La anestesia subaracnoidea no produce disfunción ventricular izquierda transitoria en pacientes mayores de 60 años sin enfermedad cardiovascular / Spinal anesthesia does not cause left ventricular dysfunction in patients older than 60 years without cardiovascular disease

Objetivos: Evaluar la función sistólica ventricular izquierda por ecocardiograma transtorácico en pacientes mayores de 60 años, sin enfermedad cardiovascular, bajo anestesia subaracnoidea instaurada. Pacientes y métodos: Estudio observacional prospectivo con un total de 54 pacientes mayores de 60 años sin enfermedad cardiovascular, a quienes, tras la instauración de una anestesia subaracnoidea con bupivacaína hiperbárica al 0,5% con bloqueo sensitivoT10 o mayor, se les midió la función sistólica ventricular izquierda a partir del movimiento sistólico del anillo mitral (mitral anular plane systolic excursion [MAPSE].) Además, se midió el índice de colapsabilidad de vena cava inferior (ICVCI), la integral velocidad tiempo del tracto de salida del ventrículo izquierdo (ITTSVI) y del gasto cardiaco (GC). Los valores a los 5min del bloqueo se compararon con los obtenidos previamente al mismo. Resultados: Se evidenció una disminución del 3,3% del MAPSE y una ligera disminución del IVTTSVI y GC, en ningún caso con significación estadística ni clínica. El 14,8% de los pacientes presentó presión arterial media (PAM) igual o inferior a 60mmHg. La comparación de los cambios ecocardiográficos entre estos pacientes y los que no presentaron hipotensión no fueron estadísticamente significativos ni clínicamente relevantes. Discusión: Se demuestra que la anestesia subaracnoidea con nivel anestésico T10 o superior en pacientes mayores de 60 años sin enfermedad cardiovascular, es una técnica segura ya que no altera de forma significativa parámetros ecocardiográficos de medición de la función sistólica ventricular izquierda.(AU)

Background: Elderly patients are undergoing surgery more frequently than ever. In this population, spinal anesthesia, which is known to cause sympathetic blockade associated with arterial vasodilation, is proposed as an excellent option. However, its effects on left ventricular systolic function have not been studied. Objectives: To evaluate left ventricular systolic function by transthoracic echocardiography in patients older than 60 years, without prior cardiovascular disease, under spinal anesthesia. Patients and methods: Prospective observational study with a total of 54 patients older than 60 years without prior cardiovascular disease, in whom, after the completion of subarachnoid anesthesia with hyperbaric 0.5% bupivacaine with sensory block equal to or greater than T10, left ventricular systolic function was measured using MAPSE. In addition, CI-IVC, LVOT-VTI and CO were measured. Values at 5 minutes after the blockade were compared with those obtained previously. Results: A 3.3% decrease in MAPSE and a slight decrease in LVOT-VTI and CO were found, with no statistical or clinical significance. The 14.8% of the patients presented MAP equal to or less than 60mmHg. Comparison of echocardiographic changes between hypotensive and non-hypotensive patients was not statistically significant or clinically relevant. Discussion: Our study shows that spinal anesthesia with anesthetic level T10 or higher in patients older than 60 years without cardiovascular disease is a safe technique since it does not significantly alter echocardiographic parameters measuring left ventricular systolic function.(AU)

Spinal anesthesia does not cause left ventricular dysfunction in patients older than 60 years without cardiovascular disease.

BACKGROUND: Elderly patients are undergoing surgery more frequently than ever. In this population, spinal anesthesia, which is known to cause sympathetic blockade associated with arterial vasodilation, is proposed as an excellent option. However, its effects on left ventricular systolic function have not been studied. OBJECTIVES: To evaluate left ventricular systolic function by transthoracic echocardiography in patients older than 60 years, without prior cardiovascular disease, under spinal anesthesia. PATIENTS AND METHODS: Prospective observational study with a total of 54 patients older than 60 years without prior cardiovascular disease, in whom, after the completion of subarachnoid anesthesia with hyperbaric 0.5% bupivacaine with sensory block equal to or greater than T10, left ventricular systolic function was measured using MAPSE. In addition, CI-IVC, LVOT-VTI and CO were measured. Values at 5 min after the blockade were compared with those obtained previously. RESULTS: A 3.3% decrease in MAPSE and a slight decrease in LVOT-VTI and CO were found, with no statistical or clinical significance. 14.8% of the patients presented MAP equal to or less than 60 mmHg. Comparison of echocardiographic changes between hypotensive and non-hypotensive patients was not statistically significant or clinically relevant. DISCUSSION: Our study shows that spinal anesthesia with anesthetic level T10 or higher in patients older than 60 years without cardiovascular disease is a safe technique since it does not significantly alter echocardiographic parameters measuring left ventricular systolic function.

