Progress in non-viral localized delivery of siRNA therapeutics for pulmonary diseases

Emerging therapies based on localized delivery of siRNA to lungs have opened up exciting possibilities for treatment of different lung diseases. Localized delivery of siRNA to lungs has shown to result in severalfold higher lung accumulation than systemic route, while minimizing non-specific distribution in other organs. However, to date, only 2 clinical trials have explored localized delivery of siRNA for pulmonary diseases. Here we systematically reviewed recent advances in the field of pulmonary delivery of siRNA using non-viral approaches. We firstly introduce the routes of local administration and analyze the anatomical and physiological barriers towards effective local delivery of siRNA in lungs. We then discuss current progress in pulmonary delivery of siRNA for respiratory tract infections, chronic obstructive pulmonary diseases, acute lung injury, and lung cancer, list outstanding questions, and highlight directions for future research. We expect this review to provide a comprehensive understanding of current advances in pulmonary delivery of siRNA.

Administração de medicamentos por via intramuscular: caracterização dos vídeos brasileiros veiculados no YouTube® / Intramuscular drug administration: characterization of Brazilian videos on YouTube®

RESUMO Objetivo caracterizar os vídeos que contém a demonstração do procedimento de administração de medicamentos por via intramuscular em indivíduos adultos. Métodos estudo de corte transversal descritivo, foram selecionados 44 vídeos brasileiros disponíveis no YouTube® que abordavam o procedimento de administração de medicamentos por via intramuscular. Resultados a maioria dos vídeos selecionados é de origem pessoal (86,4%), tem como autor um técnico de Enfermagem (59,1%), adota a região dorsoglútea como local de injeção (54,5%), foi produzido em ambiente de saúde utilizando um paciente para a demonstração do procedimento (52,3%). Nenhum vídeo apresentou a completude do procedimento, sendo identificada grande frequência de erros em todas as etapas do procedimento. Observou-se uma diferença estatisticamente significante entre os testes de confiabilidade e popularidade dos vídeos (p=0,042). Conclusão os vídeos que abordam o procedimento de administração de medicamentos por via intramuscular disponíveis na plataforma YouTube® foram considerados atuais, de pouca relevância, elaborados por fontes não confiáveis, de baixa acurácia e frágil finalidade. Contribuições para a prática os vídeos disponíveis na plataforma YouTube® sobre a administração de medicamentos por via intramuscular não devem ser indicados como material educativo para a formação ou atualização profissional.

ABSTRACT Objective to characterize videos that contain a demonstration of the procedure for administering drugs intramuscularly to adults. Methods a descriptive cross-sectional study, 44 Brazilian videos available on YouTube® were selected which addressed the procedure of intramuscular drug administration. Results the majority of the videos selected are of personal origin (86.4%), were made by a Nursing technician (59.1%), used the dorsal gluteal region as the injection spot (54.5%), and were produced in a healthcare environment using a patient to demonstrate the procedure (52.3%). No video showed the completeness of the procedure, and a high frequency of errors was identified at all stages of the procedure. There was a statistically significant difference between the reliability and popularity tests of the videos (p=0.042). Conclusion the videos on intramuscular drug administration available on the YouTube® platform were considered to be up-to-date, of little relevance, produced by unreliable sources, of low accuracy, and with a weak purpose. Contributions to practice the videos available on the YouTube® platform on intramuscular drug administration should not be used as educational material for professional training or updating.

Transição de via de linezolida endovenosa para via oral: uma análise de custo-minimização / Switching from intravenous to oral linezolid therapy: a cost-minimization analysis

Objetivo: Comparar custos da terapia endovenosa exclusiva com linezolida com os custos da terapia iniciada por via endovenosa com transição para via oral após 72 horas, como estratégia de intervenção em programas de gestão de antimicrobianos. Métodos: Avaliação econômica de custo-minimização comparando custos diretos da terapia endovenosa exclusiva com linezolida com a terapia endovenosa seguida de transição para via oral em cenário simulado, sob a perspectiva do Sistema Único de Saúde (SUS), com árvore de decisão como modelo para tomada de decisão. Resultados: A alternativa englobando a transição de via mostrou-se a mais econômica em todos os cenários analisados. Para 28 dias de tratamento com linezolida, houve redução de 22% nos custos, considerando o paciente internado. Ao considerar alta após o sexto dia de tratamento, a redução de custos variou de 26%, com financiamento pelo SUS do restante do tratamento, a 84%, com financiamento do tratamento pós-alta pelo paciente. Conclusão: Conclui-se que a transição de via de linezolida é uma importante estratégia nos programas de gerenciamento de antimicrobianos, capaz de gerar economia significativa para a instituição. As avaliações econômicas de custo-minimização, nesse contexto, são uma importante ferramenta para demonstrar o aspecto econômico com potencial para sensibilizar gestores e tomadores de decisão.

Objective: To compare the direct costs of linezolid intravenous therapy with the costs of intravenous therapy switching to oral therapy after 72 hours as an intervention strategy in antimicrobial stewardship programs. Methods: Economic evaluation cost-minimization comparing direct costs of exclusive linezolid intravenous therapy with intravenous therapy for 72 hours and after switching to oral therapy in a simulated scenario, from the perspective of the National Health Service, with a decision tree as a decision modeling. Results: The alternative encompassing the therapy transition proved to be the most economical in all analyzed scenarios. For 28 days of treatment with linezolid, there was a 22% reduction in costs, considering the hospitalized patient. When considering discharge after the sixth day of treatment, the cost reduction ranged from 26%, with funding from the National Health Service for the rest of the treatment, to 84%, with funding for the post-discharge treatment by the patient. Conclusion: It was concluded that the linezolid therapy transition is an important strategy in antimicrobial management programs, capable of generating significant savings for the institution. In this context, economic cost-minimization assessments are an important tool to demonstrate the economic aspect with the potential to raise awareness among managers and decision-makers.

