Methodology for the Development of Clinical Practice Guidelines for Chinese Patent Medicine （Part 6）： Formation and Presentation of Recommendations / 中医杂志

Recommendation formation is a key component of clinical practice guidelines for Chinese patent medicine （CPM）， and should encompass the determination of the strength and direction of the recommendation， the rationale for the recommendation， and the methodology for implementing the recommendation. Recommendations can be formed through formal consensus and informal consensus. The strength and direction of recommendations for CPM guidelines should be determined by considering the quality of evidence for CPMs， the priority of the clinical questions， the pros and cons of efficacy and adverse effects， patient acceptance， the feasibility of the recommendation and the availability of resources， social fairness， economic benefits， and other influencing factors. In order to better guide guideline developers to consider these factors more rationally， this article provideed a detailed explanation of each factor in the context of the characteristics of TCM.

Recommendations for Publishing Clinical Cases

The importance of publishing clinical cases lies in the diagnostic or therapeutic developments they can contribute. This paper mainly aims to guide young doctors in writing and publishing a clinical case. Reflections are encouraged on choosing a clinical case and writing it sharply, briefly, and chronologically to improve the chances of acceptance and publication. Recommendations on how to use the CARE (Case Report Statement and Checklist) are also given.

La importancia de la publicación de los casos clínicos radica en las novedades diagnósticas o terapéuticas que el mismo pueda aportar. Este trabajo está dirigido principalmente a los médicos jóvenes con la finalidad de orientarlos en el proceso de la redacción y publicación de un caso clínico. Se plantean reflexiones sobre cómo escoger un caso clínico, como redactarlo de una forma cronológica clara, nítida y breve, para mejorar las posibilidades de que sea aceptado y publicado. También se dan recomendaciones acerca de cómo utilizar la lista de comprobación CARE (Declaración y Lista de Comprobación-Case Report).

Marcadores bioquímicos propuestos para el estudio de la sarcopenia / Proposed biochemical markers for the study of sarcopenia

La sarcopenia asociada a la edad es una condición clínica caracterizada por una disminución en la fuerza, calidad y cantidad de masa muscular así como también en la función muscular. Un biomarcador se define como una característica que es medible objetivamente y evaluable como indicador de un proceso biológico normal, patológico o respuesta terapéutica a una intervención farmacológica. Los marcadores bioquímicos propuestos para el estudio de la sarcopenia pueden ser categorizados en dos grupos. El primero de ellos evalúa el estatus musculoesquelético; este panel de marcadores está formado por miostatina/folistatina, procolágeno aminoterminal tipo III e índice de sarcopenia. El segundo grupo de marcadores bioquímicos evalúa factores causales, para lo cual se sugiere medir el factor de crecimiento insulino-símil tipo 1 (IGF-1), dehidroepiandrosterona (DHEAS), cortisol, facto-res inflamatorios [proteína C reactiva (PCR), interleuquina 6 (IL-6) y factor de necrosis tu-moral (TNF-a)]. Las recomendaciones realiza-das están basadas en la evidencia científica disponible en la actualidad y la disponibilidad de la metodología apropiada para cada uno de los biomarcadores. (AU)

Sarcopenia is a progressive and generalized skeletal muscle disorder defined by decrease in the strength, quality and quantity of muscle mass as well as in muscle function. A biomarker is defined as a feature objectively measured and evaluated as an indicator of a normal biologic process, a pathogenic process or a pharmacologic response to therapeutic intervention. The biochemical markers proposed for the study of sarcopenia may be classified in two groups. The first group evaluates the musculoskeletal status, made up by myostatin/follistatin, N-terminal Type III Procollagen and the sarcopenia index. The second evaluates causal factors, where the measurement of the following is suggested: hormones insulin-like growth factor-1 (IGF-I), dehydroepiandrosterone sulphate (DHEAS), cortisol, inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-a (TNF-a)]. The recommendations made are based on scientific evidence currently available and the appropriate methodology availability for each biomarker. (AU)

Formulación de conclusiones de investigación

Este artículo trata sobre la metodología de formulación de las conclusiones de una investigación. De forma inicial, se distingue y descarta que los comentarios, las síntesis de resultados, la reiteración de datos y la descripción de las actividades realizadas no son propiamente conclusiones de una investigación. En segundo lugar, se define lo que constituyen las conclusiones, las condiciones, las actividades de formulación y la estructura que se sigue en su exposición. También se sugieren las actividades de evaluación de la investigación, así como la forma y los aspectos sobre los cuales realizar las recomendaciones respectivas en torno al estudio realizado.

