Elevated serum IL-6 levels predict treatment interruption in patients with moderate to severe psoriasis: a 6-year real-world cohort study

Abstract Background: Real-world, primary data on the treatment of psoriasis are scarce, especially concerning the role of soluble biomarkers as outcome predictors. Objective: The authors evaluated the utility of Th1/Th17 serum cytokines along with clinical characteristics as predictors of drug survival in the treatment of psoriasis. Methods: The authors consecutively included participants with moderate to severe psoriasis who were followed up for 6 years. Baseline interferon-α, tumor necrosis factor-α, and inter-leukin (IL)-2, IL-4, IL-6, IL-10, and IL-17A were measured using a cytometric bead array; clinical data were assessed. The authors calculated hazard ratios (HRs) for drug survival using a Cox proportional hazards model. Results: The authors included 262 patients, most of whom used systemic immunosuppressants or biologics. In the multivariate model, poor quality of life measured by the Dermatology Life Quality Index (HR = 1.04; 95% CI 1.01-1.07; p = 0.012) and elevated baseline IL-6 (HR = 1.99; 95% CI 1.29-3.08; p = 0.002) were associated with treatment interruption. Study limitations: The main limitation of any cohort study is the presence of confounders that could not be detected in clinical evaluation. Conclusions: Poor quality of life and elevated baseline serum IL-6 level predicted treatment interruption in patients with moderate to severe psoriasis. Although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment, it is an interesting biomarker candidate for predicting psoriasis treatment response.

Papel inmunomodulador de la vitamina D y los ácidos grasos poliinsaturados omega-3 en trastornos autoinmunes: Revisión de la Literatura / Immunomodulatory role of vitamin D and omega-3 polyunsaturated fatty acids in autoinmune disorders: Literature Review

Los trastornos autoinmunes representan una familia de al menos 80 condiciones diferentes que surgen de una respuesta aberrante del sistema inmunológico resultando finalmente en la destrucción de tejidos y órganos específicos del cuerpo. Es importante destacar que durante las últimas tres décadas los estudios epidemiológicos han proporcionado evidencia de un aumento constante en la incidencia y prevalencia de trastornos autoinmunes. En los últimos años, varios estudios han demostrado que la vitamina D y los ácidos grasos poliinsaturados (AGPs) omega-3 ejercen propiedades inmunomoduladoras y antiinflamatorias sinérgicas que pueden aprovecharse positivamente para la prevención y el tratamiento de trastornos autoinmunes. En este sentido, el reciente ensayo clínico denominado VITAL (ensayo de vitamina D y omega 3); un estudio a gran escala, aleatorizado, doble ciego, controlado con placebo encontró que la suplementación conjunta de vitamina D y AGPs omega-3 (VIDOM) puede reducir la incidencia de enfermedades autoinmunes. En esta revisión de la literatura, resumimos los mecanismos moleculares detrás de las propiedades inmunomoduladoras y antiinflamatorias de la vitamina D y los AGPs omega-3, así como la posible interacción bidireccional entre el metabolismo de la vitamina D y el metabolismo de los AGPs omega-3 que justifica la co- suplementación VIDOM en trastornos autoinmunes(AU)

Autoimmune disorders represent a family of at least 80 different conditions that arise from an aberrant immune system response, which ultimately results in the destruction of specific body tissues and organs. It is important to highlight that during the last three decades epidemiological studies have provided evidence of a steady increase in the incidence and prevalence of autoimmune disorders. In recent years, several studies have shown that vitamin D and omega-3 polyunsaturated fatty acids (PUFAs) exert synergistic immunomodulatory and anti-inflammatory properties that can be positively harnessed for the prevention and treatment of autoimmune disorders. In this sense, the recent clinical trial called VITAL (Vitamin D and Omega 3 trial) - a large, randomized, double-blind, placebo- controlled study - found that co-supplementation of vitamin D and omega-3 PUFAs (VIDOM) can reduce the incidence of autoimmune diseases. In this literature review, we summarize the molecular mechanisms behind the immunomodulatory and anti-inflammatory properties of vitamin D and omega-3 PUFAs, as well as the possible bidirectional interaction between vitamin D metabolism and omega-3 PUFA metabolism that justifies VIDOM co- supplementation in autoimmune disorders(AU)

Integrating Role of Immunity in Cancer: Journey from Immune Surveillance to Tumour Escape

Cancer immunoediting is crucial to understand the success or failure of a tumor. Immune system plays dual roles in tumor development and progression, promoting or suppressing tumor depending on tumor microenvironment and the events that lead to initiation of carcinogenesis. The immune system has potential to recognize and destroy tumors, and thus function as a primary defense mechanism against cancer. On the other hand, unresolved immune responses can result in the growth and progression of cancer. Objectives: The host immune system determines tumour fate in three phases (Elimination, Equilibrium and Escape) and ac- cording to this theory, it blocks adaptive and innate tumour responses or promotes conditions that favour tumour progression. Conclusion: The purpose of this review is to emphasise the importance of immunity in tumour promotion and suppression.

