The consumption of botanicals for therapeutic purposes has increased significantly in recent years. Drug-induced liver disease (DILI) is a frequent cause of acute liver injury, around 50% in the United States, and about 1% is secondary to the use of phytotherapeuticals and herbal supplies. Ruellia bahiensis, a plant species of the Acanthaceae family, is a tropical plant distributed in Northeastern Brazil. In folk medicine in the state of Bahia, the species is known as “mãe-boa” and is commonly used. L.S.S, a 23-year old, female, patient was admitted at University Hospital of Bahia-Brazil with signs and symptoms of acute hepatitis. She had made daily use of an herbal supply popularly known as “mãe-boa” for at least two years prescribed by a physician. Diagnostic investigation was negative for viral and autoimmune hepatitis, leptospirosis, dengue, and CMV (cytomegalovirus). The patient had to undergo liver transplantation. Explant revealed massive hepatic necrosis. According to histological findings, and after exclusion of other etiologies, liver damage was assigned to herbal supply. The prolonged use of Ruellia bahiensis infusions may have caused the liver dysfunction.

RESUMO CONTEXTO E OBJETIVO: Em 2004, a Agência Nacional de Vigilância Sanitária (ANVISA) publicou uma resolução que estabelece diretrizes para o uso de albumina. Embora os dados publicados não indiquem conclusões definitivas sobre os benefícios do uso de albumina em pacientes com síndrome nefrótica (SN), a diretriz recomenda o procedimento apenas em casos de edema refratário ao uso de diuréticos. O objetivo aqui foi analisar o uso de albumina em pacientes com síndrome nefrótica. TIPO DE ESTUDO E LOCAL: Estudo farmacoeconômico realizado em quatro grandes hospitais públicos de referência em serviços de nefrologia no nordeste do Brasil. MÉTODO: Foram realizadas avaliações econômicas do tipo custo-efetividade e custo-utilidade em uma coorte concorrente de pacientes com síndrome nefrótica, divididos em dois grupos de acordo com o cumprimento ou descumprimento das diretrizes. Dados de qualidade de vida foram obtidos a partir dos questionários SF36 e CHQ-PF50. RESULTADOS: Este estudo incluiu 109 pacientes (60% adultos e 56% mulheres); 41,3% estavam usando albumina conforme as diretrizes. Os parâmetros de peso, diurese e balanço hídrico foram mais custo-efetivos para pacientes que aderiram às diretrizes. Quanto a dias de internação evitados, a razão incremental mostrou um custo diário de R$ 55,33, sendo que os pacientes que seguiram as diretrizes ficaram cinco dias a menos internados. A qualidade de vida melhorou 8%, gerando economia de R$ 3,458.13/QALY (quality-adjusted life year) para o sistema de saúde por meio do cumprimento das diretrizes. CONCLUSÃO: As análises econômicas deste estudo demonstraram maiores benefícios em termos de custo para os pacientes cujo tratamento seguiu as diretrizes.

ABSTRACT CONTEXT AND OBJECTIVE: In 2004, the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária, ANVISA) published a resolution establishing guidelines for albumin use. Although the published data do not indicate any definitive conclusions about the benefits of albumin use in patients with nephrotic syndrome (NS), the guidelines recommend this procedure only in cases of edema that is refractory to use of diuretics. The aim here was to analyze albumin use among patients with nephrotic syndrome. DESIGN AND SETTING: Pharmacoeconomic study conducted in four large public referral hospitals for nephrology services in northeastern Brazil. METHOD: Cost-effectiveness and cost-utility economic evaluations were performed on a concurrent cohort of patients with nephrotic syndrome, who were divided into two groups according to compliance or noncompliance with the guidelines. Quality-of-life data were obtained from the SF36 and CHQ-PF50 questionnaires. RESULTS: This study enrolled 109 patients (60% adults and 56% women); 41.3% were using albumin in accordance with the guidelines. The weight, diuresis and fluid balance parameters were more cost-effective for patients who adhered to the guidelines. Regarding days of hospitalization avoided, the incremental ratio showed a daily cost of R$ 55.33, and guideline-compliant patients were hospitalized for five days or fewer. The quality of life improved by 8%, and savings of R$ 3,458.13/QALY (quality-adjusted life year) for the healthcare system were generated through guideline compliance. CONCLUSION: The economic analyses of this study demonstrated that there were greater cost benefits for patients whose treatment followed the guidelines.

