Aplicación de la Prueba Nacional de Pesquisa de Trastornos Inaparentes del Desarrollo en pacientes del Consultorio de Niño Sano

La detección precoz de los problemas de desarrollo psicomotor del niño es una de las acciones relevantes que se deben cumplir en el primer nivel de atención. Esta detección permite que se hagan intervenciones eficaces, que se obtengan mejores resultados en los tratamientos y planes de rehabilitación. Para lograrlo es necesario contar con personal capacitado y con instrumentos eficaces. La Prueba Nacional de Pesquisa de Trastornos Inaparentes del Desarrollo (PRUNAPE) es un test de pesquisa recomendado por la Sociedad Argentina de Pediatría para ser aplicado a niños menores de 6 años. Objetivo: aplicar la prueba a niños del consultorio de niño sano para detectar trastornos inaparentes del desarrollo. Método: se capacitó a médicos residentes de clínica pediátrica en la aplicación de la PRUNAPE. Se aplicó el test en su modalidad completa según metodología e instrumentación estandarizada a 65 pacientes menores de 6 años del consultorio de niño sano. Se registró la duración exacta de cada sesión y se confeccionó una planilla con variables universales de cada paciente. Resultados: -25 pacientes (38,46%) fracasaron, siendo citados para realizar una segunda prueba 15 a 20 días después. Todos ellos eran recién nacidos de término. -19 de estos pacientes concurrieron para realizar la prueba, 12 de ellos fracasaron nuevamente (18,46%): siete pacientes con sospecha de retardo madurativo global (dos o más áreas comprometidas según test) y cinco con sospecha de retardo madurativo focal (3 afectados el área del lenguaje y 2 motor fino). El tiempo promedio de duración de la prueba, sobre la base de 84 aplicaciones cronometradas fue de 12,95 minutos. Discusión: la mayoría de los problemas de desarrollo en los primeros años de la vida pueden ser causa de discapacidad en la etapa escolar o en la adultez. La aplicación de un test de pesquisa en el primer nivel de atención nos permite detectarlos y tratarlos en forma oportuna.The early discovery of problems on psychomotor development in children is one of the relevant actions that should be accomplished in the first level of attention. This detection allows for effective interventions to be carried out, and enables better results in treatment and rehabilitation programs. In order to obtain this it is necessary to count on qualified personnel and effective instruments. The PRUNAPE is an investigative test of hidden development disorders recommended by the Argentine Pediatric Society to be applied to children under 6 years of age

Nocturnal Arrhythmias and Heart-Rate Swings in Patients With Obstructive Sleep Apnea Syndrome Treated With Beta Blockers

Background: The higher cardiovascular variability and the increased prevalence of arrhythmias in patients with obstructive sleep apneas may contribute to their higher rate of fatal events during sleep. In this regard, the use of beta blockers (BB) is debated because they may induce bradyarrhythmias and alter the pattern of heart rate changes induced by apneas. Thus, the aim of our study is to quantify peri-apneic heart-rate swings and prevalence of nocturnal bradyarrhythmias in BB-treated and BB-naive patients with obstructive sleep apnea. Methods and Results: Our real-life, retrospective, cohort study analyzed data from patients with obstructive sleep apnea after a basal cardiorespiratory polysomnography. Among 228 eligible participants, we enrolled 78 BB-treated and 88 BB-naive patients excluding those treated with antiarrhythmic drugs or pacemakers, or with uninterpretable ECG traces during polysomnography. In each patient, type and frequency of arrhythmias were identified and peri-apneic changes of RR intervals were evaluated for each apnea. BB-treated patients were older and with more comorbidities than BB-naive patients, but had similar obstructive sleep apnea severity, similar frequency of arrhythmic episodes, and similar prevalence of bradyarrhythmias. Apnea-induced heart-rate swings, unadjusted for age, showed lower RR interval changes in BB-treated (133.5 +/- 63.8 ms) than BB-naive patients (171.3 +/- 87.7 ms, P=0.01), lower RR interval increases during apneas (58.5 +/- 28.5 versus 74.6 +/- 40.2 ms, P=0.01), and lower RR interval decreases after apneas (75.0 +/- 42.4 versus 96.7 +/- 55.5 ms, P0.05). Conclusions: BB appear to be safe in patients with obstructive sleep apnea because they are not associated with worse episodes of nocturnal bradyarrhythmias and even seem protective in terms of apnea-induced changes of heart rate

Heart Rate Variability from Wearable Photoplethysmography Systems: Implications in Sleep Studies at High Altitude

