Background: Current treatment for chronic kidney disease (CKD) focuses on improving manifestations and delaying progression. Nutritional approaches play a crucial role in CKD management, and various supplements have become available. Ketoanalogues of amino acids (KAs), calcium citrate, and inulin have been proposed as suitable supplements, yet their widespread use has been limited due to insufficient evidence. This study aimed to generate general guidance statements on the appropriateness of these supplements through a RAND/UCLA consensus process. Methods: A RAND/UCLA consensus panel was convened to evaluate the appropriateness of these supplements in different clinical scenarios. In this study, we present a subgroup analysis focusing on a panel of eleven clinical nephrologists from among the experts. Results: Supplementation of low-protein diets (LPDs) and very low-protein diets (VLPDs) with KA was considered appropriate to reduce manifestations and delay CKD outcomes, supplementation with calcium citrate is considered appropriate to reduce CKD manifestations, and supplementation with inulin is considered appropriate to delay CKD outcomes and manage comorbidities. Conclusions: Based on a combination of clinical experience and scientific evidence, the panel reached a consensus that KA supplementation of LPD and VLPD, calcium citrate, and inulin are appropriate in patients with CKD across various scenarios.

Background/Objectives: Obesity is a major public challenge globally, and pharmacological treatments, though effective, face important limitations related to access, cost, and adherence. Nutraceuticals have emerged as potentially safer, more accessible alternatives. A polysaccharide-rich hydrolysate derived from Saccharomyces cerevisiae (Stetikal®, Lipigo®) has shown promise in clincal trials, but no systematic reviews have been conducted. Methods: We conducted a systematic review and meta-analysis following Cochrane protocols and PRISMA guidelines. The study was prospectively registered in PROSPERO (CRD420251024965). We searched Pubmed, SciELO, ClinicalTrials.gov, CENTRAL, and EMBASE (April 2025) for blinded, randomized, placebo-controlled trials evaluating this hydrolysate in overweight or obese adults. Abstract screening, study selection, data extraction, risk of bias assessment (RoB-2), were performed independently by five reviewers. Outcomes included body weight, BMI, abdominal circumference and fat mass. Results: Three eligible studies comprising 273 participants were included. The meta-analysis showed significant reductions in body weight (SMD = -2.35 kg), BMI (SMD = -2.47 kg/m²), abdominal circumference (SMD = -3.15 cm), and fat mass (SMD = -0.76 kg), all favoring the intervention. Heterogeneity was high for most outcomes, except for abdominal circumference (I² = 0%). Risk of bias was deemed low in all studies. Conclusions: This systematic review and meta-analysis support the clinical efficacy of a polysaccharide -rich hydrolysate derived from Saccharomyces cerevisiae for short-term weight loss and adiposity reduction. While modest, the observed benefits are comparable to those of conventional pharmacological treatments and suggest that this nutraceutical could serve as a cost-effective, accessible complement or alternative for obesity management.

Background: Current treatment for Chronic Kidney Disease (CKD) focuses on improving manifestations and delaying progression. Nutritional approaches play a crucial role in CKD management, and various supplements have become available. Ketoanalogues of amino acids (KA), calcum citrate, and inulin have been proposed as suitable supplements, yet their widespread use has been limited due to insufficient evidence. This study aimed to generate general guidance statements on the appropriateness of these supplements through a RAND/UCLA consensus process; Methods: A RAND/UCLA consensus panel was convened to evaluate the appropriateness of these supplements in different clinical scenarios. In this study, we present a subgroup analysis focusing on a panel of eleven clinical nephrologists from among the experts; Results: Supplementation of low protein diets (LPD) and very low protein diets (VLPD) with KA was considered appropriate to reduce manifestations and delay CKD outcomes, supplementation with calcium citrate is considered appropriate to reduce CKD manifestations, and supplementation with inulin is considered appropriate to delay CKD outcomes and manage comorbidities; Conclusions: Based on a combination of clinical experience and scientific evidence , the panel reached a consensus that KA supplementation of LPD and VLPD, calcium citrate, and inulin are appropriate in patients with CKD across various scenarios.

