RCAAP Repository

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Information related to adverse effects of antiretroviral therapy can determine non-compliance and future therapeutic options. Evidence based practice includes a focalized clinical question to obtain the better information assessed by the parameters sensitivity and specificity. The main purpose of the work is the optimization of a systematic methodology of research clinical information about adverse effects of antiretroviral therapy, in MEDLINE database, with their identification in the literature and the construction of different search strategies to subsequent comparison of sensitivity and specificity values. A generic search strategy developed to find information related to drug iatrogenicity was considered as a reference to the development of search studied strategies. The results show the known adverse effects of antiretroviral agents that are mainly found in case reports. As the first work that approaches two different concepts simultaneously, adverse effects of antiretro-viral therapy and evidence based medicine approach to search literature, it shows and reinforces the real need for more available information to a better assessment of its quality.

While new more potent and complex pharmaceutical agents are becoming available, increasing demands on doctors and the health care system, the increase of drug related morbidity and mortality throughout the world and rising costs related with the incorrect use of medicines make it clear that the identification of a practitioner who is available to focus on the management of all of a patient’s medicines would be an important asset to the future of human health. Medicines are precious, but patients need to learn how to use them. It is possible that this will be one of the advantages that the pharmacist, as a medicine specialist, will bring to the health system, i.e. the promotion of the rational use of medicines as laid down in legislation. The correct use of medicines will significantly decrease the negative outcomes of phar- macotherapy, namely untreated health problems, ineffective treatment and unsafe treatment.Pharmaceutical care is a patient-centered philosophy of assistential practice in which the pharmacist, as a health care team member, has responsibilities in patient medication. There are pharmaceutical services that monitor the process of the use of medicines from a preventive standpoint, identifying risk factors and acting within their constraints – dispensing, preventable morbidity indicators, medication review – and there are pharmaceutical services that monitor the outcomes from a reactive standpoint, identifying negative clinical outcomes and acting on their causes – pharmacotherapy follow-up, disease management. The clinical pharmacist will have to develop new competencies in communication, information retrieval, critical analysis, ethical behavior, teamwork and leadership. And, more than ever, the clinical pharmacist will have to be technically competent, which requires solid training in cellular biology, biochemistry, anatomophysiology, physiopathology, pharmacology and pharmacotherapy. The assistential pharmacist will have to learn to systematize and to register its action in each type of service carried out. The main barrier that he will have to overcome will be his own mind. This will not only provide new ways of boosting the professional satisfaction of the clinical pharmacist but will also provide concrete answers to the real situations of patients, who will ultimately receive better care. 

Resumo: a responsabilidade penal e contra-ordenacional das organizações ou entes colectivos está prevista no ordenamento jurídico português de um certo modo. A interpretação das respectivas normas jurídicas tem que respeitar a História, a teleologia, mas também o elemento literal da legislação correspondente. Alterar a legislação é um caminho; fazer do juiz legislador é outra coisa diferente. Uma interpretação extensiva equivocada pode significar a violação da Constituição. É preciso separar bem os poderes: legislativo, executivo, judicial. Sem prejuízo da natural interdependência. A Sociologia do Direito não tira o lugar ao Direito. O Direito não tira o lugar à Sociologia do Direito. Fundamental é aprofundar o Estado de Direito social, democrático, livre e verdadeiro. Abstract: the criminal liability and “administrative” offences (Ordnungswidrigkeitengesetz) of collective organizations or entities is provided in Portuguese law in a certain way. The interpretation of the legal rules have to respect history, teleology, but also the literal element of the legislation. Changing the law is one path; making the judge legislator is something else. A mistaken broad interpretation can mean the violation of the Constitution. It takes quite separate powers: legislative, executive, judicial. Notwithstanding the natural interdependence. The Sociology of Law does not take the place of the Law itself. The Law does not take the place of Sociology of Law. Key is to deepen the rule of law, social, democratic, free and true.

