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Obreli-Neto P.R.,State University of Maringa | Nobili A.,Laboratory Of Qual Assess Of Geriatric Therapies And Serv And Drug Information Services For The Elderly | De Oliveira Baldoni A.,University of Sao Paulo | Guidoni C.M.,University of Sao Paulo | And 7 more authors.
European Journal of Clinical Pharmacology | Year: 2012

Purpose Although the prevalence of drug-drug interactions (DDIs) in elderly outpatients is high, many potential DDIs do not have any actual clinical effect, and data on the occurrence of DDI-related adverse drug reactions (ADRs) in elderly outpatients are scarce. This study aimed to determine the incidence and characteristics of DDI-related ADRs among elderly outpatients as well as the factors associated with these reactions. Methods A prospective cohort study was conducted between 1 November 2010 and 31 November 2011 in the primary public health system of the Ourinhos microregion, Brazil. Patients aged ≥60 years with at least one potential DDI were eligible for inclusion. Causality, severity, and preventability of the DDI-related ADRs were assessed independently by four clinicians using validated methods; data were analysed using descriptive analysis and multiple logistic regression. Results A total of 433 patients completed the study. The incidence of DDI-related ADRs was 6 % (n030). Warfarin was the most commonly involved drug (37%cases), followed by acetylsalicylic acid (17 %), digoxin (17 %), and spironolactone (17 %). Gastrointestinal bleeding occurred in 37 % of the DDI-related ADR cases, followed by hyperkalemia (17 %) and myopathy (13 %). The multiple logistic regression showed that age ≥80 years [odds ratio (OR) 4.4; 95 % confidence interval (CI) 3.0-6.1, p<0.01], a Charlson comorbidity index ≥4 (OR 1.3; 95 % CI 1.1-1.8, p<0.01), consumption of five or more drugs (OR 2.7; 95 % CI 1.9- 3.1, p<0.01), and the use of warfarin (OR 1.7; 95 % CI1.1-1.9, p<0.01) were associated with the occurrence of DDI-related ADRs. With regard to severity, approximately 37 % of the DDI-related ADRs detected in our cohort necessitated hospital admission. All DDI-related ADRs could have been avoided (87 % were ameliorable and 13 % were preventable). The incidence of ADRs not related to DDIs was 10 % (n044). Conclusions The incidence of DDI-related ADRs in elderly outpatients is high; most events presented important clinical consequences and were preventable or ameliorable. © Springer-Verlag 2012. Source


Neto P.R.O.,State University of Maringa | Vieira J.C.,Faculdades Integradas de Ourinhos | Cuman R.K.N.,State University of Maringa
Acta Scientiarum - Health Sciences | Year: 2011

The indiscriminate use of antimicrobials in primary health care leads to increased bacterial resistance, morbidity, mortality and health expenditures resulting from infectious processes. This study aims to evaluate the impact of a Pharmaceutical Care Program in the rartional use of antimicrobials at a Basic Health Unit in Center-west São Paulo State, Brazil. To that end, a comparative analysis of the pattern of prescription of antimicrobials for a year before and after the implementation of the program was conducted. The data obtained showed that the Pharmaceutical Care Program promoted a reduction in the number of prescriptions containing antimicrobials, the average number of antimicrobials per prescription and the number of prescriptions of these drugs to the same patient in the timeframes of ≤ 7 days and 8 to 30 days. The study also observed a reduction in the prescription of antimicrobials of second choice and with high toxicity, as well as the occurrence of unwanted clinical effects resulting from clinically relevant drug interactions. Therefore, we concluded that the implementation of the Pharmaceutical Care Program in the Basic Health Unit "Cidinha Leite" promoted a significant improvement in the rational use of antimicrobials. Source


Rasmussen L.T.,Sacred Heart University of Brazil | de Labio R.W.,Disciplina Genetica Hemocentro | Gatti L.L.,Faculdades Integradas de Ourinhos | da Silva L.C.,Disciplina de Anatomia Patologica | And 3 more authors.
Memorias do Instituto Oswaldo Cruz | Year: 2010

