The consensus of the Asociación Mexicana de Gastroenterología on the diagnosis and treatment of gastroesophageal reflux and gastroesophageal reflux disease in infants.

Gastroesophageal reflux (GER) is a frequent normal phenomenon in children of any age. It is more common in infants, in whom the majority of episodes are short-lived and cause no other symptoms or complications, differentiating it from gastroesophageal reflux disease (GERD). The diagnosis and management of GER and GERD continue to be a challenge for the physician. Therefore, the aim of the Asociación Mexicana de Gastroenterología was to adapt international documents to facilitate their adoption by primary care physicians, with the goal of standardizing quality of care and reducing the number of diagnostic tests performed and inappropriate medication use. The ADAPTE methodology was followed, and the recommendations were approved utilizing the Delphi strategy. The executive committee carried out the review of the guidelines, position papers, and international reviews that met the a priori quality criteria and possible applicability in a local context. The recommendations were taken from those sources and adapted, after which they were approved by the working group. The consensus consists of 25 statements and their supporting information on the diagnosis and treatment of GER and GERD in infants. The adapted document is the first systematic effort to provide an adequate consensus for use in Mexico, proposing a practical approach to and management of GER and GERD for healthcare providers.

Discontinuation of contact precautions with the introduction of universal daily chlorhexidine bathing.

Contact precautions are a traditional strategy to prevent transmission of methicillin-resistant Staphylococcus aureus (MRSA). Chlorhexidine bathing is increasingly used to decrease MRSA burden and transmission in intensive care units (ICUs). We sought to evaluate a hospital policy change from routine contact precautions for MRSA compared with universal chlorhexidine bathing, without contact precautions. We measured new MRSA acquisition in ICU patients and surveyed for MRSA environmental contamination in common areas and non-MRSA patient rooms before and after the policy change. During the baseline and chlorhexidine bathing periods, the number of patients (453 vs. 417), ICU days (1999 vs. 1703) and MRSA days/1000 ICU days (109 vs. 102) were similar. MRSA acquisition (2/453 vs. 2/457, P = 0·93) and environmental MRSA contamination (9/474 vs. 7/500, P = 0·53) were not significantly different between time periods. There were 58% fewer contact precaution days in the ICU during the chlorhexidine period (241/1993 vs. 102/1730, P < 0·01). We found no evidence that discontinuation of contact precautions for patients with MRSA in conjunction with adoption of daily chlorhexidine bathing in ICUs is associated with increased MRSA acquisition among ICU patients or increased MRSA contamination of ICU fomites. Although underpowered, our findings suggest this strategy, which has the potential to reduce costs and improve patient safety, should be assessed in similar but larger studies.

Mechanisms of Neuronal Silencing After Cortical Spreading Depression.

Cortical spreading depression (CSD) is associated with migraine, stroke, and traumatic brain injury, but its mechanisms remain poorly understood. One of the major features of CSD is an hour-long silencing of neuronal activity. Though this silencing has clear ramifications for CSD-associated disease, it has not been fully explained. We used in vivo whole-cell recordings to examine the effects of CSD on layer 2/3 pyramidal neurons in mouse somatosensory cortex and used in vitro recordings to examine their mechanism. We found that CSD caused a reduction in spontaneous synaptic activity and action potential (AP) firing that lasted over an hour. Both pre- and postsynaptic mechanisms contributed to this silencing. Reductions in frequency of postsynaptic potentials were due to a reduction in presynaptic transmitter release probability as well as reduced AP activity. Decreases in postsynaptic potential amplitude were due to an inhibitory shift in the ratio of excitatory and inhibitory postsynaptic currents. This inhibitory shift in turn contributed to the reduced frequency of APs. Thus, distinct but complementary mechanisms generate the long neuronal silence that follows CSD. These cellular changes could contribute to wider network dysfunction in CSD-associated disease, while the pre- and postsynaptic mechanisms offer separate targets for therapy.

Mechanisms of prion disease progression: a chemical reaction network approach.

Fatal neurodegenerative diseases such as bovine spongiform encephalopathy in cattle, scrapie in sheep and Creutzfeldt-Jakob disease in humans are caused by prions. Prion is a protein encoded by a normal cellular gene. The cellular form of the prion, namely PrP(C), is benign but can be converted into a disease-causing form (named scrapie), PrP(Sc), by a conformational change from -helix to -sheets. Prions replicate by this conformational change; that is, PrP(Sc) interacts with PrP(C) producing a new molecule of PrP(Sc). This kind of replication is modelled in this contribution as an autocatalytic process. The kinetic model accounts for two of the three epidemiological manifestations: sporadic and infectious. By assuming irreversibility of the PrP(Sc) replication and describing a first-order reaction for the degradation of cellular tissue, the authors explore dynamical scenarios for prion progression, such as oscillations and conditions for multiplicity of equilibria. Feinberg's chemical reaction network theory is exploited to identify multiple steady states and their associate kinetic constants.

