Colonoscopy Satisfaction and Safety Questionnaire based on patient experience (CSSQP): A valuable quality tool for all colonoscopies.

INTRODUCTION: The Colonoscopy Satisfaction and Safety Questionnaire based on Patient experience (CSSQP) was recently developed and validated within a Bowel Cancer Screening Program. We aimed to identify factor related to patient experience through the CSSQP, including all indications for colonoscopy. Indicators of satisfaction and perceived safety with colonoscopy were also assessed to compare the different centers. METHODS: Multicenter study in nine Spanish hospitals. Consecutive patients who had undergone a colonoscopy completed the CSSQP adding a novel item on bowel preparation. Factors related to patient experiences and data from non-respondents were analyzed. RESULTS: Of 2200 patients, 1753 filled out the questionnaire (response rate 79.7%, sample error 2%). Patients whose colonoscopy indication was a primary colorectal cancer screening (OR: 1.68, 95% CI: 1.15-2.44, p=0.007) or due to a +FIT (OR: 1.73, 95% CI: 1.18-2.53) reported higher satisfaction than patients with gastrointestinal symptoms. In addition, college-educated patients (OR: 2.11, 95% CI: 1.25-3.56) were more likely to report better overall satisfaction than patients with lower education level. Significant differences were observed in the majority of the CSSQP items between centers. Safety incidents were reported by 35 (2%) patients, and 176 (10%) patients reported that they received insufficient information. CONCLUSION: The CSSQP identifies several significant factors on satisfaction and perceived safety in patients referred for colonoscopy for any reason. The CSSQP also allows comparison of patient-identified colonoscopy quality indicators between centers.

Congenital Epulis in the Newborn: Report of a Clinical Case / Épulis Congénoito en el Recién Nacido: Reporte de un Caso Clínico / Epulis Congênita no Recém-Nascido: Relato de Caso Clínico

Odontogenic oral lesions in pediatric patients It is essential to understand the pathogenesis of odontogenic tumors. The clinical presentation, microscopic features, and prognosis are addressed for odontogenic lesions in the newborn, but familiarity with these entities is essential due to the different therapeutic implications of these diagnoses. The case we present is a five-day-old newborn in the Neonatology service of the Dos de Mayo National Hospital, Peru, the reason for consultation was "he was born with a lump in his mouth." On clinical inspection, a palatine lobe was found. The palatine lobe was presented for inspection. Conventional outpatient surgery is performed to remove the foreign body, completely removing the tumor. The surgical specimen was sent to pathology, which confirmed the definitive diagnosis: congenital epulis of the newborn.

Lesiones orales odontogénicos en pacientes pediátricos es esencial comprender la patogénesis de los tumores odontogénicos. La presentación clínica, las características microscópicas y el pronóstico se abordan para las lesiones odontogénicos en el recién nacido, pero la familiaridad con estas entidades es esencial debido a las diferentes implicaciones terapéuticas de estos diagnósticos. El caso que presentamos es un recién nacido de cinco días en el servicio de Neonatología del Hospital Nacional Dos de Mayo, Perú, el motivo de consulta "nació con un bulto en la boca". En la inspección clínica se encontró un lóbulo palatino. Presentaba a la inspección el lóbulo palatino. Se realiza una cirugía convencional ambulatoria para retirar el cuerpo extraño, extirpando de manera total la tumoración. Se envió la pieza quirúrgica a patología, en los resultando confirmaron como diagnóstico definitivo: épulis congénito del recién nacido.

Lesões orais odontogênicas em pacientes pediátricos É essencial compreender a patogênese dos tumores odontogênicos. A apresentação clínica, as características microscópicas e o prognóstico são abordados nas lesões odontogênicas do recém-nascido, mas a familiaridade com essas entidades é essencial devido às diferentes implicações terapêuticas desses diagnósticos. O caso que apresentamos é um recém-nascido de cinco dias atendido no serviço de Neonatologia do Hospital Nacional Dos de Mayo, Peru, o motivo da consulta foi "ele nasceu com um caroço na boca". Na inspeção clínica, foi encontrado um lobo palatino. O lobo palatino foi apresentado para inspeção. A cirurgia ambulatorial convencional é realizada para retirada do corpo estranho, retirando completamente o tumor. A peça cirúrgica foi encaminhada ao serviço de patologia, que confirmou o diagnóstico definitivo: epúlide congênita do recém-nascido.

Molar Incisor Hypomineralization (MIH): effective treatment, clinical approach in pediatric dentistry: Clinical case report. / Hipomineralización Incisivo Molar (HIM): tratamiento eficaz abordaje clínico en odontopediatría: Reporte de caso clínico. / Hipomineralização Molar Incisivo (HMI): tratamento eficaz, abordagem clínica em odontopediatria: relato de caso clínico.

