Efficacy of Roncolab mobile application for diagnosing the primary sign of sleep-disordered breathing (snoring) in children / Eficacia de la aplicación móvil Roncolab para el diagnóstico de signo primario de trastorno respiratorio del sueño (ronquido) en niños

ABSTRACT Sleep-disordered breathing (SDB) is a group of disorders associated with breathing anomalies during sleep. Easily detectable by sound, snoring is one of the most common manifestations and the main sign of SDB. Snoring is characteristic of breathing sound during sleep, without apnea, hypoventilation, or interrupted sleep. It may reduce the percentage of sleep and increase microarousals due to breathing effort or gas exchange. A range of questionnaires have been validated and adapted to the pediatric population to screen for patients who require laboratory testing. The Pediatric Sleep Questionnaire (PSQ) screens for SDB and identifies primary signs such as snoring. RoncoLab is a mobile application that records and measures snoring intensity and frequency Aim To compare the RoncoLab app and the PSQ regarding how efficiently they diagnose snoring Materials and Method This was an observational, analytical study of 31 children aged 7 to 11 years who visited the pediatric dental clinic at Benemérita Universidad Autónoma de Puebla, Mexico (BUAP). The PSQ was applied to diagnose SDB. Guardians were then instructed on how to download and use the mobile application to record data while the child was sleeping at home. Agreement between RoncoLab and the PSQ was analyzed statistically by Cohen's Kappa index at 95% confidence level Results The Kappa index for identification of primary snoring was 0.743 (p<0.05). App sensitivity was 0.92, and specificity 0.82 Conclusion There is good agreement between PSQ and RoncoLab for diagnosing primary snoring, with acceptable sensitivity and specificity.

RESUMEN Los trastornos respiratorios del sueño (TRS) son un grupo de padecimientos asociados con anormalidades respiratorias del sueño. Una de las manifestaciones más comunes es el ronquido; signo fácil de detectar por el ruido que emite y se considera como el signo principal. Este trastorno es característico del ruido respiratorio durante el sueño, sin apneas, hipoventilación, ni interrupciones del sueño. Este puede ocasionar disminución del porcentaje del sueño y aumentar los microdespertares, esto debido al esfuerzo respiratorio o al intercambio de gases. En la actualidad existen cuestionarios validados y adaptados para la población pediátrica útiles como herramienta clínica para el tamizaje y selección de pacientes que requieran pruebas de laboratorio. El Pediatric Sleep Questionnaire (PSQ) permite el cribado de TRS e identificación de signos primarios como el ronquido. RoncoLab es una aplicación móvil que registra y mide la intensidad y frecuencia del ronquido. Objetivo Comparar la eficacia del diagnóstico del ronquido por medio del RoncoLab contrastado con el PSQ Materiales y Método Estudio observacional, analítico, en el cual se incluyeron 31 niños de 7 a 11 años, que acudieron a la clínica de odontopediatría de la Benemérita Universidad Autónoma de Puebla, México (BUAP) Se aplicó el PSQ a los 31 niños para el diagnóstico de TRS, después se le instruyó al tutor como descargar y utilizar la aplicación móvil para registrar los datos obtenidos en las horas de sueño en casa. El análisis estadístico de concordancia entre los instrumentos diagnósticos se realizó con el Índice Kappa de Cohen a un nivel de confianza del 95% Resultados El Índice de Kappa para la identificación de los ronquidos primarios fue de 0.743 (p<0.05). La sensibilidad de la aplicación fue de 0.92, mientras la especificidad fue de 0.82 Conclusión Existe buena concordancia entre el PSQ y el RoncoLab en el diagnóstico de ronquido primario, con sensibilidad y especificidad aceptable.

Symbiotic pectin microparticles with native Jerusalem artichoke (Helianthus tuberosus L.) enhance Lactobadllus paracasei subsp. tolerans survival / La encapsulación de Lactobacillus paracasei subsp. toleraos en microgeles de pectina con inulina extraída de topinambur (Helianthus tuberosus L.) incrementa su supervivencia

Resumen El efecto sinérgico de la microencapsulación en geles de pectina e inulina extraída de cultivos nativos de topinambur se evaluó como una estrategia natural para aumentar la supervivencia de Lactobacillus paracasei subsp. toleraos F2, bacteria seleccionada por sus propiedades probióticas sobre la trucha arco iris (Oncorhynchus mykiss). La cepa fue capaz de crecer y fermentar la inulina de topinambur en caldo MRS modificado, lo que condujo al incremento del número de células (~+5 unidades logarítmicas) y la disminución neta del pH (6,2 ±0,2 a 4,0±0,5). La encapsulación de F2 en microgeles de pectina en presencia de inulina mejoró su supervivencia no solo a lo largo del almacenamiento sino también en condiciones donde se simuló el pasaje por el tracto gastrointestinal. Después de 56 días de almacenamiento a 4 °C, se registraron números significativamente mayores de células viables microencapsuladas en presencia del prebiótico (8,2-8,4 log UFC/g) que sin él (~7,00 log UFC/g). Estos resultados alientan la aplicación de estas técnicas para la formulación de alimentos funcionales utilizando fuentes alternativas naturales de inulina que incrementan la viabilidad del probiótico almacenado y su digestibilidad.

