Arginine vasopressin regulates the renal Na+-Cl- and Na+-K+-Cl- cotransporters through with-no-lysine kinase 4 and inhibitor 1 phosphorylation.

Vasopressin regulates water homeostasis via the V2 receptor in the kidney at least in part through protein kinase A (PKA) activation. Vasopressin, through an unknown pathway, upregulates the activity and phosphorylation of Na+-Cl- cotransporter (NCC) and Na+-K+-2Cl- cotransporter 2 (NKCC2) by Ste20-related proline/alanine-rich kinase (SPAK) and oxidative stress-responsive kinase 1 (OSR1), which are regulated by the with-no-lysine kinase (WNK) family. Phosphorylation of WNK4 at PKA consensus motifs may be involved. Inhibitor 1 (I1), a protein phosphatase 1 (PP1) inhibitor, may also play a role. In human embryonic kidney (HEK)-293 cells, we assessed the phosphorylation of WNK4, SPAK, NCC, or NKCC2 in response to forskolin or desmopressin. WNK4 and cotransporter phosphorylation were studied in desmopressin-infused WNK4-/- mice and in tubule suspensions. In HEK-293 cells, only wild-type WNK4 but not WNK1, WNK3, or a WNK4 mutant lacking PKA phosphorylation motifs could upregulate SPAK or cotransporter phosphorylation in response to forskolin or desmopressin. I1 transfection maximized SPAK phosphorylation in response to forskolin in the presence of WNK4 but not of mutant WNK4 lacking PP1 regulation. We observed direct PP1 regulation of NKCC2 dephosphorylation but not of NCC or SPAK in the absence of WNK4. WNK4-/- mice with desmopressin treatment did not increase SPAK/OSR1, NCC, or NKCC2 phosphorylation. In stimulated tubule suspensions from WNK4-/- mice, upregulation of pNKCC2 was reduced, whereas upregulation of SPAK phosphorylation was absent. These findings suggest that WNK4 is a central node in which kinase and phosphatase signaling converge to connect cAMP signaling to the SPAK/OSR1-NCC/NKCC2 pathway.NEW & NOTEWORTHY With-no-lysine kinases regulate the phosphorylation and activity of the Na+-Cl- and Na+-K+-2Cl- cotransporters. This pathway is modulated by arginine vasopressin (AVP). However, the link between AVP and WNK signaling remains unknown. Here, we show that AVP activates WNK4 through increased phosphorylation at putative protein kinase A-regulated sites and decreases its dephosphorylation by protein phosphatase 1. This work increases our understanding of the signaling pathways mediating AVP actions in the kidney.

Growth performance, carcass, and meat quality traits of Tropical Milking criollo bulls fed with two energy-level diets.

The aim of this study was to determine the effect of two energy-level diets on the beef performance of Tropical Milking criollo bulls grouped by weight and age in three periods: initial, middle, and final. Evidence on intensive beef production from Tropical Milking criollo cattle breeds are unknown, and productive alternatives for dairy producers in the hot tropics are needed. Bulls were fed in each period with low (LE, 2.2 Mcal ME/kg DM) and high (HE, 2.9 Mcal ME/kg DM) energy diets and content phase feeding protein of 14.5, 12.0, and 10.3%, respectively. For each period, ten bulls were randomly assigned to diets. In all periods, growth performance for final body weight, average daily gain, feed intake, and feed conversion were all superior in HE (p ≤ 0.05). For the final period, slaughter body, hot and cold carcass weights, and dressing were also superior in HE (p ≤ 0.05); for meat quality traits, differences were observed in muscles Longissimus dorsi, Semimembranosus, Infraspinatus, and Serratus ventralis for pH and tenderness (p ≤ 0.05), although not for diets. For color L*, a*, and b* system, neither diet nor muscle had effect on L* (p > 0.05); however, the diet-muscle interaction was significant for a* (p ≤ 0.05), and only muscle effect was detected for b* (p ≤ 0.05). Tropical Milking bulls responded positively to a high-energy diet, despite not being a beef breed.

Effectiveness of a treatment guideline for schizophrenia in adolescents: Lessons from a middle-income country.

