Classification and Assessment of the Patelar Reflex Response through Biomechanical Measures.

Clinical evaluation of the patellar reflex is one of the most frequent diagnostic methods used by physicians and medical specialists. However, this test is usually elicited and diagnosed manually. In this work, we develop a device specifically designed to induce the patellar reflex and measure the angle and angular velocity of the leg during the course of the reflex test. We have recorded the response of 106 volunteers with the aim of finding a recognizable pattern in the responses that can allow us to classify each reflex according to the scale of the National Institute of Neurological Disorders and Stroke (NINDS). In order to elicit the patellar reflex, a hammer is attached to a specially designed pendulum, with a controlled impact force. All volunteer test subjects sit at a specific height, performing the Jendrassik maneuver during the test, and the medical staff evaluates the response in accordance with the NINDS scale. The data acquisition system is integrated by using a tapping sensor, an inertial measurement unit, a control unit, and a graphical user interface (GUI). The GUI displays the sensor behavior in real time. The sample rate is 5 kHz, and the control unit is configured for a continuous sample mode. The measured signals are processed and filtered to reduce high-frequency noise and digitally stored. After analyzing the signals, several domain-specific features are proposed to allow us to differentiate between various NINDS groups using machine learning classifiers. The results show that it is possible to automatically classify the patellar reflex into a NINDS scale using the proposed biomechanical measurements and features.

Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico

BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma

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Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico.

BACKGROUND: With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma. METHODS: The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management. RESULTS: The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference - all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6-11 years and ≥12 years. CONCLUSIONS: For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.

Use of gold nanoparticles as crosslink agent to form chitosan nanocapsules: study of the direct interaction in aqueous solutions.

A systematic study of the interaction between free anionic gold nanoparticles and chitosan in a solution is presented. A spectroscopic study of the interaction between 10nm gold nanoparticles and low molecular weight chitosan is reported as a function of the concentration and pH of the polymer in a solution. Zeta potential measurements and TEM images indicate the effective aggregation of the nanoparticles in the presence of chitosan. At the same time, anionic gold nanoparticles act as crosslink agents to form chitosan nanocapsules with an average molecular size of 260nm. The changes of the surface plasmon band due to the adsorption of the polymer on the nanoparticle surface allow using of the citrate gold nanoparticles as sensors of the polymer for analytical purposes. The limit of detection for chitosan biopolymer is 69nM. The optimum pH for the interaction between the biopolymer and the nanoparticles is found at a value of 6.4, obtained from spectrophotometric measurements and applying a deconvolution analysis of the experimental data. A simple model based on molecular surface electrostatic interactions is proposed to understand the pH dependence of the investigated system.

Thermodynamic and structural study of phenanthroline derivative ruthenium complex/DNA interactions: probing partial intercalation and binding properties.

The binding of [Ru(PDTA-H(2))(phen)]Cl (PDTA = propylene-1,2-diaminetetra-acetic acid; phen = 1,10 phenanthroline) with ctDNA (=calf thymus DNA) has been investigated through intrinsic and induced circular dichroism, UV-visible absorption and fluorescence spectroscopies, steady-state fluorescence, thermal denaturation technique, viscosity and electrochemical measurements. The latter indicate that the cathodic and anodic peak potentials of the ruthenium complex shift to more positive values on increasing the DNA concentration, this behavior being a direct consequence of the interaction of both the reduced and oxidized form with DNA binding. From spectrophotometric titration experiments, the equilibrium binding constant and the number of monomer units of the polymer involved in the binding of one ruthenium molecule (site size) have been quantified. The intrinsic circular dichroism (CD) spectra show an unwinding and a conformational change of the DNA helix upon interaction of the ruthenium complex. Quenching process, thermal denaturation experiments and induced circular dichroism (ICD) are consistent with a partial intercalative binding mode.

[Cognitive aspects in girls with fragile X syndrome]. / Aspectos cognitivos en niñas con sindrome X fragil.