The role of pharmacists caring for patients with chronic kidney disease has been documented in the international literature. This study aims at compiling all pharmaceutical services provided to these patients in order to adapt them to the Portuguese reality. Medline, International Pharmaceutical Abstracts, Pharmacy Abstracts and The Cochrane Library were searched for studies describing pharmacist interventions in patients with chronic kidney disease. Ultimately, and after applying the inclusion and exclusion criteria, 37 studies (corresponding to 38 articles) were included and analysed. Pharmacist interventions reported were: performing medication reviews to identify drug-related problems, adjusting and optimising drug therapy, identifying and correcting drug records discrepancies, evaluating admission and discharge medication appropriateness, performing laboratory monitoring of specific parameters, implementing anaemia-managing, phosphate-managing and lipid-managing protocols, performing patient education, improving compliance, participating in medical rounds and multidisciplinary patient care meetings, communicating and interacting with other health care professionals, and providing information about drug selection and therapeutic regimes. In conclusion, a multitude of potential pharmacist interventions in patients with chronic kidney disease was reported in the literature, where pharmacists played a key role in contributing to improve the process of use of medicines and clinical outcomes in these patients. 

Resumo: 1 – Sumário do Acórdão do Supremo Tribunal de Justiça, de 10 de Abril de 2013; 2 – Parte que destacamos no Acórdão do Supremo Tribunal de Justiça, de 10 de Abril de 2013; 3 – Anotação sintética; 3.1 – Introdução à anotação sintética e suas características neste caso concreto; 3.2 – Anotação sintética; 3.2.1 – Anotação sintética: alguns desenvolvimentos formais e materiais no pensamento de Jorge de Figueiredo Dias acerca dos “acordos sobre a sentença em processo penal”; 3.3 - Da Constitucionalidade dos Acordos Sobre Sentença em Processo Penal em Portugal; 4 – Conclusões. Summary: 1 - Summary of the Judgment of the Supreme Court of Justice of 10 April 2013; 2 - Part that we highlight of the Judgment of the Supreme Court of Justice of 10 April 2013; 3 - Short annotation; 3.1 - Introduction to synthetic note and its features in this particular case; 3.2 - Synthetic Note; 3.2.1 - Synthetic Note: some formal and material developments at the thought of Jorge de Figueiredo Dias about the "agreements on the sentence in criminal proceedings"; 3.3 - The Constitutionality of Agreements About Sentence in Criminal Procedure in Portugal; 4. Conclusions.

Aging and illness are not synonymous, but with aging, anatomical and physiological changes occur and make elderly most vulnerable to an onset of various diseases. Anaemia is a hematologic disease quite common in the elderly and has been subdivided into four types, anaemia by nutritional deficiencies, anaemia of chronic inflammation, anaemia of chronic kidney disease and unexplained anaemia. Anemia has many adverse consequences in the elderly, increasing morbidity and mortality. Thus, the appropriate diagnosis and treatment of each type of anaemia allows to minimize these adverse consequences and to improve the quality of life in these patients. The vascular, renal and hematopoietic changes, as well as, the wild chronic proinflammatory state, that are associated with the aging process, in combination with comorbidities and a genetic predisposition, favor the development of anaemia in this population. In this paper we performed a review of the main etiologies associated with anaemia in the elderly, and discusse its pathophysiology. 

