Factores asociados al control de síntomas nucleares en pacientes pediátricos con trastorno de déficit de atención e hiperactividad, en un centro especializado de Medellín entre 2018 y 2019 / Factors associated with the control of nuclear symptoms in pediatric patients with Attention Deficit Hyperactivity Disorder in a specialized center in Medellín between 2018 and 2019 / Fatores associados ao controle de sintomas nucleares em pacientes pediátricos com transtorno de déficit de atenção e hiperatividade, em um centro especializado em Medellín entre 2018 e 2019

Objetivo: el trastorno de déficit de atención e hiperactividad (TDAH) ha sido descrito como el trastorno del neurodesarrollo más común en la infancia. Esta condición se asocia a un significativo deterioro en calidad de vida, múltiples comorbilidades y, a largo plazo, a menores logros académicos y laborales. A pesar de que se ha evidenciado que en los pacientes de ascendencia latina se presenta un posible subdiagnóstico, que en Colombia se han estimado prevalencias mayores a las descritas en el planeta, y que los efectos de la pandemia por Covid-19 han podido exacerbar esta problemática, el volumen de estudios con estimaciones reproducibles sobre las características, tratamientos recibidos y control de síntomas de estos pacientes aún requiere ampliarse. Este estudio busca establecer los factores sociodemográficos, clínicos y del tratamiento asociados al control de los síntomas nucleares de este trastorno, que consisten en patrones persistentes y generalizados de inatención, impulsividad e hiperactividad. Metodología: estudio descriptivo con intención analítica en una cohorte retrospectiva de pacientes pediátricos con trastorno de déficit de atención e hiperactividad seguidos durante seis meses en un centro especializado de Medellín, Colombia, entre 2018 y 2019. Resultados: se identificó una incidencia de control de síntomas de 46,7% que se asoció de manera significativa con la adherencia al tratamiento y con historia familiar de TDAH. Conclusiones: puede afirmarse que, en pacientes pediátricos con TDAH, estos factores podrían aumentar la probabilidad de lograr el control de los síntomas nucleares.

Objective: Attention Deficit Hyperactivity Disorder (ADHD) has been described as the most common neurodevelopmental disorder in childhood. This condition is associated with significant deterioration in the quality of life, multiple comorbidities and, in the long term, lower academic and work achievements. Despite the fact that it has been shown that patients of Latin descent present a possible underdiagnosis, that in Colombia higher prevalence has been estimated than those described worldwide, and that the effects of the Covid-19 pandemic have been able to exacerbate this problem, the volume of studies with reproducible estimates on the characteristics, treatments received, and symptom control of these patients still needs to be expanded. This study seeks to establish the sociodemographic, clinical and treatment factors associated with the control of the core symptoms of this disorder, which consist of persistent and generalized patterns of inattention, impulsivity and hyperactivity. Methodology: Descriptive study with analytical intent in a retrospective cohort of pediatric patients with attention deficit hyperactivity disorder followed up for 6 months in a specialized center in Medellín, Colombia, between 2018 and 2019. Results: An incidence of symptom control of 46.7% was identified, which was significantly associated with adherence to treatment and with a family history of ADHD. Conclusions: It can be affirmed that, in pediatric patients with ADHD, these factors could increase the probability of achieving control of nuclear symptoms.