RESUMO OBJETIVO: Identificar, caracterizar e medir a associação de fatores relacionados à qualidade de vida (QV) de pacientes asmáticos sob a perspectiva da farmacoterapia. MÉTODOS: Estudo de corte transversal com 49 pacientes (≥ 18 anos) portadores de asma grave não controlada ou asma refratária, atendidos em um ambulatório especializado do Sistema Único de Saúde, em uso regular de altas doses de corticoides inalatórios (CIs) e/ou de diversos medicamentos e com comorbidades. Obtiveram-se as medidas de QV através da aplicação do questionário Asthma Quality of Life Questionnaire (AQLQ) num único momento. O escore global e dos domínios do AQLQ foram relacionados com variáveis demográficas (gênero e idade), escore do Asthma Control Questionnaire, terapia medicamentosa (dose inicial de CI, dispositivos inalatórios e politerapia) e comorbidades. RESULTADOS: Melhores escores do AQLQ associaram-se com asma controlada - escore global (OR = 0,38; IC95%: 0,004-0,341; p < 0,001) e domínios "sintomas" (OR = 0,086; IC95%: 0,016-0,476; p = 0,001) e "função emocional" (OR = 0,086; IC95%: 0,016-0,476; p = 0,001) - e com dose de CI ≤ 800 µg - domínio "limitação de atividades" (OR = 0,249; IC95%: 0,070-0,885; p = 0,029). Piores escores do AQLQ correlacionaram-se com politerapia - domínio "limitação de atividades" (OR = 3,651; IC95%: 1,061-12,561; p = 0,036) - e com número de comorbidades ≤ 5 - domínio "estímulo ambiental" (OR = 5,042; IC95%: 1,316-19,317; p = 0,015). CONCLUSÕES: Nossos resultados, a importância do tema, e a escassez de estudos sob a perspectiva da farmacoterapia apontam a necessidade da realização de estudos longitudinais para se estabelecer uma relação de causalidade entre os fatores identificados e a QV em pacientes com asma.

ABSTRACT OBJECTIVE: To identify, characterize, and quantify associations of various factors with quality of life (QoL) in patients with asthma, according to the pharmacotherapy employed. METHODS: This was a cross-sectional study involving 49 patients (≥ 18 years of age) with severe uncontrolled or refractory asthma treated at a specialized outpatient clinic of the Brazilian Unified Health Care System, regularly using high doses of inhaled corticosteroids (ICs) or other medications, and presenting comorbidities. At a single time point, QoL was assessed with the Asthma Quality of Life Questionnaire (AQLQ). The overall AQLQ score and those of its domains were correlated with demographic variables (gender and age); Asthma Control Questionnaire score; pharmacotherapy (initial IC dose, inhaler devices, and polytherapy); and comorbidities. RESULTS: Better AQLQ scores were associated with asthma control-overall (OR = 0.38; 95% CI: 0.004-0.341; p < 0.001), "symptoms" domain (OR = 0.086; 95% CI: 0.016-0.476; p = 0.001), and "emotional function" domain (OR = 0.086; 95% CI: 0.016-0.476; p = 0.001)-and with IC dose ≤ 800 µg-"activity limitation" domain (OR = 0.249; 95% CI: 0.070-0.885; p = 0.029). Worse AQLQ scores were associated with polytherapy-"activity limitation" domain (OR = 3.651; 95% CI: 1.061-12.561; p = 0.036)-and number of comorbidities ≤ 5-"environmental stimuli" domain (OR = 5.042; 95% CI: 1.316-19.317; p = 0.015). CONCLUSIONS: Our results, the importance of this issue, and the lack of studies taking pharmacotherapy into consideration warrant longitudinal studies to establish a causal relationship between the identified factors and QoL in asthma patients.

