Consumption of benzylpenicillin as a syphilis control indicator

Syphilis is a disease with compulsory and mandatory notification to the Notifiable Diseases Information System (SINAN), with benzathine benzylpenicillin being the treatment of choice. The aim of the study was to compare the consumption of benzylpenicillin benzathine, from the dispensation, between the health regions of a capital in the southern region of the country, according to the georeferencing of notified cases of syphilis. This is a descriptive, cross-sectional, retrospective study of the use of benzylpenicillin benzathine and of reported cases of syphilis. Data on syphilis cases were obtained from notifications made in SINAN, and drug consumption data were obtained from the Municipal Health Department computerized system for Drug Dispensing from January 1st, 2019 to December 31st, 2019. Notifications and drug consumption were georeferenced according to 8 health regions. From the compilation of data, the rates of cases and consumption in relation to the population of each region were calculated. A total of 3188 notifications and a total of 35191 vials of benzathine benzylpenicillin were analyzed. The ratio of vials by SINAN notifications showed that each patient took 11 vials of the drug, which is a higher value if we consider that the complete treatment is 2 to 6 vials per case

MULTIPLEX SYBR® GREEN-REAL TIME PCR (qPCR) ASSAY FOR THE DETECTION AND DIFFERENTIATION OF Bartonella henselae AND Bartonella clarridgeiae IN CATS

A novel SYBR® green-real time polymerase chain reaction (qPCR) was developed to detect two Bartonella species, B. henselae and B. clarridgeiae, directly from blood samples. The test was used in blood samples obtained from cats living in animal shelters in Southern Brazil. Results were compared with those obtained by conventional PCR targeting Bartonella spp. Among the 47 samples analyzed, eight were positive using the conventional PCR and 12 were positive using qPCR. Importantly, the new qPCR detected the presence of both B. henselae and B. clarridgeiae in two samples. The results show that the qPCR described here may be a reliable tool for the screening and differentiation of two important Bartonella species.Um novo teste baseado na reação em cadeia da polimerase em tempo real (qPCR) com SYBR ® Green foi desenvolvido para detectar duas espécies de Bartonella, B. henselae e B. clarridgeiae, diretamente em amostras de sangue. Este teste foi utilizado em amostras de sangue obtidas de gatos que vivem em abrigos de animais do sul do Brasil. Os resultados foram comparados aos obtidos pelo PCR convencional utilizado para a detecção de Bartonella spp. Das 47 amostras analisadas, oito foram positivas no PCR convencional e 12 foram positivas para qPCR. A reação de qPCR, permitiu a detecção da presença simultânea de B. henselae e B. clarridgeiae em duas destas amostras. Os resultados mostram que a qPCR aqui descrita pode ser uma ferramenta confiável para a detecção e diferenciação de duas espécies importantes de Bartonella spp

Analysis of R213R and 13494 g→a polymorphisms of the p53 gene in individuals with esophagitis, intestinal metaplasia of the cardia and Barrett’s Esophagus compared with a control group

Protein p53 is the tumor suppressor involved in cell cycle control and apoptosis. There are several polymorphisms reported for p53 which can affect important regions involved in protein tumor suppressor activity. Amongst the polymorphisms described, R213R and 13949 g→a are rarely studied, with an estimate frequency not yet available for the Brazilian population. The purpose of this study was to investigate the genotype and allele frequencies and associations of these polymorphisms in a group of patients with altered esophageal tissue from South Brazil and compare with the frequency observed for a control population. A total of 35 patients for R213R and 45 for 13494 g→a polymorphisms analysis with gastroesophageal reflux disease (GERD) symptoms diagnosed by upper digestive endoscopy and confirmed by biopsy were studied. For both groups, 100 controls were used for comparison. Loss of heterozygosity (LOH) was also analyzed for a selected group of patients where normal and affected tissue was available. There was one patient with Barrett’s Esophagus (BE) showing LOH for R213R out of two heterozygous samples analyzed and two patients (esophagitis and BE) for 13494 g→a polymorphism. We also aimed to build a haplotype for both polymorphisms collectively analyzed with R27P polymorphism, previously reported by our group. There were no significant differences in allele and genotype distribution between patients and controls. Although using esophagitis, intestinal metaplasia of the cardia and BE samples, all non-neoplastic lesions, we can conclude that these sites do not represent genetic susceptibility markers for the development and early progression of GERD to BE and esophageal cancer. Additional studies are required in order to investigate other determiners of early premalignant lesions known to predispose to esophageal cancer

