Electronic health records have brought valuable improvements to hospital practices by integrating patient information. In fact, the understanding of these data can prevent mistakes that may put ...patients' lives at risk. Nonetheless, to the best of our knowledge, there are no previous studies addressing the automatic detection of outlier prescriptions, regarding dosage and frequency. In this paper, we propose an unsupervised method, called density-distance-centrality (DDC), to detect potential outlier prescriptions. A dataset with 563 thousand prescribed medications was used to assess our proposed approach against different state-of-the-art techniques for outlier detection. In the experiments, our approach achieves better results in the task of overdose and underdose detection in medical prescriptions, compared to other methods applied to this problem. Additionally, most of the false positive instances detected by our algorithm were potential prescriptions errors.
The Charlson comorbidity index (CCI) is widely used to predict mortality for patients who may have many comorbid conditions. Such index is also used as an indicator of the patients' complexity inside ...a hospital. In this paper, we evaluate a variety of feature extraction and regression methods to predict the CCI from clinical notes. We used a tertiary hospital dataset with 48 thousand hospitalizations featuring the CCI annotated by physicians. In our experiments, Dense Neural Networks with Word Embeddings proved to be the best regression method, with a mean absolute error of 0.51.
This study was undertaken to verify the effects of chronic stress and lithium treatments on the hippocampal Na
+,K
+-ATPase activity of rats, as well as to investigate the effects of stress ...interruption and post-stress lithium treatment on this enzyme activity and on spatial memory. Two experiments were carried out; in the first experiment, adult male Wistar rats were divided into two groups: control and submitted to a chronic variate stress paradigm, and subdivided into treated or not with LiCl. After 40 days of treatment, rats were killed, and Na
+,K
+-ATPase activity was determined. In the second experiment, rats were stressed during 40 days, and their performance was evaluated in the Water Maze task. The stressed group was then subdivided into four groups, with continued or interrupted stress treatment and treated or not with lithium for 30 additional days. After a second evaluation of performance in the Water Maze, rats were killed and Na
+,K
+-ATPase activity was also measured. Results showed an impairment in Na
+,K
+-ATPase activity and in Water Maze performance of chronically stressed rats, which were prevented by lithium treatment and reversed by lithium treatment and by stress interruption. These results suggest that the modulation of Na
+,K
+-ATPase activity may be one of the mechanisms of action of lithium in the treatment of mood disorders.
Recent evidence indicates a potential therapeutic role of fluvoxamine for COVID-19. In the TOGETHER trial for acutely symptomatic patients with COVID-19, we aimed to assess the efficacy of ...fluvoxamine versus placebo in preventing hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to a tertiary hospital due to COVID-19.
This placebo-controlled, randomised, adaptive platform trial done among high-risk symptomatic Brazilian adults confirmed positive for SARS-CoV-2 included eligible patients from 11 clinical sites in Brazil with a known risk factor for progression to severe disease. Patients were randomly assigned (1:1) to either fluvoxamine (100 mg twice daily for 10 days) or placebo (or other treatment groups not reported here). The trial team, site staff, and patients were masked to treatment allocation. Our primary outcome was a composite endpoint of hospitalisation defined as either retention in a COVID-19 emergency setting or transfer to tertiary hospital due to COVID-19 up to 28 days post-random assignment on the basis of intention to treat. Modified intention to treat explored patients receiving at least 24 h of treatment before a primary outcome event and per-protocol analysis explored patients with a high level adherence (>80%). We used a Bayesian analytic framework to establish the effects along with probability of success of intervention compared with placebo. The trial is registered at ClinicalTrials.gov (NCT04727424) and is ongoing.
The study team screened 9803 potential participants for this trial. The trial was initiated on June 2, 2020, with the current protocol reporting randomisation to fluvoxamine from Jan 20 to Aug 5, 2021, when the trial arms were stopped for superiority. 741 patients were allocated to fluvoxamine and 756 to placebo. The average age of participants was 50 years (range 18–102 years); 58% were female. The proportion of patients observed in a COVID-19 emergency setting for more than 6 h or transferred to a teritary hospital due to COVID-19 was lower for the fluvoxamine group compared with placebo (79 11% of 741 vs 119 16% of 756); relative risk RR 0·68; 95% Bayesian credible interval 95% BCI: 0·52–0·88), with a probability of superiority of 99·8% surpassing the prespecified superiority threshold of 97·6% (risk difference 5·0%). Of the composite primary outcome events, 87% were hospitalisations. Findings for the primary outcome were similar for the modified intention-to-treat analysis (RR 0·69, 95% BCI 0·53–0·90) and larger in the per-protocol analysis (RR 0·34, 95% BCI, 0·21–0·54). There were 17 deaths in the fluvoxamine group and 25 deaths in the placebo group in the primary intention-to-treat analysis (odds ratio OR 0·68, 95% CI: 0·36–1·27). There was one death in the fluvoxamine group and 12 in the placebo group for the per-protocol population (OR 0·09; 95% CI 0·01–0·47). We found no significant differences in number of treatment emergent adverse events among patients in the fluvoxamine and placebo groups.
Treatment with fluvoxamine (100 mg twice daily for 10 days) among high-risk outpatients with early diagnosed COVID-19 reduced the need for hospitalisation defined as retention in a COVID-19 emergency setting or transfer to a tertiary hospital.
FastGrants and The Rainwater Charitable Foundation.
For the Portuguese translation of the abstract see Supplementary Materials section.
