Parkinson's disease patients show delayed hemodynamic changes in primary motor cortex in fine motor tasks and decreased resting-state interhemispheric functional connectivity: a functional near-infrared spectroscopy study.

Significance: People with Parkinson's disease (PD) experience changes in fine motor skills, which is viewed as one of the hallmark signs of this disease. Due to its non-invasive nature and portability, functional near-infrared spectroscopy (fNIRS) is a promising tool for assessing changes related to fine motor skills. Aim: We aim to compare activation patterns in the primary motor cortex using fNIRS, comparing volunteers with PD and sex- and age-matched control participants during a fine motor task and walking. Moreover, inter and intrahemispheric functional connectivity (FC) was investigated during the resting state. Approach: We used fNIRS to measure the hemodynamic changes in the primary motor cortex elicited by a finger-tapping task in 20 PD patients and 20 controls matched for age, sex, education, and body mass index. In addition, a two-minute walking task was carried out. Resting-state FC was also assessed. Results: Patients with PD showed delayed hypoactivation in the motor cortex during the fine motor task with the dominant hand and delayed hyperactivation with the non-dominant hand. The findings also revealed significant correlations among various measures of hemodynamic activity in the motor cortex using fNIRS and different cognitive and clinical variables. There were no significant differences between patients with PD and controls during the walking task. However, there were significant differences in interhemispheric connectivity between PD patients and control participants, with a statistically significant decrease in PD patients compared with control participants. Conclusions: Decreased interhemispheric FC and delayed activity in the primary motor cortex elicited by a fine motor task may one day serve as one of the many potential neuroimaging biomarkers for diagnosing PD.

An educational intervention to implement skin-to-skin contact and early breastfeeding in a rural hospital in Mexico.

Background: Early skin-to-skin contact promotes infant physiologic stability, provides warmth and makes breast milk readily available. Despite the known benefits of early skin-to-skin contact, this practice is not included within standard care in the Mexican public healthcare system. After birth, newborns are usually taken to an incubator in the nursery where they transition to extrauterine life and receive either dextrose 5% or infant formula for their first feed. The aim of this study was to assess if a dual educational intervention in a rural hospital in Mexico could modify current practice and accomplish early skin-to-skin contact and early breastfeeding. Methods: A two-step educational intervention was designed. The first step was to educate the labor and birthing staff of the hospital, and the second step was to educate all pregnant women with uncomplicated pregnancies at 36 weeks' gestation. The educational intervention explored the benefits, implications and steps of early skin-to-skin contact and early breastfeeding. All births were registered for the three month period following the intervention. The time of onset of skin-to-skin (SSC) contact, its duration and time of initiation of breastfeeding were recorded and analyzed using ANOVA testing. Results: A total of 142 births met our inclusion criteria, from those, 77% (n = 109) received skin-to-skin contact and early breastfeeding. The average time of initiation of skin-to-skin contact in the first and last month of the study was 18.5 (± 2.2) and 9.6 (± 2.2) minutes of life, respectively (p < 0.001). The average duration of SSC in the first and last month was 22 (± 10.9) and 40.9 (± 17.4) minutes, respectively (p < 0.001). The average time of onset of breastfeeding in the first and last month was 48.9 (± 15) and 34.4 (± 16.7) minutes of life, respectively (p < 0.001). Conclusions: A simple and low-cost educational intervention achieved the inclusion of skin-to-skin contact and early breastfeeding as part of standard care in a rural hospital. Further studies could replicate our intervention in similar settings to test the generalizability of the findings.

Factors Associated With Knowledge and Comfort Providing Palliative Care: A Survey of Pediatricians in Mexico.

BACKGROUND:: Lack of education and training in palliative care has been described to be one of the most important barriers to pediatric palliative care implementation. OBJECTIVE:: To examine what factors determine the degree of knowledge and level of comfort Mexican pediatricians have providing pediatric palliative care. METHODS:: A questionnaire that assessed palliative care concepts was developed and applied online to Mexican pediatricians, both generalists and specialists. RESULTS:: A total of 242 pediatricians responded. The majority had not received palliative care education (92.6%) and felt uncomfortable discussing palliative needs with patients and families (92.1%). The mean score of the questionnaire was 6.8 (±1.4) of 10 correct answers. Knowledge in palliative care was associated with exposure to oncologic patients ( P = .01) and previous palliative care education ( P = .02) but inversely related to the pediatrician's age ( P = .01). Comfort addressing patient's palliative care needs was associated with knowledge in palliative care ( P < .01), exposure to oncologic patients ( P = .03), and previous education in palliative care ( P = .02). CONCLUSIONS:: Although Mexican pediatricians have basic knowledge of palliative care concepts, they do not feel comfortable addressing palliative care needs, suggesting that the main barrier for implementing palliative care is not the lack of knowledge but rather feeling uncomfortable when addressing these issues with patients and families. Educational programs should incorporate strategies that could help physicians develop comfort in approaching palliative care patients.

Development and validation of an algorithm to predict the treatment modality of burn wounds using thermographic scans: Prospective cohort study.

BACKGROUND: The clinical evaluation of a burn wound alone may not be adequate to predict the severity of the injury nor to guide clinical decision making. Infrared thermography provides information about soft tissue viability and has previously been used to assess burn depth. The objective of this study was to determine if temperature differences in burns assessed by infrared thermography could be used predict the treatment modality of either healing by re-epithelization, requiring skin grafts, or requiring amputations, and to validate the clinical predication algorithm in an independent cohort. METHODS AND FINDINGS: Temperature difference (ΔT) between injured and healthy skin were recorded within the first three days after injury in previously healthy burn patients. After discharge, the treatment modality was categorized as re-epithelization, skin graft or amputation. Potential confounding factors were assessed through multiple linear regression models, and a prediction algorithm based on the ΔT was developed using a predictive model using a recursive partitioning Random Forest machine learning algorithm. Finally, the prediction accuracy of the algorithm was compared in the development cohort and an independent validation cohort. Significant differences were found in the ΔT between treatment modality groups. The developed algorithm correctly predicts into which treatment category the patient will fall with 85.35% accuracy. Agreement between predicted and actual treatment for both cohorts was weighted kappa 90%. CONCLUSION: Infrared thermograms obtained at first contact with a wounded patient can be used to accurately predict the definitive treatment modality for burn patients. This method can be used to rationalize treatment and streamline early wound closure.

