This update and revision of the international guideline for urticaria was developed in accordance with the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is an initiative of the Global Allergy and Asthma Excellence Network (GA(2)LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), with the participation of 210 delegates from 107 national and international societies, from 59 countries. The consensus conference was held on December 6th, 2024. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease, defined by a rapid appearance of wheals, angioedema, or both. The lifetime prevalence of acute urticaria is estimated to be approximately 20%. Chronic urticaria, categorized as either chronic spontaneous urticaria or chronic inducible urticaria, is disabling, impairs quality of life, and affects performance at work and school, however, novel therapies are available. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.
BACKGROUND:Renal stones in anomalous kidneys pose surgical challenges due to altered anatomy. Miniaturized percutaneous nephrolithotomy (mini-PCNL) reduces morbidity, but concerns remain about stone-free rates (SFRs) and infection. Suction-assisted mini-PCNL (SM-PCNL) enhances fragment removal and controls intrarenal pressure, but its role in anomalous kidneys is unclear. OBJECTIVE:To evaluate perioperative outcomes of SM-PCNL in anomalous kidneys in a multicenter, real-world study and assess variations based on positioning, lithotripsy modality, and renal anomalies. METHODOLOGY:This prospective study across 15 centers (January-December 2024) included 287 adults undergoing SM-PCNL for renal stones in anomalous kidneys. Patients with normal anatomy, non-suction PCNL, or incomplete data were excluded. SFR was assessed via a 30-day non-contrast CT: 100% stone-free (Grade A), residual fragments ≤4 mm (Grade B), or >4 mm/multiple (Grade C, requiring reintervention). RESULTS:Malrotation (65.5%) was the most common anomaly, followed by duplex systems (25.1%), horseshoe kidneys (8.4%), and ectopic kidneys (1.0%). Median stone size was 1.7 cm. Supine positioning was used in 54.4%. Lithotripsy was performed with holmium laser (50.9%), thulium fiber laser (11.1%), or pneumatic lithotripsy (26.1%). Intraoperative clearance was 95.4%. At 30 days, 93.4% achieved Grade A, 5.6% Grade B, and 1.0% required reintervention. Complications were low; 0.7% had sepsis requiring intensive care unit admission. No transfusions or pleural injuries occurred. CONCLUSION:SM-PCNL using 18F suction sheaths with laser in a single stage achieved 93.4% complete SFR with negligible complications and minimal reintervention.
Introduction. Parental literacy in matters of nutrition is a factor capable of significantly influencing eating behavior and, subsequently, the health of children. Aim: to assess and compare knowledge of healthy nutrition with the implementation of healthy nutrition principles in the family by mothers of children of older preschool and school ages. Materials and methods. A face-to-face survey of 319 mothers of children aged 6 to 17 was conducted in a comprehensive school and kindergarten in Moscow. The questionnaire included questions on socio-demographic characteristics, to assess knowledge of healthy nutrition and adherence to healthy eating habits. For the analysis, proportions and mean values were calculated and compared, and correlation coefficients were determined in SPSS. Results. 230 (72.1%) mothers know the principles of healthy nutrition, 145 (45.5%) implement healthy eating behavior. The higher the level of maternal nutrition literacy, the more healthy eating habits she has (r=0.186; p <0.001). Mothers who reported higher family income have better nutrition literacy, demonstrate lower alcohol consumption, higher consumption of vegetables and protein, regular breakfast consumption, but higher consumption of fast carbohydrates (p <0.001). Conclusion. It is relevant for medical workers of children’s educational institutions to initiate the assessment of mothers’ nutrition literacy and their adherence to the principles of healthy nutrition in the family.
Chronic lung infection caused by Pseudomonadota (PCH) in patients with cystic fibrosis (pwCF) is difficult to eradicate. CFTR modulators have a potential role in the prevention of airway infections, but their ability to eradicate chronic infection remains to be investigated. The aim of our study was to evaluate the impact of combination (antibacterial (AT) and modulator (MT)) therapy on the lung bacteriome composition (LBC) in the pwCF cohort. The bacteriomes of sputum samples longitudinally collected from 57 Russian adult pwCFs chronically infected with Pseudomonadota CF pathogens (PCH) were analyzed. MT tended to reduce the bacterial load. The LMC did not significantly change in PCH pwCFs that received MT for less than three years. Two-component MT resulted in a temporary decrease in the proportion of the CF pathogen only when combined with a course of AT. Three-component MT has been successful in inducing favorable bacteriome changes (in terms of the abundance and diversity of anaerobic taxa) over a period of more than 3 years but not for all cases of Burkholderiales infection. The respiratory system damaged by bronchiectasis is susceptible to new infections, so patient management requires constant monitoring of the LBC and replenishment of the therapeutic landscape with both new modulators and new antibacterial drugs.
Type 2 (T2) immunity is classically associated with defense against helminths and environmental threats, from a physiological perspective, and with allergies and eosinophilic inflammatory diseases, in a pathological sense. However, growing evidence reveals that T2 pathways also support other essential homeostatic functions, including tissue protection and repair. There are major clues from the early evolution of T2 responses for protection against massive tissue damage and positive selection for survival against parasites starting over 500 million years ago. These responses likely co-evolved stepwise with immune-regulatory circuits, culminating in the emergence of the fully functional human-type IgG4 in the great apes (Hominidae) within the last ~10 million years. The involvement of body barriers along with the strong influence of local epithelial cells and their interaction with the microbiome and the immune system is a common characteristic of T2 inflammation. An expanding list of new T2 diseases is being reported, characterized by epithelial cell and immune system activation, epithelial barrier damage, and microbial dysbiosis, including opportunistic pathogen colonization and loss of commensals. This evolving understanding coincides with the clinical success of biologics targeting key T2 mediators such as IL-4, IL-5, IL-13, IL-31, TSLP, and IgE, which have transformed the management of severe allergic diseases and other T2-driven pathologies. However, the contribution of T2 immunity to homeostatic programs raises questions about the long-term consequences of sustained T2 suppression. In this review, we examine the dual role of T2 immunity in health and disease, revisit its evolutionary origins, highlight its protective functions beyond allergy, and discuss the potential implications of prolonged T2 pathway blockade.
