Proof of concept of the Universal Baby video innovation for early child development in Lima, Peru.

OBJECTIVE: Community-based video interventions offer an effective and potentially scalable early interaction coaching tool for caregivers living in low resource settings. We tested the Universal Baby (UB) video innovation; an early interaction coaching tool using video sourced and produced locally with early child development (ECD) expert supervision. METHODS: This proof-of-concept study enrolled 40 caregivers of children ages 10-18 months assigned to intervention and control groups by health establishments in Carabayllo, Lima, Peru. Mother/child dyads received 12 weekly group health education sessions with social support. Of those, 16 caregivers also received 6 UB videos featuring brain science education and local clips of responsive, reciprocal interaction, also known as "serve and return" interaction. Survey data assessed feasibility and acceptability of the intervention. We assessed improved quality of mother/child interaction using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO). RESULTS: We found the program feasible. We successfully trained the local team to produce UB videos using locally-sourced footage and delivered the videos as part of a community-based intervention. We also found it to be acceptable in that participants enthusiastically received the UB videos, reporting they enjoyed being videotaped, and learned how to recognize and appropriately respond to their child's nuanced sounds and gestures. The median change in total PICCOLO scores favored the intervention group compared to the control group. CONCLUSIONS: UB offers great potential as a sustainable, potentially scalable, and culturally appropriate tool to promote equity for child development among young children living in low resource homes globally.

Rango normal de subunidad ácido-lábil (ALS) en niños españoles y su relación con la edad, el sexo, el estadio puberal y otros factores de crecimiento / Normal range for acid-labile subunit in paediatric patients in Spain and its association with age, sex, pubertal stage and other growth factors

Introducción: La subunidad ácido-lábil (ALS) tiene un papel importante en los efectos endocrinos de los factores de crecimiento similares a la insulina (IGF) en tejidos diana. Históricamente ha recibido una atención limitada. El objetivo de nuestro estudio fue describir el rango normal de ALS en niños sanos y su relación con otros factores de crecimiento. Pacientes y métodos: Se diseñó un estudio descriptivo transversal. Se recopilaron datos sobre edad, altura, índice de masa corporal, edad gestacional, antropometría al nacer y niveles séricos de ALS, IGF1 e IGFBP3 de niños sanos de 2 a 15años con estatura estándar. Los niveles de ALS, IGF1 e IGFBP3 se midieron mediante ELISA. Se utilizaron modelos de normalización GAMLSS para la estandarización de variables. Resultados: Se recogieron muestras de 446 niños. En niños prepúberes, los niveles de ALS, IGF1 e IGFBP3 se correlacionaron de manera positiva en ambos sexos y con la edad (p<0,01). Los niveles de ALS, IGF1 e IGFBP3 y la relación molar IGF1/IGFBP3 fueron significativamente diferentes entre ambos sexos y más altos en los niños puberales (p<0,01). Se realizaron gráficas de normalidad por género para cada uno de los componentes del complejo ternario y para las relaciones molares IGF1/IGFBP3 e IGFBP3/ALS. Además, se construyeron fórmulas modelo para calcular el Z Score según la edad y el sexo. ConclusionesEste estudio podría determinar valores de referencia específicos por edad y sexo para IGF1, IGFBP3, ALS, IGF1/IGFBP3 e IGFBP3/ALS en niños españoles y parece establecer la relación entre edad, sexo y estadio puberal. (AU)

