Artificial intelligence in the clinical pharmacy service in a public hospital in Belo Horizonte/MG

Objective: to evaluate aspects related to the analysis of prescriptions by clinical pharmacists and the rate of medication-related errors after the implementation of an AI tool for the analysis of medical prescriptions in a large public teaching hospital in the city of Belo Horizonte/MG. Method: This is an observational study in which the results of the analysis of medical prescriptions performed in two periods were verified: the first (denoted BEFORE), period previously to the use of the AI tool (NoHarm.ai), in the months of March to September 2021; the second (named AFTER), comprises the same period in 2022, already in use of the AI tool. Results: In the BEFORE period, it was found that the rate of prescriptions evaluated was 0.6%, with an error rate of 13% and an average of 85 pharmaceutical interventions/month, which resulted in average savings of direct medication costs of R$1020.76/month. In the AFTER period, there was a 49$ 7848.39/month. Conclusion: The use of an AI tool contributed substantially to the pharmaceutical analysis of medical prescriptions with an average increase of 50% in the prescriptions evaluated, a 43-fold reduction in the number of errors and generated almost triple the number of pharmaceutical interventions after the implementation of the tool, in addition to the direct savings obtained with these interventions that increased sevenfold. The results of this study show that the use of an AI tool probable save of financial resources, increased productivity of the Clinical Pharmacy Service, and increased safety related to the medication use

Building an antimicrobial stewardship program: A narrative of six years under the Donabedian perspective

Introduction: Antimicrobial resistance (AMR) is increasing and represents one of the world’s major challenges. AMR increase morbimortality, length of hospital stay and costs. Antimicrobial Stewardship Programs (ASP) are one of the key strategies to promote the rational use of antimicrobials since AMR is mostly driven by antimicrobial consumption.Objective: To describe the ASP implementation in a teaching hospital from the perspective of Donabedian quality assessment and the Brazilian regulatory requirements.Method: This was a descriptive study with secondary data collection, including document review of the ASP. The study setting was a general public 392-bed hospital. The ASP activities were performed by the hospital infection control committee (HICC), hospital pharmacy (HP) and diagnostic support laboratory (DSL). The description of the three services mainly involved in the ASP was based on a quality assessment model involving the dimensions of “structure”, “process” and “result” proposed by Donabedian. The distribution among dimensions was guided by the checklist of essential elements of the ASP that compose the Brazilian regulatory requirements. The checklist was applied in July, 2022, and the ASP results described from 2016 to 2021.Results: ASP actions have been gradually implemented since 2008 with the implementation of HICC and improved over the years. Regarding structure, the investments in technology were mapped, quantifying 26 computers and three software programs employed to computerize the ASP processes performed in specific physical areas by HICC, HP and DSL. Institutional guidelines used by HICC, HP and DSL guided clinical practices to operationalize ASP. The evaluation metrics improved for 10 indicators and worsened for four indicators. From the 60 items composing the checklist, the hospital met the requirements in 73.3% of the items (n = 44).Conclusion: This study described the implementation of ASP in a teaching hospital, applying the Donabedian perspective. Although the hospital still does not have a classic ASP model, there were investments to improve structure, processes and results, aiming to comply with international guidelines. A high proportion of key elements of ASP in the hospital were followed according to the Brazilian regulatory requirements. Aspects related to antimicrobial consumption and the emergence of microbial resistance deserve further investigations

