Neotropical xenarthrans: a data set of occurrence of xenarthran species in the neotropics

Xenarthrans -anteaters, sloths, and armadillos- have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. Have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become.Fil: Marques Santos, Paloma. Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas; BrasilFil: Bocchiglieri, Adriana. Universidade Federal de Sergipe; BrasilFil: Garcia Chiarello, Adriano. Universidade de Sao Paulo; BrasilFil: Pereira Paglia, Adriano. Universidade Federal de Minas Gerais. Instituto de Ciências Biológicas; BrasilFil: Moreira, Adryelle. Amplo Engenharia e Gestão de Projetos ; BrasilFil: Abba, Agustin Manuel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Estudios Parasitológicos y de Vectores. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Centro de Estudios Parasitológicos y de Vectores; ArgentinaFil: Paviolo, Agustin Javier. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Universidad Nacional de Misiones. Instituto de Biología Subtropical; ArgentinaFil: Gatica, Ailin. Universidad Nacional de San Luis; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis. Instituto Multidisciplinario de Investigaciones Biológicas de San Luis. Universidad Nacional de San Luis. Facultad de Ciencias Físico Matemáticas y Naturales. Instituto Multidisciplinario de Investigaciones Biológicas de San Luis; ArgentinaFil: Ochoa, Ana Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis. Instituto Multidisciplinario de Investigaciones Biológicas de San Luis. Universidad Nacional de San Luis. Facultad de Ciencias Físico Matemáticas y Naturales. Instituto Multidisciplinario de Investigaciones Biológicas de San Luis; ArgentinaFil: de Angelo, Carlos Daniel. Universidad Nacional de Rio Cuarto. Facultad de Cs.exactas Fisicoquimicas y Naturales. Instituto de Ciencias de la Tierra, Biodiversidad y Ambiente. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - Cordoba. Instituto de Ciencias de la Tierra, Biodiversidad y Ambiente.; ArgentinaFil: Tellaeche, Cintia Gisele. Universidad Nacional de Jujuy. Facultad de Ciencias Agrarias. Centro de Estudios Ambientales Territoriales y Sociales; Argentina. Universidad Nacional de Jujuy. Instituto de Ecorregiones Andinas. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Ecorregiones Andinas; ArgentinaFil: Varela, Diego Martin. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Vanderhoeven, Ezequiel Andres. Ministerio de Salud. Instituto Nacional de Medicina Tropical; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Caruso, María Flavia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Administración de Parques Nacionales. Delegación Regional del Noroeste; ArgentinaFil: Arrabal, Juan Pablo. Secretaria de Gobierno de Salud. Instituto Nacional de Medicina Tropical - Sede Puerto Iguazú Misiones; Argentina. Centro de Investigaciones del Bosque Atlántico; ArgentinaFil: Iezzi, María Eugenia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Di Bitetti, Mario Santiago. Centro de Investigaciones del Bosque Atlántico; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Cruz, Paula Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; Argentina. Centro de Investigaciones del Bosque Atlántico; ArgentinaFil: Reppucci, Juan Ignacio. Administración de Parques Nacionales. Delegación Regional del Noroeste; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Benito Santamaria, Silvia. Centro de Investigaciones del Bosque Atlántico; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Quiroga, Verónica Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Diversidad y Ecología Animal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto de Diversidad y Ecología Animal; ArgentinaFil: Di Blanco, Yamil Edgardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Marás, Gustavo Arnaldo. Administración de Parques Nacionales. Delegación Regional del Noroeste; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Camino, Micaela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Centro de Ecología Aplicada del Litoral. Universidad Nacional del Nordeste. Centro de Ecología Aplicada del Litoral; ArgentinaFil: Perovic, Pablo Gastón. Administración de Parques Nacionales. Delegación Regional del Noroeste; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Martínez Pardo, Julia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Costa, Sebastián Andrés. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Pinheiro, Fabiana. Universidade Federal do Rio Grande do Sul; BrasilFil: Volkmer de Castilho, Pedro. Universidade Federal de Santa Catarina; BrasilFil: Bercê, William. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Camara Assis, Julia. Universidade Estadual Paulista Julio de Mesquita Filho. Faculdade de Engenharia.; BrasilFil: Rodrigues Tonetti, Vinicius. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Alves Eigenheer, Milene. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Chinem, Simonne. Universidade de Sao Paulo; BrasilFil: Honda, Laura K.. Universidade Estadual Paulista Julio de Mesquita Filho; BrasilFil: Bergallo, Helena de Godoy. Universidade do Estado de Rio do Janeiro; BrasilFil: Alberici, Vinicius. Universidade de Sao Paulo; BrasilFil: Wallace, Robert. Wildlife Conservation Society; Estados UnidosFil: Ribeiro, Milton Cezar. Universidade de Sao Paulo; BrasilFil: Galetti, Mauro. Universidade Estadual Paulista Julio de Mesquita Filho; Brasi

