Algoritmo de Tratamiento Multimodal para Preescolares Latinoamericanos con Trastorno por Déficit de Atención con Hiperactividad (TDAH)

Introduction During the first Latin American ADHD consensus held in Mexico in 2007 a treatment algorithm for attention-deficit/hyperactivity disorder (ADHD) in preschoolers was proposed. Since then, some studies have emerged regarding not only pharmacological treatment but also psychosocial managing strategies for this population that require a review. The main objective was to review the recent literature on preschool ADHD clinical management in order to update the treatment algorithm and to include together both psychopharmacological treatment and psychosocial management strategies into the decision tree. Method A task force with six experts from five Latinamerican countries was constituted. The task force included different health specialties: child and adolescent psychiatry, neuropaediatrics, psychology and neuropsychology. Literature in the field of preschool ADHD, published between 2006 and 2008, was reviewed, and the evidence level of studies was assessed, to develop the Multimodal Treatment Algorithm for Preschool ADHD in accordance with the Latin American population needs. From the gathered information, the experts elaborated the main recommendations for the assessment and management of ADHD Latin American preschoolers, and constructed the decision tree according to the evidence level of each treatment intervention. Results ADHD is among the most common neuropsychiatric consultations in preschool-aged children. There are five studies in Latin America showing a preschool ADHD prevalence between 3.24% and 11.2%. The main clinical manifestations are mostly related with poor impulse control, difficulty to follow simple instructions, overactivity and, in some cases, aggression and rejection by peers. Many studies show high comorbidity with oppositional defiant disorder and other neuropsychiatric disorders, such as language, learning and motor disorder and anxiety and depression as well. The ADHD clinical presentation in preschoolers has the same severity level and comorbidity as in school-age children, and it requires comprehensive treatment. There are some helpful scales to assess ADHD preschool children, such as the Parent and Teacher versions of the Conners Rating Scale, the IDC-PRE Scale, and the Early Childhood Inventory4. A diagnosis of preschool ADHD requires patient fulfilling DSM-IVTR criteria. Special recommendations made by the Latin American Multimodal Treatment Algorithm for Preschool ADHD group were: 1. to guarantee a minimum duration of ADHD symptoms of nine months; 2. to verify the report of symptoms directly with teachers; 3. to obtain clear-cut impact and repercussion criteria for «clear evidence of clinically significant impairment in social, academic, or family functioning»; severity is more important than the number of symptoms, and finally; 4. to rule out a list of different disorders mimicking ADHD, and also to detect factors and psychosocial situations influencing the ADHD presentation. There are several alternatives for the preschool ADHD treatment, population, which were inserted in the decision tree according to their evidence level. The Latin American Multimodal Treatment Algorithm for Preschool ADHD group recommends the integrated and rational use of both pharmacological and psychosocial treatments. Psychosocial treatments for the ADHD preschooler with good clinical evidence are: psychoeducation, parental management training (PMT), parentchild interaction therapy (PCIT) and behavioral school-based intervention. After parental assessment on ADHD knowledge, parent’s psychoeductation promotes good information about ADHD, and also gives parents guidance and support. There are some published studies about the efficacy of PMT and PCIT in Latin American preschool population. These therapeutic interventions help families to learn how to manage their children difficulties and improve family functioning. PCIT was designed for 2-7 year old children; it has a clinical orientation and involves the child, parents, and other family members in the treatment. Recent studies show a robust response to the PCIT reducing the ADHD symptomatology. Finally, behavioral school-based intervention has some evidence, and its implementation includes teacher training in contingency management plans in order to promote children self-regulation. Methylphenidate (MPD) is the most studied psychopharmacological agent in this young population. Due to its robust clinical evidence, it is the first-line agent for the treatment of preschool children with ADHD. The group for the development of the Multimodal Treatment Algorithm for Latin American Preschool ADHD recommends