Importância da interação entre comunidade e graduando, para uma formação humanizada: relato de experiência / Importance of interaction between community and undergraduate, for humanized training: experience report

Durante a vivência acadêmica, as universidades conectam seus futuros profissionais para assistência à comunidade, tendo em vista uma formação centrada na humanização dos pacientes. O programa de monitoria para a clínica interdisciplinar no tratamento de feridas, do Centro Universitário do Espírito Santo (UNESC), não se limita apenas ao campo teórico, abrangendo muito a prática com o corpo social e possibilita essa experiência com a comunidade de forma humanizada. Objetivo: Relatar a inter-relação com a sociedade durante o tempo de monitoria, como isso é importante para a capacitação de excelência, e também como essa humanização contribui para tratamento e evolução do paciente. Metodologia: O estudo consiste em um relato de experiência de um dos monitores da clínica de feridas durante um semestre de monitoria, apresentando caráter descritivo. Resultados e Discussão: Durante a vivência notou-se o quão importante é enxergar esse lado humano do paciente, não se preocupando apenas com suas queixas. Agindo desse modo, teve como resultado pacientes mais felizes, engajados com o tratamento e gostando de estar naquele ambiente, por mais doloroso que fosse o real motivo. Considerações finais: É vital para o graduando aprender a lapidar sua abordagem com o paciente, atuando de maneira holística. Essa interação entre universidade e corpo social é de fundamental importância para desenvolver profissionais que saiam ainda mais capacitados para o mercado de trabalho, principalmente quando se trata de profissionais da área da saúde, possibilitando mesclar assistência e atendimento, com o processo de ensino-aprendizado das práticas de saúde.(AU)

During their academic experience, universities connect their future professionals to assist the community, with a view to training centred on the humanization of patients. The monitoring program for the interdisciplinary wound care clinic at the Centro Universitário do Espírito Santo (UNESC) is not just limited to the theoretical field, but also encompasses a lot of practice with the social body and enables this experience with the community in a humanized way. Objective: To report on the interrelationship with society during the monitoring period, how important this is for the training of excellence, and also how this humanization contributes to the treatment and evolution of the patient. METHODOLOGY: The study consists of a report on the experience of one of the wound clinic monitors during a semester of monitoring, and is descriptive in nature. Results and Discussion: During the experience, we noticed how important it is to see the human side of the patient, not just worrying about their complaints. Acting in this way resulted in happier patients, engaged with the treatment and enjoying being in that environment, no matter how painful the real reason.Final considerations: It is vital for undergraduates to learn how to refine their approach to patients, acting in a holistic way. This interaction between the university and society is of fundamental importance for developing professionals who are even more qualified for the job market, especially when it comes to health professionals, making it possible to merge assistance and care with the teaching-learning process of health practices.(AU)

Durante su experiencia académica, las universidades vinculan a sus futuros profesionales con la asistencia a la comunidad, con vistas a una formación centrada en la humanización de los pacientes. El programa de acompañamiento de la clínica interdisciplinaria de cuidado de heridas del Centro Universitario do Espírito Santo (UNESC) no se limita apenas al campo teórico, sino que abarca mucha práctica con el cuerpo social y posibilita esta experiencia con la comunidad de forma humanizada. Objetivo: Informar sobre la interrelación con la sociedad durante el período de seguimiento, cuán importante es esto para la formación de excelencia, y también cómo esta humanización contribuye al tratamiento y evolución del paciente. Metodología: El estudio consiste en un informe sobre la experiencia de uno de los monitores de la clínica de heridas durante un semestre de monitorización, y es de naturaleza descriptiva. RESULTADOS Y DISCUSIÓN: Durante la experiencia, nos dimos cuenta de lo importante que es ver el lado humano del paciente, no sólo preocuparse por sus quejas. Actuar de esta manera resultó en pacientes más felices, comprometidos con el tratamiento y disfrutando de estar en ese ambiente, por más doloroso que sea el motivo real.Consideraciones finales: Es fundamental que los estudiantes universitarios aprendan a perfeccionar su abordaje con los pacientes, actuando de forma holística. Esta interacción entre la universidad y la sociedad es de fundamental importancia para el desarrollo de profesionales aún más cualificados para el mercado de trabajo, especialmente cuando se trata de profesionales de la salud, haciendo posible la fusión de la asistencia y el cuidado con el proceso de enseñanza-aprendizaje de las prácticas de salud.(AU)

