Predicting response to a smartphone-based cognitive-behavioral therapy for body dysmorphic disorder.

BACKGROUND: Body dysmorphic disorder (BDD) is a severe, chronic disorder if untreated. Smartphone cognitive behavioral therapy (CBT) for BDD is efficacious and can reduce key treatment barriers (e.g., lack of clinicians, cost, stigma). While promising, little is known about who is more or less likely to benefit from this approach. METHODS: This is a secondary data analysis of a randomized, waitlist-controlled trial of smartphone CBT for BDD. Participants (N = 80) were recruited nationally and randomized to receive a 12-week, coach-guided CBT for BDD app, either immediately or after a 12-week waitlist. The main outcome for this analysis was BDD severity (BDD-YBOCS) over time (baseline, week 6, week 12) during the active app use phase in each randomized group (n = 74). Secondary outcomes included treatment response (≥30 % reduction in BDD-YBOCS) and remission (total BDD-YBOCS ≤16) at end-of-treatment. RESULTS: Immediate (vs. delayed) CBT predicted better outcomes (symptom improvement), as did gender identity (symptom improvement), higher baseline treatment credibility and expectancy (response, remission), lower baseline BDD severity (remission), and sexual minority status (vs. heterosexual; response, remission). LIMITATIONS: Limitations include the relatively small sample, drop-out rate of 22 %, and limited gender and racial-ethnic diversity. CONCLUSIONS: These results highlight a potential advantage of smartphone CBT in historically marginalized populations, and the importance of efforts to hasten treatment access, bolster confidence in the treatment at treatment onset, and develop stratified care models to optimize treatment allocation and efficacy.

Molecular insights into GPCR mechanisms for drugs of abuse.

Substance abuse is on the rise, and while many people may use illicit drugs mainly due to their rewarding effects, their societal impact can range from severe, as is the case for opioids, to promising, as is the case for psychedelics. Common with all these drugs' mechanisms of action are G protein-coupled receptors (GPCRs), which lie at the center of how these drugs mediate inebriation, lethality, and therapeutic effects. Opioids like fentanyl, cannabinoids like tetrahydrocannabinol, and psychedelics like lysergic acid diethylamide all directly bind to GPCRs to initiate signaling which elicits their physiological actions. We herein review recent structural studies and provide insights into the molecular mechanisms of opioids, cannabinoids, and psychedelics at their respective GPCR subtypes. We further discuss how such mechanistic insights facilitate drug discovery, either toward the development of novel therapies to combat drug abuse or toward harnessing therapeutic potential.

Neurotoxicity and Oxidative Stress Development in Adult Atya lanipes Shrimp Exposed to Titanium Dioxide Nanoparticles.

Titanium dioxide is a type of nanoparticle that is composed of one titanium atom and two oxygen atoms. One of its physicochemical activities is photolysis, which produces different reactive oxygen species (ROS). Atya lanipes shrimp affect detrital processing and illustrate the potential importance of diversity and nutrient availability to the rest of the food web. It is essential in removing sediments, which have an important role in preventing eutrophication. This study aimed to determine the toxic effect of changes in behavior and levels of oxidative stress due to exposure to titanium dioxide nanoparticles in Atya lanipes and to determine the effective concentration (EC50) for behavioral variables. The concentrations of TiO2 NPs tested were 0.0, 0.50, 1.0, 2.0, and 3.0 mg/L with the positive controls given 100 µg/L of titanium and 3.0 mg/L of TiO2 NPs ± 100 µg/L of titanium. After 24 h of exposure, significant hypoactivity was documented. The EC50 was determined to be a concentration of 0.14 mg/L. After the exposure to 10 mg/L of TiO2 NPs, oxidative stress in gastrointestinal and nervous tissues was documented. The toxic effects of this emerging aquatic pollutant in acute exposure conditions were characterized by sublethal effects such as behavior changes and oxidative stress.

