Resumen El caso didáctico relata la situación real de la empresa CVC S.A., del ramo de turismo, que fue fundada en 1972 y cuya primera agencia estaba ubicada en el municipio de Santo André, SP. El dilema gira en torno a una situación provocada por posibles errores contables que incrementaron los resultados de dicha empresa y generaron el pago de compensación variable a los exejecutivos. Se espera que el caso contribuya a la discusión sobre posibles estímulos que generan conflictos de interés y la identificación de herramientas de control interno que minimicen la exposición al fraude contable. La construcción del caso implicó la recolección de datos, a través de internet, de reportajes periodísticos, análisis de notas explicativas, formularios de referencia, informe de los estados financieros auditados e informe de auditoría independiente no auditado, disponibles en los sitios web de la empresa y de la Bolsa de Valores B3. Se recomienda que se utilice en cursos de grado o posgrado en Administración y Contabilidad, así como en disciplinas que aborden los temas de conflicto de intereses y gestión de resultados, como Gobernanza Corporativa, Finanzas Corporativas, Auditoría, Fraude Corporativo o Análisis de Estados Financieros. SA S A S.A. turismo 197 André SP exejecutivos contable datos internet periodísticos explicativas referencia auditado B3 B Contabilidad Corporativa Corporativas Auditoría Financieros S.A 19 1

Abstract This teaching case reports the real situation of CVC S.A., a company operating in the tourism industry. The company was founded in 1972, with its first agency located in the Brazilian city of Santo André (SP). The dilemma of the case refers to accounting failures that boosted the company’s results. and led to payment of bonuses to former executives. This teaching case aims to contribute to the discussion about possible incentives that generate conflicts of interest and the identification of internal control tools that minimize exposure to accounting fraud. The construction of the case involved data collection from the Internet through newspaper reports, analysis of explanatory notes, reference forms, report of audited financial statements, and unverified independent audit reports, available on the company’s and B3’s websites. This teaching case is recommended for undergraduate or graduate programs in Administration and Accounting, in courses addressing conflict of interest and earnings management, such as Corporate Governance, Corporate Finance, Auditing, Corporate Fraud, or Analysis of Financial Statements. SA S A S.A. industry 1972 SP. SP . (SP) companys s results executives fraud notes forms statements B3s Bs B3 B websites Accounting management Governance Finance Auditing Fraud Statements S.A 197 (SP 19 1

Resumo O caso de ensino relata a situação real de uma companhia com atuação no ramo de turismo, que foi fundada em 1972 e teve sua primeira agência localizada no município de Santo André, SP. O dilema dá-se em torno de uma situação causada por possíveis falhas contábeis que elevaram os resultados da companhia CVC S.A. e geraram o pagamento de remuneração variável aos ex-executivos. Espera-se que o caso contribua para a discussão sobre possíveis estímulos que geram conflito de interesses, bem como para a identificação de ferramentas de controle interno que minimizem a exposição a fraudes contábeis. A construção do caso envolveu a coleta de dados na internet por meio de reportagens de jornais, análise das notas explicativas, dos formulários de referência, do relatório das demonstrações financeiras auditadas e do relatório de auditoria independente não auditado, disponíveis nos sites da companhia e da B3. Recomenda-se a sua aplicação em cursos de graduação ou pós-graduação em Administração e Contabilidade, assim como sua utilização em disciplinas que abordem os tópicos “conflito de interesses” e “gerenciamento de resultados”, tais como Governança Corporativa, Finanças Corporativas, Auditoria, Fraude Corporativa ou Análise das Demonstrações Financeiras. turismo 197 André SP dáse dá se SA S S.A exexecutivos. exexecutivos ex executivos. executivos ex-executivos Esperase Espera interesses jornais explicativas referência auditado B3 B Recomendase Recomenda pósgraduação pós Contabilidade gerenciamento resultados, , resultados” Corporativas Auditoria Financeiras 19 1

