Clinical applications and methemoglobinemia induced by dapsone

Dapsona é uma sulfona sintética que é utilizada como um antibiótico em seres humanos e animais para prevenir e tratar doenças, incluindo hanseníase, tuberculose, malária, e pneumonia por Pneumocystis carinii e encefalites por Toxoplasma gondii em pacientes com síndrome da imunodeficiência adquirida (AIDS), bem como em doenças anti-inflamatórias como dermatite herpetiforme. No entanto, este fármaco também está associado com vários efeitos adversos, incluindo a hemólise relacionada com a dose, metemoglobinemia, psicose, neuropatia periférica, agranulocitose, anemia aplástica, síndrome de hipersensibilidade, síndrome de sulfona, e outros. Destes efeitos, a metemoglobinemia é o mais comum efeito adverso da dapsona, que leva a anemia funcional e hipóxia celular com sintomas de cianose, dores de cabeça, fadiga, taquicardia, fraqueza e tonturas. Assim, esta revisão sumariza informações relevantes sobre a estrutura, mecanismo de ação, indicação clínica, e reações adversas de dapsona.

Efeito de elementos substitucionais e intersticiais na microestrutura, dureza e módulo de elasticidade de ligas Ti-Nb

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

O uso do peritônio de paca conservado em solução supersaturada de açúcar a 300% ou glicerina a 98% implantados na parede abdominal de ratos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Efeito da aldosterona e da espironolactona na hipertrofia ventricular esquerda em pacientes com doença renal crônica em hemodiálise

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Perfil da farmacoterapia utilizada por idosos institucionalizados: uma análise dos problemas relacionados ao uso de medicamentos em instituições de longa permanência para idosos

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Microdureza e rugosidade superficial do esmalte submetido ao clareamento: uma revisão de literatura

The increasing importance of aesthetic in the Dentistry for the patients and the consumers brought a constant rise in the number of products and procedures to facilitate the confection of the dental bleaching. Concomitantly, thone was a sudden increase in the number of research and publications, in vitro and in vivo, about its possible adverse reactions. Through literature revision this study aims to verify the possible morphologic alterations of the submitted enamel and dentine with different bleaching agents making critical analysis of the results of the current research with relation to the study of the microhardness and superficial roughness.

Intravenous procedural sedation: an alternative in the treatment of patients with intellectual disability

Conscious sedation has become established as an important alternative to general anesthesia (GA) in dental treatment of patients with intellectual disability (ID). Aim: to investigate dental patients undergoing sedation using a mean dose of 0.6 mg/kg intravenous midazolam and the adverse events of sedation in patients with ID. Methods: This study analyzed the records of 163 dental patients with ID aged between 2 and 76 years who had undergone conscious intravenous sedation (CIV) using a mean dose of 0.61 mg/kg of midazolam at Araçatuba Dental School, São Paulo State University, Brazil. The efficacy and complications induced by CIV were evaluated in each subject. Results: CIV was effective for dental treatment in 80% of the cases. A total of 626 dental procedures were performed. The mean treatment time was 33.9 minutes. There was statistically significant difference (p<0.05) between absence and presence of adverse reactions. Adverse reactions were observed in 21.47% of the cases. Conclusions: The results of this study showed that CIV is a useful method for dental treatment of patients with ID and these patients can need higher doses of sedative to reach an adequate level of sedation.

Estudo de segurança de cosméticos: presente e futuro

Cosmetics have been used since ancient times and, recently, their consumption has increased greatly in many countries, including brazil, which is the third largest consumer market in the world. Thus, concern for the safety and efficacy of these products should be heightened, even though these products are rarely related to adverse reactions that damage the health. Brazilian law requires manufacturers to subject their products to safety testing, to assess the possible reactions that could be caused by them (irritation, sensitization, systemic effects). To this end, in general, animals have been used as the experimental model, but this practice is being increasingly controlled, so that the scientific community is looking for alternative tests that do not require experimental in vivo models. Thus, this review aims to describe the main biological assays used to assess the safety of cosmetics, as well as in vitro assays that can replace them.

