Upgrading the Power Grid Functionalities with Broadband Power Line Communications: Basis, Applications, Current Trends and Challenges.

This article reviews the basis and the main aspects of the recent evolution of Broadband Power Line Communications (BB-PLC or, more commonly, BPL) technologies. The article starts describing the organizations and alliances involved in the development and evolution of BPL systems, as well as the standardization institutions working on PLC technologies. Then, a short description of the technical foundation of the recent proposed technologies and a comparison of the main specifications are presented; the regulatory activities related to the limits of emissions and immunity are also addressed. Finally, some representative applications of BPL and some selected use cases enabled by these technologies are summarized, together with the main challenges to be faced.

Allergies and COVID-19 vaccines: An ENDA/EAACI Position paper.

BACKGROUND: Anaphylaxis, which is rare, has been reported after COVID-19 vaccination, but its management is not standardized. METHOD: Members of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology interested in drug allergy participated in an online questionnaire on pre-vaccination screening and management of allergic reactions to COVID-19 vaccines, and literature was analysed. RESULTS: No death due to anaphylaxis to COVID-19 vaccines has been confirmed in scientific literature. Potential allergens, polyethylene glycol (PEG), polysorbate and tromethamine are excipients. The authors propose allergy evaluation of persons with the following histories: 1-anaphylaxis to injectable drug or vaccine containing PEG or derivatives; 2-anaphylaxis to oral/topical PEG containing products; 3-recurrent anaphylaxis of unknown cause; 4-suspected or confirmed allergy to any mRNA vaccine; and 5-confirmed allergy to PEG or derivatives. We recommend a prick-to-prick skin test with the left-over solution in the suspected vaccine vial to avoid waste. Prick test panel should include PEG 4000 or 3500, PEG 2000 and polysorbate 80. The value of in vitro test is arguable. CONCLUSIONS: These recommendations will lead to a better knowledge of the management and mechanisms involved in anaphylaxis to COVID-19 vaccines and enable more people with history of allergy to be vaccinated.

[Melanoma: A pediatric challenge. A two cases report]. / Melanoma: un desafío para el pediatra. Dos casos clínicos.

Melanoma is the most serious skin cancer. Morbimortality is variable as it is related to the preventive measures, early detection, and access to early treatment. The incidence has increased in recent years, despite the raise in awareness of avoiding sun exposure and the use of sunscreen. What is more, the disease age range has expanded, affecting increasingly younger individuals. It is estimated that 1 to 4 % of all melanoma cases occurred in people younger than twenty years old. We present two pediatric cases with prolonged evolution and wrong initial diagnosis. Since the general pediatrician is the patient's first contact with the health system, it is extremely important to know the characteristics of these lesions. A high index of suspicion would allow an early referral to the specialist.

El melanoma es la forma más grave de cáncer de piel. La morbimortalidad es variable, ya que se relaciona con las medidas de prevención implementadas, la detección temprana y el acceso al tratamiento temprano. La incidencia ha aumentado en los últimos años a pesar de la mayor concientización con respecto a la exposición a la luz solar y la utilización de cremas protectoras. A su vez, el rango etario se ha ampliado, y esta enfermedad afecta a individuos cada vez más jóvenes. Se estima que del 1 % al 4 % de todos los casos de melanoma ocurren en menores de 20 años. Se presentan dos casos pediátricos, con evolución prolongada y diagnóstico inicial erróneo. Es fundamental para el pediatra general, primer contacto del paciente con el sistema de salud, conocer las características de estas lesiones. Un alto índice de sospecha permitiría la derivación al especialista de forma temprana.

