Exposição ao praguicida glifosato e a ocorrência do transtorno do espectro autista: existe associação? / Exposure to the pesticide glyphosate and the occurrence of autistic spectrum disorder: is there an association?

O presente estudo teve como objetivo estudar a associação entre a exposição ao glifosato e a ocorrência do Transtorno do Espectro Autista (TEA). Trata-se de um estudo documental com busca de dados acerca da prevalência do TEA (Centers of Disease Control and Prevention) e de um levantamento para verificar o princípio ativo do praguicida mais usado no Brasil (Instituto Brasileiro do Meio Ambiente e dos Recursos Naturais Renováveis) e no mundo (United States Evironmental Prevention Agency). Os resultados mostraram que a prevalência do TEA aumentou ao longo dos anos. Do mesmo modo, o uso e a compra de praguicidas também aumentaram, sendo o glifosato o princípio ativo mais usado. Ainda que os resultados apontem a existência de uma relação entre a exposição ao glifosato e a ocorrência de autismo, são necessários mais estudos para afirmar o potencial neurotóxico do glifosato e sua associação com o nascimento de crianças autistas.

The present study aimed to study the association between exposure to glyphosate and the occurrence of Autistic Spectrum Disorder (ASD). This is a documental study with search for data about the prevalence of ASD (Centers of Disease Control and Prevention) and a survey to verify the active principle of the most used pesticide in Brazil (Brazilian Institute of Environment and Renewable Natural Resources) and worldwide (United States Environmental Prevention Agency). The results showed that the prevalence of ASD increased over the years. Likewise, the use and purchase of pesticides have also increased, with glyphosate being the most widely used active ingredient in the world. Although the results point to the existence of a relationship between exposure to glyphosate and the occurrence of autism, further studies are needed to confirm the neurotoxic potential of glyphosate and its association with the birth of autistic children.

Intoxicações por alimentos e bebidas e ocorrência das doenças de transmissão hídrica e alimentar no Brasil / Food and drink poisoning and occurrence of waterborne and foodborne diseases in Brazil

O presente estudo teve como objetivo fazer um levantamento do perfil epidemiológico das notificações por intoxicação e das doenças de transmissão hídrica e alimentar (DTHA) no Brasil, entre 2016 a 2021. Trata-se de um estudo documental com análises quantitativas e descritivas dos dados coletados no Sistema de Informação de Agravos de Notificação - SINAN e Ministério da Saúde. Os resultados mostraram uma diminuição no número de notificações ao longo dos anos, apesar do grande número encontrado em 2017 e 2018. O perfil dos intoxicados entre 2016-2021, foi de indivíduos do sexo masculino (58,3%), com faixa etária 20-59 anos (60,5%) e cor parda (46,6%). Já quanto aos principais agentes etiológicos relacionados aos surtos de DTHA no período analisado, destacou-se a bactéria Escherichia coli (7,9%). A investigação dos dados disponibilizados acerca das intoxicações e DTHA se faz necessária para verificação e monitorização sobre os casos que ocorrem anualmente no Brasil e no mundo.

The present study aimed to investigate the epidemiological profile of notifications for intoxication and water and foodborne diseases (WFD) in Brazil, between 2016 and 2021. This was a documentary, quantitative, descriptive study with data collected from the Notifiable Diseases Information System - SINAN and Ministry of Health. The results showed a decrease in the number of notifications over the years, despite the high number found in 2017 and 2018. The profile of people intoxicated between 2016 and 2021 was male (58.3%), aged 20-59 years (60.5%) and brown (46.6%). As for the main etiological agents related to WFD outbreaks in the analyzed period, the bacterium Escherichia coli (7.9%) stood out. The investigation of available data on intoxications and WFD is necessary for verification and monitoring of cases that occur annually in Brazil and in the world.

Pyrene-polyethylene glycol-modified multi-walled carbon nanotubes: Genotoxicity in V79-4 fibroblast cells.

The genotoxicity of pyrene-polyethylene glycol-modified multi-walled carbon nanotubes (MWCNT-PyPEG), engineered as a nanoplatform for bioapplication, was evaluated. Toxicity was assessed in hamster lung fibroblast cells (V79-4). MTT and Cell Titer Blue methods were used to evaluate cell viability. Genotoxicity was measured by the comet assay and the cytokinesis-block micronucleus cytome (CBMN-Cyt) assay, and fluorescence in situ hybridization (FISH) was used to test induction of structural chromosome aberrations (clastogenic activity) and/or numerical chromosome changes (aneuploidogenic activity). Exogenous metabolic activation enzymes were used in the CBMN-Cyt and FISH tests. Only with metabolic activation, the hybrids caused chromosomal damage, by both clastogenic and aneugenic processes.