Assignment based learning of different dosage form and newer and targeted drug delivery system among undergraduate students

Background: Knowledge of newer and targeted drug delivery system is essential for applying pharmacology in treating various clinical conditions. Using appropriate dosage form considering patient抯 age, comorbidities, socioeconomic status, literacy, severity of clinical condition will enhance the effect of drug, decrease the adverse reactions and improve the patient抯 compliance. Learning is most effective when student involvement, participation, and interaction is maximized. Aim and Objectives: To evaluate improvement in knowledge of 2nd year MBBS students for availability, use and necessity of different dosage forms and newer and targeted drug delivery system by assignment based learning. Materials and Methods: The assignment-based activity was conducted for 2nd year MBBS students on different dosage forms and newer and targeted drug delivery system. Seventy students were divided into seven groups and assigned seven questions. Pre-test and post-test were conducted. Results: Post-test results were significantly higher than the pre-test results when compared by paired t-test. There was significant difference among the groups when Analysis of variance test was applied. Group 3, 4, 5 and 6 had gathered good information from e-resources about different drugs list of newer and targeted drug delivery system and Group 3 and 4 gathered details of liposomal and radio-pharmaceuticals based newer drug delivery system. Conclusion: Assignment based activities should be carried out for the critical topics where recent advances are going on, newer techniques for treatment are developing and newer dosage forms are marketed. Through this activity students with poor performance can be identified and guided personally and encouraged for better performance to be a competent physician.

Efficacy of intratympanic injection versus intravenous drip of prednisolone acetate in the treatment of sudden hearing loss / 中国基层医药

Objective:To investigate the efficacy of intratympanic injection versus intravenous drip of prednisolone acetate in the treatment of sudden hearing loss. Methods:A total of 120 patients with sudden hearing loss who received treatment in the Department of Otolaryngology, Mingzhou Hospital between January 2017 and January 2020 were included in this study. They were divided into intratympanic injection group (intratympanic injection of prednisolone acetate, n = 60) and intravenous injection group (intravenous injection of prednisolone acetate, n = 60) according to route of drug administration. After 8 days of treatment, clinical efficacy was compared between the two groups. The hearing thresholds at 500 Hz and 1 000 Hz in both groups were detected using pure tone audiometry. The levels of procalcitonin and high-sensitivity C-reactive protein and adverse drug reactions were compared between the two groups. Results:After treatment, total response rate in the intratympanic injection group was significantly higher than that in the intravenous injection group (93.33% vs. 80.00%, χ2 = 4.61, P < 0.05). The hearing threshold at 500 Hz in the intratympanic injection group was significantly lower than that in the intravenous injection group [(38.69 ± 3.56) vs. (42.36 ± 4.36), t = 5.05, P < 0.001). The hearing threshold at 1 000 Hz in the intratympanic injection group was significantly lower than that in the intravenous injection group [(32.36 ± 3.36) vs. (40.15 ± 4.12), t = 11.35, P < 0.001). After treatment, procalcitonin level in the intratympanic injection group was significantly lower than that in the intravenous injection group [(0.65 ± 0.12) μg/L vs. (0.98 ± 0.15) μg/L, t = 13.30, P < 0.001)]. High-sensitivity C-reactive protein level in the intratympanic injection group was significantly lower than that in the intravenous injection group [(3.28 ± 0.36) mg/L vs. (5.26 ± 0.56) mg/L, t = 23.03, P < 0.001]. There was no significant difference in incidence of adverse reactions between intratympanic injection and intravenous injection groups (8.33% vs. 10.00%, χ2 = 0.10, P > 0.05). Conclusion:Compared with intravenous drip of prednisolone acetate, intratympanic injection of prednisolone acetate can improve the clinical symptoms of patients with sudden hearing loss and enhance clinical efficacy.

mRNA cancer vaccines: Advances, trends and challenges

Patients exhibit good tolerance to messenger ribonucleic acid (mRNA) vaccines, and the choice of encoded molecules is flexible and diverse. These vaccines can be engineered to express full-length antigens containing multiple epitopes without major histocompatibility complex (MHC) restriction, are relatively easy to control and can be rapidly mass produced. In 2021, the U.S. Food and Drug Administration (FDA) approved the first mRNA-based coronavirus disease 2019 (COVID-19) vaccine produced by Pfizer and BioNTech, which has generated enthusiasm for mRNA vaccine research and development. Based on the above characteristics and the development of mRNA vaccines, mRNA cancer vaccines have become a research hotspot and have undergone rapid development, especially in the last five years. This review analyzes the advances in mRNA cancer vaccines from various perspectives, including the selection and expression of antigens/targets, the application of vectors and adjuvants, different administration routes, and preclinical evaluation, to reflect the trends and challenges associated with these vaccines.

Effectiveness of three different local routes of dexamethasone administration on postoperative sequelae following mandibular third molar surgery. A prospective randomised single-blind clinical study / Eficácia de três diferentes vias locais de administração de dexametasona em sequelas pós-operatórias após cirurgia de terceiros molares inferiores. Um estudo clínico prospectivo randomizado simples-cego

Objective: The aim of this study was to provide evidence for comparing the effectiveness of three different routes of local administration of Dexamethasone on the postoperative pain, edema and trismus following surgical removal of impacted mandibular third molar. Material and Methods: Forty-five patients underwent surgical removal of impacted lower third molars and were randomly allocated postoperatively into 3 groups: 8 mg of dexamethasone injected into the submucosa of the vestibule near the surgical site (group I), 8 mg of dexamethasone injected into the pterygomandibular space (group II) and 10 mg of dexamethasone powder applied to the extraction site, after bleeding control (group III). Facial swelling and maximal interincisal opening were measured at preoperatively. Pain was measured by the patient response to a visual analogue scale. Pain perception, Facial edema and trismus were evaluated for one week postoperatively. Results: There was no significant difference between the three groups concerning pain after 1, 2, 5, 7 days of follow up. However, group II showed less pain at 3 and 4 days. The difference between edema measurements was not significant in the three groups at 1, 5, 7 days, though in group I and II edema subsided from day 2. As for trismus, group I and III showed statistically significant lower maximum interincisal opening measurement than group II after two days. Conclusion: Local administration of Dexamethasone through three different routes is beneficial in decreasing postoperative sequelae following third molar surgery. Pterygomandibular space injection of Dexamethasone resulted in earlier resolution of pain, and less facial edema and trismus at the second postoperative day compared to the submucosal injection and transalveolar application. However, at one week the difference in measurements of the three variables between the groups was not significant. (AU)

