Avaliação in silico da afinidade de drogas ao receptor TRPA1 como preditor para o manejo farmacológico da sensibilidade provocada pelo clareamento dentário / In silico assessment of drug affinity to the TRPA1 receptor as a predictor for the pharmacological management of sensitivity caused by tooth whitening

Introdução: Reduzir a sensibilidade do clareamento dental em consultório representa um desafio para os profissionais. Pesquisadores associaram o bloqueio do receptor de dor TRPA1 com a redução da sensibilidade ao clareamento. No entanto, a afinidade química dos analgésicos/anti-inflamatórios para o TRPA1 ainda precisa ser averiguada. Objetivo: Realizar uma triagem virtual de múltiplos medicamentos (analgésicos e antiinflamatórios) para verificar a afinidade química pelo receptor TRPA1. Metodologia: A estrutura cristalina das proteínas do receptor TRPA1 foi recuperada do Protein Data Bank. Os códigos SMILES dos ligantes foram extraídos do PubChem. A energia de ligação do complexo foi obtida em ∆G - kcal/mol pelo AutoDock Vina© e replicada nos servidores SwissDock©, Dockthor© e CbDock©. LigPlus© confirmou os sítios de ligação. Resultados: Apesar dos antagonistas dos receptores analisados apresentarem alta afinidade, codeína e dexametasona apresentaram regularidade em todos os servidores, mesmo apresentando valores de energia de ligação de -7,9 kcal/mol para codeína e -8,1 kcal/mol para dexametasona. Conclusão: A codeína e a dexametasona podem ser drogas potenciais para controlar a sensibilidade ao clareamento dental caso atinjam o receptor TRPA1 da polpa dentária (AU).

Introduction: Reducing in-office tooth bleaching sensitivity represents a challenge for professionals. Researchers have associated the block of the pain receptor TRPA1 with reducing bleaching sensitivity. However, the chemical affinity of analgesic/antiinflammatory drugs to the TRPA1 needs to be verified. Objective: To perform a virtual screening of multiple drugs (analgesic and anti-inflammatory drugs) to verify chemical affinity for the TRPA1 receptor. Methodology: The crystal structure of the TRPA1 receptor proteins was retrieved from the Protein Data Bank. The SMILES codes of the ligands were extracted from PubChem. The binding energy of the complex was obtained in ∆G - kcal/mol by AutoDock Vina© and replicated in the webservers SwissDock©, Dockthor©, and CbDock©. LigPlus© confirmed the binding sites. Results: Although the receptor antagonists analyzed showed high affinity, codeine and dexamethasone showed regularity among all servers, even showing binding energy values of -7.9 kcal/mol for codeine and -8.1 kcal/mol for dexamethasone. Conclusion: Codeine and dexamethasone may be potential drugs to manage tooth bleaching sensitivity if they reach the dental pulp TRPA1 receptor (AU).

Evaluation on the application effect of comprehensive management model for pulmonary tuberculosis patients / 公共卫生与预防医学

Objective To evaluate and analyze the feasibility and application effect of “DOTS + WeChat” in the treatment and management of tuberculosis patients. Methods From 2018 to 2019, a total of 2 420 active pulmonary tuberculosis patients were registered in Zibo City, and 1 988 patients meeting the inclusion criteria were selected as the research subjects. 836 patients were randomly enrolled under the “DOTS + WeChat” integrated management mode, while the other 1152 cases were treated with single DOTS management mode. The regular medication status, treatment and outcome, and core knowledge awareness of the two groups were analyzed by SPSS16.0 software, χ2- test and t- test methods. Result The “DOTS + WeChat” comprehensive management group had higher a regular medication rate (98.80%), coincidence rate of sputum test times (95.81%), and success rate of treatment (98.68%) than the single DOTS management group (92.10%, 90.19%, and 96.53%) (P=0.000, 0.000, 0.003). The rate of medical staff participating in supervision and management in the comprehensive management group (100%) was higher than that in the single management group (75.87%) (P=0.000). The complete follow-up rate in the consolidation period (100%) and the complete whole course follow-up rate (99.76%) were both higher than those in the single management group (P=0.000, 0.001). The awareness level of core knowledge in the comprehensive management group (78.58±4.32) was higher than that in the single management group (70.70±8.02) (P=0.000). Conclusion The application of WeChat management mode has a positive effect on the treatment and management of tuberculosis patients in Zibo City. It is a feasible and effective supplement and improvement to the current tuberculosis control and management measures, which is worthy of further promotion and exploration.

