Ultrasonographic description of brain cortex and cingulate sulcus development in Mexican neonates and infants with congenital hypothyroidism.

BACKGROUND: Ultrasonography of cortical and cingulum maturity patterns, were studied in newborns and infants with congenital hypothyroidism (CH). METHOD: Transversal study of 29 newborns and infants with CH, detected by neonatal screening and confirmed with thyroid function test, thyroid ultrasonography, and thyroid scintigraphy. During the first 2 months of life, transfontanelar brain ultrasonography was performed. Brain cortex maturity was assessed by normality referents provided by Slagle and Timor methods. RESULTS: Cortical immaturity signs were observed in 69% of infants (20 patients with Slage's method brain cortex development delay (Pearson's p=0.05). Logistic nominal analysis for normality prediction demonstrated a correlation between brain cortex development and age, bone age, treatment duration, and type of CH. The most sensitive detecting technique was sagittal sight by Slagle's method. CONCLUSIONS: Brain cortex delayed development is frequent in children with CH. Bone age, postnatal age at treatment start, and time since treatment start, correlates with neurological development, but not athyreosis or sublingual nodule.

[Perinatal encephalopathy sequelae identified by a neurobehavioral scale in one year old infants]. / Secuelas de encefalopatía perinatal identificadas con una escala de desarrollo neuroconductual.

OBJECTIVE: to identify neurodevelopmental sequelae in one year old infants with perinatal encephalopathy utilizing the neurobehavioral scale named Vanedela. METHODS: a cohort of 75 newborns with perinatal encephalopathy was assessed with a neurobehavioral follow-up scale at age of 1, 4, 8 and 12 months. A distinction was made between functional, structural and combined encephalopathy. Two groups of neurodevelopmental outcome at one year were identified: with or without sequelae. Nonparametric statistics was used. RESULTS: infants with functional encephalopathy had the best scores, followed by those with structural encephalopathy, while infants with a combined encephalopathy had the lowest scores. At one year of age, the group with neurobehavioral sequelae exhibited the lowest scores and retarded growth. At the same age, the group with functional encephalopathy exhibited no neurobehavioral sequelae, and reached better scores and growth. CONCLUSIONS: the neurobehavioral follow-up scale is able to identify the neurodevelopmental sequelae at the age of one year in infants with perinatal encephalopathy. The application of Vanedela in the clinical field requires of little time, its results are trustworthy and very useful for the neurobehavioral follow-up assessment.

Membrane of Plasma Rich in Growth Factors in Primary Pterygium Surgery Compared to Amniotic Membrane Transplantation and Conjunctival Autograft.

This prospective and comparative study aimed to compare the use of a conjunctival autograft (CAG), plasma rich in growth factors fibrin membrane (mPRGF) or amniotic membrane transplantation (AMT) in primary pterygium surgery. Patients were assigned for surgery with CAG (group A), mPRGF (group B), or AMT (group C). Pterygium recurrence, Best Corrected Visual Acuity (BCVA), graft size (measured with anterior segment optical coherence tomography (AS-OCT)), and ocular surface symptoms (visual analogue scale (VAS) and ocular surface disease index (OSDI)) were evaluated. Thirteen eyes in group A, 26 in group B, and 10 in group C were evaluated. No changes in BCVA (p > 0.05) were found. Recurrence cases for groups A, B, and C were none, two, and two, respectively, and three cases of pyogenic granulomas in group A. The horizontal/vertical graft size was lower in group B vs group A (p < 0.05) from months 1 to 12. The improvement in VAS frequency for groups A, B, and C was: 35.5%, 86.2%, and 39.1%, respectively. The OSDI scale reduction for groups A, B, and C was: 12.7%, 39.0%, and 84.1%. The use of the three surgical techniques as a graft for primary pterygium surgery was safe and effective, showing similar results. The mPRGF graft represents an autologous novel approach for pterygium surgery.

Colchicine in Recently Hospitalized Patients with COVID-19: A Randomized Controlled Trial (COL-COVID).

