Evaluation of hematological changes and immune response biomarkers as a prognostic factor in critical patients with COVID-19.

COVID-19 disease has been a challenge for health systems worldwide due to its high transmissibility, morbidity, and mortality. Severe COVID-19 is associated with an imbalance in the immune response, resulting in a cytokine storm and a hyperinflammation state. While hematological parameters correlate with prognosis in COVID patients, their predictive value has not been evaluated specifically among those severely ill. Therefore, we aim to evaluate the role of hematological and immune response biomarkers as a prognostic factor in critically ill patients with COVID-19 admitted to the intensive care unit. From May 2020 to July 2021, a retrospective cohort study was conducted in a reference hospital in Manaus, which belongs to the Brazilian public health system. This study was carried out as single-center research. Clinical and laboratory parameters were analyzed to evaluate the association with mortality. We also evaluated the role of neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein-to-lymphocyte ratio (CLR). We gathered information from medical records, as well as from prescriptions and forms authorizing the use of antimicrobial medications. During the study period, 177 patients were included, with a mean age of 62.58 ± 14.39 years. The overall mortality rate was 61.6%. Age, mechanical ventilation (MV) requirement, leukocytosis, neutrophilia, high c-reactive protein level, NLR, and CLR showed a statistically significant association with mortality in the univariate analysis. In the multivariate logistic regression analysis, only MV (OR 35.687, 95% CI: 11.084-114.898, p< 0.001) and NLR (OR 1.026, 95% CI: 1.003-1.050, p = 0.028) remained statistically associated with the outcome of death (AUC = 0.8096). While the need for mechanical ventilation is a parameter observed throughout the hospital stay, the initial NLR can be a primary risk stratification tool to establish priorities and timely clinical intervention in patients with severe COVID-19 admitted to the ICU.

Clinical and pharmacological factors associated with mortality in patients with COVID-19 in a high complexity hospital in Manaus: A retrospective study.

COVID-19 is a contagious infection caused by the SARS-CoV-2 virus, responsible for more than 5 million deaths worldwide, and has been a significant challenge for healthcare systems worldwide. Characterized by multiple manifestations, the most common symptoms are fever, cough, anosmia, ageusia, and myalgia. However, several organs can be affected in more severe cases, causing encephalitis, myocarditis, respiratory distress, hypercoagulable state, pulmonary embolism, and stroke. Despite efforts to identify appropriate clinical protocols for its management, there are still no fully effective therapies to prevent patient death. The objective of this study was to describe the demographic, clinical, and pharmacotherapeutic management characteristics employed in patients hospitalized for diagnosis of COVID-19, in addition to identifying predictive factors for mortality. This is a single-center, retrospective cohort study carried out in a reference hospital belonging to the Brazilian public health system, in Manaus, from March 2020 to July 2021. Data were obtained from analyzing medical records, physical and electronic forms, medical prescriptions, and antimicrobial use authorization forms. During the study period, 530 patients were included, 51.70% male, with a mean age of 58.74 ± 15.91 years. The overall mortality rate was 23.58%. The variables age, number of comorbidities, admission to the ICU, length of stay, oxygen saturation, serum aspartate transaminase, and use of mechanical ventilation showed a positive correlation with the mortality rate. Regarding pharmacological management, 88.49% of patients used corticosteroids, 86.79% used antimicrobials, 94.15% used anticoagulant therapy, and 3.77% used immunotherapy. Interestingly, two specific classes of antibiotics showed a positive correlation with the mortality rate: penicillins and glycopeptides. After multivariate logistic regression analysis, age, number of comorbidities, need for mechanical ventilation, length of hospital stay, and penicillin or glycopeptide antibiotics use were associated with mortality (AUC = 0.958).

Management of chemotherapy-induced febrile neutropenia and use of granulocyte colony-stimulating factor in patients with soft tissue or bone sarcoma.