Pharmacotherapy used for alcohol and cocaine use disorders in a CAPS-AD of Minas Gerais

Abstract Substance use disorder is one of the major social and public health problems in the world. The present study analyzed the pharmacoepidemiological profile of patients treated at the Psychosocial Treatment Center for Alcohol and Substance Use Disorders (CAPS-AD) for treatment of alcohol use disorders (AUD), cocaine use disorders (CUD) and concomitant alcohol and cocaine use disorders (A-CUD) in the city of Betim-MG. The study used quantitative and descriptive data and was based on the evaluation of medical records of patients attended from January to December 2016. After analyzing 295 medical records, the majority of study participants were male (83.7 %) with an average age of 46.26 for AUD, 28.88 for CUD and 34.29 for A-CUD. The most prescribed drugs for AUD were diazepam (54.1 %), thiamine (37 %), complex B vitamins (29.5 %), and disulfiram (2.7 %); for CUD, diazepam (26.9 %) and haloperidol (23.1 %). It should be noticed that although contraindicated by the guidelines, chlorpromazine (42.3 %, 25.3 %, 20.3 %) was prescribed for CUD, AUD, and A-CUD respectively. Knowing the pharmacoepidemiological profile of CAPS-AD patients is extremely important for making decisions regarding which medicines to make available to the population.

Can parabens be added to cosmetics without posing a risk to human health? A systematic review of its toxic effects Pode adicionar parabenos a cosméticos sem risco para a saúde humana? Uma revisão sistemática de seus efeitos tóxicos

Objective: To summarize evidence regarding the toxic potential of administering parabenscontaining cosmetics in humans. Methods: The systematic review followed the methodology proposed in Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). Electronic searches of the PubMed, Virtual Health Library (BVS), and Science Direct databases were performed between October 1st and 31st, 2018. No language restriction was determined. Original articles reporting observational, in vitro and in silico studies of toxicity caused by parabens in human or human cells were considered for eligibility. Two independent reviewers performed data extraction and assessed the methodological quality and risk of bias of articles by using the Downs & Black Scale. Score levels greater than 70% were assumed to reflect good methodological quality. The Kappa coefficient was calculated. Results: A total of 254 studies were found. Following the eligibility evaluation, 22 studies were included for the qualitative synthesis. The concordance between the reviewers was substantial (Kappa coefficient = 0.650). The meaningful reported outcomes were: high concentrations of parabens in the body; apoptosis damage to sperm DNA; oxidative stress; DNA damage; irritative potential; interference in the control of adipogenesis; estrogenic activity; genotoxicity; necrosis; role in carcinogenesis of breast cancer; harmful effects on human skin when exposed to the sun; stimulation of oncogenes expression; and interference with DNA transcription. Despite most included articles presenting appreciable methodological quality, remarkable limitations were observed and the mechanisms by which parabens exert toxicity on humans remained unclear. Conclusions: The accumulation of parabens in the human organism following repeated cosmetics administration on the skin is noteworthy. However overall, the evidence so far does not make it possible to determine whether, and in what extent, the use of paraben-containing cosmetics can disturb human health. Further investigations are still required for clarifying these issues.

Color determination method and evaluation of methods for the detection of cannabinoids by thin-layer chromatography (TLC).

Cannabis sativa is the drug of abuse most cultivated, trafficked, and consumed worldwide. One of several techniques used to detect cannabinoids is based on the thin-layer chromatography (TLC). However, the designation of the colors observed can be inaccurate and not reproducible. The designation of colors goes beyond physical and physiological aspects, because what is conventionally called color is a socio-cultural construction. Thus, the objective of this paper was to evaluate the different TLC methods to detection of cannabinoids, and apply standardization method in naming of colors. TLC analysis performed using silica gel 60 F254 as a stationary phase. Three mobile phase compositions [hexane:chloroform (8:2 v:v), hexane:ethyl ether (8:2 v:v), and chloroform:hexane (8:2 v:v)], as well as, two different solutions of Fast Blue B salt (FBBS, Azoic Diazo No. 48) and Fast Blue RR (FBRR, Azoic Diazo No. 24) were evaluated. Determination of colors names was realized through the Sci-Chromus® software. The best resolution was obtained using hexane:ethyl ether (8:2 v:v) as a mobile phase. It was observed that although the cannabidiol (CBD), delta-9-tetrahydrocannabinol (Δ9 -THC), cannabinol (CBN), and cannabigerol (CBG) were detect using both the FBBS- and FBRR-acidified solutions, the best visualization was achieved using the latter reagent. To the best of our knowledge, this is the first study that applied and demonstrated a method for standardization and denomination of colors in the TLC analysis of cannabinoids. This method was able to reduce the subjectivity in naming the colors observed and presented several application possibilities.

