Medication reconciliation and adherence: a call for clinical pharmacist

Introduction and Objectives: With the population ageing, there is a growing number of people who have several comorbidities and make use of a variety of drugs. These factors lead to a greater predisposition to adverse drug events, as well as to medication errors. The clinical pharmacist is the most indicated health professional to target these issues. The aims of this study were to analyze the profile of medication reconciliation and assess the role of the clinical pharmacist regarding medication adherence. Material and Methods: Prospective observational cohort study conducted from Jan-Mar 2013 at the Surgical Clinic of the University Hospital of the University of Sao Paulo. 117 admitted patients - over the age of 18 years, under continuous medication use and with length of hospitalization up to 120h - were included. Discrepancies were classified as intentional/unintentional and according to their risk to cause harm, and interventions were divided into accepted/not accepted. Medication adherence was measured by Morisky questionnaire. Results and Conclusions: Only 30% of hospital prescriptions showed no discrepancies between the medications that the patient was using at home and those which were being prescribed at the hospital and more than one third of those had the potential to cause moderate discomfort or clinical deterioration. One third of total discrepancies were classified as unintentional. About 90% of the interventions were accepted by the medical staff. In addition, about 63% of patients had poor adherence to drug therapy. The study revealed the importance of the medication reconciliation at patient admission, ensuring greater safety and therapeutic efficacy of the treatment during hospitalization, and orienting the patient at discharge, assuring the therapy safety.

Feeding ecology of the Brazilian silverside Atherinella brasiliensis (Atherinopsidae) in a sub-tropical estuarine ecosystem

The feeding ecology of the Brazilian silverside, Atherinella brasiliensis, in a sub-tropical estuary of Brazil was investigated through the gut analysis of 1431 individuals. We described dietary composition and analysed seasonal, estuarine habitat, and body size variations in the diet; trophic level; feeding diversity; and gut fullness indices. Results reveal that A. brasiliensis is a typical, generalistic and opportunistic predator that makes use of a wide array of prey types (at least 89 different types), with zooplankton (mainly calanoids), diatoms, terrestrial insects, and plant detritus making up the bulk of the overall diet. The exotic calanoid Temora turbinata ranked as the primary prey. A wide feeding diversity (mean H` = 2.26), low trophic level (mean TROPH = 2.57), and high gut replenishment were persistent across seasons and habitats. Diet composition varied largely and significantly with respect to habitat, season, and body size. A closer assessment showed that habitat and season had a stronger effect on diet than fish size.

PHENOLOGY AND FRUIT TRAITS OF ARCHONTOPHOENIX CUNNINGHAMIANA, AN INVASIVE PALM TREE IN THE ATLANTIC FOREST OF BRAZIL

The Australian palm Archontophoenix cunninghamiana was introduced into Brazil as an ornamental species, and became a dangerous invader of remnant Atlantic forest patches, demanding urgent management actions that require careful planning. Its fruits are greatly appreciated by generalist birds and its sudden eradication could be as harmful as its permanence in the native community. Our hypothesis was that A. cunninghamiana phenology and fruit traits would have facilitated the invasion process. Hence the aim of the study was to characterize the reproductive phenology of the palm by registering flowering and fruiting events, estimating fruit production, and evaluating fruit nutritional levels. Phenological observations were carried out over 12 months and analyzed statistically. Fruit traits and production were estimated. Pulp nutritional levels were determined by analyzing proteins, lipids, and carbohydrates. Results showed constant flowering and fruiting throughout the year with a weak reproductive seasonality. On average, 3651 fruits were produced per bunch mainly in the summer. Fruit analysis revealed low nutrient contents, especially of proteins and lipids compared with other Brazilian native palm species. We concluded that the abundant fruit production all year round, and fruit attractivity mainly due to size and color, :may act positively on the reproductive performance and effective dispersion of A. cunninghamiana. As a management procedure which would add quality to frugivore food resources we suggest the replacement of A. cunninghamiana by the native palm Euterpe edulis, especially in gardens and parks near to Atlantic forest fragments.