Aprendizado de máquina nos serviços farmacêuticos: uma revisão integrativa

The growing application of artificial intelligence (AI) in complex real-world problems has shown an enormous potential to improve health services, including the role of pharmacists in the care process. Thus, the objective of this study was to identify, in the scientific literature, studies that addressed the use of machine learning (ML) algorithms applied to the activities of clinical pharmacists in patient care. This is an integrative review, conducted in the databases Pubmed, VHL Regional Portal, Cochrane Library and Embase. Original articles, related to the proposed topic, which were available and published before December 31, 2021, were included, without language limitations. There were 831 articles retrieved 5 of which were related to activities included in the pharmacotherapy review services (3) and therapeutic monitoring (2). Supervised (3) and unsupervised (2) ML techniques were used, with a variety of algorithms tested, with all studies published recently (2019 - 2021). It is concluded that the application of AI in clinical pharmacy is still discreet, signaling the challenges of the digital age.A crescente digitalização e aplicação de inteligência artificial (IA) em problemas complexos do mundo real, tem potencial de melhorar os serviços de saúde, inclusive da atuação dos farmacêuticos no processo do cuidado. O objetivo deste estudo foi identificar na literatura científica, estudos que testam algoritmos de aprendizado de máquina (Machine Learning - ML) aplicados as atividades de farmacêuticos clínicos no cuidado ao paciente. Trata-se de uma revisão integrativa, realizada nas bases de dados, Pubmed, Portal BVS, Cochrane Library e Embase. Artigos originais, relacionados ao objetivo proposto, disponíveis e publicados antes de 31 de dezembro de 2021, foram incluídos, sem limitações de idioma. Foram encontrados 831 artigos, sendo 5 incluídos relacionados as atividades inseridas nos serviços de revisão da farmacoterapia (3) e monitorização terapêutica (2). Foram utilizadas técnicas supervisionadas (3) e não supervisionadas (2) de ML, com variedade de algoritmos testados, sendo todos os estudos publicados recentemente (2019 - 2021). Conclui-se que a aplicação da IA na farmácia clínica, ainda é discreta, sinalizando os desafios da era digital.A crescente digitalização e aplicação de inteligência artificial (IA) em problemas complexos do mundo real, tem potencial de melhorar os serviços de saúde, inclusive da atuação dos farmacêuticos no processo do cuidado. O objetivo deste estudo foi identificar na literatura científica, estudos que testam algoritmos de aprendizado de máquina (Machine Learning - ML) aplicados as atividades de farmacêuticos clínicos no cuidado ao paciente. Trata-se de uma revisão integrativa, realizada nas bases de dados, Pubmed, Portal BVS, Cochrane Library e Embase. Artigos originais, relacionados ao objetivo proposto, disponíveis e publicados antes de 31 de dezembro de 2021, foram incluídos, sem limitações de idioma. Foram encontrados 831 artigos, sendo 5 incluídos relacionados as atividades inseridas nos serviços de revisão da farmacoterapia (3) e monitorização terapêutica (2). Foram utilizadas técnicas supervisionadas (3) e não supervisionadas (2) de ML, com variedade de algoritmos testados, sendo todos os estudos publicados recentemente (2019 - 2021). Conclui-se que a aplicação da IA na farmácia clínica, ainda é discreta, sinalizando os desafios da era digital

Inhalation therapy during noninvasive ventilation in patients with chronic obstructive pulmonary disease