Molar Incisor Hypomineralization is defined as a qualitative enamel defect, although its etiology still differs and may be a consequence of problems during pregnancy or the formation of the organic matrix of the tooth. It comes with different characteristics and grades. The clinical case report presents a Central Incisor with a demarcated creamy white opacity corresponding to grade 2 by Ghanim et al. (2015). They classify injuries into degrees; thus affecting the patient's aesthetics and being a concern for parents, a treatment was proposed that consists of a minimally invasive alternative using the infiltrating resin with the commercial name ICON, it is indicated for D1 or R3 lesions according to radiological detection criteria (radiolucency up to external third of the dentin) and white spot lesions on free vestibular surfaces, the early detection of these lesions will lead us to initiate prevention measures incorporating hygienic practices and application of restorative and preventive materials, infiltrative resins are an alternative and novel method to despite their cost and difficulty of acquisition since they must be imported from neighboring countries.

La Hipomineralización Incisivo molar se define como defecto cualitativo del esmalte aunque aún su etiología difiere pudiendo ser consecuencia de problemas en embarazo o formación de la matriz orgánica del diente, se presenta con diferentes características y grados, el reporte del caso clínico presenta un Incisivo Central con una opacidad demarcada blanco crema que corresponde a un grado 2 por Ghanim et al. (2015). clasifican las lesiones en grados; afectando así la estética del paciente y siendo una preocupación para padres de familia, se le planteo un tratamiento que consiste en una alternativa mínimamente invasiva usando la resina infiltrante con nombre comercial ICON, está indicado para lesiones D1 o R3 según criterio de detección radiográfico (radiolucidez hasta el tercio externo de la dentina) y lesiones de mancha blanca en superficies libres vestibulares, la temprana detección de estas lesiones nos llevara a iniciar medidas de prevención incorporando practicas higiénicas y aplicación de materiales restauradores y preventivos, las resinas infiltrativa son un método alternativo y novedoso a pesar de su costo y dificultad de adquisición ya que se las debe importar de países vecinos.

A hipomineralização molar incisivo é definida como um defeito qualitativo do esmalte, embora sua etiologia ainda seja diferente, podendo ser consequência de problemas durante a gravidez ou na formação da matriz orgânica do dente. Ele vem com diferentes características e notas. O relato de caso clínico apresenta um Incisivo Central com opacidade branco-creme demarcada correspondente ao grau 2 de Ghanim et al. (2015). Eles classificam as lesões em graus; afetando assim a estética do paciente e sendo uma preocupação para os pais, foi proposto um tratamento que consiste em uma alternativa minimamente invasiva utilizando a resina infiltrante de nome comercial ICON, é indicada para lesões D1 ou R3 conforme critérios de detecção radiológica (radiolucência até terço externo da dentina) e lesões de manchas brancas nas superfícies vestibulares livres, a detecção precoce destas lesões nos levará a iniciar medidas de prevenção incorporando práticas higiênicas e aplicação de materiais restauradores e preventivos, as resinas infiltrativas são um método alternativo e novo para apesar de sua custo e dificuldade de aquisição, pois devem ser importados de países vizinhos.

Untangling the evolution of body-part terminology in Pano: conservative versus innovative traits in body-part lexicalization.

Although language-family specific traits which do not find direct counterparts outside a given language family are usually ignored in quantitative phylogenetic studies, scholars have made ample use of them in qualitative investigations, revealing their potential for identifying language relationships. An example of such a family specific trait are body-part expressions in Pano languages, which are often lexicalized forms, composed of bound roots (also called body-part prefixes in the literature) and non-productive derivative morphemes (called here body-part formatives). We use various statistical methods to demonstrate that whereas body-part roots are generally conservative, body-part formatives exhibit diverse chronologies and are often the result of recent and parallel innovations. In line with this, the phylogenetic structure of body-part roots projects the major branches of the family, while formatives are highly non-tree-like. Beyond its contribution to the phylogenetic analysis of Pano languages, this study provides significative insights into the role of grammatical innovations for language classification, the origin of morphological complexity in the Amazon and the phylogenetic signal of specific grammatical traits in language families.

Spanish Intragastric Balloon Consensus Statement (SIBC): practical guidelines based on experience of over 20 000 cases.

