Un mecanismo nefrogénico subyace a la poliuria inducida por dexmedetomidina: informe de un caso / Nephrogenic mechanism underlies dexmedetomidine-induced polyuria: A case report

La dexmedetomidina, agonista del adrenorreceptor α, se utiliza cada vez más como agente sedativo-hipnótico y analgésico, aunque su popularidad suscita preocupación acerca de los efectos secundarios de dicho fármaco.La bradicardia y la hipotensión son efectos adversos comunes, pero también existen diversos informes de gasto urinario excesivo, posiblemente debido a la secreción de vasopresina y a la permeabilidad de los conductos colectores.La poliuria se resuelve normalmente con la discontinuación del fármaco, no habiéndose reportado morbilidad significativa. La identificación temprana, la eliminación del agente y el tratamiento son imperativos para minimizar las complicaciones, principalmente natremia y síntomas neurológicos.Este informe de caso describe la poliuria relacionada con dexmedetomidina durante la anestesia general libre de opioides para cirugía mayor de cabeza y cuello. Nuestra hipótesis de etiología nefrogénica se ve reforzada por los datos analíticos obtenidos. También describimos cómo abordar la poliuria intraoperatoria. (AU)

Dexmedetomidine's α-adrenoreceptor agonism has been gaining popularity in the anesthetic room as a sedative-hypnotic and analgesic agent, and with extensive perioperative use rising concern about side effects is necessary.Bradycardia and hypotension are common but excessive urine output is increasingly reported, suggested mechanisms being vasopressin secretion and increasing permeability of the collecting ducts.Polyuria usually resolves with discontinuation of the drug and significant morbidity has not been reported. Early identification, removal of agent and treatment are imperative to minimize complications, mainly associated with natremia levels and neurological symptoms.This case report describes a dexmedetomidine-related polyuric syndrome during opioid-free general anesthesia for major head and neck surgery. A nephrogenic mechanism for the clinical effect is proposed and reinforced by analytical data obtained. An intra-operative polyuria approach is also delineated. (AU)

Propriedades Químicas e Farmacológicas do Gênero Copaifera no Tratamento de Lesões/feridas: Revisão Integrativa / Chemical and Pharmacological Properties of the Genus Copaifera in the Treatment of Injuries/wounds: Integrative Review / Propiedades Químicas y Farmacológicas del Género Copaifera en el Tratamiento de Lesiones/heridas: Revisión Integradora

Objetivo:Identificar propriedades químicas e farmacológicas do gênero Copaifera no tratamento de lesões e feridas. Método: Revisão integrativa da literatura realizada nas bases de dados LILACS, MEDLINE, PubMed, Taylor & Francis e Scopus, em janeiro de 2022, por meio da estratégia de busca: "Chemical Properties" AND "Copaifera" AND "Wounds and Injuries" e "Pharmacology" AND "Copaifera" AND "Wounds and Injuries". Foram incluídos artigos originais, de texto completo, identificados de acordo nível de evidência, redigidos em português, inglês ou espanhol. Resultados: Na busca primária foram encontrados 261 artigos. Após a seleção sistematizada, 12 estudos foram selecionados para análise qualitativa. Espécies do gênero Copaifera apresentam propriedades farmacológicas favoráveis ao tratamento de feridas: controle da dor inflamatória, diminuição da reação inflamatória, reepitelização e reparo tecidual, angiogênese, retração da ferida e remodelagem de cicatrizes. Dentre as propriedades químicas associadas ao tratamento de lesões, destacam-se presença de compostos bioativos: diterpenos, 3-hidroxi-copálico, sesquiterpenos, éster kolavic-15-metílico. Entre os diterpenos testados, o caurenoico e os ácidos copálicos mostraram atividades hemolíticas significativas. Apenas o ácido copálico e o ácido hardwíckiico inibiram a produção de óxido nítrico em macrófagos ativados por lipopolissacarídeos. Conclusão: As plantas do gênero Copaifera apresentam propriedades químicas e farmacológicas favoráveis ao tratamento de lesões e feridas

Objective:To identify chemical and pharmacological properties of Copaifera in the treatment of injuries and wounds. Method: Integrative literature review conducted in the LILACS, MEDLINE, PubMed, Taylor & Francis and Scopus databases in January 2022, using the search strategy: "Chemical Properties" AND "Copaifera" AND "Wounds and Injuries" and "Pharmacology" AND "Copaifera" AND "Wounds and Injuries." Original articles, full text, identified according to level of evidence, written in Portuguese, English or Spanish, were included. Results: In the primary search 261 articles were found. After systematized selection, 12 studies were selected for qualitative analysis. Species of the genus Copaifera have pharmacological properties favorable for wound treatment: control of inflammatory pain, reduction of inflammatory reaction, tissue reepithelialization and repair, angiogenesis, wound retraction and scar remodeling. Among the chemical properties associated with the treatment of injuries, the presence of bioactive compounds stand out: diterpenes, 3-hydroxy-copalic, sesquiterpenes, kolavic-15-methyl ester. Among the tested diterpenes, kaurenoic and copalic acids showed significant hemolytic activities. Only copalic acid and hardwickiic acid inhibited nitric oxide production in lipopolysaccharide-activated macrophages. Conclusion: Plants of the genus Copaifera have chemical and pharmacological properties favorable for the treatment of injuries and wounds.

Objetivo:Identificar las propiedades químicas y farmacológicas del género Copaifera en el tratamiento de lesiones y heridas. Método: Revisión integradora de la literatura realizada en las bases de datos LILACS, MEDLINE, PubMed, Taylor & Francis y Scopus, en enero de 2022, mediante la estrategia de búsqueda: "Chemical Properties" AND "Copaifera" AND "Wounds and Injuries" e "Pharmacology" AND "Copaifera" AND "Wounds and Injuries". Se incluyeron artículos originales, a texto completo, identificados según el nivel de evidencia, escritos en portugués, inglés o español. Resultados: En la búsqueda primaria se encontraron 261 artículos. Tras una selección sistematizada, se seleccionaron 12 estudios para el análisis cualitativo. Las especies del género Copaifera presentan propiedades farmacológicas favorables para el tratamiento de las enfermedades: control del dolor inflamatorio, disminución de la reacción inflamatoria, reepitelización y reparación tecidual, angiogénesis, retracción de la piel y remodelación de las cicatrices. Entre las propiedades químicas asociadas al tratamiento de las lesiones, destaca la presencia de compuestos bioactivos: diterpenos, 3-hidroxicopálico, sesquiterpenos, éster kolavico-15-metilo. Entre los diterpenos probados, los ácidos kaurenoico y copálico mostraron actividades hemolíticas significativas. Sólo el ácido copálico y el ácido hardwickiico inhibieron la producción de óxido nítrico en macrófagos activados por lipopolisacáridos. Conclusión: Las plantas del género Copaifera presentan propiedades químicas y farmacológicas favorables para el tratamiento de lesiones y heridas.