Resumo O objetivo deste artigo foi analisar a relação entre o conteúdo informacional dos principais assuntos de auditoria (PAA) reportados no Relatório de Auditoria Independente (RAI) e a previsão de analistas financeiros das empresas listadas na B3 S.A. - Brasil, Bolsa, Balcão (B3). As pesquisas que investigaram a relevância dos PAA não analisaram as informações incrementais sobre o auditado, na visão do auditor independente, que possam vir a afetar a previsão dos analistas financeiros. Os achados desta pesquisa evidenciam que os PAA reportados apresentam conteúdo informacional relevante sobre o auditado aos analistas financeiros, melhorando a qualidade das suas previsões. Adicionalmente, observou-se na análise quantílica que os PAA contribuem para um ajuste fino nas previsões dos analistas. Ainda, amplia-se o debate da relação auditor-analista, especificamente quanto à utilidade dos PAA para os analistas financeiros, no tocante à consideração de uso dessas informações nas suas projeções das empresas analisadas, reforçando a busca pela sua melhoria por parte do regulador. A análise foi realizada com base em regressão de mínimos quadrados generalizados [generalized least square (GLS)] e quantílica em 137 companhias não financeiras, utilizando dados de previsões (trimestrais e anuais) de analistas disponíveis na Thomson Reuters Eikon® e informações financeiras na Economatica®. De modo geral, a quantidade e o conteúdo dos itens reportados como PAA se revelaram significantes em relação à previsão do lucro por ação e ao erro das projeções dos analistas, evidenciando redução da assimetria. Assim, quanto maior o valor informativo dos PAA, melhor é a qualidade dessa informação, contribuindo para formar o consenso de previsão de lucro e minimizar o erro das estimativas dos analistas financeiros. Adicionalmente, observou-se que a divulgação dos PAA não tem reflexo imediato sobre a previsão de lucros no trimestre seguinte à sua divulgação, sendo que seu conteúdo informacional é diluído ao longo do exercício seguinte, refletindo na previsão do lucro anual.

Abstract The aim of this article was to analyze the relationship between the informational content of the key audit matters (KAMs) reported in the Independent Audit Report (IAR) and financial analysts’ forecasts for the companies listed on the B3 S.A. - Brasil, Bolsa, Balcão (B3). The research that has investigated the relevance of KAMs has not analyzed the incremental information about the audited firm, from the independent auditor’s viewpoint, that can affect financial analysts’ forecasts. The findings of this research reveal that the KAMs reported present relevant informational content about the audited firm for financial analysts, thus improving the quality of their forecasts. In addition, it was observed in the quantile analysis that the KAMs contribute to the fine tuning of analysts’ forecasts. The debate on the auditor-analyst relationship is also widened, specifically regarding the utility of KAMs for financial analysts, in terms of them considering using this information in their projections for the analyzed companies, thus reinforcing the search for their improvement by the regulator. The analysis was conducted based on generalized least squares (GLS) and quantile regressions covering 137 non-financial companies, using data from (quarterly and annual) analysts’ forecasts available from Thomson Reuters Eikon® and financial information from Economatica®. In general, the quantity and content of the items reported as KAMs were revealed to be significant in relation to the analysts’ earnings per share forecasts and to their forecasting error, revealing a reduction in asymmetry. Thus, the higher the informational value of the KAMs, the better the quality of that information is, contributing to forming an earnings forecast consensus and minimizing the error in the financial analysts’ estimates. In addition, it was observed that the disclosure of KAMs has no immediate reflection in the earnings forecast in the quarter following their disclosure, with their informational content being diluted over the following financial period, impacting the annual earnings forecast.

RESUMO Neste estudo, 308 amostras de fetos mumificados foram testadas para parvovírus suíno (PPV), circovírus suíno tipos 2 e 3 (PCV2 e PCV3) e leptospiras patogênicas. A idade gestacional no momento da perda gestacional e a frequência da mumificação fetal de acordo com a ordem de parto também foram investigadas. As amostras foram coletadas em granjas comerciais de criação de suínos da região sul do Brasil que apresentassem taxas de mumificação fetal igual ou maiores a 2,5%. Fragmentos de pulmão, rim, fígado e coração de fetos suínos mumificados foram coletados para análise molecular. Resultados da PCR foram classificados de acordo com a região de origem das amostras, tendo Santa Catarina, Paraná e Rio Grande do Sul contabilizado 87 (28,25%), 89 (28,90%) e 132 (42,86%) do total de amostras de fetos suínos mumificados, respectivamente. Coinfecções foram observadas na maioria dos casos e PCV3 foi o agente mais prevalente detectado, encontrado em 298 amostras (96,75%). A maioria das perdas gestacionais foi observada entre 50 e 70 dias de gestação (168; 54,5%) e a mumificação fetal não foi associada à ordem de parto das matrizes. Os achados sugerem que as altas taxas de fetos suínos mumificados na região Sul do Brasil podem ser explicadas pela infecção com esses agentes virais.

