Functional assessment of children and adolescents with autism spectrum disorder in Argentina: ICF-ASD multicenter study. / Evaluación funcional de niños, niñas y adolescentes con diagnóstico de trastorno del espectro autista en Argentina: estudio multicéntrico TEA-CIFunciona.

Introduction. Autism spectrum disorder (ASD) is characterized by difficulties in social communication and repetitive and stereotyped behaviors. In addition to the diagnostic category, the activities performed by children and adolescents and their social involvement are the main aspects to be considered according to the International Classification of Functioning, Disability, and Health (ICF) proposed by the World Health Organization to describe health status. In a previous study, we developed the first version of a pediatric tool based on the ICF called ICF-ASD for the functional assessment of children and adolescents with ASD to capture functional characteristics adapted to our cultural setting. Our subsequent objective was to apply the ICF-ASD in a multicenter format to assess children and adolescents from different regions, review, and update it, and identify barriers and facilitators. Population and methods. The ICF-ASD version 1.0 was administered to children and adolescents younger than 16 years with a confirmed diagnosis of ASD (as per DSM-5 criteria), who were receiving follow-up at 5 children's health centers across Argentina. Results. Version 2.0 of the ICF-ASD was obtained, which included 34 categories (10 under body function, 15 under activities and participation, and 9 under environmental factors). A functional profile was developed for the whole sample (n = 308). Conclusions. The updated version of the ICF-ASD helps to standardize and systematize the collection of necessary data for an adequate follow-up of children and adolescents with ASD at a national level. It also allows to identify barriers to overcome and facilitators to be generalized.

Introducción. El trastorno del espectro autista (TEA) se caracteriza por dificultades de comunicación social y comportamientos repetitivos y estereotipados. Además de la categoría diagnóstica, las actividades que los niños, niñas y adolescentes (NNyA) pueden realizar y la participación social son los aspectos principales por considerar desde el marco de la Clasificación Internacional del Funcionamiento, la Discapacidad y la Salud (CIF), propuesta por la Organización Mundial de la Salud, para describir los estados de salud. En una investigación previa, elaboramos la primera versión de una herramienta pediátrica basada en la CIF llamada TEA-CIFunciona para evaluación funcional de NNyA con diagnóstico de TEA, que permitió captar características funcionales adaptadas a nuestro contexto cultural. Se propuso como objetivo posterior aplicar TEA-CIFunciona en formato multicéntrico para evaluar NNyA de diferentes regiones, revisar y actualizar la herramienta, e identificar barreras y facilitadores. Población y métodos. Se administró TEA-CIFunciona versión 1.0 a NNyA con diagnóstico confirmado de TEA (según criterios del DSM-5), menores de 16 años, en seguimiento en cinco centros de atención pediátrica del país. Resultados. Se obtuvo la versión 2.0 de TEA-CIFunciona con 34 categorías (10 funciones corporales, 15 actividades y participación, y 9 factores ambientales). Se elaboró el perfil funcional de la muestra completa (n = 308). Conclusiones. La versión actualizada de TEA-CIFunciona contribuye a estandarizar y a sistematizar la obtención de información necesaria para adecuar el seguimiento de los NNyA con TEA a nivel nacional. Además, permite identificar barreras por superar y facilitadores para generalizar.

Short-Term Therapeutic Adherence of Hospitalized Older Patients with Oropharyngeal Dysphagia after an Education Intervention: Analysis of Compliance Rates, Risk Factors and Associated Complications.

Oropharyngeal dysphagia (OD) is associated with adverse outcomes that require a multidisciplinary approach with different strategies. Our aim was to assess the adherence of older patients to dysphagia management recommendations during hospitalization, after a specific nurse guided dysphagia education intervention and to identify short term complications of OD and their relationship with short-term adherence. We carried out a prospective observational study in an acute and an orthogeriatric unit of a university hospital over ten months with a one-month follow-up. Four hundred and forty-seven patients (mean age 92 years, 70.7% women) were diagnosed with dysphagia using Volume-Viscosity Swallow Test (V-VST). Compensatory measures and individualized recommendations were explained in detail by trained nurse. Therapeutic adherence was directly observed during hospital admission, after an education intervention, and self-reported after one-month. We also recorded the following reported complications at one month, including respiratory infection, use of antibiotics, weight loss, transfers to the emergency department, or hospitalization). Postural measures and liquid volume were advised to all patients, followed by modified texture food (95.5%), fluid thickeners (32.7%), and delivery method (12.5%). The in-hospital compliance rate with all recommendations was 37.1% and one-month after hospital discharge was 76.4%. Both compliance rates were interrelated and were lower in patients with dementia, malnutrition, and safety signs. Higher compliance rates were observed for sitting feeding and food texture, and an increase in adherence after discharge in the liquid volume and use of thickeners. Multivariate logistic regression analysis showed that adherence to recommendations during the month after discharge was associated with lower short-term mortality and complications (i.e., respiratory infection, use of antibiotics, weight loss, transfers to the emergency department, or hospitalization). One-third of our participants followed recommendations during hospitalization and three-quarters one month after admission, with higher compliance for posture and food texture. Compliance should be routinely assessed and fostered in older patients with dysphagia.