The germline mutational landscape of BRCA1 and BRCA2 in Brazil

The detection of germline mutations in BRCA1 and BRCA2 is essential to the formulation of clinical management strategies, and in Brazil, there is limited access to these services, mainly due to the costs/availability of genetic testing. Aiming at the identification of recurrent mutations that could be included in a low-cost mutation panel, used as a first screening approach, we compiled the testing reports of 649 probands with pathogenic/likely pathogenic variants referred to 28 public and private health care centers distributed across 11 Brazilian States. Overall, 126 and 103 distinct mutations were identified in BRCA1 and BRCA2, respectively. Twenty-six novel variants were reported from both genes, and BRCA2 showed higher mutational heterogeneity. Some recurrent mutations were reported exclusively in certain geographic regions, suggesting a founder effect. Our findings confirm that there is significant molecular heterogeneity in these genes among Brazilian carriers, while also suggesting that this heterogeneity precludes the use of screening protocols that include recurrent mutation testing only. This is the first study to show that profiles of recurrent mutations may be unique to different Brazilian regions. These data should be explored in larger regional cohorts to determine if screening with a panel of recurrent mutations would be effective.This work was supported in part by grants from Barretos Cancer Hospital (FINEP - CT-INFRA, 02/2010), Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, 2013/24633-2 and 2103/23277-8), Fundação de Apoio à Pesquisa do Rio Grande do Norte (FAPERN), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS), Ministério da Saúde, the Breast Cancer Research Foundation (Avon grant #02-2013-044) and National Institute of Health/National Cancer Institute (grant #RC4 CA153828-01) for the Clinical Cancer Genomics Community Research Network. Support in part was provided by grants from Fundo de Incentivo a Pesquisa e Eventos (FIPE) from Hospital de Clínicas de Porto Alegre, by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, BioComputacional 3381/2013, Rede de Pesquisa em Genômica Populacional Humana), Secretaria da Saúde do Estado da Bahia (SESAB), Laboratório de Imunologia e Biologia Molecular (UFBA), INCT pra Controle do Câncer and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). RMR and PAP are recipients of CNPq Productivity Grants, and Bárbara Alemar received a grant from the same agencyinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

ATLANTIC-CAMTRAPS: a dataset of medium and large terrestrial mammal communities in the Atlantic Forest of South America

Our understanding of mammal ecology has always been hindered by the difficulties of observing species in closed tropical forests. Camera trapping has become a major advance for monitoring terrestrial mammals in biodiversity rich ecosystems. Here we compiled one of the largest datasets of inventories of terrestrial mammal communities for the Neotropical region based on camera trapping studies. The dataset comprises 170 surveys of medium to large terrestrial mammals using camera traps conducted in 144 areas by 74 studies, covering six vegetation types of tropical and subtropical Atlantic Forest of South America (Brazil and Argentina), and present data on species composition and richness. The complete dataset comprises 53,438 independent records of 83 species of mammals, includes 10 species of marsupials, 15 rodents, 20 carnivores, eight ungulates and six armadillos. Species richness averaged 13 species (±6.07 SD) per site. Only six species occurred in more than 50% of the sites: the domestic dog Canis familiaris, crab-eating fox Cerdocyon thous, tayra Eira barbara, south American coati Nasua nasua, crab-eating raccoon Procyon cancrivorus and the nine-banded armadillo Dasypus novemcinctus. The information contained in this dataset can be used to understand macroecological patterns of biodiversity, community, and population structure, but also to evaluate the ecological consequences of fragmentation, defaunation, and trophic interactions. © 2017 by the Ecological Society of Americ

