Pro-adherence complementary audiovisual educational intervention model for chronic myeloid leukemia patients treated with imatinib mesylate.

BACKGROUND: Imatinib mesylate (IM) treatment adherence is a challenge, especially in an economic-social population neglected from developing countries. OBJECTIVE: To create a new complementary audiovisual educational intervention model to improve IM treatment adherence of CML patients. METHODS: Two adherence verification methods were applied before and after intervention: modified Morisky-Green test and molecular responses (BCR-ABL transcripts quantification). Adherence estimates were calculated using univariate and multivariate component analysis (MCA) for the socio-demographic and clinical characteristics of patients. RESULTS: Modified Morisky-Green test results demonstrated a substantial increase of CML patient adherence from 23% (pre-film) to 65% (post-film). Greater improvement was obtained for patients presenting major molecular response (MMR) from 38% (pre-film) to 60% (post-film). Although slight gain for complete molecular response (CMR) from 23% (pre-film) to 26% (post-film) was achieved, it represents a total tumour regression. MCA identified that females <50 years-old, using less than two medications (no disease associated) and CMR condition were the most benefited with intervention. CONCLUSION: Audiovisual educational intervention was an effective complementary pro-adherence model, activating patient memory and improving IM treatment adherence. Although this intervention shows effective, not all patients responded as expected, being necessary a combination of educational and clinical interventions to improve IM adherence.

Monitorización terapéutica de la digoxinemia en pacientes con insuficiencia cardiaca: comparación entre dos métodos analíticos / Therapeutic drug monitoring of digoxin in cardiac heart failure outpatients: comparisons of two analytical methods

OBJETIVO: Comparar las dos técnicas analíticas más utilizadas en la determinación de la digoxinemia y verificar cuál de ellas atiende mejor las necesidades de la rutina de seguimiento clínico de los pacientes con insuficiencia cardíaca. MÉTODOS: En este trabajo fue investigado el perfil clínico y de laboratorio de 15 pacientes con insuficiencia cardiaca los cuales fueron atendidos en el Ambulatorio para pacientes con Insuficiencia Cardiaca del Hospital das Clínicas de la Universidad Federal de Goiás, Brasil. Las muestras de sangre de los pacientes fueron recogidas y analizadas por Inmunoensayo y Cromatografía Líquida de Alta Eficiencia acoplada a Espectrometría de Masas (LC-MS/MS). RESULTADOS: Los resultados del test "t" de Student (p = 0,05) mostraron que hubo diferencia significativa entre los dos métodos analíticos. Las concentraciones determinadas por inmunoensayo fueron mayores que las concentraciones determinadas por LC-MS/MS, ya que ese método analiza la digoxina y también sus metabolitos y substancias endógenas, mientras que el LC-MS/MS analiza solamente la molécula de digoxina. Por otro lado, ninguno de los pacientes, presentó datos clínicos relevantes sugestivos de intoxicación digitálica, a pesar de que varios fármacos con potencial de interacción estuvieron asociados al tratamiento. CONCLUSIONES: A partir de los resultados obtenidos puede concluirse que el método por LC-MS/MS se mostró más selectivo y específico, siendo una opción para la monitorización terapéutica de la digoxina, desde que se obtengan valores de referencia para la digoxinemia por LC-MS/MS

OBJECTIVE: To compare two analytical techniques used in the determination of plasma digoxin (LC-MS/MS and immunoassay) and to verify which one better answer the need of the clinical monitoring routine of patients with cardiac heart failure. METHOD: The clinical findings in 15 cardiac heart failure (CHF) out patients of the Cardiac Heart Service of the Goias Federal University Clinical Hospital were investigated. Blood samples of the patients were collected and analysed by Immunoassay and by Liquid Chromatography coupled to Mass Spectrometry (LC-MS/MS). RESULTS: The results of the statistic test (Studentp = 0,05) showed a significant difference between the analytical methods: immunoassay concentrations were higher than the concentrations determined by LC-MS/MS. The explanation may be because immunoassay methodmeasures digoxin plus other metabolites and endogenous substances,while the LC-MS/MS method measures only the digoxin molecule. None of the patients, showed relevant clinical data suggestive of digi-talis intoxication, even several drugs with potential interaction wereassociated with treatment. CONCLUSION: It was concluded, therefore, that LC-MS/MS me thod issafer, more selective and specific than immunoassay, being an option for therapeutic drug monitoring of digoxin, since the reference values would be obtain for digoxinemia by LC-MS/MS

