Developing a System for Processing Health Data of Children Using Digitalized Toys: Ethical and Privacy Concerns for the Internet of Things Paradigm.

EDUCERE (Ubiquitous Detection Ecosystem to Care and Early Stimulation for Children with Developmental Disorders) is a government funded research and development project. EDUCERE objectives are to investigate, develop, and evaluate innovative solutions for society to detect changes in psychomotor development through the natural interaction of children with toys and everyday objects, and perform stimulation and early attention activities in real environments such as home and school. In the EDUCERE project, an ethical impact assessment is carried out linked to a minors' data protection rights. Using a specific methodology, the project has achieved some promising results. These include use of a prototype of smart toys to detect development difficulties in children. In addition, privacy protection measures which take into account the security concerns of health data, have been proposed and applied. This latter security framework could be useful in other Internet of Things related projects. It consists of legal and technical measures. Special attention has been placed in the transformation of bulk data such as acceleration and jitter of toys into health data when patterns of atypical development are found. The article describes the different security profiles in which users are classified.

A Smart Toy to Enhance the Decision-Making Process at Children's Psychomotor Delay Screenings: A Pilot Study.

BACKGROUND: EDUCERE ("Ubiquitous Detection Ecosystem to Care and Early Stimulation for Children with Developmental Disorders") is an ecosystem for ubiquitous detection, care, and early stimulation of children with developmental disorders. The objectives of this Spanish government-funded research and development project are to investigate, develop, and evaluate innovative solutions to detect changes in psychomotor development through the natural interaction of children with toys and everyday objects, and perform stimulation and early attention activities in real environments such as home and school. Thirty multidisciplinary professionals and three nursery schools worked in the EDUCERE project between 2014 and 2017 and they obtained satisfactory results. Related to EDUCERE, we found studies based on providing networks of connected smart objects and the interaction between toys and social networks. OBJECTIVE: This research includes the design, implementation, and validation of an EDUCERE smart toy aimed to automatically detect delays in psychomotor development. The results from initial tests led to enhancing the effectiveness of the original design and deployment. The smart toy, based on stackable cubes, has a data collector module and a smart system for detection of developmental delays, called the EDUCERE developmental delay screening system (DDSS). METHODS: The pilot study involved 65 toddlers aged between 23 and 37 months (mean=29.02, SD 3.81) who built a tower with five stackable cubes, designed by following the EDUCERE smart toy model. As toddlers made the tower, sensors in the cubes sent data to a collector module through a wireless connection. All trials were video-recorded for further analysis by child development experts. After watching the videos, experts scored the performance of the trials to compare and fine-tune the interpretation of the data automatically gathered by the toy-embedded sensors. RESULTS: Judges were highly reliable in an interrater agreement analysis (intraclass correlation 0.961, 95% CI 0.937-0.967), suggesting that the process was successful to separate different levels of performance. A factor analysis of collected data showed that three factors, trembling, speed, and accuracy, accounted for 76.79% of the total variance, but only two of them were predictors of performance in a regression analysis: accuracy (P=.001) and speed (P=.002). The other factor, trembling (P=.79), did not have a significant effect on this dependent variable. CONCLUSIONS: The EDUCERE DDSS is ready to use the regression equation obtained for the dependent variable "performance" as an algorithm for the automatic detection of psychomotor developmental delays. The results of the factor analysis are valuable to simplify the design of the smart toy by taking into account only the significant variables in the collector module. The fine-tuning of the toy process module will be carried out by following the specifications resulting from the analysis of the data to improve the efficiency and effectiveness of the product.

A Virtual Environment to Improve the Detection of Oral-Facial Malfunction in Children with Cerebral Palsy.

The importance of an early rehabilitation process in children with cerebral palsy (CP) is widely recognized. On the one hand, new and useful treatment tools such as rehabilitation systems based on interactive technologies have appeared for rehabilitation of gross motor movements. On the other hand, from the therapeutic point of view, performing rehabilitation exercises with the facial muscles can improve the swallowing process, the facial expression through the management of muscles in the face, and even the speech of children with cerebral palsy. However, it is difficult to find interactive games to improve the detection and evaluation of oral-facial musculature dysfunctions in children with CP. This paper describes a framework based on strategies developed for interactive serious games that is created both for typically developed children and children with disabilities. Four interactive games are the core of a Virtual Environment called SONRIE. This paper demonstrates the benefits of SONRIE to monitor children's oral-facial difficulties. The next steps will focus on the validation of SONRIE to carry out the rehabilitation process of oral-facial musculature in children with cerebral palsy.

