O impacto do envelhecimento populacional brasileiro para o sistema de saúde sob a óptica da farmacoepidemiologia: uma revisão narrativa / The impact of Brazilian population aging to the health system under the pharmacoepidemiology vision: a narrative review

A população idosa mundial cresce em ritmo acelerado e o Brasil segue esta tendência. Entretanto, diante dos limitados recursos financeiros disponíveis à saúde, e considerando que a população idosa é a faixa etária que mais consome medicamentos - que devem ser utilizados com maior cuidado nesses pacientes devido a alterações fisiológicas que ocorrem com o aumento da idade -, os estudos farmacoepidemiológicos tornam-se fundamentais para traçar o perfil de utilização dos medicamentos a fim de adotar medidas estratégicas para garantir o acesso e o uso racional desse importante recurso terapêutico, principalmente para os pacientes idosos, devido às suas particularidades e necessidades relacionadas ao envelhecimento.

The world’s elderly population grows at a rapid pace and Brazil follows this trend. However, in the face of limited financial resources available to health issues, and considering that the elderly population is the age group that most consumes drugs - that must be used with greater caution by them due to physiological changes that occur with increasing age - pharmacoepidemiological studies become fundamental to perform the profile of drug utilization with the purpose of adopting strategic actions to ensure the access and rational use of this important therapeutic resource, especially for elderly patients, due to their particularities and needs related to aging.

[Evaluation of the drug interaction between carbamazepine and lamotrigine in the treatment of refractory epilepsy patients]. / Evaluación de la interacción medicamentosa de la carbamacepina y la lamotrigina en el tratamiento de los pacientes epilépticos refractarios.

INTRODUCTION: Carbamazepine (CBZ) is a pharmacological agent used to control epileptic syndromes. In refractory epilepsy patients, however, a second anticonvulsive drug such as lamotrigine (LTG) is often added. This association can reduce the frequency of the epileptic seizures and favour control over them. AIMS: This study was conducted to evaluate the plasma concentration of CBZ throughout a period of mono and polytherapy. Furthermore, tests were also carried out to determine whether any alterations were caused in the haematological parameters or in plasma concentrations by adding LTG to the therapy with CBZ. PATIENTS AND METHODS: This study involved a sample of refractory epilepsy patients who were following monotherapy with CBZ and who had a wholly unsatisfactory control over their bouts of seizures. LTG was thus added to these patients' treatment in an attempt to improve their control over the seizures. RESULTS AND CONCLUSIONS: On ending the study, we found that LTG did not interfere with the plasma concentrations of CBZ or give rise to any kind of alteration in the haematological parameters of any of the patients. Nevertheless, one patient did break out in a rash, which shows that therapeutic monitoring may be a key tool, especially when the treatment that is prescribed includes two drugs with a narrow therapeutic range.

Avaliação de prescrições de medicamentos para pacientes com Diabetes Mellitus atendidos por uma Unidade Básica de Saúde / Evaluation of the prescriptions of medicines to subjects with Diabetes Mellitus assisted by a basic Unit of Health

O Diabetes Mellitus (DM) é uma síndrome decorrente da falta de insulina e/ou da incapacidade da insulina de exercer adequadamente seus efeitos, devido à redução da sensibilidade dos tecidos a este hormônio.O Diabetes Mellitus tipo 2 (DM2), atinge entre 80 a 90 por cento da população diabética, sendo que cerca de 7,6 por cento dos indivíduos com idade entre 30 e 69 anos são portadores de DM, aumentando para 20 por cento nos pacientes com idade superior a 70 anos.Além da obesidade, o aumento da mortalidade nos pacientes com DM2 está relacionado à agregação de vários fatores de risco, como hipertensão arterial sistêmica, dislipidemia e ausência de informações do paciente em relação à sua patologia.O tratamento do DM baseia-se no aumento da atividade física, suspensão do fumo, hábitos alimentares corretos e, se necessário, uso de insulina e antidiabéticos orais.Esse trabalho realizou um levantamento farmacoepidemiológico com 130 pacientes portadores de DM atendidos pela UBS São José em Ribeirão Preto, SP.Foram avaliadas as 130 prescrições medicamentosas indicadas aos usuários, com relação aos fármacos prescritos, bem como as doses e o tipo de DM de cada paciente.Os pacientes diagnosticados com DM2 utilizaram para o tratamento quatro esquemas terapêuticos distintos:monoterapia com glibenclamida(38,5 por cento),monoterapia com metformina (24,6por cento), metformina associada com glibenclamida (19,2 por cento) e metformina associada com insulina (5,4 por cento).Dos usuários, 12,3 por cento eram portadores de DM1 e utilizaram apenasinsulina.Concluiu-se que a prescrição racional e o seguimento farmacoterapêutico podem diminuir a incidência de comorbidades e melhorar a adesão dos pacientes portadores de DM.

