Addressing the unmet needs in patients with type 2 inflammatory diseases: when quality of life can make a difference.

Background: Patients with asthma (AS), atopic dermatitis (AD), allergic rhinitis (AR), eosinophilic esophagitis (EoE), chronic rhinosinusitis with nasal polyps (CRSwNP), chronic urticaria (CU), non-steroidal anti-inflammatory drugs-exacerbated respiratory disease (N-ERD), and certain phenotypes of chronic obstructive pulmonary disease (COPD), among others, have a common underlying pathogenesis known as Type 2 inflammation (T2i). These diseases often coexist with other T2i conditions and have a substantial impact on the quality of life (QoL) of patients. However, limited data on patients' experiences, perspectives, and current management of T2i diseases have been published thus far. Aims: This survey, promoted by the patient-driven T2i Network Project, aimed at identifying the common drivers and challenges related to the QoL of patients with T2i diseases by putting the patient's perspective at the force and including it in the design of new care strategies. Methodology: An anonymous online survey was carried out through convenience sampling between May and June 2023. The survey was codesigned by members of different patient associations, healthcare professionals and healthcare quality experts, and implemented using EUSurvey and distributed through eight patient associations from Spain. The survey consisted of 29 questions related to the participant's sociodemographic features, a series of self-reported multiple choice or rating scale questions, including diagnosis, QoL measures, disease severity, healthcare resource utilization, and quality of care. Results: The survey included 404 participants, members from eight patient associations, the majority of whom had moderate-to-severe self-reported disease severity (93%) and one or more coexisting pathologies related to T2i (59%). Patients with more than one pathology had a significantly greater impact on QoL than those with only one pathology (p < .001). Participants with self-reported severe symptoms reported significantly worse QoL than those with mild-to-moderate severity (p < .001). More than half of the patients (56%) felt constantly bothered by the unpredictability of their illness caused by potential exposure to known or unknown disease triggers. The lack of coordination between specialists and primary care was also expressed as an area of dissatisfaction by participants, with 52% indicating a complete lack of coordination and 21% indicating an average coordination. Conclusion: This article reports the initial findings of a patient-led initiative, which highlights the common QoL challenges faced by individuals with type 2 inflammation-related diseases and emphasizes the importance of further clinical research to improve the management of this patient group. Considering the significant impact on QoL, a multidisciplinary approach integrated into new healthcare protocols has the potential to improve patient management and QoL, shorten the time to diagnosis and reduce healthcare resource utilization.

Shared Decision-Making in Allergen Immunotherapy (AIT) Options Using a Questionnaire for Respiratory Allergic Patients: A Delphi Consensus Study.

Purpose: The objective of this study was to develop and validate a questionnaire, through a Delphi consensus, to be used by allergists in their routine clinical practice to assess the preferences of patients starting allergen immunotherapy (AIT) treatment using an objective approach. Patients and Methods: A Delphi consensus-driven process was used. The scientific committee, composed of 15 allergists, led the study and participated in the preparation of the questionnaire. Two-hundred panelists from different Spanish regions were invited to complete a 16-item questionnaire on a nine-point Likert scale covering six topic blocks. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. Results: Of the 200 experts invited to participate in the Delphi process, a total of 195 (97.5%) answered the questionnaire. The panel experts reached a consensus on "agreement" on a total of 12 of the 16 (75.0%) items, covering a total of six categories: (a) patient knowledge (2 questions), (b) barriers to patient adherence (3 questions), (c) patient behavior (4 questions), (d) future actions (3 questions), (e) treatment costs (2 questions), and (f) final patient preferences (2 questions). Conclusion: This Delphi consensus study validated a set of twelve recommended questions for patients objectively assessing their preferences and suitability for the most common AIT options available. The questionnaire intends to assist allergists in making an objective, unconditioned decision regarding the best AIT option for each patient, after informing them about the different routes.

[Basophil activation test to follow-up of patients treated with hymenoptera venom immunotherapy: a review of current evidence]. / Prueba de activación de basófilos en el seguimiento de pacientes que reciben inmunoterapia con veneno de himenópteros: revisión de la evidencia actual.

Hymenoptera venom immunotherapy (HVI) is a long-term effective treatment to avoid new systemic reactions in patients with Hymenoptera allergy. The sting challenge test is considered the gold standard to confirm the tolerance. However, the use of this technique is not generalized in clinical practice, being the basophil activation test (BAT), which functionally explores allergen response, an alternative that does not entail any of the provocation risks associated with the sting challenge test. This study reviews the publications that used the BAT to follow up and evaluate the success of the HVI. Studies assessing the changes between a baseline BAT before the start and BATs performed between the starting and maintenance phases of the HVI were selected. Ten articles were found, comprising information from 167 patients, of which 29% used the sting challenge test. The studies concluded the importance of evaluating the responses with submaximal allergen concentrations, which reflect basophil sensitivity, to monitor the HVI using the BAT. It was also observed that changes in the maximum response (reactivity) could not reflect the clinical status of tolerance, particularly in the initial phases of HVI.