Efeitos tóxicos à saúde humana e ao ambiente causados pelo derramamento de rejeitos de minério da barragem de Fundão / Toxic effects to human health and the environment caused by the spillage of ore tailings from the Fundão dam

Objetivo: analisar as evidências científicas existentes até o presente momento que descrevem os efeitos tóxicos causados à saúde humana e ao ambiente, devido à liberação dos rejeitos de minério, decorrentes do rompimento da barragem de Fundão em Mariana - MG. Métodos: a revisão narrativa da literatura baseou-se na busca de artigos em quatro bases de dados: PubMed, SciELO, Science Direct e LILACS, utilizando os descritores "Dam", "Fundão" e "Mariana" junto com o operador booleano "AND". Resultados: trinta e quatro das oitenta e cinco publicações encontradas atenderam aos critérios de inclusão e foram utilizadas para compor a presente revisão. Foram observados os seguintes efeitos tóxicos: contaminação da água e do solo, principalmente, por metais pesados, potencial genotóxico, citotóxico e mutagênico da água, diminuição da diversidade microbiana, contaminação de peixes, perda da vegetação e prejuízos ao metabolismo de crescimento de plantas. Entre esses metais, foi relatado aumento na concentração de ferro, manganês, cobre, cádmio, chumbo, arsênio, cromo, magnésio, alumínio, mercúrio, cobalto, bário, níquel e selênio. Além disso, o desastre promoveu o aumento no número de casos de doenças humanas, como dengue, doenças respiratórias, dermatológicas, intestinais, psicológicas e comportamentais. Conclusão: todas as evidências científicas expostas na presente revisão sugerem que houve a contaminação ambiental, bem como da população local, por agentes tóxicos presentes nos rejeitos de minério, em especial metais pesados, liberados após o rompimento da barragem de Fundão. Assim, torna-se essencial a realização de mais estudos que visem esclarecer os efeitos tóxicos crônicos decorrentes dos rejeitos de minério liberados ao ambiente.

Objective: to analyze the scientific evidence existing to date that describes the toxic effects caused to human and the environmental health, due to the release of ore tailings, resulting from the rupture of the Fundão dam in Mariana-MG. Methods: the narrative literature review was based on a search for articles in four databases: PubMed, SciELO, Science Direct and LILACS, using the descriptors "Dam", "Fundão" and "Mariana" together with the Boolean operator "AND". Results: thirty-four, of the eighty-five publications found, met the inclusion criteria and were used to compose the present review. The following toxic effects were observed: contamination of water and soil mainly by heavy metals, genotoxic, cytotoxic and mutagenic potential of water, decrease in microbial diversity, contamination of fish, loss of vegetation, and impairment of plant growth metabolism. Among these metals, increased concentrations of iron, manganese, copper, cadmium, lead, arsenic, chromium, magnesium, aluminum, mercury, cobalt, barium, nickel and selenium were reported. In addition, the disaster promoted an increase in the number of cases of human diseases, such as dengue, respiratory, dermatological, intestinal, psychological and behavioral diseases. Conclusion: all the scientific evidence exposed in the present review that there was environmental contamination, as well as of the local population, by toxic agents present in the ore tailings, especially heavy metals, released after the collapse of the Fundão dam. Thus, further studies aimed at clarifying the chronic toxic effects resulting from the ore tailings released into the environment are essential.

Deprescribing benzodiazepines: Do Brazilian package inserts address this issue? / Desprescrição de benzodiazepínicos: As bulas brasileiras abordam essa temática?

OBJECTIVE: To analyze the presence and quality of content on drug deprescribing in Brazilian package inserts for benzodiazepine drugs. METHODS: Documentary study where we analyzed data on deprescribing extracted from electronic package inserts of drugs containing benzodiazepines; these documents were available at the Brazilian Health Surveillance Agency website. Our search was performed independently by 2 researchers who used the following keywords: "deprescription," "withdrawal," and "tapering." The deprescribing plan, when presented by the package insert, was compared to deprescribing protocols for benzodiazepines found in the literature. Moreover, we assessed the presence of guidance on the maximum length of treatment and risks of long-term use. RESULTS: We found 12 package inserts for benzodiazepines and 100% of them suggested gradual withdrawal; only 1 (8.33%) suggested a systematized deprescribing plan. One document (8.33%) did not offer guidance on maximum treatment duration. Eleven (91.67%) had the information on long-term use possibly causing dependence or tolerance, and 1 (8.33%) did not describe the risks of continuous use. CONCLUSIONS: It is known that benzodiazepines should be withdrawn in a gradual and schematized manner, but package inserts do not currently bring this information in detail. It is of utmost importance that health professionals be educated on their conduct, hence the necessity for updating medication package inserts.