Factibilidad, eficacia y satisfacción lograda por la intervención transdisciplinaria de un comité de ética clínico-hospitalario. Un estudio cualicuantitativo / Feasibility, effectiveness, and satisfaction achieved by the transdisciplinary intervention of a clinical-hospital ethics committee. A qualitative and quantitative study

Introducción. Las funciones del Comité de Ética Clínica (CEC) son educativas, normativas, consultivas, mediadoras y reflexivas. Como cualquier servicio de salud, las consultas de casos a un CEC deben ser sujetas a revisión y mejora de la calidad. Los objetivos fueron evaluar la factibilidad, la efectividad y la satisfacción de las recomendaciones ético-asistenciales dadas por el CEC, y evaluar su impacto en el equipo tratante y en la familia. Población y métodos. Estudio descriptivo, retrospectivo, cualicuantitativo, de casos clínicos presentados en el Comité de Ética Clínica del hospital desde el 1 de enero de 2013 hasta el 31 de diciembre de 2017, según datos del libro de actas, historias clínicas, registros de la Oficina de Comunicación a Distancia y entrevistas semiestructuradas al equipo de salud. Resultados. Se analizaron 108 casos (106 pacientes), 73 casos con encuesta y registros, y 35 solamente con registros. Los motivos principales más frecuentes de consulta fueron los siguientes: adecuación del esfuerzo terapéutico (46/42,6 %), compromiso neurológico grave (15/13,9 %), calidad de vida del paciente (11/10,2 %), conflictos entre el paciente, la familia y el sistema de salud (7/6,5 %), y rechazo del tratamiento por la familia (6/5,6 %). Se hallaron niveles altos de satisfacción (> 95 %) y niveles moderados de factibilidad (> 74 %) y efectividad (> 85 %). Solo en 50/108 casos (46,3 %) quedó registro en la historia clínica de la consulta al CEC y el 44 % de los profesionales opinó que la consulta tuvo un impacto positivo en la familia y en el paciente. Conclusiones. Los resultados contribuyeron a descubrir oportunidades de mejora, especialmente en la documentación y en la comunicación en el proceso de consulta.

Introduction. A clinical ethics committee (CEC) has educational, regulatory, advisory, mediation, and reflexive functions. As any health care service, the consults with the CEC should be subjected to review and quality improvement. The study objectives were to assess the feasibility, effectiveness, and satisfaction with the bioethical recommendations made by the CEC and assess their impact on the treating team and the patient's family. Population and methods. Descriptive, retrospective, qualitative, and quantitative study of clinical cases submitted to the hospital's CEC between January 1 st, 2013 and December 31, 2017 using data from the CEC minute book, medical records, registries from the Office for Remote Communication, and semi-structured interviews with health care team members. Results. A total of 108 cases (106 patients) were analyzed: 73 cases with survey and registries and 35 with registries only. The main most frequent reasons for consultation were adequacy of therapeutic effort (46/42.6%), severe neurological involvement (15/13.9%), patient's quality of life (11/10.2%), patient-family-health system conflict (7/6.5%), and family's refusal of treatment (6/5.6%). High levels of satisfaction (> 95%) and moderate levels of feasibility (> 74%) and effectiveness (> 85%) were observed. In only 50/108 cases (46.3%), the consultation with the CEC was registered in the medical record, 44% of health care providers stated that the consultation had a positive impact on the patient and their family. Conclusions. Results helped to establish improvement opportunities, especially in terms of documentation and communication in the consultation process.

Feasibility, effectiveness, and satisfaction achieved by the transdisciplinary intervention of a clinical-hospital ethics committee. A qualitative and quantitative study. / Factibilidad, eficacia y satisfacción lograda por la intervención transdisciplinaria de un comité de ética clínico-hospitalario. Un estudio cualicuantitativo.

INTRODUCTION: A clinical ethics committee (CEC) has educational, regulatory, advisory, mediation, and reflexive functions. As any health care service, the consults with the CEC should be subjected to review and quality improvement. The study objectives were to assess the feasibility, effectiveness, and satisfaction with the bioethical recommendations made by the CEC and assess their impact on the treating team and the patient's family. POPULATION AND METHODS: Descriptive, retrospective, qualitative, and quantitative study of clinical cases submitted to the hospital's CEC between January 1st, 2013 and December 31st, 2017 using data from the CEC minute book, medical records, registries from the Office for Remote Communication, and semi-structured interviews with health care team members. RESULTS: A total of 108 cases (106 patients) were analyzed: 73 cases with survey and registries and 35 with registries only. The main most frequent reasons for consultation were adequacy of therapeutic effort (46/42.6%), severe neurological involvement (15/13.9%), patient's quality of life (11/10.2%), patient-family-health system conflict (7/6.5%), and family's refusal of treatment (6/5.6%). High levels of satisfaction (> 95%) and moderate levels of feasibility (> 74%) and effectiveness (> 85%) were observed. In only 50/108 cases (46.3%), the consultation with the CEC was registered in the medical record, 44% of health care providers stated that the consultation had a positive impact on the patient and their family. CONCLUSIONS: Results helped to establish improvement opportunities, especially in terms of documentation and communication in the consultation process.

