Acesso da população a medicamentos durante a pandemia do novo coronavírus / Access of the population to medicines during the pandemic of the new coronavirus / Acceso de la poblacióna medicamentos durante la pandemia del nuevo coronavirus

Introdução:Em 2020 a Organização Mundial da Saúde declarou a pandemia do novo coronavírus. Diante desse cenário vários estudos começaram a ser realizados em busca de uma terapia eficaz para o manejo clínico dos pacientes. A Cloroquina e a Hidroxicloroquina foram os primeiros medicamentos testados. A divulgação dos resultados iniciais fez aumentar a procura desses medicamentos em farmácias e drogarias. Objetivo:Avaliar o acesso da população a medicamentos na pandemia e o uso das "promessas terapêuticas":Cloroquina, Hidroxicloroquina e Ivermectina para prevenção e tratamento da COVID-19. Metodologia:Trata-se de um estudo descritivo exploratório de abordagem quantitativa, não probabilístico e por conveniência. A coleta de dados foi realizada online,via Google Formulários. Participaram 1.754 pessoas, resultando em 1.748 questionários válidos. A amostra foi distribuída em 3 grupos, de acordo com a pergunta de nº 11 do formulário de pesquisa: "Você já teve COVID-19?". Resultados:Dos 1.748 respondentes, 200 (11,4%) pertenciam ao grupo que "teve COVID-19", 1.041 (59,6%) ao grupo que não teve a doença, e 507 (29%) responderam não saber se foram infectados. No que diz respeito ao acesso a medicamentos na pandemia, 55,2% do total da amostra relatou não ter sido afetado, e 29% disseram ter tido o acesso afetado de alguma forma. Em relação ao uso das "promessas terapêuticas", 61% dos respondentes disse não ter feito uso com finalidade de prevenção, e sim para tratamento, já 52,6% da população do estudo disse que não fez uso de jeito nenhum, e 46,2% relatou que fez uso dos medicamentos mencionados para tratar a COVID-19. Conclusões:Constatou-se que a explosão na busca por medicamentos durante a pandemia não afetou o acesso da população. Além disso, a Cloroquina e a Hidroxicloroquina, não foram amplamente utilizadas para prevenção da doença (AU).

Introduction:In 2020the World Health Organization declared the new coronavirus pandemic. In view of this scenario, several studies began to be carried out in search of an effective therapy for the clinical management of patients. The release of initial results has increased demand for Chloroquine and Hydroxychloroquine in pharmacies and drugstores. Objective: To assess the population's access to medicines in the pandemic and the use of "therapeutic promises": Chloroquine, Hydroxychloroquine and Ivermectin for the prevention and treatment of COVID-19. Methodology:Exploratory descriptive study with a quantitative approach, non-probabilistic and for convenience. Data collection was performed online, via Google Forms. 1,754 people participated, resulting in 1,748 valid questionnaires. The sample was divided into 3 groups, according to question #11 of the survey form: "Have you ever had COVID-19?". Results:Of the 1,748 respondents, 200 (11.4%) belonged to the group that "had COVID-19", 1,041 (59.6%) to the group that did not have the disease, and 507 (29%) answered not knowing if they were infected. With regard to access to medicines in the pandemic, 55.2% of the total sample reported not being affected, and 29% said their access was affected in some way. Regarding the use of "therapeutic promises", 61% of respondents said they did not use it for prevention purposes, but for treatment, while 52.6% of the study population said they did not use it at all, and 46, 2% used the medications mentioned to treat COVID-19. Conclusions:It wasfound that the explosion in the search for medicines during the pandemic did not affect the population's access. Furthermore, Chloroquine and Hydroxychloroquine have not been widely used for disease prevention (AU).

Introducción:En 2020, la Organización Mundial de la Salud declaró la nueva pandemia de coronavirus. Ante este escenario, se comenzaron a realizar varios estudios en busca de una terapia eficaz para el manejo clínico de lospacientes. La publicación de los resultados iniciales ha aumentado la demanda de cloroquina e hidroxicloroquina en farmacias y droguerías. Objetivo:Evaluar el acceso de la población a medicamentos en la pandemia y el uso de "promesas terapéuticas": cloroquina, hidroxicloroquina e ivermectina para la prevención y tratamiento de COVID-19. Metodología:Se trata de un estudio descriptivo exploratorio con enfoque cuantitativo, no probabilístico y por conveniencia. La recopilación de datos se realizó en línea, a través de Google Forms. Participaron 1.754 personas, resultando 1.748 cuestionarios válidos. La muestra se dividió en 3 grupos, de acuerdo con la pregunta # 11 del formulario de la encuesta: "¿Alguna vez ha tenido COVID-19?". Resultados: De los 1.748 encuestados, 200 (11,4%) pertenecían al grupo que "tenía COVID-19", 1.041 (59,6%) al grupo que no tenía la enfermedad y 507 (29%) respondieron sin saber si estaban infectados. Con respecto al acceso a medicamentos en la pandemia, el 55,2% del total de la muestra informó no estar afectado y el 29% dijo que su acceso se vio afectado de alguna manera. Con respecto al uso de "promesas terapéuticas", el 61% de los encuestados dijo que no lo usaba con fines de prevención, sino de tratamiento, mientras que el 52,6% de la población del estudio dijo que no lo usaba en absoluto, y el 46,2% informó que utilizaron los medicamentos mencionados para tratar COVID-19. Conclusiones: Se encontró que la explosión en la búsqueda de medicamentos durante la pandemia no afectó el acceso de la población. Además, la cloroquina y la hidroxicloroquina no se han utilizado ampliamente para la prevención de enfermedades (AU).