Práticas Avançadas de Enfermagem ­ PAE / Advanced Nursing Practices ­ ANP

Trata de nota técnica sobre Práticas Avançadas de Enfermagem (PAE) no Brasil, elaborada por comissão e submetida à aprovação do plenário do Conselho Federal de Enfermagem (Cofen). O documento aborda conceitos, ações, implementação e regulação das práticas avançadas de Enfermagem, expandindo os limites do escopo da atuação do enfermeiro e reforçando a sua prática clínica. (AU)

This is a technical note on Advanced Nursing Practices (ANP) in Brazil, prepared by a committee and submitted for approval by the plenary of the Federal Nursing Council (Cofen). The document addresses concepts, actions, implementation and regulation of advanced nursing practices, expanding the limits of the scope of nurses' work and reinforcing their clinical practice. (AU)

Esta es una nota técnica sobre las Prácticas Avanzadas de Enfermería (PAE) en Brasil, elaborada por un comité y sometida a la aprobación del plenario del Consejo Federal de Enfermería (Cofen). El documento aborda los conceptos, acciones, implementación y reglamentación de las prácticas avanzadas de enfermería, ampliando los límites del ámbito de actuación de las enfermeras y reforzando su práctica clínica. (AU)

Application status of risk assessment models for periodontal disease / 口腔疾病防治

@#Risk assessment models for periodontal disease provide dentists with a precise and consolidated evaluation of the prognosis of periodontitis, enabling the formulation of personalized treatment plans. Periodontal risk assessment systems have been widely applied in clinical practice and research. The application fields of periodontal risk assessment systems vary based on the distinctions between clinical periodontal parameters and risk factors. The assessment models listed below are commonly used in clinical practice, including the periodontal risk calculator (PRC), which is an individual-based periodontal risk assessment tool that collects both periodontal and systemic information for prediction; the periodontal assessment tool (PAT), which allows for quantitative differentiation of stages of periodontal disease; the periodontal risk assessment (PRA) and modified periodontal risk assessment (mPRA), which are easy to use; and the classification and regression trees (CART), which assess the periodontal prognosis based on a single affected tooth. Additionally, there are orthodontic-periodontal combined risk assessment systems and implant periapical risk assessment systems tailored for patients needing multidisciplinary treatment. This review focuses on the current application status of periodontal risk assessment systems.

Application progress on in vivo drug analysis technique in clinical pharmacy / 药学实践杂志

Objective To explore the progress on the application of in vivo drug analysis techniques in clinical pharmacy work. Methods Relevant literature was reviewed to provide an overview of the characteristics of clinical samples, common in vivo drug analysis methods used in the clinic, the application and existing problems of in vivo drug analysis in clinical pharmacy. Results and Conclusion In recent years, with the increasing demand for individualized and precise treatment in clinical practice and the continuous development of analytical techniques, in vivo drug analysis techniques have been widely used in clinical pharmacy work, which have become one of the important auxiliary techniques to promote rational clinical drug use, improve individualized treatment and reduce the occurrence of adverse reactions. However, in the actual application, there were still problems such as the invasive blood sampling that hinders sampling, the weak ability to interpret drug monitoring results and clinical testing methods that still need to be improved. These problems should be taken seriously and continuously improved and solved in the subsequent research and application.

Research progress in therapy drug monitoring of levetiracetam / 中国药房

Levetiracetam （LEV） is the second generation of broad-spectrum anti-epileptic drug. LEV has the advantages of rapid absorption， short half-life， precise efficacy， good tolerance and few drug interactions. In order to improve the clinical efficacy of LEV， and reduce the occurrence of adverse reactions， children， pregnant women， the elderly， and patients with renal insufficiency should receive therapeutic drug monitoring （TDM）. Clinically， the samples are usually plasma or serum， and the TDM methods are mostly immunoassay or chromatography. There is currently no consensus on the effective concentration range of LEV， and the correlation between plasma concentration and adverse reactions is also unclear. The main factors affecting LEV plasma concentration include age， pregnancy， and patient compliance. How to interpret TDM results and adjust dosage based on the results will be the focus of future work.

Monitoring and risk assessment of total α and β radioactivity levels in drinking water in the nine districts of metropolitan Chongqing in 2019-2021 / 公共卫生与预防医学