to start with low doses of MPD, 1.25–2.5 mg/day, and gradually increase them every 2-3 weeks, until the maximum dose of 2.5-7.5 mg/day is reached. There are only two open-studies showing atomoxetine efficacy in this population. Atomoxetine has a medium evidence level and further studies are needed for more conclusions. The group recommends the use of atomoxetine with a maximum dose of 1.25 mg/kg/day. Other agents have a low level of evidence. Ampehtamines (available only in Chile and Puerto Rico), with only one study, and the alpha-agonists (clonidine and guanfacine) have been used based on clinical experience only. Further research is needed, especially head to head studies, comparing these agents with the MPD gold standard in both short and long-term follow-up studies. Any treatment decision should be closely monitored in order to make efficacy accurate in clinical response and to provide security for the young patient. While a child is using psychopharmacological treatment, it is important to monitor weight and size monthly. The main modifications to the former version of the Multimodal Treatment Algorithm for Latin American Preschool ADHD are: 1. the specific recommendation of psychosocial treatment such as psychoeducation, PMT, PCIT, and behavioral school-based intervention; 2. the recommendation of methylphenidate (available in all Latin American countries) as first pharmacological agent, followed by atomoxetine or amphetamines, and, in last instance, to consider the use of clonidine, and; 3. psychosocial treatment continuation is recommended for the maintenance jointly with the medication showing the best response. Conclusions There are two main pillars for the adequate treatment of preschool ADHD. On the one hand, there are psychosocial interventions such as psychoeducation, PMT, PCIT and behavioral school-based interventions; on the other hand, pharmacological treatment, especially with methylphenidate. Other pharmacological agents have a lack of scientific evidence. As the Multimodal Treatment Algorithm for Latin American Preschoolers with ADHD group, we recommend to start with the psychosocial treatment intervention, and then to follow the pharmacological options. New proposals should be developed according to the special needs and contexts of Latin America. - Introducción: En el Primer Consenso Latinoamericano de TDAH, celebrado en México en 2007 se propuso un algoritmo de tratamiento farmacológico para preescolares con Trastorno por Déficit de Atención con Hiperactividad (TDAH). Desde entonces han surgido algunos estudios no solo sobre tratamiento farmacológico, sino también sobre estrategias de manejo psicosociales en esta población que ameritan una revisión. El objetivo fue integrar la literatura reciente sobre el manejo clínico del TDAH en preescolares con el fin de actualizar el algoritmo latinoamericano de tratamiento e incorporar al árbol de decisiones las medidas psicosociales. Metodología: Se integró un panel de expertos con seis especialistas de diferentes áreas: psiquiatría infantil y de la adolescencia, neuropediatría, psicología y neuropsicología de cinco países latinoamericanos. Se revisó la literatura de entre 2006 y 2008; se evaluó el nivel de evidencia científica de los estudios, y se desarrolló el algoritmo de tratamiento de preescolares con TDAH, de acuerdo con las necesidades de la población latinoamericana. A partir de la información obtenida los especialistas propusieron las principales recomendaciones para evaluar y manejar a los preescolares latinoamericanos con TDAH y construyeron un árbol de decisiones según el nivel de evidencia científica de cada propuesta de tratamiento. Resultados: El algoritmo multimodal para el tratamiento de preescolares latinoamericanos con TDAH plantea como primer recurso el manejo psicosocial y luego el tratamiento farmacológico. Los principales cambios en el algoritmo son: la recomendación específica de los tratamientos psicosociales como la psicoeducación, el Entrenamiento en Manejo Parental (EMP) y la Terapia Interaccional Padre-Hijo (TIPH). La recomendación del metilfenidato como primera etapa farmacológica (disponible en todos los países de Latinoamérica), seguido de la atomoxetina o las anfetaminas; en el último término se puede considerar el uso de clonidina. Finalmente, se recomienda continuar con los tratamientos psicosociales para el mantenimiento en conjunto con la medicación con la que se mostró la mejor respuesta. Conclusiones: Existen diversas alternativas de tratamiento para esta población; éstas se distribuyeron en el árbol de decisiones de acuerdo con el nivel de evidencia. El algoritmo para preescolares latinoamericanos con TDAH recomienda el uso conjunto y racional de tratamientos farmacológicos y psicosociales

