Abstract The objective of this study was to determine the prevalence and describe the factors associated with off-label drug use in an adult intensive care unit (ICU) of a Brazilian hospital. An analytical, cross-sectional, prospective study was conducted in the adult ICU population from March 2018 to May 2018. Off-label use of medication was classified by indication, dosage, route of administration, type and volume of diluent, and duration of administration. Most patients were female (57.89%), non-elderly (56.14%), and had a mean age of 54.44 ± 17.15 years. The prevalence of off-label drug use was 70.31%, but was not associated with the clinical severity of the patients. A statistically significant association was observed between label use of drugs and prescribing potentially inappropriate medicines (PIM). The most common reasons for off-label drug use were therapeutic indication (19.58%) and volume of diluent (23.30%). Drug administration by enteral tubes accounted for the largest number of off-label uses due to route of administration (90.85%). There was a higher prevalence of off-label use of systemic antimicrobials (14.44%) and norepinephrine (9.28%). Our study provided a broad characterization of off-label drug use in an adult ICU and showed why it is important for health professionals to evaluate the specific risks and benefits of this practice.

Investigou-se a ocorrência de anticorpos anti-Neospora caninum em cães no Estado de Alagoas, Brasil e os fatores de risco associados à infecção. Para a pesquisa de anticorpos contra N. caninum empregou-se a Reação de Imunofluorescênica Indireta (RIFI). Para identificar os fatores de risco associados à infecção pelo N. caninum foi realizada análise univariada das variáveis de interesse. Foram analisadas 237 amostras de cães de ambos os sexos, diferentes raças e idades e procedentes de áreas urbanas e rurais. Obteve-se 10 (4,2%) animais soropositivos, sendo cinco (4,8%) de áreas rurais e cinco (3,8%) de áreas urbanas. Com relação ao sexo, cinco (4,0%) eram machos e cinco (4,5%) fêmeas. Quanto às raças foram positivos quatro animais de raças indefinidas e seis de raças definidas. As idades dos animais soropositivos variaram de dois meses a 11 anos. Os resultados da análise estatística revelaram não haver associação significativa entre a soropositividade e as variáveis analisadas. Os resultados indicam a necessidade de incluir a neosporose no diagnóstico diferencial das desordens neurológicas caninas.

This study investigated occurrences of antibodies to anti-Neospora caninum in dogs in the state of Alagoas, Brazil, and the risk factors associated with the infection. To investigate antibodies against N. caninum, an indirect immunofluorescence antibody test (IFAT) was used. To identify risk factors associated with infection by N. caninum, univariate analyses on variables of interest were conducted. The study analyzed 237 samples from dogs of both sexes and different breeds and ages, both from rural and from urban areas. Ten animals (4.2%) were seropositive: five (4.8%) from rural areas and five (3.8%) from urban areas. Regarding sex, five (4.0%) were male and five (4.5%) were female. In relation to breed, four animals of undefined breed and six of defined breed were positive. The ages of the seropositive animals ranged from two months to eleven years. Results show there are no significant associations between seropositivity and the variables analyzed. Results indicate neosporosis must be included in differential diagnosis of dog neurological disorders.

Este estudo mostra a experiência e resultados da terapêutica endovascular nas lesões estenóticas em bifurcação carotídea. Entre fevereiro de 1998 e março de 2003 foram tratados 79 pacientes com idades entre 57 e 72 anos (média 64,5 anos) sendo 45 do masculino e 34 do feminino. Todos os pacientes enquadravam-se nos critérios do estudo "NASCET" com comprometimento das artérias carótidas internas. Dos 79 pacientes, 43 foram tratados sem os sistemas de proteção e 36 pacientes foram tratados com sistema de proteção. Dos 36 pacientes tratados com sistema de proteção foram utilizados filtros de proteção (Angioguard e EPI). Observou-se melhora angiográfica em todos os 79 pacientes tratados. Ultrasom Doppler realizado após 6 meses mostrou artérias pérvias em todos os pacientes. Nos 43 pacientes tratados por "stent"/angioplastia sem a utilização de sistemas de proteção tivemos um paciente com déficit neurológico que perdurou por mais de 30 dias ("stroke major") e um óbito por transformação hemorrágica devido à reperfusão. Ocorreu síndrome de hiperperfusão em 1 paciente dos 36 pacientes tratados com o sistema de proteção, regredindo em 7 dias, sendo que nos demais não houve morbi-mortalidade. A angioplastia e "stent" no território carotídeo com a utilização de sistema de proteção é um método seguro com reduzida morbidade e mortalidade estando indicada nas lesões estenóticas das bifurcações carotídeas.

We evaluate the results of stenting and angioplasty on carotid bifurcation stenotic lesions using protection systems, emphasizing the indications and technical aspects. Seventy-nine patients, mean age 64.5 years were treated from February,1998 to March, 2003. All patients were included in NASCET study criteria. Forty three patients were treated without the protection systems and thirty six were treated with carotid protection filtering system (Angioguard, EPI). Technical success and 6-months carotid Doppler ultrasound follow-up showing stent patency were achieved in all patients. One major stroke and one death due to intracranial reperfusion bleeding occurred in patients treated without cerebral protection devices. Only one patient presenting hyper perfusion syndrome improving after 7 days, was found in the group treated with the cerebral protection filter mechanism, no other neurologic symptom or death occured in this group. Stenting and angioplasty with protection systems for thromboembolic debris is a safe endovascular method to treat stenotic lesions in the carotid bifurcation with low morbidity and mortality.