Determination of the frequency and direct cost of the adverse drug events in Argentina.

To determine the frequency and the direct costs of adverse drug reactions, in an ambulatory population of the City of Buenos Aires, Argentina and its area of influence. A retrospective study was done during a period of three months on approximately 300.000 residents of the Buenos Aires area, gathering data according to the selected variables by means of the electronic capture of prescriptions dispensed in pharmacies of the area. This method enables the detection and registration of potential conflicts that may arise between a prescribed drug and factors such as: patient's demographic, clinical and drug profile. The analysis unit was defined as the happening of a moderate or severe adverse event reported by the system. The selected variables were the incidence of these effects and the direct cost was calculated as the value of the drugs that induced the adverse event. The events were classified according to the following interactions: a) drug-drug, b) drug-pediatrics, c) drug-gender, d) drug-pregnancy and abuse of controlled substances. The observed frequency shows great variability and the shortage of available data for ambulatory populations. We found 6.74% of reported events over the total of processed items, which generated an additional cost equivalent to 4.58% of the total pharmaceutical expenses. This study has only evaluated the cost occurred by the use of a drug that will lead to an adverse reaction. Moderate and severe reactions were included regardless of the important indirect costs, hospitalization costs, tests, physician fees, etc.

Reyes's syndrome, encephalopathy, hyperammonemia and acetyl salicylic acid ingestion in a city hospital of Buenos Aires, Argentina.

Twelve cases of Reye's syndrome are presented with different degrees of encephalopathy, hyperammonemia and hypoglycemia; associated to acetyl salicylic acid (ASA) ingestion. The aim of the present retrospective study was to describe our experience in selected patients with Reye's syndrome associated to the ASA ingestion and to underline the influence of hyperammonemia on Reye's encephalopathy. All the cases presented moderate hyperbilirubinemia, elevated alanine aminotransferase, aspartate aminotransferase with an average of 302+/-205 UI/L and 285+/-149 UI/L respectively. Arterial blood ammonia averaged 172.4+/-71.3 micromol/L and glycaemia averaged 35.2+/-17.0 mg/dl. A high mortality was found in our series (41.7%). Considering that encephalopathy is the leading syndrome in these cases, the influence of ammonia on brain tissue was described. Glutamate is an excitotoxic neurotransmitter, capable to produce neuron and astrocyte damage and apoptosis. The presence of ASA could cause the onset of the mitochondrial permeability transition and the mitochondrial swelling in the astrocyte, leading to hyperammonemia. In Reye's syndrome, hyperammonemia and perhaps the increase of glutamate are the leading factors in the mechanism of brain damage and encephalopathy. Aspirin must be carefully administrated and controlled by professionals. Furthermore, parents must be informed about the risks in the use of this drug in children.

Involvement of serum apolipoprotein AI and B100 and lecithin cholesterol acyl transferase in alcoholic cirrhotics.

Lipoproteins are synthesized by the liver and secreted to plasma. Chronic alcoholic intoxication produces frequently cirrhosis and concomitantly alterations in liver metabolism. Thirty patients with alcoholic cirrhosis and 83 healthy controls were selected for this study. Apolipoprotein A1, B100, lecithin cholesterol acyltransferase, responsible for cholesterol esterification and seudocholinesterase enzyme activity not related to lipid metabolism, as a referent of proteins synthesized by the liver were analyzed. In 7 patients serum tiobarbituric acids, catalase, glutathione peroxidase were measured, as exponent of the presence of oxidative stress. Our results showed a significant decrease in lipoproteins, lecithin cholesterol acyltransferase and seudocholinesterase activities. An increase in serum tiobarbituric acids and a decrease in both antioxidant enzymes were found as well. In conclusion, alcohol cirrhotic liver decreases the production of liver proteins including those related to lipid metabolism, allowing the formation of steatosis and/or necrosis. Moreover oxidative stress participate possible as a major mechanism in liver damage.

Atención Farmacéutica en el seguimiento de pacientes ambulatorios psiquiátricos / No disponible

El objeto del presente trabajo es implementar un programa de atención farmacéutica en pacientes ambulatorios psiquiátricos. Este es un trabajo experimental, paralelo, longitudinal y con entrecruzamiento que se llevó a cabo durante dos años. Se dividió a los pacientes en dos grupos: grupo A de intervención (con Atención Farmacéutica) y grupo B de control (sin Atención Farmacéutica). Después de un año de seguimiento de los pacientes se entrecruzaron los grupos durante 12 meses más. Se analizaron en los problemas relacionados a medicamentos, los problemas relacionados a hábitos, los factores inespecíficos que intervienen en el tratamiento, la calidad de vida y el nivel de satisfacción del paciente con los servicios farmacéuticos en los grupos seleccionados. Nuestros resultados señalan que la aplicación del programa de atención farmacéutica mejoró la calidad de vida de los pacientes y la relación médico-farmacéutica

