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Clinical oncology has shown outstanding progress improving patient survival due to the incorporation of new drugs. However, treatment success may be reduced by the emergency of dose-limiting side effects, such as intestinal mucositis and diarrhea. Mucositis and diarrhea management is symptomatic, and there is no preventive therapy. Bacterial and fungal-based compounds have been suggested as an alternative for preventing the development of diarrhea in cancer patients. Using probiotics is safe and effective in immunocompetent individuals, but concerns remain during immunosuppressive conditions. Paraprobiotics, formulations composed of non-viable microorganisms, have been proposed to overcome such limitation. The present literature review discusses current evidence regarding the possible use of paraprobiotics as an alternative to probiotics to prevent gastrointestinal toxicity of cancer chemotherapy.

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Clinical oncology has shown outstanding progress improving patient survival due to the incorporation of new drugs. However, treatment success may be reduced by the emergency of dose-limiting side effects, such as intestinal mucositis and diarrhea. Mucositis and diarrhea management is symptomatic, and there is no preventive therapy. Bacterial and fungal-based compounds have been suggested as an alternative for preventing the development of diarrhea in cancer patients. Using probiotics is safe and effective in immunocompetent individuals, but concerns remain during immunosuppressive conditions. Paraprobiotics, formulations composed of non-viable microorganisms, have been proposed to overcome such limitation. The present literature review discusses current evidence regarding the possible use of paraprobiotics as an alternative to probiotics to prevent gastrointestinal toxicity of cancer chemotherapy.

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Babaçu (A. speciosa), Buriti (M. flexuosa), and Macaúba (A. aculeata) are palm trees typical of the ecotone area between Cerrado and the Amazon rainforest. The purpose of this study was to evaluate the antimicrobial potential of the extracts prepared from the leaves of those palms as well as determine their chemical compositions. The ethanol extracts were prepared in a Soxhlet apparatus and tested by disk diffusion and agar dilution technique against Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Candida albicans, and Candida parapsilosis. However, there was no significant activity at concentrations of 25, 50, and 100 mg·Ml(-1). Moreover, the phytochemical analysis revealed the presence of tannins, flavonoids, catechins, steroids, triterpenes, and saponins. Gas chromatography (GC/MS) analysis also identified organic acids, such as capric (decanoic) acid, lauric (dodecanoic) acid, myristic (tetradecanoic) acid, phthalic (1,2-benzenedicarboxylic) acid, palmitic (hexadecanoic) acid, stearic (octadecanoic) acid, linoleic (9,12-octadecadienoic) acid (omega-6), linolenic (octadecatrienoic) acid (omega-3), and the terpenes citronellol and phytol. Based on the chemical composition in the palm leaf extracts, the palms have the potential to be useful in the food, cosmetic, and pharmaceutical industries.

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OBJETIVO: Analisar os conceitos básicos da FarE e sua possível utilização em drogarias de bairro para o incremento financeiro e competitividade destes estabelecimentos. MATERIAIS E MÉTODOS: Trata-se de um estudo teórico dos conceitos básicos da FarE, e análise desta ferramenta para utilização em drogarias de bairro. O levantamento bibliográfico foi realizado através das bases de dados: Scielo, Lilacs, Ibecs, Medline e Google Acadêmico, com os descritores "farmacoeconomia", "economia da saúde" e "farmacoeconomia e drogarias", nos vernáculos inglês e português. Foram incluídos trabalhos sobre análise dos conceitos básicos e formas de análise, e trabalhos experimentais realizados no Brasil que utilizaram a FarE. RESULTADOS E DISCUSSÃO: A comercialização de medicamentos em drogarias alcançam cifras na ordem de bilhões, porém é observada a crescente abertura e interiorização de grandes redes, o que dificulta o mercado para as drogarias conhecidas como "drogarias de bairro". Como estes estabelecimentos geralmente dispõem de baixo capital e estoques, as análises de FarE podem orientar a compra de produtos mais eficazes, menos onerosos e permitem a redução do estoque, a fim de evitar a retenção de grande capital em produtos que não teriam fácil comercialização. Isto possibilitaria ainda uma melhor orientação aos pacientes, o que resulta provavelmente em uma maior fidelização dos mesmos. CONCLUSÃO: Pode-se concluir com este estudo através da análise dos conceitos básicos da FarE que esta ferramenta pode ser utilizada pelas drogarias de bairro para organização tanto financeira da compra e venda de produtos como a uma melhor assistência farmacêutica e fidelização de clientes