Estilos y enfoques de aprendizaje en estudiantes de Estomatología y relación con el rendimiento académico en Farmacología

Fundamento: los estilos y enfoques de aprendizaje permiten conocer cómo el estudiante enfrenta este proceso y el modo en que procesa la información que debe ser asimilada. Objetivo: identificar los estilos y enfoques de aprendizaje que utilizan estudiantes de Estomatología y su relación con el rendimiento académico en la disciplina Farmacología. Métodos: estudio descriptivo-transversal, con enfoque cualicuantitativo, realizado de noviembre 2021 a enero 2022. La muestra, no probabilística, fue de 28 estudiantes (90,3 %) de segundo año de la carrera de Estomatología impartida en la Facultad de Estomatología de La Habana. A los participantes se les aplicaron dos instrumentos: cuestionario Honey y Alonso sobre estilos de aprendizaje y cuestionario Enfoques e Inventario de Habilidades de Estudio de los Estudiantes. Las dimensiones del rendimiento académico fueron excelente, bueno, y regular. Resultados: predominó la preferencia muy alta/alta en el estilo teórico (67,86 %) y la preferencia moderada en el reflexivo (67,86 %). Se encontró relación significativa entre la cantidad de estilos de aprendizaje de preferencia muy alta/alta y el rendimiento académico (p=0,044), y entre el estilo reflexivo y el rendimiento académico (p=0,024). También, se encontró relación significativa entre el rendimiento académico y el enfoque de aprendizaje estratégico (p=0,008) y la preferencia por la transmisión de la información (p=0,028). Conclusiones: en los estudiantes existen estilos y enfoques de aprendizaje que se relacionan con el rendimiento académico en Farmacología; se muestran aspectos que se deben considerar para el mejoramiento del proceso docente de esta disciplina en Estomatología.

Foundation: the learning styles and approaches allow us to know how the student faces this process and the way in which they process the information that must be assimilated. Objective: to identify the learning styles and approaches used by Dentistry students and their relationship with academic performance in the Pharmacology discipline. Methods: a descriptive-cross-sectional study, with a qualitative-quantitative approach, carried out from November 2021 to January 2022. The non-probabilistic sample consisted of 28 students (90.3%) in the second year of the Dentistry course taught at the Havana Dentistry Faculty. Two instruments were applied to the participants: the Honey and Alonso questionnaire on learning styles and the Approaches and Inventory of Student Study Skills questionnaire. The dimensions of academic performance were excellent, good, and regular. Results: the very high/high preference predominated in the theoretical style (67.86%) and the moderate preference in the reflective style (67.86%). A significant relationship was found between the number of very high/high preference learning styles and academic performance (p=0.044), and between the reflective style and academic performance (p=0.024). Also, a significant relationship was found between academic performance and the strategic learning approach (p=0.008) and the preference for the transmission of information (p=0.028). Conclusions: there are learning styles and approaches among students that are related to academic performance in Pharmacology; Aspects that should be considered for the improvement of the teaching process of this discipline in Dentistry are shown.

A nephrogenic mechanism underlies dexmedetomidine-induced polyuria. A case report.

Dexmedetomidine's α-adrenoreceptor agonism has been gaining popularity in the anesthetic room as a sedative-hypnotic and analgesic agent, and with extensive perioperative use rising concern about side effects is necessary. Bradycardia and hypotension are common adverse effects, but there are also several reports of excessive urine output, possibly due to vasopressin secretion and permeability of collecting ducts. Polyuria usually resolves with discontinuation of the drug, and significant morbidity has not been reported. Early identification, removal of the agent, and treatment are imperative to minimize complications - mainly natremia and neurological symptoms. This case report describes a dexmedetomidine-related polyuric syndrome during opioid-free general anesthesia for major head and neck surgery. A nephrogenic mechanism for the clinical effect is proposed and reinforced by analytical data obtained. An intra-operative polyuria approach is also delineated.

Impacto do uso sistêmico de estatinas e de bisfosfonatos nos tecidos periodontais: revisão narrativa / Impact of the systemic use of statins and bisphosphonates in the periodontal tissues: narrative review

Introdução: A literatura tem apontado uma possível relação entre diversas condições sistêmicas e as doenças periodontais. Dentro das doenças sistêmicas que podem gerar o uso crônico de medicamentos, com potencial associação com as doenças periodontais, destacam-se a hipercolesterolemia e o uso de estatinas; e as doenças do metabolismo ósseo e o uso de bisfosfonatos. Objetivo: Dessa maneira, o presente estudo objetivou revisar a literatura sobre o efeito das estatinas e dos bisfosfonatos nos parâmetros clínicos e radiográficos periodontais de indivíduos adultos. Resultados: Apenas estudos observacionais em humanos foram incluídos. Um estudo mostrou que, em pacientes que apresentam doença periodontal e usam estatina, houve 37% menos bolsas periodontais (profundidade de sondagem ≥4mm) quando comparadas aos que não utilizam a medicação, além de apresentarem menor índice de carga inflamatória e menor perda de inserção clínica. Em relação aos bisfosfonatos em indivíduos com doenças que envolvem o metabolismo ósseo, sugere-se que a utilização do fármaco tem obtido resultados positivos nos parâmetros periodontais, como menores sinais clínicos de inflamação gengival, menor profundidade de sondagem, menor perda de inserção clínica e maior nível de osso alveolar, quando comparados aos que nunca realizam essa terapia. Conclusão: Dessa forma, as estatinas e os bisfosfonatos apresentam efeitos promissores, em pacientes sob tratamento para suas respectivas condições sistêmicas, na melhoria dos parâmetros periodontais, porém é importante salientar que são necessários mais estudos sobre o assunto para melhor entender os reais efeitos a longo prazo do uso desses fármacos.(AU)

Introduction: The literature showed a possible relationship between several systemic conditions and periodontal diseases. Within the systemic diseases that can generate the chronic use of these drugs, potentially related with periodontal diseases, it may be cited the hypercholesterolemia and the use of statins; and bone metabolism diseases and the use of bisphosphonates. Objective: In this sense, the present study aimed to review the literature about the effect of statins and bisphosphonates in the periodontal parameters of adults individuals. Results: Only observational studies in humans were included. A study showed that, in patients with periodontal disease and users of statins, there 37% fewer periodontal pockets (probing depth ≥4mm) when compared to those who do not use the medication, as well as having a lower rate of inflammatory burden and less loss of clinical insertion. Regarding the bisphosphonates in individuals diagnosed with diseases involving bone metabolism, it was suggested that the use of the drug has obtained positive results in periodontal parameters, such as a greater absence of plaque, less clinical signs of gingival inflammation, less probing depth, lower level of clinical insertion and higher level of alveolar bone when compared to those who never undergo this therapy. Conclusion: Thus, statins and bisphosphonates have promising effects in patients under treatment for their respective systemic condition in improving periodontal parameters, but it is important to emphasize that further studies on the subject are needed to better understand the long-term effects of the use of these drugs.(AU)

