The Microbiota in Cancer: A Secondary Player or a Protagonist?

The intestinal microbiota and the human body are in a permanent interaction. There is a symbiotic relationship in which the microbiota plays a vitally important role in the performance of numerous functions, including digestion, metabolism, the development of lymphoid tissue, defensive functions, and other processes. It is a true metabolic organ essential for life and has potential involvement in various pathological states, including cancer and pathologies other than those of a digestive nature. A growing topic of great interest for its implications is the relationship between the microbiota and cancer. Dysbiosis plays a role in oncogenesis, tumor progression, and even the response to cancer treatment. The effect of the microbiota on tumor development goes beyond a local effect having a systemic effect. Another aspect of great interest regarding the intestinal microbiota is its relationship with drugs, modifying their activity. There is increasing evidence that the microbiota influences the therapeutic activity and side effects of antineoplastic drugs and also modulates the response of several tumors to antineoplastic therapy through immunological circuits. These data suggest the manipulation of the microbiota as a possible adjuvant to improve oncological treatment. Is it possible to manipulate the microbiota for therapeutic purposes?

Influence of Healthcare Delivery Type on Patients' Mental Health: Is Hospitalization Always a Stressful Factor? Can Allostatic Load Help Assess a Patient's Psychological Disorders?

BACKGROUND: Psychological distress is a predictor of future health and disease data, with consequent implications for both the patient and the healthcare system. Taking advantage of the unprecedented situation caused by the COVID-19 pandemic we aimed to assess whether the type of medical care received by patients during the initial months of the pandemic influenced their evolution, particularly at the psychological level. Additionally, we investigated whether allostatic load was associated not only with physical but also psychological alterations. METHODS: All the patients diagnosed with COVID-19 infection at HM Madrid Hospital during the month of March 2020 were studied, both those hospitalized (110) and those treated on an outpatient basis (46). They were psychologically evaluated using the Profile of Mood States (POMS) test. We calculated the allostatic load using different laboratory parameters. RESULTS: Outpatient patients had significantly higher scores than hospitalized ones in Tension-Anxiety (52 ± 19.3 vs. 38 ± 4.3; p < 0.001). So, 36.9% of the outpatient patients exhibited anxiety. Allostatic load has not been correlated with patients' psychological alterations. CONCLUSIONS: Psychological distress of outpatient patients should be taken into account in their management to improve mental health planning. This knowledge could provide comprehensive care to patients including their mental health, in the face of subsequent epidemics/pandemics.

Perilesional edema diameter associated with brain metastases as a predictive factor of response to radiotherapy in non-small cell lung cancer.

Background: Different prognostic scales exist in patients with brain metastasis, particularly in lung cancer. The Graded Prognostic Assessment for lung cancer using molecular markers (Lung-molGPA index) for brain metastases is a powerful prognostic tool that effectively identifies patients at different risks. However, these scales do not include perilesional edema diameter (PED) associated with brain metastasis. Current evidence suggests that PED might compromise the delivery and efficacy of radiotherapy to treat BM. This study explored the association between radiotherapy efficacy, PED extent, and gross tumor diameter (GTD). Aim: The aim of this study was to evaluate the intracranial response (iORR), intracranial progression-free survival (iPFS), and overall survival (OS) according to the extent of PED and GT. Methods: Out of 114 patients with BM at baseline or throughout the disease, 65 were eligible for the response assessment. The GTD and PED sum were measured at BM diagnosis and after radiotherapy treatment. According to a receiver operating characteristic (ROC) curve analysis, cutoff values were set at 27 mm and 17 mm for PED and GT, respectively. Results: Minor PED was independently associated with a better iORR [78.8% vs. 50%, OR 3.71 (95% CI 1.26-10.99); p = 0.018] to brain radiotherapy. Median iPFS was significantly shorter in patients with major PED [6.9 vs. 11.8 months, HR 2.9 (95% CI 1.7-4.4); p < 0.001] independently of other prognostic variables like the Lung-molGPA and GTD. A major PED also negatively impacted the median OS [18.4 vs. 7.9 months, HR 2.1 (95% CI 1.4-3.3); p = 0.001]. Conclusion: Higher PED was associated with an increased risk of intracranial progression and a lesser probability of responding to brain radiotherapy in patients with metastatic lung cancer. We encourage prospective studies to confirm our findings.