Introduction: The acid-labile subunit (ALS) plays an important role in the endocrine effects of insulin-like growth factors (IGFs) on target tissues. Historically, it has attracted limited attention. The aim of our study was to describe the normal range of ALS in healthy children and its association with other growth factors. Patients and methods: We designed a cross-sectional descriptive study. We collected data on age, height, body mass index, gestational age, anthropometry at birth and serum levels of ALS, IGF1 and IGFBP3 in healthy children aged 2-15years with a normal height. The levels of ALS, IGF1 and IGFBP3 were measured by ELISA. We fitted GAMLSS normalization models to standardize the variables. Results: Samples were collected from 446 children. In prepubertal children, the levels of ALS, IGF1 and IGFBP3 were positively correlated in both sexes and with age (P<.01). We found significant differences in the levels of ALS, IGF1 and IGFBP3 and the IGF1/IGFBP3 molar ratio between the sexes and higher levels in pubertal boys (P<.01). We generated normal probability plots for each sex for each of the components of the ternary complex and for the IGF1/IGFBP3 and IGFBP3/ALS molar ratios. In addition, we extracted equations from the models for the calculation of z-scores for age and sex. Conclusions: This study may contribute to age- and sex-specific reference values for IGF1, IGFBP3 and ALS levels and IGF1/IGFBP3 and IGFBP3/ALS ratios in Spanish children and suggests an association between age, sex and pubertal stage. (AU)

Normal range for acid-labile subunit in paediatric patients in Spain and its association with age, sex, pubertal stage and other growth factors.

INTRODUCTION: The acid-labile subunit (ALS) plays an important role in the endocrine effects of insulin-like growth factors (IGFs) on target tissues. Historically, it has attracted limited attention. The aim of our study was to describe the normal range of ALS in healthy children and its association with other growth factors. PATIENTS AND METHODS: We designed a cross-sectional descriptive study. We collected data on age, height, body mass index, gestational age, anthropometry at birth and serum levels of ALS, IGF1 and IGFBP3 in healthy children aged 2-15 years with a normal height. The levels of ALS, IGF1 and IGFBP3 were measured by ELISA. We fitted GAMLSS normalization models to standardize the variables. RESULTS: Samples were collected from 446 children. In prepubertal children, the levels of ALS, IGF1 and IGFBP3 were positively correlated in both sexes and with age (P < .01). We found significant differences in the levels of ALS, IGF1 and IGFBP3 and the IGF1/IGFBP3 molar ratio between the sexes and higher levels in pubertal boys (P < .01). We generated normal probability plots for each sex for each of the components of the ternary complex and for the IGF1/IGFBP3 and IGFBP3/ALS molar ratios. In addition, we extracted equations from the models for the calculation of z-scores for age and sex. CONCLUSIONS: This study may contribute age- and sex-specific reference values for IGF1, IGFBP3 and ALS levels and IGF1/IGFBP3 and IGFBP3/ALS ratios in Spanish children and suggests an association between age, sex, and pubertal stage.

[Interactions between herbals medicines and drugs in chronic patients with complexity in primary care.] / Interacciones entre plantas medicinales y medicamentos en pacientes crónicos complejos en atención primaria.

OBJECTIVE: Taking medicinal herbs (MH) is frequent in patients and can cause interactions with others medications. Consumption of MH could be high in chronic patients with complexity (CPC) and produce interactions with drugs and knowledge about these drugs in primary health care (PC) professionals about these interactions is low. The aim was to measure the prevalence of potencial interactions between HM and drugs in CPC and evaluate the degree of knowledge of PC professionals. METHODS: Descriptive observational study in a population of CPC assigned to two PC teams. We investigated MH consumption through interviews and review potential drug interactions. We evaluated the degree of professionals knowledge through a survey designed for the study. A descriptive analysis was carried out. The Student-t test for paired data was used to compare the means.The statistical significance was established at p<0.05. RESULTS: The survey was distributed among 179 patients, mean age 76.9 years old (DE 9.7), 54.6% women. 62.57% (112) take MH. We detected 88 potentially relevant interactions in 51 patients (45.54%). Of the 219 professionals interviewed 51.1% consider that their knowledge about MH were low and 64,4% thought that was important to know the mH consumption of their patients. CONCLUSIONS: We detected a high prevalence of MH consumption in CPC and interactions between herbs medicinal and drugs. Lack of knowledge of PC health professionals is important. It's necessary to record this consumption in the medical history and improve the knowledge of professionals about MH to detect possible interactions, reduce the associated risk and improve the quality of care.

