Anemia is an inevitable complication of hemodialysis, and the primary cause is erythropoietin deficiency. After diagnosis, treatment begins with an erythropoiesis-stimulating agent (ESA). However, some patients remain anemic even after receiving this medication. This study aimed to investigate the factors associated with resistance to recombinant human erythropoietin therapy with epoetin alfa (αEPO). We performed a prospective, longitudinal study of hemodialysis patients receiving treatment with αEPO at our reference hospital from July 2015 to June 2016. Clinical data was collected, and the response to αEPO treatment was evaluated using the erythropoietin resistance index (ERI). The ERI was defined as the weekly weight-adjusted αEPO dose (U/kg per week)/hemoglobin level (g/dL). A longitudinal linear regression model was fitted with random effects to verify the relationships between clinical and laboratory data and ERI. We enrolled 99 patients (average age, 45.7 (±17.6) years; male, 51.5%; 86.8% with hypertension). The ERI showed a significant positive association with serum ferritin and C-reactive protein, percentage interdialytic weight gain, and continuous usage of angiotensin receptor blocker (ARB) hypertension medication. The ERI was negatively associated with serum iron and albumin, age, urea reduction ratio, and body mass index. Our findings indicate that resistance to αEPO was related to a low serum iron reserve, an inflammatory state, poor nutritional status, and continuous usage of ARBs.

Anemia is a frequent complication of chronic kidney disease, and its primary cause is erythropoietin deficiency. After diagnosis, treatment begins with administration of an erythropoiesis-stimulating agent (ESA). However, some patients present with resistance to ESA, which needs to be reversed, as it can increase the risk of death in patients with kidney disease. Therefore, we provide a discussion of the current literature regarding the factors that can modify the response to this class of drugs and the strategies that can be considered to optimize the benefits of treating anemia.

supplementation promotes improvement of chronic diarrhea of unknown etiology in patient with chronic kidney disease and provides better outcomes in dialysis.

Epidemiological studies have demonstrated that the variability of the clinical response to infection caused by Mycobacterium leprae is associated with host genetic factors. The present study investigated the frequency of human leukocyte antigen (HLA) class II (DRB1) alleles in patients with leprosy from São Luís, Maranhão, Brazil. A case-control study was performed in 85 individuals with leprosy and 85 healthy subjects. All samples were analysed via polymerase chain reaction-sequence specific oligonucleotide probes. The HLA-DRB1*16 allele showed a higher frequency in the group with leprosy [(9.41% vs. 4.12%) odds ratio (OR) = 2.41 95% confidence interval (CI) (0.96-6.08) p = 0.05], whereas the HLA-DRB1*11 allele was less frequent in the group with leprosy [(6.47% vs. 11.76%) OR = 0.51 95% CI (0.23-1.12) p = 0.09]. The frequency of HLA-DRB1* alleles between the control group and leprosy patient subgroups presenting different forms of the disease showed that the HLA-DRB1*16 (16.13% vs. 8.24%, OR = 4.10, CI = 1.27-13.27, p = 0.010) and HLA-DRB1*14 (5% vs. 3.53%, OR = 4.63, CI = 1.00-21.08, p = 0.032) alleles were significantly more frequent in patients with different clinical subtypes of leprosy. The sample size was a limitation in this study. Nevertheless, the results demonstrated the existence of a genetic susceptibility associated with the clinical forms of leprosy. The low frequency of the HLA-DRB1*11 allele should be further studied to investigate the possible protective effect of this allele.

The objective was to evaluate the association between nutritional status and the glomerular filtration rate (GFR) in remaining quilombolas. Cross-sectional study carried out on 32 remaining quilombola communities in the municipality of Alcântara-MA. The nutritional indicators (IN) used were: body mass index (BMI); Waist circumference (WC); Waist-to-hip ratio (WHR); Waist-to-height ratio (WHtR); conicity index (CI) and estimated visceral adipose tissue (VAT). GFR was estimated from the CKD-EPI creatinine-cystatin C formula. The Shapiro Wilk test was used to evaluate the normality of the quantitative variables. In order to compare the second IN sex, the chi-square test was applied. The Anova or Kruskal-Wallis tests were used to verify the association between IN and GFR. Of the 1,526 remaining quilombolas studied, 89.5% were black or brown, 51.2% were women, 88.6% belonged to economic classes D and E and 61.2% were farmers or fishermen. Clinical investigation revealed 29.2% of hypertensive patients, 8.5% of diabetics and 3.1% with reduced GFR. The BMI revealed 45.6% of the remaining quilombolas with excess weight. When compared to men, women presented a higher prevalence of overweight by BMI (56.6% vs 33.8%, p <0.001) and abdominal obesity CC (52.3% vs 4.3%), WHR (76,5% vs 5.8%), WHtR (82.3% vs 48.9%) and VAT (27.1% vs 14.5%) (p <0.001). Comparing the means of IN according to the GFR, it was observed that the higher the mean value of the IN lower the GFR (p <0.05). The GFR reduced with increasing mean values of nutritional indicators of abdominal obesity, regardless of sex.

