Intravenous prostaglandin E1 (alprostadil) bolus in ductus arteriosus-dependent CHD: valid or absolutely contraindicated?

The use of prostaglandin E1 is well documented in ductus arteriosus-dependent CHD or in neonatal pulmonary pathologies that cause severe pulmonary hypertension. The intravenous infusion is well established in loading infusion and maintenance with an onset of action of 30 minutes until 2 hours or even more. Our aim is to report three patients with pulmonary atresia that presented hypercyanotic spell due to a ductal spasm during cardiac catheterisation in whom the administration of a bolus of alprostadil reversed the spasm and increased pulmonary flow, immediately stabilising the condition of the patients allowing subsequent successful stent placement with no serious complications or sequelae after the administration of the bolus. More studies are needed to make a recommendation regarding the use of alprostadil in bolus in cases where the ductal spasm might jeopardise the life of the patient.

Childhood Systemic Lupus Erythematosus: Clinical and Immunologic Patterns in Mexican Children.

Introduction Systemic lupus erythematosus (SLE) is a complex autoimmune disease with heterogeneous clinical and laboratory features. The incidence increases markedly in women. The reason for the predominance of the female gender is still under study. The ethnicity could influence the clinical and serological features of SLE. Material and methods This is a retrospective, descriptive, and longitudinal study. We studied 89 patients diagnosed with childhood-onset systemic lupus erythematosus (cSLE) in our center in 2000-2020 for men and 2010-2020 for women. We investigated disease manifestations, ranging from clinical symptoms to renal involvement, at the time of diagnosis and compared them by gender. Results We studied 89 patients, comprising 23 males and 66 females. The mean age for both groups was 12 years. Concerning clinical manifestations, serositis exhibited a higher prevalence among males, while hair loss was more prominent among females. In the paraclinical evaluation, noteworthy differences were observed regarding average hemoglobin levels and the prevalence of positive anti-DNA antibodies. Males demonstrated an average hemoglobin level of 11.47 g/dL, whereas females displayed 9.84 g/dL (p=0.017). The prevalence of anti-DNA antibodies exhibited marked elevation in males, at 88.9%, compared to females' 42.9% (p=0.024). On a contrary note, our male cohort displayed heightened prevalence in using hydroxychloroquine, cyclophosphamide, and mycophenolate. Similarly, renal involvement presented a higher prevalence in males (100% against 83.3%), albeit lacking statistical significance. Nevertheless, significant disparities emerged in the occurrence of granular casts, proteinuria, and the average glomerular filtration rate, with males experiencing greater impact in each instance. Finally, it is noteworthy that the application of mycophenolate and azathioprine was more frequently observed among patients with renal involvement. Conclusion cSLE patients in our inception cohort showed statistical significance in dermatological and vascular manifestations, serositis, granular casts, low kidney glomerular filtration, and high proteinuria, which are predominant in male patients. Immunological features were predominantly positive in ds-DNA antibodies for male patients. Separation by gender for future studies might identify a better treatment strategy.

Effectiveness of a coordinated community effort to promote early literacy behaviors.

The purpose of this study is to report on the effectiveness of a coordinated, community-wide intervention to promote early literacy behaviors with low-income parents, especially parents with limited English language proficiency. The interventions include book distribution programs that were based in clinical settings, childcare centers and home visitation programs. The intent of these interventions was to communicate a message that reading to infants and young children and accessing services at the public library are beneficial. The methodology involved in the administration of a Community Based Parental Survey (CBPS) included questions related to early literacy behaviors in order to evaluate the effectiveness of these efforts. Two independent samples collected in 2001 and 2003 were compared. The data comparison between the two time periods showed a 77% increase in parents reporting that they showed books to their infants on a daily basis. There was also a 71% increase in parents reading books aloud to their children on a daily basis. Other indicators also improved. Establishing an early reading ritual encourages infants to have an association to books, helps in language acquisition and supports the social and emotional connection between a parent and his or her young child. The act of holding an infant and reading to him/her on a consistent basis can improve health literacy and hopefully improve student reading achievements. Early interventions like these are relatively low cost and can yield considerable long term results. We conclude that multi-level community based interventions show positive trends in promoting early literacy behaviors.

