Pharmacists' interventions on 2 years of drug monitoring in an oncology pediatric inpatient ward.

BACKGROUND: In oncology, pharmacists contribute to safety and effectiveness of drug treatment, identifying, preventing and forwarding solutions to drug-related problems (DRPs). However, it is still necessary to elucidate the profile of drug-related problems in pediatric cancer treatment to contribute to guide clinical pharmacy activities. METHODS: A retrospective cross-sectional study was conducted. Records on Excel® spreadsheets of 2 years of pharmaceutical assistance were analyzed regarding the prescriptions of chemotherapy for hospitalized patients aged 0-19 years. Data on age, sex, cancer diagnosis, protocol and drugs prescribed were collected. Causes and types of DRPs and pharmacists' interventions as their rate of acceptance were measured according to PCNE V 9.0. RESULTS: Drug-related problems were identified for 84 patients, in 5.3% of analyzed prescriptions. Leukemias, patients aged 0-4 years and male sex were associated with higher rates of drug-related problems. The BFM 2009 protocol for acute lymphocytic leukemia treatment had the highest frequency of prescriptions with drug-related problems. Main drug-related problems were related to effectiveness (49.2%) and safety (33.2%), with most of them due to drug selection and dose. Rate of acceptance of interventions was 92.2% and 90.6% of drug-related problems were fully resolved. Mercaptopurine and filgrastim were the drugs most associated with drug-related problems. Oral antineoplastic agents represented 36% of the prescriptions with drug-related problems. CONCLUSION: The high rate of acceptance of pharmacist interventions demonstrates the relevance of the pharmacist participation in the care of hospitalized pediatric patients undergoing chemotherapy. Pharmacists need to take attention to cases of necessity of drug prescription, intervening with other health professionals. Special attention to oral chemotherapy is required.

Challenges for expansion of thoracic transplant clinical pharmacy in a developing country: comparison with U.S. accredited centres and call for action.

WHAT IS KNOWN AND OBJECTIVE: Clinical pharmacists' involvement in the care of solid organ transplant recipients has been discussed worldwide given its potential to improve clinical outcomes. As thoracic transplant activity grows in Brazil, it is important to understand how pharmacists are inserted in transplant programmes nationwide. We conducted a survey to explore clinical pharmacy activities in thoracic transplant centres in Brazil and compared them with accredited programmes in the United States. METHODS: An electronic questionnaire was distributed to all 40 heart and lung transplant centres registered in the Brazilian Organ Transplantation Agency (ABTO) in May 2019. Survey findings were compared to previously published data from accredited U.S. centres. RESULTS AND DISCUSSION: From 22 centre respondents, ten (45.5%) declared not to have a pharmacist at any part of the transplantation process, which translated into 158 (37.6%) transplant recipients without any direct pharmaceutical care. In centres with pharmacists (n = 12), none had a full-time professional dedicated to their heart and/or lung programmes. When compared to U.S. centres, there was a significantly lower insertion of clinical pharmacist activities among Brazilian centres. WHAT IS NEW AND CONCLUSION: Our findings point to an unmet need related to clinical pharmacy activity within thoracic transplant programmes, especially in a developing country, and highlight a call for action in order to reach higher accredited regulatory standards regarding pharmacist-driven workforce in transplant care worldwide.

Intersecting care through specialized pharmacists: A case report of residency rotation focused on the new horizon of cardio-oncology.