Pseudomicroangiopatía trombótica por deficiencia de vitamina B12 en un lactante / Pseudo-thrombotic microangiopathy due to vitamin B12 deficiency in an infant

La seudomicroangiopatía trombótica o síndrome de Moschcowitz es una manifestación infrecuente del déficit de vitamina B12. Se caracteriza por anemia hemolítica con características microangiopáticas, reticulocitos e índices hematimétricos normales o con ligera megaloblastosis, asociados a manifestaciones neurológicas. La vitamina B12 está presente en alimentos proteicos de origen animal. La lactancia materna es una fuente adecuada para los niños cuando los niveles maternos son normales. Se presenta a una paciente de 16 meses que se internó por anemia hemolítica con requerimiento transfusional, plaquetopenia, mal progreso pondoestatural y retraso neuromadurativo. Durante su internación se arribó al diagnóstico de seudomicroangiopatía trombótica secundaria a déficit de vitamina B12.

Pseudo-thrombotic microangiopathy, or Moschcowitz syndrome, is a rare manifestation of vitamin B12 deficiency. It is characterized by microangiopathic hemolytic anemia, reticulocytes, and hematimetric indices that can be normal or that might present a mild megaloblastosis, and which are associated with neurological manifestations. Vitamin B12 can be found in animal-based protein foods. Breastfeeding is an adequate source of this vitamin for children, when maternal serum levels are normal. The case of a 16-month-old infant is presented. She was admitted for hemolytic anemia with transfusion requirement, thrombocytopenia, failure to thrive and developmental delay. During her hospitalization, she was diagnosed with pseudothrombotic microangiopathy caused by vitamin B12 deficiency.

[Pseudo-thrombotic microangiopathy due to vitamin B12 deficiency in an infant]. / Pseudomicroangiopatía trombótica por deficiencia de vitamina B12 en un lactante.

Pseudo-thrombotic microangiopathy, or Moschcowitz syndrome, is a rare manifestation of vitamin B12 deficiency. It is characterized by microangiopathic hemolytic anemia, reticulocytes, and hematimetric indices that can be normal or that might present a mild megaloblastosis, and which are associated with neurological manifestations. Vitamin B12 can be found in animal-based protein foods. Breastfeeding is an adequate source of this vitamin for children, when maternal serum levels are normal. The case of a 16-month-old infant is presented. She was admitted for hemolytic anemia with transfusion requirement, thrombocytopenia, failure to thrive and developmental delay. During her hospitalization, she was diagnosed with pseudothrombotic microangiopathy caused by vitamin B12 deficiency.

La seudomicroangiopatía trombótica o síndrome de Moschcowitz es una manifestación infrecuente del déficit de vitamina B12. Se caracteriza por anemia hemolítica con características microangiopáticas, reticulocitos e índices hematimétricos normales o con ligera megaloblastosis, asociados a manifestaciones neurológicas. La vitamina B12 está presente en alimentos proteicos de origen animal. La lactancia materna es una fuente adecuada para los niños cuando los niveles maternos son normales. Se presenta a una paciente de 16 meses que se internó por anemia hemolítica con requerimiento transfusional, plaquetopenia, mal progreso pondoestatural y retraso neuromadurativo. Durante su internación se arribó al diagnóstico de seudomicroangiopatía trombótica secundaria a déficit de vitamina B12.

Melanoma: un desafío para el pediatra. Dos casos clínicos / Melanoma: A pediatric challenge. A two cases report

El melanoma es la forma más grave de cáncer de piel. La morbimortalidad es variable, ya que se relaciona con las medidas de prevención implementadas, la detección temprana y el acceso al tratamiento temprano. La incidencia ha aumentado en los últimos años a pesar de la mayor concientización con respecto a la exposición a la luz solar y la utilización de cremas protectoras. A su vez, el rango etario se ha ampliado, y esta enfermedad afecta a individuos cada vez más jóvenes. Se estima que del 1 % al 4 % de todos los casos de melanoma ocurren en menores de 20 años.Se presentan dos casos pediátricos, con evolución prolongada y diagnóstico inicial erróneo. Es fundamental para el pediatra general, primer contacto del paciente con el sistema de salud, conocer las características de estas lesiones. Un alto índice de sospecha permitiría la derivación al especialista de forma temprana.