Objetivo: O objetivo deste estudo foi fornecer evidências para comparar a eficácia de três diferentes vias de administração local de dexametasona na dor pós-operatória, edema e trismo após a remoção cirúrgica do terceiro molar inferior impactado. Material e Métodos: Quarenta e cinco pacientes foram submetidos à remoção cirúrgica de terceiros molares inferiores impactados e distribuídos aleatoriamente no pós-operatório em 3 grupos: 8 mg de dexametasona injetados na submucosa vestíbular próximo ao local da cirurgia (grupo I), 8 mg de dexametasona injetados no espaço pterigomandibular (grupo II) e 10 mg de pó de dexametasona aplicados no local da extração, após o controle do sangramento (grupo III). Edema facial e abertura interincisal máxima foram medidos no pré-operatório. A dor foi medida pela resposta do paciente a uma escala visual analógica. Percepção de dor, edema facial e trismo foram avaliados por uma semana de pós-operatório. Resultados: Não houve diferença significativa entre os três grupos em relação à dor após 1, 2, 5, 7 dias de acompanhamento. No entanto, o grupoII mostrou menos dor em 3 e 4 dias. A diferença entre as medidas de edema não foi significativa nos três grupos em 1, 5, 7 dias, embora nos grupos I e II o edema cedeu a partir do dia 2. Quanto ao trismo, os grupos I e III apresentaram medida de abertura interincisal máxima inferior estatisticamente significativa do que o grupo II depois de dois dias. Conclusão: A administração local de dexametasona por três vias diferentes é benéfica na redução das sequelas pós-operatórias após a cirurgia do terceiro molar. A injeção de dexametasona no espaço pterigomandibular resultou na resolução mais precoce da dor e menos edema facial e trismo no segundo dia de pós-operatório em comparação com a injeção submucosa e a aplicação transalveolar. No entanto, em uma semana, a diferença nas medidas das três variáveis entre os grupos não foi significativa.(AU)

Novos olhares sobre a cidade: uma experiência educativa de lazer e turismo com estudantes da educação de jovens e adultos / New perpectives on the city: an educational experience of leisure and tourism with students from the education program for young people and adults

Este artigo pretende refletir sobre a constituição de novos olhares sobre a cidade e o espaço urbano a partir de uma experiência educativa no âmbito do lazer e do turismo realizado por estudantes do curso técnico em Guia de Turismo do Instituto Federal do Espírito Santo (IFES) ­ campus Vitória, ofertado na modalidade de Educação de Jovens e Adultos (EJA). A partir de uma reflexão teórica sobre os limites e potencialidades do lazer, bem como sua importância para a concretização do direito à cidade, buscou-se demonstrar como uma experiência educativa relacionada à elaboração de roteiros turísticos urbanos contribuiu para que os estudantes, em sua maioria, de bairros de periferia, ressignificassem sua visão sobre a cidade, passando a valorizar sua identidade cultural, espaços de vivência e antigos espaços de lazer.

This article aims to reflect on the constitution of new views of the city, and the urban space from an educational experience in the field of leisure and tourism carried out by students of the technical course in Tourism Guide of the Federal Institute of Espírito Santo (Ifes) - Vitória campus, offered in the Education Program for Young People and Adults (EJA). From a theoretical reflection on the limits and potentialities of leisure, as well as its importance for the realization of the right to the city, we sought to demonstrate how an educational experience related to the elaboration of urban tourist itineraries helped students, most of whom from suburban neighborhoods, redefine their views of the city, valuing their cultural identity, living spaces, and former recreation areas.

Errores de administración de medicamentos en enfermería / Medication administration errors in nursing

Introducción: los errores en el proceso de administración de medicamentos (EPAM) corresponden a múltiples factores, como: la condición de vulnerabilidad del usuario, dinámica que se vive dentro de las propias unidades y confusión en la terapia farmacológica, entre otros. El mayor porcentaje de los EPAM se produce en la etapa de administración, por lo que el rol de enfermería es fundamental. Existen diversas estrategias destinadas a la prevención, con distintos niveles de complejidad, en términos de implementación. Objetivo: conocer las múltiples causas que llevan al personal de enfermería a realizar una mala praxis en el proceso de administración de medicamentos. Material y métodos: se realizó una revisión de literatura mediante la búsqueda de artículos científicos en las siguientes bases de datos: Cochrane, Embase, Medline y SciELO. Conclusión: es indispensable hacer conciencia de la responsabilidad en los profesionales de enfermería para cumplir con las normas en la administración de medicamentos, con los "10 correctos" y evitar riesgos innecesarios a los pacientes que pueden en algunos casos ocasionar consecuencias graves.

