Worldwide Prevalence of Polypharmacy: A Systematic Review.

INTRODUCTION: The present study has compiled the prevalence of polypharmacy worldwide and assessed the prevalence of polypharmacy in different populations, including community-dwelling individuals, hospitalized patients, and institutionalized patients. METHODS: This systematic review was conducted and reported according to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A systematic search of electronic databases, including PubMed, Web of Science, and Scielo, was performed in March 2021 without any date and language restrictions. Combinations of the following keywords were used for the search strategy: polypharmacy OR multiple medications OR multiple medicines OR multiple drug AND prevalence. Based on the search and inclusion criteria, two hundred and eight studies (73,076,167 individuals) were selected for inclusion in the systematic review. It was observed that there is a wide variation in the prevalence of polypharmacy between studies. RESULTS: The prevalence of polypharmacy was found to be 30.2%, 61.7%, and 56.9% for community-dwelling individuals, hospitalized patients, and institutionalized patients, respectively. CONCLUSION: Based on the analyses, this systematic review has demonstrated a wide variation in the prevalence of polypharmacy between studies and countries and a high prevalence of polypharmacy in institutionalized and hospitalized patients.

Nuclear Magnetic Resonance Approach in Brazil Nut Oil and the Occurrence of Aflatoxins.

Carcinogenic metabolites of fungi such as aflatoxins play a toxic role in some tree nuts and need to be monitored in their by-products, such as oil. In this context, Brazil nut (Bertholletia excelsa) oil, which is a commodity of great economic importance to Brazil, requires attention to monitor the presence of these toxic agents. Therefore, this study aimed to evaluate the presence of aflatoxins in Brazil nut oil and relate it to the presence of fatty acids in the oil as a surveillance tool for food safety. Brazil nut oil samples (n= 25) were acquired in northern Brazil as (a) non-branded products (n= 07) produced by local farmers using artisanal methods from nuts to be discarded by the industry and (b) industrialized products (n= 18). The samples were analyzed for total aflatoxin content by high-performance liquid chromatography and fatty acid content by nuclear magnetic resonance imaging. Seven (28%) samples were positive for the aflatoxin fractions (B1 + B2 + G1 + G2), ranging from undetected (<2.32) to 50.87 µg/kg. Of the aflatoxin positive samples evaluated by NMR analysis, it was not possible to state that the presence of a particular fatty acid can interfere or influence aflatoxin contamination. This was the first study with data on aflatoxin occurrence in Brazil nut oil. Nevertheless, further research is required to relate saturated or unsaturated fatty acid content with aflatoxin levels. We also suggest the implementation of systems to prevent contamination of the raw materials (seed) and detoxification of the oil to guarantee the product's safety and quality.