Lithium interactions with non-steroidal anti-inflammatory drugs and diuretics – A review

Background: Lithium is often used in bipolar disorder and occasionally in unipolar depression. Non-steroidal anti-inflammatory drugs (NSAIDs) and diuretics are frequently prescribed and their interaction with lithium is based mainly in few small studies. Objectives: Conduct a review, identify different interaction patterns and discuss treatment options. Methods: Three searches were made in PubMed in January 2016: 1) using the keywords “lithium” [and] “non-steroidal anti-inflammatory”; 2) using the keywords “lithium” [and] “diuretics” and the filter “title/abstract”; 3) using the terms “lithium” [and] “toxicity” and the filters “title” [and] “review”. From the 293 remaining articles, 10 were selected. Another search in Scielo.org was made, using the term “lítio” and the filter “Psiquiatria”. Two articles were selected from the initial 53. Six textbooks were added to expand the evidence, achieving a total of 18 references. Results: The majority of NSAIDs and diuretics rises lithium levels, specially thiazides. However, some show great variability or no interaction at all, and others even decrease lithium levels. Discussion: Lower-doses, shorter durations, lithium adjustments and levels' follow-ups are recommended, especially in elderly and multiple co-morbid patients

Resting heart rate as a predictor of metabolic dysfunctions in obese children and adolescents

<p>Abstract</p> <p>Background</p> <p>Recent studies have identified that a higher resting heart rate (RHR) is associated with elevated blood pressure, independent of body fatness, age and ethnicity. However, it is still unclear whether RHR can also be applied as a screening for other risk factors, such as hyperglycemia and dyslipidemia. Thus, the purpose of the presented study was to analyze the association between RHR, lipid profile and fasting glucose in obese children and adolescents.</p> <p>Methods</p> <p>The sample was composed of 180 obese children and adolescents, aged between 7-16 years. Whole-body and segmental body composition were estimated by Dual-energy X-ray absorptiometry. Resting heart rate (RHR) was measured by heart rate monitors. The fasting blood samples were analyzed for serum triglycerides, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and glucose, using the colorimetric method.</p> <p>Results</p> <p>Fasting glucose, TC, triglycerides, HDL-C, LDL-C and RHR were similar in both genders. The group of obese subjects with a higher RHR presented, at a lower age, higher triglycerides and TC. There was a significant relationship between RHR, triglycerides and TC. In the multivariate model, triglycerides and TC maintained a significant relationship with RHR independent of age, gender, general and trunk adiposity. The ROC curve indicated that RHR has a high potential for screening elevated total cholesterol and triglycerides as well as dyslipidemia.</p> <p>Conclusion</p> <p>Elevated RHR has the potential to identify subjects at an increased risk of atherosclerosis development.</p

The contribution of alpha particles to the solar wind angular momentum flux in the inner heliosphere

This is the final version. Available from EDP Sciences via the DOI in this recordContext. An accurate assessment of the Sun’s angular momentum (AM) loss rate is an independent constraint for models that describe the rotation evolution of Sun-like stars. Aims. In-situ measurements of the solar wind taken by Parker Solar Probe (PSP), at radial distances of ∼ 28−55R , are used to constrain the solar wind AM-loss rate. For the first time with PSP, this includes a measurement of the alpha particle contribution. Methods. The mechanical AM flux in the solar wind protons (core and beam), and alpha particles, is determined as well as the transport of AM through stresses in the interplanetary magnetic field. The solar wind AM flux is averaged over three hour increments, so that our findings more accurately represent the bulk flow. Results. During the third and fourth perihelion passes of PSP, the alpha particles contain around a fifth of the mechanical AM flux in the solar wind (the rest is carried by the protons). The proton beam is found to contain ∼ 10−50% of the proton AM flux. The sign of the alpha particle AM flux is observed to correlate with the proton core. The slow wind has a positive AM flux (removing AM from the Sun as expected), and the fast wind has a negative AM flux. As with previous works, the differential velocity between the alpha particles and the proton core tends to be aligned with the interplanetary magnetic field. Conclusions. In future, by utilising the trends in the alpha-proton differential velocity, it may be possible to estimate the alpha particle contribution when only measurements of the proton core are available. Based on the observations from this work, the alpha particles contribute an additional 10 − 20% to estimates of the solar wind AM-loss rate which consider only the proton and magnetic field contributions. Additionally, the AM flux of the proton beam can be just as significant as the alpha particles, and so should not be neglected in future studies.European Union Horizon 202

A contribuição do farmacêutico para a promoção do acesso e uso racional de medicamentos essenciais no SUS

