Alteraciones de la pared abdominal: onfalocele / Abdominal wall defects: omphalocele

Introducción: los defectos de la pared son malformaciones congénitas con herniación de algunos órganos de la cavidad abdominal, como es el onfalocele. La prevalencia calculada es 1/10.000 nacimientos en países occidentales, en Colombia se desconoce. El diagnóstico es pre o posnatal requiriendo una serie de exámenes clínicos sistémicos, evaluación diagnóstica secundaria y búsqueda de anomalías asociadas; el tratamiento ha mejorado las tasas de supervivencia entre 70 y 95%. Objetivo: dar a conocer la patología y correlacionar los hallazgos genéticos, ambientales, clínicos y exámenes complementarios para el diagnóstico oportuno, derivando así al paciente a un tratamiento óptimo con disminución de la mortalidad. Materiales y métodos: revisión actualizada de la literatura utilizando buscadores Pubmed, UpToDate y ClinicalKey con énfasis en revisiones sistemáticas, casos clínicos y principales guías clínicas internacionales. Después se envió al jefe del departamento de cirugía pediátrica y a la división de publicaciones para su conocimiento, revisión y aprobación. Resultados: se analizaron 17 artículos publicados en los últimos 5 años, seleccionando los más relevantes y con evidencia clínica actual. Discusión y conclusiones: los estudios recientes han evidenciado nuevos hallazgos que han mejorado la supervivencia y reducido la mortalidad en los últimos 50 años.

Introduction: abdominal wall defects are congenital malformations associated with herniated abdominal organs, such as omphalocele. Its estimated prevalence is 1 per 10.000 live births in western countries. In Colombia the prevalence of omphalocele remains unknown. Omphalocele may be pre or postnatally diagnosed. A series of systemic clinical exams, secondary diagnostic evaluation and assessment for accompanying anomalies, are necessary. Treatment has improved survival rate to 70 and 95%. Objective: to increase awareness of this anomaly and correlate genetic, environmental and clinical findings and complementary exams to enable the early diagnosis and referral of these patients to receive optimal treatment which will reduce mortality. Materials and methods: updated literature review using Pubmed, UpToDate and ClinicalKey search engines, focused on systematic reviews, clinical cases and main international clinical practice guidelines. Found data was submitted to the head of the pediatric surgery department and to the publications division for their information, review and approval Results: 17 articles published in the last 5 years including the most relevant which contained current clinical evidence, were selected. Discussion and conclusions: recent studies have evidenced new findings that have improved survival and reduced mortality in the last 50 years.

Partial Articular Supraspinatus Tendon Avulsion Repair and Patch: A Technical Note for Augmenting the Supraspinatus Reinsertion with the Long Head of the Biceps Tendon.

BACKGROUND: There is no clear consensus on the treatment of partial articular-sided supraspinatus tendon avulsions. Debridement alone might not be sufficient to prevent further tendon degradation or alleviate patient complaints. Direct repair using a suture anchor without treating the concomitant conditions of the long head of the biceps tendon might come with residual anterior shoulder pain or even further loss of function in cases of failed repair. The purpose of the present study is to describe an arthroscopic technique by which the long head of the biceps tendon can be included in the partial articular-sided supraspinatus tendon avulsion repair. TECHNIQUE PRESENTATION WITH VIDEO: In this technical note we describe the arthroscopic repair and augmentation with tenotomized biceps of partial supraspinatus tendon tears to address three main concepts for successful rotator cuff repairs, namely rotator cuff biologic augmentation, tendon to bone healing and postoperative pain prevention. CONCLUSION: The biceps tendon is a mechanically robust, locally available autograft that can be used in borderline partial articular-sided supraspinatus tendon avulsions in order to biologically augment healing at the tendon-bone interface without any immunogenic reactions or morbidity following harvesting.

Clinical outcomes and complications of single anastomosis duodenal-ileal bypass with sleeve gastrectomy: A 2-year follow-up study in Bogotá, Colombia.