Análisis del programa de Farmacología Clínica en el plan de estudio E para la carrera de Medicina / Analysis of the program of Clinical Pharmacology in the E plan study for the Medicine career i: en

Introducción: En Cuba han existido varias concepciones sobre planes de estudio. La necesidad de revisar y proponer cambios que aseguren los niveles de calidad deseados en el proceso de formación integral de los futuros profesionales motivó a investigar los elementos teóricos y metodológicos que regulan y orientan el proceso de enseñanza-aprendizaje en la asignatura Farmacología Clínica. Objetivo: Analizar el programa de Farmacología Clínica del plan de estudio E para la carrera de Medicina desde un enfoque crítico y sistematizado. Métodos: Se realizó un estudio cualitativo del programa de estudio de la asignatura Farmacología Clínica según el plan E, vigente en la Universidad de Ciencias Médicas de Santiago de Cuba, durante el 2022, para lo cual se utilizaron los métodos de revisión documental, los documentos rectores del proceso docente en la educación superior y la metodología propuesta por algunos autores. Resultados: Varios temas enunciaban un número excesivo de objetivos específicos sin tener en cuenta el nivel de asimilación; la forma de organización de la enseñanza más utilizada fue la conferencia. En las evaluaciones frecuentes no se tuvo en cuenta el trabajo investigativo independiente; en tanto, la bibliografía básica correspondió a una edición del 2002. Conclusiones: El programa no requirió trasformaciones temáticas, pero desde el punto de vista didáctico deben modificarse componentes del proceso de enseñanza-aprendizaje y, además, se debe actualizar la bibliografía básica pertinente.

Introduction: In Cuba several conceptions have existed on the study plans. The necessity to revise and propose changes that assure the levels of quality wanted in the process of integral formation of the future professionals motivated to investigate the theoretical and methodological elements that regulate and guide the teaching-learning process in the Clinical Pharmacology subject. Objective: To analyze the program of Clinical Pharmacology of the E plan study for the medicine career, from a critical and systematized approach. Methods: A qualitative study of the study program in the Clinical Pharmacology subject was carried out according to the E plan, effective in the University of Medical Sciences in Santiago de Cuba, during 2022, for which the methods of documental review, the rector documents of the teaching process in higher education and the methodology proposed by some authors were used. Results: Several topics enunciated an excessive number of specific objectives without taking into account the level of assimilation; the form of organization most used in teaching was the conference. Independent investigative work was not taken into account in frequent evaluations; meanwhile, the basic bibliography corresponded to an edition from 2002. Conclusions: The program did not require of thematic transformations, but from the didactic point of view components of the teaching-learning process should be modified, besides updating the pertinent basic literature.

Validación de la utilidad de la guía farmacológica Ostomecum en formato de software de aplicación / Validation of the utility of the OSTOMECUM pharmacological guidelines in application software format

Objetivo: evaluar el perfil farmacoterapéutico del paciente con ileostomía y validar el uso de una aplicación móvil en las plataformas iOS y Android de carácter universal, gratuito y funcional dirigida a la comunidad de enfermeras expertas en ostomía y probar esta aplicación tanto por médicos como por enfermeras.Método: veinte especialistas en ostomía (10 médicos y 10 enfermeras) respondieron de forma anónima a un cuestionario de prescripción. Se preguntaron un total de 576 ítems en dos fases. La primera fase se llevó a cabo utilizando fuentes tradicionales de consulta y la segunda empleando la app Ostomecum. Se comparó la velocidad (proporción de preguntas respondidas en el tiempo dado) y la precisión (proporción de respuestas correctas) a la hora de contestar las preguntas. También se investigaron diferencias en la evaluación entre diferentes escenarios de práctica de la Enfermería. La comparación se realizó mediante la prueba pareada de Wilcoxon.Resultados: el porcentaje de preguntas respondidas pasó de 36% en la primera ronda con fuentes tradicionales (43% médicos, 30% enfermeras) a 99% en la segunda ronda usando el software de la aplicación (99% médicos, 99% enfermeras). La precisión de las respuestas aumentó del 22% (26% médicos, 18% enfermeras) al 94% (93% médicos, 95% enfermeras). Las diferencias entre médicos y enfermeras en la primera ronda(p< ,0001) se igualaron al emplear Ostomecum (p= ,7882). El nivel de certeza con la respuesta también cambió del 12% (20% médicos, 4% enfermeras) al 60% con la aplicación móvil (70% médicos, 50% enfermeras) (p< ,0001 total y ambos grupos). En cuanto al entorno laboral, la proporción de aciertos aumentó por igual tanto en el ámbito de Enfermería de consultorio como hospitalario (p< 0,0001 en cada uno).Conclusión: el estomaterapeuta con frecuencia es consultado en los cuidados del paciente ostomizado...(AU)

Objectives: to assess the pharmacotherapeutic profile of the patient with ileostomy and to validate the use of a universal, free and functional mobile application in the IOS and Android platforms, targeted to the community of ostomy-expert nurses, and to try this application both by doctors and by nurses.Method: twenty ostomy specialists (10 doctors and 10 nurses) answered anonymously a prescription questionnaire. In total, 576 items were asked in two stages. The first stage was conducted using traditional sources of reference, and the second one using the OSTOMECUM application. There was a comparison in speed (proportion of questions answered within the given time) and accuracy (proportion of correct answers) at the time of answering the questions. There was also research into the differences in assessment among different settings of Nursing practice. The comparison was conducted through the paired samples Wilcoxon test.Results: the proportion of answered questions went from 36% in the first round using traditional sources (43% for doctors, 30% for nurses) to 99% in the second round using the application software (99% for doctors, 99% for nurses). The accuracy in answers increased from 22% (16% for doctors, 18% for nurses) to 94% (93% for doctors, 95% for nurses). Differences between doctors and nurses in the first round(p< .0001) were equalled when using OSTOMECUM (p= .7882). The level of certainty with the answer also changed from 12% (20% for doctors, 4% for nurses) to 60% with the mobile application (70% for doctors, 50% for nurses) (p< .0001 total and both groups). In terms of work setting, the proportion of right answers increased equally both in the outpatient and the hospital Nursing settings (p< 0.0001 in each one).Conclusion: the stomal therapist is frequently consulted about care for ostomized patients. The OSTOMECUM application is a useful tool for reviewing medication and reconsidering the adequacy of a treatment prescribed to ostomized...(AU)