Adaptive software architecture based on confident HCI for the deployment of sensitive services in Smart Homes.

Smart spaces foster the development of natural and appropriate forms of human-computer interaction by taking advantage of home customization. The interaction potential of the Smart Home, which is a special type of smart space, is of particular interest in fields in which the acceptance of new technologies is limited and restrictive. The integration of smart home design patterns with sensitive solutions can increase user acceptance. In this paper, we present the main challenges that have been identified in the literature for the successful deployment of sensitive services (e.g., telemedicine and assistive services) in smart spaces and a software architecture that models the functionalities of a Smart Home platform that are required to maintain and support such sensitive services. This architecture emphasizes user interaction as a key concept to facilitate the acceptance of sensitive services by end-users and utilizes activity theory to support its innovative design. The application of activity theory to the architecture eases the handling of novel concepts, such as understanding of the system by patients at home or the affordability of assistive services. Finally, we provide a proof-of-concept implementation of the architecture and compare the results with other architectures from the literature.

Evaluating a web-based clinical decision support system for language disorders screening in a nursery school.

BACKGROUND: Early and effective identification of developmental disorders during childhood remains a critical task for the international community. The second highest prevalence of common developmental disorders in children are language delays, which are frequently the first symptoms of a possible disorder. OBJECTIVE: This paper evaluates a Web-based Clinical Decision Support System (CDSS) whose aim is to enhance the screening of language disorders at a nursery school. The common lack of early diagnosis of language disorders led us to deploy an easy-to-use CDSS in order to evaluate its accuracy in early detection of language pathologies. This CDSS can be used by pediatricians to support the screening of language disorders in primary care. METHODS: This paper details the evaluation results of the "Gades" CDSS at a nursery school with 146 children, 12 educators, and 1 language therapist. The methodology embraces two consecutive phases. The first stage involves the observation of each child's language abilities, carried out by the educators, to facilitate the evaluation of language acquisition level performed by a language therapist. Next, the same language therapist evaluates the reliability of the observed results. RESULTS: The Gades CDSS was integrated to provide the language therapist with the required clinical information. The validation process showed a global 83.6% (122/146) success rate in language evaluation and a 7% (7/94) rate of non-accepted system decisions within the range of children from 0 to 3 years old. The system helped language therapists to identify new children with potential disorders who required further evaluation. This process will revalidate the CDSS output and allow the enhancement of early detection of language disorders in children. The system does need minor refinement, since the therapists disagreed with some questions from the CDSS knowledge base (KB) and suggested adding a few questions about speech production and pragmatic abilities. The refinement of the KB will address these issues and include the requested improvements, with the support of the experts who took part in the original KB development. CONCLUSIONS: This research demonstrated the benefit of a Web-based CDSS to monitor children's neurodevelopment via the early detection of language delays at a nursery school. Current next steps focus on the design of a model that includes pseudo auto-learning capacity, supervised by experts.

Future of ADHD Care: Evaluating the Efficacy of ChatGPT in Therapy Enhancement.

This study explores the integration of large language models (LLMs), like ChatGPT, to improve attention deficit hyperactivity disorder (ADHD) treatments. Utilizing the Delphi method for its systematic forecasting capabilities, we gathered a panel of child ADHD therapy experts. These experts interacted with our custom ChatGPT through a specialized interface, thus engaging in simulated therapy scenarios with behavioral prompts and commands. Using empirical tests and expert feedback, we aimed to rigorously evaluate ChatGPT's effectiveness in therapy settings to integrate AI into healthcare responsibly. We sought to ensure that AI contributes positively and ethically to therapy and patient care, thus filling a gap in ADHD treatment methods. Findings show ChatGPT's empathy, adaptability, and communication strengths, thereby highlighting its potential to significantly improve ADHD care. The study points to ChatGPT's capacity to transform therapy practices through personalized and responsive patient care. However, it also notes the need for enhancements in privacy, cultural sensitivity, and interpreting nonverbal cues for ChatGPT's effective healthcare integration. Our research advocates for merging technological innovation with a comprehensive understanding of patient needs and ethical considerations, thereby aiming to pioneer a new era of AI-assisted therapy. We emphasize the ongoing refinement of AI tools like ChatGPT to meet ADHD therapy and patient care requirements more effectively.