La inmunoterapia con veneno de himenópteros (IVH) es, a largo plazo, un tratamiento eficaz para evitar nuevas reacciones sistémicas en pacientes con alergia a este tipo de insectos. La prueba de repicadura controlada es el estudio de referencia para confirmar la tolerancia del individuo. Sin embargo, no se ha generalizado su indicación clínica, por lo que la prueba de activación de basófilos (TAB) resulta una buena alternativa, pues valora de manera funcional la respuesta al alérgeno y está exenta de los riesgos asociados con la provocación. En esta revisión se explora la utilidad de la TAB en el seguimiento y valoración del éxito de la IVH. Se seleccionaron estudios que evalúan los cambios entre una TAB basal y en otro momento de la fase de inicio o mantenimiento de la IVH. Se incluyeron 10 estudios con datos de 167 pacientes, de los que el 29% había tenido prueba de repicadura controlada. Para vigilar la eficacia de la IVH debe explorarse la respuesta del basófilo, con la determinación de las concentraciones submáximas del alérgeno, que reflejan la sensibilidad del basófilo. Los cambios en la respuesta máxima (reactividad) no pueden aportar información del estado de tolerancia, especialmente en las fases iniciales de la IVH.

Enfermedades cardiovasculares: ¿qué perciben las mujeres de Uruguay? / Cardiovascular diseases: what do women in Uruguay perceive? / Doenças cardiovasculares: ¿o que percebem as mulheres no Uruguai?

Antecedentes: aunque la enfermedad cardiovascular (ECV) es la principal causa de muerte de las mujeres en Uruguay, ellas no lo perciben. Objetivos: el propósito de este estudio fue evaluar la percepción, el conocimiento y las conductas de prevención de las ECV entre mujeres por grupos de edad, nivel socioeconómico (NSE) y región, así como su conocimiento sobre factores de riesgo, síntomas y comportamientos cardiosaludables. Métodos: en 2020 se encuestaron vía web 700 mujeres de entre 20 y 70 años, residentes en Uruguay (Montevideo: 301, interior del país: 399). Se pautó publicidad en redes sociales para convocar a la población objetivo a participar. Las integrantes de la muestra, que completaron una encuesta autoadministrada, presentaban distribución similar a la población general en cuanto al NSE y la edad. Resultados: las mujeres encuestadas percibieron a la ECV como principal problema de salud (PS) en el 10% y como primera CM en el 18%. Las montevideanas, comparadas con las del interior, tuvieron mayores niveles de percepción (PS: 13% vs. 7%-CM: 20% vs. 17%); así como las de NSE alto vs. las de medio-bajo (PS: 17% vs. 8%-CM: 29% vs. 14%). La percepción y el conocimiento sobre ECV son bajos, las jóvenes son las menos informadas (escasos/muy escasos: 62%). Los médicos advierten poco sobre síntomas (23%) y estrategias de prevención (48%). Conclusión: la percepción de las mujeres encuestadas sobre la ECV es baja, existiendo brechas por edad, NSE y región. En la consulta, los médicos informan poco sobre el tema. Es necesario un esfuerzo continuo para mejorar la percepción de las mujeres sobre la ECV en su propio género, intentando llegar principalmente a las poblaciones de mayor riesgo.

Background: although cardiovascular disease (CVD) is the main cause of death for women in Uruguay, they do not perceive it. Objectives: the purpose of this study was to evaluate the perception, knowledge, and prevention behaviors of CVD among women by age group, socioeconomic level (SEL), and region, as well as knowledge of risk factors, symptoms, and heart-healthy behaviors. Method and result: online survey of 700 women residents of Uruguay (Montevideo: 301, interior of the country: 399), was conducted in 2020, ages between 20 and 70 years. Advertising was scheduled on social networks, calling the target population to participate in that research by completing a selfadministered survey, obtaining a set of cases with a similar distribution to the general population in terms of SEL and age. CVD was perceived in 10% as the main health problem (HP) and 18% as the first CD. Women from Montevideo vs. interior had higher levels of perception (HP: 13% vs. 7%-CD: 20% vs. 17%); as well as those of high vs. those of mediumlow SEL (HP: 17% vs. 8%-CD: 29% vs. 14%). The perception and knowledge about CVD are low, with young women being the least informed (little/very little: 62%). Doctors report little on symptoms (23%) and prevention (48%). Conclusion: the perception of the women surveyed about CVD is low, with gaps by age, NSE and region. Doctors inform little about this topic during clinical visits. A continuous effort is necessary to improve women's perception of CVD in their own gender, trying to reach mainly the populations at greatest risk.