INTRODUCTION AND AIMS: Fragile X syndrome (FXS) is the first cause of intellective dysfunction due to hereditary reasons, but above all it is a multisystemic pathology, in which the cognitive behavioural phenotype is going to mark the child's entire school and social life. An early diagnosis is fundamental for proper genetic counselling and for the pedagogical approach. In girls, this diagnosis is hindered by a poorer knowledge of the semiology and because of the variability of the symptoms. Recognising the most significant clinical signs that suggest a diagnosis during early childhood is fundamental. DEVELOPMENT: An analysis of the literature offered us very few reports of girls affected by FXS and most of them are to be found in publications about genetics. There is often no clear separation between adulthood and childhood or between permutation and complete mutation, and extreme shyness and low self esteem are the most commonly reported data. Intellective capacity is normal in 40% of those affected by complete mutation; the pragmatic aspects of language and difficulties at school that can take on symptoms of non verbal learning disorder are the most significant data at school age; the incidence that the number of CGG repetitions, the degree of methylation and the FMR protein rate can have on both the symptomatology and the intensity with which they appear do not offer any homogeneous data; the attitude of the school and familial environment is a factor that has recently been considered to be of great importance in the maintenance or improvement of behavioural aspects. CONCLUSIONS: Although the discovery of the FMR1 gene provided us with a greater understanding of the symptomatology of FXS in girls, the scarcer knowledge available about its manifestations means that we can find ourselves before the problem of possibly mistaking it for learning disorders. The greater variability of its clinical symptoms and the shortage of studies that have appeared in publications on paediatrics and neuropaediatrics may be the underlying reason behind this lack of knowledge. Spanish language publications practically ignore cases of girls with FXS.

Aspectos cognitivos en niñas con síndrome X frágil / Cognitive aspects in girls with fragile X syndrome

Introducción y objetivo. El síndrome X frágil (SXF) es la primera causa de disfunción intelectiva de causa hereditaria; pero, sobre todo, es una patología multisistémica, en la que el fenotipo cognitivoconductual va a marcar toda la vida escolar y social del niño. El diagnóstico precoz es fundamental para el consejo genético y para el abordaje pedagógico. En las niñas, este diagnóstico se interfiere por un menor conocimiento de la semiología y por la variabilidad de la misma. Es una prioridad reconocer los signos clínicos más significativos que ya en la primera infancia sugieran el diagnóstico. Desarrollo. El análisis de la literatura médica nos ofrece pocos textos dedicados a las niñas afectadas por el SXF, y la mayoría de ellos se encuentran en publicaciones genéticas; con frecuencia no existe una clara separación entre edad adulta e infantil, ni entre premutación y mutación completa; la timidez extrema y la baja autoestima son los datos más referidos; la capacidad intelectiva es normal en el 40% de las afectadas por mutación completa; los aspectos pragmáticos del lenguaje y las dificultades escolares que pueden adoptar semiología de trastorno de aprendizaje no verbal son los datos más relevantes en la edad escolar; la incidencia que tanto en la sintomatología como en la intensidad de sus manifestaciones pueda tener el número de repeticiones CGG, grado de metilación y tasa de proteína FMR, no ofrece datos homogéneos; la actitud del entorno escolar y familiar es un dato recientemente considerado como de gran trascendencia en el mantenimiento o en la mejoría de los aspectos conductuales. Conclusiones. Aunque el descubrimiento del gen FMR1 permitió la mejor comprensión de la semiología del SXF, en las niñas, el menor conocimiento de sus manifestaciones nos sitúa frente al problema de que puedan confundirse con trastornos del aprendizaje. La mayor variabilidad de su clínica y la escasez de trabajos en publicaciones pediátricas y neuropediátricas puede encontrarse en la base de este infraconocimiento. En las publicaciones en lengua española prácticamente se ignora a las niñas con SXF (AU)