O objetivo deste estudo é descrever os aspectos técnicos e cuidados a serem observados durante a administração de medicamentos inalatórios contidos em inalador pressurizado (pMDI) em pacientes com doença pulmonar obstrutiva crônica em ventilação não-invasiva (VNI). Trata-se de uma revisão integrativa elaborada em quatro fases: (1) busca na literatura; (2) consulta às sociedades médicas; (3) pesquisa em bulas e monografias dos fármacos inalatórios; e (4) contato com empresas de ventiladores, medicamentos e espaçadores. A busca aos estudos foi conduzida a partir de palavras-chaves e restringida a publicações até 31 de dezembro de 2019, nos idiomas português e inglês. Foram selecionados 9 artigos, sendo 1 estudo primário, 6 estudos de revisão e 2 estudos em modelos experimentais de ventilação. Foram incluídas 2 diretrizes a partir da consulta às sociedades médicas e das 8 empresas contatas, quatro fizeram recomendações quanto à técnica inalatória. Não foram encontradas informações sobre a administração dos fármacos em VNI nas bulas e monografias. Recomenda-se atentar para as medidas que podem aumentar a deposição pulmonar dos fármacos inalatórios, como uso de aerocâmara com pMDI, minimização de escape indesejável de ar, sincronia entre paciente-ventilador, disparo do jato na fase inspiratória e inserção de porta de vazamento na máscara ou circuito.The aim of this study is to describe the technical aspects and cautions to be observed during the administration of inhaled medications contained in a pressurized inhaler (pMDI) in patients with chronic obstructive pulmonary disease on noninvasive ventilation. This integrative review consisted of 4 phases: (1) search in the literature; (2) consultation with medical societies; (3) research on package inserts and monographs of inhaled drugs; and (4) contact with ventilator, medication and spacer companies. The search for studies was based on keywords and restricted to articles published until December 31, 2019, written in Portuguese and English. Nine articles were selected, including 1 primary study, 6 review studies and 2 studies on experimental ventilation models. Two guidelines were included from the consultation with medical societies, and of the 8 companies contacted, 4 made recommendations regarding the inhalation technique. No information was found on the administration of noninvasive ventilation drugs in package inserts and monographs. Attention should be given to measures that increase the pulmonary deposition of inhaled drugs, such as the use of an air chamber with pMDI, minimization of undesirable air leakage, patient-ventilator synchronization, jet firing in the inspiratory phase and insertion of a leak port in the mask or circuit

Machine learning in pharmaceutical services : an integrative review

A crescente digitalização e aplicação de inteligência artificial (IA) em problemas complexos do mundo real, tem potencial de melhorar os serviços de saúde, inclusive da atuação dos farmacêuticos no processo do cuidado. O objetivo deste estudo foi identificar na literatura científica, estudos que testam algoritmos de aprendizado de máquina (Machine Learning – ML) aplicados as atividades de farmacêuticos clínicos no cuidado ao paciente. Trata-se de uma revisão integrativa, realizada nas bases de dados, Pubmed, Portal BVS, Cochrane Library e Embase. Artigos originais, relacionados ao objetivo proposto, disponíveis e publicados antes de 31 de dezembro de 2021, foram incluídos, sem limitações de idioma. Foram encontrados 831 artigos, sendo 5 incluídos relacionados as atividades inseridas nos serviços de revisão da farmacoterapia (3) e monitorização terapêutica (2). Foram utilizadas técnicas supervisionadas (3) e não supervisionadas (2) de ML, com variedade de algoritmos testados, sendo todos os estudos publicados recentemente (2019-2021). Conclui-se que a aplicação da IA na farmácia clínica, ainda é discreta, sinalizando os desafios da era digital.The growing application of artificial intelligence (AI) in complex real-world problems has shown an enormous potential to improve health services, including the role of pharmacists in the care process. Thus, the objective of this study was to identify, in the scientific literature, studies that addressed the use of machine learning (ML) algorithms applied to the activities of clinical pharmacists in patient care. This is an integrative review, conducted in the databases Pubmed, VHL Regional Portal, Cochrane Library and Embase. Original articles, related to the proposed topic, which were available and published before December 31, 2021, were included, without language limitations. There were 831 articles retrieved 5 of which were related to activities included in the pharmacotherapy review services (3) and therapeutic monitoring (2). Supervised (3) and unsupervised (2) ML techniques were used, with a variety of algorithms tested, with all studies published recently (2019–2021). It is concluded that the application of AI in clinical pharmacy is still discreet, signaling the challenges of the digital age

Terapia Inalatória em Ventilação Não-invasiva em Pacientes com Doença Pulmonar Obstrutiva Crônica

