ABSTRACT
The objective of this study was to evaluate the effects of increasing levels of the M-E complex (xylanase, glucanase, cellulase, and invertase) Optimax E® on the performance of growing lambs, their digestibility, and their rumen microbiota, and to estimate NEm, NEg, and ruminal methane levels. Forty lambs (Katahdin x Dorset; 22.91 ± 4.16 kg) were randomly assigned to dietary concentrations of ME (0, 0.2, 0.4, and 0.8% DM) and fed individually for 77 days. Increasing M-E improved feed conversion (p < 0.05) as well as NEm and NEg (p < 0.05), which were associated with increased in vivo DM and NDF digestion (linear and quadratic p < 0.01). Few microbial families showed abundancy changes (Erysipelotrichaceae, Christensenellaceae, Lentisphaerae, and Clostridial Family XIII); however, the dominant phylum Bacteroidetes was linearly reduced, while Firmicutes increased (p < 0.01), resulting in a greater Firmicutes-to-Bacteroidetes ratio. Total Entodinium showed a quadratic response (p < 0.10), increasing its abundancy as the enzyme dose was augmented. The daily emission intensity of methane (per kg of DMI or AGD) was reduced linearly (p < 0.01). In conclusion, adding the M-E complex Optimax E® to growing lambs' diets improves their productive performance by acting synergistically with the rumen microbiota, modifying the Firmicutes-to-Bacteroidetes ratio toward more efficient fermentation, and shows the potential to reduce the intensity of greenhouse gas emissions from lambs.
ABSTRACT
Objective: Atopic dermatitis is a chronic, systemic, relapsing disease with dermatological manifestations, which imposes a high burden on patients, families and the health care system and has a high psychological, social, and economic impact and on the quality of life of patients. It mainly affects the pediatric population and, to a lesser extent, the adult population. The clinical presentation varies according to the age and evolution of the disease, and currently there are multiple pharmacological and non-pharmacological therapies available for the symptomatic management of patients. Methods: To present an algorithm for the management of atopic dermatitis, proposed as a series of recommendations on the management, diagnosis, education, and follow-up of these patients. Results: A consensus was reached using the nominal group technique. The methodology was developed in 7 phases, including: posing the research questions, literature search, an initial proposal of recommendations, elaboration of the final recommendations and the management algorithm with three voting cycles, consensus was established with 80% favorability. Conclusions: The result of the consensus process is a management algorithm for patients with mild, moderate/severe atopic dermatitis derived from expert recommendations. The algorithm establishes diagnostic and treatment criteria and provides updated recommendations, including all therapeutic alternatives available in Peru for the management of patients with mild, moderate, and severe atopic dermatitis.
Objetivo: La dermatitis atópica es una enfermedad crónica, sistémica, reincidente, con manifestaciones dermatológicas, que impone una alta carga a los pacientes, las familias y los sistemas de salud, y tiene repercusión psicológica, social y económica, y en la calidad de vida de los pacientes. Afecta principalmente a la población pediátrica y con menor frecuencia a la adulta. Las manifestaciones clínicas varían según la edad y evolución de la enfermedad, y en la actualidad se dispone de múltiples opciones farmacológicas y no farmacológicas para el tratamiento de los pacientes. Métodos: Presentar un algoritmo de tratamiento de la dermatitis atópica, propuesto con una serie de recomendaciones acerca del diagnóstico, tratamiento y seguimiento de los pacientes. Resultados: Se llevó a cabo un consenso de expertos, utilizando la técnica del grupo nominal. La metodología se desarrolló en 7 fases que incluyeron: planteamiento de las preguntas de investigación, búsqueda de la bibliografía, propuesta inicial de las recomendaciones, elaboración de las recomendaciones finales y del algoritmo de tratamiento con tres ciclos de votación. Se estableció el consenso con un 80% de favorabilidad. Conclusiones: El resultado del consenso fue un algoritmo de tratamiento de pacientes con dermatitis atópica leve, moderada-grave, derivado de las recomendaciones de expertos. En el algoritmo se establecen criterios diagnósticos y de tratamiento, y se aportan recomendaciones actualizadas que incluyen las alternativas disponibles en Perú.
