Pandemic H1N1 illness prognosis: evidence from clinical and epidemiological data from the first pandemic wave in São Paulo, Brazil

OBJECTIVES: The pandemic of 2009 H1N1 influenza A emerged in February 2009, with high morbidity and mortality, and rapidly spread globally. São Paulo was among the most affected areas in Brazil. This study compares the clinical and epidemiological characteristics of influenza-like illness between outpatients and hospitalized patients and evaluates the impact of oseltamivir therapy on the outcome of 2009 H1N1 influenza A patients. METHODS: This is a case series study comparing the clinical and epidemiological characteristics of influenza-like illness between outpatients attended at Hospital São Paulo in August 2009 (the peak of the first pandemic wave) and those patients hospitalized between May and September 2009 (the entire first pandemic wave). RESULTS: The 1651 patients evaluated were predominantly female (927×686, p<0.001) and aged 31.71±16.42 years, with 148 reporting chronic pulmonary disease. Dyspnea was presented by 381 (23.4%) patients and was more frequent among those aged 30 years or more (p<0.001). Hospitalization occurred at 3.73±2.85 days, and antiviral treatment started 2.27±2.97 days after the onset of first symptoms. A delay of more than 5 days in starting oseltamivir therapy was independently associated with hospitalization (p<0.001), a stay in the ICU (p<0.001) and a higher risk of dying (OR = 28.1, 95% CI 2.81-280.2, p = 0.007). CONCLUSION: The 2009 pandemic of H1N1 influenza A affected young adults, presented a significant disease burden and produced severe cases with a significant fatality rate. However, promptly starting specific therapy improved the outcome.Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Laboratório de Virologia ClínicaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaHospital São Paulo Unidade de Doenças InfecciosasUniversidade de São Paulo Faculdade de MedicinaUNIFESP, EPM, Laboratório de Virologia ClínicaUNIFESP, EPM, Depto. de MedicinaHospital São Paulo Unidade de Doenças InfecciosasSciEL

Pandemic H1N1 illness prognosis: evidence from clinical and epidemiological data from the first pandemic wave in São Paulo, Brazil

OBJECTIVES: The pandemic of 2009 H1N1 influenza A emerged in February 2009, with high morbidity and mortality, and rapidly spread globally. São Paulo was among the most affected areas in Brazil. This study compares the clinical and epidemiological characteristics of influenza-like illness between outpatients and hospitalized patients and evaluates the impact of oseltamivir therapy on the outcome of 2009 H1N1 influenza A patients. METHODS: This is a case series study comparing the clinical and epidemiological characteristics of influenza-like illness between outpatients attended at Hospital São Paulo in August 2009 (the peak of the first pandemic wave) and those patients hospitalized between May and September 2009 (the entire first pandemic wave). RESULTS: The 1651 patients evaluated were predominantly female (927×686,

Análise da prescrição e dispensação de medicamentos psicotrópicos em dois municípios do Estado de São Paulo

OBJECTIVES: To investigate the prescription and dispensation of psychotropic medications through the analysis of the prescriptions/notices kept at various institutions in two cities in the state of São Paulo. METHODS: The prescriptions kept at drugstores, magistral pharmacies, primary care settings and hospitals were collected and analyzed in collaboration with the Sanitary Vigilance agencies in the year of 1999. The information in the prescriptions/notices were typed and tabulated. RESULTS: A total of 108,215 prescriptions were processed, being 76,954 for benzodiazepines, 26,930 for anorexigenic drugs, 3,540 for opiates and 788 for other drugs. The benzodiazepines most frequently prescribed were: diazepam (31,644), bromazepam (16,911) and clonazepam (7,929). Among the anorexigenic drugs, diethylpropion (14,800) and femproporex (10,942) were the most common. When compared to men, women were given more prescriptions, mainly for anorexigenic drugs: the ratio was 10:1 in the prescriptions for diethylpropion and femproporex. The few magistral pharmacies (n=6) handled even more prescriptions than did the drugstores (n=49). A number of errors and inconsistencies were detected in the prescriptions analyzed. CONCLUSIONS: The results confirm the occurrence of an irrational use of such medications and a series of inadequate practices related to their prescription in Brazil. Therefore, they point out to the need of a comprehensive review of the government's control system of these substances.OBJETIVOS: Analisar a prescrição e dispensação de medicamentos psicotrópicos por meio da análise das receitas/notificações retidas em diferentes estabelecimentos de dois municípios do estado de São Paulo. MÉTODOS: Em parceria com as Vigilâncias Sanitárias dos municípios, foram coletadas e analisadas as prescrições retidas em drogarias, farmácias de manipulação, postos públicos e hospitais no ano de 1999. Os dados contidos nas receitas/notificações foram digitados e tabulados. RESULTADOS: Foram processadas 108.215 prescrições, sendo 76.954 de benzodiazepínicos, 26.930 de anorexígenos, 3.540 de opiáceos e 788 de outros. Os benzodiazepínicos mais freqüentes foram: diazepam (31.644), bromazepam (16.911) e clonazepam (7.929) e, entre os anorexígenos, dietilpropiona (14.800) e femproporex (10.942). As mulheres, em geral, receberam mais prescrições em comparação com os homens, especialmente para os anorexígenos, com uma relação dez vezes maior nas prescrições de dietilpropiona e femproporex. As poucas farmácias de manipulação (n=6) chegaram a movimentar mais prescrições do que as drogarias (n=49). Também foi detectada uma série de erros e incoerências nas prescrições analisadas. CONCLUSÕES: Os resultados confirmam a ocorrência de uso irracional e uma série de práticas inadequadas que envolvem a prescrição desses medicamentos no Brasil e, portanto, indicam a necessidade de uma ampla revisão no atual sistema de controle dessas substâncias no país.Brazilian Information Center on Psychotropic DrugsFederal University of São Paulo Paulista Medical School Department of PsychobiologyUNIFESP, EPM, Department of PsychobiologySciEL