Association of adverse drug reaction to anti-tuberculosis medication with quality of life in patients in a tertiary referral hospital

Abstract INTRODUCTION: Adverse drug reactions can develop when using anti-tuberculosis medication, and the effects of the drugs can also significantly hinder the treatment of patients. METHODS: A cross-sectional survey was conducted in 73 patients using two standardized questionnaires and the World Health Organization Quality of Life-Bref. RESULTS: All patients reported the presence of adverse drug reactions, 71.6% of which are minor and 28.3% both major and minor. The global quality of life analysis showed that patients with tuberculosis have a good average (67.3%). CONCLUSIONS: There is an association between quality of life and adverse drug reaction, educational level, and vulnerability.

Association of adverse drug reaction to anti-tuberculosis medication with quality of life in patients in a tertiary referral hospital.

INTRODUCTION: Adverse drug reactions can develop when using anti-tuberculosis medication, and the effects of the drugs can also significantly hinder the treatment of patients. METHODS: A cross-sectional survey was conducted in 73 patients using two standardized questionnaires and the World Health Organization Quality of Life-Bref. RESULTS: All patients reported the presence of adverse drug reactions, 71.6% of which are minor and 28.3% both major and minor. The global quality of life analysis showed that patients with tuberculosis have a good average (67.3%). CONCLUSIONS: There is an association between quality of life and adverse drug reaction, educational level, and vulnerability.

Feasibility of a Symptom Management Intervention for Honduran Adults Undergoing Chemotherapy.

Evidence-based interventions often need to be adapted to maximize their implementation potential in low-to middle-income countries. A single-arm feasibility study was conducted to determine the feasibility and acceptability of a telephone-delivered, nurse-led, symptom management intervention for adults undergoing chemotherapy in Honduras. Over the course of 6 months, nurses engaged 25 patients undergoing chemotherapy in the intervention. Each participant received an average of 16.2 attempts to contact them for telephone sessions (SD = 8.0, range = 2-28). Collectively, the participants discussed 24 different types of symptoms. The most commonly discussed symptoms were pain (12%), nausea (7%), and constipation (5%). Qualitative and quantitative data were used to identify treatment manual modifications (i.e., adding content about different symptoms and addressing scheduling of treatment) and workplace modifications (i.e., dedicated nurse time and space) that are needed to optimize implementation of the intervention.

Neuroimmunology of Behavioral Comorbidities Associated With Cancer and Cancer Treatments.

Behavioral comorbidities (depression, anxiety, fatigue, cognitive disturbances, and neuropathic pain) are prevalent in cancer patients and survivors. These mental and neurological health issues reduce quality-of-life, which is a significant societal concern given the increasing rates of long-term survival after various cancers. Hypothesized causes of behavioral comorbidities with cancer include tumor biology, stress associated with the cancer experience, and cancer treatments. A relatively recent leading mechanism by which these causes contribute to changes in neurobiology that underlie behavior is inflammation. Indeed, both basic and clinical research indicates that peripheral inflammation leads to central inflammation and behavioral changes in other illness contexts. Given the limitations of assessing neuroimmunology in clinical populations, this review primarily synthesizes evidence of neuroimmune and neuroinflammatory changes due to two components of cancer (tumor biology and cancer treatments) that are associated with altered affective-like or cognitive behaviors in rodents. Specifically, alterations in microglia, neuroinflammation, and immune trafficking to the brain are compiled in models of tumors, chemotherapy, and/or radiation. Evidence-based neuronal mechanisms by which these neuroimmune changes may lead to changes in behavior are proposed. Finally, converging evidence in clinical cancer populations is discussed.

Uso do Coping Religioso/Espiritual diante das Toxicidades da Quimioterapia no Paciente Oncológico / Uso del Coping Religioso/Espiritual ante las Toxicidades de la Quimioterapia en el Paciente Oncológico / Cancer Patient use of Religious/Spiritual Coping to Deal with the Toxicities of Chemotherapy

Introdução: O adoecimento por câncer é considerado um grave problema de saúde pública e um evento estressante na vida dos pacientes. Isso porque é significativo o impacto emocional diante do diagnóstico e o desgaste psíquico durante o tratamento, sobretudo no que toca à quimioterapia antineoplásica, que expõe o paciente a toxicidades indesejáveis. Nesse sentido, emerge a necessidade de mobilização de recursos pessoais adaptativos para lidar com os diversos desconfortos, processo este compreendido como coping, podendo ainda estar associado ao uso da religião, espiritualidade ou fé (coping religioso/espiritual). Objetivo: Investigar a relação entre o uso do coping religioso/ espiritual e as respostas orgânicas às toxicidades da quimioterapia. Método: Estudo analítico, observacional, com corte transversal e delineamento correlacional. A amostra não probabilística foi composta por 40 pacientes da Unidade de Alta Complexidade em Oncologia de um Hospital Universitário. Como instrumentos, foram utilizados um questionário sociodemográfico e de saúde, e a escala de coping religioso/espiritual. Resultados: De um modo geral, o coping religioso/espiritual tanto positivo como negativo foi moderadamente utilizado por todos os participantes, independentemente do nível de toxicidades. Conclusão: A partir dos resultados encontrados, conclui-se que os pacientes com câncer submetidos à quimioterapia fazem uso tanto de estratégias de coping positivas como negativas, sendo as positivas utilizadas em maior intensidade.

