Variaciones en el consumo de medicamentos para la salud mental en una unidad de atención primaria brasileña: ¿hay influencia de la pandemia? / Variations in the consumption of mental health medications in a brazilian primary care unit: is there influence of the pandemic?

Introducción: La pandemia de COVID-19 ha generado la necesidad de ajustes y adaptaciones en diversas áreas, desde el comportamiento hasta la normativa, con grandes repercusiones en términos de salud pública. Objetivo: Comparar los consumos promedio mensuales (CPM) de medicamentos de control especial utilizados para la salud mental antes y durante la pandemia en una Unidad Básica de Salud (UBS) en el Distrito Federal, Brasil. Métodos: Los consumos se obtuvieron a través del sistema de gestión de inventarios local y el CPM (±desviación estándar) se calculó sin tener en cuenta los meses de desabastecimiento, considerando el período de 2020 a 2022. Como parámetro comparativo, se utilizó el CPM±DE de 2019. Resultados: Se analizaron los consumos de 32 medicamentos, siendo la mayoría antiepilépticos (N=10; 31,2 %), antidepresivos (N=10; 31,2 %) y antipsicóticos (N=8; 25,0 %). Se observó que más de la mitad de los medicamentos analizados (n=18; 56,3 %) mantuvieron un aumento en el consumo a lo largo de los años de la pandemia. Conclusión: Hubo una variación significativa en el consumo de medicamentos sujetos a control especial en la UBS durante la pandemia. Estos resultados pueden estar asociados a diversos factores, como el aumento de los cuadros clínicos que justifican su prescripción, en línea con la literatura actual sobre el impacto potencial del aislamiento social y las medidas tomadas por las autoridades competentes para contener la propagación del virus SARS-COV-2. (AU)

Introduction: The COVID-19 pandemic has generated the need for adjustments and adaptations in various areas, from behaviour to regulations, with significant repercussions in terms of public health. Objective: To compare the monthly average consumption (MAC) of special control medications used for mental health before and during the pandemic in a Basic Health Unit (UBS) in the Federal District, Brazil. Methods: Consumption data were obtained through the local inventory management system, and the MAC (±stan-dard deviation) was calculated excluding months of stockouts, considering the period from 2020 to 2022. The MAC±SD of 2019 was used as a comparative parameter. Results: Consumption of 32 medications was analyzed, with the majority being antiepileptics (N=10; 31.2 %), anti-depressants (N=10; 31.2 %), and antipsychotics (N=8; 25.0 %). It was observed that more than half of the analyzed medications (n=18; 56.3 %) maintained an increase in consumption throughout the pandemic years. Conclusion: There was a significant variation in the consumption of special control medications at the UBS during the pandemic. These results may be associated with various factors, such as the increase in clinical conditions justi-fying their prescription, in line with current literature on the potential impact of social isolation and measures taken by competent authorities to contain the spread of the SARS-CoV-2 virus. (AU)

Availability of emergency contraception in large Brazilian municipalities: a guaranteed right?

Introduction: Emergency Contraception (EC) is available in Brazil since 1996, when it was adopted as one if the family planning strategies and, in 1998, for use in services assisting victims of sexual violence. In the country, its use is regulated by guidelines. Its access through SUS (Unified Health System), however, does not seem to occur in a standardized manner. Methods: The aim of the study was to analyze the availability and barriers to accessing emergency contraception (levonorgestrel) in Brazilian municipalities with more than 500 thousand inhabitants. The survey was carried out by a form sent to the Municipal Health Departments (SMS) managers and a search on the list of standardized medicines by the hospitals in the same municipalities. Results: The Basic Health Units were identified as the standard access places to EC. However, one of the obstacles mentioned is the need for a prescription for dispensing in almost 80% of the analyzed cities. Access in emergency situations at night and on weekends is also uncertain, since although 67% of the places stated that they dispense at the hospital level, the item was only standardized in 21% of the hospital lists. Discussion: The difficult access this drug in the public system essentially tends to harm the poorest women, who are the ones who suffer most from the consequences of an unwanted pregnancy.

Untargeted Metabolomic Study of Lung Cancer Patients after Surgery with Curative Intent.

