SUMMARY Introduction: An ever increasing number of elderly live with multiple chronic diseases and take several drugs concomitantly. The elderly are subjected to a variety of pharmacodynamic and pharmacokinetic alterations that change the responsiveness of drugs, which makes them potentially inappropriate to use in older people. The aim of this study is to quantitatively assess the prescription pattern of potentially inappropriate medications (PIMs) in different inward clinical services of University Hospital Center of Cova da Beira, Covilhã, Portugal. Methods: We searched the hospital's computerized system database for every patient admitted in previously selected clinical services, from January 1st to June 30th 2018. Patients less than 65 years old were excluded. Data regarding the patients' hospital ID number, their age, prescribed drugs during admission, prescribed dose, frequency, medications' start date and their respective end date were anonymously collected. The patients' medications prescribed during the admission period were assessed, and the PIMs were identified according to Beers Criteria 2015. Results: The benzodiazepines were the most frequently prescribed potentially inappropriate therapeutic drug class in the four clinical services studied, accounting for 29.97% in Medicine 2, 39.96% in Cardiology, 30.21% in Medicine 1 and 41.10% in Pneumology of the total of prescribed PIMs. The antipsychotics were the next most prescribed potentially inappropriate therapeutic drug classes. Intestinal motility modifiers, namely metoclopramide, also had a significant expression. Conclusions: Reconciliation tools such as the Beers Criteria are useful to identify inappropriate prescribing during the pharmaceutical validation of prescription. Further studies will provide more insight into the impact of the pharmacist's intervention.

RESUMEN Introducción: Un número cada vez mayor de ancianos vive con múltiples enfermedades crónicas y toma varios medicamentos concomitantementes. Los ancianos presentan una variedad de alteraciones farmacodinámicas y farmacocinéticas que alteran la respuesta de los fármacos, lo que los hace potencialmente inapropiados para su uso en estos pacientes. El objetivo de este estudio es evaluar cuantitativamente el patrón de prescripción de medicamentos potencialmente inapropiados (PIMs) en diferentes servicios clínicos de hospitalización en el Centro Hospitalario Universitario de Cova da Beira, Covilha, Portugal. Métodos: Se realizó una investigación en la base de datos del sistema informático del hospital para todos los pacientes internados en servicios clínicos previamente seleccionados, del 1 de enero al 30 de junio de 2018. Se excluyeron a los pacientes menores de 65 años. Los datos referentes al número del proceso clínico del paciente, edad, medicamentos prescritos en el momento de la admisión en el hospital, dosis prescrita, frecuencia, fecha de inicio de los medicamentos y sus respectivas fechas finales fueron recolectados anónimamente. Se evaluaron los medicamentos prescritos de los pacientes durante el período de internamiento, y los PIMs se identificaron de acuerdo con los criterios de Beers de 2015. Resultados: Las benzodiazepinas fueron la clase terapéutica medicamentosa potencialmente inapropiada prescrita con mayor frecuencia en los cuatro servicios clínicos estudiados, siendo el 29,97% en la Medicina 2, el 39,96% en la Cardiología, el 30,21% en la Medicina 1 y el 41,10% en la Neumología del total de PIMs prescritos. Los antipsicóticos fueron la segunda clase más prescrita de PIMs. Los modificadores de la motilidad intestinal, en particular la metoclopramida, también tuvieron una expresión significativa. Conclusiones: Las herramientas de reconciliación, como los criterios de Beers, son útiles para identificar prescripciones inadecuadas durante la validación farmacéutica de la prescripción. Otros estudios proporcionarán más información sobre el impacto de la intervención del farmacéutico.

RESUMO A síndrome de granuloma leproide canino (SGLC), também conhecida como lepra canina, é uma doença infecciosa cutânea nodular causada por Mycobacterium sp. Apesar de ser relatada mundialmente, ainda é bastante desconhecida e subdiagnosticada. O diagnóstico pode ser conseguido por citopatologia ou histopatologia de lesões cutâneas, mas a identificação do agente infeccioso é complexa, uma vez que o crescimento in vitro bacteriano não é possível, dependendo de técnicas moleculares como a PCR para confirmar o DNA de Mycobacterium na amostra. Relatou-se um caso da SGLC em Niterói, estado do Rio de Janeiro, Brasil, diagnosticado por citopatologia e submetido à identificação molecular do agente. Foi realizada amplificação por PCR do gene hsp65, que revelou 100% de homologia genética com a cepa M. murphy. Este é o primeiro relato da SGLC com identificação molecular no estado do Rio de Janeiro, o que mostra a importância de se acrescentar a SGLC ao diagnóstico diferencial das doenças granulomatosas de pele nessa região.

ABSTRACT Canine Leproid Granuloma Syndrome (CLGS), also known as canine leprosy, is a cutaneous nodular infectious disease caused by Mycobacterium sp.. Despite being reported worldwide, it is still quite unknown and underdiagnosed. Diagnosis may be achieved by cytopathology or histopathology of skin lesions, but identification of the infectious agent is complex, since bacterial in vitro growth is not possible, relying upon molecular techniques such as PCR to confirm Mycobacterium DNA in the sample. We report a CLGS case in Niteroi, Rio de Janeiro state, Brazil, diagnosed by cytopathology and submitted to molecular identification of the agent. PCR amplification of hsp65 gene was performed and revealed 100% genetic homology to M. murphy strain. This is the first CLGS report with molecular identification in Rio de Janeiro state, and this finding should raise awareness about CLGS as a differential diagnosis among granulomatous skin diseases in this region.