Subject(s)
Dermatitis, Atopic , Quality of Life , Adult , Humans , Child , Dermatitis, Atopic/therapy , Peru , CyclosporineABSTRACT
The prevalence of food allergy (FA) is increasing in some areas of the globe, highlighting the need for better strategies for prevention, diagnosis, and therapy. In the last few decades, we have made great strides in understanding the causes and mechanisms underlying FAs, prompting guideline updates. Earlier guidelines recommended avoidance of common food allergens during pregnancy and lactation and delaying the introduction of allergenic foods in children aged between 1 and 3 years. Recent guidelines for allergy prevention recommend consumption of a healthy and diverse diet without eliminating or increasing the consumption of allergenic foods during pregnancy or breast-feeding. Early introduction of allergenic foods is recommended by most guidelines for allergy prevention after a period of exclusive breast-feedng (6 months [World Health Organization] or 4 months [European Academy of Allergy and Clinical Immunology]). New diagnostics for FA have been developed with varied availability of these tests in different countries. Finally, the first oral immunotherapy drug for FA was approved by the US Food and Drug Administration and European Medicines Agency in 2020. In this review, we will address the global prevalence of FA, our current understanding of the causes of FA, and the latest guidelines for preventing, diagnosing, and treating FA. We will also discuss similarities and differences between FA guidelines.
Subject(s)
Desensitization, Immunologic/methods , Food Hypersensitivity/epidemiology , Allergens/immunology , Animals , Breast Feeding , Child, Preschool , Diet Therapy , Female , Food , Food Hypersensitivity/diagnosis , Food Hypersensitivity/therapy , Humans , Infant , Practice Guidelines as Topic , Pregnancy , PrevalenceABSTRACT
INTRODUCTION: Adoption of control tools for atopic dermatitis (AD) in Latin America (LA) is currently very limited. Clinical assessment tools represent a practical method to measure the impact of treatment on disease activity and on the quality of life of patients. However, the use of these tools in the LA clinical practice setting is limited. METHODS: A selected panel of Latin American experts in fields related to atopic dermatitis were provided with a series of relevant questions to address prior to the multi-day conference. Within this conference, each narrative was discussed and edited by the entire group, through numerous drafts and rounds of discussion, until a consensus was achieved. RESULTS: The panel proposes specific and realistic recommendations for implementing control tools for AD care in LA. In creating these recommendations, the authors strove to address all barriers to the widespread use of these tools. CONCLUSION: This article includes a narrative analysis of barriers to AD control in LA and provides necessary recommendations to integrate and increase the use of validated AD control assessment tools throughout the region.
ABSTRACT
RESUMEN Actualmente no existe vacuna disponible ni medicación específica contra la enfermedad por coronavirus 2019 (COVID-19). El tratamiento se basa fundamentalmente en medidas de soporte. En este contexto, se han aprobado múltiples terapias de potencial utilidad para su uso en ensayos clínicos, como la transfusión de plasma convaleciente (TPC). Se realizó una búsqueda en PubMed de estudios sobre plasma convaleciente y COVID-19, SARS o MERS. Los estudios sobre la eficacia clínica en enfermedades causadas por otros coronavirus (SARS-CoV y MERS-CoV) evidenciaron mejoría clínica, aumento de anticuerpos neutralizantes, disminución de la mortalidad y ausencia de eventos adversos durante y después del tratamiento. En el caso de la COVID-19, se encontraron 13 estudios en pacientes con la COVID-19 grave y crítica. Aunque existen limitaciones en la metodología, en el número de pacientes y en los protocolos para el análisis del plasma convaleciente de los donantes, los pacientes que recibieron TPC evidenciaron mejoría clínica, mejoría de patrones ventilatorios, resolución de lesiones pulmonares, disminución de mortalidad, mejoría de parámetros laboratoriales, aumento de anticuerpos neutralizantes, disminución de carga viral y baja frecuencia de eventos adversos.
ABSTRACT There is currently no vaccine available and no specific medication against Coronavirus 2019 disease (COVID-19). The treatment is mainly based on support measures. In this context, several potentially useful therapies have been approved for use in clinical trials, such as convalescent plasma transfusion (CPT). PubMed was searched for studies on convalescent plasma and COVID-19, SARS or MERS. Studies on clinical efficacy in diseases caused by other coronaviruses (SARS-CoV and MERS-CoV) showed clinical improvement, increase of neutralizing antibodies, decreased mortality and absence of adverse events during and after treatment. We found 13 studies on this type of treatment used in patients with severe and critical COVID-19. Despite limitations regarding methodology, number of patients and the protocols for the analysis of donors' convalescent plasma, patients who received CPT showed clinical improvement, improvement of ventilatory patterns, resolution of lung injuries, decreased mortality, improvement of laboratory parameters, increase of neutralizing antibodies, decreased viral load and low frequency of adverse events.
