Consensus on the diagnosis and treatment of cow's milk protein allergy of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein.

Quantifying Fusion Born Ion Populations in Magnetically Confined Plasmas using Ion Cyclotron Emission.

Ion cyclotron emission (ICE) offers a unique promise as a diagnostic of the fusion born alpha-particle population in magnetically confined plasmas. Pioneering observations from JET and TFTR found that ICE intensity P_{ICE} scales approximately linearly with the measured neutron flux from fusion reactions, and with the inferred concentration, n_{α}/n_{i}, of fusion born alpha particles confined within the plasma. We present fully nonlinear self-consistent kinetic simulations that reproduce this scaling for the first time. This resolves a long-standing question in the physics of fusion alpha-particle confinement and stability in magnetic confinement fusion plasmas. It confirms the magnetoacoustic cyclotron instability as the likely emission mechanism and greatly strengthens the basis for diagnostic exploitation of ICE in future burning plasmas.

Asociación entre el conocimiento de las mujeres peruanas acerca del VIH y sus actitudes frente a personas infectadas / Association between knowledge of Peruvian women about HIV and their attitudes towards infected people

Objetivo: Determinar la asociación entre el conocimiento de las mujeres peruanas acerca del VIH con sus actitudes frente a las personas con VIH y sus características socio demográficas. Métodos: Análisis secundario de la Encuesta Demográfica y de Salud Familiar (ENDES) del año 2011. El conocimientos sobre VIH se evaluó mediante cinco preguntas: ¨se puede reducir el riesgo teniendo solo una pareja sexual?, ¨usando siempre condón?, ¨una persona saludable puede tener VIH?, ¨se puede contraer el VIH por besos y abrazos?, ¨por utensilios? Se consideró conocimiento adecuado si se contestó correctamente las cinco preguntas (directrices para el Desarrollo de Indicadores Básicos para el seguimiento de la Declaración Política sobre VIH/SIDA). La actitudes frente a personas infectadas se evaluaron mediante seis preguntas: si niño(a) tiene infección por VIH, ¨se le debe permitir asistir a la escuela o colegio? si un médico tiene infección por VIH, ¨se le debe permitir que siga con su trabajo en el establecimiento de salud? si una persona tiene infección por VIH y necesita operarse, ¨deben permitirle la operación?; ¨compraría vegetales de un vendedor con SIDA?; si un profesor tiene infección por VIH, ¨se le debe permitir seguir impartiendo clases en la escuela, colegio o universidad? Los análisis fueron realizados empleando el procedimiento de ponderación establecido por el INEI. Resultados: La pregunta sobre conocimiento mejor respondida fue la referida al uso del condón para disminuir el riesgo de contagio (86.5 por ciento), mientras que el 35.2 p respondió erróneamente que se puede contraer el VIH al compartir utensilios con una persona infectada...

Objective: To determine the association between the Peruvian women's knowledge about HIV and her attitudes towards the people with HIV, and the socio-demographic features. Methods: Secondary analysis of the Demographic and Family Health Survey (ENDES in espanish) 2011. The knowledge about HIV was measured with five questions: can the risk of contracting HIV be reduced by having only one sexual partner?, by using condom? A person who seems healthy, can have HIV? Can HIV be contracted by kisses and hugs?, by utensils? It was considered an adequate knowledge if the woman answered correctly the five questions (Guidelines on construction of core indicators for monitoring the political declaration of HIV/AIDS). The attitudes towards people with HIV was evaluated through six questions: if a child have HIV infection, should he or she be allowed to go to the school?; if a doctor have HIV infection, should he or she be allowed to continue working in a health center?; if a person with HIV need a surgery, should he or she be allowed to have the surgery?; would you buy vegetables from a seller with AIDS?; if a teacher have HIV infection, should he or she continue giving classes in the school, college or university? Every analysis was done using the weights established by the Statistics and Informatics National Institute (INEI). Results: The question about knowledge best answered was the one about using condom to reduce the risk of infection (86.5 percent), while 35.2 percent answered that HIV can be contracted by sharing utensils with a person infected. Only 38.9 percent answered correctly the five questions about knowledge. The best attitudes were observed in the scenario of a person with HIV who need a surgery and about the decision of firing an infected person, while the worst attitudes were observed about allowing a doctor with HIV to continue working and buying vegetables to a seller with AIDS...