Reporte de Pecari tajacu y Procyon lotor con anomalías cromáticas en el Estado de Guerrero, México

Este trabajo documenta el primer registro de anomalías cromáticas en el pecarí de collar (Pecari tajacu) y el tercero en el mapache (Procyon lotor) para México. Los hallazgos se realizaron durante el monitoreo realizado entre el 2009 y el 2021, utilizando cámaras-trampa, principalmente en la ecorregión de la Sierra Madre del Sur del estado de Guerrero, México. Procyon lotor fue registrado entre el 5 de noviembre y el 1 de diciembre de 2019, en vegetación riparia de bosque tropical caducifolio (17°47’35”N, 98°39’59”W, 1134 m de altitud). Mientras que Pecari tajacu se registró el 7 de junio y el 22 de julio del 2021 en una brecha saca cosecha abandonada (17°38’12”N, 100°40’50”W; 1532 m de altitud)

Lag-luminosity relation in gamma-ray burst X-ray flares: a direct link to the prompt emission

The temporal and spectral analysis of 9 bright X-ray flares out of a sample of 113 flares observed by Swift reveals that the flare phenomenology is strictly analogous to the prompt gamma-ray emission: high energy flare profiles rise faster, decay faster and peak before the low energy emission. However, flares and prompt pulses differ in one crucial aspect: flares evolve with time. As time proceeds flares become wider, with larger peak lag, lower luminosities and softer emission. The flare spectral peak energy E_{p,i} evolves to lower values following an exponential decay which tracks the decay of the flare flux. The two flares with best statistics show higher than expected isotropic energy E_{iso} and peak luminosity L_{p,iso} when compared to the E_{p,i}-E_{iso} and E_{p,i}-L_{iso} prompt correlations. E_{p,i} is found to correlate with L_{iso} within single flares, giving rise to a time resolved E_{p,i}(t)-L_{iso}(t). Like prompt pulses, flares define a lag-luminosity relation: L_{p,iso}^{0.3-10 keV} t_{lag}^{-0.95+/-0.23}. The lag-luminosity is proven to be a fundamental law extending 5 decades in time and 5 in energy. Moreover, this is direct evidence that GRB X-ray flares and prompt gamma-ray pulses are produced by the same mechanism. Finally we establish a flare-afterglow morphology connection: flares are preferentially detected superimposed to one-break or canonical X-ray afterglows.Comment: MNRAS accepte

On the consistency of the peculiar GRBs 060218 and 060614 with the Ep,i - Eiso correlation

We analyze and discuss the position of GRB 060218 and GRB 060614 in the Ep,i - Eiso plane. GRB 060218 is important because of its similarity with GRB 980425, the proto-type event of the GRB-SN connection. While GRB 980425 is an outlier of the Ep,i - Eiso correlation, we find that GRB 060218 is fully consistent with it. This evidence, combined with the `chromatic' behavior of the afterglow light curves, is at odds with the hypothesis that GRB 060218 was a `standard' GRB seen off-axis and supports the existence of a class of truly sub--energetic GRBs. GRB 060614 is a peculiar event not accompanied by a bright Supernova. Based on published spectral information, we find that also this event is consistent with the Ep,i - Eiso correlation. We discuss the implications of our results for the rate of sub--energetic GRBs, the GRB/SN connection and the properties of the newly discovered sub-class of long GRBs not associated with bright Supernovae. We have included in our analysis other recent GRBs with clear evidence (or clear no evidence) of associated SNe.Comment: 9 pages, 4 figures, FINAL REVISED VERSION (added Figure 4 and short GRBs in Figure 1; minor changes and style corrections applied; references updated), submitted to A&A on November 25, 200