Safety protocol on medication prescription, use and administration: mapping of nursing interventions / Protocolo de seguridad para la prescripción, el uso y la administración de medicamentos: mapeo de intervenciones de enfermería / Protocolo de segurança na prescrição, uso e administração de medicamentos: mapeamento de intervenções de enfermagem

ABSTRACT Objective: to analyze the correspondence between actions contemplated in the safety protocol on medication prescription, use and administration of the Ministry of Health with interventions of the Nursing Interventions Classification, by means of cross-mapping. Method: a descriptive study developed in four stages: extraction of the protocol's Nursing actions; identification of the interventions of the Nursing Interventions Classification; cross-mapping; and cross-mapping validation by experts. Results: 61 actions of the protocol and 32 interventions of the Nursing Interventions Classification were identified. After two rounds of mapping analysis by the experts, correspondence was identified between 53 actions and seven interventions. The interventions that presented the highest correspondence were the following: Medication Administration, Medication Management and Medication Prescription. Of the 53 mapped actions of the protocol, 56,6% were considered more detailed and specific than the activities of the interventions, 20,8% were classified as similar in meaning, 17,0% as broader and general, and 5,7% were only mapped with the title and definition of the intervention. Conclusion: the mapped actions of the protocol were considered more detailed and specific in relation to the activities of the interventions of the Nursing Interventions Classification. The unmapped interventions can contribute to elaborating operational protocols that expand the Nursing actions related to the mitigation of medication errors.

RESUMEN Objetivo: analizar la correspondencia entre las acciones contempladas en el protocolo de seguridad para la prescripción, el uso y la administración de medicamentos del Ministerio de la Salud y las intervenciones de la Clasificación de Intervenciones de Enfermería, por medio de la técnica de mapo cruzado. Método: estudio descriptivo desarrollado en cuatro etapas: extracción de las acciones de Enfermería del protocolo; identificación de las intervenciones de la Clasificación de Intervenciones de Enfermería; mapeo cruzado; y validación del mapeo cruzado a cargo de expertos. Resultados: se identificaron 61 acciones del protocolo y 32 intervenciones de la Clasificación de Intervenciones de Enfermería. Después de dos rondas de análisis del mapo a cargo de los expertos, se identificó correspondencia entre 53 acciones y siete intervenciones. Las intervenciones que presentaron mayor correspondencia fueron las siguientes: administración de medicamentos, control de medicamentos y prescripción de medicamentos. De las 53 acciones del protocolo mapeadas, se consideró que el 56,6% eran más detalladas y específicas que las actividades de las intervenciones, el 20,8% fueron clasificadas como similares en relación al significado, el 17,0% como más amplias y generales y el 5,7% se mapearon solamente con el título y la definición de la intervención. Conclusión: se consideró que las acciones del protocolo mapeadas eran más detalladas y específicas en relación con las actividades de las intervenciones de la Clasificación de Intervenciones de Enfermería. Las intervenciones no mapeadas pueden ser útiles para elaborar protocolos operativos que amplíen las acciones de Enfermería relacionadas a la mitigación de errores de medicación.