OBJETIVO: El consumo de plantas medicinales (PM) es frecuente en pacientes y puede causar interacciones con otros medicamentos. El consumo de PM puede ser alto en pacientes crónicos complejos (PCC) y producir interacciones con su medicación y el conocimiento sobre estos fármacos en profesionales sanitarios de Atención Primaria (AP) es bajo. El objetivo del estudio fue medir prevalencia de interacciones potenciales entre PM y medicamentos en PCC y evaluar grado de conocimiento de los profesionales de AP. METODOS: Estudio observacional descriptivo en una población de PCC asignados a dos equipos de AP. Se evaluaron el consumo de PM mediante entrevistas y se revisaron las interacciones potenciales con su medicación. Se evaluó el grado de conocimiento de los profesionales mediante una encuesta diseñada para el estudio. Se realizó un análisis descriptivo, La comparación de medias se realizó con la prueba t de Student. La significación estadística se estableció en p<0,05. RESULTADOS: La encuesta se distribuyó entre 179 pacientes, con una edad media de 76,9 años (DE 9,7), 54,6% mujeres. El 62,57% (112) consumieron PM. Detectamos 88 interacciones potencialmente relevantes en 51 pacientes (45,54%). De los 219 profesionales entrevistados el 51,1% consideraron que sus conocimientos sobre PM eran bajos y 64,4% pensaron que era importante conocer el consumo de PM de sus pacientes. CONCLUSIONES: Detectamos una alta prevalencia del consumo de PM en PCC y de interacciones entre PM y medicamentos. La falta de conocimientos de los profesionales sanitarios es importante. Es necesario registrar en la historia clínica este consumo y mejorar el conocimiento de los profesionales de AP sobre PM para detectar posibles interacciones, disminuir el riesgo asociado y mejorar la calidad asistencial.

"Send & hold" clinical decision support rules improvement to reduce unnecessary testing of vitamins A, E, K, B1, B2, B3, B6 and C.

BACKGROUND: We assessed the impact of several "send & hold" clinical decision support rules (CDSRs) within the electronical request system for vitamins A, E, K, B1, B2, B3, B6 and C for all outpatients at a large health department. METHODS: When ordered through electronical request, providers (except for all our primary care physicians who worked as a non-intervention control group) were always asked to answer several compulsory questions regarding main indication, symptomatology, suspected diagnosis, vitamin active treatments, etc., for each vitamin test using a drop-down list format. After samples arrival, tests were later put on hold internally by our laboratory information system (LIS) until review for their appropriateness was made by two staff pathologists according to the provided answers and LIS records (i.e. "send & hold"). The number of tests for each analyte was compared between the 10-month period before and after CDSRs implementation in both groups. RESULTS: After implementation, vitamins test volumes decreased by 40% for vitamin A, 29% for vitamin E, 42% for vitamin K, 37% for vitamin B1, 85% for vitamin B2, 68% for vitamin B3, 65% for vitamin B6 and 59% for vitamin C (all p values 0.03 or lower except for vitamin B3), whereas in control group, the majority increased or remained stable. In patients with rejected vitamins, no new requests and/or adverse clinical outcome comments due to this fact were identified. CONCLUSIONS: "Send & hold" CDSRs are a promising informatics tool that can support in utilization management and enhance the pathologist's leadership role as tests specialist.

Community-Based Needs Assessment of Neurodevelopment, Caregiver, and Home Environment Factors in Young Children Affected by HIV in Lima, Peru.

BACKGROUND: In many resource-poor settings such as Peru, children affected by HIV have a high prevalence of neurodevelopmental delays (NDDs) and remain excluded from adequate treatment. METHODS: Community health workers (CHWs) administered NDD screening instruments to assess child development and associated caregiver and household factors in 14 HIV-affected parent-child dyads. Focus group discussion with caregivers was conducted to explore their needs and behaviors around early child stimulation and to assess their perceptions of the screening experience. RESULTS: Over 70% of the children had abnormal classification in at least 1 (out of 5) developmental domains according to Ages and States Questionnaire-provided cutoff scores. Caregiver depression and stress were associated with abnormal development as were some parenting behavior factors. Knowledge about child development was low. Caregivers felt testing and discussing results with a CHW were very insightful. Reported caregiver behavior differed between caregivers with HIV-infected children and those with uninfected children. CONCLUSION: Taken together, these exploratory quantitative data suggest that parenting behaviors associated with low child development scores may be modifiable and that community-based testing is well received and informative to these HIV-infected caregivers.