ATLANTIC EPIPHYTES: a data set of vascular and non-vascular epiphyte plants and lichens from the Atlantic Forest

Epiphytes are hyper-diverse and one of the frequently undervalued life forms in plant surveys and biodiversity inventories. Epiphytes of the Atlantic Forest, one of the most endangered ecosystems in the world, have high endemism and radiated recently in the Pliocene. We aimed to (1) compile an extensive Atlantic Forest data set on vascular, non-vascular plants (including hemiepiphytes), and lichen epiphyte species occurrence and abundance; (2) describe the epiphyte distribution in the Atlantic Forest, in order to indicate future sampling efforts. Our work presents the first epiphyte data set with information on abundance and occurrence of epiphyte phorophyte species. All data compiled here come from three main sources provided by the authors: published sources (comprising peer-reviewed articles, books, and theses), unpublished data, and herbarium data. We compiled a data set composed of 2,095 species, from 89,270 holo/hemiepiphyte records, in the Atlantic Forest of Brazil, Argentina, Paraguay, and Uruguay, recorded from 1824 to early 2018. Most of the records were from qualitative data (occurrence only, 88%), well distributed throughout the Atlantic Forest. For quantitative records, the most common sampling method was individual trees (71%), followed by plot sampling (19%), and transect sampling (10%). Angiosperms (81%) were the most frequently registered group, and Bromeliaceae and Orchidaceae were the families with the greatest number of records (27,272 and 21,945, respectively). Ferns and Lycophytes presented fewer records than Angiosperms, and Polypodiaceae were the most recorded family, and more concentrated in the Southern and Southeastern regions. Data on non-vascular plants and lichens were scarce, with a few disjunct records concentrated in the Northeastern region of the Atlantic Forest. For all non-vascular plant records, Lejeuneaceae, a family of liverworts, was the most recorded family. We hope that our effort to organize scattered epiphyte data help advance the knowledge of epiphyte ecology, as well as our understanding of macroecological and biogeographical patterns in the Atlantic Forest. No copyright restrictions are associated with the data set. Please cite this Ecology Data Paper if the data are used in publication and teaching events. © 2019 The Authors. Ecology © 2019 The Ecological Society of Americ

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Therapeutic Drug Monitoring of topiramate in patients with refractory epilepsy