Objective To investigate the radioactivity levels of total α and total β in drinking water in nine districts of Chongqing City from 2019 to 2021, and to provide reference for the risk monitoring of drinking water in the metropolitan areas of Chongqing. Methods The total α and total β radioactivity levels in water samples were determined by the comparative measurement method and the thin source deposit method in GB/T5750.13-2006 “Standard Examination Methods for Drinking Water-Radiological Parameters”. The monitoring results were assessed according to GB5749-2006 “Standards for Drinking Water Quality” and the fourth edition of the WHO Guidelines for Drinking Water Quality. Results From 2019 to 2021, the total α activity concentration of the water samples measured in the nine districts of metropolitan Chongqing ranged from 0.002 to 0.039 Bq /L, and the total β activity concentration ranged from 0.015 to 0.190 Bq /L. There was no significant difference in the activity concentration (tα=0.545, Pα=0.591; tβ=-1.438, Pβ=0.163>0.05). From 2019 to 2021, the average value of total α radioactivity decreased year by year and its activity value was relatively low, indicating a low health risk. However, the average value of total β radioactivity increased year by year, which should be paid attention to. Conclusion The total α and total β radioactivity in water samples measured in the present study are lower than the standard recommended limits. The estimated annual average effective dose of radiation caused by drinking water is 0.005-0.010 mSv, which is lower than the limit of 0.1 mSv recommended by WHO, and this radioactivity level will not have an impact on the health of residents. However, the total β radioactivity level of the monitoring points in Banan and Shapingba is relatively high compared to other jurisdictions, and further tracking and monitoring should be carried out.

Clinical treatment and management of invasive fungal disease in recipients of solid organ transplantation / 器官移植

With widespread application of solid organ transplantation (SOT), the incidence of postoperative invasive fungal disease (IFD) in SOT recipients has been increased year by year. In recent years, the awareness of preventive antifungal therapy for SOT recipients has been gradually strengthened. However, the problem of fungal resistance has also emerged, leading to unsatisfactory efficacy of original standardized antifungal regimens. Drug-drug interaction and hepatorenal toxicity induced by drugs are also challenges facing clinicians. In this article, the characteristics of drug-drug interaction and hepatorenal toxicity among triazole, echinocandin and polyene antifungal drugs and immunosuppressants were reviewed, and postoperative preventive strategies for IFD in different types of SOT recipients and treatment strategies for IFD caused by infection of different pathogens were summarized, aiming to provide reference for physicians in organ transplantation and related disciplines.

Investigation of patients’preferences regarding therapeutic drug monitoring of mycophenolic acid in solid organ transplantation / 中国药房

OBJECTIVE To investigate the preferences of patients who underwent solid organ transplantation regarding therapeutic drug monitoring （TDM） of mycophenolic acid （MPA） and explore the factors influencing patients’ decision-making process， so as to provide support for the development of individualized medication guidelines for MPA and improvement of clinical decision-making. METHODS The cross-sectional study was used to design the questionnaire on the patients’ preferences to accept MPA TDM， and involved patients who underwent solid organ transplantation and received MPA treatment at two tertiary hospitals in Beijing from April 14， 2022， to June 27， 2022. The Likert 5-level scoring method was used to score the patients’ preferences to accept MPA TDM， the influencing factors and their correlation of the patients’ preferences to accept MPA TDM were analyzed by Pearson correlation analysis and binary Logistic regression analysis， and the nonparametric test and chi-square test were used to rank and analyze the consistency of the factors affecting patients’ preference decision. RESULTS A total of 140 questionnaires were collected， and the effective recovery rate was 77.35%. The average preference score of 140 patients to receive MPA TDM was （4.01±0.65）， and the overall preference value was high. There were 116 （82.86%） patients agreed or strongly agreed with MPA TDM. Significant differences were observed in preference scores between patients who had previously undergone MPA TDM and those who had never undergone it （[ 4.30±0.53） scores vs. （3.80±0.65） scores， P＜0.001]. Additionally， patients’ preference scores were significantly influenced by their understanding level and attention level （P＜0.001）. The ranking of factors contributing to decision-making exhibited consistency （P＜0.001）. The factors were ranked in descending order of clinical efficacy， safety， comfortability， economy and time cost. CONCLUSIONS The patients who underwent solid organ transplantation hold high preferences towards MPA TDM. The primary factors influencing their decisions are their prior experience， understanding level， and attention level.

Evaluation of the hygiene status of teaching environment in primary and secondary schools in Beijing City from 2016 to 2020 / 中国学校卫生