Neuroinflammation, Microbiota-Gut-Brain Axis, and Depression: The Vicious Circle.

Depression is the leading cause of disability worldwide, contributing to the global disease burden. From above, it is a priority to investigate models that fully explain its physiopathology to develop new treatments. In the last decade, many studies have shown that gut microbiota (GM) dysbiosis influences brain functions and participate, in association with immunity, in the pathogenesis of depression. Thereby, GM modulation could be a novel therapeutic target for depression. This review aims to evidence how the GM and the immune system influence mental illness, particularly depression. Here, we focus on the communication mechanisms between the intestine and the brain and the impact on the development of neuroinflammation contributing to the development of Major Depressive Disorder (MDD). However, most of the current findings are in animal models, suggesting the need for studies in humans. In addition, more analysis of metabolites and cytokines are needed to identify new pathophysiological mechanisms improving anti-depression treatments.

Cytokine and microbiota profiles in obesity-related hypertension patients.

Background: Systemic arterial hypertension is linked to a heightened risk of cardiovascular diseases on a global scale. In Mexico, nearly half of adults in vulnerable conditions experience hypertension. Imbalance in the oral and intestinal microbiota composition has been observed in patients with hypertension, documented by a decrease of bacteria producing short-chain fatty acids, which play a critical role in blood pressure regulation. Aim: To examine the cytokines' profile and assess the characteristics of oral and gut microbiota in obesity-related hypertension in Mexican patients. Methods: A cross-sectional, observational, and analytical study was carried out. Twenty-two patients were categorized by their body mass index (BMI) as overweight and obese, and the diagnosis of primary hypertension. DNA from supragingival dental plaque and feces samples was used to carry out 16S rRNA sequencing. Additionally, 13 cytokines were quantified. Results: In the oral microbiota, Kluyvera was found to be significantly enriched in obese compared to overweight patients. Instead, the gut microbiota was dominated by Firmicutes. However, the correlation between certain genera and proinflammatory cytokines was noted. Conclusion: This exploratory study provides insights into the complex relationship between the oral and gut microbiota and their association with systemic inflammation in obesity-related hypertension.

Overexpression of proinflammatory cytokines in dental pulp tissue and distinct bacterial microbiota in carious teeth of Mexican Individuals.

The prevalence of dental caries in the Mexican adult population aged 20 to 85 years is around 93.3%, and 50% in Mexican children and adolescents. Worldwide, it is the most common non-communicable disease. One of the main etiological factors for dental caries is the oral microbiome and changes in its structure and function, with an expansion of pathogenic bacteria like Streptococcus mutans. The exposed dental pulp tissue triggers an innate immune response to counteract this bacterial invasion. The relation between oral dysbiosis and innate immune responses remains unclear. We aimed to understand the relationship between innate immune response and the oral microbiota by quantifying the expression of Toll-like receptors (TLRs) and proinflammatory markers (cytokines and a chemokine) in dental pulp tissue, either exposed or not to carious dentin, and to correlate this information with the oral microbiome found in healthy teeth and those with moderate caries. RNA was purified from pulp tissue, subjected to RT-qPCR and analysed with the ΔΔCt method. Supragingival dental plaque of non-carious teeth and dentin of carious teeth were subjected to 16S targeted sequencing. Principal coordinate analysis, permutational multivariate ANOVA, and linear discriminant analysis were used to assess differences between non-carious and carious teeth. Correlations were assessed with Spearman´s test and corrected for multiple comparisons using the FDR method. The relative abundance (RA) of Lactobacillus, Actinomyces, Prevotella, and Mitsuokella was increased in carious teeth; while the RA of Haemophilus and Porphyromonas decreased. Olsenella and Parascardovia were only detected in carious teeth. Significant overexpression of interleukin 1 beta (IL1 ß), IL6, and CXCL8 was detected in pulp tissue exposed to carious dentin. IL1ß correlated positively with TLR2 and Actinomyces; yet negatively with Porphyromonas. These findings suggest that immune response of pulp tissue chronically exposed to cariogenic microbiome is triggered by proinflammatory cytokines IL1ß and IL6 and the chemokine CXCL8.

