Nutritional Issues in Children with Dysphagia.

(1) Background: Pediatric dysphagia presents significant nutritional challenges, often impacting growth and development due to reduced oral intake, increased nutritional needs, and gastrointestinal complications; (2) Methods: This prospective quasi-experimental study assessed 117 children under 14 years old (20 patients were under 1 year old, 80 were aged 1-7 years, and 17 were older than 7 years), diagnosed with swallowing disorders, to analyze their caloric, macro-, and micronutrient intake and identify potential deficiencies. The severity of dysphagia was established using functional oral intake scales, and dietary records were reviewed over a 3-day period; (3) Results: The study revealed that 39.8% of participants did not meet their total energy expenditure (TEE), highlighting a high prevalence of malnutrition among these children. Furthermore, patients using feeding devices exhibited a significantly lower caloric intake, and over half required significantly modified food textures. After individualized speech therapy and nutritional rehabilitation, participants showed significant improvements in caloric intake, with their energy coverage increasing from 958% to 1198% of the daily requirement. Rehabilitation also improved tolerance to a broader range of food textures; (4) Conclusions: This research underscores the importance of multidisciplinary, individualized nutritional strategies to address the specific challenges of pediatric dysphagia, emphasizing the role of enteral nutrition and therapeutic interventions in improving the quality of life and nutritional outcomes of these children. Further studies are recommended to assess the long-term impact of such strategies.

Strong conservatism of floral morphology during the rapid diversification of the genus Helianthemum.

PREMISE: Divergence of floral morphology and breeding systems are often expected to be linked to angiosperm diversification and environmental niche divergence. However, available evidence for such relationships is not generalizable due to different taxonomic, geographical and time scales. The Palearctic genus Helianthemum shows the highest diversity of the family Cistaceae in terms of breeding systems, floral traits, and environmental conditions as a result of three recent evolutionary radiations since the Late Miocene. Here, we investigated the tempo and mode of evolution of floral morphology in the genus and its link with species diversification and environmental niche divergence. METHODS: We quantified 18 floral traits from 83 taxa and applied phylogenetic comparative methods using a robust phylogenetic framework based on genotyping-by-sequencing data. RESULTS: We found three different floral morphologies, putatively related to three different breeding systems: type I, characterized by small flowers without herkogamy and low pollen to ovule ratio; type II, represented by large flowers with approach herkogamy and intermediate pollen to ovule ratio; and type III, featured by small flowers with reverse herkogamy and the highest pollen to ovule ratio. Each morphology has been highly conserved across each radiation and has evolved independently of species diversification and ecological niche divergence. CONCLUSIONS: The combined results of trait, niche, and species diversification ultimately recovered a pattern of potentially non-adaptive radiations in Helianthemum and highlight the idea that evolutionary radiations can be decoupled from floral morphology evolution even in lineages that diversified in heterogeneous environments as the Mediterranean Basin.

Contribution to optimization and standardization of antibacterial assays with silver nanoparticles: the culture medium and their aggregation.

The antimicrobial activity of silver nanoparticles is determined by their size and specific properties, as well as by the chemical composition of the exposure medium in which the nanoparticles are suspended. When the antibacterial tests are carried out in a culture medium, aggregation of the nanoparticles is produced, decreasing their effectiveness. This study proposes the addition of surfactants to the culture medium to prevent the aggregation of silver nanoparticles and optimizes the concentrations of these surfactants. The aggregation of silver nanoparticles was studied by dynamic light scattering (DLS) after dispersion in three liquid culture media (Mueller-Hinton (MH), Luria-Bertani (LB) and Brain Heart Infusion) in which four different surfactants (SDS, Triton X100, Tween 80 and CTAB) were added at concentrations of 0, 0.1, 0.5, 1, 1.5 and 2%. Results showed that, the optimal culture media to prevent aggregation of silver nanoparticles were MH and LB with higher concentrations of Tween 80 and Triton X100 surfactants; being MH + 2% of Tween 80 and MH + 1% Triton X100 the best combinations obtained because the results obtained were closest to the sizes of nanoparticles in ultrapure water. In addition, it has been verified that the optimal medium + surfactant combinations chosen did not affect the viability of Escherichia coli bacteria. Nanoparticle aggregation was not observed by single particle inductively coupled plasma mass spectrometry (SP-ICP-MS) when nanoparticles were incubated for long incubations periods (24 h) in the optimal medium chosen.

