Medication reconciliation in the elderly: a literature review

INTRODUCTION: Aging people represent a growing population in Brazil and worldwide. Physiological changes due to age, comorbidities, and polypharmacy make them highly susceptible to adverse drug events. Medication reconciliation may be a useful strategy to reduce these events, when the patient is transferred between different levels of health care. OBJECTIVE: To conduct a review of the literature on medication reconciliation in elderly people in the transition of health care. METHODOLOGY: It was done an overview of the literature available in PubMed. INCLUSION CRITERIA WERE: population involving exclusively elderly or mostly elderly; language in English, Spanish or Portuguese; articles published in the last five years. Two reviewers examined the titles and abstracts, and proceeded in a completed reading of each article and the inclusion of the most relevant ones. RESULTS: Twelve studies were included. Half described the rate and types of discrepancies in the transition points; highlighting the drug omission as the main discrepancy. Three assessed the contribution of pharmacists in the process, indicating the higher quality obtained with their involvement. Five analyzed the consistency of the information provided in the continuity of care and the impact of medication reconciliation on medication errors, demonstrating the importance of collecting an initial precise medication history to reduce adverse events, polypharmacy and medication errors. CONCLUSION: Medication reconciliation may be an important tool for the safety of elderly patients in the transition of health care. The role of the pharmacist and the integrity of the medication history were related to the improvement of the process and patient care.</p

Anxiolytics, Sedatives, and Hypnotics Prescribed by Dentists in Brazil in 2010

Objective. To describe dental prescriptions for anxiolytics, sedatives, and hypnotics for Brazilian outpatients in 2010. Methods. A cross-sectional study was conducted using data on the use of anxiolytics, sedatives, and hypnotics from the Brazilian Health Surveillance Agency, Brazil, 2010. For each prescription, prescribed drugs and the prescribed amount were identified. Prescribed medications were classified according to Anatomical Therapeutic Chemical code. We calculated the number of Defined Daily Doses (DDD) for anxiolytics, sedatives, and hypnotics by code, their mean DDD, and DDD per inhabitant per year. Results. There were 16,436 prescriptions dispensed, including anxiolytics, sedatives, and hypnotics. These prescriptions corresponded to 3,555,780.50 mg, distributed as 2,286,200.50 mg (64.30%) of anxiolytics and 1,269,580.00 mg (35.70%) of sedatives and hypnotics. This amount allowed treating approximately 474,106 individuals (number of DDD). The anxiolytics most frequently dispensed were bromazepam (25.30%), alprazolam (19.19%), and diazepam (15.60%). Sedatives and hypnotics mostly prescribed were zolpidem (9.55%), midazolam (6.99%), and flunitrazepam (2.14%). The per capita rates (100,000 inhabitants) of anxiolytics and sedatives/hypnotics were 6.83 and 1.78, respectively. Conclusions. Benzodiazepines and derivatives were the most frequently prescribed drugs. There was a low rate of dental prescriptions for anxiolytics, sedatives, and hypnotics, although excessive doses were concentrated in the same prescription

Evaluation of the In vitro leishmanicidal and In vivo acute oral toxicity of the Caesalpinia echinata L. extracts as source of natural products against Leishmaniasis