Intervención de enfermería a paciente con síndrome coronario agudo y síndrome compartimental abdominal / Nursing interventions to patients with acute coronary syndrome and abdominal compartment syndrome

Introducción: Las enfermedades cardiovasculares son la primera causa de muerte en el mundo, México no es la excepción llegando a ser la primera causa de muerte, esto debido a que en la mayoría de los pacientes no se diagnostica ni reciben atención oportuna, mientras que los sobrevivientes llegan a sufrir infartos por falta de orientación para la modificación de sus factores de riesgo. Objetivo: Aplicar las intervenciones de enfermería a paciente con síndrome coronario agudo y síndrome compartimental abdominal. Metodología: Estudio de caso clínico, descriptivo, transversal y prospectivo, a paciente de 83 años de edad con demencia senil, factores de riesgo cardiovasculares; síndrome coronario agudo y síndrome compartimental abdominal. Se estructuran los cuidados de acuerdo con las cinco etapas del proceso de enfermería. Se utiliza un instrumento de valoración con base en los patrones funcionales de Marjory Gordon; las taxonomías de la North American Nursing Diagnosis Association, la Clasificación de Intervenciones y de Resultados de Enfermería. Resultados: Se realizaron las intervenciones de enfermería dando prioridad a dos patrones: eliminación y actividad ejercicio. Conclusión: Las intervenciones de enfermería se priorizaron con base en las manifestaciones clínicas presentadas en las cinco semanas de hospitalización del paciente, sin embargo, los factores de riesgo complicaron el pronóstico.

Introduction: Cardiovascular diseases are the leading cause of death in the world, Mexico is not the exception becoming the leading cause of death, that because in the majority of patients not diagnosed or receive timely care, while survivors arrive to seffer heart attacks from lack of guidance for modifyingtrisk factors. Objective:Toapply the nursing interventions to patients whit acute coronary syndrome and abdominal compartment syndrome. Methodology:Clinical study, descriptive, transversal and prospective case, a patients of 83 year-old, senile dementia, cardiovascular risk factors; acute coronary syndrome and abdominal compartment syndrome. Care according to the five stages of the nursing process are structured: an assessment tool based on the functional patterns Marjory Gordon is used; taxonomies of the North American Nursing Diagnosis Association, Interventions Classification and Nursing Outcomes. Results: The nursing interventions were made by prioritizing two patterns: elimination and the activity-exercise pattern. Conclusion: Nursing interventions were priorized based on clinic manifestations presented in the five weeks of hospitalization, however the risk factors complicated the forecast.

Failure to review STAT clinical laboratory requests and its economical impact.

BACKGROUND: Failure to follow-up laboratory test results has been described as one of the major processes contributing to unsafe patient care. Currently, most of the laboratories do not know with certainty not only their rate of missed (or unreviewed) requests but the economical cost and impact that this issue implies. The aim of our study was to measure that rate and calculate the resulting costs. MATERIAL AND METHODS: In January 2015, we checked in our Laboratory Information Management System (LIMS) for every emergency request from 1(st) July 2011 to 30(th) June 2014, if they had been reviewed by any allowed user or not. 319,064 requests were ordered during that period of time. Results were expressed as "ordered requests", "missed requests" and its percentage. Additionally, total cost of missed requests was calculated in euros (€). "Non-productive days" were theorised (as the days producing requests that were not reviewed) based on these results. RESULTS: 7924 requests (2.5%) were never reviewed by clinicians. This represented a total cost of 203,039 € and 27 "non-productive" days in three years. Significant differences between inpatients, outpatients and emergency department as well as different emergencies units were found after application of statistical analysis. CONCLUSIONS: In terms of resources, never reviewed or missed requests appear to be a not negligible problem for the clinical laboratory management. Electronic result delivery, with electronic endorsement to indicate follow-up of requests along with better systems of electronic requesting should be investigated as a way of improving patient outcomes and save unnecessary expenses.