ABSTRACT BACKGROUND: Brazilian opportunistic screening programs for cervical cancer have limited impact. In the regions of two cities (Campinas and Curitiba) with high human development indices, consistent information from 96-97% of all cervical cancer cases managed within the public healthcare system is available. OBJECTIVE: To estimate the incidence rate (IR) and temporal trends in these regions, covering 2001-2012. DESIGN AND SETTING: A population-based cohort study was conducted under the assumption that all cervical cancer cases were managed in cancer referral center hospitals. METHODS: 3,364 records (1,646 from Campinas; 1,718 from Curitiba) were analyzed to provide estimates of IR, age-standardized IR (ASR) and cervical cancer trends (shown per 100,000 women/year). Longitudinal patterns were analyzed using linear regression and shown as annual percentage change (APC); P < 0.05 for significance. RESULTS: Annual IR and ASR estimates for cervical cancer ranged from 3.8 to 8.0 over 2001-2012, decreasing over more recent years, and were similar for the two regions. The age-specific IR was about 50% lower among women aged 45 years or older (IR-2001/IR-2012: Campinas = 14.8/8.0; Curitiba = 18.7/8.3; P < 0.001). There was an increasing APC trend in Campinas among women aged 15-24 years, and a decreasing IR trend for squamous-cell histology in both regions (P < 0.05). CONCLUSION: Cervical cancer incidence estimates showed slowly decreasing trends in both regions, most evidently for women aged 45 years or older and for squamous-cell histology. These findings reflect the opportunistic nature of the population screening program, despite the comparatively high economic development level in the two regions.

Resumo Objetivo Avaliar as tendências temporais e padrão de diagnóstico de câncer de colo de útero (CCU) através de programa de rastreamento oportunístico em duas regiões brasileiras desenvolvidas, no período de 2001 a 2012. Métodos Estudo observacional com 3.364 registros de câncer (n = 1.646 da região de Campinas e n = 1.718 da região de Curitiba) obtidos de sistemas de registro hospitalar de câncer. Para a região de Campinas foram analisados 1.836 registros adicionais de CIN3/AIS. A análise estatística avaliou os dados agrupados e por região considerando o ano de diagnóstico, grupo etário, estágio de câncer e tipo histológico, e utilizou o teste de tendência Cochran-Armitage com valor p < 0,05. Resultados O total anual de CCU registrado no período de 2001 a 2012 apresentou uma ligeira queda (273 para 244), comidade média de 49,5 anos, 13 amais que a idade média (36,8 anos) para CIN3/AIS. O total de diagnósticos realizados fora da faixa etária oficial de rastreamento foi 20,6% (1,6% abaixo de 25 anos). Houve uma tendência de aumento de casos nas faixas etárias inferior a 25 anos (p = 0,007) e de 25 a 44 anos (p = 0,003) para a região de Campinas. Ambas as regiões apresentaram maior proporção diagnósticos de câncer em estágio III (43% em média), sem modificação de tendência. Houve tendência crescente para diagnóstico em estágio I na região de Campinas (p = 0,033) e da proporção de tipos histológicos glandulares em ambas regiões (p = 0,002), 21,1% para a região de Campinas e 12,5% para Curitiba. Conclusão O número, o padrão e as tendências dos casos registrados de câncer de colo de útero apresentaram modificações pequenas e lentas ao longo do tempo, reflexo da efetividade limitada do programa de rastreio oportunista, mesmo em locais desenvolvidos.

Abstract Objective The aim of this study was to assess the time trends and pattern of cervical cancer diagnosed in the period from 2001 to 2012 by means of an opportunistic screening program from two developed regions in Brazil. Methods An observational study analyzing 3,364 cancer records (n = 1,646 from Campinas and n = 1,718 from Curitiba region) available in hospital-based cancer registries was done. An additional 1,836 records of CIN3/AIS from the region of Campinas was analyzed. The statistical analysis assessed the pooled data and the data by region considering the year of diagnosis, age-group, cancer stage, and histologic type. The Cochran-Armitage trend test was applied and p-values < 0.05 were considered significant. Results The total annual cervical cancer registered from2001 to 2012 showed a slight drop (273-244), with an age average of 49.5 y, 13 years over the average for CIN3/AIS (36.8 y). A total of 20.6% of the diagnoses (1.6% under 25 y) were done out of the official screening age-range. The biennial rate of diagnoses by age group for the region of Campinas showed an increase trend for the age groups under 25 y (p = 0.007) and 25 to 44 y (p = 0.003). Stage III was the most recorded for both regions, with an annual average of 43%, without any trend modification. There was an increasing trend for stage I diagnoses in the region of Campinas (p = 0.033). The proportion of glandular histologic types registered had an increased trend over time (p = 0.002), higher for the region of Campinas (21.1% versus 12.5% for the region of Curitiba). Conclusion The number, pattern and trends of cervical cancer cases registered had mild and slow modifications and reflect the limited effectivity of the opportunistic screening program, even in developed places.

