Assistência ao diabetes no Sistema Único de Saúde: análise do modelo atual

O sistema de saúde nacional, impulsionado por contextos econômicos restritivos, passou por uma reestruturação organizacional na década de 1990, voltada à atenção primária. Apesar das reformas, a incidência de diabetes mellitus ainda atinge elevadas proporções. Devido à alta morbi-mortalidade, a prevenção dessa morbidade tem-se tornado foco atual, fazendo-se necessário o desenvolvimento de programas eficazes e viáveis ao Sistema Único de Saúde, tais como ênfase na prevenção primária, controle da incidência e complicações da doença. Para que isso ocorra, o modelo da atenção atual prestada ao paciente deve ser modificado, priorizando a atenção primária, com a substituição do modelo médico-hegemônico por uma equipe interdisciplinar, onde o farmacêutico, como membro da equipe, possa prover seus serviços, minimizando assim impactos sociais, humanísticos e econômicos que a doença acarreta para a sociedade. O objetivo da presente revisão foi abordar a temática do diabetes mellitus e as dificuldades do controle associado à ineficácia da logística adotada, principalmente no Sistema Único de Saúde.The Brazilian Health Care System stimulated for restrictive economic contexts had passed for reorganization in the decade of 1990, directed mainly to the primary attention. Although the reforms, the incidence of diabetes mellitus still reaches epidemic levels. The diabetes prevention has become actual preoccupation due the high morbimortality that accompanies this disease, becoming necessary the development of efficient and viable programs for Brazilian Public Health system such as emphasis in the primary prevention, control of the diseases incidence and complications. To obtain this goal, the current model of attention given to the patient must be modified, prioritizing the primary attention and a replacement of the hegemonic medical model for another one, formed by an interdisciplinary team, where the pharmacist as a member could offer his/her services should occur, thus minimizing social, humanistic and economic impacts that the diabetes causes for the society. The aim of this present revision is to approach the diabetes mellitus, the difficulties for its control associated with the adopted ineffective system, mainly in the Brazilian Public Health System.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Stir bar-sorptive extraction, solid phase extraction and liquid-liquid extraction for levetiracetam determination in human plasma: comparing recovery rates

Levetiracetam (LEV), an antiepileptic drug (AED) with favorable pharmacokinetic profile, is increasingly being used in clinical practice, although information on its metabolism and disposition are still being generated. Therefore a simple, robust and fast liquid-liquid extraction (LLE) followed by high-performance liquid chromatography method is described that could be used for both pharmacokinetic and therapeutic drug monitoring (TDM) purposes. Moreover, recovery rates of LEV in plasma were compared among LLE, stir bar-sorptive extraction (SBSE), and solid-phase extraction (SPE). Solvent extraction with dichloromethane yielded a plasma residue free from usual interferences such as commonly co-prescribed AEDs, and recoveries around 90% (LLE), 60% (SPE) and 10% (SBSE). Separation was obtained using reverse phase Select B column with ultraviolet detection (235 nm). Mobile phase consisted of methanol:sodium acetate buffer 0.125 M pH 4.4 (20:80, v/v). The method was linear over a range of 2.8-220.0 µg mL-1. The intra- and inter-assay precision and accuracy were studied at three concentrations; relative standard deviation was less than 10%. The limit of quantification was 2.8 µg mL-1. This robust method was successfully applied to analyze plasma samples from patients with epilepsy and therefore might be used for pharmacokinetic and TDM purposes.</p

Influence of the clinical profile of patients with refractory epilepsy on lamotrigine plasma concentration

The purpose of this work was to evaluate the influence of the clinical profile on lamotrigine (LTG) plasma concentrations from patients with refractory epileptic seizures. In this cross-sectional study, therapeutic monitoring of LTG, and questionnaires with 75 patients with refractory epileptic seizures of a Hospital in Ribeirão Preto-SP-Brazil were performed. The multiple linear regression model was used to verify association between the LTG plasma concentrations and the independent variables. Covariance analysis was used to compare the mean LTG plasma concentration among the co-medication groups. The LTG plasma concentration was associated both with the LTG dosage (mg/kg/day) (p=0.0096) and with the use of first generation antiepileptic drugs (AED) (p&lt;0.01), being carbamazepine (CBZ) and phenytoin (PHT), the AEDs showing the most prominent influence in reducing LTG plasma concentrations. Adverse events, adherence to the pharmacological treatment, and epileptic seizures frequency, did not show significant correlation with LTG plasma concentration values. The conclusion is that LTG plasma concentration is significantly influenced by the LTG dosage and by the concomitant use of a first generation AED