INTRODUCTION: Febrile neutropenia, an oncological complication related to myelosuppressive chemotherapy, can lead to unplanned hospitalization, morbidity, mortality, and changes in the oncological therapeutic plan. The present study aimed (1) to determine the prevalence of chemotherapy-induced febrile neutropenia requiring hospitalization and the use of granulocyte colony-stimulating factor and (2) to evaluate its consequences for the oncological treatment of patients with soft tissue or bone sarcomas. METHODS: This is a cross-sectional and retrospective study (January 2018 to December 2019) carried out in a reference oncology hospital in the Brazilian public health system. Inpatients diagnosed with chemotherapy-induced febrile neutropenia, older than the age of 18 years, and treated with granulocyte colony-stimulating factor were included in the study. RESULTS: Twenty-nine chemotherapy-induced febrile neutropenia events were identified, involving 25 patients. Among the febrile neutropenia events, 90% were grade 4, and 59% occurred during palliative chemotherapy. Among patients with febrile neutropenia, 31% had arterial hypertension or/and diabetes mellitus comorbidities, 34% had infectious skin sites, such as compression ulcers and tumor wounds, and 31% had infections with defined etiologic agents. Treatment of hospitalized patients was performed with cefepime in combinations or alone (97%) and filgrastim. The outcomes related to chemotherapy-induced febrile neutropenia were chemotherapy dose reduction (31%), chemotherapy cycle delays (21%), chemotherapy treatment suspension (17%), deaths (7%), and other associated complications (10%). Granulocyte colony-stimulating factor prophylaxis was prescribed in 72.41% of febrile neutropenia events. The frequency of febrile neutropenia concerning total chemotherapy cycles was 2.15%. CONCLUSION: Even with granulocyte colony-stimulating factor prophylaxis, an overall prevalence of 2.15% of febrile neutropenia associated with hospitalization was observed, causing negative outcomes in chemotherapy treatment of patients.

Pharmacological profile and potential drug interactions in ovarian cancer hospitalized patients.

The aim of this study was to identify the main therapeutic classes prescribed to ovarian cancer patients and the potential drug interactions (PDI) during hospitalization. This descriptive retrospective work was carried out in a referral gynecological cancer hospital from the Brazilian public health system. The first 24 h inpatients' prescriptions were evaluated to obtain the pharmacological profile data. Clinical and epidemiological characteristics were collected through the analysis of electronic medical records. A total of 236 patients were included in the study, of which 154 (65.25%) had PDI, with a mean of 1.43 ± 1.76 interactions per patient. The main therapeutic classes prescribed were analgesics and antiemetics (35%), compatible with the oncologic supportive care. All PDI identified (n = 331) were categorized by severity, using the Micromedex database, resulting in: 1.51% contraindicated, 67.67% major, 24.77% moderate, and 6.04% minor. The more prevalent PDI were ondansetron/tramadol (22.05%) and metoclopramide/tramadol (7.25%), both major. An association between PDI and polypharmacy was observed, which did not occur between age or length of stay. Ongoing prescription review by the pharmaceutical team is necessary to identify, monitor, and manage PDI-related adverse events and carry out required interventions with patients, physicians, and nurses. Taken together the data showed that even in a specialized hospital, the complexity of the pharmacotherapy can cause harm to the ovarian cancer patient. The clinical pharmacist acting in a multidisciplinary team is important for improving patient safety in oncology services.

Glicopeptídeos: aspectos farmacológicos e aplicações clínicas / Glycopeptides: pharmacological aspects and clinical applications / Glicopeptidos: aspectos farmacológicos y aplicaciones clínicas

O uso indiscriminado dos antimicrobianos tem gerado um problema significativo na saúde pública, acarretando impactos negativos como fracasso na farmacoterapia frente as infecções bacterianas e aumentos nos custos assistenciais. Esta revisão narrativa tem como objetivo descrever as propriedades farmacocinéticas e farmacodinâmicas e aplicações clínicas dos principais antibióticos pertencentes a classe dos glicopeptídeos. A busca de artigos foi realizada nas seguintes bases de dados: Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS/PUBMED), SciELO (Scientific Electronic Library Online) e Biblioteca Virtual em Saúde (BVS). A vancomicina e a teicoplanina são fármacos de primeira linha no tratamento de infecções por bactérias gram-positivas com resistência a outros antibióticos. Ambos apresentam estruturas cíclicas complexas, contendo aminoácidos ligados a grupos de carboidratos que lhe conferem propriedades únicas. A administração dos glicopetídeos deve ponderar fatores relacionados ao paciente como faixa etária, função renal, desnutrição e obesidade devido a sua heterogeneidade farmacocinética, por isso o monitoramento sérico é recomendado para assegurar concentrações plasmáticas efetivas. Diante do exposto, o uso adequado e baseado em evidência científica dessa importante classe de antibióticos visa otimizar o tratamento farmacoterapêutico e diminuir o avanço da resistência bacteriana.