BACKGROUND AND PURPOSE: Cardio-oncology is a nascent discipline in the synergy of clinical cardiology and oncology, aiming to improve antineoplastic therapies, whilst minimizing cardiovascular toxicities. It requires a multidisciplinary approach with particular knowledge to build individualized care for patients. As part of multidisciplinary teams, pharmacists are uniquely positioned to play a role in the management of these patients, being responsible for monitoring adverse reactions and having an active approach in preventing drug-related morbidity. However, despite the existence of oncology and cardiology residency pharmacy programs, and the burden of cancer and cardiovascular diseases, there is a lack of data regarding pharmacists training focusing on cardio-oncology. EDUCATIONAL ACTIVITY AND SETTING: A 15-days rotation was built to develop knowledge and clinical skills on pharmacological cardiovascular management of patients in a hemato-oncology residency program. The hospital where the rotation was offered is a 900-bed university hospital in Porto Alegre, south of Brazil. The rotation was designed for a postgraduate year 2 (PGY2) onco-hematology pharmacy resident and mentored by two staff clinical pharmacists from the cardiology field. The rotation schedule was distributed to reach three different approaches of learning: theoretical, practical-theoretical and practical. Activities were proposed aiming to provide experiences in cardiac care for the PGY2 resident, and clinical activities with patients were developed in both inpatient and outpatient settings. After the end of the 15 days rotation period, an evaluation was carried out by the PGY2 resident together with the staff menthors. FINDINGS: This is the first cardio-oncology pharmacist rotation described in our country. The rotation was considered positive by residents evaluation on providing a clinical experience through cardiotoxicity management of oncology protocols. SUMMARY: Collaborations between cardiology and oncology clinical pharmacy teams, and the multidisciplinary teams as well, can help provide structured cardio-oncology rotation opportunities for pharmacy residents.being the team's specialist on antineoplastic agents monitoring and preventable drug related morbidity, the pharmacist can contribute to achieve better outcomes to patients with cancer.

Pancreatitis as a Potential Trigger for Severe Accelerated Cardiac Allograft Vasculopathy Early Post Heart Transplant: A Case Report.

BACKGROUND: We present a case of severe accelerated cardiac allograft vasculopathy (CAV), an infrequent finding usually related to dismal prognosis, in a heart recipient with recurrent episodes of acute pancreatitis. CASE DESCRIPTION: A 38-year-old male was transplanted owing to advanced heart failure related to nonischemic dilated cardiomyopathy. On the fifth day after transplantation, a nonbiliary acute ischemic pancreatitis occurred. Recurrent relapses ensued within the following year requiring hospital readmissions for both supportive and pain management. The patient developed graft dysfunction by the 18th month post-transplant with severe multivessel CAV. A trial of bortezomib and percutaneous coronary interventions with drug-eluting stents at coronary arteries were attempted but the patient died suddenly, before the scheduled staged percutaneous coronary intervention for the coronary total occlusion was performed. DISCUSSION: The causal mechanisms of aggressive accelerated CAV are unclear, but it is suggested that important inflammatory and/or humoral responses may play a pivotal role in this life-threatening disease pathogenesis. Increased levels of biomarkers have been linked to advanced CAV, as well as pancreatitis pathogenesis, related to cytokine activation with remarkable systemic inflammatory response. Some of those inflammatory mediators have been reported as central in both pancreatitis and CAV, more specifically interleukin-6. CONCLUSION: A pro-inflammatory state due to recurrent acute pancreatitis early after transplantation may have contributed to severely accelerated CAV development in the presented case. Comprehensive evaluation of risk factors may assist in close surveillance and targeted therapies in the management of this challenging post-heart transplant scenario.

Impact of COVID-19 Infection Among Heart Transplant Recipients: A Southern Brazilian Experience.

