Systematic review and meta-analyses on the accuracy of diagnostic tests for IgE-mediated food allergy.

The European Academy of Allergy and Clinical Immunology (EAACI) is updating the Guidelines on Food Allergy Diagnosis. We aimed to undertake a systematic review of the literature with meta-analyses to assess the accuracy of diagnostic tests for IgE-mediated food allergy. We searched three databases (Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase (OVID)) for diagnostic test accuracy studies published between 1 October 2012 and 30 June 2021 according to a previously published protocol (CRD42021259186). We independently screened abstracts, extracted data from full texts and assessed risk of bias with QUADRAS 2 tool in duplicate. Meta-analyses were undertaken for food-test combinations for which three or more studies were available. A total of 149 studies comprising 24,489 patients met the inclusion criteria and they were generally heterogeneous. 60.4% of studies were in children ≤12 years of age, 54.3% were undertaken in Europe, ≥95% were conducted in a specialized paediatric or allergy clinical setting and all included oral food challenge in at least a percentage of enrolled patients, in 21.5% double-blind placebo-controlled food challenges. Skin prick test (SPT) with fresh cow's milk and raw egg had high sensitivity (90% and 94%) for milk and cooked egg allergies. Specific IgE (sIgE) to individual components had high specificity: Ara h 2-sIgE had 92%, Cor a 14-sIgE 95%, Ana o 3-sIgE 94%, casein-sIgE 93%, ovomucoid-sIgE 92/91% for the diagnosis of peanut, hazelnut, cashew, cow's milk and raw/cooked egg allergies, respectively. The basophil activation test (BAT) was highly specific for the diagnosis of peanut (90%) and sesame (93%) allergies. In conclusion, SPT and specific IgE to extracts had high sensitivity whereas specific IgE to components and BAT had high specificity to support the diagnosis of individual food allergies.

EAACI guidelines on the diagnosis of IgE-mediated food allergy.

This European Academy of Allergy and Clinical Immunology guideline provides recommendations for diagnosing IgE-mediated food allergy and was developed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Food allergy diagnosis starts with an allergy-focused clinical history followed by tests to determine IgE sensitization, such as serum allergen-specific IgE (sIgE) and skin prick test (SPT), and the basophil activation test (BAT), if available. Evidence for IgE sensitization should be sought for any suspected foods. The diagnosis of allergy to some foods, such as peanut and cashew nut, is well supported by SPT and serum sIgE, whereas there are less data and the performance of these tests is poorer for other foods, such as wheat and soya. The measurement of sIgE to allergen components such as Ara h 2 from peanut, Cor a 14 from hazelnut and Ana o 3 from cashew can be useful to further support the diagnosis, especially in pollen-sensitized individuals. BAT to peanut and sesame can be used additionally. The reference standard for food allergy diagnosis is the oral food challenge (OFC). OFC should be performed in equivocal cases. For practical reasons, open challenges are suitable in most cases. Reassessment of food allergic children with allergy tests and/or OFCs periodically over time will enable reintroduction of food into the diet in the case of spontaneous acquisition of oral tolerance.

Meropenem allergy testing performed at the bedside of hospitalized patients labelled with a penicillin allergy.

BACKGROUND: Meropenem is a widely prescribed beta-lactam for hospitalized patients. There are few data on meropenem allergy assessments in inpatients with a reported history of penicillin allergy who require a treatment with meropenem. This can lead to the use of less effective second-line antibiotics that may increase antibiotic resistances. We aimed to evaluate the clinical outcomes of a meropenem allergy assessment in admitted patients with a reported history of penicillin allergy that required meropenem for the treatment of an acute infection. METHODS: A retrospective analysis was performed on 182 inpatients labelled with a penicillin-allergy who received meropenem after an allergy assessment. The allergy study was performed bedside if meropenem was required urgently. The study included skin prick tests (SPTs) followed by an intradermal skin test (IDT) to meropenem, and a meropenem drug challenge test (DCT). If a non-immediate reaction to a beta-lactam was suspected, it was initiated with patch tests. RESULTS: The median age of the patients was 59.7 years (range 28-95) and 80 (44%) were women. A total of 196 sets of diagnostic workups were performed, with 189 (96.4%) of them being tolerated. Only two patients had a positive meropenem IV DCT, both presenting a non-severe cutaneous reaction that completely resolved after treatment. CONCLUSIONS: This study evidenced that a bedside meropenem allergy assessment of hospitalized patients labelled with a 'penicillin allergy' who require a broad-spectrum antibiotic for empiric coverage is a safe and effective procedure, avoiding the use of second-line antimicrobial agents.

Physics Perception in Sloshing Scenes With Guaranteed Thermodynamic Consistency.

