Efectividad de la intervención motora temprana en el desarrollo motor de los niños con parálisis cerebral entre 3 y 5 años de edad. Revisión sistemática / Effectiveness of early motor interventions in children with cerebral palsy between 3 to 5 years of age: Systematic review

La intervención motora temprana es esencial en niños con parálisis cerebral; sin embargo, se desconoce su efectividad entre los 3 y los 5años. El objetivo fue determinar la efectividad de la intervención motora temprana en el desarrollo motor de dicha población. Se realizó una revisión sistemática de literatura acerca de intervenciones motoras tempranas realizada en diferentes bases de datos como Pubmed/Medline, PEDro, OTSeeker, Embase y LILACS. Finalmente se seleccionaron 18 artículos, de los cuales 4 presentaron cambios a favor del grupo experimental en los desenlaces desarrollo motor global y función motora manual, con la terapia de integración sensorial y la terapia de movimiento inducido por restricción, respectivamente; no obstante, los resultados no fueron estadísticamente significativos y el nivel de evidencia fue bajo. La intervención motora temprana podría incluirse con precaución para la mejoría del desarrollo motor global y la función manual. Es necesario realizar estudios de mayor calidad metodológica. (AU)

Early motor intervention is essential in children with cerebral palsy; however, it is unknown its effectiveness between 3 to 5years. The objective was to determinate the effectiveness of early motor intervention in the motor development of this population. A systematic literature search was performed in Pubmed/Medline, PEDro, OTSeeker, Embase, and LILACS. Finally, 18 articles were selected, of which 4 showed favorable changes in the experimental group in the outcomes of overall motor development and manual motor function, with sensory integration therapy and movement-induced restriction therapy, respectively; however, the results were not statistically significant, and the level of evidence was low. Early motor intervention could be cautiously considered for improving overall motor development and manual function. Higher-quality methodological studies are necessary. (AU)

[Effectiveness of early motor interventions in children with cerebral palsy between 3 to 5years of age: Systematic review]. / Efectividad de la intervención motora temprana en el desarrollo motor de los niños con parálisis cerebral entre 3 y 5años de edad. Revisión sistemática.

Early motor intervention is essential in children with cerebral palsy; however, it is unknown its effectiveness between 3 to 5years. The objective was to determinate the effectiveness of early motor intervention in the motor development of this population. A systematic literature search was performed in Pubmed/Medline, PEDro, OTSeeker, Embase, and LILACS. Finally, 18 articles were selected, of which 4 showed favorable changes in the experimental group in the outcomes of overall motor development and manual motor function, with sensory integration therapy and movement-induced restriction therapy, respectively; however, the results were not statistically significant, and the level of evidence was low. Early motor intervention could be cautiously considered for improving overall motor development and manual function. Higher-quality methodological studies are necessary.

TPEN selectively eliminates lymphoblastic B cells from bone marrow pediatric acute lymphoblastic leukemia patients.

B-cell acute lymphoblastic leukemia (B-ALL) is a hematologic disorder characterized by the abnormal proliferation and accumulation of immature B-lymphoblasts arrested at various stages of differentiation. Despite advances in treatment, a significant percentage of pediatric patients with precursor B-ALL still relapse. Therefore, alternative therapies are needed to improve the cure rates for pediatric patients. TPEN (N, N, N', N'-tetrakis(2-pyridylmethyl)-ethylenediamine) is a pro-oxidant agent capable of selectively inducing apoptosis in leukemia cell lines. Consequently, it has been suggested that TPEN could be a potential agent for oxidative therapy. However, it is not yet known whether TPEN can selectively destroy leukemia cells in a more disease-like model, for example, the bloodstream and bone marrow (BM), ex vivo. This investigation is an extension of a previous study that dealt with the effect of TPEN on ex vivo isolated/purified refractory B-ALL cells. Here, we evaluated the effect of TPEN on whole BM from nonleukemic patients (control) or pediatric patients diagnosed with de novo B-ALL or refractory B-ALL cells by analyzing the hematopoietic cell lineage marker CD34/CD19. Although TPEN was innocuous to nonleukemic BM (n = 3), we found that TPEN significantly induced apoptosis in de novo (n = 5) and refractory B-ALL (n = 6) leukemic cell populations. Moreover, TPEN significantly increased the counts of cells positive for the oxidation of the stress sensor protein DJ-1, a sign of the formation of H2O2, and significantly increased the counts of cells positive for the pro-apoptotic proteins TP53, PUMA, and CASPASE-3 (CASP-3), indicative of apoptosis, in B-ALL cells. We demonstrate that TPEN selectively eliminates B-ALL cells (CD34 + /CD19 +) but no other cell populations in BM (CD34 + /CD19-; CD34-/CD19 + ; CD34-/CD19-) independent of age, diagnosis status (de novo or refractory), sex, karyotype, or immunophenotype. Understanding TPEN-induced cell death in leukemia cells provides insight into more effective therapeutic oxidation-inducing anticancer agents.

