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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.
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ABSTRACT Objective: To draw an epidemiological and occupational profile of eye trauma at a Brazilian referral center, make comparisons with the literature and provide subsidies for the adoption of adequate prevention and enforcement measures. Methods: Descriptive and prospective epidemiological study using a standardized questionnaire to collect data from 60 patients presenting with eye trauma at an ophthalmology service (HUCAM) between 1 april 2013 and 1 october 2013. Results: The male gender was predominant (80%). Ages ranged from 8 to 60 years. Most accidents (56.7%) occurred in the workplace, followed by the home (28.3%). Most injuries were closed, predominantly contusions, followed by foreign body on the external eye. Importantly, 82.9% of the victims of work-related trauma wore no eye protection at the time of the accident. Conclusions: Eye trauma in the workplace and elsewhere is an important problem of public health as it affects primarily the economically active population and may have serious consequences. A considerable proportion of eye trauma is easily avoidable by using personal protective equipment. To minimize the incidence of eye trauma, more attention should be given to instruction in and enforcement of the use of such equipment, supported by frequent prevention campaigns.
RESUMO Objetivo: Caracterizar os aspectos trabalhistas e epidemiológicos regionais envolvidos no trauma ocular, comparar os dados obtidos com os já publicados na literatura e fornecer subsídios para a elaboração de medidas de prevenção e fiscalização adequadas. Metodologia: Estudo epidemiológico, descritivo, prospectivo, realizado no serviço de Oftalmologia do HUCAM, em 60 pacientes com trauma ocular, no período de 01 de abril a 01 de outubro de 2013, quando foram colhidos dados, por meio de questionário padronizado. Resultados: Houve predomínio de indivíduos do sexo masculino (80%) e em sua maioria os pacientes tinham idades que variavam entre 8 e 60 anos. Predominaram os acidentes no ambiente de trabalho (56,7%) seguido dos acidentes domiciliares (28,3%). A maioria dos traumas foi do tipo fechado, com predomínio das contusões seguidas pelo corpo estranho na superfície ocular. Observou-se também que 82,9% dos pacientes que tiveram o trauma no ambiente de trabalho não usavam o equipamento de proteção individual. Conclusões: Trauma ocular é um importante problema de saúde pública, pois acomete principalmente a população economicamente ativa e pode ter graves consequências. Grande parte destes acidentes poderiam ser facilmente preveni-da através do uso apropriado de equipamentos de proteção individual. Desta forma, orientação, fiscalização para o fornecimento e uso dos EPIs e campanhas de prevenção são importantes para redução desses acidentes.