A obesidade é uma doença crônica que vêm alcançando proporções epidêmicas em todo o mundo. É um fator de risco para inúmeras desordens médicas, morbidade e mortalidade, além de estar também associada a um aumento dos custos socioeconômicos e com saúde. O tratamento a longo prazo, incluindo a farmacoterapia, mostra-se necessário para muitos pacientes obesos. Neste contexto, este trabalho teve a finalidade de avaliar a tolerabilidade e eficácia clínica da Fluoxetina, adjunta a uma dieta de 1.500 Kcal/dia, na redução de parâmetros antropométricos e metabólicos em mulheres obesas. Cloridrato de Fluoxetina (60 mg/dia), foi comparado ao placebo em 19 mulheres obesas, durante 90 dias de tratamento. O grupo Fluoxetina (n=9) apresentou uma redução estatisticamente significativa do peso (-9,24 vs -1,05 kg), IMC (-3,64 vs -0,45 Kg/m²) e circunferência abdominal (-12,3 vs -2,9 cm), em relação ao placebo (n=10). Observou-se ainda uma elevação estatisticamente significativa dos níveis séricos de HDL-colesterol (p< 0,01) no grupo tratado com o fármaco, e uma redução significativa dos níveis plasmáticos de triglicérides (-39,5 vs +18,7 mg/dL) quando comparado ao grupo placebo. As reações adversas mais comumente reportadas pelos pacientes foram insônia, náuseas e sonolência. Concluímos que a Fluoxetina demonstrou ser um fármaco bem tolerado e eficaz na redução de parâmetros antropométricos e metabólicos, prevenindo o desenvolvimento de fatores de risco cardiovasculares e diminuindo morbidade em mulheres obesas. / Obesity is a chronic condition that has been reaching epidemic proportions worldwide. It is a risk factor for numerous medical disorders and excessive mortality. Long-term treatment, including pharmacotherapy, may be necessary for many obese patients. This study aimed to assess the tolerability and clinical effectiveness of Fluoxetine, as an adjunct therapy to a 1.500 Kcal/day diet, in reducing anthropometric and metabolic parameters in obese women. Fluoxetine (60 mg/day), was compared to placebo in 19 obese females in a 90-day trial. Fluoxetine therapy (n=9) resulted in a statistically significant greater mean reduction in weight (-9,24 vs -1,05 kg), BMI (-3,64 vs -0,45 Kg/m²) and waist circumference (-12,3 vs -2,9 cm), than placebo group (n=10). There was also an elevation of HDL-cholesterol (p< 0,01) in Fluoxetine group and mean triglycerides levels was reduced (-39,5 vs +18,7 mg/dL) when compared to placebo. Side effects most commonly reported by the patients were insomnia, nausea and somnolence. We concluded that Fluoxetine may provide an effective and well tolerated possibility in reducing anthropometric and metabolic parameters, preventing the development of cardiovascular risk factors and reducing morbidity in obese women.

Excerpt: Navari and colleagues (July 14 issue)1 report on the use of olanzapine for the prevention of chemotherapy-induced nausea and vomiting.

Introduction:  Migraine is a chronic neurological disease, partly hereditery. One non-pharmacological alternative treatment is yoga, whose effects have been investigated in a few scientific studies. No one has in a scientific studie investigated the effect of medical yoga for patients with migraine. Aim: The primary aim was to investigate if medical yoga in combination with pharmcological treatment could have an effect on headache frequency, intensity, and/or duration for patients with episodic and chronic migraine. Method: A pilot study, with SSED-design, with seven patients. Everyone had different long baselines before intervention. The intervention was a period of sex weeks of medical yoga. A headache diary with frequency, intensity and duration was conducted throughout the study period. Results: For two patients (patient two and six) the number of days with migraine reduced, effectsize (ES) 0,50 and 0,39 respectively. For four the freguence increased. The experience of pain decreased for two patients, increased for three and unchanged for one. The duration of migraine is reduced for one patient (patient seven) and increased for five. Some are improved in secondary outcome measures. Conclusion: At present, the intervention can possibly be used for patients who are similar to the individuals who had effect of the intervention and are interested in medical yoga as a self-care, but further studies are needed, as well as larger studies to be able to generalize to the migraine group. / Introduktion: Migrän är en kronisk neurologisk sjukdom, delvis ärftlig. En icke farmakologisk alternativ behandling är yoga, vars effekter har undersökts i några få vetenskapliga studier, men ingen har i en vetenskaplig studie undersökt effekten av MediYoga för patienter med migrän. Syfte: Primärt syfte var att undersöka om MediYoga i tillägg till farmakologisk behandling kunde ha effekt på huvudvärksfrekvens, intensitet och/eller duration hos patienter med episodisk och kronisk migrän. Metod: Pilotstudie med SSED-upplägg, och multipel baslinjedesign med totalt sju patienter. Alla hade olika långa baslinjer innan intervention. Interventionen var sex veckors Mediyoga. Huvudvärksdagbok med frekvens, intensitet och duration fördes under hela studietiden. Rultat: För två patienter (patient två och sex) minskade antalet dagar med migrän, effektstorlek (ES) 0,50 respektive 0,39. För fyra ökade frekvensen. Upplevelsen av smärta minskade för två patienter, och ökade för tre samt oförändrad för en. Durationen av migrän minskade för en patient (patient sju) och ökade för fem. Några förbättrades i sekundära utfallsmått. Slutsats: I dagsläget kan interventionen möjligen nyttjas för enstaka patienter som liknar de individer som haft effekt av interventionen och är intresserade av MediYoga som egenvård, men det behövs ytterligare, samt större studier för att kunna generalisera till gruppen migräniker.