Farmacogenética da esquizofrenia

Exportado OPUSMade available in DSpace on 2019-08-13T13:57:11Z (GMT). No. of bitstreams: 1 tese_renan_pedra_de_souza.pdf: 3251518 bytes, checksum: 99292fc73259c979b3bf4a10da9d27be (MD5) Previous issue date: 1Conhecidos há aproximadamente 2500 anos, os transtornos do humor continuam a dominar o interesse da saúde pública. Cerca de 5% dos pacientes depressivos não respondem a qualquer medida farmacológica e/ou psicoterápica. Para esses pacientes, a eletroconvulsoterapia (ECT) constitui uma importante oportunidade de melhora. Indução de convulsões na forma de ECT tem sido usada no tratamento de desordens psiquiátricas por mais de 60 anos. As principais indicações diagnósticas incluem depressão, mania, catatonia e esquizofrenia. Devido às dificuldades na identificação dos mecanismos de ação da ECT, têm-se usado a estimulação eletroconvulsiva (EEC) aplicada experimentalmente a animais com o intuito de obter dados que contribuam para explicar alguns efeitos terapêuticos da ECT. Há relatados de alteração nos níveis das proteínas DARPP-32 (fosfoproteína regulada por AMPc e dopamina) e NCS-1 (sensora neuronal de cálcio 1) em pacientes com transtornos neuropsiquiátricos. Neste trabalho foram avaliados os níveis de expressão das proteínas DARPP-32 e NCS-1 em quatro regiões cerebrais (striatum, córtex, hipocampo e cerebelo) de ratos submetidos ao choque eletroconvulsivo agudo e crônico. A estimulação eletroconvulsiva aguda gerou aumento na expressão de DARPP-32 no córtex. É interessante notar que nessa área as alterações foram observadas logo após a realização do estímulo e após 24 horas sendo essa sustentada até às 48 horas. Nas outras áres avaliadas (striatum, hipocampo e cerebelo) não foram observadas alterações significativas. Tais achados corroboram a ausência de eficácia dessa terapêutica de modo agudo usualmente. A estimulação crônica provocou alterações significativas em todas as áreas estudadas, o que está de acordo com a utilização de repetidas sessões desta técnica na clínica. A estimulação eletroconvulsiva aguda gerou somente alterações pontuais nos níveis de NCS-1 no córtex (diminuição em 48 horas), hipocampo (diminuição em 03 horas) e cerebelo (aumento em 3 horas). A estimulação crônica gerou modificações importantes no striatum e córtex, cerebelo. No striatum, aumento é notado logo após do último estímulo e a partir de 03 horas até às 24 horas. No córtex e cerebelo, o aumento é evidente de 12 horas até às 48 horas. Tais dados, assim como os obtidos para DARPP-32, mostram uma maior eficiência da terapia crônica em relação à aguda e uma dinâmica temporal que favorece a aplicação da técnica num intervalo de 2-3 dias (tempo pelo qual manteve-se os níveis elevados das proteínas)

SARS-CoV-2 Genomic Surveillance in Brazil: A Systematic Review with Scientometric Analysis

Several studies have monitored the SARS-CoV-2 variants in Brazil throughout the pandemic. Here, we systematically reviewed and conducted a scientometric analysis of the SARS-CoV-2 genomic surveillance studies using Brazilian samples. A Pubmed database search on October 2022 returned 492 articles, of which 106 were included. Ninety-six different strains were reported, with variant of concern (VOC) gamma (n = 35,398), VOC delta (n = 15,780), and the variant of interest zeta (n = 1983) being the most common. The top three states with the most samples in the published articles were São Paulo, Rio de Janeiro, and Minas Gerais. Whereas the first year of the pandemic presented primary circulation of B.1.1.28 and B.1.1.33 variants, consecutive replacements were observed between them and VOI zeta, VOC gamma, VOC delta, and VOC omicron. VOI mu, VOI lambda, VOC alpha, and VOC beta were also detected but failed to reach significant circulation. Co-infection, re-infection, and vaccine breakthrough reports were found. Article co-citation differed from the co-authorship structure. Despite the limitations, we expect to give an overview of Brazil’s genomic surveillance studies and contribute to future research execution

AVALIAÇÃO DO PERFIL DE CONSUMO DE ANTIMICROBIANOS DE ALERTA SEGUNDO A CLASSIFICAÇÃO AWARE EM UM HOSPITAL DE BELO HORIZONTE

