Insulinoma Associated with MEN1 Syndrome: A Case of Persistent Hypoglycemia in School-aged Child.

Insulinoma is a rare cause of non-ketotic hypoglycemia both in adults and in children. Pediatric patients account for approximately 5% of all cases, mostly due to isolated benign lesions, but it can also be part of a multiple endocrine neoplasia type 1 syndrome (MEN1). We report the case of a patient with multiple hospitalizations related to hypoglycemia and neuroglycopenia symptoms, with multiple studies demonstrating the presence of an insulinoma as part of the spectrum of MEN1 syndrome. The primary significance of our report is to underscore that insulinoma can present as the initial manifestation of MEN1 syndrome in 10% of pediatric patients. Furthermore, we describe a likely pathogenic variant in the MEN1 gene not previously reported in the literature. Our report highlights the importance of the convergence of clinical, biochemical and molecular investigations in establishing a precise diagnosis, prognosis, and appropriate follow-up for pediatric patients with hypoglycemia.

Building a Chatbot in a Pandemic.

Easy access to evidence-based information on COVID-19 within an infodemic has been a challenging task. Chatbots have been introduced in times of emergency, when human resources are stretched thin and individuals need a user-centered resource. The World Health Organization Regional Office for Europe and UNICEF (United Nations Children's Fund) Europe and Central Asia came together to build a chatbot, HealthBuddy+, to assist country populations in the region to access accurate COVID-19 information in the local languages, adapted to the country context. Working in close collaboration with thematic technical experts, colleagues and counterparts at the country level allowed the project to be tailored to a diverse range of subtopics. To ensure that HealthBuddy+ was relevant and useful in countries across the region, the 2 regional offices worked closely with their counterparts in country offices, which were essential in partnering with national authorities, engaging communities, promoting the tool, and identifying the most relevant communication channels in which to embed HealthBuddy+. Over the past 2 years, the project has expanded from a web-based chatbot in 7 languages to a multistream, multifunction chatbot available in 16 regional languages, and HealthBuddy+ continues to expand and adjust to meet emerging health emergency needs.

The Vagus Nerve Somatosensory-evoked Potential in Neural Disorders: Systematic Review and Illustrative Vignettes.

Objective. To review the scientific publications reporting vagal nerve somatosensory-evoked potential (VSEP) findings from individuals with brain disorders, and present novel physiological explanations on the VSEP origin. Methods. We did a systematic review on the papers reporting VSEP findings from individuals with brain disorders and their controls. We evaluated papers published from 2003 to date indexed in PubMed, Web of Science, and Scielo databases. We extracted the following information: number of patients and controls, type of neural disorder, age, gender, stimulating/recording and grounding electrodes as well as stimulus side, intensity, duration, frequency, and polarity. Information about physiological parameters, neurobiological variables, and correlation studies was also reviewed. Representative vignettes were included to add support to our conclusions. Results. The VSEP was studied in 297 patients with neural disorders such as Parkinson's disease (PD), Alzheimer's disease, vascular dementia, mild cognitive impairment, subjective memory impairment, major depression, and multiple sclerosis. Scalp responses marked as the VSEP showed high variability, low validity, and poor reproducibility. VSEP latencies and amplitudes did not correlate with disease duration, unified PD rating scale score, or heart function in PD patients nor with cerebrospinal fluid ß amyloid, phosphor-τ, and cognitive tests from patients with mental disorders. Vignettes demonstrated that the VSEP was volume conduction propagating from muscles surrounding the scalp recording electrodes. Conclusion. The VSEP is not a brain-evoked potential of neural origin but muscle activity induced by electrical stimulation of the tragus region of the ear. This review and illustrative vignettes argue against assessing the parasympathetic system using the so-called VSEP.

The vagus nerve somatosensory evoked potential in the intact brain: state-of-evidence and some representative vignettes.

OBJECTIVE: Scalp-recorded evoked potentials elicited by applying afferent electrical stimulation at the tragus region of the human external ear have shown inconsistent results. We aim to disentangle discrepant findings and interpretations, and put forward novel physiological explanations on the origin of the vagus nerve somatosensory evoked potentials (VSEP). METHODS: We systematically search and critically appraise in PubMed, Web of Science, and Scielo databases the scientific reports publishing VSEP findings elicited by afferent electrical stimulation at the tragus region from individuals without brain disorders. Eligible studies published from January 2000 to April 2020 were extracted. The following information was identified from each article: number of participants; age; gender; stimulating/recording and grounding electrodes as well as stimulus side, intensity, duration, frequency, and polarity. Information about physiological parameters and neurobiological variables was also extracted. Representative vignettes with novel scalp responses induced by stimulating the tragus were also included to add support to our conclusions. RESULTS: 140 healthy participants were identified from six selected reports. Mean age ranged from 24.3 to 61.5 years. Stimulating and recording aspects were miscellaneous among studies. Scalp responses marked as the VSEP were recorded in 76% of participants, and showed high variability, low validity and poor reproducibility. Age correlated with response latencies. There were not gender differences in scalp response parameters. Cardiovascular function was unaltered by tragus stimulation. Vignettes showed that the VSEP was scalp muscle responses. CONCLUSION: VSEP did not fulfil evoked potential guidelines. VSEP corresponded to volume conduction propagating from muscles surrounding scalp recording sites.