Intervenciones tecnológicas adaptativas para el trastorno del espectro autista: una revisión bibliográfica / Adaptive technological interventions for autism spectrum disorder: a literature review

Resumen Los individuos con trastornos del espectro autista suelen describirse con deficiencias comunicativas, sociales, emocionales y de comportamiento. A menudo están aislados y son pasivos, con pocas oportunidades de interacción positiva y constructiva con el mundo exterior. Por otra parte, pueden mostrar comportamientos retraídos, estereotipados y disruptivos. Estas condiciones pueden dificultar seriamente sus habilidades adaptativas al ambiente, con consecuencias negativas en su calidad de vida. La heterogeneidad fenotípica y la manifestación, así como la gravedad de los síntomas, pueden variar considerablemente según el niño. Esos determinan la necesidad de intervenciones personalizadas y adaptivas según las necesidades específicas, incluyendo factores como la edad, las habilidades intelectuales y las áreas afectadas específicas. Una intervención temprana promovería las habilidades adaptativas, la autodeterminación y la autonomía hacia el entorno. No obstante, los tiempos de esperas y los costes no permiten una evaluación temprana y como consecuencia los tiempos de intervención se retrasan afectando la cualidad de vida de los niños y de los pa dres. Además, los programas tradicionales de intervención dependen de la experiencia de los terapeutas. Una posible forma de superar este problema es el uso de tecnología adaptativa objetiva según las necesidades. El objetivo de este artículo es proporcionar una visión general de las pruebas empíricas disponible en los últimos siete años. En total, se seleccionaron 8 estudios, con 132 participantes que utilizaron 4 sistemas tecnológicos. Por último, se discuten las implicaciones tecnológicas, clínicas, psicológicas y rehabilitadoras de los hallazgos. Se esbozaron directrices prácticas dentro de esta área temática como perspectivas de investigación futuras.

Abstract Individuals with autistic spectrum disorder are often described as having communication, social, emo tional, and behavioral impairments. They are often isolated and passive, with few opportunities for positive and constructive interaction with the outside world. Moreover, they may exhibit withdrawn, stereotyped and disruptive behaviors. The aforementioned conditions can seriously hamper their ability to adapt to the environment, with negative consequences on their quality of life. Phenotypic heterogeneity and manifestation, as well as symptom severity, can vary greatly from child to child. These determine the need for individualized and adaptive interventions according to specific needs, including factors such as age, intellectual ability, and specific affected areas. Early intervention would promote adaptive skills, self-determination, and autonomy towards the environment. However, wait times and costs do not allow for early assessment, and therefore intervention times are delayed, affecting the quality of life of children and parents. In addition, traditional intervention programs depend on the expertise of the therapists. One possible way to overcome this problem is by using objective adaptive technologies based on needs. This article aims to provide an overview of the empirical evidence available over the past seven years. Overall, 8 studies were selected, with 132 participants using 4 technological systems. Finally, the technological, clinical, psychological, and rehabilitative implications of the findings are discussed. Practical guidelines within this topic area are outlined as future research perspectives.

Health policy and systems research capacity development to support maternal, newborn, child and adolescent health in West and Central Africa

Objectives: To examine how and why a South-South capacity development and networking program for leadership, research, practice and advocacy on maternal new-born, child and adolescent health and health policy and systems strengthening in West Africa and Cameroon worked and identify lessons for low- and middle-income countries. Design: Single qualitative case study drawing on data from document review, observations, key informant interviews and a deliberative workshop. Ethics approval for primary data collection was obtained from the Ghana Health Service Ethical Review Committee (GHS-ERC 012/10/18). Setting: West Africa and Cameroon Participants: Researchers, policy and programme managers and frontline health workers Interventions: Networking and capacity development Results: The programme made good progress in implementing many but not all planned capacity development and networking activities. The opportunity to network with other organisations and individuals and across countries, disciplines, and languages as well as to learn, to develop skills, and obtain mentorship support, were considered valuable benefits of the partnership. Human and financial resource constraints meant that not all planned interventions could be implemented. Conclusions: Lessons for health policy and systems research capacity building in LMIC include the potential of South-South partnerships, the need for dedicated resources, the potential of Sub-regional health organizations to support capacity building and recognition that each effort builds on preceding efforts of others, and that it is important to explore and understand where the energy and momentum for change lies.

Establishing communities of practice to improve health policy, systems and reproductive, maternal, newborn, child and adolescent health in West Africa

Objectives: To explore and analyse factors that facilitate and inhibit the initiation and functioning of a national and transnational Community of Practice (CoP) for health policy and systems (HPS) and Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) in West Africa and to identify lessons for CoP interventions in similar multilingual low and middle-income contexts. Design: A case study, with the case defined as processes, enablers and barriers to the initiation and functioning of a national and transnational CoP for HSP and RMNCAH in West Africa and drawing on a review and analysis of secondary data from the program, workshop, country team and project reports, and training sessions. Setting: The Economic Community of West African States (ECOWAS). Participants: Professionals from two Anglophone (Ghana and Sierra Leone) and four Francophone (Burkina Faso, Cote d'Ivoire, Niger e Senegal) ECOWAS countries. Interventions: Training and mentoring of multi-disciplinary country teams supported by small research grants to undertake formative evaluation and advocacy of priority HPS and RMNCAH issues; support for CoP development within and across country teams. Results: The desire to learn from peers and mentors was a major enabler of the process. Human and financial resource availability, competing demands for time, communication in the context of a Francophone-Anglophone official language divide and the arrival of COVID-19 were all constraints. Conclusions: This study highlights the processes, achievements, and challenges of establishing country-level and transnational CoPs in West Africa. CoPs require sustained human and financial resource investments, communication and medium-to-long-term implementation support for sustainability and impact.

