Acta Farmacêutica Portuguesa

2025-07-13T03:32:00-07:00

Num contexto de crescente complexidade medicamentosa, envelhecimento populacional e múltiplos desafios à sustentabilidade dos sistemas de saúde, o papel do farmacêutico revela-se mais relevante do que nunca. Atualmente os farmacêuticos são profissionais altamente qualificados, detentores de competências clínicas, científicas e comunicacionais que os tornam elementos centrais na promoção da saúde, na prevenção da doença e na gestão medicamentosa. Estão presentes em todas as etapas da sequência de cuidados, com um olhar atento, técnico e humano que se traduz em ganhos concretos para os doentes e para o SNS.
A Doença Inflamatória Intestinal (DII), patologia crónica de base imunológica, exige um acompanhamento rigoroso e contínuo. Um estudo nacional, baseado na dispensa de medicamentos entre 2017 e 2022, a 4200 doentes em 18 hospitais portugueses, demonstrou que os tratamentos biológicos são o pilar no tratamento da DII moderada a grave, pelo que foi necessário, em muitos casos, ajustar os esquemas medicamentosos à realidade clínica de cada doente. Mais de 70% das medicações foram administradas de acordo com o previsto, mas, em cerca de um quarto dos casos com ustekinumab, a frequência foi superior à recomendada, indiciando escaladas de dose. Nestes contextos, o farmacêutico assume um papel determinante na monitorização da medicação, na vigilância de adesão e na promoção do uso racional do medicamento, assegurando uma articulação eficaz com os restantes profissionais de saúde.

Description of real-world treatment patterns of advanced therapies for Inflammatory Bowel Disease in Portugal

2025-07-13T03:41:32-07:00

Inflammatory bowel disease (IBD) is a complex immunologic condition. Biological therapies are the key to managing moderate to severe IBD in patients who fail or are intolerant to conventional treatment. There are some patients for whom, to maintain an appropriate response, it is necessary to adjust the frequency of the therapies for each patient compared to what is approved or recommended in the summary of product characteristics.
The goal of this study was to describe real-world treatment patterns of advanced therapies for IBD in Portugal during the maintenance treatment phase, using data from a drug dispensing nationwide database. This was a retrospective study that included a cohort from a patient-level hospital dispensing a Portuguese database of advanced therapies for IBD between april 2017-february 2022.
4200 patients followed in 18 Portuguese hospitals were included. In the first-line advanced therapies, 53.7% of the patients were on infliximab, 28.6% on adalimumab, 12.6% on vedolizumab, 3.7% on ustecinumab, 1.2% on golimumab and 0.2% in tofacitinib. 756 patients (18.0%) switched to another advanced therapy (second line). Of the patients that were in first-line and switched, 38% were on golimumab, 21.4% on vedolizumab, 19.7% on adalimumab, 17.1% on infliximab, and 1.3% on ustecinumab. More than 70% of all advanced therapies were dispensed according to the expected dispensing interval. 10.3% of the patients treated with infliximab and 23.7% treated with ustecinumab dispensed the drugs more frequently.
More than 80% of the patients with moderate to severe IBD were treated with anti-TNF-α therapy in the first-line. Most of the patients were on ustecinumab or vedolizumab in the second line. Although more than 70% of the patients had their drug dispensed, approximately ¼ of the patients treated with ustecinumab have a higher frequency of drug dispensing, showing that dose escalation could have a role in the Portuguese clinical practice.

Keywords: Inflammatory bowel disease, advanced therapies, real-world treatment, drug dispensing.