Recomendaciones para el uso de la hormona de crecimiento humana recombinante en pacientes pediátricos de talla baja en Colombia / Recommendations for treatment with recombinant human growth hormone in pediatric patients in Colombia

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Abstract In Colombia there are no guidelines for diagnosis and management of patients with short stature and for the use of recombinant human growth hormone, mainly caused by the diversity of training centers in pediatric endocrinology. In response to this situation, the Asociación Colegio Colombiana de Endocrinología Pediátrica leds the first colombian short stature expert committee in order to standardize the use of human recombinant growth hormone. This work had the participation and endorsement of a consortium of clinical experts representing the Sociedad Colombiana de Pediatría, Secretaría Distrital de Salud de Bogotá- Subred Integrada de Servicios de Salud Suroccidente, Fundación Universitaria Sanitas, Universidad de los Andes and some public and private health institutions in the country, in addition to the participation of methodological experts from the Instituto Global de Excelencia Clínica Keralty. By reviewing the literature and with the best available evidence, we proposed to unify definitions, a diagnostic algorithm, biochemical and dynamic tests with their reference parameters, a description of the considerations about growth hormone use among the indications approved by regulatory agency for medications and food in Colombia and finally a proposal for an informed consent and a medication fact sheet available for parents and patients.

Vaccine Hesitancy and Demand for Immunization in Eastern Europe and Central Asia: Implications for the Region and Beyond.

Immunization is a global success story. It has saved millions of lives and prevented disease worldwide and millions more have been spared the permanent disabilities caused by diseases such as polio and the long-term morbidity caused by other diseases such as measles. Despite the compelling evidence of the public health and economic value of vaccines, vaccine hesitancy has become a growing concern globally. By calling into question the safety and efficacy of vaccines, vaccine hesitancy threatens the progress made in combating morbidity and mortality including efforts to introduce COVID-19 vaccines. This paper a) examines key factors that drive limited demand for vaccines and vaccine hesitancy, (b) highlights the role of demand promotion for immunization and of risk communication and community engagement to address those challenges, (c) discusses vaccine demand and hesitancy in Eastern Europe and Central Asia, and (d) makes recommendations for public health policy and programming for the introduction of the COVID-19 vaccine and beyond.Recommendations include strengthen social listening and digital engagement to address the concerns of caregivers and healthcare professionals, improve the availability and use of social data for evidence-based programming, reinforce public trust in health institutions and service providers, mainstream demand for immunization, strengthen the communication competencies of health service providers, test and apply solutions based on behavioral insights to reinforce demand, engage regularly with local governments and local actors, and strengthen resilience and response capacities for diseases outbreaks and public health emergencies.

Niñez afectada con VIH/SIDA: información sobre VIH/SIDA en cinco ciudades colombianas / Children affected with HIV/AIDS: information of HIV/AIDS in five Colombian cities

Objectives: To describe information about HIV/AIDS in a youth population under 18 years of age affected with HIV/AIDS and caregivers in five Colombian cities: Cali, Buenaventura, Barranquilla, Santa Marta, and Cartagena. Methods: 286 personal surveys were conducted: 11 of children who were aware of their status of involvement with HIV/AIDS and 275 of caregivers of children who did not know their status of involvement with HIV/AIDS. The surveys were conducted in health institutions in the State and private sectors and private, using instruments in line with training programs from participating institutions to inquire about HIV/AIDS. Descriptive analysis was performed of the data and tabulation was done with the SPSS program. Results: Most children who knew their status of involvement with HIV/AIDS report that by acquiring the HIV virus, they may develop other diseases; however, half of these fail to recognize that AIDS weakens the body’s ability to fight infection. The children surveyed partly recognized the HIV/AIDS transmission and treatment mechanisms, while caregivers possess adequate information on the disease. We found reasons to delay the delivery of diagnosis by caregivers 96.2% (N=275) related to avoiding psychological harm to the children, and that if they were to know said status, they might inadvertently disclose this to others, probably exposing them to stigma and/or discrimination. Likewise, professionals providing health services to HIV seropositive children express lack of training regarding the proper procedure and age to reveal such information. Conclusions: It is a priority to enhance the capacity, information, and education of patients about effects, characteristics, manifestations, and treatment of the disease within the comprehensive health management processes conducive to supporting affected families.

