Tratamento medicamentoso do infarto agudo do miocárdio no Hospital de Clínicas de Porto Alegre

OBJECTIVE: To determine the prescription rates of thrombolytics, aspirin, betaadrenergic antagonists and angiotensin-converting-enzyme inhibitors during the acutephase of the infarction, and to determine the prescription rates of aspirin, betaadrenergic antagonists, and angiotensin-converting-enzyme inhibitors for secondaryprophylaxis.MATERIALS AND METHODS: The prescription rates were determined by reviewing the medical records of all patients whose diagnosis of acute myocardial infarctionwas made at Hospital de Clínicas de Porto Alegre from January 1996 to February 1997.RESULTS: We identified 100 patients, with a mean age of 63 ± 13 years, 58% men and 89% white. The drug prescription rates in the acute phase were: 41% forthrombolytics, 97% for aspirin, 81% for beta-adrenergic antagonists and 38% for angiotensin-converting-enzyme inhibitors. The secondary prophylaxis prescriptionrates were: 71% for aspirin, 68% for beta-adrenergic antagonists and 45% for angiotensin-converting-enzyme inhibitors.CONCLUSION: The prescripition rates forthe drugs listed above are still bellow the ideal ranges, although they are comparable to the rates reported in the medicalliterature.OBJETIVO: Determinar a taxa de prescrição de trombolíticos, aspirina, betabloqueadores e inibidores da enzima conversora da angiotensina na fase aguda doinfarto e, no caso dos três últimos fármacos citados, na profilaxia secundária do infarto agudo do miocárdio.MATERIAIS E MÉTODOS: As taxas de prescrição foram determinadas mediante revisão de prontuários de todos os pacientes que estiveram internados com odiagnóstico de infarto agudo do miocárdio no Hospital de Clínicas de Porto Alegre entre janeiro de 1996 e fevereiro de 1997.RESULTADOS: Foram identificados 100 pacientes, com uma idade média de 63 ± 13 anos, 58% homens e 89% brancos. As taxas de prescrição dos fármacos nafase aguda foram: 41% para trombolíticos, 97% para aspirina, 81% para betabloqueadores e 38% para inibidores da enzima conversora. As taxas de prescriçãona profilaxia secundária foram: 71% para aspirina, 68% para beta-bloqueadores e 45% para inibidores da enzima conversora.CONCLUSÃO: As taxas de prescrição dos fármacos acima citados ainda encontramse abaixo dos valores ideais, apesar de serem comparáveis às taxas relatadas na literatura

Translation of the Multiple Sclerosis Quality of Life-54 : Brazilian version

Objective: This study translated the Portuguese version of the Multiple Sclerosis Quality of Life-54 (MSQoL-54) questionnaire. Methods: The original version of 18 items from the MSQoL-54 was translated into Brazilian Portuguese using international guidelines. Two independent translations were completed by Brazilians fluent in English and the results were evaluated and harmonized, concluding version: 1. This version was back-translated by an American living in Brazil and then another analysis was conducted, resulting in version 2. Concluding the translation and harmonization phase, the final version was pre-tested with ten participants from the Reference Centre for Multiple Sclerosis at the Porto Alegre Clinical Hospital in Rio Grande do Sul (RS)-Brazil. Results: The questionnaire was well accepted by the patient’s sample that tested the 18 specific items. They presented no conceptual problems. Conclusion: Patients with multiple sclerosis (MS) felt the questionnaire was easy to understand. We thus attained terms of conceptual equivalence between the original questionnaire and the translation

Interferon-lambda 3 and 4 polymorphisms increase sustained virological responses and regulate innate immunity in antiviral therapy with pegylated interferon-alpha