[Buspirone chlorhydrate in the treatment of cerebellar ataxia]. / Clorhidrato de buspirona en el tratamiento de la ataxia cerebelosa.

AIM: To evaluate the efficiency of buspirone chlorhydrate in a group of patients who all presented sporadic or family primary cerebellar ataxia. PATIENTS AND METHODS: In this open label study of addiction, the following eligibility criteria were used: 1) Clinical: primary cerebellar ataxia; 2) Radiological: nuclear magnetic resonance showing pure cerebellar cortical atrophy; 3) Age: over 20 years old. Any patient with a history of food deficiency, alcoholism, neoplasic, infectious, degenerative and vascular diseases was excluded from taking part in the study. Of the 20 patients examined initially, 18 met the eligibility criteria, and of these 11 reached the end of the study, although drop outs were not related to treatment. Four patients had been diagnosed as suffering from cerebellar cortical atrophy of the sporadic type and the remaining seven had a family type cerebellar cortical atrophy. All the patients were thoroughly evaluated and received scores both at the beginning and at the end of the study, according to the modified Massaquoi scale for clinical evaluation of cerebellar functioning, and the Hamilton Anxiety Scale. They were all administered buspirone chlorhydrate in doses that progressively increased by 5 mg/month over a total period of 12 months. The maximum dose was considered to be 1 mg/kg body weight, without exceeding 60 mg. The increase in dosage was stopped if it was not well tolerated by the patient

Clorhidrato de buspirona en el tratamiento de la ataxia cerebelosa / Buspirone chlorhydrate in the treatment of cerebellar ataxia

Objetivo. Evaluar la eficacia del clorhidrato de buspirona en un grupo de pacientes que se caracteriza por presentar una ataxia cerebelar primaria de tipo esporádico o familiar. Pacientes y métodos. Se trata de un estudio prospectivo de adición (open label study).Se utilizaron los siguientes criterios de inclusión: 1) Clínico: ataxia cerebelar primaria; 2) Radiológico: resonancia magnética que mostró una atrofia cortical cerebelar pura; 3) Edad: por encima de los 20 años. Se excluyeron del estudio todos los pacientes con historial de deficiencia alimentaria, alcoholismo, enfermedades neoplásicas, infecciosas, degenerativas y vasculares. De los 20 pacientes examinados inicialmente, 18 cumplieron los criterios de inclusión. De éstos, tan sólo 11 llegaron hasta el final del estudio, sin que los abandonos estuvieran relacionados con el tratamiento. Cuatro pacientes tenían un diagnóstico de atrofia cortical cerebelar de tipo esporádica, y siete, de atrofia cortical cerebelar de tipo familiar. Todos los pacientes se evaluaron de manera minuciosa y recibieron puntuaciones tanto al inicio como al final del estudio, según la escala de Massaquoi modificada para la evaluación clínica de la función cerebelar y según la escala de Hamilton para la ansiedad. A todos los pacientes se les administró clorhidrato de buspirona, con un aumento progresivo de la dosis de 5 mg/mes, durante un total de 12 meses. La dosis máxima considerada fue de 1 mg/kg de peso, sin sobrepasar los 60 mg. La progresión de la dosis se interrumpió cuando el paciente no la toleró (AU)

Malaria transmission by Anopheles subpictus (Diptera: Culicidae) in a new irrigation project in Sri Lanka.

Indoor resting Anopheles subpictus in a new irrigation scheme in Sri Lanka were investigated during 1989-1990 for malaria infection by dissection and ELISA, and human feeding rates by ELISA analysis of blood meals. Indoor resting abundance was 22.3 females per house per 15-min catch in April-June 1989, 2.2 in November-December 1989, and 7.5 in April-June 1990. ELISA-based malaria infection rates (Plasmodium vivax and P. falciparum combined) were 1.4% during April-June and 3.2% during November-December 1989, and 12.5% during April-June 1990. Dissection and ELISA confirmed the presence of oocysts and sporozoites of P. falciparum in 1990. Human blood was detected in 4.3, 0.8, and 5.2% of analyzed meals, respectively, during the three sampling periods. Estimates of the entomological inoculation rate (EIR) ranged from 0.00006 to 0.005 in different samples and vectorial capacity (VC) was 0.0005 for the 1990 sample. Thus, An. subpictus is incriminated as a vector of human malaria in Sri Lanka.