Introduction and aims. Fragile X syndrome (FXS) is the first cause of intellective dysfunction due to hereditary reasons, but above all it is a multisystemic pathology, in which the cognitive-behavioural phenotype is going to mark the child’s entire school and social life. An early diagnosis is fundamental for proper genetic counselling and for the pedagogical approach. In girls, this diagnosis is hindered by a poorer knowledge of the semiology and because of the variability of the symptoms. Recognising the most significant clinical signs that suggest a diagnosis during early childhood is fundamental. Development. An analysis of the literature offered us very few reports of girls affected by FXS and most of them are to be found in publications about genetics. There is often no clear separation between adulthood and childhood or between permutation and complete mutation, and extreme shyness and low self-esteem are the most commonly reported data. Intellective capacity is normal in 40% of those affected by complete mutation; the pragmatic aspects of language and difficulties at school that can take on symptoms of non-verbal learning disorder are the most significant data at school age; the incidence that the number of CGG repetitions, the degree of methylation and the FMR protein rate can have on both the symptomatology and the intensity with which they appear do not offer any homogeneous data; the attitude of the school and familial environment is a factor that has recently been considered to be of great importance in the maintenance or improvement of behavioural aspects. Conclusions. Although the discovery of the FMR1 gene provided us with a greater understanding of the symptomatology of FXS in girls, the scarcer knowledge available about its manifestations means that we can find ourselves before the problem of possibly mistaking it for learning disorders. The greater variability of its clinical symptoms and the shortage of studies that have appeared in publications on paediatrics and neuropaediatrics may be the underlying reason behind this lack of knowledge. Spanish language publications practically ignore cases of girls with FXS (AU)

[Aspects of cognition and language in children with fragile X syndrome]. / Aspectos cognitivos y del lenguaje de niños con síndrome X frágil.

INTRODUCTION: Fragile X syndrome, which is produced by mutation of a gene in the X chromosome, is the most frequent cause of hereditary mental retardation. The multisystemic alterations of the disorder are due to the inhibition of the expression of the FMR1 gene and to the lack or absence of FMRP protein. Mental retardation and autistic spectrum constitute the most serious manifestations of the syndrome, but there are numerous neuropsychological disorders that make up the cognitive behavioural (CB) phenotype of patients, and the number of clinical manifestations they are going to present is also high. AIMS: The aim of the study was to evaluate the parameters that can contribute to the elaboration of a set of generally agreed guidelines that include early diagnosis and the indispensable genetic counselling, as well as a multidisciplinary intervention that contemplates, in a global manner, the medical and educational needs of those affected. METHODOLOGY: The method used to conduct the study involved an analysis of the early manifestations of the disease and the neuropsychological aspects of those affected, by means of a study protocol that includes biological and pedagogical data together with batteries of standard tests. RESULTS AND CONCLUSIONS: Preliminary results confront us with the delay in diagnosis and in genetic counselling because the CB phenotype, in which language disorders were the most constant element, is not taken as being an early sign of the clinical manifestations or as a serious interference factor in the cognitive aspects in the progress of the disease.

Aspectos cognitivos y del lenguaje en niños con síndrome X frágil / Aspects of cognition and language in children with fragile X syndrome

Introducción. Producido por la mutación de un gen del cromosoma X, el síndrome X frágil es la causa más frecuente de retraso mental hereditario. Las alteraciones multisistémicas de la afección se deben a la inhibición de la expresión del gen FMR1 y a la disminución o ausencia de proteína FMRP. Las manifestaciones más graves del síndrome son retraso mental y espectro autista, pero son numerosos los trastornos neuropsicológicos que van a formar parte del fenotipo cognitivoconductual (CC) de los afectados, así como son múltiples las manifestaciones clínicas que van a presentar. Objetivo. Evaluar los parámetros que puedan contribuir a la elaboración de un proyecto de actuación consensuada que incluya tanto el diagnóstico precoz y el imprescindible consejo genético, como una intervención multidisciplinar que contemple la globalidad de las necesidades médicas y educativas de los afectados. Metodología. Estudio de las manifestaciones precoces de la enfermedad y aspectos neuropsicológicos de los afectados, mediante un protocolo de estudio que incluye datos biológicos y pedagógicos y una batería de pruebas normativas. Resultados y conclusiones. Los resultados preliminares nos enfrentan al retraso en el diagnóstico y en el consejo genético al no valorar el fenotipo CC, en el que los trastornos del lenguaje han sido el elemento más constante, como signo precoz de las manifestaciones clínicas y como factor de interferencia grave en los aspectos cognitivos y en la evolución del paciente (AU)

