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Reações adversas a medicamento sem pacientes hospitalizados por insuficiência hepática crônica moderada ou grave em hospitais do Nordeste do Brasil

2026-06-11T17:18:22Z

Título: Reações adversas a medicamento sem pacientes hospitalizados por insuficiência hepática crônica moderada ou grave em hospitais do Nordeste do Brasil Autor(es): Araújo, Breno Queiroz de Abstract: Chronic liver failure (CLF) is characterized by progressive and irreversible loss of liver function, which may lead to alterations in the pharmacokinetics of various medications and increased susceptibility to adverse drug reactions (ADRs). In this context, the clinical pharmacist plays a fundamental role in the prevention, identification, and management of these reactions. This study aimed to characterize the incidence, determinants, and clinical relevance of ADRs in patients hospitalized with moderate to severe CLF in hospitals in the Northeast region of Brazil. This is an observational, analytical, multicenter prospective cohort study that included patients with moderate to severe CLF (Child-Pugh B or C) hospitalized in seven hospitals in Northeast Brazil between September 2023 and January 2026. Daily collection of clinical, laboratory, and pharmacotherapeutic data was performed, with active surveillance of ADRs through medical record review, trigger tools, and reports from the healthcare team and patients. ADRs were coded according to the Medical Dictionary for Regulatory Activities (MedDRA®) and classified regarding causality, severity, and preventability using validated tools. Data analysis was performed using Stata 15®, adopting a significance level of p < 0.05. A total of 252 patients were included, with a predominance of males (59.1%) and a mean age of 59.2 years. Overall, 38.9% of patients experienced at least one ADR, totaling 207 events. The most frequent ADRs involved gastrointestinal, nervous system, and metabolic disorders, with furosemide, lactulose, and carvedilol identified as the main suspected drugs. Most ADRs were classified as probable or possible, of mild severity, and largely preventable. ADRs were associated with longer follow-up time, previous upper gastrointestinal bleeding, and laboratory abnormalities suggestive of hepatic and renal dysfunction, such as elevated urea, bilirubin, and aspartate aminotransferase (AST), as well as hyponatremia. ADRs were also associated with relevant clinical outcomes, including hepatorenal syndrome, prophylactic variceal ligation, acute-on-chronic liver failure, jaundice, and hepatic coma. In conclusion, ADRs are frequent in patients with CLF, many of which are preventable, and are associated with worse clinical outcomes, highlighting the need for rigorous pharmacotherapeutic monitoring and strategies to ensure safe medication use in this population. Tipo: Dissertação

Investigação da relação do polimorfismo de nucleotídeo único (rs187238) no gene da interleucina-18 e do tempo de isquemia fria com a função do enxerto em receptores de transplante renal de um Hospital Universitário de Fortaleza

2026-05-19T19:03:51Z

Título: Investigação da relação do polimorfismo de nucleotídeo único (rs187238) no gene da interleucina-18 e do tempo de isquemia fria com a função do enxerto em receptores de transplante renal de um Hospital Universitário de Fortaleza Autor(es): Duque, Bruna Ribeiro Abstract: Renal dysfunction is a common complication among recipients of organs from deceased donors and can be caused by ischemia-reperfusion injury, which affects the therapeutic success of the transplant. Cold ischemia time (CIT) refers to the period of organ transport, from its removal from the donor to its implantation in the recipient. Prolonged periods of CIT can influence renal graft survival, causing irreversible renal injury. In the search for early biomarkers of renal function, urinary neutrophil gelatinase-associated lipocalin (NGAL) and interleukin-18 (IL-18) may be potential predictors of graft dysfunction. IL-18 is a proinflammatory cytokine that may be involved in modulating the immune response related to acute kidney injury. The single nucleotide polymorphism rs187238 (-137G/C), located in the gene for this interleukin, is known to cause an increase in the expression of this cytokine, which may influence the individual's inflammatory profile. The present study sought to investigate the influence of the rs187238 polymorphism and CIT on graft function in kidney transplant recipients. The work is structured in three articles. The first is a narrative review on the influence of CIT on delayed graft renal function. The other articles are cross-sectional studies including renal allograft recipients from a university hospital in Fortaleza between 2023 and 2025. These studies evaluated the influence of CIT, urinary IL-18 levels, and rs187238 polymorphism genotypes on graft renal function one month after transplantation. It was observed that prolonged periods of cold ischemia are related to longer hospital stays and graft renal dysfunction, reflected in higher serum creatinine levels, lower estimated glomerular filtration rate (eGFR), and higher urinary NGAL levels. Urinary IL-18 levels and rs187238 polymorphism genotypes had no influence on clinical parameters of renal function one month post-transplant. It is concluded that urinary IL-18 is not characterized as a biomarker of renal injury in this period, and its rs187238 polymorphism did not impact the markers of renal function of the allograft. In addition, the findings demonstrate that CIT can determine the patient's prognosis and the therapeutic success of the transplant. Tipo: Dissertação