Introducción. Las funciones del Comité de Ética Clínica (CEC) son educativas, normativas, consultivas, mediadoras y reflexivas. Como cualquier servicio de salud, las consultas de casos a un CEC deben ser sujetas a revisión y mejora de la calidad. Los objetivos fueron evaluar la factibilidad, la efectividad y la satisfacción de las recomendaciones ético-asistenciales dadas por el CEC, y evaluar su impacto en el equipo tratante y en la familia. Población y métodos. Estudio descriptivo, retrospectivo, cualicuantitativo, de casos clínicos presentados en el Comité de Ética Clínica del hospital desde el 1 de enero de 2013 hasta el 31 de diciembre de 2017, según datos del libro de actas, historias clínicas, registros de la Oficina de Comunicación a Distancia y entrevistas semiestructuradas al equipo de salud. Resultados. Se analizaron 108 casos (106 pacientes), 73 casos con encuesta y registros, y 35 solamente con registros. Los motivos principales más frecuentes de consulta fueron los siguientes: adecuación del esfuerzo terapéutico (46/42,6 %), compromiso neurológico grave (15/13,9 %), calidad de vida del paciente (11/10,2 %), conflictos entre el paciente, la familia y el sistema de salud (7/6,5 %), y rechazo del tratamiento por la familia (6/5,6 %). Se hallaron niveles altos de satisfacción (> 95 %) y niveles moderados de factibilidad (> 74 %) y efectividad (> 85 %). Solo en 50/108 casos (46,3 %) quedó registro en la historia clínica de la consulta al CEC y el 44 % de los profesionales opinó que la consulta tuvo un impacto positivo en la familia y en el paciente. Conclusiones. Los resultados contribuyeron a descubrir oportunidades de mejora, especialmente en la documentación y en la comunicación en el proceso de consulta.

Teleconsulta en épocas de pandemia. Experiencia de los pediatras del desarrollo del Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" / Teleconsultation during a pandemic. Experience of developmental pediatricians at Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"

La teleconsulta es uno de los componentes de la telemedicina. Los pediatras del desarrollo realizan evaluaciones y seguimiento de niños y niñas con esafíos en su desarrollo. Durante la pandemia, debido a las restricciones de movilidad y traslado y la importancia de la continuidad de la atención, comenzaron a trabajar de manera remota realizando consultas virtuales. El objetivo del trabajo fue describir la implementación de la atención virtual, las características de los pacientes atendidos y la percepción de sus familias. Se programaron 122 teleconsultas. La media de edad de los pacientes fue de 40 ± 13 meses. Los motivos de consulta más frecuentes fueron ausencia y retraso lenguaje y dificultades conductuales. Si bien un 16 % de las familias encontró alguna dificultad, todas se mostraron agradecidas con las consultas. La atención virtual debe considerarse como un complemento de la presencialidad, que disminuye los costos y los tiempos de traslado y acerca a los pediatras del desarrollo a lugares remotos.

Teleconsultation is one of the components of telemedicine. Developmental pediatricians provide assessments and follow-up to children with developmental challenges. During the pandemic, due to movement and travel restrictions and the importance of continued care, pediatricians started working remotely with virtual consultations. The objective of this study was to describe the implementation of virtual care, the characteristics of patients seen, and their families' perception. A total of 122 teleconsultations were scheduled. Patients' mean age was 40 ± 13 months. The most common reasons for consultation were absence of and delay in language and behavioral difficulties. Although 16 % of families described some obstacles, all were grateful for the consultations. Virtual health care should be regarded as a complement to in-person care, alongside reductions in costs and travel time and the possibility of bringing developmental pediatricians to remote locations

Teleconsultation during a pandemic. Experience of developmental pediatricians at Hospital de Pediatría "Prof. Dr. Juan P. Garrahan". / Teleconsulta en épocas de pandemia. Experiencia de los pediatras del desarrollo del Hospital de Pediatría "Prof. Juan P. Garrahan".

Teleconsultation is one of the components of telemedicine. Developmental pediatricians provide assessments and followup to children with developmental challenges. During the pandemic, due to movement and travel restrictions and the importance of continued care, pediatricians started working remotely with virtual consultations. The objective of this study was to describe the implementation of virtual care, the characteristics of patients seen, and their families' perception. A total of 122 teleconsultations were scheduled. Patients' mean age was 40 ± 13 months. The most common reasons for consultation were absence of and delay in language and behavioral difficulties. Although 16 % of families described some obstacles, all were grateful for the consultations. Virtual health care should be regarded as a complement to in-person care, alongside reductions in costs and travel time and the possibility.