This article deals with the methodology for formulating the conclusions of an investigation. Initially, it is distinguished and ruled out that the comments, the synthesis of results, the reiteration of data and the description of the activities carried out are not properly conclusions of an investigation. Secondly, it defines what constitutes the conclusions, the conditions, the formulation activities and the structure that is followed in their presentation. Research evaluation activities are also suggested, as well as the form and aspects on which to make the respective recommendations regarding the study carried out.

Este artigo trata da metodologia para formular as conclusões de uma investigação. Inicialmente, distingue-se e exclui-se que os comentários, a síntese de resultados, a reiteração de dados e a descrição das atividades realizadas não sejam propriamente conclusões de uma investigação. Em segundo lugar, define o que constituem as conclusões, as condições, as atividades de formulação e a estrutura que se segue na sua apresentação. São também sugeridas actividades de avaliação da investigação, bem como a forma e os aspectos sobre os quais fazer as respectivas recomendações relativamente ao estudo realizado.

Opiniones y recomendaciones de la Sociedad Argentina de Diabetes. Hemoglobina A1c / Opinions and recommendations of the Argentine Diabetes Society. Hemoglobin A1c

La estandarización de la hemoglobina A1c (HbA1c) permitió en algunos países su uso para el diagnóstico de la diabetes mellitus (DM) y la prediabetes, además de su empleo en el seguimiento del paciente con DM. Es importante recordar que se trata de una medida indirecta del promedio glucémico durante el tiempo de vida media del eritrocito, pudiendo verse afectada por variables no glucémicas, como también por interferencias analíticas según la metodología empleada para su determinación. A continuación, se describen las recomendaciones y consideraciones a tener en cuenta para la determinación de la HbA1c cuando se emplea como criterio diagnóstico de la DM, teniendo en cuenta que al utilizarla para tal fin es necesario que la medida se realice con métodos certificados y estandarizados al ensayo utilizado en el Diabetes Control and Complications Trial (DCCT).

The standardization of hemoglobin A1c (HbA1c) allowed in some countries its use for the diagnosis of diabetes mellitus (DM) and prediabetes, in addition to its use in the follow-up of patients with DM. It is important to highlight that it is an indirect measurement of the glycemic average during the halflife of the erythrocyte, and may be affected by non-glycemic variables, as well as by analytical interferences depending on the methodology used for its determination. The recommendations and considerations to take into account for the determination of HbA1c when it is used as a diagnostic criterion for diabetes are described below. In addition, it is important to emphasize that it is essential that the HbA1c measurement be performed with certified and standardized methods to the Diabetes Control and Complications Trial (DCCT)results.

Opiniones y recomendaciones de la Sociedad Argentina de Diabetes. Glucemia en ayunas alterada: ¿es oportuno utilizar el punto de corte en 100 mg/dl en Argentina? / Opinions and recommendations of the Argentine Diabetes Society. Impaired fasting blood glucose: is it appropriate to use a cut-off point of 100 mg/dl in Argentina?

Establecer el punto de corte entre la glucemia en ayunas normal y la alterada resulta de suma importancia a los efectos de considerar a un paciente en riesgo, tanto de progresar a estdos más avanzados de la enfermedad como de sufrir complicaciones micro y macroangiopáticas. Desde 2006 la Sociedad Argentina de Diabetes (SAD), sobre la base de la evidencia considerada en ese momento, estableció el límite inferior de la glucemia alterada en ayunas (GAA) en 110 mg/dl; posteriormente, durante 2022, la Comisión Directiva de la SAD convocó a un grupo de expertos con el objeto de evaluar si esta recomendación debía mantenerse o, al igual que otras sociedades científicas de prestigio, adoptar a tal efecto 100 mg/dl. En este documento de Opiniones y Recomendaciones se encuentran los fundamentos por los cuales la SAD adoptará, de ahora en más, 100 mg/dl como límite inferior de la GAA, en base a las nuevas evidencias científicas que muestran que desde este punto de corte se produce un aumento en la progresión a la diabetes mellitus y de las complicaciones tanto macro como microangiopáticas.

To establish the cut-off point between normal and impaired fasting glycemia (IFG) is extremely important for the purposes of considering a patient at risk both of progressing to more advanced stages of the disease and of suffering micro- and macroangiopathic complications. Since 2006, the Argentine Diabetes Society (ADS), based on the evidence considered at that time, established the lower limit of IFG at 110 mg/d, laterduring the year 2022, The Board of Directors of the ADS vened a group of experts in order to assess whether this recommendation should be maintained or, like other prestigious scientific societies, adopt 100 mg/dl for this purpose. This Opinions and Recommendations document contains therationale for which the SAD will adopt, from now on, 100 mg/dlas the lower limit of the IFG, based on the new scientific edence that shows that from this cut-off point it produces increase in progression to diabetes and both macro and microangiopathic complications.