Validación de una estrategia didáctica para las relaciones interdisciplinarias entre Farmacología y asignaturas clínicas estomatológicas

Introducción: La validación de estrategias didácticas para favorecer las relaciones interdisciplinarias en el proceso enseñanza aprendizaje, resulta necesaria para su posterior aplicación en la práctica pedagógica y posible generalización. Objetivo: Validar una estrategia didáctica para las relaciones interdisciplinarias en el proceso enseñanza aprendizaje de las asignaturas clínicas, con la Farmacología en la carrera Estomatología. Métodos: Se realizó una investigación educativa entre enero y junio de 2022. Se asumieron métodos teóricos (analítico-sintético, inductivo-deductivo y sistematización), empíricos (consulta a expertos) y matemáticos-estadísticos (estadística descriptiva). Se seleccionó a los expertos según el nivel de competencia. Se elaboró y aplicó un cuestionario para valorar 16 aspectos de la estrategia en términos de: muy adecuado, bastante adecuado, adecuado, poco adecuado y no adecuado. Los criterios valorativos emitidos por los expertos se procesaron mediante el modelo matemático de Torgerson y se determinó el nivel de consenso de los expertos mediante el cálculo del coeficiente de concordancia de Kendall. Resultados: El coeficiente de competencia promedio de los expertos fue alto. De los 16 aspectos valorados, uno resultó "bastante adecuado" y el resto, "muy adecuado". Se estimó concordancia significativa entre los expertos consultados. Conclusiones: Los resultados de la consulta a expertos apuntan al reconocimiento del valor científico, teórico y práctico, de la estrategia didáctica diseñada para favorecer las relaciones interdisciplinarias en el proceso enseñanza aprendizaje de las asignaturas clínicas, con la Farmacología en la carrera Estomatología y le otorgan validez.

Introduction: The validation of didactic strategies to favor interdisciplinary relationships in the teaching-learning process is necessary for their subsequent application in pedagogical practice and possible generalization. Objective: To validate a didactic strategy for interdisciplinary relationships in the teaching-learning process of clinical subjects, with Pharmacology in the Stomatology career. Methods: Educational research was carried out, between January and June, 2022. Theoretical methods (analytical-synthetic, inductive-deductive and systematization), empirical (consultation to experts) and mathematical-statisticians (descriptive statistics). The experts were selected according to the level of competence. A questionnaire was developed and applied to assess 16 aspects of the strategy, in terms of: very suitable, quite suitable, suitable, not very suitable and not suitable. The evaluative criteria issued by the experts were processed using the Torgerson mathematical model and the level of consensus of the experts was determined by calculating the Kendall concordance coefficient. Results: The average competence coefficient of the experts turned out to be high. Of the 16 aspects assessed, one was "fairly adequate" and the rest, "very adequate". Significant agreement was estimated between the experts consulted Conclusions: The results of the expert consultation point to the recognition of the scientific, theoretical and practical value of the didactic strategy designed to favor interdisciplinary relationships in the teaching-learning process of clinical subjects with Pharmacology in the Stomatology career, and give validity to the same.

Bases científicas del principio de curación homeopática en la farmacología moderna / Scientific bases of the homeopathic healing principle in modern pharmacology

La homeopatía emplea el denominado 'principio de similares' como método terapéutico ­ el cual consiste en administrar medicamentos que provocan ciertos síntomas en individuos sanos para tratar síntomas similares en individuos enfermos (similia similibus curantur) - para inducir una reacción curativa secundaria del cuerpo en contra de sus propios trastornos. Esta reacción secundaria (vital, homeostática o paradójica) del cuerpo se basa en el 'efecto de rebote' de los fármacos modernos, un tipo de evento adverso que se produce después de interrumpir varias clases de fármacos prescritos según el 'principio de los contrarios' (contraria contrariis curantur). Objetivo: La presente revisión ha buscado justificar científicamente el principio de curación homeopática frente a la farmacología clínica y experimental a través de un estudio sistemático del efecto de rebote de los fármacos modernos o reacción paradójica del cuerpo. Métodos: Empleando como referencia estudios y revisiones sobre el tema publicados a partir de 1998, actualizamos los datos añadiendo estudios recientes incluidos en la base de datos PubMed. Resultados: El efecto de rebote se produce después de interrumpir varias clases de fármacos con acción contraria a los síntomas de las enfermedades, exacerbándolos a niveles superiores a aquellos previos al tratamiento. Independientemente de la enfermedad, fármaco, dosis y duración del tratamiento, el fenómeno del rebote se manifiesta en una pequeña proporción de los individuos susceptibles. Siguiendo las premisas homeopáticas, los fármacos modernos también podrían usarse según el principio de la similitud terapéutica, empleando entonces el efecto de rebote (reacción paradójica) con propósito curativo. Conclusiones: Evidenciado por cientos de estudios que constatan la similitud de conceptos y manifestaciones, el efecto de rebote de los fármacos modernos justifica científicamente el principio de la cura homeopática. Aunque el fenómeno de rebote es un evento adverso estudiado por la farmacología moderna, no es conocido por los profesionales de la atención médica, lo cual priva a los médicos de un conocimiento indispensable para el manejo seguro de los fármacos.

Homeopathy employs the so-called 'principle of similars' as therapeutic method - which consists in administering medicines that cause certain symptoms in healthy individuals to treat similar symptoms in sick individuals (similia similibus curantur) - to induce a secondary and healing reaction by the body against its own disorders. This secondary (vital, homeostatic or paradoxical) reaction of the body is based on the 'rebound effect' of modern drugs, a type of adverse event that occurs following discontinuation of several classes of drugs prescribed according to the 'principle of contraries' (contraria contrariis curantur). Aim: The present review sought to scientifically substantiate the homeopathic healing principle vis-à-vis experimental and clinical pharmacology through a systematic study of the rebound effect of modern drugs or paradoxical reaction of the body. Methods: Employing as reference studies and revisions on the subject published since 1998, we updated the data adding recent studies included in database PubMed. Results: The rebound effect occurs after discontinuation of several classes of drugs with action contrary to the symptoms of diseases, exacerbating them to levels above the ones before treatment. Regardless of disease, drug, dose and duration of treatment, the rebound phenomenon manifests in a small proportion of susceptible individuals. Following the homeopathic premises, modern drugs might also be used according to the principle of therapeutic similitude, thus employing the rebound effect (paradoxical reaction) with curative intent. Conclusions: Evidenced by hundreds of studies that attest to the similarity of concepts and manifestations, the rebound effect of modern drugs scientifically substantiates the principle of homeopathic cure. Although the rebound phenomenon is an adverse event studied by modern pharmacology, it is not known by health care professionals, thus depriving doctors of knowledge indispensable for safe management of drugs.

Efficacy and marginal cost of treatment with tocilizumab in COVID-19 patients. / Resultados en la práctica asistencial y coste marginal del tratamiento con tocilizumab en pacientes COVID-19.