BACKGROUND: intragastric balloons (IGBs) are a minimally invasive, increasingly popular option for obesity treatment. However, there is only one worldwide guideline standardizing the technical aspects of the procedure (BIBC, SOARD 2018). OBJECTIVES: to construct a practical guideline for IGB usage by reproducing and expanding the BIBC survey among the Spanish Bariatric Endoscopy Group (GETTEMO). METHODS: a 140-question survey was submitted to all GETTEMO members. Twenty-one Spanish experienced endoscopists in IGBs answered back. Eight topics on patient selection, indications/contraindications, technique, multidisciplinary follow-up, results, safety, and financial/legal aspects were discussed. Consensus was defined as consensus ≥ 70 %. RESULTS: overall data included 20 680 IGBs including 12 different models. Mean age was 42.0 years-old, 79.9 % were women, and the mean preoperative body mass index (BMI) was 34.05 kg/m². Indication in BMI > 25 kg/m², 10 absolute contraindications, and nutritional and medication measures at follow-up were settled. A mean %TBWL (total body weight loss) of 17.66 % ± 2.5 % was observed. Early removal rate due to intolerance was 3.62 %. Adverse event rate was 0.70 % and 6.37 % for major and minor complications with consensual management. A single case of mortality occurred. IGBs were placed in private health, prior contract, and with full and single payment at the beginning. Seven lawsuits (0.034 %) were received, all ran through civil proceeding, and with favorable final resolution. CONCLUSIONS: this consensus based on more than 20 000 cases represents practical recommendations to perform IGB procedures. This experience shows that the device leads to satisfactory weight loss with a low rate of adverse events. Most results are reproducible compared to those obtained by the BIBC.

Una aproximación a la dignidad del trabajo médico / The dignity of medical work. A qualitative approach

BACKGROUND: A work that dignifies, that is adequately rewarded and is carried out with social protection is considered decent by the International Labor Organization. AIM: To describe and understand the different dimensions of the dignity of medical work from the perspective of Chilean male and female doctors. MATERIAL AND METHODS: From a qualitative approach, the first stage of the study consisted in the application of an open response survey which was answered by doctors from all over the country. The second stage consisted in discussion instances about dignity of medical work. In the third stage, semi-structured in-depth interviews with doctors of both sexes and of different generations were conducted. The analysis of the data was carried out following the approaches of the Grounded Theory. RESULTS: The concept of dignity of medical work arises from a historical process of social conquest and implies the recognition of the rights of professionals and patients. Optimal conditions are required to provide quality health care. However, even in unworthy conditions, doctors do everything possible to provide a decent care. The need to humanize the relationships that occur in the context of health care is proposed. Carrying out medical work with excellence and professionalism contributes to personal fulfillment. Associativity contributes to dignify medical work. CONCLUSIONS: The dignity of medical work is understood by doctors as a polysemic and relational concept.

Randomized clinical trial of integral cognitive remediation program for major depression (INCREM).

BACKGROUND: Despite achieving clinical remission, patients with depression encounter difficulties to return to their premorbid psychosocial functioning. Cognitive dysfunction has been proposed to be a primary mediator of functional impairment. Therefore, the new non-pharmacological procognitive strategy INtegral Cognitive REMediation for Depression (INCREM) has been developed with the aim of targeting cognitive and psychosocial functioning. METHODS: This is a single-blind randomized controlled clinical trial with three treatment arms. Fifty-two depressed patients in clinical remission, with psychosocial difficulties and cognitive impairment, were randomly assigned to receive INCREM intervention, Psychoeducation programme, or treatment as usual. Patients were assessed before and after the study period, and six months after. The primary outcome was the change from baseline of patients' psychosocial functioning. Changes in cognitive functioning and other variables were considered secondary outcomes. RESULTS: The analysis showed a significant improvement in psychosocial functioning in the INCREM group, especially six months after the intervention, compared to patients who received the psychoeducation programme. An improvement in cognitive performance was also observed in the INCREM group. LIMITATIONS: This study includes a small sample size due to the anticipated end of the clinical trial because of the COVID-19 pandemic. DISCUSSION: These results provide preliminary evidence on the feasibility and potential efficacy of the INCREM program to improve not only cognitive performance but also psychosocial functioning in clinically remitted depressed patients, and such improvement is maintained six months after. It can be speculated that the maintenance is mediated by the cognitive enhancement achieved with INCREM.

[The dignity of medical work. A qualitative approach]. / Una aproximación a la dignidad del trabajo médico.

BACKGROUND: A work that dignifies, that is adequately rewarded and is carried out with social protection is considered decent by the International Labor Organization. AIM: To describe and understand the different dimensions of the dignity of medical work from the perspective of Chilean male and female doctors. MATERIAL AND METHODS: From a qualitative approach, the first stage of the study consisted in the application of an open response survey which was answered by doctors from all over the country. The second stage consisted in discussion instances about dignity of medical work. In the third stage, semi-structured in-depth interviews with doctors of both sexes and of different generations were conducted. The analysis of the data was carried out following the approaches of the Grounded Theory. RESULTS: The concept of dignity of medical work arises from a historical process of social conquest and implies the recognition of the rights of professionals and patients. Optimal conditions are required to provide quality health care. However, even in unworthy conditions, doctors do everything possible to provide a decent care. The need to humanize the relationships that occur in the context of health care is proposed. Carrying out medical work with excellence and professionalism contributes to personal fulfillment. Associativity contributes to dignify medical work. CONCLUSIONS: The dignity of medical work is understood by doctors as a polysemic and relational concept.

