Personalized Nutrition with Banked Human Milk for Early Gut Microbiota Development: In Pursuit of the Perfect Match.

The correct initial colonization and establishment of the gut microbiota during the early stages of life is a key step, with long-lasting consequences throughout the entire lifespan of the individual. This process is affected by several perinatal factors; among them, feeding mode is known to have a critical role. Breastfeeding is the optimal nutrition for neonates; however, it is not always possible, especially in cases of prematurity or early pathology. In such cases, most commonly babies are fed with infant formulas in spite of the official nutritional and health international organizations' recommendation on the use of donated human milk through milk banks for these cases. However, donated human milk still does not totally match maternal milk in terms of infant growth and gut microbiota development. The present review summarizes the practices of milk banks and hospitals regarding donated human milk, its safety and quality, and the health outcomes in infants fed with donated human milk. Additionally, we explore different alternatives to customize pasteurized donated human milk with the aim of finding the perfect match between each baby and banked milk for promoting the establishment of a beneficial gut microbiota from the early stages of life.

Old Folks, Bad Boon: Antimicrobial Resistance in the Infant Gut Microbiome.

The development of the intestinal microbiome in the neonate starts, mainly, at birth, when the infant receives its founding microbial inoculum from the mother. This microbiome contains genes conferring resistance to antibiotics since these are found in some of the microorganisms present in the intestine. Similarly to microbiota composition, the possession of antibiotic resistance genes is affected by different perinatal factors. Moreover, antibiotics are the most used drugs in early life, and the use of antibiotics in pediatrics covers a wide variety of possibilities and treatment options. The disruption in the early microbiota caused by antibiotics may be of great relevance, not just because it may limit colonization by beneficial microorganisms and increase that of potential pathogens, but also because it may increase the levels of antibiotic resistance genes. The increase in antibiotic-resistant microorganisms is one of the major public health threats that humanity has to face and, therefore, understanding the factors that determine the development of the resistome in early life is of relevance. Recent advancements in sequencing technologies have enabled the study of the microbiota and the resistome at unprecedent levels. These aspects are discussed in this review as well as some potential interventions aimed at reducing the possession of resistance genes.

Obesogenic Behaviors of Rural Children on School and Nonschool Days.

Background: Children living in rural areas are at increased risk of overweight and obesity compared with their urban-dwelling counterparts. The purpose of this study was to provide preliminary evidence of rural children's obesogenic behaviors (e.g., activity, sedentary behaviors, sleep, and diet) during school days, nonschool weekdays, and weekend days. Methods: A repeated measures 14-day observational study was conducted early March 2020. Children (n = 54, 92% 6-11 years old; 66% female; 98% non-Hispanic white; 22% overweight or obese) wore accelerometers on the nondominant wrist for 24 hours/day for 14 consecutive days to capture moderate-to-vigorous physical activity (MVPA), sedentary time, and sleep. Parents completed diaries to report daily activities, diet, and screen time of their child each day. Mixed effect models compared behaviors between school days, nonschool weekdays, and weekend days. Results: Children accumulated +16 additional minutes/day of MVPA (95% confidence interval, CI: +10 to +23 minutes/day), reduced sedentary time (-68 minutes/day, 95% CI: -84 to -51 minutes/day), and reduced screen time (-99 minutes/day; 95% CI: -117 to -81 minutes/day) on school days vs. nonschool weekdays. Similar patterns were observed on school weekdays days vs. weekend days, and on nonschool days when children attended a structured program vs. days they did not attend. Minimal differences were observed in reported consumption of food groups across different days. Conclusions: Preliminary evidence suggests rural children display multiple unfavorable obesogenic behaviors on days when they do not attend school or other structured programs. Future interventions targeting obesogenic behaviors of rural children may want to target times when rural children are not engaged in school and "school-like" environments.

Incorporando nuevas evidencias sobre medicamentos inhalados en la EPOC. Asociación Latinoamericana de Tórax (ALAT) 2019 / Incorporating New Evidence on Inhaled Medications in COPD. The Latin American Chest Association (ALAT) 2019

