Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines

Background: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, see Supplementary data) concluded the following: Results: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50–200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 9

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, volumen 9, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada de acceso abierto a todas las áreas del conocimiento, que cuenta con el esfuerzo de investigadores de varios países del mundo, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico que consoliden la transformación del conocimiento en diferentes escenarios, tanto organizacionales como universitarios, para el desarrollo de habilidades cognitivas del quehacer diario. La gestión del conocimiento es un camino para consolidar una plataforma en las empresas públicas o privadas, entidades educativas, organizaciones no gubernamentales, ya sea generando políticas para todas las jerarquías o un modelo de gestión para la administración, donde es fundamental articular el conocimiento, los trabajadores, directivos, el espacio de trabajo, hacia la creación de ambientes propicios para el desarrollo integral de las instituciones

Ten millennia of hepatitis B virus evolution

Hepatitis B virus (HBV) has been infecting humans for millennia and remains a global health problem, but its past diversity and dispersal routes are largely unknown. We generated HBV genomic data from 137 Eurasians and Native Americans dated between ~10,500 and ~400 years ago. We date the most recent common ancestor of all HBV lineages to between ~20,000 and 12,000 years ago, with the virus present in European and South American hunter-gatherers during the early Holocene. After the European Neolithic transition, Mesolithic HBV strains were replaced by a lineage likely disseminated by early farmers that prevailed throughout western Eurasia for ~4000 years, declining around the end of the 2nd millennium BCE. The only remnant of this prehistoric HBV diversity is the rare genotype G, which appears to have reemerged during the HIV pandemic

The impact of surgery on mortality and morbidity in patients with severe acute pancreatitis and intra-abdominal hypertension

Objectives: To determine the impact of surgery in mortality and morbidity in patients with severe acute pancreatitis (SAP) and intra-abdominal hypertension (IAH) or low abdominal perfusion pressure (APP). Materials and methods: We performed a case-control study of adult patients who presented with SAP and IAH or low APP defined as APP < 60 mmHg at the intensive care unit (ICU) of a tertiary care center. We evaluated the effect of surgery on mortality, morbidity, hospital and ICU length of stay. Results: We found 48 patients with IAH and 35 patients with low APP. We found no association with mortality. In the subgroup with IAH we found an association of protection for organ failure (adjusted OR = 0.17 [95% CI 0.41–0.69], p = 0.014), respiratory failure (adjusted OR = 0.15 [95% CI 0.04–0.62], p = 0.008) and renal failure (adjusted OR = 0.02 [95% CI 0.00–0.24], p = 0.002), and in the subgroup with low APP an association of protection for kidney failure (OR = 0.06 [95% CI 0.00–0.64], p = 0.012). In both subgroups, hospital and ICU length of stay were increased (p < 0.01). Conclusions: In patients with SAP, surgery seems protective for respiratory and kidney failures in the subgroup with IAH and for kidney failure in the subgroup with low APP, nonetheless, it increases hospital and ICU length of stay

The impact of surgery on mortality and morbidity in patients with severe acute pancreatitis and intra-abdominal hypertension

Objectives: To determine the impact of surgery in mortality and morbidity in patients with severe acute pancreatitis (SAP) and intra-abdominal hypertension (IAH) or low abdominal perfusion pressure (APP). Materials and methods: We performed a case-control study of adult patients who presented with SAP and IAH or low APP defined as APP < 60 mmHg at the intensive care unit (ICU) of a tertiary care center. We evaluated the effect of surgery on mortality, morbidity, hospital and ICU length of stay. Results: We found 48 patients with IAH and 35 patients with low APP. We found no association with mortality. In the subgroup with IAH we found an association of protection for organ failure (adjusted OR = 0.17 [95% CI 0.41–0.69], p = 0.014), respiratory failure (adjusted OR = 0.15 [95% CI 0.04–0.62], p = 0.008) and renal failure (adjusted OR = 0.02 [95% CI 0.00–0.24], p = 0.002), and in the subgroup with low APP an association of protection for kidney failure (OR = 0.06 [95% CI 0.00–0.64], p = 0.012). In both subgroups, hospital and ICU length of stay were increased (p < 0.01). Conclusions: In patients with SAP, surgery seems protective for respiratory and kidney failures in the subgroup with IAH and for kidney failure in the subgroup with low APP, nonetheless, it increases hospital and ICU length of stay

