Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.483
Filtrar
2.
Ital J Pediatr ; 46(1): 84, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32546234

RESUMO

The COVID-19 pandemic has surprised the entire population. The world has had to face an unprecedented pandemic. Only, Spanish flu had similar disastrous consequences. As a result, drastic measures (lockdown) have been adopted worldwide. Healthcare service has been overwhelmed by the extraordinary influx of patients, often requiring high intensity of care. Mortality has been associated with severe comorbidities, including chronic diseases. Patients with frailty were, therefore, the victim of the SARS-COV-2 infection. Allergy and asthma are the most prevalent chronic disorders in children and adolescents, so they need careful attention and, if necessary, an adaptation of their regular treatment plans. Fortunately, at present, young people are less suffering from COVID-19, both as incidence and severity. However, any age, including infancy, could be affected by the pandemic.Based on this background, the Italian Society of Pediatric Allergy and Immunology has felt it necessary to provide a Consensus Statement. This expert panel consensus document offers a rationale to help guide decision-making in the management of children and adolescents with allergic or immunologic diseases.


Assuntos
Alergia e Imunologia , Betacoronavirus , Consenso , Infecções por Coronavirus/terapia , Gerenciamento Clínico , Pandemias , Pneumonia Viral/terapia , Sociedades Médicas , Adolescente , Criança , Infecções por Coronavirus/epidemiologia , Tomada de Decisões , Humanos , Itália/epidemiologia , Pneumonia Viral/epidemiologia , Ensaios Clínicos Pragmáticos como Assunto/métodos
3.
Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi ; 36(4): 376-382, 2020 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-32519674

RESUMO

During the pandemic of coronavirus disease 2019 (COVID-19), the Chinese Ministry of Education put forward the requirement of turning offline education into online teaching to universities. Our department positively responded and rapidly mobilized to establish an online teaching system of medical immunology based on the small private online course (SPOC) model, which has a main body of the SPOC model with "video course as the main part, supplemented by online Q&A". The system also has feedback improvement sections of online discussion and chapter tests and evaluates the quality and effect of teaching with students' group display, course examination, and questionnaires. At the same time, the COVID-19 hotspot is also organically combined with immunological knowledge throughout the online teaching. In this process, our department continuously summarizes experiences and discovers problems. Herein, we generalize and sort out the exploration and practice of constructing the online teaching system, to carry out offline teaching after the pandemic and to continue this teaching model in the future, for reference and guidance.


Assuntos
Alergia e Imunologia , Infecções por Coronavirus , Coronavirus , Educação a Distância , Modelos Educacionais , Pandemias , Pneumonia Viral , Alergia e Imunologia/educação , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Internet , Pneumonia Viral/epidemiologia
4.
PLoS Comput Biol ; 16(5): e1007757, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32453790

RESUMO

T cell epitope candidates are commonly identified using computational prediction tools in order to enable applications such as vaccine design, cancer neoantigen identification, development of diagnostics and removal of unwanted immune responses against protein therapeutics. Most T cell epitope prediction tools are based on machine learning algorithms trained on MHC binding or naturally processed MHC ligand elution data. The ability of currently available tools to predict T cell epitopes has not been comprehensively evaluated. In this study, we used a recently published dataset that systematically defined T cell epitopes recognized in vaccinia virus (VACV) infected C57BL/6 mice (expressing H-2Db and H-2Kb), considering both peptides predicted to bind MHC or experimentally eluted from infected cells, making this the most comprehensive dataset of T cell epitopes mapped in a complex pathogen. We evaluated the performance of all currently publicly available computational T cell epitope prediction tools to identify these major epitopes from all peptides encoded in the VACV proteome. We found that all methods were able to improve epitope identification above random, with the best performance achieved by neural network-based predictions trained on both MHC binding and MHC ligand elution data (NetMHCPan-4.0 and MHCFlurry). Impressively, these methods were able to capture more than half of the major epitopes in the top N = 277 predictions within the N = 767,788 predictions made for distinct peptides of relevant lengths that can theoretically be encoded in the VACV proteome. These performance metrics provide guidance for immunologists as to which prediction methods to use, and what success rates are possible for epitope predictions when considering a highly controlled system of administered immunizations to inbred mice. In addition, this benchmark was implemented in an open and easy to reproduce format, providing developers with a framework for future comparisons against new tools.