Feeding ecology of the American freshwater goby Ctenogobius shufeldti (Gobiidae, Perciformes) in a sub-tropical estuary

The feeding ecology of the American freshwater goby Ctenogobius shufeldti in a low salinity salt-marsh habitat in the Paranagua Bay estuarine complex (Brazil) was assessed through the gut analysis of 632 individuals. The effects of a set of abiotic factors (type of sediment, salinity, temperature and estuarine reach), season and body size on dietary composition were analysed. Seasonal and size-related changes in feeding strategy, feeding intensity and trophic level were assessed. The effects of gape and body size on prey size use were also analysed. The results showed that C. shufeldti is a typical omnivorous, generalized benthic predator of low trophic levels throughout the seasons and size classes, feeding on 56 dietary items; tanaids, chlorophyte algae, ostracods, gastropods, detritus and benthic diatoms made up the bulk of its diet. The tanaid Kalliapseudes schubarti was the main prey item in both numerical and volumetric terms. The gut fullness was persistently high across the seasons. As expected for a typical generalized, opportunistic omnivorous feeder: (1) seasonal and spatial-temporal variability of abiotic factors had a significant effect on diet structure, (2) season accounted for most of the dietary variation and (3) diet composition and the size of prey consumed did not vary across the size classes.

Habitat structure and food resources for wildlife across successional stages in a tropical forest

Tropical forests are experiencing an increase in the proportion of secondary forests as a result of the balance between the widespread harvesting of old-growth forests and the regeneration in abandoned areas. The impacts of such a process on biodiversity are poorly known and intensely debated. Recent reviews and multi-taxa studies indicate that species replacement in wildlife assemblages is a consistent pattern, sometimes stronger than changes in diversity, with a replacement from habitat generalists to old-growth specialists being commonly observed during tropical forest regeneration. However, the ecological drivers of such compositional changes are rarely investigated, despite its importance in assessing the conservation value of secondary forests, and to support and guide management techniques for restoration. By sampling 28 sites in a continuous Atlantic forest area in Southeastern Brazil, we assessed how important aspects of habitat structure and food resources for wildlife change across successional stages, and point out hypotheses on the implications of these changes for wildlife recovery. Old-growth areas presented a more complex structure at ground level (deeper leaf litter, and higher woody debris volume) and higher fruit availability from an understorey palm, whereas vegetation connectivity, ground-dwelling arthropod biomass, and total fruit availability were higher in earlier successional stages. From these results we hypothetize that generalist species adapted to fast population growth in resource-rich environments should proliferate and dominate earlier successional stages, while species with higher competitive ability in resource-limited environments, or those that depend on resources such as palm fruits, on higher complexity at the ground level, or on open space for flying, should dominate older-growth forests. Since the identification of the drivers of wildlife recovery is crucial for restoration strategies, it is important that future work test and further develop the proposed hypotheses. We also found structural and functional differences between old-growth forests and secondary forests with more than 80 years of regeneration, suggesting that restoration strategies may be crucial to recover structural and functional aspects expected to be important for wildlife in much altered ecosystems, such as the Brazilian Atlantic forest. (C) 2012 Elsevier B.V. All rights reserved.

A model of road effect using line integrals and a test of the performance of two new road indices using the distribution of small mammals in an Atlantic Forest landscape

Effects of roads on wildlife and its habitat have been measured using metrics, such as the nearest road distance, road density, and effective mesh size. In this work we introduce two new indices: (1) Integral Road Effect (IRE), which measured the sum effects of points in a road at a fixed point in the forest; and (2) Average Value of the Infinitesimal Road Effect (AVIRE), which measured the average of the effects of roads at this point. IRE is formally defined as the line integral of a special function (the infinitesimal road effect) along the curves that model the roads, whereas AVIRE is the quotient of IRE by the length of the roads. Combining tools of ArcGIS software with a numerical algorithm, we calculated these and other road and habitat cover indices in a sample of points in a human-modified landscape in the Brazilian Atlantic Forest, where data on the abundance of two groups of small mammals (forest specialists and habitat generalists) were collected in the field. We then compared through the Akaike Information Criterion (AIC) a set of candidate regression models to explain the variation in small mammal abundance, including models with our two new road indices (AVIRE and IRE) or models with other road effect indices (nearest road distance, mesh size, and road density), and reference models (containing only habitat indices, or only the intercept without the effect of any variable). Compared to other road effect indices, AVIRE showed the best performance to explain abundance of forest specialist species, whereas the nearest road distance obtained the best performance to generalist species. AVIRE and habitat together were included in the best model for both small mammal groups, that is, higher abundance of specialist and generalist small mammals occurred where there is lower average road effect (less AVIRE) and more habitat. Moreover, AVIRE was not significantly correlated with habitat cover of specialists and generalists differing from the other road effect indices, except mesh size, which allows for separating the effect of roads from the effect of habitat on small mammal communities. We suggest that the proposed indices and GIS procedures could also be useful to describe other spatial ecological phenomena, such as edge effect in habitat fragments. (C) 2012 Elsevier B.V. All rights reserved.