Melanoma is the most serious skin cancer. Morbimortality is variable as it is related to the preventive measures, early detection, and access to early treatment. The incidence has increased in recent years, despite the raise in awareness of avoiding sun exposure and the use of sunscreen. What is more, the disease age range has expanded, affecting increasingly younger individuals. It is estimated that 1 to 4 % of all melanoma cases occurred in people younger than twenty years old.We present two pediatric cases with prolonged evolution and wrong initial diagnosis. Since the general pediatrician is the patient's first contact with the health system, it is extremely important to know the characteristics of these lesions. A high index of suspicion would allow an early referral to the specialist.

Enfermedad por arañazo de gato con compromiso óseo múltiple / Cat-scratch disease with multiple bone involvement

La enfermedad por arañazo de gato es producida por la bacteria Bartonella henselae, bacilo Gram-negativo transmitido desde gatos y perros a los seres humanos a través de la inoculación cutánea por rasguños o mordeduras. Tiene un amplio espectro clínico, desde una forma típica caracterizada por una linfadenopatía regional cercana al sitio de inoculación hasta formas atípicas con compromiso sistémico. Las formas óseas son infrecuentes; representan, aproximadamente, del 0,2 % al 0,5 % de los casos.Se presenta a una paciente de 3 años de edad, previamente sana, que se internó por síndrome febril prolongado asociado a dolor y limitación del movimiento a nivel de la columna vertebral cervical, con diagnóstico de enfermedad por arañazo de gato con afectación ósea múltiple

Cat-scratch disease is produced by the bacterium Bartonella henselae, a gram-negative bacillus transmitted through cutaneous inoculation by a cat or dog's scratch or bite. It has a wide clinical spectrum, from a typical picture characterized by a regional lymphadenopathy near to the inoculation site to atypical pictures with systemic compromise. Bone compromise is infrequent, it represents around 0.2-0.5 % of the cases.We present a 3-year-old previously healthy patient, who was admitted with prolonged fever related to pain and movement limitation of the cervical spine. Diagnosis of cat-scratch disease with multiple bone involvement was reached.

[Cat-scratch disease with multiple bone involvement]. / Enfermedad por arañazo de gato con compromiso óseo múltiple.

Cat-scratch disease is produced by the bacterium Bartonella henselae, a gram-negative bacillus transmitted through cutaneous inoculation by a cat or dog's scratch or bite. It has a wide clinical spectrum, from a typical picture characterized by a regional lymphadenopathy near to the inoculation site to atypical pictures with systemic compromise. Bone compromise is infrequent, it represents around 0.2-0.5 % of the cases. We present a 3-year-old previously healthy patient, who was admitted with prolonged fever related to pain and movement limitation of the cervical spine. Diagnosis of cat-scratch disease with multiple bone involvement was reached.

La enfermedad por arañazo de gato es producida por la bacteria Bartonella henselae, bacilo Gram-negativo transmitido desde gatos y perros a los seres humanos a través de la inoculación cutánea por rasguños o mordeduras. Tiene un amplio espectro clínico, desde una forma típica caracterizada por una linfadenopatía regional cercana al sitio de inoculación hasta formas atípicas con compromiso sistémico. Las formas óseas son infrecuentes; representan, aproximadamente, del 0,2 % al 0,5 % de los casos. Se presenta a una paciente de 3 años de edad, previamente sana, que se internó por síndrome febril prolongado asociado a dolor y limitación del movimiento a nivel de la columna vertebral cervical, con diagnóstico de enfermedad por arañazo de gato con afectación ósea múltiple.

Safety and effectiveness of a microcrystalline tyrosine-associated mite extract immunotherapy for allergic rhinitis.