Microbioma oral: variabilidad entre regiones y poblaciones / Oral Microbiome: Variability Between Regions and Populations

Resumen De acuerdo con la Organización Mundial de la Salud (OMS), 3.58 billones de personas son afectadas por desórdenes orales, donde la caries, seguida de la enfermedad periodontal son las más frecuentes y las principales causas de daño al tejido pulpar y pérdida de órganos dentales. En México, el Sistema de Vigilancia Epidemiológica de Patologías Bucales (SIVEPAB) reportó que el 53% de la población se ve afectada por algún grado de enfermedad periodontal, mientras que en promedio la caries afecta al 93.3% de la población de entre 20 a 85 años y más, así como a alrededor del 50.0% de niños y adolescentes, por lo que ambos padecimientos son considerados un problema de salud pública importante en este país. Adicionalmente, se sabe que el microbioma oral humano está asociado con la salud y la enfermedad bucodental. Entre los géneros bacterianos que comúnmente habitan la cavidad oral humana destacan Streptococcus spp., Lactobacillus spp. y Porphyromonas spp. que, a través del desequilibrio del microbioma oral (disbiosis), se asocian con la caries o la enfermedad periodontal. En vista de que estamos constantemente expuestos a este tipo de infecciones crónicas inflamatorias, se sabe que las bacterias orales se trasladan a otras partes del cuerpo contribuyendo al desarrollo y exacerbación de la inflamación sistémica y otras enfermedades. Ya que existen factores como la ubicación geográfica, además de la disbiosis, la edad, la dieta y la genética, que influyen en la variabilidad del microbioma humano. Es importante analizar la diversidad del microbioma oral desde esta perspectiva, ya que el conocimiento que se tiene hasta el momento aún es escaso; por lo anterior se realizó una búsqueda de artículos publicados entre 2010 y 2020 en poblaciones de Asia, África, América y Europa, con el fin de responder la siguiente pregunta: ¿el factor geográfico tiene un impacto en la composición de la variabilidad del microbioma oral humano?

Abstract According to the World Health Organization (WHO), 3.58 billion people were affected by oral disorders, where caries, followed by periodontal disease are the most frequent and the main causes of damage to pulp tissue and loss of dental organs. In Mexico, the Epidemiological Surveillance System for Oral Pathologies (SIVEPAB) reported that 53% of the population is affected by some degree of periodontal disease, while on average caries affects 93.3% of the population between 20 and 85 years old and older, as well as about 50.0% of children and adolescents, so both conditions are considered an important public health problem in this country. Additionally, the human oral microbiome is known to be associated with oral health and disease. An imbalance in the oral microbiome (dysbiosis) can result in the proliferation of Streptococcus mutans and Porphyromonas gingivalis, linked to caries and periodontal disease. The latter two conditions, the most prevalent oral diseases worldwide, are the main causes of damage to pulp tissue and loss of dental organs. In the presence of these pathologies, constant exposure to the corresponding inflammatory chronic infection could lead to the translocation of oral bacteria to other parts of the body, where they may contribute to the development and/or exacerbation of systemic inflammation and trigger disease. Since age, diet, genetics, and geographical location are known to influence the variability of the human microbiome, it is important to analyze differences in the oral microbiome between distinct populations. Up to now, little attention has been given to this task. The current review carried out for articles published between 2010 and 2020 and describes the human oral microbiome in populations of Asia, Africa, America and Europa, to explore whether geographical differences have an impact on the variability of the human oral microbiome.

Persons with Substance Abuse Disorders and Other Addictions: Coping with the COVID-19 Pandemic.

