Avaliação dos aspectos físicos de comprimidos de hidroxicloroquina 400 mg referência, genéricos e similares comercializados em drogarias na cidade de Irecê-BA / Evaluation of physical aspects of reference hydroxychloroquine 400 mg tablets, generic and similar sold in drugstore in the city of Irecê-BA

Desde dezembro de 2019, quando foram noticiados os primeiros casos de infecção por SARS-CoV-2 (COVID-19) pesquisas têm sido conduzidas para testar opções terapêuticas para o tratamento desta doença. Dentre os vários agentes farmacológicos está a hidroxicloroquina, um medicamento antimalárico que não apresenta evidências de eficácia e segurança nos estudos em COVID-19. Mesmo mediante deste cenário, ocorreu um aumento pela procura e venda desse medicamento. Diante disso, considerando a diversificação dos medicamentos do mercado nacional, a qualidade desses produtos é objeto de perguntas e avaliações. Nesse sentido, o objetivo deste estudo foi analisar a qualidade física de comprimidos de referência, genéricos e similares dos comprimidos de hidroxicloroquina 400 mg comercializados em drogarias na cidade de Irecê-BA, avaliando os testes descritos na Farmacopeia Brasileira 6º edição, afim de avaliar a equivalência farmacêutica dos medicamentos. Trata-se de uma pesquisa experimental e exploratória, de natureza quantitativa, no qual avaliou quatro amostras de medicamentos de hidroxicloroquina de diferentes laboratórios (1 referência, 2 genéricos e 1 similar). Foram analisados: o aspecto visual, peso médio, dureza, friabilidade e desintegração. Todos os comprimidos das marcas analisadas apresentaram integridade, superfície homogênea, lisa e brilhante, coloração branca e visualmente não apresentavam nenhum defeito como falhas, fissuras e contaminação e foram caracterizados como oblongo e biconvexo, ou seja, não apresentaram irregularidade no aspecto visual. A determinação de peso médio mostrou que todas as amostras testadas dos comprimidos permaneceram dentro da variação máxima aceitável de 5%. Sendo assim, os lotes apresentaram uniformidade em seu peso e conteúdo. Para dureza, registrou-se valores unitários elevados para as amostras característico de comprimidos revestidos. Tal resultado não influenciou no processo de desintegração, uma vez que as amostras levaram poucos minutos para se desintegrarem, não ultrapassando também o tempo limite permitido menor que 30 minutos, para comprimidos revestidos por filme. Com relação ao teste de friabilidade, as amostras apresentaram uma pequena perda de massa, caracterizando-se como comprimidos de alta resistência a abrasão sem perda de integridade. No mais, todas as amostras atenderam as especificações da literatura descrita. Diante disso, entende-se que os medicamentos de hidroxicloroquina avaliados mostraram boa qualidade física podendo ser considerados equivalentes farmacêuticos

Impactos da COVID-19 na saúde mental dos profissionais de enfermagem: revisão integrativa: Impacts of COVID-19 on the mental health of nursing professionals: integrative review

O objetivo foi descrever os impactos da pandemia da Covid-19 na saúde mental dos profissionais de enfermagem, a partir da literatura científica. Trata-se de uma pesquisa de revisão integrativa de natureza descritiva, exploratória e qualitativa. A busca se deu a partir das bases de dados, Biblioteca Virtual em Saúde do Ministério da Saúde (BVS), Literatura Latino-americana do Caribe em Ciências da Saúde (LILACS) e Scientific Eletronic Libray Online(Scielo). A amostra final compôe-se por oito artigos que atendem aos critérios estabelecidos, entre os anos de 2020 e 2022, por meio de descritores e operadores boleanos. Observou-se que os impactos mentais como, ansiedade, depressão, estresse ocupacional e burnout foram frequentemente apontados nos estudos, mediante a sensação de sobrecarga, afastamento do convívio social e atuação em ambientes insalubres com falta de equipamentos e treinamentos efetivos durante a assistência na pandemia. Tal fato demonstra que asaúde mental dos profissionais de enfermagem foi impactada negativamente e de maneiras diversas pela pandemia de Covid-19. Conclui-se a urgência no desenvolvimento e melhorias nas estratégias que minimizem o desgaste emocional dos enfermeiros, mesmo em tempos não pandêmicos