A Regional and Projection-Specific Role of RGSz1 in the Ventrolateral Periaqueductal Grey in the Modulation of Morphine Reward.

Opioid analgesics exert their therapeutic and adverse effects by activating µ opioid receptors (MOPR); however, functional responses to MOPR activation are modulated by distinct signal transduction complexes within the brain. The ventrolateral periaqueductal gray (vlPAG) plays a critical role in modulation of nociception and analgesia, but the exact intracellular pathways associated with opioid responses in this region are not fully understood. We previously showed that knockout of the signal transduction modulator Regulator of G protein Signaling z1 (RGSz1) enhanced analgesic responses to opioids, whereas it decreased the rewarding efficacy of morphine. Here, we applied viral mediated gene transfer methodology and delivered adeno-associated virus (AAV) expressing Cre recombinase to the vlPAG of RGSz1fl\fl mice to demonstrate that downregulation of RGSz1 in this region decreases sensitivity to morphine in the place preference paradigm, under pain-free as well as neuropathic pain states. We also used retrograde viral vectors along with flippase-dependent Cre vectors to conditionally downregulate RGSz1 in vlPAG projections to the ventral tegmental area (VTA) and show that downregulation of RGSz1 prevents the development of place conditioning to low morphine doses. Consistent with the role for RGSz1 as a negative modulator of MOPR activity, RGSz1KO enhances opioid-induced cAMP inhibition in periaqueductal gray (PAG) membranes. Furthermore, using a new generation of bioluminescence resonance energy transfer (BRET) sensors, we demonstrate that RGSz1 modulates Gαz but not other Gαi family subunits and selectively impedes MOPR-mediated Gαz signaling events invoked by morphine and other opioids. Our work highlights a regional and circuit-specific role of the G protein-signaling modulator RGSz1 in morphine reward, providing insights on midbrain intracellular pathways that control addiction-related behaviors. SIGNIFICANCE STATEMENT: This study used advanced genetic mouse models to highlight the role of the signal transduction modulator named RGSz1 in responses to clinically used opioid analgesics. We show that RGSz1 controls the rewarding efficacy of opioids by actions in ventrolateral periaqueductal gray projections to the ventral tegmental area, a key component of the midbrain dopamine pathway. These studies highlight novel mechanisms by which pain-modulating structures control the rewarding efficacy of opioids.

A Conserved Proline Hinge Mediates Helix Dynamics and Activation of Rhodopsin.

Despite high-resolution crystal structures of both inactive and active G protein-coupled receptors (GPCRs), it is still not known how ligands trigger the large structural change on the intracellular side of the receptor since the conformational changes that occur within the extracellular ligand-binding region upon activation are subtle. Here, we use solid-state NMR and Fourier transform infrared spectroscopy on rhodopsin to show that Trp2656.48 within the CWxP motif on transmembrane helix H6 constrains a proline hinge in the inactive state, suggesting that activation results in unraveling of the H6 backbone within this motif, a local change in dynamics that allows helix H6 to swing outward. Notably, Tyr3017.48 within activation switch 2 appears to mimic the negative allosteric sodium ion found in other family A GPCRs, a finding that is broadly relevant to the mechanism of receptor activation.

Analysis of Spatio-Temporal Representations for Robust Footstep Recognition with Deep Residual Neural Networks.

Human footsteps can provide a unique behavioural pattern for robust biometric systems. We propose spatio-temporal footstep representations from floor-only sensor data in advanced computational models for automatic biometric verification. Our models deliver an artificial intelligence capable of effectively differentiating the fine-grained variability of footsteps between legitimate users (clients) and impostor users of the biometric system. The methodology is validated in the largest to date footstep database, containing nearly 20,000 footstep signals from more than 120 users. The database is organized by considering a large cohort of impostors and a small set of clients to verify the reliability of biometric systems. We provide experimental results in 3 critical data-driven security scenarios, according to the amount of footstep data made available for model training: at airports security checkpoints (smallest training set), workspace environments (medium training set) and home environments (largest training set). We report state-of-the-art footstep recognition rates with an optimal equal false acceptance and false rejection rate (equal error rate) of 0.7 percent an improvement ratio of 371 percent compared to previous state-of-the-art. We perform a feature analysis of deep residual neural networks showing effective clustering of client's footstep data and to provide insights of the feature learning process.