Severity and correlates of depressive symptoms among recipients of meals on wheels: age, gender, and racial/ethnic difference.

In this study, we briefly described a large urban Meals on Wheels program's adoption of the Patient Health Questionnaire-9 (PHQ-9) as its depression-screening tool. Then we reported the assessment outcomes with respect to the rates, severity, and correlates of depressive symptoms. The sample consisted of 736 MOW clients. Bivariate analysis, with chi(2) statistics, was performed to examine differences in the rates and severity of depressive symptoms by age group, gender, race/ethnicity, and cognitive status. Negative binomial regression analysis was used to determine the correlates of depression symptom severity. Of the sample, 17.5% had clinically significant depressive symptoms (PHQ-9 > or = 10), and 8.8% had probable major depressive disorder (MDD). A significantly higher proportion of those under age 60 years was found to have clinically significant depressive symptoms and probable MDD. The multivariate regression results show that age, gender, race/ethnicity, income, cognitive impairment, number of chronic medical conditions, and the nutritional risk score were significant predictors of the severity of depression symptoms. Implications of and recommendations for incorporating a valid depression-screening tool into social service agencies' existing assessment process are discussed.

Gut-Induced Inflammation during Development May Compromise the Blood-Brain Barrier and Predispose to Autism Spectrum Disorder.

Recently, the gut microbiome has gained considerable interest as one of the major contributors to the pathogenesis of multi-system inflammatory disorders. Several studies have suggested that the gut microbiota plays a role in modulating complex signaling pathways, predominantly via the bidirectional gut-brain-axis (GBA). Subsequent in vivo studies have demonstrated the direct role of altered gut microbes and metabolites in the progression of neurodevelopmental diseases. This review will discuss the most recent advancements in our understanding of the gut microbiome's clinical significance in regulating blood-brain barrier (BBB) integrity, immunological function, and neurobiological development. In particular, we address the potentially causal role of GBA dysregulation in the pathophysiology of autism spectrum disorder (ASD) through compromising the BBB and immunological abnormalities. A thorough understanding of the complex signaling interactions between gut microbes, metabolites, neural development, immune mediators, and neurobiological functionality will facilitate the development of targeted therapeutic modalities to better understand, prevent, and treat ASD.

Hipertensión arterial pulmonar en pacientes con dermatomiositis juvenil y esclerosis sistémica en un centro pediátrico de tercer nivel

INTRODUCCIÓN: La hipertensión arterial pulmonar puede estar asociada secundariamente a enfermedades del tejido conectivo. Entre estas enfermedades, predominan la esclerosis sistémica y la dermatomiositis juvenil. MATERIALES Y MÉTODOS: Se realizó un estudio retrospectivo, descriptivo y transversal. Se incluyeron todos los pacientes con diagnóstico de dermatomiositis juvenil y esclerosis sistémica que acudieron a nuestro hospital. Posteriormente se verificaron los niveles de presión arterial pulmonar mediante ecocardiografía. RESULTADOS: Se incluyeron 58 pacientes, de los cuales sólo 17 pacientes tuvieron ecocardiografía diagnóstica. Entre ellos, dos pacientes presentaron hipertensión arterial pulmonar. CONCLUSIÓN: La detección oportuna de la hipertensión arterial pulmonar en las enfermedades del tejido conectivo es esencial. Generalmente es asintomático. Es necesario adherirse al protocolo internacional que sugiere realizar ecocardiografía en todos los pacientes con dermatomiositis juvenil y esclerosis sistémica.