OBJETIVO: Analisar a presença e a qualidade do conteúdo sobre desprescrição em bulas brasileiras de benzodiazepínicos. METODOLOGIA:Estudo do tipo documental, em que foram analisados dados sobre a desprescrição extraídos de bulas eletrônicas de medicamentos que contêm benzodiazepínicos disponibilizadas na página eletrônica da Agência Nacional de Vigilância Sanitária. A busca foi realizada de forma independente por dois pesquisadores que utilizaram as palavras-chave "desprescrição", "retirada" e "redução". Para fins de comparação, quando a bula apresentou esquema de desprescrição, este foi comparado com protocolos de desprescrição de benzodiazepínicos encontrados na literatura. Além disso, foi analisada nas bulas a existência de orientações quanto ao tempo máximo de uso e os riscos do uso prolongado. RESULTADOS: Foram encontradas 12 bulas de benzodiazepínicos e 100% delas sugeriram a redução gradual do medicamento; apenas uma (8,33%) sugeria o esquema sistematizado de desprescrição. Uma (8,33%) não apresentou orientações quanto ao tempo máximo de uso. Onze (91,67%) continham a informação de que o uso prolongado pode causar dependência ou tolerância e uma (8,33%) não descrevia os riscos do uso contínuo. CONCLUSÕES: Sabe-se que os benzodiazepínicos devem ser retirados de forma gradual e esquematizada, porém, atualmente, as bulas não trazem essas informações de forma detalhada. É de suma importância que os profissionais de saúde sejam orientados quanto a sua conduta e, por isso, há grande necessidade de atualização das bulas.

Potentially inappropriate medication use in older adults: prevalence and physician knowledge / Medicamentos potencialmente inapropriados para idosos: prevalência de uso e conhecimento médico

OBJECTIVE: To analyze the frequency, profile, and additional variables associated with the prescription of potentially inappropriate medications (PIM) to older adults in primary care, and evaluate physicians' knowledge about these medications. METHODS: A cross-sectional study was conducted based on data from patient records for the period of January 2014 to December 2017 in a city located in the state of Minas Gerais. The frequency of PIM use was evaluated based on the 2019 Beers-Fick criteria. Physician knowledge was evaluated using a validated questionnaire as a primary data source. RESULTS: In a sample of 423 older adults, 75.89% (n = 321) used at least one PIM, the most common of which were medications used to treat central nervous system disorders (48.00%; n = 203). Most participants were female (62.41%; n = 264) and 70 years or older (69.50%; n = 294). When presented with clinical cases illustrating common situations in the management of older patients, 53.33% of physicians (n = 8) answered four or five questions correctly out of a possible seven; 13.33% (n = 2) answered six questions correctly; and 33.33% (n = 5) obtained three correct answers or fewer. CONCLUSIONS: These findings showed a high frequency of PIM use among older adults treated in Primary Health Care settings, with medications used in the treatment of central nervous system disorders. Our results highlight the importance of continuing education for health professionals and improved assessments of the medication available in the Unified Health System (Sistema Único de Saúde; SUS) for use in older adults, especially those taking multiple medications.

OBJETIVOS: Analisar a frequência, o perfil e os fatores associados à prescrição de medicamentos potencialmente inapropriados (MPI) aos idosos na Atenção Primária à Saúde, além de avaliar o conhecimento dos médicos sobre esses medicamentos. METODOLOGIA: Trata-se de um estudo transversal, cujas informações foram coletadas de prontuários dos pacientes, referentes ao período de janeiro de 2014 a dezembro de 2017, em um município localizado no estado de Minas Gerais. Para análise da frequência de uso de MPI, utilizou-se o critério Beers-Fick de 2019. Para avaliação do conhecimento médico, utilizou-se uma fonte primária de informação, um questionário validado. RESULTADOS: Dos 423 idosos, 75,89% (n=321) utilizavam pelo menos um MPI e a classe mais utilizada foi do sistema nervoso central (48,00%; n=203). Houve maior prevalência no sexo feminino (62,41%; n=264) e em idosos com idade ≥70 anos (69,50%; n=294). Em relação aos casos clínicos apresentados para avaliar o conhecimento dos médicos referentes às situações comuns no cuidado à saúde do idoso, 53,33% (n=8) acertaram quatro ou cinco questões das sete existentes, enquanto 13,33% (n=2) responderam corretamente a seis perguntas e 33,33% (n=5) obtiveram três ou menos acertos. CONCLUSÕES: Os resultados evidenciaram alta taxa de prescrição de MPI entre os idosos da Atenção Primária à Saúde, destacando-se os medicamentos que são destinados ao tratamento de doenças do sistema nervoso central. Ressalta-se a importância da educação continuada desses profissionais de saúde e a melhor avaliação de medicamentos incorporados ao Sistema Único de Saúde (SUS) e destinados à população geriátrica, sobretudo o idoso polimedicado.

