Analysis of pharmaceutical assistance in the Taquari Valley, Rio Grande do Sul: profile of service users and access to medication

Pharmaceutical assistance concerns actions developed by the pharmacist and other professionals with the purpose of promoting, protecting and restoring health. Medications are an essential tool in this process that focuses on the access to, and the rational use of, drugs. This study is aimed at evaluating the Pharmaceutical Assistance provided by Municipal Health Offices in the Taquari Valley, Rio Grande do Sul. For this purpose, 2,794 users of public pharmacies were interviewed and data was analyzed using descriptive statistics. The users of the public pharmacies were mainly female and individuals with low educational level and income. On average, 2.41 drugs were prescribed per medical prescription and 1.72 of these were procured. Out of the total medicines prescribed, 76.5% were listed in the municipal standard drug list (SDL). Medication was prescribed by its generic name in 81.8% of the prescriptions. Antibiotics and injections were prescribed in 11.9% and 4.0% of the prescriptions, respectively. Users' access to information is partial, which can impair adherence to the treatment. Thus, it is possible to conclude that review of the service is necessary for it to be effective.A Assistência Farmacêutica se preocupa com ações desenvolvidas pelo farmacêutico ou outros profissionais com o propósito de promover, proteger e restaurar a saúde. Medicamentos são ferramentas essenciais nesse processo, que se concentra no acesso e no uso racional de fármacos. Este estudo objetivou a avaliação da Assitência Farmacêutica suprida pela Secretaria Municipal da Saúde no Vale do Taquari, no Rio Grande do Sul. Com esse propósito, 2.794 usuários das farmácias públicas foram entrevistados e analisaram-se os dados usando estatística descritiva. Os usuários das farmácias públicas eram, principalmente, mulheres e indivíduos com baixo nível educacional e financeiro. Na média, 2,41 fármacos eram prescritos por prescrição médica e 1,72 destes foram obtidos. Do total de medicamentos prescritos, 76,5% estava inscritos na lista de medicamentos padrão do município (SDL). A medicação foi prescrita pelo nome genérico em 81,8% dos casos. Antibióticos e injeções foram prescritas em 11,9% e 4,0% das prescrições, respectivamente. O acesso dos usuários à informação é parcial, o que pode prejudicar a adesão ao tratamento. Dessa forma, é possível concluir que a revisão do serviço é necessária para que seja eficaz

Reversal of chronic stress-induced pain by transcranial direct current stimulation (tDCS) in an animal model

AbstractTranscranial direct current stimulation (tDCS) has been suggested as a therapeutic tool for pain syndromes. Although initial results in human subjects are encouraging, it still remains unclear whether the effects of tDCS can reverse maladaptive plasticity associated with chronic pain. To investigate this question, we tested whether tDCS can reverse the specific behavioral effects of chronic stress in the pain system, and also those indexed by corticosterone and interleukin-1β levels in serum and TNFα levels in the hippocampus, in a well-controlled rat model of chronic restraint stress (CRS). Forty-one adult male Wistar rats were divided into two groups control and stress. The stress group was exposed to CRS for 11 weeks for the establishment of hyperalgesia and mechanical allodynia as shown by the hot plate and von Frey tests, respectively. Rats were then divided into four groups control, stress, stress+sham tDCS and stress+tDCS. Anodal or sham tDCS was applied for 20min/day over 8 days and the tests were repeated. Then, the animals were killed, blood collected and hippocampus removed for ELISA testing. This model of CRS proved effective to induce chronic pain, as the animals exhibited hyperalgesia and mechanical allodynia. The hot plate test showed an analgesic effect, and the von Frey test, an anti-allodynic effect after the last tDCS session, and there was a significant decrease in hippocampal TNFα levels. These results support the notion that tDCS reverses the detrimental effects of chronic stress on the pain system and decreases TNFα levels in the hippocampus

Association of anxiety with intracortical inhibition and descending pain modulation in chronic myofascial pain syndrome