Qualidade de vida e eventos adversos de pacientes com epilepsia farmacorresistente em uso de lamotrigina

Study design: Cross-sectional study. Introduction: Pharmacological treatment is the first option to treat epilepsy, and about 40% of patients require polytherapy to better control epileptic seizures, which may be associated with an increase in adverse events and impairment of quality of life. Objective: To evaluate the quality of life of patients with pharmacoresistant epilepsy using lamotrigine (LTG), as well as to verify the association of adverse events with antiepileptic drugs with quality of life. Methods: This cross-sectional study was carried out with 75 patients with drugresistant epilepsy using LTG, in a Clinic of Epilepsy of Difficult Control of Ribeirão Preto-SP, from May/2011 to April / 2012. The clinical variables analyzed were Quality of Life in Epilepsy (QOLIE31) and the Adverse Events Profile Questionnaire (AEP). Socio-demographic and pharmacotherapeutic data were collected through patient records. This study was approved by the Research Ethics Committee of the General Hospital of the Medical School of Ribeirão Preto of the University of São Paulo (HCFMRP-USP), whose case number is 8791/2010. Results: The most frequent adverse events were somnolence and difficulty concentrating. In addition, low scores were observed in all domains related to quality of life (Qolie-31). Conclusion: Quality of life has an inverse association with adverse events in patients using antiepileptic drugs (p &lt;0.01).Modelo do estudo: Estudo transversal. Introdução: O tratamento farmacológico é a primeira opção para o tratamento da epilepsia, e cerca de 40% dos pacientes necessitam de politerapia para melhor controle das crises epilépticas, o que pode estar associado ao aumento de eventos adversos e comprometimento da qualidade de vida. Objetivos: Avaliar a qualidade de vida de pacientes com epilepsia farmacoresistente em uso de lamotrigina (LTG), bem como verificar a associação dos eventos adversos dos antiepilépticos com a qualidade de vida. Metodologia: Este estudo transversal foi realizado com 75 pacientes com epilepsia farmacorresistente em uso LTG atendidos em um Ambulatório de Epilepsia de Difícil Controle de Ribeirão Preto-SP, no período de maio/2011 a abril/2012. As variáveis clínicas analisadas foram a qualidade de vida (Quality of Life in Epilepsy - Qolie-31) e o perfil de eventos adversos (AEP – Adverse Events Profile Questionnaire). Dados sociodemográficos e farmacoterapêuticos foram coletados através dos prontuários dos pacientes. Este trabalho foi aprovado pelo Comitê de Ética em Pesquisa do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), cujo número do processo é 8791/2010. Resultados: Os eventos adversos mais frequentes foram sonolência e dificuldade de concentração. Além disso, observou-se baixos escores em todos os domínios relacionados à qualidade de vida (Qolie-31). Conclusão: A qualidade de vida possui associação inversamente significativa com os eventos adversos, nos pacientes em uso de antiepilépticos (p&lt;0,01)

Stir bar-sorptive extraction, solid phase extraction and liquid-liquid extraction for levetiracetam determination in human plasma: comparing recovery rates

Levetiracetam (LEV), an antiepileptic drug (AED) with favorable pharmacokinetic profile, is increasingly being used in clinical practice, although information on its metabolism and disposition are still being generated. Therefore a simple, robust and fast liquid-liquid extraction (LLE) followed by high-performance liquid chromatography method is described that could be used for both pharmacokinetic and therapeutic drug monitoring (TDM) purposes. Moreover, recovery rates of LEV in plasma were compared among LLE, stir bar-sorptive extraction (SBSE), and solid-phase extraction (SPE). Solvent extraction with dichloromethane yielded a plasma residue free from usual interferences such as commonly co-prescribed AEDs, and recoveries around 90% (LLE), 60% (SPE) and 10% (SBSE). Separation was obtained using reverse phase Select B column with ultraviolet detection (235 nm). Mobile phase consisted of methanol:sodium acetate buffer 0.125 M pH 4.4 (20:80, v/v). The method was linear over a range of 2.8-220.0 µg mL-1. The intra- and inter-assay precision and accuracy were studied at three concentrations; relative standard deviation was less than 10%. The limit of quantification was 2.8 µg mL-1. This robust method was successfully applied to analyze plasma samples from patients with epilepsy and therefore might be used for pharmacokinetic and TDM purposes.</p