Nuevas perspectivas en el estudio y tratamiento de la sepsis

La sepsis es una disfunción orgánica potencialmente mortal debida a una respuesta desregulada del hospedero a la infección. No sólo contribuye con el 20 % de todas las causas de muerte de forma global, sino que los sobrevivientes de esta también pueden experimentar una significativa morbilidad a largo plazo. La sepsis y el shock séptico son emergencias médicas que requieren reconocimiento rápido, administración de antimicrobianos apropiados, soporte hemodinámico cuidadoso y control de la fuente infecciosa. El objetivo de esta revisión fue describir la definición y los criterios diagnósticos, la epidemiología, los factores de riesgo, la patogenia y la conducta inicial ante la sepsis.

Sepsis is a life-threatening organ dysfunction due to a dysregulated host response to infection. It severely impacts global disease burden as it constates 20 % of all causes of death; its survivors may experience long-term morbidity. Sepsis and septic shock are medical emergencies that require rapid identification, administration of appropriate antimicrobials, careful hemodynamic support, and control of the infection source. This review aims to update the definition of sepsis and its diagnostic criteria, epidemiology, risk factors, pathogenesis, and baseline behavior.

Canales dominantes de percepción del conocimiento. Influencia en la evaluación del aprendizaje de la inmunología / Knowledge Perception Dominant Channels. Influence of the Evaluation of Immunology Learning

Introducción: Los estilos de aprendizaje según canales de percepción dominante del conocimiento de los estudiantes influyen en su aprendizaje. Su uso por los docentes puede favorecer o no a estudiantes con un canal específico. Objetivo: Describir la ubicación según los canales de percepción dominante del conocimiento de los estudiantes de medicina y la relación de estos con el resultado de las evaluaciones frecuentes en la asignatura Sangre y Sistema Inmune. Métodos: Se realizó una investigación en 234 estudiantes y 30 profesores de la carrera de medicina en los cursos 2020-2021 y 2022. Los estudiantes se clasificaron según los resultados de un cuestionario para identificar el predominio del canal de percepción (visuales-auditivos-kinestésicos) y a los profesores se les realizó una encuesta para determinar su percepción sobre el uso de estrategias de enseñanza diferenciales para cada canal. El procesamiento se realizó en programa SPSS 25, a través de números, porcentaje y prueba de ji al cuadrado. Resultados: Predominó el canal visual con el 48 por ciento. Existió asociación con el sexo con p = 0,0016; en varones prevaleció el canal auditivo y en hembras el visual. La relación entre los canales de percepción dominante y el rendimiento académico fue significativa con p = 0,000. Conclusiones: Prevaleció el canal de percepción dominante visual. La distribución de cada canal se asoció con el sexo y el rendimiento académico; así se lograron mejores resultados por los estudiantes con percepción dominante visual. Esto último estuvo relacionado con el predominio de acciones por parte de los docentes que potencian este canal de percepción(AU)

Introduction: Learning styles according to dominant perception channels of students' knowledge influence their learning. Their use by professors may or may not favor students with a specific channel. Objective: To describe the location according to the dominant knowledge perception channels of medical students and their relationship with the results of frequent evaluations in the subject Blood and Immune System. Methods: A research was conducted with 234 students and 30 professors of the Medicine major during the academic years 2020-2021 and 2022. The students were classified according to the results of a questionnaire to identify the perception channel predominance (visual-auditory-kinesthetic), while the professors were surveyed to determine their perception on the use of differential teaching strategies for each channel. Processing was performed in SPSS 25, using numbers, percentages and the chi-squared test. Results: The visual channel predominated, accounting for 48 percent. There was an association with sex (p=0.0016); the auditory channel prevailed among males, while the visual channel prevailed among females. The relationship between dominant perception channels and academic performance was significant (p=0.000). Conclusions: The visual dominant perception channel prevailed. The distribution of each channel was associated with sex and academic performance; thus, better results were achieved by students with visual dominant perception. The latter was related to the predominance of actions by professors that enhance this perception channel(AU)

Aproximando a Atenção Especializada da Atenção Primária à Saúde: em busca do cuidado integral ao paciente com asma no Brasil / Aligning Specialized Care with Primary Health Care: in search of comprehensive care for asthma patients in Brazil