Bulas de medicamentos cardiovasculares: elas têm informações sobre precauções necessárias aos idosos? / Cardiovascular drug labeling: Do they have information on necessary precautions for older people?

OBJETIVO: Analisar a existência de informações, em bulas destinadas aos profissionais de saúde, sobre precaução de uso de medicamentos cardiovasculares em idosos. METODOLOGIA: Trata-se de estudo documental realizado por meio de análise de dados contidos em bulas de medicamentos. Analisou-se a existência, na bula, de informações sobre precauções no uso de medicamentos para idosos, conforme descrito no Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos de 2016. RESULTADOS: Dos 29 medicamentos pertencentes ao grupo do sistema cardiovascular que devem ser evitados por idosos e estão disponíveis no Brasil, 15 independem da condição clínica prévia do paciente para que sejam vetados para os idosos. Desses 15, apenas 3 medicamentos (20%) têm informações explícitas concordantes com o Consenso (metildopa, digoxina e espironolactona); 2 (13,33%) têm informações explícitas ausentes; 4 (26,66%) têm informações explícitas discordantes; e 6 bulas (40%) foram categorizadas como informações não explícitas. Quanto às precauções dos medicamentos de acordo com a condição clínica do paciente, incluíram-se 14 medicamentos que devem ser evitados por idosos e estão disponíveis no Brasil. Destes, 12 (85,71%) têm em suas bulas recomendações concordantes com o Consenso, porém não explícitas, e 2 (14,28%) não têm as contraindicações. CONCLUSÕES: A maioria das bulas carece de informações sobre precauções de uso de medicamentos para a população idosa.

OBJECTIVE: To analyze the existence of information on drug labeling intended for health professionals on the precaution of cardiovascular drugs use in older people. METHODS: This is a documentary study, carried out with the analysis of data contained in drug labelings. The existence of information on precautions in the use of drugs for older people as described in the 2016 Brazilian Consensus on Potentially Inappropriate Drugs for Older People (Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos de 2016). RESULTS: Of the 29 drugs belonging to the cardiovascular system group that should be avoided by older people and are available in Brazil, 15 are independent of the clinical condition. Of these fifteen, only three drugs (20%) have explicit information in accordance with the Consensus (methyldopa, digoxin, and spironolactone); two (13.33%) have missing explicit information; four (26.66%) have explicitly discordant information; and six drug labels (40%) were categorized as non-explicit information. Regarding drug precautions according to clinical condition, 14 drugs were included. Of these, 12 (85.71%) have equal contraindications of that of Consensus on their drug labels, however, non-explicit; and two (14.28%) contraindications are missing. CONCLUSION: Most drug labels lack information on the precautions for the use of drugs in older people.

Linguistic and cultural adaptation to the Portuguese language of antimicrobial dose adjustment software.

OBJECTIVE: To adapt an antibiotic dose adjustment software initially developed in English, to Portuguese and to the Brazilian context. METHODS: This was an observational, descriptive study in which the Delphi method was used to establish consensus among specialists from different health areas, with questions addressing the visual and operational aspects of the software. In a second stage, a pilot experimental study was performed with the random comparison of patients for evaluation and adaptation of the software in the real environment of an intensive care unit, where it was compared between patients who used the standardized dose of piperacillin/tazobactam, and those who used an individualized dose adjusted through the software Individually Designed and Optimized Dosing Strategies. RESULTS: Twelve professionals participated in the first round, whose suggestions were forwarded to the software developer for adjustments, and subsequently submitted to the second round. Eight specialists participated in the second round. Indexes of 80% and 90% of concordance were obtained between the judges, characterizing uniformity in the suggestions. Thus, there was modification in the layout of the software for linguistic and cultural adequacy, minimizing errors of understanding and contradictions. In the second stage, 21 patients were included, and there were no differences between doses of piperacillin in the standard dose and adjusted dose Groups. CONCLUSION: The adapted version of the software is safe and reliable for its use in Brazil.

Efeito das "promessas terapêuticas" sobre os preços de medicamentos em tempos de pandemia / Effect of "therapeutic promises" on drug prices in times of pandemic

Objetivo: Analisar o preço real de aquisição de medicamentos anunciados como promessas terapêuticas para tratamento da COVID-19 no Brasil. Métodos: Identificaram-se os medicamentos que estão sendo estudados e/ou noticiados como promissores e, posteriormente, analisaram-se os custos de aquisição desses medicamentos por uma drogaria do interior do estado de Minas Gerais, entre janeiro e junho de 2020. Resultados: Sete (87,5%) medicamentos apresentaram aumento do valor de compra no período estudado. Dexametasona e ivermectina apresentaram elevação de mais de 200% no preço. A menor elevação foi o polivitamínico, 5,44%. A hidroxicloroquina foi o único medicamento (12,5%) que não sofreu variação no preço e só foi adquirida nos três primeiros meses do ano de 2020. Conclusão: O preço de aquisição da maioria dos medicamentos anunciados como "promessas terapêuticas" para tratamento da Covid-19 no Brasil sofreu aumento significativo no período da pandemia.