Clinicopathological characterization of children with dysphagia, family impact and health-related quality of life of their caregivers.

INTRODUCTION: Oropharyngeal dysphagia (DOF) without proper evaluation can be underdiagnosed in certain groups of the pediatricpopulation. Meeting the needs of these patients can lead to an overload of their caregivers. OBJECTIVES: To describe the epidemiological and clinical characteristics of the patients evaluated after starting a monographic DOF clinic (C-DOF) and study whether there are changes at the nutritional level, as well as the burden and impact that caregivers find on quality of life related to health (HRQL). MATERIAL AND METHODS: Descriptive observational study of patients evaluated in a C-DOF from its start-up. To evaluate HRQoL, an ad hoc survey adapted from the Swallowing Quality of Life Questionnaire of the adult population was designed. RESULTS: 103 patients were evaluated, 85.4% presenting some neurological disease. A videofluoroscopic study was performed in 51 patients (49.5%), reporting combined alterations in both the oral and pharyngeal phases in 64.7% of them. There was a directly proportional correlation between the severity of the DOF and the presence of aspirations, as well as with the patient's motor impairment. Regarding the anthropometric evaluation, there was a trend towards improvement in weight z-score (+0.14 SD), height (+0.17 SD) and BMI (+0.16 SD). Out of 46.2% of the caregivers reported that the DOF problem interfered negatively in the basic activities of daily life. The increase in HRQOL, after the evaluation in the monographic DOF clinic, was statistically significant overall. CONCLUSIONS: The monographic DOF clinic provided specialized care, impacting positively at the nutritional status of patients, as well as perceived changes in HRQOL, with a probable impact on caregivers.

Caracterización clínico-patológica de niños con disfagia, impacto familiar y calidad de vida de sus cuidadores / Clinicopathological characterization of children with dysphagia, family impact and health-related quality of life of their caregivers

Introducción: La disfagia orofaríngea (DOF) puede resultar infradiagnosticada en determinados grupos de población pediátrica. Atender las necesidades de estos pacientes puede derivar en una sobrecarga de sus cuidadores. Objetivos: Describir las características epidemiológicas y clínicas de los pacientes evaluados tras la creación de una consulta monográfica de DOF (C-DOF), estudiar cambios a nivel nutricional, así como la repercusión en la calidad de vida relacionada con la salud (CVRS) de los cuidadores. Material y métodos: Estudio observacional descriptivo de los pacientes evaluados en una C-DOF desde su puesta en marcha. Para evaluar la CVRS, se diseña una encuesta ad hoc adaptada del Swallowing Quality of Life Questionnaire de población adulta. Resultados: Se evaluaron 103 pacientes (85,4% con patología neurológica de base). Se realizó estudio videofluoroscópico a 51 pacientes (49,5%), reportando alteraciones combinadas de fases oral y faríngea un 64,7%. Existió una correlación directamente proporcional entre la gravedad de la DOF y la presencia de aspiraciones, así como con la afectación motora del paciente. En cuanto a la evaluación antropométrica, se observó mejoría en z-score de peso (+0,14 DE), de talla (+0,17 DE) y de IMC (+0,16 DE). El 46,2% de los cuidadores refirieron que la DOF interfiere negativamente en las actividades básicas de la vida diaria. El incremento en calidad de vida, tras la evaluación en la C-DOF, de forma global resultó estadísticamente significativo. Conclusiones: La C-DOF proporciona una atención especializada, repercute positivamente en el estado nutricional de los pacientes, así como en los cambios percibidos en la CVRS, con probable impacto en los cuidadores. (AU)