INTRODUCTION: Treatment guidelines for schizophrenia represent a standard way to manage patients, especially in countries with limited staff resources. However, they have not been compared on their efficacy with treatment as usual, despite adult studies suggesting they can be more effective. METHODS: Inpatient and outpatient adolescents with schizophrenia were randomly allocated to be either treated according to a guideline-based treatment ( n = 43) or treatment as usual ( n = 44). The effects on symptoms, psychosocial functioning and cognition were compared in a 6-month follow-up. RESULTS: There were no differences between groups in the pharmacological treatment, reduction in symptom severity or cognition. The guideline-based treatment group showed a better functioning at months 3 and 6. CONCLUSION: The guideline-based treatment had a greater effect than the treatment as usual in the psychosocial functioning of adolescent patients ( www.clinicaltrials.gov ; II3/02/0811).

Diet inclusion of devil fish (Plecostomus spp.) silage and its impacts on ruminal fermentation and growth performance of growing lambs in hot regions of Mexico.

The aim of this study was to evaluate the inclusion of devil fish (Plecostomus spp.-DF) silage in Criollo × Blackbelly lamb diets in hot region of Guerrero state of Mexico. Rumen fermentation including pH, volatile fatty acids (VFA) and ammonia-N (NH3-N) and productive variables including feed intake (FI), average daily gain (ADG), and feed conversion were determined. Twenty lambs with 18 ± 1.2 kg body weight in a completely randomized design were fed a total mixed ration (TMR) of concentrate (based on soybean meal, whole oat hay, ground corn cob, vitamins-minerals supplement) with DF silage at 0 % (DF0), 9 % (DF9), 18 % (DF18), and 27 % (DF27) of the TMR for 75 days. The ruminal pH showed no difference (P > 0.05) between treatments: ranging between 6.21 and 6.36. Propionic acid molar proportions showed an irregular pattern between experimental groups, which only differed (P < 0.05) between DF9 and DF27, without differences between the other treatments. A greater molar proportion of butyric acid was noted (P < 0.05) in DF27 when compared to the other treatments. The ruminal concentration of NH3-N showed some insignificant differences (P > 0.05) among treatments. The daily FI was increased (P < 0.01) in DF27 (1.131 g) when compared with DF0, while DF9 and DF18 showed intermediate consumption with no differences (P > 0.05) among them. The ADG showed only difference (cubic effect, P = 0.02) between DF9 and DF18. The highest feed conversion was observed (cubic effect, P < 0.01) with DF18, with a value of 4.7 kg of feed to gain 1 kg of body weight. It could be concluded that the inclusion of up to 18 % of DF silage in the TMR of growing lamb diets, in hot regions of Mexico, may improve productive performance and ruminal fermentation kinetics, without any negative effects.

Diagnostic Approach to Equine Testicular Disorders.

Management of breeding stallions is crucial to equine reproduction. The longevity of the breeding career is the ultimate objective, whether the stallion is used for natural cover or for semen collection and artificial insemination. Stud farm veterinarians should be aware of the techniques used to evaluate testicular function and the diagnostic approach to testicular disorders in cases of emergency. This paper presents the clinical methods used to evaluate testicular health, including palpation, ultrasonography, biopsy, and fine-needle aspiration. The discussion of testicular disorders is broken down into four categories: congenital disorders (cryptorchidism, monorchidism, and testicular hypoplasia), differential diagnosis of scrotal enlargement, differential diagnosis of causes of progressive testicular enlargement, and differential diagnosis of testicular asymmetry or reduction in size with an emphasis on testicular degeneration. The sudden increase in testicular size is often accompanied by severe clinical signs and is a major cause for referral of stallion for surgery. Testicular disorders are illustrated with clinical cases seen by the authors.

Clinical and Histological Features of Ovarian Hypoplasia/Dysgenesis in Alpacas.