A ocorrência de doenças alérgicas e asma ainda cresce em muitos países. Dados mostram que aproximadamente um quarto dos habitantes de países industrializados apresenta algum tipo de alergia, e nos países em desenvolvimento estas doenças podem alcançar proporções ainda maiores da população. No Brasil, embora não exista até o momento uma agenda política nacional de atenção à saúde dos pacientes com alergias e asma, iniciativas individuais em diferentes regiões têm beneficiado milhares de pacientes ao longo das últimas décadas. Estes programas têm como principais objetivos qualificar o cuidado em saúde, melhorar a qualidade de vida (especialmente dos pacientes com asma e rinite alérgica) e reduzir os indicadores de morbimortalidade relacionados às doenças. Com essa finalidade, os programas vêm se ocupando de diversas ações de educação em saúde, capacitação profissional, busca ativa para garantir diagnóstico e tratamento oportuno, e proporcionar acesso a medicamentos de forma gratuita e continuada. Entretanto, a falta de um caráter institucional que garanta o acesso universal a ações cientificamente fundamentadas, impede a equidade e a continuidade do cuidado, além de dificultar a atenção integral em asma e em outras doenças alérgicas.

Allergic diseases and asthma are on the rise in many countries. Data show that approximately 25% of the inhabitants of industrialized countries have some type of allergy, reaching even greater proportions in developing countries. Although a national health care agenda for patients with allergies and asthma has not yet been developed in Brazil, individual initiatives in different regions have benefited thousands of patients in recent decades. The main objectives of these programs are to improve health care, quality of life (especially for patients with asthma and allergic rhinitis), and reduce disease-related morbidity and mortality indicators. To this end, these programs have been engaged in health education actions, professional training, performing active searches to ensure timely diagnosis and treatment, and providing free and continuous access to medication. However, the due to the non-institutional character of these programs, universal access, evidence-based actions, and continuity of care are not guaranteed, and it is difficult to provide comprehensive care for asthma and other allergic diseases.

Advances of n-3 polyunsaturated fatty acids in food allergy / 中华实用儿科临床杂志

Food allergy is a common allergic disease threatening the growth and development of infants and children.n-3 polyunsaturated fatty acids (PUFAs) are common nutrients in the diet, which have important structural functions and immunomodulatory effects.Their protective effect in food allergy has gradually become a potential research hotspot.This review highlights the function and immune regulation of PUFAs, the regulation of n-3 PUFAs on immunological indexes, the mechanism of food allergy, and the relationship between food allergy, and the impact of n-3 PUFAs on other allergic diseases.

Análisis in silico de las alteraciones de la secuencia y estructura de RBD-SARS-CoV-2, que afectan su complementariedad por anticuerpos neutralizantes IgG-antiRBD

Las vacunas anti-SARS-CoV-2 inducen la producción de anticuerpos neutralizantes IgG contra el Dominio de Unión al Receptor de la proteína S del virus (IgG-antiRBD). En Bolivia, Sinopharm y Sputnik V fueron vacunas ampliamente utilizadas durante la pandemia. Sin embargo, las mutaciones y los cambios sufridos en SARS-CoV-2 fueron responsables de las nuevas olas de contagio. Objetivo: determinar las alteraciones a nivel de secuencia y de estructura del RBD-SARS-CoV-2, que afectan su complementariedad por anticuerpos neutralizantes IgG-antiRBD. Material y Métodos: se obtuvieron las secuencias y estructuras cristalográficas del RBDSARS-CoV-2 a partir de la base de datos Protein Data Bank. Para el Alineamiento Múltiple de Secuencias y el Alineamiento Estructural, se emplearon Mega6 y Chimera1,15. Resultados: el Alineamiento Múltiple de Secuencias y Alineamiento Estructural de las principales variantes epidemiológicas de SARS-CoV-2 evidencian que, krakenXBB1.5 fue la más divergente a nivel de secuencia, mientras que, omicronBA2.75 presentó más cambios estructurales y mayores impedimentos estéricos al interaccionar con IgG-antiRBD, siendo la más contagiosas y más evasiva a la respuesta inmunológica. Conclusiones: el uso de herramientas bioinformáticas para el seguimiento en los cambios moleculares de SARS-CoV-2 permiten predecir el comportamiento epidemiológico de nuevas variantes emergentes y además promover el mejoramiento en los criterios de prevención.

Anti-SARS-CoV-2 vaccines induce the production of IgG neutralizing antibodies against the Receptor Binding Domain of the S protein of the virus (IgG-antiRBD). In Bolivia, Sinopharm and Sputnik V were widely used vaccines during the pandemic. However, the mutations and changes suffered in SARS-CoV-2 were responsible for the new contagion outbreaks. Objective: To determine the sequence and structure alterations of RBD-SARS-CoV-2, which affect its complementarity by IgG-antiRBD neutralizing antibodies. Material and Methods: The sequences and crystallographic structures of RBD-SARS-CoV-2 were obtained from the Protein Data Bank database. For Multiple Sequence Alignment and Structural Alignment, Mega6 and Chimera1.15 were used. Results: The Multiple Sequence Alignment and Structural Alignment of the main epidemiological variants of SARS-CoV-2 showed that krakenXBB1.5 was the most divergent at the sequence level, while omicronBA2.75 presented more structural changes and greater steric hindrances when interacting with IgG-antiRBD, being the most contagious and most evasive to the immune response. Conclusions: The use of bioinformatics tools for monitoring the molecular changes of SARS-CoV-2 make it possible to predict the epidemiological behavior of new emerging variants and also promote improvement in prevention criteria