Concern levels of beta-lactamase-producing Gram-negative bacilli in hospital wastewater: hotspot of antimicrobial resistance in Latin-America.

Hospital wastewater (HWW) discharges are among the main sources of antibiotic-resistant bacteria. This study detected a high frequency of beta-lactamase-producing Gram-negative Bacilli in HWW of different geographical regions of Colombia, even in the presence of the wastewater treatment plant, highlighting the importance of regulating these environments in developing countries.

Difference between both eyes in the calculation of the dioptre power of the intraocular lens in a series of 7994 patients.

PURPOSE: To analyse the distribution of the difference between both eyes in the calculation of the dioptric power of the intraocular lens in a series of 7994 patients and the biometric variables that determine it. METHODS: The data of patients between 3 and 99 years old, residents of the city of Guayaquil and neighbouring sites, who received ocular biometry by partial optical coherence interferometry between 2004 and 2020 were reviewed. Ocular biometrics, including axial length (AL), anterior chamber depth (ACD), and the mean corneal dioptre power (CD), were measured by partial coherence interferometry. Refraction without or with cycloplegia was recorded in spherical equivalent (SE). The Haigis formula from the IOL Master instrument was used to calculate the dioptric power of the intraocular lens in both eyes. RESULTS: Data from the bilateral optical biometry of 7994 patients were analysed. The mean and standard deviation of AL, CD, ACD and dioptre power of the IOL were 23.66 ±â€¯1.25, 43.70 ±â€¯1.49, 3.34 ±â€¯0.40 and +20.46 ±â€¯3.84, respectively. 2538 (31.7%) patients had equal dioptre power of the IOL between both eyes. 3243 (40.6%) patients had a 0.50 D difference; 1162 (14.5%), 1.0 D; 425 (5.3%), 1.5 D. 626 patients (7.8%) had a difference in IOL dioptre of 2 D or more, with a maximum of 24 D. The asymmetry of AL between OU was ≥0.4 mm in 10.49%, while that of CD reached ≥1 D in 1.9%. CONCLUSIONS: 92.16% of patients had a difference within 1.5 D between both eyes in the calculation of the dioptre power of the intraocular lens. In case an eye is programmed in which it is impossible to perform a reliable biometry, either due to trauma or due to white or brunescent cataract, the calculation of the intraocular lens could be done taking as a reference the biometry of the contralateral eye.

Diferencia entre ambos ojos en el cálculo del poder dióptrico del lente intraocular en una serie de 7.994 pacientes / Difference between both eyes in the calculation of the dioptre power of the intraocular lens in a series of 7994 patients

Objetivo Analizar la distribución de la diferencia entre ambos ojos en el cálculo del poder dióptrico del lente intraocular (LIO) en una serie de 7.994 pacientes y las variables biométricas que la determinan. Métodos Se revisaron los datos de pacientes entre 3 y 99años, residentes en la ciudad de Guayaquil y sitios aledaños, que recibieron biometría ocular por interferometría de coherencia óptica parcial entre 2004 y 2020. La medición incluyó la longitud axial (LA), la profundidad de la cámara anterior (PCA) y la queratometría (Km) media. La refracción sin o con cicloplejia en dioptrías (D) fue registrada en equivalente esférico (EE). La fórmula de Haigis, incluida en el instrumento IOL Master, fue usada para realizar el cálculo del poder dióptrico del LIO en ambos ojos. Resultados Se analizaron los datos de la biometría óptica bilateral de 7.994 pacientes. El promedio y la desviación estándar de LA, Km, PCA y poder dióptrico del LIO fueron 23,66±1,25, 43,70±1,49, 3,34±0,40 y +20,46±3,84, respectivamente. Un total de 2.538 (31,7%) pacientes tuvieron igual poder dióptrico del LIO entre ambos ojos, y 3.243 (40,6%) pacientes tuvieron 0,50D de diferencia; 1,162 pacientes (14,5%), 1,0D; 425 pacientes (5,3%), 1,5D; 626 pacientes (7,8%) tuvieron una diferencia en el poder dióptrico del LIO de ≥2D, con un máximo de 24D. La asimetría de la LA entre ambos ojos fue ≥0,4mm en el 10,49%, mientras que el de la Km alcanzó ≥1D en 1,9%. Conclusiones El 92,2% de los pacientes tuvieron una diferencia dentro de 1,5D entre ambos ojos en el cálculo del poder dióptrico del LIO. En el caso de tratarse de un ojo en que resultara imposible realizar una biometría confiable, ya fuera por traumatismo o por catarata blanca o brunescente, el cálculo del LIO podría hacerse tomando como referencia la biometría del ojo contralateral (AU)