Role of the clinical pharmacist in detection of drug therapy problemas in critically impatients: experience report

This is an experience report on clinical pharmacy in New York, United States of America, in a teaching hospital, describing the results of drug therapy monitoring in critically ill patients, as well as interventions to solve or prevent identified drug therapy problems. The cross-sectional study was conducted by the clinical staff at the Surgical Intensive Care Unit during August 20th to 24th, 2012. Blood counts, serum levels of certain antibiotics, microbiological cultures and their antibiotic susceptibility, possible drug interactions, dosage of each drug prescribed and the compatibility between the route of administration and pharmaceutical form were assessed daily through review of electronic medical records. Twenty seven patients were followed up and 16 drug therapy problems were identified: Unnecessary drug therapy (seven), adverse drug reaction (four), needs additional drug therapy (two), noncompliance (two) and dosage too low (one). After evaluation, the drug therapy problems and their pharmaceutical interventions were reported to clinical pharmaceutical responsible for the Surgical ICU, as well as the multidisciplinary team. Further, the clinical outcomes were monitored and interventions were classified as to its acceptance. Data demonstrate that clinical pharmacists can contribute to the security and proper use of medications, as the trigger tools for intensive monitoring helps in early detection of drug therapy problems and patient safety.

L'uso dei farmaci antibatterici negli ospedali dell'Emilia-Romagna

Obiettivo Analisi di consumi e costi degli antibiotici sistemici negli ospedali dell’Emilia-Romagna dal 2004 al 2011, con attenzione alla variabilità interaziendale e al significato, in termini di resistenza batterica, dell’aumento di alcuni gruppi terapeutici; Sottoanalisi nei reparti pediatrici, individuando i gruppi terapeutici critici, e valutazione delle reazioni avverse pediatriche da antibiotici segnalate, per il periodo in esame. Metodi I dati di consumo e spesa degli antibiotici sistemici per il periodo 2004-2011 sono stati ottenuti dal database regionale AFO e le giornate di degenza per ogni reparto dal database regionale di dimissione ospedaliera SDO. Le segnalazioni di sospette reazioni avverse da antibiotici tra gennaio 2004 e dicembre 2011 sono state estratte dal database nazionale VigiSegn. Risultati Negli otto anni, il consumo di antibiotici negli ospedali dell’Emilia-Romagna è aumentato del 27% e la spesa del 3%. Il consumo è apparso nettamente superiore nei reparti chirurgici che medici. La prima classe per consumo e spesa sono le penicilline/inibitori delle beta lattamasi. Nei reparti pediatrici, sono stati utilizzati 65 principi attivi diversi e amoxicillina/acido clavulanico è stato il più usato (26% del totale del 2011). Tra gli antibiotici critici, le cefalosporine di terza generazione sono state le più consumate in tutti i reparti pediatrici nel 2011. Tra le molecole il cui uso ospedaliero è vincolato, spiccano il linezolid e la teicoplanina che, comunque, hanno inciso più di tutte nella spesa del 2011 (18% e 15%, rispettivamente). Per la farmacovigilanza, i bambini (3-13 anni) sono stati coinvolti in 23 casi, mentre gli infanti (≤2 anni) solo in 4. L’associazione amoxicillina/acido clavulanico è stata più frequentemente segnalata (n=7), e soltanto 2 casi erano gravi. Conclusioni I risultati mostrano un quadro critico sul massiccio uso delle cefalosporine di terza generazione e sull’incremento del linezolid, da approfondire se per inappropriatezza d’uso oppure per aumento delle resistenze batteriche.