Introduction: Cancer is considered a serious public health problem and a stressful event in the lives of patients. That is because the emotional impact of the diagnosis and the psychological damage during treatment are significant, especially in patients undergoing antineoplastic chemotherapy, which exposes them to undesirable toxicities. Therefore, cancer patients need to marshal adaptive personal resources to deal with various types of discomfort, a coping process that can be associated with a reliance on religion, spirituality, or faith (religious/spiritual coping). Objective: To investigate the relationship between the use of religious/spiritual coping and the organic responses to the toxicities of chemotherapy. Method: This was an analytical, observational, cross-sectional, correlational study. Using non-probability sampling, we selected 40 patients under treatment in the high complexity oncology unit of a university hospital. We applied a custom sociodemographic/health questionnaire and the brief religious coping scale. Results: In general, religious/spiritual coping, positive and negative, was moderately employed by all participants, regardless of the degree of the toxicities. Conclusion: We conclude that cancer patients undergoing chemotherapy use positive and negative coping strategies, although positive coping was used to a greater degree in our sample.

Introducción: La enfermedad por cáncer se considera un grave problema de salud pública y un evento estresante en la vida de los pacientes. Esto es porque es significativo el impacto emocional ante el diagnóstico y el desgaste psíquico durante el tratamiento, sobre todo, en lo que toca a la quimioterapia antineoplásica, que expone al paciente a toxicidades indeseables. En este sentido, emerge la necesidad de movilización de recursos personales adaptativos para lidiar con las diversas incomodidades, proceso este comprendido como coping, pudiendo aún estar asociado al uso de la religión, espiritualidad o fe (coping religioso/espiritual). Objetivo: Investigar la relación entre el uso del coping religioso/espiritual y las respuestas orgánicas a las toxicidades de la quimioterapia. Método:Estudio analítico, observacional, con corte transversal y delineamiento correlacional. La muestra no probabilística fue compuesta por 40 pacientes de la Unidad de Alta Complejidad en Oncología de un Hospital Universitario. Como instrumentos se utilizaron un cuestionario socio demográfico y de salud y la escala de coping religioso-espiritual. Resultados: En general, el coping religioso espiritual, tanto positivo como negativo, fue moderadamente utilizado por todos los participantes, independientemente del nivel de toxicidades. Conclusión: A partir de los resultados encontrados se concluye que los pacientes con cáncer sometidos a quimioterapia hacen uso tanto de estrategias de coping positivas como negativas, siendo las positivas utilizadas en mayor intensidad.

[Physicians´ insight about adverse drug reaction to frequently used medication groups in Bogotá (Colombia)]. / Percepción entre médicos bogotanos del riesgo de reacciones adversas a grupos de medicamentos de uso común.

INTRODUCTION: Adverse drug reactions are a public health problem; however, still many prescribers do not seem to recognize the risk associated with the use of medications. OBJECTIVE: To assess the perception of the risk of adverse reactions associated with the groups of drugs most frequently used in clinical practice. MATERIALS AND METHODS: Descriptive study made in 200 physicians with at least 2 years of clinical experience in Bogota, Colombia. The risk of adverse drug reactions associated with the use of medications was assessed using a visual analog scale (0-10 points). RESULTS: The perception of risk was <5 points for 19 of the 31 (61%) therapeutic groups. The therapeutic groups that were related to increased perception of risk were chemotherapy for cancer (median, 8.5, interquartile range: 1.8), insulin (median, 8, interquartile range: 4.8) and anticoagulants (median, 7.5, interquartile range: 4). CONCLUSIONS: Although there is a relationship between the perception of risk and the frequency of adverse drug reactions associated with therapeutic groups of higher score, there is also a strong underestimation of the risk of medicines in common use at hospital and ambulatory level such as NSAID, antihypertensive drugs and oral contraceptives.

Percepción entre médicos bogotanos del riesgo de reacciones adversas a grupos de medicamentos de uso común / Physicians´ insight about adverse drug reaction to frequently used medication groups in Bogotá (Colombia)