A estratégia mais amplamente utilizada no tratamento da epilepsia é a farmacoterapia. Entretanto cerca de 30% dos pacientes mesmo utilizando o fármaco adequado para o seu diagnóstico não respondem ao tratamento proposto, sendo então diagnosticados com epilepsia refratária. Entre as drogas antiepilépticas (DAE) utilizadas no tratamento da epilepsia refratária encontra-se o topiramato (TPM). O objetivo do presente estudo foi avaliar a concentração plasmática (Cp) do TPM verificando a influência da dose prescrita (mg/Kg/dia), sexo, idade e o uso de outras DAE sobre a mesma, correlacionando-a com a frequência de crises epilépticas, reações adversas, qualidade de vida e adesão a farmacoterapia. Este estudo observacional transversal foi realizado com 37 pacientes com epilepsia refratária em uso de TPM atendidos no Ambulatório de Epilepsia de Difícil Controle do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. As variáveis de interesse foram qualidade de vida (Quality of Life in Epilepsy - QOLIE-31), reações adversas ao medicamento (RAM) (Liverpool Adverse Event Profile - LAEP), adesão a farmacoterapia (Modified Morisky Scale - MMS), tipo de crise epiléptica, tipo de epilepsia, frequência das crises, características farmacoterapêuticas e sociodemográficas, obtidas por meio de instrumentos na entrevista com o paciente ou em prontuário. Além disso, amostras de sangue de todos os participantes foram coletadas para dosagem da Cp de TPM, lamotrigina e DAEs de primeira geração em uso. O trabalho foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Ciências Farmacêuticas de Ribeirão Preto-USP (nº 030/2014). A idade média dos pacientes foi 40 anos (DP 10,7) e apresentavam prevalentemente epilepsia focal sintomática (73,0%) e crises parciais complexas (67,6%). Em relação ao perfil farmacoterapêutico, 97,3% dos pacientes estavam em politerapia, sendo o esquema farmacoterapêutico mais prevalente a associação entre TPM, carbamazepina e clobazam (29,8%). A Cp de 83,8% dos pacientes em uso de TPM encontraram-se abaixo do intervalo de referência recomendado (5,0 -20,0 mg/L), sendo a Cp média de 3,21 mg/L (DP 2,76). A dose prescrita (mg/Kg/dia) e o uso concomitante de indutores do metabolismo do TPM explicaram 69,0% da variabilidade da Cp do TPM: estimou-se que o aumento na dose de 1,0 mg/Kg/dia tenha promovido o aumento de 0,68 mg/L na Cp do TPM, enquanto o uso de indutores esteve relacionado a uma redução de 2,97 mg/L (p?0,001). Os pacientes com Cp < 5,0 mg/L apresentaram o número médio de crises epilépticas maior do que aqueles com Cp no intervalo de referência (p<0,001). A pontuação média do LAEP foi de 40,5 (DP 10,1) e a sonolência, problemas de memória e o nervosismo e/ou agressividade foram as reações adversas mais prevalentes. Com relação à qualidade de vida o escore médio obtido no QOLIE-31 foi de 47,7 (DP 15,2), sendo que a preocupação com as crises e a função social foram os domínios que apresentaram maior comprometimento na qualidade de vida dos pacientes. Ademais, foram encontradas evidências de uma relação inversa entre RAM e a qualidade de vida, sendo que o aumento de um ponto no escore do LAEP reduz o escore do QOLIE-31 em 0,91 pontos. Finalmente, segundo resultados do MMS, 62,2% dos pacientes eram aderentes ao tratamento medicamentoso. Em conclusão a dose prescrita e o uso de DAE indutoras do metabolismo do TPM influenciaram a Cp deste fármaco, a qual afetou o controle das crises epilépticas. Diante disto sugere-se a monitorização