Introduction. Fragile X syndrome, which is produced by mutation of a gene in the X chromosome, is the most frequent cause of hereditary mental retardation. The multisystemic alterations of the disorder are due to the inhibition of the expression of the FMR1 gene and to the lack or absence of FMRP protein. Mental retardation and autistic spectrum constitute the most serious manifestations of the syndrome, but there are numerous neuropsychological disorders that make up the cognitive-behavioural (CB) phenotype of patients, and the number of clinical manifestations they are going to present is also high. Aims. The aim of the study was to evaluate the parameters that can contribute to the elaboration of a set of generally agreed guidelines that include early diagnosis and the indispensable genetic counselling, as well as a multidisciplinary intervention that contemplates, in a global manner, the medical and educational needs of those affected. Methodology. The method used to conduct the study involved an analysis of the early manifestations of the disease and the neuropsychological aspects of those affected, by means of a study protocol that includes biological and pedagogical data together with batteries of standard tests. Results and conclusions. Preliminary results confront us with the delay in diagnosis and in genetic counselling because the CB phenotype, in which language disorders were the most constant element, is not taken as being an early sign of the clinical manifestations or as a serious interference factor in the cognitive aspects in the progress of the disease (AU)

Non-linear QSAR modeling by using multilayer perceptron feedforward neural networks trained by back-propagation.

The use of multilayer perceptrons (MLP) feedforward neural networks trained by back-propagation (BP) for non-linear QSAR model building is presented and explained in detail through a case study. This method was compared with others often used in this field, such as multiple linear regression (MLR), partial least squares (PLS) and quadratic PLS (QPLS). The case study deals with a series of 18 alpha adrenoreceptors agonists belonging to three different classes (alpha-1, alpha-2 and alpha-1,2) according to their different pharmacological effects. Each of them is described by 15 chemical features (the X block). Six pharmacological responses were also measured for each one to build the matrix of biological responses (the Y block). The results obtained indicated a slightly better performance of MLP against the other procedures, when using the correlation coefficient of the observed versus predicted response plots as an indicator of the goodness of the fit.

Performing procrustes discriminant analysis with HOLMES.

Program HOLMES devised by target factor analysis has been updated for performing procrustes discriminant analysis (PDA). Computational details are outlined. The equivalence between PDA and partial least squares-discriminant analysis (PLS-DA) is established. Application of the PDA is illustrated by two case studies taken from literature.

Enfermedades alérgicas e infección por el virus de inmunodeficiencia humana (VIH)-SIDA en pacientes pediátricos / Allergic diseases and HIV infection in childrens

La infección por el virus de la inmunodeficiencia humana (VIH) causa una alteración en la regulación inmunológica, aún antes de que haya inmunodeficiencia, linfopenia y datos clínicos de SIDA. Las alteraciones inmunológicas que se encuentran son una diferenciación de la subclase de los linfocitos T, Th1 hacia Th0. Frente a un estímulo estas células Th0 se desarrollan posteriormente hacia Th2 con predominio de la última subclase. La expresión clínica de este desequilibrio inmunológico es una predisposición de los pacientes VIH seropositivos a las enfermedades alérgicas y autoinmunitarias en las que la producción de anticuerpos es importante. En ocasiones el diagnóstico diferencial con lupus eritematoso sistémico es difícil. Hasta el momento está descrita una mayor prevalencia de alergias, sobre todo de rinitis alérgica, en pacientes adultos con infección por VIH-SIDA. Los reportes de pacientes pediátricos son aún esporádicos y se desconoce la prevalencia de alergias en niños con infección por VIH-SIDA. Sólo si se reconoce la causa alérgica de algunos síntomas, se tratarán de manera adecuada, lo que podría disminuir la morbilidad y las complicaciones (infecciosas)

[Allergic diseases and infection with human immunodeficiency virus (HIV)-AIDS in pediatric patients]. / Enfermedades alérgicas e infección por el virus de inmunodeficiencia humana (VIH)-SIDA en pacientes pediátricos.