Formation of vocabularies in a decentralized graph-based approach to human language.

Zipf's law establishes a scaling behavior for word frequencies in large text corpora. The appearance of Zipfian properties in vocabularies (viewed as an intermediate phase between referentially useless one-word systems and one-to-one word-meaning vocabularies) has been previously explained as an optimization problem for the interests of speakers and hearers. Remarkably, humanlike vocabularies can be viewed also as bipartite graphs. Thus, the aim here is double: within a bipartite-graph approach to human vocabularies, to propose a decentralized language game model for the formation of Zipfian properties. To do this, we define a language game in which a population of artificial agents is involved in idealized linguistic interactions. Numerical simulations show the appearance of a drastic transition from an initially disordered state towards three kinds of vocabularies. Our results open ways to study Zipfian properties in language, reconciling models seeing communication as a global minima of information entropic energies and models focused on self-organization.

Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines.

BACKGROUND: Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. METHODS: Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, Supplementary data) concluded the following. RESULTS: Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50-200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. CONCLUSIONS: Countries where European and American AIT extracts are available should adjust AIT according to which school is followed.

Contenido de humedad, proteínas y minerales en diez variedades de quínoa chilena cultivadas en distintas zonas geográficas / Moisture, protein and mineral content of ten varieties of Chilean quinoa grown in different geographic zones

RESUMEN El consumo de quínoa (Chenopodium quínoa Willd) ha aumentado, renovando el interés en su composición y valor nutricional. El objetivo del estudio fue determinar los contenidos de humedad, cenizas, proteínas y algunos minerales (Fe, Zn y Cu) de 10 variedades de quínoa chilena cultivadas en cuatro zonas geográficas, utilizando metodologías analíticas validadas. Las muestras (n=10) de quínoa cultivada en Vallenar, Los Tilos, Hidango y Santa Rosa fueron analizadas en triplicado. Los métodos normalizados aplicados fueron: humedad; cenizas; proteínas; hierro, zinc y cobre, bajo los requisitos de ISO/IEC 17025:2017. Los datos se analizaron usando análisis de varianza para comparar variedades y zonas de cultivo. Las muestras contienen en promedio 16,6 g de proteínas/100 g (14,4-17,5), 8,97 mg de hierro/100 g (7,71-10,76), 3,38 mg de zinc/100 g (2,17-5,30), y 0,83 mg de cobre/100 g (0,60-1,10). Las variedades cultivadas en Vallenar, Los Tilos e Hidango mostraron mayor contenido proteico que las de Santa Rosa (p<0,05). Todas las variedades tienen un contenido destacado de los microminerales cobre, zinc y hierro. Los resultados aportan información relevante sobre el valor nutricional de la quínoa chilena, entregando datos para la actualización de las Tablas de Composición Química de alimentos.

ABSTRACT The intake of quinoa (Chenopodium quinoa Willd) has increased worldwide. Its revival has renewed interest in its composition and nutritional value. The aim of this study was to determine the contents of moisture, ash, protein, and some minerals (Fe, Zn and Cu) of ten varieties of Chilean quinoa grown in various geographical zones, using validated analytical methods under rule ISO/IEC 17025:2017. Grains grown in Vallenar, Los Tilos, Hidango, and Santa Rosa were analyzed in triplicates, using previously validated analytical methodologies and certified reference materials. The normalized methods used were: moisture; ash; protein; mineral, under the ISO/IEC 17025:2017 norm. Data were analyzed using ANOVA to compare varieties and growth zones. The analyzed quinoa grains contain a mean of 16.6 g proteins/100 g (range 14.4-17.5), 8.97 mg iron/100 g (range 7.71-10.76), 3.38 mg zinc/100 g, and 0.83 mg copper/100 g (range 0.60-1.10). The varieties grown in Vallenar, Los Tilos and Hidango showed higher protein content compared to Santa Rosa (p<0.05). All varieties exhibit considerable microminerals content, such as copper, zinc, and iron. These results provide relevant information about the nutritional value of Chilean quinoa and updated reliable data for Food Composition Tables.

Structural and kinetic features of aldehyde dehydrogenase 1A (ALDH1A) subfamily members, cancer stem cell markers active in retinoic acid biosynthesis.

