Confirmed clinical case of chronic kidney disease of nontraditional causes in agricultural communities in Central America: a case definition for surveillance.

Over the last 20 years, many reports have described an excess of cases of chronic kidney disease (CKD) in the Pacific coastal area of Central America, mainly affecting male farmworkers and signaling a serious public health problem. Most of these cases are not associated with traditional risk factors for CKD, such as aging, diabetes mellitus, and hypertension. This CKD of nontraditional causes (CKDnT) might be linked to environmental and/or occupational exposure or working conditions, limited access to health services, and poverty. In response to a resolution approved by the Directing Council of the Pan American Health Organization (PAHO) in 2013, PAHO, the U.S. Centers for Disease Control and Prevention, and the Latin American Society of Nephrology and Hypertension (SLANH) organized a consultation process in order to expand knowledge on the epidemic of CKDnT and to develop appropriate surveillance instruments. The Clinical Working Group from SLANH was put in charge of finding a consensus definition of a confirmed clinical case of CKDnT. The resulting definition establishes mandatory criteria and exclusion criteria necessary for classifying a case of CKDnT. The definition includes a combination of universally accepted definitions of CKD and the main clinical manifestations of CKDnT. Based on the best available evidence, the Clinical Working Group also formulated general recommendations about clinical management that apply to any patient with CKDnT. Adhering to the definition of a confirmed clinical case of CKDnT and implementing it appropriately is expected to be a powerful instrument for understanding the prevalence of the epidemic, evaluating the results of interventions, and promoting appropriate advocacy and planning efforts.

Rhodium Catalyst Structural Changes during, and Their Impacts on the Kinetics of, CO Oxidation.

Catalysts can undergo structural changes during the reaction, affecting the number and/or the shape of active sites. For example, Rh can undergo interconversion between nanoparticles and single atoms when CO is present in the reaction mixture. Therefore, calculating a turnover frequency in such cases can be challenging as the number of active sites can change depending on the reaction conditions. Here, we use CO oxidation kinetics to track Rh structural changes occurring during the reaction. The apparent activation energy, considering the nanoparticles as the active sites, was constant in different temperature regimes. However, in a stoichiometric excess of O2, there were observed changes in the pre-exponential factor, which we link to changes in the number of active Rh sites. An excess of O2 enhanced CO-induced Rh nanoparticle disintegration into single atoms, affecting catalyst activity. The temperature at which these structural changes occur depend on Rh particle size, with small particle sizes disintegrating at higher temperature, relative to the temperature required to break apart bigger particles. Rh structural changes were also observed during in situ infrared spectroscopic studies. Combining CO oxidation kinetics and spectroscopic studies allowed us to calculate the turnover frequency before and after nanoparticle redispersion into single atoms.

Eco-friendly hybrid Paper-AgBr-TiO2 for efficient photocatalytic aerobic mineralization of ethanol.

In this study, a facile and effective route to prepare hybrid photocatalysts (paper-TiO2, paper-TiO2-AgBr and paper-AgBr-TiO2) has been reported. The preparation procedure consisted of the direct adsorption of the previously synthesized titania nanoparticles (TiO2 sol) to generate the TiO2 nanosphere and the immersion process in an aqueous suspension of AgBr to form the AgBr nanoclusters on paper fibers. The synthesis technology is economic, efficient, environmentally friendly and easy to implement even at industrial scale. A cellulose-based structure with well dispersed TiO2 particles of around 1 µm and a pseudo-liquid coating of Ag+ and AgBr species was obtained. All the prepared photocatalysts demonstrated effective photocatalytic performance in gaseous phase ethanol degradation with simulated sunlight illumination, through the direct mineralization to CO2 and the parallel reaction via acetaldehyde degradation. A relevant improvement in the photocatalytic activity was noticed when TiO2 was associated with AgBr nanocrystals, with a higher effect observed when AgBr was loaded onto the paper surface prior to TiO2. Ag-Ti interaction reduces the pair recombination rate and increases the available charge carriers generating reactive OH- radicals from both Ag-species and TiO2, and O2- radicals from Ag+-AgBr species, which would be involved in the ethanol degradation process.

[Sedation-analgesia protocol for the injection of botulinum toxin A in cerebral palsy]. / Protocolo sedoanalgésico para la infiltración de toxina botulínica A en parálisis cerebral.