BACKGROUND: The global prevalence of obesity has increased over the past 40 years, and bariatric surgery has proven to be the most effective therapy for long-term weight loss. Its principles are based on modifying the brain-gut axis by altering the gastrointestinal anatomy and affecting the function of gastrointestinal hormones, thereby modifying satiety signals. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) combines both techniques and has become an alternative to gastric bypass and biliopancreatic diversion procedures for treating severe obesity and associated metabolic diseases in selected patients. AIM: To describe the outcomes and complications of SADI-S. METHODS: We retrospectively analyzed the data of patients who underwent SADI-S laparoscopically at the Clínica Reina Sofía in Bogotá, Colombia. This study assessed the therapeutic effectiveness of SADI-S in terms of short-term preoperative clinical characteristics, postoperative complications, comorbidities, nutritional defi-ciencies, and intraoperative complications during a 2-year follow-up. RESULTS: Sixty-one patients with a mean body mass index (BMI) of 50 ± 7.1 kg/m2 underwent laparoscopic SADI-S. The mean operative time and hospital stays were 143.8 ± 42 min and 2.3 ± 0.8 d, respectively. The mean follow-up period was 18 mo, and the mean BMI decreased to 28.5 ± 12.2 kg/m2. The excess BMI loss was 41.8% ± 13.5%, and the weight loss percentage was 81.1% ± 17.0%. Resolution of obesity-related comorbidities, including type 2 diabetes mellitus, hypertension, dyslipidemia, and obstructive sleep apnea, was achieved and defined as complete or partial remission. No intraoperative complications were observed. Short-term complications were observed in four (6.8%) patients. However, larger studies with longer follow-up periods are required to draw definitive conclusions. CONCLUSION: SADI-S has a low intraoperative and postoperative complication rate and is effective for weight loss and improving obesity-related comorbidities, including hypertension, type 2 diabetes mellitus, dyslipidemia, and sleep apnea syndrome.

Resilience, adverse childhood experiences, and mental health in Health Science students during the COVID-19 pandemic / Resiliencia, eventos adversos en la infancia y salud mental en estudiantes de Ciencias para la Salud en la pandemia por COVID-19

Abstract Introduction A steady rise in mental problems has been observed in the university population, particularly in the area of health, related to the COVID-19 pandemic. Protective factors such as resilience and risk factors such as adverse events in childhood have been associated with mental health outcomes. Objective Describe psychiatric symptoms and their association with adverse childhood experiences and resilience in first-semester students in the three undergraduate programs of the Faculty of Health Sciences of the University of Caldas, Colombia in 2020. Method Descriptive, cross-sectional, correlational study, using a virtual survey including the SRQ (Self Reporting Questionnaire), Wagnild and Young's Resilience Scale and questions on adverse childhood experiences. Results A total of 108 students with a mean age of 19.6 years participated in the study. Affective symptoms were found in 6.4% of subjects. The most frequent level of resilience was medium, while the most commonly reported adverse event was child abuse. An association was found between being exposed to adverse childhood experiences and the presence of symptoms that compromise mental health and alter one of the domains of resilience. A link was also found between the presence of these symptoms and the alteration of domains of resilience. Discussion and conclusion It was possible to identify a risk of mental health disorders in students, and to establish an association between adverse events in childhood and resilience.

Resumen Introducción Se ha descrito un aumento progresivo de problemas mentales en la población universitaria, especialmente en el área de la salud, relacionado con la pandemia por COVID-19. Factores protectores como la resiliencia y factores de riesgo como eventos adversos en la infancia, se han relacionado con desenlaces en la salud mental. Objetivo Describir síntomas psiquiátricos y su asociación con eventos adversos en la infancia y resiliencia, en estudiantes de primer semestre de los tres programas de pregrado de la Facultad de Ciencias para la Salud de la Universidad de Caldas, Colombia en 2020. Método Estudio descriptivo, transversal, correlacional, mediante una encuesta virtual incluyendo el SRQ (Self Reporting Questionnaire), escala de resiliencia de Wagnild y Young y preguntas relacionadas con eventos adversos en la infancia. Resultados Participaron 108 estudiantes con edad media de 19.6 años. Hubo presencia de síntomas afectivos en 6.4%. El nivel de resiliencia más frecuentemente encontrado fue "medio" y el evento adverso en la infancia más comúnmente reportado fue el maltrato. Se demostró asociación entre haber estado expuesto a eventos adversos en la infancia tanto con presencia de síntomas que comprometen la salud mental como con afectación de uno de los dominios de resiliencia. Asimismo, hubo asociación entre presencia de dichos síntomas con afectación de los dominios de la resiliencia. Discusión y conclusión Se pudo identificar riesgo de alteraciones de la salud mental en los estudiantes, resaltando la asociación con eventos adversos en la infancia y la resiliencia.