As neoplasias hematológicas apresentam elevado potencial de dano sistêmico ao indivíduo, sendo capazes de desencadear sérias condições de saúde. A quimioterapia antineoplásica continua sendo uma das principais abordagens utilizadas no tratamento dessas neoplasias, no entanto, ainda é reconhecida por desencadear reações adversas importantes e que interferem na qualidade de vida do paciente. Dessa maneira, o estudo proposto destinou-se analisar o perfil e impacto de reações adversas à quimioterapia em pacientes onco-hematológicos em tratamento, reconhecendo as intervenções que são necessárias para otimizar a terapia farmacológica. A pesquisa configurou-se como um estudo analítico longitudinal prospectivo, realizado através de entrevista e coleta de dados sociodemográficos, clínicos e laboratoriais de pacientes na clínica de onco-hematologia de um hospital público de referência em tratamento do câncer no Maranhão. Os resultados evidenciaram repercussões no sistema hematopoético, principalmente em mulheres, e o maior índice de reações encontradas foram àquelas relacionadas ao sistema gastrointestinal, dermatológico, muscoesquelético, neurológico e psiquiátrico. Dados os resultados encontrados, foram sugeridas formas de manejo para cada reação, uma vez que, identificar e aplicar formas adequadas de manejo dessas reações possibilita otimizar a terapia oncológica e consequentemente tornar essa terapia mais segura, sustentável e eficaz.   O farmacêutico é um profissional essencial nesse cuidado ao solucionar problemas relativos à medicamentos contribui de forma integral para a qualidade de vida do paciente.

Objective: To evaluate the impact of the application of the FASTHUG-MAIDENS mnemonic by clinical pharmacists to optimize critically ill patients’ pharmacotherapy. Methods: Cross-sectional study performed on an adult intensive care unit of an University Hospital, between august and november 2019, where 155 patients were followed by three clinical pharmacists during hospital stay. Patients who stayed less than 24 hours in the hospital or whose stay was during weekends or holidays were excluded. The interventions were performed together with a multidisciplinary team using FASTHUG-MAIDENS, as well as technical analysis of medical prescription and patients’ clinical evaluation. The clinical evaluation included analysis of laboratory tests, nursing records and medical prescription, all registered in an institutional spreadsheet. The pharmaceutical interventions were registered in the pharmaceutical section of both physic and electronic medical records, and the data were later evaluated, classified, and submitted to descriptive analytical analysis. Results: 1.145 pharmaceutical interventions were performed, with an acceptance rate of 99,3%. The number of pharmaceutical interventions were increased by 104,4% with the application of the FASTHUG-MAIDENS mnemonic, compared to the period before the research. The main interventions performed were: inclusion of a drug (25,2%), exclusion of a drug (17,9%), dose adjustment (12,2%), change of the administration timetable to avoid intravenous incompatibility (11,4%), inclusion of infusion rate (7,3%), dilution adequacy (5,8%), inclusion of reconstitution (3,5%), microbiological culture request (3,4%), drug interaction monitoring (2,7%), adequacy of infusion rate (2,6%) and others (7,4%).Pharmaceutical interventions showed clinical (96,9%), preventive (99,3%) and economic (21,6%) impact. Conclusion: The application of the FASTHUG-MAIDENS mnemonic extended the pharmaceutical care to critically ill patients, enabling an accurate evaluation of the pharmacotherapy, clinically impacting critical patient care and reducing errors and adverse drug events.

Objetivo: determinar os níveis de resiliência de pacientes com insuficiência cardíaca e sua associação com a qualidade de vida e sintomas depressivos. Método: estudo transversal envolvendo 102 pacientes. O período da coleta foi de janeiro a dezembro de 2019. Foram aplicados os seguintes instrumentos: o Minnesota Living With Heart Failure Questionnaire, o World Health Organization Quality of Life - WHOQOL-Bref, o instrumento Hospital Anxiety and Depression Scale na subescala depressão e a Escala de Resiliência de Wagnild e Young. Para avaliar correlação dos escores das escalas foram utilizados os testes coeficiente de Correlação de Pearson ou Coeficiente de Correlação de Spearman. Resultados: ao associar a escala de resiliência com qualidade de vida e sintomas depressivos, apenas o HADS-D foi significante com a escala de resiliência. Conclusão: nesse estudo observou-se que os indivíduos mais resilientes não possuíam sintomas depressivos.