Purpose To analyse the distribution of the difference between both eyes in the calculation of the dioptric power of the intraocular lens in a series of 7994 patients and the biometric variables that determine it. Methods The data of patients between 3 and 99years old, residents of the city of Guayaquil and neighbouring sites, who received ocular biometry by partial optical coherence interferometry between 2004 and 2020 were reviewed. Ocular biometrics, including axial length (AL), anterior chamber depth (ACD), and the mean corneal dioptre power (CD), were measured by partial coherence interferometry. Refraction without or with cycloplegia was recorded in spherical equivalent (SE). The Haigis formula from the IOL Master instrument was used to calculate the dioptric power of the intraocular lens in both eyes. Results Data from the bilateral optical biometry of 7994 patients were analysed. The mean and standard deviation of AL, CD, ACD and dioptre power of the IOL were 23.66±1.25, 43.70±1.49, 3.34±0.40 and +20.46±3.84, respectively. 2538 (31.7%) patients had equal dioptre power of the IOL between both eyes. 3243 (40.6%) patients had a 0.50D difference; 1162 (14.5%), 1.0D; 425 (5.3%), 1.5D. 626 patients (7.8%) had a difference in IOL dioptre of 2D or more, with a maximum of 24D. The asymmetry of AL between OU was ≥0.4mm in 10.49%, while that of CD reached ≥1D in 1.9%. Conclusions 92.16% of patients had a difference within 1.5D between both eyes in the calculation of the dioptre power of the intraocular lens. In case an eye is programmed in which it is impossible to perform a reliable biometry, either due to trauma or due to white or brunescent cataract, the calculation of the intraocular lens could be done taking as a reference the biometry of the contralateral eye (AU)

Integrating multiple land cover maps through a multi-criteria analysis to improve agricultural monitoring in Africa.

Monitoring agricultural land cover is highly relevant for global early warning systems such as ASAP (Anomaly hot Spots of Agricultural Production), because it represents the basis for detecting production deficits in food security assessment. Given the significant inconsistencies among existing land cover datasets, there is a need to obtain a more accurate representation of the spatial distribution and extent of agricultural area in Africa. In this research, we explore a fusion approach that combines the strength of individual datasets and minimises their limitations. Specifically, a semi-automatic method is developed, relying on multi-criteria analysis (MCA) complemented with manual fine-tuning using the best-rated datasets, to generate two hybrid and static agricultural masks - one for cropland and another for grassland. Following a comprehensive selection of land cover maps, each dataset is evaluated at country level according to five criteria: timeliness, spatial resolution, comparison with FAO statistics, accuracy assessment and expert evaluation. A sensitivity analysis is performed, based on an evaluation of the impact of weight settings on the resulting land cover. The proposed methodology is capable of improving agricultural characterisation in Africa. As a result, two static masks at 250 m spatial resolution for the nominal year 2016 are provided.

High frequency of gram-negative bacilli harboring blaKPC-2 in the different stages of wastewater treatment plant: A successful mechanism of resistance to carbapenems outside the hospital settings.

