Uveítis pediática no infecciosa, una experiencia de una cohorte colombiana

Resumen: •Antecedentes: La uveítis pediátrica no infecciosa tiene el potencial de desencadenar severas complicaciones visuales y su manejo farmacológico convencional está asociado a importantes efectos secundarios. 1 Infliximab (INF) y Adalimumab (ADA), son dos medicamentos biológicos disponibles para el manejo de la uveítis pediátrica refractaria. Se unen específicamente al TNFα y previenen la unión del mismo con los receptores celulares; interacción directamente implicada en el proceso inflamatorio y el subsecuente daño tisular. 2,3 •Métodos: Se realizó estudio de tipo cohorte retrospectiva mediante revisión de historias clínicas de 35 pacientes pediátricos diagnosticados con uveítis durante los años 2009-2015. Se comparó control de la inflamación ocular, tiempo de respuesta y eventos adversos en pacientes tratados con ADA o INF con dosis bajas de Metotrexate vs. Metotrexate (MTX) como única terapia. •Resultados: El 45.7% de la población estudiada correspondía al sexo femenino, cuya edad promedio de inicio de síntomas y de diagnósticos fue de 9 años. El 80% de los casos fueron uveítis idiopáticas, seguido por Vogt-Koyanagi-Harada (8,5%) y AIJ (5,7%). El 91,4% presentó compromiso ocular bilateral y se documentaron 2 casos de ambliopía. El 12,9% de los pacientes que recibieron MTX como tratamiento de primera línea requirieron escalonamiento terapéutico por presentar eventos adversos (Elevación de enzimas hepáticas e intolerancia gastrointestinal (GI)). El tiempo promedio para alcanzar control de la inflamación con MTX fue 9 semanas, y para Adalimumab fue de 8,75 semanas (P: 0,90). Se comparó la capacidad de controlar la inflamación del MTX vs Anti-TNF, y no se observaron diferencias significativas (P: 0.88).

Diabetes relacionada a la fibrosis quística (DRFQ)

Importancia: el paciente con fibrosis quística después de las complicaciones gastrointestinales y pulmonares debe enfrentar otras comorbilidades como la diabetes relacionada a su condición . Dado el aumento en la esperanza de vida y el hecho de que virtualmente todas los pacientes con esta enfermedad pueden desarrollar alteración en el metabolismo de los carbohidratos, se requiere una sensibilización frente al tema que posibilite una detección temprana de esta entidad y un tratamiento óptimo que evite las complicaciones microvasculares e impacte entre otros el crecimiento pondo-estatural en pacientes en desarrollo y la función pulmonar. Objetivo : realizar una revisión actualizada de la literatura sobre la diabetes relacionada a la fibrosis quística, destacando las indicaciones de tamización y tratamiento. Conclusión : la FQ dentro de su abordaje requiere la detección temprana de la alteración del metabolismo de los carbohidratos con una prueba de tolerancia a la glucosa , el daño del islote pancreático , la disfunción inmune, la resistencia a la insulina, el estrés oxidativo entre otros elementos fisiopatológicos conllevan a un estado de depleción de insulina que producirán un efecto negativo microvascular así como a una reducción marcada de la función pulmonar, mayores tasa de infección e incremento de la mortalidad. La piedra angular del tratamiento en pacientes con o sin hiperglicemia es la insulina que mejora tanto el estado nutricional como la función pulmonar ; nuevos antidiabéticos orales con efecto incretinas y fármacos modificadores de la enfermedad se vislumbran como alternativas al corto plazo

Hector the hermit crab.

Héctor, el cangrejo ermitaño, es muy tímido, odia llamar la atención y evita el contacto con otras criaturas del fondo marino siempre que sea posible. Una noche, mientras duerme, crece una flor en su concha, y de repente Héctor se convierte en el foco de atención de todos. Cree que sus compañeros cangrejos no son amistosos, pero pronto se da cuenta de su error y aprende que hacer amigos no es tan difícil como había imaginado.

Games for vocabulary practice : interactive vocabulary activities for all levels.

Este recurso para el profesor se organiza en dieciocho unidades temáticas, cada una con tres juegos para cada uno de los niveles: elemental, intermedio y avanzado. Las actividades permiten a los estudiantes practicar con el vocabulario y cada una de ellas consta de dos páginas, la de la izquierda para información y notas del profesor, y la de la derecha, que puede fotocopiarse, para los alumnos.

Ocho relatos, un mismo proyecto

El art??culo forma parte de un dossier titulado: El desaf??o de la diversidad : un est??mulo para el desarrollo profesional

Development of a simple index to predict benefit and satisfaction from amplification

The purpose of this study was to evaluate the use of non-audiological patient-based variables; amount of bother, importance of improved hearing, and expectations, as reliable predictors of benefit and satisfaction from amplification. Study findings were then used to develop two initial prognostic indices.