OBJECTIVE: To evaluate the impact of the sedation-analgesia technique on the pain experienced by the patient. METHODS: This cross-sectional study was conducted on consecutive patients with cerebral palsy (CP) who underwent infiltration with botulinum toxin A (BoTNA). The patients were divided into 4 different groups according to the analgesic strategy assigned: Group I, without sedation or topical anaesthetic cream; Group II, inhalation of nitrous oxide; Group III, deep intravenous sedation; and Group IV, light sedation with benzodiazepines. Pain was assessed with different scales depending on patient age. Parents were asked to rate their satisfaction with their child's comfort by using a 5-point Likert-type scale. The primary end-point was the proportion of patients that experienced a pain level equal or lower than 2, according to pain scales, in the different study groups. RESULTS: Of the 124 patients included in the study, 56 (45.2%) experienced a pain level ≤2. In the Group III a significantly greater proportion of patients were classified with a pain level score ≤2, P<.001, as compared with all the study groups, respectively. The BoTNA injection was guided by ultrasonography in 109 (87.9%) patients, and by palpation in 15 (12.1%). CONCLUSION: The results of this study suggested that, in patients with CP treated with BoTNA injections, the sedation-analgesic strategy had a significant impact on the pain experienced by the subject. Selecting an appropriate analgesic strategy is crucial for reducing the stress associated with the administration of BoTNA injections in children with CP.

Citius, Altius, Fortius: Agreement between Perkins and Dynamic Contour Tonometry (Pascal) and the Impact of Altitude.

INTRODUCTION: To ascertain differences in intraocular pressure (IOP) measurement and their repeatability between dynamic contour tonometry (DCT) and Goldmann/Perkins applanation tonometry (GAT) at two different atmospheric pressures. MATERIALS AND METHODS: Forty-one eyes of 41 healthy consenting subjects were enrolled for this observational, cross-sectional study. Pachymetry and IOP measurements with DCT and GAT for both eyes of each subject at Acapulco (0 m from sea level) and at Mexico City (2,234 m from sea level) were done by the same observer. The IOP was compared between tonometers at each of the altitudes, and also for repeatability of each tonometer at different altitudes. Pearson's correlation coefficient and Bland-Altman plots were used to assess reliability of measurements and their differences at the two altitudes. RESULTS: The mean age of patients was 41.7 (28-66 years); 22 were females. Mean IOP with DCT was 16.1 ± 2.2 mm Hg at sea level and 15.9 ± 2.1 mm Hg at 2,234 m above sea level, not a significant difference. Mean GAT IOP at the two altitudes was 13.1 ± 1.8 and 11.5 ± 1.7 mm Hg respectively, a statistically sig -nificant difference. In contrast, central corneal thickness (CCT) was not significantly changed (548.3 to 549.4 µm, p = 0.496). CONCLUSION: Repeatability of single-observer measurements with GAT remains clinically acceptable, but not at different altitudes. The DCT seems to more consistently measure a similar IOP at different altitudes in the same subjects. The two tonometers may not be used interchangeably in the serial follow-up of patients at any of the altitudes.How to cite this article: Albis-Donado O, Bhartiya S, Gil-Reyes M, Casale-Vargas G, Arreguin-Rebollar N, Kahook MY. Citius, Altius, Fortius: Agreement between Perkins and Dynamic Contour Tonometry (Pascal) and the Impact of Altitude. J Curr Glaucoma Pract 2018;12(1):40-44.

Protocolo sedoanalgésico para la infiltración de toxina botulínica A en parálisis cerebral / Sedation-analgesia protocol for the injection of botulinum toxin A in cerebral palsy

Objetivo: Evaluar el impacto de la técnica sedoanalgésica en el dolor experimentado por el paciente. Métodos: Estudio transversal realizado en pacientes consecutivos con parálisis cerebral (PC) que se infiltraron con toxina botulínica A (OnabotA). Los pacientes fueron divididos en 4 grupos según la estrategia analgésica asignada: Grupo I, sin sedación o crema anestésica tópica; Grupo II, inhalación de óxido nitroso; Grupo III, sedación intravenosa profunda y Grupo IV, sedación ligera con benzodiacepinas. El dolor se evaluó con diferentes escalas según la edad del paciente. Los padres clasificaron su satisfacción con la comodidad de su hijo mediante una escala tipo Likert de 5 puntos. La variable primaria de eficacia fue la proporción de pacientes que experimentaron un nivel de dolor ≤ 2, según las escalas de dolor, en los diferentes grupos de estudio. Resultados: De los 124 pacientes incluidos en el estudio, 56 (45,2%) experimentaron un nivel de dolor ≤ 2. En el Grupo III, una proporción significativamente mayor de pacientes presentó un nivel de dolor ≤ 2, p < 0,001, en comparación con todos los grupos de estudio, respectivamente. La inyección de OnabotA fue guiada por ultrasonografía en 109 (87,9%) pacientes y por referencia anatómica en 15 (12,1%). Conclusión: En los pacientes con PC tratados con infiltraciones de OnabotA, la estrategia sedoanalgésica tuvo un impacto significativo en el dolor experimentado por el sujeto. Seleccionar una estrategia analgésica apropiada es crucial para reducir el estrés asociado con la administración de inyecciones de OnabotA en niños con PC