Aim: To assess the safety and effectiveness of an allergen immunotherapy (AIT) with a microcrystalline tyrosine-associated mite allergoid in real-world patients with allergic rhinitis (AR). Materials & methods: Retrospective, multicenter study assessing the safety of AIT in patients aged 5 to 65 years with AR, with or without asthma, sensitized to mites. Secondary objective was effectiveness, measured as unscheduled visits to healthcare centers and emergency rooms, rhinitis and asthma evolution, medication use and patients' and physicians' disease perception 12 months before and after treatment. Results: The 306 patients evaluated, with a mean (standard deviation) age of 29.68 (14.66) years, received different treatment compositions and regimens, and 25 (8.2%) experienced nonserious adverse reactions. Unscheduled visits to the specialist and emergency room admissions significantly decreased after immunotherapy (mean [standard deviation] 2.11 [1.95] and 0.3 [0.93] vs 0.66 [1.09] and 0.02 [0.2], before and after treatment, respectively). Rhinitis and asthma classification ('AR and its impact on asthma' and 'Guía Española para el Manejo del Asma', respectively) significantly changed (p < 0.0001 for all classifications), showing symptom reduction after AIT. Median (interquartile range)-combined rhinitis and combined asthma medication scores significantly decreased (4.0 [1.33, 7.0] vs 0.25 [0, 10.0]; p < 0.0001 and 6.94 [1.5, 6.0] vs 0.67 [0, 4.67]; p < 0.0001) within 12 months before and after starting AIT, respectively. Conclusion: AIT with microcrystalline tyrosine-associated mite allergoid appears to be safe and effective in treating rhinitis caused by mites.

Schwannoma orbitario en un niño con proptosis aguda / Orbital schwannoma in a child with acute proptosis

El schwannoma es un tumor primario, habitualmente, benigno, procedente de las células de Schwann, productoras de la vaina de mielina que recubre los nervios periféricos. Constituye menos del 10 % de los tumores intracraneales y es infrecuente en la edad pediátrica.Se presenta a un paciente de 6 años y 11 meses de edad, previamente sano, con antecedente de cefalea holocraneana intermitente asociado a proptosis y disminución de la agudeza visual del ojo izquierdo, epífora y estrabismo, con evidencia tomográfica de una masa retroocular. Se realizó la exéresis macroscópicamente completa, con diagnóstico anatomopatológico de schwannoma orbitario

Schwannoma is a usually benign primary tumor. It develops from the Schwann cells, which produce the myelin sheath that surrounds the peripheral nerves. It represents less than 10 % of the intracranial tumors, and it is infrequent in the pediatric age.We hereby present a 6-year-and-11-month-old previously healthy patient, with a history of intermittent generalized cephalea associated with proptosis and a diminished visual acuity of the left eye, epiphora and strabismus, with radiological evidence of retro-ocular mass. A macroscopically complete exeresis was performed, with an anatomopathological diagnosis of orbital schwannoma

[Orbital schwannoma in a child with acute proptosis]. / Schwannoma orbitario en un niño con proptosis aguda.

Schwannoma is a usually benign primary tumor. It develops from the Schwann cells, which produce the myelin sheath that surrounds the peripheral nerves. It represents less than 10 % of the intracranial tumors, and it is infrequent in the pediatric age. We hereby present a 6-year-and-11-month-old previously healthy patient, with a history of intermittent generalized cephalea associated with proptosis and a diminished visual acuity of the left eye, epiphora and strabismus, with radiological evidence of retro-ocular mass. A macroscopically complete exeresis was performed, with an anatomopathological diagnosis of orbital schwannoma.

El schwannoma es un tumor primario, habitualmente, benigno, procedente de las células de Schwann, productoras de la vaina de mielina que recubre los nervios periféricos. Constituye menos del 10 % de los tumores intracraneales y es infrecuente en la edad pediátrica. Se presenta a un paciente de 6 años y 11 meses de edad, previamente sano, con antecedente de cefalea holocraneana intermitente asociado a proptosis y disminución de la agudeza visual del ojo izquierdo, epífora y estrabismo, con evidencia tomográfica de una masa retroocular. Se realizó la exéresis macroscópicamente completa, con diagnóstico anatomopatológico de schwannoma orbitario.

Quality of Life in Patients with Allergic Reactions to Medications: Influence of a Drug Allergy Evaluation.

