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

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

Reduction in COVID-19 prevalence in healthcare workers in a university hospital in southern Brazil after the start of vaccination

Introduction: The quick spread of SARS-CoV-2 led to the development of vaccines that are capable of reducing infection and the number of more severe COVID-19 cases. Aim: To assess COVID-19 prevalence among healthcare workers (HCWs) after vaccination against SARS-CoV-2. Methods: This was a cross-sectional study on the prevalence of COVID-19 diagnosis among 7523 HCWs vaccinated against SARS-CoV-2 with CoronaVac and ChAdOx1 nCoV-19 in a university hospital, in southern Brazil, between January 18 and March 18, 2021.The variables evaluated were: sex, age, work area, role, source of infection, previous diagnosis of COVID-19, date of vaccine administration, type of vaccine, and need for hospitalization. The statistical analysis used Poisson regression and Fisher's exact test with SPSS software version 25, and a level of significance set at 5%. Results: 813 vaccinated HCWs showed symptoms suggestive of COVID-19, of whom 35.4% (288) had a detectable result after undergoing RT-PCR for SARS-CoV-2. There was a reduction of 62% in new cases of COVID-19 among HCWs in the institution 7 weeks after the start of vaccine rollout. Conclusion: Our data suggest that the vaccines used by the institution reduced the number of COVID-19 cases among healthcare workers, demonstrating the effectiveness of the vaccines