Objetivo: o transtorno dedéficit de atenção e hiperatividade (TDAH) tem sido descrito como o transtorno do neurodesenvolvimento mais comum na infância. Esta condição está associada a uma deterioração significativa na qualidade de vida, múltiplas comorbidades e, a longo prazo, menores rendimentos acadêmicos e profissionais. Apesar de ter sido demonstrado que os pacientes de ascendência latina apresentam um possível subdiagnóstico, e que na Colômbia foram estimadas prevalências mais altas do que as descritas no planeta e que os efeitos da pandemia de Covid-19 foram capazes de exacerbar esse problema, o volume de estudos com estimativas reprodutíveis sobre as características, tratamentos recebidos e controle de sintomas desses pacientes ainda precisam ser ampliados. Este estudo busca estabelecer os fatores sociodemográficos, clínicos e de tratamento associados ao controle dos sintomas centrais desse transtorno, que consistem em padrões persistentes e generalizados de desatenção, impulsividade e hiperatividade. Metodologia: estudo descritivo com intenção analítica em uma coorte retrospectiva de pacientes pediátricos com transtorno de déficit de atenção e hiperatividade acompanhados por seis meses em um centro especializado em Medellín, Colômbia, entre 2018 e 2019.Resultados: identificou-se uma incidência de controle dos sintomas de 46,7%, signifi-cativamente associada à adesão ao tratamento e ao histórico familiar de TDAH.Conclusões: Pode-se afirmar que, em pacientes pediátricos com TDAH , esses fatores podem aumentar a probabilidade de controle dos sintomas nucleares.

Two-Swim Operators in the Modified Bacterial Foraging Algorithm for the Optimal Synthesis of Four-Bar Mechanisms.

This paper presents two-swim operators to be added to the chemotaxis process of the modified bacterial foraging optimization algorithm to solve three instances of the synthesis of four-bar planar mechanisms. One swim favors exploration while the second one promotes fine movements in the neighborhood of each bacterium. The combined effect of the new operators looks to increase the production of better solutions during the search. As a consequence, the ability of the algorithm to escape from local optimum solutions is enhanced. The algorithm is tested through four experiments and its results are compared against two BFOA-based algorithms and also against a differential evolution algorithm designed for mechanical design problems. The overall results indicate that the proposed algorithm outperforms other BFOA-based approaches and finds highly competitive mechanisms, with a single set of parameter values and with less evaluations in the first synthesis problem, with respect to those mechanisms obtained by the differential evolution algorithm, which needed a parameter fine-tuning process for each optimization problem.

Response of yeast cells to high glucose involves molecular and physiological differences when compared to other osmostress conditions.

Yeast cells can be affected by several causes of osmotic stress, such as high salt, sorbitol or glucose concentrations. The last condition is particularly interesting during natural processes where this microorganism participates. Response to osmostress requires the HOG (High Osmolarity Glycerol) pathway and several transcription factors, including Hot1, which plays a key role in high glucose concentrations. In this work, we describe how the yeast response to osmotic stress shows differences in accordance with the stress agent responsible for it. Compared with other conditions, under high glucose stress, delocalization of MAPK (Mitogen-Activated Protein Kinase) Hog1 is slower, induction of HOT1 expression is higher and Msn2/4 transcription factors are involved to a lesser extent. The transcriptomic analyses carried out with samples incubated for 30 min in the presence of high glucose or sorbitol reveal the presence of two functional categories with a differential expression between these conditions: glycogen biosynthesis and mobilization, and membrane-anchored proteins. We present data to demonstrate that the cells treated with 20% (w/v) (1.11 M) glucose contain higher chitin levels and are more sensitive to calcofluor white and ethanol.

Nacer y crecer en plenitud: Dispositivos de salud mental para el acompañamiento de niños y adolescentes y familias / To be born and grow to the fullest: mental health devices to go along with children, adolescents, their families and expectant families. Metropolitan health district of the province of Neuquén / Nascer e crescer em plenitude: dispositivos de saúde mental para o acompanhamento de crianças e adolescentes, suas famílias e famílias gestantes. Área sanitária metropolitana na província de Neuquén

El presente artículo caracteriza los dispositivos de atención en salud mental a niños y adolescentes, sus familias y familias gestantes que se desarrollan, desde el ámbito de la salud pública, en la Zona Sanitaria Metropolitana de la Provincia del Neuquén (período 2008-2012). Dicha caracterización surge de una investigación descriptiva cualitativa en la que se utilizaron como instrumentos de recolección de datos la revisión de los registros sanitarios existentes y la aplicación de encuestas y entrevistas a los profesionales intervinientes. Los dispositivos así descriptos cobran relevancia bajo el concepto de “buenas prácticas” en salud desde el cual se buscan sistematizar experiencias exitosas que puedan ser aplicables y transferibles a otras realidades. “Buenas prácticas” que, en este caso, se dirigen a acompañar etapas claves en la estructuración psíquica del ser humano teniendo, por ello, un alto potencial preventivo y de promoción de la salud a nivel de salud mental

