Construindo o consultório do Alergista e Imunologista: o que é preciso? / Starting a practice in Allergy & Immunology: what do I need?

O que é preciso para abrir o consultório do especialista em Alergia e Imunologia? Esta é uma preocupação frequente dos jovens especialistas, que muitas vezes fica sem resposta. A Comissão de Estatuto, Regulamentos e Normas da Associação Brasileira de Alergia e Imunologia (CERN-ASBAI) propõe a publicação de uma série de artigos com o objetivo de orientar sobre os passos essenciais para o estabelecimento de boas práticas no atendimento clínico de pacientes alérgicos.

What do I need to start a practice in Allergy & Immunology? This has been a frequent concern for young specialists, one that often goes unanswered. The Statute, Regulations, and Standards Committee of the Brazilian Association of Allergy and Immunology (CERN-ASBAI) proposes the publication of a series of articles to provide guidance on the essential steps for establishing good practices in the clinical care of allergic patients.

Principais agentes sensibilizantes na dermatite de contato alérgica em pacientes de um hospital da região oeste de Santa Catarina / Main sensitizing agents involved in allergic contact dermatitis in patients of a hospital in western Santa Catarina, Brazil

Introdução: A dermatite de contato alérgica (DCA) corresponde a 20% dos casos de dermatite de contato, sendo recorrente em doenças ocupacionais e causa frequente de procura por profissionais dermatologistas e alergistas. Objetivo: Identificar os principais agentes sensibilizantes na dermatite de contato alérgica em um centro especializado em alergia do oeste de Santa Catarina. Metodologia: Trata-se de um estudo do tipo retrospectivo, descritivo, quantitativo e observacional, no qual se realizou a análise por meio de prontuários médicos de 394 pacientes que realizaram o teste de contato por dermatite de contato alérgica no período de 2018 a julho de 2020 no serviço de referência do oeste de Santa Catarina. Os agentes sensibilizantes avaliados no teste de contato foram conforme as baterias padrão (bateria padrão brasileira, bateria de cosméticos e higiene e bateria regional da América Latina). Foram realizadas análises de frequência para as variáveis qualitativas e avaliação da prevalência dos principais agentes sensibilizantes. Além disso, foram relacionados os principais agentes com as variáveis sexo e idade por meio do teste de Qui-quadrado de Pearson. Resultados: Os agentes sensibilizantes mais prevalentes foram: níquel (33,5%), PPD mix (23,2%), perfume mix (22,4%), fragrância mix (22,0%) e cobalto (18,9%). As substâncias mais prevalentes foram o níquel e o PPD mix, que são agentes sensibilizantes usados amplamente no cotidiano dos pacientes. Conclusão: A identificação dos alérgenos através do patch test possibilita aos pacientes a oportunidade de amenizarem a DCA provocada pelos agentes sensibilizantes encontrados.

Introduction: Allergic contact dermatitis (ACD) corresponds to 20% of contact dermatitis cases, being the most common type of occupational skin disease and a common cause of consultation with a dermatologist or allergist. Objective: To identify the main sensitizing agents involved in ACD at a specialized allergy center in western Santa Catarina, a state in the south of Brazil. Methodology: This retrospective, descriptive, quantitative, and observational study involved the review of medical records of all patients who underwent patch testing for ACD from 2018 to July 2020 in the allergy center. The sensitizing agents evaluated in the patch test followed the standard patch series (including the standard Brazilian patch series, cosmetic series, and regional Latin America series). Frequency analyses were performed for qualitative variables and to assess the prevalence of the main sensitizing agents. In addition, the main agents were correlated with sex and age variables using Pearson's chi-square test. Results: The most prevalent sensitizing agents were nickel sulfate (33.5%), PPD mix (23.2%), perfume mix (22.4%), fragrance mix (22.0%), and cobalt chloride (18, 9%). The most prevalent substances were nickel sulfate and PPD mix, which are widely used in patients' daily lives. Conclusion: The identification of allergens via patch testing provides patients with an opportunity to reduce ACD caused by the sensitizing agents identified.

