RESUMO
The prevalence of schistosomiasis and strongyloidiasis among Brazilian immigrants in the United States is unknown. We performed a retrospective chart review of serologic screening of asymptomatic Brazilian immigrants during routine physicals. Of 208 eligible patients, 189 were screened: 27.7% (n = 52) had elevated Schistosoma antibodies and 5.8% (n = 11) had elevated Strongyloides stercoralis antibodies.
RESUMO
The US Food and Drug Administration (FDA) has recently warned consumers about the risks of weight loss supplements adulterated with multiple pharmaceutical agents. Some of these supplements combine potent anorectics, such as amphetamines derivatives, with benzodiazepines, beta-blockers, and other medications to suppress the anorectics' adverse effects. These weight loss supplements represent the most recent generation of rainbow diet pills, named for their bright and varied colors, which date back more than 70 years. Beginning in the 1940s, several US pharmaceutical firms aggressively promoted rainbow pills to physicians and patients. By the 1960s the pills had caused dozens of deaths before the FDA began removing them from the US market. We used a variety of original resources to trace these deadly pills from their origins in the United States to their popularity in Spain and Brazil to their reintroduction to the United States as weight loss dietary supplements.
Assuntos
Anfetaminas/efeitos adversos , Fármacos Antiobesidade/efeitos adversos , Depressores do Apetite/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Contaminação de Medicamentos , Redução de Peso , Anfetaminas/química , Anfetaminas/história , Fármacos Antiobesidade/química , Fármacos Antiobesidade/história , Depressores do Apetite/química , Depressores do Apetite/história , Brasil , Suplementos Nutricionais/história , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Espanha , Estados UnidosRESUMO
BACKGROUND: Pai You Guo is a weight loss supplement manufactured in China and adulterated with the banned pharmaceutical products sibutramine and phenolphthalein. The US Food and Drug Administration (FDA) announced a voluntary recall of Pai You Guo in 2009, yet clinicians have noted its continued use among Brazilian-born women in Massachusetts. OBJECTIVE: To assess prevalence of Pai You Guo use, associated side effects, modes of acquisition, and impact of FDA regulatory action on these outcomes. DESIGN: Cross-sectional study using an anonymous questionnaire. PARTICIPANTS: Women ≤60 years of age, born in Brazil who attended one primary care clinic or one of six churches in Massachusetts. MAIN MEASURES: Prevalence of use, how users first heard about the product, location of purchase, associated side effects, patterns of use before and after the FDA recall. KEY RESULTS: Twenty-three percent (130/565) of respondents reported using Pai You Guo. In multivariate analysis, obesity (adj OR 3.7, p-value <0.001) and lack of insurance (adj OR 2.6, p-value 0.005) were associated with use. The majority of users (85%) reported at least one side effect. Dry mouth (59%), anxiety (29%), and insomnia (26%) were most commonly reported adverse effects. Nearly thirty-percent of users (38/130) purchased Pai You Guo from local stores and 9% (11/130) purchased it over the Internet. The majority of respondents (79/130; 61%) purchased Pai You Guo after the FDA recall. No respondent was aware of the FDA recall. CONCLUSIONS: Use of this pharmaceutically adulterated supplement is common among Brazilian-born women in Massachusetts. The FDA alerts and recall did not appear to decrease its use.
Assuntos
Fármacos Antiobesidade/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Contaminação de Medicamentos , Emigrantes e Imigrantes , Adolescente , Adulto , Fármacos Antiobesidade/química , Brasil/etnologia , Criança , China , Estudos Transversais , Ciclobutanos/efeitos adversos , Ciclobutanos/química , Recall de Medicamento/legislação & jurisprudência , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/tratamento farmacológico , Obesidade/etnologia , Fenolftaleína/efeitos adversos , Fenolftaleína/química , Estados Unidos/etnologia , Adulto JovemAssuntos
Anfetaminas/efeitos adversos , Clordiazepóxido/efeitos adversos , Fluoxetina/efeitos adversos , Automedicação/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adulto , Anfetaminas/administração & dosagem , Benzodiazepinas/administração & dosagem , Benzodiazepinas/efeitos adversos , Clordiazepóxido/administração & dosagem , Combinação de Medicamentos , Feminino , Fluoxetina/administração & dosagem , Humanos , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversosRESUMO
In Brazil, compounded diet pills that combine amphetamines, benzodiazepines, antidepressants, diuretics and laxatives are often prescribed. In 2006, the Food and Drug Administration banned their sale in the United States (US) citing substantial safety concerns. This study evaluates the prevalence of, and factors associated with, use of these pills among Brazilian immigrant women aged 18-50. Pill use was assessed at one clinic and two churches using an anonymous survey (n = 307). While living in the US, 18% of clinic respondents and 9% of church respondents reported using these diet pills. Nearly two thirds of pill users reported adverse effects. In multivariate logistic regression analysis, being unmarried, college educated, dissatisfied with current weight, and advised by a US physician to lose weight were associated with greater odds of imported diet pill use. To enhance care of Brazilian immigrants, US physicians should become familiar with the health consequences of imported diet pills from Brazil.
Assuntos
Depressores do Apetite/administração & dosagem , Atitude Frente a Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Obesidade/etnologia , Medicamentos sob Prescrição/administração & dosagem , Adulto , Depressores do Apetite/efeitos adversos , Brasil/etnologia , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/tratamento farmacológico , Educação de Pacientes como Assunto , Medicamentos sob Prescrição/efeitos adversos , Inquéritos e Questionários , Estados Unidos/epidemiologia , Saúde da Mulher/etnologia , Adulto JovemRESUMO
Banned amphetamine-based anorectics are illicitly imported into the United States (US), but little is known regarding the harm these diet pills pose to US residents. A 26-year-old woman using imported diet pills presented with a two-year history of intermittent chest pains, palpitations, headaches and insomnia. Urine toxicology screen detected amphetamines and benzodiazepines. Fenproporex and chlordiazepoxide were detected in her pills. Her symptoms resolved after she stopped using diet pills. A 38-year-old man using imported diet pills presented after his occupational urine screen was significantly positive for amphetamine. Fenproporex and fluoxetine were detected in his pills. These cases illustrate the potential harm from imported prescription diet pills that combine fenproporex with benzodiazepines, antidepressants, diuretics, laxatives and other substances. Increasing physicians' awareness of imported diet pill use may improve care of patients suffering from the pills' many adverse effects.