BACKGROUND: Colchicine has been proposed as a potential therapy in coronavirus disease 2019 (COVID-19) due to their anti-inflammatory actions. METHODS: The COL-COVID study was a prospective, randomized, controlled and open-label clinical trial that compared colchicine added to standard treatment vs standard treatment in hospitalized COVID-19 patients that do not need mechanical ventilatory support. Colchicine was initiated within the first 48 hours of admission at a 1.5 mg loading dose, followed by 0.5 mg b.i.d. for one week and 0.5 mg per day for 28 days. The study endpoints were clinical status (7-points WHO ordinal scale) and inflammatory biomarkers (IL-6 and CRP). RESULTS: A total of 103 patients (51±12 years, 52% male) were randomly allocated to colchicine arm (n=52) and control arm (n=51). At day 28, all patients in the colchicine group were alive and discharged, whereas in the control group, two patients died in-hospital and one patient remained hospitalized. Clinical improvement in terms of changes on WHO scale at day 14 and 28 and time to 1-point clinical improvement did not differ between the two groups. Clinical deterioration (increase of at least 1-point in WHO scale) was observed in a higher proportion of cases in colchicine group (13.8%) vs control group (5.8%) (p=0.303); after adjustment by baseline risk factors and concomitant therapies, colchicine therapy was associated with a lower risk of clinical deterioration (p=0.030). Inflammatory biomarkers CRP and IL-6 concentrations course did not differ between the two arms. CONCLUSION: In hospitalized COVID-19 patients, colchicine treatment neither improved the clinical status, nor the inflammatory response, over the standard treatment. Nevertheless, a preventive effect for further clinical deterioration might be possible. TRIAL REGISTRATION: NCT04350320.

Validity and reliability of the Neurobehavioral Evaluation of Infant Development (VANEDELA). Screening Instrument from one to 24 months in primary health care in Mexico / Validez y confiabilidad del instrumento de tamizaje Valoración Neuroconductual del Desarrollo del Lactante (VANEDELA) de uno a 24 meses en el primer nivel de atención en México

Abstract: Introduction: Early identification of developmental delays or disabilities in children is a challenge and a global concern. In Mexico, the prevalence of childhood disability is 6%, and it is estimated that 25% of the unattended delays will have consequences on their potential. VANEDELA is a rapid screening test to detect and prevent developmental disorders in primary health care. Objective: To determine the external validity and test-retest reliability of the behavioral (DB) and reflex (DR) developmental formats of the VANEDELA screening test, compared with the diagnostic test of Gesell's Developmental Schedule Test. Method: Descriptive, transversal, and prospective study in 379 infants aged one to 24 months attending the Neurodevelopment Monitoring Laboratory / INP and the ISSSTE Tlalpan Family Medicine Clinic from 2011 to 2014. Measurements: A set of four aspects was evaluated including validity by external criteria: sensitivity, specificity, positive-negative predictive criteria, and test-retest reliability. Results: In the DB format, we found a 79% - 89% sensitivity (S) and a 83% - 95% specificity (Sp). In the DR format, a 18% - 35% sensitivity and a 81% - 96% specificity were found. Using both DB-DR formats, we found a 82% - 89% sensitivity and 72% to 91% specificity, and a test-retest reliability .62-1. Discussion and conclusion: The VANEDELA increased its validity parameters with respect to the previous assessment with adequate stability. The DB formats and the DB-DR combination of VANEDELA have an adequate validity based on external criteria, making them suitable for use in primary health care.