Deployment and validation of a smart system for screening of language disorders in primary care.

Neuro-evolutive development from birth until the age of six years is a decisive factor in a child's quality of life. Early detection of development disorders in early childhood can facilitate necessary diagnosis and/or treatment. Primary-care pediatricians play a key role in its detection as they can undertake the preventive and therapeutic actions requested to promote a child's optimal development. However, the lack of time and little specific knowledge at primary-care avoid to applying continuous early-detection anomalies procedures. This research paper focuses on the deployment and evaluation of a smart system that enhances the screening of language disorders in primary care. Pediatricians get support to proceed with early referral of language disorders. The proposed model provides them with a decision-support tool for referral actions to trigger essential diagnostic and/or therapeutic actions for a comprehensive individual development. The research was conducted by starting from a sample of 60 cases of children with language disorders. Validation was carried out through two complementary steps: first, by including a team of seven experts from the fields of neonatology, pediatrics, neurology and language therapy, and, second, through the evaluation of 21 more previously diagnosed cases. The results obtained show that therapist positively accepted the system proposal in 18 cases (86%) and suggested system redesign for single referral to a speech therapist in three remaining cases.

Serious Game for the Screening of Central Auditory Processing Disorder in School-Age Children: Development and Validation Study.

BACKGROUND: Currently, many central auditory processing disorder screening tests are available for children, and serious games (SGs) are frequently used as a tool for the diagnosis of different neural deficits and disorders in health care. However, it has not been possible to find a proposal that unifies both ideas. In addition, the validation and improvement of SGs, in general, does not take into account the player-game interaction, thus omitting valuable information about the playability and usability of the game. OBJECTIVE: This study presented Amalia's Planet, a game conceived for use in school environments, which allows a first assessment of a child through their performance of the proposed tasks related to different aspects of auditory performance. In addition, the game defines a series of events in relation to the execution of the tasks, which were evaluated for the subsequent optimization of its performance and the improvement of its usability. METHODS: Using screening tools based on the use of SG technologies, a total of 87 school-age children were evaluated to test the various hypotheses proposed in this study. By grouping users according to whether they had personal history of hearing pathologies, the discriminant power, playability, and usability of the final solution were examined using traditional statistical techniques and process mining (PM) algorithms. RESULTS: With a confidence level of 80% for test 2 (P=.19), there was no statistical evidence to reject the null hypothesis that a player's performance is affected by whether the player had a previous auditory pathology. Furthermore, the tool allowed the screening of 2 players initially categorized as healthy because of their low level of performance in the tests and the similarity of their behavior with that of the group of children with a previous pathology. With regard to the validation of the proposed solution, the use of PM techniques made it possible to detect the existence of events that lasted too long, which can lead to player frustration, and to discover small structural flaws in the game. CONCLUSIONS: SGs seem to be an appropriate tool for the screening of children at risk of central auditory processing disorder. Moreover, the set of PM techniques provides a reliable source of information regarding the playability and usability of the solution to the development team, allowing its continuous optimization.

The Potential of Digital Screening Tools for Childhood ADHD in School Environments: A Preliminary Study.

Attention deficit hyperactivity disorder (ADHD) is a highly prevalent developmental disorder in children. However, accurately identifying ADHD in early childhood remains a crucial challenge. Electronic health (e-health) systems offer promising possibilities to enhance the diagnostic process for ADHD, particularly concerning the executive functions (EFs) that play a direct role. This study aims to validate an evidence-based tool for screening ADHD through EFs in the school environment. The tool, named Sendero Gris, is designed for tablet devices and is based on a previously validated test with the same name. To ensure its validity, a comparison was made between the results obtained from the tool to be validated and the original format of the test. The analysis revealed no statistically significant differences between the two approaches at a 90% confidence level (p-value = 0.49). Moreover, a user experience study focusing on usability was conducted to assess the children's inclination to use the developed tool, yielding highly positive results. The implementation of Sendero Gris on a tablet device, with its objective and versatile nature, seems to maintain the potential of the original format as a screening tool for ADHD.