Objective@#To understand the trend of changes of hygiene status in the teaching environment among primary and secondary schools in Beijing City during 2016-2020, so as to provide basis for further improving the teaching environment and campus hygiene conditions in primary and secondary schools.@*Methods@#A proportional systematic sampling method covered over 50% of schools selected annually in Beijing from 2016 to 2019, and 34% were selected in 2020. Two representative classrooms were selected from each selected school for testing based on their structure and other factors, with 6 196 classrooms supervised, from 2016 to 2020,1 330,1 312,1 384,1 322,848 classrooms were monitored for each year.@*Results@#From 2016 to 2020, the overall lighting qualification rate of classrooms (lighting coefficient 72.8%, window to floor area ratio 41.8%, rear wall reflectance ratio 42.2%, blackboard reflection ratio 37.4%), the overall qualification rate of average blackboard illumination and uniformity (50.6%, 34.9 %), and the overall qualification rate of desk and chair allocation (58.6%) were all below 80%. The overall qualification rate of per capita classroom area (87.5%), blackboard size (83.2%), average desk illumination ( 80.1% ), average desk illumination and uniformity (82.9%), the distance between lamp and desk (99.1%), carbon dioxide ( 86.6% ), temperature (84.9%), and noise (96.6%) were all above 80%. The following indicators, blackboard size, the distance between lamp and desk, average blackboard illumination, lighting coefficient, blackboard reflectance, rear wall reflectance, carbon dioxide, temperature, and noise ( χ 2=78.38, 9.71, 11.76, 320.59, 37.63, 58.45, 236.45, 1 347.56, 101.97), had statistically significance between years. Among those indicators, the qualified rates of blackboard size, blackboard reflectance, lighting coefficient, and noise had been increasing year by year ( χ 2 trend =69.98, 15.82, 240.02, 5.77) ( P <0.05). The qualified rates of per capita classroom area, window to floor area ratio, and blackboard reflection ratio in primary schools (81.6%, 39.8%, 36.3%) were all lower than those in secondary schools (94.9%, 44.5%, 40.3%) ( χ 2=246.32, 12.03, 10.51, P <0.05). The qualified rates of blackboard size, average blackboard illumination, average blackboard illumination and uniformity, and desk and chair allocation (89.3%, 55.6% , 36.0%, and 60.2%) were all higher than those in secondary schools (75.4%, 44.1%, 33.3%, and 56.5%) ( χ 2=209.33, 78.41, 4.44, 8.22) ( P <0.05). The qualified rates of average desk illumination and uniformity, average blackboard illumination, rear wall reflectance ratio, desk and chair allocation, carbon dioxide, temperature, and noise indicators in urban area (82.9%, 84.1% , 51.9%, 45.0%, 60.9%, 91.2%, 89.5%, 97.8%) were all higher than those in suburban area (77.3%, 81.7%, 49.2%, 39.5%, 56.3%, 82.3%, 80.4%, 95.5%) ( χ 2=31.16, 6.28, 4.36, 16.40, 13.39, 105.29, 98.23, 24.66， P <0.05). The qualified rates of the distance between lamp and desk, lighting coefficient, window to floor area ratio, blackboard size, blackboard reflection ratio, average blackboard illumination and uniformity, and per capita classroom area in urban areas (98.8%, 65.2%, 34.3%, 76.7%, 35.9%, 30.1%, 84.6%) were all lower than those in suburban areas (99.4%, 81.4%, 49.8%, 89.7%, 40.2%, 39.6%, 90.3%) ( χ 2=6.80, 171.67, 132.43, 188.46 , 12.45, 60.28, 44.82) ( P <0.05).@*Conclusions@#The main problems in the teaching environment of schools in Beijing are classroom lighting, as well as desk and chair allocation. The findings suggest technical rationality and operability of relevant standard should be considered when under revision, and standard training and supervision management should be strengthened, with the aim of teaching environment improvement.

Continuous vital signs monitoring using wireless wearable devices in patients after video-assisted thoracoscopic surgery for lung cancer: A prospective self-control study / 中国胸心血管外科临床杂志

@#Objective To explore the reliability and safety of continuous monitoring of vital signs in patients using wireless wearable monitoring devices after video-assisted thoracoscopic surgery (VATS) for lung cancer. Methods The patients undergoing VATS for lung cancer in West China Hospital, Sichuan University from May to August 2023 were prospectively enrolled. Both wireless wearable and traditional wired devices were used to monitor the vital signs of patients after surgery. Spearman correlation analysis, paired sample t test and ratio Bland-Altman method were used to test the correlation, difference and consistency of monitoring data measured by the two devices. The effective monitoring rate of the wireless wearable device within 12 hours was calculated to test the reliability of its continuous monitoring. Results A total of 20 patients were enrolled, including 15 females and 5 males with an average age of 46.20±11.52 years. Data collected by the two monitoring devices were significantly correlated (P<0.001). Respiratory rate and blood oxygen saturation data collected by the two devices showed no statistical difference (P>0.05), while heart rate measured by wireless wearable device was slightly lower (=−0.307±1.073, P<0.001), and the blood pressure (=1.259±5.354, P<0.001) and body temperature(=0.115±0.231, P<0.001) were slightly higher. The mean ratios of heart rate, respiratory rate, blood oxygen saturation, blood pressure and body temperature collected by the two devices were 0.996, 1.004, 1.000, 1.014, and 1.003, respectively. The 95% limits of agreement (LoA) and 95% confidence interval of 95%LoA of each indicator were within the clinically acceptable limit. The effective monitoring rate of each vital signs within 12 hours was above 98%. Conclusion The wireless wearable device has a high accuracy and reliability for continuous monitoring vital signs of patients after VATS for lung cancer, which provides a security guarantee for subsequent large-scale clinical application and further research.