Programmed cell death-1 and its ligands: Current knowledge and possibilities in immunotherapy

Abstract Programmed Cell Death-1 (PCD-1) is a key immune checkpoint receptor, which mainly expresses on activated T, B, Dendritic (DC), Natural Killer (NK), and Treg cells. On the surface of activated T-cells, PCD-1 expression is upregulated after the recognition of peripherals antigens by T cells; subsequently, the elevated binding of PD-1 to Programmed Death Ligand-1 (PD-L1) and Programmed Death Ligand-2 (PD-L2) becomes a key step for downstream inhibitory signaling. Although the role of PD-L1 has been evaluated more thoroughly by clinical research, and PD-L1 has also been used more widely in the clinical setting, PD-L2 also plays an important role in the negative regulation of T-cells, one of the necessary conditions that lead to immune tolerance. Expression of PD-L1 either in tumors or in infiltrating immune cells has been verified predominantly by Immunohistochemistry (IHC) in a variety of tumors, suggesting a role for the PD-1/PD-L1 axis as a prognostic trait and therapeutic target across multiple histotypes. The complex interplay between these factors plays a major role in the diffusion and clinical application of PD-L1 IHC assays as predictive biomarkers of response to PD-1/PD-L1 inhibitors. Checkpoint blockades are registered for the treatment of various cancers, including gynecological malignancies.

Eritema Multiforme, Una Rara Presentación De Exantema En Población Pediátrica. A Propósito De Un Caso. / Erythema Multiforme, A Rare Occurrence Of Exanthema In The Pediatric Population. On The Subject Of A Case.

El Eritema multiforme (EM) o eritema polimorfo es una enfermedad aguda de la piel de naturaleza inmunológica con o sin compromiso de mucosas, que puede comportarse como crónica recurrente. Se presenta con lesiones cutáneas en diana distintivas, a menudo acompañado de úlceras o bullas en mucosas (oral, genital u ocular). Entre sus formas clínicas se distingue: una forma menor caracterizado por un síndrome cutáneo leve y su forma mayor que se manifiesta como una afectación cutánea con daño mucoso marcado. Entre sus principales diagnósticos diferenciales se encuentran el Síndrome de Stevens-Johnson (SSJ) y Síndrome de Lyell (Necrólisis epidérmica tóxica (NET)). Tiene una incidencia estimada < 1%, siendo su forma mayor levemente más frecuente que su forma menor (0.8-6 por millón/año). Puede darse a cualquier edad, presentando un peak de incidencia entre los 20 y 30 años, predominando ligeramente el sexo masculino con una proporción 3:2, sin predilección racial. Su presentación en edad pediátrica es rara, más aún en la primera infancia. En esta población es más frecuente el EM menor recurrente. En el presente texto se reporta un caso de EM en población pediátrica como una rara forma de presentación exantemática, abordado en el Servicio de Pediatría del Complejo Asistencial Dr Victor Rios Ruiz (CAVRR)en la ciudad de Los Ángeles, Chile en el presente año.

Erythema multiforme (EM) also known as polymorph erythema is an acute skin disease of immunological nature with or without mucous membrane involvement, which may behave as chronic recurrent. It presents with distinctive targets like skin lesions, often together with ulcers or bullae in mucous membranes (oral, genital or ocular). Among its clinical forms are: a minor form characterized by a mild skin syndrome and its major form that manifests as a skin disease with marked mucosal damage. Among its main differential diagnoses are Stevens-Johnson Syndrome (SJS) and Lyell Syndrome (Toxic Epidermal Necrolysis (TEC)). It has an estimated incidence < 1%, with its major form being slightly more frequent than its minor form (0. 8-6 per million/year). It can occur at any age, presenting a peak incidence at the age between 20 and 30 years, with a slight predominance of males with a 3:2 ratio, without racial predilection. Its presentation in pediatric age is rare, even more so in early childhood. Minor recurrent EM is more common in this population. This paper reports a case of EM in the pediatric population as a rare form of exanthematic presentation, addressed at the Department of Pediatrics of the Complejo Asistencial Victor Rios Ruiz (CAVRR) in the city of Los Angeles, Chile this year.