Resumen: Introducción: La identificación temprana de retrasos o discapacidades del desarrollo en los niños es un reto y una preocupación mundial. En México, la prevalencia de discapacidad infantil es del 6% y se estima que un 25% de los retrasos no atendidos tendrán consecuencias en su potencial alcanzado. El VANEDELA es una prueba de tamizaje rápido para detectar y prevenir alteraciones del desarrollo en el primer nivel de atención. Objetivo: Determinar la validez (criterio externo) y confiabilidad (test-retest) de los formatos de conductas (CD) y reacciones del desarrollo (RD) de la prueba de tamizaje VANEDELA, contrastado con la Prueba Diagnóstica de Desarrollo de Gesell. Método: Estudio descriptivo, transversal y prospectivo en 379 lactantes de uno a 24 meses que asistieron al Laboratorio de Seguimiento del Neurodesarrollo del INP y la Clínica de Medicina Familiar Tlalpan del ISSSTE de 2011 a 2012. Mediciones: Validez por criterio externo, sensibilidad y especificidad, validez predictiva positiva y negativa; confiabilidad test-retest (intervalo de siete días). Resultados: En el formato CD, se encontró sensibilidad (S) de 79% a 89% y especificidad (E) de 83% a 95%. Utilizando ambos formatos CD-RD, se encontraron una sensibilidad de 82% a 89% y una especificidad de 72% a 91%. Test-retest .62-1. Discusión y conclusión: El VANEDELA aumentó sus parámetros de validez con respecto a la valoración anterior, estabilidad adecuada. Los formatos CD y la combinación CD-RD del VANEDELA poseen una adecuada validez por criterio externo y estabilidad test-retest, para ser utilizada en el primer nivel de atención.

Interacciones tempranas madre-niño y predicción de desarrollo motor mediante ecuaciones estructurales: Aplicación del modelo en niños con riesgo de daño neurológico perinatal / Mother-child interactions and early motor development prediction using structural equation: Application of the model in children with perinatal risk of neurological damage

Los impactos más importantes de las expresiones tempranas del daño neurológico en los niños, son las dificultades para establecer intercambios con su medio social, afectando en la etapa inicial las primeras interacciones con su madre. Niños con riesgo biológico muestran grandes dificultades para iniciar interacciones. Cuando las madres se ajustan en una relación bidireccional se logra un aumento en las iniciaciones del niño; si las madres responden menos, los niños disminuyen las iniciaciones y aumentan la irritabilidad. Los programas de intervención temprana que integran en sus estrategias el manejo de las interacciones madre-niño se han considerado exitosos por sus implicaciones directas en el desarrollo del niño. Se requiere mayor soporte empírico sobre la influencia de patrones específicos de interacciones tempranas madre-hijo y el desarrollo posterior de niños con daño neurológico perinatal, en términos de prevención de alteraciones o discapacidad. Se realizó un estudio longitudinal y se reporta el efecto de las interacciones de reciprocidad madre-hijo en el desarrollo motor observado en niños a los 4, 8 y 12 meses de edad, a través del empleo del Modelo de Ecuaciones Estructurales (Curva de Crecimiento Latente). Se concluye que el modelo permitió mostrar que en niños de riesgo perinatal, las interacciones madre-hijo representan un buen predictor del desarrollo motor en el primer año de vida. Estos hallazgos tienen importantes implicaciones en la práctica clínica como estrategia integral para el diseño de acciones de intervención temprana debido a que los logros motores en los primeros meses representan un indicador predictivo del desarrollo infantil posterior.