In This paper we describe mental health care devices for children and adolescents, their families and expectant families that are developed from the field of public health, in the Metropolitan Health District of the Province of Neuquén (2008-2012). This characterization comes from a qualitative descriptive research in which the revision of existing health records and the use of surveys and interviews with the professionals involved were used as data collection instruments. The devices described this way become relevant under the concept of “good practices” in health from which they seek to systematize successful experiences that may be applicable and transferable to other realities. “Good practices” that, in this case, aim at accompanying key stages in the psychic structure of human beings having, therefore, a high preventive potential and a health promotion potential as regards mental health level

Nacer y crecer en plenitud: Dispositivos de salud mental para el acompañamiento de niños y adolescentes y familias / To be born and grow to the fullest: mental health devices to go along with children, adolescents, their families and expectant families. Metropolitan health district of the province of Neuquén / Nascer e crescer em plenitude: dispositivos de saúde mental para o acompanhamento de crianþas e adolescentes, suas famílias e famílias gestantes. Area sanitária metropolitana na província de Neuquén

El presente artículo caracteriza los dispositivos de atención en salud mental a niños y adolescentes, sus familias y familias gestantes que se desarrollan, desde el ámbito de la salud pública, en la Zona Sanitaria Metropolitana de la Provincia del Neuquén (período 2008-2012). Dicha caracterización surge de una investigación descriptiva cualitativa en la que se utilizaron como instrumentos de recolección de datos la revisión de los registros sanitarios existentes y la aplicación de encuestas y entrevistas a los profesionales intervinientes. Los dispositivos así descriptos cobran relevancia bajo el concepto de ôbuenas prácticasö en salud desde el cual se buscan sistematizar experiencias exitosas que puedan ser aplicables y transferibles a otras realidades. ôBuenas prácticasö que, en este caso, se dirigen a acompañar etapas claves en la estructuración psíquica del ser humano teniendo, por ello, un alto potencial preventivo y de promoción de la salud a nivel de salud mental(AU)

In This paper we describe mental health care devices for children and adolescents, their families and expectant families that are developed from the field of public health, in the Metropolitan Health District of the Province of Neuquén (2008-2012). This characterization comes from a qualitative descriptive research in which the revision of existing health records and the use of surveys and interviews with the professionals involved were used as data collection instruments. The devices described this way become relevant under the concept of ôgood practicesö in health from which they seek to systematize successful experiences that may be applicable and transferable to other realities. ôGood practicesö that, in this case, aim at accompanying key stages in the psychic structure of human beings having, therefore, a high preventive potential and a health promotion potential as regards mental health level(AU)

Estudio de cohorte prospectiva de un programa de seguimiento farmacoterapéutico a pacientes anticoagulados ingresados en residencias geriátricas / Prospective cohort study of a pharmacological follow-up program of anticoagulated patients admitted to nursing homes

