Publications by authors named "Cristina Sanches"

32 Publications

Is Dosing of Ethambutol as Part of a Fixed-Dose Combination Product Optimal for Mechanically Ventilated ICU Patients with Tuberculosis? A Population Pharmacokinetic Study.

Antibiotics (Basel) 2021 Dec 20;10(12). Epub 2021 Dec 20.

UQ Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4029, Australia.

Background: Tuberculosis (TB) patients admitted to intensive care units (ICU) have high mortality rates. It is uncertain whether the pharmacokinetics of first-line TB drugs in ICU patients are different from outpatients. This study aims to compare the pharmacokinetics of oral ethambutol in TB patients in ICU versus TB outpatients and to determine whether contemporary dosing regimens achieve therapeutic exposures.

Methods: A prospective population pharmacokinetic study of ethambutol was performed in Amazonas State, Brazil. Probability of target attainment was determined using AUC/MIC > 11.9 and C/MIC > 0.48 values. Optimized dosing regimens were simulated at steady state.

Results: Ten ICU patients and 20 outpatients were recruited. Ethambutol pharmacokinetics were best described using a two-compartment model with first-order oral absorption. Neither ICU patients nor outpatients consistently achieved optimal ethambutol exposures. The absorption rate for ethambutol was 2-times higher in ICU patients ( < 0.05). Mean bioavailability for ICU patients was >5-times higher than outpatients ( < 0.0001). Clearance and volume of distribution were 93% ( < 0.0001) and 53% ( = 0.002) lower in ICU patients, respectively.

Conclusions: ICU patients displayed significantly different pharmacokinetics for an oral fixed-dose combination administration of ethambutol compared to outpatients, and neither patient group consistently achieved pre-defined therapeutic exposures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/antibiotics10121559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8698281PMC
December 2021

Ideal benznidazole dose regimen in chronic chagasic patients: a systematic review.

Rev Inst Med Trop Sao Paulo 2020 24;62:e52. Epub 2020 Jul 24.

Universidade Federal de São João del-Rei, Divinópolis, Minas Gerais, Brazil.

The present study aimed to review the existing literature and to evaluate the best dose regimen for benznidazole in adult patients with Chagas disease in the chronic phase. A systematic review was conducted followed by meta-analysis. Searches were performed in four databases, to include studies published until May 2019. The descriptors used were: "Chagas disease", "benznidazole", "Drug Therapy", "Pharmacokinetics", "Dose-response relationship, drug" and "Chronic disease". The meta-analysis compared studies using the standard dose of 5 mg/kg/day for 30 or 60 days. A total of 608 articles were found, 23 of which were considered eligible for this review and nine were included in the meta-analysis. The studies selected and analyzed were published between 1996 and 2018, with various benznidazole dose regimens, ranging from 2.5 mg/kg/day to 10 mg/kg/day, for 30 to 80 days of treatment. The results pointed to a great diversity of dose regimens, thus there is no consensus on the optimal dose regimen for benznidazole in the chronic phase of Chagas disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/s1678-9946202062052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384592PMC
August 2020

Pharmacokinetic and Pharmacodynamic Characteristics of Vancomycin and Meropenem in Critically Ill Patients Receiving Sustained Low-efficiency Dialysis.

Clin Ther 2020 04 19;42(4):625-633. Epub 2020 Mar 19.

Department of Infection Control, Faculty of Medicine, Clinical Hospital, University of São Paulo, São Paulo, Brazil; Department of Infectious Diseases, Laboratory of Medical Investigation, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil.

Purpose: Antibiotic dosing is challenge in critically ill patients undergoing renal replacement therapy. Our aim was to evaluate the pharmacokinetic and pharmacodynamic (PK/PD) characteristics of meropenem and vancomycin in patients undergoing SLED.

Methods: Consecutive ICU patients undergoing SLED and receiving meropenem and/or vancomycin were prospectively evaluated. Serial blood samples were collected before, during, and at the end of SLED sessions. Antimicrobial concentrations were determined using a validated HPLC method. Noncompartmental PK analysis was performed. AUC was determined for vancomycin. For meropenem, time above MIC was calculated.

Findings: A total of 24 patients receiving vancomycin and 21 receiving meropenem were included; 170 plasma samples were obtained. Median serum vancomycin and meropenem concentrations before SLED were 24.5 and 28.0 μg/mL, respectively; after SLED, 14 and 6 μg/mL. Mean removal was 42% with vancomycin and 78% with meropenem. With vancomycin, 19 (83%), 16 (70%), and 15 (65%) patients would have achieved the target (AUC >400) considering MICs of 1, 2, and 4 mg/L, respectively. With meropenem, 17 (85%), 14 (70%), and 10 (50%) patients would have achieved the target (100% of time above MIC) if infected with isolates with MICs of 1, 4, and 8 mg/L, respectively.

Implications: SLED clearances of meropenem and vancomycin were 3-fold higher than the clearance described by continuous methods. Despite this finding, overall high PK/PD target attainments were obtained, except for at higher MICs. We suggest a maintenance dose of 1 g TID or BID of meropenem. With vancomycin, a more individualized approach using therapeutic drug monitoring should be used, as commercial assays are available.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clinthera.2020.02.011DOI Listing
April 2020

The Academic Self-Regulation Questionnaire: a study with Portuguese elementary school children.

Psicol Reflex Crit 2019 Apr 11;32(1). Epub 2019 Apr 11.

Centro de Investigação em Educação (CIE - ISPA), Lisbon, Portugal.

