Is Bariatric Surgery Effective in Reducing Comorbidities and Drug Costs? A Systematic Review and Meta-Analysis.

The aim of this study was to assess drug use and costs before and after bariatric surgery (BS). A systematic review of the literature was carried out using the MeSH terms obesity, bariatric surgery, and drug costs for searches of 10 electronic databases up to July 2014. Data were extracted from the 11 studies (37,720 patients) that fulfilled the inclusion criteria. Where applicable, data were pooled by meta-analysis. The average number of drugs per patient decreased from 3.9 ± 1.86 before surgery to 1.75 ± 1.85 after surgery. Mean reduction in total cost of drugs was 49.8 % over a follow-up duration of 6-72 months. BS is effective for the improvement or resolution of comorbidities and significantly reduces drug use and costs.

Prescribing practice for antibiotic prophylaxis for 3 commonly performed surgeries in a teaching hospital in Brazil.

BACKGROUND: The contribution of antibiotic prophylaxis to reduce surgical wound infection for some procedures is well known. In spite of extensive knowledge about the effectiveness of antibiotic prophylaxis, its administrative regimens are often inappropriate. METHODS: Antibiotic prophylaxis was evaluated in a university-affiliated community teaching hospital. Data were collected from medical records of patients undergoing cholecystectomy, hysterectomy, and herniorrhaphy during a 9-month observation period. A total of 598 procedures were observed. Data were collected about the patient, the surgery, and the antibiotic prophylaxis. RESULTS: Based on the existing guidelines, the choice to use the prophylactic antibiotic was correct in 75% of the cases. Of these cases, only 3% of the patients received the recommended regimen according to the proposed procedure. It was verified that antibiotic prophylaxis was performed more frequently in patients undergoing open cholecystectomy than laparoscopic cholecystectomy (P =.004). In 46% of the cholecystectomies, more than 4 doses were administered. In hysterectomy, a single dose was used in 54% of the patients, and the antibiotic was administered preoperatively in 80% of the cases. Prophylactic antibiotics were used in 47% of herniorrhaphies. CONCLUSION: The surgeons infrequently met the hospital guideline for antibiotic prophylaxis, and compliance varied by type of procedure.

Drug utilization study in pediatric prescriptions of a university hospital in southern Brazil: off-label, unlicensed and high-alert medications.

OBJECTIVE: To describe and determine the extent of use of unlicensed, off-label and high-alert drugs in the general pediatric units of a university hospital in southern Brazil. METHODS: A cross-sectional study conducted from November 2007 to January 2008 involving patients up to 14 years of age. Intensive care and pediatric oncology unit patients were excluded. Classification according to the Food and Drug Administration approval criteria was performed using the DrugDex-Micromedex(®) and high-alert medications were classified according to the Institute for Safe Medication Practices. RESULTS: During the study period, 342 prescriptions were analyzed. Analgesic drugs were the most frequently prescribed therapeutic class of drugs (26.9%) and antispasmodic drugs (31.5%) were the most frequently issued off-label drugs. About 12% of the prescriptions analyzed presented unlicensed drugs and 39% presented at least one off-label drug, especially in relation to its therapeutic indication (38.4%) and age (21.9%). Approximately 6% of the total (2026) were classified as high-alert medications, such as opioid analgesic drugs (35%). No association was observed between off-label use and high-alert drugs. CONCLUSION: Frequency of unlicensed and off-label drug prescriptions showed in the study is according to the literature and may be considered high. High-alert drugs, although low in frequency, can present risks due to the harmful effects they can produce in patients. Thus, the highlighted drugs in this study constitute a constant concern in hospitals.

Use of tacrolimus and the development of posttransplant diabetes mellitus: a Brazilian single-center, observational study.

INTRODUCTION: Posttransplant diabetes mellitus (PTDM) is considered to be a serious complication of kidney transplantation that may reduce patient and graft survival. The immunosuppressant tacrolimus (TAC) increases the risk of developing PTDM. PURPOSE: We sought to estimate the risk of PTDM among renal transplant recipients treated with TAC, to identify other risk factors for PTDM, and to describe its consequences. METHODS: We retrospectively analyzed 413 recipients of ages >or=18 years who were free of diabetes before kidney transplantation. They were treated with TAC, cyclosporine (CyA), or sirolimus (SIR) plus steroid therapy with a minimum follow-up posttransplant of 6 months. PTDM was diagnosed according to American Diabetes Association guidelines. RESULTS: The mean age was 42.3 years and 230 (55.7%) were male. The initial immunosuppression for 171 (41.4%) patients was TAC; 221 (53.5%), CyA; and 21 (5.1%), SIR. PTDM occurred in 85/413 (20.6%) of patients. The median time to PTDM development was 54 days posttransplant. The cumulative incidence of PTDM was 24.6% and 17.2% for TAC and CyA treatment groups, respectively. In the intention-to-treat analysis, the proportion of patients receiving TAC who developed PTDM was significantly higher than that of CyA (HR = 1.6 [1.01-2.42]; P = .04). The Kaplan-Meier method showed that 78.5% patients taking TAC were free of PTDM at 6 months compared with 88.8% taking CyA (P = .003). The other independent risk factors were body mass index (BMI; P < .0001); recipient age (P < .0001) and acute rejection episodes (AE; P = .01). Three-year actuarial graft survivals were 85.5% for PTDM patients compared with 93.3% for those without diabetes (P = .021); patient survivals, 88.9% and 96.7%, respectively (P = .017). CONCLUSION: The incidence of PTDM is associated with TAC use, recipient age, BMI, and ARE. Therefore, PTDM is an important risk factor for graft loss and mortality.

