Medical-legal aspects in infectious diseases. / Aspectos medicolegales en las enfermedades infecciosas.

This article reviews the medico-legal aspects associated with infectious diseases, highlighting their complexity and the challenges they pose. Infectious diseases cause not only an increase in morbidity and mortality in the healthcare setting but also involve complex legal issues. Healthcare-Associated Infections (HAIs) represent a growing risk with the increase in invasive procedures and can lead to patient complications and legal claims against healthcare professionals and institutions. The consequences of medical malpractice in this context are discussed, such as diagnostic delays, inappropriate use of treatments, and lack of adequate testing, which can have serious sequelae or even result in the patient's death. The review focuses on highlighting the importance of prevention, considering that healthcare-associated infections can be difficult to avoid, posing complex legal challenges. It concludes that managing infectious diseases and their legal consequences requires careful consideration of clinical practice guidelines, prevention and control strategies, and effective communication with patients. An integrated and evidence-based approach is advocated to address these challenges, emphasizing continuous education, the use of advanced diagnostic technologies, and interdisciplinary collaboration.

Agências de regularização técnica odontológica em relação ao manejo clínico em crianças: uma revisão de literatura / Dental technical regularization agencies in relation to management clinic in children: a review of the literature

O manejo clínico em Odontopediatria é individual, podendo variar nas diversas culturas mundiais. O objetivo desta revisão de literatura é reunir as principais diretrizes de diferentes países ao redor do mundo, incluindo o Brasil, visando identificar como em cada lugar o uso das técnicas de comportamento são aplicadas e sua eficiência. Inicialmente, foram selecionados os principais guias nacionais e internacionais, sendo eles retirados da Associação Internacional de Odontopediatria (IAPD) e Associação Americana de Odontopediatria (AAPD), além de artigos de diferentes países e continentes, como Argentina, Brasil, Europa e Ásia, também foram analisados se o protocolo dos principais guias estão condizentes com os protocolos do Departamento de Clínica Infantil da Faculdade de Odontologia de Ribeirão Preto - USP. Os resultados obtidos nos guias para manejo clínico odontológico brasileiro, americano, internacional e os artigos estudados recomendam inicialmente utilizar técnicas menos invasivas, com o intuito proporcionar um atendimento tranquilo e sem criar traumas para a criança, uma vez que muito do comportamento não cooperativo vem de experiências anteriores traumáticas. Entretanto, técnicas avançadas podem ser utilizadas para casos mais desafiadores. Concluímos com o estudo dos guias e artigos, que o cirurgião dentista possui diversas técnicas a serem aplicadas para que o atendimento infantil seja atraumático e restabelecer saúde ao paciente.

Clinical management in Pediatric Dentistry is individual and varies across different cultures around the world. The objective of this literature review is to bring together the main guidelines from different countries around the world, including Brazil, aiming to identify how the use of behavioral techniques are applied and their efficiency in each place. Initially, the main national and international guides were selected, taken from the International Association of Pediatric Dentistry (IAPD) and the American Association of Pediatric Dentistry (AAPD), as well as articles from different countries and continents, such as Argentina, Brazil, Europe and Asia, as well as It was analyzed whether the protocols of the main guides are consistent with the protocols of the Children's Clinic Department of the Faculty of Dentistry of Ribeirão Preto - USP. The results obtained in the guides for Brazilian, American and international dental clinical management and the articles studied recommend initially using less invasive techniques, with the aim of providing calm care and without creating trauma for the child, since much of the uncooperative behavior comes from previous traumatic experiences. However, advanced techniques can be used for more challenging cases. We conclude from studying the guides and articles that the dental surgeon has several techniques to be applied so that child care is atraumatic and restores health to the patient.

Utilization of abdominal radiography in the emergency department: Appropriateness, interpretation, radiation protection and costs.