Quantitative systems pharmacology model-based investigation of adverse gastrointestinal events associated with prolonged treatment with PI3-kinase inhibitors.

Several PI3K inhibitors are in clinical development for the treatment of various forms of cancers, including pan-PI3K inhibitors targeting all four PI3K isoforms (α, ß, γ, and δ), and isoform-selective inhibitors. Diarrhea and immune-mediated colitis are among the adverse events observed with PI3K inhibition which limits the maximal tolerated dose. A quantitative systems pharmacology model was developed to investigate PI3K-inhibitor-induced colitis. The effects of individual PI3K isoforms on relevant cellular pathways were incorporated into a mechanistic representation of mucosal inflammation. A virtual clinical population captures the observed clinical variability in the onset timing and rates of diarrhea and colitis for seven clinically tested PI3K inhibitors. Model-based analysis suggests that colitis development is governed by both the inhibition of PI3Kδ, which drives T cell differentiation and proliferation, and PI3Kα, which regulates epithelial barrier integrity. Specifically, when PI3Kα is inhibited below a given threshold, epithelial barrier dysfunction precipitates an exaggerated T effector response due to PI3Kδ-inhibition, leading to risk of diarrhea and colitis. This synergy explains why the lowest diarrhea and colitis rates are seen with the weakest PI3Kδ inhibition (alpelisib), and higher rates are seen with strong PI3Kδ inhibition if PI3Kα is even mildly inhibited (e.g., idelalisib), whereas strong PI3Kδ inhibition in the absence of PI3Kα inhibition does not result in high colitis rates (umbralisib). Thus, the model-based analysis suggests that PI3Kα and δ inhibition play unique but synergistic roles in driving colitis. Finally, we explore if and how dose-regimen might influence colitis rates for molecules that inhibit both PI3Kα and PI3Kδ.

A New Architecture for Customizable Exergames: User Evaluation for Different Neuromuscular Disorders.

This paper presents a modular approach to generic exergame design that combines custom physical exercises in a meaningful and motivating story. This aims to provide a tool that can be individually tailored and adapted to people with different needs, making it applicable to different diseases and states of disease. The game is based on motion capturing and integrates four example exercises that can be configured via our therapeutic web platform "Blexer-med". To prove the feasibility for a wide range of different users, evaluation tests were performed on 14 patients with various types and degrees of neuromuscular disorders, classified into three groups based on strength and autonomy. The users were free to choose their schedule and frequency. The game scores and three surveys (before, during, and after the intervention) showed similar experiences for all groups, with the most vulnerable having the most fun and satisfaction. The players were motivated by the story and by achieving high scores. The average usage time was 2.5 times per week, 20 min per session. The pure exercise time was about half of the game time. The concept has proven feasible and forms a reasonable basis for further developments. The full 3D exercise needs further fine-tuning to enhance the fun and motivation.

Augmentation technique for partial ACL ruptures using semitendinosus tendon in the over-the-top position.

The aim of this study is to present a surgical augmentation technique for partial ACL ruptures in which an isolated, autologous, double-bundle semitendinosus tendon graft is passed over the top of the femur, thus fully preserving the still-intact fibers of the ligament remnant. Between 1992 and 2006, 24 patients underwent ACL semitendinosus autograft reconstruction and were followed up for at least 2 years. The median follow-up was 6.2 years (2-15.6). At the last follow-up examination, the patients were evaluated using the International Knee Documentation Committee scale. Subjective and functional parameters were assessed using the Tegner activity scale and the Lysholm scale. Instrumental evaluation was carried out using the KT-1000 instrument. Sixteen of the 24 patients achieved an IKDC score of A. Of the remaining eight patients, six achieved an IKDC score of B, one an IKDC score of C, and one an IKDC score of D. According to the Tegner activity scale, the median pre-injury sports activity level was seven (5-9) and the median post-injury level was six (4-9), while the mean Lysholm scale score was 95 (90-100). Clinical and biomechanical studies have shown that reconstruction techniques that address both bundles of the ACL provide better rotational stability than techniques that address only a single bundle. Therefore, it seems logical than in patients with a partial rupture of the ACL, the intact bundle could be preserved and only the torn bundle would need to be reconstructed.

Osteoid osteoma: CT-guided radiofrequency ablation.