Background: Several studies have focused on the assessment of students' motivation because this construct is very important to understand students' learning and how to enhance it. The Academic Self-Regulation Questionnaire (SRQ-A), based on the self-determination theory is a self-report instrument developed to access the reasons why students do their school work. However, there is no Portuguese version of this questionnaire for late elementary students. The primary goal of this research was to analyze the psychometric properties of a Portuguese version of SRQ-A in the domain of Mathematics with elementary school children.

Methods: Participants were 341 elementary school children ranging from 8 to 11 years old from the third and fourth grades. The Portuguese version of the SRQ-A included 24 items assessing four regulatory styles (external, introjected, identified, and intrinsic) in three behavioral categories (homework, classwork, and answering questions in mathematics lessons). To examine the psychometric properties of the instrument, we conducted an exploratory structural equation modeling (ESEM), measured gender and grade invariance, and calculated internal consistency indexes and temporal stability.

Results: ESEM analyses supported the original multidimensional structure of the measure with four regulatory styles using a reduced version of the instrument with 16 items. Correlations between the four regulatory styles revealed a simplex pattern consistent with the continuum of self-determination theory. Results showed adequate internal consistency for all regulatory styles (α ≥ .73; CR ≥ .76) and temporal stability (4-month test-retest ≥ .43). The questionnaire showed measurement and structural invariance across gender and grade. Finally, some gender differences were observed; on average, boys scored higher than girls in external regulation. No differences were observed between grades.

Conclusions: Our findings suggest that the Portuguese version of the SRQ-A has good psychometric properties providing adequate support for its use in educational research on motivational styles, including studies concerning gender and grade differences in self-regulation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s41155-019-0124-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966964PMC
April 2019

Linguistic and cultural adaptation to the Portuguese language of antimicrobial dose adjustment software.

Einstein (Sao Paulo) 2020 27;18:eAO5023. Epub 2020 Jan 27.

Universidade Federal de São João del-Rei, Divinópolis, MG, Brazil.

Objective: To adapt an antibiotic dose adjustment software initially developed in English, to Portuguese and to the Brazilian context.

Methods: This was an observational, descriptive study in which the Delphi method was used to establish consensus among specialists from different health areas, with questions addressing the visual and operational aspects of the software. In a second stage, a pilot experimental study was performed with the random comparison of patients for evaluation and adaptation of the software in the real environment of an intensive care unit, where it was compared between patients who used the standardized dose of piperacillin/tazobactam, and those who used an individualized dose adjusted through the software Individually Designed and Optimized Dosing Strategies.

Results: Twelve professionals participated in the first round, whose suggestions were forwarded to the software developer for adjustments, and subsequently submitted to the second round. Eight specialists participated in the second round. Indexes of 80% and 90% of concordance were obtained between the judges, characterizing uniformity in the suggestions. Thus, there was modification in the layout of the software for linguistic and cultural adequacy, minimizing errors of understanding and contradictions. In the second stage, 21 patients were included, and there were no differences between doses of piperacillin in the standard dose and adjusted dose Groups.

Conclusion: The adapted version of the software is safe and reliable for its use in Brazil.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31744/einstein_journal/2020AO5023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986457PMC
March 2020

Cost-effectiveness analysis of a pharmacotherapeutic empowerment strategy for patients with type 2 diabetes mellitus.

BMJ Open Diabetes Res Care 2019 16;7(1):e000647. Epub 2019 Jul 16.

Faculdade de Farmácia, Universidade Federal de Sao Joao del-Rei - Campus CCO, Sao Joao del-Rei, Brazil.

Background: The economic feasibility of pharmacotherapeutic empowerment of patients with type 2 diabetes mellitus (DM2) is still not well established.

Objectives: To evaluate the cost-effectiveness of an individual pharmacotherapeutic empowerment strategy (IPES) for patients with DM2.

Methods: This is a cost-effectiveness study nested in a non-randomized clinical trial with patients ≥18 years of age, of both genders, with low and moderate cardiovascular risks. This study was carried out from the perspective of the municipal health system of Divinópolis in Minas Gerais state, and compared patients submitted to an IPES and patients who received only traditional care, 1 year before the beginning of the intervention (baseline) and 1 year after its completion (follow-up). The costs of the services offered by the municipality were computed, and in the intervention group IPES costs were included. Glycated hemoglobin (A1c) was the effectiveness parameter adopted. Cost-effectiveness ratio analyses, incremental cost-effectiveness ratio (ICER), and sensitivity analysis were performed.

Results: In the analysis of cost-effectiveness, it is observed that a reduction of 0.359 in A1c costs US$708.47 in the intervention group and a reduction of 0.170 costs US$1927.13 in the control group. Thus, the ICER is US$387.66 per patient/year. In the sensitivity analysis, it was observed that the IPES was dominant in 19.8% of the simulated scenarios and cost-effective in 80.2%.

Conclusions: The IPES is an alternative that presents economic feasibility for the municipal public health system scenario. The absence of randomization in patient selection is a limitation of this study.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjdrc-2018-000647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6673768PMC
April 2020

Carbapenem-resistant Acinetobacter baumannii in patients with burn injury: A systematic review and meta-analysis.

Burns 2019 11 25;45(7):1495-1508. Epub 2019 Jul 25.

Laboratório de Diagnóstico Laboratorial e Microbiologia Clínica, Campus Centro-Oeste/Dona Lindu, Universidade Federal de São João del-Rei, Divinópolis, MG, Brazil.

Purpose: In this study, we aimed reviewed the data about the patterns of antimicrobial susceptibility and resistance determinants among carbapenem-resistant Acinetobacter baumannii (CRAB) from patients with burn injury.

Methods: A systematic review was conducted using the PRISMA statement in PUBMED/MEDLINE, Scopus, Scientific Electronic Library Online (SciELO), Biblioteca Virtual de Saúde (BVS) and Cochrane Library. The data referring to enzymatic resistance mechanisms were evaluated by meta-analyses according to random effect.