The aim of this works is to implement a pharmaceutical care program in psychiatric outpatients. This is an experimental, longitudinal, parallel and cross over work that was carried during two years. The patients were divided in two groups: group A intervention (with pharmaceutical care) and group B control (without pharmaceutical care). After a year of follow up of the outpatients, the groups were crossed over during another period of 12 month. The drug related problems, habit related problems, unspecified factor which are involved in the treatment, the quality of life and the satisfaction level with the pharmacist services were analyzed in the selected groups. Our results show that the pharmaceutical care program improved the quality of life of the outpatients and the physician-pharmacist relation

Aumento del porcentaje de cobertura de los medicamentos en pacientes crónicos: impacto económico sobre los costos de los sistemas de salud en Argentina / No disponible

Introduccion. El objetivo del estudio es analizar el incremento del costo farmacéutico ambulatorio para los sistemas de salud en Argentina como consecuencia de la Resolución ministerial nº 310/04 que llevó del 40% al 70% la cobertura farmacéutica de pacientes crónicos e implantó un sistema de precios de referencia. Métodos. Se analizaron dos sistemas de salud "A" con cobertura básica y "B" con una cobertura amplia, mediante un modelo de reasignación de consumos reales correspondientes al último trimestre de 2003. Resultados. Nuestros resultados muestran significativos aumentos en los costos netos, del 49,0% para el sistema "A" y del 24,4% para "B". Mediante un análisis de sensibilidad se verificó que un aumento del 10,2% de las bonificaciones recibidas por “A” anulaba el incremento en sus costos. El mismo efecto se observó en el sistema “B”, tan sólo con un aumento del 3,8% en las citadas bonificaciones. Utilizando la estrategia de suprimir la cobertura de los productos no incluidos en la Resolución, sólo el sistema “B” pudo anular los mayores costos, aplicando una restricción parcial del 47,5% en el gasto sobre estos productos. Sin embargo, el modelo tiende a producir resultados positivos en salud al facilitar el acceso del paciente crónico al medicamento mediante la disminución de su gasto de bolsillo (AU)

Introduction. The main purpose was to analyze the increase of the ambulatory pharmaceutical cost for the health systems in Argentina as a result of the Ministerial resolution Nº 310/04, that increase went up from 40% to 70% the pharmaceutical cover of chronic patients and it established a reference prices system. Methods. Two systems of health were analyzed: "A" with basic cover and "B" with extended cover, by means of a model of reassignment of real consumptions in relation to the last quarter of 2003. Results. Our results showed significant increases in the net costs: 49% and 24.4% for the systems "A" and "B" respectively. Using an analysis of sensibility it was verified that an increased of 10.2% in the received discounts by system "A" cancelled the augment in its cost. The same effect was observed in the system "B" just for an increase of 3.8% in the same discounts. Using the strategy to eliminate the cover of the products which were excluded by the new normative, only the system "B" could eliminate the greatest costs, because it was considered a 47.5% partial discount of the waste in this products. Nevertheless, the model tends to produce positive results in health because it provides the access of the chronic patient to the medicine by means of the decrease of its pocket expense (AU)

Hepatic morphological changes and oxidative stress in chronic streptozotocin-diabetic rats.

Oxidative stress (OS) is a biological entity quoted as responsible for several pathologies including diabetes. Diabetes mellitus (DM) has been also associated to human cirrhosis. The present work was designed to study the occurrence of OS as well as morphologic alterations in rat livers following induction of DM. Two groups of rats were used: Control and Diabetic. DM was induced in the second group by streptozotocin (STZ) in a single dose of 60 mg/kg, injected i.p. The occurrence of OS was determined in liver homogenates by measuring the hydroperoxide-initiated chemiluminescence and the activity of antioxidant enzymes (superoxide dismutase, catalase and glutathione peroxidase). Liver sinusoids were morphometrically analyzed. In conclusion, livers from the diabetic group did not show evidence of the occurrence of OS, as it would be expected, but dilation of hepatic sinusoids was documented and it was significantly different from control group.