Sibutramine versus Metformin: assessment of anthropometric, lipid and glycemic parameters in obese and overweight high-risk patients

Anthropometric, lipid and glycemic parameters were compared in obese or overweight high-risk patients. This double-blind trial included 16 obese and overweight patients who followed a standard caloriecontrolled diet and received 15mg/day sibutramine or 1700mg/day metformin over three months. The changes observed in the sibutramine and metformin groups were, respectively: body mass index -6.0% and -4.0%; abdominal circumference -7.9% and -6.6%; fatty tissue -10.5% and -1.7%; total cholesterol -2.9% and -2.8%; LDL-C -0.01% and -0.1%; HDL-C -11.0% and -6.8%; total cholesterol/ HDL-C ratio +12.0% and +4.5%; HDL-C-to-LDL-C ratio -7.2% and -0.1%; triglycerides +14.0% and +22.3%; fasting glucose +4.3% and +1.4%; insulin -10.4% and -4.9%; HOMA -8.0% and -3.9%. Although the study was conducted with only 16 patients and the drugs were taken for only three months, we can see that sibutramine-treated obese or overweight highrisk patients showed a reduction of anthropometric parameters and better control of insulin resistance

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Brazilian pharmacists’ education and training aims to prepare them for the various activities they will undertake during professional practice, especially in the national health system (SUS). By using an exploratory transversal study based on a validated questionnaire, we have characterized the educational and training background of pharmacists working in SUS municipal units in Ribeirão Preto, State of São Paulo (SP), Brazil, and the frequency with which these professionals carry out several activities. Pharmacists working in these municipal outpatient units (N=44) graduated between 1981 and 2014 (56.8% of them graduated from public state or federal institutions), are predominantly female (84%), and are aged 25-57 years; 34% of these pharmacists have a “Generalist” degree, and 90.9% attended postgraduate programs, mostly specialization (75%). All the pharmacists pointed out the need for continuing education. The frequency with which they carry out activities varies, but those involving direct contact with patients predominate. Consultations, therapeutic follow-up, case discussions, and health promotion activities take place only occasionally. We concluded that pharmacists who work in the municipality of Ribeirão Preto, SP, are very much involved with dispensing, but not with health education or pharmacotherapeutic follow-up, so investing in education and training in these areas is necessary

Psychoactive drugs in the Brazilian public health system: Use profile and associated factors

The purpose of this study is to estimate the prevalence of and characterize the use of psychoactive drugs among drug users in a Brazilian municipality, relating the findings to factors associated with the consumption of these substances. Through a cross-sectional design, 1,355 drug users from the public health systems community pharmacies were interviewed. Sociodemographic and health-related data were collected, as well as any other prescribed drugs. The prevalence of psychoactive drug use within the last month was 31.0%, with antidepressants and benzodiazepines being the most prescribed (53.5% and 24.6% respectively). Most psychoactive drug users were female (81.9%), lived with a partner (52.6%), had private health insurance (69.2%) and a monthly per-capita income up to one minimum wage (54.0%). The adjusted Odds Ratio (OR) confirmed the following factors to be positively associated with the use of psychoactive drugs: female gender (OR=2.06; 95% CI 1.44; 2.95), age ≥60 years old (OR=1.77; 95% CI 1.26; 2.48), follow-up with a psychologist (OR=4.12; 95% CI 1.84; 5.25), absence of regular physical activity (OR=1.59; 95% CI 1.13; 2.23), and smokers (OR=1.94; 95% CI 1.26; 2.97). Approximately one out of three individuals used at least one psychoactive drug. Health managers should focus the planning and actions aimed at their rational use for these groups, leading to increased overall treatment success