Desafios e propostas para a assistência aos pacientes com doenças imunoalérgicas no Sistema Único de Saúde brasileiro ­ Carta de Maceió / Challenges and proposals for the care of patients with immune and allergic diseases within the Brazilian Unified Health System: The Maceió Charter

A Carta de Maceió foi elaborada com base nas discussões do 3º Fórum SUS da Associação Brasileira de Alergia e Imunologia (ASBAI). O documento destaca os desafios e propostas para aprimorar a assistência a pacientes com doenças imunoalérgicas no Sistema Único de Saúde (SUS) do Brasil. Tais condições, frequentemente crônicas e debilitantes, afetam milhões de brasileiros e exigem uma abordagem integrada, desde a atenção primária à saúde até a atenção especializada. Foram discutidos a necessidade de aprimorar a gestão de referência e contrarreferência, a urgência na superação da carência de especialistas e o desafio representado pelo limitado acesso tanto a diagnóstico quanto a tratamento adequados. As doenças raras, incluindo os erros inatos da imunidade (EII), apresentam um desafio adicional, exigindo acesso a tecnologias de alto custo para diagnóstico e tratamento e cuidado multidisciplinar. Do fórum emergiram propostas como o financiamento adequado da saúde, o fortalecimento do diagnóstico precoce, a gestão integrada de cuidados, a educação continuada dos profissionais de saúde e a implementação de telemedicina. Essas ações visam um sistema de saúde mais inclusivo, eficiente e humanizado, atendendo às necessidades dos pacientes com doenças imunoalérgicas.

The Maceió Charter was based on discussions held at the 3rd Unified Health System Forum (Fórum SUS) of the Brazilian Association of Allergy and Immunology (ASBAI). This document highlights challenges and proposals to improve care for patients with immune and allergic diseases within the Brazilian Unified Health System (SUS). Such conditions, often chronic and debilitating, affect millions of Brazilians and require an integrated approach from primary health through to specialty care. The need for improved management of referrals and counter-referrals, the urgency of overcoming the shortage of specialists, and the challenge represented by limited access to proper diagnosis and treatment alike were discussed. Rare diseases, including inborn errors of immunity (IEI), pose an additional challenge, requiring access to high-cost technologies for diagnosis and treatment as well as multidisciplinary care. Several proposals emerged from the Forum, such as securing sufficient funding for health, strengthening early diagnosis, integrating management, continuing education for health professionals, and implementation of telemedicine. These proposed interventions seek a more inclusive, efficient, and humanized healthcare system which meets the needs of patients with immune and allergic diseases.

Effects of immune exhaustion and senescence of innate immunity in autoimmune disorders

Innate immune system activation is crucial in the inflammatory response, but uncontrolled activation can lead to autoimmune diseases. Cellular exhaustion and senescence are two processes that contribute to innate immune tolerance breakdown. Exhausted immune cells are unable to respond adequately to specific antigens or stimuli, while senescent cells have impaired DNA replication and metabolic changes. These processes can impair immune system function and disrupt homeostasis, leading to the emergence of autoimmunity. However, the influence of innate immune exhaustion and senescence on autoimmune disorders is not well understood. This review aims to describe the current findings on the role of innate immune exhaustion and senescence in autoimmunity, focusing on the cellular and molecular changes involved in each process. Specifically, the article explores the markers and pathways associated with immune exhaustion, such as PD-1 and TIM-3, and senescence, including Β-galactosidase (β-GAL), lamin B1, and p16ink4a, and their impact on autoimmune diseases, namely type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus, and immune-mediated myopathies. Understanding the mechanisms underlying innate immune exhaustion and senescence in autoimmunity may provide insights for the development of novel therapeutic strategies.

Elevated serum IL-6 levels predict treatment interruption in patients with moderate to severe psoriasis: a 6-year real-world cohort study

Abstract Background: Real-world, primary data on the treatment of psoriasis are scarce, especially concerning the role of soluble biomarkers as outcome predictors. Objective: The authors evaluated the utility of Th1/Th17 serum cytokines along with clinical characteristics as predictors of drug survival in the treatment of psoriasis. Methods: The authors consecutively included participants with moderate to severe psoriasis who were followed up for 6 years. Baseline interferon-α, tumor necrosis factor-α, and inter-leukin (IL)-2, IL-4, IL-6, IL-10, and IL-17A were measured using a cytometric bead array; clinical data were assessed. The authors calculated hazard ratios (HRs) for drug survival using a Cox proportional hazards model. Results: The authors included 262 patients, most of whom used systemic immunosuppressants or biologics. In the multivariate model, poor quality of life measured by the Dermatology Life Quality Index (HR = 1.04; 95% CI 1.01-1.07; p = 0.012) and elevated baseline IL-6 (HR = 1.99; 95% CI 1.29-3.08; p = 0.002) were associated with treatment interruption. Study limitations: The main limitation of any cohort study is the presence of confounders that could not be detected in clinical evaluation. Conclusions: Poor quality of life and elevated baseline serum IL-6 level predicted treatment interruption in patients with moderate to severe psoriasis. Although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment, it is an interesting biomarker candidate for predicting psoriasis treatment response.