Carcinoma adrenocortical no funcionante con mielolipoma. Una rara asociación / Non-functioning adrenocortical carcinoma associated with myelolipoma. A case report

El carcinoma adrenocortical es un tumor infrecuente con una incidencia de 1 por millón de habitantes por año. El 80% aproximadamente de estos carcinomas son funcionantes, representando los no funcionantes solo un 20% de los carcinomas comunicados en las mayores series de la literatura. Se trató de paciente masculino de 55 años de edad con tumor adrenal derecho de 75×62mm. La pieza quirúrgica fue procesada para histología e inmunohistoquímica convencional. El tumor estaba constituido por células redondeadas, eosinofílicas, dispuestas en sabanas y en trabéculas. Se observaron de 3–5 figuras de mitosis en 50 campos de gran aumento y se identificó invasión vascular y sinusoidal. Se evidenció la presencia de mielolipoma entremezclado con el tumor y en la periferia del mismo. Solo 5 casos de carcinoma adrenocortical y concomitante mielolipoma han sido descritos en la literatura médica. En nuestro conocimiento mielolipoma asociado con carcinoma adrenocortical no funcionante no ha sido descrito previamente(AU)

Adrenocortical carcinoma is a rare tumour, with an annual incidence of only one case per million. Functioning tumours account for about 80% of all adrenocortical carcinomas, whereas non-functioning tumours are even rarer, accounting for only 20% of adrenal carcinomas in the largest reported series. We present a case of a 75×62mm right adrenal tumour occurring in a 55 year old male. Routine histological and immunohistochemical examinations were carried out on the surgical specimen. The tumour cells were mostly round, eosinophilic cells arranged in a sheet-like or trabecular pattern separated by thick fibrous bands. 3 to 5 mitoses were seen in 50 high-power fields; vascular and sinusoidal invasion was observed. A myelolipoma was found intermixed with the tumour at its periphery. To date, only five cases of adrenocortical carcinoma with concomitant myelolipoma have been published and to the best of our knowledge, this is the first report of myelolipoma associated with non-functioning adrenocortical carcinoma(AU)

Screening for hypertension in a Primary Care Dental clinic

Objective: The aim of this study was to record blood pressure in patients during their visit to a dental clinic, withthe aim of identifying those who have high blood pressure and are unaware of it, as well as those who are awareof their condition but do have their blood pressure under adequate control.Study design: We designed a cross-sectional study which included 154 patients who were seen for a dental checkupat the Primary Dental Care of the Gallician Health Service (SERGAS). All participants completed a standardizedmedical questionnaire after measuring their systolic blood pressure (SBP) and diastolic blood pressure (DBP),which was conducted using the protocol established by the Spanish Society of Hypertension-Spanish League forthe Fight Against Hypertension (HTA).Results: In 45 patients (29%), the figures for blood pressure were recorded as SBP¡Ý140 mmHg and/or DBP ¡Ý90mmHg, indicating that they may have hypertension. Only 12 of them had been previously diagnosed with hypertension,but did not have their blood pressure under adequate control. The remaining 33 had no history ofhypertension and were referred to a family physician, but only 19 saw their doctor; 11 of these patients were givennon-pharmacological treatment, 6 were prescribed drug treatment and no type of treatment was indicated for theother two patients.Conclusions: By screening for hypertension, especially among patients who are more than 40 years old, the dentistcan play an important role in the early diagnosis (AU)

No disponible

No disponible

Screening for hypertension in a primary care dental clinic.

