The interference of polypharmacy and the importance of clinical pharmacy advice in the treatment of leprosy: a case-control study

Abstract INTRODUCTION: Although supervised doses are essential for reducing leprosy treatment failure, the impact of specific drug interactions has rarely been assessed. This study aimed to estimate the risk of leprosy treatment suspension in patients receiving polypharmacy. METHODS We performed this case-control study in which the primary outcome was defined as the need to discontinue multibacillary leprosy treatment for at least one supervised dose, and the main risk factor was the detection of polypharmacy. Multivariate analysis by logistic regression was used for calculating odds ratio (OR). RESULTS: This study included 103 patients, of whom 43 needed to discontinue leprosy treatment (hemolysis = 26, hepatitis = 2, hemolysis associated with hepatitis = 6, and suspected treatment resistance = 9) and the rest did not. The severity of drug interactions had no effect on treatment discontinuation. Patients who used five or more drugs in addition to leprosy treatment had almost a 4-fold greater risk of treatment suspension (OR, 3.88; 95% confidence interval: 1.79-9.12; p < 0.001). The number of drugs used also positively influenced the occurrence of hemolysis (p < 0.001). No patient presented evidence of molecular resistance to rifampicin, dapsone, or ofloxacin treatment, as evidenced by genetic sequencing detection of rpoB, folp1, and gyrA mutations. CONCLUSIONS: Polypharmacy has deleterious effects on the already difficult-to-adhere-to treatment of leprosy and polypharmacy induces hemolysis. Additional measures must be taken to avoid the undesirable effects of inadequate polypharmacy.

Evaluation of the occurrence of sexual dysfunction and general quality of life in female patients with psoriasis

Abstract: Background: Psoriasis has a significant impact on quality of life (QoL). Sexual life can also be affected, with sexual dysfunction being reported by 25-70% of patients. Objectives: To determine the occurrence of sexual dysfunction and evaluate QoL in women with psoriasis. Methods: This case-control study included women aged 18-69 years. The validated Brazilian Portuguese versions of the Female Sexual Function Index (FSFI) and of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were administered to all participants to assess sexual function and QoL, respectively. Patients with psoriasis underwent clinical evaluation for the presence of comorbidities, especially psoriatic arthritis and other rheumatic manifestations. Location of lesions and the extent of skin involvement were also assessed. Results: The sample consisted of 150 women, 75 with diagnosis of psoriasis and 75 healthy controls. Prevalence of sexual dysfunction was high in women with psoriasis (58.6% of the sample). Prevalence was statistically higher in women with psoriasis than in controls (P = 0.014). The SF-36 domain scores were also lower in women with psoriasis, with role limitations due to physical health, limitations due to emotional problems, and mental health being the most affected domains. Study limitations: Sample size was calculated to evaluate the association between the occurrence of sexual dysfunction and psoriasis, but it did not include the determination of the possible causes of this dysfunction. Conclusions: QoL and sexual function were altered in women with psoriasis and should be taken into consideration when assessing disease severity.

Medical learning in a private hospital: patients' and companions' perspectives / Ensino médico em um hospital privado: perspectiva dos pacientes e acompanhantes

CONTEXT AND OBJECTIVE: Contact with patients has important implications for medical students' education. Previous studies have shown that patients in teaching hospitals have positive views about medical education. The aim here was to assess the acceptability of medical education among patients and their companions in a non-teaching private hospital that is planning to implement a medical teaching program in the near future. DESIGN AND SETTING: Cross-sectional study conducted in a 200-bed tertiary-care private hospital in Brasília. METHODS: Between March and April 2005, patients and their companions in three different sections of the hospital (intensive care unit, ward and emergency waiting room) were surveyed using a questionnaire. RESULTS: The questionnaire was completed by 209 volunteers. The majority of the volunteers (178; 85 percent) said that they would allow a student to be present during consultations. Of these, 102 (57 percent) said that they would like to have a student present. Acceptance of the presence of students was higher among males (males 93 percent; females 81 percent; P = 0.026). Intensive care unit respondents said that they would like medical students to be present more frequently than the other two groups said this (ward 48 percent; emergency room 49 percent; intensive care unit 74 percent; P = 0.011). CONCLUSIONS: Not only were medical students well accepted but also their presence during consultations was desired by many patients and their companions. These findings may be of great value for plans to implement medical teaching programs in private hospitals.

CONTEXTO E OBJETIVO: O contato com pacientes tem implicações importantes na educação de estudantes de medicina. Estudos prévios revelam que pacientes em hospitais escola têm opiniões positivas sobre ensino médico. O objetivo foi avaliar a aceitação de ensino médico em um hospital privado não-universitário que planeja implementar um programa de ensino médico em futuro próximo. TIPO DE ESTUDO E LOCAL: Estudo transversal conduzido em hospital privado de 200 leitos, em Brasília. MÉTODOS: Em Brasília entre março e abril de 2005, foram aplicados questionários a pacientes e acompanhantes em três diferentes seções do hospital: unidade de terapia intensiva, enfermaria e sala de espera do pronto-socorro. RESULTADOS: O questionário foi respondido por 209 voluntários. A maioria, 178 (85 por cento), permitiria a presença do estudante de medicina durante a consulta e dentre estes, 102 (57 por cento) gostariam da presença do estudante. A aceitação à presença de estudantes foi maior em voluntários do sexo masculino (homens 93 por cento; mulheres 81 por cento; P = 0,026). Os voluntários da unidade de terapia intensiva foram os que mais gostariam da presença do estudante quando comparados aos outros dois grupos (enfermaria 48 por cento; pronto-socorro 49 por cento; unidade de terapia intensiva 74 por cento; P = 0,011). CONCLUSÕES: Estudantes de medicina são não apenas bem aceitos, mas também desejados por muitos pacientes e acompanhantes durante consultas médicas. Esses achados podem ter grande valor para o plano de implementação de um programa de ensino médico em um hospital privado.