La teleconsulta es uno de los componentes de la telemedicina. Los pediatras del desarrollo realizan evaluaciones y seguimiento de niños y niñas con desafíos en su desarrollo. Durante la pandemia, debido a las restricciones de movilidad y traslado y la importancia de la continuidad de la atención, comenzaron a trabajar de manera remota realizando consultas virtuales. El objetivo del trabajo fue describir la implementación de la atención virtual, las características de los pacientes atendidos y la percepción de sus familias. Se programaron 122 teleconsultas. La media de edad de los pacientes fue de 40 ± 13 meses. Los motivos de consulta más frecuentes fueron ausencia y retraso lenguaje y dificultades conductuales. Si bien un 16 % de las familias encontró alguna dificultad, todas se mostraron agradecidas con las consultas. La atención virtual debe considerarse como un complemento de la presencialidad, que disminuye los costos y los tiempos de traslado y acerca a los pediatras del desarrollo a lugares remotos.

Sleep problems in a sample of children with developmental disorders, before and during the COVID-19 pandemic. / Problemas del sueño en una muestra de niñas y niños con trastornos del desarrollo, antes y durante la pandemia por COVID-19.

INTRODUCTION: Sleep problems (SPs) are common, especially among children with developmental disorders (DDs), and affect their functioning and quality of family life. Pediatricians play a major role in their management. OBJECTIVE: To define the frequency and types of SPs in a sample of children with DDs, determine the proportion of pediatricians who addressed such difficulties, assess the effects of sleep hygiene (SH), and describe the impact of the COVID-19 pandemic on sleep. POPULATION AND METHODS: This was a quasiexperiment. SPs were diagnosed based on parents' concerns and/or clinical criteria. SH strategies were provided and their effect was assessed as per parents' reports and the Children's Sleep Habits Questionnaire in Spanish (CSHQ-S) before and after the strategies. During the COVID-19 pandemic, the SP outcome measure and SH-related outcome measures were measured again. RESULTS: A total of 161 children were included. The frequency of SPs was 55 %; 80 % improved with SH. Eighty-three percent of children had a primary pediatrician; of these, 45 % had consulted about sleep. During the COVID-19 pandemic, SPs increased and SH outcome measures changed. CONCLUSION: Approximately half of children with DDs have SPs; and the problem was only addressed by 45 % of pediatricians. SH was beneficial for most children, so pediatricians' role seems critical. During the COVID-19 pandemic, SPs increased, probably as a result of its environmental impact on children with DDs.

Los problemas del sueño (PS) son frecuentes, principalmente en niñas y niños con trastornos del desarrollo (TD), y causan un impacto en su funcionamiento y calidad de vida familiar. El pediatra tiene un rol importante en su abordaje. Objetivo. Definir la frecuencia y los tipos de PS en una muestra de niñas y niños con TD, determinar la proporción de pediatras que abordaron estas dificultades, evaluar los efectos de la higiene del sueño (HS) y describir el impacto de la pandemia por COVID-19 en el sueño. Población y métodos. Estudio cuasiexperimental. El diagnóstico de PS se realizó con la preocupación de los padres y/o criterios clínicos. Se brindaron estrategias de HS, luego se evaluó su efecto según referencia de los padres y uso del cuestionario CSHQ-S (Children´s Sleep Habits Questionnaire en español) pre- y posestrategias. Durante la pandemia por COVID-19, se midió nuevamente la variable PS y las relacionadas a HS. Resultados. Se incluyeron 161 niñas y niños. La frecuencia de PS fue del 55 %. El 80 % mejoró con HS. El 83 % tenía pediatra de cabecera, y de ellos, el 45 % había preguntado acerca del sueño. Durante la pandemia por COVID-19 hubo aumento de PS y cambios en las variables de HS. Conclusión. Aproximadamente la mitad de los niñas y niños con TD presentan PS; esto solo fue abordado por el 45 % de los pediatras. La HS resultó beneficiosa para la mayoría, por lo que la intervención del pediatra parece fundamental. Durante la pandemia por COVID-19 aumentaron los PS, como posible reflejo del impacto ambiental en los niñas y niños con TD.

Changes in taxonomic and functional diversity of plants in a chronosequence of Eucalyptus grandis plantations.

Tree plantations have become one of the fastest-growing land uses and their impact on biodiversity was evaluated mainly at the taxonomic level. The aim of this study was to analyze environmental changes after the Eucalyptus plantation in an area originally covered by natural grasslands, taking into account the alpha and beta (taxonomic and functional) diversity of plant communities. We selected nine plantation ages, along a 12 years chronosequence, with three replicates per age and three protected grasslands as the original situation. At each replicate, we established three plots to measure plant species cover, diversity and environmental variables. Results showed that species richness, and all diversity indices, significantly declined with increasing plantation age. Canopy cover, soil pH, and leaf litter were the environmental drivers that drove the decrease in taxonomic and functional diversity of plants through the forest chronosequence. Based on the path analyses results, canopy cover had an indirect effect on plant functional diversity, mediated by leaf litter depth, soil pH, and plant species richness. The high dispersal potential, annual, barochorous, and zoochorous plant species were the functional traits more affected by the eucalypt plantations. We recommend two management practices: reducing forest densities to allow higher light input to the understory and, due to the fact that leaf litter was negatively associated with all diversity facets, we recommend reducing their accumulation or generate heterogeneity in its distribution to enhance biodiversity.