Results: 17 articles that evaluated 1226 CRAB recovered from patients with burn injury were included in study. The majority of studies are from Iran (12/17; 70.6%), published in 2016 (6/17; 35.3%) and showed prospective design (15/17; 88.2%). The samples were obtained mainly from burn wounds (14/17; 82.3%) and more than half of the studies did not identify if the isolates originated from infected or colonized patients (10/17; 58.8%). Second the meta-analyses, OXA-type carbapenemase was the main mechanism involved in low susceptibility to carbapenems (53.2%; 95% CI = 60, 80.0%, I = 86.0%), followed by metallo-β-lactamases (MBL) (30.2%; 95% CI = 11, 42.0%, I = 93.0%), and Klebsiella pneumoniae carbapenemase (KPC) (16.6%; 95% CI = 5, 63.0%, I = 88.0%). The majority of strains harbored bla (12/17; 70.6%) or bla (12/17; 35.3%) genes. The studies included showed that minocycline (69.5%) and colistin (99.9%) susceptibility remains high and is not impacted by carbapenem resistance in these isolates.

Conclusions: The results summarized in this review indicate the importance of a high-quality surveillance program to design suitable and effective interventions to control CRAB infection in burn units worldwide.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.burns.2019.07.006DOI Listing
November 2019

What is the effectiveness of post-discharge pharmacotherapeutic empowerment of patients with diabetes?

Diabetes Metab Syndr 2019 Mar - Apr;13(2):1321-1323. Epub 2019 Feb 5.

Central-West Campus Dona Lindu, Federal University of São João del-Rei, Divinopolis, MG, Brazil; Group of Research in Epidemiology and Evaluation of New Technologies in Health, GPEANTS, UFSJ/CNPq, Brazil. Electronic address:

The objective of the present article was to evaluate the glycemic control of patients with diabetes mellitus (DM) after discharge from a pharmacotherapeutic empowerment program. The results suggest that the strategy is effective for short-term glycemic control, but the benefits are not maintained after discharge, indicating the need for the pharmacist's continuous role.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dsx.2019.02.002DOI Listing
December 2019

Patients with chronic kidney disease and diabetes mellitus: How is health care?

Diabetes Metab Syndr 2019 May - Jun;13(3):2292-2298. Epub 2019 May 23.

Central-West Campus Dona Lindu, Federal University of São João del-Rei, Divinopolis, MG, UFSJ, Brazil. Electronic address:

Objective: To evaluate if the recommendations of appropriate health care for Chronic Kidney Disease (CKD) are implemented in patients with Diabetes Mellitus (DM) and Systemic Arterial Hypertension (SAH).

Methods: This is a descriptive study conducted between January and March 2019 in Divinópolis, in the Brazilian state of Minas Gerais. Patients aged 18 years or older with CKD, DM and/or SAH were followed up at the municipal nephrology outpatient clinic. An interview was conducted using a structured questionnaire to assess care, which was categorized as adequate or inadequate, based on the health care recommendations of the national guidelines for care of patients with CKD.

Results: 42 participants with CKD participated in the study. All participants had SAH and 42.9% (n = 18) also had DM. It was evidenced that 81.0% (n = 34) of the individuals with CKD had adequate health care, especially among patients in earlier stages (3A and 3B) and those who progressed to renal replacement therapy. However, 80.0% (n = 8) of the participants in the intermediate stage (stage 4) were inadequately followed up by the nephrologist and multidisciplinary team.

Conclusions: Patients in intermediate stages do not receive follow-up with a multidisciplinary team at the recommended frequency. The preventive approach of the progression of renal disease in the intermediate stage in the studied municipality was not within the recommendations of the Ministry of Health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dsx.2019.05.022DOI Listing
December 2019

Post-marketing Study of Linagliptin: A Pilot Study.

Front Pharmacol 2019 24;10:576. Epub 2019 May 24.

Grupo de Pesquisa em Epidemiologia e Avaliação de Novas Tecnologias em Saúde, Universidade Federal de São João del-Rei, Divinópolis, Brazil.

Introduction: Linagliptin is a high-cost oral antidiabetic that has been widely used, and studies on its effectiveness and safety for the treatment of type 2 diabetes mellitus (DM2) in the real world is rare and necessary.

Objective: To analyze the values of glycated hemoglobin (HbA1c) and adverse events before and after the use of linagliptin in the post-marketing context of a pilot study.

Methods: This is a descriptive observational and exploratory study with a retrospective longitudinal approach, conducted between January 2014 and December 2016. All patients who participated in the study were over 18 years of age, with DM2, assisted by the Brazilian Public Health System ( - SUS) and had been indicated for use of linagliptin. The users were followed up and the variables of interest were collected from a computerized health information system ( - SIS) and patient records. For effectiveness analysis, HbA1c before (T) and after (T) the use of linagliptin was considered in patients registered as having collected linagliptin at the pharmacy for at least three consecutive months. For safety analysis, registered adverse events (AE) were verified in patients' records. The sample was stratified according to the pharmacotherapeutic scheme of the users. To compare the means before (T) and after (T), a paired -test (data with normal distribution) and Wilcoxon Signed Rank Sum test (non-normal distribution data) were performed.

Results: Considering the total population of the study, in a different pharmacotherapeutic regimen, a median reduction in HbA1c of -0.86% ( < 0.05) was observed. After stratification by pharmacotherapeutic regimen, the most significant reduction of HbA1c was -1.07% ( = 0.014) for the linagliptin group associated with insulins and oral antidiabetic agents ( = 13). On the other hand, patients taking linagliptin in monotherapy had the lowest HbA1c reduction, -0.48% ( > 0.05). AE occurred in 12 (36.4%) patients, and 16.7% were in monotherapy.