The indiscriminate use of antimicrobials has generated a significant problem in public health, causing negative impacts such as failure in pharmacotherapy against bacterial infections and increases in healthcare costs. This narrative review aims to describe the pharmacokinetic and pharmacodynamic properties and clinical applications of the main antibiotics belonging to the class of glycopeptides. The search for articles was carried out in the following databases: Latin American and Caribbean Literature in Health Sciences (LILACS/PUBMED), SciELO (Scientific Electronic Library Online), and Virtual Health Library (BVS). Vancomycin and teicoplanin are first- line drugs in infections caused by gram-positive bacteria it resistant to other antibiotics. Both have complex cyclic structures containing amino acids linked to carbohydrate groups that give them unique properties. The administration of glycopeptides must consider patient-related factors such as age group, renal function, malnutrition, and obesity due to its pharmacokinetic heterogeneity. Therefore, serum monitoring is recommended to ensure effective plasma concentrations. Thus, the proper use based on scientific evidence of this important class of antibiotics aims to optimize pharmacotherapeutic treatment and reduce the progress of bacterial resistance.

El uso indiscriminado de antimicrobianos ha generado un problema impor- tante en la salud pública, provocando impactos negativos como el fracaso en la farmaco- terapia contra las infecciones bacterianas y el aumento de los costos sanitarios. Esta revi- sión narrativa tiene como objetivo describir las propiedades farmacocinéticas, farmaco- dinámicas y aplicaciones clínicas de los principales antibióticos pertenecientes a la clase de los glicopéptidos. La búsqueda de artículos se realizó en las siguientes bases de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS/PUBMED), SciELO (Scientific Electronic Library Online) y Biblioteca Virtual en Salud (BVS). La vancomicina y la teicoplanina son fármacos de primera línea en el tratamiento de infec- ciones causadas por bacterias grampositivas resistentes a otros antibióticos. Ambos tienen estructuras cíclicas complejas, que contienen aminoácidos unidos a grupos de carbohi- dratos que les otorgan propiedades únicas. La administración de glicopéptidos debe con- siderar factores relacionados con el paciente, como el grupo de edad, la función renal, la desnutrición y la obesidad debido a su heterogeneidad farmacocinética, por lo que se re- comienda el monitoreo sérico para asegurar concentraciones plasmáticas efectivas. En vista de lo anterior, el uso adecuado basado en la evidencia científica de esta importante clase de antibióticos tiene como objetivo optimizar el tratamiento farmacoterapéutico y reducir la propagación de resistencias bacterianas.

Avaliação da atividade antimicrobiana e antitumoral, frente ao sarcoma 180, do extrato bruto de luffa operculata cogn. (cucurbitaceae) / Assessment of antimicrobial and anti-tumor activity, against sarcoma 180, of the crude extract of luffa operculata cogn. (cucurbitaceae) / Evaluación de la actividad antimicrobiana y antitumoral frente a sarcoma 180 del extracto crudo de luffa operculata cogn. (cucurbitaceae)