Wastewater treatment plants (WWTPs) are considered to be a reservoir and a source of bacterial resistance. Worryingly, the presence of carbapenem-resistant Gram-negative bacilli (CRGNB) in WWTPs has recently been reported, but there are still many research gaps regarding its emergence and impact. The distribution of CRGNB in the different stages of a WWTP in Colombia and the relationship between the physicochemical factors involved with their presence are described in this paper. Additionally, given the impact on public health, the CRGNB detected were compared with isolates previously found in hospital patients. Residual water samples were taken from five different stages of a WWTP between January and July 2017. A total of 390 GNB were isolated, and a significant frequency of CRGNB harboring blaKPC-2 (38.2%, n = 149/390) was detected, of which 57% were Enterobacteriaceae, 41.6% Aeromonadaceae, and 1.3% Pseudomonadaceae. The Enterobacteriaceae were more frequent in the raw effluent compared to the Aeromonadaceae, which in turn were more prevalent in the recycled activated sludge and final effluent. Environmental variables such as pH, oxygen, chemical oxygen demand, and temperature were significantly correlated with the quantification of carbapenem-resistant Enterobacteriaceae (CRE) at specific points in the WWTP. Interestingly, isolated K. pneumoniae harboring blaKPC-2 from the WWTPs were diverse and did not relate genetically to the hospital strains with which they were compared. In conclusion, these results confirm the worrying scenario of the dissemination and persistence of emerging contaminants such as CRGNB harboring blaKPC-2, and reinforce the need to establish strategies aimed at containing this problem using multifocal interventions.

High clonal diversity of multidrug-resistant and extended spectrum beta-lactamase-producing Escherichia coli in a wastewater treatment plant.

Increasing beta-lactam resistance has led to the exploration of different places, such as wastewater treatment plants (WWTPs) which have been considered to be reservoirs and sources of bacterial resistance. This work aims to determine the presence of beta-lactamase-producing-Enterobacteriaceae in different points of a WWTP in Colombia. Six samplings were carried out in 2017 in the raw influent, aeration tanks, recycled sludge and final effluent of a WWTP. The beta-lactamase-producing-Enterobacteriaceae were detected and identified using phenotypic and molecular methods. Of the 353 isolates included, 28.3% corresponded to enterobacteria. The most frequent microorganisms were Escherichia coli (83%), Citrobacter freundii (11%) and Enterobacter cloacae complex (4%). The 97% of enterobacteriaceae had at least one beta-lactamase, and the most prevalent were the blaTEM (43.8%) and blaCTX-M-1group (35.8%) which were detected specially in recycled sludge and final effluent sample points. High percentage of multidrug resistance (to beta-lactams and non-beta-lactam antibiotics) was detected in E. coli (63.2%). Additionally, the typing by PFGE and MLST showed high genotypic diversity and the presence of the successful ST131 clone, globally spread. This work highlights the strong role of E. coli as a vector for the dissemination of resistance and the beta-lactamases in aquatic environments.

Radiofrequency exposure in the Neonatal Medium Care Unit.

The aims of this study were to characterize electromagnetic fields of radiofrequency (RF-EMF) levels generated in a Neonatal Medium Care Unit and to analyze RF-EMF levels inside unit's incubators. Spot and long-term measurements were made with a dosimeter. The spot measurement mean was 1.51±0.48V/m. Higher values were found in the proximity to the window and to the incubator evaluated. Mean field strength for the entire period of 17h was 0.81 (±0.07)V/m and the maximum value was 1.58V/m for long-term RF-EMF measurements in the incubator. Values found during the night period were higher than those found during the day period. It is important to consider RF-EMF exposure levels in neonatal care units, due to some evidence of adverse health effects found in children and adults. Characterization of RF-EMF exposure may be important to further investigate the mechanisms and underlying effects of electromagnetic fields (EMF) on infant health. A prudent avoidance strategy should be adopted because newborns are at a vulnerable stage of development and the actual impact of EMF on premature infants is unknown.

Estudio de prevalencia del trastorno por déficit de atención e hiperactividad en niños en régimen de acogimiento residencial / Prevalence study of attention deficit hyperactivity disorder in children in residential care

INTRODUCCIÓN: Los niños que se encuentran en régimen de acogimiento residencial constituyen un colectivo de riesgo en el que los problemas médicos pueden alcanzar altas tasas, especialmente aquellos relacionados con la esfera psicológica, donde el trastorno por déficit de atención e hiperactividad (TDAH) es una de las alteraciones del neurodesarrollo más frecuentes. OBJETIVO: El propósito de este estudio fue determinar la prevalencia de TDAH en los niños de un centro de acogida en Albuñol (Granada) en 2016. Material y Métodos. En este estudio transversal se incluyeron los 106 niños de edades comprendidas entre los 5 y los 17 años del Centro Hogar "Cristo Rey". La evaluación psicométrica se basó en la Escala de Vanderbilt de TDAH. Las funciones ejecutivas se evaluaron mediante el Behavior Rating Inventory of Executive Function (BRIEF) en aquellos participantes que cumplieron los criterios de Vanderbilt, y también se aplicaron los criterios del DSM-5 en la entrevista clínica para reforzar el diagnóstico de TDAH. RESULTADOS: La prevalencia de TDAH fue del 17.9% en nuestro grupo, siendo el subtipo inatento el más frecuente. CONCLUSIONES: La prevalencia de TDAH en el centro de acogida "Cristo Rey" fue notablemente elevada en comparación con la prevalencia en niños de la población general. Es necesario seguir investigando acerca de las comorbilidades relacionadas con el TDAH en niños en régimen de acogimiento residencial. Deberían instaurarse programas de detección e intervención en centros de acogida por las repercusiones que puede llegar a tener el TDAH