During an infection with human immunodeficiency virus (HIV) the immune system is deregulated, even before real immunodeficiency, lymphopenia and AIDS occur. The immunologic alterations that have been described are a differentiation of a T-lymphocyte subclass, Th1 to Th0. Immunologic stimulation of these Th0 cells afterwards, makes them mature into Th2 cells. This causes a imbalance between the Th1 and Th2 cells, in favor of the second group. The clinical expression of this imbalance is an elevated risk of HIV-seropositive patients for allergies and for autoimmune disease, specially those autoimmune disease in which the production of autoantibodies prevails. Sometimes of differential diagnosis with systemic lupus erythematosus is difficult. There has been describes a major prevalence of allergic diseases, especially allergic rhinitis, in adult patients infected by HIV. Reports in pediatric patients are still sporadic, and the prevalence of allergies in children infected with HIV-AIDS is unknown. Only after recognizing the allergic nature of some symptoms, the treatment will be complete, reducing morbidity and infectious complications.

[Early identification of respiratory viruses in asthmatic children]. / Identificación temprana de virus respiratorios en niños asmáticos.

The role of viral infections as a part of the environmental factors that triggered asthma in atopic subjects, their age specific pattern, as well as many risk factors for the development of subsequent wheezing are described. Some pathogenic mechanisms and their importance in the induction of airway inflammation are mentioned and early identification by laboratory tests in outlined for preventive approach and early antiinflammatory treatment.

[Viruses precipitating asthmatic crises]. / Los virus como desencadenantes de crisis asmáticas.

Study made with 45 patients in the allergy service of the Instituto Nacional de Pediatría, with the purpose of analyzing the virus participation in the precipitation of asthmatic crisis in children who lived in the southeast of Mexico City. The subjects were included in the study if they presented signs of atopy or infection of the superior air channels. Pollen allergics, rhinosinusitis, smokers relatives and patients who own pets were excluded. In this population group, the participation of the virus were RSV, influenza B and parainfluenza.

[The role of neuropeptides in the physiopathogenesis of asthma]. / El papel de los neuropéptidos en la fisiopatogenia del asma.

This article review the effects of neuropeptides in the pathogenesis of Asthma. It is a review of literature and show most important neuropeptides, physical and chemical characteristics effects and some clinical studies about them.

Síndrome de intesino corto experimental: Estudio comparativo de diferentes técnicas medidas con productos radioactivos. Nuestra experiencia / Experimental short bowell syndrome: comparative study of different techniques measured with radiactive products

Estudio comparativo, diseñado para evaluar la eficiencia, seguridad y buenos resultados, de la aplicación de la válvula experimental ideada por López Pérez, a animales a los que se les interviene y practica una resección del 85 por ceinto de su intestino delgado distal para que conlleve también el sacrificio de la válvula ileocecal, y ciego, añadiéndoles al 25 por ciento la válvula LP, a otro 25 por ciento una Miectomía Longitudinal a todo el intestino residual, y miectomía + válvula para el cuarto 25 por ciento. Valoramos: 1) Supervivencia. 2) Curvas de peso, crecimiento y desarrollo y 3) La mala absorción consecuente a su intestino corto, mediante marcadores radiactivos, midiéndose la Velocidad de tránsito, digestivo y absorción

[Intestinal obstruction caused by milk curds in newborns]. / Obstrucción intestinal por tapón de leche en neonatos.

Intestinal obstruction due to milk curds syndrome may present with a clinical picture and radiological findings which suggest the correct diagnosis. This type of intestinal obstruction usually affects neonates, previously healthy, with concentrated formula feeding. Surgical treatment may be avoided in some cases by the administration of Gastrografin enemas. Two patients with milk curd obstruction treatment in our Hospital, are presented.