Introducción: El tratamiento anticoagulante, pese a conseguir un claro beneficio para prevenir y tratar la patología tromboembólica, presenta dificultades para su manejo en la práctica habitual. Ello debido a la variabilidad individual de dosificación, estrecho margen terapéutico, interacciones farmacológicas y efectos secundarios graves. Los pacientes ingresados en residencias geriátricas presentan cada vez más indicaciones para seguir un tratamiento anticoagulante oral, producto de trombosis venosa profunda y, muy especialmente, fibrilación auricular. Se trata de pacientes con un perfil que dificulta la prescripción del tratamiento anticoagulante: edad avanzada, polimedicación y pluripatologías. Objetivos: nos planteamos la hipótesis de que la implantación desde atención primaria de un programa de seguimiento farmacoterapéutico del tratamiento anticoagulante oral en pacientes ingresados en residencias geriátricas, que coordine a distintos profesionales de diferentes estamentos y niveles asistenciales, ha de mejorar su beneficio y disminuir los efectos secundarios. Métodos: se realiza un estudio descriptivo tipo cohorte prospectiva, de un año de evolución, de 27 pacientes ingresados en residencia geriátrica que realizan tratamiento anticoagulante controlado por el equipo de atención primaria. Se analizan distintas variables obtenidas a partir de la historia clínica informatizada, a partir de las cuales se establecen indicadores sobre el procedimiento del programa (indicadores de cobertura y registro) y otros sobre el resultado (indicadores definidos por el Comité Británico de Estándares en Hematología). Resultados: los resultados muestran que el perfil del paciente ingresado en una residencia geriátrica tratado con anticoagulantes es de edad avanzada (84 años), con predominio de mujeres (70 por ciento), con fibrilación auricular como indicación más frecuente (70,4 por ciento)...

Introduction. Anticoagulant treatment, despite providing a clear benefit to prevent and treat thrombo-embolic disease, is difficult to manage in routine practice. This is due to individual variability of dosing, narrow therapeutic margin, drug interactions, and side effects. An increasing number of patients admitted to nursing homes are under oral anticoagulant therapy because of deep venous thrombosis and, especially, atrial fibrillation. These are patients with a profile that makes prescription of anticoagulant treatment more difficult - elderly, taking multiple concomitant medications and with multiple ailments. Objetive. We hypothesized that the implementation of a primary care pharmacological follow-up program of oral anticoagulant therapy in patients admitted to nursing homes, with the purpose of coordinating the different professionals and care levels, would lead to greater benefit and reduction of side effects. Methods. A one-year descriptive prospective cohort study was conducted of 27 patients admitted to nursing homes who are under anticoagulation therapy followed by the primary care team. We analyzed different variables obtained from computerized medical records, from which indicators on the program were established (coverage and registration) as well as outcome indicators (as defined by the British Committee for Standards in Haematology). Results. The profile of patients under anticoagulation and admitted to nursing homes is elderly (84 years), with a predominance of women (70 percent), atrial fibrillation as most frequent indication (70.4 percent), hypertension as major cardiovascular risk factor (92 percent) and most of them on multiple drugs (92 percent). The analysis of the program results showed excellent coverage and registration indicators (100 percent)...

Genotype-dependent response to energy-restricted diets in obese subjects: towards personalized nutrition.

Obesity is a complex disease, which in many cases appears as a polygenic condition affected by environmental factors (mainly unbalanced dietary patterns and physical inactivity). In this context, the weight loss response to dietary interventions varies widely and predictive factors of successful slimming including those concerned with the individual's genetic make-up are poorly understood. Indeed, a number of genes involved in the regulation of energy expenditure, appetite, lipid metabolism and adipogenesis have been reported to affect the risk of treatment failure in some obese subjects. Some candidate genes for the prognosis of weight loss response related to energy expenditure are those codifying for the adrenergic receptors (ADBRs) and uncoupling proteins (UCPs), while genes related to appetite potentially affected by energy restriction are leptin (LEP), leptin receptor (LEPR), melanocortin pathways genes (MC3R, POMC) and the serotonin receptor. Furthermore, adipogenesis related genes such as peroxisome proliferator-activated receptor (PPAR gamma 2) and genes related to cytokines such as interleukin-6 (IL-6) and lipid metabolism including hepatic lipase (LIPC), perilipin (PLIN) and lipoprotein lipase (LPL) have also been associated to the weight lowering outcome induced by hypocaloric diets. Therefore, this review shows preliminary evidence from human studies that support the existence of a genetic component in the fat reduction process associated to a negative energy balance.

Impact of weight loss on cortisol secretion in obese men with and without metabolic syndrome features.