Quadriceps tendon vs hamstring autograft in primary ACL reconstruction - a comparative study with minimum two-year follow-up.

Recently there has been growing interest in the quadriceps tendon (QUAD) as a valid option for reconstruction of the anterior cruciate ligament (ACLR). The aims of the study is to compare the outcomes achieved in anatomic ACLR involving QUAD vs. Hamstring (HT) autografts. A total of 52 consecutive patients underwent an ACLR, 25 patients with QUAD graft and 27 with HT graft. The same surgical technique, fixation method and postoperative protocol were used in both groups. The following parameters were evaluated: functional status (Lysholm, Tegner, subjective IKDC scores), joint stability (Lachman and pivot shift tests), surgical reoperation rate, complications, degree of satisfaction and return to previous level of activity. Descriptive statistics were analysed using the Student's t-test. Forty four patients were evaluated (20 QUAD, 24 HT), with a mean follow-up of 27.4 months. Two patients were re-operated in the QUAD group (including one ACL revision), and one patient in the HT group required an ACL revision. There were no significant differences between the two groups in postoperative scores: Lysholm (96.05 vs. 96.05), IKDC (86.2 vs. 91.2) and Tegner (6 vs. 5) scales. The percentage of negative Lachman and pivot shift tests was similar in the two groups (45% vs. 50% and 40% vs. 45.8%, respectively). There were no significant differences between the groups in the degree of satisfaction (95.8% vs. 80%, p = .16) or in the percentage who returned to their previous level of activity (62.5% vs. 45%, p = .17). The use of a QUAD graft in ACL reconstruction leads to similar clinical and functional outcomes to those obtained with HT.

Role of IgG against N-protein of SARS-CoV2 in COVID19 clinical outcomes.

The Nucleocapsid Protein (N Protein) of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV2) is located in the viral core. Immunoglobulin G (IgG) targeting N protein is detectable in the serum of infected patients. The effect of high titers of IgG against N-protein on clinical outcomes of SARS-CoV2 disease has not been described. We studied 400 RT-PCR confirmed SARS-CoV2 patients to determine independent factors associated with poor outcomes, including Medical Intensive Care Unit (MICU) admission, prolonged MICU stay and hospital admissions, and in-hospital mortality. We also measured serum IgG against the N protein and correlated its concentrations with clinical outcomes. We found that several factors, including Charlson comorbidity Index (CCI), high levels of IL6, and presentation with dyspnea were associated with poor clinical outcomes. It was shown that higher CCI and higher IL6 levels were independently associated with in-hospital mortality. Anti-N protein IgG was detected in the serum of 55 (55%) patients at the time of admission. A high concentration of antibodies, defined as signal to cut off ratio (S/Co) > 1.5 (75 percentile of all measurements), was found in 25 (25%) patients. The multivariable logistic regression models showed that between being an African American, higher CCI, lymphocyte counts, and S/Co ratio > 1.5, only S/Co ratio were independently associated with MICU admission and longer length of stay in hospital. This study recommends that titers of IgG targeting N-protein of SARS-CoV2 at admission is a prognostic factor for the clinical course of disease and should be measured in all patients with SARS-CoV2 infection.

Update of the Mexican College of Rheumatology Guidelines for the Pharmacological Treatment of Rheumatoid Arthritis, 2018. / Actualización de las guías del tratamiento farmacológico de la artritis reumatoide del Colegio Mexicano de Reumatología 2018.

Therapeutic advances in rheumatoid arthritis require periodic review of treatment guidelines. OBJECTIVE: To update the Mexican College of Rheumatology guidelines on the pharmacological treatment of rheumatoid arthritis. METHOD: Board certified rheumatologists from different health institutions and regions of the country participated. Work teams were formed that reviewed the previous guidelines, elaborated new questions, reviewed the literature, and scored the evidence that was presented and discussed in plenary session. The conclusions were presented to infectologists, gynaecologists and patients. Recommendations were based on levels of evidence according to GRADE methodology. RESULTS: Updated recommendations on the use of available medications for rheumatoid arthritis treatment in Mexico up to 2017 are presented. The importance of adequate and sustained control of the disease is emphasized and relevant safety aspects are described. Bioethical conflicts are included, and government action is invited to strengthen correct treatment of the disease. CONCLUSIONS: The updated recommendations of the Mexican College of Rheumatology on the pharmacological treatment of rheumatoid arthritis incorporate the best available information to be used in the Mexican health care system.

