Critical analysis of the regulations regarding the disposal of medication waste

As sobras de medicamentos oriundas do desuso ou da expiração do prazo de validade que constam nos domicílios da população, normalmente, são destinadas diretamente para o lixo comum, rede de esgoto ou, em alguns casos, devolvidas para a rede pública. Sobre essas sobras, ainda não há legislação específica que regulamenta e orienta sobre a manipulação e destinação correta do descarte dos resíduos de medicamentos. Entretanto, sobre os resíduos sólidos de serviços de saúde já se possui regulamentações definidas. O presente artigo tem como objetivo discutir modelos de gestão de descarte de resíduos de medicamentos e as recomendações de legislações internacionais e nacionais pertinentes. Por meio de revisão de literatura, analisou-se a estrutura do gerenciamento de resíduos para medicamentos de legislação internacional e as regulamentações relacionadas ao meio ambiente, assim como a legislação nacional de resíduos sólidos de serviços de saúde. Com a análise foi possível apresentar melhores esclarecimentos quanto aos possíveis impactos ao meio ambiente, à saúde da população e alternativas para se obter gestão eficaz de descarte de medicamentos, reduzindo e/ou evitando o risco sanitário, garantindo qualidade e segurança da saúde pública.Expired or unused medication at people's homes is normally disposed of in normal garbage, sewage system or, in certain cases, returned to the public health system. There is still no specific legislation regarding this leftover medication to regulate and orient the handling and correct disposal of medication waste. However, there is defined regulation regarding health services' solid waste. This article has the objective of discussing management models for the disposal of medication waste and the recommendations made by pertinent national and international legislation. By means of literature reviews, the management structure for medication waste of international legislation and the regulations regarding the environment, as well as the national legislation for the solid waste from health services was analyzed. Through the analysis it was possible to present better clarifications as to the possible impacts to the environment, to the public's health and alternatives in order to obtain the efficient disposal of medication, reducing and/or avoiding sanitary risk, guaranteeing the quality and safety of public health

Critical analysis of the regulations regarding the disposal of medication waste

Expired or unused medication at people's homes is normally disposed of in normal garbage, sewage system or, in certain cases, returned to the public health system. There is still no specific legislation regarding this leftover medication to regulate and orient the handling and correct disposal of medication waste. However, there is defined regulation regarding health services' solid waste. This article has the objective of discussing management models for the disposal of medication waste and the recommendations made by pertinent national and international legislation. By means of literature reviews, the management structure for medication waste of international legislation and the regulations regarding the environment, as well as the national legislation for the solid waste from health services was analyzed. Through the analysis it was possible to present better clarifications as to the possible impacts to the environment, to the public's health and alternatives in order to obtain the efficient disposal of medication, reducing and/or avoiding sanitary risk, guaranteeing the quality and safety of public health

Adaptation behaviour, consumption and digestibility in change of diet in ruminants

Todos os textos, informa??es e resultados apresentados s?o de inteira responsabilidade dos autores.Objetivou-se com esta revis?o, reunir informa??es sobre adapta??o de comportamento, consumo e digestibilidade na mudan?a da dieta em ruminantes. Durante a vida, os animais passam por diversas mudan?as na alimenta??o. A primeira transi??o acontece na fase inicial, quando h? a substitui??o de alimentos l?quidos por s?lidos, esta altera??o deve ser realizada de forma fracionada, com maiores volumes de aleitamento nas primeiras semanas diminuindo gradualmente at? o desaleitamento. Outra mudan?a na alimenta??o se deve a estacionalidade, ocorrendo varia??o na quantidade e qualidade da forragem dispon?vel. No per?odo da seca, as forrageiras tropicais apresentam baixo valor nutritivo, com teores de PB inferiores ao m?nimo de 7,0% na MS, limitando a atividade de microrganismos. Em animais em termina??o h? aumento no n?vel de concentrado na dieta, a transi??o de uma dieta com alta propor??o de volumoso para uma com alta propor??o de concentrado ? um dos fatores que causa maiores impactos sobre a microbiota ruminal. A adapta??o a uma nova dieta ? um ponto cr?tico para a produ??o animal. ? importante conhecer as mudan?as de comportamento, de consumo e de digestibilidade e o tempo necess?rio para que os animais estejam adaptados ? nova dieta, evitando causar danos no desenvolvimento e na produ??o animal.The objective of this review, gather information about adaptive behavior, intake and digestibility in diet change in ruminants. During life, the animals undergo several changes in food, the first transition occurs at an early stage, when there is the replacement net for solid foods, this amendment should be held in divided doses with larger feeding volumes in the first weeks gradually decreasing until weaning. Another shift in power is due to seasonality, occurring variation in the quantity and quality of available forage. During the dry season, tropical forages have low nutritional value, with lower crude protein content to a minimum of 7.0% in MS, limiting microorganism activity. In finishing animals there is an increase in the concentrate level in the diet, the transition from a diet with a high proportion of roughage for a high proportion of concentrate is one of the factors that cause major impacts on ruminal microflora. Adapting to a new diet is critical for livestock production. It is important to minimize the inappropriate handling during this period, knowing the changes in behavior, consumption and digestibility and the time required for the animals are adapted to the new diet, avoiding damage in developing and animal production