O objetivo é descrever os aspectos técnicos e cuidados a serem observados durante a administração de medicamentos inalatórios contidos em inalador pressurizado (pMDI) em pacientes com Doença Pulmonar Obstrutiva Crônica em ventilação não-invasiva. Trata-se de uma revisão integrativa elaborada em quatro fases: (1) busca na literatura; (2) consulta às sociedades médicas; (3) pesquisa em bulas e monografias dos fármacos inalatórios; e (4) contato com empresas de ventiladores, medicamentos e espaçadores. A busca aos estudos foi conduzida a partir de palavras-chaves e restringida a publicações até 31 de dezembro de 2019, nos idiomas português e inglês. Foram selecionados 9 artigos, sendo 1 estudo primário, 6 estudos de revisão e 2 estudos em modelos experimentais de ventilação. Foram incluídas 2 diretrizes a partir da consulta às sociedades médicas e das 8 empresas contatas, quatro fizeram recomendações quanto à técnica inalatória. Não foram encontradas informações sobre a administração dos fármacos em VNI nas bulas e monografias. Recomenda-se atentar para as medidas que podem aumentar a deposição pulmonar dos fármacos inalatórios, como uso de aerocâmara com pMDI, minimização de escape indesejável de ar, sincronia entre paciente-ventilador, disparo do jato na fase inspiratória e inserção de porta de vazamento na máscara ou circuito

Prevalence of potential drug-drug interactions in the intensive care unit of a Brazilian teaching hospital

Patients in intensive care unit are prescribed large numbers of drugs, highlighting the need to study potential Drug-Drug Interactions in this environment. The aim of this study was to delineate the prevalence and risk of potential drug-drug interactions between medications administered to patients in an ICU. This cross-sectional observational study was conducted during 12 months, in an adult ICU of a teaching hospital. Inclusion criteria were: prescriptions with 2 or more drugs of patients admitted to the ICU for >; 24 hours and age of ≥18 years. Potential Drug-Drug Interactions were quantified and classified through MicromedexTM database. The 369 prescriptions included in this study had 205 different drugs, with an average of 13.04 ± 4.26 (mean ± standard deviation) drugs per prescription. Potential Drug-Drug Interactions were identified in 89% of these, with an average of 5.00 ± 5.06 interactions per prescription. Of the 405 different pairs of potentially interacting drugs identified, moderate and major interactions were present in 74% and 67% of prescriptions, respectively. The most prevalent interaction was between dipyrone and enoxaparin (35.8%), though its clinical occurrence was not observed in this study. The number of potential Drug-Drug Interactions showed significant positive correlations with the length of stay in the intensive care unit, and with the number of prescribed drugs. Acknowledging the high potential for Drug-Drug Interactions in the ICU represents an important step toward improving patient safety and best therapy results

Fixed and on-demand regimens of acetaminophen in periodontal surgery : randomized clinical trial

Aim: to evaluate the clinical efficacy of an acetaminophen analgesic by comparing its prescription in fixed versus ondemand schedules after periodontal surgery. The hypothesis of the study was that the fixed regimen would be more effective than the on-demand regimen for postoperative analgesics following periodontal surgery. Methods: An open randomized clinical trial was conducted. The 68 patients who needed total flap surgery to restore supracrestal tissue attachment or surgical treatment of periodontitis were randomized”. Visual Analogue Scale was used to assess pain. The fixed group (n = 34) received 500 mg of acetaminophen every 4 hours for 2 days. The on-demand group (n = 34) was instructed to use the acetaminophen “as needed,” at intervals of no less than 4 hours between doses. Ibuprofen was the rescue medication for both groups. Pain scores and medication use were recorded 2, 6, 12, 24 and 48 hours after the surgical procedure. The study was registered at the Brazilian Registry of Clinical Trials under RBR-7wv259. Results: The two groups did not differ in relation to the frequency or the intensity of pain in a 48-hour period (n=20 in the fixed group, and n=22 in the on-demand group), or even in the intention-to-treat (n=34 in each group). Individuals who experienced moderate to severe pain used rescue medication more frequently in both groups. No adverse events were reported. Conclusion: Both regimens were effective in controlling postoperative pain after periodontal surgery