The Role of the Gut Microbiota and the Immune System in the Development of Autism.

Autism| |spectrum| |disorders| |(ASDs)| |are| |neurodevelopmental| |disorders| |that| |present| |with| |social| skills| |and| |communication| |challenges,| |restricted| |interest,| |and| |repetitive| |behavior.| |The| |specific| cause |of| |autism| |is| |not| |well| |understood| |yet.| |However,| |numerous| |studies| |indicated| |that| |environmental| |and| |genetic| |factors,| |dysregulated| |immune| |response,| |and| |alterations| |to| |the| |balance| |and| |content| |of| |the| |gut| |microbiota| |are| |implemented| |in| |the| |development| |of| |autism.| |Many| |non-pharmacological| |interventions| |are| |nominated| |to| |manage |autism,| |including| |family| |support| |services| |and| |psychoeducational| |methods|. Moreover,| |different| |pharmacological| |therapy| |modalities| |are| |recommended| |for| |children| |with| |ASD.| |Learning| |more| |about| |the| |brain,| |immune| |system, |and| |gut| |connections| |could| |assist| |in early| |diagnosis| |and| |treatment| |of| |this| |devastating| |neurodevelopmental| |disorders| |as| |an| |early| |intervention| |in| |ASD| |could| |improve| |a| |child's| |overall| |development.| We| |gathered| |data| |from| |relevant| |previously| |published| |articles| |on| |PubMed| |to| |evaluate |the| |role| |of| |the| |gut| |microbiota| |and| |the| |immune| |system| |on| |the| |development| |of| |autism.|.

Can Nutritional Adequacy Help Evade Neurodegeneration in Older Age? A Review.

There is an increase in susceptibility to chronic and debilitating diseases with aging. The reason for the underlying neuronal degeneration and normal aging of the brain remains elusive. Different research studies have been conducted to discover how the brain degenerates and the importance of vitamins' role in the neurocognitive decline. Comprehensive literature research was conducted using all relevant data available from PubMed and Google scholar for this article. There has been evidence linking the consumption of essential nutrients to preventing the disease conditions that result in cognitive decline. This article provides the latest scientific advances specific to how dietary nutrients and non-nutrient may affect cognitive aging. An adequate supply of nutrients like vitamin B2 (riboflavin), vitamin B12, vitamin E, essential fatty acid (omega-3 fatty acid), and flavonoids play a vital role in ensuring healthy aging, enhancing memory, and strengthening neuroprotection. These nutrients help in neurodegenerative diseases like Alzheimer's disease and Parkinson's. We recommend more research studies to determine the underlying mechanism of how these essential nutrients work in the prevention of cognitive decline. These studies will help provide the evidence needed for new dietary recommendations for combating these diseases that often affect aging patients.

Minerals: An Untapped Remedy for Autoimmune Hypothyroidism?

For decades, the focus of managing autoimmune hypothyroidism has been on thyroxine replacement. Correcting lab parameters such as thyroid stimulating hormone (TSH) has been a primary goal. The increasing prevalence of Hashimoto's thyroiditis (HT) continues to impact the quality of life in patients. We believe a holistic approach to this disease entity, considering its underlying complex etiopathogenesis, would benefit patients. Nutraceuticals are combinations of essential nutrients and are becoming a part of novel medical treatments despite the lack of regulation. This review aims to present a concise summary of recent developments regarding minerals such as zinc, selenium, magnesium, iron, and their potential clinical benefit as nutraceuticals in patients with HT. We have explored the potential benefits and associations of these minerals in HT and thyroid function. We reviewed relevant articles, metanalyses, and clinical trials in literature platforms such as PubMed, PubMed Central, and Google Scholar. Significant data found in the literature suggesting a potential health benefit of these minerals in HT though there were many studies to the contrary. Many trials demonstrated the restoration of residual symptoms, reversal of HT-associated thyroid morphological changes, and improvement in thyroid functions. Many of these trials lack statistical power due to the small sample sizes, and their external validity may be questionable due to unaccounted confounding factors. In our opinion, to support an evidence-based holistic clinical approach, further scientific evidence is needed. The association of these elements in thyroid function necessitates more large scale pragmatic trials to elucidate the benefits of nutraceuticals in HT.

