RESUMEN

CASES DESCRIPTION: We report two cases of drug rash with eosinophilia and systemic symptoms (DRESS) associated with the use of carbamazepine and phenytoin in Brazilian boys tested for human leukocyte antigen (HLA) class I and II alleles. The clinical manifestations were similar: a maculopapular eruption progressing to exfoliative erythroderma, fever, and lymphadenopathy. Leukocytosis, atypical lymphocytes, and liver injury were also observed. Assessment of causality using the Naranjo algorithm established a "probable" relationship (score 6) in both cases. Case 1 patient presented the following results of HLA typing: HLA-A*02,29 B*44,50 C*06,16 DRB1*01,07 DQA1*01,02. Case 2 patient presented the following results of HLA typing: HLAA*23,24 B*39,53 C*04,07 DRB1*04,08 DQA1*03,05 DQB1*03,03. CONCLUSION: Neither of the cases reported here presented HLA typing similar to that strongly associated with the occurrence of DRESS in Asian or European patients.

Asunto(s)

Anticonvulsivantes/efectos adversos , Carbamazepina/efectos adversos , Erupciones por Medicamentos/etiología , Fenitoína/efectos adversos , Alelos , Anticonvulsivantes/uso terapéutico , Brasil , Carbamazepina/uso terapéutico , Niño , Erupciones por Medicamentos/inmunología , Eosinofilia/inducido químicamente , Eosinofilia/inmunología , Epilepsia/tratamiento farmacológico , Antígenos de Histocompatibilidad Clase I/inmunología , Antígenos de Histocompatibilidad Clase II/inmunología , Prueba de Histocompatibilidad , Humanos , Masculino , Fenitoína/uso terapéutico

RESUMEN

PURPOSE: Although the prevalence of drug-drug interactions (DDIs) in elderly outpatients is high, many potential DDIs do not have any actual clinical effect, and data on the occurrence of DDI-related adverse drug reactions (ADRs) in elderly outpatients are scarce. This study aimed to determine the incidence and characteristics of DDI-related ADRs among elderly outpatients as well as the factors associated with these reactions. METHODS: A prospective cohort study was conducted between 1 November 2010 and 31 November 2011 in the primary public health system of the Ourinhos micro-region, Brazil. Patients aged ≥60 years with at least one potential DDI were eligible for inclusion. Causality, severity, and preventability of the DDI-related ADRs were assessed independently by four clinicians using validated methods; data were analysed using descriptive analysis and multiple logistic regression. RESULTS: A total of 433 patients completed the study. The incidence of DDI-related ADRs was 6 % (n = 30). Warfarin was the most commonly involved drug (37 % cases), followed by acetylsalicylic acid (17 %), digoxin (17 %), and spironolactone (17 %). Gastrointestinal bleeding occurred in 37 % of the DDI-related ADR cases, followed by hyperkalemia (17 %) and myopathy (13 %). The multiple logistic regression showed that age ≥80 years [odds ratio (OR) 4.4; 95 % confidence interval (CI) 3.0-6.1, p < 0.01], a Charlson comorbidity index ≥4 (OR 1.3; 95 % CI 1.1-1.8, p < 0.01), consumption of five or more drugs (OR 2.7; 95 % CI 1.9-3.1, p < 0.01), and the use of warfarin (OR 1.7; 95 % CI1.1-1.9, p < 0.01) were associated with the occurrence of DDI-related ADRs. With regard to severity, approximately 37 % of the DDI-related ADRs detected in our cohort necessitated hospital admission. All DDI-related ADRs could have been avoided (87 % were ameliorable and 13 % were preventable). The incidence of ADRs not related to DDIs was 10 % (n = 44). CONCLUSIONS: The incidence of DDI-related ADRs in elderly outpatients is high; most events presented important clinical consequences and were preventable or ameliorable.

Asunto(s)

Atención Ambulatoria/estadística & datos numéricos , Interacciones Farmacológicas , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Anciano , Brasil/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos

RESUMEN

PURPOSE: The primary objective of this study was to investigate the incidence of drug-drug interactions (DDIs) related to adverse drug reactions (ADRs) in elderly outpatients who attended public primary healthcare units in a southeastern region of Brazil. The secondary objective was to investigate the possible predictors of DDI-related ADRs. METHODS: A prospective cohort study was conducted between November 1, 2010, and November 31, 2011, in the primary public healthcare system in the Ourinhos micro-region in Brazil. Patients who were at least 60 years old, with at least one potential DDI, were eligible for inclusion in the study. Eligible patients were assessed by clinical pharmacists for DDI-related ADRs for 4 months. The causality of DDI-related ADRs was assessed independently by four clinicians using three decisional algorithms. The incidence of DDI-related ADRs during the study period was calculated. Logistic regression analysis was used to study DDI-related ADR predictors. RESULTS: A total of 433 patients completed the study. The incidence of DDI-related ADRs was 6.5%. A multivariate analysis indicated that the adjusted odds ratios (ORs) rose from 0.91 (95% confidence interval [CI] = 0.75-1.12, p = 0.06) in patients aged 65-69 years to 4.40 (95% CI = 3.00-6.12, p < 0.01) in patients aged 80 years or older. Patients who presented two to three diagnosed diseases presented lower adjusted ORs (OR = 0.93 [95% CI = 0.68-1.18, p = 0.08]) than patients who presented six or more diseases (OR = 1.12 [95% CI = 1.02-2.01, p < 0.01]). Elderly patients who took five or more drugs had a significantly higher risk of DDI-related ADRs (OR = 2.72 [95% CI = 1.92-3.12, p < 0.01]) than patients who took three to four drugs (OR = 0.93 [95% CI = 0.74-1.11, p = 0.06]). No significant difference was found with regard to sex (OR = 1.08 [95% CI 0.48-2.02, p = 0.44]). CONCLUSION: The incidence of DDI-related ADRs in elderly outpatients was significant, and most of the events presented important clinical consequences. Because clinicians still have difficulty managing this problem, highlighting the factors that increase the risk of DDI-related ADRs is essential. Polypharmacy was found to be a significant predictor of DDI-related ADRs in our sample.

Asunto(s)

Interacciones Farmacológicas , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Pacientes Ambulatorios/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Brasil , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Médicos de Atención Primaria , Polifarmacia , Estudios Prospectivos

RESUMEN

PURPOSE: The primary objective of this study was to investigate the prevalence of clinically important potential drug-drug interactions (DDIs) in elderly patients attending the public primary health care system in Brazil. The secondary objective was to investigate possible predictors of potential DDIs. METHODS: A cross-sectional study was carried out in 5 Brazilian cities located in the Ourinhos Micro-region, Sao Paulo State, between November 2010 and April 2011. The selected sample was divided according to the presence (exposed) or absence (unexposed) of one or more potential DDIs (defined as the presence of a minimum 5-day overlap in supply of an interacting drug pair). Data were collected from medical prescriptions and patients' medical records. Potential DDIs (rated major or moderate) were identified using 4 DDI-checker programs. Logistic regression analysis was used to study potential DDI predictors. RESULTS: The prevalence of clinically important potential DDIs found during the study period was 47.4%. Female sex (OR = 2.49 [95% CI 2.29-2.75]), diagnosis of ≥ 3 diseases (OR = 6.43 [95% CI 3.25-12.44]), and diagnosis of hypertension (OR = 1.68 [95% CI 1.23-2.41]) were associated with potential DDIs. The adjusted OR increased from 0.90 [95% CI 0.82-1.03] in patients aged 60 - 64 years to 4.03 [95% CI 3.79 - 4.28] in those aged 75 years or older. Drug therapy regimens involving ≥ 2 prescribers (OR = 1.39 [95% CI 1.17-1.67]), ≥ 3 drugs (OR = 3.21 [95% CI 2.78-3.59]), ≥ 2 ATC codes (OR = 1.19 [95% CI 1.12-1.29]), ≥ 2 drugs acting on cytochrome P450 (OR = 2.24 [95% CI 2.07-2.46]), and ATC codes B (OR = 1.89 [95% CI 1.05-2.08]) and C (OR = 4.01 [95% CI 3.55-4.57]) were associated with potential DDIs. CONCLUSION: Special care should be taken with the prescription and therapeutic follow-up of patients who present characteristics identified as predictors. Knowledge of potential DDI predictors could aid in developing preventive practices and policies that allow public health services to better manage this situation.

Asunto(s)

Interacciones Farmacológicas , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Anciano , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Médicos de Atención Primaria