ABSTRACT OBJECTIVE To investigate the HCV cascade of care and to identify the factors associated with loss or absence to follow-up of patients identified as infected with hepatitis C through blood donation. METHODS Blood donors from 1994 to 2012, identified with positive anti- HCV by enzyme immunoassay and immunoblot tests were invited to participate in the study, through letters or phone calls. Patients who agreed to participate were interviewed and their blood samples were collected for further testing. The following variables were investigated: demographic data, data on comorbidities and history concerning monitoring of hepatitis C. Multiple regression analysis by Poisson regression model was used to investigate the factors associated with non-referral for consultation or loss of follow-up. RESULTS Of the 2,952 HCV-infected blood donors, 22.8% agreed to participate: 394 (58.2%) male, median age 48 years old and 364 (53.8%) Caucasian. Of the 676 participants, 39.7% did not receive proper follow-up or treatment after diagnosis: 45 patients referred not to be aware they were infected, 61 did not seek medical attention and 163 started a follow-up program, but were non-adherent. The main reasons for inadequate follow-up were not understanding the need for medical care (71%) and health care access difficulties (14%). The variables showing a significant association with inadequate follow-up after multiple regression analysis were male gender (PR = 1.40; 95%CI 1.15–1.71), age under or equal to 50 years (PR = 1.36; 95%CI 1.12–1.65) and non-Caucasians (PR = 1.53; 95%CI 1.27–1.84). CONCLUSIONS About 40.0% of patients did not receive appropriate follow-up. These data reinforce the need to establish strong links between primary care and reference centers and the need to improve access to specialists and treatments.

ABSTRACT OBJECTIVE To investigate the HCV cascade of care and to identify the factors associated with loss or absence to follow-up of patients identified as infected with hepatitis C through blood donation. METHODS Blood donors from 1994 to 2012, identified with positive anti- HCV by enzyme immunoassay and immunoblot tests were invited to participate in the study, through letters or phone calls. Patients who agreed to participate were interviewed and their blood samples were collected for further testing. The following variables were investigated: demographic data, data on comorbidities and history concerning monitoring of hepatitis C. Multiple regression analysis by Poisson regression model was used to investigate the factors associated with non-referral for consultation or loss of follow-up. RESULTS Of the 2,952 HCV-infected blood donors, 22.8% agreed to participate: 394 (58.2%) male, median age 48 years old and 364 (53.8%) Caucasian. Of the 676 participants, 39.7% did not receive proper follow-up or treatment after diagnosis: 45 patients referred not to be aware they were infected, 61 did not seek medical attention and 163 started a follow-up program, but were non-adherent. The main reasons for inadequate follow-up were not understanding the need for medical care (71%) and health care access difficulties (14%). The variables showing a significant association with inadequate follow-up after multiple regression analysis were male gender (PR = 1.40; 95%CI 1.15–1.71), age under or equal to 50 years (PR = 1.36; 95%CI 1.12–1.65) and non-Caucasians (PR = 1.53; 95%CI 1.27–1.84). CONCLUSIONS About 40.0% of patients did not receive appropriate follow-up. These data reinforce the need to establish strong links between primary care and reference centers and the need to improve access to specialists and treatments.

Objective: this study analyzes the medication errors reported to a pharmacovigilance system by 26 hospitals for patients in the healthcare system of Colombia. Methods: this retrospective study analyzed the medication errors reported to a systematized database between 1 January 2008 and 12 September 2013. The medication is dispensed by the company Audifarma S.A. to hospitals and clinics around Colombia. Data were classified according to the taxonomy of the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). The data analysis was performed using SPSS 22.0 for Windows, considering p-values < 0.05 significant. Results: there were 9 062 medication errors in 45 hospital pharmacies. Real errors accounted for 51.9% (n = 4 707), of which 12.0% (n = 567) reached the patient (Categories C to I) and caused harm (Categories E to I) to 17 subjects (0.36%). The main process involved in errors that occurred (categories B to I) was prescription (n = 1 758, 37.3%), followed by dispensation (n = 1 737, 36.9%), transcription (n = 970, 20.6%) and administration (n = 242, 5.1%). The errors in the administration process were 45.2 times more likely to reach the patient (CI 95%: 20.2-100.9). Conclusions: medication error reporting systems and prevention strategies should be widespread in hospital settings, prioritizing efforts to address the administration process.