Alpacas have a high incidence of congenital reproductive tract abnormalities, including ovarian hypoplasia/dysgenesis. Diagnosis of this condition is often challenging. The present study describes the clinical, ultrasonographic, and histologic features of ovarian hypoplasia/dysgenesis syndrome in 5 female alpacas. Additionally, serum AMH levels were compared between female alpacas diagnosed with ovarian hypoplasia/dysgenesis and a group of reproductively sound females (n = 11). The syndrome was suspected based on the presence of an infantile uterus and lack of ovaries by ultrasonography and laparoscopy. All females had normal female karyotype (n = 74 XX), but one presented a minute chromosome. The ovaries from these cases showed 3 main histological classifications: hypoplasia (n = 2), dysgenesis (n = 2), and dysplasia (n = 1). Serum AMH levels in affected females were significantly lower (P < 0.05) than those of reproductively sound control females. In conclusion, Serum AMH level may be helpful in the rapid diagnosis of ovarian hypoplasia/dysgenesis syndrome in alpacas. Furthermore, this syndrome in alpacas presents a variety of histological features. Different mechanisms may be involved in the derangement of ovarian differentiation. Further studies are needed to elucidate the causes of the syndrome.

The genetic legacy of religious diversity and intolerance: paternal lineages of Christians, Jews, and Muslims in the Iberian Peninsula.

Most studies of European genetic diversity have focused on large-scale variation and interpretations based on events in prehistory, but migrations and invasions in historical times could also have had profound effects on the genetic landscape. The Iberian Peninsula provides a suitable region for examination of the demographic impact of such recent events, because its complex recent history has involved the long-term residence of two very different populations with distinct geographical origins and their own particular cultural and religious characteristics-North African Muslims and Sephardic Jews. To address this issue, we analyzed Y chromosome haplotypes, which provide the necessary phylogeographic resolution, in 1140 males from the Iberian Peninsula and Balearic Islands. Admixture analysis based on binary and Y-STR haplotypes indicates a high mean proportion of ancestry from North African (10.6%) and Sephardic Jewish (19.8%) sources. Despite alternative possible sources for lineages ascribed a Sephardic Jewish origin, these proportions attest to a high level of religious conversion (whether voluntary or enforced), driven by historical episodes of social and religious intolerance, that ultimately led to the integration of descendants. In agreement with the historical record, analysis of haplotype sharing and diversity within specific haplogroups suggests that the Sephardic Jewish component is the more ancient. The geographical distribution of North African ancestry in the peninsula does not reflect the initial colonization and subsequent withdrawal and is likely to result from later enforced population movement-more marked in some regions than in others-plus the effects of genetic drift.

Identifying genetic traces of historical expansions: Phoenician footprints in the Mediterranean.

The Phoenicians were the dominant traders in the Mediterranean Sea two thousand to three thousand years ago and expanded from their homeland in the Levant to establish colonies and trading posts throughout the Mediterranean, but then they disappeared from history. We wished to identify their male genetic traces in modern populations. Therefore, we chose Phoenician-influenced sites on the basis of well-documented historical records and collected new Y-chromosomal data from 1330 men from six such sites, as well as comparative data from the literature. We then developed an analytical strategy to distinguish between lineages specifically associated with the Phoenicians and those spread by geographically similar but historically distinct events, such as the Neolithic, Greek, and Jewish expansions. This involved comparing historically documented Phoenician sites with neighboring non-Phoenician sites for the identification of weak but systematic signatures shared by the Phoenician sites that could not readily be explained by chance or by other expansions. From these comparisons, we found that haplogroup J2, in general, and six Y-STR haplotypes, in particular, exhibited a Phoenician signature that contributed > 6% to the modern Phoenician-influenced populations examined. Our methodology can be applied to any historically documented expansion in which contact and noncontact sites can be identified.

First case of detection of Plasmodium knowlesi in Spain by Real Time PCR in a traveller from Southeast Asia.

