Adverse drug reaction monitoring: support for pharmacovigilance at a tertiary care hospital in Northern Brazil

BACKGROUND: Adverse drug reactions (ADRs) are recognised as a common cause of hospital admissions, and they constitute a significant economic burden for hospitals. Hospital-based ADR monitoring and reporting programmes aim to identify and quantify the risks associated with the use of drugs provided in a hospital setting. This information may be useful for identifying and minimising preventable ADRs and may enhance the ability of prescribers to manage ADRs more effectively. The main objectives of this study were to evaluate ADRs that occurred during inpatient stays at the Hospital Geral de Palmas (HGP) in Tocantins, Brazil, and to facilitate the development of a pharmacovigilance service. METHODS: A prospective study was conducted at HGP over a period of 8 months, from January 2009 to August 2009. This observational, cross-sectional, descriptive study was based on an analysis of medical records. Several parameters were utilised in the data evaluation, including patient demographics, drug and reaction characteristics, and reaction outcomes. The reaction severity and predisposing factors were also assessed. RESULTS: The overall incidence of ADRs in the patient population was 3.1%, and gender was not found to be a risk factor. The highest ADR rate (75.8%) was found in the adult age group 15 to 50 years, and the lowest ADR rate was found in children aged 3 to 13 years (7.4%). Because of the high frequency of ADRs in orthopaedic (25%), general medicine (22%), and oncology (16%) patients, improved control of the drugs used in these specialties is required. Additionally, the nurse team (52.7%) registered the most ADRs in medical records, most likely due to the job responsibilities of nurses. As expected, the most noticeable ADRs occurred in skin tissues, with such ADRs are more obvious to medical staff, with rashes being the most common reactions. Metamizole, tramadol, and vancomycin were responsible for 21, 11.6, and 8.4% of ADRs, respectively. The majority of ADRs had moderate severity (58.9%), thus requiring intervention. Type A reactions were the most common (82.1%). At least one predisposing factor was present in 79.9% of the reports examined, and the most common predisposing factor was polypharmacy. CONCLUSIONS: The results obtained will contribute to the development of strategies for the pharmacovigilance service at HGP and other hospitals throughout the country, which will improve the quality of ADR reporting and ensure safer drug use in Brazilian hospitals

EPIDEMIOLOGICAL STUDY OF POST-NEONATAL MORTALITY ASSOCIATED WITH AVOIDABLE CAUSES IN PALMAS, TOCANTINS AND BRAZIL

A mortalidade infantil, em especial a pós neonatal, é um sensível indicador da qualidade de vida de uma população. Objetivou-se apresentar o coeficiente de mortalidade pós neonatal de Palmas, Tocantins e Brasil, no triênio 2014-2016 e expor as principais causas evitáveis desses óbitos. Trata-se de um estudo descritivo exploratório que analisa dados públicos disponibilizados pelo Sistema de Informações sobre Mortalidade (SIM) e Sistema de Informação sobre Nascidos Vivos (SINASC). Os resultados apresentaram como principais fatores vinculados a mortalidade pós neonatal a deficiência no diagnóstico e tratamento, em ações de promoção vinculadas a atenção primária, na atenção ao recém-nascido (RN), a gestação e ao parto, e imunizações. Encontrou-se uma redução significativa da mortalidade em Palmas-TO, o oposto dos panoramas Estadual e Nacional. As taxas de mortalidade apresentaram variações. Palmas e Tocantins aumentaram seu valor de 2014 (1,55/1.000 nascidos vivos (NV) e 2,00/1.000 NV, respectivamente) para 2015 (2,30/1.000 NV e 2,07/1.000 NV, respectivamente) e reduziram de 2015 para 2016 (1,34/1.000 NV e 2,06/1.000 NV, respectivamente); o Brasil reduziu seu valor de 2014 (2,05/1.000 NV) para 2015 (1,88/1.000 NV) e aumentou de 2015 para 2016 (2,21/1000 NV). Foi possível concluir que a capacitação e atualização dos profissionais seriam a chave para maior integração com a comunidade, melhoria nos atendimentos, diagnósticos precisos e atuação precoce nas patologias vinculadas à saúde materno-infantil.Infant mortality, especially post neonatal mortality, is a sensitive indicator of the quality of life of a population. The objective of this study was to present the post-neonatal mortality coefficient of Palmas, Tocantins and Brazil in the 2014-2016 triennium and to present the main avoidable causes of these deaths. It is an exploratory descriptive study that analyzes public data provided by the Mortality Information System (SIM) and the Live Birth Information System (SINASC). The results showed a significative reduction of the mortalities in Palmas-TO, the opposite of the State and National scenarios. Mortality rates presented variations, Palmas and Tocantins increased their value from 2014 (1,55/1000 born lives (BL) and 2,00/1000 BL respectively) to 2015 (2,30/1000 BL and 2,07/1000 BL respectively) and reduced from 2015 to 2016 (1,34/1000 BL and 2,06/1000 BL respectively); Brazil reduced its value from 2014 (2,05/1000 BL) to 2015 (1,88/1000 BL) and increased from 2015 to 2016 (2,21/1000 BL). It was identified that the decline in the absolute number of deaths in Palmas-TO is due to actions of health promotion, diagnosis and treatment and attention to gestation. Thus, the local decline in mortality is linked to early diagnosis, quality of care, access to primary health services and the availability of these services at the national level, associated with integral management mechanisms for maternal and child health

Polymorphisms in the MBL2 gene are associated with the plasma levels of MBL and the cytokines IL-6 and TNF-α in severe COVID-19