The most important impact of early expressions of neurological damage in children is the difficulty of mixing up in their social environment which at the beginning affects their interactions with their mother. Children with biological risks show great difficulties to begin interactions. When mothers get adjusted to bidirectional relations with neurologically damaged children, an increase in the commencement of interactions by a child is achieved, while fewer responses of the mother to child produce fewer interactions and increases irritability. Early intervention programs which contain in their strategies management of mother-infant interactions have been considered effective for child development. However, further empirical studies are required, concerning the influence of specific patterns of early mother-infant interaction and future development of children with perinatal neurological damage, in terms of prevention of alterations or disability. The present longitudinal study reports the effect of reciprocity of mother-infant interactions in the motor development observed in children of 4, 8, and 12 months old, latent growth curve in structural equation modeling. This model permits the identifications of causal factors that could affect the results in different age groups and provides predictions of the relations in a more complex form than lineal relations. Based on the model designed, it could be shown that mother-infant interactions of reciprocity best characterized children with higher development level while the absence is seen in children with retarded development. We classified mothers and children in two types, respectively: interactive and organized mothers vs. non-interactive and disorganized ones; interactive and responsive children vs. non-interactive and non-responsive ones. Subjecting these two types of mothers and children to four possible combinations, the model results showed different motor development predictions in the children. On one hand, we estimated regression coefficient of four dyadic systems, obtained by combinations of different types of mothers and children: interactive and organized mother with interactive and responsive child (Dyadic system 1); interactive and organized mother with non-interactive and non-responsive child (Dyadic system 2); non-interactive and disorganized mother with interactive and responsive child (Dyadic system 3); and non-interactive and disorganized mother with non-interactive and non-responsive child (Dyadic system 4). Dyadic system 1 was associated with a better motor development in children with a mayor regression coefficient (19.82), followed by System 2 and System 3 (regression coefficient of 17.54 and 11.46, respectively). System 4 had a negative estimate value of regression coefficient (-11.27) in our model. On the other hand, we estimated intercept values according to the interactive type of these mothers and children. Among the four interactive types, solely two of them had statistically significant intercepts (p < .05), or = 66.13 for interactive children and or = 42.76, for non-interactive children. To predict the motor development of 4, 8, and 12 months old children, the slope with attenuation permitted to give a mayor model fitting, with the regression coefficient of 0, 1 and 1.5, respectively. This model presented excellent values of model fitting indicators (X² = .96, p = .97, CFI = 1.00, RMSEA = .00). This line of study should be widened, because motor development is the principal domain consolidated in the first months of life. It is fundamental in domain organizations of higher complexity as cognition and language. We conclude that this model showed that in high risk perinatal children, early mother-child interactions represent a good predictor of motor development in the first year of life. Moreover, we found that motor achievements in the first months of life can be a strong predictive indicator of future development of a child. These findings suggest the importance in clinical practice of observation and registration of mother-child interactions as part of an integral strategy of child evaluation.

Evaluación del desarrollo motor en función de género, estimulación disponible en el hogar y nivel socioeconómico en niños de 0 a 3 años de edad del área rural / Motor development in child from 0 to 3 years of age of the central rural area of the Mexican Republic, as a function at gender, socioeconomic level and stimulation available at home

Introducción. La edad en que los niños controlan sus movimientos se utiliza frecuentemente como indicador del nivel de desarrollo. El objetivo de este trabajo es evaluar el desarrollo motor grueso, de niños de 0 a 3 años de edad, en función de género, nivel socioeconómico y estimulación disponible en el hogar, y elaborar una escala de desarrollo aplicable a la población rural mexicana.Material y métodos. Se estudiaron 82 niños en los que se evaluó el desarrollo motor utilizando la escala para el diagnóstico del desarrollo de Gesell, modificada para su calificación por Cravioto. Se observó que utilizando esta forma de calificación, los niños se ubican por debajo de la norma propuesta por Gesell. Por esta razón, empleando el orden y la edad a la que se presentaron las conductas de desarrollo motor en el total de los niños examinados, se construyó una escala, con la cual se realizaron comparaciones, en función de género, nivel socioeconómico y calificación total en estimulación disponible en el hogar. Resultados. Los datos indican que el nivel socioeconómico alto tiene mejores calificaciones a la misma edad y género que los niños de familias de medio y bajo índice socioeconómico. Por género se observó que el femenino abandona tempranamente el gateo y presenta tardíamente la conducta de correr respecto al masculino. Por disponibilidad total de estimulación en el hogar se observó que los niños con calificación alta abandonan el gateo y presentan la conducta de correr a más temprana edad que los de baja calificación. Conclusiones. Esta escala ajustada para la población estudiada, permitió discriminar con niveles de significancia estadística el desarrollo motor en función del nivel socioeconómico del niño. Se propone el uso de esta escala como norma para la evaluación de la población infantil en el área rural mexicana. Desarrollo motor; clase socioeconómica; estimulación en el hogar; prueba de Gesell.