Advantages of Ciona intestinalis as a Model Organism and Its Applications / 实验动物与比较医学

With the continuous development of experimental biology, the limitations of commonly utilized model organisms are becoming increasingly apparent. Discrepancies between research conducted on laboratory animals and humans significantly impede the translational application of findings derived from animal experiments. This review introduces ascidian Ciona intestinalis as a novel model organism, an invertebrate that is evolutionarily closest to vertebrates and is a sister group to vertebrates. The review summarizes recent research progress on Ciona intestinalis in various fields to illustrate the significant advantages and promising application prospects of it as a model organism. The research progress outlined in the review mainly encompasses: (1) The whole-genome sequencing of Ciona intestinalis has been determined and numerous related databases have been established. Various embryonic gene editing technologies have been successfully applied, making it an animal model easy to manipulate genetically and study the functions and interactions of target genes visually. (2) In the field of neurobiology, Ciona intestinalis boasts a central nervous system structure similar to that of vertebrates and possesses numerous homologous neuropeptides and hormone molecules. These features grant it an edge in exploring the mechanisms and functional evolution of endocrine and neuroendocrine-related molecules. Additionally, the sensitivity and habituation of its larvae to light stimulation provide an avenue for exploring mechanisms related to behavioral plasticity. (3) In the field of immunology, Ciona intestinalis possesses a mature innate immune system and has evolved precursor genes to the adaptive immune system, with a relatively simple coding of immune-related genes. These features make it an exemplary model organism for immunological studies. (4) In the field of developmental biology, many studies have focused on the notochord development process in Ciona intestinalis and the regulatory mechanisms of gene expression within it, indicating common evolutionary developmental strategies among chordates. Additionally, insights into its heart development also significantly enhance our comprehension on the genetic network of human heart development. (5) In medical research, the ability of Ciona intestinalis to regenerate its neural complex and siphon, as well as the resilience of its heart to recover contractile function from substantial damage, renders it a valuable animal model for the study of regeneration and heart injury. It also has unique advantages as a research model for Alzheimer's disease and new drug development. Furthermore, its brief five-month lifespan facilitates the observation and recording of the entire aging process and the exploration of the effects of various factors on aging. In summary, this review aims to demonstrate that Ciona intestinalis stands out as a model organism with unique attributes and is expected to play a significant role in a wider range of scientific research areas.

Role of micronucleus-activated cGAS-STING signaling in antitumor immunity / 浙江大学学报·医学版

cGAS-STING signaling is a significant component of the innate immune system and functions as a vital sentinel mechanism to monitor cellular and tissue aberrations in microbial invasion and organ injury. cGAS, a cytosolic DNA sensor, is specialized in recognizing abnormally localized cytoplasmic double-stranded DNA (dsDNA) and catalytically synthesizes the second messenger cyclic-GMP-AMP (cGAMP), which initiates a cascade of type I interferon and inflammatory responses mediated by STING. Micronucleus, a byproduct of chromosomal missegregation during anaphase, are also significant contributors to cytoplasmic dsDNA. These unstable subcellular structures are susceptible to irreversible nuclear envelope rupture, exposing genomic dsDNA to the cytoplasm, which potently recruits cGAS and activates STING-mediated innate immune signaling and its downstream activities, including type I interferon and classical nuclear factor-κB (NF-κB) signaling pathways lead to senescence, apoptosis, autophagy activating anti-cancer immunity or directly killing tumor cells. However, sustained STING activation-induced endoplasmic reticulum stress, activated chronic type I interferon and nonclassical NF-κB signaling pathways remodel immunosuppressive tumor microenvironment, leading to immune evasion and facilitating tumor metastasis. Therefore, activated cGAS-STING signaling plays a dual role of suppressing or facilitating tumor growth in tumorigenesis and therapy. This review elaborates on research advances in mechanisms of micronucleus inducing activation of cGAS-STING signaling and its implications in tumorigenesis and therapeutic strategies of malignant tumors.