INTRODUCTION: The use of abdominal radiography (AXR) apparently continues to be widespread despite its limited indications, the potential radiation and unnecessary costs associated. In addition, the interpretation and its report seem variable and not always performed by a radiologist. Our objective is to analyze the use, adequacy and usefulness of AXR in the emergency of a tertiary referral hospital. MATERIAL AND METHODS: We retrospectively reviewed all the AXR performed in January 2020 in the emergency of our centre, as well as the patient's demographics and medical records, technical quality of the radiographs, indications according to the SERAM (Spanish Society of Radiology) Appropriateness Guidelines, presence of a formal radiology report, and impact on the clinical management of the patient. Of all non-appropriated AXR we calculated the radiation received by the patients and its extra costs. RESULTS: In January 2020, 429 AXR (9.1% of all radiographies) were performed in the emergency of our centre. The most frequent indication was abdominal pain (40%, n = 176), followed by low back pain (21.4%, n = 92). 12.4% of AXR requested did not include any clinical information. Most of the AXR (79.6%) had sufficient technical quality. 61.3% (n = 263) of the AXR performed were not indicated, assuming an average unjustified radiation dose per patient of 0.50 ±â€¯0.33 mSv, and a total additional cost of 6575;. Only 6% of the inadequate AXRs led to a change in the clinical management of the patient, compared to 29% of the adequate AXR (p < 0.001). Only 3% of the AXR had a formal radiology report. CONCLUSIONS: AXR is still common in the emergency setting, although most of them might be inadequate according to the SERAM Appropriateness Guidelines. Its use should be optimized to avoid unnecessary radiation and costs. Radiologists must have a more active participation in the management of AXR.

Management, development and methodology of the Clinical Practice Guidelines and Recommendations of the Spanish Society of Rheumatology.

The Spanish Society of Rheumatology (SER) brings together the majority of Spain's rheumatologists and, among the many services it offers its members, has a Research Unit (RU). This unit provides methodological support to SER members in clinical and epidemiological research, coordinates and carries out research projects, designs and maintains large patient databases, develops qualitative research projects and produces evidence-based medicine (EBM) documents. Through this last activity, the RU of the SER produces clinical practice guidelines and recommendation documents on topics relevant to rheumatology that meet the most demanding methodological standards. The aim of this article is to describe the management process and methodology followed by the UI of the SER to identify the topics of its EBM documents and how it executes and develops its guidelines and recommendations.

Poor compliance with clinical practice guidelines in the management of asthma in primary care in the community of Madrid.

INTRODUCTION: Asthma is a common chronic disease in the paediatric age group that requires close follow-up. Clinical practice guidelines offer evidence-based recommendations to achieve adequate control of the disease. OBJECTIVE: To assess the management of childhood asthma in the primary care setting in the Community of Madrid, and the adherence of health care professionals to guideline recommendations. To analyse the association of asthma management with age, the socioeconomic level of the catchment population and the workload of primary care centres. METHODS: retrospective longitudinal study in patients aged 6-14 years newly diagnosed with asthma in primary care centres of the Community of Madrid in 2021. We analysed sociodemographic and clinical variables and the compliance with recommendations at the time of diagnosis and over 1 year of follow-up. The source of data was the electronic health record database of the primary care system. RESULTS: We found a proportion of compliance with the recommendations upon diagnosis of the disease of 5.84%, with differences associated to the socioeconomic level of the catchment population (P = .033), and the pressure of care (P = .006). The proportion of compliance with recommendations during follow-up was 12.73%, with differences based on age (P = .01), socioeconomic level (P = 0.006) and centre workloads (P = .002). CONCLUSIONS: Compliance with the recommendations of the main childhood asthma management guidelines in the primary care setting was low in the Community of Madrid. Strategies need to be implemented to improve the management of this disease and the adherence of professionals to the protocols developed for this purpose.

Latin-American guidelines of recommendations at discharge from an acute coronary syndrome.

The diagnostic criteria, treatments at the time of admission, and drugs used in patients with acute coronary syndrome are well defined in countless guidelines. However, there is uncertainty about the measures to recommend during patient discharge planning. This document brings together the most recent evidence and the standardized and optimal treatment for patients at the time of discharge from hospitalization for an acute coronary syndrome, for comprehensive and safe care in the patient's transition between care from the acute event to the outpatient care, with the aim of optimizing the recovery of viable myocardium, guaranteeing the most appropriate secondary prevention, reducing the risk of a new coronary event and mortality, as well as the adequate reintegration of patients into daily life.

Los criterios diagnósticos, los tratamientos en el momento de la admisión y los fármacos utilizados en pacientes con síndrome coronario agudo están bien definidos en innumerables guías. Sin embargo, existe incertidumbre acerca de las medidas para recomendar durante la planificación del egreso de los pacientes. Este documento reúne las evidencias más recientes y el tratamiento estandarizado y óptimo para los pacientes al momento del egreso de una hospitalización por un síndrome coronario agudo, para un cuidado integral y seguro en la transición del paciente entre la atención del evento agudo y el cuidado ambulatorio, con el objetivo de optimizar la recuperación de miocardio viable, garantizar la prevención secundaria más adecuada, reducir el riesgo de un nuevo evento coronario y la mortalidad, así como la adecuada reinserción de los pacientes en la vida cotidiana.

