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- Adverse reactions by radiopharmaceuticals: Retrospective analysis of the Portuguese National Pharmacovigilance SystemPublication . Martins, Sara; Jesus, Ângelo; Andrade, Ricardo; Rocha, Mariana; Martín-Suarez, Ana; Jesus, ÂngeloRadiopharmaceuticals are essential in the field of nuclear medicine, but like any other medicinal product, radiopharmaceuticals can potentially cause adverse reactions in patients. To describe the adverse reactions to radiopharmaceuticals reported to the Portuguese National Pharmacovigilance System (SNF). Methods: We performed a retrospective, observational study by examining individual case safety reports (ICSRs) provided by the SNF related to all radiopharmaceuticals commercially available in Portugal from 2010 to 2023. The SNF received a total of 84 ICSRs. These reports resulted in a total of 224 adverse drug reactions (ADR), which involved a total of 15 different radiopharmaceuticals. The mean age of patients was 61.9 years old. Twenty-one different system organ classes (SOCs) were identified, with the most prevalent situations being “Gastrointestinal Disorders” (18.3%; n = 41) followed by “General disorders and administration site conditions” (16.5%; n = 37), “Skin and subcutaneous tissue disorders” (11.2%; n = 25) and “Blood and lymphatic system disorders” (10.3%; n = 23). Fifty-seven reports (67.85%) showed at least 1 serious ADR. Most notified radiopharmaceuticals were, respectively, radium—223 (n = 36, 41.4%), lutetium-177 oxotreotide (n = 12, 13.8%) and iodide—131 (n = 9, 10.3%). Although the number of notifications is limited, these findings provide valuable insights into the types and frequencies of adverse reactions associated with radiopharmaceuticals used in Portugal between 2010 and 2023. The data highlight the importance of continued pharmacovigilance efforts to monitor the safety of these specialized medical products and inform clinical decision-making.
- Health effects of ergonomics and personal protective equipment on chemotherapy professionalsPublication . Reis, Ana; Silva, Vítor; Joaquim, João José; Valadares, Luís; Matos, Cristiano; Valeiro, Carolina; Mateos-Campos, Ramona; Moreira, Fernando; Moreira, FernandoChemotherapy drugs are vital for treating cancer, but the professionals who prepare and administer them may be exposed to small amounts that can harm their health over time. To stay protected, they use personal protective equipment like gloves, gowns, and masks, and must also work under ergonomic conditions that prevent strain from repetitive tasks and awkward postures. This review examined recent studies to see how these protective measures are applied and what risks remain. We found that use of protective equipment is often inconsistent and ergonomic challenges are common, especially for nurses and pharmacy technicians. These findings show the importance of better training, safer workplace design, and stronger institutional support. Improving protective practices and ergonomics can help protect healthcare workers, enhance their wellbeing, and ensure safer patient care.
- Multidimensional evaluation of Lisdexamfetamine: Pharmacology, therapeutic use, toxicity and forensic implicationsPublication . Silva-Carvalho, Mariana; Barbosa, Daniel José; Silva, Diana Dias da; Oliveira, Ricardo Jorge Dinis; Dias da Silva, Diana CristinaLisdexamfetamine (LDX), a prodrug of d-amphetamine, is widely used in the pharmacological treatment of neuropsychiatric disorders such as attention-deficit/hyperactivity disorder (ADHD) and binge eating disorder (BED). Chemically, it consists of the amino acid lysine linked to d-amphetamine. Its enzymatic conversion to d-amphetamine sets the stage for a prolonged and controlled release, influencing its clinical profile and differentiating it from other stimulant medications. As a central nervous system stimulant, LDX primarily acts by increasing the release of neurotransmitters, particularly dopamine and noradrenaline, in the brain. Clinically, this enhanced availability of neurotransmitters is believed to contribute to improvements in attention, focus and impulse control in individuals with ADHD. The side effects of LDX include insomnia, decreased appetite, weight loss and xerostomia. This work reviews the pharmacological mechanisms, clinical applications and forensic considerations associated with its use. It is expected that clinicians, researchers and policymakers have a comprehensive understanding of the pharmacological and toxicological aspects of LDX.
