DESCARTE DE MEDICAMENTOS VENCIDOS DAS DROGARIAS NO MUNICÍPIO DE MOSSORÓ/RN

RESUMOOs fármacos possuem um papel positivo e relevante em nossa sociedade, desde o combate as doenças até sua possibilidade de aumentar a expectativa de vida das pessoas. Por outro lado, há um aspecto negativo por contribuir com o aumento na geração de resíduos de serviços de saúde. Este artigo teve como objetivo caracterizar o descarte de medicamentos vencidos nas drogarias do município de Mossoró/RN, verificar se as drogarias possuem um Plano de Gerenciamento de Resíduos de Serviços de Saúde e identificar iniciativas acerca de programas para evitar o desperdício de medicamentos. Os resultados obtidos demonstraram que as drogarias geram os resíduos de serviços de saúde dos grupos B, D e E. O controle para evitar a comercialização de medicamentos que estão fora do prazo de validade é realizado por 86% das drogarias e mesmo percentual para os estabelecimentos que possuem Plano de Gerenciamento de Resíduos de Serviços de Saúde. As iniciativas das drogarias para reduzir a geração de resíduos classe B através da comercialização de medicamentos fracionados ocorrem em 33% dos estabelecimentos. Apesar de verificar que 86% das drogarias de Mossoró apresentaram o Plano de Gerenciamento de Resíduos de Serviços de Saúde é preciso melhorar os níveis de eficiência e eficácia no processo de operacionalização para gerenciar o descarte de medicamentos vencidos gerados e integrar indústria farmacêutica e consumidores na responsabilidade compartilhadas pelo ciclo de vida dos medicamentos.

evidence- and practice-based guidance

The authors thank Luı́s Veloso, Daniela Carvalho, and Catarina Oliveira Silva (from CTI, Clinical Trial & Consulting Services) for their assistance with the project.Systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and Sjögren's syndrome (SS) are heterogeneous autoimmune diseases. Severe manifestations and refractory/intolerance to conventional immunosuppressants demand other options, namely biological drugs, and small molecules. We aimed to define evidence and practice-based guidance for the off-label use of biologics in SLE, APS, and SS. Recommendations were made by an independent expert panel, following a comprehensive literature review and two consensus rounds. The panel included 17 internal medicine experts with recognized practice in autoimmune disease management. The literature review was systematic from 2014 until 2019 and later updated by cross-reference checking and experts' input until 2021. Preliminary recommendations were drafted by working groups for each disease. A revision meeting with all experts anticipated the consensus meeting held in June 2021. All experts voted (agree, disagree, neither agree nor disagree) during two rounds, and recommendations with at least 75% agreement were approved. A total of 32 final recommendations (20 for SLE treatment, 5 for APS, and 7 for SS) were approved by the experts. These recommendations consider organ involvement, manifestations, severity, and response to previous treatments. In these three autoimmune diseases, most recommendations refer to rituximab, which aligns with the higher number of studies and clinical experience with this biological agent. Belimumab sequential treatment after rituximab may also be used in severe cases of SLE and SS. Second-line therapy with baricitinib, bortezomib, eculizumab, secukinumab, or tocilizumab can be considered in SLE-specific manifestations. These evidence and practice-based recommendations may support treatment decision and, ultimately, improve the outcome of patients living with SLE, APS, or SS.publishersversionpublishe

Germline MUTYH (MYH) mutations in portuguese individuals with multiple colorectal adenomas

Germinal mutations in the base excision repair (BER) gene MUTYH (MYH) have recently been described in association with predisposition to multiple colorectal adenomas and cancer. In contrast to the classic dominant condition of familial adenomatous polyposis (FAP) due to germinal mutations in the APC gene, the MYH polyposis is an autosomal recessive disease. The identification of individuals affected by MYH polyposis brings new and important implications for the diagnostic, screening, genetic counseling, follow up and therapeutic options in these patients. In this study, screening for germinal mutations in the MYH gene was performed in 53 Portuguese individuals with multiple colorectal adenomas or classic adenomatous polyposis, in whom no mutation had been identified in the APC gene. The results revealed the presence of biallelic germline MYH mutations in 21 patients. In addition, we here report 3 mutations (c.340T>C [p.Y114H]; c.503G>A [p.R168H]; and c.1186_1187insGG [p.E396fsX437]) which, to our knowledge, have not been previously described. © 2004 Wiley-Liss, Incinfo:eu-repo/semantics/publishedVersio