Objective: To evaluate the impact of the sedation-analgesia technique on the pain experienced by the patient. Methods: This cross-sectional study was conducted on consecutive patients with cerebral palsy (CP) who underwent infiltration with botulinum toxin A (BoTNA). The patients were divided into 4 different groups according to the analgesic strategy assigned: Group I, without sedation or topical anaesthetic cream; Group II, inhalation of nitrous oxide; Group III, deep intravenous sedation; and Group IV, light sedation with benzodiazepines. Pain was assessed with different scales depending on patient age. Parents were asked to rate their satisfaction with their child's comfort by using a 5-point Likert-type scale. The primary end-point was the proportion of patients that experienced a pain level equal or lower than 2, according to pain scales, in the different study groups. Results: Of the 124 patients included in the study, 56 (45.2%) experienced a pain level ≤ 2. In the Group III a significantly greater proportion of patients were classified with a pain level score ≤ 2, P < .001, as compared with all the study groups, respectively. The BoTNA injection was guided by ultrasonography in 109 (87.9%) patients, and by palpation in 15 (12.1%). Conclusion: The results of this study suggested that, in patients with CP treated with BoTNA injections, the sedation-analgesic strategy had a significant impact on the pain experienced by the subject. Selecting an appropriate analgesic strategy is crucial for reducing the stress associated with the administration of BoTNA injections in children with CP

Confirmed clinical case of chronic kidney disease of nontraditional causes in agricultural communities in Central America: a case definition for surveillance / Caso clínico confirmado de enfermedad renal crónica de causas no tradicionales en comunidades agrícolas de Centroamérica: una definición de caso para la vigilancia

Over the last 20 years, many reports have described an excess of cases of chronic kidney disease (CKD) in the Pacific coastal area of Central America, mainly affecting male farmworkers and signaling a serious public health problem. Most of these cases are not associated with traditional risk factors for CKD, such as aging, diabetes mellitus, and hypertension. This CKD of nontraditional causes (CKDnT) might be linked to environmental and/or occupational exposure or working conditions, limited access to health services, and poverty. In response to a resolution approved by the Directing Council of the Pan American Health Organization (PAHO) in 2013, PAHO, the U.S. Centers for Disease Control and Prevention, and the Latin American Society of Nephrology and Hypertension (SLANH) organized a consultation process in order to expand knowledge on the epidemic of CKDnT and to develop appropriate surveillance instruments. The Clinical Working Group from SLANH was put in charge of finding a consensus definition of a confirmed clinical case of CKDnT. The resulting definition establishes mandatory criteria and exclusion criteria necessary for classifying a case of CKDnT. The definition includes a combination of universally accepted definitions of CKD and the main clinical manifestations of CKDnT. Based on the best available evidence, the Clinical Working Group also formulated general recommendations about clinical management that apply to any patient with CKDnT. Adhering to the definition of a confirmed clinical case of CKDnT and implementing it appropriately is expected to be a powerful instrument for understanding the prevalence of the epidemic, evaluating the results of interventions, and promoting appropriate advocacy and planning efforts