Background: This study aimed to answer three questions related to chronic myofascial pain syndrome (MPS): 1) Is the motor cortex excitability, as assessed by transcranial magnetic stimulation parameters (TMS), related to state-trait anxiety? 2) Does anxiety modulate corticospinal excitability changes after evoked pain by Quantitative Sensory Testing (QST)? 3) Does the state-trait anxiety predict the response to pain evoked by QST if simultaneously receiving a heterotopic stimulus [Conditional Pain Modulation (CPM)]? We included females with chronic MPS (n = 47) and healthy controls (n = 11), aged 19 to 65 years. Motor cortex excitability was assessed by TMS, and anxiety was assessed based on the State-Trait Anxiety Inventory. The disability related to pain (DRP) was assessed by the Profile of Chronic Pain scale for the Brazilian population (B:PCP:S), and the psychophysical pain measurements were measured by the QST and CPM. Results: In patients, trait-anxiety was positively correlated to intracortical facilitation (ICF) at baseline and after QST evoked pain (β = 0.05 and β = 0.04, respectively) and negatively correlated to the cortical silent period (CSP) (β = -1.17 and β = -1.23, respectively) (P <0.05 for all comparisons). After QST evoked pain, the DRP was positively correlated to ICF (β = 0.02) (P < 0.05). Pain scores during CPM were positively correlated with trait-anxiety when it was concurrently with high DRP (β = 0.39; P = 0.02). Controls’ cortical excitability remained unchanged after QST. Conclusions: These findings suggest that, in chronic MPS, the imbalance between excitatory and inhibitory descending systems of the corticospinal tract is associated with higher trait-anxiety concurrent with higher DRP

Morphine treatment alters nucleotidase activities in rat blood serum

Morphine has been widely used in neonatal pain management. However, this treatment may produce adaptive changes in several physiologic systems. Our laboratory has demonstrated that morphine treatment in neonate rats alters nucleoside triphosphate diphosphohydrolase (NTPDase) activity and gene expression in central nervous system structures. Considering the relationship between the opioid and purinergic systems, our aim was to verify whether treatment with morphine from postnatal days 8 (P8) through 14 (P14) at a dose of 5 μg per day alters NTPDase and 5′-nucleotidase activities in rat serum over the short, medium, and long terms. After the in vivo assay, the morphine group showed increased hydrolysis of all nucleotides at P30, and a decrease in adenosine 5′-diphosphate hydrolysis at P60. Moreover, we found that nucleotidase activities change with age; adenosine 5′-triphosphate hydrolysis activity was lower at P16, and adenosine 5′-monophosphate hydrolysis activity was higher at P60. These changes are very important because these enzymes are the main regulators of blood nucleotide levels and, consequently, nucleotide signaling. Our findings showed that in vivo morphine treatment alters nucleotide hydrolysis in rat blood serum, suggesting that purine homeostasis can be influenced by opioid treatment during the neonatal period

Combined neuromodulatory interventions in acute experimental pain : assessment of melatonin and non-invasive brain stimulation

Transcranial direct current stimulation (tDCS) and melatonin can effectively treat pain. Given their potentially complementary mechanisms of action, their combination could have a synergistic effect. Thus, we tested the hypothesis that compared to the control condition and melatonin alone, tDCS combined with melatonin would have a greater effect on pain modulatory effect, as assessed by quantitative sensory testing (QST) and by the pain level during the Conditioned Pain Modulation (CPM)-task. Furthermore, the combined treatment would have a greater cortical excitability effect as indicated by the transcranial magnetic stimulation (TMS) and on the serum BDNF level. Healthy males (n = 20), (aged 18–40 years), in a blinded, placebo-controlled, crossover, clinical trial, were randomized into three groups: sublingual melatonin (0.25 mg/kg) + a-tDCS, melatonin (0.25 mg/kg) + sham-(s)-tDCS, or sublingual placebo+sham-(s)- tDCS. Anodal stimulation (2 mA, 20 min) was applied over the primary motor cortex. There was a significant difference in the heat pain threshold ( C) for melatonin+a-tDCS vs. placebo+s-tDCS (mean difference: 4.86, 95% confidence interval [CI]: 0.9 to 8.63) and melatonin+s-tDCS vs. placebo+s-tDCS (mean: 5.16, 95% CI: 0.84 to 8.36). There was no difference between melatonin+s-tDCS and melatonin+a-tDCS (mean difference: 0.29, 95% CI: 3.72 to 4.23). The mean change from the baseline on amplitude of motor evocate potential (MEP) was significantly higher in the melatonin+a-tDCS (19.96% 5.2) compared with melatonin+s-tDCS group (1.36% 5.35) and with placebo+s-tDCS group (3.61% 10.48), respectively (p < 0.05 for both comparisons). While melatonin alone or combined with a-tDCS did not significantly affect CPM task result, and serum BDNF level. The melatonin effectively reduced pain; however, its association with a-tDCS did not present an additional modulatory effect on acute induced pain