Conclusion: Linagliptin did not presented, in real world, the desired performance as showed in randomized premarketing clinical trials and it should be carefully evaluated in public health services.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fphar.2019.00576DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543281PMC
May 2019

Patients participation in pharmaceutical care consultations in Brazil.

Int J Clin Pharm 2019 Jun 22;41(3):677-681. Epub 2019 Apr 22.

Universidade Federal de São João del-Rei (UFSJ), Rua Sebastião Gonçalves Coelho, 400 - Bairro Chanadour, Divinópolis, MG, CEP:35501-296, Brazil.

Background The effectiveness of pharmaceutical care has already been evidenced in several studies and scenarios; the lack of patient's consultation has been little explored in the literature. Unprovided care is a missed opportunity to offer care to another individual who needs attention to their health. The need for investigation of missed consultations in a Brazilian pharmaceutical care service arises. Objective To evaluate the participation and characteristics of patients in pharmaceutical care consultations in a university outpatient unit in the Brazilian city of Divinópolis. Methods A descriptive study was carried out from a secondary source of information. The socio-demographic profile of the patients who were absent from the pharmacy consultations from January to December 2017 was outlined. Results Of the 832 scheduled appointments from January to December 2017, 501 were not attended by patients, revealing 60.2% missed consultations. The female gender was predominant, corresponding to 67.8% of the patients. A total of 63.8% of the absentees were over 60 years of age. Most of the patients had two comorbidities (32.5%) and came from an active identification by the Outpatient unit pharmacists (86.60%). Furthermore, the patients who were more absent from the consultations had their primary health care units farther away from the outpatient unit, and this could be one of the causes of the high number of absent patients from the pharmaceutical consultations. Conclusion The lack of participation in patient's consultations is high. It is necessary to articulate new strategies aimed at reducing absences from consultations, since this is a source of waste of financial resources and opportunities to improve the patients' health and quality of life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11096-019-00823-5DOI Listing
June 2019

Effective vancomycin concentrations in children: a cross-sectional study.

Einstein (Sao Paulo) 2019 Feb 14;17(1):eAO4396. Epub 2019 Feb 14.

Universidade Federal de São João del-Rei, Divinópolis, MG, Brazil.

Objective: Analyze the microbiological effectiveness, based on the pharmacokinetics/pharmacodynamics correlation of vancomycin in pediatric patients, and to propose dose adjustment.

Methods: This is an observational, cross-sectional study, conducted in a pediatric hospital, over a 1-year period (2016 to 2017). Children of both sexes, aged 2 to 12 years, were included in the study; burn children, and children in renal replacement therapy were excluded. For the pharmacokinetic analysis, two samples of 2mL of whole blood were collected, respecting the 2-hour interval between each withdrawal.

Results: Ten pediatric patients with median age of 5.5 years and interquartile range (IQR) of 3.2-9.0 years, median weight of 21kg (IQR: 15.5-24.0kg) and median height of 112.5cm (IQR: 95-133cm), were included. Only one child achieved trough concentrations between 10µg/mL and 15µg/mL.

Conclusion: The empirical use of vancomycin in the children studied did not achieve the therapeutic pharmacokinetic/pharmacodynamic target for minimum inhibitory concentration of 1µg/mL.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31744/einstein_journal/2019AO4396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377041PMC
February 2019

Pharmacotherapeutic empowerment and its effectiveness in glycemic control in patients with Diabetes Mellitus.

Diabetes Metab Syndr 2019 Jan - Feb;13(1):137-142. Epub 2018 Aug 3.

Central-West Campus Dona Lindu, Federal University of São João del-Rei, Divinopolis, MG, Brazil; Group of Research in Epidemiology and Evaluation of New Technologies in Health, GPEANTS, UFSJ/CNPq, Brazil. Electronic address:

Aims: To develop an intervention and evaluate its effectiveness in pharmacotherapeutic empowerment of patients with type 2 diabetes mellitus (T2DM).

Method: This is an intervention study with before and after evaluation. The intervention was conducted between 2015 and 2016 with users of the Unified Health System (SUS) in Brazil. The study was divided into six stages: initial evaluation, three individual patient-pharmacist meetings every 15 days over 6 weeks, clinical discussion between pharmacists, and final evaluation. At each meeting with the patient, specific themes for empowerment were addressed using educational booklets and pharmaceutical care. Clinical and laboratory evaluations and questionnaires on self-efficacy (IMDSES), self-care (QAD) and distress (PAID-5) were conducted before and three months after the intervention.

Results: 47 patients completed the intervention. Glycated hemoglobin of patients had a median reduced from 7.0% to 6.6% after the intervention (p = 0.02). There was a significant difference (p < 0.01) in the reduction in total cholesterol, fasting glycemia, creatinine and blood pressure. Participants showed significant improvements (p < 0.01) in scores related to self-efficacy and self-care and less distress related to T2DM.

Conclusion: The results of the study suggest that the strategy developed is effective in promoting the empowerment of T2DM patients, improved glycemic control and self-care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dsx.2018.08.002DOI Listing
May 2019

Linagliptin safety profile: A systematic review.

Prim Care Diabetes 2018 12 28;12(6):477-490. Epub 2018 May 28.

Universidade Federal de São João del-Rei, Campus Centro Oeste Dona Lindu, Rua Sebastião Gonçalves Coelho, 400, Bairro Chanadour, CEP 35501-296, Divinópolis, MG, Brazil; Grupo de Pesquisa em Epidemiologia e Avaliação de Novas Tecnologias em Saúde, GPEANTS, UFSJ/CNPq, Brazil. Electronic address:

Objective: To describe the safety profile of linagliptin.