Objetivos: analizar los errores de medicación reportados en un sistema de fármacovigilancia en 26 hospitales para pacientes del sistema de salud de Colombia. Métodos: estudio retrospectivo que evaluó las bases de datos sistematizadas de reportes de errores de medicación entre el 1 de enero de 2008 y el 12 de septiembre de 2013 de los medicamentos dispensados por la empresa Audifarma S.A a hospitales de Colombia. Se utilizó la clasificación taxonómica del National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). El análisis de los datos se realizó mediante SPSS 22.0 para Windows Se determinó como nivel de significación estadística una p < 0,05. Resultados: se reportaron 9.062 EM en 45 servicios farmacéuticos hospitalarios. El 51,9% (n = 4.707) de los errores realmente se produjeron, de los cuales el 12,0% (n = 567) afectaron al paciente (categorías C a I) y causaron daño (categorías E a I) a 17 (0,36%). El proceso implicado en los EM ocurridos (categorías B a I) con mayor frecuencia fue la prescripción (n = 1.758, 37,3%), seguido por la dispensación (n = 1.737, 36,9%), la transcripción (n = 970, 20,6%) y, por último, la administración (n = 242, 5,1%). Los errores relacionados con los procesos de administración aumentaban 45,2 veces el riesgo de que el medicamento erróneo afectara al paciente (IC 95% 20,2-100,9). Conclusiones: es necesario aumentar la cobertura de los sistemas de reporte de errores de medicación, y crear estrategias para su prevención, especialmente en la etapa de administración del medicamento.

Avaliou-se o perfil eletrocardiográfico de 50 equinos da raça Quarto de Milha, clinicamente sadios, com idades variando de seis meses a 28 anos, sendo 34 fêmeas e 16 machos. A frequência cardíaca não diminuiu com a idade, e a duração do complexo QRS aumentou ao longo do crescimento do animal. A amplitude das ondas S e T1 foram maiores nos indivíduos machos do que nas fêmeas da raça Quarto de Milha.

An evaluation of the electrocardiographic profile of 50 clinically healthy Quarter Horses, with ages ranging from six months to 28 years old, 34 females and 16 males, was performed. Heart rate has not decreased with age, and duration of the QRS complex increased with the growth of the animal. The amplitude of the S and T1 waves were higher in male subjects than in female Quarter Horses.

Objectives Reducing the occurrence of negative stavudine use-associated outcomes by reporting such risk to doctors responsible for the care of HIV/AIDS patients in Colombia as stavudine has been associated with cumulative and irreversible toxicity. Methods All stavudine users were identified from Audifarma S.A. (drug suppliers) databases (covering about 4.5million people). The risk was then reported to health service providers and the substitution of stavudine for zidovudine or tenofovir was recommended. Results It was found that 1,410 patients registered in the afore mentioned databases were receiving antiretroviral therapy during 2010, of whom 109 (7.5 %) were receiving stavudine; these patients were living in 20 cities and being attended by 19 institutions. Stavudine use became reduced by 94.6 % during the 28 months following the intervention. Zidovudine was the most commonly used replacement drug. Discussion Stavudine was successfully replaced following World Health Organization recommendations aimed at preventing the occurrence of lipodystrophy and the peripheral neuropathy associated with its use.

Objetivos Dado que la estavudina se ha asociado a toxicidad acumulativa e irreversible, se pretendió reducir la aparición de resultados negativos asociados al uso de estavudina mediante la notificación del riesgo a diferentes responsables de la atención sanitaria de pacientes con VIH/SIDA en Colombia. Métodos A partir de la base de datos de dispensación de medicamentos de Audifarma S.A a unos 4,5 millones de personas, se identificaron todos los usuarios de estavudina, se notificó el riesgo a los prestadores del servicio de salud y se recomendó la sustitución por zidovudina o tenofovir. Resultados En 2010 se identificaron 1 410 pacientes en tratamiento antirretroviral, de los cuales 109 (7,5 %) recibían estavudina, distribuidos en 20 ciudades del país y atendidos por 19 instituciones diferentes. Tras la intervención se consiguió en 28 meses reducir su empleo en 94,6 %. El medicamento más empleado en la sustitución fue zidovudina. Discusión Se consiguió exitosamente reemplazar estavudina siguiendo las recomendaciones de la Organización Mundial de la Salud, con lo cual se puede evitar la aparición de lipodistrofia y neuropatía periférica asociada a su empleo.

Objetivos Dado que la estavudina se ha asociado a toxicidad acumulativa e irreversible, se pretendió reducir la aparición de resultados negativos asociados al uso de estavudina mediante la notificación del riesgo a diferentes responsables de la atención sanitaria de pacientes con VIH/SIDA en Colombia. Métodos A partir de la base de datos de dispensación de medicamentos de Audifarma S.A a unos 4,5 millones de personas, se identificaron todos los usuarios de estavudina, se notificó el riesgo a los prestadores del servicio de salud y se recomendó la sustitución por zidovudina o tenofovir. Resultados En 2010 se identificaron 1 410 pacientes en tratamiento antirretroviral, de los cuales 109 (7,5 %) recibían estavudina, distribuidos en 20 ciudades del país y atendidos por 19 instituciones diferentes. Tras la intervención se consiguió en 28 meses reducir su empleo en 94,6 %. El medicamento más empleado en la sustitución fue zidovudina. Discusión Se consiguió exitosamente reemplazar estavudina siguiendo las recomendaciones de la Organización Mundial de la Salud, con lo cual se puede evitar la aparición de lipodistrofia y neuropatía periférica asociada a su empleo.

