A Pilot Study Testing Intranasal Ketamine for the Treatment of Procedural Anxiety in Children Undergoing Laceration Repair.

Identifying non-invasive methods for anxiolysis is becoming increasingly important in the pediatric emergency department (ED). Few studies have examined the use of intranasal (IN) ketamine for procedural anxiolysis. We aim to evaluate if IN ketamine provides satisfactory anxiolysis for patients undergoing laceration repair based on anxiety and sedation scoring. We also evaluated the feasibility of using IN ketamine in future trials based on its tolerability and side-effects. A pilot study evaluating IN ketamine in the treatment of procedural anxiety for patients, 2 years and older, weighing 40 kg or less, presenting to the pediatric ED with lacerations. The need for anxiolysis was defined by an elevated modified-Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) score. Patients received 5 mg/kg of IN ketamine in addition to topical anesthesia, mYPAS-SF scoring before and during the procedure, sedation scoring, adverse events, vital signs, age, weight, laceration size and location, and satisfaction surveys were recorded. Twenty-five patients were enrolled, with mean age of 61 ± 29.2 months and mean weight of 21 ± 6.4 kg. Lacerations were located on the face, extremities, and groin with mean size of 2.1 cm. A decrease in anxiety levels was observed, from median m-YPAS-SF score of 66.7 (62.50-80.2) to 33.3 (27.09-52.00), p < 0.001. Among the patients, 92% (n = 23) were less anxious during the procedure. IN ketamine appears to be safe and well-tolerated with a positive impact on procedural anxiety. A dosage of 5 mg/kg is a reasonable starting point, as 80% of patients had appropriate anxiolysis.

Comparison of growth and psychomotor development in daycare centers attended by professionals.

BACKGROUND: Growth and development reflect the child's health condition. Currently, child care is supported in daycare centers. In this context, this article aimed to identify the differences in growth and psychomotor development in children according to their attendance at daycare centers. METHODS: We conducted an analytical cross-sectional study in children aged 25 to 48 months. Two groups were identified: 68 children attended daycare, and 68 children did not attend daycare. Growth was assessed with weight-for-height curves, and psychomotor development was evaluated with the child developmental assessment instrument (psychosocial, language, psychomotor, and cognitive area). The X2 test was used for statistical analysis. RESULTS: The percentage of daycare children with ideal weight was higher than those not attending in daycare (p = 0.035). Psychomotor development was significantly higher in daycare children: in the psychosocial (p = 0.000), language (p = 0.000), motor (p = 0.000), and cognitive development (p = 0.000) areas. CONCLUSIONS: The psychomotor development of children attending daycare centers is superior to that of children not in daycare centers.

INTRODUCCIÓN: La salud del niño se puede evaluar a partir de su crecimiento y desarrollo. En la sociedad actual, el cuidado de los hijos se comparte con las guarderías infantiles. En este contexto, el objetivo del artículo fue identificar las diferencias de crecimiento y desarrollo psicomotor en niños de acuerdo con su asistencia a las guarderías. MÉTODOS: Se llevó a cabo un estudio transversal analítico en niños de 25 a 48 meses de edad. Se identificaron dos grupos: 68 niños atendidos en guarderías y 68 niños no atendidos en guarderías. El crecimiento se evaluó con las curvas de peso para la talla y el desarrollo psicomotor, con el instrumento de evaluación del desarrollo del niño (área psicosocial, lenguaje, psicomotriz, y cognitiva). Se utilizó la prueba de X2 para el análisis estadístico. RESULTADOS: El porcentaje de niños de guardería con peso ideal es superior al de los no atendidos en guardería (p = 0.035). El desarrollo psicomotor es significativamente mayor en los niños de guardería: en el área psicosocial (p = 0.000), en lenguaje (p = 0.000), en el área motriz (p = 0.000) y en desarrollo cognitivo (p = 0.000). CONCLUSIONES: El desarrollo psicomotor de los niños atendidos en guardería es superior al de los niños no atendidos en guardería.

Validation of the Delirium Diagnostic Tool-Provisional (DDT-Pro) in a skilled nursing facility and comparison to the 4 'A's test (4AT).