[Non-prescription drugs in Brazil]. / Medicamentos de venta libre en el Brasil.

In this study we examined the 100 over-the-counter drugs that were most widely sold in Brazil from June 1992 to June 1993. We excluded 23 food products that were classified as medicinal. The sample, which included 77 drugs, was representative of about 67% of all sales in monetary value, and 76.8% of all units sold of the different classes of over-the-counter drugs. The anatomical-therapeutic-chemical (ATC) system was used to classify the various drugs; each class of drugs was also graded according to a scale of its intrinsic value, taking into account effectiveness and risks. Most classes of drugs (91%) showed "little intrinsic value" (that is, were of questionable or no value, of relative value, or unacceptable), and 70% were fixed-dose combinations. Only 10 classes of drugs were included in the Ministry of Health's National Drug List, and four appeared in WHO's list of essential drugs. The therapeutic classes to which the drugs belonged were, in descending order of frequency, for the digestive tract, skin, genitourinary system, musculo-skeletal system, central nervous system, parasitic diseases, respiratory tract, and sensory system. The therapeutic subgroup that commanded the highest sales was that of the non-opiate analgesics and antipyretics. Our results confirm the hypothesis that over-the-counter drugs in Brazil are of poor therapeutic quality and that the use of many such drugs is a source of unnecessary expense for the population. Some of them should not be accessible to individuals who lack current knowledge of their side effects, since 25% of all cases of poisoning in the country are related to self-medication. Modifying the public's perception of the need for taking drugs to relieve their ailments is one approach that may improve their use of medications in the long term.

[Analysis of non-prescription drug radio advertising in Rio Grande do Sul State, Brazil] / Análise da publicidade de medicamentos veiculada em emissoras de rádio do Rio Grande do Sul, Brasil

Drug advertisements for non-prescription (over-the-counter) drugs on the main radio stations in the State of Rio Grande do Sul, Brazil, were analyzed as to the information provided about generic names, pharmaceutical company, composition, and dosage. From August 1995 to January 1996, 250 advertisements for 28 products were recorded. More than 80% of these advertisements provided no information on these topics and thus failed to comply with Brazilian legislation. On the contrary, a large number of advertisements (39%) emphasize absence of risks, with claims such as "no contraindications" inducing consumers to use such drugs indiscriminately. The study showed that drugs were advertised like any other merchandise with no concern over fundamental information such as product identification, precautions, and possible side effects.

Drug utilization study in pediatric prescriptions of a university hospital in southern brazil: off-label, unlicensed and high-alert medications

Objective: To describe and determine the extent of use of unlicensed, off-label and high-alert drugs in the general pediatric units of a university hospital in southern Brazil. Methods A cross-sectional study conducted from November 2007 to January 2008 involving patients up to 14 years of age. Intensive care and pediatric oncology unit patients were excluded. Classification according to the Food and Drug Administration approval criteria was performed using the Drug Dex-Micromedex® and high-alert medications were classified according to the Institute for Safe Medication Practices. Results During the study period, 342 prescriptions were analyzed. Analgesic drugs were the most frequently prescribed therapeutic class of drugs (26.9%) and antispasmodic drugs (31.5%) were the most frequently issued off-label drugs. About 12% of the prescriptions analyzed presented unlicensed drugs and 39% presented at least one off-label drug, especially in relation to its therapeutic indication (38.4%) and age (21.9%). Approximately 6% of the total (2026) were classified as high-alert medications, such as opioid analgesic drugs (35%). No association was observed between off-label use and high-alert drugs. Conclusion Frequency of unlicensed and off-label drug prescriptions showed in the study is according to the literature and may be considered high. High-alert drugs, although low in frequency, can present risks due to the harmful effects they can produce in patients. Thus, the highlighted drugs in this study constitute a constant concern in hospitals (AU)

Objetivo: Describir y determinar el alcance del uso de medicamentos de alto riesgo, no aprobados y en indicaciones no aprobadas en las unidades generales de pediatría de un hospital universitario del sur de Brasil. Métodos: Estudio transversal realizado entre noviembre de 2007 y enero de 2008 en el que participaron pacientes de hasta 14 años. Se excluyó a los pacientes de las unidades de oncología pediátrica y cuidados intensivos. La clasificación, según los criterios de aprobación de la Agencia de Alimentos y Medicamentos de EE. UU., se realizó usando DrugDex de Micromedex,®y los medicamentos de alto riesgo se clasificaron de acuerdo con el Instituto para las Prácticas de Medicación Seguras. Resultados: Durante el periodo de estudio se analizaron 342 prescripciones. Los analgésicos fueron la categoría terapéutica más prescrita, con un 26,9%, y los antiespasmódicos, con un31,5%, fueron los medicamentos más usados en indicaciones no aprobadas. Alrededor del 12%de las prescripciones correspondían a medicamentos no aprobados, y el 39% contenían al menos un medicamento para una indicación no aprobada, especialmente en relación con su indicación terapéutica (38,4%) y la edad (21,9%). Aproximadamente el 6% del total (2.026) de los fármacos se clasificaron como medicamentos de alto riesgo, y entre ellos destacaron los analgésicos opiáceos (35%). No se observó ninguna relación entre el uso de fármacos en indicaciones no aprobadas y los medicamentos de alto riesgo. Conclusión: La frecuencia de la prescripción de fármacos no aprobados y de medicamentos en indicaciones no aprobadas coincide con la hallada en la literatura, y puede considerarse alta. A pesar de su baja frecuencia, los medicamentos de alto riesgo pueden ser peligrosos, por los efectos perjudiciales que pueden causar en los pacientes. Por lo tanto, el uso de los fármacos en los que se centra este estudio constituye una alerta constante en los hospitales (AU)