Agricultural pesticide residues in water from a karstic aquifer in Yucatan, Mexico, pose a risk to children's health.

Yucatan is a region with a high impact of water contamination since it has a karst type soil favoring contaminants entry into the phreatic level, the only source of freshwater in the area. However, no studies report pesticides in water for human consumption or the risk it represents. The objective of this study was to detect and measure pesticide concentrations in domestic tap water to estimate the risk (carcinogenic and non-carcinogenic) to health. A non-probabilistic sampling was applied of 48 tap water sources, and then pesticide detection with solid-phase extraction gas chromatography coupled to the electron capture and flame photometric detectors allowed the estimation of risk through hazard ratios. The present results suggest that aldrin, heptachlor, and ß-BHC residues in domestic tap water from Ticul, Yucatan, pose a risk to children's health, particularly for potential carcinogenic risks.

Tratamiento con toxina botulínica en niños con parálisis cerebral espástica. Análisis del tratamiento en tríceps sural durante 2017-2018 en el / Centro de Rehabilitación Infantil Teletón, Uruguay / Botulinum toxin in the treatment of children with spastic cerebral palsy. Analysis of sural tricep therapy during 2017-2018 at the Teletón Children's Rehabilitation Center, Uruguay / Tratamento com toxina botulínica em crianças com paralisia cerebral espástica. Análise do tratamento do tríceps sural durante 2017-2018 no Centro de Rehabilitación Infantil Teletón, Uruguai

Resumen: Introducción: la parálisis cerebral (PC) es la causa más frecuente de discapacidad motriz en niños y adolescentes. En el 85% de los casos, la manifestación motora predominante es la espasticidad. Las inyecciones de toxina botulínica tipo A (TB-A) se han usado para reducir la espasticidad en niños con PC. No existen investigaciones a nivel nacional que comprueben si los resultados son comparables a los reportados en la literatura. Objetivo: determinar el efecto del tratamiento con TB-A en el tríceps sural en conjunto con la rehabilitación física en niños con PC espástica durante los años 2017-2018 en el Centro de Rehabilitación Infantil Teletón, Uruguay. Métodos: se realizó un estudio descriptivo, retrospectivo, de cohorte histórica única con seguimiento longitudinal, mediante la revisión de historias clínicas de los pacientes con PC con marcha independiente o asistida que recibieron tratamiento con TB-A para el tratamiento de la espasticidad del tríceps sural durante el período 2017-2018. Resultados: se analizaron 40 procedimientos de inyección de TB-A. Se observó una buena respuesta al mes y a los 3 meses del tratamiento con TB-A, con mejoría del ángulo de dorsiflexión del pie con la rodilla en flexión y en extensión, mejoría del puntaje de la escala de espasticidad de Ashworth modificada y, en el 95% de los procedimientos, de la percepción subjetiva de los padres. Se observó una disminución del efecto hacia los 6 meses de la aplicación. Conclusión: la aplicación de TB-A en el Centro Teletón muestra resultados positivos, comparables con los reportados en la bibliografía internacional.

Abstract: Introduction: cerebral palsy (CP) is the most common source of motor disability in children and adolescents. In 85% of cases, the prevailing motor manifestation is spasticity. Botulinum toxin Type A injections (TB-A) have been used to reduce spasticity in children with cerebral palsy (CP). There are no studies at the national level that show whether the results are comparable to those reported in literature. Objective: to determine the effect of TB-A therapy in the triceps surae along with the physical rehabilitation in children with spastic cerebral palsy (CP) during 2017-2018 at the Teleton Children´s Rehabilitation Center, Uruguay. Method: retrospective, descriptive study of a single cohort with a longitudinal follow-up was conducted, through the review of medical records belonging to patients with CP with independent or assisted gait, who received TB-A therapy to treat sural triceps spasticity during 2017-2018. Results: 40 TB-A injection procedures were analysed. A good response was observed one month and three months after being treated with TB-A, evidencing improvement in the dorsiflexion angle between the foot and the knee in flexion and extension, improvement on the modified Ashworth spasticity scale score and, in 95% of procedures, the subjective perception of parents. The effect was observed to decrease towards 6 months after the procedure. Conclusion: application of TB-A at the Teletón Center shows positive results, comparable to those reported by international blibliography.

Resumo: Introdução: a paralisia cerebral (PC) é a causa mais freqüente de deficiência motora em crianças e adolescentes. Em 85% dos casos, a manifestação motora predominante é a espasticidade. As injeções de toxina botulínica tipo A (TB-A) têm sido usadas para reduzir a espasticidade em crianças com PC. Não há pesquisas nacionais que verifiquem se os resultados são comparáveis aos relatados na literatura. Objetivo: determinar o efeito do tratamento da TB-A no tríceps sural em conjunto com a reabilitação física em crianças com PC espástica durante os anos 2017-2018 no Centro de Rehabilitación Infantil Teletón, Uruguai. Métodos: estudo descritivo, retrospectivo, com coorte histórica única com acompanhamento longitudinal, realizado por meio da revisão de prontuários de pacientes com PC com deambulação independente ou assistida que receberam tratamento com TB-A para o tratamento da espasticidade do tríceps sural, no período 2017-2018. Resultados: 40 procedimentos de injeção de TB-A foram analisados. Observou-se boa resposta um mês e três meses após o tratamento com TB-A, com melhora no ângulo de dorsiflexão do pé com o joelho em flexão e extensão, melhora no escore da escala de espasticidade de Ashworth modificada e, em 95% dos procedimentos, a partir da percepção subjetiva dos pais. Uma diminuição no efeito foi observada 6 meses após a aplicação. Conclusão: a aplicação do TB-A no Centro de Rehabilitación Infantil Teletón apresentou resultados positivos, comparáveis aos relatados na literatura internacional.

Prevalence of Severe Periodontitis in a Colombian Adult Population.

OBJECTIVE: To determine the prevalence of severe chronic periodontitis in a cross-sectional national sample of Colombian adults held by the Colombian Health Ministry. METHODS: In 2014, a selected national sample, based on a multi-stage, stratified method, received an oral examination. Periodontal data was collected on 9,821 adults aged 18-79 years following a full-mouth examination. Pocket depth (PD) and clinical attachment loss (CAL) served for extent and severity of disease description. Two systems for detection of severe periodontitis cases were used. The first was the criteria for surveillance of periodontitis described by the Center for Disease Control and the American Academy of Periodontology (2014), the second was the periodontitis case definition described by the European Federation of Periodontology (EFP, 2005). Weighted prevalence was calculated and logistic models constructed to assess the association with demographic, socio-economic and oral hygiene factors. RESULTS: Based on the CDC-AAP criteria, the prevalence estimate of severe periodontitis was 10.6% (standard error (SE) 0.2), and for moderate periodontitis was 43.6% (SE 0.4). Adults aged after 65 had a high prevalence of severe periodontitis, 26.0% (SE 0.9), and a low mean number of teeth, 8.0 (SE 0.1). Increases in the presence of PD leveled after age 45, but CAL continued to increase in the age range 65-79, as approximately 23.7% of teeth, not previously affected, demonstrated CAL greater than or equal to 1 mm at this age range. Factors associated with severe periodontitis were age, gender, income, smoking habits and presence of diabetes. For the EFP detection system, not-daily oral hygiene had an association. CONCLUSION: Prevalence of severe periodontitis was 10.6%, a lower percentage than other epidemiological studies in Latin America; but still a high proportion of individuals, which would support the importance of preventive and treatment strategies for the country.

Comparison of Clinical Periodontal Parameters in Two Colombian Oral Health National Studies, 1998 and 2014.

OBJECTIVES: The aim was to compare the results of two large Colombian epidemiological studies in order to describe trends in the presence of clinical periodontal parameters. METHODS: In 1998 and 2014, two epidemiological studies on national representative samples selected following probabilistic methods were performed. In 1998, a total of 9747 subjects received a partial-mouth periodontal examination in ten approximal sites, and in 2014 a total of 9821 participants received a full-mouth examination, with an average of 126 sites per person. Although the studies followed different methodologies, the newer study was adapted to be able to perform a direct comparison, including analysis of index teeth and clinical parameters in accordance with the 1998 protocol. Number of teeth and value of the extent and severity index were compared. Descriptive statistics were reported. RESULTS: The results showed that the mean number of teeth increased in the more recent study: for the age category 35 - 44 years, this increased from 19.2 to 23.8 teeth; however, both studies described a signifi cant decrease in the number of teeth at later ages. Values for the extent and severity index were high in both studies. A larger proportion of subjects was affected by mild and generalized attachment loss in the new study, but the percentages of participants affected by moderate and severe attachment loss were similar. CONCLUSION: It could be concluded that the periodontal conditions of large samples examined 16 years apart did not reveal signifi cant changes in the presence of generalized attachment loss. Renewed health policies are needed to diminish periodontitis prevalence.

Prevalence and Extent of Gingival Recession in a National Sample of Colombian Adults.

OBJECTIVE: To perform an analysis of the Fourth Colombian Oral Health Study in order to describe the prevalence and extent of gingiva. METHODS: A national representative sample including 9255 adult individuals was randomly selected using probabilistic methods. Periodontal assessments were performed for all teeth, six sites per tooth. Clinical data collected were: number of teeth, pocket depth and position of the gingival margin. Presence of gingival recession was registered. Demographic, environmental and dental variables were collected. Prevalence and extent of gingival recession at different cut-off values, by tooth types, and factors associated with buccal recession ≥ 4 mm were described. RESULTS: Gingival recession was common in the examined population: 69.7% of subjects had ≥ 1 site with recession ≥ 1 mm, and 30.3% had ≥ 1 site with recession greater than or equal to 3 mm. A total of 28.6% of teeth were affected by recession greater than or equal to 1 mm, and 7.6% by recession ≥ 3 mm. The most frequently affected tooth types were first maxillary molars, first and second mandibular premolars, and the first maxillary premolar. Factors significantly associated with recession greater than or equal to 4 mm were: older age, male gender, lower income, former smoker, diabetes, and less frequent toothbrushing. CONCLUSION: Gingival recession is a common finding in the Colombian population. Factors associated with recession presence were the same as for periodontitis. Less frequent toothbrushing was associated with deep buccal recession.

Rehabilitación cognitiva de pacientes con alteraciones perceptivas sobrevivientes a ictus isquémico / Cognitive rehabilitation of patients with perceptive disorders surviving to ischemic ictus

Se realizó una intervención terapéutica en 30 pacientes con déficit motor (hemiplejía/ hemiparesia), sobrevivientes a ictus isquémico, irrigado por la arteria cerebral media con alteraciones perceptivas (negligencia sensorial, atencional o anosognosia), atendidos en el Departamento de Rehabilitación del Hospital General Docente Dr Juan Bruno Zayas Alfonso, de Santiago de Cuba, desde enero hasta noviembre del 2016, con vistas a evaluar la efectividad del tratamiento rehabilitador. La muestra fue dividida en 2 grupos de 15 integrantes cada uno: los del grupo control recibieron tratamiento convencional; los del grupo de estudio, tratamiento convencional y terapia ocupacional asociada a rehabilitación cognitiva. Se consideraron parámetros sociodemográficos, de valoración clínica y funcional, así como de recuperación funcional global. La heminegligencia resultó ser la alteración perceptiva más frecuente (63,4 por ciento) y al finalizar el tratamiento el grupo de estudio mostró una mejor recuperación funcional (93,3 por ciento), por lo cual quedó demostrada la eficacia de la rehabilitación convencional integrada a técnicas cognitivas y terapia ocupacional

A therapeutic intervention in 30 patients with motor deficit (hemiplegia/hemiparesis), surviving to ischemic ictus, irrigated by the mean cerebral artery with perceptive disorders (sensorial or atentional negligence or anosognosia), assisted in the Rehabilitation Department of Dr Juan Bruno Zayas Alfonso Teaching General Hospital, was carried out in Santiago de Cuba, from January to November, 2016, aimed at evaluating the effectiveness of the rehabilitative treatment. The sample was divided in 2 groups of 15 members each: those of the control group received conventional treatment; those of the study group, conventional treatment and occupational therapy associated with cognitive rehabilitation. They were considered sociodemographic parameters, of clinical and functional valuation, as well as of global functional recovery. Heminegligence was the most frequent perceptive disorder (63.4 percent) and the study group showed a better functional recovery (93.3 percent) when concluding the treatment, reason why the effectiveness of the conventional rehabilitation integrated to cognitive techniques and occupational therapy was demonstrated

Lesiones traumáticas del plexo braquial en Uruguay: estudio clínico-epidemiológico sobre 50 pacientes / Traumatic brachial plexus injuries in Uruguay: clinical and epidemiological study of 50 patients

RESUMEN Introducción: Las lesiones de plexo braquial son poco frecuentes, pero son devastadoras para la funcionalidad del miembro superior. Los autores presentan una serie retrospectiva de 50 pacientes valorados clínicamente por equipo de fisiatría y neurocirugía. Resultados: Se trata de 42 hombres y 8 mujeres de entre 8 y 70 años al momento del trauma. Cerca del 60% de los pacientes tenía 25 años o menos al momento del trauma y el 90% sufrió un trauma cerrado. Más del 70% de los accidentes involucraron el uso de motocicletas y el 50% de los pacientes tuvo una lesión completa (C5-T1). De los pacientes que presentaban lesiones tipo Erb, 5/6 (83%) mejoraron parcialmente en la evolución, en tanto solo mejoraron 2/25 pacientes con lesión total (8%). Conclusión: Este tipo de lesiones afecta severamente la funcionalidad de los miembros superiores de individuos jóvenes y por lo tanto, se debe optimizar su diagnóstico y tratamiento. Dada su evolución, se deben acortar los tiempos pre-quirúrgicos en las lesiones completas de plexo braquial.

Introduction: Brachial plexus injuries are infrequent, but are devastating for the functionality of the upper limb. The authors present a retrospective series of 50 patients evaluated clinically by a rehabilitation and neurosurgery team. Results: Our series comprises of 42 men and 8 women aged between 8 and 70 years at the time of injury. About 60% of patients were 25 years or younger at the time of injury and 90% suffered a blunt trauma. Over 70% of accidents involved the use of motorcycles and 50% of patients had a complete lesion (C5-T1). With reference to the type of injury, 83% of patients with Erb type injuries (C5-C6) change the clinical status in 4 months (partially improved), but only 8% of patients with complete lesions (C5-T1) change the clinical status (very partially improved). Conclusion: This type of injury severely affects the functionality of the upper limbs of young individuals and therefore should be optimized diagnosis and treatment. Given its evolution, pre surgical times must be shortened in complete brachial plexus injuries.

Changes in colorectal cancer screening intention among people aged 18-49 in the United States.

BACKGROUND: To determine whether exposure to a peer-led intervention focused on colorectal cancer (CRC) screening, physical activity, and multi-vitamin intake can lead to increased intentions to be screened for CRC once age eligible among adults under the age of 50. METHODS: Participants were residents of low-income housing sites, and CRC screening intentions were assessed at baseline and at follow-up (approximately 2 years later) to determine changes in screening intentions and factors associated with changes in intentions. RESULTS: Participants (n = 692) were 78.4% female, 42.6% Hispanic and 50.8% black. At follow-up, 51% maintained their intention to be screened and 14.6% newly intended to get screened. Individuals newly intending to get screened were more likely to have participated in the intervention, be older, male, and born in Puerto Rico or the United States compared to those who maintained their intention not to get screened (p < 0.05). CONCLUSION: Exposure to CRC prevention messages before the age of 50 can increase screening intentions among individuals who did not initially intend to get screened. Peer-led interventions to promote CRC screening should include individual less than 50 years of age, as this may contribute to increased screening at the recommended age threshold.

Variante anatómica de los músculos escalenos y su implicancia en la cirugía del plexo braquial / Anatomical variant of the escalenos muscles and their implication in brachial plexus surgery

Introducción: Se reporta una variante anatómica de los músculos escalenos hallada durante una cirugía de exploración del plexo braquial. Métodos: Se trató de una masa muscular entre los músculos escalenos anterior y posterior, que cubría al plexo braquial dificultando su identificación. La misma se hizo siguiendo en forma retrógrada al nervio frénico para ubicar la raíz C5.Resultado: A partir de esta maniobra se identificó el plexo y se resecó la masa muscular. Conclusiones: Si bien hay múltiples variantes anatómicas en la región supraclavicular, los puentes musculares entre los escalenos anterior y medio son poco frecuentes y escasamente reportadas en la literatura.

Introduction: We report an anatomical variation of the scalenic muscles, discovered during a surgical exploration of the brachial plexus. Methods: A muscle mass was found between the anterior and posterior scalenic muscles, over the brachial plexus, hindering its identification. The phrenic nerve was dissected in a retrograde approach, in order to locate the C5 root. Results: After this maneuver the plexus was identified, and a resection of the supernumerary muscle mass was performed. Conclusions: While there are multiple anatomic variants in the supraclavicular region, muscle bridges between the scalenic muscles are rare and poorly reported in the literature.

Association between oxidative stress and masked hypertension in a multi-ethnic population of obese children and adolescents.

OBJECTIVE: To evaluate whether oxidative stress is correlated with adiposity, obesity-related metabolic abnormalities, and ambulatory blood pressure (ABP) in a multi-ethnic pediatric population. STUDY DESIGN: We conducted a prospective study enrolling 42 obese children (age, 12.8 ± 2.4 years) and 34 non-obese children (age, 11.8 ± 3.4 years). We measured urine 8-isoprostane and hydrogen peroxide (markers of oxidative stress) in both obese and non-obese groups. In the obese group, we measured the 24-hour ABP and obtained an oral glucose tolerance test, lipid panel, interleukin-6, and tumor necrosis factor-α. RESULTS: 8-isoprostane and hydrogen peroxide were correlated with body mass index standard deviation score and waist circumference. The mean 8-isoprostane and hydrogen peroxide levels of the obese group were higher than those of the non-obese group. In the subset of obese subjects who underwent ABP monitoring, 8-isoprostane was correlated with mean 24-hour systolic blood pressure: within the obese group, 8-isoprostane was higher in obese children with elevated mean 24-hour systolic blood pressure. CONCLUSIONS: Our findings provide evidence of a significant correlation between oxidative stress, adiposity, and blood pressure in children. Longitudinal studies in a larger population sample are needed to validate the association between elevated urine 8-isoprostane level and cardiovascular risk factors in an obese pediatric population.

Elevated ambulatory blood pressure in a multi-ethnic population of obese children and adolescents.

OBJECTIVES: To evaluate the relationship among ambulatory blood pressure (ABP), body mass index (BMI), and homeostasis model assessment (HOMA) in a multi-ethnic population of obese children with clinic blood pressure in the reference range. STUDY DESIGN: A total of 43 obese normotensive children (7-17 years old) were recruited. ABP monitoring, oral glucose tolerance test, lipid levels, and urine microalbumin levels were obtained. RESULTS: Fourteen percent of the subjects had elevated 24-hour systolic blood pressure (SBP), 9.3% had elevated daytime SBP, and 32.6 % elevated nighttime SBP. For diastolic blood pressure, 4.7% of the sample had an elevated mean nighttime value. Children with more severe obesity (BMI SD score >2.5) had higher 24-hour and nighttime SBP than children with less severe obesity (BMI SD score < or =2.5). Children with HOMA values in the highest quartile had larger waist circumference and higher clinic blood pressure than children with HOMA values in the lowest quartile, and no difference in the mean ABP values was found in the 2 groups . Multiple linear regression analysis showed that 24-hour and nighttime SBP were significantly correlated with BMI SD score. CONCLUSION: Obese children with normal clinic blood pressure often exhibit elevated ABP. The risk for ambulatory hypertension appears to be correlated with the degree of obesity.

Association between inadequate sleep and insulin resistance in obese children.

OBJECTIVE: To analyze the relationships between sleep duration, obstructive sleep apnea syndrome (OSAS), and markers of insulin resistance in obese children. STUDY DESIGN: Forty obese children were evaluated for sleep-related complaints. Each child underwent a polysomnogram, an oral glucose tolerance test (OGTT), and fasting lipid panel tests. Indices of insulin resistance (HOMA-IR and WBISI) and insulin secretion (IGI) were calculated based on the results of the OGTT. Markers of insulin resistance were compared among groups categorized according to polysomnogram results. RESULTS: Subjects with shorter sleep duration had higher fasting insulin, peak insulin, and HOMA-IR levels and lower WBISI levels, findings suggestive of insulin resistance. In contrast, differences in body mass index z scores were not observed. Subjects with OSAS (32 of 40 children) had higher triglyceride levels and HOMA-IR values than those without OSAS, but did not differ in sleep duration. Multiple linear regression analysis revealed that HOMA-IR was significantly correlated with age, sleep duration, and percentage of rapid-eye-movement sleep. CONCLUSIONS: Insulin resistance in obese children is associated with short sleep duration and OSAS.