Assuntos
Alergia e Imunologia/normas , Epitopos de Linfócito T/imunologia , Antígenos de Histocompatibilidade Classe I/química , Algoritmos , Alelos , Animais , Área Sob a Curva , Automação , Epitopos de Linfócito T/química , Sistema Imunitário , Ligantes , Aprendizado de Máquina , Camundongos , Camundongos Endogâmicos C57BL , Redes Neurais de Computação , Peptídeos/química , Ligação Proteica , Proteoma , Curva ROC , Vírus Vaccinia
5.
J Allergy Clin Immunol Pract ; 8(7): 2125-2134, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32450236

RESUMO

In early 2020, the first US and Canadian cases of the novel severe acute respiratory syndrome coronavirus 2 infection were detected. In the ensuing months, there has been rapid spread of the infection. In March 2020, in response to the virus, state/provincial and local governments instituted shelter-in-place orders, and nonessential ambulatory care was significantly curtailed, including allergy/immunology services. With rates of new infections and fatalities potentially reaching a plateau and/or declining, restrictions on provision of routine ambulatory care are lifting, and there is a need to help guide the allergy/immunology clinician on how to reinitiate services. Given the fact that coronavirus disease 2019 will circulate within our communities for months or longer, we present a flexible, algorithmic best-practices planning approach on how to prioritize services, in 4 stratified phases of reopening according to community risk level, as well as highlight key considerations for how to safely do so. The decisions on what services to offer and how fast to proceed are left to the discretion of the individual clinician and practice, operating in accordance with state and local ordinances with respect to the level of nonessential ambulatory care that can be provided. Clear communication with staff and patients before and after all changes should be incorporated into this new paradigm on continual change, given the movement may be forward and even backward through the phases because this is an evolving situation.


Assuntos
Alergia e Imunologia , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Humanos , Síndromes de Imunodeficiência/complicações , Telemedicina
6.
J Allergy Clin Immunol Pract ; 8(5): 1477-1488.e5, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32224232

RESUMO

In the event of a global infectious pandemic, drastic measures may be needed that limit or require adjustment of ambulatory allergy services. However, no rationale for how to prioritize service shut down and patient care exists. A consensus-based ad-hoc expert panel of allergy/immunology specialists from the United States and Canada developed a service and patient prioritization schematic to temporarily triage allergy/immunology services. Recommendations and feedback were developed iteratively, using an adapted modified Delphi methodology to achieve consensus. During the ongoing pandemic while social distancing is being encouraged, most allergy/immunology care could be postponed/delayed or handled through virtual care. With the exception of many patients with primary immunodeficiency, patients on venom immunotherapy, and patients with asthma of a certain severity, there is limited need for face-to-face visits under such conditions. These suggestions are intended to help provide a logical approach to quickly adjust service to mitigate risk to both medical staff and patients. Importantly, individual community circumstances may be unique and require contextual consideration. The decision to enact any of these measures rests with the judgment of each clinician and individual health care system. Pandemics are unanticipated, and enforced social distancing/quarantining is highly unusual. This expert panel consensus document offers a prioritization rational to help guide decision making when such situations arise and an allergist/immunologist is forced to reduce services or makes the decision on his or her own to do so.


Assuntos
Alergia e Imunologia , Instituições de Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Humanos , Telemedicina
7.
Ann Allergy Asthma Immunol ; 124(5): 424-440.e17, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32336463

RESUMO

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus. Many new studies have been reported recently that describe EoE management. An expert panel was convened by the American Gastroenterological Association Institute and the Joint Task Force on Allergy-Immunology Practice Parameters to provide a technical review to be used as the basis for an updated clinical guideline. This technical review was developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Eighteen focused EoE management questions were considered, with 15 answered using the GRADE framework and 3 with a narrative summary. There is moderate certainty in the evidence that topical glucocorticosteroids effectively reduce esophageal eosinophil counts to <15 per high-power field over a short-term treatment period of 4-12 weeks, but very low certainty about the effects of using topical glucocorticosteroids as maintenance therapy. Multiple dietary strategies may be effective in reducing esophageal eosinophil counts to <15 per high-power field over a short-term treatment period, with moderate certainty for elemental diets, low certainty for empiric 2-, 4-, and 6-food elimination diets, and very low certainty that allergy-based testing dietary eliminations have a higher failure rate compared to empiric diet elimination. There is very low certainty for the effect of proton pump inhibitors in patients with esophageal eosinophilia. Although esophageal dilation appears to be relatively safe, there is no evidence that it reduces esophageal eosinophil counts. There is very low certainty in the effects of multiple other medical treatments for EoE: anti-interleukin-5 therapy, anti-interleukin-13 therapy, anti-IgE therapy, montelukast, cromolyn, and anti-TNF therapy.