INTRODUCTION: Children in residential care constitute a risk group in which medical problems can reach high rates, especially those concerned to the psychological sphere, including attention deficit hyperactivity disorder (ADHD), one of the most common neurodevelopmental disorders. OBJECTIVE: The purpose of this study was to determine the prevalence of ADHD in children in a foster care institution in Albuñol (Granada) in 2016. MATERIALS AND METHODS: This cross-sectional descriptive study included 106 children aged 5 to 17 years from "Cristo Rey" foster care institution. Psychometric evaluation was based on Vanderbilt ADHD Diagnostic Rating Scale. Executive functions were tested using the Behavior Rating Inventory of Executive Function (BRIEF) in participants who met Vandebilt criteria, as well Diagnostic and DSM- 5 criteria were applied in a clinical interview to strengthen ADHD diagnosis. RESULTS: The prevalence of ADHD was determined to be 17.9 % in our group, with innatentional subtype being the most important. CONCLUSION: Prevalence of ADHD in "Cristo Rey" foster care institution was visibly high in comparison with estimated prevalence in children general population. Research is needed to identify comorbidities in children in residential care suffering from ADHD. ADHD detection and intervention programmes in residential care must be developed because of its repercussion

Reflexiones sobre la neurotoxicidad inducida por opioides en el contexto de una anestesia general en población pediátrica / Opioid related neurotoxicity on pediatric population after general anestesia

Introducción: Desde el año 2000 vienen apareciendo en distintas publicaciones científicas los resultados de numerosos estudios experimentales realizados en animales, evaluando el impacto neurotóxico que sobre sus cerebros tenía la exposición a combinaciones de anestésicos de uso habitual. Se constata que la exposición en periodo de máxima sinaptogénesis conlleva una apoptosis neural diseminada. Comienzan entonces a preocuparse los anestesiólogos que trabajan con niños, pues quizás ese daño neuronal también pudiera acontecer a la población pediátrica. Así, son varios los estudios que están en marcha desde hace años valorando el desarrollo neurocognitivo de cohortes de niños que se sometieron a anestesias generales en edades tempranas de sus vidas. En este sentido, la necesidad de medir un daño cerebral agudo nos anima a utilizar marcadores que han demostrado su asociación con dicho deterioro cerebral en diferentes situaciones clínicas como la hipoxia perinatal, la parada cardiorrespiratoria o el traumatismo craneoencefálico. Objetivos: Planteamos este trabajo con el objetivo de determinar si la proteína S100B podría comportarse como un biomarcador de daño cerebral agudo postanestésico y si pudiéramos establecer asociación entre la elevación de este marcador en sangre y alguno de los fármacos anestésicos utilizados habitualmente. Metodología: Determinación sanguínea de la proteína S100B en 76 pacientes pediátricos intervenidos de hipertrofia amigdalar bajo anestesia general, antes y después de la cirugía Conclusión: Tras analizar los resultados podemos concluir que existe una elevación estadísticamente significativa entre los niveles de proteína S100B antes y después de la exposición anestésica. En segundo lugar, podemos establecer una correlación positiva, también con significación estadística, entre el fentanilo administrado y la elevación de dicha proteína al final del acto anestésico (AU)

Introduction: In the last decade many scietific publications bring out the results of experimental studies about the neurotoxic impact of an anesthetic expossure in animal´s brain. It is confirm that when this expossure occurs in a maximum synaptogenesis period of the animal´s live a widespread neuroapoptosis befall. From there on all the pediatrics anesthesiologist warried about if this damage could also affect the pediatric population. Nowadays there are several observational studies exploring the neurobehavioral conduct of many children who underwent general anesthesia early in their lives. Objetive: As a results of this we propose to use actual neuronal damage biomarkes, wich have demonstrated association between brain damage and perinatal hypoxia, or cardiac arrest or mild brain injury. When we planned this essay we intend to determine if S100B protein could work as an accute postanesthetic expossure neuronal damage biomarker, and if there would be any relationship between the biomarker elevation and any of the drugs commonly use for anesthesia. Metodology: In order to determinate the S100B protein serum level is, we obtained a blood sample before and after general anaesthesia expousure in 76 paediatric patient undergoing amigdalar hypertropy surgery. Conclusions: Once we analized our results we can coclude that an elevation of the blood levels of S100B protein occurs after anesthesia. We have also found a possitive correlation between the total amount of fentanyl administred and the higher level of this protein concentration at the end of the anesthetic expossure (AU)