Investigation and analysis of late reporting and under-reporting of occupational diseases from 2018 to 2020 in China / 中华劳动卫生职业病杂志

Objective: To understand the late reporting and the under-reporting of occupational disease from 2018 to 2020 in China and analyze the causes, so as to provide scientific evidence for improving the quality of occupational disease reports in China, timely acquiring the incidence of occupational disease, and assessing the occupational hazards. Methods: From May to December 2021, A total of 320 occupational disease diagnostic institutions were selected for investigation. The original documents of occupational disease diagnosis cases from 2018 to 2020 were compared with the online reported cases, and late reported and under-reported cases of occupational disease were analyzed. Results: A total of 32207 diagnosed cases from 2018 to 2020 were investigated, including 28934 confirmed cases and 3273 cases without occupational disease. The overall late reported rate and under-reported rate of confirmed cases were 20.2% and 2.1%, respectively. There were significant differences in the rate of late reporting and under-reporting of occupational diseases in different regions and different types of diagnostic institutions (P<0.001). The southwest region had the highest rates of late reporting and under-reporting, 61.6% and 7.9% respectively. The late reported rate of all kinds of occupational diseases was about 15.0%, and the under-reported rate was from 1.5.0% to 5.0%. Conclusion: At present, the phenomenon of late reporting and under-reporting occupational diseases is still obvious. It is necessary to strengthen the inspection of occupational disease reporting, improve the quality of occupational disease reporting, and provide scientific basis for the formulation of occupational disease prevention and control policies.

Re-evaluation of systematic reviews of acupuncture and moxibustion for childhood autism / 中国针灸

OBJECTIVE@#To re-evaluate the systematic review/Meta-analysis of acupuncture and moxibustion for childhood autism (CA), aiming to provide decision-making basis for clinical diagnosis and treatment.@*METHODS@#The systematic review and/or Meta-analysis of acupuncture and moxibustion for CA were searched in PubMed, EMbase, Cochrane Library, SinoMed, CNKI and Wanfang databases. The retrieval time was from the database establishment to May 5th, 2022. PRISMA (preferred reporting items for systematic reviews and Meta-analyses) was used to evaluate the report quality, and AMSTAR 2 (a measurement tool to assess systematic reviews 2) was used to evaluate the methodological quality, bubble map was used to construct the evidence map and GRADE was used to evaluate the quality of evidence.@*RESULTS@#A total of 9 systematic reviews were included. The PRISMA scores ranged from 13 to 26. The report quality was low, and there was a serious lack in the aspects of program and registration, search, other analysis and funding. The main problems in methodology included not making prespecified protocol, incomplete retrieval strategy, not providing a list of excluded literatures, and incomplete explanation on heterogeneity analysis and bias risk. The evidence map showed that 6 conclusions were valid, 2 conclusions were possible valid and 1 conclusion was uncertain valid. The overall quality of evidence was low, and the main factors leading to the downgrade were limitations, followed by inconsistency, imprecision and publication bias.@*CONCLUSION@#Acupuncture and moxibustion has a certain effect for CA, but the quality of reporting, methodology and evidence in included literature need to be improved. It is suggested to perform high-quality and standardized research in the future to provide evidence-based basis.

Radiation therapy amidst the COVID-19 pandemic in the Philippines: When guidelines are not enough