Problemas del sueño en una muestra de niñas y niños con trastornos del desarrollo, antes y durante la pandemia por COVID-19 / Sleep problems in a sample of children with developmental disorders, before and during the COVID-19 pandemic

Los problemas del sueño (PS) son frecuentes, principalmente en niñas y niños con trastornos del desarrollo (TD), y causan un impacto en su funcionamiento y calidad de vida familiar. El pediatra tiene un rol importante en su abordaje. Objetivo. Definir la frecuencia y los tipos de PS en una muestra de niñas y niños con TD, determinar la proporción de pediatras que abordaron estas dificultades, evaluar los efectos de la higiene del sueño (HS) y describir el impacto de la pandemia por COVID-19 en el sueño. Población y métodos. Estudio cuasiexperimental. El diagnóstico de PS se realizó con la preocupación de los padres y/o criterios clínicos. Se brindaron estrategias de HS, luego se evaluó su efecto según referencia de los padres y uso del cuestionario CSHQ-S (Children ́s Sleep Habits Questionnaire en español) pre- y posestrategias. Durante la pandemia por COVID-19, se midió nuevamente la variable PS y las relacionadas a HS. Resultados. Se incluyeron 161 niñas y niños. La frecuencia de PS fue del 55 %. El 80 % mejoró con HS. El 83 % tenía pediatra de cabecera, y de ellos, el 45 % había preguntado acerca del sueño. Durante la pandemia por COVID-19 hubo aumento de PS y cambios en las variables de HS. Conclusión. Aproximadamente la mitad de los niñas y niños con TD presentan PS; esto solo fue abordado por el 45 % de los pediatras. La HS resultó beneficiosa para la mayoría, por lo que la intervención del pediatra parece fundamental. Durante la pandemia por COVID-19 aumentaron los PS, como posible reflejo del impacto ambiental en los niñas y niños con TD.

Sleep problems (SPs) are common, especially among children with developmental disorders (DDs), and affect their functioning and quality of family life. Pediatricians play a major role in their management. Objective. To define the frequency and types of SPs in a sample of children with DDs, determine the proportion of pediatricians who addressed such difficulties, assess the effects of sleep hygiene (SH), and describe the impact of the COVID-19 pandemic on sleep. Population and methods. This was a quasi-experiment. SPs were diagnosed based on parents' concerns and/or clinical criteria. SH strategies were provided and their effect was assessed as per parents' reports and the Children's Sleep Habits Questionnaire in Spanish (CSHQ-S) before and after the strategies. During the COVID-19 pandemic, the SP outcome measure and SH-related outcome measures were measured again. Results. A total of 161 children were included. The frequency of SPs was 55 %; 80 % improved with SH. Eighty-three percent of children had a primary pediatrician; of these, 45 % had consulted about sleep. During the COVID-19 pandemic, SPs increased and SH outcome measures changed. Conclusion. Approximately half of children with DDs have SPs; and the problem was only addressed by 45 % of pediatricians. SH was beneficial for most children, so pediatricians' role seems critical. During the COVID-19 pandemic, SPs increased, probably as a result of its environmental impact on children with DD

Developing a Culturally Sensitive ICF-Based Tool to Describe Functioning of Children with Autism Spectrum Disorder: TEA-CIFunciona Version 1.0 Pilot Study.

BACKGROUND: Autism spectrum disorder (ASD) affects the daily functioning of children and their families; however, in Argentina, there are no standardized tools to guide the description, evaluation, and follow-up of functioning and disability of children with ASD. To fill this gap, the overarching purpose of this study was to create a novel tool guided by the International Classification of Functioning, Disability, and Health (ICF) Core Sets for ASD for clinical practice. METHODS: A multistep methodology was used to identify the most relevant ICF categories for an Argentinian clinical setting. The content of this ICF-based shortlist was piloted and revised according to the results. Subsequently, a toolbox of measures was proposed to operationalize each ICF category. Finally, profiles of the functioning of 100 children with ASD were created. RESULTS: An ICF-based tool called TEA-CIFunciona was created, consisting of 32 ICF categories (10 body functions, 15 activities and participation, 7 environmental factors categories). The application of TEA-CIFunciona incorporated a family-centered approach in ASD evaluations and helped identify functional needs. CONCLUSIONS: TEA-CIFunciona is the first ICF-based instrument that guides the description of functioning of children with ASD in Argentina. TEA-CIFunciona standardizes collaborative assessments in pediatric ASD populations in Latin American contexts.

Oropharyngeal dysphagia in older patients with hip fracture.

BACKGROUND: oropharyngeal dysphagia (OD) and hip fracture are common problems in older patients, both associated with important complications. OBJECTIVE: the aim of this study was to measure the prevalence and identify the main risk factors of dysphagia in older patients with hip fracture. DESIGN: a prospective study in an orthogeriatric unit of a university hospital over 10 months. METHODS: a total of 320 patients (mean age 86.2 years, 73.4% women) were assessed for dysphagia within 72 hours post-surgery using the Volume-Viscosity Swallow Test. Geriatric assessment, hip fracture management and complications were examined to determine their relationship with the presence of OD. RESULTS: dysphagia was present in 176 (55%) patients. Multivariate logistic regression analysis showed that the presence of delirium during hospitalization and the inability to perform instrumental activities of daily living before admission were associated with OD. CONCLUSIONS: the prevalence of OD is high in hip fracture patients. Objective dysphagia assessment should be routinely included as part of the geriatric assessment of such patients.