En los 20 últimos años, en muchos informes se ha descrito un número inusual de casos de enfermedad renal crónica (ERC) en la costa del Pacífico de Centroamérica, que afecta principalmente a trabajadores agrícolas varones y señala un grave problema de salud pública. La mayoría de estos casos no se asocia con los factores de riesgo tradicionales de ERC, como envejecimiento, diabetes mellitus e hipertensión. Esta ERC de causas no tradicionales (ERCnT) podría estar vinculada con la exposición laboral o ambiental o las condiciones de trabajo, el escaso acceso a los servicios de salud y la pobreza. En respuesta a una resolución aprobada por el Consejo Directivo de la Organización Panamericana de la Salud (OPS) en el 2013, la OPS, los Centros para el Control y la Prevención de Enfermedades de los Estados Unidos y la Sociedad Latinoamericana de Nefrología e Hipertensión (SLANH) organizaron un proceso de consulta para ampliar los conocimientos sobre la epidemia de ERCnT y elaborar instrumentos apropiados para la vigilancia. El Grupo Clínico de Trabajo de la SLANH tuvo la responsabilidad de consensuar una definición de caso clínico confirmado de ERCnT. En la definición resultante se establecen criterios obligatorios y criterios de exclusión necesarios para clasificar un caso como de ERCnT. La definición incluye una combinación de definiciones de ERC universalmente aceptadas y las principales manifestaciones clínicas de ERCnT. Sobre la base de los mejores datos científicos disponibles, el Grupo Clínico de Trabajo también formuló recomendaciones generales acerca del manejo clínico, que se aplican a cualquier paciente con ERCnT. Se espera que la adopción de la definición de caso confirmado de ERCnT y su aplicación adecuada sean una herramienta poderosa para conocer la prevalencia de la epidemia, evaluar los resultados de las intervenciones y promover acciones apropiadas de sensibilización y planificación.

Conocimiento de maestros de primaria sobre el trastorno por déficit de atención e hiperactividad / Knowledge of Elementary School Teachers about the Attention Deficit Hyperactivity Disorder

El propósito del estudio fue averiguar la influencia del sexo, edad y clase social de maestros de primaria respecto del Trastorno por Déficit de Atención e Hiperactividad (TDAH), sus causas y como tratarlo. El estudio también averiguó la influencia del grado escolar y del tamaño del grupo que atendían los maestros, así como del tipo de escuela en la que trabajaban. Maestros de primaria (N = 691) señalaron si sabían qué era el TDAH y en caso afirmativo escribieron en qué consiste. También escribieron las conductas que creían emitiría en el salón de clases un niño etiquetado y cómo lo tratarían. Los resultados mostraron que en comparación con sus contrapartes, una proporción mayor de mujeres, de maestros mayores de 43 años, de clase social media, que enseñaban en 5°- 6°, que atendían grupos pequeños y de escuelas privadas dijeron saber qué es el TDAH. Estos mismos maestros consideraron que el TDHA se trata de una enfermedad orgánica, esperarían un peor comportamiento de los niños y estarían más inclinados a etiquetarlos. Los maestros dijeron que emplearían técnicas como sentar al niño etiquetado cerca de ellos para fomentar su atención y disminuir su distracción. Los resultados se discuten contrastando el punto de vista psiquiátrico y el psicológico sobre el concepto de conducta anormal.

The purpose of the study was to determine the influence of sex, age and social class of elementary school teachers on their knowledge about the attention deficit hyperactivity disorder (ADHD). The study also determined the influence of the school grade in which the teachers taught, the size of their group and the kind of school in which they worked. Elementary school teachers (N = 691) mentioned whether they knew what ADHD was and if they did, wrote down their definition of ADHD. Teachers also wrote down the specific behaviors they expected from a child with ADHD and how will they treat that child during their classes. Results showed that compared with their counterparts, a greater percentage of women, teachers older than 43 years, of middle social class, that taught in fifth and sixth grades, that had small groups and that worked in private schools said they knew what ADHD was. Those teachers considered that ADHD has an organic cause, expected children to behave worse and be willing to label their students more often than their counterparts. The majority of teachers said they would use strategies such as sitting a student with ADHD next to them to foster his/her attention and to avoid distractions. Results are discussed contrasting the psychiatric and psychological approximations to abnormal behavior.

Síndrome de dispersión pigmentaria / Pigmentary dispersion syndrome

Se hace una revisión histórica del síndrome de dispersión pigmentaria. Se presentan los argumentos que proponen diferentes investigadores para apoyar que la presencia del pigmento es la causa, por azolve, del aumento de la presión intraocular, así como las teorías que abogan que es la lesión de las células endoteliales trabeculares el factor producto del glaucoma. Se hace referencia a los estudios genéticos con relación a la determinación de la presencia clínica de este síndrome. Se discute sobre los posibles mecanismos de aumento de la presión con el ejercicio y el cuadro clínico y la evolución natural de la enfermedad. Se hace un análisis de los métodos de tratamiento médico y quirúrgico