Lung cancer (LC) is a leading cause of mortality, claiming more than 1.8 million deaths per year worldwide. Surgery is one of the most effective treatments when the disease is in its early stages. The study of metabolic alterations after surgical intervention with curative intent could be used to assess the response to treatment or the detection of cancer recurrence. In this study, we have evaluated the metabolomic profile of serum samples (n = 110) from preoperative (PRE) and postoperative (POST) LC patients collected at two different time points (1 month, A; 3-6 months, B) with respect to healthy people. An untargeted metabolomic platform based on reversed phase (RP) and hydrophilic interaction chromatography (HILIC), using ultra-high performance liquid chromatography (UHPLC) and mass spectrometry (MS), was applied (MassIVE ID MSV000092213). Twenty-two altered metabolites were annotated by comparing all the different studied groups. DG(14,0/22:1), stearamide, proline, and E,e-carotene-3,3'-dione were found altered in PRE, and their levels returned to those of a baseline control group 3-6 months after surgery. Furthermore, 3-galactosyllactose levels remained altered after intervention in some patients. This study provides unique insights into the metabolic profiles of LC patients after surgery at two different time points by combining complementary analytical methods.

Metallomic Signatures of Lung Cancer and Chronic Obstructive Pulmonary Disease.

Lung cancer (LC) is the leading cause of cancer deaths, and chronic obstructive pulmonary disease (COPD) can increase LC risk. Metallomics may provide insights into both of these tobacco-related diseases and their shared etiology. We conducted an observational study of 191 human serum samples, including those of healthy controls, LC patients, COPD patients, and patients with both COPD and LC. We found 18 elements (V, Al, As, Mn, Co, Cu, Zn, Cd, Se, W, Mo, Sb, Pb, Tl, Cr, Mg, Ni, and U) in these samples. In addition, we evaluated the elemental profiles of COPD cases of varying severity. The ratios and associations between the elements were also studied as possible signatures of the diseases. COPD severity and LC have a significant impact on the elemental composition of human serum. The severity of COPD was found to reduce the serum concentrations of As, Cd, and Tl and increased the serum concentrations of Mn and Sb compared with healthy control samples, while LC was found to increase Al, As, Mn, and Pb concentrations. This study provides new insights into the effects of LC and COPD on the human serum elemental profile that will pave the way for the potential use of elements as biomarkers for diagnosis and prognosis. It also sheds light on the potential link between the two diseases, i.e., the evolution of COPD to LC.

Albendazole - Ivermectin combination decreases inflammation in experimental neurocysticercosis.

Neurocysticercosis (NCC) is a public health issue in endemic regions and is considered the main preventable cause of neurologic disease. It is caused by the presence of Taenia solium cysticercus in the central nervous system. The current treatment is performed with anthelminthic drugs - albendazole (ABZ) or praziquantel - associated with anti-inflammatory and corticosteroids in order to prevent the negative effects of the inflammatory reaction to the parasite's death. Ivermectin (IVM) is an anthelminthic drug that has been shown to present an anti-inflammatory effect. The aim of this study was to was to evaluate the histopathologic aspects of experimental NCC after in vivo treatment with a combination of ABZ-IVM. Balb/c mice were intracranially inoculated with T. crassiceps cysticerci and after 30 days of infection were treated with a single dose of NaCl 0.9% (control group), ABZ monotherapy (40 mg/kg), IVM monotherapy (0.2 mg/kg) or a combination of ABZ-IVM. 24h after the treatment the animals were euthanized and the brain was removed for histopathologic analysis. The IVM monotherapy and ABZ-IVM combination showed more degenerated cysticerci, less inflammatory infiltration, meningitis and hyperemia than the other groups. Therefore, it is possible to recommend the combination of albendazole and ivermectin as alternative chemotherapy for NCC due to its antiparasitic and anti-inflammatory effects, with potential to decrease the negative effects of the inflammatory burst when the parasite is killed within the CNS.