BACKGROUND: Suspicion of allergic drug reaction can cause important disturbances in the patient's life. OBJECTIVE: We evaluated in a prospective multicenter study the quality of life of patients who suffered a possible allergic drug reaction, and analyzed the effect of a drug allergy evaluation. METHODS: Patients (>18 years old) answered the specific questionnaire twice: before the drug allergy evaluation, and 1 month after it was completed. Statistics were performed using STATA. RESULTS: A total of 360 patients (240, 66.6% female; mean age, 45.4 years; standard deviation [SD], 15.6 years) completed the first questionnaire. After the evaluation, 150 of 346 patients (43.4%) were diagnosed as allergic to the drug (115 of 150 immediate; 35 of 150 delayed) and 196 of 346 patients (56.6%) as nonallergic. The mean value of the first questionnaire was 32.14 (SD, 11.84); patients with anaphylaxis, nonanaphylactic immediate reaction, with more than 1 drug reaction, or a chronic osteoarticular disease, had a statistically significant higher score in Q0 (worse quality of life). After the allergy study, the mean of the second questionnaire was 27.27 (SD, 9.96), showing a global improvement (P < .001). No statistically significant difference was found between drug allergic and non-drug allergic patients (P = .340); however, being >40 years old (P = .030), having a chronic osteoarticular disease (P = .003) and having more than 1 reaction to drugs (P < .001) were associated with a statistically significant worse quality of life after the evaluation. CONCLUSIONS: Having suffered anaphylaxis, more than 1 reported drug allergy or presenting a musculoskeletal disease are factors that worsen the quality of life. Quality of life improved significantly after completing a drug allergy evaluation.

Síndrome diencefálico en un niño con desnutrición crónica e hiperactividad / Diencephalic syndrome in a child with chronic malnutrition and hyperactivity

El síndrome diencefálico es una causa infrecuente de desnutrición. Se produce por la disfunción del hipotálamo y está asociado a tumores del encéfalo. Los pacientes presentan una grave y progresiva pérdida de peso, aunque el apetito y la ingesta calórica son, por lo general, adecuados. Característicamente, los síntomas neurológicos son tardíos, lo que retrasa la sospecha diagnóstica. Se presenta a un paciente de 2 años y 6 meses de edad con desnutrición crónica grado II, derivado con diagnóstico presuntivo de enfermedad celíaca con mala adherencia y fracaso del tratamiento. Durante la internación, se arribó al diagnóstico de síndrome diencefálico secundario a un astrocitoma pilocítico grado I.

Diencephalic syndrome is an infrequent cause of malnutrition. It is produced by a malfunctioning hypothalamus, and it is related to encephalic tumors. Patients present a serious and progressive weight loss although the appetite and calorie intake are, usually, adequate. Neurological symptoms typically have a late appearance, delaying diagnostic suspicion. We present a patient aged 2 years and a half with grade II chronic malnutrition, referred with presumptive diagnosis of celiac disease, with poor adherence and treatment failure. During hospitalization, diagnosis of diencephalic syndrome secondary to grade I pilocytic astrocytoma was reached.

[Diencephalic syndrome in a child with chronic malnutrition and hyperactivity]. / Síndrome diencefálico en un niño con desnutrición crónica e hiperactividad.

Diencephalic syndrome is an infrequent cause of malnutrition. It is produced by a malfunctioning hypothalamus, and it is related to encephalic tumors. Patients present a serious and progressive weight loss although the appetite and calorie intake are, usually, adequate. Neurological symptoms typically have a late appearance, delaying diagnostic suspicion. We present a patient aged 2 years and a half with grade II chronic malnutrition, referred with presumptive diagnosis of celiac disease, with poor adherence and treatment failure. During hospitalization, diagnosis of diencephalic syndrome secondary to grade I pilocytic astrocytoma was reached.