Objective: To analyze the real purchase price of drugs announced as therapeutic promises for the treatment of Coronavirus disease in Brazil. Methods: The drugs that are being studied and/or announced as promising were identified and, subsequently, the costs of purchasing these drugs by a drugstore in the countryside of the state of Minas Gerais were analyzed between January and June 2020. Results: A total of seven (87.5%) drugs showed an increase in the purchase price in the period studied. Dexamethasone and ivermectin showed an increase of more than 200% in price. The lowest increase was the multivitamin, 5.44%. Hydroxychloroquine was the only drug (12.5%) that did not change its price and was only purchased in the first three months of 2020. Conclusion: The purchase price of the vast majority of drugs announced as "therapeutic promises" for the treatment of Covid-19 in Brazil suffered a significant increase during the pandemic period.

Análise comparativa do processo de registro oficial de praguicidas no Brasil com outros em nível internacional: revisão narrativa da literatura / Comparative analysis of the process of official registration of pesticides in Brazil with others at the international level: narrative review of the literature

Objetivo: comparar o processo de registro oficial de praguicidas no Brasil com o da China, Canadá, Estados Unidos da América (EUA) e União Europeia. Métodos: a revisão narrativa da literatura baseou-se na pesquisa de atos normativos sobre praguicidas nos sites oficiais dos Ministérios e do Governo do Brasil, dos EUA, da China, do Canadá e da Comissão Europeia, utilizando-se os termos: "agrotóxicos", "registro de agrotóxicos" e "legislação sobre agrotóxicos" e suas respectivas traduções para o inglês. Para fins de comparação, lançou-se mão da metodologia de análise exploratória, resumindo e organizando os dados coletados. Resultados: no Brasil, o pedido de registro é avaliado por órgãos de três Ministérios (da Agricultura, da Saúde e do Meio ambiente), enquanto na China essa responsabilidade é centralizada num único órgão do Ministério da Agricultura. Brasil e EUA apresentam o maior prazo para concessão de registro, de 6 a 10 anos. A taxa de registro mais alta é cobrada nos EUA e a mais baixa, no Brasil. Nesse país, não há encargos para manutenção, nem prazo para reavaliação do praguicida. Enquanto nos EUA e Canadá a validade máxima dos registros é de 15 anos. Conclusão: apesar de existirem normas que impedem o registro de praguicidas com potenciais riscos à saúde, isenções de taxas e não periodicidade de reavaliação do registro contribuem para o uso descontrolado desses produtos no Brasil.

Objective: to compare the process of official registration of pesticides in Brazil with that of China, Canada, the United States of America (USA) and the European Union. Methods: the narrative review of the literature was based on the search for normative acts on pesticides on the official websites of the Ministries and the Government of Brazil, the USA, China, Canada and the European Commission, using the terms: "pesticides", "registration of pesticides" and "legislation on pesticides" and their respective translations into English. For comparison purposes, the exploratory analysis methodology was used, summarizing and organizing the collected data. Results: in Brazil, the registration request is evaluated by government agencies from three Ministries (of Agriculture, Health and Environment), while in China this responsibility is centralized in a single agency of the Ministry of Agriculture. Brazil and the USA have the longest term for granting registration, from 6 to 10 years. The highest registration fee is charged in the USA and the lowest in Brazil. In that country, there are no maintenance charges, nor a deadline for re-evaluating the pesticide. While in the USA and Canada the maximum validity of records is 15 years. Conclusion: although there are rules that prevent the registration of pesticides with potential health risks, exemptions from fees and non-periodicity of re-evaluation of the registration contribute to the uncontrolled use of these products in Brazil.

Efetividade e toxicidade da cloroquina e da hidroxicloroquina associada (ou não) à azitromicina para tratamento da COVID-19. O que sabemos até o momento? / Effectiveness and toxicity of chloroquine and hydroxychloroquine associated (or not) with azithromycin for the treatment of COVID-19. What do we know so far?