Sustained virologic response (SVR) in chronic hepatitis C (CHC) treatment denotes that the host genetics controls the immune response and unequivocally contribute to viral clearance or disease severity. In this context, single nucleotide polymorphisms (SNPs) in the locus of interferon lambda 3 and 4 genes (IFNL3/4) have been important genetic markers of responsiveness to CHC as prognostic markers for the pegylated-Interferonalpha/ ribavirin (Peg-IFN-a/RBV). Here, we analyzed 12 SNPs at the IFNL3/4 region in 740 treatment-naïve patients with CHC infected with hepatitis C virus (HCV) genotypes 1, 2, or 3 treated with Peg-IFN-a/RBV. Individually, rs12979860-CC, rs8109886-CC, or rs8099917-TT were predictive markers of SVR, while rs12979860-CC demonstrated the stronger effect. Besides, the genotypic combination of these three predictors’ genotypes, CC/CC/TT, increased the rate of SVR. Serum levels of cytokines and gene expression analysis on the genes IFNL3, IFNL4, IFNA1, and some of the IFN-stimulated genes (ISGs) were measured in a subgroup of 24 treated patients and 24 healthy volunteers. An antagonist effect was highlighted between the expression of IFNL3/4 and IFNA1 mRNA among patients. Besides, a prominent production of the proinflammatory chemokines CCL4 and CXCL10 was observed at a 12-week treatment follow-up. Lower serum levels of these chemokines were detected in patients with an rs12979860-CC genotype associated with the better treatment outcome. Also, lower expression levels of the IFI6, IFI16, IRF9 genes were observed among rs12979860-CC individuals. In conclusion, a combination of the genotypes at the IFNL3/4 locus can act as a better marker for the prognosis for virological responses in an admixed Brazilian population presenting the modulating effect over innate immunity and inflammation that are controlling the outcome of the viral infection, but also other infectious diseases

Pharmaceutical care in the Brazilian public health system : a successful experience example with hepatitis C patients

Existem evidências relevantes, mas não definitivas, de que a Atenção Farmacêutica aumenta a qualidade e adesão aos tratamentos e melhora desfechos clínicos. Seguindo recomendação do Protocolo Clínico e Diretrizes Terapêuticas do Ministério da Saúde a Secretaria Estadual de Saúde do Rio Grande do Sul implementou um serviço voltado para o atendimento dos portadores de hepatite C, com intuito de melhoria do atendimento dos usuários e otimização do tratamento com interferon peguilado e ribavirina. Métodos: O processo envolveu a criação de um serviço de aplicação e acompanhamento dos pacientes em tratamento com interferon peguilado e ribavirina com objetivo específico de promover Atenção Farmacêutica plena aos portadores de hepatite C em tratamento. Os pacientes foram acompanhados em entrevistas mensais com o profissional farmacêutico, nas quais são questionados quanto ao aparecimento de reações adversas, bem como realizada a monitorização dos exames laboratoriais e orientações sobre o tratamento e a doença. A aplicação do medicamento foi realizada pela enfermeira, o que permitiu o compartilhamento das ampolas e redução de custos. Após 10 meses da implementação do trabalho foi realizada uma pesquisa de satisfação para avaliação da qualidade do ser viço prestado. Resultados: Foram atendidos no serviço 395 pacientes com hepatite crônica pelo vírus C, sendo que 230 já concluíram o tratamento, com uma economia de 1.300.000 reais/ano e 100% de satisfação dos usuários. Discussão e Conclusão: A criação deste serviço gerou melhoria do atendimento dos usuários do SUS, permitiu otimização dos recursos públicos e ainda promoveu a pesquisa clínica no país, podendo servir como modelo para outras regiões do Brasil e para outros países.There are relevant but not definitive scientific evidence that Pharmaceutical Attention improves care quality as well the adhesion to medical treatments and clinical outcomes. Following recommendation from the Brazilian Ministry of Health and its Clinical Guidelines the Health State Authority of Rio Grande do Sul implemented a service to provide care to patients who needed treatment for chronic hepatitis C. The intention was to improve the care quality and treatment dose optimization with peguinterferon and ribavirin. An outcome clinic were prepared to provide peguinterferon injection (avoid vial content waste) and created individually ribavirin delivery to patients using the concepts of Pharmaceutical Attention as standard of treatment. Until now 395 patients with genotype 1 chronic hepatitis C were followed by the service and 230 had already finished at the end of 48 weeks of treatment. With this method the cost-saving (R$1.300,000 approximately U$ 600,000 per year) 100% of patients declaring fully satisfaction with the car e provided at the center. The implementation of that cost-saving intervention might be useful to other regions in Brazil and also to other countries