Genomic insights into the origin and diversification of late maritime hunter-gatherers from the Chilean Patagonia.

Patagonia was the last region of the Americas reached by humans who entered the continent from Siberia ∼15,000-20,000 y ago. Despite recent genomic approaches to reconstruct the continental evolutionary history, regional characterization of ancient and modern genomes remains understudied. Exploring the genomic diversity within Patagonia is not just a valuable strategy to gain a better understanding of the history and diversification of human populations in the southernmost tip of the Americas, but it would also improve the representation of Native American diversity in global databases of human variation. Here, we present genome data from four modern populations from Central Southern Chile and Patagonia (n = 61) and four ancient maritime individuals from Patagonia (∼1,000 y old). Both the modern and ancient individuals studied in this work have a greater genetic affinity with other modern Native Americans than to any non-American population, showing within South America a clear structure between major geographical regions. Native Patagonian Kawéskar and Yámana showed the highest genetic affinity with the ancient individuals, indicating genetic continuity in the region during the past 1,000 y before present, together with an important agreement between the ethnic affiliation and historical distribution of both groups. Lastly, the ancient maritime individuals were genetically equidistant to a ∼200-y-old terrestrial hunter-gatherer from Tierra del Fuego, which supports a model with an initial separation of a common ancestral group to both maritime populations from a terrestrial population, with a later diversification of the maritime groups.

G Protein-Coupled Receptors Contain Two Conserved Packing Clusters.

G protein-coupled receptors (GPCRs) have evolved a seven-transmembrane helix framework that is responsive to a wide range of extracellular signals. An analysis of the interior packing of family A GPCR crystal structures reveals two clusters of highly packed residues that facilitate tight transmembrane helix association. These clusters are centered on amino acid positions 2.47 and 4.53, which are highly conserved as alanine and serine, respectively. Ala2.47 mediates the interaction between helices H1 and H2, while Ser4.53 mediates the interaction between helices H3 and H4. The helical interfaces outside of these clusters are lined with residues that are more loosely packed, a structural feature that facilitates motion of helices H5, H6, and H7, which is required for receptor activation. Mutation of the conserved small side chain at position 4.53 within packing cluster 2 is shown to disrupt the structure of the visual receptor rhodopsin, whereas sites in packing cluster 1 (e.g., positions 1.46 and 2.47) are more tolerant to mutation but affect the overall stability of the protein. These findings reveal a common structural scaffold of GPCRs that is important for receptor folding and activation.

Free backbone carbonyls mediate rhodopsin activation.

Conserved prolines in the transmembrane helices of G-protein-coupled receptors (GPCRs) are often considered to function as hinges that divide the helix into two segments capable of independent motion. Depending on their potential to hydrogen-bond, the free C=O groups associated with these prolines can facilitate conformational flexibility, conformational switching or stabilization of the receptor structure. To address the role of conserved prolines in family A GPCRs through solid-state NMR spectroscopy, we focus on bovine rhodopsin, a GPCR in the visual receptor subfamily. The free backbone C=O groups on helices H5 and H7 stabilize the inactive rhodopsin structure through hydrogen-bonds to residues on adjacent helices. In response to light-induced isomerization of the retinal chromophore, hydrogen-bonding interactions involving these C=O groups are released, thus facilitating repacking of H5 and H7 onto the transmembrane core of the receptor. These results provide insights into the multiple structural and functional roles of prolines in membrane proteins.