Osteoid osteoma is a benign bone tumour; its main symptom is pain, which is sometimes resistant to analgesic or anti-inflammatory medication. The surgical treatment consists of en bloc excision or curettage of the lesion. Several alternative methods have been proposed, among which CT guided-percutaneous radiofrequency ablation. We report on ten patients who were diagnosed clinically and radiologically as presenting an osteoid osteoma and were treated with this technique, with more than two years follow-up. Results were uniformly excellent. The pain was relieved and the rate of post-operative complications was very low. We recommend percutaneous CT-guided radiofrequency ablation for the treatment of this lesion.

Characterization of a novel CYP2A7/CYP2A6 hybrid allele (CYP2A6*12) that causes reduced CYP2A6 activity.

The human CYP2A6 enzyme metabolizes certain drugs and pre-carcinogens and appears to be the most important enzyme for nicotine metabolism. At present, more than 10 different allelic variants are known that cause abolished or decreased enzyme activity. Genetic polymorphism in this gene might be of particular importance for an individual's need for nicotine and for susceptibility to lung and/or liver cancer. We have identified a new CYP2A6 allele (CYP2A6*12) which carries an unequal crossover between the CYP2A6 and CYP2A7 genes in intron 2. This results in a hybrid allele where the 5' regulatory region and exons 1-2 are of CYP2A7 origin and exons 3-9 are of CYP2A6 origin, resulting in 10 amino acid substitutions compared to the CYP2A6(*)1 allele. Phenotyping with the CYP2A6 substrate coumarin indicates that it causes reduced CYP2A6 activity in'vivo. Furthermore, when expressed in mammalian COS-1 cells, the enzyme variant catalyzed 7-hydroxylation of coumarin at a rate approximately 60% of that of the wild-type enzyme. The CYP2A6(*)12 allele was present at an allele frequency of 2.2% among Spaniards, but was absent in Chinese.

Direct infussion Electrospray Mass Spectrometry as a new non-invasive tool for serum metabolomics in induced-stress subjects

Background and Objectives: Nanotechnology is becoming a tool for the study of changes in the metabolome of patients in different states of disease. Analytical techniques such as Electrospray Mass Spectrometry, allow to find biomarkers by determination of metabolites. Nowadays, there is not an objective analytical approach for diagnosis of stress. Thus, the objectives of this pilot work are: Describing the development of a fast, direct and non-invasive analytical protocol, applied for the first time, to study the metabolomic profile of patient´s different states through a disease. Testing the protocol in a pilot sample with non-stressed and stress-induced subjects. Methods: High resolution direct infusion electrospray mass spectrometry has been used to analyse the metabolome of blood samples (0.3 ml) from six subjects. Results: Data prove a clear discrimination between non-stressed and stressed states in the metabolome. Data showed different predominant metabolites in both states. Results allow objective characterization of the state of the patient. Conclusions: Although this is a pilot study, the method was successful in discriminating different metabolites in non-stressed and stress-induced subjects (AU)

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Consumo de alcohol en la adolescencia: Consideraciones médicas y orientaciones educativas / Alcohol consumption during adolescence: Medical considerations and educational counseling

El consumo de alcohol por parte de los adolescentes supera en España el consumo de otras sustancias psicoactivas. Los daños que el cerebro humano sufre a causa del etanol, especialmente en la etapa de la adolescencia, son objeto de muchos estudios y se centran principalmente en cómo se afecta la neurotransmisión. Además, la vulnerabilidad del cerebro de los adolescentes a la influencia del alcohol ofrece rasgos peculiares por cuanto se encuentra en una etapa de intensa actividad de remodelación sináptica. Es necesario unir fuerzas, conocimientos y recursos dirigidos a un mejor conocimiento, tanto de los efectos biológicos del alcohol en el individuo adolescente como de los derivados del consumo en los ámbitos emocional, social y familiar, para diseñar actuaciones educativas que faciliten la modificación o erradicación de hábitos no saludables relacionados con la ingesta de alcohol. La evaluación previa se dirige a promover la calidad de vida en la Educación Secundaria, una etapa crucial en el desarrollo global del ser humano.