Dynamics and transport in mean-field coupled, many degrees-of-freedom, area-preserving nontwist maps.

Area-preserving nontwist maps, i.e., maps that violate the twist condition, arise in the study of degenerate Hamiltonian systems for which the standard version of the Kolmogorov-Arnold-Moser (KAM) theorem fails to apply. These maps have found applications in several areas including plasma physics, fluid mechanics, and condensed matter physics. Previous work has limited attention to maps in 2-dimensional phase space. Going beyond these studies, in this paper, we study nontwist maps with many-degrees-of-freedom. We propose a model in which the different degrees of freedom are coupled through a mean-field that evolves self-consistently. Based on the linear stability of period-one and period-two orbits of the coupled maps, we construct coherent states in which the degrees of freedom are synchronized and the mean-field stays nearly fixed. Nontwist systems exhibit global bifurcations in phase space known as separatrix reconnection. Here, we show that the mean-field coupling leads to dynamic, self-consistent reconnection in which transport across invariant curves can take place in the absence of chaos due to changes in the topology of the separatrices. In the context of self-consistent chaotic transport, we study two novel problems: suppression of diffusion and breakup of the shearless curve. For both problems, we construct a macroscopic effective diffusion model with time-dependent diffusivity. Self-consistent transport near criticality is also studied, and it is shown that the threshold for global transport as function of time is a fat-fractal Cantor-type set.

Short communication: Detection of Shiga toxin-producing Escherichia coli (STEC) in healthy cattle and pigs in Lima, Peru.

The aim of this study was to determine the prevalence of Shiga toxin-producing Escherichia coli (STEC) in cattle and pigs as a possible STEC reservoir in Lima, Peru. One hundred and fourteen cattle and 112 pigs from 10 and 4 farms, respectively, were studied. Five E. coli colonies per culture were studied by a multiplex real-time PCR to identify Shiga toxin-producing (stx1, stx2, eaeA), enterotoxigenic (lt, st), enteropathogenic (eaeA), enteroinvasive (ipaH), enteroaggregative (aggR), and diffusely adherent E. coli (daaD). Shiga toxin-producing E. coli were isolated from 16 cattle (14%) but none from pigs. stx1 was found in all bovine isolates, 11 of which also carried eaeA genes (69%); only 1 sample had both stx1 and stx2. Thirteen stx-positive strains were classified as Shiga-toxigenic (81%) using an enzymatic immunoassay, 2 STEC strains were from serogroup O157 (13%), and 7 were sorbitol negative (44%). Enteropathogenic E. coli were detected more frequently in cattle (18%, 20/114) than in pigs (5%, 6/112). To our knowledge, this is the first study on the prevalence of STEC in farms animals in Peru using molecular methods. Further studies are needed in a large number of farms to determine the relevance of these findings and its consequences for public health.

Síndrome pospolio: informe de un caso / Post-polio syndrome: a case report

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[Nutritional evaluation of Lepidium meyenii (MACA) in albino mice and their descendants]. / Evaluación nutricional de Lepidium meyenii (MACA) en ratones albinos y su descendencia.

The Maca (Lepidium meyenii) is a Peruvian hypocotyl that grows exclusively between the 3700 and 4500 masl at the Peruvian Andes. Traditionally it is attributed nutritional, energizing, fertilizing properties among others. With the purpose of evaluate scientifically the nutritional property of Maca, we carried out a controlled study in two generations of albino Swiss mice (parents and breeding). The parents were aleatorily assigned to one of three nutritional schedules. The food of each group was prepared based on powder from a commercial balanced food (CBF) of which 30% was replaced by raw or cooked Maca according to the corresponding group or pure CBF in the control group. The groups were this way: 1) Raw Maca Group; 2) Cooked Maca Group; and, 3) Control Group. The results showed that the curves of growth were similar and adequate for the three groups. However, the cooked Maca group showed the best curve. These data were better observable in the second generation of animals, with significant statistical difference (p < 0.05). The CBF group had a better growth than raw Maca group. No signs of malnutrition nor overweight were observed in none of the groups. The serum values of total proteins and albumin were statistically superior for the mice group eating cooked Maca than that of the raw Maca and CBF groups. This study demonstrates, in a scientifical evaluation, one of the traditionally attributed properties of Maca, the nutritional capability.