OBJECTIVE: To describe the marginal cost and survival of patients treated with tocilizumab in a university hospital under real-life conditions and to evaluate factors that could influence costs and health outcomes will be evaluated. METHODS: Observational, single-center, retrospective study of a cohort of adult patients infected with SARS-CoV-2 treated with tocilizumab. The one-year restricted mean survival time was analyzed in life-years gained (LYG). The influence of sex, age and severity on patient survival was evaluated. The marginal cost/LYG and marginal cost/survivor ratios were calculated. RESULTS: 508 patients (66 ± 13 years; 32% women) were included. Seventeen percent were admitted to the ICU. Overall survival was 77%. Age older than 71.5 years (HR = 1.08; 95% CI 1.07-1.10; p < 0.001) and ICU admission at initiation of treatment (HR = 2.01; 95% CI 1.30-3.09; p = 0.002) were identified as risk factors. The total budgetary impact of tocilizumab in the period analyzed was 206,466 euros. The patients with the highest cost per unit of health outcome were those admitted to the ICU and those over 71.5 years, with a marginal cost/LYG of € 966 and a marginal cost/survivor of € 1,136. CONCLUSION: The efficiency of treatment with tocilizumab is associated with the age and severity of the patients. The figures are lower in all subgroups than the thresholds usually used in cost-effectiveness evaluations. The results of the present study suggest that early first dose of tocilizumab is an efficient strategy.

[Translated article] Efficacy and marginal cost of treatment with tocilizumab in COVID-19 patients.

OBJECTIVE: To describe the marginal cost and survival of patients treated with tocilizumab in a university hospital under real-life conditions and to evaluate factors that could influence costs and health outcomes will be evaluated. METHODS: Observational, single-center, retrospective study of a cohort of adult patients infected with SARS-COV2 treated with tocilizumab. The 1 year restricted mean survival time was analyzed in life-years gained (LYG). The influence of sex, age and severity on patient survival was evaluated. The marginal cost/LYG and marginal cost/survivor ratios were calculated. RESULTS: 508 patients (66 ±â€¯13 years; 32% women) were included. Seventeen percent were admitted to the ICU. Overall survival was 77%. Age older than 71.5 years (HR = 1.08; 95% CI 1.07-1.10; p < 0.001) and ICU admission at initiation of treatment (HR = 2.01; 95% CI 1.30-3.09; p = 0.002) were identified as risk factors. The total budgetary impact of tocilizumab in the period analyzed was 206,466 euros. The patients with the highest cost per unit of health outcome were those admitted to the ICU and those over 71.5 years, with a marginal cost/LYG of €966 and a marginal cost/survivor of €1136. CONCLUSION: The efficiency of treatment with tocilizumab is associated with the age and severity of the patients. The figures are lower in all subgroups than the thresholds usually used in cost-effectiveness evaluations. The results of the present study suggest that early first dose of tocilizumab is an efficient strategy.

Resultados en la práctica asistencial y coste marginal del tratamiento con tocilizumab en pacientes COVID-19 / Efficacy and marginal cost of treatment with tocilizumab in COVID-19 patients

Objetivo: describir el coste marginal y la supervivencia de los pacientes tratados con tocilizumab en un hospital universitario en condiciones de vida real y evaluar los factores que podrían influir en los costes y los resultados en la salud.Metodologíaestudio observacional, retrospectivo y unicéntrico de una cohorte de pacientes adultos infectados con SARS-CoV-2 tratados con tocilizumab. Se analizó, en años de vida ganados (AVG), la media de supervivencia restringida a un año. Se evaluó la influencia del sexo, la edad y la gravedad en la supervivencia de los pacientes. Se calcularon el ratio, el coste marginal/AVG y coste marginal/superviviente.Resultadosse incluyeron 508 pacientes (66 ± 13 años; 32% mujeres). Un 17% ingresó en la UCI. La supervivencia global fue del 77%. Se identificaron como factores de riesgo la edad mayor de 71,5 años (HR=1,08; IC 95% 1,07–1,10; p < 0,001), y el ingreso en la UCI al iniciar el tratamiento (HR=2,01; IC 95% 1,30–3,09; p = 0,002). El impacto presupuestario total de tocilizumab en el periodo analizado ascendió a 206.466 €. Los pacientes con mayor coste por unidad de resultado en salud son los pacientes ingresados en la UCI y mayores de 71,5 años, que presentan un coste marginal/AVG de 966 € y un coste marginal/superviviente de 1.136 €.Conclusiónla eficiencia del tratamiento con tocilizumab se asocia a la edad y a la gravedad de los pacientes. Las cifras son inferiores en todos los subgrupos a los umbrales habitualmente utilizados en las evaluaciones coste-efectividad. Los resultados del presente estudio sugieren que el inicio precoz de tocilizumab es una estrategia eficiente. (AU)

Objective: To describe the marginal cost and survival of patients treated with tocilizumab in a university hospital under real-life conditions and to evaluate factors that could influence costs and health outcomes will be evaluated.MethodsObservational, single-center, retrospective study of a cohort of adult patients infected with SARS-CoV-2 treated with tocilizumab. The one-year restricted mean survival time was analyzed in life-years gained (LYG). The influence of sex, age and severity on patient survival was evaluated. The marginal cost/LYG and marginal cost/survivor ratios were calculated.Results508 patients (66 ± 13 years; 32% women) were included. Seventeen percent were admitted to the ICU. Overall survival was 77%. Age older than 71.5 years (HR = 1.08; 95% CI 1.07-1.10; p < 0.001) and ICU admission at initiation of treatment (HR = 2.01; 95% CI 1.30-3.09; p = 0.002) were identified as risk factors. The total budgetary impact of tocilizumab in the period analyzed was 206,466 euros. The patients with the highest cost per unit of health outcome were those admitted to the ICU and those over 71.5 years, with a marginal cost/LYG of € 966 and a marginal cost/survivor of € 1,136.ConclusionThe efficiency of treatment with tocilizumab is associated with the age and severity of the patients. The figures are lower in all subgroups than the thresholds usually used in cost-effectiveness evaluations. The results of the present study suggest that early first dose of tocilizumab is an efficient strategy. (AU)

Recetario médico-farmacológicos para el cuidado y el embellecimiento del cabello: fuentes árabes medievales / [Medical-pharmacological recipes for hair care and beautification: medieval Arabic sources]