Variables associated with nest survival of Golden-winged Warblers (Vermivora chrysoptera) among vegetation communities commonly used for nesting

Among shrubland- and young forest-nesting bird species in North America, Golden-winged Warblers (Vermivora chrysoptera) are one of the most rapidly declining partly because of limited nesting habitat. Creation and management of high quality vegetation communities used for nesting are needed to reduce declines. Thus, we examined whether common characteristics could be managed across much of the Golden-winged Warbler’s breeding range to increase daily survival rate (DSR) of nests. We monitored 388 nests on 62 sites throughout Minnesota, Wisconsin, New York, North Carolina, Pennsylvania, Tennessee, and West Virginia. We evaluated competing DSR models in spatial-temporal (dominant vegetation type, population segment, state, and year), intraseasonal (nest stage and time-within-season), and vegetation model suites. The best-supported DSR models among the three model suites suggested potential associations between daily survival rate of nests and state, time-within-season, percent grass and Rubus cover within 1 m of the nest, and distance to later successional forest edge. Overall, grass cover (negative association with DSR above 50%) and Rubus cover (DSR lowest at about 30%) within 1 m of the nest and distance to later successional forest edge (negative association with DSR) may represent common management targets across our states for increasing Golden-winged Warbler DSR, particularly in the Appalachian Mountains population segment. Context-specific adjustments to management strategies, such as in wetlands or areas of overlap with Blue-winged Warblers (Vermivora cyanoptera), may be necessary to increase DSR for Golden-winged Warblers.

Acute effects of elevated NEFA on vascular function: a comparison of SFA and MUFA

There is emerging evidence to show that high levels of NEFA contribute to endothelial dysfunction and impaired insulin sensitivity. However, the impact of NEFA composition remains unclear. A total of ten healthy men consumed test drinks containing 50 g of palm stearin (rich in SFA) or high-oleic sunflower oil (rich in MUFA) on separate occasions; a third day included no fat as a control. The fats were emulsified into chocolate drinks and given as a bolus (approximately 10 g fat) at baseline followed by smaller amounts (approximately 3 g fat) every 30 min throughout the 6 h study day. An intravenous heparin infusion was initiated 2 h after the bolus, which resulted in a three- to fourfold increase in circulating NEFA level from baseline. Mean arterial stiffness as measured by digital volume pulse was higher during the consumption of SFA (P,0·001) but not MUFA (P¼0·089) compared with the control. Overall insulin and gastric inhibitory peptide response was greater during the consumption of both fats compared with the control (P,0·001); there was a second insulin peak in response to MUFA unlike SFA. Consumption of SFA resulted in higher levels of soluble intercellular adhesion molecule-1 (sI-CAM) at 330 min than that of MUFA or control (P#0·048). There was no effect of the test drinks on glucose, total nitrite, plasminogen activator inhibitor-1 or endothelin-1 concentrations. The present study indicates a potential negative impact of elevated NEFA derived from the consumption of SFA on arterial stiffness and sI-CAM levels. More studies are needed to fully investigate the impact of NEFA composition on risk factors for CVD.

Vermillion Vortex

An animated film commissioned and screened by Art Review Magazine on their website (Oct-Dec 2010), and a double page comic strip (Art Review, Oct 2010. The project addresses a key problem with contemporary debates regarding ideas of ‘performativity’ and ‘fictioning’ (Foucault/Deleuze/Butler) whereby the structural requirement for an ‘End’ pre-determines or back-codes the ‘story’ or progression of events leading up to this ‘End’ and therefore cuts against the potentials claimed for ‘performance’ and ‘performativity’. Film credits Primary soundtrack: Music: Rose Kallal. Spoken word: Mark Beasley Voices: Katie Barrington, Marnie Watts, Maria Deegan & John Russell Sound engineer: Bob Geal PLUS Special bonus track: (after 'The End'): 'Strychnine Motive' (2011) by Gum Takes Tooth

Minimum recovery time between reactive hyperemia stimulus in the repeated measurement of brachial flow-mediated dilatation.

The ability to undertake repeat measurements of flow-mediated dilatation (FMD) within a short time of a previous measurement would be useful to improve accuracy or to repeat a failed initial procedure. Although standard methods report that a minimum of 10 min is required between measurements, there is no published data to support this. Thirty healthy volunteers had five FMD measurements performed within a 2-h period, separated by various time intervals (5, 15 and 30 min). In 19 volunteers, FMD was also performed as soon as the vessel had returned to its baseline diameter. There was no significant difference between any of the FMD measurements or parameters across the visits indicating that repeat measurements may be taken after a minimum of 5 min or as soon as the vessel has returned to its baseline diameter, which in some subjects may be less than 5 min.