Avaliação do conhecimento sobre metotrexato e da adesão ao tratamento em pacientes ambulatoriais com artrite reumatóide: das análises e correlações a uma estratégia educativa

2026-04-17T13:07:03Z

Título: Avaliação do conhecimento sobre metotrexato e da adesão ao tratamento em pacientes ambulatoriais com artrite reumatóide: das análises e correlações a uma estratégia educativa Autor(es): Andrade, Samylia Mota de Abstract: Rheumatoid arthritis (RA) is a chronic inflammatory disease that can affect extra-articular joints. The prevalence of RA in Brazil ranges from 0.2% to 1% and is three times more prevalent in middle-aged women. The objective of this study was to analyze knowledge about methotrexate (MTX) and medication adherence in RA. This was a cross-sectional and prospective study with collection of sociodemographic and clinical data, adherence to rheumatoid arthritis treatment using the Brazilian version of the Compliance Questionnaire Rheumatology (bCQR) and assessment of knowledge about MTX with the Methotrexate Questionnaire (bMTXQ). The sample consisted of 69 patients, with a mean age of 55.11 years and a predominance of females (95.65%). Most participants had been diagnosed with RA for ten years or more (49.28%) and had a family history of the disease (65.22%). Systemic arterial hypertension (47.83%) and diabetes mellitus (27.54%) were the most prevalent comorbidities. The analysis of adherence revealed that 62.3% of patients presented satisfactory adherence, while 37.7% were classified as having unsatisfactory adherence. The knowledge assessment showed that only 18.84% of participants answered all the essential questions for the safe use of the medication correctly. Critical items presented low accuracy rates, such as interaction with trimethoprim (23.99%), hematologic risk (28.99%) and maximum recommended weekly dose (44.93%). The analysis identified a significant association between essential knowledge about MTX and adherence to treatment (p=0.013). Patients with better knowledge demonstrated greater adherence to therapy. In addition, the presence of caregivers was associated with a higher level of knowledge about MTX (p=0.027), suggesting the positive impact of support on therapeutic management. However, the correlation between knowledge and adherence, although positive, was considered weak (r=0.210; p=0.084), indicating the influence of other factors on adherence. The correlation between knowledge about methotrexate and patient adherence to therapy showed that the level of adherence was more satisfactory when the results of knowledge about methotrexate were also higher, which corroborates data from the literature that knowledge about the treatment, such as its risks and benefits, can increase adherence and obtain better results in therapy. The literature reinforces that educational actions improve adherence and reduce the risk of treatment discontinuation. Thus, this study highlights the need for continuous, personalized and accessible educational interventions to optimize the management of RA and the safety of MTX use. Tipo: Dissertação

Cuidado farmacêutico em terapia intensiva: avaliação de dez anos de recomendações farmacêuticas

2026-03-31T17:46:00Z

Título: Cuidado farmacêutico em terapia intensiva: avaliação de dez anos de recomendações farmacêuticas Autor(es): Furtado, Ingrid Peixoto Abstract: Clinical Pharmacy is the area of pharmacy where pharmacists provide patient care in order to optimize pharmacotherapy and promote the rational use of medications through the provision of pharmaceutical services (PS), which are essential in a hospital unit, especially in Intensive Care Units (ICU) where clinical and therapeutic complexity increases the risk of medication-related problems (MRP). MRP can be solved through pharmaceutical recommendations (PR) made during the provision of PS. A crosssectional, descriptive, retrospective, single-center study was conducted to evaluate the PR performed in the clinical ICU of a teaching hospital in the state of Ceará. Information regarding PR performed from January 2015 to December 2024 was collected from the service's database.Study approved by the ethics committee under number: 7.994.509. A total of 18.017 PR were performed on 1.439 patients, with an average of 12.5 PR per patient and an overall acceptance rate of 90.1%. The most frequent MRP were "necessary medication not prescribed" (21.1%), followed by "unnecessary medication prescribed" (15.5%). The most frequently performed PR were "medication inclusion" (21.1%) and "dose (adequacy)" (19.4%). Regarding the most involved drug class (ATC level 1), antiinfectives for systemic use received (33,3%), followed by alimentary tract and metabolism (18,8%), with vancomycin being the main drug (8.5%), followed by potassium chloride (4.5%) and meropenem (4.3%). During the COVID-19 period, the main MRP found for patients admitted to beds exclusively designated for patients with this disease were "necessary medication not prescribed" 19.9% and "dilution/reconstitution" 11.6%, and the PR were "inclusion of medication" 19.9% and "dose (adequacy)" 19.0%. The most frequently involved drug class (ATC level 1) was antiinfectives for systemic use (41.3%), with vancomycin (10.4%) and hypromellose/dextran (8.2%) being the most involved medications. These results demonstrate the fundamental role of the pharmacist in the ICU in resolving MRP, contributing significantly to patient safety and the optimization of pharmacotherapy. The high number of PR and the high acceptance rate demonstrate the consolidation and relevance of pharmacy services, even in challenging scenarios such as during the COVID-19 pandemic, reinforcing their essential role in the multidisciplinary team. Tipo: Dissertação