Helicobacter pylori is an important human pathogen that causes chronic gastritis and is associated with the development of peptic ulcer disease and gastric malignancies. The oral cavity has been implicated as a potential H. pylori reservoir and may therefore be involved in the reinfection of the stomach, which can sometimes occur following treatment of an H. pylori infection. The objectives of this paper were (i) to determine the presence of H. pylori in the oral cavity and (ii) to examine the relationship between oral H. pylori and subsequent gastritis. Gastric biopsies, saliva samples and dental plaques were obtained from 78 dyspeptic adults. DNA was extracted and evaluated for the presence of H. pylori using polymerase chain reaction and Southern blotting methods. Persons with gastritis were frequently positive for H. pylori in their stomachs (p < 0.0001) and there was a statistically significant correlation between the presence of H. pylori in gastric biopsies and the oral cavity (p < 0.0001). Our results suggest a relationship between gastric infection and the presence of this bacterium in the oral cavity. Despite this, H. pylori were present in the oral cavity with variable distribution between saliva and dental plaques, suggesting the existence of a reservoir for the species and a potential association with gastric reinfection. Source


Obreli-Neto P.R.,State University of Maringa | Pereira L.R.L.,University of Sao Paulo | Guidoni C.M.,State University Londrina | De Baldoni A.O.,University of Sao Paulo | And 8 more authors.
PLoS ONE | Year: 2013

Background: Combined oral contraceptive (COC) use is the most commonly used reversible method of birth control. The incorrect use of COCs is frequent and one of the most common causes of unintended pregnancies. Community pharmacists (CPs) are in a strategic position to improve COC use because they are the last health professional to interact with patients before drug use. Objective: To evaluate the COC dispensing practices of CPs in a developing country. Method: A cross-sectional study was conducted in community pharmacies of Assis and Ourinhos microregions, Brazil, between June 1, 2012, and October 30, 2012. Four simulated patients (SPs) (with counseled audio recording) visited community pharmacies with a prescription for Ciclo 21® (a COC containing ethinyl estradiol 30 mcg + levonorgestrel 15 mcg). The audio recording of every SP visit was listened to independently by 3 researchers to evaluate the COC dispensing practice. The percentage of CPs who performed a screening for safe use of COCs (i.e., taking of patients' medical and family history, and measuring of blood pressure) and provided counseling, as well as the quality of the screening and counseling, were evaluated. Results: Of the 185 CPs contacted, 41 (22.2%) agreed to participate in the study and finished the study protocol. Only 3 CPs asked the SP a question (1 question asked by each professional), and all of the questions were closed-ended, viz., "do you smoke?" (n = 2) and "what is your age?" (n = 1). None of the CPs measured the patient's blood pressure. Six CPs provided counseling when dispensing COCs (drug dosing, 5 CPs; possible adverse effects, 2 CPs), and one CP provided counseling regarding both aspects. Conclusion: The CPs evaluated did not dispense COC appropriately and could influence in the occurrence of negatives therapeutic outcomes such as adverse effects and treatment failure. © 2013 Obreli-Neto et al. Source


De Goes Maciel C.D.,Faculdades Integradas de Ourinhos | Hama J.T.,Faculdades Integradas de Ourinhos | De Souza J.I.,Faculdades Integradas de Ourinhos
Pesquisa Agropecuaria Tropical | Year: 2010

A phytosociological analysis was carried out in Ourinhos, São Paulo State, Brazil, in order to evaluate the weed community behavior prevalent in P. notatum Flügge turfgrass, recently installed through sowing. Four evaluations were accomplished, between March and May (2007), after turfgrass and weeds emergence. Through the analysis, 23 weed species were identified, distributed in nine families, pointing out the number of species per family for Poaceae and Malvaceae. The Sida glaziovii (Malvaceae), Cyperus flavus (Cyperaceae), Cyperus rotundus (Cyperaceae), Chamaecrista rotundifolia (Leguminosae), and Cynodon dactylon (Poaceae) species showed the highest relative frequencies; S. glaziovii, Chamaesyce hyrta (Euphorbiaceae), C. flavus, Crotalaria lanceolata (Leguminosae), Sida cordifolia (Malvaceae), and Sida spinosa (Malvaceae) the highest abundance level; and S. glaziovii > C. flavus > C. rotundus > C. rotundifolia > C. dactylon the highest importance value index (IVI). Source

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