Aldehyde dehydrogenases catalyze the NAD(P)+-dependent oxidation of aldehydes to their corresponding carboxylic acids. The three-dimensional structures of the human ALDH1A enzymes were recently obtained, while a complete kinetic characterization of them, under the same experimental conditions, is lacking. We show that the three enzymes, ALDH1A1, ALDH1A2 and ALDH1A3, have similar topologies, although with decreasing volumes in their substrate-binding pockets. The activity with aliphatic and retinoid aldehydes was characterized side-by-side, using an improved HPLC-based method for retinaldehyde. Hexanal was the most efficient substrate. ALDH1A1 displayed lower Km values with hexanal, trans-2-hexenal and citral, compared to ALDH1A2 and ALDH1A3. ALDH1A2 was the best enzyme for the lipid peroxidation product, 4-hydroxy-2-nonenal, in terms of kcat/Km. The catalytic efficiency towards all-trans and 9-cis-retinaldehyde was in general lower than for alkanals and alkenals. ALDH1A2 and ALDH1A3 showed higher catalytic efficiency for all-trans-retinaldehyde. The lower specificity of ALDH1A3 for 9-cis-retinaldehyde against the all-trans- isomer might be related to the smaller volume of its substrate-binding pocket. Magnesium inhibited ALDH1A1 and ALDH1A2, while it activated ALDH1A3, which is consistent with cofactor dissociation being the rate-limiting step for ALDH1A1 and ALDH1A2, and deacylation for ALDH1A3, with hexanal as a substrate. We mutated both ALDH1A1 (L114P) and ALDH1A2 (N475G, A476V, L477V, N478S) to mimic their counterpart substrate-binding pockets. ALDH1A1 specificity for citral was traced to residue 114 and to residues 458 to 461. Regarding retinaldehyde, the mutants did not show significant differences with their respective wild-type forms, suggesting that the mutated residues are not critical for retinoid specificity.

[MASK (Mobile Airways Sentinel Network), a mobile App with ARIA's comprehensive solution in Spanish-speaking countries]. / MASK (Mobile Airways Sentinel Network), una app móvil con la solución integral de ARIA en países de habla hispana.

Although there are high quality clinical guidelines about allergic rhinitis, many patients receive deficient treatment, partly due to the high level of self-medication. MASK (Mobile Airways Sentinel Network) is an integral part of a project against chronic diseases which it is focused on active and healthy aging and is supported by the European Union. It forms the third phase of ARIA (Allergic Rhinitis and its Impact on Asthma) in which, through a mobile app on a smart device, the purpose is to guide patients in the control of their multimorbidity, allergic rhinitis or conjunctivitis, or asthma. The "Allergy Diary" app by MACVIA-ARIA is free and it is available for Android and iOS; on it, patients indicate how unpleasant the symptoms are on a daily basis through five screens with an analogous visual scale; two more screens were recently added (sleep affectation). With the app, it is also possible to download the information of the "Allergy Diary" on the physician's computer through a QR code at the moment of the medical consultation. In this article, we review the first year of experience in Spain, Mexico and Argentina, where the Spanish version is used.

Aunque existen guías clínicas de alta calidad sobre rinitis alérgica, numerosos pacientes reciben tratamiento deficiente, en parte debido al alto grado de automedicación. MASK (Mobile Airways Sentinel Network) forma parte integral de un proyecto apoyado por la Unión Europea contra las enfermedades crónicas y enfocado al envejecimiento activo y saludable. Constituye la tercera fase de ARIA (Allergic Rhinitis and its Impact on Asthma), en la cual mediante una aplicación móvil en un dispositivo inteligente se intenta guiar al paciente en el control de su multimorbilidad, rinitis o conjuntivitis alérgicas o asma. La aplicación Diario de Alergia por MACVIA-ARIA es gratuita y está disponible para Android e iOS; en ella, los pacientes indican diariamente cuánto les molestan los síntomas a través de cinco pantallas con una escala visual análoga; recientemente se agregaron dos pantallas más (afectación del sueño). La aplicación también permite descargar los datos del "Diario de alergias" en la computadora del médico en el momento de la consulta a través de un código QR. En este artículo reseñamos el primer año de experiencia en España, México y Argentina, que utilizan la versión española.

[GUIMIT 2019, Mexican Guideline on Immunotherapy. Guideline on the diagnosis of IgE-mediated allergic disease and immunotherapy following the ADAPTE approach]. / GUIMIT 2019, Guía Mexicana de Inmunoterapia. Guía de diagnóstico de alergia mediada por IgE e inmunoterapia aplicando el método ADAPTE.