Alagille syndrome (ALGS) is a multisystem disorder characterized by a paucity of intrahepatic bile ducts and cholestasis, often requiring liver transplantation before adulthood. Due to the lack of genotype–phenotype correlation, case series are essential to understand disease presentation and prognosis. Data on Mexican ALGS patients are limited. Therefore, we aimed to characterize a large series of Mexican patients by consolidating cases from major institutions and independent geneticists, with the goal of generating one of the most comprehensive cohorts in Latin America. We retrospectively analyzed clinical records of pediatric ALGS patients, focusing on demographics, clinical features, laboratory and imaging results, biopsy findings, and transplant status. Genetic testing was performed for all cases without prior molecular confirmation. We identified 52 ALGS cases over 13 years; 22 had available clinical records. Of these, only 6 had molecular confirmation at study onset, prompting genetic testing in the remaining 16. We identified six novel JAG1 variants and several previously unreported phenotypic features. A liver transplantation rate of 13% was observed in the cohort. This study represents the largest molecularly confirmed ALGS cohort in Mexico to date. Novel genetic and clinical findings expand the known spectrum of ALGS and emphasize the need for improved therapies, such as IBAT inhibitors, which may alleviate symptoms and reduce the need for transplantation.

Background: Nutraceuticals are bioactive compounds that have shown promise in disease prevention and management. Due to their accessibility and affordability, they have gained increasing interest in obesity management. Some such nutraceuticals are Saccharomyces cerevisiae hydrolysates. Despite this growing interest, clinical practice guidelines rarely address their use, leaving clinicians with limited direction of their usage in routine care. This study aimed to develop a general guidance statement on the appropriateness of a Saccharomyces cerevisiae hydrolysate using a RAND/UCLA consensus process. Methods: A multidisciplinary panel of nine experts was convened to evaluate the appropriateness of a Saccharomyces cerevisiae hydrolysate in various clinical scenarios related to obesity management. Results: The panel deemed the use a Saccharomyces cerevisiae hydrolysate, in combination with lifestyle modifications, as an appropriate intervention for managing obesity-related outcomes. This included its use in patients with specific comorbidities, as an adjunct to standard pharmacotherapy, and in a set of selected clinical scenarios. Conclusions: Combining practitioners' insights with available data, the panel reached consensus that a Saccharomyces cerevisiae hydrolysate represents an appropriate intervention in a range of clinical scenarios for obesity management.

Flexible gastrointestinal endoscopy in small animal veterinary practice requires psychomotor and visuospatial skills that differ from those used in open surgery. Training opportunities are often limited by reliance on live animals, which raises ethical and logistical challenges, while high-fidelity simulators remain cost-prohibitive for many programs. This creates a gap in accessible, early-stage endoscopy training. This Teaching Tip describes the development and implementation of a set of low-cost, modular simulation models designed to support acquisition of core endoscopic skills in veterinary learners. Two custom-built task trainers were designed for foreign body retrieval and polypectomy, and a biological model incorporated porcine gastrointestinal tissue into a life-size canine dummy to provide realistic anatomical context and haptic feedback. Although the biological model is based on canine anatomy, the technical skills targeted (endoscope navigation, instrument handling, and visuospatial coordination) are not species-specific and are readily transferable across veterinary and human endoscopy contexts. Training was delivered in a clinical skills laboratory using a station-based format with demonstration and supervised practice. The simulators enabled repeated, hands-on practice of key skills, including scope navigation, mucosal visualization, retroflexion, biopsy, and object retrieval, in a controlled, low-risk environment. Informal feedback from learners and faculty indicated high usability and perceived educational value, particularly for early skill acquisition. These low-cost simulation models offer an accessible and practical approach to veterinary endoscopy training, reducing reliance on live animals and expanding opportunities for deliberate practice in resource-limited settings. Future work should focus on formal validation and integration of objective performance assessment.