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1
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Sayuri Rocha Yamashita
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A cross-sectional study in critically ill patients with COVID-19 in an intensive care unit.
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Leader : FRANCINE JOHANSSON AZEREDO
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MEMBRES DE LA BANQUE :
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DIEGO GNATTA
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ADEMIR EVANGELISTA DO VALE
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FRANCINE JOHANSSON AZEREDO
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GUBIO SOARES CAMPOS
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LINDEMBERG ASSUNÇÃO COSTA
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Data: 16 janv. 2023
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Afficher le Résumé
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COVID-19 is a severe acute respiratory syndrome caused by SARS-CoV-2, and in March 2020, it was considered a pandemic. In this context, a multidisciplinary group monitored and investigated clinical and laboratory findings in search of information that would add to the studies of this new virus. Along with changes in conventional infection prevention and control practices, the investigative perspective has adapted studies to the current scenario. This study aimed to describe the clinical and laboratory profile of critically ill patients affected by COVID-19 admitted to an intensive care unit (ICU) using dexamethasone. The methodology used was a cross-sectional study conducted on patients admitted to the ICU of a COVID reference hospital in the city of Salvador, Bahia. Regarding the deaths found, 55% of the patients had a diagnosis of hypertension, 44% had diabetes and/or insulin therapy, 33% had a history of cardiovascular disease (atrial fibrillation and congestive heart failure), and 22% had a history of stroke. Alterations in renal function (creatinine) had the relative risk considered significant. In addition, of the 22 patients listed, 45% (10) had blood infection or pneumonia associated with mechanical ventilation by Acinetobacter baumannii (A. baumannii) in blood cultures and/or tracheal aspirate secretion. We observed that there is a moderate correlation between length of hospital stay and infection by A. baumannii (Spearman's ρ; 0.592; p-value<0.005) and a strong correlation between the number of days on mechanical ventilation and infection by this bacterium (Spearman's ρ; 0.740; p-value <0.001). These data contribute to the etiological description of SARS-CoV-2 infections and suggest that laboratory medicine can also make a relevant contribution to scientific and health knowledge during the first outbreak of COVID-19. Hospitals that receive these patients may be vulnerable to outbreaks of multidrug-resistant organisms, such as A. baumannii . It is worth reflecting on care and operational practices in managing these patients, especially regarding isolation and restriction measures.
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2
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Erlan Canguçu Aguiar
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Use of text messages to promote medication adherence and reduce blood pressure in hypertensive patients: the ESSENCE Study
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Leader : MARCIO GALVAO GUIMARAES DE OLIVEIRA
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MEMBRES DE LA BANQUE :
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ANDRÉ OLIVEIRA BALDONI
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Fabiane Raquel Motter
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MARCIO GALVAO GUIMARAES DE OLIVEIRA
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PABLO DE MOURA SANTOS
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SOSTENES MISTRO
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Data: 20 mars 2023
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Afficher le Résumé
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Introduction: Non-communicable chronic diseases have a great impact on the health system and, among them, systemic arterial hypertension is the most prevalent, being associated with high socioeconomic costs, represented by the high rates of hospitalizations in the Unified Health System (SUS) , due to the loss of work productivity and family income. Despite its diagnosis being considered easy and the broad therapeutic arsenal available, effective blood pressure control and maintenance of the therapeutic regimen have been difficult due, among other factors, to non-adherence to treatment. Although several interventions have been developed to improve adherence to medication treatment, no high-quality evidence was found to support the use of a specific intervention. However, recently, studies have shown that sending text messages (Short Message Service - SMS) as reminders or patient engagement messages has increased adherence to the treatment of patients with chronic diseases, requiring, however, to be deepened through other designs. Objective: The ESSENCE study evaluated the effect of sending text messages with and without a reminder of the time of medication use on adherence to medication treatment and on the reduction of blood pressure in hypertensive patients. Methods: This is a randomized, cross-over, double-blind clinical trial with active control, which included hypertensive patients, aged between 30 and 69 years, monitored at a public community pharmacy. The messages were sent automatically by software and received on the participants' cell phones. Group 1 included patients who received informational text messages about antihypertensives and hypertension control for 90 days. Group 2 included patients who received informational messages associated with reminder messages at the time of each drug dose for 90 days. After a 30-day washout period, the groups were switched and received the interventions for another 90 days. Results: The 157 individuals evaluated had a mean age of 52(8.8) years and most were female (76.4%). No significant difference was found in self-reported adherence within and between groups in the pre- and post-crossover periods. For systolic and diastolic blood pressure, there was a significant reduction in the pre-crossover period, but with no difference when comparing groups. In the post-crossover period, the reduction was not significant in the intra and between groups analyses. Conclusion: Thus, it was possible to observe that there was equivalence of effect between the two interventions for the primary outcomes evaluated. The results point to the possibility of implementing messaging systems in health services.