Biomarcadores del trastorno del especto autista basados en bioseñales, realidad virtual e inteligencia artificial / Autism spectrum disorder biomarkers based on biosignals, virtual reality and artificial intelligence

Se ha observado que la estratificación de trastornos del espectro autista (TEA) generada por las escalas actuales no es efectiva para la personalización de tratamientos tempranos. La evaluación clínica de TEA requiere su consideración como un continuo de déficits, y existe la necesidad de identificar parámetros biológicamente significativos (biomarcadores) que tengan el poder de caracterizar automáticamente a cada individuo en diferentes etapas del desarrollo neurológico. El incipiente campo de la psiquiatría computacional (CP) intenta satisfacer las necesidades de diagnóstico de precisión mediante el desarrollo de potentes técnicas computacionales y matemáticas. Una creciente actividad científica propone el uso de medidas implícitas basadas en bioseñales para la clasificación de ASD. Las tecnologías de realidad virtual (VR) han demostrado potencial para las intervenciones de TEA, pero la mayoría de los trabajos han utilizado la realidad virtual para el aprendizaje / objetivo de las intervenciones. Muy pocos estudios han utilizado señales biológicas para el registro y el análisis detallado de las respuestas conductuales que se pueden utilizar para monitorear o producir cambios a lo largo del tiempo. En el presente trabajo se introduce el concepto de biomarcadores conductuales basados en VR o VRBB. Los VRBB van a permitir la clasificación de TEA utilizando un paradigma de psiquiatría computacional basado en procesos cerebrales implícitos medidos a través de señales psicofisiológicas y el comportamiento de sujetos expuestos a complejas réplicas de condiciones sociales utilizando interfaces de realidad virtual.

It has been observed that the stratification of Autism Spectrum Disorders (ASD) generated by the current scales is not effective for the personalization of early treatments. The clinical evaluation of ASD requires its consideration as a continuum of deficits, and there is a need to identify biologically significant parameters (biomarkers) that have the power to automatically characterize each individual at different stages of neurological development. The emerging field of computational psychiatry (CP) attempts to meet the needs of precision diagnosis by developing powerful computational and mathematical techniques. A growing scientific activity proposes the use of implicit measures based on biosignals for the classification of ASD. Virtual reality (VR) technologies have demonstrated potential for ASD interventions, but most of the work has used virtual reality for the learning / objective of interventions. Very few studies have used biological signals for recording and detailed analysis of behavioral responses that can be used to monitor or produce changes over time. In this paper the concept of behavioral biomarkers based on VR or VRBB is introduced. VRBB will allow the classification of ASD using a paradigm of computational psychiatry based on implicit brain processes measured through psychophysiological signals and the behavior of subjects exposed to complex replicas of social conditions using virtual reality interfaces.

Alteraciones posturales frecuentes en pacientes con diferentes tipos de trastornos temporomandibulares / Frequent postural alterations in patients with different types of temporomandibular disorders

RESUMEN Objetivo Describir las alteraciones posturales más frecuentes, de acuerdo al tipo de trastorno temporomandibular (TTM). Metodología Se analizaron 30 pacientes con edad media de 27,4 años; 80% mujeres, con diagnóstico de TTM confirmado con los Criterios Diagnósticos (CD/TTM) por investigador capacitado en la clínica de la Facultad de Estomatología de la BUAP. Posteriormente se realizó el análisis postural (tres vistas) con ayuda de una cuadrícula de acetato en las instalaciones de la Licenciatura de Fisioterapia de la BUAP. Se analizaron los resultados con estadística descriptiva en el programa SPSS v20. Resultados El 16,7% de los pacientes presentó TTM de origen muscular, el 36,7% articular y el resto combinado. Las alteraciones posturales más frecuentes fueron: hombro elevado: 93,3%, basculación pélvica: 86,7% y posición de cabeza adelantada: 83,3%. El mayor porcentaje de pacientes presentó cinco alteraciones posturales. El 100% presentó alteraciones en la vista lateral y el 50% de los pacientes con TTM de origen combinado presentaron alteraciones en las tres vistas, mientras en los de origen articular; el 45,5% y en los de origen muscular; el 60%. Conclusiones Los pacientes con TTM presentan alteraciones posturales; principalmente posición de cabeza adelantada, basculación pélvica y hombro elevado, con especial compromiso en los de diagnóstico muscular y combinado.(AU)

ABSTRACT Objective To describe postural alterations according to the type of temporomandibular disorder (TMD). Methods Prior informed consent, 30 patients were included in the study, with a mean age of 27.4 years; 80% women, diagnosed with TMD based on Diagnostic Criteria (DC/ TTM) by a trained researcher in the clinic of the Faculty of Stomatology of the BUAP. Subsequently, a postural analysis (three views) was carried out at the facilities of the School of Physiotherapy of the BUAP using an acetate grid. The results were analyzed with descriptive statistics in the SPSS v20 program. Results 16.7% of the patients presented muscular TMD, 36.7% joint TMD, and the rest combined TMD. The most common postural alterations were: high shoulder: 93.3%, pelvic tilt: 86.7%, and forward head posture: 83.3%. On average, the patients had between 4 and 5 postural changes. 100% of the patients ha alterations in the side view, while 50% of the patients with TMD of combined origin had alterations in the three views, as well as 45.5% of the patients with TMD of joint origin, and 60% of the patients with TMD of muscular origin. Conclusions TMD patients present postural changes, mainly forward head posture, pelvic tilt and high shoulder, with special involvement related to muscle and combined diagnosis.(AU)