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Guidance on mucositis assessment from the MASCC Mucositis Study Group and ISOO: an international Delphi studyResearch in context

Summary: Background: Mucositis is a common and highly impactful side effect of conventional and emerging cancer therapy and thus the subject of intense investigation. Although common practice, mucositis assessment is heterogeneously adopted and poorly guided, impacting evidence synthesis and translation. The Multinational Association of Supportive Care in Cancer (MASCC) Mucositis Study Group (MSG) therefore aimed to establish expert recommendations for how existing mucositis assessment tools should be used, in clinical care and trials contexts, to improve the consistency of mucositis assessment. Methods: This study was conducted over two stages (January 2022–July 2023). The first phase involved a survey to MASCC-MSG members (January 2022–May 2022), capturing current practices, challenges and preferences. These then informed the second phase, in which a set of initial recommendations were prepared and refined using the Delphi method (February 2023–May 2023). Consensus was defined as agreement on a parameter by >80% of respondents. Findings: Seventy-two MASCC-MSG members completed the first phase of the study (37 females, 34 males, mainly oral care specialists). High variability was noted in the use of mucositis assessment tools, with a high reliance on clinician assessment compared to patient reported outcome measures (PROMs, 47% vs 3%, 37% used a combination). The World Health Organization (WHO) and Common Terminology Criteria for Adverse Events (CTCAE) scales were most commonly used to assess mucositis across multiple settings. Initial recommendations were reviewed by experienced MSG members and following two rounds of Delphi survey consensus was achieved in 91 of 100 recommendations. For example, in patients receiving chemotherapy, the recommended tool for clinician assessment in clinical practice is WHO for oral mucositis (89.5% consensus), and WHO or CTCAE for gastrointestinal mucositis (85.7% consensus). The recommended PROM in clinical trials is OMD/WQ for oral mucositis (93.3% consensus), and PRO-CTCAE for gastrointestinal mucositis (83.3% consensus). Interpretation: These new recommendations provide much needed guidance on mucositis assessment and may be applied in both clinical practice and research to streamline comparison and synthesis of global data sets, thus accelerating translation of new knowledge into clinical practice. Funding: No funding was received

Global Burden of Cardiovascular Diseases and Risks, 1990-2022

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is a multinational collaborative research study with >10,000 collaborators around the world. GBD generates a time series of summary measures of health, including prevalence, cause-specific mortality (CSMR), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) to provide a comprehensive view of health burden for a wide range of stakeholders including clinicians, public and private health systems, ministries of health, and other policymakers. These estimates are produced for 371 causes of death and 88 risk factors according to mutually exclusive, collectively exhaustive hierarchies of health conditions and risks. The study is led by a principal investigator and governed by a study protocol, with oversight from a Scientific Council, and an Independent Advisory Committee.1 GBD is performed in compliance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER).2 GBD uses de-identified data, and the waiver of informed consent was reviewed and approved by the University of Washington Institutional Review Board (study number 9060). This almanac presents results for 18 cardiovascular diseases (CVD) and the CVD burden attributed to 15 risk factors (including an aggregate grouping of dietary risks) by GBD region. A summary of methods follows. Additional information can be found online at https://ghdx.healthdata.org/record/ihme-data/cvd-1990-2022, including:Funding was provided by the Bill and Melinda Gates Foundation, and the American College of Cardiology Foundation. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. The contents and views expressed in this report are those of the authors and do not necessarily reflect the official views of the National Institutes of Health, the Department of Health and Human Services, the U.S. Government, or the affiliated institutions