Previously, Plasmodium knowlesi was not considered as a species of Plasmodium that could cause malaria in human beings, as it is parasite of long-tailed (Macaca fascicularis) and pig-tailed (Macaca nemestrina) macaques found in Southeast Asia. A case of infection by P. knowlesi is described in a Spanish traveller, who came back to Spain with daily fever after his last overseas travel, which was a six-month holiday in forested areas of Southeast Asia between 2008 and 2009. His P. knowlesi infection was detected by multiplex Real time quantitative PCR and confirmed by sequencing the amplified fragment. Using nested multiplex malaria PCR (reference method in Spain) and a rapid diagnostic test, the P. knowlesi infection was negative. This patient was discharged and asymptomatic when the positive result to P. knowlesi was reported. Prior to this case, there have been two more reports of European travellers with malaria caused by P. knowlesi, a Finnish man who travelled to Peninsular Malaysia during four weeks in March 2007, and a Swedish man who did a short visit to Malaysian Borneo in October 2006. Taken together with this report of P. knowlesi infection in a Spanish traveller returning from Southeast Asia, this is the third case of P. knowlesi infection in Europe, indicating that this simian parasite can infect visitors to endemic areas in Southeast Asia. This last European case is quite surprising, given that it is an untreated-symptomatic P. knowlesi in human, in contrast to what is currently known about P. knowlesi infection. Most previous reports of human P. knowlesi malaria infections were in adults, often with symptoms and relatively high parasite densities, up to the recent report in Ninh Thuan province, located in the southern part of central Vietnam, inhabited mainly by the Ra-glai ethnic minority, in which all P. knowlesi infections were asymptomatic, co-infected with P. malariae, with low parasite densities and two of the three identified cases were very young children under five years old.

Mitochondrial DNA error prophylaxis: assessing the causes of errors in the GEP'02-03 proficiency testing trial.

We report the results of the Spanish and Portuguese working group (GEP) of the International Society for Forensic Genetics (ISFG) Collaborative Exercise 2002-2003 on mitochondrial DNA (mtDNA) analysis. Six different samples were submitted to the participating laboratories: four blood stains (M1-M2-M3-M4), one mixture blood sample (M5), and two hair shaft fragments (M6). Most of the labs reported consensus results for the blood stains, slightly improving the results of previous collaborative exercises. Although hair shaft analysis is still carried out by a small number of laboratories, this analysis yielded a high rate of success. On the contrary, the analysis of the mixture blood stain (M5) yielded a lower rate of success; in spite of this, the whole results on M5 typing demonstrated the suitability of mtDNA analysis in mixture samples. We have found that edition errors are among the most common mistakes reported by the different labs. In addition, we have detected contamination events as well as other minor problems, i.e. lack of standarization in nomenclature for punctual and length heteroplasmies, and indels. In the present edition of the GEP-ISFG exercise we have paid special attention to the visual phylogenetic inspection for detecting common sequencing errors.

High resolution Y chromosome typing: 19 STRs amplified in three multiplex reactions.

Nineteen Y-specific short tandem repeat (STR) loci have been amplified in 768 samples from the Iberian Peninsula in order to evaluate their usefulness in forensic casework. Two previously published multiplex reactions by Thomas et al. [Hum. Genet. 6 (1999) 577] (MS1, modified here: DYS19, DYS388, DYS390, DYS391, DYS392 and DYS393) and by Ayub et al. [Nucl. Acids Res. 28 (2000) e8] (CTS: DYS434, DYS435, DYS436, DYS437, DYS438 and DYS439) plus a novel one reported here (EBF: DYS385, DYS389, DYS460, DYS461, DYS462 and amelogenin) have been used. DYS385, DYS439 and DYS391 were the most informative loci with allele diversities of 0.7997, 0.6683 and 0.5940, respectively. A total of 635 different haplotypes were observed, of which 573 (90.24%) were found in single individuals. The overall haplotype diversity was 0.9988 and that obtained by each multiplex system was 0.9812 for EBF, 0.9292 for MS1 and 0.9089 for CTS.

Results of the 1999-2000 collaborative exercise and proficiency testing program on mitochondrial DNA of the GEP-ISFG: an inter-laboratory study of the observed variability in the heteroplasmy level of hair from the same donor.

The Spanish and Portuguese working group (GEP) of international society for forensic genetics (ISFG) 1999-2000 collaborative exercise on mitochondrial DNA (mtDNA) included the analysis of four bloodstain samples and one hair shaft sample by 19 participating laboratories from Spain, Portugal and several Latin-American countries. A wide range of sequence results at position 16,093 of the HV1 (from T or C homoplasmy to different levels of heteroplasmy) were submitted by the different participating laboratories from the hair shaft sample during the first phase of this exercise. During the discussion of these results in the Annual GEP-ISFG 2000 Conference a second phase of this exercise was established with two main objectives: (i) to evaluate the incidence of the HV1 sequence heteroplasmy detected in Phase I across different sample types from the same donor including blood, saliva, and hair shafts, (ii) to perform a technical review of the electropherograms to evaluate the relative levels of heteroplasmies obtained by the different laboratories and also to examine the source of possible errors detected in Phase I. Anonymous review of the raw sequence data permitted the detection of three transcription errors and three errors due to methodological problems. Highly variable levels of heteroplasmy were found in the hair shaft and more stability in blood and saliva. Three laboratories found variable levels of heteroplasmy at position 16,093 across adjacent fragments from the same hair shaft. Two laboratories also described more than one heteroplasmic position from a single hair. The relevance of these findings for the interpretation of mtDNA data in the forensic context is also discussed.

