Factors Associated with Mortality among Elderly People in the COVID-19 Pandemic (SARS-CoV-2): A Systematic Review and Meta-Analysis.

The objective of this meta-analysis was to evaluate the factors associated with the mortality of elderly Italians diagnosed with coronavirus who resided in institutions or who were hospitalized because of the disease. METHODS: A systematic review following the recommendations of The Joanna Briggs Institute (JBI) was carried out, utilizing the PEO strategy, i.e., Population, Exposure and Outcome. In this case, the population was the elderly aged over 65 years old, the exposure referred to the SARS-CoV-2 pandemic and the outcome was mortality. The National Center for Biotechnology Information (NCBI/PubMed), Latin American and Caribbean Literature in Health Sciences (LILACS), Excerpta Medica Database (EMBASE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were used until 31 July 2020. RESULTS: Five Italian studies were included in this meta-analysis, with the number of elderly people included varying between 18 and 1591 patients. The main morbidities presented by the elderly in the studies were dementia, diabetes, chronic kidney disease and hypertension. CONCLUSIONS: The factors associated with the mortality of elderly Italian people diagnosed with SARS-CoV-2 who lived in institutions or who were hospitalized because of the disease were evaluated. It was found that dementia, diabetes, chronic kidney disease and hypertension were the main diagnosed diseases for mortality in elderly people with COVID-19.

Cyclophosphamide administration routine in autoimmune rheumatic diseases: a review.

Cyclophosphamide is an alkylating agent widely used for the treatment of malignant neoplasia and which can be used in the treatment of multiple rheumatic diseases. Medication administration errors may lead to its reduced efficacy or increased drug toxicity. Many errors occur in the administration of injectable drugs. The present study aimed at structuring a routine for cyclophosphamide use, as well as creating a document with pharmacotherapeutic guidelines for the patient. The routine is schematized in three phases: pre-chemotherapy, administration of cyclophosphamide, and post-chemotherapy, taking into account the drugs to be administered before and after cyclophosphamide in order to prevent adverse effects, including nausea and hemorrhagic cystitis. Adverse reactions can alter laboratory tests; thus, this routine included clinical management for changes in white blood cells, platelets, neutrophils, and sodium, including cyclophosphamide dose adjustment in the case of kidney disease. Cyclophosphamide is responsible for other rare - but serious - side effects, for instance, hepatotoxicity, severe hyponatremia and heart failure. Other adverse reactions include hair loss, amenorrhea and menopause. In this routine, we also entered guidelines to post-chemotherapy patients. The compatibility of injectable drugs with the vehicle used has been described, as well as stability and infusion times. The routine aimed at the rational use of cyclophosphamide, with prevention of adverse events and relapse episodes, factors that may burden the health care system.

Prevalência do uso de medicamentos potencialmente inapropriados ao idoso no Brasil: uma revisão sistemática / Prevalencia del uso de medicamentos potencialmente inapropiados para los ancianos en Brasil: una revisión sistemática / Prevalence use of potentially inappropriate drugs for elderly in Brazil: a sistematic review

O envelhecimento está relacionado, via de regra, ao uso de medicamentos. Esta é uma revisão sistemática sobre as prevalências de uso de medicamento potencialmente perigosos em idosos, em estudos brasileiros, utilizando-se o Critério de Beers. A prevalência variou entre 17 e 98,2% em amostras domiciliares, ambulatoriais, hospitalares e em instituições de longa permanência. Dados que demonstram a necessidade de políticas de enfrentamento aos riscos inerentes ao uso de medicamento pelo paciente idoso no Brasil.

The aging is related with use of drugs. This research is a systematic review about use of potentially inappropriate drugs for elderly evaluated by Beers Criteria. The prevalence's range was 17 to 98,2% on home, ambulatory, hospital or nursing home samples. These data demonstrate that governmental politics are necessary to face the risks of drugs using by elderly in Brazil.

El envejecimiento generalmente está relacionado con el uso de medicamentos. Esta es una revisión sistemática de la prevalencia del uso de drogas potencialmente peligrosas en los ancianos, en estudios brasileños, utilizando el Criterio de Beers. La prevalencia varió entre 17 y 98.2% en muestras de atención domiciliaria, ambulatoria, hospitalaria y de atención a largo plazo. Datos que demuestran la necesidad de políticas para enfrentar los riesgos inherentes al uso de medicamentos por parte de pacientes de edad avanzada en Brasil.

Cyclophosphamide administration routine in autoimmune rheumatic diseases: a review / Rotina de administração de ciclofosfamida em doenças autoimunes reumáticas: uma revisão

Abstract Cyclophosphamide is an alkylating agent widely used for the treatment of malignant neoplasia and which can be used in the treatment of multiple rheumatic diseases. Medication administration errors may lead to its reduced efficacy or increased drug toxicity. Many errors occur in the administration of injectable drugs. The present study aimed at structuring a routine for cyclophosphamide use, as well as creating a document with pharmacotherapeutic guidelines for the patient. The routine is schematized in three phases: pre-chemotherapy, administration of cyclophosphamide, and post-chemotherapy, taking into account the drugs to be administered before and after cyclophosphamide in order to prevent adverse effects, including nausea and hemorrhagic cystitis. Adverse reactions can alter laboratory tests; thus, this routine included clinical management for changes in white blood cells, platelets, neutrophils, and sodium, including cyclophosphamide dose adjustment in the case of kidney disease. Cyclophosphamide is responsible for other rare - but serious - side effects, for instance, hepatotoxicity, severe hyponatremia and heart failure. Other adverse reactions include hair loss, amenorrhea and menopause. In this routine, we also entered guidelines to post-chemotherapy patients. The compatibility of injectable drugs with the vehicle used has been described, as well as stability and infusion times. The routine aimed at the rational use of cyclophosphamide, with prevention of adverse events and relapse episodes, factors that may burden the health care system.

Resumo A ciclofosfamida (CFM) é um agente alquilante vastamente usado para o tratamento de neoplasias malignas e pode ser usado no tratamento de diversas doenças reumatológicas. O erro de administração de medicamentos pode levar à diminuição da eficácia ou ao aumento da toxicidade medicamentosa. Diversos erros ocorrem na administração de medicamentos injetáveis. O trabalho objetivou a estruturação de uma rotina do uso de ciclofosfamida, bem como a criação de um documento de orientações farmacoterapêuticas para o paciente. A rotina foi esquematizada em três fases, a pré-quimioterapia (pré-QT), a administração da ciclofosfamida e a pós-quimioterapia (pós-QT), que levaram em consideração os medicamentos que devem ser administrados antes e depois da ciclofosfamida para prevenção aos efeitos adversos, incluindo náusea e cistite hemorrágica. As reações adversas podem alterar os exames laboratoriais e a rotina incluiu manejo clínico para alteração clínica dos leucócitos, das plaquetas, dos neutrófilos e do sódio incluindo o ajuste de dose de ciclofosfamida em caso de insuficiência renal. A ciclofosfamida é responsável por outras reações adversas raras, mas sérias, como hepatotoxicidade, hiponatremia severa e falência cardíaca. Outras reações adversas incluem perda de cabelo, amenorreia e menopausa. A rotina foi composta também por orientações ao paciente pós-QT. A compatibilidade dos medicamentos injetáveis com o veículo foi descrita, bem como o tempo de estabilidade e o tempo de infusão. A rotina visou ao uso racional da ciclofosfamida e prevenir os efeitos adversos e os episódios de recidiva, os quais podem onerar o sistema de saúde.