Resumo O objetivo deste artigo é descrever o processo da inserção do farmacêutico na equipe de uma Unidade Básica de Saúde e os resultados na promoção do acesso e uso racional de medicamentos. Trata-se de estudo descritivo, transversal, realizado em unidade de atenção primária do município de São Paulo. As atividades do farmacêutico foram avaliadas em relação à estruturação e organização do serviço, melhoria do padrão de prescrição médica, elaboração de método de orientação e implantação de serviços farmacêuticos clínicos. A análise estatística foi realizada empregando o teste Qui-Quadrado de Pearson, com nível de significância de 5%, e o ODDs Ratio, quando comparados os períodos anterior e posterior à intervenções e resultados entre os anos de 2010 e 2011. A atuação do farmacêutico apresentou resultados estatisticamente significativos na redução da falta de medicamentos; melhora da qualidade da prescrição (com aumento do número de prescrições atendidas); redução do número de medicamentos prescritos entre os pacientes em seguimento farmacoterapêutico; e, comparando-se os anos 2010 e 2011, as recomendações de mudanças na farmacoterapia passaram a ter maior nível de aceitação. O farmacêutico contribuiu efetivamente para o acesso e a promoção do uso racional de medicamentos

Interventions designed to improve the quality and efficiency of medication use in managed care: A critical review of the literature – 2001–2007

<p>Abstract</p> <p>Background</p> <p>Managed care organizations use a variety of strategies to reduce the cost and improve the quality of medication use. The effectiveness of such policies is not well understood. The objective of this research was to update a previous systematic review of interventions, published between 1966 and 2001, to improve the quality and efficiency of medication use in the US managed care setting.</p> <p>Methods</p> <p>We searched MEDLINE and EMBASE for publications from July 2001 to January 2007 describing interventions targeting drug use conducted in the US managed care setting. We categorized studies by intervention type and adequacy of research design using commonly accepted criteria. We summarized the outcomes of well-controlled strategies and documented the significance and magnitude of effects for key study outcomes.</p> <p>Results</p> <p>We identified 164 papers published during the six-year period. Predominant strategies were: educational interventions (n = 20, including dissemination of educational materials, and group or one-to-one educational outreach); monitoring and feedback (n = 22, including audit/feedback and computerized monitoring); formulary interventions (n = 66, including tiered formulary and patient copayment); collaborative care involving pharmacists (n = 15); and disease management with pharmacotherapy as a primary focus (n = 41, including care for depression, asthma, and peptic ulcer disease). Overall, 51 studies met minimum criteria for methodological adequacy. Effective interventions included one-to-one academic detailing, computerized alerts and reminders, pharmacist-led collaborative care, and multifaceted disease management. Further, changes in formulary tier-design and related increases in copayments were associated with reductions in medication use and increased out-of-pocket spending by patients. The dissemination of educational materials alone had little or no impact, while the impact of group education was inconclusive.</p> <p>Conclusion</p> <p>There is good evidence for the effectiveness of several strategies in changing drug use in the managed care environment. However, little is known about the cost-effectiveness of these interventions. Computerized alerts showed promise in improving short-term outcomes but little is known about longer-term outcomes. Few well-designed, published studies have assessed the potential negative clinical effects of formulary-related interventions despite their widespread use. However, some evidence suggests increases in cost sharing reduce access to essential medicines for chronic illness.</p

Study of the reaction e^{+}e^{-} -->J/psi\pi^{+}\pi^{-} via initial-state radiation at BaBar

We study the process $e^+e^-\to J/\psi\pi^{+}\pi^{-}$ with initial-state-radiation events produced at the PEP-II asymmetric-energy collider. The data were recorded with the BaBar detector at center-of-mass energies 10.58 and 10.54 GeV, and correspond to an integrated luminosity of 454 $\mathrm{fb^{-1}}$. We investigate the $J/\psi \pi^{+}\pi^{-}$ mass distribution in the region from 3.5 to 5.5 $\mathrm{GeV/c^{2}}$. Below 3.7 $\mathrm{GeV/c^{2}}$ the $\psi(2S)$ signal dominates, and above 4 $\mathrm{GeV/c^{2}}$ there is a significant peak due to the Y(4260). A fit to the data in the range 3.74 -- 5.50 $\mathrm{GeV/c^{2}}$ yields a mass value $4244 \pm 5$ (stat) $\pm 4$ (syst)$\mathrm{MeV/c^{2}}$ and a width value $114 ^{+16}_{-15}$ (stat)$\pm 7$(syst)$\mathrm{MeV}$ for this state. We do not confirm the report from the Belle collaboration of a broad structure at 4.01 $\mathrm{GeV/c^{2}}$. In addition, we investigate the $\pi^{+}\pi^{-}$ system which results from Y(4260) decay

A systematic review of complex system interventions designed to increase recovery from depression in primary care

BACKGROUND: Primary care is being encouraged to implement multiprofessional, system level, chronic illness management approaches to depression. We undertook this study to identify and assess the quality of RCTs testing system level depression management interventions in primary care and to determine whether these interventions improve recovery. METHOD: Searches of Medline and Cochrane Controlled Register of Trials. 'System level' interventions included: multi-professional approach, enhanced inter-professional communication, scheduled patient follow-up, structured management plan. RESULTS: 11 trials met all inclusion criteria. 10 were undertaken in the USA. Most focussed on antidepressant compliance. Quality of reporting assessed using CONSORT criteria was poor. Eight trials reported an increase in the proportion of patients recovered in favour of the intervention group, yet did not account for attrition rates ranging from 5 to 50%. CONCLUSION: System level interventions implemented in the USA with patients willing to take anti-depressant medication leads to a modest increase in recovery from depression. The relevance of these interventions to countries with strong primary care systems requires testing in a randomised controlled trial