Intoxicações por alimentos e bebidas e ocorrência das doenças de transmissão hídrica e alimentar no Brasil

O presente estudo teve como objetivo fazer um levantamento do perfil epidemiológico das notificações por intoxicação e das doenças de transmissão hídrica e alimentar (DTHA) no Brasil, entre 2016 a 2021. Trata-se de um estudo documental com análises quantitativas e descritivas dos dados coletados no Sistema de Informação de Agravos de Notificação - SINAN e Ministério da Saúde. Os resultados mostraram uma diminuição no número de notificações ao longo dos anos, apesar do grande número encontrado em 2017 e 2018. O perfil dos intoxicados entre 2016-2021, foi de indivíduos do sexo masculino (58,3%), com faixa etária 20-59 anos (60,5%) e cor parda (46,6%). Já quanto aos principais agentes etiológicos relacionados aos surtos de DTHA no período analisado, destacou-se a bactéria Escherichia coli (7,9%). A investigação dos dados disponibilizados acerca das intoxicações e DTHA se faz necessária para verificação e monitorização sobre os casos que ocorrem anualmente no Brasil e no mundo.

Avaliação da qualidade de produtos magistrais e fitoterápicos à base de Ginkgo biloba, Passiflora incarnata e Matricaria recutita comercializados no mercado brasileiro e argentino

Os produtos naturais, além de refletir nossa cultura e tradição, representam uma grande participação no mercado de medicamentos. Dentre as plantas mais usadas, estão Ginkgo biloba, Matricaria recutita e Passiflora incarnata. O objetivo desse estudo foi avaliar a qualidade das cápsulas e comprimidos contendo estas plantas, produzidas por farmácias magistrais ou por empresas de fitoterápicos do Brasil e da Argentina, avaliando conforme os parâmetros farmacopeicos e/ou normas vigentes brasileiras. As informações descritas nas embalagens, o peso médio e desvio padrão relativo das cápsulas e comprimidos, análises microscópicas e macroscópicas do seu conteúdo, bem como o perfil fitoquímico por Cromatografia em Camada Delgada e os teores de compostos fenólicos e de flavonoides totais foram avaliados. Nesse estudo foram analisados seis produtos fitoterápicos contendo G. biloba (5 brasileiros e 1 argentino), três à base de M. recutita (todos brasileiros) e cinco contendo P. incarnata (4 brasileiros e 1 argentino).   Observou-se que 100% dos produtos não continham o nome do prescritor, em 21,42% faltavam a posologia e 21,46% estavam fora do limite de variação aceitável de peso médio e desvio padrão relativo. Quanto à qualidade, 28,57% deles podem ter sido fraudados por sofisticação e 7,14% das amostras não foram detectados os compostos bioativos. Os resultados mostraram uma negligência ainda existente em relação aos produtos fitoterápicos. Esse estudo mostra uma falha na garantia da qualidade nas matérias-primas e no desenvolvimento do produto fitoterápico. Essa deficiência pode aumentar a taxa de adulteração nesses produtos, comprometendo a eficácia e segurança dos produtos naturais.

Pyrene-polyethylene glycol-modified multi-walled carbon nanotubes: Genotoxicity in V79-4 fibroblast cells

The genotoxicity of pyrene-polyethylene glycol-modified multi-walled carbon nanotubes (MWCNT-PyPEG), engineered as a nanoplatform for bioapplication, was evaluated. Toxicity was assessed in hamster lung fibroblast cells (V79-4). MTT and Cell Titer Blue methods were used to evaluate cell viability. Genotoxicity was measured by the comet assay and the cytokinesis-block micronucleus cytome (CBMN-Cyt) assay, and fluorescence in situ hybridization (FISH) was used to test induction of structural chromosome aberrations (clastogenic activity) and/or numerical chromosome changes (aneuploidogenic activity). Exogenous metabolic activation enzymes were used in the CBMN-Cyt and FISH tests. Only with metabolic activation, the hybrids caused chromosomal damage, by both clastogenic and aneugenic processes.