Behavior of detoxifying enzymes of Aedes aegypti exposed to girgensohnine alkaloid analog and Cymbopogon flexuosus essential oil.

Because mosquito control depend on the use of commercial insecticides and resistance has been described in some of them, there is a need to explore new molecules no resistant. In vivo effects of girgensohnine analog 2-(3,4-dimethoxyphenyl)-2-(piperidin-1-yl)acetonitrile DPPA and Cymbopogon flexuosus essential oil CFEO, on the detoxifying enzymes acetylcholinesterase (AChE), glutathione-S-transferase (GST), nonspecific esterases (α- and ß-), mixed function oxidases (MFO) and p-NPA esterases were evaluated on a Rockefeller (Rock) and wild Aedes aegypti population from Santander, Colombia (WSant). The action was tested after 24h of exposure at concentrations of 20.10, 35.18 and 70.35mgL-1 of DPPA and 18.45, 30.75 and 61.50mgL-1 of CFEO, respectively. It was found that AChE activity of Rock and WSant was not influenced by the evaluated concentration of DPPA and CFEO (p>0.05), while MFO activity was significantly affected by all CFEO concentrations in WSant (p<0.05). GST, α- and ß-esterase activities were affected in Rock exposed at the highest CFEO concentration, this concentration also modified ß-esterases activity of WSant. DPPA and CFEO sublethal doses induced inhibition of AChE activity on untreated larvae homogenate from 12 to 20% and 18 to 26%, respectively. For untreated adult homogenate, the inhibition activity raised up to 14 to 27% for DPPA and 26 to 34% for CFEO. Elevated levels of detoxifying enzymes, found when CFEO was evaluated, showed a larval sensitivity not observed by the pure compound suggesting that DPPA, contrary to CFEO, was not recognized, transformed or eliminated by the evaluated detoxifying enzymes.

Treatment of nail psoriasis with Pulse Dye Laser plus calcipotriol betametasona gel vs. Nd:YAG plus calcipotriol betamethasone gel: An intrapatient left-to-right controlled study.

BACKGROUND: Treatment of nail psoriasis remains a challenging and often disappointing situation. OBJECTIVE: To compare the efficacy, adverse reactions and tolerability of treatment of nail psoriasis with PDL vs. Nd:YAG, in association with betametasona calcipotriol gel. METHODS: An open, prospective intrapatient left-to-right study was designed. The right hand of each patient received treatment with PDL and the left hand with Nd:YAG. Betamethasone calcipotriol gel was applied once a day during the first week after each laser session. A total of four sessions were administered. RESULTS: The clinical efficacy was evaluated according to the NAPSI score. All patients showed improvement in nail bed and nail matrix psoriasis. The global NAPSI mean declined in 15.46 (p<0.000). There was neither statistical difference between the reduction in nail bed and matrix NAPSI nor in the treatment with PDL vs. Nd:YAG. The administration of Nd:YAG was more painful. No serious adverse effects were documented. LIMITATIONS: No random assignment and the small number of patients. CONCLUSIONS: PDL and Nd:YAG have proven to be an effective treatment for nail psoriasis with no serious adverse effect. No statistically significant difference was found between the two treatments.

A cost-efficiency and health benefit approach to improve urban air quality.