Este documento sobre EPOC de la Asociación Latinoamericana de Tórax (ALAT) 2019 analiza las nuevas evidencias de medicación inhalada utilizando la metodología de preguntas clínicas en formato PICO. Surgen de este análisis los siguientes puntos claves: 1) no hay evidencia que compare el uso de broncodilatadores de acción corta vs. larga en pacientes con EPOC leve; en aquellos con EPOC moderada-grave existe mayor beneficio de los broncodilatadores de acción larga, 2) beneficios similares de la monoterapia con antimuscarínicos de acción prolongada (LAMA) y la terapia combinada β2-agonistas de acción larga/corticosteroides inhalados (LABA/CIS), asociada esta última a mayor riesgo de neumonía, 3) mayores beneficios del LABA/LAMA en función pulmonar y riesgo de exacerbación vs. LABA/CIS (esta última con mayor riesgo de neumonía) y 4) mayores beneficios de la terapia LAMA/LABA/CIS comparada con LABA/LAMA sobre el riesgo de exacerbaciones moderadas-severas. En relación al rol de los eosinófilos para guiar el uso de los CIS: debe considerarse su retiro cuando la indicación inicial fue errada o sin respuesta, en pacientes con efectos secundarios como neumonía, y en aquellos con bajo riesgo de exacerbación con recuento de eosinófilos en sangre < 300 cél/μl. Incorporando estas evidencias según la gravedad de la obstrucción, síntomas y riesgo de exacerbaciones se genera un algoritmo para el uso de medicación inhalada en la EPOC

This document on COPD from the Latin American Chest Association (ALAT-2019) uses PICO methodology to analyze new evidence on inhaled medication and answer clinical questions. The following key points emerged from this analysis: 1) evidence is lacking on the comparison of short-acting vs. long-acting bronchodilators in patients with mild COPD; patients with moderate-to-severe COPD obtain greater benefit from long-acting bronchodilators; 2) the benefits of monotherapy with long-acting antimuscarinic agents (LAMA) and combined therapy with long-acting β2-agonists and inhaled corticosteroids (LABA/ICS) are similar, although the latter is associated with a greater risk of pneumonia; 3) LABA/LAMA offer greater benefits in terms of lung function and risk of exacerbation than LABA/ICS (the latter involve an increased risk of pneumonia), 4) LAMA/LABA/ICS have greater therapeutic benefits than LABA/LAMA on the risk of moderate-severe exacerbations. With regard to the role of eosinophils in guiding the use of ICS, ICS withdrawal must be considered when the initial indication was wrong or no response is elicited, in patients with side effects such as pneumonia, and in patients with a low risk of exacerbation and an eosinophil blood count of <300 cells/μl. All this evidence, categorized according to the severity of the obstruction, symptoms, and risk of exacerbations, has been used to generate an algorithm for the use of inhaled medication in COPD

Incorporating New Evidence on Inhaled Medications in COPD. The Latin American Chest Association (ALAT) 2019. / Incorporando nuevas evidencias sobre medicamentos inhalados en la EPOC. Asociación Latinoamericana de Tórax (ALAT) 2019.

This document on COPD from the Latin American Chest Association (ALAT-2019) uses PICO methodology to analyze new evidence on inhaled medication and answer clinical questions. The following key points emerged from this analysis: 1) evidence is lacking on the comparison of short-acting vs. long-acting bronchodilators in patients with mild COPD; patients with moderate-to-severe COPD obtain greater benefit from long-acting bronchodilators; 2) the benefits of monotherapy with long-acting antimuscarinic agents (LAMA) and combined therapy with long-acting ß2-agonists and inhaled corticosteroids (LABA/ICS) are similar, although the latter is associated with a greater risk of pneumonia; 3) LABA/LAMA offer greater benefits in terms of lung function and risk of exacerbation than LABA/ICS (the latter involve an increased risk of pneumonia), 4) LAMA/LABA/ICS have greater therapeutic benefits than LABA/LAMA on the risk of moderate-severe exacerbations. With regard to the role of eosinophils in guiding the use of ICS, ICS withdrawal must be considered when the initial indication was wrong or no response is elicited, in patients with side effects such as pneumonia, and in patients with a low risk of exacerbation and an eosinophil blood count of <300 cells/µl. All this evidence, categorized according to the severity of the obstruction, symptoms, and risk of exacerbations, has been used to generate an algorithm for the use of inhaled medication in COPD.

Clasificación de los pacientes con enfermedad pulmonar obstructiva crónica según los sistemas de estadificación de la Asociación Latinoamericana de Tórax (ALAT) y la iniciativa global para la enfermedad pulmonar obstructiva crónica (GOLD) / Classification of patients with chronic obstructive pulmonary disease according to the Latin American Thoracic Association (ALAT) staging systems and the global initiative for chronic obstructive pulmonary disease (GOLD)