Enfermedad invasora por Haemophilus influenzae. A propósito de dos casos en lactantes menores / Haemophilus influenzae invasive disease: A report of two cases in young infants / Doença invasora por Haemophilus influenzae. A propósito de dois casos em lactantes menores

En la actualidad, la enfermedad invasora por Haemophilus influenzae es un evento poco común en niños, particularmente, luego de la introducción de una vacuna altamente efectiva contra este microorganismo. Se presentan los casos de dos lactantes menores, previamente sanos, a quienes se les aisló de sangre y líquido cefalorraquídeo H. influenzae, dentro del contexto clínico de una sepsis y meningitis bacteriana. En el paciente pediátrico no vacunado o con esquemas de vacunación incompletos contra H. influenzae tipo b, debe considerarse este agente dentro del diagnóstico diferencial etiológico de los casos de infección bacteriana invasora.

Today, invasive disease due to Haemophilus influenzae is an extremely rare event in children, especially after the introduction of highly effective conjugated vaccines against this microorganism. We report two cases of previously healthy infants with H. influenzae within the clinical context of sepsis and bacterial meningitis. In unvaccinated pediatric patients or patients with incomplete vaccination schedules against H. influenzae type b, this pathogen should be considered in the differential etiological diagnosis of invasive bacterial infection.

Na atualidad, a doença invasora por Haemophilus influenzae é um evento pouco comum em crianças, particularmente, após da introdução de uma vacina altamente efetiva contra este microrganismo. Se apresentam os casos de duas lactantes menores, previamente saudáveis, a quem se lhes isolou de sangre e líquido cefalorraquidiano H. influenzae, dentro do contexto clínico de uma sepse e meningite bacteriana. No paciente pediátrico não vacinado ou com esquemas de vacinação incompletos contra H. influenzae tipo b, deve considerar-se este agente dentro do diagnóstico diferencial etiológico dos casos de infecção bacteriana invasora.

Oxygen dependency as equivalent to bronchopulmonary dysplasia at different altitudes in newborns ⩽ 1500 g at birth from the SIBEN network.

OBJECTIVE: To compare the incidence of oxygen dependency in SIBEN neonatal units while adjusting for altitude. STUDY DESIGN: We reviewed the charts of infants who were ⩽ 1500 g at birth, admitted to six neonatal intensive care units (NICUs) near sea level and in seven NICUs at varying altitudes above sea level from the SIBEN network between 2008 and 2010. We defined bronchopulmonary dysplasia (BPD) as oxygen dependency at 28 days of life and at 36 weeks postmenstrual age. RESULT: There were 767 babies in the first group and 318 in the second group. BPD incidence was greater in hospitals at higher altitudes when it was not corrected for barometric pressure. After correction, there was a decrease in the incidence of oxygen dependency at 28 days of life (P<0.0002) and at 36 weeks corrected age. (P<0.0001) CONCLUSION: After correction for higher altitudes, the decrease in oxygen dependency as equivalent to BPD was significant. A proper classification of BPD for higher altitudes is urgently needed.

Problemas de salud prevalentes en los menores en centros de acogida / Prevalent health problems of children in residential care centers