Luffa operculata Cogn. pertence à família Cucurbitaceae, sendo popularmente denominada como buchinha, cabaçinha e purga-dos-paulistas. Sua análise fitoquímica demonstrou a presença de glicosídeos, saponina e resina, esteróis livres, ácidos orgânicos, fenóis e, com ausência de taninos. Além disso, essa família é produtora de triterpenos com esqueletos modificados denominados de cucurbitacinas, substâncias de alto valor farmacológico. Este trabalho teve como objetivo avaliar a atividade antimicrobiana e antitumoral, frente ao Sarcoma 180, do extrato bruto da Luffa operculata Cogn.. No ensaio antimicrobiano foram utilizadas espécimes bacterianas e fúngicas da origem clínica e de coleção. Para analisar a atividade antitumoral, células tumorais foram implantadas na região axilar de camundongos albinos Swiss (Mus musculus). O grupo controle recebeu solução salina 0,9% e no grupo padrão administrou-se metotrexato (10 mg/kg de peso corpóreo). Os grupos tratados receberam por via intraperitoneal doses nas concentrações de 0,3, 0,6 ou 1,0 mg/kg de peso corpóreo do extrato bruto etanólico de Luffa operculata Cogn.. Os resultados demonstraram que o extrato do Luffa operculata Cogn. apresenta atividade antimicrobiana contra Staphylococcus aureus, Staphylococcus epidermidis, Candida albicans e Candida tropicalis. No que diz respeito a atividade antitumoral, os animais tratados com o extrato nas doses 0,3 e 0,6 mg/kg não apresentaram redução relevante dos tumores de Sarcoma 180, quando comparado com o grupo controle. Entretanto, os animais tratados com a dose 1,0 mg/kg obtiveram índice de inibição de 61,7%. Dessa forma, concluímos que o extrato bruto de Luffa operculata Cogn. apresenta atividade antimicrobiana e, na dose de 1 mg/kg, apresenta atividade antitumoral reduzindo significativamente os tumores de Sarcoma 180.

Luffa operculata Cogn. belongs to the Cucurbitaceae family, popularly known as buchinha, cabaçinha and purga-dos-paulistas. Its phytochemical analysis demonstrated the presence of glycosides, saponin and resin, free sterols, organic acids, phenols and the absence of tannins. In addition, this family produces triterpenes with modified skeletons called cucurbitacins, substances of high pharmacological value. This work aimed to evaluate the antimicrobial and antitumor activity, against Sarcoma 180, of the crude extract of Luffa operculata Cogn.. In the antimicrobial assay, bacterial and fun- gal specimens of clinical and collection origin were used. To analyze the antitumor activ- ity tumor cells were implanted in the axillary region in albino Swiss mice (Mus musculus). The control group received 0.9% saline solution; and the standard group received meth- otrexate (10 mg/kg per body weight). The treated groups received intraperitoneal doses at concentrations of 0.3, 0.6; and 1.0 mg/kg per body weight of crude ethanolic extract of Luffa operculata Cogn., respectively. The results demonstrated that the extract of Luffa operculata Cogn. has antimicrobial activity against Staphylococcus aureus, Staphylococ- cus epidermidis, Candida albicans, and Candida tropicalis. Concerning antitumor activ- ity, the animals treated with the extract at doses of 0.3 and 0.6 mg/kg did not show a relevant reduction in Sarcoma 180 tumors, when compared to the control group. How- ever, animals treated with a dose of 1mg/kg had an inhibition rate of 61.7%. Thus, we concluded that the crude extract of Luffa operculata Cogn. it has antimicrobial activity; and only at the highest dose (1 mg/kg) did it significantly reduce Sarcoma 180 tumors. KEYWORDS: Luffa Operculata Cogn.; Antimicrobian Activity; Sarcoma 180.