Cuba implemented policies mandating social distancing on March 11, 2020, which were still in place at the time of this study. During such periods of isolation, people with psychoactive substance-related disorders and other addictions may be tempted to reduce tension, stress, uncertainty and possible distress by increasing the use of substances or practices they have abused. This can mean relapses and setbacks for patients undergoing treatment. A multidisciplinary team of health professionals specializing in addiction at the Center for Academic Development in Drug Addiction, in Havana, Cuba, cares for people with these disorders and followed their evolution during the initial period of COVID-19 social isolation. With the aim of characterizing strategies employed by patients undergoing treatment for substance abuse and addictions, we conducted a qualitative study from April 2020 through May 2020, using a convenience sample of 37 patients (all students) who had been progressing towards recovery from addictive behaviors when face-to-face encounters were suspended due to COVID-19 restrictions. Contact was maintained through information and communication technologies. The research used telepsychology and focused on understanding patient life experiences. Patients were interviewed using a semi-structured survey, which was then transcribed and coded thematically using a grounded-theory approach. We found that patients' ability to cope successfully with challenges presented by COVID-19 were influenced by: 1) the individual's own methods for maintaining self-control (commitment to studies, projects, and work with therapists) that aided them in their goals concerning abstinence; 2) difficulties faced in addressing specific events and situations (doubts, uncertainties, disagreements, isolation and time use); 3) perpetuation and revivification of myths related to substances and addictive activities (exacerbation of supposed benefits of tobacco, alcohol, marijuana, overuse of social networks); and 4) tendencies toward irrationality and lack of emotional control (fear, sadness, anger, constant worry and self-imposed demands). Our findings suggest that despite the potential negative psychological impact of preventive social isolation during the COVID-19 pandemic, individual coping mechanisms developed by these patients, aiming at improved self-control, allowed most to avoid setbacks that could have affected their recovery. Nevertheless, patients faced challenges to their recovery that were compounded by difficulties in specific situations, myths related to substances and addictive activities, and tendencies toward irrationality or lack of emotional control.

A novel AAGAB mutation in a Peruvian family with punctate palmoplantar keratoderma.

Buschke-Fischer-Brauer (BFB) disease is a rare keratoderma characterized by multiple hyperkeratotic lesions on the palms and soles, with an autosomal dominant pattern. In several countries, some genetic alterations have been associated with this clinical entity. A 68-year-old Peruvian woman presenting with hyperkeratotic lesions on both her palms and soles was diagnosed with BFB keratoderma. After sequencing of the genes that had previously been related to this disease, a mutation (c.249C>G) that was predicted to generate a termination codon (Tyr83*) was found in the alpha and gamma adaptin binding protein P34 gene (AAGAB). After treatment with 30% urea plus 10% salicylic acid, the patient experienced an improvement in her condition. Here we report a novel mutation in the AAGAB gene of a patient diagnosed with BFB keratoderma and a treatment that improved her symptoms.

Epilepsia pediátrica y telemedicina, una alternativa en tiempos de la COVID-19 / Pediatric epilepsy and telemedicine: an alternative in times of COVID-19

La epilepsia es la enfermedad neurológica tratable más frecuente en pediatría. La actual epidemia de la COVID-19 ha limitado la atención a los pacientes con epilepsia. La telemedicina es un recurso tecnológico que permite aplicar la medicina a distancia, tanto para el diagnóstico como el tratamiento, así como la educación a distancia. El objetivo de esta revisión es exponer las potencialidades de la telemedicina como alternativa a las consultas presenciales convencionales. Los servicios de telemedicina aplicados en otros países, han probado ser muy útiles para permitir continuar dando servicios de salud remotos a personas con epilepsia. La telemedicina incluye la telefonía fija y móvil, mensajería, correos electrónicos y video-llamadas por diferentes herramientas digitales. A través de la telemedicina se puede precisar el grado de control de las crisis, ajustar o cambiar la medicación, asesorar sobre el estilo de vida en estos tiempos de aislamiento, insistir en la importancia de la buena higiene del sueño, y apoyar psicológicamente al niño y la familia. Se ha demostrado que la telemedicina no es inferior a las consultas presenciales en relación con el control de crisis, las hospitalizaciones, las visitas a servicios de urgencias o la adherencia a la medicación; y es más económica porque disminuye los gastos, y el tiempo empleado, en transportación al hospital. Se recomienda la promoción y la facilitación institucional de la telemedicina para prestar la asistencia médica a distancia en epilepsia pediátrica como una gran alternativa en la era de la COVID-19(AU)

