Polifarmácia e cognição em pacientes com idade avançada / Polypharmacy and cognition in elderly patients

Objetivo: Avaliar a prevalência da polifarmácia e da prescrição de medicações inapropriadas, bem como suas associações com a capacidade cognitiva e funcional do idoso. Métodos: Estudo observacional transversal, no qual foram analisadas as medicações prescritas em 141 prontuários para pacientes acima de 50 anos, em associação com testes que quantificaram a capacidade funcional e cognitiva deles. Resultados: Observou-se média de 4,41 medicamentos por paciente, sendo que 0,41 deles foram considerados inapropriado, segundo o critério de Beers. Verificou-se também relação estatisticamente significativa quanto ao número de medicações e testes que mediam a capacidade funcional e cognitiva dos idosos. Conclusão: O aumento da polifarmácia e da prescrição de medicações potencialmente inadequadas acarretou significativa piora da capacidade cognitiva e funcional do idoso

Objective: To evaluate the prevalence of polypharmacy and of the prescription of inappropriate medications, as well as their associations with the cognitive and functional capacity of the elderly. Methods: Cross-sectional observational study which analyzed the drugs prescribed in 141 medical records for patients over 50 years of age, associated with tests that quantified their functional and cognitive capacity. Results: An average of 4.41 medications per patient was observed, and 0.41 were considered inappropriate according to the Beers criteria. There was also a statistically significant relation regarding the number of medications and tests that measure the functional and cognitive capacity of the elderly. Conclusion: The increase in polypharmacy and in the prescription of potentially inappropriate medications led to a significant impairment of the cognitive and functional capacity of the elderly

Prescripción de fármacos bloqueadores del sistema renina angiotensina en pacientes con enfermedad renal crónica etapa 3 en atención primaria de salud / Prescription of renin-angiotensin-aldosterone system blockers in patients with stage 3 chronic kidney disease

Background: To reduce the progression of chronic kidney disease (CKD) and cardiovascular risk, the guidelines recommend the blockade of the renin-angiotensin-aldosterone system (RAAS) in patients with proteinuria. Aim: To assess the frequency of enalapril or losartan use in diabetics or hypertensive patients with stage 3 CKD. Material and Methods: Review of clinical records of patients with CKD in an urban primary care clinic. Results: We identified 408 subjects aged 40 to 98 years (66% women) with stage 3 CKD. Sixty six percent had only hypertension and 34% were diabetic with or without hypertension. Seventy four percent received RAAS blockers (52% used enalapril, 45% losartan and 2% both medications). RAAS blockers were used in 70% of hypertensive and 78% of diabetic patients. The prescription in hypertensive diabetics with microalbuminuria was lower than in those without microalbuminuria (72% vs 87%, p < 0.05), but the opposite occurred in pure hypertensive patients with and without microalbuminuria (88% vs 69%, p < 0.05). There were no significant differences in blood pressure levels, microalbuminuria or serum potassium levels between RAAS blocker users and non-users. No differences were observed either between enalapril and losartan users. Conclusions: The adherence to clinical guidelines is insufficient and users of the recommended drugs did not achieve the expected goals.

Fracturas costales simétricas asociadas a tos / Symmetrical rib fractures associated with chronic cough: report of one case

Cough may be associated with complications such as syncope, urinary incontinence, pneumothorax, and less frequently, pulmonary hernia and costal fractures. Chronic cough is a cause of rib fractures and when they occur it is likely to affect more than one rib. We report a 53 year-old obese male in treatment with enalapril 10 mg for hypertension with a dry cough lasting five months. He consulted for bilateral chest pain and a Chest X ray examination showed symmetrical fractures in the seventh left and right ribs. Enalapril was discontinued, cough and pain subsided in two weeks.

Acción del enalapril sobre la enfermedad renal secuela de síndrome urémico hemolítico / Activity of enalapril in the sequelae of renal disease of hemolitic-uremic syndrome

Los inhibidores de la enzima de conversión (ACE) disminuyen la proteinuria en pacientes con diversas enfermedades renales. La proteinuria es indicador de lesion renal y su persistencia acelera el daño renal progresivo. Evaluamos el efecto del enalapril en 25 niños con proteinuria persistente secuela de Síndrome Urémico Hemolítico (SUH) con fallo renal prolongado en la etapa aguda. Los pacientes fueron seguidos durante x=25.9 meses con aporte controlado en proteinas según RDA. Dada la persistencia de la proteinuria se indicó enalapril con iguales prescripciones dietéticas. La dosis utilizada fue de x=0.18 mg/k/día, durante un período de observación de x=26.84 meses. La proteinuria disminuyó de 63.55 +- 11.05 mg/m2/hora á 9.79 +- 2.06 mg/m2/hora (x+-ESM) p< 0.001. El Clearance de creatinina fue de 80 +- 6.3 ml/min/1.73 m2 pre-enalapril y de 87.9 +- 5.8 ml/min/1.73 m2 al finalizar el período de observación (p no significativa). Todos los pacientes disminuyeron la proteinuria, cada paciente entre el 28-100 por ciento, x=79.93 por ciento (p<0.001). Conclusión: los inhibidores de la ACE son eficaces para el control de la proteinuria del SUH no produciendo cambios en la función renal medida por Clearances de creatinina ni otros efectos colaterales.