OBJECTIVE: to analyze the basic concepts of pharmacoeconomy (PharmE) and its possible use in neighborhood drugstores as a way of enhancing these establishments financially and competitively. MATERIAL AND METHODS: This is a theoretical study on the basic concepts of PharmE and its use in neighborhood drugstores. Literature searches were performed on the databases: SciELO, Lilacs, IBECS, Medline and Google Scholar, using the keywords "pharmacoeconomics", "health economics" and "pharmacoeconomics and drugstores", in English and Portuguese. We included studies addressing basic definitions and analysis tools as well as experimental work carried out in Brazil using PharmE. RESULTS AND DISCUSSION: the sale of medicines in drugstores accounts for billions. There has been an increasing establishment and internalization of big pharmacy chains, which makes difficult the market for drugstores known as "neighborhood drugstores". As these establishments generally have low capital and stock, analysis of PharmE can guide the purchase of more effective, less costly products. In addition, PharmE could drive the reduction of stocks in order to avoid large capital retention in products that would not have rapid commercialization. This would provide an even better orientation for patients, which probably results in increased loyalty. CONCLUSION: PharmE can be used by neighborhood drugstores for financial organization ­ purchase and sale of products ­ as well as for a better pharmaceutical care and customer loyalty

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In this study, Annona coriacea Mart., Annonaceae, was examined for possible toxic effects on brain, liver and kidney of mice exposed to crude extract of the seeds (CESAN) of this plant. CESAN was administered by gavage for four days at doses of 12.5, 25, 50, and 100 mg/kg/day. Significant changes on liver were observed, which showed reduction in the number of hepatocytes per area and increase the apoptotic index in the exposed groups, and changes in the cytoplasm and nucleus of these cells and reduced consumption of water and feed in these animals. For the other studied areas, brain and kidneys showed no changes in the parameters used in this study. The results suggest hepatotoxic effects of CESAN, but without damage to brain and kidneys in this experiment, showing a toxic potential to this species, as to the Annonaceae family.

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Sulfated polysaccharides from 11 species of tropical marine algae (one edible specie of Rhodophyta, six species of Phaeophyta and four species of Chlorophyta) collected from Natal city coast (Northeast of Brazil) were evaluated for their anticoagulant, antioxidant and antiproliverative in vitro activities. In the activated partial thromboplastin time (APTT) test, which evaluates the intrinsic coagulation pathway, seven seaweeds presented anticoagulant activity. Dictyota cervicornis showed the highest activity, prolonging the coagulation time to double the baseline value in the APTT with only 0.01 mg/100 microl of plasma, 1.4-fold lesser than Clexane, a low molecular weight heparin. In the protrombin time (PT) test, which evaluates the extrinsic coagulation pathway, only Caulerpa cupresoides showed anticoagulant activity. All species collected showed antioxidant activities. This screening emphasized the great antioxidant potential (total capacity antioxidant, power reducing and ferrous chelating) of four species: C. sertularioide; Dictyota cervicornis; Sargassum filipendula and Dictyopteris delicatula. After 72 h incubation, HeLa cell proliferation was inhibited (p<0.05) between 33.0 and 67.5% by S. filipendula; 31.4 and 65.7% by D. delicatula; 36.3 and 58.4% by Caulerpa prolifera and 40.2 and 61.0% by Dictyota menstrualis at 0.01-2mg/mL algal polysaccharides. The antiproliferative efficacy of these algal polysaccharides were positively correlated with the sulfate content (r=0.934). Several polysaccharides demonstrated promising antioxidant, antiproliferative an/or anticoagulant potential and have been selected for further studies on bioguided fractionation, isolation and characterization of pure polysaccharides from these species as well as in vivo experiments are needed and are already in progress.