Background@#To respond to the pandemic, many societies, including the American Society for Radiation Therapy (ASTRO), the United Kingdom’s National Institute for Health and Care Excellence (NICE), and the Philippine Radiation Oncology Society (PROS), recommended guidelines to allow for continued safe delivery of oncologic services. Yet, the delivery of radiotherapy during the COVID-19 pandemic remains a challenge.@*Objective@#To describe the situation of radiotherapy delivery in Metro Manila (NCR) during the COVID-19-related quarantine. Specifically, the objectives were to determine: (1) how the radiotherapy providers implemented the recommended changes, (2) if these implemented changes allowed the hospitals to operate with pre-COVID capacities, and (3) the causative factors of treatment interruptions if these were present. Additionally, in the face of treatment interruptions, the authors sought to put forth recommendations to decrease treatment interruptions.@*Methods@#Investigators gathered data on the prevailing situation of RT services in their respective institutions during the strictest period of quarantine — Enhanced Community Quarantine (ECQ). Patients aged 18-70 years old who missed at least one fraction during the ECQ from March 16 – April 15, 2020, were invited to participate in a phone survey to determine factors contributing to treatment interruptions.@*Results@#All the institutions implemented global recommendations to adapt to the pandemic, including infection control measures, telemedicine, and modification of RT plans. Despite this, most institutions had increased treatment interruptions during ECQ. The percentage of patients with interruptions was also much higher during the ECQ (66.37%) than during the pre-COVID month (30.56%). Among 142 patients unable to continue treatment, there were no significant differences in demographic variable and oncologic profile rates. The majority were more worried about getting COVID-19 than missing RT. The most common factor for treatment interruptions was transportation, followed by fear of getting COVID-19.@*Conclusion@#Compliance with global recommendations is not enough to ensure that the patients who require radiotherapy will receive it. Based on institutional and patient results, the causative factors of interruptions included suspension of services, lack of transportation, and anxiety of patients and staff. Especially in low-resource settings, recommendations are to use available resources as efficiently as possible by having an organized referral system, providing transportation or nearby accommodation for patients and staff, and communicating effectively to reassure patients that radiotherapy can be continued safely.

Diagnosis and treatment recommendations of dialysis patients with SARS-CoV-2 infection for primary care clinicians / 西安交通大学学报(医学版)

End-stage renal disease (ESRD) patients undergoing outpatient hemodialysis (HD) and home peritoneal dialysis (PD) are high risk population of severe and critical types caused by SARS-CoV-2 infection. In order to improve the quality of diagnosis and treatment in dialysis patients with SARS-CoV-2 infection, we wrote this recommendation for primary care clinicians. During the epidemic period of SARS-CoV-2 infection, all patients should be instructed to strengthen self-management. Once the SARS-CoV-2 infection was found in dialysis patients, early stratified management should be carried out within 72 hours after the first positive nucleic acid or antigen test results, which includes early antiviral therapy, early recognition, and transferring severe patients from community or primary hospital to a referral hospital promptly. Guidance for dietary and sports rehabilitation after SARS-CoV-2 infection should also be started as soon as possible.

Ethical challenges faced by community mental health workers in urban Chennai

Background: Delivery of mental health interventions to youth in schools requires a cadre of community mental health workers (CMHWs) in addition to psychiatrists. Literature is sparse in the India context on the ethical and professional challenges faced by CMHWs, especially those working with youth. Hence, the aim of the study was to understand these challenges faced by CMHWs working in schools in urban Chennai and explore ways to overcome them. Methods: A qualitative study was done with CMHWs involved in the delivery of youth mental health (YMH) interventions, including mental health literacy, screening for mental disorders and mental health support to youth in schools in urban Chennai. Focus group discussions (FGDs) were conducted with the study participants and audio recorded. Transcription of the recording was done verbatim and coded for themes using a thematic analysis approach. Results: Two FGDs were conducted with a total of eight participants. The mean (± standard deviation) age of the participants was 27 ± 3.7 years; all having a master’s degree in either psychology, social work, or public health. The major themes that emerged were the meaning of ethics and professionalism, confidentiality, dilemma in decision making, incongruence between the requirements of student and school administration, and personal and professional challenges faced by CMHWs. Recommendations to overcome these challenges were also explored. Conclusion: The results indicate CMHWs face significant ethical challenges with confidentiality, and decision making while delivering YMH interventions in schools, highlighting the need for designing and implementing a framework to address these challenges.

Manifestaciones orales de la viruela símica y recomendaciones para su prevención en la práctica odontológica / Oral manifestations of monkeypox and recommendations for its prevention in dental practice

El brote reciente de viruela símica ha despertado el interés de la comunidad internacional por su creciente número de contagiados en países no endémicos. Entre sus síntomas se encuentran la fiebre, dolor de cabeza, fatiga, dolor muscular, exantema y linfadenoma. La cavidad bucal es el lugar en el que suelen aparecer los primeros signos de la enfermedad. Por tanto, el objetivo de este trabajo fue establecer las principales manifestaciones orales de la viruela del mono y enumerar algunas recomendaciones de prevención. Para ello, se hizo una revisión bibliográfica entre 2012 y 2022 en la base de datos PubMed, usando las palabras clave, en inglés, monkeypox, oral manifestation y transmission. Se garantizó que, de los 14 documentos seleccionados, al menos el 80%, fueran publicaron en 2022. Las manifestaciones orales más frecuentes fueron: úlcera eritematosa, vesículas-ulcerosas y las asociadas a linfadenopatía (disfagia, odinofagia y faringitis). Entre las recomendaciones se encuentran: uso de mascarilla N95 y visores faciales, lavado constante de manos y espacios y atención de contagiados solo por eventos agudos (urgencias). Aunque no se ha confirmado, es posible que el Tecovirimat sea de ayuda en pacientes con sintomatología grave. Se concluye que es necesario que los odontólogos sepan distinguir los signos orales de la enfermedad para que contribuyan a cortar la cadena de contagio y deriven prontamente a los sospechosos para que se hagan las pruebas diagnósticas y las terapias medicamentosas de manera oportuna(AU)