Observations of an ion-driven instability in non-neutral plasmas confined on magnetic surfaces.

The first detailed experimental study of an instability driven by the presence of a finite ion fraction in an electron-rich non-neutral plasma confined on magnetic surfaces is presented. The instability has a poloidal mode number m=1, implying that the parallel force balance of the electron fluid is broken and that the instability involves rotation of the entire plasma, equivalent to ion-resonant instabilities in Penning traps and toroidal field traps. The mode appears when the ion density exceeds approximately 10% of the electron density. The measured frequency decreases with increasing magnetic field strength, and increases with increasing radial electric field, showing that the instability is linked to the E x B flow of the electron plasma. The frequency does not, however, scale exactly with E/B, and it depends on the ion species that is introduced, implying that the instability consists of interacting perturbations of ions and electrons.

Dynamical systems techniques reveal the sexual dimorphic nature of motor patterns in birdsong.

In this work we analyze the pressure motor patterns used by canaries (Serinus canaria) during song, both in the cases of males and testosterone treated females. We found a qualitative difference between them which was not obvious from the acoustical features of the uttered songs. We also show the diversity of patterns, both for males and females, to be consistent with a recently proposed model for the dynamics of the oscine respiratory system. The model not only allows us to reproduce qualitative features of the different pressure patterns, but also to account for all the diversity of pressure patterns found in females.

Respiratory patterns in oscine birds during normal respiration and song production.

In this work we study the generation of respiratory patterns by oscine birds. We present a model capable of generating realistic respiratory patterns, during normal respiration and song production. The model accounts for the interaction between neural nuclei and air sac dynamics. We performed experiments in vivo in order to test the predictions of the model, measuring air sac pressure during song and normal respiration in canaries (Serinus canaria).

Synthesizing bird song.

In this work we present an electronic syrinx: an analogical integrator of the equations describing a model for sound production by oscine birds. The model depends on time varying parameters with clear biological interpretation: the air sac pressure and the tension of ventral syringeal muscles. We test the hypothesis that these physiological parameters can be reconstructed from the song. In order to do so, we built two transducers. The input for these transducers is an acoustic signal. The first transducer generates an electric signal that we use to reconstruct the bronchial pressure. The second transducer allows us to reconstruct the syringeal tension (in both cases, for the time intervals where phonation takes place). By driving the electronic syrinx with the output of the transducers we generate synthetic song. Important qualitative features of the acoustic input signal are reproduced by the synthetic song. These devices are especially useful to carry out altered feedback experiences, and applications as biomimetic resources are discussed.

[Patterns of health care in an out patient rheumatologic clinic]. / La atención médica en reumatología en un hospital de segundo nivel de atención.

INTRODUCTION: Studies evaluating the pattern of diseases evaluated by rheumatology services are required to improve the planning of healthcare resource distribution. AIM: To describe the pattern of diseases motivating consultations in an outpatient clinic of a secondary care center in Guadalajara, Mexico. MATERIAL AND METHODS: A cross-sectional, descriptive study was performed. Data on the diseases evaluated in the rheumatology service and other healthcare indicators were obtained through a search of the hospital's computerized database. The number of initial and repeat consultations, their distribution by age and sex, the mean monthly number of prescriptions, and other indicators of performance were identified. RESULTS: There were 5,790 consultations in 1 year (26% were initial visits). The three most frequent diseases were: rheumatoid arthritis (47.1%, 95% CI 46-48%), systemic lupus erythematosus (12.7%, 95% CI 12-14%), and ankylosing spondylitis (7.7%, 95% CI 7-8%). Four women were attended for each man. Consultations were most frequent in the group aged 30-59 years old. The mean number of consultations per rheumatologist/month was 242, with a mean of 2.5 prescriptions per patient. The rate of compliance with appointments was 85%. A mean of 7.5 were diagnosed with temporary work disability for each rheumatologist/month. CONCLUSIONS: The most prevalent disorders in our outpatient rheumatology clinic were inflammatory joint diseases and systemic autoimmune diseases. These disorders required a high proportion of health-care resource. Further studies are required to evaluate the costs of these resources with the aim of establising better strategies for the health care needs in these patients.

Disinfection kinetics of pathogens in physicochemical sludge treated with ammonia.