Crude protein of tropical forage legumes grown in silvopastural system and full sol

Todos os textos, informa??es e resultados apresentados s?o de inteira responsabilidade dos autores.Ag?ncia financiadora para a realiza??o desse trabalho: Funda??o de Amparo ? Pesquisa do Estado de Minas Gerais (FAPEMIG).Objetivou-se neste estudo avaliar o teor de prote?na bruta (PB) de tr?s leguminosas forrageiras tropicais cultivadas em dois sistemas: no sub-bosque de sistema silvipastoril (SSP) e a pleno sol. O experimento foi conduzido em Curvelo-MG, na fazenda experimental da UFVJM. Utilizou-se um delineamento em blocos casualizados em esquema fatorial 2 (SSP e pleno sol) x 3 esp?cies (estilosantes, kudzu tropical e macrotiloma) com 4 repeti??es. O teor de PB foi determinado nas por??es: planta inteira, folha e hastes das tr?s leguminosas forrageiras em fun??o dos tratamentos. Foi observado efeito de esp?cie para as por??es planta inteira e haste (P<0,05), n?o sendo verificado este efeito para a por??o folha. Os maiores teores de PB para planta inteira e haste foram encontrados nas esp?cies kudzu e estilosantes (P<0,05), os quais diferiram do teor de PB apresentado no macrotiloma. Para o teor de PB na folha observou-se efeito da intera??o esp?cie x sistema de cultivo, tendo o macrotiloma apresentado acr?scimo no valor de PB (P<0,05) quando cultivado no sub-bosque do SSP. O sombreamento no sub-bosque do sistema silvipastoril estudado n?o promoveu incremento no teor de prote?na bruta para nenhuma das esp?cies cultivadas.The aim of this study was to evaluate the crude protein (CP) of three tropical forage legumes grown in two systems: the silvopastoral system understory (SSP) and full sun. The experiment was conducted in Curvelo, Minas Gerais at the experimental farm of UFVJM. We used a randomized block design in a factorial 2 (SSP and full sun) x 3 species (estilosantes, tropical kudzu and macrotiloma) with 4 repetitions. The crude protein content was determined in portions: Whole plant, leaves and stems of three forage legumes in the treatments. Kind of effect was observed for whole plant and stem portions (P <0.05), not being checked for this purpose the sheet portion. The higher crude protein content for whole plant and stem were found on kudzu and estilosantes species (P <0.05), which differ from the CP content presented in macrotiloma. For the PB content in the leaf it was observed effect of interaction species x cropping system, with the macrotiloma presented increase in the amount of CP (P <0.05) when grown in SSP understory. The shading in the understory of the silvopastoral system studied did not promote increase in crude protein content for any of the cultivated species

Parameters on silage sorghum

Todos os textos, informa??es e resultados apresentados s?o de inteira responsabilidade dos autores.O Brasil, devido ? sua vasta extens?o territorial, associado ao clima predominantemente tropical, destaca-se no contexto mundial como uma das grandes pot?ncias para a produ??o animal. Essa caracter?stica do clima ainda permite a exist?ncia de uma grande diversidade de plantas forrageiras, de elevado potencial de produ??o por ?rea. No entanto, a estacionalidade na produ??o de forragem tem sido apontada como um dos fatores que mais contribui para a baixa produtividade dos rebanhos. O processo de ensilagem serve como alternativa para suprir a demanda alimentar no per?odo de estacionalidade. O sorgo, devido a sua boa qualidade qualitativa e quantitativa segue como uma cultura em potencial para a produ??o de silagem.The Brazil due to its vast size, coupled with the predominantly tropical climate, stands out on the world stage as one of the great powers for animal production. This characteristic climate still allows for a wide variety of forage plants, high potential for production per area. However, seasonality in forage production has been identified as one of the factors that contributes to the low productivity of livestock. The ensiling process is an alternative to meet the food demand in the seasonality period. The sorghum, due to its good qualitative and quantitative quality remains as a potential crop to produce silage