Introduction: Oropharyngeal dysphagia (DOF) without proper evaluation can be underdiagnosed in certain groups of the pediatric population. Meeting the needs of these patients can lead to an overload of their caregivers. Objectives: To describe the epidemiological and clinical characteristics of the patients evaluated after starting a monographic DOF clinic (C-DOF) and study whether there are changes at the nutritional level, as well as the burden and impact that caregivers find on quality of life related to health (HRQOL). Material and methods: Descriptive observational study of patients evaluated in a C-DOF from its start-up. To evaluate HRQOL, an ad hoc survey adapted from the Swallowing Quality of Life Questionnaire of the adult population was designed. Results: 103 patients were evaluated, 85.4% presenting some neurological disease. A videofluoroscopic study was performed in 51 patients (49.5%), reporting combined alterations in both the oral and pharyngeal phases in 64.7% of them. There was a directly proportional correlation between the severity of the DOF and the presence of aspirations, as well as with the patient's motor impairment. Regarding the anthropometric evaluation, there was a trend toward improvement in weight z-score (+0.14 SD), height (+0.17 SD) and BMI (+0.16 SD). Out of 46.2% of the caregivers reported that the DOF problem interfered negatively in the basic activities of daily life. The increase in HRQOL, after the evaluation in the monographic DOF clinic, was statistically significant overall. Conclusions: The monographic DOF clinic provided specialized care, impacting positively at the nutritional status of patients, as well as perceived changes in HRQOL, with a probable impact on caregivers. (AU)

Sirolimus for the Treatment of Juvenile Polyposis in Childhood.

Juvenile polyposis syndrome (JPS) is a rare disease with an autosomal dominant inheritance pattern characterized by the development of multiple hamartomatous polyps in the gastrointestinal tract. The most frequent signs and symptoms are recurrent abdominal pain, rectal bleeding, anemia, and iron deficiency. The treatment of JPS is symptomatic, requiring serial endoscopic polypectomies or intestinal resections in the most severe cases. We describe the clinical case of a patient with JPS with a childhood juvenile polyposis phenotype because of a mutation on the SMAD4 gene, who received treatment with sirolimus successfully.

[Clinicopathological characterization of children with dysphagia, family impact and health-related quality of life of their caregivers]. / Caracterización clínico-patológica de niños con disfagia, impacto familiar y calidad de vida de sus cuidadores.

INTRODUCTION: Oropharyngeal dysphagia (DOF) without proper evaluation can be underdiagnosed in certain groups of the pediatric population. Meeting the needs of these patients can lead to an overload of their caregivers. OBJECTIVES: To describe the epidemiological and clinical characteristics of the patients evaluated after starting a monographic DOF clinic (C-DOF) and study whether there are changes at the nutritional level, as well as the burden and impact that caregivers find on quality of life related to health (HRQOL). MATERIAL AND METHODS: Descriptive observational study of patients evaluated in a C-DOF from its start-up. To evaluate HRQOL, an ad hoc survey adapted from the Swallowing Quality of Life Questionnaire of the adult population was designed. RESULTS: 103 patients were evaluated, 85.4% presenting some neurological disease. A videofluoroscopic study was performed in 51 patients (49.5%), reporting combined alterations in both the oral and pharyngeal phases in 64.7% of them. There was a directly proportional correlation between the severity of the DOF and the presence of aspirations, as well as with the patient's motor impairment. Regarding the anthropometric evaluation, there was a trend toward improvement in weight z-score (+0.14 SD), height (+0.17 SD) and BMI (+0.16 SD). Out of 46.2% of the caregivers reported that the DOF problem interfered negatively in the basic activities of daily life. The increase in HRQOL, after the evaluation in the monographic DOF clinic, was statistically significant overall. CONCLUSIONS: The monographic DOF clinic provided specialized care, impacting positively at the nutritional status of patients, as well as perceived changes in HRQOL, with a probable impact on caregivers.

Biogeographic history and environmental niche evolution in the palearctic genus Helianthemum (Cistaceae).