El cuidado y el embellecimiento del cabello forman parte de la tradición de todas las culturas y, a lo largo de la historia, los hombres y las mujeres se han preocupado por su aspecto, no solo desde el punto de vista estético sino también desde el punto de vista terapéutico. Un cabello sano indica una piel sana y, por lo tanto, un cuerpo sano. El trabajo que aquí presentamos recoge una colección de recetas de carácter médico-farmacológico destinadas al cuidado y el embellecimiento del cabello. Para ello, y partiendo de la Materia Médica de Dioscórides, obra de cabecera de la ciencia árabe, se han seleccionado una serie de fuentes árabes medievales de las que se han extraído dichas recetas. Los autores elegidos son: Al-Idrīsī, Abū l-Qāsim al-Zahrāwī, Abū l-ʿAlā’ Zuhr, Ibn Zuhr e Ibn al-Bayttār (AU)

Transformaciones en el programa de la asignatura Farmacología General: análisis comparativo de planes de estudio / Changes in the syllabus of the General Pharmacology subject: comparative analysis of study plans

Introducción: los sistemas de conocimientos y habilidades de cada profesión deben responder a los cambios sociales; esto implica el análisis constante para perfeccionarlos permanentemente. Objetivo: comparar los elementos fundamentales de los planes de estudio C, D y E de la asignatura Farmacología General para contribuir a la preparación de los docentes y mejorar el proceso enseñanza aprendizaje. Métodos: se realizó una revisión bibliográfica sistemática y documental que incluyó varias fuentes, entre ellas: resoluciones, programas de la asignatura Farmacología General, libros, artículos originales y de revisión. Se seleccionaron 24 fuentes teniendo en cuenta su pertinencia y actualización según el objetivo del trabajo. La búsqueda digital se realizó en las bases de datos Scopus, SciELO y Medline de los últimos cinco años. Las palabras claves utilizadas fueron: proceso docente educativo, farmacología general, plan de estudio, programa y educación médica. Desarrollo: se constató coherencia sistémica en los temas básicos de los programas, ajuste en sus objetivos, contenidos y evaluación de acuerdo con el modelo del profesional que se aspira a formar, con transformaciones en las horas clase, contenidos y formas organizativas de la enseñanza, responde al modelo del profesional que se aspira a formar; sin embargo, es susceptible de ser perfeccionado. Conclusiones: el programa de la asignatura Farmacología General ha experimentado un constante proceso de transformación según los cambios experimentados en el sistema de salud cubano, en busca de un mejor desarrollo del proceso docente educativo y de elevar su calidad y pertinencia.

Introduction: the knowledge and skills systems of each profession must respond to social changes; this implies constant analysis to improve them permanently. Objective: to compare the fundamental elements of the C, D and E study plans of the General Pharmacology subject to contribute to the preparation of teachers and improve the teaching-learning process. Methods: a systematic and documentary bibliographic review was carried out that included several sources, among them: resolutions, General Pharmacology subject programs, books, original and review articles. 24 sources were selected taking into account their relevance and updating according to the objective of the work. The digital search was carried out in the Scopus, SciELO and Medline databases of the last five years. The keywords used were educational teaching process, general pharmacology, study plan, program and medical education. Development: systemic coherence was verified in the basic topics of the programs, adjustment in their objectives, contents, and evaluation in accordance with the model of the professional desired to train, with transformations in class hours, contents, and organizational forms of teaching, responds to the model of the professional to train; however, it is capable of being perfected. Conclusions: the program of the General Pharmacology subject has undergone a constant transformation process according to the changes experienced in the Cuban health system, in search of a better development of the teaching-learning process and to raise its quality and relevance.

Glicopeptídeos: aspectos farmacológicos e aplicações clínicas / Glycopeptides: pharmacological aspects and clinical applications / Glicopeptidos: aspectos farmacológicos y aplicaciones clínicas

O uso indiscriminado dos antimicrobianos tem gerado um problema significativo na saúde pública, acarretando impactos negativos como fracasso na farmacoterapia frente as infecções bacterianas e aumentos nos custos assistenciais. Esta revisão narrativa tem como objetivo descrever as propriedades farmacocinéticas e farmacodinâmicas e aplicações clínicas dos principais antibióticos pertencentes a classe dos glicopeptídeos. A busca de artigos foi realizada nas seguintes bases de dados: Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS/PUBMED), SciELO (Scientific Electronic Library Online) e Biblioteca Virtual em Saúde (BVS). A vancomicina e a teicoplanina são fármacos de primeira linha no tratamento de infecções por bactérias gram-positivas com resistência a outros antibióticos. Ambos apresentam estruturas cíclicas complexas, contendo aminoácidos ligados a grupos de carboidratos que lhe conferem propriedades únicas. A administração dos glicopetídeos deve ponderar fatores relacionados ao paciente como faixa etária, função renal, desnutrição e obesidade devido a sua heterogeneidade farmacocinética, por isso o monitoramento sérico é recomendado para assegurar concentrações plasmáticas efetivas. Diante do exposto, o uso adequado e baseado em evidência científica dessa importante classe de antibióticos visa otimizar o tratamento farmacoterapêutico e diminuir o avanço da resistência bacteriana.

The indiscriminate use of antimicrobials has generated a significant problem in public health, causing negative impacts such as failure in pharmacotherapy against bacterial infections and increases in healthcare costs. This narrative review aims to describe the pharmacokinetic and pharmacodynamic properties and clinical applications of the main antibiotics belonging to the class of glycopeptides. The search for articles was carried out in the following databases: Latin American and Caribbean Literature in Health Sciences (LILACS/PUBMED), SciELO (Scientific Electronic Library Online), and Virtual Health Library (BVS). Vancomycin and teicoplanin are first- line drugs in infections caused by gram-positive bacteria it resistant to other antibiotics. Both have complex cyclic structures containing amino acids linked to carbohydrate groups that give them unique properties. The administration of glycopeptides must consider patient-related factors such as age group, renal function, malnutrition, and obesity due to its pharmacokinetic heterogeneity. Therefore, serum monitoring is recommended to ensure effective plasma concentrations. Thus, the proper use based on scientific evidence of this important class of antibiotics aims to optimize pharmacotherapeutic treatment and reduce the progress of bacterial resistance.

El uso indiscriminado de antimicrobianos ha generado un problema impor- tante en la salud pública, provocando impactos negativos como el fracaso en la farmaco- terapia contra las infecciones bacterianas y el aumento de los costos sanitarios. Esta revi- sión narrativa tiene como objetivo describir las propiedades farmacocinéticas, farmaco- dinámicas y aplicaciones clínicas de los principales antibióticos pertenecientes a la clase de los glicopéptidos. La búsqueda de artículos se realizó en las siguientes bases de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS/PUBMED), SciELO (Scientific Electronic Library Online) y Biblioteca Virtual en Salud (BVS). La vancomicina y la teicoplanina son fármacos de primera línea en el tratamiento de infec- ciones causadas por bacterias grampositivas resistentes a otros antibióticos. Ambos tienen estructuras cíclicas complejas, que contienen aminoácidos unidos a grupos de carbohi- dratos que les otorgan propiedades únicas. La administración de glicopéptidos debe con- siderar factores relacionados con el paciente, como el grupo de edad, la función renal, la desnutrición y la obesidad debido a su heterogeneidad farmacocinética, por lo que se re- comienda el monitoreo sérico para asegurar concentraciones plasmáticas efectivas. En vista de lo anterior, el uso adecuado basado en la evidencia científica de esta importante clase de antibióticos tiene como objetivo optimizar el tratamiento farmacoterapéutico y reducir la propagación de resistencias bacterianas.