CANINE VISCERAL LEISHMANIASIS (CVL): integrative review of the literature on case reports of treatment with Miltefosine

2025-07-13T04:02:30-07:00

Canine visceral leishmaniasis (CVL) is a serious parasitic disease, caused by the protozoan Leishmania spp, which represents a significant public health problem in several regions of the world, including Brazil. This course conclusion work has as its theme the integrative review of the literature on case reports of CVL treatment with Miltefosine, a medication that has shown promise in the therapy of the disease. There is a perceived need to gather and critically analyze the case reports available in the scientific literature on the use of Miltefosine, aiming to comprehensively understand the results obtained with this therapy. Analysis of available evidence will identify gaps in knowledge and encourage the carrying out of new controlled and randomized clinical studies. Therefore, the objective of this research was to prepare an integrative review of the literature on case studies of dogs affected by CVL and who were treated with Miltefosine, presenting the treatment and prognoses. The material was collected on the Google Scholar and Bvs platform in articles and course completion works published between 2019 and 2024. The conclusions of the study indicate that Miltefosine demonstrated efficacy in reducing the parasitic load in dogs affected by CVL, contributing to the improvement prognosis and quality of life of treated animals.

Keywords: Canine Visceral Leishmaniasis, CVL, veterinary treatment, public health, Milteforan®.

Consciousness, Body and Emotions: A New Perspective

2025-07-13T04:38:46-07:00

This essay offers a new way of looking at consciousness, suggesting that its origin lies in bodily sensations rather than rational activity. Through the concept of interoception - the ability to perceive the body’s internal signals - it argues that feelings related to maintaining bodily balance, such as pain, hunger, thirst, or discomfort, form the foundation of conscious experience. These physiological signals, often subtle, not only influence what we do and decide but also shape our sense of self and the way we relate to others and to the world around us.
Throughout the text, a distinction is made between feelings and emotions, and neuroscientific models are presented to show how the brain anticipates, interprets, and regulates signals coming from the body. Consciousness is thus seen as a living, ever-changing process, arising from the interaction between the body, the brain, and the surrounding context. This perspective brings important clinical implications, highlighting body-centered therapeutic practices such as mindfulness, biofeedback, and psychotherapeutic approaches focused on emotional regulation.

Keywords: Homeostatic feelings, consciousness, interoception.

Aspects related to oral health situation in older adults

2025-07-13T04:14:21-07:00

Older adults may be exposed to various factors that negatively affect their health. This study aimed to describe the main risk factors associated with the oral health of the elderly population. It is an observational, retrospective, and cross-sectional study conducted with elderly individuals residing in Los Guido de Desamparados, Costa Rica, with informed consent. The initial sample included over 300 individuals, of whom 203 agreed to participate. Data were collected across three domains: Pharmacy, Gerontology, and Dentistry. A mixed-methods approach was used, involving: a) professional dental assessment and b) home visits to collect sociodemographic and clinical data. Among the participants, 140 (63%) were women and 63 (31%) were men, predominantly aged between 70 and 79 years. About 45% had completed primary education, 39% had five to eight children, and 86% lived with others. Most participants did not consume alcohol (83%) or smoke (73%). Regarding oral health, 80 individuals were completely edentulous and used dentures, while 166 (81%) required dental prostheses. In addition, 77% did not use dental floss, 70% did not use mouthwash, and 62% had not seen a dentist in over a year. Approximately 50% had poor oral health conditions. In terms of pharmacology, 78% were taking medications with potential oral side effects, belonging to one to ten pharmacological groups, and 44% were using drugs from three to four Anatomical Therapeutic Chemical (ATC) classification groups. The findings reveal that elderly individuals face multiple challenges that negatively impact their oral health, related to factors such as education level, family context, tooth loss (with or without prostheses), oral hygiene habits, and medication use. It is concluded that the greater the number of contributing factors, the higher the probability of developing oral health issues. Therefore, multidisciplinary strategies are essential to identify, monitor, and reduce the impact of these factors to improve the quality of life in the elderly population. Elderly people may have factors that affect their health. The aim of this study was to describe the possible risk factors that affect the oral health of elderly people. This is a retrospective, cross-sectional, observational study in which informed consent was obtained from elderly people in Los Guido de Desamparados, Costa Rica. The total study sample was over 300 people. This work shows the results of all people who agreed to provide data in three components: Pharmacy, Gerontology and Dentistry. It was developed with a mixed approach: a) professional dental evaluation and b) home visit for data collection. Of the 203 participants who agreed to participate, 140/63% were women and 63/31% were men, with a predominance of: 70-79 years old, with complete elementary education (92/45%), with 5-8 children (81/39%), living with other people (176/86%), not consuming alcoholic beverages (170/83%) or smoking (149/73%), 80 were completely toothless with dentures and 166 needed dentures (166/81%), did not use dental floss (157/77%) or mouthwash (143/70%), the last visit to the dentist was one to nine years ago (125/62%) or had poor oral condition (103/50%), used medications that can affect the mouth belonging to one to ten pharmacological groups (159/78%) and three to four groups in the ATC classification. (90/44%). Elderly people present or experience situations related to aspects that can affect their oral health due to general educational contexts, support network, absence of teeth, with or without dentures. The situation can be aggravated by people’s behavior, such as lack of brushing, alcohol consumption, smoking or use of preventive measures (dental floss, mouthwash, visits to the dentist) or medications. It is inferred that the greater the number of aspects, the greater the probability of oral problems. Strategies are needed to help identify, manage and minimize the impact and consequences that various factors can have on the quality of life of elderly people.