High Prevalence of Oropharyngeal Dysphagia in Acutely Hospitalized Patients Aged 80 Years and Older.

OBJECTIVES: Oropharyngeal dysphagia is a geriatric syndrome that is usually underdiagnosed in older patients. The aim of this study was to determine the prevalence and identify the main risk factors of dysphagia in the oldest old patients admitted to an acute geriatric unit. DESIGN: Observational prospective study. SETTING AND PARTICIPANTS: Older patients admitted to an acute geriatric unit of a university hospital. MEASURES: 329 patients (mean age 93.5 years, range 81-106) were assessed for oropharyngeal dysphagia within 48 hours of hospital admission using the Volume-Viscosity Swallow Test. Demographic characteristics, geriatric assessment, geriatric syndromes, comorbidities, drug treatment, and complications were examined to determine their association with the presence of dysphagia. RESULTS: Oropharyngeal dysphagia was present in 271 (82.4%) of the participants. Multivariate logistic regression showed that malnutrition [odds ratio (OR) 3.62, 95% confidence interval (CI) 1.01-12.93; P = .048], admission for respiratory infection (OR 2.89, 95% CI 1.40-5.94; P = .004), delirium (OR 2.89, 95% CI 1.40-5.94; P = .004), severe dependency (OR 3.23, 95% CI 1.23-8.87; P = .017), and age (OR 1.11, 95% CI 1.01-1.21; P = .03) were significantly associated with dysphagia. The use of a calcium antagonist at the time of admission was associated with a reduced risk of dysphagia (OR 0.39, 95% CI 0.16-0.92; P = .03). CONCLUSIONS AND IMPLICATIONS: The prevalence of oropharyngeal dysphagia is high in the oldest old patients admitted to an acute geriatric unit when assessed with an objective diagnostic method. Our findings suggest that objective swallowing assessment should be routinely performed on admission in order to start early interventions to avoid complications of dysphagia in this complex population.

Series de Pediatría Garrahan. El niño con trastornos del neurodesarrollo / Garrahan Pediatrics Series. The child with neurodevelopmental disorders

La infancia es una etapa vital clave, ya que en ella se forman los cimientos que luego determinarán el desarrollo físico y mental de las personas. Por eso, brindar las herramientas necesarias para satisfacer las necesidades y los derechos del niño es fundamental para garantizar la inclusión y la igualdad de oportunidades de todos. El desarrollo del niño conlleva cambios biológicos, psicológicos y emocionales que ocurren desde el nacimiento hasta la adolescencia, a medida que el individuo pasa de la dependencia al aumento de la autonomía. La frecuencia de los trastornos del neurodesarrollo es importante y creciente y el pediatra desempeña un papel crucial en su detección oportuna, asesoría a las familias y estrategias de manejo o derivación para asegurar las mejores posibilidades de prevención y asistencia. Asimismo, la elevada morbilidad pediátrica asociada al concepto de enfermedad crónica requiere una actitud diagnóstica anticipatoria de la disfunción neurocognitiva y madurativa a la que están expuestos estos niños. En este nuevo volumen de las Series de Pediatría Garrahan destacados profesionales estudian la temática del desarrollo desde un abordaje interdisciplinario centrado en el rol del pediatra. Entre sus características se destacan: Presentación mediante casos y ejemplos de la práctica clínica de los trastornos más frecuentes del desarrollo infantil estructurados según las diferentes etapas de lactante, preescolar y escolar, así como el abordaje de la discapacidad intelectual, el impacto de la enfermedad crónica en el aprendizaje y los marcos normativos en educación. El cierre de cada capítulo con un recordatorio de puntos clave y lecturas recomendadas, además del material complementario disponible en el sitio web. Una obra sólida y práctica, que transmite la experiencia de los profesionales del Hospital de Pediatría Prof. Dr. Juan P Garrahan, dedicada a los pediatras, dondequiera que trabajen al servicio de la salud de los niños.

Low doses of ivermectin cause sensory and locomotor disorders in dung beetles.

Ivermectin is a veterinary pharmaceutical generally used to control the ecto- and endoparasites of livestock, but its use has resulted in adverse effects on coprophilous insects, causing population decline and biodiversity loss. There is currently no information regarding the direct effects of ivermectin on dung beetle physiology and behaviour. Here, based on electroantennography and spontaneous muscle force tests, we show sub-lethal disorders caused by ivermectin in sensory and locomotor systems of Scarabaeus cicatricosus, a key dung beetle species in Mediterranean ecosystems. Our findings show that ivermectin decreases the olfactory and locomotor capacity of dung beetles, preventing them from performing basic biological activities. These effects are observed at concentrations lower than those usually measured in the dung of treated livestock. Taking into account that ivermectin acts on both glutamate-gated and GABA-gated chloride ion channels of nerve and muscle cells, we predict that ivermectin's effects at the physiological level could influence many members of the dung pat community. The results indicate that the decline of dung beetle populations could be related to the harmful effects of chemical contamination in the dung.