Methodology: Systematic review using PubMed/MEDLINE, BVS and Web of Science. The search strategy "Linagliptin" AND "safety" was used. The inclusion criteria were clinical trials with a control group composed of conventional DM2 pharmacotherapy.

Results: We identified 16 studies, and the most frequent adverse events (AEs) were nasopharyngitis with linagliptin at 5 and 10mg in monotherapy (31.6% and 29.6%, respectively) and gastrointestinal events (>10.0%) with linagliptin in combination. Of the AEs, 14.9 (±3.1)% were associated with the use of linagliptin in monotherapy, and 17.6 (±6.0)% in combination. The linagliptin AEs have a varied occurrence and frequency, ranging from mild to moderate intensity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pcd.2018.04.006DOI Listing
December 2018

Hollow mesoporous structured molecularly imprinted polymer as adsorbent in pipette-tip solid-phase extraction for the determination of antiretrovirals from plasma of HIV-infected patients.

Electrophoresis 2018 10 13;39(20):2581-2589. Epub 2018 Jun 13.

Departamento de Ciências Naturais, Universidade Federal de São João del-Rei, Campus Dom Bosco, São João del-Rei, Minas Gerais, Brazil.

In this work a hollow mesoporous structured molecularly imprinted polymer was synthetized and used as adsorbent in pipette-tip solid-phase extraction for the determination of lamivudine (3TC), zidovudine (AZT) and efavirenz (EFZ) from plasma of human immunodeficiency virus (HIV) infected patients by high-performance liquid chromatography (HPLC). All parameters that influence the recovery of the pipette tip based on hollow mesoporous molecularly imprinted polymer solid-phase extraction (PT-HM-MIP-SPE) method were systematically studied and discussed in detail. The adsorbent material was prepared using methacrylic acid and 4-vinylpyridine as functional monomers, ethylene glycol dimethacrylate as crosslinker, acetonitrile as solvent, 4,4'-azobis(4-cyanovaleric acid) as radical initiator, benzalkonium chloride as surfactant, 3TC, and AZT as templates. The simultaneous separation of 3TC, AZT and EFZ by HPLC-UV was performed using a Gemini C18 Phenomenex® column (250 mm × 4.6 mm, 5 μm) and mobile phase consisting of acetonitrile: water pH 3.2 (68:32, v/v), flow rate of 1.0 mL/min and λ = 260 nm. The method was linear over the concentration range from 0.25 to 10 μg/mL for 3TC and EFZ, and 0.05 to 2.0 μg mL for AZT, with correlation coefficients larger than 0.99 for all analytes. Recovery ± relative standard deviations (RSDs %) were 41.99 ± 2.38%, 82.29 ± 1.63%, and 83.72 ± 7.52% for 3TC, AZT, and EFZ, respectively. The RSDs and relative errors (REs) were lower than 15% for intra and interday assays. The method has been successfully applied for monitoring HIV-infected patients outside the therapeutic dosage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/elps.201800165DOI Listing
October 2018

Is quality of life associated with compliance to pharmacoterapy in patients with chronic kidney disease undergoing maintenance hemodialysis?

Einstein (Sao Paulo) 2018 23;16(1):eAO4036. Epub 2018 Apr 23.

Universidade Federal de São João del-Rei, Divinópolis, MG, Brazil.

Objective To analyzed the association of quality of life and compliance to drug treatment in chronic kidney disease patients. Methods The Short Form Health Survey was used to evaluate the quality of life of these patients, and the therapeutic complexity index was verified. The Morisky-Green test and the Brief Medication Questionnaire were applied to check compliance to drug therapy. Results A total of 197 patients were included. The Morisky-Green test and Brief Medication Questionnaire showed that most patients had low compliance to treatment (50.3% and 80.6%, respectively). Compliance was highly associated with gender (male) and slightly associated with complexity of therapy, mental health, and social aspects. Conclusion We observed a slight association between compliance to pharmacotherapy and quality of life and complexity of therapy, and a strong association with gender.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1590/s1679-45082018ao4036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968805PMC
May 2018

Hospital pharmacy workforce in Brazil.

Hum Resour Health 2018 01 4;16(1). Epub 2018 Jan 4.

Federal University of Sao Joao del Rei, Campus Centro-Oeste Dona Lindu, Av. Sebastião Gonçalves Coelho, 400 - Chanadour, Divinópolis, MG, CEP 35.501-296, Brazil.

Background: This study aims to describe the distribution of the hospital pharmacy workforce in Brazil.

Methods: Data were acquired, during 2016, through the Brazilian National Database of Healthcare Facilities (CNES). The following variables were extracted: hospital name, registry number, telephone, e-mail, state, type of institution, subtype, management nature, ownership, presence of research/teaching activities, complexity level, number of hospital beds, presence of pharmacists, number of pharmacists, pharmacist specialization. All statistical analyses were performed by IBM SPSS v.19.

Results: The number of hospitals with a complete registry in the national database was 4790. The majority were general hospitals (77.9%), managed by municipalities (66.1%), under public administration (44.0%), had no research/teaching activities (90.5%), classified as medium complexity (71.6%), and had no pharmacist in their team (50.6%). Furthermore, almost 60.0% of hospitals did not comply with the minimum recommendations of having a pharmacist per 50 hospital beds. The Southeast region had the highest prevalence of pharmacists, with 64.4% of hospitals having a pharmaceutical professional. This may have occurred as this region had the highest population to hospital ratio. Non-profit hospitals were more likely to have pharmacists compared to those under public administration and private hospitals.