The interest in photoplethysmography (PPG) for sleep monitoring is increasing because PPG may allow assessing heart rate variability (HRV), which is particularly important in breathing disorders. Thus, we aimed to evaluate how PPG wearable systems measure HRV during sleep at high altitudes, where hypobaric hypoxia induces respiratory disturbances. We considered PPG and electrocardiographic recordings in 21 volunteers sleeping at 4554 m a.s.l. (as a model of sleep breathing disorder), and five alpine guides sleeping at sea level, 6000 m and 6800 m a.s.l. Power spectra, multiscale entropy, and self-similarity were calculated for PPG tachograms and electrocardiography R-R intervals (RRI). Results demonstrated that wearable PPG devices provide HRV measures even at extremely high altitudes. However, the comparison between PPG tachograms and RRI showed discrepancies in the faster spectral components and at the shorter scales of self-similarity and entropy. Furthermore, the changes in sleep HRV from sea level to extremely high altitudes quantified by RRI and PPG tachograms in the five alpine guides tended to be different at the faster frequencies and shorter scales. Discrepancies may be explained by modulations of pulse wave velocity and should be considered to interpret correctly autonomic alterations during sleep from HRV analysis

El concepto de observación en las Ciencias Naturales

El concepto de observación en el ámbito de las ciencias naturales nos parece un tema promisorio de investigación filosófica La epistemología tradicional ha descuidado varios aspectos importantes de la práctica observacional científica, y como consecuencia de ello, la noción de observación empleada por los filósofos frecuentemente no corresponde a la actividad de la ciencia real. Para evitar esta dificultad establecemos como punto de partida general dos criterios de adecuación para un concepto filosófico de observación: A) Debe servir para elaborar una teoría epistemológíca tan explicativa, simple, y fértil como sea posible. B) Debe proveer .una reconstrucción racional del concepto científico de observación que sea lo más cercana posible a los usos y prácticas de ese concepto en la ciencia rea

Fuerza muscular de los miembros inferiores entre las mujeres con artritis reumatoide y las mujeres sin esta enfermedad: ¿habrá diferencias?

Rheumatoid arthritis (RA) is a systemic inflammatory disease, which is chronic and affects the joints’ synovial membrane. Among the physical aptitude qualities that can be impaired in individuals with RA, muscle strength deserves attention. It is directly associated with the capacity of performing all activities of daily living, from the simplest to the most complex. The aim of this study was to assess the muscle strength of the lower limbs of women with RA. Seventeen volunteers with RA (I, II and III functional classes) and 17 women without the disease, with mean age corresponding to 54.7+6.63 years, underwent the one-maximum repetition test to assess knee flexors and extensors, hip abductors and adductors. We used Student’s T test to analyze the data, considering significant p values < 0.05. In all assessments, the group of women with RA showed lower values when compared with women without the disease. However, there were no statistically significant differences between the groups. The descriptive levels obtained from the comparison between the groups’ muscle strength were: knee extensors, p=0.224; knee flexors, p=0.467; hip abductors, p=0.190 and hip adductors, p=0.127. The muscle strength of the lower limbs does not differ between women with RA (I, II and III functional classes) and women without the disease.La artritis reumatoide (AR) es una enfermedad inflamatoria sistémica, crónica, que afecta específicamente a la membrana sinovial de las articulaciones. Entre las cualidades de aptitud física que pueden reducirse en individuos con AR, se señala la fuerza muscular, que está directamente relacionada con la capacidad para realizar todas las actividades de la vida diaria, desde las más simples hasta las más complejas. Este estudio propone evaluar la fuerza muscular de los miembros inferiores de mujeres con AR. Métodos: Se sometieron a 17 voluntarias con AR (de categorías funcionales I, II y III) y a 17 sin la enfermedad –con un promedio de edad de 54,7+6,63 años– a la prueba de repetición máxima para que se evalúe la fuerza muscular de los flexores y los extensores de rodilla, así como los extensores y abductores de cadera. Se utilizó la prueba τ para analizar los datos, siendo considerados estadísticamente significativos los niveles de α <0,05. En todas las evaluaciones, el grupo de mujeres con AR presentó valores más bajos en comparación con el grupo sin la enfermedad. Sin embargo, no hubo ninguna diferencia estadísticamente significativa entre los grupos. Los niveles descriptivos obtenidos de la comparación entre la fuerza muscular de los grupos fueron: los extensores de rodilla, p=0,224; los flexores de rodilla, p=0,467; los abductores de cadera, p=,190; y los aductores de cadera, p=0,127. La fuerza muscular de los miembros inferiores no difirió entre las mujeres con AR (de categorías funcionales I, II y III) y las mujeres sin esta enfermedad.A artrite reumatoide (AR) é uma doença inflamatória sistêmica, crônica, que acomete preferencialmente a membrana sinovial das articulações. Dentre as qualidades de aptidão física que podem ser reduzidas em indivíduos com AR merece destaque a força muscular, que está diretamente relacionada à capacidade de realização de todas as atividades da vida diária, desde as mais simples até as mais complexas. O objetivo deste estudo foi avaliar a força muscular de membros inferiores de mulheres com AR. Métodos: 17 voluntárias com AR (das classes funcionais I, II e III) e 17 sem a doença, com idade média de 54,7+6,63 anos, foram submetidas ao teste de uma repetição máxima para avaliar a força muscular de flexores e extensores de joelho e de abdutores e adutores de quadril. Utilizou-se o teste τ para analisar os dados, sendo considerados estatisticamente significativos os níveis de α <0,05. Em todas as avaliações o grupo de mulheres com AR apresentou valores inferiores quando comparados ao grupo sem a doença. No entanto não houve diferenças estatisticamente significativas entre os grupos. Os níveis descritivos obtidos da comparação entre a força muscular dos grupos foram: para extensores de joelho, p=0,224; flexores de joelho, p=0,467; abdutores de quadril, p=0,190; e adutores de quadril, p=0,127. A força muscular de membros inferiores não difere entre mulheres com AR (das classes funcionais I, II e III) e mulheres sem a doença