La vocación de curar a través del arte / The vocation of healing through art

La humanización del ejercicio de la medicina considera la vivencia de enfermar del paciente, así como el verdadero sentido del curar, aliviar, sanar y acompañar a la persona. Esa vivencia pone en juego la sensibilidad. La experiencia sensible y afectiva es motor de la capacidad simbólica del género humano, y el símbolo es lazo afectivo-representativo y acuerdo imaginario entre la persona y su mundo. Las imágenes, como símbolos, no pueden ser reducidas al lenguaje verbal racional. El Arte Terapia, a través de esas imágenes, acompaña a la persona en la prevención o tratamiento de enfermedades. Es una disciplina del campo de la salud en desarrollo en todo el mundo, con un creciente número de estudios que sustentan sus efectos positivos. Sus herramientas terapéuticas son la estimulación de la sensibilidad, el uso de la imagen como lenguaje, el juego creativo, la simbolización y la experiencia grupal. Su inclusión en el ámbito hospitalario tiene una fuerte razón de ser: el Arte siempre ha acompañado al hombre y a la Medicina, como otra forma de la vocación de curar. (AU)

Humanization of medical practice takes into account the patient's experience of illness, as well as the true sense to cure, to alleviate, to heal and to care about the person. Sensitiveness comes into play in that experience. The sensitive and emotional experience is the engine of the symbolic capacity of humankind; and the symbol is the representative-affective tie and the imaginary agreement between the person and his world. Images, as symbols, cannot be reduced to the rational verbal language. Art Therapy, through those images, takes care about the person in the prevention or treatment of different diseases. Art Therapy is a health-related discipline in development around the world with an increasing number of studies supporting its positive effects. Its therapeutic tools are the stimulation of the sensitivity, the use of the image as a language, the creative play, the symbolization, and the group experience. Art Therapy incorporation in the hospital setting has a strong rationale: Art has always been along with humankind and Medicine as another vocational way to heal. (AU)

Perceptions of traditional, complementary and alternative medicine among conventional healthcare practitioners in Accra, Ghana: Implications for integrative healthcare / 中西医结合学报

<p><b>OBJECTIVE</b>Integrative medicine refers to ongoing efforts to combine the best of conventional and evidence-based complementary therapies. While this effort for collaboration is increasing, traditional complementary and alternative medicine (TM-CAM) remains poorly integrated into the current healthcare system of Ghana. At present, it is not clear if practitioners of mainstream medicine favor integrative medicine. The present study, therefore, sought to explore the perceptions of conventional healthcare professionals on integrative medicine.</p><p><b>METHODS</b>A qualitative design composed of semi-structured interviews was conducted with 23 conventional healthcare professionals comprising pharmacists, physicians, nurses and dieticians from two quasi-government hospitals in Accra, Ghana.</p><p><b>RESULTS</b>Participants' knowledge of TM-CAM was low, and although they perceived alternative medicine as important to current conventional healthcare in Ghana, they expressed anxieties about the potential negative effects of the use of TM-CAM. This paradox was found to account for the low levels of use among these professionals, as well as the low level of recommendation to their patients. The practitioners surveyed recommended that alternative medicine could be integrated into mainstream allopathic healthcare in Ghana through improving knowledge, training as well as addressing concerns of safety and efficacy. These findings are discussed under the themes: the knowledge gap, the paradox of TM-CAM, experience of use and prescription, and guided integration. We did not observe any differences in views among the participants.</p><p><b>CONCLUSION</b>The conventional healthcare professionals were ready to accept the idea of integrative medicine based on knowledge of widespread use and the potential role of TM-CAM products and practices in improving healthcare delivery in the country. However, to achieve an institutional integration, practitioners' understanding of TM-CAM must be improved, with specific attention to issues of safety, regulation and evidence-based practice of TM-CAM products and services in Ghana.</p>

Asociación entre estructuras craneofaciales de adolescentes y los trastornos temporomandibulares / Association between craniofacial structures adolescents and temporomandibular disorders

Objetivo Determinar la asociación entre las dimensiones de las estructuras craneofaciales de adolescentes y la presencia de TTM. Material y Métodos Estudio de casos y controles. Se evaluaron 46 pacientes de 10 a 16 años de edad con sus respectivas radiografías laterales de cráneo (23 casos y 23 controles, pareados por edad y sexo). Se aplicaron los Criterios Diagnósticos para la Investigación de los TTM (CDI/TTM) para establecer los casos y los controles por investigador estandarizado. Resultados La comparación entre casos y controles de las estructuras craneofaciales, no demostró diferencias significativas, sin embargo la altura facial inferior, el eje facial y el plano mandibular fueron ligeramente superiores en el grupo de los casos. En el análisis de ANOVA de dos vías, (diagnóstico y edad), la convexidad facial presentó diferencias entre los adolescentes varones con y sin Trastornos temporomandibulares (p=0,002). Conclusión Las estructuras craneofaciales no se asocian con el diagnóstico de TTM en los adolescentes, sin embargo se presentan cambios en las relaciones maxilomandibulares, (ubicación anterior del maxilar con respecto a la mandíbula) que provocan un patrón esquelético Clase II y una forma alargada de la cara.(AU)

Objective To determine the association between craniofacial structures and the presence of TMD in adolescents. Material and Methods Cases-control study. 46 patients aged 10 to 16 years old were evaluated with their respective lateral cephalometric X-rays (23 cases and 23 controls matched for age and sex). The TTM was evaluated with the research diagnostic criteria for temporomandibular disorders (RDC/TMD). Results The comparison between cases and controls of the craniofacial structures did not show significant differences, however the lower facial height, facial axis and the mandibular plane were slightly higher in the group of cases. In the two-way analysis of ANOVA (diagnosis and age), facial convexity presented differences between the adolescent with and without temporomandibular disorders (p=0,002). Conclusion Craniofacial structures are not associated with the diagnosis of TMD in adolescents. However, changes occur in relation to the former location of the jaw, resulting in a skeletal pattern class II and an elongated shape of the face.(AU)