The biogeographic history and the degree of environmental niche conservatism provide essential clues to decipher the underlying macroevolutionary processes of species diversification and to understand contemporary patterns of biodiversity. The genus Helianthemum constitutes an excellent case study to investigate the impact of the geo-climatic changes and the environmental niche shifts on the origins of plant species diversity in the Mediterranean hotspot. It is a palearctic species-rich lineage with c. 140 species and subspecies mostly belonging to three distinct evolutionary radiations, almost confined to the Mediterranean region and occurring across varied environmental conditions. In this work, we studied the ample and rapid diversification of the genus Helianthemum across its whole distribution range by performing phylogenetic reconstructions of ancestral ranges and environmental niche evolution. We observed a striking synchrony of biogeographic movements with niche shifts between the three major clades of the genus Helianthemum, likely related to the geo-climatic events occurred in the Mediterranean Basin since the Upper Miocene. In particular, Late Miocene and Early Pliocene were dominated by episodes of range expansions, the Late Pliocene by range contraction and vicariance events, and Pleistocene by most intense environmental niche shifts and in-situ diversification. Our study also provides evidence for four main environmental niches in Helianthemum (i.e., Mediterranean, subdesert, humid-montane and subtropical-insular) and a tendency toward environmental niche conservatism within different subclades, with few niche shifts mostly occurring from Mediterranean ancestors. The relative longer time spent in Mediterranean areas by the ancestors of Helianthemum suggests that the larger species diversity observed in the Mediterranean (i.e. Northern Africa and Southern Europe) may have been generated by a time-for-speciation effect reinforced by environmental niche conservatism. Overall, our work highlights the role of the Mediterranean Basin as a 'cradle of diversity' and an 'evolutionary hub', facilitating the environmental transitions and determining the building up of a global plant biodiversity hotspot.

Puesta en marcha de una consulta virtual de gastroenterología pediátrica antes de la epidemia por COVID-19: un proyecto piloto pionero / Launch of a virtual pediatric gastroenterology consultation prior to the COVID-19 epidemic: A pioneering pilot Project

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The New Molecules Are Changing the Course of Pediatric Chronically Active Ulcerative Colitis: A Series of Pediatric Cases.

Chronically active ulcerative colitis (UC) constitutes a challenge in an era where medical therapeutic options have increased while experience with colectomies has decreased. The change in the therapeutic paradigm of the disease means that patients with chronically active UC are being managed waiting to find their therapeutic target. We present 2 cases of children with chronically active UC who did not respond to intravenous steroids nor sequential therapy. A response was obtained with ustekinumab and tofacitinib, 2 drugs widely used in adults but still with little evidence in children. Highlighting the important role of patients and their families helped decision-making, facilitating the work of the medical team. With multidisciplinary management and close follow-up, they have been able to avoid surgery entering complete clinical remission.

Identification of free-living amoebas and amoeba-resistant bacteria accumulated in Dreissena polymorpha.

To identify the free-living amoeba (FLA) and amoeba-resistant bacteria (ARB) accumulated in zebra mussels and in the water in which they are found, mussels were collected at two locations in the Ebro river basin (North East Spain). FLAs and bacteria were isolated from mussel extracts and from natural water. PCR techniques were used to identify the FLAs and endosymbiont bacteria (Legionella, Mycobacterium, Pseudomonas and cyanobacteria), and to detect Giardia and Cryptosporidium. The most frequently found FLAs were Naegleria spp. The presence of Legionella, Mycobacterium and Pseudomonas inside the FLA was demonstrated, and in some cases both Legionella and Pseudomonas were found together. Differences between FLAs and ARB identified inside the mussels and in the water were detected. In addition, Escherichia coli, Clostridium perfringens, Salmonella spp. and Enterococcus spp. were accumulated in mussels in concentrations unconnected with those found in water. The results show the ability of the zebra mussel to act as a reservoir of potentially pathogenic FLAs, which are associated with potentially pathogenic ARB, although the lack of association between microorganisms inside the mussels and in the water suggests that they are not useful for monitoring microbiological contamination at a specific time.