Consumo de álcool e tabaco: fator de risco para doença cardiovascular em população idosa do sul do Brasil

Objective: This cross-sectional study evaluated the prevalence of tobacco and/or alcohol consumption and cardiovascular diseases in a population in southern Brazil.Methods and Individuals: study population: 229 elderly (56.3% of women and 43.7% of men) with more than 60 years living in the city of Cachoeira do Sul / RS. A structured questionnaire was used, containing information such as age, sex, education, and reports of alcohol, tobacco and cardiovascular diseases.Results: 38.4% of the interviewees reported using tobacco (66% of men and 17% of women) and 24.5% reported being ex-smokers. Gender and schooling showed a significant association with tobacco use in the multivariate analysis. Among the subjects who declared themselves smokers, 37.5% consume alcohol. Univariate and multivariate analysis indicated a significant association between heart disease and smoking. Logistic regression showed association between hypertension and smoking. The overall prevalence estimated for alcohol use was 35.4% (12.4% of women and 65% of men). About 50% of hypertensive individuals consume alcohol and we observed a significant association between age and alcohol consumption.Conclusion: This is a cross-sectional study that is not suitable for causality study. However, we can affirm that there is an association between alcohol and/or tobacco consumption and an increase in the prevalence of cardiovascular diseases in the elderly.Objetivo: este estudo transversal avaliou a associação entre consumo de tabaco e/ou de álcool e a ocorrência de doenças do sistema cardiovascular em população do sul do Brasil.Métodos e Indivíduos: a população em estudo foi constituída de 229 idosos (56,3% de mulheres e 43,7% de homens) com mais de 60 anos moradores da cidade de Cachoeira do Sul/RS. Utilizou-se questionário estruturado, contendo questões relativas aos dados pessoais (idade, sexo, grau de escolaridade), uso de álcool e tabaco e relato de doenças do sistema cardiovascular.Resultados: a prevalência estimada para uso de tabaco foi 38,4% (66% dos homens e 17% das mulheres). 24,5% são ex-tabagistas; gênero e grau de escolaridade mostraram associação com uso de tabaco. 37,5% dos tabagistas relataram uso de álcool. Ao analisarmos o relato de doenças cardíacas e consumo de tabaco, evidenciou-se associação significativa tanto na análise univariada quanto na multivariada. A regressão logística mostrou associação entre hipertensão e tabagismo. A prevalência estimada para uso de álcool foi de 35,4% (12,4% das mulheres e 65% dos homens). Cerca de 50% dos indivíduos hipertensos consomem álcool e observamos associação significativa entre idade e álcool. 19.2% relataram uso de álcool e tabaco.Conclusão: consumo de álcool e/ou tabaco traz inúmeras conseqüências negativas para a saúde, destacando-se aumento da prevalência de doenças cardiovasculares

Caracterização de Pacientes com Câncer de Mama e Critérios da National Comprehensive Cancer Network para Realização do Teste Genético BRCA1 e BRCA2

