COVID-19 and Mucormycosis: The Toll of Hyperglycemia in Viral and Fungal Coinfection

A fungal infection that is difficult to diagnose and treat, mucormycosis gained prominence with the SARS-CoV-2 pandemic as infection with the new coronavirus predisposes patients to a greater risk of developing opportunistic infections, such as that caused by the “black fungus”. In order to identify the physiological changes and risk factors related to SARS-CoV-2 infection that favor the development of mucormycosis, an integrative review was carried out based on the PICO strategy, in which searches were performed in December 2021 in the Virtual Library in Health, on the PubMed portal and on the Web of Science, using the Mesh terms: COVID-19, SARS-CoV-2 Infection and Mucormycosis together with the Boolean operators “AND” and “OR”. Full-text articles were included that were available in journals/periodicals and were published in Portuguese, English or Spanish from December 2019 to 2021 that addressed the metabolic changes caused by COVID-19 related to the involvement of mucormycosis and excluded review, editorial and duplicate studies. With the application of filters and the exclusion of duplicates, 140 and 151 studies were selected by title and abstract—113 convergent and 41 divergent—and, after reading in full, nine studies remained to compose the review. The results indicated a greater number of publications from India and a predominance of male and diabetic patients with elevated inflammatory markers. The higher prevalence of diabetics and hyperglycemia are in line with the hypotheses raised by other literature, given the impacts resulting from COVID-19 on glycemic control and the risks to the body from diabetes. Thus, post-SARS-CoV-2 hyperglycemia may be a risk factor for the development of mucormycosis

Combinations and Risks of Drug Interactions in Patients Admitted to a University Hospital in a Northeastern Brazilian State

A drug is defined as a substance capable of influencing biological functions through chemical reactions, either by agonism or antagonism, to achieve the desired therapeutic effect. During this process, several pharmacokinetic and pharmacodynamic events occur, which can be potential sites for drug interactions to occur. For patients undergoing hospital treatment, drugs of different classes are usually prescribed, and it is necessary to understand the risk of interactions between these drugs and their possible change in therapeutic efficacy or safety. Therefore, the study sought to identify the main classes of drugs, and their combinations, used in the treatment of pneumonia in pediatric patients at a teaching hospital in Brazil. This is a cross-sectional, retrospective and descriptive study, from September 2017 to December 2020, based on data obtained from medical records provided by the Júlio Bandeira University Hospital. Regarding the most used antibiotics in the analyzed period, we reported the following drugs: ampicillin (61.76%) and azithromycin (23.53%) in 2017; ampicillin (41.04%) and ceftriaxone (23.51%) in 2018; ampicillin (45.70%) and ceftriaxone (25.50%) in 2019; ceftriaxone (39.20%) and azithromycin (31.49%) in 2020. The main combinations identified in the study were as follows: dipyrone and fenoterol (60.70%), dipyrone and hydrocortisone (47.92%), dipyrone and ondansetron (34.66%) and dipyrone, hydrocortisone and fenoterol (37.38%). It is important to highlight that 58 different drugs were found in the prescriptions of this period, alerting us to the possibility of drug interactions of various types. In view of this, it is possible to highlight the combination of azithromycin and ondansetron as a potentially moderate risk of drug interaction, since both increase the QT interval, (The measurement from the beginning of the QRS complex to the end of the T wave), requiring patient monitoring by means of ECG (electrocardiogram). Therefore, an in-depth analysis of these data may be useful to prepare technical material and assist in therapeutic decision-making, improving the quality of prescriptions and the patient’s clinical response, adopt even more effective conducts and as close to what is expected from the pharmacological characteristics of drugs

Antibiotic Prescriptions in Pediatric Patients Hospitalized with Pneumonia at a University Hospital

Community-acquired pneumonia (CAP) is the leading cause of hospitalization in the Brazilian Unified Health System, with a mortality rate of 18% in children under 5 years of age. Therefore, there is a need for an effective treatment, including antibiotic therapy, based on the main causative agents of the infection. However, there is a risk of the development of bacterial resistance, making it necessary to monitor this use in order to reduce the speed of emergence of multidrug-resistant strains. Thus, this study aims to verify the profile of antibiotic use in children and adolescents treated at a Brazilian university hospital. The research consists of a cross-sectional retrospective and descriptive study based on data obtained from medical records provided by the institution, after approval by the ethics committee, and organized in Excel spreadsheets, covering the period from September 2017 to December 2020. It was observed that the profile of this group of patients consisted of: a female prevalence in 2017 and 2020 (59% and 57% respectively); while in the years 2018 and 2019, males were higher, 52% and 59%. Regarding age, the age group from 3 months to 4 years was predominant (59.64%). Regarding the use of antibiotics by age group, the following data were found: up to 3 months, the most used were ampicillin (44%) and azithromycin (24.25%); from 4 months to 4 years, ampicillin (32.9%), ceftriaxone (31.7%) and azithromycin (25.9%); and over 5 years, ceftriaxone (33.8%), ampicillin (29.95%) and azithromycin (22.22%). Thus, when comparing the profile found with that recommended by the protocol adopted by the hospital, we can conclude, with the data analyzed, that there is negligence in the prescription of antimicrobials in the treatment of pediatric CAP, which may corroborate the growth of bacterial resistance, longer hospital stays and, as a result, greater expenditure on care and a reduced favorable clinical outcome