Analysis of 16S rRNA and mxaF genes revealing insights into Methylobacterium niche-specific plant association

The genus Methylobacterium comprises pink-pigmented facultative methylotrophic (PPFM) bacteria, known to be an important plant-associated bacterial group. Species of this group, described as plant-nodulating, have the dual capacity of producing cytokinin and enzymes, such as pectinase and cellulase, involved in systemic resistance induction and nitrogen fixation under specific plant environmental conditions. The aim hereby was to evaluate the phylogenetic distribution of Methylobacterium spp. isolates from different host plants. Thus, a comparative analysis between sequences from structural (16S rRNA) and functional mxaF (which codifies for a subunit of the enzyme methanol dehydrogenase) ubiquitous genes, was undertaken. Notably, some Methylobacterium spp. isolates are generalists through colonizing more than one host plant, whereas others are exclusively found in certain specific plant-species. Congruency between phylogeny and specific host inhabitance was higher in the mxaF gene than in the 16S rRNA, a possible indication of function-based selection in this niche. Therefore, in a first stage, plant colonization by Methylobacterium spp. could represent generalist behavior, possibly related to microbial competition and adaptation to a plant environment. Otherwise, niche-specific colonization is apparently impelled by the host plant.

CLEANING ASSOCIATIONS BETWEEN BIRDS AND HERBIVOROUS MAMMALS IN BRAZIL: STRUCTURE AND COMPLEXITY

Birds that remove ectoparasites and other food material from their hosts are iconic illustrations of mutualistic-commensalistic cleaning associations. To assess the complex pattern of food resource use embedded in cleaning interactions of an assemblage of birds and their herbivorous mammal hosts in open habitats in Brazil, we used a network approach that characterized their patterns of association. Cleaning interactions showed a distinctly nested pattern, related to the number of interactions of cleaners and hosts and to the range of food types that each host species provided. Hosts that provided a wide range of food types (flies, ticks, tissue and blood, and organic debris) were attended by more species of cleaners and formed the core of the web. On the other hand, core cleaner species did not exploit the full range of available food resources, but used a variety of host species to exploit these resources instead. The structure that we found indicates that cleaners rely on cleaning interactions to obtain food types that would not be available otherwise (e.g., blood-engorged ticks or horseflies, wounded tissue). Additionally, a nested organization for the cleaner bird mammalian herbivore association means that both generalist and selective species take part in the interactions and that partners of selective species form an ordered subset of the partners of generalist species. The availability of predictable protein-rich food sources for birds provided by cleaning interactions may lead to an evolutionary pathway favoring their increased use by birds that forage opportunistically. Received 30 June 2011, accepted 10 November 2011.

Enhancing health care for type 2 diabetes in Northern Brazil: A pilot study of pharmaceutical care in community pharmacy

To evaluate the impact of a medication therapy management (MTM) program on the clinical outcomes and the quality of life (QoL) of a group of elderly patients with type 2 diabetes mellitus (DM). The study was conducted in a community pharmacy in Aracaju, Brazil, from February to November 2009. A quasi-experimental, longitudinal, prospective study was conducted by intervention. The group patients received medication therapy management from a clinical pharmacist. A sample of convenience was obtained for patients of both genders aged from 60 to 75 years. Monthly visits were scheduled over 10 months. At these consultations, sociodemographic, clinical data were obtained. QoL assessment was conducted using a generic instrument-the Medical Outcomes Studies 36-item Short Form Survey (SF-36 (R)). In total, 34 completed the study. The mean age of the patients was 65.9 (4.7) years. In total, 117 DRPs were identified. Patients' baseline and final evaluation measures for glycosylated hemoglobin, capillary blood glucose, blood pressure, and waist circumference were significantly different (p < 0.05). The domains of QoL assessed by the SF-36 (R) also shows significant differences between patients' baseline and final evaluation scores. The co-responsibility and active participation on the part of the elderly may have helped pharmacotherapy achieve its clinical and humanistic aims.