Assuntos
Dieta , Esofagite Eosinofílica/terapia , Glucocorticoides/uso terapêutico , Imunoterapia/métodos , Comitês Consultivos , Alérgenos/imunologia , Alergia e Imunologia , Esofagite Eosinofílica/epidemiologia , Prova Pericial , Humanos , Comunicação Interdisciplinar , Guias de Prática Clínica como Assunto , Inibidores da Bomba de Prótons/uso terapêutico
8.
J Allergy Clin Immunol Pract ; 8(6): 1781-1790.e3, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32259628

RESUMO

The global spread of coronavirus disease 2019 (COVID-19) has caused sudden and dramatic societal changes. The allergy/immunology community has quickly responded by mobilizing practice adjustments and embracing new paradigms of care to protect patients and staff from severe acute respiratory syndrome coronavirus 2 exposure. Social distancing is key to slowing contagion but adds to complexity of care and increases isolation and anxiety. Uncertainty exists across a new COVID-19 reality, and clinician well-being may be an underappreciated priority. Wellness incorporates mental, physical, and spiritual health to protect against burnout, which impairs both coping and caregiving abilities. Understanding the stressors that COVID-19 is placing on clinicians can assist in recognizing what is needed to return to a point of wellness. Clinicians can leverage easily accessible tools, including the Strength-Focused and Meaning-Oriented Approach to Resilience and Transformation approach, wellness apps, mindfulness, and gratitude. Realizing early warning signs of anxiety, depression, substance abuse, and posttraumatic stress disorder is important to access safe and confidential resources. Implementing wellness strategies can improve flexibility, resilience, and outlook. Historical parallels demonstrate that perseverance is as inevitable as pandemics and that we need not navigate this unprecedented time alone.


Assuntos
Alergia e Imunologia , Esgotamento Profissional/psicologia , Infecções por Coronavirus/psicologia , Saúde Mental , Médicos/psicologia , Pneumonia Viral/psicologia , Adaptação Psicológica , Assistência Ambulatorial , Ansiedade/psicologia , Comunicação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Assistência à Saúde , Depressão/psicologia , Eficiência , Pesar , Culpa , Alocação de Recursos para a Atenção à Saúde , Promoção da Saúde , Nível de Saúde , Humanos , Atenção Plena , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Profissionalismo , Comportamento Social , Mídias Sociais , Espiritualidade , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Suicídio
9.
Xi Bao Yu Fen Zi Mian Yi Xue Za Zhi ; 36(1): 86-94, 2020 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-32314728

RESUMO

Objective The comprehensive test is adaptable to medical integration education and is an effective way to evaluate students' performance and assess the effects of teaching reform. Given the special characteristics of the comprehensive test, this paper is designed to apply item response theory to immunology test question analysis in the comprehensive test of basic medicine, illustrating the method of applying the theory to the medical test evaluation and elaborating its role and significance in quality control of medical comprehensive test. Methods The software e-irt and SPSS were used to analyze 180 immunology test questions from the comprehensive test of basic medicine for six years. All parameters were calculated and then equated to produce characteristic curve and information function curve. Results The immunology test questions from the comprehensive test of basic medicine was of high reliability, but of lower difficulty value and discrimination value than the overall level of the comprehensive test paper. The test parameters and examinees' ability showed significant differences among the six years. The quality of certain immunology test questions did not meet the ideal standard, which is required to be analyzed. Conclusion Medical integration education facilitates the process of our students acquiring immunology knowledge. The item response theory can be effectively applied to comparing the papers, questions and examinees' abilities among the years on the same scale, thus presenting the existing problems in terms of question quality, teaching process and examines' abilities, improving the quality of test questions, and facilitating the establishment of a standardized examination database.


Assuntos
Alergia e Imunologia/educação , Educação Médica , Avaliação Educacional/normas , Humanos , Reprodutibilidade dos Testes
12.
Allergy Asthma Proc ; 41(2): 76-81, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32122443

RESUMO

Telemedicine (TM) involves the use of technology to overcome the patient care barriers of distance and time. Asynchronous TM can be used to monitor patients remotely and for providers and patients to communicate with each other without needing to be online at the same time. Synchronous TM can include direct-to-consumer visits in which patients use their own equipment to communicate with a provider or facilitated visits in which a patient travels to a clinic to use the clinic's equipment with a facilitator. The advantage of the latter is that a physical examination can be performed. Although some patients and providers may prefer in-person visits, patients who are seen by TM report satisfaction that it is as good as or better than that of an in-person visit. TM can be used in the outpatient setting, in the hospital to perform consults, or in the school. The convenience of TM makes it likely that more patients will adopt TM as their preferred mode of obtaining health care. It is important for allergists to become familiar with this new technology because patients will demand it.