BACKGROUND: In Mexico, allergen immunotherapy (AIT) and immunotherapy with hymenoptera venom (VIT) is traditionally practiced combining aspects of the European and American school. In addition, both types of extracts (European and American) are commercially available in Mexico. Moreover, for an adequate AIT/VIT a timely diagnosis is crucial. Therefore, there is a need for a widely accepted, up-to-date national immunotherapy guideline that covers diagnostic issues, indications, dosage, mechanisms, adverse effects and future expectations of AIT (GUIMIT 2019). METHOD: With nationwide groups of allergists participating, including delegates from postgraduate training-programs in Allergy/Immunology-forming, the guideline document was developed according to the ADAPTE methodology: the immunotherapy guidelines from European Academy of Allergy and Clinical Immunology, German Society for Allergology and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology and American College of Allergy, Asthma, and Immunology were selected as mother guidelines, as they received the highest AGREE-II score among international guidelines available; their evidence conforms the scientific basis for this document. RESULTS: GUIMIT emanates strong or weak (suggestions) recommendations about practical issues directly related to in vivo or in vitro diagnosis of IgE mediated allergic diseases and the preparation and application of AIT/VIT and its adverse effects. GUIMIT finishes with a perspective on AIT modalities for the future. All the statements were discussed and voted on until > 80 % consensus was reached. CONCLUSIONS: A wide and diverse group of AIT/VIT experts issued transculturized, evidence-based recommendations and reached consensus that might improve and standardize AIT practice in Mexico.

Antecedentes: En México, la inmunoterapia con alérgenos (ITA) y con veneno de himenópteros (VIT) se practica tradicionalmente combinando criterios de las escuelas europea y estadounidense; los dos tipos de extractos están comercialmente disponibles en México. Para una ITA adecuada es crucial un diagnóstico oportuno. Objetivo: Presentar GUIMIT 2019, Guía Mexicana de Inmunoterapia 2019, de base amplia, actualizada, que abarca temas de diagnóstico, indicaciones, dosificación, mecanismos, efectos adversos de la ITA y expectativas con esta modalidad de tratamiento. Método: Con la participación de múltiples grupos mexicanos de alergólogos, que incluían los centros formadores universitarios en alergia e inmunología, se desarrolló el documento de la guía según la metodología ADAPTE. Las guías de inmunoterapia de la European Academy of Allergy and Clinical Immunology, The American Academy of Allergy, Asthma and Immunology, German Society for Allergology and Clinical Immunology y del American College of Allergy, Asthma, and Immunology se seleccionaron como guías fuente, ya que recibieron la puntuación AGREE-II más alta entre las guías internacionales disponibles; su evidencia conforma la base científica de GUIMIT 2019. Resultados: En GUIMIT 2019 se emiten recomendaciones fuertes o débiles (sugerencias) acerca de temas directamente relacionados con el diagnóstico in vivo o in vitro de las enfermedades alérgicas mediadas por IgE, la preparación y aplicación de ITA o VIT y sus efectos adversos; se incluye la revisión de las modalidades de ITA para el futuro. Todos los argumentos que se exponen fueron discutidos y votados con > 80 % de aprobación. Conclusión: Un grupo amplio y diverso de expertos en ITA y VIT emitió recomendaciones transculturizadas basadas en evidencia, que alcanzaron consenso; con ellas se pretende mejorar y homologar la práctica de la inmunoterapia en México.

Cuff-assisted versus cap-assisted colonoscopy for adenoma detection: results of a randomized study.

BACKGROUND: The adenoma detection rate (ADR) is the most important marker of colonoscopy quality. Devices to improve adenoma detection have been developed, such as the Endocuff and transparent cap. The aim of the current study was to examine whether there was a difference in ADR between Endocuff-assisted (EAC) and cap-assisted colonoscopy (CAC). METHODS: A randomized prospective trial was conducted. Eligible patients included adults ≥ 18 years referred because of symptoms, surveillance, or colonoscopies as part of the Bowel Cancer Screening Programme (BCSP). The primary outcome measure was ADR. Secondary outcomes included mean number of adenomas, mean number of polyps, polyp detection rate, cecal intubation rate, and time to cecal intubation. Procedural measures, device removal rate, and adverse events were also recorded. RESULTS: A total of 711 patients (51.1 % men; median age 63 years) were included, of whom 357 patients were randomized to EAC and 354 patients to CAC. In the intention-to-treat analysis, the ADR was similar in both groups: EAC 50.4 % (95 % confidence interval [CI] 45.1 - 55.7) vs. CAC 50.6 % (95 %CI 45.2 - 55.9). Similar results were obtained in the per-protocol analysis: EAC 51.6 % (95 %CI 46.2 - 57) vs. CAC 51.4 % (95 %CI 46 - 56.8). There were no differences between the two devices in ADR according to the mean number of adenomas and polyps per procedure, polyp detection rate, cecal intubation rate, and time to cecal intubation. Device removal rate and adverse events were also similar. CONCLUSION: In this randomized study, no differences in ADR were found between Endocuff- and cap-assisted colonoscopy.

The Colonoscopy Satisfaction and Safety Questionnaire (CSSQP) for Colorectal Cancer Screening: A Development and Validation Study.