The distribution and abundance of small mammals in agroecosystems of southeastern Brazil

The conservation of biodiversity in agricultural landscapes depends on information about the ways in which species are affected by the conversion of native habitats into novel anthropogenic environments and the strategies that the species use to persist in these altered ecosystems. Here, we investigate how small mammals occupy the different agroecosystems of an agricultural landscape in the state of Sao Paulo, Brazil. From August 2003 through January 2005, we surveyed small mammals using Sherman traps at 16 sampling sites in each of the four predominant environments of the local agricultural landscape: remnant fragments of semideciduous forest, Eucalyptus plantations, sugarcane plantations, and pastures. With a total effort of 23,040 trap-nights and a capture success of 0.8%, we captured 177 rodents and marsupials belonging to eight species. The assemblage represented by these mammals is essentially composed of generalist species, which are common in degraded areas. Sugarcane plantations had the highest abundance, whereas pastures had the lowest species richness. Our results suggest that the loss of forest species can be related to the loss of native forest. The results also indicate that to improve the conservation value of agricultural landscapes, native forest fragments should be conserved, extensive monocultures should be avoided and agricultural impacts should be mitigated.

NEW RECORD OF CALYPTRAEID HOSTS FOR THE PEA CRAB CALYPTRAEOTHERES GARTHI (FENUCCI, 1975) (DECAPODA, PINNOTHERIDAE) IN ARGENTINA

Calyptraeotheres garthi (Fenucci, 1975) is one of nine species of Pinnotheridae occurring in Argentina and the only species of that genus located in this region. This species can be found from the San Maths Gulf, Argentina to Rio Grande do Sul, Brazil where it lives in symbiotic association with limpets of the family Calyptraeidae. Currently, two species of limpets have been reported as hosts of this species: Crepidula protea (d'Orbigny, 1841) and Crepidula argentina Simone, Pastorino & Penchaszadeh, 2000. We report here four more species of limpets serving as hosts of C. garthi, namely Bostrycapulus odites Collin, 2005, Crepidula cachimilla Cledon, Simone & Penchaszadeh, 2004, Crepidula plana Say, 1822 and Trochita pileus (Lamarck, 1822). Thus, this pinnotherid appears to be, as others members of the family, a generalist symbiotic species since it dwells on almost all the potential limpet species reported for Argentina. However, there are notable differences in prevalence of C. garthi on each host, which suggest that the symbiont might prefer species of Crepidula over the others genera (Trochita and Bostrycapulus). Additionally, there exists an apparent relationship between host size and prevalence (e.g., Crepidula cachimilla, the limpet with the highest prevalence, is clearly larger than the others hosts). Perhaps it is premature to conclude that the size of the host might be of benefit for the symbiont, but it is a hypothesis worthy of being explored.

Trypanosoma livingstonei: a new species from African bats supports the bat seeding hypothesis for the Trypanosoma cruzi clade

Abstract Background Bat trypanosomes have been implicated in the evolutionary history of the T. cruzi clade, which comprises species from a wide geographic and host range in South America, Africa and Europe, including bat-restricted species and the generalist agents of human American trypanosomosis T. cruzi and T. rangeli. Methods Trypanosomes from bats (Rhinolophus landeri and Hipposideros caffer) captured in Mozambique, southeast Africa, were isolated by hemoculture. Barcoding was carried out through the V7V8 region of Small Subunit (SSU) rRNA and Fluorescent Fragment Length barcoding (FFLB). Phylogenetic inferences were based on SSU rRNA, glyceraldehyde phosphate dehydrogenase (gGAPDH) and Spliced Leader (SL) genes. Morphological characterization included light, scanning and transmission electron microscopy. Results New trypanosomes from bats clustered together forming a clade basal to a larger assemblage called the T. cruzi clade. Barcoding, phylogenetic analyses and genetic distances based on SSU rRNA and gGAPDH supported these trypanosomes as a new species, which we named Trypanosoma livingstonei n. sp. The large and highly polymorphic SL gene repeats of this species showed a copy of the 5S ribosomal RNA into the intergenic region. Unique morphological (large and broad blood trypomastigotes compatible to species of the subgenus Megatrypanum and cultures showing highly pleomorphic epimastigotes and long and slender trypomastigotes) and ultrastructural (cytostome and reservosomes) features and growth behaviour (when co-cultivated with HeLa cells at 37°C differentiated into trypomastigotes resembling the blood forms and do not invaded the cells) complemented the description of this species. Conclusion Phylogenetic inferences supported the hypothesis that Trypanosoma livingstonei n. sp. diverged from a common ancestral bat trypanosome that evolved exclusively in Chiroptera or switched at independent opportunities to mammals of several orders forming the clade T. cruzi, hence, providing further support for the bat seeding hypothesis to explain the origin of T. cruzi and T. rangeli.