¿Qué condiciones deben reunir las guías de diagnóstico y tratamiento para ser verdaderas guías de práctica clinica basadas en la evidencia? / What conditions should the diagnosis and treatment guidelines meet, to be true clinical practice guidelines based on evidence?

Resumen Las guías de diagnóstico y tratamiento elaboradas por las sociedades científicas médicas, constituyen una herramienta muy útil para el ejercicio profesional de la especialidad. Sustentadas en bibliografía actualizada, representan un material de enorme valor con reco mendaciones de los expertos en los diversos temas de la especialidad. En el presente artículo se intenta determinar si las mismas podrían ser diseñadas acercándolas lo más estrechamente posible al formato de las Guías de Práctica Clínica Basadas en la Evidencia (GPC-BE), para lo cual se revisan las etapas en su elaboración y los requisitos que deberían cumplir para ser conside radas como tales. Las GPC-BE son un "conjunto de recomendaciones elaboradas de forma sistemática para ayudar a los profe sionales y a los pacientes en la toma de decisiones sobre la atención sanitaria más apropiada, seleccionando las opciones diagnósticas y/o terapéuticas más adecuadas en el abordaje de un problema de salud o una condición clínica específica". Su objetivo es mejorar la efectividad, la eficiencia y la seguridad de las decisiones clínicas, y pueden servir de base para la elaboración de políticas de salud. La elaboración de las GPC representa un proceso complejo, que requiere conocimientos, experiencia y re cursos tanto en tiempo como en dinero. Su robustez no depende de quienes la realizan, sino de cómo es realiza da. Ello implica la participación de técnicos que aporten la evaluación de la evidencia por el método GRADE, y la consideración de aspectos de costo-efectividad.

Abstract The guides for diagnosis and treatment prepared by scientific medical societies constitute a very useful tool for the professional practice of the specialty. Supported by an updated bibliography, they represent material of enormous value with recommendations from experts on the various topics of the specialty. This article attempts to determine if they could be designed as "Evidence - Based Clinical Practice Guide lines" (CPG BE), for which the stages in their develop ment and the requirements that they reviewed. The CPG BE are a "set of recommendations prepared systematically to help professionals and patients in making decisions about the most appropriate health care, selecting the most appropriate diagnostic and/or therapeutic options to address a problem of health or a specific clinical condition". Their objective is to improve the effectiveness, efficiency and safety of clinical deci sions, and they can serve a basis for the development of health policies. The preparation of CPGs represents a complex pro cess, which requires knowledge, experience and re sources, both in time and money. Its robustness does not depend on who does it, but on how it is done. This implies the participation of technicians who provide the evaluation of the evidence using the GRADE method and the consideration of cost-effectiveness aspects.

Cómo generar recomendaciones de tromboprofilaxis venosa en instituciones de salud / How to generate recommendations for venous thromboprophylaxis in health institutions?

Resumen La prevención de la enfermedad tromboembólica venosa (ETV) es motivo de continua actualización en función de nueva evidencia que se genera permanentemente. Cada institución debe contar con una estrategia activa de prevención contra la ETV y debe generar normas de tromboprofilaxis (TP) de acuerdo con la realidad local. Durante este proceso de adaptación de una guía a la región debemos siempre tener en cuenta los recursos locales disponibles, el riesgo tromboembólico y hemorrágico propio del paciente, de la enfermedad por la que se encuentra internado (ya sea clínica o quirúrgica) y las consideraciones o preferencias del paciente. La tasa de adherencia a recomendaciones locales de TP es uno de los indicadores de excelencia más importantes evaluados en organismos que califican la calidad de una institución de salud. Las medidas de profilaxis que propongamos para los centros de salud, deben ser individualizadas para cada paciente, tienen que considerar antecedentes personales y familiares del enfermo y utilizar modelos de evaluación de riesgo validados de trombosis y de sangrado. También deben incluir a la población con riesgo de trombosis persistente luego del alta. Lo ideal es tener estadísticas propias de cada nosocomio para la toma de decisiones de cómo implementar una correcta TP. Extrapolar guías de los países desarrollados a nuestro ámbito podría tener un impacto negativo, si no se conoce la propia realidad. En este documento encontraremos herramientas prácticas para las instituciones de salud de la región, que les permita orientarse al momento de confeccionar recomendaciones para una adecuada TP.