Analysis on the route of conception vessel and governor vessel in / 中国针灸

On the base of the analysis on the original text in

Estudo experimental da translocação, percolação e lixiviação dos metais presentes no rejeito de mineração: rompimento de barragem em Mariana-MG / Experimental study of translocation, percolation and leaching of metals present in mining tailings: dam failure in Mariana-MG

A exploração mineral é uma relevante atividade econômica desenvolvida no Brasil, principalmente, no Estado de Minas Gerais. A região do Quadrilátero Ferrífero é considerada uma das maiores províncias poliminerais do Planeta e possui importantes reservas de minério de ferro, manganês, níquel, alumínio e ouro. Com o rompimento da barragem de Fundão em Mariana-MG, em 2015, milhões de toneladas de rejeitos extravasaram ficando depositados no solo e nos recursos hídricos. A carga de rejeitos atingiu, primeiramente, a Barragem de Santarém, provocando o seu galgamento, subsequentemente, alcançou o subdistrito de Bento Rodrigues, Rio Gualaxo do Norte, Rio Carmo, Rio Doce e Oceano Atlântico. Foram 663,2 km de corpos hídricos diretamente impactados, 41 municípios e dois estados atingidos: Minas Gerais e Espírito Santo. Diante da magnitude dos danos provocados ao ecossistema e carência de informações e de estudos na área da saúde, esta pesquisa tem por objetivo avaliar as concentrações de metais na área afetada pelo rompimento da barragem de rejeitos de mineração e simular, experimentalmente, a translocação, percolação e lixiviação desses metais no ambiente. Foram realizadas coletas de solo natural e rejeitos in loco, nos locais mais afetados pelo rompimento (Paracatu de Baixo-MG), para análise de parâmetros físicos e químicos. Avaliação do Fator de Translocação dos metais foi desenvolvida em hortaliças (alface, rúcula e rabanete), cultivada com solo natural de Mariana-MG e com rejeitos de mineração. Além disso, foram realizados ensaios de lixiviação e percolação de água em solo contaminado. Considerando os resultados desta pesquisa, foi possível realizar um diagnóstico básico sobre rotas de dispersão ambiental dos metais no solo após ruptura da Barragem do Fundão, Mariana, MG. Após analisar as amostras do solo e rejeitos, foi evidenciado que o As, Pb, Tl, Al e Fe apresentaram as maiores concentrações. Algumas amostras analisadas apresentaram Cu e Ni em concentrações superiores às recomendadas pela Resolução 420 do CONAMA e por normativas da Alemanha. Os resultados dos ensaios com hortaliças apontam amostras que apresentaram Fator de Translocação superior a 1, evidenciando o transporte de metais das raízes até a parte aérea dos vegetais, o que pode representar risco para saúde da população. De acordo com os resultados obtidos durante a simulação de percolação e lixiviação nos cilindros experimentais, verificou-se que ocorreu movimentação de metais na dimensão horizontal e vertical. Os resultados dos ensaios de translocação, percolação e lixiviação mostram, de maneira experimental, diferentes rotas de dispersão dos metais contidos nos rejeitos do minério. Esses resultados permitem inferir o que pode ter acontecido no ambiente após o rompimento da barragem na região de Mariana. Fica evidenciada a necessidade de se dar continuidade a estudos em áreas atingidas pelos rejeitos de mineração a médio e longo prazo, com foco em estratégias de remediação que objetivem a redução de efeitos adversos à saúde nas comunidades assentadas após esse tipo de desastres. Certamente, a obtenção de dados toxicológicos e de avaliações de risco à saúde da população subsidiarão a tomada de decisão e o desenvolvimento de ações intersetoriais, visando à promoção e proteção da saúde e melhoria das condições sociais e de vida da população afetada pelo desastre

Mineral exploration is an important economic activity developed in Brazil, mainly in the State of Minas Gerais. The Quadrilátero Ferrífero region is considered one of the largest polymineral provinces on the planet and has important reserves of iron ore, manganese, nickel, aluminum and gold. With the collapse of the Fundão dam in Mariana-MG in 2015, millions of tons of tailings overflowed, being deposited in the soil and in water resources. The tailings load first reached the Santarém Dam causing its overtopping, subsequently reaching the sub-district of Bento Rodrigues, Rio Gualaxo do Norte, Rio Carmo, Rio Doce and Oceano Atlântico. There were 663.2 km of water bodies directly impacted, 41 municipalities and two states affected: Minas Gerais and Espírito Santo. Given the magnitude of the damage caused to the ecosystem and the lack of information and studies in the area of health, this research aimed to evaluate the concentrations of metals in the area affected by the collapse of the mining tailings dam and to experimentally simulate translocation, percolation and leaching of these metals in the environment. Natural soil and tailings were collected in loco, in the places most affected by the rupture (Paracatu de Baixo-MG), for the analysis of physical and chemical parameters. Evaluation of the Translocation Factor of metals was developed in vegetables (lettuce, arugula and radish), cultivated with natural soil from Mariana-MG and with mining tailings. In addition, leaching and water percolation tests were carried out in contaminated soil. Considering the results of this research, it was possible to carry out a basic diagnosis of environmental dispersion routes of metals in the soil after the Fundão Dam rupture, Mariana, MG. After analyzing the soil and tailings samples, it was evidenced that As, Pb, Tl, Al and Fe had the highest concentrations. Some analyzed samples presented Cu and Ni at concentrations higher than those recommended by Res. 420 of CONAMA and German regulations. The results of the tests with vegetables indicate samples that presented a Translocation Factor greater than 1, showing the transport of metals from the roots to the aerial part of the vegetables, which may represent a risk to the health of the population. According to the results obtained during the simulation of percolation and leaching in the experimental cylinders, it was verified that metal movement occurred in the horizontal and vertical dimensions. The results of the translocation, percolation and leaching tests show, in an experimental way, different routes of dispersion of the metals contained in the ore tailings. These results allow us to infer what may have happened in the environment after the dam collapsed in the Mariana region. The need to continue studies in areas affected by mining tailings in the medium and long term is evidenced, with a focus on remediation strategies aimed at reducing adverse health effects in settled communities after this type of disaster. Certainly, obtaining toxicological data and health risk assessments for the population will support decision-making and the development of intersectoral actions, aimed at promoting and protecting health and improving the social and living conditions of the population affected by the disaster

Quantitative study of wild animals received at the Wild Animals Triage Centers (CETAS) in Bahia and identification of trafficking routes / Estudo quantitativo de animais silvestres recebidos nos Centros de Triagens de Animais Silvestres (CETAS) da Bahia e identificação de rotas de tráfico