Financiamiento del Costo Farmacéutico Ambulatorio / No disponible

El objetivo del presente trabajo es analizar la financiación del costo farmacéutico ambulatorio, generado por el consumo de medicamentos, de una población correspondiente al 10% de las personas residentes en la Ciudad de Buenos Aires, en Argentina. La variable seleccionada fue el costo para el financiador (obra social o empresa de medicina prepaga) de los medicamentos consumidos durante el período del estudio. Se realizó un estudio retrospectivo de la información proveniente de una muestra de 78.778 recetas, dispensadas por 271 farmacias, durante el mes de mayo de 2003. Mediante un análisis de sensibilidad y en base a consideraciones de la estructura del mercado se determinó el nivel de descuentos y qué sector del mercado podía aportarlos para generar un ahorro del 20% en el gasto del financiador (AU)

The objective of the present work was to analyze the financing of the outpatient pharmaceutical cost that it is generated by the consumption of medicines in a population who correspond to the 10% of the inhabitants of the Buenos Aires City in Argentina. The selected variable was the cost for the finance company (Social medicine, Medical prepaid medicine) of the consumption of medicines during the period of this study. It was carried out a retrospective study about the information obtained of a sample of 78778 prescription dispensed by 271 community pharmacies during May 2003. Using an analysis of sensibility and taking care consideration of the marked structure, it was determined the discount level and which market area could be provide it order to generate a saving of 20% in the cost of the finance company (AU)

Análisis del gasto farmacéutico ambulatorio argentino / No disponible

El gasto farmacéutico es una de las actuales preocupaciones de los administradores de los sistemas de salud. En el presente trabajo se definen las variables constituyentes del gasto farmacéutico, analizando sus características, sus implicancias y la interrelación entre cada una de ellas. También se estudian las posibilidades de actuar sobre una o varias de estas variables para contener y contralar el gasto, corregir desvíos y así optimizar los recursos disponibles. Se concluye que la ecuación del gasto farmacéutico constituye un abordaje muy útil cuando se desea calcular una cápita para cotizar la prestación de un servicio de cobertura farmacéutica ambulatorio a un sistema de salud, además de generar una herramienta de análisis para caracterizar un determinado modelo (AU)

The pharmaceutical cost is one of the current worry of the health system. In the present work, the constituent variables of the pharmaceutical cost were defined. Its characteristics, its implications and the interrelation between everyone of them were also anilzed. Moreover it was studied the possibilities to perform one are several of these variables in order to contain and to control the cost, to correct the deflection and so to optimize the available resource. It was concluded that the equation of the pharmaceutical cost constitutes an approach very inseful when are wants to calculate the capitalion in order to price a benefit of a service of pharmaceutical-ambulatory cover to a health system, as well as generating a tool of analysis the characterize a determined model (AU)

Atención farmacéutica en pacientes psiquiátricos ambulatorios. Interacción médico-farmacéutico / Pharmacy services in psychiatry outpatients. Interaction physician-pharmacist

El objetivo del trabajo es demostrar las ventajas de la interrelación profesional entre el médico y el farmacéutico en un programa de Atención Farmacéutica en pacientes ambulatorios con Trastornos Psiquiátricos. Ademas de ser una modalidad de trabajo necesaria en el abordaje de cualquier patología, es critica en estos pacientes, existiendo varios puntos en los cuales una falta de coordinación puede hacer fracasar el tratamiento (AU)

The objective of this work is to show the advantage of the interaction between physicians and pharmacists in a psychiatric outpatients Pharmaceutical Care program. Besides it should be a normal practice in every pathology, is critical in these patients because there are several subjects that if are not coordinate will lead to a treatment failure (AU)

Platelet monoamineoxidase activity in chronic schizophrenics

Se dosó la actividad de monoamino oxidasa (MAO) plaquetaria en 17 pacientes esquizofrénicos crónicos y en 13 sujetos-control, utilizándose kinuramina como substrato. La actividad de MAO fue aproximadamente 10 veces mayor en los sujetos del grupo control que en los esquizofrénicos (controles: 31,7 + ou - 4,5 nmoles.mg proteína-1.h-1, n=13; esquizofrénicos: 3,3 + ou - 0,6 nmoles.mg proteína-1.h-1, n=17). Los valores de Vmáx y Km para kinuramina fueron significativamente más bajos en os pacientes que en los controles. La actividad de MAO fue aun menor en el subgrupo de pacientes cuya forma clínica previa actual estado residual fue paranoide. Estos resultados permitirían utilizar la determinación de MAO plaquetaria como una variable en la investigación, sobre esquizofrenía

Platelet monoamineoxidase activity in chronic schizophrenics

Se dosó la actividad de monoamino oxidasa (MAO) plaquetaria en 17 pacientes esquizofrénicos crónicos y en 13 sujetos-control, utilizándose kinuramina como substrato. La actividad de MAO fue aproximadamente 10 veces mayor en los sujetos del grupo control que en los esquizofrénicos (controles: 31,7 + ou - 4,5 nmoles.mg proteína-1.h-1, n=13; esquizofrénicos: 3,3 + ou - 0,6 nmoles.mg proteína-1.h-1, n=17). Los valores de Vmáx y Km para kinuramina fueron significativamente más bajos en os pacientes que en los controles. La actividad de MAO fue aun menor en el subgrupo de pacientes cuya forma clínica previa actual estado residual fue paranoide. Estos resultados permitirían utilizar la determinación de MAO plaquetaria como una variable en la investigación, sobre esquizofrenía (AU)