Immuno-oncology in head and neck squamous cell carcinoma - a narrative review

Immuno-oncology studies the immune system in cancer. In recent decades, immunotherapy has shown a good response to the treatment of various locally advanced and metastatic cancers. The main mechanisms of action include stimulation of the patient's own immune system to enhance immune responses acting in tumor escape pathways. This review examined the literature related to immune system mechanisms in head and neck squamous cell carcinoma (HNSCC) and their application in immunotherapy using biomarkers. The PUBMED, LILACS, MEDLINE, WHOLIS, and SCIELO databases were searched using the terms squamous cell carcinoma, head and neck, immuno-oncology, immunotherapy, and immunology. The main drugs currently available for clinical use in patients diagnosed with HNSCC include pembrolizumab and nivolumab, both classified as check-point inhibitors. These immunobiological agents improve patient survival and quality of life. Many authors and clinical trials point out that the recommendation of these agents is linked to the dose of PD-L1 (ligand expressed primarily by tumor cells), which proved to be an unreliable biomarker in the patient selection. Recommendation of immunotherapy depends on reliable biomarkers that must be identified in order to achieve good therapeutic results.

Pediatric allergy and immunology for patients and parents: challenges of developing website and social network during COVID-19 pandemic in Brazil / Alergologia e imunologia pediátricas para pacientes e pais: desafios de desenvolver website e rede social durante a pandemia de COVID-19 no Brasil

Abstract Objective: To describe the development of a website and the creation of a social network account about pediatric allergy/immunology with reliable information, to promote education and have a channel for patient-doctor contact. Methods: This is a descriptive study. A survey was conducted with 93 patients (12 years and older) and caregivers of a Pediatric Allergy/Immunology outpatient clinic, to assess internet usage patterns of potential users. A webpage in Portuguese and an Instagram® account were launched in which it was created an area for patient-doctor communication in the pandemic context. Results: Among 93 participants, 77% were female, 82% caregivers. Median age was 33.2 years, family income 403 dollars/month. The internet was accessed via smartphone by 81,7% of the participants; 76% reported using internet to access health information but 72% did not trust on the information from the internet, and 96% believed that an institutional site could provide meaningful information. From the website release in November 6, 2018 to January 20, 2022, it was counted 10,062 page views by 4,896 users; 55% were 18-34 years old, 70.2% female. Instagram® account gathered 882 followers. Website went through a period of instability during which access were not counted. Due to social isolation during COVID-19 pandemic, the website served as a tool for first response to help patients and doctors. Conclusions: Patients and caregivers of the Pediatric Allergy/Immunology service, consulted about digital tools, considered the information supported by a teaching/research institution timely and relevant. The website and Instagram® account have both performed well and shown good return in relation to hits, and results are continuously being evaluated. During COVID-19 pandemic, the website has been connecting patients/families and doctors.

RESUMO Objetivo: Descrever o desenvolvimento de um website e a criação de uma conta em rede social sobre alergologia/imunologia pediátrica com informações confiáveis, para promover educação e ter um canal de contato paciente-médico. Métodos: Trata-se de um estudo descritivo. Um questionário foi aplicado a 93 pacientes (12 anos de idade ou mais) e cuidadores frequentadores de um ambulatório de alergologia/imunologia pediátrica, para abordar o padrão de uso de internet de potenciais usuários. Lançou-se um website em português e uma página no Instagram®, nos quais foi criada, no contexto da pandemia, uma área para comunicação paciente-médico. Resultados: Dos 93 participantes, 77% eram mulheres, 82% cuidadores, com idade mediana de 33,2 anos e renda mensal de 403 dólares. A internet foi acessada via smartphone por 81,7% dos participantes; 76% relataram usar a internet para informações em saúde, mas 72% não confiavam nessa informação, e 96% acreditavam que um site institucional poderia prover informações seguras. Do lançamento do website em 6 de novembro de 2018 até 20 de janeiro de 2022, contabilizaram-se 10.062 visualizações de páginas por 4.896 usuários; 55% tinham idade entre 18 e 34 anos, 70,2% eram mulheres. A página no Instagram® reuniu 882 seguidores. O website apresentou período de instabilidade, sem registrar acessos. Em razão do isolamento social durante a pandemia de COVID-19, o website apresentou-se como ferramenta de primeira linha para auxiliar pacientes e médicos. Conclusões: Pacientes e cuidadores do ambulatório de Alergologia/Imunologia Pediátrica, consultados sobre ferramentas digitais, consideraram as informações fornecidas por uma instituição de ensino/pesquisa como oportunas e relevantes. O website e a página do Instagram® têm apresentado bom desempenho e visualização, e os resultados estão sendo continuamente avaliados. Durante a pandemia de COVID-19, o website tem conectado pacientes/familiares e médicos.