In Brazil, the illegal capture of wild animals is a crime that contributes to the extinction of species, besides causing environmental imbalance and suffering to the animals. Here, we undertook a quantitative survey of animals sent to the "Centro de Triagem de Animais Silvestres" (CETAS - Wild Animals Triage Centers) from units of Porto Seguro, Salvador, and Vitória da Conquista during 2009-2019. The 19,317, 34,460, and 43,874 specimens were registered in the units of Porto Seguro, Vitória da Conquista, and Salvador, respectively. The distribution of the totals by class included 80,948 (82.90%) birds, 12,007 (12.30%) reptiles, 4,661 (4.77%) mammals, and 35 arachnids (0.03%). The operations that generated registration at the CETAS were most frequently apprehensions (67,974; 69.67%), followed by voluntary surrender (13,367; 13.69%), rescues (12,803; 13.11%), and transfers (2,735; 2.67%). The animals came from 236 municipalities in the state of Bahia, with emphasis on the municipalities of Salvador, Vitória da Conquista, Feira de Santana, Lençóis, Jequié, and Paulo Afonso. The evaluation of the quantitative seizures by municipalities indicates that the BR-116 is one of the most representative routes for the illegal traffic of wild animals in the state of Bahia and the country.(AU)

No Brasil a captura ilegal de animais silvestres é crime e contribui para a extinção das espécies, além de causar desequilíbrios ambientais e sofrimentos aos animais. Este trabalho apresenta quantitativos de animais recebidos e/ou armazenados nos Centros de Triagem de Animais Silvestres (CETAS) do estado da Bahia, no período de 2009-2019. Os totais de 19.317, 34.460 e 43.874 espécimes foram registrados nas unidades de Porto Seguro, Vitória da Conquista e Salvador, respectivamente. A distribuição dos totais por classe incluiu 80.948 (82,90%) aves, 12.007 (12,30%) répteis, 4.661 (4,77%) mamíferos e 35 aracnídeos. Quanto à natureza da operação que gerou o registro nos CETAS, as mais frequentes foram apreensão (67.974; 69,67%), entrega voluntária (13.367; 13,69%), resgate (12.803; 13,11%) e transferência (2.735; 2,67%). Os animais foram apreendidos em 236 municípios do estado da Bahia, com destaque para Salvador, Vitória da Conquista, Feira de Santana, Lençóis, Jequié e Paulo Afonso. A avaliação dos quantitativos das apreensões por municípios indica que a BR-116 é uma das rotas de escoamento mais representativa do tráfico ilegal de animais silvestres, no estado da Bahia e no país.(AU)

Quantitative study of wild animals received at the Wild Animals Triage Centers (CETAS) in Bahia and identification of trafficking routes

ABSTRACT: In Brazil, the illegal capture of wild animals is a crime that contributes to the extinction of species, besides causing environmental imbalance and suffering to the animals. Here, we undertook a quantitative survey of animals sent to the Centro de Triagem de Animais Silvestres (CETAS - Wild Animals Triage Centers) from units of Porto Seguro, Salvador, and Vitória da Conquista during 2009-2019. The 19,317, 34,460, and 43,874 specimens were registered in the units of Porto Seguro, Vitória da Conquista, and Salvador, respectively. The distribution of the totals by class included 80,948 (82.90%) birds, 12,007 (12.30%) reptiles, 4,661 (4.77%) mammals, and 35 arachnids (0.03%). The operations that generated registration at the CETAS were most frequently apprehensions (67,974; 69.67%), followed by voluntary surrender (13,367; 13.69%), rescues (12,803; 13.11%), and transfers (2,735; 2.67%). The animals came from 236 municipalities in the state of Bahia, with emphasis on the municipalities of Salvador, Vitória da Conquista, Feira de Santana, Lençóis, Jequié, and Paulo Afonso. The evaluation of the quantitative seizures by municipalities indicates that the BR-116 is one of the most representative routes for the illegal traffic of wild animals in the state of Bahia and the country.

RESUMO: No Brasil a captura ilegal de animais silvestres é crime e contribui para a extinção das espécies, além de causar desequilíbrios ambientais e sofrimentos aos animais. Este trabalho apresenta quantitativos de animais recebidos e/ou armazenados nos Centros de Triagem de Animais Silvestres (CETAS) do estado da Bahia, no período de 2009-2019. Os totais de 19.317, 34.460 e 43.874 espécimes foram registrados nas unidades de Porto Seguro, Vitória da Conquista e Salvador, respectivamente. A distribuição dos totais por classe incluiu 80.948 (82,90%) aves, 12.007 (12,30%) répteis, 4.661 (4,77%) mamíferos e 35 aracnídeos. Quanto à natureza da operação que gerou o registro nos CETAS, as mais frequentes foram apreensão (67.974; 69,67%), entrega voluntária (13.367; 13,69%), resgate (12.803; 13,11%) e transferência (2.735; 2,67%). Os animais foram apreendidos em 236 municípios do estado da Bahia, com destaque para Salvador, Vitória da Conquista, Feira de Santana, Lençóis, Jequié e Paulo Afonso. A avaliação dos quantitativos das apreensões por municípios indica que a BR-116 é uma das rotas de escoamento mais representativa do tráfico ilegal de animais silvestres, no estado da Bahia e no país.

Fatores associados com a escolha da terapia nos pacientes com doença inflamatória intestinal no Brasil / Factors associated with patient´s preference in choosing their therapy for inflammatory bowel disease in brazil

BACKGROUND: Biological therapy and new drugs have revolutionized the treatment of inflammatory bowel disease. Ideally, the choice of medication should be a shared decision with the patient, aiming at greater satisfaction, compliance, and consequently, favorable clinical outcome. OBJECTIVE: This study aims to evaluate patient's preferences in the choice of their therapy and the factors that influence this choice. METHODS: This cross-sectional study enrolled 101 outpatients with Crohn's disease or ulcerative colitis. The inclusion criteria were age ≥18 years and no previous exposure to biological therapy. Patients' preferences were assessed through questions that addressed the preferred mode of administration (oral, subcutaneous, or intravenous) and the factors that determined the choice of medication (efficacy, medical indication, fear of medication, convenience, mode of application, and personal doctors' indication). RESULTS: The mean age was 43.6±13.5 years, 75.3% were female, and 81.2% were cases of ulcerative colitis. Regarding the mode of administration, the majority of patients preferred oral (87.1%), followed by intravenous (6.93%) and subcutaneous (5.94%) medications. The reasons were "I prefer to take it at home" (42.57%), "I have more freedom" (36.63%), "I don't like self-application" (29.70%), and "I believe it works better" (19.80%). Younger patients and patients in clinical disease activity preferred intravenous mode compared to the oral route (P<0.05). Doctor's opinion (98%) was an important factor associated with the medication choice. CONCLUSION: Oral route was the preferred mode of administration and most patients took their physician's opinion into account in their choice of medication.