- Rare but relevant: MDMA and hyponatraemiaPublication . Garcia, Maria Rita; Gomes, Nelson G. M.; Silva, Diana Dias da; Dias da Silva, Diana CristinaConventionally used for its stimulant, empathogenic and entactogenic effects,3,4-methylenedioxymethamphetamine (MDMA, ecstasy) is one of the most commonlyused psychoactive drugs, specifically among young adults and in nightlife and recrea-tional party contexts. Often perceived as a safe drug, MDMA can display an array oftoxic effects on multiple organs, with hyponatraemia (a low blood sodium concentrationthat can cause an altered mental state) being increasingly reported. Although hypona-traemia per se is among the most common electrolyte disorders encountered in clinicalcare, acute MDMA-induced hyponatraemia was first described in 1993 and constitutes alife-threatening condition if left untreated, particularly among women, who presenthigher incidence rates and increased odds of developing severe clinical effects. The pre-sent review outlines the main clinical manifestations and prevalence of MDMA-inducedhyponatraemia, its pathophysiological mechanisms and the therapeutical approaches tocorrect this electrolyte imbalance.
- Pharmacy technicians in immunization services: Mapping roles and responsibilities through a Scoping ReviewPublication . Valeiro, Carolina; Silva, Vítor; Balteiro, Jorge; Patterson, Diane; Bezerra, Gilberto; Mealiff, Karen; Matos, Cristiano; Jesus, Ângelo; Joaquim, João; Jesus, ÂngeloPharmacy technicians are increasingly involved in immunization services, enhancing vaccine accessibility and reducing pharmacies’ workload. This scoping review aims to (1) provide a comprehensive overview of pharmacy technicians’ involvement in immunization services across various healthcare settings and countries, and (2) conduct a comparative analysis of training curricula for pharmacy technicians on immunization. A scoping review was conducted following the Arksey and O’Malley framework. A comprehensive search of the PubMed and Scopus databases was performed using keywords and MeSH terms such as “pharmacy technician(s)”, “immunization”, “vaccination”, “role”, and “involvement”. Studies included assessed pharmacy technicians’ roles in vaccine administration, training, and public health outcomes. Descriptive and thematic analyses were used to synthesize the findings. In addition, a supplementary analysis of immunization training curricula was conducted, reviewing programs from different countries to identify similarities, differences, and gaps in course structure, content, and delivery formats. Lastly, a comprehensive toolkit was developed, offering guidelines intended to facilitate the implementation of immunization training programs. A total of 35 articles met the inclusion criteria, primarily from the United States of America (n = 30), Canada (n = 2), Ethiopia (n = 1), Denmark (n = 1) and United Kingdom (n = 1). The findings indicate that pharmacy technicians contribute significantly to vaccine administration, patient education, and workflow optimization, particularly in community pharmacies. The COVID-19 pandemic accelerated their involvement in immunization programs. Key challenges include regulatory barriers, a lack of standardized training, and resistance from other healthcare professionals. Facilitators include legislative support (e.g., the PREP Act), structured training programs, and collaborative pharmacist–technician models. Pharmacy technicians can play a vital role in expanding immunization services, improving vaccine uptake, and reducing pharmacist workload. Addressing regulatory inconsistencies, enhancing training, and fostering interprofessional collaboration are crucial for their effective integration of immunization programs. Since immunization by pharmacy technicians is not yet allowed in many EU countries, this review will provide a foundational basis to address their potential to support the healthcare workforce and improve access to immunization services.