Introdução/Objetivo: O uso inadequado de antimicrobianos é apontado como importante contribuinte para a disseminação de resistência microbiana. Para acompanhar e contribuir com a gestão do consumo de antimicrobianos, a Organização Mundial de Saúde (OMS) propôs a categorização AWaRe (Access, Watch, Reserve) que estabelece os medicamentos de alerta ou watch como aqueles de alto potencial de resistência. O objetivo desse trabalho foi avaliar o perfil de consumo de medicamentos classificados como alerta em um hospital público de ensino. Métodos: Foi realizado estudo retrospectivo no período de setembro/2019 a dezembro/2021 em um hospital público de ensino em Belo Horizonte. O consumo dos antimicrobianos da categoria AWaRe “alerta” monitorados nos hospitais brasileiros com leitos de UTI foi estimado a partir da Dose Diária Definida (DDD/1000 pacientes-dia). Dividiu-se o período de análise em três fases: pré-pandemia da COVID-19 (setembro/2019-fevereiro/2020), fase aguda da pandemia (março/2020-junho/2021) e pós-fase aguda da pandemia (julho/2021-dezembro/2021). Os resultados foram apresentados de modo descritivo utilizando-se o software Jamovi 2.3.21. O código de aprovação pelo Comitê de Ética em Pesquisa foi CAAE 54060321.8.0000.5149. Resultados: A ceftriaxona e o meropenem foram os antibacterianos mais utilizados em cada um dos três períodos de análise, tendo, na fase aguda da pandemia o maior DDD médio, 140,7 e 85,0 DDD/1000 pacientes-dia, respectivamente. A média geral de consumo no período agudo da pandemia foi o maior dentre os três períodos (422,2 DDD/1000 pacientes-dia), sendo evidenciado também o aumento no consumo de cefalosporinas (30,1%), glicopetídeos (4,2%), penicilinas (8,7%) e carbapenêmicos (12,7%) em comparação ao período pré-pandemia. No período pós-fase aguda, o consumo diminuiu em relação ao período anterior, exceto para as quinolonas, com aumento 45,0% e 40,5% no consumo de levofloxacino parenteral e ciprofloxacino oral, respectivamente, sendo este o período de maior consumo de quinolonas (37,7 DDD/1000 pacientes-dia). Conclusão: O aumento no consumo de antimicrobianos durante a pandemia, principalmente cefalosporinas e carbapenêmicos, pode impactar no aumento da disseminação de resistência microbiana. Assim, se faz necessária a intensificação de ação de Programas de Gerenciamento de Antimicrobianos (PGA) para melhor avaliação do uso de antimicrobianos a fim, principalmente, de reduzir a resistência microbiana

Disentangling the Environmental Factors That Shape Genetic and Phenotypic Leaf Trait Variation in the Tree Qualea grandiflora Across the Brazilian Savanna

Identifying the environmental factors that shape intraspecific genetic and phenotypic diversity of species can provide insights into the processes that generate and maintain divergence in highly diverse biomes such as the savannas of the Neotropics. Here, we sampled Qualea grandiflora, the most widely distributed tree species in the Cerrado, a large Neotropical savanna. We analyzed genetic variation with microsatellite markers in 23 populations (418 individuals) and phenotypic variation of 10 metamer traits (internode, petiole and corresponding leaf lamina) in 36 populations (744 individuals). To evaluate the role of geography, soil, climate, and wind speed in shaping the divergence of genetic and phenotypic traits among populations, we used Generalized Dissimilarity Modelling. We also used multiple regressions to further investigate the contributions of those environmental factors on leaf trait diversity. We found high genetic diversity, which was geographically structured. Geographic distance was the main factor shaping genetic divergence in Qualea grandiflora, reflecting isolation by distance. Genetic structure was more related to past climatic changes than to the current climate. We also found high metamer trait variation, which seemed largely influenced by precipitation, soil bulk density and wind speed during the period of metamer development. The high degree of metamer trait variation seems to be due to both, phenotypic plasticity and local adaptation to different environmental conditions, and may explain the success of the species in occupying all the Cerrado biome

WGS-Based Lineage and Antimicrobial Resistance Pattern of Salmonella Typhimurium Isolated during 2000–2017 in Peru

Salmonella Typhimurium is associated with foodborne diseases worldwide, including in Peru, and its emerging antibiotic resistance (AMR) is now a global public health problem. Therefore, country-specific monitoring of the AMR emergence is vital to control this pathogen, and in these aspects, whole genome sequence (WGS)—based approaches are better than gene-based analyses. Here, we performed the antimicrobial susceptibility test for ten widely used antibiotics and WGS-based various analyses of 90 S. Typhimurium isolates (human, animal, and environment) from 14 cities of Peru isolated from 2000 to 2017 to understand the lineage and antimicrobial resistance pattern of this pathogen in Peru. Our results suggest that the Peruvian isolates are of Typhimurium serovar and predominantly belong to sequence type ST19. Genomic diversity analyses indicate an open pan-genome, and at least ten lineages are circulating in Peru. A total of 48.8% and 31.0% of isolates are phenotypically and genotypically resistant to at least one antibiotic, while 12.0% are multi-drug resistant (MDR). Genotype–phenotype correlations for ten tested drugs show >80% accuracy, and >90% specificity. Sensitivity above 90% was only achieved for ciprofloxacin and ceftazidime. Two lineages exhibit the majority of the MDR isolates. A total of 63 different AMR genes are detected, of which 30 are found in 17 different plasmids. Transmissible plasmids such as lncI-gamma/k, IncI1-I(Alpha), Col(pHAD28), IncFIB, IncHI2, and lncI2 that carry AMR genes associated with third-generation antibiotics are also identified. Finally, three new non-synonymous single nucleotide variations (SNVs) for nalidixic acid and eight new SNVs for nitrofurantoin resistance are predicted using genome-wide association studies, comparative genomics, and functional annotation. Our analysis provides for the first time the WGS-based details of the circulating S. Typhimurium lineages and their antimicrobial resistance pattern in Peru

WGS-Based Lineage and Antimicrobial Resistance Pattern of Salmonella Typhimurium Isolated during 2000-2017 in Peru.