Abstract Venous thromboembolism disease (VTE) prevention strategy has to be constantly updated based on new evidence that is generated every year. Each institution must have a formal and active prevention policy against VTE and must develop guidelines or standards for thromboprophylaxis (TP) according to the local reality. During this process of adapting a guideline to the region and the generation of hospital recommendations, we must always consider the available local resources, the thromboembolic and hemorrhagic risk of the patients, even after discharge, and also their considerations and preferences. Adherence to local TP recommendations is one of the most important items evaluated by organizations that measure institutional quality. Individualized prophylaxis should consider personal and family history of VTE, the use of validated risk assessment models or RAMs for thrombosis and bleeding events, as well as the special characteristics of each patient. Ideally, each center's own statistics should be available for decision-making. Extrapolating guidelines from developed countries could have a negative impact, if we ignore our hospital´s reality. In this document we will find practical tools for health institutions that will allow them to prepare recommendations or guidelines for adequate VTE prophylaxis.

Update of the guidelines for the pharmacological treatment of rheumatoid arthritis by the Mexican College of Rheumatology 2023.

OBJECTIVE: To develop updated guidelines for the pharmacological management of rheumatoid arthritis (RA). METHODS: A group of experts representative of different geographical regions and various medical services catering to the Mexican population with RA was formed. Questions based on Population, Intervention, Comparison, and Outcome (PICO) were developed, deemed clinically relevant. These questions were answered based on the results of a recent systematic literature review (SLR), and the evidence's validity was assessed using the GRADE system, considered a standard for these purposes. Subsequently, the expert group reached consensus on the direction and strength of recommendations through a multi-stage voting process. RESULTS: The updated guidelines for RA treatment stratify various therapeutic options, including different classes of DMARDs (conventional, biologicals, and JAK inhibitors), as well as NSAIDs, glucocorticoids, and analgesics. By consensus, it establishes the use of these in different subpopulations of interest among RA patients and addresses aspects related to vaccination, COVID-19, surgery, pregnancy and lactation, and others. CONCLUSIONS: This update of the Mexican guidelines for the pharmacological treatment of RA provides reference points for evidence-based decision-making, recommending patient participation in joint decision-making to achieve the greatest benefit for our patients. It also establishes recommendations for managing a variety of relevant conditions affecting our patients.

Quality assessment of clinical practice guidelines on hypoxic-ischaemic encephalopathy in newborns using the AGREE II tool: a systematic review.

INTRODUCTION: Hypoxic-ischaemic encephalopathy is a clinical syndrome of neurological dysfunction that occurs immediately after birth following an episode of perinatal asphyxia. We conducted a scoping review to assess the methodological quality of clinical practice guidelines that address this condition. METHODOLOGY: We conducted the evaluation using the AGREE II tool. High methodological quality was defined as a score greater than 70% in every domain. RESULTS: The analysis included three clinical practice guidelines; the highest scores were in the scope and purpose domain (84.26%; SD, 14.25%) and the clarity of presentation domain (84.26%; SD, 17.86%), while the lowest score corresponded to the applicability domain (62.50%; SD, 36.62%). Two guidelines were classified as high quality and one guideline as low-quality. CONCLUSIONS: Two of the assessed guidelines were classified as being of high quality; however, the analysis identified shortcomings in the applicability domain, in addition to methodological variation between guidelines developed in middle- or low-income countries versus high-income countries. Efforts are needed to make high-quality guidelines available to approach the management of hypoxic-ischaemic encephalopathy in newborns.

Numerical values and impact of hypertension in Spain.