RESUMO Objetivo: analisar a correspondência entre ações contempladas no protocolo de segurança na prescrição, uso e administração de medicamentos do Ministério da Saúde com intervenções da Classificação de Intervenções de Enfermagem, por meio do mapeamento cruzado. Método: estudo descritivo desenvolvido em quatro etapas: extração das ações de enfermagem do protocolo; identificação das intervenções da Classificação de Intervenções de Enfermagem; mapeamento cruzado; e validação do mapeamento cruzado por peritos. Resultados: foram identificadas 61 ações do protocolo e 32 intervenções da Classificação de Intervenções de Enfermagem. Após duas rodadas de análise do mapeamento pelos peritos, identificou-se correspondência de 53 ações com sete intervenções. As intervenções que apresentaram maior correspondência foram: administração de medicamentos, controle de medicamentos e prescrição de medicamentos. Das 53 ações do protocolo mapeadas, 56,6% foram consideradas mais detalhadas e específicas do que as atividades das intervenções, 20,8% foram classificadas como similares em significado, 17,0% como mais amplas e gerais e 5,7% foram mapeadas apenas com o título e definição da intervenção. Conclusão: as ações do protocolo mapeadas foram consideradas mais detalhadas e específicas em relação às atividades das intervenções da Classificação de Intervenções de Enfermagem. As intervenções não mapeadas podem contribuir para a construção de protocolos operacionais que ampliem as ações de enfermagem relacionadas à mitigação de erros de medicação.

Analysis of MDR-TB Treatment Management and ADR in Our Hospital / 中国药房

OBJECTIVE:To provide reference for rational use of antituberculosis drugs and reduce the occurrence of ADR in multiple-drug resistance tuberculosis (MDR-TB) patients.METHODS:TB inpatients were selected from our hospital during Feb.2012-May 2015,and then divided into suspected MDR-TB group (202 cases) and diagnosed MDR-TB group (162 cases).According to the patient's condition,different treatment management modes were chosen,and the incidence of ADR were observed.Treatment and management period of 2 groups were 18 months.RESULTS:In suspected MDR-TB group,the drug resistance rates to first line drugs were greater than or equal to 26.24％,among which drug resistance rates to isoniazid and rifampicin were about 40％.Resistance rates to second line-drugs were greater than or equal to 4.95％,among which resistance rate to protionamide was the highest,being 46.04％.The results of drug sensitivity tests showed that 44.06％ of patients were sensitive to all first-line drugs,14.36％ of patients were resistant to single drug,9.90％ of patients were usually resistant to drugs and 31.68％ of patients were resistant to multiple drugs.21.78％ of patients were sensitive to all first-line drugs and second-line drugs,24.75％ of patients were resistant to single drug,17.82％ of patients were usually resistant to drugs,32.67％ of patients were resistant to multiple drugs and 2.97％ of patients were extensively resistant to drugs.In the management plan of MDR-TB patients therapy,56.17％ were treated in tuberculosis control institutions;referral to special hospital for treatment accounted for 14.81％;22.22％ didn't receive any treatment;other factors lead to a change in treatment or unable to continue to treat accounted for 6.79％.The incidence of ADR in MDR-TB patients was higher than suspected MDR-TB patients,there was statistical significance between 2 groups (P＜0.05).After the following symptomatic treatment,all patients were improved.CONCLUSIONS:For patients with MDR-TB,according to disease condition,appropriate treatment management program can be found so as to improve therapeutic efficacy,reduce the incidence of ADR,control spreading and development of tubercle bacillus.

Sufficient explanation of management affects patient satisfaction and the practice of post-treatment management in spinal pain, a multicenter study of 1007 patients

BACKGROUND: Spinal pain is most common symptom in pain clinic. In most cases, before the treatment of spinal pain, physician explains the patient's disease and treatment. We investigated patient's satisfaction and physician's explanation related to treatments in spinal pain patients by questionnaires. METHODS: Anonymous questionnaires about physician's explanation and patient's satisfaction in each treatment and post-treatment management were asked to individuals suffering from spinal pain. Patients who have spinal pain were participated in our survey of nationwide university hospitals in Korea. The relationships between patient's satisfaction and other factors were analyzed. RESULTS: Between June 2016 and August 2016, 1007 patients in 37 university hospitals completed the questionnaire. In the statistical analysis, patient's satisfaction of treatment increased when pain severity was low or received sufficient preceding explanation about nerve block and medication (P < 0.01). Sufficient explanation increased patient's necessity of a post-treatment management and patients' performance rate of post-treatment management (P < 0.01). CONCLUSIONS: These results show that sufficient explanation increased patients' satisfaction after nerve block and medication. Sufficient explanation also increased the practice of patients' post-treatment management.