Conclusion: This study mapped the hospital pharmacy workforce in Brazil, showing a higher prevalence of hospital pharmacists in the Southeast region, and in non-profit specialized hospitals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12960-017-0265-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5755413PMC
January 2018

Patients lacking glycemic control place more burdens on health services with the use of medications.

Diabetes Metab Syndr 2018 May 17;12(3):279-283. Epub 2017 Dec 17.

Federal University of São João Del-Rei (UFSJ), Rua Sebastião Gonçalves Coelho, 400, Bairro Chanadour, Divinópolis, MG, CEP: 35.501-296, Brazil. Electronic address:

Introduction: DM spending in the world is high, and Brazilian studies of public spending caused by DM are scarce.

Objective: To estimate the annual direct cost for the municipal health sphere, related to DM2 treatment, in patients with and without glycemic control.

Method: A cross-sectional study carried out in a city in the interior of Minas Gerais state, with patients with DM2, being municipal PHS users. Data were collected from the computerized system of the municipality and patient records, and analyzed using the IBM SPSS v.19 statistical package. The response variable was categorized into controlled A1c (≤7%) and uncontrolled A1c (>7%).

Results: Glycemic control in 56.6% of the patients was unsatisfactory; the mean cost of pharmacotherapy for DM2 was US$ 3.14 per year for patients in the control group and US$ 45.54 per year for uncontrolled patients.

Conclusion: Patients with unsatisfactory glycemic control are more expensive for the municipal health system.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dsx.2017.12.010DOI Listing
May 2018

Effectiveness of individual strategies for the empowerment of patients with diabetes mellitus: A systematic review with meta-analysis.

Prim Care Diabetes 2018 04 20;12(2):97-110. Epub 2017 Nov 20.

Central-West Campus Dona Lindu, Federal University of São João del-Rei, Divinopolis, MG, Brazil; Group of Research in Epidemiology and Evaluation of New Technologies in Health, GPEANTS, UFSJ/CNPq, Brazil. Electronic address:

Aims: To identify and evaluate the effectiveness of individual empowerment strategies in patients with diabetes mellitus (DM).

Methods: A systematic review was performed in the PubMed, Scopus, Science Direct and BVS. For meta-analysis and evaluation of Cochrane Risk and Bias, Revman V 5.2 software was used.

Results: Eleven studies of 1073 publications met the inclusion criteria. The strategies used were individual consultations, phone calls, sessions via a website and use of a booklet. Glycemic Hemoglobin (HbA1c) was used to evaluate the effectiveness of the strategies, and 45.4% of the studies also used the Diabetes Empowerment Scale. Five studies (45.5%) showed significant improvements in HbA1c reduction, improvements in self-efficacy (18.2%), knowledge levels of DM (18.2%), quality of life (18.2%). However, after meta-analysis, no statistically significant improvement was found for HbA1c.

Conclusion: This systematic review showed that individual strategies for DM empowerment were not effective in reducing HbA1c, despite contributing to improvements in psychosocial parameters. Therefore, individual strategies need to be reviewed so that they become effective in DM control.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pcd.2017.10.004DOI Listing
April 2018

A Cross-sectional, Descriptive Study of Medication Use Among Persons With a Gastrointestinal Stoma.

Ostomy Wound Manage 2017 Sep;63(9):24-31

Federal University of São João Del Rei, Bairro Chanadour, Divinópolis, Brazil.

Research on the use of medications in people with intestinal stomas is lacking, creating gaps in knowledge of pharmacoepidemiology in these patients. A cross-sectional, descriptive study was conducted over a period of 4 months in Divinópolis, Brazil to describe the profile of medication use among people enrolled in the Health Support Service for People with Stoma - Level II (SSPS II) of a municipality in the state of Minas Gerais, Brazil. All patients from SSPS II with a colostomy or ileostomy were invited by phone to participate; those with incomplete registration data and/or who were <18 years old, hospitalized for any reason, or had their stoma reversed were excluded from participation. During home interviews, researchers obtained sociodemographic profiles (age, gender, education, occupation, and family income) and information on comorbidities, medication use, adherence to medication protocols (per the Morisky Green Levine test), polypharmacy, and adult/pharmaceutical care (medication description and indication, expiration date, self-medication). Drug storage was assessed by visual evaluation. The information was entered onto individual data sheets, numbered to ensure patient anonymity. The data then were entered into and analyzed using SSPS II statistical software using frequency measurements, measures of central tendency, and dispersion of demographic variables, health conditions, and medicine use. The study population included 59 persons (average age 66.9 ± 13.27 years), 36 (61.0%) women, 38 (64.4%) with an incomplete/primary level education, and 44 (74.5%) retired. Forty-nine (49) patients had a colostomy and 10 had an ileostomy; cancer was the main reason for stoma creation (61.1%). Half of the survey participants reported having 1 or 2 comorbidities (average 2.3); the most prevalent (52) was circulatory system disease among which hypertension (38, 64.4%) was most common. Analysis of the pharmacotherapeutic profile (prescribed and used) showed 89.8% of the study population used medication, and 52.8% were prescribed >5 medications (polypharmacy). Low and medium level adherence with prescriptions was noted (37.7%); 39.6% reported receiving no guidance on the use of the medication associated with their condition. Improper storage was observed in 33.9% of participants. In this population, persons with a stoma had complex pharmacotherapy, a high rate of polypharmacy, and deficiency in guidance on the use of medication. Further research into determining whether investments in both inclusion of a pharmacist on the team and more pharmacoepidemiological studies would improve patient care and medication safety in patients with a stoma is warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.25270/owm.2017.09.2431DOI Listing
September 2017

Determining the optimal vancomycin daily dose for pediatrics: a meta-analysis.