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The objective of this work was to report the tomographic findings in five cases of intrathoracic textilomas. The CT scans of five patients presenting with textilomas after being submitted to thoracotomy for myocardial revascularisation were reviewed retrospectively. Two chest radiologists studied the scans independently, and decisions concerning the CT findings were made by consensus. In each of the five cases, the imaging findings were similar and showed lesions resembling an extrapulmonary mass and well-defined contours situated at the marginal posterior pleural surface. In four of the five cases, a low-density centre and peripheral rim-like enhancement were observed after administration of contrast media. The suspicion of textiloma should be raised when a patient with a history of previous myocardial revascularisation surgery presents with an extrapulmonary mass in close contact with the posterior pleural surface.

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Obesity is a multifactorial pathology currently considered one of the main public health problems. Its prevalence is increasing dramatically in the last decades, reaching huge rates in Brazil and many other countries. Regardless of the factors associated with genetic predisposition, this pathology is often associated with abnormal food intake, and also with high consumption of caloric foods and sedentary habits. Thus, obesity is the result of an imbalance between food intake and energy expenditure. One of the greatest research interests in nutrition has currently been the dietetic determinants that may exert an influence on the process of food intake, as well as the role of foods on physiological, physical and chemical factors most related to the processes of satiation and satiety. Based on these aspects, this paper analyzes several research works to gain a better insight of the dietetic factors affecting food intake and body weight regulation.

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The impact of oral rehydration therapy (ORT) on the recent decline in diarrhoea mortality in the northeast of Brazil was studied. Proportionate infant mortality fell from 32% in 1980 to 17% in 1989 and infant deaths attributed to diarrhoea dropped from 41% to 25%, resulting in an overall reduction of 57%. Similar decreases were observed for children aged 1-4 years. Diarrhoea admissions also fell from 57% of infant hospitalizations in 1980 to 30% in 1990. None of the other major causes of death or admissions showed such decline. ORT was introduced in the early 1980s, being used in 35% of all episodes in 1991 and in 62% of those regarded as severe by the mother. Other changes included a worsening of socioeconomic conditions and increases in water supply, vaccine coverage, breastfeeding duration and nutritional status. A simulation model estimated that changes in factors other than ORT would lead to a 21% reduction in infant diarrhoea mortality, or about one-third of the actual decline. Finally, an ecological analysis showed that ORT use rates were inversely correlated to infant diarrhoea mortality (r=-0.61; p=0.04). Despite the shortcomings of the available data, these findings suggest an important impact of ORT on diarrhoea mortality.

PIP: Proportionate infant mortality in the northeast of Brazil fell from 32% in 1980 to 17% in 1989, with infant deaths attributed to diarrhea falling from 41% to 25%; these declines comprise an overall reduction of 57%. Similar decreases were observed for children aged 1-4 years. Diarrhea admissions also fell from 57% of infant hospitalizations in 1980 to 30% in 1990. No such decline was observed in any of the other major causes of death or admissions. The authors explored the impact of oral rehydration therapy (ORT) upon this recent decline in diarrhea mortality in the region. ORT was introduced in the early 1980s, being used in 35% of all episodes in 1991 and in 62% of those regarded as severe by the mother. Socioeconomic conditions worsened during the 1980s, but the levels of water supply, vaccine coverage, breastfeeding duration, and nutritional status increased. A simulation model estimated that changes in factors other than ORT would lead to a 21% reduction in infant diarrhea mortality, or approximately one third of the actual decline. An ecological analysis found ORT use rates to be inversely correlated with infant diarrhea mortality. These findings suggest that the introduction and use of ORT in northeastern Brazil had an important impact upon diarrhea mortality.