Potentially inappropriate medication use in older adults: prevalence and physician knowledge

OBJECTIVE: To analyze the frequency, profile, and additional variables associated with the prescription of potentially inappropriate medications (PIM) to older adults in primary care, and evaluate physicians’ knowledge about these medications. METHODS: A cross-sectional study was conducted based on data from patient records for the period of January 2014 to December 2017 in a city located in the state of Minas Gerais. The frequency of PIM use was evaluated based on the 2019 Beers-Fick criteria. Physician knowledge was evaluated using a validated questionnaire as a primary data source. RESULTS: In a sample of 423 older adults, 75.89% (n = 321) used at least one PIM, the most common of which were medications used to treat central nervous system disorders (48.00%; n = 203). Most participants were female (62.41%; n = 264) and 70 years or older (69.50%; n = 294). When presented with clinical cases illustrating common situations in the management of older patients, 53.33% of physicians (n = 8) answered four or five questions correctly out of a possible seven; 13.33% (n = 2) answered six questions correctly; and 33.33% (n = 5) obtained three correct answers or fewer. CONCLUSIONS: These findings showed a high frequency of PIM use among older adults treated in Primary Health Care settings, with medications used in the treatment of central nervous system disorders. Our results highlight the importance of continuing education for health professionals and improved assessments of the medication available in the Unified Health System (Sistema Único de Saúde; SUS) for use in older adults, especially those taking multiple medications

Deprescribing benzodiazepines: Do Brazilian package inserts address this issue?

OBJECTIVE: To analyze the presence and quality of content on drug deprescribing in Brazilian package inserts for benzodiazepine drugs. METHODS: Documentary study where we analyzed data on deprescribing extracted from electronic package inserts of drugs containing benzodiazepines; these documents were available at the Brazilian Health Surveillance Agency website. Our search was performed independently by 2 researchers who used the following keywords: “deprescription,” “withdrawal,” and “tapering.” The deprescribing plan, when presented by the package insert, was compared to deprescribing protocols for benzodiazepines found in the literature. Moreover, we assessed the presence of guidance on the maximum length of treatment and risks of long-term use. RESULTS: We found 12 package inserts for benzodiazepines and 100% of them suggested gradual withdrawal; only 1 (8.33%) suggested a systematized deprescribing plan. One document (8.33%) did not offer guidance on maximum treatment duration. Eleven (91.67%) had the information on long-term use possibly causing dependence or tolerance, and 1 (8.33%) did not describe the risks of continuous use. CONCLUSIONS: It is known that benzodiazepines should be withdrawn in a gradual and schematized manner, but package inserts do not currently bring this information in detail. It is of utmost importance that health professionals be educated on their conduct, hence the necessity for updating medication package inserts.

Color determination method and evaluation of methods for the detection of cannabinoids by thin-layer chromatography (TLC)

Cannabis sativa is the drug of abuse most cultivated, trafficked, and consumed worldwide. One of several techniques used to detect cannabinoids is based on the thin-layer chromatography (TLC). However, the designation of the colors observed can be inaccurate and not reproducible. The designation of colors goes beyond physical and physiological aspects, because what is conventionally called color is a socio-cultural construction. Thus, the objective of this paper was to evaluate the different TLC methods to detection of cannabinoids, and apply standardization method in naming of colors. TLC analysis performed using silica gel 60 F254 as a stationary phase. Three mobile phase compositions [hexane:chloroform (8:2 v:v), hexane:ethyl ether (8:2 v:v), and chloroform:hexane (8:2 v:v)], as well as, two different solutions of Fast Blue B salt (FBBS, Azoic Diazo No. 48) and Fast Blue RR (FBRR, Azoic Diazo No. 24) were evaluated. Determination of colors names was realized through the Sci-Chromus® software. The best resolution was obtained using hexane:ethyl ether (8:2 v:v) as a mobile phase. It was observed that although the cannabidiol (CBD), delta-9-tetrahydrocannabinol (Δ⁹ -THC), cannabinol (CBN), and cannabigerol (CBG) were detect using both the FBBS- and FBRR-acidified solutions, the best visualization was achieved using the latter reagent. To the best of our knowledge, this is the first study that applied and demonstrated a method for standardization and denomination of colors in the TLC analysis of cannabinoids. This method was able to reduce the subjectivity in naming the colors observed and presented several application possibilities.

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

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.

Cardiovascular drug labeling: Do they have information on necessary precautions for older people?