Prevalencia de trastornos temporomandibulares en niños mexicanos con dentición mixta / Prevalence of temporomandibular disorders in Mexican children with mixed dentition

Objetivo Determinar y contrastar con la bibliografía reportada, la prevalencia de trastornos temporomandibulares con un instrumento validado en dentición mixta de niños mexicanos. Métodos Se incluyeron 150 niños de 8 a 12 años de edad, de cualquier sexo que asistieron a la clínica de estomatología pediátrica de la BUAP, evaluados con los criterios diagnósticos para la Investigación de los TTM (CDI/TTM) por investigador previamente estandarizado (kappa=0,93). Los resultados se contrastaron con lo reportado en la bibliografía. Resultados La prevalencia de TTM fue del 20,7%, predominantemente de tipo muscular (77,4%), el 33,3% presentó alteración del patrón de apertura bucal, el 34% presentó ruidos articulares (chasquido), la función mandibular más comprometida fue el masticar (6%). Estos resultados contrastan con lo reportado en la bibliografía, específicamente en los sitios musculares doloridos y las cefaleas, probablemente explicado por los diferentes instrumentos utilizados. Conclusión La prevalencia de TTM es contrastante entre diversos estudios, es necesario enfatizar la necesidad de evaluar éstos durante la niñez y la juventud con instrumentos validados.(AU)

Objective To determine and compare with reports in the bibliography, the prevalence of temporomandibular disorders with an instrument validated for Mexican children with mixed dentition. Methods 150 children, from 8 to 12 years of age and of any sex who attended the pediatric stomatology clinic of the BUAP (Meritorious Autonomous University of Puebla) were included and evaluated with the diagnostic criteria for research on TTM (CDI/TTM) by a researcher who had been previously standardized (kappa=0.93). The results contrasted with reports in the bibliography. Results The prevalence of TTM was 20.7%. It was predominantly muscular (77.4%), though 33.3% showed alteration of the mouth-opening pattern, 34% showed joint noises (clicks). The most compromised mandibular function was chewing (6%). These results contrast with reports in the bibliography, specifically in terms of muscle pain sites and headaches, probably explained by different instruments used. Conclusion The prevalence of TTM is in contrast among different studies. It is necessary to place emphasis on the need to evaluate these factors during the childhood and adolescence with validated instruments.(AU)

Adherence to Anti-retroviral Therapy among HIV-Positive Individuals in Ghana: The Role of Stress and Post Traumatic Stress Symptoms.

Aims: To identify stress and post traumatic stress symptoms (PTSS) in HIV patients on Antiretroviral therapy (ART) and further assess the possible relationship between stress, PTSS, immune function and ART medication adherence. Methods: After obtaining written informed consent, 150 HIV out-patients attending Pantang and Amasaman Hospitals in Accra, Ghana, were recruited for the study. Participants were interviewed using a questionnaire comprising of sections measuring demographic characteristics, perceived stress, post traumatic stress symptoms, and medication adherence. A measure of the immune function (CD4+) from individual’s health records was noted at the time of interview. Results: Ninety four (62.7%) patients exhibited higher stress levels compared to the remaining 56(37.3%). The majority of participants (74%) showed PTSS at levels that met the optimal criteria indicative of post traumatic stress disorder (PTSD) and may have required clinical attention and management. Participants with high stress levels were 84% less likely to be adherent to their antiretroviral medication compared to those with lower levels of stress [OR=0.16 (0.050–0.512), P<0.0001]. Patients who showed evidence of stress were approximately four times more likely to develop PTSD compared to nonstressed patients [OR=3.898 (1.428–10.635), P=0.007]. The experience of side effects did not influence adherence [OR = 0.536 (0.224–1.285), P = 0.155]. On the other hand, stress significantly related with adherence when side effects were present [OR=0.648 (0.252– 1.662), P=0.002]. The PTSD importantly associated with adherence to ART with approximately 42% less odds of attaining optimal adherence by participants with PTSD compared to non-PTSD patients [OR=0.576 (0.189–1.751), P=0.017]. Conclusion: HIV patients on ART need to be screened for stress, PTSS and PTSD in order to benefit from psychological support and therapy. This activity can significantly enhance medication adherence as well as impact positively on the general health outcomes of HIV patients on ART.

Rehabilitación dental y trastornos temporomandibulares en adolescentes de Puebla, México / Temporomandibular dental rehabilitation and adolescent disorders of Puebla, México

OBJETIVO: determinar el factor de riesgo para desarrollar trastornos temporomandibulares en adolescentes (TTM). METODOLOGIA: cohorte prospectiva realizada en 153 adolescentes, (52,9% mujeres y 47% hombres) libres de TTM. Para diagnosticar los TTM se utilizaron los Criterios Diagnósticos para la Investigación de los TTM (CDI/TTM), para determinar caries se aplicó el índice CPOD. Se formaron dos grupos, el grupo expuesto a rehabilitación dental (74), y el grupo no expuesto (79). Se realizaron seguimientos a las dos semanas, tres y seis meses de la rehabilitación dental. Se utilizó estadística descriptiva y se calculó el riesgo relativo con intervalos de confianza al 95%. Para el grupo de los expuestos, se incluyeron adolescentes libres de TTM en los que fue necesario realizar tratamiento de rehabilitación dental en órganos posteriores con caries en esmalte y dentina en fosas y fisuras. Para el grupo no expuesto, se incluyeron adolescentes pareados por edad y sexo con los expuestos, libres de TTM sin necesidades de rehabilitación dental. RESULTADOS : la incidencia de TTM a los quince días de los expuestos (18,9%) fue superior en contraste con los no expuestos (5,0%). El riesgo relativo de desarrollar TTM en los adolescentes rehabilitados con resina a las dos semanas posteriores a la rehabilitación fue de 2.412 (I.C. 95% 1.001-5,81) veces más que en aquellos que no fueron sometidos a la rehabilitación. CONCLUSION:la rehabilitación dental es un factor de riesgo mínimo para desarrollar TTM a corto plazo (15 días) de realizado el procedimiento, dicho padecimiento inducido por la rehabilitación dental es agudo y auto limitante.