A practice case of monitoring waste resin clearance in a nuclear power plant / 中国辐射卫生

Objective To establishment a process of monitoring waste resin clearance in nuclear power plants, and to meet clearance requirements and simplify the monitoring work. Methods In accordance with the requirements specified in current laws, regulations, and standards in China, as well as the practice of slightly polluted waste resins generated during the operation of nuclear power plants, in-depth discussion was conducted on sampling methods, sample uniformity and representativeness tests, radiation monitoring contents and methods, and simplified monitoring processes, in order to accurately monitor the radionuclide activity of waste resins to be cleared. Results A process was established to monitor waste resin clearance in nuclear power plants. A total of 55 barrels of waste resins were cleared and the radiation levels met the requirements. Conclusion An effective clearance process can facilitate the sampling of representative resins, improve the accuracy of monitoring data, differentiate radioactive waste from cleared waste, and simplify the monitoring process. Our results provide a basis and reference for future waste resin clearance.

Development of an online radioactive xenon gas monitoring system for nuclear facilities / 中国辐射卫生

Objective Nowadays, radioactive xenon isotopes, including 131mXe, 133mXe, 133Xe, and 135Xe, are primarily released into the atmosphere through various reactor operation and major accidents of reactors. To improve the online monitoring capability of xenon in nuclear facilities and their gaseous effluents, a highly sensitive online xenon monitoring system was developed to monitor, warn, and alarm the activity concentration of radioactive xenon. Methods The online monitoring system for radioactive xenon gas in nuclear facilities was established using xenon membrane separation and concentration, xenon high-efficiency selective adsorption, and low-background gamma-ray spectrometry analysis methods. Results Under the operation mode of one-hour sampling and one-hour measuring, the minimum detectable activity concentration of the radioactive xenon online monitoring system for 133Xe was approximately (1.43 ± 0.03) Bq/m3. Conclusion This system can be effectively used for online monitoring of xenon activity concentration in nuclear facilities such as nuclear power plants and isotope production reactors, as well as in gaseous effluents. It helps improve the safety level of personnel, the environment, and nuclear facilities.

Blood concentration monitoring of tacrolimus in patients with nephrotic syndrome and establishment of MLP prediction model / 中国药房

OBJECTIVE To investigate the monitoring of tacrolimus blood concentration in patients with nephrotic syndrome （NS），and to establish a prediction model for tacrolimus blood concentration. METHODS Data from 509 concentration monitoring sessions of 166 NS patients using tacrolimus were collected from January 1， 2020 to August 31， 2023 in Zhongshan Hospital Affiliated to Xiamen University. The relationship of efficacy and adverse drug reaction（ADR） with blood concentration was analyzed. A multilayer perceptron （MLP） prediction model was established by using the blood concentration monitoring data of 302 times from 109 NS patients with genetic information， and then verified. RESULTS In terms of efficacy， the median blood concentration of tacrolimus in the non-remission group was 2.20 ng/mL， which was significantly lower than that in the partial remission group （4.00 ng/mL， P＜0.001） and the complete remission group （3.60 ng/mL， P＝0.002）. In terms of ADR， the median blood concentration of tacrolimus in the ADR group was 5.01 ng/mL， which was significantly higher than that in the non-ADR group （3.37 ng/mL） （P＝0.001）. According to the subgroup analysis of the receiver operating characteristic curve， when the blood concentration of tacrolimus was ≥6.65 ng/mL， patients were more likely to develop elevated blood creatinine [area under the curve （AUC） was 0.764， P＜0.001）； when the blood concentration of tacrolimus was ≥6.55 ng/mL， patients were more likely to develop blood glucose （AUC＝0.615， P＝ 0.005）. The established MLP prediction model has a loss function of 0.9， with an average absolute error of 0.279 5 ng/mL between the predicted and measured values. The determination coefficient of the validation scatter plot was 0.984， indicating an excellent predictive performance of the model. CONCLUSION Tacrolimus blood concentration has an impact on both efficacy and ADR in NS patients. The use of the MLP model for predicting blood concentration exhibits high accuracy with minimal error between predicted and measured values. The model can be used as an important tool in clinical individualized medication regimens.