Keywords: older adults, drugs, geriatricians, dentists, pharmacy.

Portuguese Pharmacists’ Perception of Deprescribing: Results of a National Survey

2025-07-13T14:13:33-07:00

Introduction: Polypharmacy is common among the elderly, which can be problematic if not used correctly. Therapeutic review and deprescribing have therefore become crucial practices to ensure safer and more effective treatments. The aim of this study was to assess portuguese pharmacists’ knowledge, perceptions, attitudes and challenges regarding deprescribing.
Method: A cross-sectional, observational and descriptive study carried out using an online questionnaire addressed to portuguese pharmacists between March 11 and April 8, 2025. Sociodemographic questions were included, followed by questions related to polymedication and deprescription. The data was analyzed using Microsoft Excel.
Results: 231 responses were collected in this study. Only 14.7% of participants use a formal methodology, although almost 55% suggest deprescribing in clinical practice. Polymedication, in 98% of cases, was considered to be very frequent; benzodiazepines, non-steroidal anti-inflammatory drugs and proton pump inhibitors were the drugs considered to be the main candidates for deprescription. Lack of training, time and communication with doctors were the main obstacles encountered. It was found that 71.9% had never received specialized training, although 74.5% were familiar with the concept of deprescribing. Deprescribing is considered advantageous, particularly in terms of avoiding side effects and reducing the use of potentially inappropriate medicines.
Discussion: Portuguese pharmacists have limited practical involvement due to a lack of procedures, communication with the doctor and specialized training, despite their theoretical understanding of deprescribing. However, they are open to a more active role, particularly in collaborative care models.
Conclusion: In order to strengthen the pharmacist’s role in deprescribing, it is essential to invest in continuous training and promote their integration into multidisciplinary teams, favoring a patient-centered approach. The data can support strategies for integrating deprescribing into pharmaceutical practice.

Keywords: deprescribing, potentially inappropriate medicines, pharmacists, patient safety, clinical pharmacy.

Postura, movimento e dor: epistemologias

2025-07-13T04:21:33-07:00

Do Corpo/“Espírito” enquanto imediaticidade nada poderia ser dito; para isso seria preciso o ato mefistofélico do pensamento, suposta liberdade racional a atentar a divisão, sem a qual não seria possível colocar a filosofia numa posição que, de ora em diante, será o próprio movimento. A analogia é uma necessidade, atendendo à permuta incessante entre Fisioterapia e Filosofia, com o propósito de ver a Unidade nas obrigatórias prestações do olhar.