terapêutica como uma ferramenta para a otimização da farmacoterapia e da resposta clínica.The most widely used strategy in epilepsy treatment is pharmacotherapy. However, near 30% of all patients, even though receiving the appropriate drug, do not respond to recommended treatment. Among the antiepileptic drugs (AED) used for the treatment of refractory epilepsy there is topiramate (TPM). The aim of this study was to evaluate TPM\'s plasma concentration (Cp) and to verify the influence of some variables [prescribed dose (mg/Kg/day), sex, age and other AED in use] on it, as well as correlate TPM\'s Cp with the frequency of epileptic crises, adverse events, quality of life and adherence to pharmacotherapy. This cross-sectional study enrolled 37 patients diagnosed with refractory epilepsy in use of TPM attended at the Epilepsy of Difficult Control\'s ambulatory of the Ribeirão Preto Medical School University Hospital. The investigated variables were quality of life (Quality of Life in Epilepsy - QOLIE-31), adverse drug reactions (ADR) (Liverpool Adverse Event Profile - LAEP), adherence to pharmacotherapy (Modified Morisky Scale - MMS), type of epileptic crisis, type of epilepsy, frequency of crises, pharmacotherapeutic and sociodemographic characteristics, all of them obtained through medical records and/or face to face interview. Moreover, blood samples of all patients were collected in order to measure Cp of TPM, lamotrigine and first generation AEDs in use. The study was approved by the Research Ethics Committee of the School of Pharmaceutical Sciences of Ribeirão Preto-USP (nº 030/2014). The patients\' mean age was 40 years (SD 10.7) and they showed predominantly symptomatic focal epilepsy (73.0%) and partial complex seizures (67.6%). Considering the pharmacotherapeutic profile, 97.3% of them were under polytherapy, in which the most prevalent regimen consisted in the combination of TPM, carbamazepine and clobazam (29.8%). From all patients in use of TPM, the mean Cp for this drug was 3.21 mg/L (SD 2.76) and 83.8% presented values below the recommended reference range (5.0 mg/L). The prescribed dose (mg/Kg/day) and concomitant use of TPM\'s metabolism inducers explained 69.0% of TPM\'s Cp variability: it was estimated that an increment of 1.0 mg/Kg/day in the dosage of TPM has lead to an increase of 0.68 mg/L in its Cp, while the use of inducers was related to a decrease of 2.97 mg/L (p?0.001). Patients with Cp < 5.0 mg/L showed a larger mean number of crises than those whose Cp was within the reference range (p<0.001). The LAEP\'s mean score was 40.5 (SD 10.1) and somnolence, memory problems and nervousness and/or agitation were the most common adverse events. Regarding quality of life, QOLIE-31\'s mean score was 47.7 (SD 15.2), wherein concern about the crisis and social role were the areas related to greater impairment in patients\' quality of life. Furthermore, we found evidences of an inverse relationship between ADR and quality of life in which the one point increase in LAEP score reduced QOLIE-31 score in 0.91 point. Finally, according to MMS results, 62.2% of patients were adherent to their treatment. In conclusion prescribed dose and concomitant use of AEDs that induced TPM\'s metabolism influenced on this drug\'s Cp, which seemed to affect epileptic seizures control. Thus, we suggest the use of therapeutic drug monitoring of TPM as a tool for pharmacotherapy optimization so as to improve the clinical response in these patients