Treatment of water with aromatic hydrocarbons by use of sequential batch reactor with fungi inoculum

Um reator em batelada, aerado, com biomassa imobilizada de Aspergillus niger AN400 foi operado durante 10 ciclos de 7 dias para remover benzeno (200 mg.L-1), tolueno (200 mg.L-1) e xileno (50 mg.L-1) - BTX - e de nutrientes de meio basal. O reator era alimentado semanalmente com 4 L do meio e glicose - 1 g.L-1, na Fase I, e 0,5 g.L-1, na Fase II. Os BTX foram detectados até o quarto dia de operação, em todos os ciclos. As melhores eficiências médias de remoção foram na Fase I: 75%de matéria orgânica solúvel, 80% de ortofosfato e 77% de amônia. O reator pode ser uma alternativa viável para tratamento de águas poluídas com BTX, porém há a necessidade de estudar o comportamento do reator durante período de operação mais longo e com ciclos reacionais mais curtos, bem como da identificação dos metabólitos produzidos

Mapping the morbidity and mortality of Chagas disease in an endemic area in Brazil

Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients’ care

Biological therapy in systemic lupus erythematosus, antiphospholipid syndrome, and Sjögren’s syndrome: evidence- and practice-based guidance

Systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and Sjögren’s syndrome (SS) are heterogeneous autoimmune diseases. Severe manifestations and refractory/intolerance to conventional immunosuppressants demand other options, namely biological drugs, and small molecules. We aimed to define evidence and practice-based guidance for the off-label use of biologics in SLE, APS, and SS. Recommendations were made by an independent expert panel, following a comprehensive literature review and two consensus rounds. The panel included 17 internal medicine experts with recognized practice in autoimmune disease management. The literature review was systematic from 2014 until 2019 and later updated by cross-reference checking and experts’ input until 2021. Preliminary recommendations were drafted by working groups for each disease. A revision meeting with all experts anticipated the consensus meeting held in June 2021. All experts voted (agree, disagree, neither agree nor disagree) during two rounds, and recommendations with at least 75% agreement were approved. A total of 32 final recommendations (20 for SLE treatment, 5 for APS, and 7 for SS) were approved by the experts. These recommendations consider organ involvement, manifestations, severity, and response to previous treatments. In these three autoimmune diseases, most recommendations refer to rituximab, which aligns with the higher number of studies and clinical experience with this biological agent. Belimumab sequential treatment after rituximab may also be used in severe cases of SLE and SS. Second-line therapy with baricitinib, bortezomib, eculizumab, secukinumab, or tocilizumab can be considered in SLE-specific manifestations. These evidence and practice-based recommendations may support treatment decision and, ultimately, improve the outcome of patients living with SLE, APS, or SS

The inventory of geological heritage of the state of São Paulo, Brazil: Methodological basis, results and perspectives

An inventory of geological sites based on solid and clear criteria is a first step for any geoconservation strategy. This paper describes the method used in the geoheritage inventory of the State of São Paulo, Brazil, and presents its main results. This inventory developed by the geoscientific community aimed to identify geosites with scientific value in the whole state, using a systematic approach. All 142 geosites representative of 11 geological frameworks were characterised and quantitatively evaluated according to their scientific value and risk of degradation, in order to establish priorities for their future management. An online database of the inventory is under construction, which will be available to be easily consulted and updated by the geoscientific community. All data were made available to the State Geological Institute as the backbone for the implementation of a future state geoconservation strategy.The authors acknowledge the Science Without Borders Programme, Process 075/2012, which supported this study and the São Paulo Research Foundation (FAPESP), Process 2011/17261-6. We also thanks C. Mazoca for his help with maps and figures.info:eu-repo/semantics/acceptedVersio