Objetivos: identificar as evidências científicas existentes até o presente momento sobre a efetividade do uso da cloroquina, da hidroxicloroquina associada (ou não) à azitromicina para tratamento da afecção pelo coronavírus e seus possíveis efeitos adversos e tóxicos aos seres humanos. Métodos: a revisão narrativa utilizou-se das bases de dados PubMed, LILACS, SciElo e Google Acadêmico. Nessas, buscaram-se estudos, utilizando-se dos descritores "covid", "coronavirus", "SARS-CoV-2", "chloroquine", "hydroxychloroquine", "azithromycin" e "adverse effects" junto com os operadores booleanos "AND" e "OR". Resultados: sete artigos, das trinta publicações encontradas, atenderam aos critérios de inclusão, sendo utilizados para compor a presente revisão. Dos sete ensaios clínicos analisados, cinco apresentaram resultados de cura e/ou remissão dos sintomas e/ou redução da carga viral dos pacientes, no entanto apresentaram muitas limitações. Conclusão: a literatura científica é escassa e divergente quanto à efetividade dos medicamentos cloroquina e hidroxicloroquina associada (ou não) à azitromicina no tratamento da COVID-19, pela rápida disseminação e instalação da pandemia na esfera global. É necessário a realização de ensaios clínicos pragmáticos, envolvendo um número maior de pacientes, para que seja possível analisar a efetividade no combate ao coronavírus, bem como a segurança do uso desses fármacos.(AU)

Objective: to identify the scientific evidence existing to date on the effectiveness of the use of chloroquine, hydroxychloroquine associated (or not) to azithromycin for the treatment of COVID-19 disease and its possible adverse drug events and toxicity to human health. Methods: the narrative review was performed using the PubMed, LILACS, SciElo and Google Academic databases. In these, studies were sought, using the descriptors "covid", "coronavirus", "SARS-CoV-2", "chloroquine", "hydroxychloroquine", "azithromycin", "adverse effects" and "toxicity", together with the Boolean operator "AND" and "OR". Results: seven studies of thirty publications met the inclusion criteria and were used in the present review. Of the seven clinical trials analyzed, five showed results of cure and/or remission of symptoms and/or reduction of patients' viral load, however these studies had many limitations. Conclusion: scientific literature is scarce and divergent as to the effectiveness of the drugs chloroquine and hydroxychloroquine associated (or not) with azithromycin in the treatment of COVID-19, due to the rapid spread and installation of the pandemic in the global sphere. It is necessary to carry out pragmatic clinical trials, involving a larger number of patients, so that it is possible to analyze the effectiveness in combating the coronavirus, as well as the safety of the use of these drugs.(AU)

Profile of intoxications served at the 24-hour emergency service unit

Intoxications represent a serious public health problem. According to the World Health Organization, 193,000 deaths per year are caused by unintended intoxications worldwide. This study aims to know the profile of intoxications at the 24-hour Emergency Service Unit in Divinópolis, in the state of Minas Gerais. This is a descriptive study in which the study population chosen were all patients treated for intoxications in the period from 2017 to 2018, registered in the health service; 421 cases of intoxications were recorded. The female gender was the most prevalent, and the age group with the most cases was 21 to 30 years. The main circumstance found was attempted suicide (83.1%), and the main causative agent was drugs (76.5%), with benzodiazepines being the main class responsible for intoxications. The most used treatment was gastric lavage and activated charcoal. This study demonstrates that knowledge about the city's intoxication profile is important for the development of treatment and patient management methods to better suit the demands of the municipality.

Linguistic and cultural adaptation to the Portuguese language of antimicrobial dose adjustment software / Adaptação linguística e cultural para a língua portuguesa de um software para ajuste de dose de antimicrobianos

ABSTRACT Objective To adapt an antibiotic dose adjustment software initially developed in English, to Portuguese and to the Brazilian context. Methods This was an observational, descriptive study in which the Delphi method was used to establish consensus among specialists from different health areas, with questions addressing the visual and operational aspects of the software. In a second stage, a pilot experimental study was performed with the random comparison of patients for evaluation and adaptation of the software in the real environment of an intensive care unit, where it was compared between patients who used the standardized dose of piperacillin/tazobactam, and those who used an individualized dose adjusted through the software Individually Designed and Optimized Dosing Strategies. Results Twelve professionals participated in the first round, whose suggestions were forwarded to the software developer for adjustments, and subsequently submitted to the second round. Eight specialists participated in the second round. Indexes of 80% and 90% of concordance were obtained between the judges, characterizing uniformity in the suggestions. Thus, there was modification in the layout of the software for linguistic and cultural adequacy, minimizing errors of understanding and contradictions. In the second stage, 21 patients were included, and there were no differences between doses of piperacillin in the standard dose and adjusted dose Groups. Conclusion The adapted version of the software is safe and reliable for its use in Brazil.