Determinação simplificada de carbamazepina, fenitoína, fenobarbital e lamotrigina em plasma emonitoração terapêutica por HPLC/PDA / Simplified determination of carbamazepine, phenytoin,phenobarbital and lamotrigine in plasma and therapeuticmonitoring by HPLC/PDA

Carbamazepina, fenitoína, fenobarbital e lamotrigina são bem conhecidos como fármacos anticonvulsivantes usados para o tratamento da epilepsia. A utilização destes fármacos é associada a várias reações adversas, tornando necessário o controle terapêutico. Os ensaios foram realizados por meio de cromatografia líquida de alta eficiência e o método de extração utilizado foi o líquido-líquido. Os fármacos e o padrão interno de zolpidem foram separados por uma coluna de fase reversa (ACE5, C18150x 4,6 mm d.i.). A fase móvel constituída de acetonitrila (30%) e ácido cítrico/tampão fosfato pH 5,0 (70%) foi utilizada sob gradiente de fluxo de 0,7 a 1,2 mL/min e o comprimento de onda utilizado para a detecção dos analitos foi fixado em 210 nm. A técnica apresentou linearidade ao longo do intervalo de 0,5 a 20,0μg/mL para carbamazepina/lamotrigina e de 2,0 a 64,0 μg/mL, para fenitoina/fenobarbital com coeficiente de correlação linear maior que 0,98. As amostras de sangue foram obtidas de pacientes adultos com diagnóstico de epilepsia em acompanhamento no Ambulatório Municipal de Psiquiatria de Goiânia. A média de recuperação obtida foi de 96,8% a 108,5% para carbamazepina/lamotrigina e de 93,8% a 108,8% para a fenitoina/fenobarbital. Os limites de quantificação, precisão (CV< 15,0 %)e exatidão (E > 85,0 %) demonstraram estar em conformidade com as exigências da ANVISA. Nove pacientes foram avaliados para confirmar a validade do método.

Carbamazepine, phenytoin, phenobarbital and lamotrigine are well known anticonvulsant drugs used in the treatment of epilepsy. However, these medications are associated with side effects and therefore require therapeutic monitoring. Blood samples of adult outpatients diagnosed with epilepsy at the Goiânia Municipal Psychiatry Clinic (Brazil) were collected and analyzed using high-performance liquid chromatography. The analytes and internal standard (zolpidem) were extracted by liquid-liquid extraction. A reversed phase column (ACE 5, C18, 150 x 4.6 mm i.d.) was used. The mobile phase was composed of acetonitrile (30%) and citric acid/phosphate buffer, pH 5.0 (70%). The gradient flow rate was from 0.7 to 1.2 mL/min and the detection wavelength was set at 210 nm for all analytes. The analysis revealed a linear range from 0.5 to 20.0μg/mL for carbamazepine/lamotrigine and 2.0 to 64.0 μg/mL for phenytoin/phenobarbital. Mean recovery ranged from 96.8% to 108.5% for carbamazepine/lamotrigine and 93.8% to 108.8% for phenytoin/phenobarbital. The quantification limit, precision (CV < 15%) and accuracy (A >85%) proved to be in accordance with the requirements stipulated by the Brazilian National Health Surveillance Agency (ANVISA). Nine outpatients were evaluated to confirm the validity of the method.

Descontaminação de escovas dentais: desenvolvimento e padronização de método para uso doméstico / Disinfection of toothbrushes: development and standardizaztion of method for domestic use

O objetivo deste estudo foi analisar a presença de microorganismos em 50 escovas dentais em uso superior a 30 dias, imersas em solução diluída de água sanitária em tempos predeterminados, a fim de detectar qual o tempo de imersão seria eficaz na eliminação dos microorganismos presentes nas escovas dentais. Os resultados demonstraram que a imersão da região das cerdas das escovas dentais na solução diluída de água sanitária por um tempo mínimo de 8 horas é um método válido na descontaminação das cerdas impregnadas por inúmeros microorganismos, podendo ser considerado como um método sanitizante de uso doméstico