Antecedentes: embora a doença cardiovascular (DCV) seja a principal causa de morte das mulheres no Uruguai, elas não a percebem. Objetivos: o objetivo deste estudo foi avaliar a percepção, conhecimento e comportamentos de prevenção de DCV entre mulheres por faixa etária, nível socioeconômico (NSE) e região, bem como o conhecimento de fatores de risco, sintomas, doenças cardíacas e comportamentos saudáveis para o coração. Método e resultado: em 2020, 700 mulheres entre 20 e 70 anos, residentes no Uruguai, foram entrevistadas via web (Montevidéu: 301, interior do país: 399). A publicidade foi agendada nas redes sociais, convocando a população alvo a participar da referida pesquisa através do preenchimento de um inquérito autoaplicável, obtendose um conjunto de casos com distribuição semelhante à população geral em termos de NSE e idade. As mulheres pesquisadas perceberam a DCV como principal problema de saúde (PS) em 10% e como principal CM em 18%. As mulheres de Montevidéu vs. interior apresentaram níveis mais elevados de percepção (PS: 13% vs. 7%-CM: 20% vs. 17%); bem como as de NSE alto vs. as de médiobaixo (PS: 17% vs. 8%-CM: 29% vs. 14%). A percepção e o conhecimento sobre DCV são baixos, sendo as mulheres jovens as menos informadas (pouco/muito pouco: 62%). Os médicos informam pouco sobre síntomas (23%) e prevenção (48%). Conclusão: a percepção das mulheres pesquisadas sobre DCV é baixa, com diferenças por idade, NSE e região. Os médicos informam pouco sobre esse tema durante as consultas clínicas. É necessário um esforço contínuo para melhorar a percepção das mulheres sobre as DCV em seu próprio gênero, tentando atingir principalmente as populações de maior risco.

Genetic characterization of atypical Citrobacter freundii.

The ability of a bacterial population to survive in different niches, as well as in stressful and rapidly changing environmental conditions, depends greatly on its genetic content. To survive such fluctuating conditions, bacteria have evolved different mechanisms to modulate phenotypic variations and related strategies to produce high levels of genetic diversity. Laboratories working in microbiological diagnosis have shown that Citrobacter freundii is very versatile in its colony morphology, as well as in its biochemical, antigenic and pathogenic behaviours. This phenotypic versatility has made C. freundii difficult to identify and it is frequently confused with both Salmonella enterica and Escherichia coli. In order to determine the genomic events and to explain the mechanisms involved in this plasticity, six C. freundii isolates were selected from a phenotypic variation study. An I-CeuI genomic cleavage map was created and eight housekeeping genes, including 16S rRNA, were sequenced. In general, the results showed a range of both phenotypes and genotypes among the isolates with some revealing a greater similarity to C. freundii and some to S. enterica, while others were identified as phenotypic and genotypic intermediary states between the two species. The occurrence of these events in natural populations may have important implications for genomic diversification in bacterial evolution, especially when considering bacterial species boundaries. In addition, such events may have a profound impact on medical science in terms of treatment, course and outcomes of infectious diseases, evading the immune response, and understanding host-pathogen interactions.

Intoxicación aguda por topiramato con intención suicida / Acute topiraranate toxicity to suic idal attempt

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Creencias Hacia la lactancia materna y la actud hacia apoyar la lactancia en público de un grupo de estudiantes de salud de una escuela superior de la Región Educativa de Caguas / Knowledge about breast feeding and attitude to breast feeding in public of a group of high school students in the Caguas Educational Region

The objective of this study was to identify the knowledge and attitudes towards breastfeeding and towards breastfeeding in public of a group of high school students in the Caguas Educational Region. The study design was a descriptive survey. The sample consisted of 101 students gistered in the Health Course. A self administered questionnaire was used to ther the information. Descriptive and inferential statistics (chi quare and t test) were used for data analysis. We found that the majority of the participants have the intention of breastfeeding or supporting breastfeeding for their children. We found, nevertheless, that there were misconceptions regarding breastfeeding hich could develop into barriers for effective breastfeeding. It was also observed that support for breastfeeding varied depending on the location where it took place. Support was greater if it was done in non-public places. In inclusion, it became evident that there is a need for educational programs with correct information on breastfeeding and the importance of breastfeeding in public

Producción de citotoxina tipo shiga (SLT) 1 en cepas de Escherichia coli aisladas de niños con diarrea en una comunidad rural / Production of shiga like toxin (SLT) 1 in strains of Escherichia coli isolated from infants with diarrhoea in arural community