RESUMO CONTEXTO: A terapia biológica e os novos medicamentos revolucionaram o tratamento da doença inflamatória intestinal. A escolha do medicamento deve ser compartilhada com o paciente, visando maior satisfação, adesão e, consequentemente, desfecho clínico favorável. OBJETIVO: Este estudo teve como objetivo avaliar as preferências do paciente na escolha de sua terapia e os fatores que influenciaram essa escolha. MÉTODOS: Este estudo transversal incluiu 101 pacientes ambulatoriais com doença de Crohn ou retocolite ulcerativa. Os critérios de inclusão foram idade ≥18 anos e nenhuma exposição prévia à terapia biológica. A preferência dos pacientes foi avaliada por meio de perguntas que abordaram o modo de administração preferido (oral, subcutâneo ou intravenoso) e os fatores que determinaram a escolha do medicamento (eficácia, indicação médica, medo da injeção, conveniência, modo de aplicação e opinião pessoal do médico). RESULTADOS: A idade média foi de 43,6±13,5 anos, 75,3% eram mulheres e 81,2% eram portadores de retocolite ulcerativa. Em relação ao modo de administração, a maioria dos pacientes preferiu os medicamentos orais (87,1%), seguidos dos endovenosos (6,93%) e subcutâneos (5,94%). Os motivos foram "prefiro aplicar em casa" (42,57%), "tenho mais liberdade com essa medicação" (36,63%), "não gosto de autoaplicação" (29,70%) e "acredito que funcione melhor" (19,80%). Pacientes jovens e pacientes em atividade clínica preferiram a via intravenosa em comparação com a via oral (P<0,05). A opinião do médico (98%) foi um fator importante associado à escolha do medicamento. CONCLUSÃO: A via oral foi preferida e a maioria dos pacientes levou em consideração a opinião do seu médico na escolha do medicamento.

Estoque e descarte de medicamentos no domicílio: uma revisão sistemática / Storage and disposal of pharmaceuticals at home: a systematic review

Resumo Este estudo teve como objetivo analisar a evidência científica nacional e internacional existente sobre o motivo do estoque e a forma de descarte dos medicamentos no domicílio. Realizou-se uma revisão sistemática da literatura de 2001 a 2016 nas bases de dados PubMed, Lilacs e Elsevier's Scopus Database, utilizando os seguintes unitermos: "Disposal of medicines in household", "Disposal of expired drugs", "Residential expired drugs", "Management of expired medications in household". Foram selecionados 33 estudos originais após aplicação dos critérios de inclusão e exclusão. Os estudos analisados demonstraram que os principais motivos de estoque no domicílio foram: automedicação; guarda para uso futuro e sobras de tratamentos anteriores. E quanto ao descarte dos medicamentos, prevalecem práticas inadequadas, como descarte no lixo comum e na rede de esgoto. Alguns países têm adotado programas de orientação sobre o armazenamento e o descarte correto, no entanto, foi apenas encontrado um estudo que descreve um programa nacional gratuito, para orientar essas práticas. A partir das evidências cientificas verificou-se a importância do incentivo para a elaboração e a implementação de políticas públicas voltadas para o uso e descarte adequado de medicamentos no domicílio.

Abstract This study's objective was to analyze Brazilian and international scientific evidence on the reasons people store medication at home and the disposal methods used. This systematic literature review includes studies published from 2001 to 2016 and indexed in PubMed, Lilacs and Elsevier's Scopus Database, using the following key words: Disposal of medicines in household, Disposal of drugs expired, Residential expired drugs, Management of expired medications in household. Thirty-three studies were selected after applying inclusion and exclusion criteria. The studies reveal that the main reasons people keep a stock of medicines at home include the possibility of future use, leftovers from previous treatments, and self-medication. Inappropriate disposal methods prevail, such as throwing medicines in the household trash or flushing them into the sewer. Some countries have adopted programs to educate on proper storage and disposal of medicines, though only one study describes a national program guiding these practices that is free of charge. Evidence shows there is a need to implement public policies intended to provide guidance on the proper storage and disposal of medicines at home.

Meta-analysis of the Efficacy and Safety of Different Administration Routes of Bevacizumab in the Treatment of Malignant Pleural Effusion / 中国药房