Tratamiento de la disgrafia fonológica cinestésica en un paciente con apraxia oral post accidente cerebro vascular / Treatment of kinesthetic phonological disgraphia in patients with oral apraxia sequelar a stroke

Introducción: los problemas en la ejecución de la escritura dificultan las actividades de la vida diaria. El conocimiento de las características de esta habilidad, en personas que han padecido de una lesión del sistema nervioso, es imprescindible para la estruturación de un abordage terapéutico con vista a un mejor desempeño en su medio social. Objetivo: describir las características de la escritura de un paciente con apraxia oral y comprobar la influencia de un sistema de actividades para compensar la disgrafia fonológica cinestésica. Metodología: se presentó un paciente (FBZ) que presentava apraxia oral y disgrafia fonológica. Durante dos meses recibió por parte de los especialistas un sistema de actividades que tenía como objetivo mejorar la percepción y diferenciación de los sonidos del habla por su posición articulatoria con vista a compensar el transtorno que presentava en la escritura. Como protocolo de evaluación se le aplicó al inicio y final del tratamiento el capítulo V referente al diagnóstico de la escritura del test Boston. Resultados: mejoró la composición y orden de los grafemas dentro de la palabra y su inteligibilidad en el plano oral. Conclusiones: el sistema de actividades aplicado influyó positivamente en la corrección de la disgrafia fonológica.

Introduction: problems in the execution of the deed hinder activities of daily life. Knowledge of the characteristics of this ability, in people who have suffered injury to the nervous system, it is essencial to structure a therapeutic approach with a view to improved performance in their social environment. Objective: to discribe the characteristics of the writing of a patient with oral apraxia and check the influence of a system to compensate knesthetic activities phonological dysgraphia. Methodology: A patient (FBZ) presenting oral apraxia and phonological dysgraphia presented. For two months he received from specialists a system of activities aimed to improve the reception and differentiation of speech sounds by the articulatory position overlooking compensate disorder presenting in writing. As evaluation protocol was applied at the beginning and end of treatment Chapter V concerning the diagnostic test script Boston. Results: Improved composition and order of graphemes within the word and inteligibility planus. Conclusions: The applied system positively influenced the activities in the correction of phonoaudiological dysgraphia.

[Experience of an Ethics Committee of a pediatric reference hospital]. / Experiencia del Comité de Ética asistencial de un hospital pediátrico de referencia.

Since 1960, there has been a growing interest in the complexity of the ethical problems posed by medical practice. Ever since then, many ethical theories have attempted to support bioethics, setting the necessary grounds for decision making process. The aim of this article is to briefly present the history and working of a pediatric hospital's Assistance Ethics Committee, as well as its evolution from the very beginning. Throughout the Committee's career, progressive changes were made in the way of working. During its first years, the fulfillment of certain formalities was demanded when presenting patients, but this was modified overtime towards a less rigid and more reflexive and pluralistic presentation. Regarding our Ethics Committee, deliberation is the main and most valuable tool in the search for the best option when dealing with harsh and problematic cases that are presented.

Experiencia del Comité de Ética asistencial de un hospital pediátrico de referencia / Experience of an Ethics Committee of a pediatric reference hospital

Desde los años 60, ha habido un interés creciente por la complejidad de los problemas éticos que plantea la práctica de la medicina. Desde entonces, numerosas teorías éticas han intentado fundamentar la bioética justificando las consideraciones que han sido necesarias para la toma de decisiones. El objetivo del artículo es exponer brevemente la historia y el funcionamiento del Comité de Ética de un hospital pediátrico, así como la evolución experimentada desde sus comienzos. A lo largo de la trayectoria como Comité de Ética, se fueron realizando progresivos cambios en la forma de trabajo. En los primeros años, se exigía el cumplimiento de una serie de formalidades en la presentación de los pacientes, pero esto se fue modificando con el tiempo hasta llegar a una presentación menos rígida y más reflexiva y plural. En el caso de nuestro Comité Hospitalario de Ética, la deliberación es la herramienta principal y más valorada de su actividad en la búsqueda de la mejor opción para la asistencia de los casos problemáticos que se plantean.

Since 1960, there has been a growing interest in the complexity of the ethical problems posed by medical practice. Ever since then, many ethical theories have attempted to support bioethics, setting the necessary grounds for decision making process. The aim of this article is to briefly present the history and working of a pediatric hospital's Assistance Ethics Committee, as well as its evolution from the very beginning. Throughout the Committee's career, progressive changes were made in the way of working. During its first years, the fulfillment of certain formalities was demanded when presenting patients, but this was modified overtime towards a less rigid and more reflexive and pluralistic presentation. Regarding our Ethics Committee, deliberation is the main and most valuable tool in the search for the best option when dealing with harsh and problematic cases that are presented.

