ABSTRACT
Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society's member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon.
Subject(s)
Gastroenterology , Infant , Child , Female , Humans , Cocos , Consensus , Latin America , Infant Nutritional Physiological PhenomenaABSTRACT
Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein.
Subject(s)
Gastroenterology , Milk Hypersensitivity , Animals , Cattle , Consensus , Female , Humans , Latin America , Milk Hypersensitivity/diagnosis , Milk Hypersensitivity/therapy , Milk Proteins/adverse effectsABSTRACT
BACKGROUND: Mucinous appendiceal neoplasms with peritoneal dissemination (PD) show a wide spectrum of clinical behaviour. Histological grade has been correlated with prognosis, but no universally accepted histological grading has been established. The aim of this systematic review was to provide historical insight to understand current grading classifications, basic histopathological features of each category, and to define which classification correlates best with prognosis. METHODS: MEDLINE and the Cochrane Library were searched for studies that reported survival across different pathological grades in patients with mucinous neoplasm of the appendix with PD treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. PRISMA guidelines were followed. RESULTS: Thirty-eight studies were included. Ronnett's classification was the most common (9 studies). Classifications proposed by the Peritoneal Surface Oncology Group International (PSOGI) (6 studies) and the seventh or eighth edition of the AJCC (7 studies) are gaining in popularity. Nine studies supported a two-tier, 12 a three-tier, and two a four-tier classification system. Three studies demonstrated that acellular mucin had a better prognosis than low-grade pseudomyxoma peritonei in the PSOGI classification or M1bG1 in the eighth edition of the AJCC classification. Four studies demonstrated that the presence of signet ring cells was associated with a worse outcome than high-grade pseudomyxoma peritonei in the PSOGI classification and M1bG2 in the eighth edition of the AJCC. CONCLUSION: There is a great need for a common language in describing mucinous neoplasms of the appendix with PD. Evolution in terminology as a result of pathological insight turns the four-tiered PSOGI classification system into a coherent classification option.
Subject(s)
Appendiceal Neoplasms , Appendix , Peritoneal Neoplasms , Pseudomyxoma Peritonei , Appendiceal Neoplasms/therapy , Cytoreduction Surgical Procedures , Humans , Peritoneal Neoplasms/therapy , Pseudomyxoma Peritonei/therapyABSTRACT
BACKGROUND: Sleep disorders in schoolchildren are a common problem worldwide, and when are not adequately diagnosed and treated, their negative impact on daytime functioning may be significant. The aim of this study was to evaluate the psychometric properties of the Spanish version of the Children's Sleep Habits Questionnaire (CSHQ). METHODS: Participants were 286 school-aged children from a community-based sample, aged 4 to 7 years. The sleep behaviour was evaluated using the CSHQ and actigraphy (ActiSleep monitor). The CSHQ was adapted to the Spanish language. The internal consistency of the questionnaire and the test-retest reliability between scores at baseline and three-weeks-later were estimated. Associations between CSHQ items and accelerometer sleep quality indicators were used as indicators of concurrent validity. RESULTS: Cronbach's alpha coefficients for the subscales ranged from 0.60 to 0.81, and 0.81 for the full scale; the intraclass correlation coefficients ranged from 0.56 to 0.81. A moderate correlation was observed in sleep latency and awakenings measurements using both parents' reported sleep habits (CSHQ-SP) and sleep quality indicators (ActiSleep). CONCLUSIONS: The CSHQ-SP has demonstrated adequate psychometric properties, and it serves as a useful instrument for clinical and research setting.
Subject(s)
Sleep Hygiene , Sleep Initiation and Maintenance Disorders/diagnosis , Actigraphy/methods , Child , Child Behavior , Child, Preschool , Female , Humans , Male , Psychometrics , Reproducibility of Results , Spain , Surveys and QuestionnairesABSTRACT
La cirugía de las hemorroides es una práctica que se puede llevar a cabo en un régimen ambulatorio. El objetivo de este trabajo es el de revisar las técnicas quirúrgicas, las complicaciones asociadas y brindar una serie de recomendaciones que favorecen la evolución del paciente ambulatorio. La hemorroidectomía sigue siendo el patrón oro en el tratamiento de la enfermedad hemorroidal cuando existe indicación quirúrgica. Dado que la hemorroidectomía se asocia a dolor y a ciertas complicaciones, se han buscado otras opciones quirúrgicas e implementado nuevas tecnologías. Estas opciones deben ser analizadas y comparadas con las técnicas clásicas. Las complicaciones, encabezadas por el dolor y el sangrado, son el principal temor de la cirugía de las hemorroides, sobre todo si ésta se realiza en un régimen ambulatorio; no obstante se pueden minimizar si se siguen una serie de recomendaciones. La cirugía ambulatoria de las hemorroides es una técnica segura y factible. La selección de los pacientes es de especial importancia pues no todos los casos se beneficiarían de la cirugía sin ingreso; la experiencia del cirujano juega un papel decisivo en dicha selección (AU)
Surgery for haemorrhoids is common practice as a day-case procedure. The aim of this article is to review the surgical options and complications and to give recommendations in order to improve ambulatory care. Haemorrhoidectomy id the gold standard treatment for haemorrhoidal disease when surgical indication exists. Because hamorrhoidectomy is associated with several complications, many different surgical options and new technique have been developed. Comparison between classic and recent procedures is needed. The complications which cause most concern are pain and bleeding, especially in an ambulatory setting. Nervetheless, they can be nearly eliminated if some recommendations are followed. Ambulatory surgery for haemorrhoids is a safe and feasible technique. Preoperative selection and surgeon experience are crucial in order to perform a successful procedure in an out-patient regime (AU)