INTRODUCTION: Pulmonary arterial hypertension may be secondary associated with connective tissue diseases. Among these diseases, systemic sclerosis and juvenile dermatomyositis predominate. MATERIALS AND METHODS: A retrospective, descriptive and cross-sectional study was carried out. All patients with a diagnosis of juvenile dermatomyositis and systemic sclerosis who attended our hospital were included. Pulmonary arterial pressure levels were subsequently verified by echocardiography. RESULTS: 58 patients were included, of which only 17 patients had a diagnostic echocardiography. Among them, two patients presented pulmonary arterial hypertension. CONCLUSION: Timely detection of pulmonary arterial hypertension in connective tissue diseases is essential. It is generally asymptomatic. It is necessary to adhere to the international protocol that suggests performing echocardiography in all patients with juvenile dermatomyositis and systemic sclerosis.

Prevalence of maternal depressive symptoms in low-income Hispanic women.

BACKGROUND: Maternal depression can have significant repercussions for the health and well-being of mothers and children. In primarily white middle-income populations, approximately 15% of mothers experience depression. Among ethnically and socioeconomically diverse populations, the prevalence of maternal depression has not been as well established. However, the highest rates have been observed among low-income women. Because information about minority, underserved women is particularly sparse, we utilize data from the San Mateo County, California, Prenatal to Three project to describe the prevalence and self-recognition of depressive symptoms among low-income Hispanic mothers of infants and toddlers. METHOD: Telephone interviews of a random sample of women who received Medicaid and gave birth in San Mateo County provided our sample of 218 nonpregnant Hispanic mothers. High levels of depressive symptoms were defined as a score of > or =10 on the Edinburgh Postnatal Depression Scale (EPDS). We performed descriptive analyses and analyses of variance. RESULTS: Twenty-three percent of mothers reported high levels of depressive symptoms. Half of them recognized a need for help with depression. CONCLUSIONS: High levels of maternal depressive symptoms were prevalent among the Hispanic women on Medicaid, but only half of the women experiencing these symptoms identified themselves as needing help with depression.

Self-recognition of and provider response to maternal depressive symptoms in low-income Hispanic women.

BACKGROUND: One quarter of mothers of young children experience high levels of depressive symptoms, and only half are identified by themselves or their providers. Little is known about what factors influence maternal and provider recognition of depression. We use data from the San Mateo County, California, Prenatal to Three project to explore self-recognition, provider response, and referral among low-income Hispanic mothers of infants and toddlers. The goals are (1) to describe the patterns of self-recognition of maternal depression, maternal reporting of health professional response, and referrals for mental health services as related to depression severity and (2) to identify determinants of self-recognition, provider response, and mental health referrals. METHODS: Our sample consists of 218 nonpregnant Hispanic mothers in San Mateo County. Self-recognition was defined as an affirmative answer to the question, "Have you thought that you needed help with sadness or depression since your child was born?" High depressive symptoms were defined as a score of > or =10 on the Edinburgh Postnatal Depression Scale (EPDS). We performed chi-square and logistic regression analyses. RESULTS: Twenty-eight percent responded that they needed help with depression since the birth of their baby. Less than half discussed depressive feelings with their provider. Depression recognition factors differed between mothers and health professionals. CONCLUSIONS: Maternal depression is prevalent among Hispanic women on Medicaid but is not readily detected by women or providers. Women and providers use different cues to identify depression, possibly leading to communication discrepancies. Further research on the factors that influence self-recognition and provider recognition of maternal depression is needed.