Lack of tocilizumab effect on mortality in COVID19 patients.

Off-label tocilizumab use in COVID-19 patients reflects concern for cytokine release syndrome. Comparison of matched COVID-19 pneumonia patients found elevated IL-6 levels correlated with mortality that did not change with tocilizumab administration. Correlating mortality with increased IL-6 doesn't imply causality however lack of improvement by tocilizumab requires further clinical trial alterations.

Clinical significance of auditive involvement in rheumatoid arthritis: a case-control study.

Introduction. Rheumatoid arthritis (RA) can involve the incudomalleolar or incudostapedial articulations. Objective. To know the punctual prevalence of audiological alterations in patients with RA. Patients and Methods. RA patients and their controls (Cs), were evaluated by Tonal Audiometry (AU); if there were alterations in the air conduction (AC), bone conduction (BC), Logoaudiometry (LG), and Tympanometry (T) were performed. Results. 45 RA patients and 45 Cs were evaluated. RA patients had 40% of bilateral and 17.8% unilateral alteration versus Cs with 22.2% bilateral and 4.4% unilateral alteration versus Cs with 22.2% bilateral and 4.4% unilateral in AC audiometry. In conventional T (CT) As-type curves in patients with RA, there were 22 LE (48.8%) and 26 RE (57.7%) versus Cs, there were16 RE (35.5%) and 20 LE (44.4%). In High-frequency T (HFT): the 3B1G pattern in RA more frequent versus Controls (Cs) in RE (P = .002 and LE (P = .01). There were no differences according to RA activity or RA disease evolution. Conclusions. There is a greater tendency of auditive loss of As curves in CT (rigidity in ossicular chain) and of the 3B1G pattern in HFT in RA.

Existen los fármacos modificadores en la osteoartritis / Do disease modifying drugs exist for osteoarthritis

La osteoartritis es una enfermedad con gran impacto epidemiológico, social y económico en los sistemas de salud. Su tratamiento se ha centrado en disminuir el dolor y la inflamación articular; en los últimos años ha aparecido en el mercado una serie de medicamentos que, en estudios in vitro, muestran mecanismos de acción que podrían tener un efecto modificador de la enfermedad, ya que disminuyen las citocinas proinflamatorias y las metaloproteinasas implicadas en la degradación de la matriz del cartílago y tienen efecto en mecanismos antiapoptóticos del condrocito. Estudios clínicos han mostrado eficacia contra el dolor y en mejoría de la función articular; algunos estudios han demostrado que no hay pérdida del espacio articular evaluado por radiografía convencional con seguimiento longitudinal de los pacientes. Se trata los mecanismos de acción in vitro que tienen estos nuevos fármacos y la evidencia clínica de su utilidad tanto en los síntomas como por su potencial efecto modificador de la historia natural de la osteoartritis (AU)

The osteoarthritis is a disease with high epidemiological, social, and economic impact in health systems. Its treatment has been focused on diminishing pain and inflammation joint; in last year’s there has appeared on the market a series of drugs that, in studies in vitro show mechanisms of action that might have a modifying effect of disease, since they diminish the proinflammatory cytokines and metalloproteinases involved in degradation of cartilage matrix and it have effect in anti-apoptotics mechanisms in chondrocyte. Clinical studies have showed efficacy against pain and improving joint function; some studies have showed that there is not loss of joint space evaluated by conventional x-ray with longitudinal follow-up of patients. We describe new in vitro action mechanisms of these new drugs and the clinical evidence of its efficacy in symptoms and potentially modifying effect of the natural history of osteoarthritis (AU)

[Do disease modifying drugs exist for osteoarthritis]. / Existen los fármacos modificadores en la osteoartritis.