Introducción. En los diferentes sistemas de clasificación de la EPOC se utilizan diversos criterios de estadificación. El objetivo de este estudio fue comparar la prevalencia y la distribución de los estadios de la EPOC con las recomendaciones de la iniciativa global para la enfermedad pulmonar obstructiva crónica (GOLD) y las orientaciones de la Asociación Latinoamericana de Tórax (ALAT) en una población de atención primaria. Métodos. Sujetos ≥ 40 años de edad, fumadores, exfumadores o expuestos a biomasa que acudieron a visitas rutinarias en centros de atención primaria cumplimentaron un cuestionario y se sometieron a una espirometría. Se definió EPOC si el cociente FEV1/FVC era < 0,70 tras la administración de un broncodilatador, y se calificó de acuerdo con los criterios GOLD-2013 y ALAT-2014. El valor pronóstico de los sistemas de estratificación se evaluó mediante el índice BODEx. Resultados. Cumplimentaron la entrevista 1.743 pacientes, de los cuales 1.540 obtuvieron espirometrías aceptables. Según los criterios GOLD-2013 la prevalencia de EPOC fue de un 20,1% y la distribución de estadios fue en forma de U (grupo A: 9,3%, B: 4,3%, C: 2,0% y D: 4,6%). Con los criterios de las orientaciones ALAT la prevalencia fue de un 19,7%, con una distribución de estadios en forma de campana (leve: 2,9%, moderada: 9%, grave: 5,4% y muy grave: 2,7%). Al utilizar las orientaciones de la ALAT, aproximadamente un 73% de los pacientes fue adjudicado a los estratos de EPOC moderada (45,4%) o grave (27,3%), mientras que con los criterios GOLD-2013 la mayoría (aproximadamente un 69%) se clasificó en los grupos A (46,3%) y B (22,7%). Con la estratificación ALAT las puntuaciones del índice BODEx aumentaron al empeorar la EPOC, lo que no se observó con los criterios GOLD-2013 (los valores de los grupos B y C fueron similares). Conclusiones. La distribución de pacientes en los estadios de la enfermedad difiere según se usen los criterios de la ALAT o GOLD-2013. Los criterios de la ALAT identificaron una mayor proporción de pacientes en las categorías moderada y grave de EPOC que los criterios GOLD-2013, con los cuales la mayoría de pacientes fueron adjudicados al grupo A. En futuras evaluaciones de la clasificación ALAT se debería analizar su capacidad predictiva de hospitalizaciones y mortalidad

Introduction. Several classification systems use different criteria when assessing COPD stages. The objective of this study was to compare the prevalence and distribution of COPD stagesusing Global initiative for chronic Obstructive Lung Disease (GOLD) recommendationsand Latin American Thoracic Association (ALAT) guidelinesin a primary-care population. Methods. Subjects attending routine primary care visits, ≥ 40 years of age, current or former smokers or exposed to biomass, completed a questionnaire and performed spirometry. COPD was defined as post-bronchodilator FEV1/FVC < 0.70 and categorised according to GOLD-2013 criteria and ALAT-2014 guideline. The BODEx index was used to assess the prognostic value of the stratification systems. Results. A total of 1743 subjects completed the interview, 1540 performed acceptable spirometry. COPD prevalence according GOLD-2013 was 20.1% and had a U-shaped stage distribution (group A: 9.3%, B: 4.3%, C: 2.0%, D: 4.6%). According to ALAT, prevalence was 19.7% with a bell-shaped stage distribution (mild: 2.9%, moderate: 9%, severe: 5.4%, very-severe: 2.7%). Approximately 73% of patients were stratified as moderate (45.4%) or severe (27.3%) by ALAT guidelines, whereas using GOLD-2013 criteria the majority of subjects (approximately 69%) were in group A (46.3%) or group B (22.7%). BODE index score increased as COPD worsened according to ALAT stratification. This is not observed with GOLD2013 criteria (similar values for B and C groups). Conclusions. Disease stages differ under ALAT and GOLD-2013 criteria. ALAT identified a greater proportion of COPD subjects in the moderate and severe categories compared with GOLD-2013, where the majority were categorised in group A. Future evaluation of the ALAT classification should address its predictive ability in terms of hospitalizations and mortality

Classification of patients with chronic obstructive pulmonary disease according to the Latin American Thoracic Association (ALAT) staging systems and the global initiative for chronic obstructive pulmonary disease (GOLD). / Clasificación de los pacientes con enfermedad pulmonar obstructiva crónica según los sistemas de estadificación de la Asociación Latinoamericana de Tórax (ALAT) y la iniciativa global para la enfermedad pulmonar obstructiva crónica (GOLD).