A short history of innate immunity

Innate immunity refers to the mechanisms responsible for the first line of defense against pathogens, cancer cells and toxins. The innate immune system is also responsible for the initial activation of the body's specific immune response (adaptive immunity). Innate immunity was studied and further developed in parallel with adaptive immunity beginning in the first half of the 19th century and has been gaining increasing importance to our understanding of health and disease. In the present overview, we describe the main findings and ideas that contributed to the development of innate immunity as a continually expanding branch of modern immunology. We start with the toxicological studies by Von Haller and Magendie, in the late 18th and early 19th centuries, and continue with the discoveries in invertebrate immunity that supported the discovery and characterization of lipopolysaccharide (LPS) and pattern recognition receptors that led to the development of the pattern recognition and danger theory.

Methods of apoptosis detection: advances and applications / 药学学报

Apoptosis, or programmed cell death, is a common phenomenon which involved in a variety of physiological and pathological conditions in humans, such as neurodegenerative diseases, ischemic injury, autoimmune diseases and cancers. Apoptosis can be detected in vitro by morphology, biochemistry, molecular biology, immunology, and other techniques. Probes for cell apoptosis detection in vivo are still under research and various reagents and methods are constantly emerging. However, none of apoptosis detection methods or reagents are perfect and they all have advantages and disadvantages, as well as suitable scope of application. With the increasing application of apoptosis detection techniques, researchers will be confused about how to choose a suitable method to detect apoptosis and define the application range of each apoptosis detection method. Therefore, it is necessary to compare the benefits and drawbacks of existing apoptosis detection techniques as well as their applicable conditions. This article reviews morphological characteristics, molecular mechanism and specific biochemical changes in apoptotic cells. We summarized various apoptosis-detection methods based on these characteristics that can be used in vitro and in vivo, the advantages and disadvantages of each method and the scope of application. Also, we highlighted the existing tracers that have been used in apoptosis detection in vivo, their potentialities and limitations as well as the clinical applications of apoptosis imaging in multiple disease fields.

Practice of network platform teaching in standardized residency training of rheumatology and immunology / 中华医学教育探索杂志

This article intends to explore the application and implementation effect of network platform teaching in the standardized residency training of rheumatology and immunology. Through the implementation of online platform teaching (micro-class, online PBL teaching, and air class) for the training residents rotating in the rheumatology and immunology department, the questionnaire survey was carried out. The results showed that the satisfaction of the residents with the online platform teaching reached 96.88% (31/32), and more than 90.00% of the residents believed that their self-learning ability and clinical thinking ability have been improved, and their learning initiative and enthusiasm have also been improved, which deserves further promotion.

Probióticos: una mirada al mecanismo de acción y aplicaciones clínicas en Pediatría

Introducción: Los probióticos son microorganismos vivos que brindan beneficios al huésped mediante diversos mecanismos de acción. Han sido fuente de estudio en diversas patologías pediátricas, mostrando algunos resultados prometedores. Objetivo: Elaborar una revisión de la literatura sobre los mecanismos de acción y la evidencia actual que tienen los probióticos sobre la salud infantil. Materiales y métodos: Se realizó una revisión narrativa de la literatura con estrategia de búsqueda sistemática de la literatura con términos MESH acerca de los mecanismos de acción de los probióticos y su uso. Se incluyeron metaanálisis, revisiones sistemáticas y ensayos clínicos aleatorizados. Resultados: Los probióticos son una nueva herramienta terapéutica usada para mejorar la salud infantil. Se ha encontrado efecto benéfico en diarrea, en enterocolitis necrosante con una disminución significativa de la mortalidad y se ha mostrado evidencia significativa en las horas de llanto en cólico del lactante. Conclusión: Se requieren más estudios en otro tipo de enfermedades como estreñimiento y en algunos procesos alérgicos e inflamatorios. Los ensayos revisados ofrecen un panorama prometedor, pero la elección de un probiótico debe ser personalizado de acuerdo con la edad, enfermedad, cepa y dosis, dado que cada uno de ellos tiene múltiples mecanismos de acción que impactan de manera diferente en la eficacia clínica.

Introduction: Prebiotics are living microorganisms that provide benefits to the host through various mechanisms of action. They have been a source of study in various pediatric pathologies showing some promising results. Objective: To prepare a review on the mechanisms of action and current evidence that prebiotics have on child health. Materials and methods: A narrative review of the literature was carried out with a systematic literature search strategy with MESH terms about the mechanisms of action of probiotics and their use. Meta-analyzes, systematic reviews, and randomized clinical trials were included. Results: Probiotics are a new therapeutic tool used to improve children's health. A beneficial effect has been found in diarrhea, in necrotizing enterocolitis with a significant decrease in mortality and significant evidence has been shown in the hours of crying in colic in infants. Conclusion: The trials reviewed offer a promising picture, but the choice of a probiotic must be customized according to the age, disease, bacterial strain and dose, since each one has different action mechanisms and clinical effectiveness. More studies are required in some allergic and inflammatory diseases.