When ambient air quality standards established in the EU Directive 2008/50/EC are exceeded, Member States are obliged to develop and implement Air Quality Plans (AQP) to improve air quality and health. Notwithstanding the achievements in emission reductions and air quality improvement, additional efforts need to be undertaken to improve air quality in a sustainable way - i.e. through a cost-efficiency approach. This work was developed in the scope of the recently concluded MAPLIA project "Moving from Air Pollution to Local Integrated Assessment", and focuses on the definition and assessment of emission abatement measures and their associated costs, air quality and health impacts and benefits by means of air quality modelling tools, health impact functions and cost-efficiency analysis. The MAPLIA system was applied to the Grande Porto urban area (Portugal), addressing PM10 and NOx as the most important pollutants in the region. Four different measures to reduce PM10 and NOx emissions were defined and characterized in terms of emissions and implementation costs, and combined into 15 emission scenarios, simulated by the TAPM air quality modelling tool. Air pollutant concentration fields were then used to estimate health benefits in terms of avoided costs (external costs), using dose-response health impact functions. Results revealed that, among the 15 scenarios analysed, the scenario including all 4 measures lead to a total net benefit of 0.3M€·y(-1). The largest net benefit is obtained for the scenario considering the conversion of 50% of open fire places into heat recovery wood stoves. Although the implementation costs of this measure are high, the benefits outweigh the costs. Research outcomes confirm that the MAPLIA system is useful for policy decision support on air quality improvement strategies, and could be applied to other urban areas where AQP need to be implemented and monitored.

[Immune reconstitution inflammatory syndrome related with infliximab interruption in patient with Crohn's disease and active tuberculosis]. / Síndrome de reconstituição imune associado à interrupção do infliximab em doente com doença de Crohn e tuberculose activa.

Tumor necrosis factor alpha inhibitors are associated with an increased risk of active tuberculosis. However, its interruption in this setting may trigger a paradoxical response to tuberculosis treatment, as an immune reconstitution inflammatory syndrome. We present the case of a 36-year-old patient, with Crohn's disease, treated with infliximab for the last 8 years, who was admitted with miliary tuberculosis. A pan-susceptible Mycobacterium tuberculosis strain was isolated. Infliximab was interrupted and standard antituberculous therapy was started, as well as systemic corticotherapy, without any clinical or radiological improvement. After exclusion of other opportunistic infections and primary or acquired immunodeficiency, we considered the possibility of an immune reconstitution inflammatory syndrome triggered by infliximab interruption. Thus, infliximab was reintroduced after 2 months of antituberculous therapy and clinical and radiological improvement was observed.

Identification of Plantago lanceolata pollen allergens using an immunoproteomic approach.

BACKGROUND: Airborne Plantago pollen triggers respiratory allergies in Mediterranean countries. OBJECTIVES: We aimed to study sensitization in patients with seasonal respiratory allergy and identify proteins of Plantago lanceolata pollen that could be responsible for hypersensitivity reactions in sensitized patients. We also determined the airborne pollen concentration of Plantago species from 2004 to 2011. METHODS: IgE-binding proteins were analyzed and characterized using 1D and 2D gel electrophoresis and immunoblotting with sera from individuals sensitized to P lanceolata pollen extracts, mass spectrometry analysis, and protein data mining. We used aerobiological methods to study airborne pollen. RESULTS: P lanceolata pollen accounts for 3% of the annual pollen spectrum in the air of Porto. Of a total of 372 patients, 115 (31%) showed specific IgE levels to P lanceolata pollen extracts. All sera from P lanceolata-allergic patients recognized 8 prominent groups of IgE-reactive allergens. Separation of proteins using 2D gel electrophoresis followed by identification with mass spectrometry revealed the presence of other IgE-reactive components that could be involved in sensitization. CONCLUSIONS: We detected proteins in P lanceolata pollen extracts that, to our knowledge, have not yet been studied and could worsen sensitization to this weed pollen species. The proteins identified were involved in a variety of cellular functions. By applying 2D electrophoresis and immunoblotting with a pool of 2 sera from different P lanceolata-allergic patients, we obtained a more detailed characterization of the P lanceolata allergen profile.