In Spain, 33% of adults aged 30 to 79 years (10 million) were hypertensive in 2019. Among them, 68% were diagnosed, 57% received drug therapy, and effective therapeutic coverage (control) reached 33%. Both diagnosis and control show geographical and social disparities. Approximately 46 000 cardiovascular deaths per year are attributable to hypertension. In recent decades, the control of hypertension has increased, due to improvements in lifestyle measures and increased use of polytherapy, coinciding with a reduction in stroke mortality. There are several modifiable determinants of the lack of hypertension control: a) white-coat phenomenon affects 22% to 33% of treated individuals, partly due to the limited availability of ambulatory blood pressure monitoring (ABPM) (49%) and self-measured BP (SMBP) (78%); b) inadequate patient adherence to medication and healthy lifestyles (weight loss, the most effective measure, is the least used, ≈40%); and c) insufficient use of polytherapy (≈55%). The remaining challenges include: a) technological aspects, such as measuring BP with more accurate techniques (ABPM, SMBP) and using cardiovascular-risk estimation tools (eg, SCORE); b) clinical challenges, such as reducing therapeutic inertia (≈59%), involving patients in their own management (medication adherence, ≈62%) and effectively implementing clinical guidelines); and c) public health challenges, such as reducing the burden of obesity (≈24%), monitoring progress with updated surveys, and setting national BP control targets.

Childhood cancer survivors: current challenges.

Rates of childhood cancer survival in developed countries have risen to over 80-85 %. In consequence, the population of childhood cancer survivors (CCS) has grown considerably. Nevertheless, CCS present a high morbidity and mortality due to cancer or its treatment, with an increased risk of premature mortality, second primary tumors and late side effects, both physical and psychosocial, all of which decrease the quality of life. Long-term follow-up (LTFU) of CCS is recommended to prevent, detect and treat those health problems. Despite the advances achieved, the management of CCS is still not optimal. Among the areas for improvement discussed in this manuscript are: (1) Quantifying the real burden of morbimortality, by implementing new frequency measures (mean cumulative count and cumulative burden), to obtain more accurate assessments, and using simulation models, to determine individual risks; (2) Assessing the impact of risk factors for late side effects, related to the patient, tumor type, treatments, lifestyle, comorbidities, genetics and ageing; (3) Considering the impact of the international harmonisation of long-term follow-up guidelines, to generate homogeneous, evidence-based recommendations and an individualized LTFU and, (4) Challenges to LTFU implementation, considering models of care adapted to patient risk and needs, with special attention to the transition to adult-care follow-up. Finally, we comment on the situation of CCS in Spain and consider future prospects for improving the health and quality of life of this population.

Antiviral treatment for SARS-CoV-2 infection in the current situation: a position paper of the Spanish Society of Emergency Medicine (SEMES). / Posicionamiento de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) ante el tratamiento antiviral frente al SARS-CoV-2 en la situación epidemiológica actual.

SUMMARY: COVID-19 continues to pose a significant threat: mortality stands at nearly twice that of influenza, and the incidence rate is growing as the population's vaccination rate decreases, particularly in Spain and other areas of Europe. Given this situation, it is vitally important know whether medical protocols are consistent and appropriately implemented by health care staff in the interest of preventing possible inefficiency or inequity. Physicians from hospital emergency departments met to study their hospitals' usual clinical practices for managing SARS-CoV-2 infection and to determine their expert opinions on the use of antiviral agents. The participating physicians then reached consensus on evidencebased recommendations for strategies that would optimize emergency treatment.

RESUMEN: Actualmente, la COVID-19 sigue representando una amenaza significativa, con una mortalidad cercana al doble de la ocasionada por la gripe y con una incidencia variable debido a una disminución en la tasa de vacunación de la población, especialmente en el contexto europeo y español. Ante este panorama, es de vital importancia comprobar que los protocolos médicos están consolidados y son debidamente implementados por los profesionales sanitarios, con la finalidad de evitar posibles ineficiencias o inequidades. A través de reuniones con profesionales de urgencias se han observado las prácticas clínicas habituales en los servicios de urgencias hospitalarios para pacientes con infección por SARS-CoV-2, con la finalidad de comprender la perspectiva de estos profesionales acerca del uso de antivirales y, tras un consenso de expertos basados en la evidencia actual, se han generado estas de recomendaciones para poder enfocar estrategias que optimicen el tratamiento de los pacientes en estos servicios.