El síndrome diencefálico es una causa infrecuente de desnutrición. Se produce por la disfunción del hipotálamo y está asociado a tumores del encéfalo. Los pacientes presentan una grave y progresiva pérdida de peso, aunque el apetito y la ingesta calórica son, por lo general, adecuados. Característicamente, los síntomas neurológicos son tardíos, lo que retrasa la sospecha diagnóstica. Se presenta a un paciente de 2 años y 6 meses de edad con desnutrición crónica grado II, derivado con diagnóstico presuntivo de enfermedad celíaca con mala adherencia y fracaso del tratamiento. Durante la internación, se arribó al diagnóstico de síndrome diencefálico secundario a un astrocitoma pilocítico grado I.

A Rare Presentation of Neuromyelitis Optica Spectrum Disorders.

Neuromyelitis optica spectrum disorders (NMOSDs) are a set of demyelinating disorders that primarily target the optic nerves and the spinal cord. Previously thought to be a subset of multiple sclerosis (MS), now is recognized as a distinct entity. We present a 59-year-old female patient who was admitted for acute upper and lower extremity weakness. The patient had woken up from sleep with sudden onset of weakness. Patient was initially diagnosed with a right hemispheric stroke; however, magnetic resonance imaging of the cervical spine later performed showed abnormal enhancement from C2-C4, representing transverse myelitis. Cerebrospinal fluid was negative for organisms and inflammatory biomarkers. An anti-aquaporin-4 receptor antibody titer was found to be elevated with titers >80 units/mL. The patient was treated with high-dose steroids and plasmapheresis. The NMOSD is a rare entity and, here, we present a rare presentation of the disease. Since its description in 1870, it was confused with MS for years. The advent of anti-aquaporin-4 antibody has been instrumental in differentiating the disease process from MS. This distinction is important, in terms of agents used for treatment and prognostication. The NMOSD is a set of debilitating disease, which requires prompt recognition and appropriate treatment, to avoid the disabling sequelae. Future prospects of the disease include development of novel biological treatment modalities which focus on restoring the loss of immune tolerance which is key to the pathogenesis of the disease.

Specific allergen immunotherapy for the treatment of atopic eczema.