Atención primaria en salud mental en el conflicto armado en Colombia / Primary mental health care in the armed conflict in Colombia / Cuidados primários de saúde mental no conflito armado na Colômbia

El presente artículo de reflexión no derivado de investigación tiene el propósito rastrear la evolución de la estrategia de atención\r\nprimaria en salud mental desde su aparición en Colombia en 1981 y su renacimiento con la Ley 1616 del 2011, así como identificar\r\nlos elementos y retos que convergen en ella en este momento histórico. El país se encuentra en un momento crucial de transformación\r\nsocial, cultural, política y asistencial debido a los acuerdos de paz; por esta razón, se resalta que la atención primaria en\r\nsalud mental puede tener un papel importante ante la necesidad de mejorar y fortalecer la asistencia sanitaria de los involucrados\r\nen el conflicto, así como en la reintegración a la vida social de los actores armados y los miembros militares de las fuerzas estatales.\r\nSe concluye que a pesar de los buenos resultados que ha tenido la aplicación de las diferentes leyes en torno a la salud mental,\r\nno se vislumbra en las negociaciones en el conflicto armado un espacio activo y consolidado para la atención primaria en salud\r\nmental para los involucrados en el conflicto armado, sean o no víctimas. También es necesario reestructurar los programas dirigidos\r\na la atención en salud mental para hacerlos más prácticos, accesibles y efectivos para las comunidades.

This article of reflection, not derived from research, aims to\r\ntrack the evolution of the strategy of primary care of mental\r\nhealth since its appearance in Colombia in 1981 and its revival\r\nwith the Act 1616 of 2011, as well as identify the elements and\r\nchallenges that converge in the mental health care at this\r\nhistorical moment. The country finds itself in a crucial moment\r\nof social, cultural, political and welfare transformation due to\r\nthe peace agreements; for this reason, it is highlighted that\r\nprimary mental health care can have an important role in the\r\nnecessity to better and strengthen healthcare of those involved\r\nin the conflict, as well as in the reintegration into social life of\r\nthe armed persons and military members of the state forces.\r\nIn conclusion, despite the good results that the application of\r\nthe various laws regarding mental health, there is no sign in\r\nthe negotiations in the armed conflict of an active and consolidated\r\nspace for primary mental health care for those involved\r\nin the armed conflict, whether or not they are victims. It is also\r\nnecessary to restructure the programs for primary mental\r\nhealth care to make them more practical, accessible and effective\r\nfor the communities.

O cuidado primário da saúde mental é uma estratégia interdisciplinar\r\ne baseada na comunidade que provou ser altamente\r\neficaz na assistência médica. Do mesmo modo, a Colômbia está\r\nem um momento crucial de mudança social e cultural, política\r\ne de bem-estar e transformação com os acordos de paz. Neste\r\nsentido, enfatiza-se que a atenção primária em saúde mental\r\npode desempenhar um papel importante na necessidade de\r\nmelhorar e fortalecer a assistência de saúde mental dos participantes\r\ndo conflito, bem como a reintegração na vida social\r\ndo ator armado e dos membros militares das forças do estado.\r\nEste artigo tem como objetivo acompanhar a evolução desta\r\nestratégia desde a sua aparição na Colômbia em 1981 e seu\r\navivamento com a lei 1616 de 2011, bem como identificar os\r\nelementos e desafios que convergem nos cuidados de saúde\r\nmental neste momento histórico da Colômbia. Em conclusão,\r\napesar dos bons resultados que a aplicação das diferentes leis\r\nem matéria de saúde mental teve, é evidente que as negociações\r\nno conflito armado não preveem uma participação ativa\r\ne consolidada dos cuidados de saúde mental primários para\r\ntodos participantes no conflito armado; sejam ou não vítimas,\r\ntambém é necessário reestruturar os programas em torno\r\ndos cuidados primários de saúde mental para torná-los mais\r\npráticos, acessíveis e eficazes para as comunidades.

A strength-based and early relationship approach to infant mental health assessment.

This paper presents a strength-based assessment process that focuses on infant emotional development within the family context. The assessment model, developed over the past five years within a preventive mental health program, represents a shift from deficit to strength-based principles that are consistent with appropriate developmental practice. The strength-based assessment process presented achieves an understanding of the infant's competencies and areas of need, and considers the negative impact that maternal mental illness has on the infant's emotional development.