Alcohol is the most commonly consumed psychoactive drug among Spanish adolescents. The effects of alcohol on human brain, specifically on neurotransmission, are broadly studied. The adolescent brain is especially vulnerable to the effects of alcohol due to the intense and active processes of synapses restructuring ocurring during this period. To achieve and establish educational interventions directed to facilitate and eradicate harmful habits related to alcohol consumption during adolescence, it is necessary to join resources, knowledge and forces focused on a better understanding of the biological effects of alcohol and the harm produced in the emotional, social and familiar realms. Here, we discuss that intervention needs previous evaluation and should focus on Secondary Education, a crucial period in human development.

[Imaging techniques and vesicoureteral reflux]. / Técnicas de imagen en el reflujo vesicoureteral.

OBJECTIVES: Although vesicoureteral reflux (VUR) is a very frequent pathology in the pediatric age and represents an important part of the activity of pediatricians, pediatric urologists, nephrologists, and radiologists, yet there is controversy about its global management both in diagnosis and treatment. The objective of this paper is to perform an update in the use of different imaging techniques in the diagnosis and followup of VUR and to propose a work up protocol. METHODS: We describe the imaging techniques: VCUG, ultrasound, intravenous urography, bladder-ultrasound, DMSA, MRI, and their role in the evaluation and followup of VUR. We performed a bibliographic review about the topic and present the experience of our working group on VUR. RESULTS: The bibliographic review shows a clear evolution of the concepts of VUR and also the management algorithms. The concepts of congenital renal lesion without urinary tract infection (UTI) or acquired lesion after UTI are clearly differentiated in the most recent reviews. Reflux is passing from being the center of the problem to a secondary phenomenon in relation to UTI, and this is leading to a change of diagnostic strategy, less and less invasive. CONCLUSIONS: VCUG has been to date the first and indisputable technique for the management of VUR, mainly in the diagnostic phase, but technological advances in the area of ultrasound (ultrasound contrasts, harmonic image, etc.) have converted ultrasound in the first imaging technique for the management of VUR in pediatric age. On the other hand, work-up algorithms have changed due to the great impact prenatal diagnosis is having in the management of urinary tract anomalies.

Analysis of the argK-tox gene cluster in nontoxigenic strains of Pseudomonas syringae pv. phaseolicola.

The analysis of 46 isolates obtained directly from different and distant common bean fields from the northwestern part of Spain revealed that they do not produce phaseolotoxin. The isolates were classified as race 5, and their analysis revealed that they do not carry the argK-tox gene cluster involved in the biosynthesis of the phaseolotoxin.

Técnicas de imagen en el reflujo vesicoureteral / Imaging techniques and vesicoureteral reflux

Objetivo: A pesar de que el RVU es una patología muy frecuente en la edad pediátrica y desde hace años ocupa gran parte de la actividad de pediatras, urólogos, nefrólogos y radiólogos pediátricos, sigue siendo controvertido su manejo global tanto en los aspectos diagnósticos como de tratamiento. El objetivo de este trabajo es hacer una puesta al día en la utilización de las diferentes técnicas de imagen en el diagnóstico y seguimiento del RVU y proponer un protocolo de estudio. Métodos: Se describen las diferentes técnicas de imagen: CUMS, Ecografía, Urografía intravenosa, Cistosonografía, Cistografía Isotópica, DMSA, Resonancia Magnética y su papel actual en la valoración y seguimiento del RVU. Se hace una revisión de la literatura sobre este tema y aportamos la experiencia de nuestro grupo de trabajo en el RVU. Resultados: La revisión de la literatura pone de manifiesto una clara evolución en los conceptos del RVU y también en los algoritmos de manejo del mismo. El concepto de lesión renal congénita sin infección del tracto urinario (ITU) o lesión adquirida después de una ITU está ya claramente diferenciado en las revisiones mas recientes. El reflujo está pasando de ser el centro del problema a ser un fenómeno secundario en relación a la ITU lo que está llevando a un cambio en la estrategia diagnóstica, cada vez menos invasiva. Conclusiones: La CUMS ha sido hasta ahora la primera e “indiscutible” técnica en el manejo del RVU, sobre todo en la fase diagnóstica, pero los avances tecnológicos en el área de los ultrasonidos (contrastes ecográficos, imagen armónica, etc) han hecho que la ecografía se haya convertido en la principal técnica de imagen en el manejo del RVU en la edad pediátrica. Por otro lado, los algoritmos de estudio del RVU han cambiado por el gran impacto que el diagnóstico prenatal está teniendo en el manejo de las anomalías del aparato urinario (AU)