OBJECTIVE: To validate the Delirium Diagnostic Tool (DDT-Pro) in a SNF and compare its performance to the 4 A's Test (4AT) in real life conditions. METHODS: Prospective cross-sectional study of 262 consecutively admitted adults to a SNF, independently assessed by psychiatrists using DSM-5 delirium criteria and by geriatricians using the DDT-Pro (0-9 points) and 4AT (0-12 points). RESULTS: 141 (53.8%) participants had dementia and 79 (30.1%) had delirium. DDT-Pro and 4AT were moderately correlated (-0.59). Accuracies against DSM-5 diagnosis ranged from 80 to 85% and were comparable between tools regardless of dementia. Recommended delirium cutoff for the DDT-Pro (≤6) had 77.2% sensitivity, 84% specificity, and NPV = 89.5% and 4AT (≥4) had 54.4% sensitivity and 92.9% specificity, with lower specificity in the dementia subsample. DDT-Pro sensitivity increased (84.8%) at ≤7cutoff. Sensitivity and specificity of all DDT-Pro and 2/4 4AT items displayed gradients along severity levels, but two dichotomously rated 4AT items had low positivity. The tools had low concordance (p < 0.05) for delirium positivity. CONCLUSIONS: DDT-Pro is valid to detect delirium in SNF population where simple, structured tools with high sensitivity are needed. DDT-Pro items assess the three core domains of delirium as a continuous measure and may have advantages over the 4AT.

Guarderías infantiles. Crecimiento y desarrollo del niño / Childcare center. Child growth and development

Introducción: la incorporación de la mujer a la planta productiva ha modificado los patrones de atención y cuidado de los hijos. Objetivo: determinar el efecto de la guardería en el crecimiento y desarrollo del niño. Metodología: diseño de cohorte antes y después en niños atendidos en guarderías; la fuente de información fue el expediente clínico que genera de manera cotidiana el personal encargado de la atención del niño. Grupo no expuesto: niños al ingresar a la guardería (43 días a 24 meses de edad); grupo expuesto: los mismos niños al salir de la guardería (31 meses a 48 meses de edad). La exposición incluyó programas de alimentación y pedagogía para estimular el desarrollo psicosocial, lingüístico, motriz y cognitivo. El tamaño de la muestra fue de 154 expedientes. Se realizó la valoración del estado nutricional (Organización Mundial de la Salud, peso para la talla) y de desarrollo psicosocial (Evaluación del Desarrollo del Niño), lingüístico, motriz y cognitivo. Se utilizaron t pareada, Wilcoxon y McNemar. Resultados: el estado nutricional no se modificó (p = 0.837). El desarrollo al egreso fue estadísticamente significativo en las áreas psicosocial (p = 0.000), lingüística (p = 0.000), motriz (p = 0.000) y cognitiva (p = 0.000). Conclusión: el niño atendido en guardería sometido a programas para el desarrollo tiene alta probabilidad de evolucionar de manera favorable en las áreas psicosocial, lingüística, motriz y cognitiva.

Introduction: The incorporation of women into the economcally active sector has changed the patterns of children development and childcare. Objective: Determine the impact that a childcare center may have on the growth and development of children. Methods: Before and after cohort design in childcare center, using the information gathered in the clinical file, by personnel in charge of watching the children. Unexposed group, children upon entering the childcare center (from 43 days to 24 months of age); exposed group, the same children after leaving the childcare center (from 31 months to 48 months of age). Intervention included feeding and pedagogical program to stimulate psychosocial, language, motor and cognitive development. The sample size was 154 files. Assessment of nutritional status (World Health Organization tables for weight for height) and psychosocial, language, motor and cognitive development (Child Development Assessment instrument) was performed.Paired t, Wilcoxon and McNemar were used. Results: Nutritional condition was not modified (p = 0.837). After visiting the childcare center, the development of children was statistically significant in the psychosocial (p = 0.000), language (p = 0.000), motor (p = 0.000) and cognitive (p = 0.000) areas. Conclusion: The children in childcare centers undergoing a program of development, evolve favorably in the psychoso-cial, language, motor, and cognitive areas.

Actions of Trace Amines in the Brain-Gut-Microbiome Axis via Trace Amine-Associated Receptor-1 (TAAR1).

Trace amines and their primary receptor, Trace Amine-Associated Receptor-1 (TAAR1) are widely studied for their involvement in the pathogenesis of neuropsychiatric disorders despite being found in the gastrointestinal tract at physiological levels. With the emergence of the "brain-gut-microbiome axis," we take the opportunity to review what is known about trace amines in the brain, the defined sources of trace amines in the gut, and emerging understandings on the levels of trace amines in various gastrointestinal disorders. Similarly, we discuss localization of TAAR1 expression in the gut, novel findings that TAAR1 may be implicated in inflammatory bowel diseases, and the reported comorbidities of neuropsychiatric disorders and gastrointestinal disorders. With the emergence of TAAR1 specific compounds as next-generation therapeutics for schizophrenia (Roche) and Parkinson's related psychoses (Sunovion), we hypothesize a therapeutic benefit of these compounds in clinical trials in the brain-gut-microbiome axis, as well as a potential for thoughtful manipulation of the brain-gut-microbiome axis to modulate symptoms of neuropsychiatric disease.