El trabajo educativo curricular desde el tema Medicamentos antiulcerosos en la asignatura Farmacología II / Curricular educational work on the topic of anti-ulcer medications in the subject Pharmacology II

El trabajo educativo consiste en transmitir un mensaje coherente desde la propia ciencia y estimula la motivación del aprendizaje de los estudiantes y su propia actividad cognoscitiva. El propósito de la educación médica superior es egresar un profesional integral; por tanto, se trata de instruir y educar a los estudiantes en los más altos valores patrióticos, morales y éticos en cada uno de los escenarios docentes, desde la propia ciencia. El objetivo de esta comunicación es ejemplificar algunos contenidos sobre la temática referente a medicamentos antiulcerosos en los que se puede intencionar el trabajo educativo desde la propia ciencia.

The educational work consists of transmitting a coherent educational message from science itself and stimulates the students' learning motivation and their own cognitive activity. The purpose of higher medical education is to graduate a comprehensive professional; therefore, it is about instructing and educating students in the highest patriotic, moral and ethical values in each of the teaching scenarios, from science itself. The objective of this research paper is to exemplify some content on the subject related to antiulcer drugs from which educational work can be intentioned from science itself.

The molecular machinery required to process endocannabinoids lipid signaling and their respective receptors / A maquinaria molecular necessária para processar mensageiros lipídicos endocanabinoides e seus respectivos receptores

ABSTRACT BACKGROUND AND OBJECTIVES: Pharmaceutical preparations of cannabis have been used by mankind since long time ago, and recently they have been the pharmaceutical industry's focus. However, for proper therapeutic application, in-depth knowledge of the endocannabinoid system, which is made mainly by lipid signaling, is needed. The purpose of this study was to explore the current understanding of the players in this system, paying special attention to the molecular machinery required to process it. CONTENTS: This is a narrative review of the current literature regarding major components of the endocannabinoid system, in particular: the receptors, main endogenous ligands, and the enzymes responsible for its components processing. The pharmacological and preclinical aspects were emphasized. CONCLUSION: The better comprehension of the molecular structure of receptors and enzymes will be crucial to developing new pharmacological strategies. A detailed description of the machinery responsible for endocannabinoid lipid metabolization will pave the way for the discovery of new drugs that act on the endogenous system and that can be applied effectively in clinical practice.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os preparados medicinais canabinoides são há muito utilizados pela humanidade e têm sido objeto de interesse da indústria farmacológica recente. Para a aplicação terapêutica adequada é necessário, no entanto, o conhecimento aprofundado do sistema canabinoide endógeno, o qual em sua grande parte é constituído por mensageiros lipídicos. O objetivo deste estudo foi explorar o conhecimento vigente a respeito dos constituintes desse sistema, com especial atenção à maquinaria molecular necessária para processá-los. CONTEÚDO: Trata-se de uma revisão narrativa da literatura atual acerca dos integrantes do sistema canabinoide endógeno, notadamente: seus receptores, os principais ligantes endógenos e as enzimas responsáveis pelo processamento de seus componentes. Os aspectos farmacológicos e pré-clínicos foram enfatizados. CONCLUSÃO: O melhor entendimento da ultraestrutura de receptores e enzimas contribuirá de forma decisiva para o desenvolvimento de novas estratégias farmacológicas. A partir da descrição pormenorizada da maquinaria responsável pela metabolização lipídica endocanabinoide é que se pavimentará o caminho para a descoberta de novos fármacos que atuem no sistema endógeno e que possam ser aplicados de forma eficaz na prática clínica.

Seguridad del paciente: análisis de la prescripción en adultos mayores de una policlínica de salud mental del Hospital Vilardebó, Uruguay / Patient safety: analysis of prescriptions in older adults in a Mental Health Outpatient Clinic at Vilardebó Hospital, Uruguay / Segurança do paciente: análise da prescrição em idosos de uma Policlínica de Saúde Mental do Hospital Vilardebó, Uruguai

Introducción: los pacientes con 65 años o más, por su condición fisiológica, tienen mayor probabilidad de estar expuestos a reacciones adversas a medicamentos. Algunos riesgos están asociados a la carga anticolinérgica de la medicación, y otros al perfil de seguridad de cada uno de los fármacos. Objetivo: realizar un análisis de los tratamientos farmacológicos para los pacientes ≥65 años y su posible implicancia en la clínica, por los riesgos potenciales debido a reacciones adversas. Método: se realizó un estudio descriptivo, transversal, observacional, naturalístico, del tratamiento farmacológico de los pacientes ≥65 años de la policlínica del Hospital Vilardebó, entre mayo y agosto de 2021. Se calculó la carga anticolinérgica de los tratamientos y se efectuó una comparación de dicha carga con la de una muestra de pacientes menores de 65 años. Resultados: 356 pacientes (83,0%) ≥65 años tenían un riesgo alto de tener algún efecto por su carga anticolinérgica y este riesgo fue similar a los pacientes menores de 65 años. Un total de 344 pacientes estaban en tratamiento con alguna benzodiazepina, destacándose el uso de flunitrazepam (47,6%) y clonazepam (32,6%). A 289 pacientes (67,4%) se le prescribió algún antipsicótico y nueve pacientes estaban con más de dos antipsicóticos. Dos pacientes estaban en tratamiento con imipramina y 49 pacientes recibían algún antiparkisoniano. Conclusiones: los pacientes mayores de 65 años están expuestos a riesgos altos de padecer reacciones adversas a medicamentos como consecuencia de una alta carga anticolinérgica (similar a la de la población más joven estudiada) y de una acentuada polifarmacia. Además, se deberían evitar algunas prácticas, como la prescripción de ciertos tipos de benzodiacepinas, así como minimizar el uso de imipramina y antiparkisonianos. Es necesario buscar estrategias de formación que disminuyan o minimicen este potencial riesgo que repercute adversamente en la salud de los pacientes.