Aspectos quirúrgicos en deformidades congénitas de la columna vertebral: clínico y radiológico / Surgical aspects in congenital spinal deformities: clinical and radiological

El tratamiento quirúrgico de las deformidades congénitas de la columna vertebral ha evolucionado en los últimos años desde fusiones in situ, hemiepifisiodesis hasta hemivertebrectomía y sustracción pedicular. En la actualidad no hay concenso cual es el procedimiento idóneo. Objetivo: Determinar la eficacia y utilidad de la Hemivertebrectomía y Sustracción Pedicular de los pacientes con Escoliosis Congénita y Cifoescoliosis. Métodos: se estudiaron 18 pacientes intervenidos en el período de enero 2013- diciembre del 2014, en un análisis estadístico retrospectivo. En 12 (66%) pacientes se realizó hemivertebrectomía y a 6 (33%) pacientes sustracción pedicular. Se evaluó edad, sexo, tipo de defecto, grado de corrección, niveles de resección y fusión, evolución neurológica, pérdida de sangre, tiempo quirúrgico y complicaciones. Resultados: se observó un ángulo de Cobb preoperatorio de 46º con escoliosis y 8 casos con ángulo de cifosis de 75º. Los porcentajes de corrección promedio de la escoliosis y la cifosis fueron 59 y 60% respectivamente, y el ángulo en el postoperatorio fue de 23º y 45º. La resección de la hemivertebra fue en un nivel (75%), dos niveles (33%). Se presentaron complicaciones en 8 pacientes, fístula de LCR, infección de la herida, pseudoartrosis, con pérdida de sangre de 528 ml, tiempo quirúrgico de 8 horas, y fusión 70%. Conclusiones: la hemivertebrectomía y la sustracción pedicular, constituyen una alternativa que permiten la corrección de la deformidad y estabilidad de la columna(AU)

Surgical treatment of congenital deformities of the spine has evolved in recent years from mergers in situ, hemiepiphysiodesis to hemivertebrectomy and pedicle subtraction. At present there is no consensus on the appropriate procedure. Objective: To determine the effectiveness and usefulness of the Hemivertebrectomía and Subtraction Pedicular of patients with congenital scoliosis and Kyphoscoliosis. Methods: in a retrospective statistical analysis 18 patients treated in the period January 2013-December 2014, were studied. In 12 (66%) patients a hemivertebrectomy was performed and a pedicle subtraction was performed on the other 6 (33%) patients. Age, sex, type of defect, degree of correction, resection and fusion levels, neurologic outcome, blood loss, operative time and complications were evaluated. Results: The preoperative Cobb angle of 46º with scoliosis and 8 cases with kyphosis angle of 75 ° were observed. The percentages of average correction of scoliosis and kyphosis were 59% and 60% respectively, and the postoperatively angle was 23º and 45º. Hemivertebra resection was on a level (75%); two levels (33%). There were complications in 8 patients, fistula LCR, wound infection, nonunion, with blood loss of 528 ml, operating time of 8 hours, and 70% merger. Conclusions: hemivertebrectomy pedicle subtraction are an alternative that allows the correction of the deformity and column stability(AU)

Algoritmo del tratamiento para el trastorno por déficit de atención con hiperactividad en niños y adolescentes