INTRODUCTION: Several classification systems use different criteria when assessing COPD stages. The objective of this study was to compare the prevalence and distribution of COPD stagesusing Global initiative for chronic Obstructive Lung Disease (GOLD) recommendationsand Latin American Thoracic Association (ALAT) guidelinesin a primary-care population. METHODS: Subjects attending routine primary care visits, ≥40 years of age, current or former smokers or exposed to biomass, completed a questionnaire and performed spirometry. COPD was defined as post-bronchodilator FEV1/FVC<0.70 and categorised according to GOLD-2013 criteria and ALAT-2014 guideline. The BODEx index was used to assess the prognostic value of the stratification systems. RESULTS: A total of 1743 subjects completed the interview, 1540 performed acceptable spirometry. COPD prevalence according GOLD-2013 was 20.1% and had a U-shaped stage distribution (group A: 9.3%, B: 4.3%, C: 2.0%, D: 4.6%). According to ALAT, prevalence was 19.7% with a bell-shaped stage distribution (mild: 2.9%, moderate: 9%, severe: 5.4%, very-severe: 2.7%). Approximately 73% of patients were stratified as moderate (45.4%) or severe (27.3%) by ALAT guidelines, whereas using GOLD-2013 criteria the majority of subjects (approximately 69%) were in group A (46.3%) or group B (22.7%). BODE index score increased as COPD worsened according to ALAT stratification. This is not observed with GOLD2013 criteria (similar values for B and C groups). CONCLUSIONS: Disease stages differ under ALAT and GOLD-2013 criteria. ALAT identified a greater proportion of COPD subjects in the moderate and severe categories compared with GOLD-2013, where the majority were categorised in group A. Future evaluation of the ALAT classification should address its predictive ability in terms of hospitalizations and mortality.

Development of a simple screening tool for opportunistic COPD case finding in primary care in Latin America: The PUMA study.

BACKGROUND AND OBJECTIVE: Opportunistic chronic obstructive pulmonary disease (COPD) case finding approaches for high-risk individuals with or without symptoms is a feasible option for disease identification. PUMA is an opportunistic case finding study conducted in primary care setting of Argentina, Colombia, Venezuela and Uruguay. The objectives were to measure COPD prevalence in an at-risk population visiting primary care for any reason, to assess the yield of this opportunistic approach and the accuracy of a score developed to detect COPD. METHODS: Subjects attending routine primary care visits, ≥40 years of age, current or former smokers or exposed to biomass smoke, completed a questionnaire and performed spirometry. COPD was defined as post-bronchodilator (post-BD) forced expiratory volume in 1 s (FEV1 )/forced vital capacity (FVC) < 0.70 and the lower limit of normal of FEV1 /FVC. RESULTS: A total of 1743 subjects completed the interview; 1540 performed acceptable spirometry. COPD prevalence was 20.1% (n = 309; ranging from 11.0% in Venezuela to 29.6% in Argentina) when defined using post-BD FEV1 /FVC < 0.70, and 14.7% (n = 226; ranging from 8.3% in Venezuela to 21.8% in Colombia) using the lower limit of normal. Logistic regression analysis for both definitions showed that the risk of COPD was significantly higher for persons >50 years, heavy smokers (>30 pack-years), with dyspnoea, and having prior spirometry. A simple score and a weighted score constructed using the following predictive factors: gender, age, pack-years smoking, dyspnoea, sputum, cough and spirometry, had a mean accuracy for detecting COPD (post-BD FEV1 /FVC < 0.70) of 76% and 79% for the simple and weighted scores, respectively. CONCLUSION: This simple seven-item score is an accurate screening tool to select subjects for spirometry in primary care.

Efecto de la inactivación de caries sobre la carga bacteriana intraoral en niños / Effect of inactivation of caries on the intraoral bacterial load in children

El derecho a la salud es un concepto que se trasciende a sí mismo, pues están implícitos derechos sociales, culturales y económicos. La medicina preventiva, dentro de la salud pública, es hoy día el principal objetivo de la mayor parte de los programas sanitarios y constituye el futuro de la medicina. La caries dental puede definirse como una enfermedad de naturaleza infecciosa, que resulta de la interacción de varios factores, ocasionando la pérdida de estructuras dentales mineralizadas, la remoción del tejido con caries y sellado de todas las lesiones es un procedimiento clínico de fundamental importancia, que inhibe el progreso de la lesión y reduce la microbiota bucal cariogénica, una vez que se remueve los nichos de retención bacteriana. Por lo expuesto precedentemente se planteó la realización de este estudio con el objetivo de determinar el efecto de la inactivación de caries sobre la carga bacteriana intraoral en 8 sujetos menores de 6 años de edad, divididos en dos grupos en los que se midió la carga bacteriana intraoral previa y a los 7 días de la inactivación de caries dependiendo si el sujeto correspondía al grupo experimental o control. Posteriormente se procedió al cultivo e identificación de microorganismos y se pudo observar una disminución de recuento microbiano (aerobios y anaerobios) en general en los grupos de control y de estudio, sobre todo en anaerobios. En el grupo de estudio en un caso hubo un aumento. Estos resultados nos sugieren la realización de otros trabajos ampliando el número de muestra y considerando otros factores que permitan obtener conclusiones más contundentes.