The recent outbreak of monkeypox has aroused the interest of the international community due to its growing number of infections in non-endemic countries. Its symptoms include fever, headache, fatigue, muscle pain, rash, and lymphadenoma. The oral cavity is the place where the first signs of the disease usually appear. Therefore, the objective of this work was to establish the main oral manifestations of monkeypox and list some prevention recommendations. For this, a bibliographic review was carried out between 2012 and 2022 in the PubMed database, using the keywords, in English, monkeypox, oral manifestation and transmission. It was guaranteed that, of the 14 selected documents, at least 80% would be published in 2022. The most frequent oral manifestations were: erythematous ulcer, ulcer-vesicles and those associated with lymphadenopathy (dysphagia, odynophagia and pharyngitis). Among the recommendations are: use of N95 mask and face visors, constant washing of hands and spaces, and attention to those infected only due to acute events (emergencies). Although it has not been confirmed, it is possible that Tecovirimat is helpful in patients with severe symptoms. It is concluded that it is necessary for dentists to know how to distinguish the oral signs of the disease so that they contribute to breaking the chain of contagion and promptly refer suspects to diagnostic tests and drug therapies in a timely manner(AU)

El buceo recreativo y la otorrinolaringología: ¿qué sabemos y deberíamos saber? / Recreational diving and otolaryngology: what do we know and should we know?

El buceo recreativo es una práctica cada vez más popular en la población mundial, sin embargo, no está exenta de riesgos. A medida que transcurre una inmersión, el buzo es susceptible a una serie de cambios de presión que afectan las distintas cavidades que contienen aire dentro del cuerpo humano, tales como el oído, cavidades paranasales y los pulmones. Existe un gran espectro de patologías asociadas al buceo, explicándose la mayoría de ellas por el barotrauma asociado, cuya gravedad depende de la magnitud del daño asociado, pudiendo presentar desde manifestaciones a nivel local, así como también a nivel sistémico. Las patologías otológicas suelen ser las más frecuentes y el principal motivo de consulta en este tipo de pacientes. Sin embargo, las afecciones otoneurológicas, rinosinusales, de vía aérea y sistémicas pueden ser comunes dependiendo de cada perfil de buceo. Actualmente no existen recomendaciones locales sobre esta práctica, por lo que el conocimiento de la fisiología, fisiopatología y el tratamiento de las patologías otorrinolaringológicas asociadas deben ser conocidas a medida que este deporte se vuelve cada vez más popular. Se realizó una revisión de la literatura sobre las distintas afecciones otorrinolaringológicas con el fin de sistematizarlas y elaborar recomendaciones para establecer una práctica segura.

Recreational diving is an increasingly popular practice in the world; however, it is not without risks. As a dive progresses, the diver is susceptible to a series of pressure changes that affect the air-containing cavities, such as the ear, paranasal cavities, and lungs. There is a large spectrum of pathologies associated with diving, most of them being explained by associated barotrauma, the severity of which depends on the magnitude of the associated damage, could present local manifestations, as well as at systemic level. Otological pathologies are usually the most frequent and the main reason for consultation in this type of patients, however, otoneurological, rhinosinusal, airway and systemic conditions can be common depending on each diving profile. Currently there are no local recommendations on this practice, therefore, knowledge of the physiology, pathophysiology and treatment of associated otorhinolaryngological pathologies should be known as this sport becomes increasingly popular. A review of the literature on the different ear, nose and throat conditions was carried out in order to systematize them and develop recommendations to establish a safe practice.