OBJECTIVE: To analyze the existence of information on drug labeling intended for health professionals on the precaution of cardiovascular drugs use in older people. METHODS: This is a documentary study, carried out with the analysis of data contained in drug labelings. The existence of information on precautions in the use of drugs for older people as described in the 2016 Brazilian Consensus on Potentially Inappropriate Drugs for Older People (Consenso Brasileiro de Medicamentos Potencialmente Inapropriados para Idosos de 2016). RESULTS: Of the 29 drugs belonging to the cardiovascular system group that should be avoided by older people and are available in Brazil, 15 are independent of the clinical condition. Of these fifteen, only three drugs (20%) have explicit information in accordance with the Consensus (methyldopa, digoxin, and spironolactone); two (13.33%) have missing explicit information; four (26.66%) have explicitly discordant information; and six drug labels (40%) were categorized as non-explicit information. Regarding drug precautions according to clinical condition, 14 drugs were included. Of these, 12 (85.71%) have equal contraindications of that of Consensus on their drug labels, however, non-explicit; and two (14.28%) contraindications are missing. CONCLUSION: Most drug labels lack information on the precautions for the use of drugs in older people.

Effective vancomycin concentrations in children: a cross-sectional study

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.

Differential toxicity of Disperse Red 1 and Disperse Red 13 in the Ames test, HepG2 cytotoxicity assay, and Daphnia acute toxicity test

Azo dyes are of environmental concern due to their degradation products, widespread use, and low-removal rate during conventional treatment. Their toxic properties are related to the nature and position of the substituents with respect to the aromatic rings and amino nitrogen atom. The dyes Disperse Red 1 and Disperse Red 13 were tested for Salmonella mutagenicity, cell viability by annexin V, and propidium iodide in HepG2 and by aquatic toxicity assays using daphnids. Both dyes tested positive in the Salmonella assay, and the suggestion was made that these compounds induce mainly frame-shift mutations and that the enzymes nitroreductase and O-acetyltransferase play an important role in the observed effect. In addition, it was shown that the presence of the chlorine substituent in Disperse Red 13 decreased the mutagenicity about 14 times when compared with Disperse Red 1, which shows the same structure as Disperse Red 13, but without the chlorine substituent. The presence of this substituent did not cause cytotoxicity in HepG2 cells, but toxicity to the water flea Daphnia similis increased in the presence of the chlorine substituent. These data suggest that the insertion of a chlorine substituent could be an alternative in the design of dyes with low-mutagenic potency, although the ecotoxicity should be carefully evaluated.

Evaluation of extracts from Coccoloba mollis using the Salmonella/microsome system and in vivo tests

The common everyday use of medicinal plants is an ancient, and still very widespread practice, whereby the need for studies on their possible toxicity and mutagenic properties. The species Coccoloba mollis has been much used in phytotherapy, mainly in cases involving loss of memory and stress. In order to investigate its genotoxic and mutagenic potential, ethanolic extracts from the leaves and roots underwent Salmonella/microsome assaying (TA98 and TA100 strains, with and without exogenous metabolism – S9), besides comet and micronucleus tests in vivo.There was no significant increase in the number of revertants/plate of Salmonella strains in any of the analyzed root-extract concentrations, although the extract itself was extremely toxic to the Salmonella TA98 strain in the tests carried out with S9 (doses varying from 0.005 to 0.5 μg/plate). On the other hand, the leaf-extract induced mutations in the TA98 strain in the absence of S9 in the highest concentration evaluated, although at very low mutagenic potency (0.004 rev/ μg). Furthermore, there was no statistically significant increase in the number of comets and micronuclei, in treatments involving Swiss mice. It was obvious that extracts of Coccoloba mollis, under the described experimental conditions, are not mutagenic.

Elderly and drugs: risks and necessity of rational use

In recent decades, the world has undergone a demographic transformation with a rapid growth of the elderly population, resulting in an increased demand for funds to maintain their health and drug consumption. Pharmacokinetic and pharmacodynamic changes occurring in the elderly can interfere directly in the adverse effects of drugs and increase the risk of intoxication. In addition, there are external factors interfering with the pharmacotherapy of the elderly, such as inappropriate use and the lack of access to information. Many therapeutic classes of drugs should be used with caution or avoided in the elderly population, such as anti-inflammatory and some anti-hypertensive drugs, diuretics and digitalis. If not managed carefully, these medicines can affect the safety and quality of life in the elderly. Thus, the aim of this review was to identify drugs that should be used with caution in elderly patients in order to avoid intoxication and/or adverse drug events.