No description available.

Estudo caso-controle realizado no Centro de Saúde Escola (FMRP USP) em Ribeirão Preto SP, no período de 2010 a 2012. O objetivo do estudo foi comparar a qualidade vida geral de dois grupos de pessoas com diabetes mellitus (DM) tipo 2: um com controle glicêmico satisfatório e outro com controle glicêmico insatisfatório. A hipótese a ser testada foi que uma boa qualidade de vida está associada a um melhor controle glicêmico nesses indivíduos. A amostra foi constituída por 90 usuários, sendo 30 casos e 60 controles, com diagnóstico de diabetes mellitus tipo 2. Foi considerado caso o paciente com o diabetes mellitus com controle glicêmico satisfatório e controle o paciente com controle glicêmico insatisfatório, avaliado por meio do resultado da hemoglobina glicada (A1c), realizada nos quatro meses anteriores à entrevista. Para a coleta de dados foram utilizados três questionários: o WHOQOL BREF, o Teste de Morisky e Green e outro sobre condições sócio-demográficas e clínicas. Para a análise utilizou-se estatística descritiva e o Teste de Wilcoxon; considerou-se um nível de significância de 0,05 para todas as análises. Os resultados mostraram que a maioria dos entrevistados era do sexo feminino (78,8%), com idade média de 61 anos. Em relação à qualidade de vida, a proporção de controles que se auto-avaliam como satisfeitos foi maior do que nos casos e quanto ao grau de satisfação com a saúde, entre os mais satisfeitos também estão os controles, porém sem diferença estatística significante. Quando se comparou os resultados de cada domínio do WHOQOL-BREF entre os grupos caso e controle, pode-se observar que os dois grupos têm uma baixa satisfação da qualidade de vida no domínio psicológico (51,2 e 50,9), seguido do domínio físico (58,4 e 56,8); os domínios das relações sociais (86,9 e 78,8) e meio ambiente (69,2 e 64,0) foram os que mais se associaram positivamente à qualidade de vida dos entrevistados. As diferenças não apresentaram significância estatística entre os casos e controles nos domínios físico (p = 0,578) e psicológico (p = 0,948) e houve diferença estatística significante entre os grupos nos domínios relações pessoais (p = 0,045) e meio ambiente (p = 0,039). De acordo com o Teste de Morisky e Green, os dois grupos foram classificados como menos aderente, e a diferença entre os grupos não foi estatisticamente significante (p = 0,878). Os dados obtidos, no presente estudo, apontam que os aspectos ligados às relações sociais e ao meio ambiente devem ser priorizados nas atividades educativas que visem a melhoria do controle glicêmico dos indivíduos com diabetes mellitus. / Case-control study conducted at the School Health Center (University of São Paulo at Ribeirão Preto Medical School FMRP-USP) in the city of Ribeirão Preto, state of São Paulo, from 2010 to 2012. This study aimed to compare the quality of life of two groups of people with diabetes mellitus (DM) type 2: one with satisfactory glycemic control and another with poor glycemic control. The hypothesis to be tested was that a good quality of life is associated with better glycemic control in these individuals. The sample consisted of 90 users, being 30 cases and 60 controls diagnosed with type 2 diabetes mellitus. Case was considered the patient with diabetes mellitus and with satisfactory glycemic control; and control, the patient with poor glycemic control, assessed through results of glycated hemoglobin (A1c), performed in the four months preceding the interview. To collect the data three questionnaires were used: the WHOQOL-BREF, the Morisky and Green Test, and one on socio-demographic and clinical conditions. For the analysis, the descriptive statistics and the Wilcoxon test were used; and the researchers considered a significance level of 0.05 for all analyzes. The results showed that the majority of respondents were female (78.8%) with an average age of 61 years. Regarding quality of life, the proportion of controls that self-assess as satisfied was higher than the cases; and regarding the degree of satisfaction with health, also the controls were among the most satisfied; however no statistically significant difference was found. When comparing the results of each domain of WHOQOL-BREF between case and control groups it can be observed that both groups have a low satisfaction of quality of life in psychological domain (51.2 and 50.9), followed by physical domain (58.4 and 56.8); domains of social relationships (86.9 and 78.8) and environment (69.2 and 64.0) were the most associated positively to quality of life of the respondents. The differences were not statistically significant between cases and controls considering physical (p=0.578) and psychological (p=0.948) domains; and the differences were statistically significant between the groups considering personal relationships (p=0.045) and environment (p=0.039) domains. According to the Morisky and Green Test, both groups were classified as \"less adherent\", and the difference between groups was not statistically significant (p=0.878). The data obtained in this study indicate that should be given priority to the aspects linked to social relations and environment in the educational activities aimed at improving glycemic control in individuals with diabetes mellitus.