Physics perception very often faces the problem that only limited data or partial measurements on the scene are available. In this work, we propose a strategy to learn the full state of sloshing liquids from measurements of the free surface. Our approach is based on recurrent neural networks (RNN) that project the limited information available to a reduced-order manifold to not only reconstruct the unknown information but also be capable of performing fluid reasoning about future scenarios in real-time. To obtain physically consistent predictions, we train deep neural networks on the reduced-order manifold that, through the employ of inductive biases, ensure the fulfillment of the principles of thermodynamics. RNNs learn from history the required hidden information to correlate the limited information with the latent space where the simulation occurs. Finally, a decoder returns data to the high-dimensional manifold, to provide the user with insightful information in the form of augmented reality. This algorithm is connected to a computer vision system to test the performance of the proposed methodology with real information, resulting in a system capable of understanding and predicting future states of the observed fluid in real-time.

The importance of prevention programs to reduce bullying: A comparative study.

Bullying is a growing and increasingly worrying phenomenon. In recent years, a number of different bullying prevention programs have been implemented to create a more positive school environment. This paper offers a description of these prevention programs, focussing on the three most commonly implemented in schools: TEI, KiVa and Mediation Teams. A qualitative, descriptive and comparative analysis was made using semi-structured interviews with tutors, coordinators and experts at nine schools, three schools for each of the programs. The results show that these bullying prevention programs help raise awareness of this problem within the entire school community, improving the school environment and reducing conflict and instances of bullying. Overall, participating schools reported being highly satisfied with the results of these programs and it is therefore important to consider the mandatory implementation of bullying prevention programs in all schools.

Replacement of Palm Oil with Soybean Acid Oil in Broiler Chicken Diet: Fat Digestibility and Lipid Class Content along the Intestinal Tract.

This study aimed to evaluate the replacement of palm oil (P) with increasing levels of soybean acid oil (SA), a by-product of soybean oil (S) refining, on lipid class content and fatty acid (FA) digestibility in the intestine and excreta of chickens at 11 and 35 days (d). Five experimental diets were obtained by supplementing a basal diet with 6% of P (P6), 6% of SA (SA6), 4% of P + 2% SA (P4-SA2), 2% of P + 4% of SA (P2-SA4) and 6% of S (S6). A total of 480 one-d-old female broiler chickens (Ross 308) were housed in metabolic cages (6 cages/treatment, with 16 birds/cage). Replacing P with SA improved fat absorption at 11 and 35 d (p < 0.05), but not feed AME values and saturated FA (SFA) digestibility at 11 d. As age increased, the absorption of SFA and free fatty acids (FFA) improved, and the contribution of the upper ileum to FA absorption increased (p < 0.05). At 35 d, SA6 (56% FFA) and P2-SA4 (40% FFA, 2.6 unsaturated-to-saturated FA ratio) could replace S6 without impairing fat utilization. The replacement of P with SA represents a suitable strategy to use this by-product.

Soybean Oil Replacement by Palm Fatty Acid Distillate in Broiler Chicken Diets: Fat Digestibility and Lipid-Class Content along the Intestinal Tract.

Palm fatty acid distillate (PFAD) is a by-product of palm oil (P) refining. Its use in chicken diets is a way to reduce the cost of feed and the environmental impact. Its low unsaturated:saturated fatty acid ratio (UFA:SFA) and its high free fatty acid (FFA) level could be partially counteracted by its blending with soybean oil (S). The objective was to assess the effect of replacing S with different levels of PFAD on lipid-class content and fatty acid (FA) digestibility along the intestinal tract and in the excreta of 11 and 35-day-old broiler chickens. Five experimental diets were prepared by supplementing a basal diet with S (S6), PFAD (PA6), two blends of them (S4-PA2 and S2-PA4), or P (P6) at 6%. Replacing S with PFAD did not affect performance parameters (p > 0.05) but negatively affected feed AME, FA digestibility, and FFA intestinal content (p < 0.05), especially in starter chicks. Including PFAD delayed total FA (TFA) absorption (p < 0.05) at 11 days, but at 35 days it did not affect the TFA absorption rate. The use of PFAD blended with S, when FFA ≤ 30% and UFA:SFA ≥ 2.6, led to adequate energy utilization in broiler grower-finisher diets.

A compendium answering 150 questions on COVID-19 and SARS-CoV-2.