Expression of metalloproteinases 2 and 9 and plasma zinc concentrations in women with fibroadenoma.

OBJECTIVE: This study aims to investigate the association between the immunohistochemical expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 and plasma zinc in women with fibroadenoma. METHODS: This cross-sectional study included 37 premenopausal women with fibroadenoma. Waist circumference and body mass index of the participants were measured. Plasma zinc concentrations were determined using atomic flame absorption spectrophotometry. Fragments of breast tissue were fixed and incubated with primary mouse monoclonal antibodies (monoclonal antibodies matrix metalloproteinase -2 -507 and monoclonal antibodies matrix metalloproteinase -9-439). Semi-quantitative analysis of matrix metalloproteinase-2 and matrix metalloproteinase-9 immunoreactivity was performed. Spearman's test and Friedman's test were used for statistical analyses. The p<0.05 were considered statistically significant. RESULTS: The average age of the participants was 32.81±9.51 years. The body mass index and waist circumference values were within the normal range. The mean plasma zinc concentration was 42.73±13.84 µg/dL, with 94.6% inadequacy. A statistically significant difference was found between the positive expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 (p=0.0184). There was no significant correlation between the matrix metalloproteinase expression and the plasma zinc levels. CONCLUSIONS: Women with fibroadenoma had hypozincemia and positive expression of metalloproteinases.

Expression of metalloproteinases 2 and 9 and plasma zinc concentrations in women with fibroadenoma

SUMMARY OBJECTIVE: This study aims to investigate the association between the immunohistochemical expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 and plasma zinc in women with fibroadenoma. METHODS: This cross-sectional study included 37 premenopausal women with fibroadenoma. Waist circumference and body mass index of the participants were measured. Plasma zinc concentrations were determined using atomic flame absorption spectrophotometry. Fragments of breast tissue were fixed and incubated with primary mouse monoclonal antibodies (monoclonal antibodies matrix metalloproteinase -2 -507 and monoclonal antibodies matrix metalloproteinase -9-439). Semi-quantitative analysis of matrix metalloproteinase-2 and matrix metalloproteinase-9 immunoreactivity was performed. Spearman's test and Friedman's test were used for statistical analyses. The p<0.05 were considered statistically significant. RESULTS: The average age of the participants was 32.81±9.51 years. The body mass index and waist circumference values were within the normal range. The mean plasma zinc concentration was 42.73±13.84 µg/dL, with 94.6% inadequacy. A statistically significant difference was found between the positive expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 (p=0.0184). There was no significant correlation between the matrix metalloproteinase expression and the plasma zinc levels. CONCLUSIONS: Women with fibroadenoma had hypozincemia and positive expression of metalloproteinases.

Avaliação do tratamento antirretroviral de pessoas convivendo com HIV/aids que participam de um grupo de adesão / Evaluation of antiretroviral treatment of people living with HIV/aids participating in an adherence group

RESUMO Modelo de estudo: Trata-se de um estudo do tipo observacional, descritivo e transversal. Objetivo: Avaliar o comportamento de adesão ao tratamento antirretroviral de pessoas convivendo com HIV/aids que participam de um Grupo de Adesão. Métodos: O questionário foi respondido por 15 pacientes maiores de 18 anos, independente do sexo, com diagnóstico confirmado de AIDS que participam de um Grupo de Adesão em um serviço de dispensação de antirretrovirais, e que após receberem informações pertinentes ao estudo, aceitaram participar voluntariamente, por meio da assinatura do Termo de Consentimento Livre e Esclarecido. Resultado: A maioria dos participantes era do sexo masculino, acima de 40 anos (73,3%) e 26,6% eram economicamente ativos. Quanto à sexualidade, 80% dos entrevistados declararam ser heterossexual. Quanto à escolaridade, 60% não havia completado o ensino médio. O tempo de diagnóstico da doença predominante foi entre 10 e 16 anos, sendo que 46,6% referiram possuir outros problemas de saúde, como toxoplasmose, herpes, tuberculose e leishmaniose. A análise do questionário de adesão mostrou que 33,3% possuía uma boa adesão ao tratamento antirretroviral. Entre as interações droga-droga identificadas, 44,4% ocorreram entre os antirretrovirais. Conclusão: A partir da realização deste estudo foi possível concluir que 66,66% dos entrevistados relataram que em algum momento houve uma descontinuidade do tratamento, revelando uma dificuldade na manutenção do uso dos antirretrovirais em indivíduos convivendo com HIV/AIDS. No contexto da farmacoepidemiologia antirretroviral, as potenciais interações medicamentosas identificadas neste estudo foram eventos que afetam a resposta terapêutica levando a toxicidade (AU)