Combined oral contraceptive pills containing desogestrel or drospirenone enhance large vessel and microvasculature vasodilation in healthy premenopausal women

OBJECTIVE: To determine the effects of different COCs on endothelial function. BACKGROUND: COCs all contain ethinylestradiol, but different progestins; three of the more common progestins are DSG, LN, and DR. Ethinylestradiol enhances some measures of vascular reactivity, but certain progestins may increase risk of vascular diseases and impair endothelial vasodilation. METHODS: Twenty-nine healthy women taking COCs containing 30 μg ethinylestradiol and 150 μg DSG (Marvelon, n = 10), 150 μg LN (Microgynon, n = 10), or 3 mg DR (Yasmin, n = 9) had their vascular reactivity measured using various techniques during their pill-free week (days 5-7) and the third week of active pills (days 26-28). A reference group (n = 10) underwent the same measurements on two consecutive cycles. RESULTS: FMD and LDI were significantly higher during active-pill visits than pill-free visits in women taking DSG and DR (p < 0.02), but not in women taking LN. There were no differences between the duplicate measures in the reference group. CONCLUSIONS: COCs containing 150 μg DSG or 3 mg DR significantly increase endothelium-dependent vasodilation in both large vessels and peripheral microvasculature. These effects may be due to the progestins exhibiting differential effects on eNOS expression.

DHA-rich fish oil reverses the detrimental effects of saturated fatty acids on postprandial vascular reactivity

Background: Experimental elevation of nonesterified fatty acids (NEFAs) impairs endothelial function, but the effect of NEFA composition is unknown. Objective: The objective was to test the effect of acute elevation of NEFAs enriched with either saturated fatty acids (SFAs) or SFAs with long-chain (LC) n−3 (omega-3) PUFAs on vascular function measured via flow-mediated dilatation (FMD), laser Doppler iontophoresis (LDI), and digital volume pulse (DVP). Design: In 59 subjects (30 men and 29 women), repeated oral fat feeding of either palm stearin (SFA) or palm stearin with DHA-rich fish oil (SFA + LC n−3 PUFA) was performed on 2 separate occasions with continuous heparin infusion to elevate NEFAs for a duration of 60 to 240 min. Vascular function was measured at baseline and at the end of NEFA elevation; venous blood was collected for measurement of lipids and circulating markers of endothelial function. Results: NEFA elevation during consumption of the SFA-rich drinks was associated with a marked impairment of FMD, whereas consumption of SFAs + LC n−3 PUFAs improved FMD response, with a mean (±SEM) difference of 2.06 ± 0.29% (P < 0.001). Positive correlations were found with percentage weight of LC n−3 PUFAs in circulating NEFAs and change in FMD response [Spearman's rho (rs) = 0.460, P < 0.001]. LDI measures increased during both treatments (P ≤ 0.026), and there was no change in DVP indexes. Conclusions: The composition of NEFAs can acutely affect FMD. The beneficial effect of LC n−3 PUFAs on postprandial vascular function warrants further investigation but may be mediated by nitric oxide–independent mechanisms. This trial is registered at clinicaltrials.gov as NCT01351324.

The role of corticospinal tract damage in chronic motor recovery and neurorehabilitation: a pilot study

Background. With diffusion-tensor imaging (DTi) it is possible to estimate the structural characteristics of fiber bundles in vivo. This study used DTi to infer damage to the corticospinal tract (CST) and relates this parameter to (a) the level of residual motor ability at least 1 year poststroke and (b) the outcome of intensive motor rehabilitation with constraint-induced movement therapy (CIMT). Objective. To explore the role of CST damage in recovery and CIMT efficacy. Methods. Ten patients with low-functioning hemiparesis were scanned and tested at baseline, before and after CIMT. Lesion overlap with the CST was indexed as reduced anisotropy compared with a CST variability map derived from 26 controls. Residual motor ability was measured through the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL) acquired at baseline. CIMT benefit was assessed through the pre—post treatment comparison of WMFT and MAL performance. Results. Lesion overlap with the CST correlated with residual motor ability at baseline, with greater deficits observed in patients with more extended CST damage. Infarct volume showed no systematic association with residual motor ability. CIMT led to significant improvements in motor function but outcome was not associated with the extent of CST damage or infarct volume. Conclusion. The study gives in vivo support for the proposition that structural CST damage, not infarct volume, is a major predictor for residual functional ability in the chronic state. The results provide initial evidence for positive effects of CIMT in patients with varying, including more severe, CST damage.