Epilepsy is the most frequent neurologic treatable disease in Pediatrics. The current COVID-19 epidemic has limited the attention to patients with epilepsy. Telemedicine is one of the technological resources that allow using remote medicine for diagnosis as well as for treatments and distance learning. The objective of this review is to show the potentials of telemedicine as an alternative to conventional consultations. Telemedicine services used in other countries have proved to be very useful in keep giving remote health services to people with epilepsy. Telemedicine includes mobile and landline telephony, text messaging, e-mails and video calls using different digital tools. Through telemedicine it can be specified the degree of crisis control, to adjust or change medications, to advise on the lifestyle in this times of isolation, to insist in the importance of a good hygiene of the sleep, and to give psychological support to the child and the family. It has been demonstrated that telemedicine is not inferior than in situ consultations regarding crisis control, hospitalization, visits to emergency services or adherence to medication; and it is more economic because it drops expenses, and the time used in transportation to the hospital. It is recommended the promotion and institutional provision of telemedicine to provide remote medical care in cases of pediatric epilepsy as a great alternative in the era of COVID-19(AU)

Impact of osmodehydrated Andean berry (Vaccinium merdionale Swartz) on overweight adults / Impacto del consumo de agraz (Vaccinium merdionale Swartz) osmodeshidratado en adultos con sobrepeso

Background: Andean berry (Vaccinium meridionale Swartz) is a native Colombian berry with potential health benefit comparable to cranberry (Vaccinium macrocarpon), both rich in phenolic compounds with a wide range of biological activities. Objectives: to evaluate the effect of Andean berry consumption on blood biochemical parameters (lipid profile and glucose), anthropometric parameters (body weight, waist circumference, body mass index or BMI) and blood pressure of overweight adults. Methods: glycemia, total cholesterol, LDL-cholesterol, HDL-cholesterol and total triglycerides in blood serum, body weight, size and waist perimeter, and blood pressure were analyzed in 25 overweight adults at day 1 and 21 after consumption of 35 g/day of osmodehydrated Andean berry. Results: a significant reduction in diastolic blood pressure (10%, p = 0.0388), systolic blood pressure (6%, p = 0.0400), BMI (1.7%, p = 0.0306), weight (2%, p = 0.0388) and waist circumference (4.1%, p = 0.0052) were observed in the participants who completed the study. However, the lipid profile did not have a significant effect, the glycemia increased significantly (6.9%, p = 0.0004). Conclusions: the results of the present study suggest that the regular consumption of Andean berry treated by osmotic dehydration is a food that may help control weight and blood pressure; however, it requires another type of osmotic agent to prevent the increase of glycemia.

Antecedentes: Agraz (Vaccinium meridionale Swartz) es una baya nativa colombiana con potencial beneficio en la salud comparable al arándano (Vaccinium macrocarpon), ambas ricas en compuestos fenólicos con amplio rango de actividades biológicas. Objetivo: evaluar el efecto del consumo de agraz osmodeshidratado en parámetros bioquímicos sanguíneos (perfil lipídico y glucemia), antropométricos, (perímetro de cintura, índice de masa corporal o IMC) y presión arterial en adultos con sobrepeso Métodos: se analizaron los parámetros glucosa, colesterol total, colesterol-LD, colesterol-HDL, triglicéridos totales en suero, peso, talla y perímetro de cintura, y presión arterial de adultos con sobrepeso al inicio y 21 días después de consumir 35g de agraz osmodeshidratado/día. Resultados: se observó en los participantes que completaron el estudio una reducción significativa en la presión arterial diastólica (10%, p = 0,0388) y sistólica (6%, p = 0,0400), así como en el índice de masa corporal (1,7%, p = 0,0306), peso (2%, p = 0,0388) y perímetro de cintura (4,1%, p = 0,0052). Sin embargo, en el perfil lipídico no tuvo efecto significativo, aunque si aumentó significativamente el valor de la glicemia (6,9%, p = 0,0004). Conclusión: los resultados del presente estudio sugieren que el consumo regular de agraz tratado por deshidratación osmótica es un alimento que ayuda al control del peso y presión arterial, sin embargo requiere otro tipo de agente osmótico para evitar el aumento de la glicemia.