Agonists and protein kinase C-activation induce phosphorylation and internalization of FFA1 receptors.

FFA1 (previously known as GPR40) is a free fatty acid receptor involved in the regulation of inflammatory processes and insulin secretion. The cellular actions resulting from FFA1 activation have received considerable attention. However, little is known on the regulation of the receptor function. In the present work, using cells transfected with this receptor, docosahexaenoic acid and α-linolenic acid increased intracellular calcium concentration and ERK 1/2 phosphorylation. It was also observed that FFA1 is a phosphoprotein whose phosphorylation state was increased (2- to 3-fold) by agonists (i.e., free fatty acids) and also by phorbol myristate acetate. Agonist- and phorbol ester-mediated FFA1 phosphorylation was markedly reduced by inhibitors of protein kinase C. Receptor stimulation by free fatty acids and protein kinase C activation also induced receptor internalization as evidenced by confocal microscopy. In summary, our data show that FFA1 is a phosphoprotein whose phosphorylation state is modulated by agonists and protein kinase C activation; such covalent modification is associated with receptor internalization.

Ancient marine hunter-gatherers from Patagonia and Tierra Del Fuego: Diversity and differentiation using uniparentally inherited genetic markers.

OBJECTIVES: The human population history from Patagonia and Tierra del Fuego has been of great interest in the context of the American peopling. Different sources of evidence have contributed to the characterization of the local populations, but some main questions about their history remain unsolved. Among the native populations, two marine hunter-gatherers groups inhabited the Patagonian channels below the 478S: Kawéskar and Yámana. Regardless of their geographical proximity and cultural resemblance, their languages were mutually unintelligible. In this study we aim to evaluate the genetic diversity of uniparental genetic markers in both groups and to test if there is a high genetic differentiation between them, mirroring their linguistic differences. MATERIAL AND METHODS: Ancient DNA was extracted from 37 samples from both populations. We compared their genetic variability of their mitochondrial lineages and Y-STR as well as with other modern native populations from the area and further north. RESULTS AND DISCUSSION: We observed an important differentiation in their maternal lineages: while Kawéskar shows a high frequency of D (80%), Yámana shows a high frequency of C (90%). The analysis of paternal lineages reveals the presence of only Q1a2a1a1 and little variation was found between individuals. Both groups show very low levels of genetic diversity compared with modern populations. We also notice shared and unique mitochondrial DNA variants between modern and ancient samples of Kawéskar and Yámana.

α1B-adrenergic receptors differentially associate with Rab proteins during homologous and heterologous desensitization.

Internalization of G protein-coupled receptors can be triggered by agonists or by other stimuli. The process begins within seconds of cell activation and contributes to receptor desensitization. The Rab GTPase family controls endocytosis, vesicular trafficking, and endosomal fusion. Among their remarkable properties is the differential distribution of its members on the surface of various organelles. In the endocytic pathway, Rab 5 controls traffic from the plasma membrane to early endosomes, whereas Rab 4 and Rab 11 regulate rapid and slow recycling from early endosomes to the plasma membrane, respectively. Moreover, Rab 7 and Rab 9 regulate the traffic from late endosomes to lysosomes and recycling to the trans-Golgi. We explore the possibility that α1B-adrenergic receptor internalization induced by agonists (homologous) and by unrelated stimuli (heterologous) could involve different Rab proteins. This possibility was explored by Fluorescence Resonance Energy Transfer (FRET) using cells coexpressing α1B-adrenergic receptors tagged with the red fluorescent protein, DsRed, and different Rab proteins tagged with the green fluorescent protein. It was observed that when α1B-adrenergic receptors were stimulated with noradrenaline, the receptors interacted with proteins present in early endosomes, such as the early endosomes antigen 1, Rab 5, Rab 4, and Rab 11 but not with late endosome markers, such as Rab 9 and Rab 7. In contrast, sphingosine 1-phosphate stimulation induced rapid and transient α1B-adrenergic receptor interaction of relatively small magnitude with Rab 5 and a more pronounced and sustained one with Rab 9; interaction was also observed with Rab 7. Moreover, the GTPase activity of the Rab proteins appears to be required because no FRET was observed when dominant-negative Rab mutants were employed. These data indicate that α1B-adrenergic receptors are directed to different endocytic vesicles depending on the desensitization type (homologous vs. heterologous).