Analysis of direct drinking water quality and its influencing factors in primary and secondary schools in Nanjing City / 中国学校卫生

Objective@#To investigate the quality and influencing factors of direct drinking water in schools in Nanjing City, so as to provide basis for management of school drinking water.@*Methods@#From April to July 2023, direct drinking water equipment from 146 primary and secondary schools were selected from Nanjing City using a stratified random sampling method and tested for colony forming units (CFU) and permanganate index. Mann-Whitney U test was used to compare the differences between groups, and multiple linear regression was used to analyze the influencing factors.@*Results@#The CFU and permanganate levels of school direct drinking water in Nanjing City were 1.00(0.00,15.50)CFU/mL and 0.47(0.26, 0.75)mg/L, respectively. The CFU level increased when the filter replacement time exceeded 3 months and when the water source was piped, while the permanganate index increased when the filter replacement time exceeded 3 months and using activated carbon technology ( Z =-2.21, -3.92, -2.31, -8.45 , P <0.05). The results of multiple linear regression analysis showed that the replacement time of filter element exceeding 3 months was positively correlated with the CFU level, and the process type involving activated carbon, a laid pipe network and a filter replacement time exceeding 3 months were positively correlated with the permanganate index( β =167.08, 0.32, 0.35, 0.11, P ＜0.05).@*Conclusions@#There are certain problems with the water quality of primary and secondary school direct drinking water in Nanjing City. Schools should promptly replace the filter and maintain the drinking water equipment to ensure the hygiene and safety of campus water quality.

Quality evaluation of Chinese and global guidelines/consensus for TDM of anti-TNF-α agents in patients with inflammatory bowel disease / 中国药房

OBJECTIVE To evaluate the quality of guidelines/consensus on therapeutic drug monitoring （TDM） of anti-tumor necrosis factor-α （TNF-α） in patients with inflammatory bowel disease （IBD） in China and globally. METHODS PubMed， Embase， CNKI， Wanfang data， VIP， and release websites of guidelines/consensus in China and globally were searched to collect guidelines/expert consensus on TDM with anti-TNF-α for IBD patients. The search period was from database establishment to June 2023. After two investigators independently screened the literature and extracted the data， the methodological quality of the included guidelines/consensuses was evaluated using the Appraisal of Guidelines for Research and Evaluation Ⅱ. The main recommendations of the included guidelines/consensuses were summarized. RESULTS A total of 9 articles were included， 3 were guidelines and 6 were expert consensus. The standardized percentages of the 9 guidelines/consensus in the 6 dimensions （scope and aims， participants， rigor of formulation， clarity of expression， application， and editorial independence） were 90.43%， 41.98%， 52.55%， 85.49%， 19.00%， and 76.85%， respectively. Eight guidelines/consensus had a recommendation of grade B and one consensus of grade C. The main recommendations involve TDM application scenarios， threshold ranges， strategy adjustments， detection methods， and interpretation of results. Most guidelines/consensus recommend passive TDM for non-responders. It is recommended to set the TDM concentration range according to the expected treatment results and make strategy adjustments in combination with the disease condition and TDM results. Additionally， the same test method is recommended for the same patient. Some guidelines/consensus hold that no differences were noted in the interpretation of results between biosimilar and original drug. CONCLUSIONS The overall quality of the included guidelines/consensus was fair， with relatively consistent recommendation. Clinicians need to understand the characteristics and limitations of TDM with this class of drugs， and interpret and apply results of TDM in combination with specific clinical treatment goals.

Long-term auditory monitoring in children with Alport syndrome based on different degrees of renal injury / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate long-term auditory changes and characteristics of Alport syndrome（AS） patients with different degrees of renal injury. Methods:Retrospectively analyzing clinical data of patients diagnosed AS from January 2007 to September 2022, including renal pathology, genetic detection and hearing examination. A long-term follow-up focusing on hearing and renal function was conducted. Results:This study included 70 AS patients, of which 33（25 males, 8 females, aged 3.4-27.8 years） were followed up, resulting in a loss rate of 52.9%.The follow-up period ranged from 1.1to 15.8 years, with 16 patients followed-up for over 10 years. During the follow-up, 10 patients presenting with hearing abnormalities at the time of diagnosis of AS had progressive hearing loss, and 3 patients with new hearing abnormalities were followed up, which appeared at 5-6 years of disease course. All of which were sensorineural deafness. While only 3 patients with hearing abnormalities among 13 patients received hearing aid intervention. Of these patients,7 developed end-stage renal disease（ESRD）, predominantly males （6/7）. The rate of long-term hearing loss was significantly different between ESRD group and non-ESRD group（P=0.013）. There was no correlation between the progression of renal disease and long-term hearing level（P>0.05）. kidney biopsies from 28 patients revealed varying degrees of podocyte lesion and uneven thickness of basement membrane. The severity of podocyte lesion was correlated with the rate of long-term hearing loss（P=0.048）, and there was no correlation with the severity of hearing loss（P>0.05）. Among 11 cases, theCOL4A5mutationwas most common （8 out of 11）, but there was no significant correlation between the mutation type and hearing phenotype（P>0.05）. Conclusion:AS patients exhibit progressive hearing loss with significant heterogeneity over the long-term.. THearing loss is more likely to occur 5-6 years into the disease course. Hearing abnormalities are closely related to renal disease status, kidney tissue pathology, and gene mutations, emphasizing the need for vigilant long-term hearing follow-up and early intervention.