Medicine adherence is a qualitative indicator in health systems with the aim of providing a safe and effective care; it is particularly relevant in chronic diseases. Therapeutic strategies currently adopted for the treatment of chronic kidney disease, associated co-morbidities and complications often involve the use of a large number of drugs which affects the patient’s adherence. In fact, the compliance failures in this pathology lead to increased hospitalizations, adverse reactions and progression of the illness. Therefore, evaluation and implementation of strategies for promoting adherence are essential. Pharmacist has a key role in promoting adherence through counseling, behavioral intervention, among other interventions that have being proven effective. In this article we propose an intervention model in renal osteodystrophy in chronic kidney patients in hemodialysis. It ́s a two steps model: evaluation of adherence and intervention of a multidisciplinary team (doctor, pharmacist, nurse, dietitian and social worker) to assess and promote compliance and afterwards follow-up to evaluate the strategy. The target population is chronic kidney disease patients on hemodialysis, with dialysis sessions and on therapy for renal osteodystrophy for more than 6 months and have analytical parameters not controlled. The implementations of a questionnaire/interview allow the assessment of variables (socio-demographic, family-related, with health services and knowledge about the disease, clinical). The methodology to assess adherence proposed is the adaptation of the simplified scale to detect adherence problems. Knowledge of factors allows outlining a program to promoting adherence on non-adherent patients in different levels with interventions recorded in form. The proactive intervention of the pharmacist in chronic kidney patients will lead to a decrease on number of hospitalizations and number of administered drugs, promoting the appropriate use of drugs by the patient and improving clinical outcomes. 

Food and feed contamination represents a major food safety problem due to its implications on human health. Among the various natural contaminants frequently found in food, mycotoxins have gained particular importance in recent years because of their adverse effects. Mycotoxins are secondary metabolites produced by different molds, mainly from Fusarium, Aspergillus and Penicillium genera, which can occur in a wide range of important food commodities, particularly in cereals and derived products, spices, nuts, wine, coffee, etc. Nowadays, hundreds of mycotoxins have been identified, but the most important ones are Aflatoxins, Trichothecenes, Ochratoxins, Zearalenone and its metabolites and Fumonisins, due to their high occurrence and toxicity. These toxins are responsible for a broad range of acute and chronic toxic effects, including carcinogenicity, neurotoxicity as well as reproductive and developmental toxicity. Their presence in crops has, moreover, a strong economic impact worldwide, owing the high percentage of crops lost. Several works revealed a significant contamination degree in a wide variety of matrices, sometimes exceeding the legal established limits. This represents an important public health problem that requires effective monitoring of their presence and the adoption of measures to prevent the entry of these foods in the supply chain. 

The use of Potentially Inappropriate Medication (PIMs) affecting elderly patients is quite prevalent and associated with a high risk of Adverse Drug Reactions (ADRs), morbidity and consumption of health resources. Thus, it is essential to pay special attention to the treatment of geriatric patients, to enhance their security through the establishment of comprehensive measures involving various institutions and health professionals. Beers Criteria concerning the Inappropriate Medication have been used to discuss and to document this issue on different levels including those related to medical care. 

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As interacções entre alimentos e medicamentos ocorrem com alguma frequência e é na população idosa que mais repetidamente acontecem. Os idosos sofrem alterações fisiológicas relacionadas com a idade que podem influenciar a farmacocinética dos fármacos desde a absorção até à eliminação passando pelas etapas de distribuição e de metabolização. Além disso as múltiplas doenças crónicas que muitas vezes apresentam, a polifarmácia a que estão sujeitos e o estado de má nutrição em que frequentemente se encontram, tornam-nos um grupo predisposto para a ocorrência deste tipo de interacções. O estado nutricional é fundamental na resposta a uma terapia farmacológica e consequentemente tem um forte impacto na qualidade de vida do idoso. Assim, no presente artigo, são brevemente descritas algumas interacções entre medicamentos e alimentos, correntemente utilizados por idosos. 

O conhecimento da existência de variações fisiológicas ao longo de um período de 24 horas (variação circadiana) em vários sistemas do organismo humano tem sido explorado por parte da Indústria Farmacêutica no sentido de adaptar a administração de medicamentos de acordo com as necessidades biológicas. Deste modo, estão descritos diversos estudos que demonstram resultados eficazes da aplicação da cronoterapia no controlo de várias doenças (e.g. gastrointestinais, cardiovasculares, respiratórias, no cancro). 

As especificações da qualidade analítica são fundamentais para o fornecimento de informação clinicamente útil. A importância da qualidade e das suas especificações são apresentadas e discutidas nesta artigo bem como uma reflexão sobre diferentes interpretações existentes e as vantagens e desvantagens dos diferentes modelos para obter as especificações de qualidade analítica. 