Introducción. Las reacciones adversas a medicamentos son un problema de salud pública; sin embargo, todavía son muchos los médicos que no parecen reconocer el riesgo asociado al uso de medicamentos. Objetivo. Valorar la percepción del riesgo de reacciones adversas asociado a los grupos de medicamentos más frecuentemente utilizados por los profesionales de la medicina en la práctica clínica. Materiales y métodos. Se llevó a cabo un estudio descriptivo y transversal con 200 médicos con un mínimo de dos años de experiencia clínica, y vinculados a hospitales públicos o clínicas privadas de Bogotá. La percepción del riesgo asociado a las reacciones adversas a medicamentos de 31 grupos farmacológicos o terapéuticos, se valoró usando una escala analógica visual (0-10 puntos). Resultados. La percepción del riesgo fue baja (puntaje promedio <5) con relación a 19 (61 %) de los 31 grupos de medicamentos. Los tres grupos que se relacionaron con una mayor percepción de riesgo de reacciones adversas a medicamentos (puntaje promedio >7) fueron: (a) la quimioterapia para el cáncer (mediana=8,5; rango intercuartílico: 1,8), (b) la insulina (mediana=8; rango intercuartílico: 4,8) y (c) los anticoagulantes (mediana=7,5; rango intercuartílico: 4). Conclusiones. Aunque existe una relación adecuada entre la percepción del riesgo y la frecuencia de las reacciones adversas a los medicamentos asociada con los grupos de mayor puntaje, también existe una importante subestimación del riesgo en medicamentos de uso común a nivel hospitalario y ambulatorio, como es el caso de los antiinflamatorios no esteroideos, los antihipertensivos y los anticonceptivos orales.

Introduction: Adverse drug reactions are a public health problem; however, still many prescribers do not seem to recognize the risk associated with the use of medications. Objective: To assess the perception of the risk of adverse reactions associated with the groups of drugs most frequently used in clinical practice. Materials and methods: Descriptive study made in 200 physicians with at least 2 years of clinical experience in Bogota, Colombia. The risk of adverse drug reactions associated with the use of medications was assessed using a visual analog scale (0-10 points). Results: The perception of risk was <5 points for 19 of the 31 (61%) therapeutic groups. The therapeutic groups that were related to increased perception of risk were chemotherapy for cancer (median, 8.5, interquartile range: 1.8), insulin (median, 8, interquartile range: 4.8) and anticoagulants (median, 7.5, interquartile range: 4). Conclusions: Although there is a relationship between the perception of risk and the frequency of adverse drug reactions associated with therapeutic groups of higher score, there is also a strong underestimation of the risk of medicines in common use at hospital and ambulatory level such as NSAID, antihypertensive drugs and oral contraceptives.

Sharing medicine: the candidacy of medicines and other household items for sharing, Dominican Republic.

BACKGROUND: People share medicines and problems can result from this behavior. Successful interventions to change sharing behavior will require understanding people's motives and purposes for sharing medicines. Better information about how medicines fit into the gifting and reciprocity system could be useful in designing interventions to modify medicine sharing behavior. However, it is uncertain how people situate medicines among other items that might be shared. This investigation is a descriptive study of how people sort medicines and other shareable items. METHODS AND FINDINGS: This study in the Dominican Republic examined how a convenience sample (31 people) sorted medicines and rated their shareability in relation to other common household items. We used non-metric multidimensional scaling to produce association maps in which the distances between items offer a visual representation of the collective opinion of the participants regarding the relationships among the items. In addition, from a pile sort constrained by four categories of whether sharing or loaning the item was acceptable (on a scale from not shareable to very shareable), we assessed the degree to which the participants rated the medicines as shareable compared to other items. Participants consistently grouped medicines together in all pile sort activities; yet, medicines were mixed with other items when rated by their candidacy to be shared. Compared to the other items, participants had more variability of opinion as to whether medicines should be shared. CONCLUSIONS: People think of medicines as a distinct group, suggesting that interventions might be designed to apply to medicines as a group. People's differing opinions as to whether it was appropriate to share medicines imply a degree of uncertainty or ambiguity that health promotion interventions might exploit to alter attitudes and behaviors. These findings have implications for the design of health promotion interventions to impact medicine sharing behavior.

Dependencia à Amineptina: relato de caso e revisäo de literatura, con ênfase nas abordagens terapêuticas / Amineptine dependence: a case report and literature review with therapeutic considerations

Os antidepressivos têm sido considerados drogas seguras no que se refere ao potencial de causar dependência, tendo inclusive sido usados com liberdade em pacientes portadores de dependência química. Atualmente, existe uma tendência entre os médicos a usar as drogas de 2ª geraçäo em detrimento dos antidepressivos tricíclicos, mais conhecidos mas com efeitos colaterais mais severos. A amineptina, com seu efeito predominantemente dopaminérgico, teoricamente seria um antidepressivo muito interessante para ser usado em caso de comorbidade de depressäo e dependência química, pois atuaria também na via dopaminérgica comum das dependências, teoricamente diminuindo as compulsöes. Os autores relatam um caso onde um paciente dependente de álcool desenvolveu dependência á amineptina (Survector), após emprego terapêutico para tratamento de quadro bipolar concomitante. A revisäo de literatura feita através dos Unitermos amineptine/amineptina e dependence/dependência das bases de dados LILACS e MEDLINE revelou 16 trabalhos sobre o tema, dois deles ppublicados no Brasil. Esta complicaçäo da amineptina é relativamente comum, embora alguns autores näo a considerem significativa para impedir seu uso mesmo em pacientes com história prévia de dependência. O uso de Clonidina, como preconizado na literatura, mostrou-se eficaz para diminuir os sintômas de abstinência. Frente à piora do quadro básico,os autores concluem que esta droga deve ser utilizada com cautela em pacientes dependentes