The osteoarthritis is a disease with high epidemiological, social, and economic impact in health systems. Its treatment has been focused on diminishing pain and inflammation joint; in last years there has appeared on the market a series of drugs that, in studies in vitro show mechanisms of action that might have a modifying effect of disease, since they diminish the proinflammatory cytokines and metalloproteinases involved in degradation of cartilage matrix and it have effect in anti-apoptotics mechanisms in chondrocyte. Clinical studies have showed efficacy against pain and improving joint function; some studies have showed that there is not loss of joint space evaluated by conventional x-ray with longitudinal follow-up of patients. We describe new in vitro action mechanisms of theses new drugs and the clinical evidence of its efficacy in symptoms and potentially modifying effect of the natural history of osteoarthritis.

Prevalencia de sensibilización hacía ácaros y hongos en trabajadores con alergia tipo I / Prevalence of sensibilization to mites and moulds on workers with allergy tipe I

Empleados de oficinas que actualmente trabajan dentro de edificaciones con sistemas cerrados de aire acondicionado, pudiesen estar expuestos a hongos y ácaros en su lugar de trabajo. Las condiciones pudiesen ser peores si estos sistemas no son mantienen de forma apropiada. El Instituto Universitario de Policía Científica de Caracas” (IUPOLC, Venezuela), pudiese ser un ejemplo de esta situación. Analizar la prevalencia de los niveles de IgE Específica en contra de ácaros (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia Tropicalis) y hongos ambientales (Penicillium notatum, Cladosporium herbarum, Aspergillus fumigatus, Alternaria tenuis/alternata) en una población que reporta sintomatología relacionadas con Alergias tipo I (Mediadas por IgE), y que labora en Instituto Universitario de Policía Científica de Caracas, IUPOLC. De la totalidad de trabajadores del edificio del IUPOLC, actualmente 47 empleados reportaron poseer síntomas asociados con Alergias Tipo I al momento de la toma de la muestra para este estudio. Se evaluó los niveles de IgE específica en contra de ácaros y hongos utilizando el sistema de Allergy Screen® de r-biopharm, (Actualmente utilizado en más de 70 países), el cual es un método de fase solida de nitro celulosa. El laboratorio que realizó el estudio está suscrito al esquema de control de calidad externo UK NEQA) (Reino Unido) y además organiza el único sistema disponible para tal fin en Venezuela. 82.98% de los pacientes estudiados presentaron sensibilizaciones en contra de ácaro y/o hongos. 53,19% mostraron valores significativos hacía ácaros; Dentro de ellos el más frecuente fue Blomia tropicalis, (25 casos), seguido Dermatophagoides pteronissynus por Dermatophagoides farinae. Dentro de los hongos los más frecuentes resultaron Cladosporium herbarum (10 casos), Aspergillus fumigatus, (9 casos) Penicillium notatum (4 casos) y Alternaria alternata (1 caso)...

Office employees that actually work inside buildings with air-conditioned closed systems are well known to be exposed to fungi and storage mites in their workplace. The conditions could be worst when those systems aren’t properly maintained. The “Instituto Universitario de Policía Científica de Caracas” (IUPOLC, Venezuela) could be an example for that situation. AIM: To evaluate the prevalence of sensitization to moulds and mites though Specific IgE levels determinations, on workers of the IUPOLC that presented clinical symptoms associated with allergy type I at the moment of the study. From the total population of workers of the IPUOLC facility, actually 47 employees of IUPOLC presented one or more clinical symptoms associated with allergy at the moment of the study. The level of serum-specific IgE to mites and moulds were evaluated, using the Allergy Screen® r-biopharm methodology enzymatic solid phase method in nitro-cellulose in all subjects (Actually used in more than 70 countries). The Laboratory that performed the tests is actually subscribed to the UK NEQAS (United Kingdom National External Quality Assessment Service), and also they organize the only Allergy External Quality Scheme available in Venezuela. 82.98% of the patients analyzed presented one or more increased values for mites or molds. 53,2% resulted with positive values for Mites; the most frequent mites involved on the population were Blomia tropicalis, (with 25 cases), Dermatophagoides pteronissynus and Dermatophagoides farinae. On molds the most frequent sensibilizations resulted on Cladosporium herbarum (10 cases), Aspergillus fumigatus, (9 cases) Penicillium notatum (4 cases) and last Alternaria alternata (1 case). This study suggests an important role of fungi and mites as occupational allergens for IUPOLC workers. The prevalence of allergic symptoms among employees of IUPOLC was relatively high...