Una propuesta para la enseñanza de la Biología en un contexto de masividad

En el marco de una universidad abierta, amplia y pluralista, a cien años de la Reforma Universitaria de 1918, nos enfrentamos a nuevos desafíos para preservar y defender sus principios que están plasmados en el Estatuto de la UNLP. Entre ellos se hallan: la gratuidad de la enseñanza, autonomía universitaria, libertad de cátedra, cogobierno, concursos docentes, ingreso libre y directo con igualdad de oportunidades para quienes deseen acceder a la formación superior. De acuerdo a una tendencia global, se ha producido un aumento de la matrícula que impone una reformulación de estrategias para la enseñanza en un contexto de masividad. Por otro lado, la formación previa de los estudiantes es muy heterogénea y eso genera un problema a resolver para los docentes de los primeros años. Para lograr los objetivos de aprendizaje propuestos, en este contexto, es que se propone un acercamiento previo de los estudiantes con el material didáctico y la bibliografía, así como diversas herramientas virtuales que permitan la clarificación de los contenidos y el desarrollo de un aula virtual extendida complementaria a las clases presenciales. En cuanto a la organización en clase, se propone la organización de “Comunidades de Aprendizaje” que consiste en grupos que trabajen dentro del aula y, en lo posible, también fuera de ella bajo la supervisión de los docentes, o colaboradores. Se le asignarán tareas adicionales, algunas opcionales, integradoras de conceptos para ser evaluadas durante y al finalizar la cursada. Además, se promoverá la participación de estudiantes de los cursos masivos, de 1er año, en actividades de investigación y/o ex-tensión que les amplíen los horizontes de su conocimiento sobre la carrera que han elegido y les ayude a resolver problemáticas. Las es-trategias en sí mismas serán evaluadas previo a su implementación (Ex -ante), durante su ejecución (durante) y después de su imple-mentación (Ex -post). Se espera mayor efectividad en el alcance de los objetivos propuestos luego de implementadas estas innovaciones.Trabajo publicado en Giordano, Carlos José y Morandi, Glenda (comps.). Memorias de las 2º Jornadas sobre las Prácticas Docentes en la Universidad Pública. La enseñanza universitaria a 100 años de la reforma: legados, transformaciones y compromisos. Universidad Nacional de La Plata: La Plata, 2019.Presidenci

Clinical and prognostic implications of the genetic diagnosis of hereditary NET syndromes in asymptomatic patients

Neuroendocrine tumors (NETs) can be sporadic or they can arise in complex hereditary syndromes. Patients with hereditary NETs can be identified before the development of tumors by performing genetic screenings. The aim of the study was to evaluate the clinical and prognostic impact of a preclinical genetic screening in subjects with hereditary NET syndromes. 46 subjects referred for hereditary NET syndrome [22 MEN1, 12 MEN2, 12 Familial Paragangliomatosis (FPGL)] were enrolled and divided in 2 groups (group A, 20 subjects with clinical appearance of NET before the genetic diagnosis; group B, 26 subjects with genetic diagnosis of hereditary NET syndromes before the clinical appearance of NETs). The main outcome measures were severity of disease, prognosis, and survival. The rate of surgery for MEN1-, MEN2-, FPGL4-related tumors was 90% in group A and 35% in group B (p<0.01). Both symptoms related to tumors and symptoms related to therapies were significantly less frequent in group B than in group A (p<0.05). Tumor stage was locally advanced or metastatic in 50% of group A and in no one of group B (p<0.01). The mortality rate was 25% in group A and 0% in group B (p<0.05). An early genetic screening for hereditary NET syndromes results in an improvement in clinical presentation and morbidity. A potential impact of the genetic screening on the mortality rate of these subjects is suggested and needs to be investigated in further and more appropriate studies