Identification of plantago lanceolata pollen allergens using an immunoproteomic approach

Background: Airborne Plantago pollen triggers respiratory allergies in Mediterranean countries. Objectives: We aimed to study sensitization in patients with seasonal respiratory allergy and identify proteins of Plantago lanceolata pollen that could be responsible for hypersensitivity reactions in sensitized patients. We also determined the airborne pollen concentration of Plantago species from 2004 to 2011. Methods: IgE-binding proteins were analyzed and characterized using 1D and 2D gel electrophoresis and immunoblotting with sera from individuals sensitized to P lanceolata pollen extracts, mass spectrometry analysis, and protein data mining. We used aerobiological methods to study airborne pollen. Results: P lanceolata pollen accounts for 3% of the annual pollen spectrum in the air of Porto. Of a total of 372 patients, 115 (31%) showed specific IgE levels to P lanceolata pollen extracts. All sera from P lanceolata –allergic patients recognized 8 prominent groups of IgE-reactive allergens. Separation of proteins using 2D gel electrophoresis followed by identification with mass spectrometry revealed the presence of other IgE-reactive components that could be involved in sensitization. Conclusions: We detected proteins in P lanceolata pollen extracts that, to our knowledge, have not yet been studied and could worsen sensitization to this weed pollen species. The proteins identified were involved in a variety of cellular functions. By applying 2D electrophoresis and immunoblotting with a pool of 2 sera from different P lanceolata -allergic patients, we obtained a more detailed characterization of the P lanceolata allergen profile (AU)

Antecedentes: El polen de Plantago provoca alergia respiratoria en los países mediterráneos. Objetivos: El objetivo de este estudio fue analizar las sensibilizaciones de pacientes con alergia estacional e identificar las proteínas de polen de Plantago lanceolata que puedan ser responsables de las reacciones de hipersensibilidad en pacientes sensibles. Adicionalmente determinamos la concentración de polen de Plantago spp en el aire, en los años 2004-2011. Métodos: Las proteínas que se unen a la IgE fueron analizadas y caracterizadas a través de electroforesis en gel 1-D y 2-D e inmunobloting con suero de pacientes sensibilizados al polen de P. lanceolata . Se analizó mediante espectrometría de masas el contenido en las proteínas y se aplicaron métodos aerobiológicos para estudiar el espectro de polen en el ambiente. Resultados: En cuanto a los resultados obtenidos, el polen de P. lanceolata representa el 3% del espectro de polen anual en la atmósfera de Oporto. De los 372 pacientes, el 31% presentaban IgE específica frente al polen de P. lanceolata. Todos los sueros de los pacientes alérgicos a P. Lanceolata reconocían los ocho grupos prominentes de alérgenos reactivos a IgE. La separación de proteínas mediante electroforesis en gel 2-D, seguida de la espectrofotometría de masas permitieron identificar en el polen la presencia de otros componentes IgE reactivos que podrían estar implicados en la sensibilización de estos pacientes. Conclusiones: En conclusión, este estudio muestra la presencia de proteínas en el polen de P. Lanceolata que hasta ahora no habían sido estudiadas y que pueden intervenir en la sensibilización a éste polen. Se detectaron proteínas involucradas en una gran variedad de funciones celulares. Mediante las técnicas aplicadas en este estudio, entre ellas el inmunobloting, nos permite realizar una detallada caracterización del perfil alergénico del polen de P. lanceolata (AU)

Design, synthesis, acetylcholinesterase inhibition and larvicidal activity of girgensohnine analogs on Aedes aegypti, vector of dengue fever.