OBJECTIVE: Determine the risk factor involved with developing temporomandibular disorders (TMD) in adolescents. METHODOLOGY: Prospective cohort study carried out on 153 TMD-free adolescents (52.9% women and 47% women). In order to diagnose TMDs the Diagnostic Criteria for Research into TMDs (CDI/TMD), and the CPOD index was used to determine cavities. Two groups were formed: one exposed to dental rehabilitation (74) and one group unexposed (79). Follow-ups were performed two weeks, three months and six months after dental rehabilitation. Descriptive statistics were used and the relative risk was calculated with confidence intervals at 95%. Included in the exposed group were TMDfree adolescents in whom it was necessary to carry out dental rehabilitation treatment on rear teeth with cavities using enamel and dentin to fill in pits and fissures. Included in the unexposed group were adolescents paired with the exposed group based on age and sex, TMD-free and without the need for dental rehabilitation. RESULTS :The incidence of TMD two weeks subsequently in the exposed group (18.9%) was greater in contrast with the unexposed group (5.0%). The relative risk of carrying out TMD on adolescents rehabilitated with resin two weeks after rehabilitation was 2.412 (C.I. 95% 1.001-5.81) times more than in those that did not undergo rehabilitation. CONCLUSION:Dental rehabilitation is a minimum risk factor for carrying out TMD in the short term (two weeks) after the procedure, as this disease induced by rehabilitation is acute and self-limiting.

Association between signs and symptoms of temporomandibular disorders and pregnancy: case control study

Los trastornos temporomandibulares (TTM) se refieren a una colección de condiciones médicas y dentales que afectan a la articulación temporomandibular (ATM), y/o músculos masticatorios, así como estructuras vecinas. Otros autores definen los TTM como un conjunto de síntomas músculo-esqueléticosde etiología multifactorial. La prevalencia es mayor en mujeres, donde las hormonas sexuales son importantes en la patogénesis y su comportamiento en las diferentes etapas de la vida reproductiva de las mujeres no ha sido completamente documentado. El objetivo general fue determinar la asociación entre los signos y síntomas de trastornos temporomandibulares y el embarazo. Se realizó un estudio de casos y controles con 66 pacientesembarazadas que acudieron con médico especialista y 66 no embarazadas pareadas por edad que acudieron a consulta al HGR 36 del IMSS. Fueron exploradas por medio de los Criteriosde Diagnóstico para la Investigación de los Trastornos Temporomandibulares (CDI/TTM) para establecer la prevalencia de TTM en ambos grupos. Se calculó estadística descriptiva de las variables a través del programa SPSS v.17 y la asociación entre grupos con Chi cuadrada y Razón de posibilidades(OR). La edad promedio fue de 28.23 ± 5.9 años en ambos grupos, con una media de semanas de gestación de 32.97. La mayoría de las participantes contaron con una pareja. La prevalencia de TTM en el grupo de las no embarazadas fue del 45.5 por ciento y de solo el 15.2, en las mujeres embarazadas (X2=14.34, p<.000). Se calculó la razón de posibilidades (OR) embarazadas/no embarazadas convalor de .41 con intervalos de confianza de .23 a .72. En conclusión, el embarazo es un factor protector para presentarsignos y síntomas de TTM, las mujeres embarazadas presentan una prevalencia considerablemente más baja dedicho padecimiento(ATM).

Estudio comparativo entre una prueba rápida y RT-PCR tiempo real en el diagnóstico de influenza AH1N1 2009 / Comparative study of a rapid testing with real time RT-PCR for diagnosis of influenza AH1N1 2009

OBJETIVO: Comparar la prueba QuickVue Influenza A+B empleando como estándar la RT-PCR tiempo real para influenza AH1N1 2009. MATERIAL Y MÉTODOS: Estudio retrospectivo-comparativo de 135 muestras de vías respiratorias de individuos sintomáticos para influenza procesadas de mayo 2009 a octubre 2010.Las pruebas citadas se realizaron simultáneamente. Se utilizó el software Confidence Interval Analysis 2000. RESULTADOS: Sensibilidad 62.96; especificidad 94.44; valor predictivo negativo 62.9; valor predictivo positivo 94.44; razón de probabilidad positiva 11.33 y razón de probabilidad negativa 0.39. Se calcularon intervalos de confianza a 95. DISCUSIÓN: Los valores obtenidos concuerdan con otros estudios donde la sensibilidad fluctúa de 50 a 70 y especificidad entre 90 y 95 por ciento. La prueba QuickVue Influenza A+B es rápida, simple y de menor costo que el RT-PCR tiempo real, útil para identificar el tipo de virus en brotes de influenza de una población determinada.

OBJECTIVE: Compare QuickVue Influenza A+B test with real-time RT-PCR for the diagnosis of influenza AH1N1 2009. MATERIAL AND METHODS: Retrospective-comparative study of 135 respiratory specimens from individuals with symptoms of influenza processed from May 2009 to October 2010.The above mentioned tests were performed simultaneously. For statistic analysisthe softwareof Confidence IntervalAnalysis 2000 was used. RESULTS: The parameters obtained were: sensitivity 62.96; specificity 94.44; negative predictive value 62.9; positive predictive value 94.44; positive likelihood ratio 11.33; negative likelihood ratio 0.39. Confidence intervals to 95,were calculated to all of the above data. DISCUSSION: The test QuickVue InfluenzaA+B is a rapid,simple test,with lower cost than real-time RT-PCR useful for identifying the type of virus outbreaks of influenza in a given population.It correlates well with more specific test and similar reports.