Study on blending traditional sinology classic "Thirty-Six Stratagems" into curriculum ideological and political education of Microbiology and Immunology / 中国免疫学杂志

Microbiology and Immunology is one of core basic curriculums for medical college undergraduates.Combining with characteristics of this course,our teaching comprehension and background calling for curriculum ideological and political education,we consider blending traditional sinology classic"Thirty-Six Stratagems"in teaching of this curriculum.Meanwhile,its practical signif-icance on many aspects will be elucidated.This paper will provide useful reference for blending other sinology classics into ideological and political education of specialized curriculums.

Method and practice of integrating online and offline hybrid teaching of Animal Immunology into curriculum ideology and politics / 中国免疫学杂志

Objective:In order to truly realize the deep integration of ideological and political education and professional edu-cation in the course of Animal Immunology and effectively improve the comprehensive quality of students.Methods:The experiment adopts the teaching method of integrating the online and offline hybrid teaching of Animal Immunology into the ideology and politics of the course,studies the course design concept,teaching objectives,teaching design and teaching implementation,and will conduct an evaluation of the teaching effect from the examination results and ideological and political effect.Results:The results show that the teaching model has stimulated students'interest in learning and improved their overall ability.Conclusion:It shows that the teaching effect of this method is good and the basic task of moral education is realized.

Strategies for resolving difficulties in immunology teaching / 中国免疫学杂志

Immunology courses are offered in the majors of biology,medicine,animal husbandry and food in Chinese colleges and universities.Due to the characteristics of multi-dimensional composition of immunology knowledge,most students are not easy to understand the logical relationship between key points and knowledge points in learning,and will encounter problems such as unable to keep up with the teaching pace,lack of confidence in learning,feeling complex association between the knowledge points of chap-ters,and not fully understanding the immunology knowledge points.This paper summarizes the teaching methods of heuristic,main line and case in Immunology teaching,so as to solve the difficulties in learning,clarify learning ideas,improve learning confidence and learning effectiveness.

Mechanisms of Apolipoprotein E in Malignancies / 生物化学与生物物理进展

Apolipoprotein E (apoE) is a critical molecule in lipid metabolism, which also plays important roles in the occurrence and development of several kinds of cancers by regulating processes including cell proliferation, energy metabolism, oxidative stress and innate immune, etc., and shows influence in patients’ response to treatment. Therefore, apoE has become a potential biomarker and treatment target for cancer. Further research of apoE will help us build deep and systematic understanding of etiology of cancer to promote the prevention and to develop new therapeutic strategies for cancer. In this review, we introduced the properties of apoE from the views of biophysics, biochemistry, molecular biology, evolution and epidemiology, in which we demonstrated the similarities and differences among the structures of 3 subtypes of apoE; we also recapitulated the role of apoE in the genesis and development of cancers in main types of malignancies including gastric cancer, colorectal cancer, hepatobiliary cancer, melanoma, pancreatic cancer, etc.; we summarized the relationship between apoE and the hallmarks of cancer, highlighting the position of apoE in immune system and its critical role for understanding the different nature of immunological background of cancers originated from different organs, and discussed its potential value for application as tumor biomarkers and therapeutic targets by demonstrating the structures of its subtypes. We further discussed the possibility of transferring the drug designing strategy of “structure corrector” from neurology to oncology.

Vitamin D status in active and inactive noninfectious uveitis - data from a reference university hospital in Rio de Janeiro, Brazil

ABSTRACT Purpose: This study aimed to investigate the correlation between serum vitamin D levels and disease activity in patients with noninfectious uveitis. Methods: We conducted a prospective case-control study, assessing 51 patients with noninfectious uveitis, categorized into active (n=22) and inactive (n=29) groups, along with 51 healthy controls. Serum 25-hydroxy vitamin D [25(OH)D] levels were measured. The uveitis group also completed a questionnaire regarding sunlight exposure habits and vitamin D supplementation. Results: Patients with inflammation-related uveitis exhibited low serum 25(OH)D levels in 68% of cases. The median 25(OH)D level in patients with active uveitis was 17.8 ng/mL (interquartile range [IQR], 15-21 ng/mL), significantly lower compared to the 31.7 ng/mL (IQR, 25-39 ng/mL) in patients with inactive uveitis (p<0.001) and the 27 ng/mL (IQR, 23-31 ng/mL) in the Control Group (p<0.001). Significantly, nearly all patients with uveitis taking vitamin D supplementation were in the Inactive Group (p<0.005). Moreover, reduced sunlight exposure was associated with active uveitis (p<0.003). Furthermore, patients with 25(OH)D levels below 20 ng/mL had ten times higher odds of developing active uveitis (p=0.001). Conclusions: This study revealed a prevalent 25(OH)D deficiency among patients with noninfectious uveitis and suggested a link between low 25(OH)D levels and disease activity. To prevent future episodes of intraocular inflammation, vitamin D supplementation and controlled sunlight exposure could be viable options.