Guía de práctica clínica de tratamiento de la polineuropatía amiloidótica familiar / Practice guideline for the treatment of familial amyloid polyneuropathy

Resumen Esta guía de práctica clínica de tratamiento de la polineuropatía amiloidótica familiar se basa en la mejor evidencia disponible de efectividad clínica. Se generó un listado de preguntas con formato PICO centradas en efectividad y seguridad del tratamiento de polineuropatía amiloidótica familiar. Se realizó la búsqueda en PubMed, Cochrane y Epistemonikos. Los niveles de evidencia y los grados de recomendación se basaron en el sistema GRADE. Las recomendaciones se graduaron según dirección y fuerza y se evaluaron con la herramienta GLIA para su implementación. Resumen de recomendaciones: En pacientes con polineuropatía amiloidótica familiar y neuropatía estadio I y II, se sugiere el tratamiento con inotersen 300 mg subcutáneo semanal o patisirán 0.3 mg/kg endovenoso una vez cada 3 semanas, dado que, probablemente, estabilicen o enlentezcan el avance de la neuropatía y el empeoramiento de la calidad de vida (calidad de la evidencia moderada; fuerza de la recomendación débil). En pacientes con polineruropatía amiloidótica familiar y neuropatía estadio I, se sugiere el tratamiento con tafamidis 20 mg vía oral, una vez por día, ya que podría enlentecer el avance de la neuropatía y el empeoramiento en la calidad de vida (calidad de la evidencia baja; fuerza de la recomendación débil), y aquellos con polineuropatía amiloidótica familiar y neuropatía sintomática y en ausencia de otros tratamientos con eficacia aprobada, se sugiere el tratamiento con diflunisal 250 mg dos veces al día, vía oral, ya que podría evitar la progresión de la neuropatía (calidad de la evidencia baja; fuerza de la recomendación débil).

Abstract. This clinical practice guideline for the treatment of familial amyloid polyneuropathy is based on the best available evi dence of clinical effectiveness. A list of questions was generated with a PICO format focused on the effectiveness and safety of the treatment of familial amyloid polyneuropathy. The search was carried out in PubMed, Cochrane and Epistemonikos. The levels of evidence and grades of recommendation were based on the GRADE system. Recommendations were graded according to their direction and their strength and were evaluated with the GLIA tool for their implementation. In patients with familial amyloid polyneuropathy and stage I and II neuropathy, it is suggested: inotersen 300 mg subcutaneous weekly or patisirán 0.3 mg/kg intravenously once every 3 weeks, since they probably stabilize or slow the progression of neuropathy and worsening quality of life (moderate qual ity of evidence; strength of recommendation weak). In patients with familial amyloid polyneuropathy and stage I neuropathy, treatment with tafamidis 20 mg orally, once a day, is suggested, as it could slow the progression of neuropathy and worsen quality of life (low quality of evidence; strength of recommendation weak). In patients with familial amyloid polyneuropathy and symptomatic neuropathy and in the absence of other treatments with approved efficacy, treatment with oral diflunisal 250 mg twice daily is suggested, as it could prevent the progres sion of neuropathy (quality evidence low; strength of recommendation weak).

Effective recommendations towards healthy routines to preserve mental health during the COVID-19 pandemic

Objective: To assess the adherence to a set of evidence-based recommendations to support mental health during the coronavirus disease 2019 (COVID-19) pandemic and its association with depressive and anxiety symptoms. Methods: A team of health workers and researchers prepared the recommendations, formatted into three volumes (1: COVID-19 prevention; 2: Healthy habits; 3: Biological clock and sleep). Participants were randomized to receive only Volume 1 (control), Volumes 1 and 2, Volumes 1 and 3, or all volumes. We used a convenience sample of Portuguese-speaking participants over age 18 years. An online survey consisting of sociodemographic and behavioral questionnaires and mental health instruments (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 [GAD-7]) was administered. At 14 and 28 days later, participants were invited to complete follow-up surveys, which also included questions regarding adherence to the recommendations. A total of 409 participants completed the study - mostly young adult women holding university degrees. Results: The set of recommendations contained in Volumes 2 and 3 was effective in protecting mental health, as suggested by significant associations of adherence with PHQ-9 and GAD-7 scores (reflecting anxiety and depression symptoms, respectively). Conclusion: The recommendations developed in this study could be useful to prevent negative mental health effects in the context of the pandemic and beyond.