Prescription review is a complex task performed by clinical pharmacists in a hospital environment. In this paper, we present the development and hospital's pharmacy evaluation of an open-source ...decision support system for clinical pharmacy called NoHarm.ai. The system relies on an unsupervised algorithm based on graph structure that ranks outliers prescriptions. We deployed the decision support system for clinical pharmacy in a 1,200-bed hospital. NoHarm.ai can correctly classify, with an average of 84% of F-measure, the dose and frequency (posology) of several medications in the real-scenario application improving the work of the hospital's pharmacists.
Phytotoxic Neocassane Diterpenes from Eragrostis plana Klein Hendges, Ana Paula P; dos Santos, Elaine Fernanda; Teixeira, Sirlei D ...
Journal of natural products (Washington, D.C.),
12/2020, Letnik:
83, Številka:
12
Journal Article
Recenzirano
Five new neocassane-like diterpenes (1–5) were isolated from the roots of Eragrostis plana. Their structures were elucidated by spectroscopic data, and the absolute configurations of the ...representative compounds neocassa-12(17),15-dien-3-one (2) and neocassa-12(13),15-diene-3,14-dione (5) were assigned by vibrational circular dichroism. The phytotoxic activity of compounds 3, 4, and 5 was evaluated against the germination and growth of Ipomoea grandifolia and Euphorbia heterophylla. Compound 4 exhibited the most potent activity for growth variables, resulting in the smallest radicle length of I. grandifolia and in the smallest aerial part length of E. heterophylla. Compound 5 reduced the germination speed index more effectively than the herbicide glyphosate (Roundup).
Abstract only
Background:
Left ventricular (LV) function assessment in patients (pts) with Chagas disease (ChD) is challenging. LV ejection fraction (LVEF) as a marker of myocardial contractility in ...these pts has issues, and alterations in myocardial deformation (MD) may occur in early stages of cardiac disease (CD) before the decline of LVEF. LV global longitudinal strain (GLS) is a good parameter to evaluate LV MD, but is dependent on afterload. LV myocardial work (MW) is a technique which integrates afterload to the calculation of GLS
Purpose:
To analyze LV function using MW in pts with ChD
Methods:
39 pts with positive serology for ChD, (74,4% women, age 68,8 ± 9,7) followed in a quaternary Brazilian hospital, were divided in groups of stages of CD: G1 - normal Echocardiography (Echo) and ECG, G2 - alterations in ECG a/o Echo, normal LVEF, G3 - reduced LVEF. LV MW was measured integrating GLS with non-invasive blood pressure as an afterload index, for generation of pressure-strain loops by specific software(fig.1). Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were measured.
Results:
11 pts (28,2%) were in G1, 14 (35,9%) in G2, and 14 (35,9%) in G3. In overall population median values of MW were within normal ranges: GWI = 1760mmHg% (>968), GCW = 2046mmHg% (>1550), GWW= 178mmHg% (<331), GWE = 92 (>83). Values of GWI, GCW and GWE were significantly lower and GWW was higher in G3, compared to G1 and G2, translating into less LV mechanical efficiency (ME) in these pts with more advanced CD (table 1). Despite LVEF and GLS similar between G1 and G2, values of GCW were 12% lower in G2 compared to G1, which could point to a tendency of early alterations in these pts, although not reaching statistical significance (p > 0,05).
Conclusion:
In pts with advanced stages with Chagas CD (G3) there were significant alterations in parameters that evaluate ME, with reduced values of GWI, GCW and GWE, with higher GWW
•Annexin A1 and Cyclooxygenase-2 are correlated in gastroesophageal inflammations, metaplasia and tumors.•The ANXA1/COX-2 deregulation contributes to gastroesophagic tumor development.•The ANXA1 ...actions are specific modulated by FPR1 receptor.
The anti−inflammatory protein Annexin−A1 (ANXA1) is associated to tumor invasion process and its actions can be mediated by formylated peptides receptors (FPRs). Therefore, we evaluated the expression and correlation of ANXA1, FPR and cyclooxygenase−2 (COX−2) enzyme in esophageal and stomach inflammations and neoplasias. The study of proteins was performed by immunohistochemistry in biopsies of esophagitis, Barrett's esophagus, squamous cell carcinoma and adenocarcinoma of the esophagus, as well as gastritis, stomach polypus and gastric adenocarcinoma. The intensity of the expressions was evaluated by densitometry. The immunohistochemical and densitometric analyzes showed specificity for the FPR1 receptor and modulation of the ANXA1, COX−2 and FPR1 expressions in the epithelial cells in the different studied conditions. Increased immunoreactivity of these proteins was observed in cases of inflammation and stomach polypus. Interestingly, moderate immunoreactivity for ANXA1 and FPR1 but increased immunolabeling for COX−2 were observed in Barrett́s esophagus and esophageal adenocarcinomas. Also, there was reduced expression of ANXA1 and FPR1 in esophageal carcinoma but COX−2 overexpression in this tumor. There was no expression of FPR2 but ANXA1 and FPR1 expressions were positively correlated in all clinical conditions studied. Positive correlation between ANXA1 and COX−2 were also observed in inflammation conditions while negative correlation between ANXA1 and COX−2 was observed in esophageal carcinoma. Our results demonstrate the unregulated expression of ANXA1 and COX−2 in precursor lesions of esophageal and stomach cancers, reinforcing their involvement in gastroesophageal carcinogenesis. In addition, the data show that the actions of ANXA1 in the inflammatory and neoplastic processes of the esophagus and stomach are specifically mediated by the FPR1 receptor.
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