Prevalence of Drug Resistance Mutations in Protease, Reverse Transcriptase, and Integrase Genes of North Central Mexico HIV Isolates.

This study set out to determine the frequency of antiretroviral drug resistance mutations in treatment-naive subjects of the north central Mexican state of San Luis Potosí. Mexican studies of antiretroviral drug resistance mutations have focused mainly on large metropolitan areas and border towns subjected to intense international migrations. This study set forth to describe the frequency of these mutations in a Mexican region less subjected to such migratory influences and more representative of smaller Mexican cities. Thirty-eight full-length pol sequences spanning the protease, reverse-transcriptase, and integrase-encoding regions were obtained from 42 treatment-naive human immunodeficiency virus (HIV)-infected subjects. Most exhibited subtype B homology, but CRF02_AG was also detected. Evidence of APOBEC3 hypermutation was seen in two samples. Calibrated population analysis revealed a surveillance drug resistance mutation prevalence of 4.9% for protease inhibitors, of 2.7% for nucleoside reverse transcriptase inhibitors, of 8.1% for non-nucleoside reverse transcriptase inhibitors, and an overall prevalence of 9.5%. This corresponds to an intermediate level of transmitted drug resistance according to the World Health Organization. The identification of integrase mutations suggests that transmitted drug mutations are being imported, as inhibitors targeting integrase have not been widely used in Mexico. Our results provide a greater understanding of HIV diversity in Mexico and highlight the way internal migrations allow HIV mutations and genetic features to permeate regions less subjected to international migrations. The implications of these findings will become more evident as Mexico hosts increased repatriations of migrants in the coming years.

Validación al español del Self-Harm Questionnaire para detección de autolesionismo en adolescentes / Validation into Spanish language of the Self-Harm Questionnaire for detection of self-harming in adolescents

ANTECEDENTES: El autolesionismo comprende las conductas encaminadas al daño físico de la propia persona. Estas conductas son un fenómeno en aumento entre los adolescentes y pueden ser consideradas como predictores de muerte por suicidio, por lo que su identificación oportuna es una necesidad. El Cuestionario de autolesionismo permite identificar la presencia de pensamientos y conductas autolesivas.OBJETIVO: Validar el cuestionario de autolesionismo al español y determinar su valor diagnóstico para detectar autolesionismo en adolescentes mexicanos que reciben atención psiquiátrica.MÉTODO: Se realizó el procedimiento de traducción-retrotraducción para la adaptación de la escala al idioma español. Se seleccionó una muestra de 106 adolescentes de entre 11 y 17 años de edad en seguimiento por trastornos afectivos o ansiedad para la aplicación de la escala. Se evaluó la consistencia interna mediante el coeficiente de fiabilidad a de Cronbach y se determinó el coeficiente de correlación de Spearman por medio de una prueba test-retest tres meses después de la primera administración. Posteriormente, se realizó una revisión del expediente clínico para determinar la presencia de autolesionismo y realizar un análisis de la sensibilidad y especificidad del cuestionario para detectar el fenómeno.RESULTADOS: El cuestionario traducido presentó un a de Cronbach de 0.960 y una estabilidad temporal a tres meses de 0.9787. La sensibilidad para detectar autolesionismo fue de 97.96%, y la especificidad de 54.39%, comparadas con el expediente clínico.DISCUSIÓN Y CONCLUSIÓN: Los resultados de este estudio sugieren que la escala traducida es una herramienta válida y confiable para detectar autolesionismo en adolescentes mexicanos. La identificación rápida y oportuna de esta población es crucial para evitar suicidios. El uso de la escala puede ayudar a identificar a estos pacientes.

BACKGROUND: Self-injurious behaviour englobes conducts in which persons hurt or harm themselves. These conducts are an increasing phenomena among adolescents, and can be considered as predictors of death by suicide, making their opportune identification a necessity. The Self Harm Questionnaireallows the identification of thoughts and self-injurious conducts.OBJECTIVE: The objective of this study was to validate it into the Spanish language and to determine its diagnostic value for detecting self- injurious behaviour in Mexican adolescents under psychiatric follow up.METHOD: The translation-retrotranslation procedure was used for the adaptation of the questionnaire into Spanish. A sample of 106, 11 to 17 year-old adolescents under follow up because of affective disorders or anxiety was selected for the application of the questionnaire. Internal consistence was evaluated through the Cronbach a reliability coefficient, and the Spearman correlation coefficient was determined through a test-retest after 3 months of the first administration of the probe. Afterwards, an evaluation of the clinical records was performed to assess the sensitivity and specificity of the test to detect self-injurious behaviour.RESULTS: The translated questionnaire possess a Cronbach a of 0.960, and a 3 month temporal stability of 0.9787. The sensitivity to detect self-injurious behaviour was 97.96%, and its specificity was 54.39%, compared to the clinical records.DISCUSSION AND CONCLUSION: This study results suggest that the translated questionnaire is a valid and reliable tool to detect self-injurious behaviour in Mexican adolescents. Rapid and opportune identification of this population of patients is crucial to avoid suicides. The use of this questionnaire can help identify these patients.