Demographic and Epidemiological Profile of Aging and Elderly Patients Receiving Heart Transplant During the Period from 2009 to 2018

Abstract Background: The aging process may be associated with the accumulation of a wide variety of health damages, such as cardiovascular diseases. HF is the final common path of the majority of these diseases, and, in its refractory form, heart transplantation continues to be the best treatment choice. Objective: To describe the demographic and epidemiological profile of aging and elderly patients receiving heart transplant from 2009 to 2018. Methods: Retrospective, descriptive longitudinal study on heart transplantation in aging and elderly patients using data from medical records and institutional documents. Results: From a total of 234 transplant recipients, 127 were 45 years or older. For the demographic profile, the variables used were sex, age, marital status, home state, and profession. For the epidemiological profile, the variables used were previous diagnosis, comorbidities before and after transplantation, and survival. Age varied from 45 to 74 years, with a mean of 57 years. The male sex accounted for 58.27% of recipients, and 59.84% were from the Federal District. Chagas, dilated, and ischemic cardiomyopathy accounted for 66.14%, 18.9%, and 14.17% of transplants, respectively. The main comorbidities were Chagas disease (66.14%), malignant arrhythmia requiring cardioverter-defibrillator implantation (28.35%), arterial hypertension (27.56%), and dyslipidemia (15.75%). Mean survival was 3 years and 4 months. Conclusion: The demographic profile showed that the majority of patients were aging, male, married, and from the Federal District. The epidemiological profile showed that Chagas cardiomyopathy was the main cause of HF, followed by dilated cardiomyopathy.

Assistência a pacientes com doenças imunoalérgicas no Sistema Único de Saúde brasileiro ­ Carta de São Paulo / Treating patients with allergic diseases in the Brazilian Unified Health System ­ Letter from São Paulo

O Sistema Único de Saúde (SUS) abrange todos os níveis de atenção à saúde e garante acesso integral, universal e gratuito para toda a população brasileira. As transições demográfica e epidemiológica observadas nas últimas décadas trouxeram um cenário de maior prevalência das doenças imunoalérgicas. Nesse contexto, a implementação de políticas de saúde voltadas à assistência à saúde dessa população tornou-se um desafio. Com o objetivo de discutir a atenção à saúde dos pacientes com doenças alérgicas e imunológicas no Brasil, a Associação Brasileira de Alergia e Imunologia (ASBAI) realizou em 26 de agosto de 2022, na cidade de São Paulo, o Fórum sobre a Assistência a Pacientes com Doenças Imunoalérgicas no SUS. O evento foi estruturado no formato de painéis e contou com a participação de membros da ASBAI e representantes da gestão pública federal, do Ministério Público, de sociedade de pacientes e profissionais de saúde de diversos serviços com experiência em programas e projetos bem sucedidos na assistência a pacientes com doenças imunoalérgicas. Após a discussão, concluiu-se que ainda existem muitas necessidades não atendidas em relação à atenção à saúde da população com doenças alérgicas e imunológicas no Brasil. A ASBAI tem trabalhado no sentido de contribuir para organizar, implantar e manter a assistência a estes pacientes no âmbito do SUS.

The Brazilian Unified Health System covers all levels of health care and guarantees full, universal and free access for the entire population. The demographic and epidemiological transitions observed in recent decades have led to a higher prevalence of allergic diseases. In this context, implementing health policies to benefit these patients has become a challenge. To discuss health care for patients with allergic and immunological diseases in Brazil, the Brazilian Association of Allergy and Immunology (ASBAI) held a forum in São Paulo on August 26, 2022 called "Treating Patients with Allergic Diseases in the Unified Health System". The event's panels included members of ASBAI, representatives of the federal government, the attorney general's office, patients, and health professionals from various services with experience in successful programs for patients with allergic diseases. It was concluded that there are still many unmet health care needs for Brazilians with allergic and immunological diseases. ASBAI is contributing to the organization, implementation, and maintenance of care for these patients within the scope of the Unified Health System.

Testes de provocação para urticárias crônicas induzidas: a experiência de um centro de referência e excelência em urticária - UCARE / Provocation tests for chronic inducible urticaria: the experience of a urticaria center of reference and excellence