Guía de práctica clínica informada en la evidencia para el abordaje de la obesidad en adultos. Versión completa. Mayo de 2024 / Evidence-informed clinical practice guide for adult obesity. Full Version. May 2024

En esta guía titulada: "Guía de práctica clínica informada en la evidencia para el abordaje de la obesidad en adultos" se presenta todo el proceso que se desarrolló para su adaptación, de acuerdo con el "Manual para el desarrollo de guías de la Organización Mundial de la Salud" y la "Guía para adaptar y aplicar directrices informadas por la evidencia en su segunda edición de la OPS año 2023". Las recomendaciones propuestas, fueron validadas por un panel con la participación de profesionales expertos clínicos del Sistema Nacional de Salud., asociaciones médicas y representantes de los pacientes. El abordaje del tratamiento de la obesidad en esta guía contribuirá a mejorar la calidad de atención de la población salvadoreña

This guide entitled "Evidence-informed clinical practice guide for the management of obesity in adults" presents the entire process that was developed for its adaptation, according to the "Manual for the development of guidelines of the World Health Organization" and the "Guide to adapt and apply guidelines informed by evidence in its second edition of PAHO year 2023". The proposed recommendations were validated by a panel with the participation of expert clinical professionals from the National Health System, medical associations and patient representatives. The approach to the treatment of obesity in this guide will contribute to improving the quality of care for the Salvadoran population

Guía de práctica clínica informada en la evidencia para el abordaje de la obesidad en adultos. Versión resumida. Mayo de 2024 / Evidence-informed clinical practice guide for the adult approach to obesity. Summary version. May 2024

En esta guía titulada: "Guía de práctica clínica informada en la evidencia para el abordaje de la obesidad en adultos" se presenta todo el proceso que se desarrolló para su adaptación, de acuerdo con el "Manual para el desarrollo de guías de la Organización Mundial de la Salud" y la "Guía para adaptar y aplicar directrices informadas por la evidencia en su segunda edición de la OPS año 2023". Las recomendaciones propuestas, fueron validadas por un panel con la participación de profesionales expertos clínicos del Sistema Nacional de Salud., asociaciones médicas y representantes de los pacientes. El abordaje del tratamiento de la obesidad en esta guía contribuirá a mejorar la calidad de atención de la población salvadoreña

This guide entitled "Evidence-informed clinical practice guide for the management of obesity in adults" presents the entire process that was developed for its adaptation, according to the "Manual for the development of guidelines of the World Health Organization" and the "Guide to adapt and apply guidelines informed by evidence in its second edition of PAHO year 2023". The proposed recommendations were validated by a panel with the participation of expert clinical professionals from the National Health System, medical associations and patient representatives. The approach to the treatment of obesity in this guide will contribute to improving the quality of care for the Salvadoran population

Critical appraisal of the Colombian clinical practice guide for the prevention, diagnosis and treatment of suicidal ideation and/or behaviour (adoption).

INTRODUCTION: Suicide is a complex, global public health problem. The Colombian clinical practice guideline provides relevant input for its prevention, diagnosis and treatment. The objective was to evaluate the methodological quality, credibility and applicability of the Colombian clinical practice guideline for suicidal behaviour. METHODS: An academic group of 12 evaluators was established to assess the guide and its recommendations in a standardised way, using the AGREE-II and AGREE-REX instruments. The evaluations were given in the range of 0.0-1.0 with 0.7 as a cut-off point for appropriate quality. RESULTS: The global assessment of the AGREE-II was greater than 0.7 in the dimensions: "scope and objective" (0.86), "clarity of presentation" (0.89), "applicability" (0.73) and "editorial independence" (0.89). The lowest scores were for "participation of those involved" (0.67) and "rigour in preparation" (0.69). With the AGREE-REX, the results in all dimensions were below 0.70, which indicates lower quality and suitability for use. CONCLUSIONS: The adoption process of the Colombian guideline for suicidal behaviour was a rigorous methodological process, while the practice recommendations were valued as of low applicability due to low support in local evidence. It is necessary to strengthen the generation and synthesis of evidence at the national level to give greater support and applicability to the practice recommendations.

Diagnóstico y abordaje inicial del niño y adolescente con hipertensión arterial

La hipertensión arterial es uno de los factores de riesgo modificable involucrados en el desarrollo de la enfermedad cardiovascular (ECV). Si bien la prevalencia de HTA en niños es baja (alrededor de un 3.5%) en relación a la prevalencia en el adulto, algunos estudios sugieren que al iniciar en edades pediátricas el riesgo de ECV en la etapa adulta se incrementa, de modo que su detección y manejo temprano contribuiría a disminuir el riesgo de ECV en etapas más avanzadas de la vida. Dado que la ECV se ha constituido en las últimas décadas en la causa individual más frecuentes de morbilidad y mortalidad prematura en adultos a nivel mundial, algunas sociedades pediátricas como la Sociedad Europea de Hipertensión en Niños y Adolescentes (ESH), y la Academia Americana de Pediatría (AAP) se han hecho eco de iniciativas para el manejo de HTA, estableciendo guías prácticas clínicas para su diagnóstico y abordaje oportuEl presente artículo comprende una revisión de la literatura médica respecto a la hipertensión arterial en niños y adolescentes la cual resume las pautas útiles y actualizadas para la evaluación apropiada de la presión arterial y el abordaje inicial de la hipertensión arterial, lo cual incluye las definiciones, técnicas para el diagnóstico establecidas, así como el tratamiento inicial de la hipertensión arterial en niños y adolescentes. (provisto por Infomedic International)