Síndrome de burnout en población mexicana: Una revisión sistemática / Burnout Syndrome in Mexican population: A systematic review

El creciente número de publicaciones que abordan el tema del síndrome de burnout sugieren que se trata de la afección psicológica-laboral más investigada en las últimas décadas. Resulta importante valorar el estado del arte de este fenómeno y ubicar en su justa medida la dimensión problemática que ha alcanzado. Por ello, el objetivo general de este trabajo fue realizar una revisión sistemática de la literatura científica para caracterizar la investigación sobre el síndrome de burnout en México. Método Se realizó una búsqueda en 12 bases de datos considerando las que incluyen revistas latinoamericanas. Se examinaron todos los artículos existentes hasta el mes de julio de 2012 y se definieron cinco criterios que aseguraran la comparabilidad entre los estudios. Se realizaron metaanálisis en los promedios de las dimensiones de burnout y los alfas de Cronbach reportados. Resultados Sesenta y cuatro estudios fueron seleccionados (n=13 801 empleados), los que en su mayoría se concentran en profesionales de la salud y poco más de la mitad en el Estado de Jalisco y el Distrito Federal. La revisión metodológica evidenció que más de 90% de dichos estudios son de diseño observacional-transversal y la mayoría con niveles de análisis que pueden ser vulnerables al efecto de variables confusoras. Destaca el hallazgo de la gran heterogeneidad existente en criterios para determinar la prevalencia. Los metaanálisis en 14 estudios seleccionados arrojaron valores promedio de "una vez al mes o menos" en la escala de frecuencia de síntomas de burnout. Discusión El balance general de la presente revisión muestra que la investigación del burnout en nuestro país tiene aún áreas de oportunidad. Es necesario ampliar el abanico de ocupaciones y regiones, así como mejorar los diseños de investigación, de análisis de información y asegurarse de las propiedades psicométricas de escalas utilizadas en su evaluación. Se sugieren recomendaciones para investigación futura.

The growing number of publications on the subject of burnout syndrome suggests this is the most widely researched psychological work-related outcome in the last decades. It is important to review the state of art in this phenomenon and to examine the challenging dimension that it has reached. The general objective of this paper was to carry out a systematic review of the published literature in order to characterize burnout research in Mexico. Methods A manual search was carried out in 12 databases including Spanish or Latin American journals. All the existent articles up to July 2012 were taken into account and five criteria were defined so as to assure the comparability among the studies. Meta-analyses were estimated with the averages of the burnout dimensions and the Cronbach alpha coefficients reported. Results Sixty-four studies were selected (n=13 801 employees); most of them were from health professionals and more than half were collected in Jalisco and Distrito Federal. The methodological analyses revealed that more than 90% of the studies were observational/cross-sectional designs, and most with data analyses that are vulnerable to the effect of confounding variables. A remarkable finding was the huge heterogeneity in the criteria used to determine the prevalence of burnout. The meta-analyses in 14 selected studies showed average burnout symptoms values of "once a month or less" within the frequency scale. Discussion The general balance of this review shows that the research on burnout in Mexico still has areas of opportunity. It is necessary to broaden the range of occupations and regions to improve the methodological designs and the information analyses, and to ensure the used scales have good psychometric properties. Some recommendations for future research are offered.

Free fatty acids and protein kinase C activation induce GPR120 (free fatty acid receptor 4) phosphorylation.