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Summary The diagnostic criteria for the Attention Deficit Hyperactivity Disorder (ADHD) have been changing according to international classifications. It is currently included in the ICD-10 as an hyperkinetic disorder and in the DSM-IV as a disorder having its onset during childhood and adolescence. The reported prevalence for ADHD is between 3% and 6%; up to 60% of the patients remain symptomatic through adolescence and adulthood. Population-based surveys of physicians who treat children and adolescents reveal that the rate and the proportion of office visits associated with ADHD are high and have increased over the past decade. This fact points to the need of elaborating clinical guidelines for the treatment of this disorder. Evidence from controlled clinical trials confirms the superiority of medication management for ADHD over behavioral therapy and the combination of medication and behavioral treatment. Stimulants are the most studied drugs for ADHD and constitute the first treatment of choice. Methylphenidate (MPH) is the only stimulant available in Mexico. Its mechanism of action is based on the blocking of the dopamine reuptake, which increases the availability of this neurotransmitter in the synaptic cleft. Based on the dopaminergic theories of ADHD, dopamine genes have been the initial candidates for molecular studies regarding response to MPH. Variations of the dopamine D4 receptor gene (DRD4) and the dopamine transporter gene (DAT1) have been related with the response to MPH. The short half life of this drug (less than three hours) supports the shift from once-a-day to twice-a-day or thrice-a-day dosing. The Osmotic Release Oral System (OROS) of MPH allows to maintain therapeutic plasmatic doses with once-a-day dose. Its efficacy and tolerability have been shown in clinical trials. Regarding the long-term effects of MPH, this drug has demonstrated efficacy in a two-year follow-up controlled study. In addition, animal models have shown that the chronic exposure to MPH during developmental periods produces changes in the function of brain dopaminergic cells, as well as changes in behavior. The association between MPH and substance abuse has also been explored. The pharmacokinetic and pharmacodinamic differences between MPH and cocaine, which also acts by blocking the dopamine transporter, were examined: When administered intravenously, MPH, like cocaine, has a reinforcing effects at doses that exceed a 60% dopamine transporter blockade threshold. When administered orally at clinical doses, the pharmacological effects of MPH also exceed this threshold, but reinforcing effects rarely occur. So, the pharmacokinetic properties of MPH in brain differ for oral and intravenous routes of administration, suggesting that the oral administration of MPH mimics the tonic dopamine cell firing, which may be a critical factor associated with clinical effects. In addition, therapeutic doses of MPH do not act at the nucleus accumbens, a brain structure highly associated with reinforcing. These data suggest that oral administration of MPH does not lead to abuse. Follow-up studies have also shown that stimulant therapy is not associated with increased risk of substance abuse. Since 30% of the patients do not respond to stimulant treatment, the efficacy and safety of other drugs have been evaluated. Among them, tricyclic antidepressants (TCAs) are considered a good choice for the management of ADHD and conduct disorders. Their half life is longer than that of MPH, which allows a once-a-day or twice-a-day dosing. It has also been described that TCAs are effective for the treatment of comorbid tics. The main disadvantage of these drugs is their effect on cardiac conduction, which has been associated with sudden death. Bupropion is another antidepressant having an effect on dopamine activity. It has shown efficacy for the treatment of ADHD in children, adolescents, and adults, particularly in patients with nicotine dependence, patients with comorbid conduct disorder, or depression. Bupropion is available in a extended-release, once-daily formulation (XL). The main side effects of this antidepressant are the increased risk of seizure development, rash and mild elevation of blood pressure. This drug is not recommended for the treatment of patients with comorbid eating disorders. Venlafaxine (a serotonin and norepinephrine reuptake inhibitor) and reboxetine (a norepinephrine reuptake inhibitor) are recently introduced antidepressants which have shown efficacy in open label trials on patients with and without comorbid depressive disorder. Atomoxetine is another non-stimulant medication; its main mechanism of action is the inhibition or the reuptake of norepinephrine. Several clinical trials have shown its efficacy for the treatment of ADHD in children, adolescents and adults. This drug can also be administered in a single dose; in addition, it has a low potential for cardiotoxicity and a reduction of tic frequency and severity has been reported with its use. It is also recommended for the ADHD comorbid with anxiety or depression. Nausea and decreased appetite are the most common side effects of atomoxetine. Modafinil is another non-stimulant drug which was initially described for the treatment of narcolepsy. This drug increases the dopamine and norepinephrine activity through its direct effect on glutamate and GABA, among other neuromodulators. Some clinical trials have shown its superiority over placebo on ADHD symptoms. The main side effects of modafinil are gastrointestinal distress and insomnia. Clonidine and risperidone are drugs considered as second treatment of choice or adjunctive treatments for patients with comorbidity. Although medication is the first treatment of choice, patients often get benefits from psychosocial interventions, particularly parent training in contingency management methods and classroom applications of contingency management techniques. The value of these measurements lies in the temporary reduction of symptom levels and/or in the reduction of related behavioral and emotional difficulties, such as defiance and conduct problems, depression, low self-esteem, or academic underachievement. Parents' training focus on general contingency management tactics, such as contingent application of reinforcement or punishment following appropriate/inappropriate behaviors. Reinforcement procedures have typically relied on praise or tokens, while punishment methods have usually been the loss of tokens or time-out from reinforcement. The classroom management include a continuous communication with teachers, in order to maintain them informed about the illness and its treatment, as well as training on contingency management tactics. The aforementioned information was used in the elaboration of clinical guidelines for the treatment of youngsters with ADHD, either alone or comorbid with internalizing or externalizing disorders. Another guideline for the management of preschool children with ADHD is included. Psychoeducation follows the assessment of the children in each case. The pharmacological treatment recommendations give priority to monotherapy. Stimulants are the first treatment of choice in each guideline. The use of non-stimulant medications as second choice will depend on the age and comorbidity of patients.