Arterial hypertension is one of the modifiable risk factors involved in the development of cardiovascular disease (CVD). Although the prevalence of hypertension in children is low (around 3.5%) in relation to the prevalence in adults, some studies suggest that when it starts in pediatric age, the risk of CVD in adulthood increases, so that its early detection and management would contribute to reducing the risk of CVD in later stages of life. Given that CVD has become the most frequent single cause of morbidity and premature mortality in adults worldwide in recent decades, some pediatric societies such as the European Society of Hypertension in Children and Adolescents (ESH) and the American Academy of Pediatrics (AAP) have taken initiatives for the management of hypertension, establishing practical clinical guidelines for its diagnosis and timely management. The present article comprises a review of the medical literature regarding hypertension in children and adolescents that summarizes useful and up-to-date guidelines for appropriate blood pressure evaluation and initial management of hypertension, including definitions, established diagnostic techniques, and initial management of hypertension in children and adolescents. (provided by Infomedic International)

Assessment of the quality, diagnosis, and therapeutic recommendations of clinical practice guidelines on patients with Helicobacter pylori infection: A systematic review.

We conducted this study to systematically review and assess the current clinical practice guidelines (CPGs) related to the diagnosis and treatment of Helicobacter pylori (H. pylori) infection. The aim was to evaluate the quality of these included CPGs and provide clinicians with a convenient and comprehensive reference for updating their own CPGs. We searched four databases to identify eligible CPGs focusing on H. pylori diagnosis and treatment recommendations. The results were presented using evidence mappings. Quality and clinical applicability were assessed comprehensively using AGREE-II and AGREE-REX. Statistical tests, specifically Bonferroni tests, were employed to compare the quality between evidence-based guidelines and consensus. A total of 30 eligible CPGs were included, comprising 17 consensuses and 13 guidelines. The quality showed no statistical significance between consensuses and guidelines, mainly within the moderate to low range. Notably, recommendations across CPGs exhibited inconsistency. Nevertheless, concerning diagnosis, the urea breath test emerged as the most frequently recommended method for testing H. pylori. Regarding treatment, bismuth quadruple therapy stood out as the predominantly recommended eradication strategy, with high-dose dual therapy being a newly recommended option. Our findings suggest the need for specific organizations to update their CPGs on H. pylori or refer to recently published CPGs. Specifically, CPGs for pediatric cases require improvement and updating, while a notable absence of CPGs for the elderly was observed. Furthermore, there is a pressing need to improve the overall quality of CPGs related to H. pylori. Regarding recommendations, additional evidence is essential to elucidate the relationship between H. pylori infection and other diseases and refine test indications. Clinicians are encouraged to consider bismuth quadruple or high-dose dual therapy, incorporating locally sensitive antibiotics, as empirical radical therapy. .

[How to improve community engagement in health: Analysis of proposed actions following the implementation of a community engagement assessment tool]. / ¿Cómo mejoramos la participación comunitaria en salud? Análisis de las acciones propuestas tras la aplicación de una herramienta de evaluación.

OBJECTIVE: To analyse the lines of action identified in the health promotion projects participating in the EvaluA GPS research, and their relationship with the scores assigned in EvalGuia, a tool for evaluating evidence-based community participation. DESIGN: Qualitative-quantitative multicentre study. SETTING: Primary care or intersectoral network of primary care and municipalities in five autonomous communities in Spain. PARTICIPANTS: Participants of 10 health promotion projects, selected with convenience sampling, following inclusion criteria (projects with a minimum of community engagement and centred on community health). METHOD: Data were collected through questionnaires (EvalGuía tool) and participatory workshops. Quantitative data were analysed with descriptive statistics, qualitative data were analysed using matrix analysis. RESULTS: After implementing the EvalGuide tool, the lowest scores were assigned in outcome evaluation, knowledge of policies related to community participation, diversity in the core working group, inclusivity policies, financial resources and diffusion of results. The lines of action proposed were heterogeneous and did not always match with those prioritised as lower score. The prioritised lines revolved around project organisation and communication. CONCLUSIONS: The EvalGuide tool can be helpful to design action plans in Health Promotion projects. The implementation of measures in 12 months to increase the diversity of the core working group, to incorporate work-life balance measures or to improve evaluation is difficult. More time is needed to implement such measures.