Looking for Crumbs in the Obesity Forest: Anti-obesity Interventions and Obesity-Associated Cardiometabolic Traits in the Mexican Population. History and Systematic Review With Meta-Analyses

Mexicans and Mexican Americans share culture, genetic background, and predisposition for chronic complications associated with obesity and diabetes making imperative efficacious treatments and prevention. Obesity has been treated for centuries focused-on weight loss while other treatments on associated conditions like gout, diabetes (T2D), and hypertriglyceridemia. To date, there is no systematic review that synthesizes the origin of obesity clinics in Mexico and the efforts to investigate treatments for obesity tested by randomized clinical trials (RCT). We conducted systematic searches in Pubmed, Scopus, and Web of Science to retrieve anti-obesity RCT through 2019 and without an inferior temporal limit. The systematic review included RCT of anti-obesity treatments in the Mexican adult population, covering alternative medicine, pharmacological, nutritional, behavioral, and surgical interventions reporting metabolism-associated traits such as BMI, weight, waist circumference, triglycerides, glucose, among others. Only the studies with at least 3 months of treatment were included in the meta-analyses in order to reduce placebo effects. We found 634 entries, after removal of duplicates and screening the studies based on eligibility criteria, we analyzed 43 national, and 2 multinational-collaborative studies. Most of the national studies had small sample sizes, and the implemented strategies do not have replications in the population. The nutrition/behavioral interventions were difficult to blind, and most studies have medium-to-high risk of bias. Nutritional/behavioral interventions and medications showed effects on BMI, waist circumference, and blood pressure. Simple measures like pure water instead of sweet beverages decrease triglycerides and systolic blood pressure. Dark chocolate showed the highest effect for BMI and high blood pressure, and treatment with insulin increased weight in those with T2D. The study of obesity in Mexico has been on-going for more than four decades, the interest on RCT just increased until this millennium, but with small sample sizes and lack of replication. The interventions affect different cardiometabolic associated traits, which should be analyzed in detail in the population living near the Mexico-U.S. border; therefore, bi-national collaboration is desirable to disentangle the cultural effects on this population\u27s treatment response

VAMOS: a Pathfinder for the HAWC Gamma-Ray Observatory

VAMOS was a prototype detector built in 2011 at an altitude of 4100m a.s.l. in the state of Puebla, Mexico. The aim of VAMOS was to finalize the design, construction techniques and data acquisition system of the HAWC observatory. HAWC is an air-shower array currently under construction at the same site of VAMOS with the purpose to study the TeV sky. The VAMOS setup included six water Cherenkov detectors and two different data acquisition systems. It was in operation between October 2011 and May 2012 with an average live time of 30%. Besides the scientific verification purposes, the eight months of data were used to obtain the results presented in this paper: the detector response to the Forbush decrease of March 2012, and the analysis of possible emission, at energies above 30 GeV, for long gamma-ray bursts GRB111016B and GRB120328B.Comment: Accepted for pubblication in Astroparticle Physics Journal (20 pages, 10 figures). Corresponding authors: A.Marinelli and D.Zaboro

Randomized Clinical Trials of obesity treatments in Mexican population. Systematic Review and Meta-Analysis