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3
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Felipe Feistauer Gomes
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EFFECTIVENESS AND SAFETY OF INDUCTION WITH ANTHRACYCLINE AND CYTARABINE IN PATIENTS WITH ACUTE MYELOID LEUKEMIA: RESTROSPECTIVE STUDY IN A PUBLIC CENTER IN SALVADOR/BAHIA
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Leader : LUCIA DE ARAUJO COSTA BEISL NOBLAT
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MEMBRES DE LA BANQUE :
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GENARIO OLIVEIRA SANTOS JUNIOR
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LINDEMBERG ASSUNÇÃO COSTA
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MARCIO GALVAO GUIMARAES DE OLIVEIRA
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MARCO AURELIO SALVINO DE ARAUJO
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Data: 28 avr. 2023
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Afficher le Résumé
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Acute myeloid leukemia (AML) is a heterogeneous aggressive leukemia with poor prognosis. The standard remission induction regimen for medically eligible patients with AML consists of a backbone of cytarabine & an anthracycline (“7+3” therapy). Brazil is a large country with striking differences in in climate, ethnic heterogeneity and socioeconomic factors. This study assessed effectiveness (Eligible to the Next Treatment-ENT CR and suficient performance status to the next treatment, PFS and OS) and security (Early Mortality) of cytarabine and anthracycline (“7 + 3”regimen) in a public health center in Salvador, Brazil. Subgroups analyzed were about FTL3 and NPM1 mutations, leukocytes (>10,000 or <10,000), platelets (>20,000 or <20,000), and transplanted or non-transplanted. It was a retrospective analysis of all the cases of non-promyelocytic AML diagnosed between 2018 and 2022 in the University Hospital Professor Edgar Santos of Federal University of Bahia, after being approved by the Ethics Committee of the hospital. Kaplan-Meier methods were used to determine the median of the time to OS and PFS. A total of 45 patients were analyzed. Median age at diagnosis was 43 years (range, 16-69 years) with 62% females. There were 17.8% and 13.3% patients with FLT3-ITD and NPM1 mutations, respectively. Only 14 patients had karyotype test (85% with normal karyotype). Regarding effectiveness, 52% of patients were eligible for the next therapy after complete remission (consolidation or stem cell transplantation). Refractory patients were 20%. Early (4 weeks) mortality was 28%. The median of PFS and OS were 3.6 and 8.2 months respectively. Patients with FLT3 mutation, platelet < 20.000 and leukocytes < 10.000 had poor outcomes. In AML patients after stem cell transplantation, PFS and OS were, respectively 20 and 43 months. Average waiting time for start induction therapy was 12 days. The outcomes were consistent with the literature, adjusted for the population in question. Even with access to diagnostic tests (not common in Brazilian’s health public centers), patients did not have access to targeted therapies, with the 7+3 regimen being the only treatment for fit patients. To achieve complete remission followed consolidation/transplantation is still the BEST scenarios in AML eligible patients, but the improvement of access to diagnostic and treatment is still an unmet need.