Colonoscopy services working in colorectal cancer screening programs must perform periodic controls to improve the quality based on patients' experiences. However, there are no validated instruments in this setting that include the two core dimensions for optimal care: satisfaction and safety. The aim of this study was to design and validate a specific questionnaire for patients undergoing screening colonoscopy after a positive fecal occult blood test, the Colonoscopy Satisfaction and Safety Questionnaire based on patients' experience (CSSQP). The design included a review of available evidence and used focus groups to identify the relevant dimensions to produce the instrument (content validity). Face validity was analyzed involving 15 patients. Reliability and construct and empirical validity were calculated. Validation involved patients from the colorectal cancer screening program at two referral hospitals in Spain. The CSSQP version 1 consisted of 15 items. The principal components analysis of the satisfaction items isolated three factors with saturation of elements above 0.52 and with high internal consistency and split-half readability: Information, Care, and Service and Facilities features. The analysis of the safety items isolated two factors with element saturations above 0.58: Information Gaps and Safety Incidents. The CSSQP is a new valid and reliable tool for measuring patient' experiences, including satisfaction and safety perception, after a colorectal cancer screening colonoscopy.

[Executive Summary of ARIA 2019: Integrated care pathways for allergic rhinitis in Argentina, Spain and Mexico]. / Resumen ejecutivo de ARIA 2019: Vías integradas de atención para la rinitis alérgica en Argentina, España y México.

The health and economic impact of allergic diseases are increasing rapidly, and changes in management strategies are required. Its influence reduces the capacity of work and school performance by at least a third. The ICPs of the airways (integrated care pathways for respiratory diseases) are structured multidisciplinary healthcare plans, promoting the recommendations of the guidelines in local protocols and their application to clinical practice. This document presents an executive summary for Argentina, Mexico, and Spain. Next-generation ARIA guidelines are being developed for the pharmacological treatment of allergic rhinitis (AR), using the GRADE-based guidelines for AR, tested with real-life evidence provided by mobile technology with visual analogue scales. It is concluded that in the AR treatment, H1-antihistamines are less effective than intranasal corticosteroids (INCS), in severe AR the INCS represent the first line of treatment, and intranasal combination INCS + anti-H1 is more effective than monotherapy. However, according to the MASK real-life observational study, patients have poor adherence to treatment and often self-medicate, according to their needs.

El impacto sanitario y económico de las enfermedades alérgicas está aumentando rápidamente y se necesitan cambios en las estrategias para su manejo. Su influencia reduce al menos en un tercio la capacidad de desempeño laboral y escolar. Los ICP (Vías Integradas de Atención) de las enfermedades de las vías respiratorias son planes de atención estructurados y multidisciplinarios, que promueven las recomendaciones de las guías en protocolos locales y su aplicación a la práctica clínica. En este documento se presenta un resumen ejecutivo para Argentina, México y España. Se desarrollan las guías ARIA de próxima generación para el tratamiento farmacológico de la rinitis alérgica (RA) utilizando las pautas basadas en GRADE para RA, probadas con evidencia de la vida real proporcionada por tecnología móvil basada en escalas visuales analógicas. Se concluye que en el tratamiento de la RA, los antihistamínicos anti-H1 son menos efectivos que los corticoides intranasales (CINS), que en la rinitis gravelos CINS representan la primera línea de tratamiento, y que la combinación intranasal de CINS + anti-H1 es más eficaz que la monoterapia. Sin embargo, según el estudio MASK observacional en vida real, los pacientes tienen pobre adherencia al tratamiento y frecuentemente se automedican de acuerdo con sus necesidades.

[Mexican consensus on the diagnosis and treatment of atopic dermatitis in adolescents and adults]. / Consenso mexicano para el diagnóstico y tratamiento de la dermatitis atópica en adolescentes y adultos.

BACKGROUND: The diagnostic approaches and therapeutic strategies of atopic dermatitis (AD) are generally inconsistent among physicians and health institutions. OBJECTIVE: To develop a consensus statement among experts to reduce the variations in practice regarding the diagnosis and treatment of patients ≥ 12 years with AD to improve their care. METHODS: Systematic literature search in PubMed and GREAT. With methodological support and using the Delphi method, a formal consensus was developed among 16 experts in Dermatology and Allergology, based on the current evidence and its applicability in the Mexican context. Apart from intense electronic communication, several issues of disagreement were discussed in two face-to-face meetings. RESULTS: The clinical experts reached consensus on 46 statements related to the definition, classification, diagnostic strategies and treatment of AD. For the diagnosis we suggest the Williams criteria and for severity scoring the SCORAD (by the doctor) and POEM (by the patient). In addition to general care and treatment education (workshops), we suggest four steps for treatment, depending on severity: 1. Topical treatment with anti-inflammatory agents (and systemic: antihistamines/antileukotrienes -low level evidence-) 2. Phototherapy, 3. Cyclosporin A and 4. Dupilumab, with the possibility of managing this biological earlier on if a fast effect is needed. In extrinsic AD we suggest evaluating the addition of allergen immunotherapy or an elimination diet, if there is an IgE-mediated respiratory or food allergy, respectively. CONCLUSION: The panel of experts reached consensus on relevant aspects of AD with a focus on the transcultural adaptation of recent evidence.