Recomendaciones de manejo de los anticoagulantes orales directos (DOACs) anti Xa y anti IIa / Recommendations for the practical management of the direct oral anticoagulants anti Xa and anti IIa

Resumen Los anticoagulantes orales directos han surgido como una de las herramientas que ha cambiado el manejo de la enfermedad trombótica en los últimos 15 años. Sus ventajas, desde el punto de vista de la facilidad de uso y menor riesgo de sangrado, especialmente de sangrado cerebral, han posicionado a estos nuevos anticoagulantes como la primera alternativa de tratamiento en las dos indicaciones más frecuentes en que necesitamos estas drogas, la fibrilación auricular y la enfermedad tromboembólica venosa. Sin embargo, no todos los pacientes pueden recibir estos agentes, no todos los anticoagulantes directos tienen las mismas pro piedades y fundamentalmente, no todas las enfermedades con indicación de un anticoagulante pueden tratarse con ellos;con lo cual es necesario que todos los profesionales que están involucrados en el manejo de estos medicamentos estén obligados a conocerlos en profundidad, para poder decidir el mejor tratamiento en cada caso particular. Este documento de posición de expertos de diferentes especialidades de Argentina, presenta lineamientos para el uso correcto de los anticoagulantes directos en base a nueva evidencia y a la experiencia de uso de un amplio grupo de profesionales. La forma de relacionarnos con el tratamiento anticoagulante ha cambiado. Los médicos que trabajamos con ellos también debemos hacerlo.

Abstract Direct oral anticoagulants have emerged as the drugs that have changed the man agement of the antithrombotic treatment in the last 15 years. Their advantages, like a more friendly way of anticoagulation and their lower risk of bleeding, especially in the brain, have positioned these new anticoagu lants as the first drug of choice in the two most frequent indications of anticoagulation, atrial fibrillation, and the venous thromboembolic disease. However, not all the patients can receive these agents, not all the direct oral anticoagulants have the same characteristics, and most importantly, not all the diseases with an indication of an anticoagulant drug can be treated with them. Therefore, it is mandatory that all the faculties involved in the management of these drugs must know them in depth, to decide the best treatment for the patient. This position paper, from a group of experts in anticoagulation in Argentina, can help the general practitioner in the daily use of direct oral anticoagulants based on the new evidence and the experience of a wide group of professionals. The way we relate to the anticoagulant treatment has changed in the last years. The doctors who work with them must also do so.

Legal acceptance of LGBT in India: Review on its implications on having equal opportunities, family acceptance and better mental health.

LGBT individuals experience higher rates of mental health disorders than their heterosexual peers. Family affirmative environment will lead to better mental health. The decriminalizing of colonial-era section 377 has given huge hope to this minority community. Future challenges still remain a question mark. But leap towards change has been initiated. Family acceptance will start from sensitizing the general population after legal reinforcement in various areas. The aim of this study is to explore strategies and programs to promote equal opportunity for LGBT youth. To review the role of family environment and functioning (family cohesion, family expressiveness, family conflict) of LGBT youth and their mental health.

Indian Academy of Pediatrics Revised (2021) Guidelines on Prevention and Treatment of Vitamin D Deficiency and Rickets

Justification: The emerging literature on prevalence of vitamin D deficiency in India, prevention and treatment strategies of rickets, and extra-skeletal benefits of vitamin D suggest the need for revising the existing guidelines for prevention and treatment of vitamin D deficiency in India. Objectives: To review the emerging literature on vitamin D prevalence and need for universal vitamin D supplementation. To suggest optimum vitamin D therapy for treatment of asymptomatic and symptomatic vitamin D deficiency, and rickets. To evaluate the extra-skeletal health benefits of vitamin D in children. Process: A National consultative committee was formed that comprised of clinicians, epidemiologists, endocrinologists, and nutritionists. The Committee conducted deliberations on different aspects of vitamin D deficiency and rickets through ten online meetings between March and September, 2021. A draft guideline was formulated, which was reviewed and approved by all Committee members. Recommendations: The group reiterates the serum 25- hydroxy vitamin D cutoffs proposed for vitamin D deficiency, insufficiency, and sufficiency as <12 ng/mL, 12-20 ng/mL and >20 ng/mL, respectively. Vitamin D toxicity is defined as serum 25OHD >100 ng/mL with hypercalcemia and/or hypercalciuria. Vitamin D supplementation in doses of 400 IU/day is recommended during infancy; however, the estimated average requirement in older children and adolescents (400-600 IU/day) should be met from diet and natural sources like sunlight. Rickets and vitamin D deficiency should be treated with oral cholecalciferol, preferably in a daily dosing schedule (2000 IU below 1 year of age and 3000 IU in older children) for 12 weeks. If compliance to daily dosing cannot be ensured, intermittent regimens may be prescribed for children above 6 months of age. Universal vitamin D supplementation is not recommended in childhood pneumonia, diarrhea, tuberculosis, HIV and non-infectious conditions like asthma, atopic dermatitis, and developmental disorders. Serum 25-hydroxy vitamin D level of >20 ng/mL should be maintained in children with conditions at high-risk for vitamin deficiency, like nephrotic syndrome, chronic liver disease, chronic renal failure, and intake of anticonvulsants or glucocorticoids.