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Extramedullary hematopoiesis is a common accompaniment of a variety of hematologic diseases such as hereditary spherocytosis, thalassemia and myelofibrosis. The association of extramedullary hematopoiesis with polycythemia vera in the proliferative phase is much less usual. We report a patient who presented with paraplegia due to spinal cord compression; clinical investigation revealed a paravertebral hematopoietic tumor, and the diagnosis of polycythemia vera was then established.

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In a population-based study, all infant deaths occurring in a one-year period in the metropolitan areas of Porto Alegre and Pelotas, in southern Brazil, were studied. There were 227 infants who presented diarrhoea during the fatal illness, and in 75% of these diarrhoea was considered to be the underlying cause of death. Acute diarrhoea (< 14 days' duration) accounted for 28% of the deaths, persistent diarrhoea for 62% and dysentery for a further 10%. Approximately one-half of the children with persistent diarrhoea were admitted to a hospital in the first two weeks of the episode. Hospital-acquired infections were likely to have contributed to one- to two-thirds of deaths due to dysentery and persistent diarrhoea. A comparison with neighbourhood controls showed that breast milk provided substantial protection against deaths due to either acute or persistent diarrhoea.

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Population ageing in Brazil has been more rapid and more intense among women. This phenomenon is well described in developed countries where mortality rates are higher for men than women. In this regard, the analysis of mortality patterns by cause contributes to elucidate the determinant factors of the present situation in Brazil and provides indications of some future trends in female mortality. This is especially important due to the fact that in Brazil the social role of women has experienced great changes. This study presents data on mortality from ten capital cities in 1985, showing age-standardized overall and cause-specific mortality rates for five of the main groups of causes by sex. Ratios and differences effect estimators were used. The results revealed that regional patterns are associated with the urban and industrial processes with greater differences by sex in more developed regions. External causes and cardiovascular diseases are the main factors responsible for higher mortality among men with special emphasis on violent deaths. It is inferred that the present trend will be maintained, though it is possible that mortality differences by sex could decrease in the near future. The authors discuss that longer survival among women in Brazil does not reveal better life conditions.

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The validity of the official information on the cause of infant deaths was studied in the Brazilian cities of Porto Alegre and Pelotas in 1985. Using data collected for a population-based case-control study of infant mortality due to infectious diseases or malnutrition, a comparison was made between the causes of death reported on the death certificates and those obtained after a careful review of case-notes and a medical interview with the parents of the decreased infants. Official death certificates showed an excess of deaths attribute to bronchopneumonia (ICD 485X) and septicemia (ICD 038.9), and an underestimation of the number of deaths due to diarrheal diseases (ICD 009.1) and of sudden infant deaths (ICD 798.0). The overall rate of agreement between official and revised certificates, in terms of groups of causes of death, was only 27.9%. Lower respiratory infections, which were the leading infectious cause of infant death according to official statistics, were superseded by diarrheal diseases after this revision.

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The association between infant feeding habits and infant mortality from diarrhea was investigated in a population-based case-control study in two urban areas in southern Brazil during 1985. Each of 170 infants who died due to diarrhea was compared with two neighborhood controls. After allowance was made for confounding variables, infants who received powdered milk or cow's milk, in addition to breast milk, were at 4.2 times (95% confidence interval (CI) 1.7-10.1) the risk of death from diarrhea compared with infants who did not receive artificial milk, while the risk for infants who did not receive any breast milk was 14.2 times higher (95% CI 5.9-34.1). Similar results were obtained when infants who died from diarrhea were compared with infants who died from diseases that were presumed to be due to noninfectious causes. Each additional daily breast feed reduced the risk of diarrhea death by 20% (95% CI 2-34%), but the increase in risk associated with each bottle feed was not significant after allowance was made for the number of breast feeds. The only other consumption variable associated with diarrhea mortality was the frequency with which tea, water, or juice were drunk with each feed (increase in risk, 42% (95% CI 4-93%]. The odds ratios associated with nonbreast milk were highest in the first two months of life. Possible biases were investigated, including the interruption of breast-feeding as an early consequence of the terminal illness, but the strong protective effect of breast-feeding persisted after these adjustments.