RESUMEN

PURPOSE: To examine the effect of a pharmaceutical care program on the coronary heart disease risk in elderly diabetic and hypertensive patients. METHODS: A total of 200 elderly (> 60 years) diabetic and/or hypertensive patients were recruited into a randomized, controlled, prospective clinical trial with a 36-month follow-up, developed in a public primary health care unit in a municipality in the Brazilian State of Sao Paulo. A range of clinical measurements were evaluated at the baseline and up to 36 months afterwards. The intervention group patients received pharmaceutical care from a clinical pharmacist, whereas the control group patients received their usual care from the medical and nursing staff. The Framingham scoring method was used to estimate changes in the 10-year coronary heart disease risk scores of all the patients. RESULTS: A total of 194 patients completed the study. Significant reductions (p < 0.05) in the mean values (baseline vs. 36 months) for the systolic blood pressure [156.7 mmHg vs 133.7 mmHg; P < 0.001), diastolic blood pressure (106.6 mmHg vs. 91.6 mmHg; P < 0.001),fasting glucose (135.1 mg/dL vs. 107.9 mg/dL; P < 0.001), hemoglobin A1C (7.7% vs. 7.0%; P <0.001), triglycerides (206.0 mg/dL vs. 152.5 mg/dL; P < 0.001), low-density lipoprotein (LDL)cholesterol (112.4 mg/dL vs. 102.0 mg/dL; P < 0.001), high-density lipoprotein cholesterol (55.5 mg/dL vs. 65.5 mg/dL; P < 0.001), total cholesterol (202.5 mg/dL vs. 185.9 mg/dL; P < 0.001), body mass index (26.2 kg/m2 vs. 26.1 kg/m2; P < 0.001), and abdominal circumference (103.2 cm vs. 102.5 cm; P= 0.001) were observed in the intervention group, whereas no significant changes were verified in the control group. The mean Framingham risk prediction score in the intervention group was 6.8% at baseline and decreased to 4.5%; P < 0.001) after 36 months, but remained unchanged in the control group. CONCLUSION: The pharmaceutical care program resulted in better clinical measurements and reduced the cardiovascular risk scores in elderly diabetic and hypertensive patients over a 36-month period.

Asunto(s)

Enfermedad Coronaria/prevención & control , Diabetes Mellitus/tratamiento farmacológico , Cardiomiopatías Diabéticas/prevención & control , Hipertensión/tratamiento farmacológico , Servicios Farmacéuticos/organización & administración , Anciano , Glucemia/efectos de los fármacos , Presión Sanguínea/efectos de los fármacos , Índice de Masa Corporal , Brasil/epidemiología , Colesterol/sangre , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/etiología , Cardiomiopatías Diabéticas/epidemiología , Determinación de Punto Final/métodos , Femenino , Hemoglobina Glucada/metabolismo , Humanos , Hipertensión/complicaciones , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Grupo de Atención al Paciente/organización & administración , Educación del Paciente como Asunto/métodos , Atención Primaria de Salud/métodos , Riesgo , Medición de Riesgo/métodos , Factores de Riesgo , Resultado del Tratamiento , Triglicéridos/sangre , Circunferencia de la Cintura/efectos de los fármacos

RESUMEN

O paciente sob tratamento oncológico, ao receber atenção do Cirurgião-Dentista (CD), necessita de cuidados especiais, assim, seria relevante que o profissional conhecesse as reações adversas do tratamento radioterápico na boca e nas regiões circunvizinhas, atuando na tentativa de amenizar o desconforto e melhorar a condição de vida do seu paciente. Considerando que a radioterapia de cabeça e pescoço pode trazer seqüelas extensas e, algumas vezes, permanentes, em especial nas glândulas salivares e no tecido ósseo, nosso objetivo é revisar tais efeitos e respectivos tratamentos, propostos na literatura. Ficou evidente após este estudo a significante importância do Cirurgião-Dentista no manejo adequado do paciente submetido à radiação de cabeça e pescoço.

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The patient undergoing oncology treatment needs special care when assisted by the dental surgeon. Therefore, it would be quite relevant that the clinician were aware of the adverse reactions of radiotherapy on the mouth and surrounding regions, in order to attempt to minimize discomfort and improve the patient’s life condition. Considering that head and neck radiotherapy can cause extensive sequelae – sometimes permanent ones – particularly on the salivary glands and bone tissue, our aim is to revise these effects and their respective treatments, as proposed in literature. After this study, the significant importance of the dental surgeon became evident for the adequate management of the patient subjected to radiation treatment on the head and neck.

Asunto(s)

Enfermedades de la Boca/complicaciones , Enfermedades de la Boca , Efectos de la Radiación , Radioterapia/efectos adversos , Ageusia , Mucositis , Osteorradionecrosis , Enfermedades Periodontales , Trismo , Xerostomía

RESUMEN

As neoplasias são a segunda causa de morte por doença no mundo, e cerca de 70 por cento dos pacientes doentes receberão quimioterapia antineoplásica no decorrer do tratamento. Dependendo do tipo, da dosagem e da freqüência de utilização dos agentes quimioterápicos, severas complicações bucais podem surgir. Na literatura, cerca de 40 por cento dos pacientes oncológicos submetidos ao tratamento quimioterápico apresentam complicações bucais, decorrentes de estomatotoxicidade direta ou indireta. Nesta revisão, relacionamos as alterações bucais mais freqüentes que podem ocorrer neste período de tratamento, enfocando a importância da atuação do dentista na equipe multidisciplinar oncológica, para melhorar a qualidade de vida pré e pós-tratamento

Asunto(s)

Humanos , Antineoplásicos , Antineoplásicos/efectos adversos , Quimioterapia , Boca