Salmonella Typhimurium is associated with foodborne diseases worldwide, including in Peru, and its emerging antibiotic resistance (AMR) is now a global public health problem. Therefore, country-specific monitoring of the AMR emergence is vital to control this pathogen, and in these aspects, whole genome sequence (WGS)-based approaches are better than gene-based analyses. Here, we performed the antimicrobial susceptibility test for ten widely used antibiotics and WGS-based various analyses of 90 S. Typhimurium isolates (human, animal, and environment) from 14 cities of Peru isolated from 2000 to 2017 to understand the lineage and antimicrobial resistance pattern of this pathogen in Peru. Our results suggest that the Peruvian isolates are of Typhimurium serovar and predominantly belong to sequence type ST19. Genomic diversity analyses indicate an open pan-genome, and at least ten lineages are circulating in Peru. A total of 48.8% and 31.0% of isolates are phenotypically and genotypically resistant to at least one antibiotic, while 12.0% are multi-drug resistant (MDR). Genotype-phenotype correlations for ten tested drugs show >80% accuracy, and >90% specificity. Sensitivity above 90% was only achieved for ciprofloxacin and ceftazidime. Two lineages exhibit the majority of the MDR isolates. A total of 63 different AMR genes are detected, of which 30 are found in 17 different plasmids. Transmissible plasmids such as lncI-gamma/k, IncI1-I(Alpha), Col(pHAD28), IncFIB, IncHI2, and lncI2 that carry AMR genes associated with third-generation antibiotics are also identified. Finally, three new non-synonymous single nucleotide variations (SNVs) for nalidixic acid and eight new SNVs for nitrofurantoin resistance are predicted using genome-wide association studies, comparative genomics, and functional annotation. Our analysis provides for the first time the WGS-based details of the circulating S. Typhimurium lineages and their antimicrobial resistance pattern in Peru

DataSheet1_Building an antimicrobial stewardship program: A narrative of six years under the Donabedian perspective.pdf

Introduction: Antimicrobial resistance (AMR) is increasing and represents one of the world’s major challenges. AMR increase morbimortality, length of hospital stay and costs. Antimicrobial Stewardship Programs (ASP) are one of the key strategies to promote the rational use of antimicrobials since AMR is mostly driven by antimicrobial consumption.Objective: To describe the ASP implementation in a teaching hospital from the perspective of Donabedian quality assessment and the Brazilian regulatory requirements.Method: This was a descriptive study with secondary data collection, including document review of the ASP. The study setting was a general public 392-bed hospital. The ASP activities were performed by the hospital infection control committee (HICC), hospital pharmacy (HP) and diagnostic support laboratory (DSL). The description of the three services mainly involved in the ASP was based on a quality assessment model involving the dimensions of “structure”, “process” and “result” proposed by Donabedian. The distribution among dimensions was guided by the checklist of essential elements of the ASP that compose the Brazilian regulatory requirements. The checklist was applied in July, 2022, and the ASP results described from 2016 to 2021.Results: ASP actions have been gradually implemented since 2008 with the implementation of HICC and improved over the years. Regarding structure, the investments in technology were mapped, quantifying 26 computers and three software programs employed to computerize the ASP processes performed in specific physical areas by HICC, HP and DSL. Institutional guidelines used by HICC, HP and DSL guided clinical practices to operationalize ASP. The evaluation metrics improved for 10 indicators and worsened for four indicators. From the 60 items composing the checklist, the hospital met the requirements in 73.3% of the items (n = 44).Conclusion: This study described the implementation of ASP in a teaching hospital, applying the Donabedian perspective. Although the hospital still does not have a classic ASP model, there were investments to improve structure, processes and results, aiming to comply with international guidelines. A high proportion of key elements of ASP in the hospital were followed according to the Brazilian regulatory requirements. Aspects related to antimicrobial consumption and the emergence of microbial resistance deserve further investigations.</p