In December 2019, China reported the first cases of the coronavirus disease 2019 (COVID-19). This disease, caused by the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), has developed into a pandemic. To date, it has resulted in ~9 million confirmed cases and caused almost 500 000 related deaths worldwide. Unequivocally, the COVID-19 pandemic is the gravest health and socioeconomic crisis of our time. In this context, numerous questions have emerged in demand of basic scientific information and evidence-based medical advice on SARS-CoV-2 and COVID-19. Although the majority of the patients show a very mild, self-limiting viral respiratory disease, many clinical manifestations in severe patients are unique to COVID-19, such as severe lymphopenia and eosinopenia, extensive pneumonia, a "cytokine storm" leading to acute respiratory distress syndrome, endothelitis, thromboembolic complications, and multiorgan failure. The epidemiologic features of COVID-19 are distinctive and have changed throughout the pandemic. Vaccine and drug development studies and clinical trials are rapidly growing at an unprecedented speed. However, basic and clinical research on COVID-19-related topics should be based on more coordinated high-quality studies. This paper answers pressing questions, formulated by young clinicians and scientists, on SARS-CoV-2, COVID-19, and allergy, focusing on the following topics: virology, immunology, diagnosis, management of patients with allergic disease and asthma, treatment, clinical trials, drug discovery, vaccine development, and epidemiology. A total of 150 questions were answered by experts in the field providing a comprehensive and practical overview of COVID-19 and allergic disease.

Physically sound, self-learning digital twins for sloshing fluids.

In this paper, a novel self-learning digital twin strategy is developed for fluid sloshing phenomena. This class of problems is of utmost importance for robotic manipulation of fluids, for instance, or, in general, in simulation-assisted decision making. The proposed method infers the (linear or non-linear) constitutive behavior of the fluid from video sequences of the sloshing phenomena. Real-time prediction of the fluid response is obtained from a reduced order model (ROM) constructed by means of thermodynamics-informed data-driven learning. From these data, we aim to predict the future response of a twin fluid reacting to the movement of the real container. The constructed system is able to perform accurate forecasts of its future reactions to the movements of the containers. The system is completed with augmented reality techniques, so as to enable comparisons among the predicted result with the actual response of the same liquid and to provide the user with insightful information about the physics taking place.

[Rib cage ostheosynthesis. Literature review and case reports]. / Osteosintesis de reja costal. Revisión de la bibliografía y reporte de casos.

BACKGROUND: Fractures of the chest wall include sternum and rib fractures. Traditionally they are managed conservatively due to the anatomy of the rib cage that allows most of them to remain stable and to form a callus that unites the fractured segments. In spite of this management, some patients present with chronic pain or instability of the wall which makes them require some type of fixation. The present article performs a literature review based on 4 cases. CLINICAL CASES: The first case was a 61 year-old man with blunt chest trauma, with a great deformity of the chest wall associated with subcutaneous emphysema, and pneumothorax. The second case was a 51 year-old man with blunt chest trauma, initially managed at another institution, who despite treatment, had persistent pain and dyspnoea. The third case was a 30 year-old man that suffered a motor vehicle accident, with resulting pain and crepitation of the rib cage and with diagnostic images showing multiple rib fractures. The last case is a 62 year-old man that fell down the stairs, with blunt chest trauma with high intensity pain, dyspnoea and basal ipsilateral hypoventilation. CONCLUSION: Rib fracture fixation offers a good alternative in selected patients to decrease associated morbidity, leading to a patient's fast return to his or her working life.

Evaluation of a heredofamilial cancer unit in increasing family history collection and genetic counseling referrals among Spanish oncologists at a university hospital.

A comprehensive family history is essential to identify patients at risk for hereditary cancer who could benefit from genetic counseling (GC). In a previous study, we observed a low occurrence of family history record (FHR) collection rate and GC referral among oncologists at our institution. The present work analyzes whether the implementation of a heredofamilial cancer unit (HFCU) would improve these parameters. We retrospectively compared the FHR rate in clinical records, National Cancer Institute (NCI) general criteria for hereditary cancer suspicion, GC referrals and FHR quality in two cohorts: cohort 1 (patients diagnosed before HFCU creation) and cohort 2 (after HFCU creation). Of 1,175 patients (590 cohort 1 and 585 cohort 2), FHRs were consigned in 27.3 % and 52.5 % of patients, respectively (p < 0.001). The GC referral of patients with any NCI criterion was 13.6 % xin cohort 1 vs. 40.5 % in cohort 2 (p < 0.001). FHR quality improved in terms of the total number of relatives (164 vs. 314, p = 0.1, N.S.) and number of healthy relatives consigned (80 vs. 191, p < 0.01). Nine mutations (6 BRCA, 1 MEN1, 2 Lynch), 4 unknown significance variants (all in BRCA) and 2 with no mutation were identified among patients referred from cohort 2. We conclude that the creation of a heredofamilial cancer unit has changed both FHR and GC referrals among oncologists at our institution, although continuous educational efforts are required.

La perseverancia emocional

La perseverancia en la atención y en el cuidado de los hijos es una cualidad necesaria que debe ser promovida y potenciada de manera permanente. La motivación para conseguirla es distinta en cada hijo. Es posible que, cuando se tiene un hijo con discapacidad, el factor emocional sea particularmente intenso. Es recomendable aprovecharlo en su mayor grado, y aplicarlo a cuantas tareas -más o menos fáciles- sea posible. Las tareas iniciadas como una forma de perseverancia terminan por transformarse en hábitos y aficiones que permanecen (AU)