Compounded drugs as an alternative to the therapeutical gaps of inborn errors of metabolism

Abstract Inborn errors of metabolism are rare disorders with few therapeutic options for their treatments, which can make patients suffer with complications. Therefore, compounded drugs might be a promising option given that they have the ability of meeting the patient's specific needs, (i) identification of the main drugs described in the literature; (ii) proposal of compounding systems and (iii) calculation of the budgetary addition for the inclusion of these drugs into the Brazilian Unified Health System. The research conducted a literature review and used management data as well as data obtained from official Federal District government websites. The study identified 31 drugs for the treatment of inborn errors of metabolism. Fifty eight percent (58%) (18) of the medicines had their current demand identified, which are currently unmet by the local Health System. The estimated budget for the production of compounded drugs was of R$363,16.98 per year for approximately 300 patients. This estimated cost represents a budgetary addition of only 0.17% from the total of expenditures planned for drug acquirement. There is a therapeutic gap for inborn errors of metabolism and compounding pharmacies show potential in ensuring access to medicine therapy with a low-cost investment.

Treatment of Extensive Soft Tissue Injury with Polypropylene Prosthesis: A Case Study.

Injuries with exposure of soft tissue are frequent in orthopaedics. Innovative therapies using prosthesis as an auxiliary material to treat this type of injury are under development, aiming to overcome applicability and execution limitations of myocutaneous flap techniques. Figueiredo's technique uses a polypropylene prosthesis extracted from sterile saline to treat trauma at the fingertip. It is an alternative technique with a high success rate, reproducible, low cost and easy to apply. This article reports a case of foot injury with exposure of soft tissue treated with a treatment similar to Figueiredo's technique. The patient was admitted with a large and contaminated skin wound, muscle damage, tendon exposure, cuboid fracture and bone loss. Initially, debridement was performed. After 72 hours, a polypropylene prosthesis extracted from a sterile saline bottle was implanted and subsequently replaced after 60 days. After 76 days, the prosthesis was removed. There was no infection. 8 months later, there was total healing by second intention. The patient's motor and sensory functions were preserved. This case study shows that Figueiredo's technique can also be employed in more extensive injuries, representing an alternative to using myocutaneous flaps. The polypropylene prosthesis is extremely affordable, which enables resolution of cases in a greater number of services. This technique still offers the best aesthetic result and does not compromise other body regions.

Medicine manipulation: An alternative to mitigate therapeutic gaps in the Brazilian Unified Health System?

Despite the various initiatives carried out in Brazil and in the world, the challenge of offering essential medicines in adequate presentations remains, especially to the public affected by diseases considered neglected and the pediatric population, for whom the therapeutic options remain limited. The main objective of this study was to evaluate the production of manipulated medicines as a strategy to mitigate therapeutic and access gaps to essential medicines within the Brazilian public health system, called the Unified Health System (SUS). The evaluation, carried out between 2020 and 2021, identified, among the medicines considered essential to the Brazilian health context, those unavailable, for which strategies were evaluated to mitigate the identified unavailability, which is conventionally called therapeutic gaps. For 57% (n = 235) of pharmaceutical presentations identified as therapeutic gaps in SUS, manipulation was identified as the best strategy to promote access. Of these presentations, 30% (n = 70) were identified as priorities in the context of patient care and were mainly related to the demands of the pediatric public and those affected by poverty-related diseases. Concerning poverty-related diseases, the absence of evidence on the development of a standard formula for drugs with indication for such diseases was demonstrated. The need for an annual investment of approximately US$74.75 per capita was estimated to offer treatments in adequate presentations to SUS users, which should reflect in the improvement of the quality of life of about 26 thousand people. It was observed that this investment amount corresponds to only 3% of the budget for the purchase of medicines financed exclusively by the Ministry of Health thorugh the Strategic Component of Pharmaceutical Assistance (CESAF) approved for 2021.

A lacuna regulatória de medicamentos órfãos impacta na disponibilidade de alternativas terapêuticas no Brasil?

Introdução: A regulação de registros específicos para os chamados "medicamentos órfãos" tem sido uma estratégia das maiores agências de medicamentos do mundo para fomentar o acesso e monitoramento de tratamento para doenças e agravos de pouca prevalência ou interesse mercadológico. Objetivos: Esse estudo visou identificar o perfil dos medicamentos que se enquadram nessa categoria internacionalmente explorar possíveis lacunas de registro gerados pela ausência de uma norma sanitária específica no Brasil. Métodos: Foram analisadas as bases de dados de registro de medicamentos órfãos de países da União Europeia e dos Estados Unidos da América e os resultados foram comparados com a base registros da Agência brasileira. Resultados: Foram identificados 369 medicamentos registrados como órfãos nos órgãos europeu e estadunidense totalizando 801 indicações clínicas. A maior parte dos medicamentos registrados no âmbito internacional era de agentes anti-neoplásicos e imunomoduladores (N=135; 36,59 %) e de medicamentos que agiam no aparelho digestivo e metabolismo (N=48; 13,01 %). Dos medicamentos órfãos registrados e comercializados no âmbito internacional, quase metade, 177 (47,97 %), não apresentavam registros ativos no Brasil e atendem a 327 indicações clínicas (40,82 %). Conclusão: O Brasil deve analisar afundo os impactos da ausência de um fluxo de registro medicamentos órfãos, que pode afetar diretamente no acesso de tratamento para determinadas doenças raras e negligenciadas.

SUMMARY Introduction: The regulation of specific registrations for the so-called "orphan drugs" has been a strategy of the largest drug agencies in the world to promote access and monitoring of treatment for diseases and conditions of low prevalence or market interest. Aims: This study aimed to identify the profile of drugs that fall into this category internationally and explore possible gaps in registration generated by the absence of a specific health standard in Brazil. Methods: Orphan drug registration databases from countries of the European Union and the United States of America were analyzed and the results were compared with the database of the Brazilian Agency. Results: A total of 369 drugs registered as orphans in European and US agencies were identified, totaling 801 clinical indications. Most of the drugs registered internationally were antineoplastic agents and immunomodulators (N=135; 36.59 %) and drugs that acted on the digestive system and metabolism (N=48; 13.01 %). Of the orphan drugs registered and marketed internationally, almost half, 177 (47.97 %), did not have active registrations in Brazil and meet 327 clinical indications (40.82 %). Conclusion: Brazil must analyze in depth the impacts of the absence of an orphan drug registration flow, which can directly affect access to treatment for certain rare and neglected diseases.

Introducción: La regulación de registros específicos para los denominados "medicamentos huérfanos" ha sido una estrategia de las agencias de drogas más grandes del mundo promover el acceso y seguimiento del tratamiento de enfermedades y condiciones de poca prevalencia o interés de mercado. Objetivos: Identificar el perfil de las drogas que entran en esta categoría a nivel internacional explorar posibles lagunas en los registros generadas por la ausencia de un estándar sistema de salud específico en Brasil. Métodos: Las bases de datos de registro de medicamentos huérfanos de países de la Unión Europea y Estados Unidos da América y los resultados fueron comparados con la base de registros de la Agencia Brasileña. Resultados: Se identificaron 369 medicamentos registrados como huérfanos en órganos europeos y americanos, totalizando 801 indicaciones clínicas. La mayor parte de los medicamentos registrados a nivel internacional fueron agentes antineoplásicos e inmunomoduladores (N=135; 36,59%) y fármacos que actuaron en el aparato digestivo y metabolismo (N=48; 13,01%). De medicamentos huérfanos registrados y vendidos internacionalmente, casi la mitad, 177 (47,97 %), no tenía registros activos en Brasil y atendió 327 indicaciones clínicas (40,82%). Conclusión: Brasil debe analizar en profundidad los impactos de la ausencia de un flujo de registro de medicamentos huérfanos, que puede afectar directamente el acceso al tratamiento para ciertas enfermedades raras y desatendidas.

Prevalence and factors associated with depression in people living with HIV/AIDS in a Brazilian metropolitan region.

The frequent association between mental disorders and HIV infection may be related to several risk factors. The present study aims to determine the prevalence of depression and its associated factors in people living with HIV/AIDS (PLWHA) who attended four outpatient clinics in Fortaleza, Brazil, between September 2014 and April 2015. In addition to the Mini International Neuropsychiatric Interview questionnaire, which was used to identify the prevalence of depressive disorder, the researchers applied a sociodemographic questionnaire, and the Hamilton Depression Scale to classify the severity of depression. In all, 257 participants were included in the analyses. The overall lifetime prevalence of depression was identified to be 29.2% (19.5% in men and 44.9% in women). The prevalence of a current depressive episode was 18.7%. Mild, moderate, and severe depression was identified in 2.1%, 12.5%, and 85.4%, respectively. The factors related to depression were: gender, marital status, income, educational level, current employment status, and family history of depression. This study highlights the importance of lifetime depression as a disorder of high prevalence in PLWHA, and associated with risk factors that are difficult or impossible to be modified. Early diagnosis and treatment of depression may improve quality of life in PLWHA.