Adverse drug reactions: incidence and risk factors in hospitalized elderly of an intensive care unit

De acordo com a Organização Mundial de Saúde a reação adversa a medicamento (RAM) é definida como \"uma resposta nociva e não intencional ao uso de um medicamento que ocorre em doses normalmente utilizadas em seres humanos para profilaxia, diagnóstico ou tratamento de doenças ou para modificação da função fisiológica\". O potencial de RAM é aumentado na população idosa e em Unidade de Terapia Intensiva (UTI). Diante disto, o objetivo do presente estudo foi avaliar a incidência de RAM, por meio de trigger tools, e identificar os fatores de risco para a ocorrência das mesmas, em idosos internados no UTI adulto do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. Para isso um estudo caso controle aninhado a uma coorte foi desenvolvido com pacientes de idade igual ou superior a 60 anos. Os exames laboratoriais, as prescrições médicas e o prontuário dos pacientes incluídos no estudo foram monitorados diariamente. Nos casos sugestivos de RAM foi realizada a análise de causalidade, os pacientes que durante a internação na UTI não tiveram identificado nenhum trigger tools ou este foi próprio do processo de doença do paciente ou não levou a uma RAM foram alocados no grupo controle. Os pacientes que possuíram a RAM classificada na categoria de causalidade como: definida, provável ou possível, foram alocados no grupo caso. As demais variáveis de interesse no estudo dividiram-se em características clínicas e farmacoterapêuticas, além disso, foi calculado o escore de risco para RAM (The GerontoNet Adverse Drug Reactions Risk Score e Brighton Adverse Drug Reactions Risk-BADRI) e avaliado o uso de medicamentos potencialmente inapropriados para idosos (MPI) (critérios AGS Beers e STOPP). Foram incluídos no estudo 41 pacientes com a média idade de 66,8 anos (DP 5,2), variando entre 60 e 78 anos, a principal razão de admissão no CTI ocorreu por comprometimentos cardiovasculares sendo 86,2% devido a choque séptico. Os pacientes permaneceram internados em média por 15,1 dias (DP 7,8) e utilizaram durante o período de internação na UTI uma média de 24,7 medicamentos/paciente (DP 7,4), sendo as classes mais prescritas de antibacterianos para uso sistêmico, analgésicos e terapia cardíaca. Apenas um dos pacientes incluídos no estudo não utilizou nenhum MPI. Foram identificados 1295 trigger tools, uma mediana de 30/paciente (IIQ 28), sendo que 3,0% tratou-se de um indicativo para RAM. Foram identificadas 15 RAM que ocorreram em 11 pacientes, alocados para o grupo caso, o coeficiente de incidência detectado foi de 36,6 RAM/100 pacientes. Os instrumentos The GerontoNet ADR Risk Score e BADRI mostraram-se efetivos para estimar os idosos com maior risco de desenvolver RAM na UTI, cerca de 50% das reações ocorreram pelo uso de MPI e metade dos medicamentos suspeitos de RAM foram antimicrobianos e opióides. Em conclusão aproximadamente um terço dos pacientes apresentou pelo menos uma RAM; os trigger tools mostraram-se efetivos na busca ativa de RAM, pois 66,7% das reações foram identificadas devido o uso desta ferramenta; e o tempo de internação no CTI e o número de medicamentos utilizados durante o período de internação foram as variáveis associadas com a ocorrência de RAM em idosos internados em UTI.According to the World Health Organization (WHO) adverse drug reaction (ADR) is defined as -a response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy of disease, or for the modifications of physiological function?. The potential of ADR is increased in the elderly population due to the number of diagnoses, number of medications used and the complexity of pharmacotherapy. In the Intensive Care Unit (ICU), pharmacotherapy is extremely important for the patient, and is used to minimize morbidity and mortality and frequently the patients requires the administration of drugs with a high risk of adverse reactions.Therefore, the aim of this study was to evaluate the incidence of ADR using trigger tools and to identify risk factors for their occurrence in elderly patients admitted to the ICU of the General Hospital of the Ribeirão Preto Medical School, University of São Paulo. Thus a nested case-control study was developed with patients aged equal or higher than 60 years. The laboratory exams, electronic prescriptions and medical records of the patients included in the study were monitored daily. In cases suggestive of ADR analysis of the causality was carried out, the patients that during hospitalization in the ICU had not identified any trigger tools or this is itself the patient\'s disease process were allocated in the control group. Patients who had a ADR classified in the category of causality as certain, probable or possible were allocated in the case group. The other variables of interest in the study were divided into clinical and pharmacotherapeutic characteristics, the risk score for ADR was calculated (The GerontoNet Adverse Drug Reactions Risk Score and Brighton Adverse Drug Reactions Risk-BADRI), and the use of potentially inappropriate drugs (PID) for the elderly was evaluated (AGS Beers criteria and STOPP criteria). The study included 41 patients with a mean age of 66.8 years (SD 5.2), ranging from 60 to 78 years, the main reason for ICU admission was cardiovascular impairment, being 86.2% due to septic shock. Patients were hospitalized for a mean of 15.1 days (SD 7.8) and used a mean of 24.7 medication/ patient (SD 7.4) during the ICU stay, with the most prescribed classes being antiinfectives for systemic use, analgesics and cardiac therapy. Only one patient included in the study did not use any PID. A total of 1295 trigger tools were identified, a median of 30 / patient (IR 28), and 3.0% was an indication for ADR. We identified 15 ADRs that occurred in 11 patients, allocated to the case group, the incidence coefficient detected was 36.6 ADR / 100 patients. The GerontoNet ADR Risk Score and BADRI instruments were effective in estimating the elderly with a higher risk of developing ADR in ICU, about 50.0% of the reactions occurred using PID and half of the drugs suspected of ADR were antiinfectives and opioids. In conclusion, approximately one third of the patients presented at least one ADR; the trigger tools were effective in the active search for ADR, since 66.7% of the reactions were identified due to the use of this tool; and the length of ICU stay and the number of medications used during the hospitalization period were the variables associated with the occurrence of ADR in elderly patients admitted to the ICU