Bone demineralization and vertebral fractures in endogenous cortisol excess: role of disease etiology and gonadal status

INTRODUCTION: The effects of endogenous cortisol (F) excess on bone mass and vertebral fractures have still not been thoroughly investigated. The aim of this cross-sectional case-control study was to investigate factors influencing bone demineralization and vertebral fractures in different conditions of F excess, i.e. Cushing's disease and adrenal and ectopic Cushing's syndrome. MATERIALS AND METHODS: Eighty consecutive patients and 80 controls were prospectively enrolled: 37 patients (21 females) with pituitary ACTH-secreting adenoma, 18 (14 females) with adrenocortical adenoma, 15 (11 females) with adrenal carcinoma of mixed secretion, and 10 (three females) with ectopic ACTH secretion. The groups had similar age. At diagnosis, bone mineral density (BMD) was determined by the dual-energy x-ray absorptiometry technique at the lumbar spine (L1-L4) and femoral neck; vertebral fractures were investigated by standard spinal radiographs. RESULTS: When comparing the groups with different etiology of F excess, the patients with ectopic ACTH secretion had higher F and lower BMD values than the other subgroups. Morning F (P = 0.03) and testosterone levels (P = 0.04) correlated with lumbar BMD. Vertebral fractures were found in 61 (76%) of the patients, were multiple in 52 (85%) of the cases, and clinically evident in 32 (52%). Only multiple fractures were more frequent in patients with ectopic ACTH hypersecretion (P &lt; 0.05). Lumbar spine BMD was the best predictor of vertebral fractures (P &lt; 0.01). Surprisingly, amenorrheic and eumenorrheic women had similar BMD values and fracture prevalence. CONCLUSION: A high prevalence (76%) of vertebral fracture was revealed, regardless of the etiology of the patients' hypercortisolism. The harmful effects of F excess at the spine were partly counterbalanced by the increased androgen production but were not affected by gonadal status in women

Liver-spleen axis, insulin-like growth factor-(IGF)-I axis and fat mass in overweight/obese females

<p>Abstract</p> <p>Background</p> <p>Fat mass (FM) in overweight/obese subjects has a primary role in determining low-grade chronic inflammation and, in turn, insulin resistance (IR) and ectopic lipid storage within the liver. Obesity, aging, and FM influence the growth hormone/insulin-like growth factor (IGF)-I axis, and chronic inflammation might reduce IGF-I signaling. Altered IGF-I axis is frequently observed in patients with Hepatic steatosis (HS). We tested the hypothesis that FM, or spleen volume and C-reactive protein (CRP)--all indexes of chronic inflammation--could affect the IGF-I axis status in overweight/obese, independently of HS.</p> <p>Methods</p> <p>The study population included 48 overweight/obese women (age 41 ± 13 years; BMI: 35.8 ± 5.8 kg/m²; range: 25.3-53.7), who underwent assessment of fasting plasma glucose and insulin, homeostasis model assessment of insulin resistance (HOMA), cholesterol and triglycerides, HDL-cholesterol, transaminases, high-sensitive CRP, uric acid, IGF-I, IGF binding protein (BP)-1, IGFBP-3, and IGF-I/IGFBP-3 ratio. Standard deviation score of IGF-I according to age (zSDS) were also calculated. FM was determined by bioelectrical impedance analysis. HS severity grading (score 0-4 according liver hyperechogenicity) and spleen longitudinal diameter (SLD) were evaluated by ultrasound.</p> <p>Results</p> <p>Metabolic syndrome (MS) and HS were present in 33% and 85% of subjects, respectively. MS prevalence was 43% in subjects with increased SLD. IGF-I values, but not IGF-I zSDS, and IGF-I/IGFBP-3 ratio were significantly lower, while FM%, FPI, HOMA, ALT, CRP, were significantly higher in patients with severe HS than in those with mild HS. IGF-I zSDS (r = -0.42, r = -0.54, respectively; p < 0.05), and IGFBP-1 (r = -0.38, r = -0.42, respectively; p < 0.05) correlated negatively with HS severity and FM%. IGF-I/IGFBP-3 ratio correlated negatively with CRP, HS severity, and SLD (r = -0.30, r = -0.33, r = -0.43, respectively; p < 0.05). At multivariate analysis the best determinants of IGF-I were FM% (β = -0.49; p = 0.001) and IGFBP-1 (β = -0.32; p = 0.05), while SLD was in the IGF-I/IGFBP-3 ratio (β = -0.43; p = 0.004).</p> <p>Conclusions</p> <p>The present study suggests that lower IGF-I status in our study population is associated with higher FM, SLD, CRP and more severe HS.</p