Eur J Clin Pharmacol 2017 Nov 4;73(11):1341-1353. Epub 2017 Aug 4.

Federal University of São João del Rei, Divinópolis, MG, Brazil.

Objective: The objective of this study was to check which initial dose of vancomycin is needed to achieve the therapeutic target that is currently used in pediatrics.

Methods: The search was conducted in the following data sources: Pubmed (1980-2017), the Cochrane Library, and Embase (1986-2017) and the references of the published studies; searches were performed using the key terms: child, children, pediatrics, infants and adolescents, vancomycin, pharmacokinetics, and pharmacodynamics. The data extracted from the studies were analyzed and grouped using RevMan V 5.2 software. The confidence interval (CI) 95% and the odds ratio (OR) were calculated considering the Mantel-Haenszel random effect.

Results: From the 704 studies identified, 40 revealed eligibility for this review and only 20 presented enough data to be included in the statistical analysis. The articles found in this review were published between 1980 and 2017. The vancomycin doses varied between 40 mg/kg/day to 120 mg/kg/day. The statistical tests demonstrated significant clinical heterogeneity of I (84%).

Conclusions: The meta-analysis study revealed in the majority of studies that doses lower than 60 mg/kg/day were not enough to achieve desirable vancomycin plasma concentrations "area under the curve in 24 h/minimum inhibitory concentration >400 (AUC/MIC>400) or trough 10-20 mg/L" to control bacterial infections in pediatrics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00228-017-2306-3DOI Listing
November 2017

Corrigendum: "To be or not to be Retained… That's the Question!" Retention, Self-esteem, Self-concept, Achievement Goals and Grades.

Front Psychol 2017 19;8:1233. Epub 2017 Jul 19.

Instituto de Educação, Universidade do MinhoBraga, Portugal.

[This corrects the article on p. 1550 in vol. 7, PMID: 27790167.].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpsyg.2017.01233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515818PMC
July 2017

Clinical Outcome and Antimicrobial Therapeutic Drug Monitoring for the Treatment of Infections in Acute Burn Patients.

Clin Ther 2017 Aug 10;39(8):1649-1657.e3. Epub 2017 Jul 10.

Department of Infection Control of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, and Department of Infectious Diseases, Laboratório de Investigação Médica-LIM 54 and Instituto de Medicina Tropical, Universidade de Sao Paulo, São Paulo, Brazil. Electronic address:

Purpose: In critical burn patients, the pharmacokinetic parameters (absorption, distribution, metabolism, and excretion) of many classes of drugs, including antibiotics, are altered. The aim of this study was to compare 2 groups of burn patients undergoing treatment for health care-associated infections with and without therapeutic drug monitoring.

Methods: A retrospective analysis of a clinical intervention (ie, a before/after study) was conducted with patients with health care-associated pneumonia, burn infection, bloodstream infection, and urinary tract infection in the burn intensive care unit of a tertiary care hospital. The patients were divided into 2 groups: (1) those admitted from May 2005 to October 2008 who received conventional antimicrobial dose regimens; and (2) those admitted from November 2008 to June 2011 who received antibiotics (imipenem, meropenem, piperacillin, and vancomycin) with doses adjusted according to plasma monitoring and pharmacokinetic modeling. General characteristics of the groups were analyzed, as were clinical outcomes and 14-day and in-hospital mortality.

Findings: Sixty-three patients formed the conventional treatment group, and 77 comprised the monitored treatment group. The groups were homogeneous, median age was 31 years (range: 1-90) and 66% were male. Improvement occurred in 60% of the patients under monitored treatment (vs 52% with conventional treatment); 14-day mortality was 16% vs 14%; and the in-hospital mortality was similar between groups (39% vs 36%). In the final multivariate models, variables significantly associated with in-hospital mortality were total burn surface area ≥30%, older age, and male sex. Treatment group did not affect the prognosis.

Implications: Therapeutic drug monitoring of antimicrobial treatment did not alter the prognosis of these burn patients. More trials are needed to support the use of therapeutic drug monitoring to optimize treatment in burn patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clinthera.2017.06.008DOI Listing
August 2017

Cost-effectiveness analysis of different dipeptidyl-peptidase 4 inhibitor drugs for treatment of type 2 diabetes mellitus.

Diabetes Metab Syndr 2017 Dec 3;11 Suppl 2:S859-S865. Epub 2017 Jul 3.

Federal University of São João Del-Rei (UFSJ), Brazil. Electronic address:

Introduction: Type 2 diabetes mellitus (T2DM) has burdened health systems in the world to the value of 500 billion dollars/year. Dipeptidyl peptidase 4 inhibitors (DPP-4 Inhibitors) have been strongly associated with spending on the treatment of T2DM by the courts in Brazil. The aim of this study was to estimate the most cost-effective DPP-4 Inhibitor for T2DM treatment. A pharmacoeconomic study of cost-effectiveness was performed in a medium-sized municipality in Minas Gerais state, Brazil.

Methods: The data are from legalization in municipal health in 2013. The effectiveness of DPP-4 Inhibitors was measured by the reduction in glycated hemoglobin (A1c). The direct medical costs of drug and adverse drug reactions were identified. With these data, a cost-effectiveness ratio (CER) and construction of the decision tree for sensitivity analysis were performed.

Results: The representative of the most effective in reducing A1c gliptins was sitagliptin in combination with metformin, it was able to reduce A1c by 1.16% (1.09 to 1.22, CI 95%). The drug with the lowest cost was linagliptin, with a cost per patient/year of US$ 481.42. Sensitivity analysis performed by the decision tree shows that sitagliptin in association with metformin had the CER of US$ 1,506.75 per patient/year, to reduce A1c by 1%.