Objectives Reducing the occurrence of negative stavudine use-associated outcomes by reporting such risk to doctors responsible for the care of HIV/AIDS patients in Colombia as stavudine has been associated with cumulative and irreversible toxicity. Methods All stavudine users were identified from Audifarma S.A. (drug suppliers) databases (covering about 4.5million people). The risk was then reported to health service providers and the substitution of stavudine for zidovudine or tenofovir was recommended. Results It was found that 1,410 patients registered in the afore mentioned databases were receiving antiretroviral therapy during 2010, of whom 109 (7.5 %) were receiving stavudine; these patients were living in 20 cities and being attended by 19 institutions. Stavudine use became reduced by 94.6 % during the 28 months following the intervention. Zidovudine was the most commonly used replacement drug. Discussion Stavudine was successfully replaced following World Health Organization recommendations aimed at preventing the occurrence of lipodystrophy and the peripheral neuropathy associated with its use.

Objetivos: Determinar potenciales interacciones medicamentosas con antidepresivos y otros fármacos que pueden generar problemas relacionados con medicamentos mediante la búsqueda activa en bases de datos de pacientes afiliados al Sistema General de Seguridad Social en Salud. Métodos: Estudio descriptivo a partir de las bases de datos de dispensación de medicamentos de Audifarma S.A. a unos 4 millones de usuarios del pa ís; se hizo una revisión sistemática de potenciales interacciones de antidepresivos entre sí y con anticolinérgicos en los meses de octubre a noviembre y con tramadol durante todo el año 2010. Resultados: Se identificó un promedio mensual de 114.465 usuarios de antidepresivos. De estos, 5.776 (5,0 %) recibían dos antidepresivos simultáneamente y 178 (0,2 %), tres. La combinación más frecuente fue fluoxetina + trazodona (n = 3.235, el 56,9 % de los casos). A unos 1.127 (1,0 %) pacientes se les prescribió de manera simultánea un anticolinérgico. A 2.523 (2,1 %) usuarios se les dispensó al mismo tiempo tramadol, con lo que se elevaba el riesgo de aparición de síndrome serotoninérgico. Conclusiones: Las interacciones medicamentosas representan un riesgo potencial que muchas veces los médicos subestiman. La farmacovigilancia es una herramienta útil para optimizar recursos y prevenir resultados negativos relacionados con la medicación. Se recomienda considerar la búsqueda sistematizada para reforzar los programas de vigilancia de uso racional de medicamentos en el pa ís.

Objectives: To determine the possible drugs interactions with antidepressive agents in data bases of patients in the Health Insurance System of Colombia. Methods: From data bases of about 4 million users in Colombia, a systematic review of drugs dispensation statistics was made to identify drug interactions between antidepressive agents, cholinergic antagonists and tramadol in 2010. Results: We identified 114,465 monthly users of antidepressive agents. Of these, 5776 (5.0 %) received two, and 178 (0.2 %) received three antidepressive agents simultaneously. The most frequent combination was fluoxetine+trazodone (n =3235; 56.9 % of cases). About 1127 (1.0 %) patients were prescribed a cholinergic antagonist simultaneously; 2523 (2.1 %) users were dispensed tramadol at the same time, while raising the risk of serotonin syndrome. Conclusions: Drug interactions represent a potential risk that is often underestimated by physicians. Pharmacovigilance is a useful tool to optimize resources and prevent negative outcomes associated with medication. It is recommended that systematic search is made to enhance surveillance programs for the rational use of medicines in this country.