La promoción de salud en la Universidad de Ciencias Médicas de La Habana / Health promotion in Havana Medical Science University

Introducción: La coordinación de la Red Ibericoamericana de Universidades Promotoras de la Salud aceptó a la Universidad de Ciencias Médicas de La Habana como miembro pleno. Para ello valoró que la promoción de salud constituye una prioridad permanente en su política institucional. Objetivo: Valorar la política institucional de la Universidad de Ciencias Médicas de La Habana en relación con las normativas y procedimientos que rigen el funcionamiento de la Red Ibericoamericana de Universidades Promotoras de la Salud. Material y Métodos: Se revisaron documentos que reflejan la política institucional de la Universidad de Ciencias Médicas de La Habana relativa a la promoción de salud. Se describieron además las principales normativas y procedimientos de la Red Ibericoamericana de Universidades Promotoras de la Salud. Desarrollo: En la Universidad de Ciencias Médicas de La Habana los programas docentes que se ejecutan parten del principio de la educación en el trabajo, por lo que los estudiantes se vinculan desde el primer año con las labores de promoción de salud y prevención de las enfermedades. Los estudiantes, profesores y trabajadores reciben el influjo de diversas áreas de atención que promueven ante todo estilos de vida saludable. Conclusiones: Las propuestas, programas, proyectos y otras acciones de la Universidad de Ciencias Médicas de La Habana impactan positivamente en la comunidad universitaria y la población en general. Se cuenta con una voluntad política institucional que garantiza la sostenibilidad de los procesos y los recursos necesarios para la sistematización de las acciones(AU)

Introduction: The Ibero-American Universities Promoters Network of Health accepted Havana Medical Science University as full member. For that, they valued that the promotion of health constitutes a permanent priority in its institutional politics. Objective: To value Havana Medical University's institutional policy with regard to the normative and procedures that rule functioning of the Ibero-American Universities Promoters Network of Health. Material and Methods: Documents that reflect Havana Medical University's institutional policy to the promotion of health were revised. Were also described the main normative and procedures of the Ibero-American Universities Promoters Network. Development: In the Havana Medical Science University the educational programs that are executed start from the point of view of the education at the job, for which the students are connected from the first year with the labor of health´s promotion and illnesses´ prevention. The students, teachers and workers receive the influence of diverse areas of attention that promotes above all healthy styles of life. Conclusions: The proposals, program, projects and other actions of the Havana Medical Science University have impact positively in the university community and in the population in general. It counts with an institutional political willingness that guarantees the sustainability of the processes and the necessary resources for the actions systematization(AU)

An Intersectoral Intervention to Prevent Early Alcohol Use in Cuban Adolescents.

To encourage development of negative attitudes toward alcohol use and thus prevent early onset of alcohol use, an intersectoral intervention was conducted from 2014 to 2015 among Cuban adolescents in 14 schools in Havana. The intervention included 312 students (189 girls and 123 boys) aged 14 to 15 years in 10th grade of high school or vocational school. Workshops were conducted using participatory techniques and group dynamics. Qualitative methods were applied, including narrative, desiderative and projective techniques. Indicators included attitudes, motivation, interests and perception of risk. Following the intervention, 82.7% (258/312) of participants reported healthy cultural and recreational interests and 61.9% (193/312) reinforced negative attitudes toward drinking. Such interventions can help prevent early onset of alcohol use in school settings. Given the positive results, the intervention is slated to be reproduced in other Cuban provinces. KEYWORDS Adolescents, prevention, alcoholism, attitudes, Cuba.

Results of the surgical correction of urinary stress incontinence according to the type of transobturator tape utilized.

OBJECTIVES: To analyze the short and long term results of tapes of different materials used to treat stress urinary incontinence (SUI). A secondary objective was to evaluate the ability to adjust the tape after implantation. MATERIALS AND METHODS: Retrospective chart review of 355 patients with SUI operated between March 2003 and October 2011. Eight different types of transobturator tapes were used: Gynecare TVT-O®, Monarc®, SAFYRE®, Contasure KIM®, I-Stop®, DynaMesh®, Aris® Bandellete and Swing-band®. Results and complications were recorded. RESULTS: The mean age at operation was 61 years. Correction of SUI was achieved in 87.88% of cases. The best results were obtained with Contasure KIM® (98.26 % continence). The tape was well tolerated and was elastic enough to be able to be adjusted 48-72 hours after implantation without deformation. Slings with macropores and over lock stitches on the superior and inferior borders presented the lower rates of postoperative urinary retention, pain, perior postoperative bleeding and urinary tract infections. CONCLUSIONS: Transobturator tension free tapes require a short operation time and have a low complication rate. The possibility of adjustment in the early postoperative period increases the success rate and reduces complications. Knotless meshes with macropores and over lock stitches appear to be better balanced, are quite resistant to stretching and deformation when readjusted after implantation and present a low infection rate.

