Needlestick accident resulting in occupational transmission of HCV: Report of two cases

Occupational transmission of hepatitis C virus (HCV) through needlestick injury is a serious problem worldwide. Occupational transmission of HCV is estimated at an average rate between 0,5% and 0,75%. There are factors associated with increased risk of transmission, such as deep injuries, procedures involving hollow-bore needle placement in the source patient’s vein or artery, and high HCV RNA titer in the source patient. We describe two cases of HCV seroconversion in nursing assistants after different risk needlestick injuries. A transmissão ocupacional do vírus da hepatite C (VHC) através de acidentes com material perfurocortante é um problema global. Essa transmissão é estimada, em média, entre 0,5% e 0,75%. Alguns fatores estão associados ao aumento do risco de transmissão, tais como lesões profundas, procedimentos que envolvam colocação da agulha em veia ou artéria, e altos títulos de HCV-RNA no paciente-fonte. Descrevemos dois casos de soroconversão ao VHC em auxiliares de enfermagem após acidentes com agulhas.

Todavía se recetan medicamentos potencialmente hepatotóxicos a pacientes con enfermedad hepática que reciben atención terciaria: es hora de decir basta

Introduction and aim: Drug-induced liver injury (DILI) manifests as a spectrum of clinical presentations that carries morbidity and mortality. Patients with chronic liver disease (CLD), particularly hospitalized, are at high risk for developing DILI. We aimed to investigate the use of potentially hepatotoxic drugs (PHD) in patients with CLD in a tertiary university hospital. Materials and methods: Adult (≥ 18 years-old) with CLD admitted to the hospital from January 2016 to December 2018 were evaluated regarding PHD, assessing the risk of DILI and liver enzymes behavior after exposure. Results: From 931 hospitalized patients with CLD, 291 (31.3%) were exposed to hepatotoxic drugs during their hospitalization. Of those, 244 (83.8%) were cirrhotic. The most frequent causes of liver disease were hepatitis C (41.2%), followed by alcohol (13.2%), hepatitis C/alcohol (11.7%) and non-alcoholic fatty liver disease (5.8%). Decompensated cirrhosis (46.7%) was the main reason for hospital admission. The most often prescribed PHD were antibiotics (67.7%), cardiovascular drugs (34.4%), neuromodulators (26.1%) and anesthetics (19.9%). After exposure, 113 patients (38.8%) presented significant elevated liver enzymes. Surprisingly, PHD were more often prescribed in GI/Liver unit (48.8%) followed by emergency/intensive care unit (28.5%). A total of 65 patients (22%) died, however in neither case was it possible to safely infer causal relationship among PHD, liver enzymes and death. Conclusion: PHD prescription is frequent in patients with CLD even in a tertiary university hospital and in the gastroenterology and hepatology department, exposing these patients to an additional risk.Introducción y objetivo: La lesión hepática inducida por fármacos (DILI) se manifiesta como un espectro de presentaciones clínicas que conlleva morbilidad y mortalidad. Los pacientes con enfermedad hepática crónica (EHC), en particular hospitalizados, tienen un alto riesgo de desarrollar DILI. Nuestro objetivo fue investigar el uso de fármacos potencialmente hepatotóxicos (FPH) en pacientes con EHC en un hospital universitario terciario. Materiales y métodos: Se evaluó la expossición a FPH en adultos (≥ 18 años) con EHC ingresados en el hospital entre enero de 2016 y diciembre de 2018, evaluando el riesgo de DILI y el comportamiento de las enzimas hepáticas tras la exposición. Resultados: De 931 pacientes hospitalizados con EHC, 291 (31,3%) estuvieron expuestos a fármacos hepatotóxicos durante su hospitalización. De ellos, 244 (83,8%) eran cirróticos. Las causas más frecuentes de enfermedad hepática fueron la hepatitis C (41,2%), seguida del alcohol (13,2%), la hepatitis C / alcohol (11,7%) y la enfermedad del hígado graso no alcohólico (5,8%). La cirrosis descompensada (46,7%) fue el principal motivo de ingreso hospitalario. Los FPH más prescritos fueron antibióticos (67,7%), fármacos cardiovasculares (34,4%), neuromoduladores (26,1%) y anestésicos (19,9%). Tras la exposición, 113 pacientes (38,8%) presentaron elevación significativa de las enzimas hepáticas. Sorprendentemente, los FPH se prescribieron con mayor frecuencia en la unidad GI / Hígado (48,8%) seguido de la unidad de emergencia / cuidados intensivos (28,5%). Un total de 65 pacientes (22%) fallecieron, sin embargo, en ninguno de los casos fue posible inferir con seguridad la relación causal entre el FHD, las enzimas hepáticas y la muerte. Conclusión: la prescripción de FPH es frecuente en pacientes con EHC incluso en un hospital universitario terciario y en el servicio de gastroenterología y hepatología, exponiendo a estos pacientes a un riesgo adicional