GPR120, free fatty acid receptor 4, is a recently deorphanized G protein-coupled receptor that seems to play cardinal roles in the regulation of metabolism and in the pathophysiology of inflammatory and metabolic disorders. In the present work a GPR120-Venus fusion protein was expressed in HEK293 Flp-In T-REx cells and its function (increase in intracellular calcium) and phosphorylation were studied. It was observed that the fusion protein migrated in sodium dodecyl sulfate-polyacrylamide gels as a band with a mass of ≈70-75kDa, although other bands of higher apparent weight (>130kDa) were also detected. Cell stimulation with docosahexaenoic acid or α-linolenic acid induced concentration-dependent increases in intracellular calcium and GPR120 phosphorylation. Activation of protein kinase C with phorbol esters also induced a marked receptor phosphorylation but did not alter the ability of 1µM docosahexaenoic acid to increase the intracellular calcium concentration. Phorbol ester-induced GPR120 phosphorylation, but not that induced with docosahexaenoic acid, was blocked by protein kinase C inhibitors (bis-indolyl-maleimide I and Gö 6976) suggesting that conventional kinase isoforms mediate this action. The absence of effect of protein kinase C inhibitors on agonist-induced GPR120 phosphorylation indicates that this kinase does not play a major role in agonist-induced receptor phosphorylation. Docosahexaenoic acid action was associated with marked GPR120 internalization whereas that induced with phorbol esters was smaller at early times.

Manejo de las fístulas interlocutoras / Management enterocutaneous fistulas

Estudio retrospectivo, descriptivo, que tiene como propósito describir el actual manejo de pacientes con Fístula Enterocutánea. Material y Métodos: se realizó un análisis retrospectivo, descriptivo, en el Seguro Social en los años 2009 a 2011, se evaluaron los siguientes aspectos: estado nutricional del paciente, características de la FE, manejo que se le proporcionó con respecto a apoyo nutricional, uso de hormonas, terapia presión negativa, cuidados de la piel, evolución de los pacientes según el tratamiento utilizado, si presentó cierre espontáneo, intervención quirúrgica o complicaciones, se realizó un instrumento para recolectar los datos mencionados...

Freshwater decapods of Puerto Rico: a checklist and reports of new localities.

An updated checklist of the freshwater decapod species of Puerto Rico is presented based on records of shrimp and crab species whose presence has been confirmed in Puerto Rico as a result of extensive field collections, examination of carcinological collections, literature review, and personal communications from researchers. The freshwater decapods fauna of Puerto Rico consists of 18 species of shrimps belonging to eight genera and three families, and one species of crab belonging to the family Pseudothelphusidae.

Presentación clínica y radiológica de la tuberculosis pediatrica / Clinical and radiological presentation of pediatric tuberculosis

Introducción. La Organización Mundial de la Salud estima que más de 8 millones de personas desarrollan tuberculosis (TB) anualmente y 1 a 3 millones mueren por esta enfermedad. El porcentaje exacto de niños con tuberculosis se estima que es de 3 al 13% de todos los casos. Fuentes. La presente revisión incluye literatura sobre las formas de TB en niños. Desarrollo. Para comprender la evolución natural de la enfermedad en niños, la TB se puede clasificar de la siguiente manera: a) Infección TB asintomática caracterizada por una prueba de tuberculina positiva y una radiografía de tórax normal, b) TB pulmonar primaria intratorácica, con presencia de adenopatías intratorácicaso lesiones parenquimatosas que dan la apariencia clínica y radiográfica de una neumonía o atelectasia., c) TB pulmonar primaria progresiva, que se desarrolla cuando el foco pulmonar primario no resuelve sino que progresa localmente, d) TB pulmonar crónica, también llamada del adulto o de reactivación, e) TB miliar, la cual es la forma más severa de TB hematógena, caracterizada por un patrón micronodular en la radiografía de tórax, f) TB extrapulmonar, sus formas más comunes son la TB de ganglios linfáticos superficiales y la TB del sistema nervioso central. Conclusiones. Debido a la escasez de manifestaciones clínicas y a que los niños son paucibacilares, el diagnostico es difícil. Por ello es esencial comprender la epidemiología, la historia natural de la enfermedad así como el cuadro clínico y radiológico sugestivo en niños...(AU)