Culturable microbiological profile of a non-sterile drugs pharmaceutical production environment

Abstract For places where non-sterile drug production occurs, regulatory bodies recommend monitoring of the environmental bioburden. This procedure provides information regarding possible microbiological risks to which the products may be exposed, so that subsequent action measures may be implemented. The aim of the present work was to quantify and characterize the microorganisms present in Grade D (ISO 8) cleanrooms of a Brazilian pharmaceutical industry, identifying any possible seasonal climatic influences on these environments. Sampling was performed by surface and air monitoring, over 12 months during the year 2019, in rooms that were in operation. For both sampling methods, no statistically significant differences in bacteria and fungi counts were found between months or seasonal periods. Microorganisms that presented higher incidence included Staphylococcus epidermidis (15%) and Micrococcus spp. (13%), common to the human microbiota, and the fungi Cladosporium sp. (23%) and Penicillium sp. (21%), typical of the external environment. The results showed that microbial contamination in the Grade D cleanrooms was within the permissible maximum levels and remained similar throughout the year. Microbiological quality control in the clean areas of the pharmaceutical industry investigated was considered effective, with regular maintenance being necessary to keep bioburden levels controlled.

Detection of arboviruses in Aedes aegypti through transovarian analysis: A study in Goiânia, Goiás

Abstract Background: Arboviral diseases are a group of infectious diseases caused by viruses transmitted by arthropods, mainly mosquitoes. These diseases, such as those caused by the dengue (DENV), Zika (ZIKV), chikungunya (CHIKV), and yellow fever (YFV) viruses, have a significant impact worldwide. In this context, entomological surveillance plays a crucial role in the control and prevention of arboviruses by providing essential information on the presence, distribution, and activity of vector mosquitoes. Based on entomological surveillance, transovarian transmission provides information regarding the maintenance and dissemination of arboviruses. The objective of this study was to detect these arboviruses in Goiânia, Goiás, and analyze the occurrence of transovarian transmission. Methods: Aedes aegypti eggs were collected from different regions of Goiânia and cultivated under controlled laboratory conditions until the emergence of adult mosquitoes. Adult females were grouped into pools containing their heads and thoraxes. These pools were subsequently evaluated using reverse-transcription quantitative polymerase chain reaction (RT-qPCR) assay. Results: A total of 157 pools (N=1570) were analyzed, with two pools testing positive for CHIKV and one pool testing positive for ZIKV, indicating that the offspring resulting from transovarian transmission are potentially infectious. Conclusions: In summary, the demonstration of the vertical transmission mechanisms of CHIKV and ZIKV in A. aegypti serves as an alert to health authorities, as these diseases are still underreported, and their primary urban vector has likely acquired this capacity, contributing to the dissemination of these infections.

Age as a predictive factor for reduced intracranial compliance in patients with headache / Idade como fator preditor de complacência intracraniana reduzida em pacientes com cefaleia

Abstract Background Increased intracranial pressure (ICP) consists of a set of signs and symptoms related to changes in intracranial compliance (ICC) and ICP. Objective This study presents a retrospective analysis of patients who underwent non-invasive monitoring of ICC based on complaints of headache, correlating decreased brain compliance and increased intracranial pressure. Methods Noninvasive ICC monitoring was performed using a Brain4care device, which contains a strain gauge and a recorder connected to a mechanical device that touches the scalp surface in the frontoparietal area lateral to the sagittal suture. This tool monitors the ICP by identifying small changes in skull measurements that are caused by pressure variations, i.e., skull deformation is associated with the detection of changes in mean ICP. A clinical evaluation of 32 patients with complaints of headache occurred from the analysis of their medical records. Results Of the 32 patients initially chosen, it was possible to complete the analysis of 18 due to the availability of data in the medical records. From the non-invasive monitoring of the ICC, the following data were collected: time-to-peak, P2/P1 ratio, age, and gender. From the statistical analysis of age and P2/P1 ratio, it was noted that as age increases, ICC tends to decrease regardless of sex (p < 0.05). Conclusion This study concluded that there is a correlation between changes in intracranial compliance and headache complaints in outpatients. There was also a relationship between age and decreased intracranial compliance but without a specific pain pattern.