Evaluación de las aplicaciones locales de una solución limpiadora suave con Dinafitol de Bardana y pH8: estudio realizado en consulta privada / Evaluation of the local application of a mild cleansing solution: study carried out in private consultation

Estudio realizado en consulta privada de los 17 médicos participantes, en 150 pacientes con vulvovaginitis, de los que se reportan 148 casos provenientes de tres principales ciudades del Ecuador (Guayaquil, Quito y Cuenca).Tipo de estudio: Abierto, multicéntrico, no comparativo.Objetivo: Evaluar la eficacia y tolerancia de una solución limpiadora suave con contenido de Bardana, en el período previo al tratamiento específico, como ayuda en el control del prurito y eritema presentes en las vulvovaginitis.Material y método: Se utilizó una solución limpiadora suave con contenido de Dinafitoles de Bardana y nivel de pH 8. Fueron reclutadas 150 pacientes de acuerdo a los criterios de inclusión, no inclusión y exclusión. La sintomatología fue evaluada al inicio y al final del estudio. Se recomendó el uso del producto en higiene local dos veces al día por siete días mientras se esperaba el resultado del examen cito bacteriológico vaginal.Resultados:•98.0% de mejoría y desaparición del prurito.•96.5% de mejoría y desaparición del eritema.En cuanto a la tolerancia al producto utilizado, el 95.3% reportó la calificación de “buena”.Conclusión: Se logró demostrar la utilidad de la solución limpiadora suave con pH8 y contenido de Dinafitol de Bardana, concluyendo que su utilización está justificada en los casos de vulvovaginitis y que, gracias a la tolerancia y aceptación de las pacientes se puede recomendar también su uso cotidiano en la higiene íntima y corporal. Por los resultados obtenidos, podemos considerar el uso de esta solución limpiadora como de primera elección en el manejo de las patologías relacionadas con el prurito y eritema y como un excelente coadyuvante en el tratamiento etiológico de las vulvovaginitis en las que con frecuencia advertimos la presencia de esta sintomatología.

Study carried out in the private consultation of 17 doctors selected to participate in the study that included 150 patients with vulvovaginitis, of which 148 cases are reported from in the three main cities of the Ecuador, (Guayaquil, Quito and Cuenca). Type of study: Open, multicentral, not comparative. Objective: To evaluate the effectiveness and tolerance of a mild cleansing solution, containing Bardana, during the period prior to a specific treatment, in order to help the control of pruritus and erythema present in the vulvovaginitis. Material and method: A mild cleansing solution with a pH level 8 was used. 150 patients were recruited according to the inclusion and exclusion criteria of the study. The symptoms were evaluated at the beginning and at the end of the study. The use of the product was recommended twice a day for seven days while expecting the results of the bacteriological vaginal exam.Results:•98.0% of improvement and disappearance of pruritus.•96.5% of improvement and disappearance of erythema. As for the tolerance to the use of product, 95.3% of the patients reported it as “good”. Conclusion: It was possible to demonstrate the how important is the use of the mild cleansing solution with a pH 8. We conclude that its use is justified in the case of vulvovaginitis and that thanks to its tolerance and the patients' acceptance, it may also be recommended to be used daily in the intimate and corporal hygiene. With the reported results, one can consider the use of this mild cleansing solution as the first election in the handling of pathologies related with pruritus and erythema and as an excellent help for etiological treatment of the vulvovaginitis in those that frequently notice the presence of this symptoms.