BACKGROUND: Specific allergen immunotherapy (SIT) is a treatment that may improve disease severity in people with atopic eczema (AE) by inducing immune tolerance to the relevant allergen. A high quality systematic review has not previously assessed the efficacy and safety of this treatment. OBJECTIVES: To assess the effects of specific allergen immunotherapy (SIT), including subcutaneous, sublingual, intradermal, and oral routes, compared with placebo or a standard treatment in people with atopic eczema. SEARCH METHODS: We searched the following databases up to July 2015: the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library (Issue 7, 2015), MEDLINE (from 1946), EMBASE (from 1974), LILACS (from 1982), Web of Science™ (from 2005), the Global Resource of EczemA Trials (GREAT database), and five trials databases. We searched abstracts from recent European and North American allergy meetings and checked the references of included studies and review articles for further references to relevant trials. SELECTION CRITERIA: Randomised controlled trials (RCTs) of specific allergen immunotherapy that used standardised allergen extracts in people with AE. DATA COLLECTION AND ANALYSIS: Two authors independently undertook study selection, data extraction (including adverse effects), assessment of risk of bias, and analyses. We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We identified 12 RCTs for inclusion in this review; the total number of participants was 733. The interventions included SIT in children and adults allergic to either house dust mite (10 trials), grass pollen, or other inhalant allergens (two trials). They were administered subcutaneously (six trials), sublingually (four trials), orally, or intradermally (two trials). Overall, the risk of bias was moderate, with high loss to follow up and lack of blinding as the main methodological concern.Our primary outcomes were 'Participant- or parent-reported global assessment of disease severity at the end of treatment'; 'Participant- or parent-reported specific symptoms of eczema, by subjective measures'; and 'Adverse events, such as acute episodes of asthma or anaphylaxis'. SCORing Atopic Dermatitis (SCORAD) is a means of measuring the effect of atopic dermatitis by area (A); intensity (B); and subjective measures (C), such as itch and sleeplessness, which we used.For 'Participant- or parent-reported global assessment of disease severity at the end of treatment', one trial (20 participants) found improvement in 7/9 participants (78%) treated with the SIT compared with 3/11 (27%) treated with the placebo (risk ratio (RR) 2.85, 95% confidence interval (CI) 1.02 to 7.96; P = 0.04). Another study (24 participants) found no difference: global disease severity improved in 8/13 participants (62%) treated with the SIT compared with 9/11 (81%) treated with the placebo (RR 0.75, 95% CI 0.45 to 1.26; P = 0.38). We did not perform meta-analysis because of high heterogeneity between these two studies. The quality of the evidence was low.For 'Participant- or parent-reported specific symptoms of eczema, by subjective measures', two trials (184 participants) did not find that the SIT improved SCORAD part C (mean difference (MD) -0.74, 95% CI -1.98 to 0.50) or sleep disturbance (MD -0.49, 95% CI -1.03 to 0.06) more than placebo. For SCORAD part C itch severity, these two trials (184 participants) did not find that the SIT improved itch (MD -0.24, 95% CI -1.00 to 0.52). One other non-blinded study (60 participants) found that the SIT reduced itch compared with no treatment (MD -4.20, 95% CI -3.69 to -4.71) and reduced the participants' overall symptoms (P < 0.01), but we could not pool these three studies due to high heterogeneity. The quality of the evidence was very low.Seven trials reported systemic adverse reactions: 18/282 participants (6.4%) treated with the SIT had a systemic reaction compared with 15/210 (7.1%) with no treatment (RR 0.78, 95% CI 0.41 to 1.49; the quality of the evidence was moderate). The same seven trials reported local adverse reactions: 90/280 participants (32.1%) treated with the SIT had a local reaction compared with 44/204 (21.6%) in the no treatment group (RR 1.27, 95% CI 0.89 to 1.81). As these had the same study limitations, we deemed the quality of the evidence to also be moderate.Of our secondary outcomes, there was a significant improvement in 'Investigator- or physician-rated global assessment of disease severity at the end of treatment' (six trials, 262 participants; RR 1.48, 95% CI 1.16 to 1.88). None of the studies reported our secondary outcome 'Parent- or participant-rated eczema severity assessed using a published scale', but two studies (n = 184), which have been mentioned above, used SCORAD part C, which we included as our primary outcome 'Participant- or parent-reported specific symptoms of eczema, by subjective measures'.Our findings were generally inconclusive because of the small number of studies. We were unable to determine by subgroup analyses a particular type of allergen or a particular age or level of disease severity where allergen immunotherapy was more successful. We were also unable to determine whether sublingual immunotherapy was associated with more local adverse reactions compared with subcutaneous immunotherapy. AUTHORS' CONCLUSIONS: Overall, the quality of the evidence was low. The low quality was mainly due to the differing results between studies, lack of blinding in some studies, and relatively few studies reporting participant-centred outcome measures. We found limited evidence that SIT may be an effective treatment for people with AE. The treatments used in these trials were not associated with an increased risk of local or systemic reactions. Future studies should use high quality allergen formulations with a proven track record in other allergic conditions and should include participant-reported outcome measures.

Antibiotic prophylaxis in elective cholecystectomy: Protocol adequacy and related outcomes in a retrospective single-centre analysis.