Presentación clínica y radiológica de la tuberculosis pediatrica / Clinical and radiological presentation of pediatric tuberculosis

Introducción. La Organización Mundial de la Salud estima que más de 8 millones de personas desarrollan tuberculosis (TB) anualmente y 1 a 3 millones mueren por esta enfermedad. El porcentaje exacto de niños con tuberculosis se estima que es de 3 al 13% de todos los casos. Fuentes. La presente revisión incluye literatura sobre las formas de TB en niños. Desarrollo. Para comprender la evolución natural de la enfermedad en niños, la TB se puede clasificar de la siguiente manera: a) Infección TB asintomática caracterizada por una prueba de tuberculina positiva y una radiografía de tórax normal, b) TB pulmonar primaria intratorácica, con presencia de adenopatías intratorácicaso lesiones parenquimatosas que dan la apariencia clínica y radiográfica de una neumonía o atelectasia., c) TB pulmonar primaria progresiva, que se desarrolla cuando el foco pulmonar primario no resuelve sino que progresa localmente, d) TB pulmonar crónica, también llamada del adulto o de reactivación, e) TB miliar, la cual es la forma más severa de TB hematógena, caracterizada por un patrón micronodular en la radiografía de tórax, f) TB extrapulmonar, sus formas más comunes son la TB de ganglios linfáticos superficiales y la TB del sistema nervioso central. Conclusiones. Debido a la escasez de manifestaciones clínicas y a que los niños son paucibacilares, el diagnostico es difícil. Por ello es esencial comprender la epidemiología, la historia natural de la enfermedad así como el cuadro clínico y radiológico sugestivo en niños...

Broncoaspiración silenciosa en niños: reporte de un caso y revisión de la literatura / Silent pulmonary aspiration in children: Case report and literature review

Se presenta el caso de una paciente femenina de cinco años y medio de edad, con historia de tos crónica de 3 meses de evolución, sin otros síntomas sugestivos de enfermedad por reflujo gastroesofágico. La paciente era eutrófica, sin alteraciones neurológicas y con radiografía de tórax, serie esofagogastroduodenaly tomografía axial computarizada de tórax normales. Se realizó fibrobroncoscopía, mediante la cual se descartó anormalidades anatómicas de la vía aérea y la presencia de cuerpo extraño, y sirvió para establecer el diagnóstico de aspiración crónica silenciosa basada en la presencia de tos crónica, macrófagos cargados de lípidos en el lavado broncoalveolar y la buena respuesta al tratamiento médico. El presente, es el primer caso de broncoaspiración crónica en niños documentada que se reporta en la literatura médica nacional...(AU)

Broncoaspiración silenciosa en niños: reporte de un caso y revisión de la literatura / Silent pulmonary aspiration in children: Case report and literature review

Se presenta el caso de una paciente femenina de cinco años y medio de edad, con historia de tos crónica de 3 meses de evolución, sin otros síntomas sugestivos de enfermedad por reflujo gastroesofágico. La paciente era eutrófica, sin alteraciones neurológicas y con radiografía de tórax, serie esofagogastroduodenaly tomografía axial computarizada de tórax normales. Se realizó fibrobroncoscopía, mediante la cual se descartó anormalidades anatómicas de la vía aérea y la presencia de cuerpo extraño, y sirvió para establecer el diagnóstico de aspiración crónica silenciosa basada en la presencia de tos crónica, macrófagos cargados de lípidos en el lavado broncoalveolar y la buena respuesta al tratamiento médico. El presente, es el primer caso de broncoaspiración crónica en niños documentada que se reporta en la literatura médica nacional...