Background: Mexicans and Mexican Americans share similar culture, genetic background, and predisposition for obesity and diabetes. Randomized clinical trials (RCT) assessing obesity treatments (ObT) are reliable to assess efficacy. To date, there is no systematic review to investigate ObT tested by RCT in Mexican adults. Methods: We conducted systematic searches in Pubmed, Scopus, and Web of Science to retrieve ObT RCT from 1990 to 2019. The ObT included alternative medicine, pharmacological, nutritional, behavioral, and surgical interventions. The analyzed RCT were at least three months of duration, and reported: BMI, weight, waist circumference, triglycerides, glucose and blood pressure. Results: We found 634 entries; after removal of duplicates and exclusions based on eligibility criteria, we analyzed 43 and 2 multinational-collaborative studies. Most of the national studies had small sample sizes, and did not have replications from other studies. The nutrition/behavioral interventions were difficult to blind, and most studies had medium to high risk of bias. Random effects meta-analysis of nutritional/behavioral interventions and medications showed effects on BMI, waist circumference, and blood pressure. Simple measures like plain water instead of sweet beverages decreased triglycerides and systolic blood pressure. Participants with obesity and hypertension had beneficial effects with antioxidants, and the treatment with insulin increased weight in those with T2D. Conclusions: The RCT’s in Mexico reported effects on metabolic components despite small sample sizes and lack of replication. In the future we should analyze ObT in population living on the U.S.-Mexico border; therefore, bi-national collaboration is desirable to disentangle cultural effects on ObT response

Hilando generaciones y moda

En el proyecto PAP llamado Hilando Generaciones y Moda del cual se presenta este reporte del periodo otoño 2022, el propósito general fue el de crear espacios en los cuales se diera paso a la colaboración intergeneracional e intercultural a través de la capacitación en costura y diseño de modas. Un espacio en donde los participantes pudieran intercambiar conocimientos, diálogos y trabajar en equipo, pero, sobre todo, mostrando empatía, confianza e interactuando mientas se conocen los estudiantes y las personas mayores. En este periodo escolar se elaboraron prendas de vestir para el uso personal y familiar de las personas mayores, se llevó a cabo una sesión fotográfica con las personas mayores, una pasarela para la exposición de las prendas, un documental y una revistacatálogo con las prendas. Las primeras sesiones se dedicaron a la sensibilización de los alumnos para con la población de personas mayores y con esto se dio pie para la interacción y convivencia entre los estudiantes y personas mayores, principalmente en las instalaciones del Centro Tapatío de atención al Adulto Mayor (CETAM) y en uno de los centros de día del DIF. Los estudiantes estuvieron interactuando con las personas mayores, en los que se generó una relación profunda de comprensión y empatía, y se crearon importantes resultados como las prendas, una capa tejida por alumnos y personas mayores, revistacatálogo, pasarela y un visible entramado entre las dos generaciones: jóvenes y personas mayores.ITESO, A.C

Measurement of Upper Limb Range of Motion Using Wearable Sensors: A Systematic Review.

Background: Wearable sensors are portable measurement tools that are becoming increasingly popular for the measurement of joint angle in the upper limb. With many brands emerging on the market, each with variations in hardware and protocols, evidence to inform selection and application is needed. Therefore, the objectives of this review were related to the use of wearable sensors to calculate upper limb joint angle. We aimed to describe (i) the characteristics of commercial and custom wearable sensors, (ii) the populations for whom researchers have adopted wearable sensors, and (iii) their established psychometric properties. Methods: A systematic review of literature was undertaken using the following data bases: MEDLINE, EMBASE, CINAHL, Web of Science, SPORTDiscus, IEEE, and Scopus. Studies were eligible if they met the following criteria: (i) involved humans and/or robotic devices, (ii) involved the application or simulation of wearable sensors on the upper limb, and (iii) calculated a joint angle. Results: Of 2191 records identified, 66 met the inclusion criteria. Eight studies compared wearable sensors to a robotic device and 22 studies compared to a motion analysis system. Commercial (n = 13) and custom (n = 7) wearable sensors were identified, each with variations in placement, calibration methods, and fusion algorithms, which were demonstrated to influence accuracy. Conclusion: Wearable sensors have potential as viable instruments for measurement of joint angle in the upper limb during active movement. Currently, customised application (i.e. calibration and angle calculation methods) is required to achieve sufficient accuracy (error < 5°). Additional research and standardisation is required to guide clinical application