Girgensohnine alkaloid was used as a natural model in the design and generation of new alkaloid-like α-aminonitrile series that was completed by the use of SSA-catalyzed Strecker reaction between commercial and inexpensive substituted benzaldehydes, piperidine (pyrrolidine, morpholine and N-methylpiperazine) and acetone cyanohydrin. Calculated ADMETox parameters of the designed analogs revealed their good pharmacokinetic profiles indicating lipophilic characteristics. In vitro AChE enzyme test showed that obtained α-aminonitriles could be considered as AChEIs with micromolar IC50 values ranging from 42.0 to 478.0 µM (10.3-124.0 µg/mL). Among this series, the best AChE inhibitor was the pyrrolidine α-aminonitrile 3 (IC50 = 42 µM), followed by the piperidine α-aminonitriles 2 and 6 (IC50 = 45 µM and IC50 = 51 µM, respectively), and the compound 7 (IC50 = 51 µM). In vivo insecticidal activity of more active AChEIs against Aedes aegypti larvae was also performed showing a good larvicidal activity at concentrations less than 140 ppm, highlighting products 2 and 7 that could serve as lead compounds to develop new potent and selective insecticides.

Nanomechanical properties of multi-block copolymer microspheres for drug delivery applications.

Biodegradable polymeric microspheres are interesting drug delivery vehicles for site-specific sustained release of drugs used in treatment of osteoarthritis. We study the nano-mechanical properties of microspheres composed of hydrophilic multi-block copolymers, because the release profile of the microspheres may be dependent on the mechanical interactions between the host tissues and the microspheres that aim to incorporate between the cartilage surfaces. Three different sizes of monodisperse microspheres, namely 5, 15, and 30µm, were tested in both dry and hydrated (swollen) states. Atomic force microscopy was used for measuring nanoindentation-based force-displacement curves that were later used for calculating the Young׳s moduli using the Hertz׳s contact theory. For every microsphere size and condition, the measurements were repeated 400-500 times at different surface locations and the histograms of the Young׳s modulus were plotted. The mean Young׳s modulus of 5, 15, and 30µm microspheres were respectively 56.1±71.1 (mean±SD), 94.6±103.4, and 57.6±58.6MPa under dry conditions and 226.4±54.2, 334.5±128.7, and 342.5±136.8kPa in the swollen state. The histograms were not represented well by the average Young׳s modulus and showed three distinct peaks in the dry state and one distinct peak in the swollen state. The peaks under dry conditions are associated with the different parts of the co-polymeric material at the nano-scale. The measured mechanical properties of swollen microspheres are within the range of the nano-scale properties of cartilage, which could favor integration of the microspheres with the host tissue.

Tos ferina y parada cardiorrespiratoria secundaria a bradicardia durante accesos de tos / Whooping cough and cardiorespiratory arrest secondary to a bradycardia during coughing spells

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Dynamics of the control of Aedes (Stegomyia) aegypti Linnaeus (Diptera, Culicidae) by Bacillus thuringiensis var israelensis, related with temperature, density and concentration of insecticide

The dynamics of the control of Aedes (Stegomyia) aegypti Linnaeus, (Diptera, Culicidae) by Bacillus thuringiensis var israelensis has been related with the temperature, density and concentration of the insecticide. A mathematical model for biological control of Aedes aegypti with Bacillus thuringiensis var israelensis (Bti) was constructed by using data from the literature regarding the biology of the vector. The life cycle was described by differential equations. Lethal concentrations (LC50 and LC95) of Bti were determined in the laboratory under different experimental conditions. Temperature, colony, larvae density and bioinsecticide concentration presented marked differences in the analysis of the whole set of variables; although when analyzed individually, only the temperature and concentration showed changes. The simulations indicated an inverse relationship between temperature and mosquito population, nonetheless, faster growth of populations is reached at higher temperatures. As conclusion, the model suggests the use of integrated control strategies for immature and adult mosquitoes in order to achieve a reduction of Aedes aegypti.

Foi elaborado um modelo matemático do controle biológico de Aedes aegypti com foco em Bacillus thuringiensis var israelensis (Bti). Na construção do modelo foram utilizados dados da literatura sobre a biologia do vetor, no qual o ciclo de vida foi descrito através de equações diferenciais. As concentrações letais (CL50 e CL95) do Bti foram determinadas no laboratório sob diferentes condições experimentais. As variáveis temperatura, colônia, densidade de larvas e concentração do bioinseticida acusaram diferenças significativas quando analisadas no modelo geral, porém quando analisadas individualmente, apenas a temperatura e concentração apresentaram diferenças. As simulações do modelo indicam que a temperatura afeta inversamente a produção de indivíduos e que os pontos máximos de produção de mosquitos são atingidos mais rápido a temperaturas maiores. Concluímos, com a simulação do modelo, que estratégias integradas de controle de imaturos e adultos devem ser utilizadas para atingir redução expressiva da população de Aedes aegypti.