Quality appraisal of existing guidelines for the management of headache disorders by the AGREE II's method.

OBJECTIVE: To evaluate the quality of existing clinical practice guidelines for headache management and their main recommendations. BACKGROUND: Evidence-based clinical practice guidelines have been developed to support the clinical decision-making. However, to achieve this goal, the quality of these guidelines must be ensured. METHODS: A systematic search for clinical practice guidelines for headache management was conducted in the PubMed database, in websites of known guideline developers and in websites of known headache associations. The quality appraisal was performed through the Appraisal of Guidelines for Research and Evaluation II method. RESULTS: Twelve guidelines were evaluated. The domains of rigor of development, applicability, and editorial independence, which most influence the overall quality of guidelines, had the lowest average scores and the highest standard deviation rates (61% ± 23; 37% ± 20; 53% ± 31). The main recommendations regarding medication use for acute treatment of episodic tension-type headache and migraine in adult patients consisted of paracetamol, acetylsalicylic acid, and other nonsteroidal anti-inflammatory drugs in all guidelines. CONCLUSIONS: The statistical results indicate that the appraised guidelines have room for both individual and collective improvement. In addition, there is a well-established medication recommendation pattern among all guidelines evaluated.

Comparative analysis of the use and control of thalidomide in Brazil and different countries: is it possible to say there is safety?

INTRODUCTION: One of the biggest drug disasters in history has not prevented thalidomide from being used to treat various clinical conditions. Currently, Brazil has a worrying scenario: high consumption of the drug and, cases of pregnant women using thalidomide, even after adopting restrictive legislation. AREAS COVERED: This review of the literature and legislation sought to comparatively analyze the monitoring of thalidomide use in Brazil and other countries that use this drug. Finally, we discuss the differences between the countries. EXPERT OPINION: This analysis allows us to think beyond the safe use of thalidomide, but the safety provided by any type of monitoring system. It seems that out-patients that use unsafe drugs are exposed to some degree of risk. To improve safety, more extensive improvements are needed than monitoring systems related to the use of thalidomide. Its safe use depends on a drastic reduction in the incidence of leprosy and Erythema Nodosum Leprosum in the world; investment in research and development of safe and effective therapeutic alternatives to thalidomide; improvement of health systems and their health surveillance systems, particularly in primary health care; awareness of health professionals and patients for greater responsibility in the use of medicines, especially thalidomide.

Evaluation of pharmaceutical care in Brazilian primary health services settings: expanding objects and approaches

Abstract The objective of this work is to reflect on the objects and approaches usually employed in the evaluation of pharmaceutical care and their potential applicability in primary care settings. We conducted the review of the literature, and, to exemplify the advantages of expanding these objects and approaches, a real-world problem situation was selected: morbidity and mortality related to lack of treatment adherence by hypertensive patients in Brazilian primary health care services. Our reflections highlight the need to evaluate the effects of interventions, understood within Donabedian's normative model as 'outcomes,' which can be clinical, humanistic, or economic. Our findings show that most published studies, even those that set out to report outcomes, actually evaluate processes, such as number of visits, number of problems identified, types of problems, or acts of the practice performed by pharmacists. On the other hand, we also identify a need for study designs and indicators to enable 'finer' normative assessment. We also discuss the importance of shifting research toward an evaluative paradigm to allow strategic, logic, effects, production, efficiency, and implementation analyses. Finally, we suggest some possible indicators to evaluate pharmaceutical care interventions in the selected problem situation, through an extension of the objects and approaches proposed.

Mesoscale and wind-driven intra-annual variability in the East Auckland Current.