Luffa operculata Cog. pertenece a la familia de las Cucurbitáceas, siendo popularmente conocida como buchinha, cabaçinha y purga-dos-paulistas. Su análisis fi- toquímico demostró la presencia de glucósidos, saponina y resina, esteroles libres, ácidos orgánicos, fenoles y ausencia de taninos. Además, esta familia es produtora de triterpenos con esqueletos modificados llamados cucurbitacinas, sustancias de alto valor farmacoló- gico. Este trabajo tuvo como objetivo evaluar la actividad antimicrobiana y antitumoral, contra el Sarcoma 180, del extracto crudo de Luffa operculata Cogn.. En el ensayo anti- microbiano se utilizaron especímenes bacterianos y fúngicos de origen clínico y de co- lección. Para analizar la actividad antitumoral, se implantaron células tumorales en la región axilar de ratones albinos suizos (Mus musculus). El grupo control recibió solución salina al 0,9% y el grupo estándar recibió metotrexato (10 mg/kg por peso corporal). Los grupos tratados recibieron dosis intraperitoneales a concentraciones de 0,3, 0,6 y 1,0 mg/kg por peso corporal de extracto etanólico crudo de Luffa operculata Cogn., respec- tivamente. Los resultados demostraron que el extracto de Luffa operculata Cogn. tiene actividad antimicrobiana contra Staphylococcus aureus, Staphylococcus epidermidis, Candida albicans y Candida tropicalis. En cuanto a la actividad antitumoral, los animales tratados con el extracto a dosis de 0,3 y 0,6 mg/kg no mostraron una reducción relevante de tumores Sarcoma 180, al compararlos con el grupo control. Sin embargo, los animales tratados con una dosis de 1 mg/kg tuvieron una tasa de inhibición del 61,7 %. Por lo tanto, concluimos que el extracto crudo de Luffa operculata Cogn. tiene actividad antimicro- biana y solo en la dosis más alta (1 mg/kg) redujo significativamente los tumores Sarcoma 180.

Avaliação toxicológica e determinação da dl 50 do extrato bruto de luffa operculata cogn. (cucurbitaceae) / Toxicological evaluation and determination of ld 50 of the crude extract of luffa operculata cogn. (cucurbitaceae) / Evaluación toxicológica y determinación de la dl 50 del extracto crudo de luffa operculata cogn. (cucurbitáceas)

As plantas medicinais têm sido bastante utilizadas para o tratamento de várias enfermidades pelo homem. Numerosos compostos bioativos obtidos de plantas medicinais apresentam atividades antimicrobianas, antivirais, anticancerígenas, anti- inflamatórias, antioxidantes e neuromoduladoras. Entretanto, existe um número crescente de estudos científicos que comprovam a toxicidade de plantas medicinais. O fruto da Luffa operculata Cogn. é utilizado popularmente como purgante, emenogogo, expectorante e rinossinusite. Este trabalho teve como objetivo avaliar a toxicidade aguda e determinar a dose letal 50% (LD50) do extrato bruto etanólico de Luffa operculata Cogn., por via intraperitoneal em camundongos. No experimento foi utilizado camundongos albinos fêmeas Swiss (Mus Muscullus). Os animais foram divididos em grupos (n=6/grupo), e a toxicidade foi avaliada em duas etapas: preliminar e definitiva. As reações comportamentais relacionadas às doses administradas do extrato de Luffa operculata Cogn. foram taquicardia, taquipneia, movimentos estereotipados e circulares e piloereção. Após essa fase, os animais apresentaram reações depressoras envolvendo apneia e prostração. Além disso, os animais apresentaram outros comportamentos como: contorções abdominais, tônus da musculatura abdominal, espasmos e irritação da conjuntiva. O extrato de Luffa operculata Cogn. apresentou uma DL50 de 3,3 mg/Kg de peso corpóreo, sendo considerada muito tóxica. Como essa planta é largamente usada pela população para fins terapêuticos, alertamos quanto a utilização indiscriminada devido ao alto potencial tóxico.

Medicinal plants have been sed for the treatment of various diseases by man. Numerous bioactive compounds obtained from medicinal plants exhibit antimicrobial, antiviral, anticancer, anti-inflammatory, antioxidant, and neuromodulatory activities. However, the number of scientific studies proving the toxicity of medicinal plants is increasing. The fruit of Luffa operculata Cogn. it is popularly used as a purgative, emmenagogue, expectorant, and rhinosinusitis. This work aimed to evaluate the acute toxicity and determine the lethal dose of 50% (LD50) of the crude ethanolic extract of Luffa operculata Cogn., intraperitoneally. In the experiment, Swiss female albino mice (Mus Muscullus) were used. The animals were divided into groups (n=6/group), and toxicity was evaluated in two steps: preliminary and definitive. Behavioral reactions related to administered doses of Luffa operculata Cogn. were tachycardia, tachypnea, stereotyped, and circular movements and piloerection. After this phase, the animals presented depressive reactions involving apnea and prostration. In addition, the animals showed other behaviors such as abdominal contortions, abdominal muscle tone, spasms, and irritation of the conjunctiva. The extract of Luffa operculata Cogn. presented an LD50 of 3.3 mg/Kg of body weight, being considered very toxic. As this plant is widely used by the population for therapeutic purposes, we warn about its use due to its high toxic potential.

