: Alucinógenos, Culturas precolombinas, Hongos, Peyote, Psilocybe spp., Turbina corymbos

Metric properties of the Spanish version of the Lake Louise Acute Mountain Sickness Questionnaire

Objectives: To assess the metric properties of the Lake Louise Acute Mountain Sickness (LLAMSQ) five-item questionnaire. Methods: At the end of the course “Neuroscience in pre-Columbian Andean cultures” (Peru, 2009), the participants answered the self-reported version of the LLAMSQ. The following psychometric attributes were explored: acceptability (observed versus possible scores; floor and ceiling effects), scaling assumptions (item-total correlation >0.30), internal consistency (Cronbach¿s alpha), precision (standard error of measurement), and convergent and discriminative validity. Differences in mean score of LLAMSQ between symptomatic acute mountain sickness subjects and asymptomatic ones were calculated. Results: The participants stayed for days at Cuzco (3,400 meters above sea level, MASL), Sacred valley (2,850 MASL) and Machu Picchu (2,450 MASL). Seventy people (60% males; mean age 50±8 years; 88.6% neurologists) were included in the study. LLAMSQ mean score was 3.36±2.02 (median 3; skewness 0.61). Ceiling and floor effects were 7.3% and 1.4%, respectively. Cronbach¿s alpha was 0.61, and standard error of measurement 1.26. LLAMSQ mean score significantly correlated (r=0.41, P=.002) with physical items (ataxia, dyspnoea, tremor, mental symptoms). LLAMSQ mean scores were significantly higher (worse) in those subjects who presented with acute sickness mountain (5.8 vs 3.0; Mann-Whitney, P 0,30), consistencia interna (alfa de Cronbach), precisión (error estándar de la medida) y validez de convergencia y discriminante. Esta última se evaluó calculando el valor medio del CMALL entre aquellos neurólogos que creían haber presentado mal de altura frente a quienes no lo habían presentado. Resultados: Estancia por días en altura: Cuzco 3.400 m sobre el nivel del mar (msnm), Valle Sagrado (2.850 msnm) y Machu Picchu (2.450 msnm). Se incluyeron 70 sujetos (60% varones, edad media 50 ± 8 años, 88,6% neurólogos). El valor medio del CMALL fue 3,36 ± 2,02 (mediana 3, asimetría 0,61). Los efectos techo y suelo fueron 7,3 y 1,4%. El alfa de Cronbach fue 0,61 y el error estándar de la medida 1,26. El CMALL se correlacionó significativamente (r = 0,41, p = 0,002) con los ítems de exploración física (ataxia, disnea, temblor, síntomas mentales). Las puntuaciones del CMALL fueron significativamente mayores (peores) en quienes presentaron mal de altura (5,8 vs 3,0; Mann-Whitney, p < 0,0001). Conclusiones: Las propiedades métricas de la versión española del CMALL parecen ser adecuadas. Este cuestionario puede ser útil en la detección precoz del mal de altura. Keywords: Metric attributes, Migraine, Internal consistency, Lake Louise Questionnaire, Mountain sickness, Validity, Palabras clave: Atributos métricos, Cefalea, Consistencia interna, Cuestionario Lago Louise, Mal de altura, Valide

International study on the psychometric attributes of the non-motor symptoms scale in Parkinson disease.