Conclusion: The most cost-effective DPP-4 Inhibitor was sitagliptin with metformin.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.dsx.2017.07.006DOI Listing
December 2017

[Treatment of Gastroenteropancreatic Neuroendocrine Tumors with 177Lu-DOTA-TATE: Experience of the Portuguese Institute of Oncology in Porto].

Acta Med Port 2016 Nov 30;29(11):726-733. Epub 2016 Nov 30.

Serviço de Medicina Nuclear. Instituto Português de Oncologia. Porto. Portugal.

Introduction: The purpose of this article is to report the experience of the Portuguese Institute of Oncology - Porto in the treatment of gastroenteropancreatic neuroendocrine tumors with 177Lu-DOTA-TATE, regarding the safety and efficacy of this treatment modality.

Material And Methods: A retrospective analysis of clinical reports of patients with gastroenteropancreatic neuroendocrine tumors undergoing treatment with 177Lu-DOTA-TATE between April 2011 and November 2013 was performed.

Results: Thirty six cases were reviewed and 30 completed all 3 cycles of 177Lu-DOTA-TATE (83.3%). In these patients it was registered: acute side effects in 8.9% of cycles; grade 3 CTCAE liver toxicity in 13.3% of patients (all with previous abnormal liver function); absence of significant renal or hematologic toxicity; symptomatic improvement in 71.4% of patients; median overall time to progression of 25.6 months; median overall survival from diagnosis of 121.7 months. Patients with higher expression of somatostatin receptors had longer progression-free survival and overall survival times (p < 0.05).

Discussion: Peptide receptor radionuclide therapy with 177Lu-DOTA-TATE is an effective, safe and well-tolerated treatment, as evidenced in our study by the following findings: symptomatic improvement in most patients and increased time to disease progression and survival (especially in those with higher sstr expression), with acute and significant subacute/chronic side effects reported only in a minority of cases.

Conclusion: Peptide receptor radionuclide therapy with 177Lu-DOTA-TATE is a promising treatment for patients with gastroenteropancreatic neuroendocrine tumors, with demonstrated benefits in terms of safety and efficacy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.20344/amp.7306DOI Listing
November 2016

"To be or not to be Retained … That's the Question!" Retention, Self-esteem, Self-concept, Achievement Goals, and Grades.

Front Psychol 2016 13;7:1550. Epub 2016 Oct 13.

Instituto de Educação, Universidade do Minho Braga, Portugal.

Keeping students back in the same grade - retention - has always been a controversial issue in Education, with some defending it as a beneficial remedial practice and others arguing against its detrimental effects. This paper undertakes an analysis of this issue, focusing on the differences in student motivation and self-related variables according to their retention related status, and the interrelationship between retention and these variables. The participants were 695 students selected from two cohorts (5th and 7th graders) of a larger group of students followed over a 3-year project. The students were assigned to four groups according to their retention-related status over time: (1) students with past and recent retention; (2) students with past but no recent retention; (3) students with no past but recent retention; (4) students with no past or recent retention. Measures of achievement goal orientations, self-concept, self-esteem, importance given to school subjects and Grade Point Average (GPA) were collected for all students. Repeated measures MANCOVA analyses were carried out showing group differences in self-esteem, academic self-concept, importance attributed to academic competencies, task and avoidance orientation and academic achievement. To attain a deeper understanding of these results and to identify profiles across variables, a cluster analysis based on achievement goals was conducted and four clusters were identified. Students who were retained at the end of the school year are mainly represented in clusters with less adaptive motivational profiles and almost absent from clusters exhibiting more adaptive ones. Findings highlight that retention leaves a significant mark that remains even when students recover academic achievement and retention is in the distant past. This is reflected in the low academic self-concept as well as in the devaluation of academic competencies and in the avoidance orientation which, taken together, can undermine students' academic adjustment and turn retention into a risk factor.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpsyg.2016.01550DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5062915PMC
October 2016

Justice judgements, school failure, and adolescent deviant behaviour.

Br J Educ Psychol 2012 Dec 19;82(Pt 4):606-21. Epub 2011 Aug 19.

Research Unit on Cognitive, Developmental and Educational Psychology, ISPA University, Portugal.

Background: The current paper is based on two different approaches. One is the relational model of authority (Tyler & Lind, 1992), which addresses the effects of justice perceptions on the legitimacy of authorities and behavioural compliance. The other is Emler and Reicher's theory (1995, 2005), which explains the involvement of adolescents in delinquency through their relationship with the institutional authorities of society.

Aims: To provide empirical evidence for the linkage of these perspectives, analysing the relationship between justice perceptions about teachers and the involvement of adolescents in deviant behaviour. Our hypotheses are that teachers' justice is negatively related with deviant behaviour and that this relationship is mediated through the evaluation of institutional authorities, after controlling for school failure.

Sample: Three hundred and ninety adolescents aged between 14 and 17 years.

Methods: Participants completed the following scales: perceptions of justice about teachers, evaluation of institutional authorities, and deviant behaviour. Data were examined through correlation and bootstrap analyses.

Results: Justice judgments about teachers were negatively related with deviant behaviour, and this relationship was partially mediated by the evaluation of institutional authorities, even after controlling for school failure. However, procedural justice revealed a much stronger relationship with deviance, compared to distributive justice.

Conclusions: As predicted, these results suggest that when adolescents perceive school authorities as fair, other institutional authorities are likely to be perceived in a similar way and the more those authorities are positively evaluated, the less often adolescents engage in deviant conduct. Results are discussed according to the theories underlying our hypothesis. Directions for future research are suggested.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.2044-8279.2011.02048.xDOI Listing
December 2012
-->