Las plantas medicinales han sido ampliamente utilizadas para el tratamiento de diversas enfermedades por parte del hombre. Numerosos compuestos bioactivos obte- nidos de plantas medicinales exhiben actividades antimicrobianas, antivirales, anticance- rígenas, antiinflamatorias, antioxidantes y neuromoduladoras. Sin embargo, hay un nú- mero creciente de estudios científicos que prueban la toxicidad de las plantas medicinales. El fruto de Luffa operculata Cogn. se utiliza popularmente como purgante, emenogogo, expectorante y rinosinusitis. Este trabajo tuvo como objetivo evaluar la toxicidad aguda y determinar la dosis letal al 50% (DL50) del extracto etanólico crudo de Luffa operculata Cogn., por vía intraperitoneal. En el experimento se utilizaron ratones albinos hembra suizos (Mus Muscullus). Los animales se dividieron en grupos (n=6/grupo) y la toxicidad se evaluó en dos etapas: preliminar y definitiva. Reacciones conductuales relacionadas con las dosis administradas de Luffa operculata Cogn. fueron taquicardia, taquipnea, mo- vimientos estereotipados y circulares y piloerección. Después de esta fase, los animales presentaron reacciones depresivas involucrando apnea y postración. Además, los anima- les mostraron otros comportamientos como: contorsiones abdominales, tono muscular abdominal, espasmos e irritación de la conjuntiva. El extracto de Luffa operculata Cogn. presentó una DL50 de 3,3 mg/Kg de peso corporal, considerándose muy tóxico. Como esta planta es muy utilizada por la población con fines terapéuticos, advertimos contra su uso indiscriminado por su alto potencial tóxico.

Sepsis and septic shock: epidemiology, clinical parameters, and prognostic factors in a brazilian intensive care unit / Sepse e choque séptico: epidemiologia, parâmetros clínicos e fatores prognósticos em uma unidade de terapia intensiva brasileira / Sepsis y shock séptico: epidemiología, parámetros clínicos y factores pronósticos en una unidad de cuidados intensivos brasileña

Sepsis is an organ dysfunction caused by a dysregulated host response to infection and is associated with high morbidity and mortality. The identification of prognostic markers in this syndrome has been a strategy to increase treatment efficacy. The objectives of this study were: 1) to describe the epidemiological and microbiological profile of septic patients and 2) to investigate the association between laboratory/clinical parameters and mortality rate, identifying prognostic markers. Using a prospective observational protocol, epidemiological, clinical and laboratory data were collected from adult patients with sepsis or septic shock admitted to a Brazilian Intensive Care Unit. During the study period, 120 patients were diagnosed with sepsis and 71.67% (n = 86) were included in the protocol. The overall mortality was 69.76% and chronic diseases were identified in 79.07% of cases. The mortality rates for sepsis and septic shock were 51.06% and 92.31%, respectively. SOFA scores on the first, third, and seventh days of hospitalization gradually increased for patients who had clinical worsening. Hyperlactatemia and hyperglycemia were identified in 45.9% and 27% of patients, respectively, and were associated with mortality. INR values greater than 1.5 or thrombocytopenia were related to 92.9% and 88.6% mortality, respectively. In the study, gender, age, ICU stay, site of infection and microbiological agent were not associated with the risk of death. However, the presence of comorbidities, high SOFA scores, three or more organ dysfunctions, and sepsis severity correlated directly with mortality rate.