Introdução: Aproximadamente 10% dos casos de câncer de mama são atribuíveis a mutações germinativas em genes de suscetibilidade, incluindo BRCA1 e BRCA2. A National Comprehensive Cancer Network (NCCN) recomenda a triagem de mulheres com câncer de mama para mutações em BRCA1/2 em cenários definidos. No entanto, esses testes genéticos não estão disponíveis no Sistema Único de Saúde (SUS). Objetivo: Caracterizar as mulheres com câncer de mama e definir os critérios para realização do teste BRCA1/2. Método: Estudo quantitativo, descritivo, analítico e retrospectivo. Foram analisados ​​prontuários de mulheres com diagnóstico de câncer de mama pelo SUS entre janeiro de 2016 e dezembro de 2018, por meio do software JAMOVI (versão 2.3 - 2022). Resultados: Foram diagnosticadas 245 mulheres. De acordo com as diretrizes da NCCN, 97 mulheres atenderam aos critérios para realizar o teste BRCA1/2, com idade média de 47 anos, predominantemente brancas (90,7%), com comorbidades (55,6%), na pré-menopausa (59,8%), diagnosticadas nos estágios iniciais 0 - IIb (68, 2%), e 48,4% tinham histórico familiar de câncer de mama. A histologia e o subtipo molecular mais frequentes foram carcinoma ductal invasivo (87,2%) e tipo luminal (59,8%). Conclusão: Considerando os critérios da NCCN, um número significativo de mulheres diagnosticadas pelo SUS teve indicação para realização do teste BRCA1/2. Essas mulheres são mais jovens, têm menos comorbidades, estão em período pré-menopausa mais frequentemente e diferem quanto ao subtipo molecular quando comparadas àquelas sem indicação de realização do exame

Analysis of medical prescriptions dispensed in pharmacy in the Brazilian Unified Health System

Objetivo: Analisar os indicadores propostos pela Organização Mundial de Saúde (OMS) em prescrições médicas fornecidas a pacientes atendidos em Centro de Saúde do município de Lajeado – RS. Métodos: Foi realizado estudo transversal, que avaliou dados relativos ao padrão de prescrição em Sistema Único de Saúde (SUS). Resultados: Foram analisadas 292 prescrições médicas. Destas, 282 continham o nome do paciente, mas em apenas três havia o seu endereço. Em 243 prescrições, constava o nome do médico, e, em 227, havia o número de inscrição no Conselho de Medicina. Foram identificados 713 medicamentos, com média de 2,44 por prescrição, sendo aqueles com ação em sistema cardiovascular os mais prevalentes. Observou-se, ainda, que 611 medicamentos constavam da Relação Nacional de Medicamentos Essenciais (RENAME), 509 constavam da Relação Municipal de Medicamentos Essenciais (REMUME) e 489 constavam da Lista Modelo da OMS. Conclusão: A maioria dos indicadores de prescrição avaliados apresentou adequação ao que é proposto pela OMS. No entanto, ainda há dificuldades, como aquelas referentes a itens faltantes nas prescrições médicas, o que pode interferir no uso racional de medicamentos.Aim: To analyze the indicators proposed by the World Health Organization (WHO) in medical prescriptions provided to patients seen in a Health Center of the municipality of Lajeado, RS, Brazil. Methods: This was a cross-sectional study evaluating data on prescriptions of patients seen in the Brazilian Unified Health System. Results: We analyzed 292 medical prescriptions. Of these, 282 had the patient name, but only three had the address; the doctor’s name was present in 243 prescriptions; the registration number on the Board of Medicine of the prescriber was identified in 227. We identified 713 drugs, with a mean of 2.44 medicines per prescription, being the most prevalent those acting in the cardiovascular system. We also observed that 611 drugs were included in the National List of Essential Medicines (RENAME), 509 were included in the Municipal Essential Medicines List (REMUME), and 489 were included in the Model List of WHO. Conclusion: Most prescribing indicators evaluated showed adequacy regarding the propositions of WHO. However, there are still difficulties, such as those observed with missed items in the medical prescriptions, which may interfere in the rational use of medicines