Maximize Resolution or Minimize Error? Using Genotyping-By-Sequencing to Investigate the Recent Diversification of Helianthemum (Cistaceae).

A robust phylogenetic framework, in terms of extensive geographical and taxonomic sampling, well-resolved species relationships and high certainty of tree topologies and branch length estimations, is critical in the study of macroevolutionary patterns. Whereas Sanger sequencing-based methods usually recover insufficient phylogenetic signal, especially in recently diversified lineages, reduced-representation sequencing methods tend to provide well-supported phylogenetic relationships, but usually entail remarkable bioinformatic challenges due to the inherent trade-off between the number of SNPs and the magnitude of associated error rates. The genus Helianthemum (Cistaceae) is a species-rich and taxonomically complex Palearctic group of plants that diversified mainly since the Upper Miocene. It is a challenging case study since previous attempts using Sanger sequencing were unable to resolve the intrageneric phylogenetic relationships. Aiming to obtain a robust phylogenetic reconstruction based on genotyping-by-sequencing (GBS), we established a rigorous methodological workflow in which we i) explored how variable settings during dataset assembly have an impact on error rates and on the degree of resolution under concatenation and coalescent approaches, ii) assessed the effect of two extreme parameter configurations (minimizing error rates vs. maximizing phylogenetic resolution) on tree topology and branch lengths, and iii) evaluated the effects of these two configurations on estimates of divergence times and diversification rates. Our analyses produced highly supported topologically congruent phylogenetic trees for both configurations. However, minimizing error rates did produce more reliable branch lengths, critically affecting the accuracy of downstream analyses (i.e. divergence times and diversification rates). In addition to recommending a revision of intrageneric systematics, our results enabled us to identify three highly diversified lineages in Helianthemum in contrasting geographical areas and ecological conditions, which started radiating in the Upper Miocene.

The Use of Quinacrine in Nitroimidazole-resistant Giardia Duodenalis: An Old Drug for an Emerging Problem.

Background: There is little evidence regarding the management of refractory giardiasis after treatment with nitroimidazoles. This study estimates the proportion of persistent giardiasis in 3 hospitals in Barcelona, describes associated risk factors and genotype, and evaluates the efficacy rate of quinacrine in those with persistent giardiasis. Methods: A clinical, prospective, observational study was conducted in patients with giardiasis treated with nitroimidazoles. Those with persistent giardiasis were provided quinacrine. Molecular characterization of Giardia isolates was performed by polymerase chain reaction amplification of a fragment of tpi and bg genes. Results: Seventy-seven patients were recruited and treated with nitroimidazoles, and in 14 of 71 (20%) of patients followed up, Giardia persisted. Refractory giardiasis was associated with malaise (P = .007) and anorexia (P = .02), with previous giardiasis (P = .03), and with previous antibiotic (P = .02) or antiparasitic(P = .04) use. Quinacrine had an effectiveness rate of 100% in refractory giardiasis (n = 13; 95% confidence interval = 75-100). Molecular characterization showed that 17 (25%) Giardia isolates belonged to assemblage A, and 31 (43%) belonged to assemblage B. In refractory giardiasis, assemblage A and B were found responsible in 4 and 6 cases, respectively. Conclusions: Almost 20% of patients presented persistent giardiasis, belonging to both assemblages A and B, after nitroimidazole. Short course of quinacrine was effective in treating refractory cases. Further controlled studies should evaluate its efficacy and safety.

A Rabbit Model of Acanthamoeba Keratitis: Use of Infected Soft Contact Lenses After Corneal Epithelium Debridement With a Diamond Burr.