Role of manometry, defecography and anal endosonography in the evaluation of colorectal disorders.

OBJECTIVE: altered motility or anatomy of the rectum, anus and perineal floor may lead to symptoms which are unresponsive to routine therapeutic approaches. These disturbances usually lead to constipation, fecal incontinence, or both. Different tests and techniques for evaluating anorectal and perineal disorders, developed in the last two decades, make a better understanding of these disorders possible. This study was designed to evaluate the diagnostic benefits of combining manometry, defecography and anal endosonography in the assessment of patients with anorectal disorders. METHODS: twenty-five children with constipation (with or without soiling), incontinence and/or prolapse underwent anal manometry, defecography and anal endosonography. Group A consisted of 9 children with fecal incontinence, group B consisted of 10 children with constipation with soiling, and group C comprised 6 children with constipation without soiling. RESULTS: in group A resting incontinence was associated with a hypotonic external sphincter in 4 out of 9 patients, 2 of whom had internal anal sphincter thinning. In group B resting incontinence was associated with a hypotonic external sphincter in 8 out of 10 patients, 6 of whom had internal anal sphincter thinning. In group C these associations were not seen in any of the patients. CONCLUSIONS: barium enema is not sufficient for an accurate diagnosis of anorectal disorders. No single test is capable of revealing the type of disease. Anal manometry, defecography and endosonography are complementary procedures in the assessment of this group of disorders. This new approach will improve our knowledge of the pathogenesis of these disorders in children. However, further studies are needed to obtain conclusive evidence.

Manometría, defecografía y ecografía endoanal en el estudio de los trastornos ano-rectales / Role of manometry, defecography and anal endosonography in the evaluation of colorectal disorders

INTRODUCCIÓN: la alteración de la motilidad o la, anatomía del recto, ano y piso perineal puede causar una sintomatología resistente a las actuaciones terapéuticas habituales. Estos trastornos suelen presentar estreñimiento y/o incontinencia. Se han desarrollado en las últimas dos décadas estudios para la valoración ano-rectal y perineal que han permitido comprender mejor estos problemas. OBJETIVO: valoración de la rentabilidad diagnóstica de la manometría ano-rectal, defecografía y ecografía endoanal combinadas en el estudio de trastornos ano-rectales. PACIENTES Y MÉTODO: se estudian 25 niños afectos de estreñimiento con o sin ensuciamiento, incontinencia y/o prolapso; grupos: A (n = 9) incontinencia; 13 (n = 10) estreñimiento con ensuciamiento; C (n = 6) estreñimiento aislado. Se les practicó manometría, defecografía y ecografía endoanal. RESULTADOS: en el grupo A destaca la asociación de incontinencia en reposo con hipotonía del esfínter anal externo (4/9), y en dos de ellos se evidencia un esfínter anal interno adelgazado. En el grupo B se observa la asociación de incontinencia en reposo e hipotonía del esfínter anal externo (8/10), con adelgazamiento de esfínter anal interno en s is de ellos. En el grupo C no se aprecian estas asociaciones. CONCLUSIONES: 1) el enema opaco no es suficiente para llegar al diagnóstico de las disfunciones ano-rectales. 2) Una sola exploración por sí misma no es capaz de diagnosticar el tipo de alteración. Estudios como manometría, defecografía y ecografía endoanal se complementan en el estudio de este grupo de afecciones, 3) Este nuevo enfoque hará que la patogenia de estos trastornos sea cada vez más conocida en Pediatría. 4) Nuevos estudios son necesarios para poder llegar a conclusiones definitivas (AU)

Circadian rhythmicity in the GABAergic system in the suprachiasmatic nuclei of the rat.

