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INTRODUCTION: Checkpoint inhibitors (PCI) have reached an important place in the pharmaceutical market in the treatment of various types of cancer. However, due to immune-related adverse events (IRAE) to the treatment, patients with preexisting autoimmune diseases (PAD) are excluded from clinical studies, leading to a large gap in knowledge on this topic. This study aims to discuss the use of PCI in the patients with cancer and PAD by an integrative review. METHODS: For this integrative review we carried out research from 2013 to 2022 using database platforms for observational studies reporting data from safety and efficacy of PCI in patients with cancer and PAD. RESULTS: The search resulted in 161 articles and after applying the exclusion criteria, 15 clinical studies that adopted a retrospective observational design were selected and analyzed. The age range of patients was 54-71 years, with 19-68% male. The proportion of patients clinically active or receiving immunosuppressants who were initiated on PCI ranged from 0% to 57% and 14% to 73%, respectively. The mean reported follow-up time ranged from 8.0 to 16.8 months. The occurrence of an outbreak or the new IRAE had an average of 32.6%. CONCLUSION: IRAE are frequent in patients who use PCI and have cancer and PAD, carrying discontinuation of therapy. However, the multidisciplinary team needs to be aligned to manage these situations in the best way.
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Flavonoids are a group of natural compounds that have been described in the literature as having anti-inflammatory, antioxidant, and neuroprotective compounds. Although they are considered versatile molecules, little has been discussed about their antiviral activities for neurotropic viruses. Hence, the present study aimed to investigate the pharmacological potential of flavonoids in the face of viruses that can affect the central nervous system (CNS). We carried out research from 2011 to 2021 using the Pubmed platform. The following were excluded: articles not in the English language, letters to editors, review articles and papers that did not include any experimental or clinical tests, and papers that showed antiviral activities against viruses that do not infect human beings. The inclusion criteria were in silico predictions and preclinical pharmacological studies, in vitro, in vivo and ex vivo, and clinical studies with flavonoids, flavonoid fractions and extracts that were active against neurotropic viruses. The search resulted in 205 articles that were sorted per virus type and discussed, considering the most cited antiviral activities. Our investigation shows the latest relevant data about flavonoids that have presented a wide range of actions against viruses that affect the CNS, mainly influenza, hepatitis C and others, such as the coronavirus, enterovirus, and arbovirus. Considering that these molecules present well-known anti-inflammatory and neuroprotective activities, using flavonoids that have demonstrated both neuroprotective and antiviral effects could be viewed as an alternative for therapy in the course of CNS infections.
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A adoção de medidas de biossegurança, associada à técnica asséptica durante a manipulação de antineoplásicos, é essencial para minimizar a exposição dos profissionais de saúde aos riscos inerentes a essas substâncias. O objetivo deste trabalho foi avaliar o conhecimento dos profissionais farmacêuticos quanto aos riscos presentes no processo de manipulação de medicamentos antineoplásicos e a conduta desses profissionais e dos serviços de saúde frente à análise de prescrição médica e adoção de normas de biossegurança, nos serviços de oncologia, na cidade metropolitana de Salvador, Bahia. Trata-se de um estudo de corte transversal, descritivo, com abordagem quantitativa, em 15 serviços de quimioterapia cadastrados no Cadastro Nacional de Estabelecimento de Saúde no estado da Bahia. Foram aplicados questionários semiestruturados com 27 profissionais farmacêuticos que exerciam atividades nos Serviços de Terapia Antineoplásica. Os resultados apontaram que a maioria da população do estudo não teve acesso ao conhecimento sobre biossegurança em oncologia na graduação, apesar de ter cursado a grade curricular generalista, evidenciando o despreparo do farmacêutico para atuação nesse âmbito. Encontrou-se um profissional fortemente vinculado às atividades técnico-administrativas e pouco presente na prática clínica, principalmente associado à gestão de estoque (70,37%). Os protocolos de quimioterapia antineoplásica são complexos e os pacientes oncológicos representam um grupo especial, que necessita de cuidados farmacêuticos. Concluiu-se que é necessário adotar medidas de biossegurança e uma constante atualização técnico-científica para o melhor desempenho da prática farmacêutica.
The adoption of biosafety measures, associated with the aseptic technique during the manipulation of antineoplastic, is essential to minimize the exposure of health professionals to the risks inherent to these substances. The objective of this study was to evaluate the knowledge of pharmacists regarding the risks for handling antineoplastic drugs as well as the conduct of health services and of these professionals, compared to the analysis of prescription and adoption of biosafety standards for oncology services in the metropolitan city of Salvador, Bahia. This is a cross-sectional study, with descriptive and quantitative approach, in 15 chemotherapy services registered in the National Register of Health Facility in the state of Bahia. Semi-structured questionnaires with 27 pharmacists who performed activities in Antineoplastic Therapy Services were applied. The results indicate that most of the study population didn't have access to knowledge about biosafety in Oncology graduation, despite having attended the general curriculum, showing how unprepared is the pharmacist to act in this area. A professional strongly linked to technical and administrative activities, with few presence to professional clinical practice, mainly associated with inventory management (70.37%) was found. Antineoplastic chemotherapy protocols are complex and oncology patients represent a special group in need of pharmaceutical care. In conclusion, it's necessary to adopt biosecurity measures and constant technical and scientific updates for better performance of pharmaceutical practice.
La adopción de medidas de bioseguridad, asociada a la técnica aséptica durante la manipulación de antineoplásicos, es esencial para minimizar la exposición de los profesionales de salud a los riesgos inherentes a estas sustancias. El objetivo de este estudio fue evaluar el conocimiento de los farmacéuticos sobre los riesgos que surgen en el manejo de los fármacos antineoplásicos y la conducta de estos profesionales y de los servicios de salud, en comparación con el análisis de la prescripción y adopción de normas de bioseguridad en los servicios de oncología en la ciudad metropolitana de Salvador, Bahia. Se trata de un estudio transversal, descriptivo, con abordaje cuantitativo, en quince servicios de quimioterapia inscritos en el Registro Nacional de Instituciones de Salud en el estado de Bahía. Se aplicaron cuestionarios semiestructurados con 27 farmacéuticos que realizan actividades en Servicios de Terapia antineoplásica. Los resultados indican que la mayoría de la población del estudio tuvo acceso a los conocimientos sobre bioseguridad en Oncología en la graduación, a pesar de haber asistido al programa general de estudios, evidenciando la ausencia de preparación del farmacéutico para actuar en este ámbito. Se encontró un profesional fuertemente ligado a las actividades técnicas y administrativas y de poca presencia en la práctica clínica, asociados principalmente con la gestión del inventario (70,37%). Los protocolos de quimioterapia antineoplásica son complejos y pacientes oncológicos representan un grupo especial que necesita de atención farmacéutica. Se concluyó que es necesario adoptar medidas de bioseguridad y las constantes actualizaciones técnicas y científicas para un mejor desempeño de la práctica farmacéutica.