Study design: This is an observational, descriptive, and cross-sectional study. Objective: Evaluating the adher-ence behavior to the antiretroviral treatment of people living with HIV/Aids who participate in an Adherence Group. Methods: The questionnaire was answered by 15 patients older than 18 years of age, regardless of sex, with a confirmed diagnosis of AIDS participating in an Adherence Group at an antiretroviral dispensing service, who, after receiving information related to the study, agreed to participate voluntarily, by singing the Written Informed Consent Form. Results: The majority of the participants were male, over 40 years old (73.3%) and 26.6% were economically active. Regarding sexuality, 80% of the interviewees stated that they were heterosexual. As for schooling, 60% had not finished high school. The time of diagnosis of the disease predominant was between 10 and 16 years, and 46.6% reported having other health problems, like toxoplasmosis, herpes, tuberculosis, and leishmaniasis. The analysis of the adherence questionnaire showed that 33.3% had good adherence to antiretroviral treatment. Among the drug-drug interactions identified, 44.4% occurred among antirretrovirals. Conclusion: Based on this study, it was possible to conclude that 66,66% at some point there was a discontinuation of treatment, revealing a difficulty in maintaining antiretroviral use in individuals living with HIV/aids. In the scenario of antiretroviral pharmacoepidemiology, the po-tential drug interactions identified in this study were events that affect the therapeutic response leading to toxicity (AU)

A case-control study of Metallothionein-1 expression in breast cancer and breast fibroadenoma.

The overexpression of Metallothionein-1 (MT-1) may play an important role in breast cancer; however, few studies have compared MT-1 expression between breast cancer and fibroadenoma. A cross-sectional controlled study was performed in 66 premenopausal women, aged 20-49 years, who had been histologically diagnosed with breast fibroadenoma or breast cancer. The patients were divided into two groups: group A, control (fibroadenoma, n = 36) and group B, study (breast cancer, n = 30). Immunohistochemistry was performed on tissue samples of fibroadenoma and breast cancer patients to evaluate the expression of metallothionein using an anti-MT-1 polyclonal antibody (rabbit polyclonal anti-metallothionein-Catalog Number biorbyt-orb11042) at a dilution of 1:100. The data were analyzed using NOVA (p < 0.05). Microscopic analysis showed a higher concentration of anti-MT-1-stained nuclei in breast cancer tissues than in fibroadenoma tissues. The mean proportion of cells with anti-MT-1-stained nuclei was 26.93% and 9.10%, respectively, in the study and control groups (p < 0.001). Histological grade 3 tumors showed a significantly higher MT-1 expression than hitological grade 1 (p < 0.05), while breast tumors negative for estrogen-, progesterone- and HER2- receptors had a significantly higher MT-1 expression than positive breast tumors positive for these parameters (p < 0.05). MT-1 protein in women of reproductive age was significantly higher in breast cancer than in fibroadenoma in this study. Furthermore, there was higher MT-1 immunoreactivity in more aggressive tumors.

Impacto da complexidade da farmacoterapia sobre parâmetros bioquímicos e pressóricos no diabetes mellitus / Impact of the complexity of pharmacotherapy on biochemical and pressure parameters in diabetes mellitus

OBJETIVOS: Avaliar a complexidade da farmacoterapia no diabetes melito numa unidade básica de saúde e investigar eventuais correlações com variáveis bioquímicas e pressóricas. MÉTODOS: Trata-se de um estudo observacional, descritivo com delineamento transversal, que incluiu todos os indivíduos com diagnóstico primário de diabetes tipo 2 e com prescrição preenchida com pelo menos um antidiabético oral. A quantificação da complexidade do regime terapêutico foi realizada conforme o índice da complexidade da farmacoterapia, e este foi correlacionado com variáveis do perfil bioquímico: glicemia capilar, creatinina e filtração glomerular, e pressórico: pressão arterial sistólica e diastólica, através da análise de correlação de Spearman. RESULTADOS: A média do índice de complexidade da farmacoterapia foi de 9,42±0,48 pontos, sendo mais proeminente na seção B (5,03±2,57). O índice esteve correlacionado com a glicemia capilar (rho=0,538), pressão arterial sistólica (rho=0,520), creatinina (rho=-0,406) e filtração glomerular (rho=0,566). Esta correlação foi diretamente proporcional ao aumento da glicemia capilar (p<0,01), pressão arterial sistólica (p<0,01) e filtração glomerular (p<0,01), e inversamente proporcional à creatinina (p<0,05). CONCLUSÕES: Nossos achados revelaram que a polifarmácia no diabete melito contribuiu para a geração da complexidade da farmacoterapia, resultando em não adesão ao tratamento prescrito e consequentemente contribuindo, principalmente, para o descontrole glicêmico e pressórico.