Intoxicación severa por ácido valproico / Severe poisoning by valproic acid

El ácido valproico es utilizado en el manejo de las crisis de ausencias simples y complejas, mioclonías y convulsiones tónico-clónicas generalizadas. Es efectivo en las crisis parciales, como profilaxis de segunda línea para la migraña y en el trastorno bipolar. Debido a su amplio uso han aumentado los casos de intoxicación en los últimos años. Los objetivos de este trabajo son describir las manifestaciones clínicas y evolución de una intoxicación severa por ácido valproico, secundaria a ingesta intencional; destacar la importancia del metabolismo de la droga para el manejo clínico de la intoxicación, la necesidad de un laboratorio capaz de proporcionar una rápida cuantificación de la misma y analizar las opciones terapéuticas actuales.

Valproic acid is used in crisis management both simple and complex absence, myoclonus and tonic-clonic seizures. It is effective in partial seizures, as second line prophylaxis for migraine and bipolar disorder. Its widespread use has increased cases of poisoning in recent years. The aim of this review is to describe the clinical manifestations and evolution of a severe valproic acid intoxication secondary to intentional consumption as well as emphasize the importance of drug metabolism for clinical management of poisoning, the need for a laboratory provide rapid quantification of this drug and discuss current treatment options.

Phosphoinositide substrates of myotubularin affect voltage-activated Ca²âº release in skeletal muscle.

Skeletal muscle excitation­contraction (E­C) coupling is altered in several models of phosphatidylinositol phosphate (PtdInsP) phosphatase deficiency and ryanodine receptor activity measured in vitro was reported to be affected by certain PtdInsPs, thus prompting investigation of the physiological role of PtdInsPs in E­C coupling. We measured intracellular Ca2+ transients in voltage-clamped mouse muscle fibres microinjected with a solution containing a PtdInsP substrate (PtdIns(3,5)P2 or PtdIns(3)P) or product (PtdIns(5)P or PtdIns) of the myotubularin phosphatase MTM1. No significant change was observed in the presence of either PtdIns(5)P or PtdIns but peak SR Ca2+ release was depressed by ~30% and 50% in fibres injected with PtdIns(3,5)P2 and PtdIns(3)P, respectively, with no concurrent alteration in the membrane current signals associated with the DHPR function as well as in the voltage dependence of Ca2+ release inactivation. In permeabilized muscle fibres, the frequency of spontaneous Ca2+ release events was depressed in the presence of the three tested phosphorylated forms of PtdInsP with PtdIns(3,5)P2 being the most effective, leading to an almost complete disappearance of Ca2+ release events. Results support the possibility that pathological accumulation of MTM1 substrates may acutely depress ryanodine receptor-mediated Ca2+ release. Overexpression of a mCherry-tagged form of MTM1 in muscle fibres revealed a striated pattern consistent with the triadic area. Ca2+ release remained although unaffected by MTM1 overexpression and was also unaffected by the PtdIns-3-kinase inhibitor LY2940002, suggesting that the 3-phosphorylated PtdIns lipids active on voltage-activated Ca2+ release are inherently maintained at a low level, inefficient on Ca2+ release in normal conditions.

Defects in Ca2+ release associated with local expression of pathological ryanodine receptors in mouse muscle fibres.

Mutations of the gene encoding the type 1 ryanodine receptor (RyR1) are associated with skeletal muscle disorders including malignant hyperthermia susceptibility (MHS) and central core disease (CCD). We used in vivo expression of EGFP-RyR1 constructs in fully differentiated mouse muscle fibres to characterize the function of several RyR1 mutants. Wild-type and Y523S, R615C, R2163H and I4897T mutants of RyR1 were separately expressed and found to be present within restricted regions of fibres with a pattern consistent with triadic localization. Confocal measurements of voltage-clamp-activated myoplasmic Ca(2+) transients demonstrated alterations of sarcoplasmic reticulum (SR) Ca(2+) release spatially correlated with the presence of exogenous RyR1s. The Y523S, R615C and R2163H RyR1 MHS-related mutants were associated with enhanced peak Ca(2+) release for low and moderate levels of depolarization, whereas the I4897T CCD mutant produced a chronic reduction of peak SR Ca(2+) release. For example, peak Ca(2+) release in response to a depolarization to -20 mV in regions of fibres expressing Y523S and I4897T was 2.0 ± 0.3 (n = 9) and 0.46 ± 0.1 (n = 5) times the corresponding value in adjacent, non-expressing regions of the same fibre, respectively. Interestingly no significant change in the estimated total amount of Ca(2+) released at the end of large depolarizing pulses was observed for any of the mutant RyR1 channels. Overall, results are consistent with an 'inherent' increase in RyR1 sensitivity to activation by the voltage sensor for the MHS-related RyR1 mutants and a partial failure of voltage-gated release for the CCD-related I4897T mutant, that occur with no sign of change in SR Ca(2+) content. Furthermore, the results indicate that RyR1 channel density is tightly regulated even under the present conditions of forced exogenous expression.