Objetivos: determinar las posibles interacciones medicamentosas que generen problemas relacionados con medicamentos de seguridad, necesidad o efectividad, mediante la búsqueda activa en bases de datos de pacientes afiliados al Sistema General de Seguridad Social en Salud. Métodos: a partir de las bases de datos de dispensación de medicamentos de Audifarma S.A, a unos 3,7 millones de usuarios del país, se hizo una revisión sistemática de estadísticas de una serie de medicamentos identificados por presentar interacciones. Resultados: del total de pacientes que tomaban omeprazol se encontró que 12,3 % recibían concomitantemente hidróxido de magnesio mas aluminio; 1,7% recibían ranitidina; 1,0% sucralfato, además 0,3% tomaban simultáneamente omeprazol + sucralfato + hidróxido de magnesio y aluminio y 0,4% omeprazol + ranitidina + hidróxido de magnesio y aluminio, que no potencian el efecto antiulceroso o pueden antagonizar sus acciones. También se halló que el 0,2% de pacientes que tomaban verapamilo recibían al mismo tiempo digoxina o metil digoxina con riesgo de aumentar la toxicidad y antagonizar el efecto inotrópico. Todos los casos fueron notificados a los responsables de su atención sanitaria. Discusión: interacciones medicamentosas representan un riesgo potencial, el cual debe ser tenido en cuenta por los médicos prescriptores. La fármacovigilancia permite optimizar recursos y prevenir eventos adversos que puedan potencialmente causar morbilidad o letalidad. Se recomienda considerar la búsqueda en bases de datos para reforzar los programas de vigilancia de uso de medicamentos en el país.

Objectives: to determine the possible medication interactions that generate problems related to safety medications, needs or effectiveness, throughout the active search in data bases of patients affiliated to the General Health System of Social Security. Methods: based on the data base from Audifarma S.A. in regards to the distribution of medications to 3.7 million of users in the country, a systematic review of the statistics of a series of drugs identified for presenting interactions. Results: out of the total of patients that were taking omeprazol, it was found that 12.3% at the same time received magnesium hydroxide plus aluminum; 1.7% received ranitidine; 1.0% sucralfate, and also 0.3% were at the same time taking omeprazol + sucralfate+magnesium hydroxide and aluminum and 0.4% omeprazol + ranitidine+magnesium hydroxide and aluminum, which do not maximize the anti ulcerous effect or may antagonize its actions. It was also found that 0.2% of the patients was taking verapamil and at the same time received digoxin or methyl digoxin with the risk of increasing the toxicity and antagonizing its inotropic effect. All these cases were notified to those responsible for their sanitary attention. Discussion: medication interactions represent a potential risk, which has to be considered by the prescribing doctors. Drug surveillance allows the optimization of resources and the prevention of adverse events which may potentially cause mortality or be lethal. It is recommended that data bases be searched in order to reinforce the surveillance programs in relation to the use of medicines in the country.

Objetivos: determinar as possíveis interações medicamentosas que gerem problemas relacionados com medicamentos de segurança, necessidade ou efetividade, mediante a busca ativa em bases de dados de pacientes afiliados ao Sistema Geral de Seguridade Social em Saúde. Métodos: a partir das bases de dados da dispensa de medicamentos de Audifarma S.A, a 3,7 milhões de usuários do país, se fez uma revisão sistemática de estatísticas de uma série de medicamentos identificados por apresentar interações. Resultados: do total de pacientes que tomavam omeprazol se encontrou que 12,3 % recebiam concomitantemente hidróxido de magnésio mais alumínio; 1,7% recebiam ranitidina; 1,0% sucralfato, e 0,3 % tomavam simultaneamente omeprazol + sucralfato + hidróxido de magnésio e alumínio; 0,4% omeprazol + ranitidina + hidróxido de magnésio e alumínio, que não potenciam o efeito anti-ulceroso ou podem antagonizar suas ações. Também se achou que 0,2% de pacientes que tomavam verapamilo recebiam ao mesmo tempo digoxina ou metil-digoxina com risco de aumentar a toxicidade e antagonizar o efeito inotrópico. Todos os casos foram notificados aos responsáveis de sua atenção sanitária. Discussão: interações medicamentosas representam um risco potencial, que deve ser levado em conta pelos médicos que prescrevem. A fármaco vigilância permite otimizar recursos e prevenir eventos adversos que possam potencialmente causar morbilidade ou letalidade. Se recomenda considerar a busca em bases de dados para reforçar os programas de vigilância de uso de medicamentos no país.