A sepse é uma disfunção orgânica causada por uma resposta desregulada do hospedeiro à infecção e está associada a alta morbidade e mortalidade. A identificação de marcadores prognósticos nessa síndrome tem sido uma estratégia para aumentar a eficácia do tratamento. Os objetivos deste estudo foram: 1) descrever o perfil epidemiológico e microbiológico de pacientes sépticos e 2) investigar a associação entre parâmetros laboratoriais/clínicos e a taxa de mortalidade, identificando marcadores prognósticos. Por meio de um protocolo observacional prospectivo foram coletados dados epidemiológicos, clínicos e laboratoriais de pacientes adultos com sepse ou choque séptico internados em uma Unidade de Terapia Intensiva brasileira. No período do estudo, 120 pacientes foram diagnosticados com sepse e 71,67% (n = 86) foram incluídos no protocolo. A mortalidade geral foi de 69,76% e doenças crônicas foram identificadas em 79,07% dos casos. As taxas de mortalidade por sepse e choque séptico foram de 51,06% e 92,31%, respectivamente. Os escores SOFA no primeiro, terceiro e sétimo dias de internação aumentaram gradativamente para os pacientes que apresentaram piora clínica. Hiperlactatemia e hiperglicemia foram identificadas em 45,9% e 27% dos pacientes, respectivamente, tendo sido associadas à mortalidade. Valores de INR maiores que 1,5 ou trombocitopenia foram relacionados a 92,9% e 88,6% de mortalidade, respectivamente. No estudo, sexo, idade, permanência na UTI, local da infecção e agente microbiológico não se associaram ao risco de óbito. No entanto, a presença de comorbidades, altos escores SOFA, três ou mais disfunções orgânicas e a gravidade da sepse correlacionaram-se diretamente com a taxa de mortalidade.

La sepsis es una disfunción orgánica causada por una respuesta desregulada del huésped a la infección y se asocia a una elevada morbilidad y mortalidad. La identificación de marcadores pronósticos en este síndrome ha sido una estrategia para aumentar la eficacia del tratamiento. Los objetivos de este estudio fueron: 1) describir el perfil epidemiológico y microbiológico de los pacientes sépticos y 2) investigar la asociación entre los parámetros de laboratorio/clínicos y la tasa de mortalidad, identificando marcadores pronósticos. Mediante un protocolo observacional prospectivo, se recogieron datos epidemiológicos, clínicos y de laboratorio de pacientes adultos con sepsis o shock séptico ingresados en una Unidad de Cuidados Intensivos brasileña. Durante el período de estudio, 120 pacientes fueron diagnosticados de sepsis y el 71,67% (n = 86) fueron incluidos en el protocolo. La mortalidad global fue del 69,76% y se identificaron enfermedades crónicas en el 79,07% de los casos. Las tasas de mortalidad por sepsis y shock séptico fueron del 51,06% y el 92,31%, respectivamente. Las puntuaciones SOFA en el primer, tercer y séptimo día de hospitalización aumentaron gradualmente en los pacientes que presentaron empeoramiento clínico. La hiperlactatemia y la hiperglucemia se identificaron en el 45,9% y el 27% de los pacientes, respectivamente, y se asociaron a mortalidad. Los valores de INR superiores a 1,5 o la trombocitopenia se relacionaron con un 92,9% y un 88,6% de mortalidad, respectivamente. En el estudio, el sexo, la edad, la estancia en la UCI, el lugar de la infección y el agente microbiológico no se asociaron con el riesgo de muerte. Sin embargo, la presencia de comorbilidades, las puntuaciones SOFA elevadas, tres o más disfunciones orgánicas y la gravedad de la sepsis se correlacionaron directamente con la tasa de mortalidad.