- Reacciones adversas a radiofármacos: Análisis retrospectivo del Sistema de Farmacovigilancia EspañolPublication . Martins, Sara; Martín-Suarez, Ana; Jesus, Ângelo; Jesus, ÂngeloLos radiofármacos se han convertido en herramientas indispensables en la medicina mo-derna, pero como cualquier otro medicamento, pue-den causar reacciones adversas en los pacientes. El objetivo de este estudio fue realizar un análisis de las notificaciones relacionadas con sospechas de reacciones adversas (RAM) relacionadas con radiofármacos, en el contexto sanitario español. Se realizó un estudio observacional, cross-sectional, retrospectivo y descriptivo, centrán-dose en el análisis de notificaciones espontáneas sobre reacciones adversas asociadas con el uso de radiofármacos (RAMr), presentadas al Sistema Español de Farmacovigilancia de Medicamentos de Uso Humano, durante el periodo de 2010 a 2023. Se recibieron 518 notificaciones espontáneas, que resultaran en 1717 RAMr. 53,1% de las reacciones fueron consideradas graves. El Radio (223Ra) dicloruro fue el radiofármaco identifi-cado con más frecuencia en los informes (29,4%) y, de las 37 muertes reportadas en notificaciones asociadas a la administración de radiofármacos, 22 ocurrieron con este radiofármaco. Los radiofármacos tienen una me-nor incidencia de RAM reportadas en comparación con los medicamentos convencionales, pero no se puede descartar por completo la posibilidad de aparición, con graves consecuencias en algunos casos. El hecho de que en 14 años solo se hayan enviado 518 informes confirma las sospechas de subnotificación por parte de profesionales, pa-cientes y otros. Es necesario tomar más medidas de sensibilización y formación, para aumentar la notificación de posibles RAMr.
- Pharmacy technicians in Europe: exploring the diversity in training, roles, and regulationPublication . Valeiro, Carolina; Silva, Vitor; Jesus, Ângelo; Joaquim, João; Matos Cristiano; Jesus, ÂngeloPharmacy technicians are increasingly recognized as essential healthcare professionals who contribute significantly to the delivery of pharmacy services. However, in Europe, the education, training, and regulatory frameworks governing pharmacy technicians vary substantially, influencing their scope of practice and integration within healthcare systems. This review maps the education, qualifications, and scope of practice of PTs across Europe, highlighting differences in professional titles and regulatory approaches. A review was conducted using publicly available data from the EU Regulated Professions Database and data collected from national organizations representing pharmacy technicians across Europe. Data on professional titles, qualification levels, regulations, program duration, and role delineation were extracted and summarized for comparison. Findings from 28 European countries revealed significant variability in pharmacy technician qualification levels (EQF 4–6), training duration (2–4.5 years), and national regulation. Regulation ranges from mandatory licensing with protected titles to a lack of regulation. The scope of practice differs, from basic dispensing and inventory tasks to broader clinical and technical responsibilities. The landscape of pharmacy technician education and regulation in Europe remains fragmented. Although PTs share core responsibilities, qualification levels, program durations, and regulatory protections vary widely, limiting professional identity, mobility, and workforce planning. Developing a shared European framework for education and professional recognition could facilitate professional mobility, reduce professional and skill disparities, and support safe, high-quality pharmacy services, ultimately optimizing the contribution of PTs to healthcare systems.
- Upcycling coffee waste into sustainable nano zerovalent iron for environmental contaminant remediation: characterization, applicability and cytotoxicityPublication . Fernandes, Filipe; Freitas, Maria; Pinho, Cláudia; Oliveira, Ana Isabel; Delerue-Matos, Cristina; Grosso, Clara; Pinho, Cláudia; Oliveira, Ana IsabelThe agrifood sector produces considerable waste, offering opportunities for sustainable innovation. In the coffee industry, spent coffee grounds (SCG) can be valorized to generate eco-friendly nanomaterials such as nano zerovalent iron (nZVI), widely applied in soil and water remediation. In this study, green nZVIs were synthesized using SCG hydromethanolic extracts and FeCl3, subsequently characterized, and assessed for cytotoxicity. High-performance liquid chromatography with diode-array detection (HPLC-DAD) was employed to identify hydroxycinnamic acids, caffeine, and trigonelline in the SCG extracts. Preliminary remediation assays were conducted with seven contaminants, with venlafaxine selected for detailed pH and kinetic studies. Characterization of nZVIs included SEM and EDS analyses, which revealed spherical nZVI particles (72–83 nm) composed of carbon (47%), oxygen (34%), and iron (16%). Dynamic light scattering (DLS) measurements indicated the presence of smaller particles (15–23 nm). Thermogravimetric analysis (TG) confirmed a residual mass of about 20% at 1400 ◦C. Fourier-transform infrared spectroscopy (FTIR) and X-ray photoelectron spectroscopy (XPS) confirmed phenolic compound incorporation, while X-ray diffraction (XRD) revealed an amorphous structure. The particles exhibited magnetic behavior and showed no cytotoxicity toward MRC-5 and U87 cell lines. Among the tested contaminants, venlafaxine displayed the highest removal efficiency in remediation tests. Compared with chemically synthesized nZVI, the green version exhibited enhanced stability, attributed to the presence of surface-bounded organic matter. Overall, this sustainable and cost-effective approach to produce nZVI from SCG provides an innovative method for waste valorization and environmental remediation.