Estudo caso-controle realizado no Centro de Saúde Escola (FMRP USP) em Ribeirão Preto SP, no período de 2010 a 2012. O objetivo do estudo foi comparar a qualidade vida geral de dois grupos de pessoas com diabetes mellitus (DM) tipo 2: um com controle glicêmico satisfatório e outro com controle glicêmico insatisfatório. A hipótese a ser testada foi que uma boa qualidade de vida está associada a um melhor controle glicêmico nesses indivíduos. A amostra foi constituída por 90 usuários, sendo 30 casos e 60 controles, com diagnóstico de diabetes mellitus tipo 2. Foi considerado caso o paciente com o diabetes mellitus com controle glicêmico satisfatório e controle o paciente com controle glicêmico insatisfatório, avaliado por meio do resultado da hemoglobina glicada (A1c), realizada nos quatro meses anteriores à entrevista. Para a coleta de dados foram utilizados três questionários: o WHOQOL BREF, o Teste de Morisky e Green e outro sobre condições sócio-demográficas e clínicas. Para a análise utilizou-se estatística descritiva e o Teste de Wilcoxon; considerou-se um nível de significância de 0,05 para todas as análises. Os resultados mostraram que a maioria dos entrevistados era do sexo feminino (78,8%), com idade média de 61 anos. Em relação à qualidade de vida, a proporção de controles que se auto-avaliam como satisfeitos foi maior do que nos casos e quanto ao grau de satisfação com a saúde, entre os mais satisfeitos também estão os controles, porém sem diferença estatística significante. Quando se comparou os resultados de cada domínio do WHOQOL-BREF entre os grupos caso e controle, pode-se observar que os dois grupos têm uma baixa satisfação da qualidade de vida no domínio psicológico (51,2 e 50,9), seguido do domínio físico (58,4 e 56,8); os domínios das relações sociais (86,9 e 78,8) e meio ambiente (69,2 e 64,0) foram os que mais se associaram positivamente à qualidade de vida dos entrevistados. As diferenças não apresentaram significância estatística entre os casos e controles nos domínios físico (p = 0,578) e psicológico (p = 0,948) e houve diferença estatística significante entre os grupos nos domínios relações pessoais (p = 0,045) e meio ambiente (p = 0,039). De acordo com o Teste de Morisky e Green, os dois grupos foram classificados como menos aderente, e a diferença entre os grupos não foi estatisticamente significante (p = 0,878). Os dados obtidos, no presente estudo, apontam que os aspectos ligados às relações sociais e ao meio ambiente devem ser priorizados nas atividades educativas que visem a melhoria do controle glicêmico dos indivíduos com diabetes mellitus. / Case-control study conducted at the School Health Center (University of São Paulo at Ribeirão Preto Medical School FMRP-USP) in the city of Ribeirão Preto, state of São Paulo, from 2010 to 2012. This study aimed to compare the quality of life of two groups of people with diabetes mellitus (DM) type 2: one with satisfactory glycemic control and another with poor glycemic control. The hypothesis to be tested was that a good quality of life is associated with better glycemic control in these individuals. The sample consisted of 90 users, being 30 cases and 60 controls diagnosed with type 2 diabetes mellitus. Case was considered the patient with diabetes mellitus and with satisfactory glycemic control; and control, the patient with poor glycemic control, assessed through results of glycated hemoglobin (A1c), performed in the four months preceding the interview. To collect the data three questionnaires were used: the WHOQOL-BREF, the Morisky and Green Test, and one on socio-demographic and clinical conditions. For the analysis, the descriptive statistics and the Wilcoxon test were used; and the researchers considered a significance level of 0.05 for all analyzes. The results showed that the majority of respondents were female (78.8%) with an average age of 61 years. Regarding quality of life, the proportion of controls that self-assess as satisfied was higher than the cases; and regarding the degree of satisfaction with health, also the controls were among the most satisfied; however no statistically significant difference was found. When comparing the results of each domain of WHOQOL-BREF between case and control groups it can be observed that both groups have a low satisfaction of quality of life in psychological domain (51.2 and 50.9), followed by physical domain (58.4 and 56.8); domains of social relationships (86.9 and 78.8) and environment (69.2 and 64.0) were the most associated positively to quality of life of the respondents. The differences were not statistically significant between cases and controls considering physical (p=0.578) and psychological (p=0.948) domains; and the differences were statistically significant between the groups considering personal relationships (p=0.045) and environment (p=0.039) domains. According to the Morisky and Green Test, both groups were classified as \"less adherent\", and the difference between groups was not statistically significant (p=0.878). The data obtained in this study indicate that should be given priority to the aspects linked to social relations and environment in the educational activities aimed at improving glycemic control in individuals with diabetes mellitus.