Objectives: Although vesicoureteral reflux (VUR) is a very frequent pathology in the pediatric age and represents an important part of the activity of pediatricians, pediatric urologists, nephrologists, and radiologists, yet there is controversy about its global management both in diagnosis and treatment. The objective of this paper is to perform an update in the use of different imaging techniques in the diagnosis and follow-up of VUR and to propose a work up protocol. Methods: We describe the imaging techniques: VCUG, ultrasound, intravenous urography, bladder-ultrasound, DMSA, MRI, and their role in the evaluation and follow-up of VUR. We performed a bibliographic review about the topic and present the experience of our working group on VUR. Results: The bibliographic review shows a clear evolution of the concepts of VUR and also the management algorithms. The concepts of congenital renal lesion without urinary tract infection (UTI) or acquired lesion after UTI are clearly differentiated in the most recent reviews. Reflux is passing from being the center of the problem to a secondary phenomenon in relation to UTI, and this is leading to a change of diagnostic strategy, less and less invasive. Conclusions: VCUG has been to date the first and indisputable technique for the management of VUR, mainly in the diagnostic phase, but technological advances in the area of ultrasound (ultrasound contrasts, harmonic image, etc.) have converted ultrasound in the first imaging technique for the management of VUR in pediatric age. On the other hand, work-up algorithms have changed due to the great impact prenatal diagnosis is having in the management of urinary tract anomalies (AU)

Leptina e insulinoterapia en la diabetes gestacional / Leptin and insulin therapy in gestational diabetes

Introducción: Se han publicado varios trabajos que implican a la leptina (L) en diversos procesos metabólicos, entre ellos la diabetes gestacional (DG) y otras alteraciones del embarazo como la preeclampsia y el retraso de crecimiento intrauterino. Se ha observado que la concentración de L en plasma es superior en gestantes diabéticas que en gestantes sanas. Objetivo: Valorar si la L puede ser un parámetro bioquímico de utilidad en pacientes con DG a la hora de predecir la necesidad de tratamiento insulínico desde el momento mismo del diagnóstico. Pacientes y método: Cincuenta mujeres diagnosticadas de DG entre las semanas 28 y 32 con: media ± desviación estándar de edad, 34,4 ± 4,5 años; IMC, 25,4 ± 2,14, y L, 48,5 ± 16 ng/ml. Fueron separadas en 2 grupos: uno con criterios de insulinización, formado por 24 pacientes, y otro que no precisó insulina, formado por 26. Los criterios de inclusión fueron: presentar un IMC > 22,5 y 40 ng/ml. Conclusiones: Con la cautela de precisar más estudios y con mayor número de pacientes, se puede indicar que la L es útil como parámetro bioquímico que nos ayude a predecir la necesidad de tratamiento insulínico en pacientes diagnosticadas de DG

Introduction: Various studies have implicated leptin in several metabolic processes, among them gestational diabetes (GD) and other pregnancy-associated alterations such as preeclampsia and uterine growth retardation. Plasma leptin levels have been observed to be higher in diabetic pregnant women than in healthy pregnant women. Objective: To evaluate whether leptin could be a useful biochemical marker in patients with GD to predict the need for insulin therapy at diagnosis. Patients and method: Fifty women with a diagnosis of GD between 28 and 32 weeks of pregnancy [mean age, 34.4 ± 4.5 years; body mass index (BMI), 25.4 ± 2.14, and leptin level, 48.5 ± 16 ng/ml] were studied. The women were divided into two groups: one group was composed of 24 women with criteria for insulin therapy and the other group consisted of 26 women not requiring insulin therapy. The inclusion criteria were BMI greater than 22.5 and lower than 27 and biochemical determination between weeks 28 and 32. Results: Maternal plasma leptin levels were significantly higher in the group requiring insulin. No differences were found in the mean age of the patients or in BMI. The odds ratio predicting the need for insulin therapy during pregnancy was 6 in pregnant women with a leptin level higher than 40 ng/ml. Conclusions: Leptin determination could be useful in predicting the need for insulin therapy in patients with GD. However, further studies with a larger number of patients are required to confirm our findings