Influência da situação sócio-familiar no desenvolvimento neuropsicomotor de crianças institucionalizadas / Influence of sociofamilial conditions on the neuropsychomotor development of institutionalized children

O objetivo deste estudo foi verificar a influência da situação sócio-familiar sobre o desenvolvimento neuropsicomotor de crianças institucionalizadas. Foi realizado estudo transversal incluindo 30 crianças abrigadas, de ambos os sexos, de 0 a 6 anos. Foram realizadas análises de prontuários e, posteriormente, o teste de desenvolvimento Denver II foi aplicado visando detectar possíveis atrasos. Os resultados foram comparados com os dados encontrados nos prontuários. 6% das crianças não apresentaram nenhum tipo de atraso. Os atrasos no desenvolvimento se manifestaram em relação a todas as áreas em 94% das crianças investigadas. As crianças abandonadas pelos pais apresentaram os níveis mais elevados de atraso: 86% no item pessoal social, 71% na categoria motor fino, 86% no item motor global, e 100% na categoria linguagem. As crianças vítimas de violência e negligência apresentaram atrasos no item pessoal social (28%), no aspecto motor fino (71%), na categoria motor grosseiro (43%), e na área da linguagem (100%). Das crianças que não recebem visitas, 100% apresentaram atrasos na linguagem; 85%, na categoria motor grosseiro; e 71%, nos itens pessoal social e motor fino. Todas as crianças abrigadas com idade entre 6 e 12 mesesa apresentaram atraso em todas as áreas, e a área da linguagem foi a mais afetada. Concluiu-se que crianças abrigadas apresentaram atraso em diversas áreas do desenvolvimento, e que, portanto, a situação sócio-familiar influenciou diretamente seu desenvolvimento.

This study aimed at verifying the influence of the sociofamilial background on the neuropsychomotor development of institutionalized children. This cross-sectional study enrolled 30 institutionalized children aged 0 to 6 years. Data from the medical records of these children were analyzed, and the Denver Development Test (Version 2) was then administered in order to identify possible developmental delays. These results were compared with those found out in their records. 6% of the children presented no delays, and the remaining 94% manifested several forms of developmental delay. The most severe lags occurred among abandoned children: 81% on the social-personal item, 71% in fine motor coordination, 86% in global motor skills, and 100% in language ability. In terms of liability, those who suffered from abuse and neglect presented developmental delays in social-personal item (28%), in fine motor aspect (71%), in general motor item, and in language abilities (100%). Of those children who were not visited, records indicated that 100% showed language delays, and 85% and 71% were backward in gross and fine motor development. Furthermore, 100% of those institucionalized children at 6 months to 1 year level suffered generalized delays. Among these children language maturation was the most seriously affected. Institucionalized children evidenced delays in several developmental categories, and the sociofamilial background of the child was the most potent source of negative influence.

Necesidades de tratamiento periodontal en adultos de la región rural Mixteca del Estado de Puebla, México / Periodontal treatment needs in adults from Mixteca rural area in Puebla State, Mexico

Objetivo Determinar las necesidades de tratamiento periodontal (NTP) utilizando el índice Comunitario de Necesidades de Tratamiento Periodontal (ICNTP) en una muestra de habitantes de la región Mixteca del estado de Puebla. Material y Métodos Se realizó un estudio transversal en el que se incluyeron 50 pacientes de la clínica rural de Nativitas Cautempan, Puebla., México. Para determinar el estado de salud periodontal se utilizaron el índice Gingival y el índice Comunitario de Necesidades de Tratamiento Periodontal propuesto por la Organización Mundial de la Salud y la Federación Dental Internacional, aplicados por el mismo investigador previamente capacitado y estandarizado. En el análisis, se calculó media y desviación estándar para las variables cuantitativas y frecuencias y proporciones para las variables categóricas. Resultados La edad promedio fue 37,6± 13,6 años. El 60,0 por ciento fueron mujeres, cuya principal ocupación fue amas de casa (46,0 por ciento). El 14 por ciento fueron campesinos. El índice gingival reportó 50,0 por ciento, 32,0 por ciento y 14,0 por ciento para gingivitis leve, moderada y severa, respectivamente. Los sextantes posteriores superiores presentaron mas comúnmente bolsas de 4 a 5 mm, los sextantes anteriores, cálculo y los posteriores inferiores cálculo y hemorragia. El 94,0 por ciento de los pacientes requiere tratamiento periodontal en un promedio de 3,6 sextantes por paciente. Conclusiones Las necesidades de tratamiento periodontal fueron altas en este estudio, nueve de cada diez pacientes de la región Mixteca del Estado de Puebla lo requieren. Es necesario encaminar esfuerzos con el fin de mejorar la salud bucal en las comunidades indígenas.