An Uncommon Case of Bilateral Breast Enlargement Diagnosed as Tumoral Pseudoangiomatous Stromal Hyperplasia: Imaging and Pathological Findings

The incidence of reported pseudoangiomatous stromal hyperplasia (PASH), as well as the variability and severity of clinical presentations, is increasing in the literature. In parallel, several authors posit the need for an improved classification of PASH to avoid possible variables associated with this diagnosis. Here, we present a 25-year-old woman with PASH accompanied by severe bilateral and symmetrical breasts enlargement, highlighting an uncommon clinical presentation of PASH as much as the careful interdisciplinary review and correlation of histology and all available imaging studies to confirm the definitive diagnosis

Integrative metabolomics science in Alzheimer's disease: Relevance and future perspectives

Alzheimer's disease (AD) is determined by various pathophysiological mechanisms starting 10-25 years before the onset of clinical symptoms. As multiple functionally interconnected molecular/cellular pathways appear disrupted in AD, the exploitation of high-throughput unbiased omics sciences is critical to elucidating the precise pathogenesis of AD. Among different omics, metabolomics is a fast-growing discipline allowing for the simultaneous detection and quantification of hundreds/thousands of perturbed metabolites in tissues or biofluids, reproducing the fluctuations of multiple networks affected by a disease. Here, we seek to critically depict the main metabolomics methodologies with the aim of identifying new potential AD biomarkers and further elucidating AD pathophysiological mechanisms. From a systems biology perspective, as metabolic alterations can occur before the development of clinical signs, metabolomics - coupled with existing accessible biomarkers used for AD screening and diagnosis - can support early disease diagnosis and help develop individualized treatment plans. Presently, the majority of metabolomic analyses emphasized that lipid metabolism is the most consistently altered pathway in AD pathogenesis. The possibility that metabolomics may reveal crucial steps in AD pathogenesis is undermined by the difficulty in discriminating between the causal or epiphenomenal or compensatory nature of metabolic findings

Las nuevas tecnologías en educación : el diseño asistido por ordenador : propuestas educativas para el alumnado de la ESO

Se analiza el papel de las nuevas tecnologías en el ámbito de la educación, mostrando sus ventajas, inconvenientes y sus diferentes aplicaciones. Se hace una revisión de las diferentes herramientas didácticas basadas en las nuevas tecnologías y se lleva a cabo un estudio sobre el diseño asistido por ordenador, los tipos de software que asisten a dicho diseño y su aplicación en la educación. Finalmente, se proponen unas actividades prácticas para que el alumno de educación secundaria adquiera las competencias básicas en cuanto a tratamiento de la información y a competencia digital.AndalucíaBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]

Entrapment Efficiency (EE) and Release Mechanism of Rhodamine B Encapsulated in a Mixture of Chia Seed Mucilage and Sodium Alginate

Chia seed mucilage is a polysaccharide capable of forming hydrogels with excellent water-binding capacity due to its physical and chemical properties and favorable characteristics for encapsulating and protecting valuable hydrophilic molecules in the food, pharmaceutical, and cosmetic industries. This research aimed to show that mixtures of chia seed mucilage and sodium alginate used as wall materials to encapsulate hydrophilic molecules are suitable. We analyzed the relationship between the mucilage–alginate solution’s properties and the capsules obtained; we quantified the entrapment efficiency (EE%) and the release of rhodamine B; and we proposed a method to follow the rhodamine B release using confocal laser scanning microscopy (CLSM). We found that more viscous solutions are obtained when the mucilage concentration increases, making it difficult to produce capsules with less sphericity. The best entrapment efficiency was found when the proportion of the polymers was close to 1:1, based both on the properties of the capsules obtained and on the characterization of the release kinetics of rhodamine B; the analysis performed by fitting rhodamine B release data to theoretical models describe the diffusion process. Our results show that the use of chia seed mucilage as a wall material to trap and retain hydrophilic molecules is convenient