Impact of pharmacist intervention in patients with Alzheimer's disease

Abstract To assess the therapy relative to indication, effectiveness, safety and adherence in patients with Alzheimer's disease (AD). An interventional, prospective, non-randomized study was conducted in a single secondary care center in Brazil. The pharmacist-led medication therapy management (MTM) was conducted to detect drug-related problems (DRPs) at baseline and after six months of intervention. The health status outcomes (i.e. cognitive screening tests; levels of glucose; total cholesterol; triglycerides; thyroid stimulating hormone; serum free thyroxine and blood pressure) were measured. 66 patients with AD were included, of whom 55 patients completed the follow-up of six months. 36 patients (36/55) were non-adherent to AD drug therapy. Out of detected 166 DRPs, 116 were solved. Four patients were withdrawn from the AD protocol due to resolution of prodromal symptoms. On the conclusion of the study, the MTM improved and controlled blood pressure, glucose, total cholesterol, triglycerides levels (p<0.05). The pharmacist-led MTM was effective in solving 69.8% of DRPs, improving and controlling the clinical parameters evaluated

Nanocellulose-collagen-apatite composite associated with osteogenic growth peptide for bone regeneration.

Despite advances in the field of biomaterials for bone repair/regeneration, some challenges for developing an ideal bone substitute need to be overcome. Herein, this study synthesized and evaluated in vitro a nanocomposite based on bacterial cellulose (BC), collagen (COL), apatite (Ap) and osteogenic growth peptide (OGP) or its C-terminal pentapeptide [OGP(10-14)] for bone regeneration purposes. The BC-COL nanocomposites were successfully obtained by carbodiimide-mediated coupling as demonstrated by spectroscopy analysis. SEM, FTIR and 31P NMR analyses revealed that in situ synthesis to apatite was an effective route for obtaining of bone-like apatite. The OGP-containing (BC-COL)-Ap stimulated the early development of the osteoblastic phenotype. Additionally, the association among collagen, apatite, and OGP peptides enhanced cell growth compared with OGP-containing BC-Ap. Furthermore, none of the nanocomposites showed cytotoxic, genotoxic or mutagenic effects. These promising results suggest that the (BC-COL)-Ap associated with OGP peptides might be considered a potential candidate for bone tissue engineering applications.

Effect of clinical use of nickel-titanium springs.

INTRODUCTION: Our objectives were to determine whether there are changes on the load deflection rate (L/DP) and the average force (FP) of the superelastic pseudoplateau, and whether permanent deformation is changed in nickel-titanium closed-coil springs (CCSs) after 6 months of clinical use. METHODS: Twenty-two nickel-titanium CCSs (Sentalloy 100 g; Dentsply GAC, York, Pa) were subjected to tensile mechanical testing at 37°C on activations varying from 3.2 to 16.0 mm before and after 6 months of clinical use. A regression line was fitted over the most horizontal area of the unloading part of the stress-strain graph of every CCS, and its slope was used as L/DP. The FP was determined by the midpoint of the longest segment of the curve that could be fit within the regression line with a R(2) of at least 0.999, and permanent deformation was determined graphically by obtaining the strain value when the measured stress reached zero. The data were analyzed by 3 analyses of variance at 2 levels, with 5% of significance. RESULTS: Time and activation significantly influenced the variables tested (P < 0.001). Time increased the L/DP and permanent deformation but decreased the FP. Activation decreased L/DP, FP, and permanent deformation. Significant interactions between time and activation were detected for FP (P = 0.013) and deformation (P < 0.001). CONCLUSIONS: After 6 months of active clinical use, the analyzed springs had a significant but small increase in their L/DP; FP dropped up to 88%, and the CCSs deformed up to 1.26 mm.

Expression of the interleukin-10 signaling pathway genes in individuals with Down syndrome and periodontitis.

BACKGROUND: Individuals with Down syndrome (DS) have a higher prevalence and severity of periodontal disease, which cannot be explained by poor oral hygiene alone and is related to changes in the immune response. The aim of this study is to evaluate whether DS was associated with differential modulation of expression of genes associated with proinflammatory and anti-inflammatory responses in periodontal disease. METHODS: A total of 51 individuals were evaluated: 19 individuals with DS and periodontal disease (group 1), 20 euploid individuals with periodontal disease (group 2; positive control), and 12 euploid individuals without periodontal disease (group 3; negative control). Clinical periodontal evaluation and gingival biopsies were performed. Quantitative reverse transcription-polymerase chain reaction was used to determine expression levels of interleukin-10 (IL-10), the receptors IL-10RA and IL-10RB, intracellular adhesion molecule 1 (ICAM-1), interferon-γ-inducible protein 10 (IP-10), and the signaling intermediates Janus kinase 1, signal transducer and activator of transcription 3 (STAT-3), and suppressor of cytokine signaling 3 (SOCS-3). RESULTS: Expression of IL10, SOCS3, IP10, and ICAM1 mRNA in DS patients was significantly lower compared to euploid individuals with periodontal disease, whereas IL-10RB and STAT-3 mRNA levels were higher in individuals with DS. CONCLUSION: Reduced expression of IL-10 coupled with a possible increase of STAT3 activation (increase of STAT3 and reduction of SOCS3 mRNA) indicates an important modulation of the immune response, with attenuation of anti-inflammatory and increase of proinflammatory mediators. This modulation may be related to the increased prevalence and severity of periodontitis in individuals with DS.