Objective This study was aimed at determining periodontal treatment needs, as determined by the Community Periodontal Index of Treatment Need (CPITN), in a sample of adults from the Mixteca region of the State of Puebla, in Mexico. Materials and Methods This was a descriptive, cross-sectional, single-centre study. Previous informed consent was obtained; 60.0 percent of the sample were women whose main activity was housework (46 percent), 14.0 percent were farmers. Average age was 37.6 ± 13.6. Gingival and Community Periodontal Index of Treatment Need proposed by the World Health Organisation and the International Dental Federation were used; they were implemented by the same, previously-standardised researcher. Means, standard deviations and confidence intervals were calculated for dimensional variables and percentages for categorical ones. Results The gingival index gave 50.0 percent light gingivitis, 32.0 percent moderate and 14.0 percent severe gingivitis. The rear superior sextants commonly showed more 4 to 5 mm pockets, the front sextants calculus and the rear inferior sextants showed calculus and bleeding. 94.0 percent of the patients required periodontal treatment (3.6 sextants per patient average). Conclusions Periodontal treatment needs were high in this study; nine out of ten patients in the Mixteca region of the State of Puebla required periodontal treatment. Efforts must thus be guided towards improving oral health in indigenous communities.

Determination of postmortem fluoxetine concentration in blood, liver, hair and in different regions of brain of albino rats

Fluoxetine is a selective serotonin reuptake inhibitor [SSRI]. Measurements of postmortem levels of the drug are helpful to demonstrate its usefulness in. forensic toxicology. For this reason, a rapid and sensitive high- pressure liquid chromatographic method has been developed for determination of the antidepressant fluoxetine in postmortem samples for 50 rats given intraperitoneal fluoxetine hydrochloride at the therapeutic levels. The postmortem samples were including blood, hair, liver, and discrete brain regions [raphenucleus, hypothalamus, and brain striatum].Fifty rats weighing from 200-250 gm. Rats were divided into 5 groups 10 rats per each group: group [1] was given ordinary rat diet, group [2] received 1ml/kg distilled water, group [3] was given fluoxetine hydrochloride once at a dose of 20mg/kg 30 minutes before killing and collection of samples, group [4] was given 10mg/kg fluoxetine hydrochloride once daily for 15 days and killed 30 minutes after the last dose, group [5] was given 10mg/kg. fluoxetine hydrochloride once daily for 9 days then killed on the 10th day after 30 minutes of 20mg/kg fluoxetine hydrochloride. Rats were sacrificed by decapitation and samples were collected immediately after death. In group III, the highest postmortem levels were observed in the raphenucleus followed by brain striatum, then the blood. In group IV, the highest postmortem levels were in hair followed by raphenucleus, then striatum followed by the liver. Meanwhile, in Group V, hair showed the highest postmortem levels followed by brain striatum then raphenucleus and lastly the liver. In conclusion, while blood is still the preferred matrix to link concentration and effect, analysis of hair, liver, and brain tissue can provide additional valuable information, not only in pure overdose cases

Green tea extract administration protects against the nephrotoxicity induced by gentamycin and amikacin in rats

Despite their beneficial effects, aminoglycosides including gentamycin [GEN] and amikacin [AK] have considerable nephrotoxic side effects. This study investigaged the effects of green tea [GT] extract on biochemical and morphological kidney damage induced by GEN and AK in rats. Sixty male albino rats were used in this study and divided into 6 groups each contains ten rats. The first group was the control group injected with 0.4 ml saline. Each rat of the second group was given 12.5 ml of green tea extract [3%] twice daily to drink it orally for 25 days. The 3[rd] group received GEN [80mg/kg] once daily intraperitoneally for 10 days. The 4[th] group was administered AK [180 mg/kg] once daily intraperitoneally for 10 days. The 5[th] group received GT extract for 15 days then concomitant with GEN for 10 days. The 6[th] group received GT extract for 15 days then concomitant with AK for 10 days. GEN and AK groups showed significant increase in serum urea and creatinine [Cr] which was significantly decreased in green tea consuming rats before GEN and AK administration. GEN and AK treated rats showed significant decrease in the activity of calalase enzyme and reduced glutathione level in kidney tissues which were significantly increased in GT consuming rats prior to GEN and AK injection. Light microscopic examination of kidney tissues of GEN and AK groups revealed tabular necrosis and degenerative changes which were modulated by the consumption of green tea prior to GEN and AK administration. In conclusion green tea ameliorates and modulates GEN and AK induced-nephrotoxicity and oxidative damage by enhancing the antioxidant defense system

effect of vitamin E administration on cisplatin-induced oxidative and histopathological damage of kidney, liver and lens tissues in albino rats

Cisplatin is one of the most active cytotoxic agents in the treatment of cancer but its clinical use is associated with toxicity. The present study evaluated biochemically and histologically the effect of vitamin E as a line of prevention of cisplatin toxicity in rats. Its was carried out on 90 adult male albino rats divided into 6 groups each contains 15 rats, the first group was used as-ve control, the second group received distilled water 1ml/animal intraperitoneally [IP], the third group received corn oil 0.25 ml/animal orally,the fourth group received vitamin E 100 mg/kg orally. Animals of groups II, III and IV served as +ve controls. The fifth group received cisplatin 5 mg/kg IP and the sixth group received vitamin E 100 mg/kg orally 24 hours prior to IP cisplatin 5 mg/kg. After 7 days of treatment, rats were sacrificed,then Malondialdehyde [MDA], reduced glutathione and glutathione perioxidase were measured in kidney, liver and lens tissues. Also kidney, liver and lens tissues were prepared for light microscopic examination. The results revealed significant increase in kidney, liver and lens MDA levels in rats treated with cisplatin in comparison to the-ve control group. Reduced glutathione and glutathione perioxidase levels in kidney, liver and lens were significantly lower in cisplatin group than in the-ve control group. Histopathological examination revealed renal and liver necrosis and cataract changes in cisplatin treated rats. The increased MDA levels, the decreased antioxidant enzymes and histopathological damage in the kidney, liver and lens of rats administered cisplatin were significantly improved with vitamin E administration. So, it is concluded that, vitamin E may play a role in preventing cisplatin induced nephrotoxicity, hepatotoxicity and cataract formation in cancer patients