OBJECTIVE：To evaluate the efficacy and s afety of different administration routes of bevacizumab in the treatment of malignant pleural effusion （MPE），and to provide evidence-based reference for rational use of drugs in clinic. METHODS ： Retrieved from Cochrane L ibrary，PubMed，Embase，VIP，CNKI，Wanfang database and CBM ，clinical studies were collected ， about bevacizumab combined with or without chemotherap eutic drugs （trial group ）versus chemotherap eutic drugs （control group ） in the treatment of MPE under different administration routes. After literature screening and data extraction ，the quality of RCTs was evaluated by using bias risk evaluation tool recommended by Cochrane Systematic Evaluator Manual 5.3. Newcastle-Ottawa scale was used to evaluate the quality of the retrospective study. Meta-analysis was performed by using Rev Man 5.3 software， network Meta-analysis was performed by using Stata 13.0 software and intervention measures were ranked by using R 3.6.1 software. RESULTS ：A total of 29 studies were included ，involving 21 RCTs and 8 retrospective studies ，including 2 254 patients. The studies involved 5 intervention measures ，such as bevacizumab+chemotherap eutic drugs （thoracic perfusion ），bevacizumab+ chemotherapeutic drugs （ivgtt），bevacizumab（thoracic perfusion ），chemotherapeutic drugs （thoracic perfusion ），chemotherapeutic drugs（ivgtt）. Network Meta-analysis showed there was no statistical significance in bevacizumab+chemotherap eutic drugs （thoracic perfusion）and bevacizumab+chemotherap eutic drugs （ivgtt）[OR＝0.81，95％CI（0.13，4.60），P＞0.05]，chemotherapeutic drugs （thoracic perfusion ）and chemo therapeutic drugs （ivgtt）[OR＝ 0.47， 95％ CI （0.07，3.10）， P＞0.05]， bevacizumab + Z19SCHX202） chemotherapeutic drugs （ivgtt） and chemotherap eutic drugs （ivgtt） [OR＝0.56，95％ CI（0.27，1.20），P＞0.05]. Total 、 response rate of bevacizumab + chemotherap eutic drugs （thoracic perfusion ） [OR＝3.10，95％ CI（2.10，4.50），P＜ 0.05]，bevacizumab（thoracic perfusion ）[OR＝1.90，95％CI （0.99，3.90），P＜0.05] were significantly higher than chemotherapeutic drugs （thoracic perfusion ）. Network Meta-analysis ranking showed that bevacizumab + chemotherapeutic drugs （ivgtt）＞ bevacizumab + chemotherapeutic drugs （thoracic perfusion ）＞ bevacizumab（thoracic perfusion ）＞chemotherapeutic drugs （ivgtt）＞chemotherapeutic drugs （thoracic perfusion ）. The incidence of elevated blood pressure [RR= 2.64，95％CI（1.56，4.43），P＝0.000 3] and proteinuria [RR ＝3.24，95％CI（1.79，5.86），P＝0.000 1] in trial group were significantly higher than control group. There was no statistical significance in the incidence of granulo- cytopenia [RR ＝0.94，95％CI（0.81，1.09），P＝0.41] or nausea and vomiting [RR ＝0.87，95％CI（0.73，1.03），P＝0.10] between 2 groups. Compared with chemotherapy alone ，bevacizumab combined chemotherapy could not prolong the total survival time of patients，but can improve the progression-free survival time. CONCLUSIONS ：Bevacizumab combined with chemotherapy can improve the efficacy of MPE patients ，but thoracic perfusion can increase the risk of proteinuria and elevated blood pressure.

Central cellular signaling pathways involved with the regulation of lipid metabolism in the liver: a review

The liver is primarilyresponsible for energy homeostasis and the regulation of lipid, carbohydrate and protein metabolism. Lipid metabolism consists of distributing lipids to peripheral tissues or ensuring their return to the liver to be reprocessed. Additionally, cellular metabolism isregulated by several molecules in different signaling pathways. Lipid homeostasis in the liver is mainly regulated by AKT, AMPK, SREBP, PPAR, and JNK. The PI3K/AKT/mTOR signaling pathway results in the biosynthesis of macromolecules and regulates lipogenesis and the expression of lipogenic genes. AMPK is an energy sensor that regulates metabolism and is activated when stored ATP is depleted, and it is responsible for the suppression of several key lipogenic factors in the liver related to cholesterol and fatty acid synthesis. SREBPs control lipogenic geneexpressionandcholesterol metabolism and actin the nutritional regulation of fatty acids and triglycerides. The continued activation of SREBPs is associated with cellular stress, inflammation and ultimately steatosis. PPARs are intrinsically important regulators of lipid metabolism. These genes are essential tovarious metabolic processes, especially lipid and glucose homeostasis, and can play a role in cell differentiation. JNK signaling is related to insulin resistance and its activation results in decreased mitochondrial activity and fat accumulation. Therefore, the study of cell signaling pathways related to lipid metabolism and liver function may help to identify abnormalities and develop strategies to manage and regulate metabolic disorders and resulting complications.

Erros na administração de medicamentos via parenteral: Perspectiva dos técnicos de enfermagem / Errores en la administración de medicamentos por vía parenteral: perspectiva de los técnicos de enfermería / Errors in parenteral medication administration: nursing technicians perspective

Resumo Objetivo: Analisar a compreensão dos técnicos de enfermagem sobre os erros e eventos adversos relacionados a administração de medicamentos via parenteral. Métodos: Estudo de abordagem qualitativa, descritivo e exploratório. Realizado com 25 técnicos de enfermagem em um hospital universitário do Nordeste no período de março a junho de 2017. Para coleta dos dados, utilizou-se um roteiro de entrevista com perguntas abertas. Na análise de dados utilizou-se o método da Classificação Hierárquica Descendente através do software IRAMUTEQ e para análise de conteúdo optou-se pela técnica de análise temática de Minayo. Resultados: Na análise da Classificação Hierárquica Descendente foram obtidas cinco classes, a partir delas emergiram as categorias: Compreensão dos técnicos de enfermagem sobre erros de medicação; Compreensão dos técnicos de enfermagem sobre eventos adversos; Fatores associados e estratégias de prevenção de erros e eventos adversos; e Conduta diante da ocorrência de erros e eventos adversos. Conclusão: Os técnicos de enfermagem mostraram que sua compreensão sobre eventos adversos é limitada ao conceito de reações adversas, entendem que a sua ocorrência está atrelada não somente a falta de atenção, mas também a fatores extrínsecos como sobrecarga de trabalho, número considerável de pacientes e dimensionamento inadequado, e reconhecem a importância da comunicação e notificação nesse processo para a melhoria da segurança do paciente.