Antigenspezifische DNA-Immunisierung in Kombination mit IDO-kodierenden Plasmiden zur Therapie der experimentellen Typ I-Allergie

Derzeit stellt die allergenspezifische Immuntherapie die einzige nicht allein antisymptomatische Behandlungsform zur langfristigen Therapie von Typ I-Allergien dar, welche grundlegende Änderungen im immunologischen Geschehen induziert. Sie ist jedoch verbesserungswürdig in Bezug auf Behandlungsdauer, Erfolgschancen und Nebenwirkungen. Daher wurde in dieser Arbeit eine Strategie zur Therapie von Typ I-Allergien entwickelt und evaluiert, welche auf der Inhibition allergenspezifischer T-Zellen durch Dendritische Zellen (DC), die selektiv nach DNA-Immunisierung sowohl das relevante Allergen als auch Indolamin 2,3-dioxygenase (IDO) konstitutiv produzieren, basiert. IDO ist ein Enzym aus dem Tryptophan-Stoffwechsel, dessen Produktion durch DC einen lokalen immunsuppressiven Mechanismus induziert und in verschiedenen Situationen mit der Induktion peripherer Toleranz assoziiert ist. Zunächst wurden Plasmide hergestellt, die entweder IDO alleine oder IDO zusammen mit dem Antigen unter der Kontrolle des ubiquitär aktiven CMV- bzw. des DC-spezifischen Fascin-Promotors kodieren. Die Überprüfung der IDO-Expression durch die monocistronischen Plasmide anhand von Transfektionsexperimenten in vitro ergab, dass die IDO-Expression unter der Kontrolle des CMV-Promotors sehr viel stärker ausfiel als unter der Kontrolle des Fascin-Promotors. Nach Transfektion mit den bicistronischen Vektoren, in denen die Transgene für das Antigen und IDO durch eine IRES-Sequenz verbunden waren, war die IDO-Expression jedoch insgesamt sehr schwach. Im Rahmen der Überprüfung der Funktionalität der IDO-Expressionplasmide in vivo unter Verwendung der Genpistole wurden daher lediglich Plasmide getestet, die alleine IDO unter der Kontrolle des CMV-Promotors bzw. des Fascin-Promotors kodieren. Auch in vivo wurde eine stärkere IDO-Expression nach biolistischer Transfektion mit solchen Vektoren beobachtet, in denen der CMV-Promotor zur Expressionskontrolle verwendet wurde. Die Analyse des Einflusses einer Koexpression von IDO auf die durch biolistische Immunisierung mit einem antigenkodierenden Vektor induzierte systemische Immunantwort offenbarte einen inhibitorischer Effekt für den Fall, dass die Antigenproduktion mittels des Fascin-Promotors auf DC fokussiert war und die Expression des koapplizierten IDO-Transgens unter der Kontrolle des CMV-Promotors stand. In diesem Fall wurde eine Reduktion der antigenspezifischen IgG1- und IgG2a-Produktion, eine verringerte Sekretion von IFN-y durch restimulierte Milz- und Lymphknotenzellen sowie eine Reduktion der Zahl antigenspezifischer CD8+ Effektor-T-Zellen nachgewiesen. Im Mausmodell der IgE-vermittelten Typ I-Allergie wurde weiterhin gezeigt, dass nach prophylaktischer biolistischer Vakzinierung unter Verwendung dieser Vektorkombination eine Inhibition der durch die Vakzinierung bedingten antigenspezifischen Th1-Immunantwort ausgelöst wurde. Die Suppression der Th2-Antwort, welche durch Transfektion mit dem Antigenkodierenden Vektor unter Kontrolle des Fascin-Promotors bewirkt wurde, wurde durch Kotransfektion mit den IDO-kodierenden Vektoren aufrecht erhalten.

American Society of Clinical Oncology/American Society of Hematology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer

Purpose To update American Society of Clinical Oncology/American Society of Hematology recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer. Methods An Update Committee reviewed data published between January 2007 and January 2010. MEDLINE and the Cochrane Library were searched. Results The literature search yielded one new individual patient data analysis and four literature-based meta-analyses, two systematic reviews, and 13 publications reporting new results from randomized controlled trials not included in prior or new reviews. Recommendations For patients undergoing myelosuppressive chemotherapy who have a hemoglobin (Hb) level less than 10 g/dL, the Update Committee recommends that clinicians discuss potential harms (eg, thromboembolism, shorter survival) and benefits (eg, decreased transfusions) of ESAs and compare these with potential harms (eg, serious infections, immune-mediated adverse reactions) and benefits (eg, rapid Hb improvement) of RBC transfusions. Individual preferences for assumed risk should contribute to shared decisions on managing chemotherapy-induced anemia. The Committee cautions against ESA use under other circumstances. If used, ESAs should be administered at the lowest dose possible and should increase Hb to the lowest concentration possible to avoid transfusions. Available evidence does not identify Hb levels � 10 g/dL either as thresholds for initiating treatment or as targets for ESA therapy. Starting doses and dose modifications after response or nonresponse should follow US Food and Drug Administration–approved labeling. ESAs should be discontinued after 6 to 8 weeks in nonresponders. ESAs should be avoided in patients with cancer not receiving concurrent chemotherapy, except for those with lower risk myelodysplastic syndromes. Caution should be exercised when using ESAs with chemotherapeutic agents in diseases associated with increased risk of thromboembolic complications. Table 1 lists detailed recommendations. This guideline was developed through a collaboration between the American Society of Clinical Oncology and the American Society of Hematology and has been published jointly by invitation and consent in both Journal of Clinical Oncology and Blood.

American Society of Hematology/American Society of Clinical Oncology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer

Purpose: To update American Society of Hematology/American Society of Clinical Oncology recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer. Methods: An Update Committee reviewed data published between January 2007 and January 2010. MEDLINE and the Cochrane Library were searched. Results: The literature search yielded one new individual patient data analysis and four literature-based meta-analyses, two systematic reviews, and 13 publications reporting new results from randomized controlled trials not included in prior or new reviews. Recommendations: For patients undergoing myelosuppressive chemotherapy who have a hemoglobin (Hb) level less than 10 g/dL, the Update Committee recommends that clinicians discuss potential harms (eg, thromboembolism, shorter survival) and benefits (eg, decreased transfusions) of ESAs and compare these with potential harms (eg, serious infections, immune-mediated adverse reactions) and benefits (eg, rapid Hb improvement) of RBC transfusions. Individual preferences for assumed risk should contribute to shared decisions on managing chemotherapy-induced anemia. The Committee cautions against ESA use under other circumstances. If used, ESAs should be administered at the lowest dose possible and should increase Hb to the lowest concentration possible to avoid transfusions. Available evidence does not identify Hb levels 10 g/dL either as thresholds for initiating treatment or as targets for ESA therapy. Starting doses and dose modifications after response or nonresponse should follow US Food and Drug Administration-approved labeling. ESAs should be discontinued after 6 to 8 weeks in nonresponders. ESAs should be avoided in patients with cancer not receiving concurrent chemotherapy, except for those with lower risk myelodysplastic syndromes. Caution should be exercised when using ESAs with chemotherapeutic agents in diseases associated with increased risk of thromboembolic complications. Table 1 lists detailed recommendations.

The complex clinical picture of side effects to biologicals

Biologicals are proteins used as drugs. Biologicals target clearly defined molecular structures, being part of established pathogenetic pathways. Therefore, their focused mode of action seems to render them superior to classic small molecular drugs regarding "off-target" adverse drug reactions (ADR). Nevertheless, the increasing use of biologicals for the treatment of different diseases has revealed partially unexpected adverse reactions. The often direct interaction of a biological with the immune system provides a clue to most side effects, which have consequently been subclassified, based on pathogenetic principles, into 5 subtypes named alpha, beta, gamma, delta, and epsilon, reflecting overstimulation (high cytokine values, type alpha), hypersensitivity (type beta), immune deviation (including immunodeficiency, type gamma), cross-reactivity (type delta), and nonimmune mediated side effects (type epsilon). This article presents typical clinical manifestations of these subtypes of ADR to biologicals, proposes general rules for treating them, and provides a scheme for a thorough allergological workup. This approach should help in future handling of these often very efficient drugs.

Preference for formulations containing calcium and vitamin D(3) in childhood: a randomized-sequence, open-label trial

Children who experience adverse reactions to cow's milk or who have diseases predisposing them to low bone mass are often prescribed a supplementation of calcium and vitamin D(3), but adherence can be poor. Age-specific preferences for different formulations may exist and at least partially explain poor compliance.