BACKGROUND AND AIM: Disturbances in cortisol metabolism have been associated with obesity and metabolic syndrome development. The aim of this study was to evaluate the effect of weight loss induced by an energy-restricted diet on postprandial cortisol secretion in obese men with and without metabolic syndrome features. METHODS AND RESULTS: Twelve obese men (BMI: 32.5-36.2 kg/m2), six without and six with at least three markers of metabolic syndrome, and six lean men (BMI: 22.2-24.9 kg/m2) participated. Plasma cortisol was measured at fasting and at 30 min intervals for 3h after standard breakfast intake. Obese volunteers repeated those measurements after weight loss induced by a 10-week hypocaloric balanced diet. Fasting (p = 0.002) and postprandial (p = 0.014) cortisol secretions in obese men were statistically lower than in lean subjects. The slimming program produced a -0.9 kg per week mean weight reduction with no differences between both groups (p = 0.297). After weight loss, postprandial cortisol secretion increased in volunteers with (p = 0.028) and without metabolic syndrome manifestations (p = 0.043), as compared to baseline, achieving values near to those of controls. Cortisol levels negatively correlated with body weight (r = -0.61; p < 0.001). CONCLUSIONS: Therefore, the effect of weight loss on cortisol metabolism appeared to be mediated by changes in body weight, which were apparently not affected by the occurrence of metabolic syndrome features.

[In vivo study of mitochondrial oxidation in obese patients treated by means of calorie restriction]. / Estudio in vivo de la oxidación mitocondrial en pacientes obesos tratados mediante restricción calórica.

The energy restriction is the most common nutritional approach to treat obesity, whose efficiency depends on oxidative response against changes in body weight. In that context, the aim of the present work was to in vivo examine the mitochondrial oxidation of obese volunteers by the 2-keto[1-(13)C]isocaproate breath test, before and after weight loss. Thirty-two volunteers (men and women) participated: 16 controls (body mass index: 19.0-27.0 kg/m2), and 16 obese (body mass index: 30.0-41.6 kg/m2) who followed a caloric restriction program for 10 weeks (-500 kcal). Before and after dieting, the 2-keto[1-(13)C]isocaproate breath test was performed by ingestion of 1 mg/kg tracer and 20 mg/kg L-leucine, dissolved in 200 ml orange juice. Breath samples were recovered at baseline and at 10 min intervals for 2 h after ingestion. The 13C-enrichment in breath was measured by isotope ratio mass spectrometry and the percentage of mitochondrial oxidation of tracer (%13C) was calculated. The percentage of oxidized tracer marginally tended to be lower in obese than in controls (25.1 +/- 5.5%, vs 27.5 +/- 4.0%, p = 0.175). After the intervention, the mean of weight loss was -7.8% +/- 3% p < 0.001), and the mitocondrial oxidation of the tracer statistically increased (25.1 +/- 5.5% vs 34.3 +/- 5.2%, p < 0.001). In fact, the body weight and the percentage of oxidized 2-keto[1-(13)C]isocaproate were inversely related (r = -0.34, p = 0.018). Thus, the 2-keto[1-(13)C]isocaproate in vivo showed the mitochondrial adaptation of obese volunteers treated by caloric-restriction intake and provided new information about the weight loss process induced by an hypocaloric diet.

Solución técnica en el retrasplante renal de un paciente portador de un by-pass femoro-femoral / Technical solution in the kidney retransplant of a patient with a femoro-femoral by-pass

El trasplante renal se ha convertido en la última década en una forma de tratamiento habitual para los pacientes con enfermedades renales terminales. Entre 1988 y 1998 la tasa de donantes por millón de habitantes ha aumentado espectacularmente en nuestro medio, ello implica que cada vez es posible ofrecer un trasplante renal a un número mayor de pacientes, de modo que las dificultades técnico-quirúrgicas con las que debemos enfrentarnos son cada vez más frecuentes, siendo preciso buscar e incorporar nuevos enfoques y modificaciones imaginativas de la técnica quirúrgica en beneficio de nuestros pacientes. (AU)