BACKGROUND: Antibiotic prophylaxis is an effective tool to reduce surgical infection rates. However, antibiotic prophylaxis in cholecystectomy is controversial when non-high risk patients are considered. This research aims to evaluate the adherence with antibiotic prophylaxis protocol in patients undergoing cholecystectomy, and its impact in the outcomes of surgical infection. METHODS: This single-center observational and retrospective study analyzed all elective cholecystectomy procedures carried out at the Fundación Alcorcón University Hospital in the period 2007-2014. Data were recovered from hospital records; rates of adherence to the available hospital protocols were evaluated for choice, initiation, duration, administration route and dosages of antibiotics, and the starting and duration of the prophylaxis. RESULTS: The overall adequacy rate to protocol was 72%. The adherence rates in both the administration route and dose were 100%. The most common violations of the protocol included the choice of antibiotic agent (19%), followed by the moment of initiating its administration (8.9%). The overall wound infection rate was lower in case of laparoscopy than in laparotomy cholecystectomy (1.4% vs. 4.3%, p < 0.05; odds rate [OR] 0.29, 95% confidence interval [CI] 0.1-0.6). No relationship between adequacy of antibiotic prophylaxis and surgical infection rate was documented, neither considering overall gallbladder surgeries (crude OR 0.26, 95% CI 0.1-2.0), nor laparoscopy vs. open surgery (MH adjusted OR 0.24, 95% CI 0.2-2.1). CONCLUSIONS: The overall adequacy rate to antibiotic prophylaxis protocol recommended for elective cholecystectomy in our hospital was high (72%). No significant association between the adequacy or antibiotic prophylaxis and surgical infection was found.

Chitosan microparticles loaded with yeast-derived PCV2 virus-like particles elicit antigen-specific cellular immune response in mice after oral administration.

BACKGROUND: Porcine circovirus type 2 (PCV2)-associated diseases are a major problem for the swine industry worldwide. In addition to improved management and husbandry practices, the availability of several anti-PCV2 vaccines provides an efficient immunological option for reducing the impact of these diseases. Most anti-PCV2 vaccines are marketed as injectable formulations. Although these are effective, there are problems associated with the use of injectable products, including laborious and time-consuming procedures, the induction of inflammatory responses at the injection site, and treatment-associated stress to the animals. Oral vaccines represent an improvement in antigen delivery technology; they overcome the problems associated with injection management and facilitate antigen boosting when an animals' immunity falls outside the protective window. METHODS: Chitosan microparticles were used as both a vehicle and mucosal adjuvant to deliver yeast-derived PCV2 virus-like particles (VLPs) in an attempt to develop an oral vaccine. The physical characteristics of the microparticles, including size, Zeta potential, and polydispersity, were examined along with the potential to induce PCV2-specific cellular immune responses in mice after oral delivery. RESULTS: Feeding mice with PCV2 VLP-loaded, positively-charged chitosan microparticles with an average size of 2.5 µm induced the proliferation of PCV2-specific splenic CD4+/CD8+ lymphocytes and the subsequent production of IFN-γ to levels comparable with those induced by an injectable commercial formulation. CONCLUSION: Chitosan microparticles appear to be a safe, simple system on which to base PCV2 oral vaccines. Oral chitosan-mediated antigen delivery is a novel strategy that efficiently induces anti-PCV2 cellular responses in a mouse model. Further studies in swine are warranted.

Gsk-3ß inhibitors mimic the cardioprotection mediated by ischemic pre- and postconditioning in hypertensive rats.

The aim of this study was to examine the effects of GSK-3 ß inhibitors compared with PRE and POS in spontaneously hypertensive rats (SHR). Isolated hearts were submitted to the following protocols: IC: 45 min global ischemia (GI) and 1-hour reperfusion (R); PRE: a cycle of 5 min GI and 10 minutes of R prior to 45 min GI; POS: three cycles of 30 sec GI/30 sec R at the start of R. Other hearts received lithium chloride (LiCl) or indirubin-3'-monoxime,5-iodo-(IMI) as GSK-3 ß inhibitors. All interventions reduced the infarct size observed in IC group. The expressions of P-GSK-3 ß and P-Akt decreased in IC and were restored after PRE, POS, and GSK-3 ß inhibitors treatments. An increase of cytosolic MnSOD activity and lipid peroxidation and a decrease of GSH content observed in IC hearts were attenuated in PRE, POS, and LiCl or IMI treatments. An increase of P-GSK-3 ß /VDAC physical association and a partial recovery of mitochondrial permeability were also detected after interventions. These data show that, in SHR hearts, GSK-3 ß inhibitors mimic the cardioprotection afforded by PRE and POS and suggest that a decrease in mitochondrial permeability mediated by P-GSK-3 ß /VDAC interaction is a crucial event.