Modelo de simulación para el control del mosquito Aedes aegypti, transmisor del dengue y la fiebre amarilla, por el crustáceo Mesocyclops spp / A simulation model for the control of the Aedes aegypti, the mosquito vector of dengue and yellow fever, by the crustacean Mesocyclops spp

OBJETIVOS: Se presenta un modelo de simulación que muestra la dinámica de depredación de Mesocyclops spp., sobre Aedes aegypti MÉTODOS: Representado por cuatro ecuaciones diferenciales: H'(t), cantidad de huevos; L'(t), cantidad de larvas; A'(t), cantidad de adultos y C'(t), cantidad de copépodos. Inicialmente las ecuaciones son del tipo clásico presa-depredador, según Lotka y Volterra. Posteriormente se modifica en un sistema con respuesta funcional para invertebrados, según Holling. RESULTADOS: El primer sistema controla y estabiliza la población de mosquitos, el segundo muestra que los copepodos son inefectivos como controladores. CONCLUSIONES: Se reconoce la necesidad de estudiar sistemas presa depredador (mosquitos - copepodos) con trabajos que integren pruebas de laboratorio y de campo. Solo así será posible establecer la validez en el uso de estos últimos como controladores biológicos efectivos de mosquitos.

Cross sectional survey of perpetrators, victims, and witnesses of violence in Bogotá, Colombia.

OBJECTIVES: To establish the prevalence and distribution of witnesses, victims, and perpetrators of different types of violence in the general population and the proportion of victims consulting health services or reporting the incident to authorities. METHODS: Cross sectional survey of a random sample of 3007 inhabitants between the ages of 15 and 60 in the city of Bogotá, Colombia, in 1997, based on a face to face interview. RESULTS: Age adjusted past year prevalence of witnesses, victims, and perpetrators of physical aggression was 61%, 27%, and 27%, respectively, while lifetime prevalence of witnesses, victims, and perpetrators of assault with a weapon in this population reached 70%, 55%, and 5.8%. Between 11% and 67% of the victims consulted a health service and less than 32% reported the incident to an authority. Those involved in most types of physical violence tended to be young, male, from lower middle social classes, with some degree of secondary education, and single or divorced. CONCLUSIONS: Prevalence of witnesses and victims of violence in this sample appears to be high, while perpetrators constitute a small proportion. Violence is not equally distributed throughout the population suggesting the possibility of identifying a population at higher risk for the development of intervention programmes.

[Beliefs and knowledge of a group of doctors about the nutritional management of the child with acute diarrhea]. / Creencias y conocimientos de un grupo de médicos sobre el manejo de la alimentación del niño con diarrea aguda.

OBJECTIVE: To identify the beliefs and knowledge of a group of rural physicians on the dietary management of children under five years of age, with acute diarrhea. Physicians' dietary management was compared with that recommended by the World Health Organization. MATERIAL AND METHODS: A cognitive anthropology study was carried out from July to December 1998, on ten physicians that care for the infant population ascribed to Hospital Rural IMSS-Solidaridad of San Juanito Bocoyna, Chihuahua, Mexico. Data were collected through focus groups, case vignettes, free listing, pile sorting, and a semi-structured questionnaire, and then cross-referred. RESULTS: The physicians recognized the negative impact of diarrhea on the nutritional state of the child, but not all of them evaluated this state. Prevailing interventions were antibiotic therapy, fluid management, and feeding recommendations. Among the latter, the most consistent were breastfeeding, delayed feeding, and gradual feeding. CONCLUSIONS: The obtained information is in conflict with WHO's recommendations, specially with that of sustained feeding. The English version of this paper is available at: http://www.insp.mx/salud/index.html.