Encuesta a neumonólogos sobre la elección de guías de enfermedades respiratorias / Survey to Pulmonologists about the Choice of Guidelines for Respiratory Diseases

RESUMEN Introducción: Dada la existencia de variadas guías para enfermedades respiratorias, se buscó conocer cuáles eligen los médicos para utilizar en su práctica clínica. Materiales y Métodos: se realizó un estudio descriptivo, transversal, mediante una encuesta a neumonólogos de la Asociación Argentina de Medicina Respiratoria. Resultados: La guía más utilizada para EPOC fue la Iniciativa Global para la Enferme dad Pulmonar Obstructiva Crónica (GOLD) (82 %), seguida por GesEPOC (51 %). Para asma las más usadas fueron la Iniciativa Global para el Asma (GINA) 2022 (89 %) y GEMA 5.2 (68 %). En asma de difícil control, se prefirieron GINA 2022 (82 %) y GEMA 2022 (53 %). En espirometría, un 54 % de los respondedores se inclinó por NHANES III y un 22 % utilizó valores teóricos de referencia de Knudson. En neumonía, el 62 % eligió SADI, el 37 %, IDSA y el 20 %, BTS. Para nódulos pulmonares, el 62 % prefirió las guías Fleischner, 35 % se inclinó por Lung-RADS 1.1. Para neumonitis por hip ersensibilidad, un 83 % seleccionó las guías de las sociedades conjuntas ATS/JRS/ ALAT. Para imágenes de fibrosis pulmonar, el 89 % utilizó ALAT/ERS/JRS/ALAT y el 18 % White Paper. Discusión: si bien hay estudios sobre adherencia a guías, no los hay acerca de pref erencias de utilización entre varias referidas a un mismo tema. En EPOC y asma (in cluyendo la de difícil control) se eligieron GOLD y GINA y las de la Sociedad Española de Patología Respiratoria (GesEPOC y GEMA). El uso preferencial de la guía nacional para neumonía es coherente con la necesidad de contemplar la epidemiología local.

ABSTRACT Introduction: Since there are various guidelines for respiratory diseases, we aimed to know which are chosen by physicians in their daily clinical practice. Materials and Methods: A descriptive, cross-sectional study was conducted through a questionnaire sent to pulmonologists of the Argentinian Association of Respiratory Medicine. Results: The most commonly used guideline for COPD (chronic obstructive pulmonary disease) was the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (82 %), followed by GesEPOC (51 %). For asthma, the most commonly used guideline was the Global Initiative for Asthma (GINA) 2022 (89 %) and the Spanish Guideline on the Management of Asthma (known for its acronym in Spanish, GEMA), GEMA 5.2 (68 %). In difficult-to-control asthma, GINA 2022 (82 %) and GEMA 2022 (53 %) were used. With regard to spirometries, 54 % of respondents favored NHANES III (Third National Health and Nutrition Examination Survey) and 22 % used theoretical Knudson reference values. For pneumonia, 62 % chose the guidelines of the SADI (Argentinian Society of Infectious Diseases), 37 % preferred those of the IDSA (Infectious Diseases Society of America) and 20 %, chose the guidelines of the BTS (British Thoracic Society). For pulmonary nodules, 62 % used Fleischner guidelines, and 35 % favored Lung-RADS 1.1. For hypersensitivity pneumonitis, 83 % selected the ATS/JRS/ALAT Guidelines (American Thoracic Society/Japanese Respiratory Society/Latin American Thoracic Society). And with respect to pulmonary fibrosis imaging, 89 % used ALAT/ERS (Eu ropean Respiratory Society)/JRS recommendations, and 18 % preferred White Paper. Discussion: Although there are studies about adherence to guidelines, none of them shows which are the chosen recommendations within a group of guidelines of the same topic. In COPD and asthma (including difficult-to-control asthma) GOLD, GINA and the guidelines of the Spanish Society of Respiratory Disease (GesEPOC and GEMA) were chosen. The preference for the national guideline for pneumonia is consistent with the need to consider local epidemiology.