AIMS: Assess the complexity of pharmacotherapy in diabetes mellitus in a basic health unit and investigate possible correlations with biochemical and pressure variables. METHODS: It is study observational, descriptive, cross-sectional study that included all patients with a primary diagnosis of type 2 diabetes and a prescription filled with at least one oral antidiabetic agent. The quantification of the complexity of the therapeutic regimen was performed according to the complexity index of the pharmacotherapy; and it was correlated with variables of the biochemical profile: capillary glycemia, creatinine and glomerular filtration, and pressure systolic and diastolic blood pressure, using the Spearman correlation analysis. RESULTS: The median of the complexity index of pharmacotherapy was 9.42±0,48 points, being more prominent in section B (5.03±2.57). The index was correlated with capillary glycemia (rho=0.538), systolic blood pressure (rho=0.520), creatinine (rho=-0.406) and glomerular filtration (rho=0.566). This correlation was directly proportional to the increase in capillary glycemia (p<0.01), systolic blood pressure (p<0.01) and glomerular filtration (p<0, 01), and inversely proportional to creatinine (p<0.05). CONCLUSIONS: Our findings revealed that polypharmacy in diabetes mellitus contributed to the generation of pharmacotherapy complexity, resulting in non-adherence to the prescribed treatment and consequently contributing mainly to the lack of glycemic and pressure control.

Complexidade terapêutica de diabéticos na atenção primária / Therapeutic complexity of diabetic patients in primary care

Objetivo Este artigo tem por objetivo avaliar a complexidade da farmacoterapia de pacientes diabéticos, usuários de uma Unidade Básica de Saúde. Métodos Trata-se de estudo observacional, descritivo com delineamento transversal. A avaliação da complexidade do regime terapêutico foi realizada com base no Índice da Complexidade da Farmacoterapia. Foi considerado o tratamento medicamentoso de uso contínuo dos pacientes, incluindo antidiabéticos e fármacos para hipertensão e dislipidemia. As variáveis independentes foram representadas pelas interações medicamentosas, total de medicamentos utilizados, número de vezes e frequência mensal de visitas à unidade de saúde. As potenciais interações medicamentosas foram avaliadas por meio da base de dados Drugdex System ­ Thomson Micromedex® ­ Interactions, e a assiduidade de consultas foi obtida pelas datas de cadastro e da última visita. Resultados Na amostra estudada, 52,0% dos participantes tinham idade superior a 60 anos, sendo 73,3% do sexo feminino e, em média, frequentavam a unidade de saúde 0,257±0,22 vezes ao mês. A média da complexidade da farmacoterapia foi de 9,42±4,24, sendo mais proeminente na seção B (frequência de doses): 5,03±2,57. Conclusão A partir da realização deste estudo foi possível identificar uma elevada complexidade da farmacoterapia, que apresentou associação positiva com diversos fatores: número de medicamentos, interações medicamentosas, consultas e frequência mensal à unidade básica de saúde.

Objective To evaluate the pharmacotherapy complexity of diabetic patients of a Basic Health Unit. Methods Observational, descriptive study with a cross-sectional design. The complexity assessment of the therapeutic regimen was performed by calculating the Pharmacotherapy Complexity Index. Continuous prescription drug treatment was considered, including antidiabetics and drugs for hypertension and dyslipidemia. The independent variables were represented by drug interactions, total medication used and monthly frequency of visits to the health unit. Potential drug interactions were evaluated using the Drugdex System ­ Thomson Micromedex® ­ Interactions database and consultation frequency was obtained through the date of registration and the last visit recorded. Results In the sample studied, 52.0% of the participants were over 60 years old, female (73.3%) and with an average frequency of visits to the health unit of 0.257±0.22 times a month. The complexity mean of pharmacotherapy was 9.42±4.24, being most prominent in section B (frequency of doses): 5.03±2.57. Conclusion Based on this study, it was possible to identify a high level of pharmacotherapy complexity and it was positively associated with several factors: amount of drugs, drug interactions, consultations and monthly frequency in the basic health unit.