Se estudió la producción de citotoxina tipo shiga-1 (SLT) por la prueba de neutralización descrita por O'Brien y col. en 1,006 cepas de Escherichia coli aisladas de 52 niños con diarrea y de 52 controles apareados por edad, sexo y vecindad, pertenecientes todos a una cohorte de niños rurales, la cual ha sido seguida longitudinalmente durante los primeros dos años de vida a partir del nacimiento. Se buscó la producción de enterotoxinas estable y lábil al calentamiento y la presencia de factores de colonización I, II y E8775 en las mismas bacterias, así como la habilidad para adherirse a células HEp-2 y de aglutinar contra antisueros pertenecientes a los serogrupos enteropatógenos de Escherichia coli, incluyendo 0142 y 0157. Los niños con diarrea presentaron aislamiento significativamente mayor de cepas productoras de citotoxina en cantidades moderadas y altas (p < 0.01). No se encontró relación entre producción de citotoxina y otras características de patogenicidad en cepas aisladas en ambos grupos. El 30% de las bacterias productoras de cantidades moderadas de citotoxina y el 80% de las productoras de cantidades moderadas elevadas pertenecieron al serotipo 0157:H7. En tres niños con diarrea y dos sin diarrea se aislaron cepas productoras de otra citotoxina cuyo efecto no fue neutralizable con un antisuero específico contra SLT-1. Estas cepas han sido confirmadas como productoras de SLT-2. Escherichia coli enterohemorrágica, citotoxina tipo Shiga; diarrea; colitis hemorrágica afebril

Relación entre aislamiento de cepas de Escherichia Coli 0157:H7 y presencia de colitis hemorrágica en niños / Relation between isolation of Escherichia Coli 0157:H7 and hemorrhagic colitis in children

En cinco de 200 niños menores de dos años de edad estudiados durante una investigación sobre agentes etiológicos de diarrea aguda, 100 con presencia de cuadro enteral y 100 controles apareados por edad y sexo, se encontró la presencia de cepas de Escherichia coli (E. coli)0157. Tres de los cinco niños presentaron cuadro enteral, uno diarrea aguda, uno diarrea crónica y otro colitis hemorrágica afebril. Los otros dos pacientes no presentaron sintomatología enteral en el momento del aislamiento de las cepas 0157. Se encontró producción elevada de citotoxina Vero (VT) o tipo Shiga en las bacterias aisladas del paciente con colitis hemorrágica afebril y en uno de los dos controles sin diarrea. Esta citotoxina pudo ser neutralizada con antisuero específico contra VT-I altamente purificada. En los otros tres pacientes las cepas encontradas produjeron sólo trazas de VT, que tambíen pudieron neutralizarse con la misma antitoxina. Ninguna de las bacterias encontradas fue capaz de producir enterotoxina lábil o estable al calentamiento, invadir la córnea de cobayos (Prueba de Séreny) o adherirse a células HEp-2. Desde el punto de vista de las características microbiológicas, a diferencia de lo reportado en la literatura, las cepas 0157 encontradas en el presente estudio fueron capaces de fermentar el sorbitol, por lo que el uso de medios selectivos con este azúcar para su aislamiento hubiera impedido su identificación

Criptococosis del sistema nervioso central en el Instituto Nacional de Pediatría / Cryptococcosis of the central nervous system at the Instituto Nacional de Pediatria

Se revisaron los expedientes clínicos de 12 niños con cultivo de LCR positivo a Criptococcus neoformans. Los signos y síntomas principales fueron cefalea, vómito e irritabilidad. Las alteraciones de la personalidad estuvieron presentes en niños de más de 7 años. Ni los valores de examen citoquímico del LCR ni la biometría hemática mostraron características alguna diferencial de infección bacteriana o viral. En 7 de los 12 niños hubo alteraciones inmunológicas compatibles con la respuesta al tratamiento que estaban recibiendo; los otros 5 no tuvieron la respuesta inmune alterada. Se sugiere que en niños mayores de 7 años con trastornos de la personalidad acompañados de irritabilidad, vómitos y cefalea se investigue la posibilidad de infección por criptococo, diferenciando la variedad ya que se relacionan a la capacidad de producir infección

Bacteriología postmortem: revisión del tema / Post-mortem bacteriology: review of the subject

Se hace un análisis de los resultados de la bacteriología en estudios postmortem señalando las etapas por las que ha cursado en lo que respecta a su importancia y significado clínico. Se mencionan también los diferentes trabajos en los que se hace hincapié, en los conceptos de invasión bacteriana agónica, preagónica, transmigración y microflora indígena, en los que los diferentes autores no se ponen de acuerdo en su significado. La bacteriología postmortem debe ser interpretada con cuidado, siguiendo una metodología particular para la toma y manejo de las muestras, para el cultivo bacteriológico y el resultado debe ser interpretado con cautela integrando la información clínica y la alteración tisular