Intra-annual variability in the East Auckland Current (EAuC) was studied using a year-long timeseries of in situ and remotely-sensed velocity, temperature and salinity observations. Satellite-derived velocities correlated well ([Formula: see text]) with in situ observations and well-represent the long-term ([Formula: see text] days) variability of the upper ocean circulation. Four mesoscale eddies were observed during the year (for 260 days) which generated distinct flows between the continental slope and rise. The EAuC dominated the circulation in the continental shelf break, slope and rise for 110 days and generated the most energetic events associated with wind forcing. Current variability on the continental slope was coherent with along-slope wind stress (wind stress curl) at periods between 4 and 12 days (16 and 32 days). We suggest that along-slope winds generated offshore Ekman transport, uplift on the shelf-break, and a downwind geostrophic jet on the slope. In contrast, positive wind stress curl caused convergence of water, downwelling, and increased the current speed in the region. Bottom Ekman transport, generated by the EAuC, was suggested to have caused the largest temperature anomaly ([Formula: see text]) at the continental shelf-break.

Avaliação da taxa de incidência anual de dengue no município de Salvador-BA entre anos de 2007 a 2019 e delineamento do perfil epidemiológico nos anos de 2011 e 2013 / Evaluation of the annual incidence rate of dengue in the city of Salvador-BA between years 2007 to 2019 and delineation of the epidemiological profile in the years 2011 and 2013

Objetivo: avaliar a taxa de incidência anual da dengue no município de Salvador-BA entre os anos de 2007 a 2019, de modo a descrever o perfil sociodemográfico da população acometida e traçar o perfil epidemiológico nos anos de 2011 e 2013 que correspondem, respectivamente, ao ano de maior e menor taxa de incidência da doença. Metodologia: trata-se de um estudo epidemiológico cujos dados foram obtidos de fontes secundárias, através do Tabnet Salvador. Foram incluídas variáveis sociodemográficas, clínicas e distribuição sazonal dos casos de dengue. Resultados: foram notificados 76.227 casos de dengue na região estudada durante o período de 2007 a 2019, cujos anos de 2011 e 2013 observou-se a predominância do nível de escolaridade fundamental/médio incompleto. Conclusão: o retrato geográfico da dengue deve servir de alerta sobre o comportamento da enfermidade, a fim de evidenciar a necessidade de medidas mais efetivas relativas às ações de controle, vigilância e tratamento da doença, sendo de fundamental importância o desenvolvimento de estratégias com enfoque na atenção primária à saúde objetivando a conscientização da população através de ações educativas e abordagens midiáticas, e fazendo-se necessário a compreensão do papel de fatores socioeconômicos e ambientais e suas importantes implicações para a implementação de medidas efetivas de prevenção e combate ao mosquito vetor.

Objective: to evaluate the annual incidence rate of dengue in the city of Salvador-BA between the years 2007 to 2019, in order to describe the sociodemographic profile of the affected population and to trace the epidemiological profile in the years 2011 and 2013 that correspond, respectively, the year with the highest and lowest incidence rate of the disease. Methodology: this is an epidemiological study whose data were obtained from secondary sources, such as Tabnet Salvador and includes sociodemographic, clinical variables and seasonal distribution of dengue cases. Results: 76.227 cases of dengue were reported in the studied region during the period from 2007 to 2019, whose years from 2011 to 2013 the predominance of the level of incomplete primary/secondary education was observed. Conclusion: the geographic portrait of dengue should serve as a warning about the behavior of the disease, in order to highlight the need for more effective measures related to the control, surveillance and treatment of the disease, with the development of strategies focusing on primary care being of fundamental importance. to health aiming at population awareness through educational actions and media approaches and making it necessary to understand the role of socioeconomic and environmental factors and their important implications for the implementation of effective measures to prevent and combat the vector mosquito.

Objective: to evaluate the annual incidence rate of dengue in the city of Salvador-BA between the years 2007 to 2019, in order to describe the sociodemographic profile of the affected population and to trace the epidemiological profile in the years 2011 and 2013 that correspond, respectively, the year with the highest and lowest incidence rate of the disease. Methodology: this is an epidemiological study whose data were obtained from secondary sources, such as Tabnet Salvador and includes sociodemographic, clinical variables and seasonal distribution of dengue cases. Results: 76.227 cases of dengue were reported in the studied region during the period from 2007 to 2019, whose years from 2011 to 2013 the predominance of the level of incomplete primary/secondary education was observed. Conclusion: the geographic portrait of dengue should serve as a warning about the behavior of the disease, in order to highlight the need for more effective measures related to the control, surveillance and treatment of the disease, with the development of strategies focusing on primary care being of fundamental importance. to health aiming at population awareness through educational actions and media approaches and making it necessary to understand the role of socioeconomic and environmental factors and their important implications for the implementation of effective measures to prevent and combat the vector mosquito.