PURPOSE: The coronavirus-2019 (COVID-19) infection is associated with a high risk of complications and death among heart transplant recipients. However, most cohorts are from high-income countries, while data from Latin America are sparse. METHODS: This is a retrospective cohort of heart transplant recipients followed at a hospital in Rio Grande do Sul, Brazil, between March 1st 2020 and October 1st 2021. RESULTS: Of the 62 heart transplant recipients on follow-up, 21 (34%) were infected by COVID-19, 58 (36-63) years of age, 67% male, body mass index of 26 (23-29) kg/m2, 48% with hypertension, 43% with chronic kidney disease, 5% with diabetes, within 2 (1-4) years of post-transplant follow-up. At presentation, the main symptoms were fever (62%), myalgia (33%), cough (33%), headache (33%), and dyspnea (19%). Hospitalization was required for 13 (62%) patients, with a time from first symptoms to the admission of 5 (1-12) days. In 38%, supplementary oxygen was needed, 19% required intensive care, and 10% mechanical ventilation. Three (14%) were infected after at least a first dose of COVID-19 vaccine. The main complications were bacterial pneumonia (38%), renal replacement therapy (19%), sepsis (10%) and venous thromboembolism (10%). Immunosuppression therapy was modified in 48%, with a reduction in the majority (89%). Two (10%) patients died in the hospital due to refractory hypoxemia and multiple organ dysfunction. The incidence of COVID-19 among transplant patients was comparable to the general population in the State of Rio Grande do Sul with a peak in December 2020. CONCLUSION: Heart transplant recipients shown a high rate of COVID-19 infection in Southern Brazil, with typical symptom presentation in most cases. There was an elevated rate of hospitalization, supplementary oxygen support, and complications. In-hospital lethality among infected heart transplanted recipients was similar to previously reported data worldwide despite the high rates of infection in Latin America.

Effect of lead acetate on cytosolic thioredoxin reductase activity and oxidative stress parameters in rat kidneys.

Oxidative stress has been suggested to be an important molecular mechanism of toxic effects of lead in the kidney. Thioredoxin reductase-1 is a selenoprotein involved in many cellular redox processes. This study evaluated the effect of acute and chronic exposure intraperitoneally to lead acetate on thioredoxin reductase-1 activity and on other oxidative stress parameters in the rat kidney, as well as on indicators of renal function commonly used to assess lead poisoning. Acute exposure to 25 mg/kg lead acetate increased superoxide dismutase and thioredoxin reductase-1 activity (after 6, 24 and 48 hr), while exposure to 50 mg/kg lead acetate increased catalase activity (after 48 hr) and inhibited delta-aminolevulinate dehydratase activity (after 6, 24 and 48 hr) in the kidney (P < 0.05). Chronic exposure (30 days) to 5 mg/kg lead acetate inhibited delta-aminolevulinate dehydratase and increased glutathione S-transferase, non-protein thiol groups, catalase, thioredoxin reductase-1 and uric acid plasma levels, while exposure to 25 mg/kg lead acetate reduced body weight and delta-aminolevulinate dehydratase, but increased glutathione S-transferase, non-protein thiol groups and uric acid plasma levels (P < 0.05). No changes were observed in thiobarbituric acid reactive substances, glutathione peroxidase, creatinine or inorganic phosphate levels after either acute or chronic exposure. Our results suggest that thioredoxin reductase-1 may be an early indicator of acute exposure to low lead doses.

Effect of lycopene on nephrotoxicity induced by mercuric chloride in rats.

Oxidative stress is an important molecular mechanism for kidney injury in mercury poisoning. We studied lycopene, a potent carotenoid found in tomatoes due to its large antioxidant properties, and also evaluated the ability of lycopene to prevent HgCl(2) nephrotoxicity. Rats were injected with HgCl(2) (0 or 5 mg/kg body weight, subcutaneously) 6 hr after lycopene administration (0, 10, 25 or 50 mg/kg by gavage) and were killed 12 hr after HgCl(2) exposure. HgCl(2)-induced inhibition of delta-aminolevulinate dehydratase activity (approximately 35%) and increase of lipid peroxidation in kidney (approximately 37%) were prevented by lycopene. However, lycopene did not prevent the increase of plasma creatinine levels (approximately 123%) and renal tubular necrosis induced by HgCl(2). Glutathione peroxidase and catalase activities were enhanced (approximately 71% and approximately 41%), while superoxide dismutase activity was depressed (approximately 44%) in HgCl(2)-treated rats when compared to control and these effects were prevented by lycopene. Our results indicate that although lycopene did not prevent HgCl(2)-induced renal failure, it could play a beneficial role against HgCl(2) toxicity by preventing lipid peroxidation and changes in the activity of delta-aminolevulinate dehydratase and antioxidant enzymes.