Objetivos: Describir información sobre VIH/SIDA en población infantil afectada y menor de 18 años y cuidadores en cinco ciudades colombianas: Cali, Buenaventura, Barranquilla, Santa Marta y Cartagena. Métodos: Se realizaron 286 encuestas personales: 11 a menores que conocían su situación de afectación para VIH/SIDA y 275 a cuidadores de menores que no conocían su situación. Las encuestas se llevaron a cabo en instituciones de salud de los sectores estatal y privado. Se usaron instrumentos que estuvieran de acuerdo con programas de capacitación de las instituciones participantes para indagar sobre VIH/SIDA. Se realizó un análisis descriptivo de los datos y tabulación en SPSS. Resultados: La mayoría de los menores que conocían su situación de afectación para VIH/SIDA sostiene que al adquirir el virus del VIH pueden contraer otras enfermedades. No obstante, la mitad no reconoce que el sida debilita la capacidad del cuerpo para combatir las infecciones. Los menores reconocen parcialmente los mecanismos de transmisión y tratamiento del VIH/SIDA mientras que los cuidadores poseen información adecuada con respecto a la enfermedad. Se encontraron razones para retrasar la entrega del diagnóstico por parte de cuidadores [96.2% (N=275)] relacionadas con evitar daño psicológico al menor y que éste, al conocer su condición, la revele de manera involuntaria a otras personas, lo que probablemente lo exponga a estigma o a la discriminación. Asimismo, los profesionales que brindan servicios de salud a los menores seropositivos para VIH, expresan falta de capacitación con respecto al procedimiento y edad para revelar esta información. Conclusiones: Es prioritario fortalecer las capacidades, información y educación de los pacientes sobre efectos de la enfermedad, características, manifestaciones y tratamiento dentro del manejo integral en salud que favorezca procesos de apoyo a familias afectadas.

Revelación del estado serológico para VIH/SIDA en niños, niñas y adolescentes: una revisión teórica / Disclosure of HIV serostatus children and adolescents: a theoretical review

El artículo presenta una revisión del estado del arte del proceso de revelación del estado serológico en la población infantil menor de 18 años afectada con VIH/SIDA. Los resultados de la revisión se presentan en torno a las modalidades y factores asociados al proceso revelación y no revelación del diagnóstico de VIH a niños, niñas y adolescentes por parte de sus cuidadores y profesionales que brindan servicios de salud en diversos contextos socioculturales y la situación en Colombia. Se seleccionaron artículos publicados en cinco bases de datos utilizándose como palabras clave para la búsqueda “disclosure”, “disclosure model”, “disclosure in children with HIV/AIDS” y ”pediatric HIV/AIDS”. Para la búsqueda se incluyeron artículos en los idiomas inglés y español entre los años 1990 y 2008.

The article presents a review of HIV serostatus disclosure in the under-18 population living with HIV/AIDS. The results include disclosure models and factors associated with disclosure and non disclosure of children and adolescents' HIV serostatus by their caregivers and health workers.The effects of these factors in various sociocultural contexts were studied, with emphasis on the Colombian context. Articles published in five databases were selected, using the key words “disclosure”, “disclosure model”, “disclosure in children with HIV/AIDS” and “pediatric HIV/AIDS”. Articles published in English and Spanish, and between 1990 and 2008, were included.

Tratamiento en pacientes diabéticos: oportunidades y barreras, estudio de caso en Cartagena de indias, Colombia, 2006 / Treatment In Diabetic Patients: Opportunities And Barriers, A Case Study In Cartagena, Colombia, 2006

Introducción: Adherencia al tratamiento es el proceso activo de adopción de cambios comportamentales para el autocuidado en enfermedades crónicas como la diabetes mellitus. Objetivo: conocer los niveles de adherencia auto reportada y los factores que la condicionan, interpretadas desde un enfoque biopsicosocial, a efectos de proponer estrategias culturalmente adaptadas que permitan el mejoramiento a los programas educativos que se imparten en la institución. Materiales y métodos: Estudio con enfoque cuantitativo descriptivo con aplicación de entrevistas en 131 pacientes diabéticos tipo 2 mayores de 30 años en Cartagena de Indias, Colombia-2006. El análisis de la información se realizó en un programa estadístico informático denominado Statistical Package for the Social Sciences version 13.Resultados: En una escala de 0 a 7, el puntaje de adherencia auto-reportada general fue de 4,61, siendo mayor para no tabaquismo (6,64) y farmacoterapia (6,22) y menor para automonitoreo (0,44) y ejercicio (3,40). Existen barreras económicas, rechazo a insulina y percepción de dificultades para dieta y ejercicios. Se evidenció apoyo de familiares y personal sanitario. Conclusiones: es necesario incrementar la adherencia al tratamiento, trabajando especialmente los elementos aceptación de la enfermedad y autoeficacia en el grupo menos adherente, y facilitando accesibilidad a dieta y a ejercicio físico.