Assuntos
Hipersensibilidade/diagnóstico , Consulta Remota/métodos , Telemedicina/métodos , Alergistas , Alergia e Imunologia , Humanos , Monitorização Fisiológica , Satisfação do Paciente
13.
Ann Otol Rhinol Laryngol ; 129(7): 699-706, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32059621

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the sinonasal mucosa and with strong associations to other immune-mediated comorbidities. Patients often require referral to both an otolaryngologist and an allergist/immunologist. This study is the first in the literature to describe a multidisciplinary clinic that offers patient care by subspecialists in rhinology and in allergy/immunology. METHODS: One hundred twenty-nine patients were seen in the Comprehensive Sinus and Allergy Clinic (CSAC) between January 2016 and June 2017 and 43 selected patients were seen in both the standalone allergy and rhinology clinics over the same time period. Patient satisfaction was retrospectively assessed using a modified Press-Ganey satisfaction survey. Time to evaluation and time to follow up appointment were compared between the CSAC and both the standalone rhinology and allergy/immunology clinics. RESULTS: Patients seen in the CSAC reported high satisfaction with the amount of time spent with the physicians (98.3%), quality of medical care (9.3 ± 1.0), and most importantly, the convenience of seeing two physicians in one day (9.5 ± 1.2). Time from referral placement to clinic evaluation (P ≤ .02) and time to follow up appointment (P ≤ .002) was significantly shorter for the CSAC than for the standalone Rhinology or Allergy clinics. CONCLUSION: Patients reported high satisfaction with the medical care provided and were also seen much faster in our multidisciplinary clinic as compared to standalone rhinology or allergy/immunology clinics. Overall, a multidisciplinary approach may be beneficial to patients presenting to tertiary referral centers with CRS and atopic conditions.


Assuntos
Alergia e Imunologia/organização & administração , Assistência Ambulatorial/organização & administração , Hipersensibilidade/diagnóstico , Otolaringologia/organização & administração , Otorrinolaringopatias/diagnóstico , Satisfação do Paciente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Asma Induzida por Aspirina/diagnóstico , Asma Induzida por Aspirina/terapia , Doença Crônica , Dessensibilização Imunológica , Eficiência Organizacional , Feminino , Humanos , Hipersensibilidade/terapia , Imunoterapia , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/diagnóstico , Pólipos Nasais/terapia , Procedimentos Cirúrgicos Nasais , Otorrinolaringopatias/terapia , Seios Paranasais/cirurgia , Equipe de Assistência ao Paciente , Qualidade da Assistência à Saúde , Encaminhamento e Consulta , Rinite/diagnóstico , Rinite/terapia , Rinite Alérgica/diagnóstico , Rinite Alérgica/terapia , Sinusite/diagnóstico , Sinusite/terapia , Adulto Jovem
15.
Neurology ; 94(11): 495-500, 2020 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-32107321

RESUMO

OBJECTIVE: To investigate the current status of postgraduate training in neuroimmunology and multiple sclerosis (NI/MS) in the United States. METHODS: We developed a questionnaire to collect information on fellowship training focus, duration of training, number of fellows, funding application process, rotations, visa sponsorship, and an open-ended question about challenges facing training in NI/MS. We identified target programs and sent the questionnaires electronically to fellowship program directors. RESULTS: We identified and sent the questionnaire to 69 NI/MS fellowship programs. We successfully obtained data from 64 programs. Most programs were small, matriculating 1-2 fellows per year, and incorporated both NI and MS training into the curriculum. Most programs were flexible in their duration, typically lasting 1-2 years, and offered opportunities for research during training. Only 56% reported the ability to sponsor nonimmigrant visas. Most institutions reported having some internal funding, although the availability of these funds varied from year to year. Several program directors identified funding availability and the current absence of national subspecialty certification as major challenges facing NI/MS training. CONCLUSION: Our study is the first to describe the current status of NI/MS training in the United States. We found many similarities across programs. We anticipate that these data will serve as a first step towards developing a standard NI/MS curriculum and help identify areas where shared resources could enhance trainee education despite differences in training environments. We identified funding availability, certification status, and nonimmigrant visa sponsorship as potential barriers to future growth in the field.


Assuntos
Alergia e Imunologia/educação , Educação de Pós-Graduação em Medicina , Bolsas de Estudo , Esclerose Múltipla , Neurologia/educação , Currículo , Humanos , Inquéritos e Questionários , Apoio ao Desenvolvimento de Recursos Humanos , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA