Developmental trajectories of children with Down syndrome by socio-economic status: the case of Latin America.

BACKGROUND: Several studies show that socio-economic status (SES) is related to the developmental trajectories of children with typical development (TD). However, few studies have analysed this relationship regarding children with neurodevelopmental disorders such as Down syndrome (DS). In this paper, we analyse the impact of SES in the neurodevelopmental trajectories of children with DS in comparison with children with TD. METHOD: Cognitive, language, motor and socio-emotional development were assessed in 31 children with DS between the ages of 15 and 80 months from high to low SES backgrounds. Data from this group were compared with data from a sample of 72 children with TD randomly selected from the Longitudinal Survey of Early Childhood. We analyse and compare these two groups using the developmental trajectories method RESULTS: The results show delayed onsets for the four abilities measured in children with DS compared with children with TD from high to low SES. In the comparison of the developmental trajectories, we found that the differences between the neurodevelopmental trajectories in DS and TD vary according to SES. High SES show differences only in language development, while low SES show significant differences in cognitive, language and socio-emotional development. CONCLUSIONS: The results indicate that SES is a factor that could impact the developmental trajectories of children with DS. Although the differences between children with DS and with TD are similar at the beginning regardless of SES, the developmental trajectories are slower in children with DS of low SES than in children of high SES. We argue that the differences are related to the complex interaction of several biological and cultural factors associated with SES. Some specific hypotheses about nutrition, health care access, quality of education and parenting practices are presented, but more research in this area is needed to fully understand these results.

Morbimortalidad en la unidad de cuidados intensivos pediátricos del Hospital Infantil Universitario de Manizales durante los años 2006 y 2007 / Morbidity and mortality in pediactric intensive care unit of Child Hospital Manizales University during 2006 and 2007

Antecedentes. La Unidad de Cuidados Intensivos Pediátricos del Hospital Infantil de la Cruz Roja “Rafael Henao Toro” de la ciudad de Manizales, Colombia, se ha convertido en referencia para esta zona del país. No se cuenta con estudios en los que se analice la epidemiología de esta unidad, datos que podrían ser importantes en varios sentidos. Objetivo. Realizar un estudio epidemiológico de la población que ingresa a la Unidad de Cuidados Intensivos Pediátricos en el Hospital Infantil Universitario de Manizales (Colombia), años 2006, 2007. Material y métodos. Estudio de corte transversal. Las variables empleadas fueron: edad, fecha de ingreso y egreso, género, procedencia, seguridad social, causa de ingreso, tiempo de estancia, procedimientos utilizados, causa de egreso, destino de alta y causas de mortalidad. Resultados. Se presenta una serie de 341 pacientes pediátricos críticos cuya edad media fue 6.8 años, género masculino 61%, de aéreas rurales 56.2%. Las enfermedades más prevalentes son las infecciosas y entre ellas la de origen pulmonar; mortalidad global de 14.15%, con no respuesta a la resucitación de 89%. Los procedimientos más empleados fueron los siguientes: 26.9% ventilación mecánica, 25.2% sonda gástrica, 22.4% sonda vesical, y 21.7% catéter venoso central. Conclusiones. Con la investigación realizada se logró la identificación de las causas más frecuentes de ingreso a la Unidad de Cuidados Intensivos Pediátricos, tales como enfermedades infecciosas y generales. Se establecieron las enfermedades que incidían en una alta mortalidad en dicha Institución, como se representó en la relación entre causa de ingreso y egreso, observándose mayor mortalidad en las enfermedades infecciosas...

An optimized enumeration method for sorbitol-fermenting Bifidobacteria in water samples.

With increased focus on watershed protection under the Surface Water Treatment Rule, indicators that discriminate among sources of microbial inputs (microbial source tracking) are needed to supplement the quantitative information provided by total and fecal coliform measurements for drinking water monitoring. Bifidobacteria are found in the digestive tract and feces of humans and other animals, and also in sewage. Sorbitol is a food additive used exclusively in food intended for human consumption. Therefore, the presence of sorbitol-fermenting Bifidobacteria in environmental waters can be indicative of sources of human fecal contamination. A series of media were evaluated using ATCC cultures of B. breve and B. adolescentis, feces from different animals, and domestic wastewater samples. The media evaluated were Human Bifid Sorbitol agar (HBSA), modified Human Bifid Sorbitol agar, Beerens Medium, modified Beerens Medium, Reinforced Clostridial agar, BIM-25 Medium, and modified BIM-25 Medium. Variables such as sample preservation, incubation time, different pH indicators, plating technique, and discontinuous exposure to sorbitol were also evaluated. A series of biochemical tests were used to confirm positive colonies enumerated on the various media. Membrane filtration and enumeration of sodium sulfite preserved samples on HBSA containing bromocresol purple using loose lidded plates for 48 h provided the best recoveries for presumptive positive colonies. A number of sorbitol-fermenters that were not Bifidobacteria were able to grow on all media tested, resulting in false-positives. Therefore, plating on HBSA should be followed by a confirmation step when monitoring for sorbitol-fermenting Bifidobacteria in environmental waters. A year-long sampling survey of a managed reservoir in Massachusetts provided field validation of the proposed methodology for sorbitol-fermenting Bifidobacteria as a human-related source tracking indicator tool.

Significance of computed tomography pathology in chronic rhinosinusitis.

OBJECTIVES/HYPOTHESIS: Multiple reports show that the extent of disease on computer tomography (CT) of the sinuses does not correlate with patients' subjective sinus symptom scores. In the current study, sinus symptom scores of patients with normal findings on sinus CT scans are compared with sinus symptom scores of patients with chronic rhinosinusitis and with disease on CT of the sinuses. The objective is to determine the significance of CT disease in patients with chronic rhinosinusitis. STUDY DESIGN: Prospective collection of data of consecutive patients seen for possible sinusitis. METHODS: Prospective data at a tertiary medical center were collected over an 8-month period. Computed tomography scans were graded according to Lund and MacKay, and patients were asked to grade each of the major and minor rhinosinusitis symptoms listed by the Rhinosinusitis Task Force from 0 to 10. A score of 0 was given for no symptom at all, and 10 indicated the most severe extent of a symptom. RESULTS: Twenty-seven patients with sinus complaints had normal findings on sinus CT scans. The average scores for major and minor rhinosinusitis symptoms were 18.6 and 15, respectively. Twenty-six patients with sinus complaints had disease on CT of their sinuses. The average scores for major and minor rhinosinusitis symptoms for these patients were 42.9 and 22, respectively. Higher symptom scores were seen in the patients with CT disease, and the differences between these two groups were statistically significant (major symptom, P = .000001; minor symptom, P = .02). Patient symptom scores did not correlate with extent of disease on CT as previously reported (r = 0.16). CONCLUSION: The presence of CT disease translates to higher patient symptom scores compared with symptom scores of patients without CT disease.

American Academy of Pediatrics. Committee on Children With Disabilities. Care coordination: integrating health and related systems of care for children with special health care needs.

Care coordination is a process that links children with special health care needs and their families to services and resources in a coordinated effort to maximize the potential of the children and provide them with optimal health care. Care coordination often is complicated because there is no single entry point to multiple systems of care, and complex criteria determine the availability of funding and services among public and private payers. Economic and sociocultural barriers to coordination of care exist and affect families and health care professionals. In their important role of providing a medical home for all children, primary care pediatricians have a vital role in the process of care coordination, in concert with the family.

Acetylsalicylate administered during simulated ischemia reduces the recovery of neuronal function in the in vitro rabbit retina.

Aspirin is widely used as an analgesic, in the secondary prevention of stroke, and has recently been suggested to be a putative neuroprotective agent, yet whether it acts directly on the central nervous system (CNS) is not yet clarified. We therefore examined the effect of lysine acetylsalicylate (L-ASA, 4-2000 microM) on neuronal function under normal conditions and following 1 h of ischemia using the in vitro rabbit retina preparation. L-ASA inhibited the light-evoked compound action potentials, but not the electroretinogram, in a concentration-dependent manner. In addition, L-ASA (2000 microM, but not 4, 40 or 200 microM) administered during ischemia, reduced the recovery of neuronal function compared to control (untreated) retinas. L-ASA therefore inhibits CNS neurotransmission, but not phototransduction, in a concentration-dependent manner. In addition, high concentration L-ASA impairs the recovery of neuronal function following an ischemic episode.

An epidemiologic profile of children with special health care needs.

OBJECTIVE: To present an epidemiologic profile of children with special health care needs using a new definition of the population developed by the federal Maternal and Child Health Bureau. METHODS: We operationalized the new definition using the recently released 1994 National Health Interview Survey on Disability. Estimates are based on 30 032 completed interviews for children <18 years old. The overall response rate was 87%. RESULTS: Eighteen percent of US children <18 years old in 1994, or 12.6 million children nationally, had a chronic physical, developmental, behavioral, or emotional condition and required health and related services of a type or amount beyond that required by children generally. This estimate includes children with existing special health care needs but excludes the at-risk population. Prevalence was higher for older children, boys, African-Americans, and children from low-income and single-parent households. Children with existing special health care needs had three times as many bed days and school absence days as other children. An estimated 11% of children with existing special health care needs were uninsured, 6% were without a usual source of health care, 18% were reported as dissatisfied with one or more aspects of care received at their usual source of care, and 13% had one or more unmet health needs in the past year. CONCLUSIONS: A substantial minority of US children were identified as having an existing special health care need using national survey data. Children with existing special health care needs are disproportionately poor and socially disadvantaged. Moreover, many of these children face significant barriers to health care.

Avoiding stroke during cerebral arterial occlusion by temporarily blocking neuronal functions in the rabbit.

The temporary occlusion of cerebral vessels is being used with increased frequency in the surgical management of cerebral vascular disease, and this procedure places brain tissue at risk of infarction. Using a modified version of a well-established model of focal cerebral ischemia in the rabbit, we tested the protective effect of a combination of six agents; each agent was selected to temporarily block one or more neuronal functions, hence reducing their metabolic demands. The combination of six agents had been previously shown to protect neurological function against ischemia. Ten male adult New Zealand White rabbits were anesthetized with halothane, and physiological parameters were maintained within normal ranges. A branch of the left external carotid artery was catheterized and the vasculature supplying the left middle cerebral artery (MCA) territory was isolated. Mannitol was infused via the external carotid artery into the left internal carotid artery to open the blood-brain barrier in the territory of the MCA. This infusion was followed by either Ames' medium alone (control) or Ames' medium containing the combination of agents: tetrodotoxin (0.1 micromol/L), 2-amino-4-phosphonobutyric acid (20 mumol/L), 2-amino-5-phosphonovaleric acid (1 mmol/L), amiloride (1 mmol/L), magnesium (10 mmol/L), and lithium (10 mmol/L). Ischemia in the left MCA territory was then induced for 2 hours, followed by 4 hours of reperfusion. Animals pretreated with the combination of agents sustained infarctions that were markedly smaller (mean+/-SEM, 46+/-19.7 mm(3), n=5) than control animals (300+/-46.5 mm(3), n=5, P<.001). We conclude that the strategy of locally delivering a combination of agents designed to temporarily reduce neuronal metabolic demands by temporarily blocking several nonvital neuronal functions, can reduce the infarction induced by a focal reduction in cerebral blood flow in the rabbit.

Family Voices: building voices for our children with special health care needs.

Family Voices is a national grassroots clearing-house for information and education concerning the health care of children with special health needs. Through the collective efforts of volunteer Coordinators in each state, 10 Regional Coordinators, and a small staff, Family Voices keeps aware of and involved in public and private sector health care changes that affect children and families. Family Voices, over 10,000 members strong, works in partnership with health care providers in public and private hospitals, public health programs, in state capitals, and Washington, DC to bring the family perspective to policy discussions and decisions. Pediatric nurses are invited to work in partnership with Family Voices to advocate for children and families.

Healing of laser incisions in rat dermis: comparisons of the carbon dioxide laser under manual and computer control and the scalpel.

