Exploring new perspectives in immunology.

Several conceptual pillars form the foundation of modern immunology, including the clonal selection theory, antigen receptor diversity, immune memory, and innate control of adaptive immunity. However, some immunological phenomena cannot be explained by the current framework. Thus, we still do not know how to design vaccines that would provide long-lasting protective immunity against certain pathogens, why autoimmune responses target some antigens and not others, or why the immune response to infection sometimes does more harm than good. Understanding some of these mysteries may require that we question existing assumptions to develop and test alternative explanations. Immunology is increasingly at a point when, once again, exploring new perspectives becomes a necessity.

The Emerging Field of Cardioimmunology: Past, Present and Foreseeable Future.

Over the past 30 years, the field of cardioimmunology has moved from being dismissed as a field that was chasing an epiphenomenon of little biological consequence to a scientific discipline that is providing important new insights into the immunologic basis for hypertension, atherosclerosis, myocarditis, pericarditis, autoimmune heart disease, and heart failure. In this article, we will review the conceptual insights and technical breakthroughs that have allowed the field to move forward, as well as the clinical trials in the cardioimmunology space, to provide a historical context for the articles that will appear in the compendium that is focused on the interface between cardioimmunology, myocardial function, and disease.

[Rheumatological care in Germany : Memorandum of the German Society for Rheumatology and Clinical Immunology 2024]. / Rheumatologische Versorgung in Deutschland : Memorandum der Deutschen Gesellschaft für Rheumatologie und Klinische Immunologie 2024.

BACKGROUND: Rheumatology in Germany is facing major challenges. The need for rheumatological care is increasing and can no longer be met in some regions for capacity reasons. Too many people with an inflammatory rheumatic disease (IRD) have to forego appropriate care or receive it too late. The 4th new edition of the memorandum of the German Society for Rheumatology and Clinical Immunology (DGRh) provides information on rheumatological care in Germany. It was produced under the leadership of the DGRh together with the Professional Association of German Rheumatologists (BDRh), the Association of Acute Rheumatology Clinics (VRA), the German Rheumatism League (DRL) and the German Rheumatism Research Center (DRFZ). METHODS: The memorandum describes the current state and development of the following areas: number of people with IRD, outpatient, inpatient and rehabilitative care structures, number of specialists in rheumatology, education and training, quality of care, health economic aspects and digital care concepts. Proposals for health policy measures to safeguard rheumatological care are presented. RESULTS: Prevalence: approximately 1.8 million adults in Germany have an IRD. The prevalence is increasing, due to changes in the demographic structure of the population, improved diagnostics, treatment and longer survival. Care structures: outpatient specialist care (ASV) for rheumatic diseases is developing as a cross-sectoral care model for hospital outpatient clinics and rheumatology practices. Hospitals have been able to be certified as rheumatology centers since 2020, which enables structural developments. Specialists in rheumatology: as of 31 December 2023, there were 1164 specialists in rheumatology working in Germany. This included 715 physicians accredited to work in practices for national health assurance patients, 39% of whom were employees. In hospitals, 39% of doctors worked part-time. At least 2 rheumatology specialists per 100,000 adults are needed, i.e. around 1400, in order to provide adequate care. This means that there is a shortage of around 700 rheumatology specialists in the outpatient sector alone. Of all working specialists, 30% are currently aged 60 years old and over. Medical training: only 10 out of 38 (26%) state universities have an independent chair in rheumatology. In addition, 11 rheumatology departments are subordinate to a nonrheumatology chair. In the rheumatology-integration into student training (RISA) III study, only 16 out of 36 faculties fulfilled the recommended minimum number of compulsory hours of student rheumatology teaching. Continuing education in rheumatology: the annual postgraduate training qualifications do not cover the demand for rheumatology specialists, which is additionally increasing due to intensified workload, reduced capacities through retirement, and part-time work. Quality of care: since the introduction of highly effective medication patients with IRD have a much better chance of achieving remission of their disease. With early initiation of targeted therapy, the lives of many patients are hardly restricted at all: however, waiting times for a first rheumatological visit often last more than 3 months. Quality target is a first consultation within the first 6 weeks after the onset of symptoms. Models for early consultation, delegation of medical services, structured patient training and digital care concepts have been positively evaluated but are not covered financially. COSTS: the total annual costs for inflammatory joint diseases alone amount to around 3 billion euros. The direct costs have significantly risen since the introduction of biologics, while the indirect costs for sick leave, disability and hospitalization have fallen. CONCLUSION: The core demands of this memorandum are a significant and sustainable increase in the number of further training positions in the outpatient and inpatient sector, the creation of chairs or at least independent departments for rheumatology at all universities and the further implementation of new and cross-sectoral forms of care. This will ensure modern needs-based rheumatological care for all patients in the future.