The organization, weaknesses, and challenges of the control of thalidomide in Brazil: A review.

The drug thalidomide has resurged in the world market under restrictive conditions for marketing and use. In Brazil, there are still cases of pregnant women using thalidomide even after the implementation of laws that regulate the control of use (Law No. 10.651/2003 and Collegiate Board Resolution No. 11/2011). The objective of this study was to discuss the control of thalidomide use in Brazil, based on a scoping review of the scientific literature, documents, and data from the Ministry of Health. A total of 51 studies and documents related to the following subthemes were selected: (1) organization of access and use of thalidomide in the health system; (2) epidemiological and population characteristics of people affected by leprosy; and (3) occurrence of pregnancy and cases of embryopathy with the use of thalidomide. The results showed that Brazil has no unified information database about thalidomide patients. Furthermore, there is inconsistency in the accreditation of public health centers that dispense this medicine, in a country that has a high consumption of thalidomide in the Unified Health System. A large part of this amount of dispensed medicine is intended for the treatment of erythema nodosum leprosum, mainly in the North, Northeast, and Central-West regions of the country, which are endemic for leprosy. This disease is the only one among the clinical indications of the medicine approved in Brazil that does not have a Clinical Protocol and Therapeutic Guidelines. The control of thalidomide use in Brazil presents historical regulatory failures. These are currently linked to the organization and structure of primary healthcare in the country, as well as to the lack of leadership of the Ministry of Health and National Health Surveillance Agency when it comes to managing the process of control of this use.

Synthesis of Densely Substituted Sulfonylfurans and Dihydrofurans via Cascade Reactions of α-Functionalized Nitroalkenes with ß-Ketosulfones.

The reaction of ß-ketosulfones with different α-functionalized nitroalkenes affords diversely substituted sulfonylfurans and dihydrofurans. Furthermore, ß-ketosulfones react with α-bromonitroalkenes and α-hydrazinonitroalkenes via a cascade Michael addition-cyclization protocol to afford nitrodihydrofurans and hydrazinodihydrofurans, respectively, bearing a key sulfonyl group, in excellent yields with a broad substrate scope. Application of these products has been demonstrated by the synthesis of pyrroles and pyrazoles in good yields. The reaction of ß-ketosulfones with nitroallylic acetates yields tetrasubstituted sulfonyl furans through a cascade SN2'-intramolecular Michael reaction, followed by aromatization. The gram-scale synthesis of a representative example of sulfonylfurans was carried out to demonstrate the synthetic efficiency of the methodology.

PARKINSONISM AS AN ATYPICAL MANIFESTATION OF PRIMARY HYPERPARATHYROIDISM.

OBJECTIVE: Primary hyperparathyroidism (PHPT) occurs as a result of hyperfunctional parathyroid glands resulting in an elevation of serum calcium levels. The association between hypoparathyroidism and parkinsonism have been frequently reported in the literature, while evidence of hyperparathyroidism associated with parkinsonism is rare. METHODS: The present study reports a case of a patient that had PHPT and developed symptoms of parkinsonism. RESULTS: A 75-year-old female patient with a history of diabetes mellitus, dyslipidemia, and systemic arterial hypertension presented to the emergency room due to unexplained drowsiness. Her serum calcium at the time was 14.2 mg/dL. A cervical ultrasound was performed, and the presence of a 2.5 × 1.9-cm nodule in the left lower parathyroid region was identified. Three days later, scintigraphy with the use of sestamibi showed an increased capture of the marker in the same region, suggesting parathyroid hyperfunction. During hospitalization, the patient developed symptoms of parkinsonism. A left inferior parathyroidectomy was performed, with normalization of serum calcium levels and a remission of drowsiness, in addition to a significant improvement in parkinsonian symptoms. The patient remained free of parkinsonism over 3 years of follow up. CONCLUSION: Parathyroidectomy can provide a significant remission of parkinsonism in a patient with PHPT. Even though it is rare, the relation between parkinsonism and PHPT exists.

The different clinical guideline standards in Brazil: High cost treatment diseases versus poverty-related diseases.