No description available.

Febrile neutropenia is a potentially life-threatening oncologic emergency characterized by a dangerously low neutrophil count that places the patient at great risk. In these patients, fever may be the only sign of infection, which requires prompt treatment. With the increasing focus in shifting health care from inpatient centers to outpatient arenas, home health care clinicians will likely have an increased role in the care of neutropenic fever patients in the future. The article describes both the pharmacologic treatment and nonpharmacologic support required of these patients with particular attention to treatment that may be required in the patient?s home.

Background: Malignancy is a significant risk factor for venous thromboembolism (VTE), conferring a 4- to 7-fold increased risk in patients with cancer. Because of its effect on certain tumors, low-molecular-weight heparin (LMWH) has been evaluated as a treatment option for cancer and as an alternative to traditional warfarin therapy in patients with active cancer. LMWH is associated with a reduced recurrence of VTE, fewer adverse bleeding events, and, in some instances, decreased mortality. The American College of Chest Physicians/American Society of Clinical Oncology has recommended LMWH for at least the initial 3 to 6 months when treating VTE in patients with cancer, based on the positive outcomes associated with LMWH. Objective: The purpose of this study was to evaluate physician prescribing patterns for LMWH or warfarin in patients with acute VTE and active cancer. Methods: We conducted a retrospective chart review of hospitalized patients at a community teaching hospital with an affiliated regional cancer center located in a rural area of the United States. Patients included in the analysis had an International Classification of Diseases, Ninth Revision code indicative of any cancer type and a concomitant code for any VTE. The primary outcome was the drug prescribed at discharge for the treatment of VTE. Secondary outcomes included specialty of the prescribing physician, adverse bleeding events, and the need for transfusion. VTE treatment regimen was evaluated using the binomial test, and logistic regression analysis was used to determine correlation of the prescriber’s specialty with the patient’s prescribed regimen. Results: Of 129 patients included in the analysis, 107 (82.9%) were prescribed warfarin compared with 9 (7%) who were prescribed LMWH. Hematologists and oncologists were more likely to prescribe LMWH than general practitioners (odds ratio, 7.8; 95% hazard ratio, 1.5-42). Seven patients had a documented adverse bleeding event and 2 patients required a transfusion. Four of the 7 adverse bleeding events and 1 of the 2 transfusions occurred in the group receiving vitamin K antagonist therapy. Conclusion: Physicians in our system were significantly more likely to prescribe warfarin for acute treatment of VTE in patients with active cancer—despite consistent evidence and multiple evidence­-based guidelines recommending treatment with LMWH in this patient population. This was lower than other observations in Canadian populations but may more accurately represent nonteaching centers in the United States, particularly those in rural areas. Specialists in oncology were significantly more likely to prescribe LMWH than generalists.

In recent years, several new oral anticancer drugs have been approved, many via an accelerated approval process. These new agents have the potential for drug interactions, but lack of familiarity with these drugs by clinicians may increase the risk for drug interactions. We describe an interaction between the new anticancer agent idelalisib (CYP 3A4 inhibitor) and diazepam (CYP 3A4 substrate) that resulted in altered mental status and type II respiratory failure resulting in hospitalization. After discontinuation of both agents, the patient recovered quickly. Idelalisib was reinitiated after discharge. Lorazepam was substituted for diazepam since it is not metabolized via CYP 3A4. Both agents were tolerated well thereafter. This interaction was only flagged by two of four commonly used drug interaction databases. Clinicians should exercise caution with initiating new oral anticancer agents and consider the potential for drug interactions without solely relying on drug interaction databases.