Antecedentes: Los abordajes diagnósticos y las estrategias terapéuticas de la dermatitis atópica generalmente son inconsistentes entre los médicos y entre las instituciones de salud. Objetivo: Consensar las opiniones de expertos para reducir las variaciones en la práctica respecto al diagnóstico y tratamiento de pacientes ≥ 12 años con dermatitis atópica para mejorar su cuidado. Métodos: Búsqueda sistemática de la literatura en PubMed y GREAT. Con apoyo metodológico y utilizando el método Delphi se desarrolló un consenso formal entre 16 expertos en dermatología y alergología, basándose en la evidencia actual y su aplicabilidad en el contexto mexicano. A parte de una comunicación electrónica intensa, se discutieron los puntos en desacuerdo en dos reuniones presenciales. Resultados: Los expertos clínicos alcanzaron consenso en 46 declaraciones relacionadas con la definición, clasificación, estrategias de diagnóstico y tratamiento de la dermatitis atópica. Para el diagnóstico sugerimos se usan los criterios de Williams y el SCORAD (por parte del médico) y POEM (por parte del paciente) para definir la gravedad. Aunado a cuidados generales y educación terapéutica, sugerimos cuatro pasos para tratamiento, según gravedad: 1. Manejo tópico con antiinflamatorio (y sistémico: antihistamínico/antileucotrieno ­evidencia reducida­) 2. Fototerapia, 3. Ciclosporina A y 4. Dupilumab, con la posibilidad de manejarlo antes si se necesita efecto rápido. En la dermatitis atópica extrínseca sugerimos agregar inmunoterapia con alérgenos o una dieta de eliminación si existe una alergia IgE-mediada, inhalatoria o alimentaria, respectivamente. Conclusión: El panel de expertos realizó consenso en aspectos relevantes de la dermatitis atópica con enfoque en la adaptación transcultural de evidencia reciente.

An Agent-Based Model for the Role of Short-Term Memory Enhancement in the Emergence of Grammatical Agreement.

What is the influence of short-term memory enhancement on the emergence of grammatical agreement systems in multi-agent language games? Agreement systems suppose that at least two words share some features with each other, such as gender, number, or case. Previous work, within the multi-agent language-game framework, has recently proposed models stressing the hypothesis that the emergence of a grammatical agreement system arises from the minimization of semantic ambiguity. On the other hand, neurobiological evidence argues for the hypothesis that language evolution has mainly related to an increasing of short-term memory capacity, which has allowed the online manipulation of words and meanings participating particularly in grammatical agreement systems. Here, the main aim is to propose a multi-agent language game for the emergence of a grammatical agreement system, under measurable long-range relations depending on the short-term memory capacity. Computer simulations, based on a parameter that measures the amount of short-term memory capacity, suggest that agreement marker systems arise in a population of agents equipped at least with a critical short-term memory capacity.

Pediatric asthma treatment: What to do when international guideline recommendations do not agree.

BACKGROUND: There was a need for a solid asthma guideline in Mexico to update and unify asthma management. Because high-quality asthma guidelines exist worldwide, in which the latest evidence on asthma management is summarized, the ADAPTE approach allows for the development of a national asthma guideline based on evidence from already existing guidelines, adapted to national needs. OBJECTIVE: To fuse evidence from the best asthma guidelines and adapt it to local needs with the ADAPTE approach. METHODS: The Appraisal of Guidelines for Research and Evaluation (AGREE) II asthma guidelines were evaluated by a core group to select 3 primary guidelines. For each step of asthma management, clinical questions were formulated and replied according to (1) evidence in the primary guidelines, (2) safety, (3) Cost, and (4) patient preference. The Guidelines Development Group, composed of a broad range of experts from medical specialties, primary care physicians, and methodologists, adjusted the draft questions and replies in several rounds of a Delphi process and 3 face-to-face meetings, taking into account the reality of the situation in Mexico. We present the results of the pediatric asthma treatment part. RESULTS: Selected primary guidelines are from the British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN), Global Initiative for Asthma (GINA), and Spanish Guidelines on the Management of Asthma (GEMA) 2015, with 2016 updates. Recommendations or suggestions were made for asthma treatment in Mexico. In this article, the detailed analysis of the evidence present in the BTS/SIGN, GINA, and GEMA sections on the (non) pharmacologic treatment of pediatric asthma, education, and devices are presented for 2 age groups: children 5 years or younger and children 6 to 11 years old with asthma. CONCLUSION: For the pediatric treatment and patient education sections, applying the AGREE II and Delphi methods is useful to develop a scientifically sustained document, adjusted to the Mexican situation, as is the Mexican Guideline on Asthma.