OBJETIVO: Determinar a taxa de adesão ao tratamento padrão com corticóide inalatório em pacientes com asma grave, identificar seus fatores preditores e avaliar a relação entre adesão ao tratamento e os parâmetros de resposta clínica e funcional. MÉTODOS: Coorte prospectiva de pacientes atendidos no Programa de Controle da Asma e da Rinite Alérgica na Bahia, Brasil. O estudo incluiu 160 pacientes com asma grave, acompanhados por um período de 180 dias para medida da adesão (variável dependente) ao corticóide inalatório prescrito. As variáveis independentes foram determinadas na avaliação inicial e durante seis meses através de entrevistas e aplicação de questionário estruturado. Os pacientes registraram em um diário as doses não utilizadas. RESULTADOS: Do total de 160 pacientes, 158 completaram o estudo. A taxa de adesão ao tratamento foi de 83,8%. Dos 158 pacientes, 112 (70,9%) foram considerados aderentes ao tratamento (ponto de corte: 80% de todas as doses administradas). Houve associação significante entre o controle da asma e adesão ao tratamento. Os fatores relacionados a uma baixa adesão foram efeitos adversos, local de residência distante do centro de referência, dificuldade de pagar pelo transporte e regime posológico. Outros fatores, como sintomas depressivos, religião e classe econômica, não tiveram relação com a adesão. CONCLUSÕES: A adesão ao tratamento foi considerada elevada, havendo relação com a resposta clínica ao tratamento em uma amostra de pacientes com asma grave atendidos em um programa público com fornecimento gratuito de medicamentos e atendimento multidisciplinar em unidade de referência.

OBJECTIVE: To determine the rate of adherence to treatment with inhaled corticosteroids in patients with severe asthma, to identify predictive factors for adherence and to evaluate the relationship between adherence to treatment and parameters of clinical and functional response. METHODS: Prospective cohort study of patients enrolled in the Program for the Control of Asthma and Allergic Rhinitis in the state of Bahia, Brazil. The study comprised 160 patients with severe asthma, monitored for 180 days in order to evaluate adherence (dependent variable) to the prescribed inhaled corticosteroid. Independent variables were assessed at baseline and for a six-month follow-up period by means of interviews and the completion of a standardized questionnaire.Patients recorded the missed doses in a diary. RESULTS: Of the 160 patients. 158 completed the study. Adherence rate was 83.8%. Of the 158 patients, 112 (70.9%) were considered adherent (cut-off point: 80% of prescribed doses administered). There was a significant association between asthma control and adherence to treatment.Predictors of poor adherence were adverse effects, living far from the referral center, limited resources to pay for transportation and dose schedule. Other factors, such as depressive symptoms, religion and economic status, were not associated with poor adherence. CONCLUSIONS: Adherence to asthma treatment was high and was associated with the clinical response to treatment, in a sample of patients with severe asthma enrolled in a public program that provides free medication and the assistance of a multiprofessional specialized team in a referral center

OBJECTIVE: To evaluate the frequency of oral antihypertensive medication preceding the increase in blood pressure in patients in a university hospital, the drug of choice, and the maintained use of antihypertensive medication. METHODS: Data from January to June 1997 from the University Hospital Professor Edgard Santos Pharmacy concerning the prescriptions of all inpatients were used. Variables included in the analysis were: antihypertensive medication prescription preceding increase in blood pressure, type of antihypertensive medication, gender, clinical or surgical wards, and the presence of maintained antihypertensive medication. RESULTS: The hospital admitted 2,532 patients, 1,468 in surgical wards and 818 in medical wards. Antihypertensive medication prescription preceding pressure increase was observed in 578 patients (22.8%). Nifedipine was used in 553 (95.7%) and captopril in 25 (4.3%). In 50.7% of patients, prescription of antihypertensive medication was not associated with maintained antihypertensive medication. Prescription of antihypertensive drugs preceding elevation of blood pressure was significantly (p<0.001) more frequent on the surgical floor (27.5%; 405/1468) than on the medical floor (14.3%; 117/818). The frequency of prescription of antihypertensive drugs preceding elevation of blood pressure without maintained antihypertensive drugs and the ratio between the number of prescriptions of nifedipine and captopril were greater in surgical wards. CONCLUSION: The use of antihypertensive medication, preceding elevation of blood pressure (22.8%) observed in admitted patients is not supported by scientific evidence. The high frequency of this practice may be even greater in nonuniversity hospitals.