Foxp3+CD39+CD73+ regulatory T-cells are decreased in the peripheral blood of women with deep infiltrating endometriosis

Abstract Endometriosis's pathophysiology remains incompletely understood, with evidence pointing towards a dysregulated immune response. Regulatory T (Treg) cells, pivotal in maintaining self-tolerance, may facilitate the survival of ectopic endometrial cells within the abdominal cavity, thereby contributing to endometriosis development. This study aimed to assess the prevalence of CD39+CD73+ suppressor Treg cell subsets in the peripheral blood of endometriosis patients. This research focuses on the pivotal role of regulatory T-cells (Tregs), which are essential for maintaining immune tolerance and preventing autoimmune diseases. A case-control study was conducted, including 32 women diagnosed with endometriosis and 22 control subjects. The frequency of peripheral blood CD39+CD73+ suppressor Treg cells was quantified using flow cytometry. No significant differences were observed in the frequency of CD3+CD4+CD25High cells (Median [M]: 10.1; Interquartile Range [IQR]: 6.32‒18.3 vs. M: 9.72; IQR: 6.22-19.8) or CD3+CD4+CD25HighCD39+Foxp3+ cells (M: 31.1; IQR: 19.7-44.0 vs. M: 30.55; IQR: 18.5-45.5) between controls and patients. However, a significantly lower frequency of CD3+CD4+CD25HighCD39+CD73+ cells was observed in the endometriosis group compared to controls (M: 1.98; IQR: 0.0377-3.17 vs. M: 2.25; IQR: 0.50-4.08; p = 0.0483), suggesting a reduction in systemic immune tolerance among these patients. This finding highlights the potential role of CD39 and CD73 expression on Treg cells as biomarkers for assessing disease severity and progression. Furthermore, elucidating the mechanisms driving these alterations may unveil new therapeutic strategies to restore immune equilibrium and mitigate endometriosis symptoms.

Papel inmunomodulador de la vitamina D y los ácidos grasos poliinsaturados omega-3 en trastornos autoinmunes: Revisión de la Literatura / Immunomodulatory role of vitamin D and omega-3 polyunsaturated fatty acids in autoinmune disorders: Literature Review

Los trastornos autoinmunes representan una familia de al menos 80 condiciones diferentes que surgen de una respuesta aberrante del sistema inmunológico resultando finalmente en la destrucción de tejidos y órganos específicos del cuerpo. Es importante destacar que durante las últimas tres décadas los estudios epidemiológicos han proporcionado evidencia de un aumento constante en la incidencia y prevalencia de trastornos autoinmunes. En los últimos años, varios estudios han demostrado que la vitamina D y los ácidos grasos poliinsaturados (AGPs) omega-3 ejercen propiedades inmunomoduladoras y antiinflamatorias sinérgicas que pueden aprovecharse positivamente para la prevención y el tratamiento de trastornos autoinmunes. En este sentido, el reciente ensayo clínico denominado VITAL (ensayo de vitamina D y omega 3); un estudio a gran escala, aleatorizado, doble ciego, controlado con placebo encontró que la suplementación conjunta de vitamina D y AGPs omega-3 (VIDOM) puede reducir la incidencia de enfermedades autoinmunes. En esta revisión de la literatura, resumimos los mecanismos moleculares detrás de las propiedades inmunomoduladoras y antiinflamatorias de la vitamina D y los AGPs omega-3, así como la posible interacción bidireccional entre el metabolismo de la vitamina D y el metabolismo de los AGPs omega-3 que justifica la co- suplementación VIDOM en trastornos autoinmunes(AU)