Evolution of biofilms during the colonization process of pyrite by Acidithiobacillus thiooxidans.

We have applied epifluorescence principles, atomic force microscopy, and Raman studies to the analysis of the colonization process of pyrite (FeS(2)) by sulfuroxidizing bacteria Acidithiobacillus thiooxidans after 1, 15, 24, and 72 h. For the stages examined, we present results comprising the evolution of biofilms, speciation of S (n) (2-) /S(0) species, adhesion forces of attached cells, production and secretion of extracellular polymeric substances (EPS), and its biochemical composition. After 1 h, highly dispersed attached cells in the surface of the mineral were observed. The results suggest initial non-covalent, weak interactions (e.g., van der Waal's, hydrophobic interactions), mediating an irreversible binding mechanism to electrooxidized massive pyrite electrode (eMPE), wherein the initial production of EPS by individual cells is determinant. The mineral surface reached its maximum cell cover between 15 to 24 h. Longer biooxidation times resulted in the progressive biofilm reduction on the mineral surface. Quantification of attached cell adhesion forces indicated a strong initial mechanism (8.4 nN), whereas subsequent stages of mineral colonization indicated stability of biofilms and of the adhesion force to an average of 4.2 nN. A variable EPS (polysaccharides, lipids, and proteins) secretion at all stages was found; thus, different architectural conformation of the biofilms was observed during 120 h. The main EPS produced were lipopolysaccharides which may increase the hydrophobicity of A. thiooxidans biofilms. The highest amount of lipopolysaccharides occurred between 15-72 h. In contrast with abiotic surfaces, the progressive depletion of S (n) (2-) /S(0) was observed on biotic eMPE surfaces, indicating consumption of surface sulfur species. All observations indicated a dynamic biooxidation mechanism of pyrite by A. thiooxidans, where the biofilms stability and composition seems to occur independently from surface sulfur species depletion.

Linfangioleiomiomatosis / Lymphagioleiomyomatosis

Se presenta una paciente de 30 años de edad, mestiza, con historia de nefrectomía por "quistes renales" que acude a consulta por disnea y tos. Se detecta derrame pleural quiloso bilateral y durante su evolución sufre un neumotórax espontáneo. Se realizó tomografía computadorizada del alta resolución, y se observó la imagen característica de una linfangioleiomiomatosis pulmonar. Se hace una breve revisión de la entidad. Se concluye que el caso es típico de esta rara entidad y los quistes renales por los que se le realizó nefrectomía pueden haber correspondido a angiolipomas renales, característicos de la enfermedad(AU)

Linfangioleiomiomatosis / Lymphagioleiomyomatosis

Se presenta una paciente de 30 años de edad, mestiza, con historia de nefrectomía por "quistes renales" que acude a consulta por disnea y tos. Se detecta derrame pleural quiloso bilateral y durante su evolución sufre un neumotórax espontáneo. Se realizó tomografía computadorizada del alta resolución, y se observó la imagen característica de una linfangioleiomiomatosis pulmonar. Se hace una breve revisión de la entidad. Se concluye que el caso es típico de esta rara entidad y los quistes renales por los que se le realizó nefrectomía pueden haber correspondido a angiolipomas renales, característicos de la enfermedad

Tratamiento de las dermatomicosis con dosis semanales de fluconazol oral / Treatment of dermatomycosis with weekly doses of oral fluconazole

Estudio abierto no comparativo, en 20 pacientes adultos con dermatomicosis. Se utilizó una dosis única de 150 mg de fluconazol por semana, para un máximo de cuatro semanas. Cinco pacientes requirieron dos dosis (25 por ciento), 7 tomaron 3 cápsulas y 8 requirieron cuatro tomas (40 por ciento). Al finalizar el periodo de tratamiento, se logró curación clínica en 90 por ciento y micológica en 85 por ciento/ En la visita a largo plazo, (28 días después de la última visita), 17 pacientes (85 por ciento) persistían con curación clínica y micológica y hubo una recaída clínica (5 por ciento). Dos pacientes no respondieron al tratamiento. Dospacientes presentaron cefalea y náuseas transitorias después de la administración de la primera cápsula. En dos pacientes hubo ligera y transitoria elevación de las transaminasas hepáticas. La respuesta fue buena, con rápida mejoría clínica; el medicamento es una buena alternativa para el tratamiento de las dermatomicosis