Resumen Objetivo: Analizar la comprensión de los técnicos de enfermería sobre los errores y eventos adversos relacionados con la administración de medicamentos por vía parenteral. Métodos: Estudio de enfoque cualitativo, descriptivo y exploratorio. Realizado con 25 técnicos de enfermería en un hospital universitario del Nordeste de Brasil en el período de marzo a junio de 2017. Para la recolección de datos se utilizó una entrevista con preguntas abiertas. En el análisis de datos se utilizó el método de clasificación jerárquica descendente a través del software IRAMUTEQ, y para el análisis de contenido se optó por la técnica de análisis temático de Minayo. Resultados: En el análisis de la clasificación jerárquica descendente se obtuvieron cinco clases, de las cuales surgieron las siguientes categorías: Comprensión de los técnicos de enfermería sobre errores de medicación, Comprensión de los técnicos de enfermería sobre eventos adversos, Factores asociados y estrategias de prevención de errores y eventos adversos, y Conducta ante episodios de errores y eventos adversos. Conclusión: Los técnicos de enfermería demostraron que su comprensión sobre eventos adversos está limitada al concepto de reacciones adversas, entienden que los incidentes están vinculados no solo a la falta de atención, sino también a factores extrínsecos como sobrecarga de trabajo, número considerable de pacientes y dimensionamiento inadecuado, y reconocen la importancia de la comunicación y notificación en este proceso para mejorar la seguridad del paciente.

Abstract Objective: To analyze the nursing technicians' understanding of errors and adverse events related to parenteral medication administration. Methods: This is a qualitative, descriptive and exploratory study conducted with 25 nursing technicians at a university hospital in Northeastern Brazil, between March and June 2017. An interview script with open questions was used for data collection. In the data analysis, the Descending Hierarchical Classification method was used through the IRAMUTEQ software. Minayo's thematic analysis technique was chosen for content analysis. Results: In the analysis of the Descending Hierarchical Classification, five classes were obtained, from which the following categories emerged: Nursing technicians' understanding of medication errors; Nursing technicians' understanding of adverse events; Associated factors and strategies for preventing errors and adverse events; and Conduct before the occurrence of errors and adverse events. Conclusion: Nursing technicians showed that their understanding of adverse events is limited to the concept of adverse reactions. They understand that its occurrence is linked not only to lack of attention but also to extrinsic factors such as work overload, a considerable number of patients and inadequate dimensioning. They recognize the importance of communication and notification in this process for improving patient safety.

Qualification of palliative nursing assistance in the use of the subcutaneous route / Cualificación de la asistencia de enfermería paliativa en el uso de la vía subcutánea / Qualificação da assistência de enfermagem paliativista no uso da via subcutânea

ABSTRACT Objectives: to describe the experience of conducting workshops for teaching the subcutaneous fluid infusion therapy in palliative care patients. Methods: experience report based on four workshops with a workload of nine hours each, addressing the teaching, implementation of the technique, and management in the use of subcutaneous fluid infusion therapy in patients in palliative care. The host institution was a private hospital, which had two care units in the state of Rio de Janeiro. Results: we identified little knowledge about the theme. Due to the dynamics used, the workshops made it possible to qualify the participants to perform and manage the subcutaneous route in palliative care environments. Conclusions: the workshops were an important means of training, qualification, and dissemination of nursing care in a palliative care environment. The resources used to enable the qualification in the execution and management of the presented technique.

RESUMEN Objetivos: describir la experiencia de la realización de talleres para la enseñanza de la terapia de infusión de fluidos por vía subcutánea en pacientes en cuidados paliativos. Métodos: relato de experiencia basado en cuatro talleres con carga horaria de nueve horas cada, abordando la enseñanza, la ejecución de la técnica y el manejo en la utilización de la terapia de infusión de fluidos por vía subcutánea en pacientes en cuidados paliativos. La institución acogedora ha sido un hospital privado, que ha contado con dos unidades asistenciales en el estado de Rio de Janeiro. Resultados: se identificó poco conocimiento acerca de la temática. Por la dinámica utilizada, los talleres posibilitaron calificar los participantes a ejecutaren y a manejaren la vía subcutánea en ambientes de cuidados paliativos. Conclusiones: Los talleres han sido importante medio de formación, cualificación y divulgación del cuidado de enfermería en ambiente de cuidados paliativos. Los recursos utilizados posibilitan la cualificación en la ejecución y en el manejo de la técnica presentada.

RESUMO Objetivos: descrever a experiência da realização de oficinas para o ensino da terapia de infusão de fluidos por via subcutânea em pacientes em cuidados paliativos. Métodos: relato de experiência baseado em quatro oficinas com carga horária de nove horas cada, abordando o ensino, a execução da técnica e o manejo na utilização da terapia de infusão de fluidos por via subcutânea em pacientes em cuidados paliativos. A instituição sediadora foi um hospital privado, que contava com duas unidades assistenciais no estado do Rio de Janeiro. Resultados: identificou-se pouco conhecimento acerca da temática. Pela dinâmica utilizada, as oficinas possibilitaram qualificar os participantes a executarem e a manejarem a via subcutânea em ambientes de cuidados paliativos. Conclusões: as oficinas foram importante meio de formação, qualificação e divulgação do cuidado de enfermagem em ambiente de cuidados paliativos. Os recursos utilizados possibilitam a qualificação na execução e no manejo da técnica apresentada.

Chinese experts consensus on clinical practice of the selection and establishment of fecal microbiota transplantation delivery routes / 中华胃肠外科杂志

Fecal microbiota transplantation (FMT) has gradually shown application prospects in the treatment of intestinal and extraintestinal diseases. In order to standardized FMT operation, based on the clinical experience of the Tenth People's Hospital Affiliated to Tongji University, combined with domestic and foreign literature, Parenteral and Enteral Nutrition Branch of Chinese Medical Association, Enhanced Recovery after Surgery Branch of China International Health Care Promotion Exchange Association, China Microecological Treatment Innovation Alliance, and Microecology Committee of Shanghai Preventive Medicine Association to formulated the" Chinese experts consensus on clinical practice of the selection and establishment of fecal microbiota transplantation delivery routes". It includes four parts: the selection of delivery route, the methodology of transplantation path establishment, the clinical application, and the monitoring of adverse events.