Analysis of 16S rRNA and mxaF genes reveling insights into Methylobacterium niche-specific plant association

The genus Methylobacterium comprises pink-pigmented facultative methylotrophic (PPFM) bacteria, known to be an important plant-associated bacterial group. Species of this group, described as plant-nodulating, have the dual capacity of producing cytokinin and enzymes, such as pectinase and cellulase, involved in systemic resistance induction and nitrogen fixation under specific plant environmental conditions. The aim hereby was to evaluate the phylogenetic distribution of Methylobacterium spp. isolates from different host plants. Thus, a comparative analysis between sequences from structural (16S rRNA) and functional mxaF (which codifies for a subunit of the enzyme methanol dehydrogenase) ubiquitous genes, was undertaken. Notably, some Methylobacterium spp. isolates are generalists through colonizing more than one host plant, whereas others are exclusively found in certain specific plant-species. Congruency between phylogeny and specific host inhabitance was higher in the mxaF gene than in the 16S rRNA, a possible indication of function-based selection in this niche. Therefore, in a first stage, plant colonization by Methylobacterium spp. could represent generalist behavior, possibly related to microbial competition and adaptation to a plant environment. Otherwise, niche-specific colonization is apparently impelled by the host plant.

Trypanosoma livingstonei: a new species from African bats supports the bat seeding hypothesis for the Trypanosoma cruzi clade

BACKGROUND: Bat trypanosomes have been implicated in the evolutionary history of the T. cruzi clade, which comprises species from a wide geographic and host range in South America, Africa and Europe, including bat-restricted species and the generalist agents of human American trypanosomosis T. cruzi and T. rangeli. METHODS: Trypanosomes from bats (Rhinolophus landeri and Hipposideros caffer) captured in Mozambique, southeast Africa, were isolated by hemoculture. Barcoding was carried out through the V7V8 region of Small Subunit (SSU) rRNA and Fluorescent Fragment Length barcoding (FFLB). Phylogenetic inferences were based on SSU rRNA, glyceraldehyde phosphate dehydrogenase (gGAPDH) and Spliced Leader (SL) genes. Morphological characterization included light, scanning and transmission electron microscopy. RESULTS: New trypanosomes from bats clustered together forming a clade basal to a larger assemblage called the T. cruzi clade. Barcoding, phylogenetic analyses and genetic distances based on SSU rRNA and gGAPDH supported these trypanosomes as a new species, which we named Trypanosoma livingstonei n. sp. The large and highly polymorphic SL gene repeats of this species showed a copy of the 5S ribosomal RNA into the intergenic region. Unique morphological (large and broad blood trypomastigotes compatible to species of the subgenus Megatrypanum and cultures showing highly pleomorphic epimastigotes and long and slender trypomastigotes) and ultrastructural (cytostome and reservosomes) features and growth behaviour (when co-cultivated with HeLa cells at 37°C differentiated into trypomastigotes resembling the blood forms and do not invaded the cells) complemented the description of this species. CONCLUSION: Phylogenetic inferences supported the hypothesis that Trypanosoma livingstonei n. sp. diverged from a common ancestral bat trypanosome that evolved exclusively in Chiroptera or switched at independent opportunities to mammals of several orders forming the clade T. cruzi, hence, providing further support for the bat seeding hypothesis to explain the origin of T. cruzi and T. rangeli.