RESUMO Objetivo Adaptar um software de ajuste de dose de antibióticos inicialmente elaborado em língua inglesa para o português e a conjuntura brasileira. Métodos Trata-se de estudo observacional, descritivo, em que foi utilizado o método Delphi para estabelecer consenso entre especialistas de diferentes áreas da saúde, com perguntas que abordaram os aspectos visuais e operacionais do software. Em uma segunda etapa, foi realizado um estudo piloto, experimental, com alocação aleatória dos pacientes, para avaliação e adaptação do software em ambiente real de uma unidade de tratamento intensivo, onde foram comparadas diferenças entre pacientes que utilizaram dose padronizada usual de piperacilina/tazobactam, e os que utilizaram a dose individualizada ajustada por meio do software Individually Designed Optimum Dosing Strategies. Resultados Participaram da primeira rodada 12 profissionais cujas sugestões foram encaminhadas ao desenvolvedor do software para adequação e ajustes, e posteriormente submetidas à segunda rodada. Oito especialistas participaram da segunda rodada. Foram obtidos índices de 80% e 90% de concordância entre os juízes, caracterizando uniformidade nas sugestões. Dessa forma, houve modificação no layout do software para adequação linguística e cultural, minimizando erros de entendimento e contradições. Na segunda etapa, foram incluídos 21 pacientes, e não houve diferenças entre doses de piperacilina nos grupos dose padronizada e dose ajustada. Conclusão A versão adaptada do software é segura e confiável para seu uso no Brasil.

Effective vancomycin concentrations in children: a cross-sectional study.

OBJECTIVE: Analyze the microbiological effectiveness, based on the pharmacokinetics/pharmacodynamics correlation of vancomycin in pediatric patients, and to propose dose adjustment. METHODS: This is an observational, cross-sectional study, conducted in a pediatric hospital, over a 1-year period (2016 to 2017). Children of both sexes, aged 2 to 12 years, were included in the study; burn children, and children in renal replacement therapy were excluded. For the pharmacokinetic analysis, two samples of 2mL of whole blood were collected, respecting the 2-hour interval between each withdrawal. RESULTS: Ten pediatric patients with median age of 5.5 years and interquartile range (IQR) of 3.2-9.0 years, median weight of 21kg (IQR: 15.5-24.0kg) and median height of 112.5cm (IQR: 95-133cm), were included. Only one child achieved trough concentrations between 10µg/mL and 15µg/mL. CONCLUSION: The empirical use of vancomycin in the children studied did not achieve the therapeutic pharmacokinetic/pharmacodynamic target for minimum inhibitory concentration of 1µg/mL.

Effective vancomycin concentrations in children: a cross-sectional study / Concentrações efetivas de vancomicina em crianças: estudo transversal

ABSTRACT Objective Analyze the microbiological effectiveness, based on the pharmacokinetics/pharmacodynamics correlation of vancomycin in pediatric patients, and to propose dose adjustment. Methods This is an observational, cross-sectional study, conducted in a pediatric hospital, over a 1-year period (2016 to 2017). Children of both sexes, aged 2 to 12 years, were included in the study; burn children, and children in renal replacement therapy were excluded. For the pharmacokinetic analysis, two samples of 2mL of whole blood were collected, respecting the 2-hour interval between each withdrawal. Results Ten pediatric patients with median age of 5.5 years and interquartile range (IQR) of 3.2-9.0 years, median weight of 21kg (IQR: 15.5-24.0kg) and median height of 112.5cm (IQR: 95-133cm), were included. Only one child achieved trough concentrations between 10µg/mL and 15µg/mL. Conclusion The empirical use of vancomycin in the children studied did not achieve the therapeutic pharmacokinetic/pharmacodynamic target for minimum inhibitory concentration of 1µg/mL.

RESUMO Objetivo Analisar a efetividade microbiológica considerando a correlação farmacocinética/farmacodinâmica de vancomicina em crianças e propor uma estimativa de ajuste na dose. Métodos Trata-se de um estudo observacional, transversal, realizado em hospital pediátrico, no período de 1 ano (2016 a 2017). Foram incluídas crianças de 2 a 12 anos de ambos os sexos, tendo sido excluídas crianças queimadas ou submetidas à terapia renal substitutiva. Para análise farmacocinética, foram coletadas duas amostras de 2mL de sangue total, respeitando o intervalo de 2 horas entre cada coleta. Resultados Foram incluídos dez pacientes pediátricos com idade de 5,5 anos (mediana) e intervalo interquartil (IQ) de 3,2-9,0 anos, peso de 21kg (mediana; IQ: 15,5-24,0kg) e altura de 112,5cm (mediana; IQ: 95-133cm). Apenas uma criança alcançou concentrações mínimas entre 10µg/mL e 15µg/mL. Conclusão A utilização empírica de vancomicina na população de crianças não alcançou o alvo farmacocinético/farmacodinâmico terapêutico para concentração inibitória mínima de 1μg/mL.