Contains fulltext : 80119.pdf (publisher's version ) (Open Access)BACKGROUND: Nonmotor symptoms (NMS) have a great impact on patients with Parkinson disease (PD). The Non-Motor Symptoms Scale (NMSS) is an instrument specifically designed for the comprehensive assessment of NMS in patients with PD. NMSS psychometric properties have been tested in this study. METHODS: Data were collected in 12 centers across 10 countries in America, Asia, and Europe. In addition to the NMSS, the following measures were applied: Scales for Outcomes in Parkinson's Disease (SCOPA)-Motor, SCOPA-Psychiatric Complications (SCOPA-PC), SCOPA-Cognition, Hoehn and Yahr Staging (HY), Clinical Impression of Severity Index for Parkinson's Disease (CISI-PD), SCOPA-Autonomic, Parkinson's Disease Sleep Scale (PDSS), Parkinson's Disease Questionnaire-39 items (PDQ-39), and EuroQol-5 dimensions (EQ-5D). NMSS acceptability, reliability, validity, and precision were analyzed. RESULTS: Four hundred eleven patients with PD, 61.3% men, were recruited. The mean age was 64.5 +/- 9.9 years, and mean disease duration was 8.1 +/- 5.7 years. The NMSS score was 57.1 +/- 44.0 points. The scale was free of floor or ceiling effects. For domains, the Cronbach alpha coefficient ranged from 0.44 to 0.85. The intraclass correlation coefficient (0.90 for the total score, 0.67-0.91 for domains) and Lin concordance coefficient (0.88) suggested satisfactory reproducibility. The NMSS total score correlated significantly with SCOPA-Autonomic, PDQ-39, and EQ-5D (r(S) = 0.57-0.70). Association was close between NMSS domains and the corresponding SCOPA-Autonomic domains (r(S) = 0.51-0.65) and also with scales measuring related constructs (PDSS, SCOPA-PC) (all p < 0.0001). The NMSS total score was higher for women (p < 0.02) and for increasing disease duration, HY, and CISI-PD severity level (p < 0.001). The SEM was 13.91 for total score and 1.71 to 4.73 for domains. CONCLUSION: The Non-Motor Symptoms Scale is an acceptable, reproducible, valid, and precise assessment instrument for nonmotor symptoms in Parkinson disease

Neuroschistosomiasis due to Schistosoma mansoni: a review of pathogenesis, clinical syndromes and diagnostic approaches Neuroesquistossomose devido a Schistosoma mansoni: revisão da patogênese, síndromes clínicas e manejo diagnóstico

Neuroschistosomiasis (NS) is the second most common form of presentation of infection by the trematode, Schistosoma mansoni. Granulomatous inflammatory reaction occurs as a result of schistosome eggs being transmitted to spinal cord or brain via the vascular system, or by inadvertent adult worm migration to these organs. The two main clinical syndromes are spinal cord neuroschistosomiasis (acute or subacute myelopathy) and localized cerebral or cerebellar neuroschistosomiasis (focal CNS impairment, seizures, increased intracranial pressure). Presumptive diagnosis of NS requires confirming the presence of S. mansoni infection by stool microscopy or rectal biopsy for trematode eggs, and serologic testing of blood and spinal fluid. The localized lesions are identified by signs and symptoms, and confirmed by imaging techniques (contrast myelography, CT and MRI). Algorithms are presented to allow a stepwise approach to diagnosis.<br>Neuroesquistossomose (NS) é a segunda forma mais freqüente de apresentação da infecção causada pelo trematódeo Schistosoma mansoni. A inflamação do tipo granulomatosa ocorre como resultado da presença de ovos do S. mansoni que atingiram a medula espinhal ou o encéfalo via o sistema vascular ou pela migração inadvertida de vermes adultos para estes órgãos. Duas síndromes clínicas principais podem ser identificadas: a mielopatia esquistossomótica (aguda ou subaguda) e a neuroesquistossomose cerebral ou cerebelar localizada (comprometimento focal do Sistema Nervoso Central, convulsões, hipertensão intracraniana). O diagnóstico presumido da NS requer a confirmação da presença da infecção por exame microscópico de fezes ou pela biópsia retal em busca de ovos de trematódeo e testes sorológicos no sangue e no líquor. As lesões localizadas são identificadas por sinais e sintomas, e confirmadas por exames de imagem (mielografia contrastada, tomografia computadorizada e ressonância magnética). Algoritmos são apresentados para orientar uma avaliação diagnóstica seqüencial