Clinical and demographic characteristics of patients hospitalized with tuberculosis in Brasil between 1994 and 2004.

OBJECTIVE: To describe the demographic and clinical characteristics of patients with tuberculosis hospitalized in the Nestor Goulart Reis Hospital, located in the city of Américo Brasiliense, Brazil. METHODS: Epidemiological investigation by means of an observational, retrospective, descriptive study based on the medical charts of patients diagnosed with tuberculosis and hospitalized between 1994 and 2004. RESULTS: There were 1787 patients diagnosed with tuberculosis during the period evaluated. Of those, 117 (7%) were females, 1670 (93%) were males; 1215 (68%) were single, separated or widowed. Most of the patients (74%) had not completed middle school, and most (63%) were between 30 and 50 years of age. In addition, 61% suffered from alcoholism. The most common occupation was farm worker (25% of the patients), and 70% of the patients were unemployed. The most common clinical form of the disease was the pulmonary form (in 92%). The rate of medical discharge was 60%. The treatment regimen differed from the standard (rifampin, isoniazid and pyrazinamide) in 34% of the cases. CONCLUSIONS: The profile of the patients with tuberculosis hospitalized in the hospital studied showed that they had special requirements: they were unable to take care of themselves (social cases) and required alternative treatment regimens, which justified their hospitalization. This hospital played an important social role in the treatment and guidance of these patients.

Características clínico-demográficas de pacientes hospitalizados com tuberculose no Brasil, no período de 1994 a 2004 / Clinical and demographic characteristics of patients hospitalized with tuberculosis in Brasil between 1994 and 2004

OBJETIVO: Descrever as características clínico-demográficas de pacientes com tuberculose internados no Hospital Nestor Goulart Reis, de Américo Brasiliense (SP). MÉTODOS: Investigação epidemiológica através de um estudo observacional, retrospectivo, descritivo, conforme as fichas de internações de pacientes com tuberculose, ocorridas no período de 1994 a 2004. RESULTADOS: O número de pacientes com tuberculose durante o período foi de 1787: 117 (7 por cento) eram do sexo feminino; 1670 (93 por cento) eram do sexo masculino; e 1215 (68 por cento) eram separados, solteiros ou viúvos. O grau de escolaridade mais freqüente foi o de 1º grau incompleto (74 por cento). A faixa etária mais atingida (de 30 a 50 anos) totalizou 63 por cento. O alcoolismo esteve associado em 61 por cento. A profissão mais freqüente foi a de lavrador (25 por cento) e 70 por cento dos pacientes estavam desempregados. A forma clínica mais freqüente foi a pulmonar (92 por cento). O índice de alta por indicação médica foi de 60 por cento. Em 34 por cento dos casos foi utilizado um esquema terapêutico diferente do usual (rifampicina, isoniazida e pirazinamida). CONCLUSÕES: O perfil dos internos para tratamento da tuberculose neste hospital indicou que estes tinham necessidades diferenciadas: dificuldades para cuidar de si mesmos (os casos sociais) e necessidade de terapia diferenciada do esquema usual, o que justificou as internações. O Hospital cumpriu importante papel social no tratamento e orientação destes pacientes.

OBJECTIVE: To describe the demographic and clinical characteristics of patients with tuberculosis hospitalized in the Nestor Goulart Reis Hospital, located in the city of Américo Brasiliense, Brazil. METHODS: Epidemiological investigation by means of an observational, retrospective, descriptive study based on the medical charts of patients diagnosed with tuberculosis and hospitalized between 1994 and 2004. RESULTS: There were 1787 patients diagnosed with tuberculosis during the period evaluated. Of those, 117 (7 percent) were females, 1670 (93 percent) were males; 1215 (68 percent) were single, separated or widowed. Most of the patients (74 percent) had not completed middle school, and most (63 percent) were between 30 and 50 years of age. In addition, 61 percent suffered from alcoholism. The most common occupation was farm worker (25 percent of the patients), and 70 percent of the patients were unemployed. The most common clinical form of the disease was the pulmonary form (in 92 percent). The rate of medical discharge was 60 percent. The treatment regimen differed from the standard (rifampin, isoniazid and pyrazinamide) in 34 percent of the cases. CONCLUSIONS: The profile of the patients with tuberculosis hospitalized in the hospital studied showed that they had special requirements: they were unable to take care of themselves (social cases) and required alternative treatment regimens, which justified their hospitalization. This hospital played an important social role in the treatment and guidance of these patients.