BACKGROUND AND OBJECTIVE: The Computer-Assisted Surgical Techniques (CAST) program was researched to decrease lateral tissue damage and improve wound healing subsequent to laser incision. CAST differs from the traditional laser because it makes the incision in a discontinuous manner, allowing tissue to cool during the incision process. STUDY DESIGN/MATERIAL AND METHODS: The transient temperature changes in the tissue adjacent to the incision were measured with a thermocouple in a rat model. The subsequent wound healing was studied with histology and tensiometry. RESULTS: The thermal measurements demonstrated that all CAST settings were cooler than the continuous mode of laser incision. However, histology and tensiometric studies showed mixed results. CONCLUSION: This research demonstrates that CAST can be used in future surgical applications with no delay in wound healing as compared to the manually controlled laser. However, this study also finds no decrease in the wound healing time when using the CAST program.

Nitric oxide produced during ischemia improves functional recovery in the rabbit retina.

We examined the effect of modulating endogenous nitric oxide (NO) production on the recovery of neuronal function from temporary ischemia using a preparation in which blood flow is not a factor. Inhibition of nitric oxide synthase (NOS) during ischemia with L-NA (100 mumol-1) resulted in worse functional recovery compared to D-NA (100 mumol-1)-treated in control retinas (p < 0.01). In contrast, addition of L-Arg (1000 mumol-1) during ischemia, resulted in a concentration-dependent functional improvement (p < 0.05). These results show that inhibition of constitutive NOS is detrimental, whilst the enhancement of endogenous NO production improves the recovery of neuronal function during a period of temporary ischemia in the isolated retina, (an in vitro avascular model of the CNS). Thus, independent of its effects on the vasculature, NO production during temporary ischemia protects neurons from irreversible function damage.

Análisis cefalométrico para ortopantomografía / Cephalometric analysis for dental orthopantomography

Se presenta un análisis cefalométrico para radiografías panorámicas. Este análisis está basado en una línea de referencia horizontal traspasada a la radiografía, según fue descrito por los autores. En el diseño y posterior interpretación del análisis propuesto, se consideraron acusiosamente los problemas distorsionales y magnificaciones que están asociadas a este tipo de radiografías. El análisis no utiliza estándares de comparación, por cuanto su objetivo es de ser proporcional y comparativo de ambos lados mandibulares. Los autores han utilizado este análisis por más de tres años en la planificación terapéutica de más de 20 casos quirúrgicos de pacientes portadores de microsomía facial. Este trabajo está en proceso de ser publicado

Fibrosis pulmonar idiop tica: aspectos clínicos, radiológicos, fisiológicos e histológicos / Idiopathic pulmonary fibrosis: clinical, radiological, physiological and histological aspects

Se reportan 12 casos de fibrosis pulmonar idiop tica,de los cuales 8 correspondían al sexo femenino y 4 al masculino, con un predominio de edad a partir de los 40 años. Un paciente presentaba artritis reumatoidea y dos eran diabéticos. La duración de la enfermedad fue menor de 1 año en la mayoría y el síntoma principal fue disnea, tos seca y síntomas constitucionales tales como fatiga, artralgias y pérdida de peso. Radiológicamente se encontró infiltrado reticulonodular basal bilateral en 8 pacientes y patrón de panal de abeja en 4. Enfermedad restrictiva pura, enfermedad mixta con predominio de restricción y patrón mixto fueron los hallazgos espirométricos en la mayoría de casos. Un paciente presentó pruebas espirométricas normales. A todos los pacientes se les efectuó biopsia pulmonar la cual se obtuvo a través de toracoscopía en 8 y por medio de biopsia a cielo abierto en 4. Histológicamente los hallazgos fueron fibrosis sin descamación, fibrosis con descamación leve, fibrosis con descamación moderada y fibrosis con descamación crónica en 3 casos en cada grupo. Diez pacientes recibieron tratamiento con prednisona, 4 antimicrobianos de amplio espectro, 5 metilxantinas y 3 isoniazida en forma profil ctica. La evolución de los pacientes ha mostrado mejoría clínica y funcional en 8, ningún cambio en 2 y fallecieron 2