Bringing the Treatment of Atopic Eczema Into a New Era with Janus Kinase Inhibitors: A Position Statement By the Persatuan Dermatologi Malaysia

Abstract@#Atopic eczema (AE) is a complex, chronic and recurrent inflammatory pruritic skin condition that impacts the quality of life and exerts an economic toll on patients and their families. One of the factors contributing to AE is the immune dysregulation of the Janus kinase-signal transducers and activators of transcription (JAK-STAT) inflammatory pathway. This has prompted the conduct of various large clinical trial programs to evaluate the efficacy and safety of Janus kinase inhibitors (JAK-i) for AE. The overall and significant benefit of these drugs from clinical studies resulted in regulatory approvals for JAK-i to treat moderate-to-severe atopic eczema. The objective of this position paper was to evaluate the safety, efficacy and role of upadacitinib, baricitinib and abrocitinib in managing AE and update the current recommended treatment algorithm within the 2018 Malaysian Clinical Practice Guidelines for the Management of Atopic Eczema. The Persatuan Dermatologi Malaysia recommends that these JAK-i can be considered as an option for systemic therapy in severe AE.

Avaliação do consumo de frutas em pacientes com diabetes mellitus tipo 2 / Fruit consumption in patients with type 2 diabetes mellitus

Introdução: O impacto do consumo de frutas sobre a saúde de pacientes com diabetes mellitus tipo 2 (DM2) requer investigações. O objetivo deste estudo foi avaliar o consumo de frutas em pacientes com DM2 e identificar a sua associação com parâmetros de controle glicêmico.Métodos: Foram incluídos 197 pacientes ambulatoriais com DM2, submetidos à avaliação clínica, sociodemográfica, antropométrica, laboratorial e de consumo alimentar. A ingestão alimentar total e o consumo de frutas foram avaliados por questionário quantitativo de frequência alimentar. Os pacientes com menor e maior consumo de frutas (de acordo com a mediana) foram comparados.Resultados: A média do consumo de frutas foi de 593,66 ± 330,74 g/dia. Entre os menores e maiores consumidores de frutas, os valores de glicemia (169,42 ± 70,83 vs. 158,62 ± 64,56 mg/dL; p = 0,273) e hemoglobina glicada (8,39 ± 1,68 vs. 8,68 ± 2,38%; p = 0,319) não foram diferentes, assim como as demais variáveis. Os pacientes com maior consumo de frutas apresentaram maior ingestão de energia (p < 0,001), carboidratos (p < 0,001) e fibras (p = 0,006) e uma menor ingestão de proteínas (p = 0,015), lipídeos totais (p = 0,040) e seus tipos. O grupo que mais consumiu frutas apresentou uma maior ingestão de vitamina C (p < 0,001) e potássio (p < 0,001) e um menor consumo de sódio (p = 0,001). Foi observado ainda uma correlação negativa entre o consumo de frutas e o índice glicêmico da dieta (p = 0,05).Conclusão: Não houve diferença na glicemia em jejum e no valor de hemoglobina glicada entre os pacientes com DM2 com maior e menor consumo de frutas.

Introduction: The impact of fruit consumption on the health of patients with type 2 diabetes mellitus (T2DM) warrants investigation. The aim of this study was to evaluate fruit consumption in patients with T2DM and to identify its association with glycemic control parameters.Methods: We included 197 outpatients with T2DM who underwent clinical, sociodemographic, anthropometric, laboratory, and food consumption assessments. A food frequency questionnaire was used to assess total food intake and fruit consumption. Patients with lower and higher fruit consumption (according to the median) were compared.Results: Average fruit consumption was 593.66 ± 330.74 g/day. Blood glucose (169.42 ± 70.83 vs. 158.62 ± 64.56 mg/dL; p = 0.273) and glycated hemoglobin (8.39 ± 1.68% vs. 8.68 ± 2.38%; p = 0.319) levels did not differ between the lower and higher fruit consumption groups, nor did the other variables. Patients with higher fruit consumption had a higher intake of energy (p < 0.001), carbohydrates (p < 0.001), and fibers (p = 0.006) but a lower intake of proteins (p = 0.015) and total and different types of lipids (p = 0.040). The higher consumption group had higher vitamin C (p < 0.001) and potassium (p < 0.001) intake and lower sodium intake (p = 0.001). We identified a negative correlation between fruit consumption and the diet's glycemic index (p = 0.05).Conclusion: Fasting blood glucose and glycated hemoglobin levels did not differ between the higher and lower fruit consumption groups.