Subject(s)
Patients , Plasma , COVID-19 , Mortality , Severe acute respiratory syndrome-related coronavirus , Middle East Respiratory Syndrome Coronavirus , LaboratoriesABSTRACT
Currently, there is no available vaccine or specific medication against Coronavirus Disease 2019 (COVID-19). The treatment is fundamentally based on supportive measures. In recent weeks, in various parts of the world, including our country, there have been flexibilities for the scientific community to conduct clinical trials with potentially useful therapies, such as the case of convalescent plasma transfusion (CPT) of patients with COVID-19. A MEDLINE search of studies on convalescent plasma and COVID-19, SARS or MERS was performed. Studies on the clinical efficacy of this treatment in diseases caused by other coronaviruses (SARS-CoV and MERS-CoV) showed clinical improvement, increased neutralizing antibodies, decreased mortality and the absence of adverse events during and after treatment. In the case of COVID-19, 6 studies were found of the use of this treatment in patients with severe COVID-19 (in mechanical ventilation and with acute respiratory distress syndrome). Although there are limitations in the methodology, number of patients and protocols for the analysis of convalescent plasma from donors, the patients who received CPT showed clinical improvement, improvement in ventilatory patterns, resolution of lung lesions, decreased mortality, improvement in laboratory parameters, increased neutralizing antibodies, decreased viral load and absence of adverse events. We also present a protocol for carrying out TPC and proposals for its implementation and use in our country.
Actualmente no existe vacuna disponible ni medicación específica contra la enfermedad de Coronavirus 2019 (COVID-19). El tratamiento se basa fundamentalmente en medidas de soporte. En las últimas semanas, en varias partes del mundo, incluido nuestro país, se han dado flexibilidades para que la comunidad científica conduzca ensayos clínicos con terapias de potencial utilidad, como es el caso de la transfusión de plasma convaleciente (TPC) de pacientes con COVID-19. Se realizó una búsqueda en MEDLINE de estudios sobre plasma convaleciente y COVID-19, SARS o MERS. Los estudios sobre la eficacia clínica de este tratamiento en enfermedades causadas por otros coronavirus (SARS-CoV y MERS-CoV) evidenciaron mejoría clínica, aumento de anticuerpos neutralizantes, disminución de mortalidad y ausencia de eventos adversos durante y después del tratamiento. En el caso del COVID-19, se encontraron 6 estudios del uso de este tratamiento en pacientes con COVID-19 severo (en ventilación mecánica y con síndrome de distrés respiratorio agudo). Aunque existen limitaciones en la metodología, número de pacientes y protocolos para el análisis del plasma convaleciente de los donantes, los pacientes que recibieron TPC evidenciaron mejoría clínica, mejoría de patrones ventilatorios, resolución de lesiones pulmonares, disminución de mortalidad, mejoría de parámetros laboratoriales, aumento de anticuerpos neutralizantes, disminución de carga viral y ausencia de eventos adversos. Presentamos además un protocolo de realización de TPC y propuestas para su implementación y uso en nuestro país.
ABSTRACT
There is currently no vaccine available and no specific medication against Coronavirus 2019 disease (COVID-19). The treatment is mainly based on support measures. In this context, several potentially useful therapies have been approved for use in clinical trials, such as convalescent plasma transfusion (CPT). PubMed was searched for studies on convalescent plasma and COVID-19, SARS or MERS. Studies on clinical efficacy in diseases caused by other coronaviruses (SARS-CoV and MERS-CoV) showed clinical improvement, increase of neutralizing antibodies, decreased mortality and absence of adverse events during and after treatment. We found 13 studies on this type of treatment used in patients with severe and critical COVID-19. Despite limitations regarding methodology, number of patients and the protocols for the analysis of donors' convalescent plasma, patients who received CPT showed clinical improvement, improvement of ventilatory patterns, resolution of lung injuries, decreased mortality, improvement of laboratory parameters, increase of neutralizing antibodies, decreased viral load and low frequency of adverse events.
Actualmente no existe vacuna disponible ni medicación específica contra la enfermedad por coronavirus 2019 (COVID-19). El tratamiento se basa fundamentalmente en medidas de soporte. En este contexto, se han aprobado múltiples terapias de potencial utilidad para su uso en ensayos clínicos, como la transfusión de plasma convaleciente (TPC). Se realizó una búsqueda en PubMed de estudios sobre plasma convaleciente y COVID-19, SARS o MERS. Los estudios sobre la eficacia clínica en enfermedades causadas por otros coronavirus (SARS-CoV y MERS-CoV) evidenciaron mejoría clínica, aumento de anticuerpos neutralizantes, disminución de la mortalidad y ausencia de eventos adversos durante y después del tratamiento. En el caso de la COVID-19, se encontraron 13 estudios en pacientes con la COVID-19 grave y crítica. Aunque existen limitaciones en la metodología, en el número de pacientes y en los protocolos para el análisis del plasma convaleciente de los donantes, los pacientes que recibieron TPC evidenciaron mejoría clínica, mejoría de patrones ventilatorios, resolución de lesiones pulmonares, disminución de mortalidad, mejoría de parámetros laboratoriales, aumento de anticuerpos neutralizantes, disminución de carga viral y baja frecuencia de eventos adversos.