Reliability and validity of a Spanish version of the Impact of Pediatric Epilepsy Scale in a Cuban population.

The Impact of Pediatric Epilepsy Scale (IPES) is a brief, accurate, and acceptable measurement scale of the impact of pediatric epilepsy on the health-related quality of life (HRQOL) of both the child and the child's family as perceived by the child's parent(s). The aim of this study was to validate a Spanish language version of the IPES in Cuban children with epilepsy. The IPES was translated and adapted to Cuban culture and administered to 76 parents of children with epilepsy. The principal component analysis indicated that two factors accounted for 72% of the variance of the IPES (family relationships and health and social well-being). The IPES was also able to detect differences in HRQOL between subjects according to epilepsy severity. The internal consistency coefficient was 0.962, and the test-retest reliability was 0.979. The Cuban version of IPES can be used to measure a child's epilepsy-specific HRQOL in Cuba.

Detection of occult cerebrospinal fluid involvement during maintenance therapy identifies a group of children with acute lymphoblastic leukemia at high risk for relapse.

We aimed at assessing the clinical significance of the levels of acute lymphoblastic leukemia (ALL) cells in samples of cerebrospinal fluid (CSF) during therapy. We studied 990 CSF samples from 108 patients, at the time of diagnosis (108) and at each time of intrathecal therapy (882). The proportions of leukemic cells in CSF samples were assessed by flow cytometry (FCM). Patients with central nervous system (CNS) involvement at diagnosis (FCM+) showed predominantly a T-ALL, and higher percentages of known negative prognostic factors: high risk group, higher white blood cell counts, normal karyotype, and the BCR-ABL fusion gene. No differences in relapse free survival (RFS) and overall survival (OS) were observed between FCM+ versus FCM- at diagnosis. Patients with CNS involvement during therapy showed significantly older age, and higher frequencies of T-cell leukemia. We found a significantly higher RFS in patients with FCM+ during therapy. The detection of subclinical CNS disease by FCM during maintenance was associated with significantly lower 3-years RFS and 3-years OS. A sensitive methodology like FCM can be applied for a close follow-up of the levels of ALL in CFS samples, and may identify a group of patients at high risk for relapse.

Diagnóstico de la epilepsia en la infancia / Epilepsy diagnosis present in childhood

La epilepsia constituye el trastorno neurológico crónico tratable de mayor frecuencia en la infancia. Su diagnóstico es usualmente fácil, pero en la práctica clínica ocurren errores con relativa frecuencia, al no existir un marcador diagnóstico confiable. En el presente artículo se explica el proceso de diagnóstico de la epilepsia en la infancia, que no depende de un solo factor y que debe estar guiado por la historia clínica como elemento esencial.

Epilepsy is the more frequent chronic neurologic disorder easy to treat in childhood. His diagnosis is commonly easy to made but in clinical practice occur relative errors provoked by lack of a reliable diagnosis. In present paper is explained the diagnostic process of epilepsy in childhood, but it not depends of a unique factor and that must to be directed by medical record as an essential element.

Repercusión de la nutrición en el neurodesarrollo y la salud neuropsiquiátrica de niños y adolescentes / Nutrition repercussion related to neurodevelopment and the neuropsychiatric health of children and adolescents

La desnutrición afecta a millones de niños en el mundo y repercute considerablemente en el desarrollo del sistema nervioso, en el cual provoca alteraciones estructurales y funcionales. El presente estudio busca detallar el papel de la nutrición adecuada en el neurodesarrollo y describir algunas de las consecuencias de la desnutrición en ese proceso.

Malnutrition affects to millions of children in world and has a significant repercussion on nervous system, where it provokes structural and functional alterations. Present paper tries to details the role of an appropriate nutrition in neurodevelopment, and to describe some of malnutrition consequences in this process.