Each year, evidence-based clinical guidelines gain more space in the health professionals' practice and in services organization. Due to the scarcity of scientific publications focused on diseases of poverty, the development of well-founded clinical guidelines becomes more and more important. In view of that, this paper aims to evaluate the quality of Brazilian guidelines for those diseases. The AGREE II method was used to evaluate 16 guidelines for poverty-related diseases (PRD) and 16 guidelines for global diseases whose treatment require high-cost technologies (HCD), with the ultimate aim of comparing the results. It was found that, in general, the guideline development quality standard is higher for the HCD guidelines than for the PRD guidelines, with emphasis on the "rigour of development" (48% and 7%) and "editorial independence" (43% and 1%) domains, respectively, which had the greatest discrepancies. The HCD guidelines showed results close to or above international averages, whereas the PRD guidelines showed lower results in the 6 domains evaluated. It can be concluded that clinical protocol development priorities need some redirecting in order to qualify the guidelines that define the healthcare organization and the care of vulnerable populations.

Evaluation of the accuracy of frozen section in different anatomical sites / Avaliação da acurácia diagnóstica do exame intraoperatório por congelação em diferentes sítios anatômicos

ABSTRACT INTRODUCTION: Frozen section is recommended in several situations to: establish the nature of a lesion; establish the presence of a lesion; confirm the presence of a benign lesion; confirm that sufficient tissue is present for diagnosis; establish the grade of the lesion; determine the organ of origin and determine the adequacy of margins. OBJECTIVES: To evaluate the accuracy of frozen section biopsy in multiple organs and analyze possible factors in discrepancy. METHODS: A retrospective study was carried out during a five-year period at a teaching hospital of Recife, Pernambuco, Brazil. The diagnoses of frozen section were compared with results obtained in the permanent section and classified as concordant or discordant. The discordant cases were reviewed by a pathologist and subdivided into false positives and false negatives. Possible reasons for discrepancy were indicated. RESULTS: A total of 1.226 specimens were analyzed, of which 1.181 (96.33%) were concordant and 45 (3.67%) were discordant. After the review of the discordant cases, 39 remained, six (15.4%) were false positives and 33 (84.6%) were false negatives. The tissue that had most false-positive results was mammary sentinel lymph node (3/1.2%), whereas ovarian showed most false negative outcomes with 17 specimens (51.51% of all false negatives). The possible reasons for discrepancy were sampling error, misunderstanding and complexity of the diagnosis. CONCLUSION: The frozen section accuracy of 96.3% found in our study is similar to specialized literature and does not seem to depend on the tissue analyzed.

RESUMO INTRODUÇÃO: O exame intraoperatório por congelação (EIC) visa avaliar histológica e intraoperatoriamente um pequeno fragmento de tecido ou órgão lesado no qual haja dúvida diagnóstica. Entre as indicações do EIC estão a determinação da natureza e a extensão da lesão, com consequente diferenciação entre lesões benignas e malignas, além da análise das margens cirúrgicas. OBJETIVOS: Avaliar a acurácia do EIC em múltiplos órgãos e analisar possíveis fatores de interferência. MÉTODOS: Foi realizado um estudo retrospectivo em um período de cinco anos (entre janeiro de 2011 e março de 2016) em um hospital de ensino da cidade do Recife, Pernambuco, Brasil. Os resultados dos EICs foram comparados com os laudos finais após o processamento histopatológico e classificados como concordantes ou discordantes. Os casos discordantes foram revistos por patologista e subdivididos em falso-positivos e falso-negativos. Possíveis causas para a discordância dos exames foram levantadas. RESULTADOS: Foram analisadas 1.226 peças cirúrgicas, das quais 1.181 (96, 33%) foram concordantes e 45 (3, 67%), discordantes. Após reavaliação dos casos discordantes, 39 permaneceram, sendo seis (15, 4%) falso-positivos e 33 (84, 6%) falso-negativos. A estrutura que mais apresentou resultado falso-positivo foi o linfonodo sentinela mamário (3/1, 2%), enquanto o ovário foi o órgão com mais resultados falso-negativos, com 17 amostras, 51, 51% de todos os casos negativos. As possíveis causas para a discordância foram tamanho da amostra, limitação do método e complexidade do diagnóstico. CONCLUSÃO: A acurácia do EIC encontrada neste estudo foi de 96, 3% e é semelhante à literatura especializada.