Objetivos Determinar los posibles resultados negativos asociados a la medicación mediante la metodología de búsqueda activa de posibles interacciones medicamentosas en bases de datos de pacientes afiliados al Sistema General de Seguridad Social en Salud. Métodos A partir de las bases de datos de dispensación de medicamentos de Audifarma S.A a unos 4 millones de usuarios del país, se hizo una revisión sistemática de estadísticas de una serie de medicamentos identificados por presentar interacciones de riesgo, dosis diferentes a las recomendadas o dispensación irregular. Los casos son socializados con las EPS responsables. Resultados Se encontró un caso de nefrotoxicidad por ácido zoledrónico; el 37,0 % de los usuarios de clopidogrel recibían concomitantemente omeprazol, que reduce la efectividad del primero; el 29,9 % de los pacientes que toman losartan están recibiendo dosis superiores a las recomendadas para su indicación; el 2,0 % de los pacientes que toman metoprolol o verapamilo, los recibe simultáneamente, con riesgo de generar bradicardia sinusal, bloqueos auriculoventriculares o disfunción sistólica. Todos los casos fueron notificados a los responsables en la EPS que atienden estos pacientes. Discusión La farmacovigilancia activa permite optimizar recursos, prevenir eventos adversos que puedan potencialmente causar morbilidad importante o incluso letalidad o determinar problemas que podrían ser responsables del fracaso terapéutico. Este tipo de estrategia se anticipa a la aparición de posibles riesgos para el paciente por lo que se recomienda considerarla para reforzar los programas de vigilancia de uso de medicamentos en el país.

Objectives Determining negative results associated with medication through an active search of possible drug interactions in databases for patients affiliated to the Colombian general social security/health system. Methods Statistics related to Audifarma S.A. dispensation drug databases for about 4 million Colombian users were systematically reviewed for identifying drugs having known interactions involving risk, doses different from recommended ones or irregular dispensation. The pertinent health-care providing services were made aware of the above. Results There was one case of nephrotoxicity being caused by zoledronic acid. 37 % of clopidogrel users concomitantly received omeprazole which reduces the former's effectiveness. 29.9 % of patients who were taking losartan were receiving doses higher than the recommended ones. 2.0 % of patients who were taking metoprolol or verapamil were simultaneously receiving them, at the risk of generating first-degree heart block, bradycardia, or systolic dysfunction. All these cases were notified to the pertinent health-care services. Conclusions Active pharmacosurveillance leads to resources being optimised, adverse events which can potentially cause morbidity or lethality being prevented or even determining problems which could be responsible for therapeutic failure. This type of strategy anticipates the appearance of possible risks for patients, meaning that drug use monitoring programmes in Colombia should be reinforced.

Objectives Determining negative results associated with medication through an active search of possible drug interactions in databases for patients affiliated to the Colombian general social security/health system. Methods Statistics related to Audifarma S.A. dispensation drug databases for about 4 million Colombian users were systematically reviewed for identifying drugs having known interactions involving risk, doses different from recommended ones or irregular dispensation. The pertinent health-care providing services were made aware of the above. Results There was one case of nephrotoxicity being caused by zoledronic acid. 37 % of clopidogrel users concomitantly received omeprazole which reduces the former's effectiveness. 29.9 % of patients who were taking losartan were receiving doses higher than the recommended ones. 2.0 % of patients who were taking metoprolol or verapamil were simultaneously receiving them, at the risk of generating first-degree heart block, bradycardia, or systolic dysfunction. All these cases were notified to the pertinent health-care services. Conclusions Active pharmacosurveillance leads to resources being optimised, adverse events which can potentially cause morbidity or lethality being prevented or even determining problems which could be responsible for therapeutic failure. This type of strategy anticipates the appearance of possible risks for patients, meaning that drug use monitoring programmes in Colombia should be reinforced.

Objetivos Determinar los posibles resultados negativos asociados a la medicación mediante la metodología de búsqueda activa de posibles interacciones medicamentosas en bases de datos de pacientes afiliados al Sistema General de Seguridad Social en Salud. Métodos A partir de las bases de datos de dispensación de medicamentos de Audifarma S.A a unos 4 millones de usuarios del país, se hizo una revisión sistemática de estadísticas de una serie de medicamentos identificados por presentar interacciones de riesgo, dosis diferentes a las recomendadas o dispensación irregular. Los casos son socializados con las EPS responsables. Resultados Se encontró un caso de nefrotoxicidad por ácido zoledrónico; el 37,0 % de los usuarios de clopidogrel recibían concomitantemente omeprazol, que reduce la efectividad del primero; el 29,9 % de los pacientes que toman losartan están recibiendo dosis superiores a las recomendadas para su indicación; el 2,0 % de los pacientes que toman metoprolol o verapamilo, los recibe simultáneamente, con riesgo de generar bradicardia sinusal, bloqueos auriculoventriculares o disfunción sistólica. Todos los casos fueron notificados a los responsables en la EPS que atienden estos pacientes. Discusión La farmacovigilancia activa permite optimizar recursos, prevenir eventos adversos que puedan potencialmente causar morbilidad importante o incluso letalidad o determinar problemas que podrían ser responsables del fracaso terapéutico. Este tipo de estrategia se anticipa a la aparición de posibles riesgos para el paciente por lo que se recomienda considerarla para reforzar los programas de vigilancia de uso de medicamentos en el país.