COVID-19 among healthcare workers in a Southern Brazilian Hospital and evaluation of a diagnostic strategy based on the RT-PCR test and retest for Sars-CoV-2

OBJECTIVE: Healthcare workers are at risk for COVID-19 contamination. It is important to protect them in order to reduce nosocomial transmission and maintain the assistance capacity of health systems. To evaluate the diagnostic test and retest strategy with RT-PCR for SARS-CoV-2 and factors associated with the diagnosis of COVID-19 among healthcare workers. PATIENTS AND METHODS: Cross-sectional study carried out in a Brazilian hospital. From April 27 to June 16, 2020, symptomatic healthcare workers underwent an RT-PCR test on upper respiratory tract specimens as soon as possible and, if negative, it was repeated close to the 5th day of symptom evolution. Working areas were divided into assistance areas dedicated or not dedicated to COVID-19 and non-assistance areas. The type of activity was divided into assistance or non-assistance activity. RESULTS: 775 individuals were evaluated. 114 were diagnosed with COVID-19, of whom 101 followed the testing protocol. A second RT-PCR identified five (4.9%) of the positive cases. Working in an area dedicated to patients with COVID-19 was more prevalent among positive cases (35.1% x 19.8%, p=0.001) as well as working in an assistance activity (80.7% x 70.8%, p=0.031). CONCLUSIONS: A second RT-PCR test after the 5th day of symptom evolution showed limited diagnostic improvement. The adoption of a single test-based strategy, carried out at the right time after the onset of symptoms, allows the optimal use of resources. Working in a COVID-19 dedicated area and in direct contact with patients is related to a higher prevalence of COVID-19 among symptomatic healthcare workers

Needlestick accident resulting in occupational transmission of HCV: Report of two cases

Occupational transmission of hepatitis C virus (HCV) through needlestick injury is a serious problem worldwide. Occupational transmission of HCV is estimated at an average rate between 0,5% and 0,75%. There are factors associated with increased risk of transmission, such as deep injuries, procedures involving hollow-bore needle placement in the source patient’s vein or artery, and high HCV RNA titer in the source patient. We describe two cases of HCV seroconversion in nursing assistants after different risk needlestick injuries.   A transmissão ocupacional do vírus da hepatite C (VHC) através de acidentes com material perfurocortante é um problema global. Essa transmissão é estimada, em média, entre 0,5% e 0,75%. Alguns fatores estão associados ao aumento do risco de transmissão, tais como lesões profundas, procedimentos que envolvam colocação da agulha em veia ou artéria, e altos títulos de HCV-RNA no paciente-fonte. Descrevemos dois casos de soroconversão ao VHC em auxiliares de enfermagem após acidentes com agulhas

Avaliação dos fatores relacionados à hepatotoxicidade, em pacientes internados com alteração das enzimas hepáticas, sob a ótica da farmacovigilância

Introdução: A lesão hepática induzida por medicamentos (DILI) é uma reação adversa rara, relacionada à hepatotoxicidade. A notificação pós comercialização ocorre pelo sistema de farmacovigilância, que adota algoritmos de causalidade como Naranjo e Rucam. Objetivo: Compreender a relação de transaminases (ALT) \u3e 5 vezes o limite da normalidade (\u3e5xLSN) com EA associados a DILI e verificar a frequência de relatos ao sistema de farmacovigilância do hospital e do VIGIMED para propor estudo de farmacovigilância ativa (aprovado pelo CEP). Método: Coorte retrospectiva, obtida de prontuários médicos de pacientes internados em 2018 que apresentaram alteração de ALT \u3e 5xLSN. Resultado: Em 2018 encontramos 597 internados com elevação de ALT, 11 deles com transplante hepático. Tratados por diferentes especialidades, 4,7%/n=28 apresentaram níveis acima de 5xLSN. Destes, 67,8%/n=19 foram a óbito com prevalência do CID A41.9 Septicemia não especificada (p\u3c0,001). Entre os medicamentos prescritos 57,1% representavam potencial de hepatotoxicidade, como antibióticos cefepime (21,4%) e Amoxicilina + clavulanato (7,1%). Nos dados do Vigimed em 2018 foram relatados 117 eventos adversos (EA), 62,39% (n=73) graves e 0,85% (n=1) com óbito. O relato de aumento das transaminases foi de 0,85% (n=1). Sintomas comuns de DILI foram relatadas: prurido 17,85%(n=21) e erupção cutânea 4,27%(n=5). Não há relato de EA descrito como DILI. Conclusão: A farmacovigilância ativa pode identificar EA associados à DILI pelas alterações nas transaminases. O êxito da investigação da causalidade e do diagnóstico depende da avaliação de risco, adoção de algoritmos de causalidade adequados, monitoramento das enzimas hepáticas e de possíveis biomarcadores