Introdução: A urticária é determinada pela ativação de mastócitos que se apresenta por urticas, angioedema ou ambos. A urticária é classificada de acordo quanto a sua duração, em duas formas: aguda (UA < 6 semanas) e crônica (UC > 6 semanas). A UC compreende Urticária Crônica Espontânea (UCE) e Urticárias Crônicas Induzidas (UCInd). Entre as UCInd estão o dermografismo, urticária por pressão tardia (UPT), frio, calor, solar, aquagênica, colinérgica e urticária/angioedema vibratório. As UCInd podem ser diagnosticadas por meio da história clínica, exame físico e da reprodução das lesões através dos testes de provocação. Objetivo: Descrever o perfil dos testes de provocação positivos para UCInd realizados em um Centro de Referência e Excelência em Urticária (GA2LEN UCARE). Métodos: Foram avaliados, retrospectivamente, os resultados dos testes de provocação para UCInd, realizados de dezembro de 2017 a setembro de 2021, de 114 pacientes que apresentavam história sugestiva de uma ou mais UCInd. Resultados: Dos 114 pacientes avaliados, oitenta e oito (77%) eram do sexo feminino e 26 (23%) do masculino. Foram diagnosticados, através de testes de provocação positivos: 65 dermografismos (FricTest® e/ou dermografômetro); 23 UPT (23 diagnosticados com o uso do dermografômetro e 11 também confirmados através do teste de Warin); 11 urticárias ao frio (temperaturas iguais ou inferiores a 27 °C) e 3 urticárias ao calor (temperaturas iguais ou superiores a 38 °C), todos diagnosticados com o TempTest® versão 4.0; 4 urticárias colinérgicas, diagnosticados através do Teste Modificado para Urticária Colinérgica - HUCFF-UFRJ e 1 urticária vibratória. Nenhum paciente apresentou teste positivo para urticária solar ou aquagênica. Sete pacientes foram negativos. Conclusão: Os testes de provocação, através do estímulo direto e seguro com o desencadeante, permitem ao médico avaliador e ao paciente a compreensão e a confirmação do estímulo causador da enfermidade em questão e seus limiares.

Introduction: Urticaria is determined by mast cell activation that presents as wheals, angioedema, or both. Urticaria is classified according to its duration into two forms: acute (< 6 weeks) and chronic (> 6 weeks). Chronic urticaria includes chronic spontaneous urticaria and chronic inducible urticaria. Chronic inducible urticarias include dermographism, delayed pressure urticaria, cold, heat, solar, aquagenic, cholinergic, and vibratory urticaria/angioedema. Chronic inducible urticaria can be diagnosed through clinical history, physical examination, and the reproduction of lesions through provocation tests. Objective: To describe the profile of positive provocation tests for chronic inducible urticaria performed at an urticaria center of reference and excellence (GA2LEN UCARE). Methods: We retrospectively evaluated the results of provocation tests performed between December 2017 and September 2021 in 114 patients with a history suggestive of one or more types of chronic inducible urticaria. Results: The sample included 88 (77%) female and 26 (23%) male patients. The following were diagnosed through positive provocation tests: 65 cases of dermographism (FricTest® and/or dermographometer); 23 cases of delayed pressure urticaria (all diagnosed with a dermographometer and 11 confirmed with the Warin test); 11 cases of cold urticaria (temperatures ≤ 27°C) and 3 cases of heat urticaria (temperatures ≥ 38°C), all diagnosed with TempTest® 4.0; 4 cases of cholinergic urticaria, all diagnosed with the Modified Test for Cholinergic Urticaria-HUCFFUFRJ, and 1 case of vibratory urticaria. No patient tested positive for solar or aquagenic urticaria. Seven patients have been negative. Conclusion: Provocation tests, which use direct and safe stimuli as triggers, allow physicians and patients to confirm the disease's causative stimulus and its thresholds.

Clinical characteristics of definite vestibular migraine diagnosed according to criteria jointly formulated by the Bárány Society and the International Headache Society

Abstract Objective: To investigate the clinical features of patients with definite vestibular migraine (dVM). Methods: A total of 91 patients with vestibular symptoms accompanied by migraines/migrainelike symptoms were enrolled and diagnosed according to the criteria of the Bárány Society and the International Headache Society. Baseline data were collected. Videonystagmography and immune-related laboratory tests were performed. Results: Among the 91 patients, 62 (68.1%) had dVM (11 men, 51 women). Among dVM patients, migraine occurred earlier than vestibular symptoms in 42 (67.7%) patients. Spontaneous vertigo occurred in 41 (66.1%) patients. Induced vertigo occurred in 21 (33.9%) patients. Motion sickness occurred in 33 (53.2%) patients. Central oculomotor dysfunction was observed in 11 (17.7%) patients. Caloric test revealed unilateral horizontal semicircular canal dysfunction in 12 (19.4%) patients. Severe intolerance during the test occurred in 44 (71.0%) patients with dVM. 12 (19.4%) patients showed abnormal immune-related indicators. Conclusion: dVM is more common in women. The onset of migraine precedes that of vestibular symptoms, which are often accompanied by photophobia and phonophobia. Motion sickness and severe caloric test intolerance can contribute to the diagnosis of dVM. Immunological indicators are abnormal in some patients with dVM, dVM may be secondary or an accompanying disorder, but the causal relationship needs further investigation. Level of evidence: IV.