Adherence to Mediterranean diet associated with health-related quality of life in children and adolescents: a systematic review

Abstract Background: Health-related quality of life (HRQoL) has become a signifcant outcome in assessing interventions in the pediatric population and could be infuenced by diet patterns. The Mediterranean diet (MD) pattern has been related to multiple positive health outcomes, including decreased cardiovascular risk and better mental health. We aimed to evaluate the association between MD adherence and HRQoL in children and adolescents. Methods: The literature search was conducted in PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Ovid-MEDLINE databases from inception to May 2022. Two researchers independently checked titles and abstracts, evaluated full-text studies, extracted data, and appraised the risk of bias using the Newcastle–Ottawa Scale (NOS). Results: Eleven studies (1 longitudinal and 10 cross-sectional), totaling 6,796 subjects, were included. Ten studies assessed MD adherence with KIDMED index, and one assessed MD adherence with Krece Plus test, while all included studies assessed HRQoL with a KIDSCREEN test. All studies analyzed the association between MD adherence and HRQoL with linear regression, and eight used adjusted models. Five studies found a signifcant positive association of MD adherence with HRQoL, with β-values ranging from 0.13 to 0.26. Two found a nonsignifcant positive relationship, while one found a negative association. According to the NOS criteria, the risk of bias assessment showed four studies with a low risk of bias and seven with a high risk of bias. Conclusion: Our fndings suggest a positive correlation of MD adherence with HRQoL in children and adolescents. However, future research is needed to strengthen the evidence of this relationshi

Medicina humana espacial: Performance fisiológico y contramedidas para mejorar la salud del astronauta: Human space medicine: Physiological performance and countermeasures to improve the astronaut's health

This Review Article is presented based on current scientific evidence on space medicine focused on human physiology and its countermeasures. Therefore, a non-systematic bibliographic search of scientific articles and research books in English-Spanish of the last 7 years was carried out, detailing their application in humans, murine models and in vitro experiments. The conditions of the space environment such as microgravity and radiation that produce considerable physiological changes in the cardiovascular system (redistribution of fluids, cardiovascular remodeling, arrhythmias) were taken into account; nervous (sensorimotor, neurosensory, neurovestibular); respiratory (volume and capacity changes); renal (lithiasis); musculoskeletal (muscular atrophy, osteoporosis); hematological (anemia); immunological (immune dysregulation) and digestive (intestinal microbiota disorder). In addition, there are biological, molecular and genetic processes still to be explored, in order to know and mitigate the uncertain mechanisms triggered in extreme and dangerous environments. Therefore, it is a priority to develop and implement countermeasures to reduce the harmful effects on health, with the aim of guaranteeing the astronaut's adaptation, safety and performance during future space flights.Se presenta este Artículo de Revisión con base en la evidencia científica actual sobre medicina espacial enfocada en fisiología humana y sus contramedidas. Por lo cual se realizó una búsqueda bibliográfica no sistemática de artículos científicos y libros de investigación en inglés-español de los últimos 7 años, que detallan su aplicación en seres humanos, modelos murinos y experimentos in vitro. Se tomaron en cuenta las condiciones del ambiente espacial como microgravedad y radiación que producen considerables cambios fisiológicos en el sistema cardiovascular (redistribución de líquidos, remodelación cardiovascular, arritmias); nervioso (sensitivomotores, neurosensoriales, neurovestibulares); respiratorio (cambios de volúmenes y capacidades); renal (litiasis); musculo-esquelético (atrofia muscular, osteoporosis); hematológico (anemia); inmunológico (desregulación inmune) y digestivo (alteración de la microbiota intestinal). Además, existen procesos biológicos, moleculares y genéticos aún por explorar, para conocer y mitigar los mecanismos inciertos desencadenados en ambientes extremos y peligrosos. Por lo tanto, es una prioridad desarrollar e implementar contramedidas para reducir los efectos nocivos en la salud, con el objetivo de garantizar la adaptación, seguridad y performance del astronauta durante futuros viajes espaciales

Guía de práctica clínica para el tratamiento farmacológico inicial de nefritis lúpica en el Seguro Social del Perú (EsSalud)

Background: This article summarizes the clinical practice guideline (CPG) for the initial pharmacological treatment of lupus nephritis in the Social Security of Peru (EsSalud). Objective: To provide evidence-based clinical recommendations for initial pharmacological treatment of non-refractory adults with class I to V lupus nephritis in EsSalud. Material and Methods: A guideline development group (GDG) was formed, which included specialist physicians and methodologists, who formulated clinical questions. Systematic searches were conducted for systematic reviews and - when deemed relevant - primary studies in PubMed during 2021. Evidence was selected to answer each of the clinical questions posed. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic working meetings, the GEG used the GRADE methodology to review the evidence and formulate recommendations. The CPG was reviewed by external experts before its approval. Results: The CPG addressed 6 clinical questions, divided into 2 topics: initial treatment of the induction and maintenance phase. Based on these questions, 11 recommendations were formulated (all conditional), 22 points of good clinical practice, and 2 flow charts. Conclusion: Evidence-based recommendations were issued for the management of patients with this pathology.Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el tratamiento farmacológico inicial nefritis lúpica en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para tratamiento farmacológico inicial de adultos con nefritis lúpica clase I a V no refractarios en EsSalud. Material y Métodos: Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos, el cual formuló preguntas clínicas. Se realizaron búsquedas sistemáticas de revisiones sistemáticas y –cuando fue considerado pertinente– estudios primarios en PubMed durante el 2021. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas. Se evaluó la certeza de evidencia usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones. La GPC fue revisada por expertos externos antes de su aprobación. Resultados: La GPC abordó 6 preguntas clínicas, divididas en 2 temas: tratamiento inicial de la fase de inducción y mantenimiento. En base a dichas preguntas se formularon 11 recomendaciones (todas condicionales), 22 puntos de buena práctica clínica, y 2 flujogramas. Conclusión: Se emitieron recomendaciones basadas en evidencia para el manejo de pacientes con esta patología