Conciliação medicamentosa em hospital universitário: estratégia de segurança em pacientes neurocirúrgicos / Medication reconciliation in a university hospital: safety strategy in neurosurgical patients / Conciliación de medicamentos en un hospital universitario: estrategia de seguridad en pacientes neuroquirúrgicos

Esse trabalho teve como objetivo identificar as discrepâncias medicamentosas, por meio do serviço de conciliação de medicamentosa, em pacientes admitidos na clínica cirúrgica de uma unidade especializada no atendimento de doença relacionadas ao sistema neuromuscular na cidade de Manaus, Amazonas. Trata-se de um estudo descritivo e prospectivo, realizado no período de setembro a dezembro de 2020 em pacientes submetidos a conciliação medicamentosa. Na primeira etapa realizou-se a anamnese farmacêutica em formulário semiestruturado e foi elaborada a melhor história possível de medicamentos (MHPM). Os medicamentos prescritos na admissão foram comparados com a MHPM e as discrepâncias foram identificadas e classificadas quanto a intencionalidade e tipo. Ao total 54 pacientes foram incluídos no estudo, sendo que para 32 foi realizada a conciliação medicamentosa por usarem medicamentos de uso contínuo. Foram identificadas 20 discrepâncias intencionais, 3 discrepâncias intencionais não documentadas e 12 discrepâncias não intencionais. Omissão de medicamentos foi o tipo de discrepância mais comum (86%). Diante do exposto, concluímos que a conciliação medicamentosa mostrou-se um importante recurso para identificação de discrepâncias na transição de cuidado de pacientes com doenças neurológicas, principalmente no que se refere à omissão de medicamentos. As intervenções farmacêuticas a partir das discrepâncias encontradas, conseguiram mitigar erros de medicação e possíveis eventos adversos, aumentando a segurança do paciente.

This work aimed to identify medication discrepancies, through the medi- cation reconciliation service, in patients admitted to the surgical clinic of a unit special- ized in treating diseases related to the neuromuscular system in the city of Manaus, Ama- zonas. This is a descriptive and prospective study, carried out from September to Decem- ber 2020 in patients undergoing medication reconciliation. In the first stage, the pharma- ceutical anamnesis was carried out in a semi-structured form and the best possible medi- cation history (MHPM) was prepared. Medications prescribed on admission were com- pared with the MHPM and discrepancies were identified and classified according to in- tentionality and type. 54 patients were included in the study, and for 32 medication rec- onciliation was performed because they used continuous medication. A total of 20 inten- tional discrepancies, 3 intentional undocumented discrepancies and 12 unintentional dis- crepancies were identified. Medication omission was the most common type of discrep- ancy (86%). We conclude that medication reconciliation proved to be an important re- source for identifying discrepancies in the transition of care for patients with neurological diseases, especially with regard to medication omission. Pharmaceutical interventions, based on the discrepancies found, managed to mitigate medication errors and possible adverse events, increasing patient safety.

Este estudio tuvo como objetivo identificar las discrepancias de medicación a través del servicio de reconciliación de medicamentos, en pacientes internados en la clínica quirúrgica de una unidad especializada en el tratamiento de enfermedades relacio- nadas con el sistema neuromuscular en la ciudad de Manaus, Amazonas. Este es un estu- dio descriptivo y prospectivo, realizado de septiembre a diciembre de 2020 en pacientes en conciliación de medicación. En la primera etapa se realizó la anamnesis farmacéutica de forma semiestructurada y se elaboró el mejor historial de medicación posible (MHPM). Los medicamentos prescritos al ingreso se compararon con el MHPM y se identificaron las discrepancias y se clasificaron según la intencionalidad y el tipo. Un total de 54 pacientes fueron incluidos en el estudio, y a 32 se les realizó conciliación de medi- cación por utilizar medicación continua. Se identificaron un total de 20 discrepancias in- tencionales, 3 discrepancias intencionales no documentadas y 12 discrepancias no inten- cionales. La omisión de medicamentos fue el tipo más común de discrepancia (86%). Concluimos que la conciliación de medicamentos demostró ser un recurso importante para identificar discrepancias en la transición de la atención a pacientes con enfermedades neurológicas, especialmente en lo que respecta a la omisión de medicamentos. Las inter- venciones farmacéuticas, en base a las discrepancias encontradas, lograron mitigar errores de medicación y posibles eventos adversos, aumentando la seguridad del paciente PALABRAS CLAVE: Conciliación de Medicamentos; Seguridad del Paciente; Servicio de Farmacia Hospitalaria; Neurología.