No abstract

The simultaneous prescription of multiple drugs used in therapeutic schemes can result in drug interactions, with desirable or undesirable effects. Thus, the objective of this study was to describe the mechanisms involved in clinically relevant drug interactions. This is a narrative review in which studies published in PUBMED and the VHL were searched in the following databases: MedLine, Lilacs, and Scielo. The search was performed in May 2021, after reading the articles and their references. The results showed that drug interactions occur through the co-administration of different compounds. In this context, drugs can suffer pharmaceutical interactions due to different physical-chemical processes, as well as after administration, interfering in the mechanisms of absorption, distribution, metabolism, and elimination of pharmacokinetics or pharmacodynamics, with changes in the pharmacological effect. Such mechanisms can cause undesirable outcomes, such as increased toxicity or impairment of therapeutic effect, or be used as a strategy for beneficial interactions to increase the pharmacological effect or reduce toxicity. Given the clinical impacts that may occur due to drug interactions, knowledge about the different mechanisms involved in drug interactions is essential.

Objective: To analyze the epidemiological and clinical profile and the time trend of hospitalizations for fall-related injuries among older people (aged 60 years or older) in Alagoas between 2008 and 2019. Methods: This is a time series study with data collected from the Hospital Information System of the Unified National Health System (SIHSUS) referring to hospitalizations for fall-related injuries among older adults in Alagoas between 2008 and 2019. Hospitalization and lethality rates, average annual percent change (AAPC), and annual percent change (APC) were calculated; time trends were analyzed using a Joinpoint Regression Model according to sex, skin color, age range, and causes. A 95% confidence interval (95%CI) was adopted. A p-value<0.01 was adopted for defining statistical significance. Results: In Alagoas, 14 817 cases of hospitalizations due to fall-related injuries were reported among older people in the analyzed period. The highest incidence rate was observed in 2016 (48.39/10 000 inhabitants). There were 517 deaths, and the mean lethality rate was 3.4%. A higher proportion of cases was seen in men (66.36%; n=9832), those aged 80 years or older(34.59%; n=5125), and with Brown skin (54.70%; n=8106). The incidence coefficient varied, showing an upward trend with time (APC: 4.1; 95%CI 0.2–8.2; p<0.01). Conclusion: During the analyzed period, the study showed a higher incidence in individuals aged 80 years or older, men, and found an upward trend in hospitalizations. We suggest the optimization of hospital care and promotion of fall prevention programs among older adults.

Objective: To describe the epidemiological profile and to analyze the trend in the incidence rate of exogenous poisoning concerning children and adolescents (0–19 years old) in the city of Arapiraca, Alagoas, Brazil, in the period from 2007 to 2015. Methods: Observational study with data extracted from the Notifiable Diseases Information System. The variables sex, age group, toxic agent, and circumstance were analyzed using descriptive statistics. For temporal analysis, cut-off rates of incidence/10,000 inhabitants were calculated and the inflection point regression model was used for analysis. Results: There were 5,539 cases of exogenous intoxication in individuals aged 0–19 years in the city, of which 53.1% (n=2,944) occurred in girls and 61.5% (n=3,405) in children aged 0–9 years. Medicines consisted in the main agent responsible for intoxications (28.5%; n=1,580), mainly by accidental use (18.2%; n=1,010). There was a significant increase in the events during the study period (Average Annual Percent Change: 12.7; 95%CI 1.1–25.6; p<0.001), with rates increasing from 56.52/10,000 inhabitants in 2007 to 56.64/10,000 inhabitants in 2015. The incidence of cases in girls increased from 57.34/10,000 inhabitants in 2007 to 62.27/10,000 inhabitants in 2015. In boys, the incidence of cases was stationary: 55.69/10,000 inhabitants to 50.9 /10,000 inhabitants in the same period. Conclusions: The study showed a higher frequency of cases in girls aged 0 to 4 years and an increasing trend in the incidence rate during the study period. Implementation of actions and strategies, with emphasis on health education, is needed in order to prevent cases of exogenous intoxication.

Introduction: COVID-19 affects several vital organs, including the brain, and can cause neurological manifestations. Objective: To characterize the neurological manifestations of hospitalized patients with laboratory confirmation of COVID-19, between May and August, 2020. Design and setting: Observational study at Veredas Hospital and University Hospital Professor Alberto Antunes in Alagoas, Brazil. Methods: Socio-demographic data, infectious and neurological symptoms, risk factors for neurological and infectious diseases, clinical history, treatment instituted and outcome of patients were collected. Results: We included 30 patients with a mean age of 61.05 ± 18.65 years, 70% were female. The average between the onset of COVID-19 symptoms and hospital admission was 10 ± 9.7 days. Systemic arterial hypertension (66.7%) and diabetes mellitus (63.3%) were the main comorbidities. Cough, fever (60%) and dyspnea (56.7%) stood out in general symptoms. The most frequent neurological symptoms were changes in the level of consciousness (56.7%), epileptic seizures (33.3%) and motor deficits (23.3%). Ischemic stroke (40%) was the main neurological diagnosis, followed by epileptic seizures (33.3%), delirium (13.3%), encephalitis (10%), SAH (6.6%), vasculitis (6, 6%), hemorrhagic stroke, TIA, cranial neuropathy, meningitis and peripheral neuropathy (3.3% each). Regarding treatment, 100% used antibiotic therapy, 96.7% prophylactic heparin, 50% mechanical ventilation, 46.7% antiparasitic, 20% vasoactive drugs and 6.7% hydroxychloroquine. The death rate was 40%. Conclusions: Neurological manifestations by patients with COVID-19 are not uncommon, presenting in different ways, and can be potentially fatal. The main neurological symptom was changes in the level of consciousness and diagnosis, ischemic stroke.