Introduction: Adherence to treatment is an active process of making changes to behavioral in chronic diseases such as diabetes mellitus. Objective: The objective of this study was to determine levels of self-reported adherence and the factors that condition, interpreted from a biopsychosocial approach, in order to propose strategies culturally suited to improving the educational programs that are taught in the institution. Materials and methods: research quantitative descriptive with applying survey questionnaire in 131 diabetic patients type 2, elders than 30 years old, in a private Health Insurer, in Cartagena de Indias, Colombia 2006. The data analysis was conducted in the Statistical Package for the Social Sciences version 13. Results: From 0 to 7 scale, the score of the general self-reported adherence was 4,61. The biggest for not smoking (6,64) and pharmacotherapy (6,22) and lowest for self-monitoring (0,44) and physical activity (3,40). Economic barriers, rejection to insulin and perception of difficulties for diet and exercises were found. Perceived support from family and health personnel was evidenced. Conclusions: it is necessary to implement programs that increase the adherence to the treatment, improving especially the topics acceptance of the disease and self-efficacy in the less adherent group, particularly by facilitating access to diet and physical activity.

People's concepts on diarrhea and dehydration in Nicaragua: the difficult of the intercultural dialogue

Objetivos: analisar os conceitos e estratégias de tratamento da população relativas à diarréia e à desidratação e suas implicações para melhorar a prática dos serviços de saúde. Métodos: foram relacionadas entrevistas individuais e de grupo a mães, outros membros da comunidade, curandeiros tradicionais e pessoal básico de saúde em dois municípios da Nicaraguá. Realizou-se uma pesquisa domiciliar, com questionário estruturado, em uma amostra aleatória de 1.924 famílias com crianças abaixo de cinco anos em três departamentos. Resultados: a população identifica facilmente a diarréia, como doença em sim mesma ou como sintoma de outras doenças populares. A construção popular das causas da diarréia é complexa, combina conceitos populares e médicos modernos, e influencia as condutas preventivas e curativas. O pessoal de saúde compartilha conceitos populares de doença. Desidratação, termo e conceito novos introduzidos pelas campanhas de educação em saúde, é confundido com o termo desnutrição. O soro de reidratação oral (SRO) é considerado como um fármaco inefetivo contra a diarréia. A utilização inadequada de fármacos está muito disseminado sendo estes, na maioria dos casos, prescritos pelos médicos. Conclusões: os resultados indicam a convivência de conceitos populares com conceitos médicos modernos nem sempre bem desenvolvidos. È necessária uma mudança na comunicação entre os serviços de saúde e a população, baseada numa análise diferente dos conhecimentos e práticas da população.

Incidência e fatores de risco de diarréia e infecçöes respiratórias agudas em comunidades urbanas de Pernambuco, Brasil / Incidence and risks factors for diarrhoea and acute respiratory infections in urban communities of Pernambuco, Brazil

Em estudo de intervençäo educativa sobre diarréia e infecçöes repiratórias agudas (IRA) nos Municípios de Olinda e Recife, realizaram-se duas pesquisas domiciliares em uma amostra de famílias, com pelo menos uma criança abaixo de cinco anos, em abril-maio de 1992 e 1994. Foram estudadas 5.436 crianças. A incidência anual corrigida (IAC) de diarréia foi de 2,7 episódios por criança/ano, com uma incidência de 10,2 por cento nas duas semanas prévias ao inquérito, estável para 1992 e 1994. Os fatores associados de forma constante a um maior risco de diarréia foram a idade da criança abaixo de dois anos, ausência de saneamento básico e de eletrodomésticos no domicílio. IAC de IRA foi de 9,5 episódios por criança/ano. A incidência de IRA foi de 41,0 por cento em 1992 e de 32,6 por cento em 1994, sendo a maioria de vias respiratórias altas (75,9 por cento). Só o fator baixa idade mostrou associaçäo com o maior risco de IRA. Os resultados indicam a importância que ambas patologias ainda têm na saúde das crianças menores de cinco anos, e, no caso da diarréia, a necessidade urgente de ampliar a cobertura dos serviços básicos visando ao impacto na reduçäo da incidência.