The perspective of allergy and immunology specialists on the innovations of metaverse: A survey study

Background: New technologies have resulted in dramatic shifts in the field of medicine, and it stands to reason that metaverse will also affect the practice of allergy and immunology. This study aimed to determine the attitudes of allergists and raise awareness about metaverse applications in allergy and immunology.Methods: A nationwide survey-based study was conducted in Turkey. First, a 28-item questionnaire was developed and sent to Turkish allergists. After completing the first questionnaire, the participants were asked to watch a 5-min informative video about the metaverse. Lastly, a second survey was conducted to evaluate the changes in the views of the participants.Results: A total of 148 allergy doctors in Turkey participated in the survey. After watching a video containing updated information about the metaverse, there was a significant increase in the importance that participants attributed to the use of virtual reality and augmented reality applications in the field of immunology and allergy (P < 0.05). Additionally, there was a significant increase in the percentage of participants who thought that Metaverse applications could be integrated into the existing system and said that this possibility excited them (P < 0.05). There was also a significant increase in the percentage of participants who thought this innovative technology could be helpful in patient examination, student and physician education, allergy testing, and patient education (P < 0.05).Conclusions: Our results demonstrate that providing information to professionals working in the field can positively influence physicians’ views on the potential of the metaverse, which is a valuable tool in the field of immunology and allergy. (AU)

El sistema inmune de los insectos: algo más complejo que simples barreras / The insect immune system: something more complex than simple barriers

En los últimos años se ha producido un aumento de toma de conciencia sobre la importancia económica y social de los insectos. Aunque algunos pueden ser perjudiciales ocasionando problemas desalud púbica o pérdidas económicas relacionadas con las plagas en cultivos, muchos son esencialesen procesos como la polinización, además de tener aplicaciones como la producción de biomasa o suuso como agentes de control biológico. Todos estos factores han contribuido a que se produzca unaumento del número de estudios relacionados con el sistema inmune de los insectos, lo cual ha ayudado a conocer el funcionamiento de estos animales. Se han observado similitudes con el sistema inmune de los mamíferos, además de descubrir la denominada sensibilización del sistema inmune (máscomúnmente conocida por su terminología inglesa “immune priming”), lo que ha provocado que serompa con la asunción de simplicidad que tradicionalmente se les ha asociado. Todo esto ha permitidola optimización de muchas aplicaciones importantes. (AU)

SEAIC Specialty Forum: Analysis of the Current Situation of Allergology in Spain and Outlook for the Future

Background: Allergology has been a recognized medical specialty in Spain, with fully defined aims and competencies for more than 4 decades. However, in recent years, its visibility seems to have decreased somewhat. Objectives: To identify which specific factors have contributed to the waning of the importance of the specialty and find tangible solutions to consolidate its place as a front-line medical specialty. Material and methods: An online population survey comprising 60 items of interest was prepared. The degree of agreement and the level of satisfaction with each item were assessed, and implementable initiatives in the short, medium, and long terms were defined in order to provide solutions to the issues identified. Results: The survey was completed by a total of 167 specialists with an average of 18 years’ experience. Most were from public reference hospitals, and 29.3% were heads of department. The line of action for which a good degree of agreement was achieved was to promote the inclusion of an allergist in multidisciplinary teams. The priority lines of action were to improve undergraduate and graduate training in allergology and specialized nursing, to identify curricula in Spain, and to develop robust teaching projects. Conclusions: The results revealed a high degree of homogeneity between professionals. The basic pillars highlighted were as follows: quality training, knowledge, and research in immunotherapy; an innovative portfolio of services endorsed by clinical practice guidelines; and presence in multidisciplinary teams and relevant hospital committees. (AU)

Antecedentes: En nuestro país, la alergología constituye una especialidad médica reconocida con fines y competencias completamente definidos desde hace más de cuatro décadas. Sin embargo, en los últimos tiempos parece hacer frente a una cierta disminución de su visibilidad y reconocimiento. Objetivos: Identificar qué factores específicos contribuyen a esta dilución de su peso específico y buscar soluciones tangibles que la afiancen como especialidad médica de primera línea. Material y métodos: Se elaboró una encuesta poblacional online compuesta por 60 ítems considerados de interés. Se valoró el grado de acuerdo y el nivel de satisfacción con cada uno, definiendo iniciativas implantables a corto, medio y largo plazo que aporten soluciones para las cuestiones identificadas. Resultados: La encuesta fue respondida por un total de 167 especialistas con una media de 18 años de experiencia, la mayoría procedentes de hospitales de referencia públicos, siendo un 29,3% jefes del servicio. La línea de acción que obtuvo un mayor grado de acuerdo fue promover la presencia del alergólogo en los equipos multidisciplinares. Como línea de acción más prioritaria se seleccionó mejorar la formación de pregrado y posgrado en alergología, así como la de enfermería especializada, identificando planes de estudio en nuestro país y elaborando proyectos docentes robustos. Conclusiones: Los resultados revelaron un elevado grado de homogeneidad entre los profesionales, destacando como pilares básicos la formación de calidad, los conocimientos e investigación en inmunoterapia, una cartera de servicios novedosa avalada por Guías de Práctica Clínica y la presencia en equipos multidisciplinares y comisiones hospitalarias relevantes. (AU)

Celebramos la inmunología con motivo del DOI 2018 / No disponible

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Safety and Quality Recommendations in Allergy Medicine (Spanish acronym, RESCAL)

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Hevea brasiliensis rather than latex

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