Autoimmune disorders represent a family of at least 80 different conditions that arise from an aberrant immune system response, which ultimately results in the destruction of specific body tissues and organs. It is important to highlight that during the last three decades epidemiological studies have provided evidence of a steady increase in the incidence and prevalence of autoimmune disorders. In recent years, several studies have shown that vitamin D and omega-3 polyunsaturated fatty acids (PUFAs) exert synergistic immunomodulatory and anti-inflammatory properties that can be positively harnessed for the prevention and treatment of autoimmune disorders. In this sense, the recent clinical trial called VITAL (Vitamin D and Omega 3 trial) - a large, randomized, double-blind, placebo- controlled study - found that co-supplementation of vitamin D and omega-3 PUFAs (VIDOM) can reduce the incidence of autoimmune diseases. In this literature review, we summarize the molecular mechanisms behind the immunomodulatory and anti-inflammatory properties of vitamin D and omega-3 PUFAs, as well as the possible bidirectional interaction between vitamin D metabolism and omega-3 PUFA metabolism that justifies VIDOM co- supplementation in autoimmune disorders(AU)

Integrating Role of Immunity in Cancer: Journey from Immune Surveillance to Tumour Escape

Cancer immunoediting is crucial to understand the success or failure of a tumor. Immune system plays dual roles in tumor development and progression, promoting or suppressing tumor depending on tumor microenvironment and the events that lead to initiation of carcinogenesis. The immune system has potential to recognize and destroy tumors, and thus function as a primary defense mechanism against cancer. On the other hand, unresolved immune responses can result in the growth and progression of cancer. Objectives: The host immune system determines tumour fate in three phases (Elimination, Equilibrium and Escape) and ac- cording to this theory, it blocks adaptive and innate tumour responses or promotes conditions that favour tumour progression. Conclusion: The purpose of this review is to emphasise the importance of immunity in tumour promotion and suppression.

Canales dominantes de percepción del conocimiento. Influencia en la evaluación del aprendizaje de la inmunología / Knowledge Perception Dominant Channels. Influence of the Evaluation of Immunology Learning

Introducción: Los estilos de aprendizaje según canales de percepción dominante del conocimiento de los estudiantes influyen en su aprendizaje. Su uso por los docentes puede favorecer o no a estudiantes con un canal específico. Objetivo: Describir la ubicación según los canales de percepción dominante del conocimiento de los estudiantes de medicina y la relación de estos con el resultado de las evaluaciones frecuentes en la asignatura Sangre y Sistema Inmune. Métodos: Se realizó una investigación en 234 estudiantes y 30 profesores de la carrera de medicina en los cursos 2020-2021 y 2022. Los estudiantes se clasificaron según los resultados de un cuestionario para identificar el predominio del canal de percepción (visuales-auditivos-kinestésicos) y a los profesores se les realizó una encuesta para determinar su percepción sobre el uso de estrategias de enseñanza diferenciales para cada canal. El procesamiento se realizó en programa SPSS 25, a través de números, porcentaje y prueba de ji al cuadrado. Resultados: Predominó el canal visual con el 48 por ciento. Existió asociación con el sexo con p = 0,0016; en varones prevaleció el canal auditivo y en hembras el visual. La relación entre los canales de percepción dominante y el rendimiento académico fue significativa con p = 0,000. Conclusiones: Prevaleció el canal de percepción dominante visual. La distribución de cada canal se asoció con el sexo y el rendimiento académico; así se lograron mejores resultados por los estudiantes con percepción dominante visual. Esto último estuvo relacionado con el predominio de acciones por parte de los docentes que potencian este canal de percepción(AU)

Introduction: Learning styles according to dominant perception channels of students' knowledge influence their learning. Their use by professors may or may not favor students with a specific channel. Objective: To describe the location according to the dominant knowledge perception channels of medical students and their relationship with the results of frequent evaluations in the subject Blood and Immune System. Methods: A research was conducted with 234 students and 30 professors of the Medicine major during the academic years 2020-2021 and 2022. The students were classified according to the results of a questionnaire to identify the perception channel predominance (visual-auditory-kinesthetic), while the professors were surveyed to determine their perception on the use of differential teaching strategies for each channel. Processing was performed in SPSS 25, using numbers, percentages and the chi-squared test. Results: The visual channel predominated, accounting for 48 percent. There was an association with sex (p=0.0016); the auditory channel prevailed among males, while the visual channel prevailed among females. The relationship between dominant perception channels and academic performance was significant (p=0.000). Conclusions: The visual dominant perception channel prevailed. The distribution of each channel was associated with sex and academic performance; thus, better results were achieved by students with visual dominant perception. The latter was related to the predominance of actions by professors that enhance this perception channel(AU)

Nuevas perspectivas en el estudio y tratamiento de la sepsis

La sepsis es una disfunción orgánica potencialmente mortal debida a una respuesta desregulada del hospedero a la infección. No sólo contribuye con el 20 % de todas las causas de muerte de forma global, sino que los sobrevivientes de esta también pueden experimentar una significativa morbilidad a largo plazo. La sepsis y el shock séptico son emergencias médicas que requieren reconocimiento rápido, administración de antimicrobianos apropiados, soporte hemodinámico cuidadoso y control de la fuente infecciosa. El objetivo de esta revisión fue describir la definición y los criterios diagnósticos, la epidemiología, los factores de riesgo, la patogenia y la conducta inicial ante la sepsis.

Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection. It severely impacts global disease burden as it constates 20 % of all causes of death; its survivors may experience long-term morbidity. Sepsis and septic shock are medical emergencies that require rapid identification, administration of appropriate antimicrobials, careful hemodynamic support, and control of the infection source. This review aims to update the definition of sepsis and its diagnostic criteria, epidemiology, risk factors, pathogenesis, and baseline behavior.

Aproximando a Atenção Especializada da Atenção Primária à Saúde: em busca do cuidado integral ao paciente com asma no Brasil / Aligning Specialized Care with Primary Health Care: in search of comprehensive care for asthma patients in Brazil

A ocorrência de doenças alérgicas e asma ainda cresce em muitos países. Dados mostram que aproximadamente um quarto dos habitantes de países industrializados apresenta algum tipo de alergia, e nos países em desenvolvimento estas doenças podem alcançar proporções ainda maiores da população. No Brasil, embora não exista até o momento uma agenda política nacional de atenção à saúde dos pacientes com alergias e asma, iniciativas individuais em diferentes regiões têm beneficiado milhares de pacientes ao longo das últimas décadas. Estes programas têm como principais objetivos qualificar o cuidado em saúde, melhorar a qualidade de vida (especialmente dos pacientes com asma e rinite alérgica) e reduzir os indicadores de morbimortalidade relacionados às doenças. Com essa finalidade, os programas vêm se ocupando de diversas ações de educação em saúde, capacitação profissional, busca ativa para garantir diagnóstico e tratamento oportuno, e proporcionar acesso a medicamentos de forma gratuita e continuada. Entretanto, a falta de um caráter institucional que garanta o acesso universal a ações cientificamente fundamentadas, impede a equidade e a continuidade do cuidado, além de dificultar a atenção integral em asma e em outras doenças alérgicas.

Allergic diseases and asthma are on the rise in many countries. Data show that approximately 25% of the inhabitants of industrialized countries have some type of allergy, reaching even greater proportions in developing countries. Although a national health care agenda for patients with allergies and asthma has not yet been developed in Brazil, individual initiatives in different regions have benefited thousands of patients in recent decades. The main objectives of these programs are to improve health care, quality of life (especially for patients with asthma and allergic rhinitis), and reduce disease-related morbidity and mortality indicators. To this end, these programs have been engaged in health education actions, professional training, performing active searches to ensure timely diagnosis and treatment, and providing free and continuous access to medication. However, the due to the non-institutional character of these programs, universal access, evidence-based actions, and continuity of care are not guaranteed, and it is difficult to provide comprehensive care for asthma and other allergic diseases.

Advances of n-3 polyunsaturated fatty acids in food allergy / 中华实用儿科临床杂志

Food allergy is a common allergic disease threatening the growth and development of infants and children.n-3 polyunsaturated fatty acids (PUFAs) are common nutrients in the diet, which have important structural functions and immunomodulatory effects.Their protective effect in food allergy has gradually become a potential research hotspot.This review highlights the function and immune regulation of PUFAs, the regulation of n-3 PUFAs on immunological indexes, the mechanism of food allergy, and the relationship between food allergy, and the impact of n-3 PUFAs on other allergic diseases.

Practice of network platform teaching in standardized residency training of rheumatology and immunology / 中华医学教育探索杂志

This article intends to explore the application and implementation effect of network platform teaching in the standardized residency training of rheumatology and immunology. Through the implementation of online platform teaching (micro-class, online PBL teaching, and air class) for the training residents rotating in the rheumatology and immunology department, the questionnaire survey was carried out. The results showed that the satisfaction of the residents with the online platform teaching reached 96.88% (31/32), and more than 90.00% of the residents believed that their self-learning ability and clinical thinking ability have been improved, and their learning initiative and enthusiasm have also been improved, which deserves further promotion.