Introducción: La población infantil sujeta a medidas de protección es una franja de población vulnerable, no sólo desde el punto de vista social, sino también sanitario. La principal limitación detectada en la bibliografía recientemente revisada es la escasez de estudios que evalúen la situación sanitaria de los menores durante su estancia en el sistema de protección. Nos proponemos analizar el estado de salud de una población en programa residencial básico, atendiendo a las diferencias entre grupos etarios, así como la asociación de distintas variables con el tiempo de institucionalización. Material y métodos: Se diseña un estudio transversal, realizándose dos visitas a los 26 centros de la provincia de Granada (entre diciembre de 2006 y marzo de 2007). En la primera se revisan los expedientes de los menores y en la segunda se procede a su valoración clínica. En cuanto al estudio estadístico, la muestra se distribuye en tres grupos de edad (0-5, 6-12 y 13-18 años), y se realiza el análisis comparativo y la inferencia estadística mediante las pruebas de la chi2, Kruskal-Wallis y Mann-Whitney. Resultados: Se revisa un total de 294 menores. La prevalencia global de desnutrición es del 4%, más frecuente en el grupo de 0-5 años, y la de sobrepeso del 18%, más habitual en el grupo de 6-12 años. Las alteraciones más frecuentemente detectadas son otorrinolaringológicas (ORL) (63,9%), dermatológicas (34,9%) –más prevalentes en los menores de 12 años– y conductuales (28,1%), más frecuentes en los mayores de 6 años. El seguimiento en consultas especializadas fue del 40%. En cuanto al tiempo de estancia en la institución, se observaron mayores estancias en los menores con un diagnóstico psicopatológico y con un mayor número de seguimientos en las consultas especializadas (AU)

Conclusiones: El estado de salud de los menores institucionalizados se podría considerar adecuado en líneas generales. Las principales diferencias con la población general derivan de la existencia de tasas de desnutrición algo superiores en los menores de 0-5 años y una alta prevalencia de patología ORL, dermatológica, mental y conductual. Cabe destacar la vulnerabilidad del grupo de niños de 6-12 años con un número más elevado de necesidades sanitarias (AU)

Introduction: Children under protection measures constitute a vulnerable population from both social and health standpoints. The main limitation detected in a review of the recent literature is the scarcity of studies on the health status of minors during their stay in the protection system. We proposed to study the health status of a population in a basic residential care program, investigating differences among age groups and analyzing the association of different variables with time of institutionalization. Methods: A cross-sectional study was designed that involv­ed two visits to the centres: the first to review the records of the minors and the second to carry out physical examinations. For the statistical study, the sample was divided into three age groups (0-5, 6-12 and 13-18 yrs) and the chi2, Kruskal-Wallis and Mann-Whitney tests were used for comparative analyses and statistical significances. Results: We revised 294 children. Prevalence of global malnutrition was 4%, highest in the 0-5-yr group; prevalence of overweight was 18%, highest in the 6-12-yr group. The most frequent disorders were: ENT (63.9%); dermatological (34.9%), most prevalent in children <12 yrs; and behavioural (28.1%), most prevalent in children >6 yrs old; 40% were under specialist follow-up. Longer stays in the institution were associated with a psychopathological diagnosis and higher frequency of specialist follow-up. Conclusions: The health status of institutionalised minors can in general be considered adequate. The main differences with the general population derive from the presence of somewhat higher malnutrition rates in the 0 to 5-year-olds and an elevated prevalence of ENT, dermatological, psychological and behavioural pathologies. We highlight the vulnerability of 6 to 12-year-olds, who have a larger number of healthcare needs (AU)

Comparison and improvements of LCMV and MUSIC source localization techniques for use in real clinical environments.

The present work shows some improvements realized on practical aspects of the implementation of Singular Value Decomposition (SVD) methods to localize the sources of neural activity by means of magnetoencephalograph (MEG). Two methods have been improved and compared i.e. a spatial filter, the Linearly Constrained Minimum Variance Beamformer (LCMV) method, and a signal subspace method that is an implementation of the MUSIC (Multiple Signal Classification) method due to Mosher et al. (1992). It also shows the performance of both methods comparing three different averaging procedures. The influence of the correct selection of the noise subspace dimension has been analyzed. Using acoustic stimulus for real patient measurements, we discuss the relevant differences of both methods and propose an adequate strategy for future diagnosis based on correct source localization.

Hypertension and Biliary Ductopenia in a Patient with Duplication of Exon 6 of the JAG1 Gene.

We describe a neonatal patient with biliary ductopenia featuring duplication of exon 6 of the JAG1 gene. Facial alterations were observed, consisting of a prominent forehead, sunken eyes, upward slanting palpebral fissures, hypertelorism, flat nasal root and prominent chin. From birth, these were accompanied by the development of haematuria and renal failure and by renal Doppler findings indicative of peripheral renal artery stenosis. JAG1 gene mutations on chromosome 20 have been associated with various anomalies, including biliary cholestasis, vertebral abnormalities, eye disorders, heart defects and facial dysmorphia. This syndrome, first described by Alagille, is an infrequent congenital disorder caused by a dominant autosomal inheritance with variable expressivity. Anatomopathological effects include the destruction and disappearance of hepatic bile ducts (ductopenia). The duplication of exon 6 of JAG1 has not previously been described as an alteration related to the Alagille syndrome with peripheral renal artery stenosis.