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4
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Dulce Brás Impene Combo
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EVALUATION OF SIMPLIFIED ANTIRETROVIRAL TREATMENT IN A UNIVERSITY HOSPITAL OF SALVADOR, BAHIA
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Leader : LUCIA DE ARAUJO COSTA BEISL NOBLAT
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MEMBRES DE LA BANQUE :
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Michael Ruberson Ribeiro da Silva
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CARLOS ROBERTO BRITES ALVES
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LUCIA DE ARAUJO COSTA BEISL NOBLAT
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PABLO DE MOURA SANTOS
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Data: 4 mai 2023
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Afficher le Résumé
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Introduction: Antiretroviral treatment and adherence to therapy have been the most effective intervention in controlling disease progression, although the human immunodeficiency virus (HIV) remains an important global public health problem. Recent studies have shown that dual therapy improves adherence and clinical outcomes and can potentially decrease toxicity and costs associated with treatment. Objective: To evaluate the virological outcomes of simplified antiretroviral regimens prescribed in a University Hospital in the State of Bahia, Brazil. Methods: This is a retrospective observational cohort conducted at the Magalhães Neto Outpatient Clinic, linked to Professor Edgard Santos University Hospital of the Federal University of Bahia (UFBA). Data were collected from January 2017 to August 2022. We included patients older than 18 years, who had already been submitted to antiretroviral therapeutic regimens in the past, without distinction of sex, and with simplified ART. Data were analyzed using the statistical software JAMOVI, version 2.2.5. Descriptive analyses were performed using frequency tables for categorical variables and median and interquartile range for continuous variables. To analyze the individual association of each qualitative independent variable with the dependent variable, Pearson's chi-square test (significance level of 5%) was used. For the joint association between the independent variables and the dependent variable, the data were analyzed by adjusting a binomial logistic regression model. Results and discussion: We analyzed 244 patients of which 65.2% were male, the median age was 58 years (IQR 50-65), evidencing an aging of PLHIV. Virological suppression corresponded to 98% of the patients, with a median time of 60.50 weeks (IQR 29.25-160.25) and a median of CD4 cells cel/mm3 of 675.00 (IQR 478.50-925.25), moreover, 89.7% of the patients prescribed the DTG+3TC regimen had no history of previous therapeutic failure, while 47.5% of the patients submitted to other therapeutic regimens had already had a history of failure. In addition, 88.1% of the patients did not change simplified regimens, which evidences an effectiveness and therapeutic optimization. Conclusion: The results corroborate the literature, demonstrating a good virological response in simplified regimens, and being a safe and effective alternative even in patients with a history of previous therapeutic failure.
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5
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EVERTON CESAR FIAES SOUZA
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Evaluation of denials of PCDT medication requests for the treatment of chronic kidney disease in the State of Bahia
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Leader : ADEMIR EVANGELISTA DO VALE
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MEMBRES DE LA BANQUE :
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ADEMIR EVANGELISTA DO VALE
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CHARLESTON RIBEIRO PINTO
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LINDEMBERG ASSUNÇÃO COSTA
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PABLO DE MOURA SANTOS
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Data: 9 juin 2023
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The Specialized Component was conceived in 2009 as a strategy within the scope of the National Pharmaceutical Assistance Policy (PNAF) to guarantee sustainable access to medicines for the treatment of a significant number of diseases and illnesses. This Component contains high-tech medications, making it an important drug dispensing strategy for the population. The CEAF Pharmacy located at the Ana Nery Hospital, corresponds to one of these outpatient medication dispensing units, for patients with kidney disease, who receive treatment monthly through the Clinical Protocols and Therapeutic Guidelines (PCDT). This study aimed to identify and describe the challenges of dispensing medications for patients with chronic kidney disease in the specialized component of pharmaceutical care. The study evaluated all patients in the period