The participation of GABAergic mechanisms in the regulation of circadian rhythmicity by the suprachiasmatic nuclei (SCN) has been suggested from different lines of evidence. Little is known, however, whether GABA synthesis, release, uptake or content within the SCN may show a circadian pattern. The present results show that the activity of the GABAergic system within the SCN region of the rat exhibits circadian rhythmicity, which is manifested by correlative changes of the GABA content and the glutamic acid decarboxylase activity under the light/dark cycle, and by changes in the GABA content in animals kept under constant darkness.

Fecal contamination of shanty town toddlers in households with non-corralled poultry, Lima, Peru.

We used direct observer techniques to measure the frequency with which toddler-aged children were contaminated by poultry feces in homes in a peri-urban shanty town in Lima, Peru. The mean number of fowl was 5.4 (SD 3.1), with 10.0 (SD 10.7) poultry defecations per 12 hours. Toddlers' hand contact with poultry feces occurred a mean of 2.9 (SD 3.0) times/12 hours. A mean of 3.9 (SD 4.6) feces-to-mouth episodes per household/12 hours occurred both by direct hand-to-mouth contamination and indirectly by handling soiled objects which were then placed in the mouth. There was a strong correlation between feces-to-hand contamination and feces-to-mouth contamination (r = 0.94). There was also an association between feces-to-mouth contamination and the number of stools deposited in the house (r = 0.66). For each additional chicken stool deposited during the day, there was an average increase of 0.27 in feces-to-mouth episodes. We collected feces from 68 infected chickens and found viable Campylobacter jejuni for up to 48 hours after deposition. Yet, a survey of 108 families demonstrated that free-roaming poultry were often not thought of as a health risk for children. An intervention program to reduce oral-fecal contamination should emphasize that all poultry be corralled and not allowed access into the house.

El plomo como causa de intoxicacion aguda y cronica en la ninez. / The lead as cause of chronic and acute intoxication in children

Se presenta la experiencia del servicio de Medicina Interna del Instituto Nacional de Pediatria con 7 pacientes que cursaron con intoxicacion por plomo.Se analizan los aspectos tanto epidemiologicos del contacto y de las vias de intoxicacion como las manifestaciones clinicas, comparando los casos con lo publicado en la literatura mundial. Se hace hincapie en la necesidad que tiene el pediatra de conocer el cuadro clinico y difundir este para el reconocimiento oportuno y prevencion de esta patologia

Evaluacion comparativa de dos formulas alimenticias en ninos con diarrea aguda. / Comparative evaluation of 2 feeding formulas in children with acute diarrhea

Se estudiaron 61 pacientes con diarrea aguda y deshidratacion del 5-10%, para valorar su comportamiento clinico al recibir una de las dos formulas alimenticias estudiadas, a saber: dieta transicional (DT) y formula especial (HN-25) inmediatamente despues de corregir el desequilibrio hidroelectronico (D.H.E.). Los resultados muestran una diferencia estadisticamente significativa (p < 0.05) en el grupo de enfermos con deshidratacion al 5% que recibieron la formula especial durante las primeras 24 horas de ayuno. Se observo que los parametros: edad, sexo, condicion socioeconomica y agente causal de la diarrea no modifican el comportamiento del cuadro enteral con ninguno de los alimentos recibidos. La necesidad de preparar una de la formulas (D.T.) en el hospital, constituye una desventaja para su uso en pacientes ambulatorios. La existencia de un preparado comercial con un contenido bajo en lactosa y grasas y elevado en electrolitos y vitaminicos, lo hace de mayor utilidad para los enfermos no hospitalizados y tambien para aqueles que han requerido internamiento en un hospital

Enfermedad de Niemann-Pick. Estudio de dos casos. / Niemann-Pick disease.Study of 2 cases

Se presentan los dos primeros casos de enfermedad de Niemann-Pick diagnosticados en el Instituto Nacional de Pediatria DIF. Se describen sus caracteristicas clinicas y sus datos de laboratorio. Se hace una revision de la literatura de este trastorno congenito del metabolismo