Submitted by Nuzia Santos ([email protected]) on 2015-03-02T11:47:49Z No. of bitstreams: 1 2014_117.pdf: 707401 bytes, checksum: 0f71bb7341baea2f96798e66b6aaca36 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-03-02T11:47:57Z (GMT) No. of bitstreams: 1 2014_117.pdf: 707401 bytes, checksum: 0f71bb7341baea2f96798e66b6aaca36 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-03-02T11:52:54Z (GMT) No. of bitstreams: 1 2014_117.pdf: 707401 bytes, checksum: 0f71bb7341baea2f96798e66b6aaca36 (MD5)Made available in DSpace on 2015-03-02T11:52:54Z (GMT). No. of bitstreams: 1 2014_117.pdf: 707401 bytes, checksum: 0f71bb7341baea2f96798e66b6aaca36 (MD5) Previous issue date: 2014Fundação Oswaldo Cruz. Centro de Pesquisa Rene Rachou. Laboratorio de Quimica de Produtos Naturais. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Centro de Pesquisa Rene Rachou. Laboratorio de Quimica de Produtos Naturais. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Centro de Pesquisa Rene Rachou. Laboratorio de Quimica de Produtos Naturais. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Centro de Pesquisa Rene Rachou. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Centro de Pesquisa Rene Rachou. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Centro de Pesquisa Rene Rachou. Belo Horizonte, MG, Brazil.Fundação Oswaldo Cruz. Centro de Pesquisa Rene Rachou. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Departamento de Fisiologia e Biofisica. Belo Horizonte, MG, BrazilUniversidade Federal de Minas Gerais. Departamento Clinico e Cirurgico Veterinario. Laboratorio de Patologia e Toxicologia. Belo Horizonte, MG, BrasilFundação Oswaldo Cruz. Centro de Pesquisa Rene Rachou. Laboratorio de Quimica de Produtos Naturais. Belo Horizonte, MG, Brazil.With the purpose of discovery leishmanicidal secondary metabolites from natural products, crude ethanolic extract (EE) from stems of the Caesalpinia echinata was assayed to verify its in vitro leishmanicidal activity. The EE showed in vitro growth inhibition activities of 90% against amastigote-like of Leishmania (Leishmania) amazonensis. The EE was then submitted to fractionation by Gel Permeation Chromatography (GPC) yielding fifteen fractions (F1 to F15). The same biological assay was performed for the fifteen fractions and the fractions F9 to F11 showed in vitro growth inhibition activities around 80%. The fractions F9 to F11 were pooled to produce an enriched fraction named EF. Evaluation of the acute toxicity of the EE and EF were carried out with Swiss-Webster mice, orally treated by a single oral dose of 300mg of the samples (EE and EF)/kg of body to verify changes in hematological and biochemical profiles and 5.0g of the samples (EE and EF)/kg body to verify the toxicity and safety in using EE and EF as therapeutic agents in the treatment of the leishmaniasis. After preliminary results, the LD50 concentration was estimated to be greater than 5.0g/kg body for both samples (EE and EF) by oral route. The EE and EF of the C. echinata were actives in vitro experiments and nontoxic for mice, moreover these experiments proved to be the first steps towards the development of leishmanicidal agents from C. echinata

Spoligotyping and variable number tandem repeat analysis of Mycobacterium bovis isolates from cattle in Brazil

We performed spoligotyping and 12-mycobacterial interspersed repetitive unit-variable number tandem repeats (MIRU-VNTRs) typing to characterise Mycobacterium bovis isolates collected from tissue samples of bovines with lesions suggestive for tuberculosis during slaughter inspection procedures in abattoirs in Brazil. High-quality genotypes were obtained with both procedures for 61 isolates that were obtained from 185 bovine tissue samples and all of these isolates were identified as M. bovis by conventional identification procedures. On the basis of the spoligotyping, 53 isolates were grouped into nine clusters and the remaining eight isolates were unique types, resulting in 17 spoligotypes. The majority of the Brazilian M. bovis isolates displayed spoligotype patterns that have been previously observed in strains isolated from cattle in other countries. MIRU-VNTR typing produced 16 distinct genotypes, with 53 isolates forming eight of the groups, and individual isolates with unique VNTR profiles forming the remaining eight groups. The allelic diversity of each VNTR locus was calculated and only two of the 12-MIRU-VNTR loci presented scores with either a moderate (0.4, MIRU16) or high (0.6, MIRU26) discriminatory index (h). Both typing methods produced similar discriminatory indexes (spoligotyping h = 0.85; MIRU-VNTR h = 0.86) and the combination of the two methods increased the h value to 0.94, resulting in 29 distinct patterns. These results confirm that spoligotyping and VNTR analysis are valuable tools for studying the molecular epidemiology of M. bovis infections in Brazil