Prognostic impact of vitamin B6 metabolism in lung cancer

Patients with non-small cell lung cancer (NSCLC) are routinely treated with cytotoxic agents such as cisplatin. Through a genome-wide siRNA-based screen, we identified vitamin B6 metabolism as a central regulator of cisplatin responses in vitro and in vivo. By aggravating a bioenergetic catastrophe that involves the depletion of intracellular glutathione, vitamin B6 exacerbates cisplatin-mediated DNA damage, thus sensitizing a large panel of cancer cell lines to apoptosis. Moreover, vitamin B6 sensitizes cancer cells to apoptosis induction by distinct types of physical and chemical stress, including multiple chemotherapeutics. This effect requires pyridoxal kinase (PDXK), the enzyme that generates the bioactive form of vitamin B6. In line with a general role of vitamin B6 in stress responses, low PDXK expression levels were found to be associated with poor disease outcome in two independent cohorts of patients with NSCLC. These results indicate that PDXK expression levels constitute a biomarker for risk stratification among patients with NSCLC.publishedVersio

Prescription appropriateness of anti-diabetes drugs in elderly patients hospitalized in a clinical setting: evidence from the REPOSI Register

Diabetes is an increasing global health burden with the highest prevalence (24.0%) observed in elderly people. Older diabetic adults have a greater risk of hospitalization and several geriatric syndromes than older nondiabetic adults. For these conditions, special care is required in prescribing therapies including anti- diabetes drugs. Aim of this study was to evaluate the appropriateness and the adherence to safety recommendations in the prescriptions of glucose-lowering drugs in hospitalized elderly patients with diabetes. Data for this cross-sectional study were obtained from the REgistro POliterapie-Società Italiana Medicina Interna (REPOSI) that collected clinical information on patients aged ≥ 65 years acutely admitted to Italian internal medicine and geriatric non-intensive care units (ICU) from 2010 up to 2019. Prescription appropriateness was assessed according to the 2019 AGS Beers Criteria and anti-diabetes drug data sheets.Among 5349 patients, 1624 (30.3%) had diagnosis of type 2 diabetes. At admission, 37.7% of diabetic patients received treatment with metformin, 37.3% insulin therapy, 16.4% sulfonylureas, and 11.4% glinides. Surprisingly, only 3.1% of diabetic patients were treated with new classes of anti- diabetes drugs. According to prescription criteria, at admission 15.4% of patients treated with metformin and 2.6% with sulfonylureas received inappropriately these treatments. At discharge, the inappropriateness of metformin therapy decreased (10.2%, P &lt; 0.0001). According to Beers criteria, the inappropriate prescriptions of sulfonylureas raised to 29% both at admission and at discharge. This study shows a poor adherence to current guidelines on diabetes management in hospitalized elderly people with a high prevalence of inappropriate use of sulfonylureas according to the Beers criteria

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37-0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76-2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations

The “Diabetes Comorbidome”: A Different Way for Health Professionals to Approach the Comorbidity Burden of Diabetes

(1) Background: The disease burden related to diabetes is increasing greatly, particularly in older subjects. A more comprehensive approach towards the assessment and management of diabetes’ comorbidities is necessary. The aim of this study was to implement our previous data identifying and representing the prevalence of the comorbidities, their association with mortality, and the strength of their relationship in hospitalized elderly patients with diabetes, developing, at the same time, a new graphic representation model of the comorbidome called “Diabetes Comorbidome”. (2) Methods: Data were collected from the RePoSi register. Comorbidities, socio-demographic data, severity and comorbidity indexes (Cumulative Illness rating Scale CIRS-SI and CIRS-CI), and functional status (Barthel Index), were recorded. Mortality rates were assessed in hospital and 3 and 12 months after discharge. (3) Results: Of the 4714 hospitalized elderly patients, 1378 had diabetes. The comorbidities distribution showed that arterial hypertension (57.1%), ischemic heart disease (31.4%), chronic renal failure (28.8%), atrial fibrillation (25.6%), and COPD (22.7%), were the more frequent in subjects with diabetes. The graphic comorbidome showed that the strongest predictors of death at in hospital and at the 3-month follow-up were dementia and cancer. At the 1-year follow-up, cancer was the first comorbidity independently associated with mortality. (4) Conclusions: The “Diabetes Comorbidome” represents the perfect instrument for determining the prevalence of comorbidities and the strength of their relationship with risk of death, as well as the need for an effective treatment for improving clinical outcomes