Resumo Antecedentes O aumento da pressão intracraniana (PIC) consiste em um conjunto de sinais e sintomas relacionados a mudanças na complacência intracraniana (CIC) e na PIC. Objetivo Este estudo apresenta uma análise retrospectiva de pacientes que foram submetidos ao monitoramento não invasivo da CIC com base em queixas de cefaleia, correlacionando a diminuição da complacência cerebral e o aumento da pressão intracraniana. Métodos O monitoramento não invasivo da CIC foi realizado utilizando um dispositivo Brain4Care, que contém um medidor de tensão e um gravador conectado a um dispositivo mecânico que toca a superfície do couro cabeludo na área frontoparietal lateral à sutura sagital. Esta ferramenta monitora a PIC identificando pequenas alterações nas medidas do crânio que são causadas por variações de pressão, ou seja, a deformação do crânio está associada à detecção de alterações na PIC média. Uma avaliação clínica de 32 pacientes com queixas de cefaleia ocorreu a partir da análise de seus prontuários médicos. Resultados Dos 32 pacientes inicialmente escolhidos, foi possível concluir a análise de 18 devido à disponibilidade de dados nos prontuários médicos. A partir do monitoramento não invasivo da CIC, foram coletados os seguintes dados: time-to-peak, relação P2/P1, idade e sexo. Da análise estatística de idade e relação P2/P1, observou-se que à medida em que a idade aumenta, a CIC tende a diminuir independentemente do sexo (p < 0,05). Conclusão Este estudo concluiu que existe uma correlação entre as mudanças na CIC e a queixa de cefaleia em pacientes ambulatoriais. Houve também uma relação entre idade e diminuição da CIC, mas sem um padrão de dor específico.

Recognize the epidemiological and geospatial profile of the Mobile Emergency Care Service: a strategy to optimize response time

Epidemiological, cross-sectional, descriptive, retrospective study of a quantitative nature, to trace the epidemiological and geospatial profile of the occurrences assisted by the Mobile Emergency Care Service. For that purpose, secondary data from the documents of the Mobile Emergency Care Service of a city in the interior of Rio Grande do Norte were used, considering the frequency of the variables: sex, age group, nature of occurrences, days of the week, ambulance sent, removal inter-hospital care and patient destination. Of the 363 occurrences, most were due to clinical causes, followed by traumatic, psychiatric, and gynecological/obstetric causes, with an emphasis on cardiovascular diseases and transport accidents. aged 19 to 59 years and over 60 years, with the Basic Support Unit providing the majority of care. Among the calls for clinical causes, women stood out, while for traumatic and psychiatric causes, men. The information contributes to the organization and planning of the service and the understanding of the morbidity profile. The geographic distribution highlights the need for integration between health agencies, for the institution of preventive actions, and the redirection of human and financial resources.

Estudio epidemiológico, transversal, descriptivo, retrospectivo, de carácter cuantitativo que tiene como objetivo trazar el perfil epidemiológico y geoespacial de los incidentes atendidos por el Servicio Móvil de Atención de Urgencias. Para ello se utilizan datos secundarios de dos documentos del Servicio Móvil de Atención de Emergencias de un municipio del interior de Rio Grande do Norte; considera la frecuencia de las variables: sexo, edad, naturaleza de los eventos, días de la semana, ambulancia enviada, retiro interhospitalario y destino del paciente. De los 363 sucesos, la mayoría se debió a causas clínicas, seguidas de causas traumáticas, psiquiátricas y ginecológicas/obstétricas, incluidas las enfermedades cardiovasculares y los accidentes de transporte. La frecuencia de ocurrencia fue ligeramente mayor en individuos masculinos con predominio de mujeres y edades entre los 19 y 59 años y mayores de 60 años; la Unidad Básica de Apoyo fue la responsable de la mayoría de los servicios. Entre los lesionados por causas clínicas destacan las mujeres, mientras que los hombres tienen causas traumáticas y psiquiátricas. Esta información contribuye a la organización y planificación de los servicios y a la comprensión del perfil de morbilidad. La distribución geográfica resalta la necesidad de integración entre las organizaciones de salud para implementar acciones preventivas y redireccionar recursos humanos y financieros.