Adenoma monomórfico de glándulas salivares menores en paladar duro: presentación de un caso y revisión de la literatura / Salivary gland monomorphic adenoma minors in hard palate: presentation of case and review of literature

Los tumores de glándulas salivares representan el 3 por ciento de las neoplasias de cabeza y cuello, de éstos, el 85 por ciento corresponden a la glándula parótida y el 15 por ciento al resto de las glándulas salivares. De los tumores de glándulas salivares. el Adenoma Monomórfico constituye menos del 2 por ciento y se caracteriza histológicamente por presentar una marcada eosinofilia, con tejido hialino alrededor de los vasos sanguíneos, islotes de epitelio, y abundantes células picnóticas, esta entidad tumoral benigna tiene predilección por glándulas salivares mayores (80 por ciento se originan en parótida) y si se originan en glándulas salivares menores tiene preferencia por el labio superior. En este trabajo presentamos un caso de Adenoma Momomórfico de glándulas salivares menores en paladar duro, encontrado en un paciente masculino de 44 años de edad, con historia de hemialgia facial de 14 años de evolución.

¿El Pandas es un subtipo de trastorno obsesivo compulsivo de los niños? / Is Pandas a subtype of obsessive-compulsive disorder in children?

La prevalencia del trastorno obsesivo compulsivo (TOC) en la población clínica de niños y adolescentes es de 0.2 por ciento a 5 por ciento. Aunque el TOC de los niños comparte algunas características, como la severidad y la respuesta al tratamiento, con el trastorno de los adultos, su etiología y su fisiopatología no están bien establecidas. El acrónimo PANDAS agrupa a las entidades neurológicas y psiquiátricas (el TOC y el síndrome de Tourette) que se presentan como una reacción autoinmune posterior a la infección por estreptococo. La principal característica de este grupo de enfermedades es que los pacientes presentan inicio o exacerbación de sus síntomas en forma abrupta, cuya duración coincide con la aparición de una infección por estreptococo.Los síntomas comórbidos (ansiedad, hiperactividad, trastornos de la conducta)también se presentan en forma abrupta y desaparecen al resolverse la infección. Para evaluar a estos pacientes se requiere determinar si presentan otros síntomas psiquiátricos, y descartar la presencia de enfermedades físicas concomitantes, y hacerles un examen físico completo. La determinación de antiestreptolisinas y el anticuerpo monoclonal, llamado D8/17, son de utilidad para hacer el diagnóstico. Los pacientes con PANDAS responden poco a los tratamientos tradicionalmente utilizados en el TOC. La inmunoterapia (plasmaféresis y aplicación de inmunoglobulina) parece ser una buena opción para controlar los síntomas.

Fusión lumbar: status funcional postoperatorio / Lumbar cualition: postoperatorio functional status

Fueron estudiados 60 pacientes intervenidos quirúrgicamente de la columna vertebral lumbar. La cirugía primaria y en algunos casos de revisión, fueron durante el período 1988-1998. El seguimiento promedio del estudio fue de 10 años. La espondilosis lumbar junto a la enfermedad degenerativa discal representaron los más frecuentes diagnósticos pre-operatorio. El procedimiento quirúrgico consistió en la artrodesis de los segmentos involucrados, a través de un abordaje posterior convencional de la columna lumbar. Se analizó el estatus funcional postoperatorio del paciente y su relación con distintas variables como: sexo, edad, diagnóstico, ocupación, compensación laboral y tipo de cirugía. Se concluye en el trabajo que el 100 por ciento de los pacientes mostraron distintos grados de mejoría clínica, sin importar el método escogido de fusión intervertebral lumbar