Subject(s)
Antibodies, Neutralizing/immunology , COVID-19/therapy , Blood Component Transfusion/methods , COVID-19/immunology , COVID-19/mortality , Humans , Immunization, Passive/adverse effects , Immunization, Passive/methods , Severity of Illness Index , Treatment Outcome , Viral Load/immunology , COVID-19 SerotherapyABSTRACT
A polyherbal feed mixture containing (Achyrantes aspera, Trachyspermum ammi, Citrullus colocynthis, Andrographis paniculata, and Azadirachta indica) was evaluated in growing calves through blood chemistry, blood biometry, and gene expression during the pre-ruminant to weaning period. Forty Holstein calves (initial BW 45.6 ± 3.2 kg; 22.8 ± 0.9 days post birth) from a dairy farm were randomly assigned to the following treatments: 0, 3, 4, and 5 g/d of a polyherbal mixture, dosed in colloid gels with gelatin. Calves were housed in individual outdoor boxes with ad libitum access to a 21.5% CP calf starter and water and fed individually with a mixture of milk and a non-medicated milk replacer (22% CP). Blood samples were collected on day 59 for blood chemistry, blood biometry, and gene expression analysis in leukocyte through microarray assays. Immunoglobulins were quantified by enzyme-linked immunosorbent assay. The animals treated with the polyherbal mixture showed a quadratic effect on final body weight, daily weight gain, final hip height, and final thoracic girth. The best performance results were obtained with a treatment dose of 4 g/d. The serum IgG increased linearly with the treatment doses. Gene set enrichment analysis of upregulated genes revealed that the three biological processes with higher fold change were tight junction, mucin type O-Glycan biosynthesis, and intestinal immune network for IgA production. Also, these upregulated genes influenced arachidonic acid metabolism, and pantothenate and CoA biosynthesis. Gene ontology enrichment analysis indicated that the pathways enriched were PELP1 estrogen receptor interacting protein pathways, nuclear receptors in lipid metabolism and toxicity, tight junction, ECM-receptor interaction, thyroid hormone signaling pathways, vascular smooth muscle contraction, ribosome function, glutamatergic synapse pathway, focal adhesion, Hippo, calcium, and MAPK signaling pathways.
ABSTRACT
Food allergy (FA) is currently a significant health care problem in the developing world. Widely varying study populations and methodologies, the use of surrogate markers such as self report or hospitalization rates due to anaphylaxis rather than objective methods, limits robust estimation of FA prevalence in low income settings. Also, allergy is under-recognized as a clinical specialty in the developing world which compromises the chance for accurate diagnosis. In this review, most published data on food allergens from developing or low income countries are displayed. The diagnostic challenges and limitations of treatment options are discussed. It seems that FA is an under-appreciated health care issue in the developing world, and accurate determination of its burden in low-income settings represents an important unmet need. Multicenter surveillance studies, using standardized methodologies, are, therefore, needed to reveal the true extent of the problem and provide epidemiological clues for prevention. Preventive strategies should be tailored to fit local circumstances in different geographic regions. In addition, studying the gene environment interactions and impact of early life microbiota on the expression of FA in developing communities would be worthwhile. Efforts and resources should be directed toward public health education and training of health care providers dealing with food allergic patients.
Subject(s)
Food Hypersensitivity , Health Knowledge, Attitudes, Practice , Pediatrics , Adult , Female , Humans , Male , Middle Aged , Peru , Self ReportABSTRACT
Oxygen saturation, measured by pulse oximetry (SpO2), is a vital clinical measure. Our descriptive, cross-sectional study describes SpO2 measurements from 6289 healthy subjects from age 1 to 80 years at 15 locations from sea level up to the highest permanent human habitation. Oxygen saturation measurements are illustrated as percentiles. As altitude increased, SpO2 decreased, especially at altitudes above 2500 m. The increase in altitude had a significant impact on SpO2 measurements for all age groups. Our data provide a reference range for expected SpO2 measurements in people from 1 to 80 years from sea level to the highest city in the world.
Subject(s)
Altitude , Oxygen/blood , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Male , Middle Aged , Oximetry , Peru , Reference ValuesABSTRACT
Inhaled corticosteroid (ICS) therapy has become standard in the treatment of asthma. A common local adverse effect of ICS therapy is dysphonia, which has been reported to affect 5% to 58% of patients. Although causes of dysphonia associated with ICS therapy have been underinvestigated, it may result from deposition of an active ICS in the oropharynx during administration, which then causes myopathy or a mucosal effect in the laryngopharynx. Use of ICS should be considered during any evaluation of dysphonia. We recommend using the lowest effective dosage of ICS, administering medication with a spacer, gargling, rinsing the mouth and washing the face after inhalation, and washing the spacer. If dysphonia develops despite these interventions, ICS use should be suspended until symptoms resolve, provided that asthma control is not compromised.