Purpose: To develop a rabbit model of Acanthamoeba keratitis (AK) as the best method to reproduce the natural course of this disease. Methods: To induce AK, infected contact lenses (1000 amoebae/mm2, 90% trophozoites) were placed over the previously debrided corneal surface, in combination with a temporary tarsorrhaphy. Environmental and clinical strains of Acanthamoeba spp. (genotype T4) were used. Three groups (1L, n = 32; 2L-21d, n = 5; 2L-3d, n = 23) were established according to the number of contact lenses used (1L, 1 lens; 2L-21d and 2L-3d, 2 lenses) and the placement day of these (1L, day 1; 2L-21d, days 1 and 21; 2L-3d, days 1 and 3). The infection was quantified by a clinical score system and confirmed using corneal cytology and culture, polymerase chain reaction and histopathologic analysis. Results: The infection rate obtained was high (1L, 87.5%; 2L-21d, 100%; 2L-3d, 82.6%), although no clinical signs were observed in the 50% of the infected animals in group 1L. Among groups, group 2L-3d showed more cases of moderate and severe infection. Among strains, no statistically significant differences were found in the infection rate. In the control eyes, cross infection was confirmed when a sterile contact lens was placed in the previously debrided corneas but not if the eye remained intact. Conclusions: The combination of two infected contact lenses after corneal debridement seems to be an alternative model, clinically and histopathologically similar to its human counterpart, to induce the different AK stages and reproduce the course of the disease in rabbits.

Servicios sanitarios y sociales utilizados por las personas mayores del medio rural / Health and social services used by the rural elderly

Objetivos. Describir la utilización de servicios sanitarios y sociales, y analizar la influencia de la capacidad funcional para las actividades instrumentales de la vida diaria (AIVD) y de otros factores en su utilización. Método. Estudio transversal en personas mayores de 64 años no institucionalizados de una zona básica de salud rural de Zaragoza. Variables dependientes: utilización de distintos servicios sociales y sanitarios. Variable independiente principal: capacidad funcional para las AIVD según Lawton-Brody. Variables modificadoras del efecto: sociodemográficas, ejercicio físico, comorbilidad, salud autopercibida, ayuda para caminar, recursos sociales y recursos económicos (OARS-MAFQ). La relación entre el uso de servicios y la capacidad funcional para las AIVD se evaluó utilizando OR crudas (ORc) y ajustadas (ORaj) con sus IC del 95% mediante modelos de regresión logística multivariantes. Resultados. Las personas más mayores y las que mostraron peor capacidad funcional en AIVD utilizaron con mayor frecuencia los servicios sociales y sanitarios. Ser mujer, tener peor estado de salud, no hacer ejercicio físico y contar con escasos recursos sociales y económicos determinaron un mayor uso de servicios sanitarios. Ser hombre, tener bajo nivel de estudios y escasos recursos sociales condicionaron una mayor utilización de servicios sociales de ayuda domiciliaria. La actividad física regular y utilizar ayudas para caminar se asociaron a mayor participación en actividades recreativas. Conclusiones. La probabilidad de utilizar los servicios sociales y sanitarios aumentó en las personas más mayores y con peor capacidad funcional para las AIVD. Su utilización más concreta varió según las diferencias en salud, sociodemográficas y contextuales (AU)

Objectives. To describe the use of health and social services, and to analyze the influence of functional capacity for Instrumental Activities of Daily Living (IADL) and other factors in their use. Method. Cross-sectional study in a non-institutionalized population older than 64 years old in a basic rural health area of Zaragoza. Dependent variables: use of different health and social services. Main independent variable: functional capacity for IADL according to the Lawton-Brody. Confounding variables: sociodemographic, physical exercise, comorbidity, self-perceived health, walking aids, social resources and economic resources (OARS-MAFQ). The relationship between the use of services and functional capacity for IADL was assessed using crude OR (ORC) and adjusted (adjusted OR) with CI95% by means of multivariate logistic regression models. Results. The use of social and health services increased with age and worse functional capacity for IADL. The increased use of health services was related with bad stage of health, limited social and economic resources, physical inactivity and female. The increased use of home help services was related with limited social resources, low education level and male. Regular physical activity and using walking aids were associated with greater participation in recreational activities. Conclusions. The probability of using social and health services increased in older people with impaired functional capacity for IADL. The specific use of them changed according to differences in health, demographic and contextual features(AU)