OBJECTIVE: The aim of this study was to record blood pressure in patients during their visit to a dental clinic, with the aim of identifying those who have high blood pressure and are unaware of it, as well as those who are aware of their condition but do have their blood pressure under adequate control. STUDY DESIGN: We designed a cross-sectional study which included 154 patients who were seen for a dental checkup at the Primary Dental Care of the Gallician Health Service (SERGAS). All participants completed a standardized medical questionnaire after measuring their systolic blood pressure (SBP) and diastolic blood pressure (DBP), which was conducted using the protocol established by the Spanish Society of Hypertension-Spanish League for the Fight Against Hypertension (HTA). RESULTS: In 45 patients (29%), the figures for blood pressure were recorded as SBP>or=140 mmHg and/or DBP>or=90 mmHg, indicating that they may have hypertension. Only 12 of them had been previously diagnosed with hypertension, but did not have their blood pressure under adequate control. The remaining 33 had no history of hypertension and were referred to a family physician, but only 19 saw their doctor; 11 of these patients were given non-pharmacological treatment, 6 were prescribed drug treatment and no type of treatment was indicated for the other two patients. CONCLUSIONS: By screening for hypertension, especially among patients who are more than 40 years old, the dentist can play an important role in the early diagnosis.

Terapia endoscópica combinada para el tratamiento de angiodisplasias de colon / Combined endoscopic therapy for the treatment of angiodysplasias of the colon

No disponible

No disponible

Plant signals and fungal perception during arbuscular mycorrhiza establishment.

Arbuscular mycorrhizal (AM) fungi are obligate symbionts that need their plant hosts to complete their life cycle. In the absence of the plant, germlings arrest growth after a few days and retract most of their cytoplasm back into the multinuclear spores. The spores can germinate again during more favorable conditions. How AM fungi recognize compatible host roots and activate their symbiotic program is not yet understood. However, research in this field in the last years has shed light into this topic. We, and others, have approached some of these aspects by studying changes in fungal gene expression observed at early stages of development, before and at the plant recognition stage in an attempt to identify genes and proteins featuring as key regulators in the switch between the asymbiotic and symbiotic style of life. The molecular bases of this recognition process are now starting to be understood and point to common signaling pathways shared with other microbe-plant associations and to arbuscular mycorrhiza specific signaling pathways.

Different nitrogen sources modulate activity but not expression of glutamine synthetase in arbuscular mycorrhizal fungi.

Glutamine synthetase (GS) is a central enzyme of nitrogen metabolism that allows assimilation of nitrogen and biosynthesis of glutamine. We isolated the cDNA encoding GS from two arbuscular mycorrhizal fungi, Glomus mosseae (GmGln1) and Glomus intraradices (GiGln1). The deduced protein orthologues have a high degree of similarity (92%) with each other as well as with GSs from other fungi. GmGln1 was constitutively expressed during all stages of the fungal life cycle, i.e., spore germination, intraradical and extraradical mycelium. Feeding experiments with different nitrogen sources did not induce any change in the mRNA level of both genes independent of the symbiotic status of the fungus. However, GS activity of extraradical hypahe in G. intraradices was considerably modulated in response to different nitrogen sources. Thus, in a N re-supplementation time-course experiment, GS activity responded quickly to addition of nitrate, ammonium or glutamine. Re-feeding with ammonium produced a general increase in GS activity when compared with hyphae grown in nitrate as a sole N source.

Inter-laboratory comparison of HCV-RNA assay results: implications for multi-centre research.

To investigate whether it is appropriate to assume comparability of hepatitis virus C (HCV)-RNA results across laboratories in multi-centre studies, nine laboratories of the European Paediatric HCV Network participated in an international proficiency study of HCV-RNA assays. A panel of 12 samples of different dilutions and genotypes was sent to each laboratory and tested with qualitative and/or quantitative HCV-RNA assays according to local procedures. Commercial assays were used in seven laboratories and in-house assays in two. All six laboratories in which a commercial qualitative assay was used were proficient, as were four of six runs (in five laboratories) in which a commercial quantitative assay was used. The proficiency of the laboratories where in-house assays were used could not be assessed according to the VQC definition because of differences in the methods used. Overall, there were several false-negative results, but only one false-positive result with a quantitative assay and none with a qualitative assay. The false-negative results may have implications for the diagnosis of infection, and highlight the need for an antibody test to be performed at 18 months to confirm the absence of infection. The results of qualitative assays were generally consistent across laboratories but it was difficult to evaluate and compare the results of quantitative assays. Multivariate analysis of data collected in multi-centre studies should therefore allow for centre and/or assay used.