Urinary excretion of phenolic acids by infants and children: a randomised double-blind clinical assay.

OBJECTIVES: The present study, which is part of the ISRCTN16968287 clinical assay, is aimed at determining the effects of cranberry syrup or trimethoprim treatment for UTI. METHODS: This Phase III randomised clinical trial was conducted at the San Cecilio Clinical Hospital (Granada, Spain) with a study population of 192 patients, aged between 1 month and 13 years. Criteria for inclusion were a background of recurrent UTI, associated or otherwise with vesico-ureteral reflux of any degree, or renal pelvic dilatation associated with urinary infection. Each child was randomly given 0.2 mL/Kg/day of either cranberry syrup or trimethoprim (8 mg/mL). The primary and secondary objectives, respectively, were to determine the risk of UTI and the levels of phenolic acids in urine associated with each intervention. RESULTS: With respect to UTI, the cranberry treatment was non-inferior to trimethoprim. Increased urinary excretion of ferulic acid was associated with a greater risk of UTI developing in infants aged under 1 year (RR 1.06; CI 95% 1.024-1.1; P = 0.001). CONCLUSIONS: The results obtained show the excretion of ferulic acid is higher in infants aged under 1 year, giving rise to an increased risk of UTI, for both treatment options.

Isolation of protein-tyrosine phosphatase-like member-a variant from cementum.

Cementum has been shown to contain unique polypeptides that participate in cell recruitment and differentiation during cementum formation. We report the isolation of a cDNA variant for protein-tyrosine phosphatase-like (proline instead of catalytic arginine) member-a (PTPLA) from cementum. A cementifying fibroma-derived λ-ZAP expression library was screened by panning with a monoclonal antibody to cementum attachment protein (CAP), and 1435 bp cDNA (gb AC093525.3) was isolated. This cDNA encodes a 140-amino-acid polypeptide, and its N-terminal 125 amino acids are identical to those of PTPLA. This isoform, designated as PTPLA-CAP, results from a read-through of the PTPLA exon 2 splice donor site, truncating after the second putative transmembrane domain. It contains 15 amino acids encoded within the intron between PTPLA exons 2 and 3, which replace the active site for PTPLA phosphatase activity. The recombinant protein, rhPTPLA-CAP, has Mr 19 kDa and cross-reacts with anti-CAP antibody. Anti-rhPTPLA-CAP antibody immunostained cementum cells, cementum, heart, and liver. Quantitative RT-PCR showed that PTPLA was expressed in all periodontal cells; however, PTPLA-CAP expression was limited to cementum cells. The rhPTPLA-CAP promoted gingival fibroblast attachment. We conclude that PTPLA-CAP is a splice variant of PTPLA, and that, in the periodontium, cementum and cementum cells express this variant.

Normalization of the sleep-wake pattern and melatonin and 6-sulphatoxy-melatonin levels after a therapeutic trial with melatonin in children with severe epilepsy.

This study evaluated the sleep-wake pattern, plasma melatonin levels and the urinary excretion of its metabolite, 6-sulphatoxy-melatonin among children with severe epileptic disorders, before and after a therapeutic trial with melatonin. Ten paediatric patients, suffering from severe epileptic disorders, were selected and given a nightly dose of 3 mg of a placebo, for 1 wk; for the next 3 months, the placebo was replaced with a nightly dose of 3 mg of melatonin. At the end of each treatment period, the urinary excretion of 6-sulphatoxy-melatonin (for the intervals 09.00 - 21:00 hr or 21:00-09:00 hr) and plasma levels of melatonin (recorded at 01:00, 05:00, 09:00, 13:00, 17:00 and 21:00 hr) were recorded, over a period of 24 hr; an actigraph record was also kept. Sleep efficiency among patients who received melatonin was significantly higher than among those given the placebo, with fewer night-time awakenings. Periodic plasma melatonin levels were regained and a better control gained of convulsive episodes, in that the number of seizures decreased. We conclude that melatonin is a good regulator of the sleep-wake cycle for paediatric patients suffering from severe epilepsy, moreover, it to a better control of convulsive episodes.