Caracterização do entendimento sobre técnicas de adminsitração de medicamentos inalatórios por pacientes do Programa da Asma de um Centro de Saúde em Porto Alegre, Brasil / Characterization of the understanding of inhaler technique by patients attending the Asthma Program at a Health Centre in Porto Alegre, Brazil

Este estudo teve por objetivo descrever o entendimento do tratamento e memorização da técnica de administração dos medicamentos inalatórios dos pacientes cadastrados no Programa de Asma de um Centro de Saúde em Porto Alegre/RS. Trata-se de um estudo transversal, realizado em duas etapas, na Farmácia Distrital de um Centro de Saúde em Porto Alegre/RS. Foram coletadas informações sobre os pacientes a partir do cadastro do Programa de Asma, do prontuário e do registro de dispensação de medicamentos da Farmácia. Para identificar possíveis problemas na utilização de medicamentos usados no tratamento da asma, foi realizada uma entrevista com 83 pacientes ou cuidadores. Nas entrevistas, 36,1% não descreveram corretamente a técnica de uso do inalatório; 13,3% consideram que o broncodilatador de curta ação é o medicamento de prevenção e usam a beclometasona nos momentos de crise. A baixa escolaridade esteve significativamente relacionada ao não cumprimento da posologia (p = 0,009). Os dados sugerem dificuldades relacionadas à identificação dos medicamentos e à técnica de administração, evidenciando a necessidade da equipe de saúde fornecer orientações complementares que auxiliem os pacientes no automanejo da doença.

The aim of this study was to describe the level of understanding of the treatment and memorization of the medication inhaling technique among patients registered with the Asthma Program at a Health Center in Porto Alegre (RS, Brazil). This cross-sectional study was carried out in two stages, in a pharmacy of the public health system in the city of Porto Alegre. Patients’ data were collected from the Asthma Program register, medical records and a spreadsheet program for the dispensing of inhaled medications. To identify potential problems in the use of medicines to treat asthma, we interviewed 83 patients or caregivers. Of the interviewees, 36.1% did not correctly describe the technique for inhaling medication and 13.3% thought that short-acting bronchodilator medication is used for prevention and used beclomethasone in times of crisis. The low educational level was significantly related to non-compliance with correct dosage (p = 0.009). The data suggest difficulties in identification of drugs and inhaler technique, highlighting a need for the healthcare team to provide further guidance to assist patients in self-management of the disease.

Shock in children

Shock, a major cause of morbidity and mortality in children, is the the most anxiety-provoking emergency that needs to be addressed urgently and effectively by the attending paediatrician. It is a state where the metabolic demands of the tissue are not met due to circulatory dysfunction. Unlike adults, hypotension is a very late feature of shock in children. As the child’s condition worsens, the clinical presentation of the different causes of shock become similar, and nullify any aetiological differences. Regardless of the type of shock, the final common pathway is inadequate tissue perfusion and oxygen supply to meet cellular demands. Delayed recognition and treatment result in progression from compensated reversible shock to uncompensated irreversible shock with widespread multiple system organ failure to death. This paper reviews the physiological basis, and pathophysiological classification of the various types of shock and their respective aetiologies. The clinical features of the different types of shock are described, and current diagnostic and therapeutic strategies are applied for the most effective and appropriate treatment for resuscitating the child in shock. A strong index of suspicion, early recognition, timely intervention and transfer to an intensive care unit are critical for successful outcomes in the management of paediatric shock.