- Multidose drug dispensing systems: a focus on user experiences, safety, quality and cost factorsPublication . Reis, Ana; Pereira, Jorge; Iacob, Andrei; Filipoi, Victoria-Adriana; Martin, Maria Luisa; Jesus, Ângelo; Jesus, ÂngeloPopulation aging is one of the most significant social transformations of the 21st century, especially in developed countries. Medication-related behaviour is complex and influenced by multiple factors, requiring diverse strategies to improve adherence. In this context, pharmacists and pharmacy technicians have taken on increasingly important roles in promoting and providing health services. Pharmacy technicians, in particular, can contribute significantly to the implementation of community adherence programs. Individualized medication preparation, such as multiple dose dispensing (MDD) systems, offers an approach that ensures patients receive the correct medication, in the correct dose and at the correct time, improving safety and adherence, particularly among older adults. The study involves identifying current evidence on the implementation and use of MDD systems and exploring possible improvements, particularly for older populations. This assessment analysis follows the Joanna Briggs Institute methodology. The protocol was developed with predefined criteria appropriate for the selected databases and repositories. Article selection, data extraction, and synthesis were performed independently by two reviewers to ensure rigor. In conclusion, MDD systems represent a promising intervention to support medication adherence, tailored to the individual needs of each patient.
- Complexity of the therapeutic regimen in older adults with cancer: associated factorsPublication . Oliveira, Rita F.; Oliveira, Ana I.; Cruz. Agostinho; Ribeiro, Oscar; Afreixo, Vera; Pimentel, Francisco; Cruz, Agostinho; Ferraz Oliveira, Rita; Oliveira, Ana IsabelPopulation aging is a worldwide phenomenon and is often associated with multimorbidity and polypharmacy. Complex medication regimens are common among older adults and contribute to the occurrence of harmful health outcomes. Age is one of the main risk factors for cancer. This study aimed to determine and characterize the therapeutic complexity in older patients with cancer, and analyze the factors associated with high complexity and the impact of the oncological context. A cross-sectional study with patients aged ≥65 years with cancer was conducted in three hospitals in northern Portugal. Data collection was obtained using self-reports. The medication regimen complexity was assessed using the Medication Regimen Complexity Index (MRCI). Descriptive and association statistical analysis were performed. Logistic, linear, simple and multiple regression analysis were conducted, with and without automatic variable selection. A total of 552 patients were included (median age, 71; IQR, 68–76). The mean MRCI before the oncological context was 18.67 (SD 12.60) and 27.39 (SD 16.67) after the oncological context, presenting a statistically significant difference in the values obtained (p < 0.001). An elevated complexity was significantly associated with polypharmacy, chronic diseases and with the administration of high-risk medications (p < 0.05). High MRCI values showed a relationship with the occurrence of potential drug interactions (p < 0.001). There was no relationship with the existence of cardiac risk comorbidity. This study demonstrated the existence of high therapeutic complexity in older patients with cancer, suggesting the need for intervention to prevent medication-related problems in this vulnerable population.