Summary: Introduction: patients aged 65 years or older are at increased risk for exposure to adverse drug reactions because of their physiological status. Some risks are associated with the anticholinergic burden of medication, and others with the safety profile of each drug. Objective: to perform an analysis of pharmacological treatments for patients aged 65 years old or older and their possible clinical implications, given the potential risks of adverse drug reactions. Method: a descriptive, cross-sectional, observational, naturalistic, observational study of the pharmacological treatment of users aged 65 years old or older of the outpatient service at Vilardebó Hospital, between May and August 2021, was performed. A calculation was made of the anticholinergic burden of treatments and a comparison of this burden was made with a sample of patients under 65 years of age. Results: 356 patients (83.0%) ≥ 65 years old were at high risk of having some kind of effect from their anticholinergic burden and this risk was similar to patients younger than 65 years. A total of 344 patients were in treatment with a benzodiazepine. The prescription of flunitrazepam (47.6%) and clonazepam (32.6%) stood out. While 289 patients (67.4%) were in treatment with an antipsychotic, 9 patients were on more than 2 antipsychotics. Two patients were on imipramine and 49 patients were in treatment with some antiparkinsonian drugs. Conclusions: patients older than 65 years old are exposed to a high risk of suffering adverse drug reactions as a consequence of a high anticholinergic load (similar to that of the younger population studied) and a marked polypharmacy. In addition, some practices should be avoided, such as the prescription of certain types of benzodiazepines used in this population, as well as minimizing the use of imipramine and antiparkinsonian drugs. It is necessary to look for training strategies to minimize this potential risk that adversely affects the health of patients.

Introdução: pacientes com 65 anos ou mais, devido à sua condição fisiológica, estão mais propensos a serem expostos a reações adversas a medicamentos. Alguns riscos estão associados à carga anticolinérgica do fármaco e outros ao perfil de segurança de cada um dos medicamentos. Objetivo: realizar uma análise dos tratamentos farmacológicos para pacientes ≥ 65 anos de idade e sua possível implicação clínica, devido aos riscos potenciais decorrentes de reações adversas. Método: foi realizado um estudo descritivo, transversal, observacional, naturalístico do tratamento farmacológico de pacientes ≥ 65 anos da Policlínica Hospitalar de Vilardebó, entre maio e agosto de 2021. A carga anticolinérgica dos tratamentos foi calculada e foi feita uma comparação com a de uma amostra de pacientes com menos de 65 anos. Resultados: 356 pacientes (83,0%) ≥ 65 anos apresentaram alto risco de ter algum efeito devido à sua carga anticolinérgica e esse risco foi semelhante aos pacientes com menos de 65 anos. Um total de 344 pacientes estava em tratamento com algum benzodiazepínico, com destaque para o uso de flunitrazepam (47,6%) e clonazepam (32,6%). 289 pacientes (67,4%) receberam algum antipsicótico e 9 pacientes estavam tomando mais de 2 antipsicóticos. Dois pacientes estavam sendo tratados com imipramina e 49 estavam recebendo um antiparkisoniano. Conclusões: pacientes com mais de 65 anos estão expostos a um alto risco de sofrer reações adversas a medicamentos em decorrência de uma carga anticolinérgica elevada (semelhante à da população mais jovem estudada) e de uma polifarmácia acentuada. Além disso, algumas práticas devem ser evitadas, como a prescrição de determinados tipos de benzodiazepínicos que são utilizados nessa população, além de minimizar o uso de imipramina e antiparkinsonianos. É necessário buscar estratégias de formação que reduzam ou minimizem esse risco potencial que afeta negativamente a saúde dos pacientes.

Perfil Clínico-Epidemiológico-Medicamentoso dos Pacientes com Doença de Alzheimer em Estratégias de Saúde da Família em um Município do Sul do Brasil / Clinical and epidemiological profile of patients with Alzheimer's disease in family health strategies in a city in southern Brazil

Introdução: A Doença de Alzheimer (DA) é um transtorno neurodegenerativo progressivo e a demência mais frequente no mundo. Pacientes com DA podem apresentar múltiplas comorbidades e maior aporte medicamentoso, o qual pode evoluir para a polifarmácia. Analisou-se o perfil clínico-epidemiológico-medicamentoso dos pacientes com Doença de Alzheimer registrados no Serviço Municipal da Secretaria de Saúde de Tubarão/SC. Métodos: Estudo epidemiológico do tipo observacional transversal, com análise documental de prontuários dos pacientes com DA registrados em 06 Estratégias de Saúde da Família de Tubarão. Resultados: A prevalência foi do sexo feminino (74,1%), (50%) dos pacientes tinham entre 81 a 90 anos, a maioria era de etnia branca (93,1%), ausência de história familiar de demência (87,9%), mais de (60%) dos pacientes não apresentaram acompanhar a doença com especialista. Em relação ao perfil dos medicamentos, (44,16%) eram drogas do Sistema Nervoso, (15,83%) fármacos antidemenciais; o Cloridrato de Donepezila (10%), o Bromidrato de Citalopram (21,53%) e o Cloridrato de Memantina (21,53%) foram os medicamentos com maior consumo. A prática da polifarmácia ocorreu em (51,71%) dos pacientes. Conclusão: As mulheres apresentam maior expectativa de vida. Apesar da maior prevalência do uso de drogas do Sistema Nervoso, cerca de um terço destas era antidemencial e possui elevada importância para o tratamento da DA. O uso de antidepressivos condiz com as características e a evolução da DA, com a presença de sintomas psiquiátricos. Ressalta-se que mais da metade dos pacientes era praticante de polifarmácia, em que pode haver interações medicamentosas e alterações fisiológicas que poderiam ser evitadas por um bom exame clínico. Palavras-chave: Farmacologia, Demência, Envelhecimento.

Introduction: Alzheimer's disease (AD) is a progressive neurodegenerative disorder and the most common dementia in the world. Patients with AD may have multiple comorbidities and increased medication intake, which can evolve into polypharmacy. This study analyzed the clinical, epidemiological, and medication profiles of patients with Alzheimer's disease registered in the City Health Department of Tubarão/ SC. Methods: Epidemiological study of the cross-sectional observational type with documentary analysis of medical records of patients with AD registered in 6 Family Health Strategies of Tubarão. Results: The prevalence was female (74.1%), and 50% of patients were between 81 to 90 years old. Most patients were of white ethnicity (93.1%), with an absence of dementia in the family history (87.9%), and more than 60% of patients did not present to follow up on the disease with a specialist. Concerning the profile of medications, 44.16% were drugs for the Nervous System, 15.83% were antidementia drugs, Donepezil Hydrochloride (10%), Citalopram Bromide (21.53%), and Memantine Hydrochloride (21.53%) were the drugs with the highest consumption. The practice of polypharmacy occurred in 51.71% of patients. Conclusion: Women have a higher life expectancy. Despite the higher prevalence of Nervous System drugs, about one-third of those were antidementia drugs and have high importance for AD treatment. The use of antidepressants matches the characteristics and evolution of AD with the presence of psychiatric symptoms. It is noteworthy that more than half of the patients practiced polypharmacy, in which it may occur drug interactions and physiological changes that could be avoided with a good clinical examination.