IntroductionMannose-binding lectin (MBL) promotes opsonization, favoring phagocytosis and activation of the complement system in response to different microorganisms, and may influence the synthesis of inflammatory cytokines. This study investigated the association of MBL2 gene polymorphisms with the plasma levels of MBL and inflammatory cytokines in COVID-19.MethodsBlood samples from 385 individuals (208 with acute COVID-19 and 117 post-COVID-19) were subjected to real-time PCR genotyping. Plasma measurements of MBL and cytokines were performed by enzyme-linked immunosorbent assay and flow cytometry, respectively.ResultsThe frequencies of the polymorphic MBL2 genotype (OO) and allele (O) were higher in patients with severe COVID-19 (p< 0.05). The polymorphic genotypes (AO and OO) were associated with lower MBL levels (p< 0.05). IL-6 and TNF-α were higher in patients with low MBL and severe COVID-19 (p< 0.05). No association of polymorphisms, MBL levels, or cytokine levels with long COVID was observed.DiscussionThe results suggest that, besides MBL2 polymorphisms promoting a reduction in MBL levels and therefore in its function, they may also contribute to the development of a more intense inflammatory process responsible for the severity of COVID-19

Determinação da prevalência e variabilidade genética de Entamoeba histolytica e Entamoeba dispar em habitantes de Pernambuco

Vários relatos da literatura revelam ser a prevalência de Entamoeba dispar maior do que Entamoeba histolytica nos indivíduos que vivem no Nordeste brasileiro, a partir de estudos utilizando Enzyme Linked Immnosorbent Assay (ELISA), imunodifusão em gel e zimodemos. Este trabalho consistiu em determinar a prevalência dessas formas de amebas mediante o uso de detecção imunocoprológica de antígeno específico para E. histolytica e Reaction Chain Polimerase (PCR) do DNA genômico extraído de trofozoitos cultivados de amostras de fezes. A presença de amebas tetranucleadas foi investigada em 1437 amostras de fezes de indivíduos vivendo em Macaparana, cidade da zona da mata norte de Pernambuco; em 346 amostras de escolares com idades de 3 a 14 anos morando em uma favela do Recife e em 109 amostras de imunodeprimidos (104 HIV positivos e 05 transplantados) atendidos no Hospital das Clínicas da UFPE (2002 e 2003). Dessas amostras, 59 (4.1%) e 45 (13%) foram positivas para aquelas coletadas das populações de Macaparana e das crianças do Recife, respectivamente, enquanto que nenhuma foi positiva para as obtidas dos imunodeprimidos. Todas as amostras foram negativas para a presença de adesina galactose específica de E. histolytica, inclusive as amostras dos pacientes imunosuprimidos. As amostras com amebas tetranucleadas cultivadas em meio de Robinson foram positivas para trofozoítos em 31 daquelas coletadas das populações de Macaparana e 21 das de Recife. A partir da amplificação por PCR de seqüências espécie-específicas de DNA genômico, extraído desses trofozoítos, foi possível identificar E. dispar em 23 e 19 amostras dos habitantes de Macaparana e das crianças do Recife, respectivamente, enquanto que nenhuma amplificação foi observada para E. histolytica. As demais amostras (08 e 02 paraMacaparana e Recife, respectivamente) foram negativas para ambas as espécies. Estes resultados corroboram aqueles previamente descritos que mostravam a prevalência de E. dispar (ameba não patogênica) nestas populações. Ademais, validam o emprego do kit imunocoprológico como alternativa a PCR na identificação de E. dispar e E. histolytica. Finalmente, o polimorfismo genético das cepas de E. dispar das amostras coletadas da população de Macaparana e de crianças do Recife foi investigado com o uso de marcadores moleculares específicos para E. dispar, Dsp1/Dsp2 e Dsp5/Dsp6. Das 42 amostras analisadas, 39 amplificaram os loci 1-2 e 5-6. O dendrograma resultante desta análise revelou uma alta variabilidade entre os isolados para esta região. Entretanto, uma comparação entre as freqüências dos produtos de amplificação para as duas localidades, através de teste de Qui-quadrado, mostrou que a incidência de uma banda obtida do locus 5-6, foi significativamente diferente entre Recife e Macaparana, evidenciando a potencialidade desta técnica para abordar questões relativas à distribuição geográfic

HIV epidemic among Brazilian women who have sex with women: An ecological study

The influences of public policies fighting HIV among women who have sex with women is scarcely studied. This study aimed to analyse the time series of human immunodeficiency virus (HIV) epidemic, between 2007 and 2020, among Brazilian women who have sex with women, in order to evaluate the eect of Brazilian policies for fighting HIV in this subpopulation compared to women who have sex with men (WSM). This ecological study employed HIV and acquired immunodeficiency syndrome (AIDS) new cases among women who have sex strictly with women (WSW), women who have sex with men and women (WSMW), and WSM reported to the Sistema de Informação de Agravos de Notificação from 2007 to 2020. Crude Brazilian and regional annual age-adjusted HIV/AIDS population-level incidence rates were calculated for WSW, WSMW and WSM. The rates were then analyzed using the Joinpoint regression model. A total of 102,890, 757, and 1,699 notifications of WSW, WSMW, and WSM living with HIV/AIDS were reported during the study period, respectively. South Brazilian region had the greatest HIV/AIDS incidence rates among WSM and bisexual women while the North region had the greatest incidence among WSW. In the WSM population, the temporal trends showed at least one stable or an increasing trend period from 2007 to 2013 or 2014, followed by one decreasing trend in all Brazilian regions. While among the WSMW most of the regions had a stable trend period from 2007 to 2020, in WSW group most of the trends had only one decreasing period. The decreasing trends were faster in WSM than in WSW. These results suggest a low efficiency of Brazilian policies for fighting HIV among WSW and WSMW and show the necessity of implementing new policies specific to this populatio

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data