from January to December / 2019, corresponding to 5,402 patients, residing in 273 municipalities in the State of Bahia. Regarding demographic data, 3038 patients (56.24%) were male and 2364 (43.76%) female, with a mean age of 54 ± 17 years. Of the patients studied, 4681 (86.65%) were able to register and withdraw their medications, while 721 (13.35%) were unsuccessful in approving the inclusion of medications. These drugs rejected, alfaepoetina represented 46.49% (457), followed by ferric hydroxide sucrate 24.62% (242). Tacrolimus and cyclosporine were the two most widely used immunosuppressants in the state, representing 48.97% and 18.89%, respectively. Of the rejections made during the year, 81.99% (806) were associated with clinical parameters in the evaluation of medical examinations and / or prescribed dose, followed by 18.01% (177), performed with administrative problems, such as absence of documents and / or incorrect completion of LME. Of the rejected clinical parameters, we observed that 79.45% of the rejections were related to the absence of clinical parameters required by the Clinical Protocol and Therapeutic Guidelines, followed by 2.44% (24) with the wrong prescribed dose, 0.20% and 0.10 % (1) with allergy to the prescribed medication. Among the rejections related to clinical parameters in the alfaepoetin dispensation, 37.64% (172) of the exams presented hemoglobin dosage above the value determined by the PCDT, followed by 22.98% (105) of the transferrin saturation result. We observed in the study, that 21.02% (37) of the patients presented hemoglobin dosage between 10 g / dl and 11 g / dl, not receiving the medication because it does not comply with the recommended by the PCDT. 36.93% (65) had hemoglobin levels between 11 g / dl and 12 g / dl and 42.05% (74) above 12.1 g / dl. The study concluded that the clinical parameters presented in the results of the medical exams, represented the main challenge in the dispensing of the component's medications, more prevalent in the requests for Alphafapoetin and Ferric Hydroxide Saccharate. The pharmacist played an important role in the evaluation of these requests, avoiding the improper use of medications, facts evidenced in the hemoglobin and transferrin saturation levels presented by the rejected patients, and the use of these medications in these circumstances would increase the risk of death.
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6
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PRISCILA MOREIRA LAUTON
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Adherence to treatment with infliximab in patients with immune-mediated inflammatory diseases treated at an infusion center of a university hospital in Salvador, Brazil
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Leader : PABLO DE MOURA SANTOS
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MEMBRES DE LA BANQUE :
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GENARIO OLIVEIRA SANTOS JUNIOR
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GENOILE OLIVEIRA SANTANA SILVA
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LINDEMBERG ASSUNÇÃO COSTA
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Michael Ruberson Ribeiro da Silva
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PABLO DE MOURA SANTOS
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Data: 6 déc. 2023
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Afficher le Résumé
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Infliximab therapy is effective in controlling symptoms and attaining clinical remission of immune-mediated inflammatory diseases; however, treatment adherence is essential to achieve the therapeutic objective. This study aimed to determine the rate of adherence to infliximab treatment in patients treated at an infusion center at a university hospital. Method: This ambispective cohort study included patients treated at the HUPES infusion center of our university hospital between March 2022 and February 2023. Sociodemographic, clinical, and pharmacotherapeutic data were collected from patients through interviews and medical record reviews using a structured form. The adherence rate was defined as the proportion of days covered in a year. Patients who achieved an adherence rate >80% were considered adherent. Results: The treatment adherence rate was 91.04%. Individuals with inflammatory bowel diseases had a 39.1% higher risk of non-adherence to treatment compared with other patients. Most patients achieved remission or control of the underlying disease activity and had good functional capacities and quality-of-life indices. The main reason for absence on the scheduled date was difficulty traveling to the infusion center.Conclusions: Despite the reported difficulties, treatment adherence was observed to be high. As the study was conducted in a reference unit with multidisciplinary care and continuous monitoring for treatment effectiveness, safety, and adherence, welcoming and good communication between professionals and patients may have contributed to the high adherence rate.
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