Ammonia is a disinfectant which can diffuse through the membrane of highly resistant structures like helminth ova. Thus, it can be considered an alternative disinfectant of wastewater sludge with high pathogenic content. In this study, the kinetic parameters of the Hom model were used to describe the inactivation with ammonia of faecal coliforms, Salmonella spp. and viable helminth ova. These were obtained in processes considering the addition of ammonia alone as well as for ammonia combined with an increase in temperature. The sludge was sampled from a municipal wastewater treatment plant using an APT (Advanced Primary Treatment) or CEP (Chemical Enhanced Primary) process. With 20% w/w of ammonia, 7 logs of faecal coliforms, 6 logs of Salmonella spp., and 83% of viable helminth ova were reduced in 2 hours contact time. To eliminate 100% of the helminth ova from samples having 88-132 ova/g TS it was needed to combine 20% of ammonia with 50 degrees C. The analysis of parameters k, n and m indicate higher resistance to inactivation of helminth ova compared to bacteria and a better performance of the ammonia process than lime stabilization to inactivate microorganisms. In addition, ammonia increased the agricultural value of the biosolids produced.

Characterization and evaluation of potential reuse options for wastewater sludge and combined sewer system sediments in Mexico.

Combined sewer systems generate sediments that have characteristics similar to those of primary sludge. Mexico City has such a system composed of a network of pipes, regulation structures (dams, basins) and open channels. The annual generation of sediments is estimated at 2.8 Mm3, which includes 0.41 Mm3 of sludge. As a result, the total capacity for transporting water is reduced considerably, making it necessary to extract yearly an approximate 0.85 Mm3 of those materials and to send them to a final disposal site with a capacity that is being exhausted. As part of the local Governmental effort, this project evaluates the quality of sediments from 6 dams, 4 regulation basins, 2 open channels, and 3 transfer stations. Also, sludge from 20 wastewater treatment plants was sampled. The results showed an important presence of lead and hydrocarbons in some sediments, and some sludge samples contained arsenic and nickel above the limits. Moreover, microbial levels exceeded the limits in all the sediments and sludge samples. Erosion was linked to the generation of an important amount of sediments based on lead concentration. A classification was established to determine the degree of contamination of the sediments as well as the required treatment to allow their potential reuse.

Sustainable sludge management in developing countries.

Worldwide, unsanitary conditions are responsible for more than three million deaths annually. One of the reasons is the low level of sanitation in developing countries. Particularly, sludge from these regions has a high parasite concentration and low heavy metal content even though the available information is limited. Different issues needed to achieve a sustainable sludge management in developing nations are analysed. Based on this analysis some conclusions arise: sludge management plays an important role in sanitation programs by helping reduce health problems and associated risks; investments in sanitation should consider sludge management within the overall projects; the main restriction for reusing sludge is the high microbial concentration, which requires a science-based decision on the treatment process, while heavy metals are generally low; adequate sludge management needs the commitment of those sectors involved in the development and enforcement of the regulations as well as those that are directly related to its generation, treatment, reuse or disposal; current regulations have followed different approaches, based mainly on local conditions, but they favour sludge reuse to fight problems like soil degradation, reduced crop production, and the increased use of inorganic fertilizers. This paper summarises an overview of these issues.

Improved alkaline stabilization of municipal wastewater sludge.

In Mexico, physicochemical sludge contains high levels of pathogens; and alkaline stabilization is an alternative for their control. However, the odours caused mainly by ammonia generation represent a disadvantage. On the other hand, the ammonia is known as an effective disinfectant. The aim of this study was to evaluate the disinfectant properties of ammonia in sludge, and use it in a closed alkaline stabilization system, which, not only copes with odours but also increases the efficiency of the process. Raw sludge from a municipal wastewater treatment plant using a physicochemical process was used. Ammonia was applied in doses from 10 to 50% w/w; also, doses from 5 to 40% of CaO were applied in open and closed systems and raw and treated sludge quality was evaluated. Results showed that ammonia removed 6 and 5 logs of faecal coliforms and Salmonella spp., respectively and up to 94% of viable helminth ova. The closed system was more efficient than the open system when applying doses from 5 to 20% of CaO. Finally, the results indicate that the ammonia represents an alternative to disinfecting wastewater sludge and it can be used to enhance alkaline stabilization processes.

Dynamics of periodically forced semiconductor laser with optical feedback.

Recently it was proposed that semiconductor lasers with optical feedback present a regime where they behave as noise driven excitable units. In this work we report on an experimental study in which we periodically force one of these lasers and we compare the results with the solutions of a simple model. The comparison is based on a topological analysis of experimental and theoretical solutions.

[Multiple carpometacarpal dislocations. Five cases]. / Luxations carpo-métacarpiennes multiples. A propos de cinq cas.

The authors report 5 cases treated and reviewed in their centre, together with the clinical and radiological results. Multiple carpometacarpal dislocations of all of the triphalangeal fingers are rare lesions induced by high-energy trauma, in which the therapeutic strategy is controversial.