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In a population-based case-control study in the metropolitan areas of Porto Alegre and Pelotas in southern Brazil children dying in infancy from diarrhoea were compared to neighbourhood controls in terms of several social and environmental variables. Factors found to be significantly associated with an increased risk of death from diarrhoea included the non-availability of piped water, the absence of a flush toilet, residence in a poorly built house and household overcrowding. When adjustment was made for confounding variables and the mutual confounding effect of the environmental variables on each other, the only association that remained statistically significant was that with the availability of piped water. The association with poor housing was almost significant (p = 0.052). Compared to those with water piped to their house, those without easy access to piped water were found to be 4.8 times more likely to suffer infant death from diarrhoea (95% confidence interval 1.7 to 13.8) and those with water piped to their plot but not to their house had a 1.5 times greater risk (95% confidence interval 0.8 to 3.0).

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The association between birth weight and infant mortality from infectious diseases was investigated in a population-based case-control study in two urban areas in southern Brazil. All deaths of children, seven to 364 days of age, occurring in a year were studied and the parents of the 357 infants dying of an infectious cause were interviewed, as were the parents of two neighborhood control infants for each case. Low birth weight infants (less than 2,500 g) were found, after allowing for confounding factors, to be 2.3 (90% confidence interval = 1.6 to 3.4) times more likely to die of an infection than those of higher birth weight. The odds ratios were 2.0 (1.1 to 3.6) for deaths due to diarrhea, 1.9 (1.0 to 3.6) for respiratory infections, and 5.0 (1.3 to 18.6) for other infections. These estimates of the risks associated with low birth weight are considerably lower than those from studies in developed countries.

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In a population-based case-control study of infant mortality in two urban areas of southern Brazil, the type of milk in an infant's diet was found to be an important risk factor for deaths from diarrhoeal and respiratory infections. Compared with infants who were breast-fed with no milk supplements, and after adjusting for confounding variables, those completely weaned had 14.2 and 3.6 times the risk of death from diarrhoea and respiratory infections, respectively. Part-weaning was associated with corresponding relative risks (RR) of 4.2 and 1.6. The risk of death from infections other than diarrhoea or respiratory infection was less clearly associated with breast-feeding (completely weaned, RR = 2.5; partly weaned, RR = 0.4). Cow's and formula milk seemed to be equally hazardous. For deaths due to diarrhoea the increased risk associated with not breast-feeding was greatest in the first two months of life (RR for completely weaned vs breast-fed without supplementary milk = 23.3).

PIP: In a population-based case-control study of infant mortality in 2 urban areas of southern Brazil, the type of milk in an infant's diet was found to be an important risk factor for deaths from diarrheal and respiratory infections. Compared with infants who were breastfed with no milk supplements, and after adjusting for confounding variables, those completely weaned had 14.2 and 3.6 times the risk of death from diarrhea and respiratory infections, respectively. Part-weaning was associated with corresponding relative risks (RR) of 4.2 and 1.6. The risk of death from infections other than diarrhea or respiratory infection was less clearly associated with breastfeeding (completely weaned, RR=2.5; partly weaned, RR=0.4). Cow's and formula milk seemed to be equally hazardous. For deaths due to diarrhea the increased risk associated with not breastfeeding was greatest in the 1st 2 months of life (RR for completely weaned vs. breastfed without supplementary milk =23.3). (author's modified).

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Numa populacao periurbana brasileira sao estudados alguns dos elementos essenciais da demanda de pacientes por servicos medicos. Criancas de zero a quatro anos sao, em numeros absolutos, o maior grupo de pacientes. Criancas e velhos demandam uma frequencia maior de consultas (frequencia media de tres a quatro consultas/ano). Os problemas que com maior frequencia trazem pacientes a consulta: infeccoes respiratorias e diarreia aguda em criancas; e problemas emocionais em adultos. Foram encaminhados para hospitais ou especialistas 10,2% do total de pacientes vistos no periodo de um ano, sendo que 81% deles tratados sem a necessidade de exames complementares

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