A infecção por Rotavírus é uma das principais causas de internamento e morte de crianças jovens em rodo o mundo. É responsável pela maior parte das diarreias nas crianças entre os 6 e os 24 meses, sendo que aos 5 anos quase todas as crianças já tiveram um episódio de infecção por Rotavírus. A Organização Mundial de Saúde (OMS) recomenda a inclusão da vacina para o Rotavírus no Plano Nacional de Vacinação de todos os países como forma de prevenção da doença. A par da vacinação, está ainda recomendada a reidratação oral, que permite evitar o internamento, desidratação e morte frequentemente associadas à infecção. 

Estudos recentes demonstram a presença inequívoca de fármacos de utilização humana e veterinária num grande número de ecossistemas aquáticos, tanto marinhos como dulçaquícolas, mas principalmente em efluentes de estações de tratamento de águas residuais. Estas substâncias são importantes do ponto de vista ecotoxicológico, pois possuem um potencial intrínseco de interferir negativamente com alguns aspectos-chaves de organismos aquáticos expostos. Adicionalmente, quando presentes na água de consumo humano, podem colocar questões toxicológicas consideráveis pois não é de destacar totalmente a possibilidade de exercerem efeitos adversos em humanos. A sua acção potencial, tanto em humanos como em organismos selvagens pode ocorrer sobre estruturas biológicas, vias bioquímicas e processos de regulação fisiológicos, com efeitos potenciais imprevisíveis. Este artigo apresenta dados que demonstram a ligação entre a presença de resíduos de fármacos de utilização humana no ambiente e alterações por eles exercidas, indicando que o ciclo de medicamento, tal como o conhecemos, pode requerer uma urgente reflexão, re-análise e medidas preventivas sérias no sentido de eliminar o risco colocado por estes resíduos.

As diferenças de eficácia dos fármacos, bem corno a sensibilidade para os seus efeitos adversos, entre o género masculino e o género feminino, constituem um tema de interesse actual e incontornável numa sociedade em que se pretende que as terapias individualizadas assumam uma importância crescente. No passado, as mulheres foram sub-representadas, ou mesmo excluídas, da participação em estudos clínicos durante o desenvolvimento de novos fármacos, assumindo-se que as diferenças entre o género feminino e masculino na farmacocinética e/ou farmacodinâmica desses novos fármacos não eram relevantes. Essa exclusão era igualmente justificada pela necessidade de uma amostragem muito superior que a inclusão de mulheres nos estudos implicaria. Actualmente, a noção de homogeneidade entre géneros tem vindo a mudar, pelo que as diferenças entre géneros têm vindo a ser consideradas relevantes e com implicações na eficácia e na segurança dos mais variados fármacos. Esta mudança de comportamento não será alheia ao facto de se ter verificado que o risco de reacções adversas a fármacos, no sexo feminino, pode atingir valores 1,5 a 1,7 vezes superiores quando comparado com o sexo masculino. Neste artigo é apresentada uma visão geral do estado actual do conhecimento sobre os mecanismos fisiológicos e moleculares responsáveis por esta variabilidade entre géneros e o impacto que tem relativamente a alguns medicamentos clinicamente relevantes e altamente consumidos em Portugal. 

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A asma assume actualmente uma enorme importância em termos sócio-económicos pela sua cronicidade, prevalência elevada e crescente, custos elevados (directos e indirectos) e mortalidade não desprezível. É uma doença que afecta todas as raças e grupos etários, desde a infância à vida adulta, atingindo ligeiramente mais rapazes do que raparigas antes da puberdade e mais mulheres na vida adulta. Estima-se que atinja cerca de 300 milhões de pessoas em todo o mundo. Em Portugal, os estudos existentes apontam para cerca de 1 milhão de asmáticos, com uma prevalência de 11-12% nas crianças e 6-7% nos adultos. 

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