Impacts of implementing a reference center in special nutritional formulae

Introdução: Em 2005, no Estado do Rio Grande do Sul, foi criado o Centro de Referência para Assessoria em Fórmulas Nutricionais Especiais (CR), com a finalidade de avaliar tecnicamente as solicitações de fórmulas nutricionais especiais (FNE), pelos usuários do SUS, à Secretaria Estadual de Saúde. O objetivo deste estudo é comparar características de solicitações e usuários e estimar custos em dois períodos pós-implantação do CR no Estado do RS. Métodos: A unidade de pesquisa foi cada solicitação de FNE. Os grupos de comparação foram constituídos por todas as solicitações avaliadas no primeiro (período 1 / n = 1077) e terceiro (período 2 / n = 944) anos de funcionamento do CR. Resultados: Houve aumento da proporção de solicitações judiciais (p<0,001), melhora do preenchimento das requisições (p<0,001) e do percentual de aprovações aos pedidos de FNE (p<0,001), para mais usuários (p=0,004). Aumentaram as solicitações para desnutridos (p=0,002) e idosos (p<0,001) e reduziram as duplicidades de solicitações no período (p<0,001). O custo estimado por usuário diminuiu de US$8,742 para US$ 6,297. Conclusões: A implantação do CR contribuiu para aprimorar o processo de solicitação e análise de pedidos de FNE, repercutindo em mais avaliações favoráveis ao fornecimento de fórmulas, para mais usuários, a menores custos.Introduction: In 2005, the Center of Reference (CR) for Consultancy in Nutritional Special Formulas was created in the State of Rio Grande do Sul in order to technically evaluate the requests for special nutritional formulas (SNF) made by SUS users to the State Department of Health. The aim of this study is to compare the characteristics of applications and users and to estimate costs in both periods after implementation of the CR in the state of RS. Methods: The research unit was each requested SNF. The comparison groups were composed of all requests evaluated in the first (period 1 / n = 1077) and third (period 2 / n = 944) years of the CR. Results: Increased proportion of court orders (p<0.001), improvement of the fulfillment of orders (p<0.001) and of the percentage of approvals of applications for SNF (p<0.001) for more users (p=0.004). There were increased requests for malnourished (p = 0.002) and elderly (p<0.001) and decreased duplications of requests in the period (p<0.001). The estimated cost per user declined from US$8,742 to US$ 6,297. Conclusions: The implementation of this CR has helped to improve the process to request and review applications for SNF, reflecting more favorable ratings in the supply of formulas, to more users and at lower costs

A population-based study of tuberculosis incidence among rheumatic disease patients under anti-tnf treatment

Introduction Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. The advent of immunobiologic therapy with TNF inhibitors agents, has been associated with a significant increase in incident cases of tuberculosis in this population. Objective To estimate the incidence of tuberculosis in patients receiving TNF inhibitors therapy for rheumatic diseases. As secondary objectives, we sought to evaluate mortality and the clinical impact of screening for latent tuberculosis infection. Methods This retrospective study included patients with rheumatic diseases of Public Health System from the Brazilian state, a high TB incidence area, who received prescriptions of TNF inhibitors agents between 2006 and 2016. Results A total of 5853 rheumatic disease patients were included. Patients were predominantly women (68.7%) aged 49.5 (± 14.7) years old. Forty-three cases of TB were found (2.86 cases per 1000 person-years; 18 times higher than in the general population). Adalimumab and certolizumab users presented a higher risk for TB development compared to etanercept users (RR: 3.11, 95%CI 1.16–8.35; 7.47, 95%CI 1.39–40.0, respectively). In a subgroup of patients, screening for latent tuberculosis infection was performed in 86% of patients, and 30.2% had a positive tuberculin skin test. Despite latent TB treatment, TB was diagnosed in 2 out of 74 (2.7%) patients. Overall, TB diagnosis did not increase mortality. Conclusion In this population-based study of rheumatic disease patients from a high incident area, TNF inhibitor exposure was associated with an 18-time increased TB incidence. Adalimumab and certolizumab were associated with greater and earlier TB diagnosis compared to etanercept