Hearing Aid Use and Auditory Verbal Therapy Improve Voice Quality of Deaf Children.

BACKGROUND: Adequate phonation is self-regulated by auditory feedback. Children with bilateral profound hearing loss (PHL) lack this feedback resulting in abnormal voice. Adequate hearing aid use and auditory-verbal therapy (AVT) may improve voice quality in deaf children. OBJECTIVE: To study whether hearing aid use and AVT approach improve acoustic parameters of voice of children with bilateral PHL. MATERIALS AND METHODS: Nineteen children with bilateral PHL were studied. Age range 2-5 years (X = 53.04 months; SD = 9.54). All children were fitted with hearing aids according to auditory testing and they underwent a 1-year auditory habilitation period using the AVT approach. Acoustic analysis of voice including F0, shimmer, and jitter was performed at the onset and at the end of the auditory habilitation period. Final acoustic data were compared to a matched control group of 19 children, age range 2-5 years (X = 52.85; SD = 9.74) with normal hearing. RESULTS: Mean fundamental frequency (F0) was significantly increased after AVT intervention. Shimmer and jitter significantly (P < 0.05) improved after the intervention period. However, despite the improvements, mean F0 at the end of the intervention period was still significantly (P < 0.05) decreased as compared to controls. Also, mean shimmer and jitter at the end of the habilitation period were still significantly (P < 0.05) higher as compared to controls. CONCLUSIONS: The results of this preliminary study suggest that hearing aid use and auditory habilitation with AVT approach improved acoustic voice parameters of children with PHL. However, acoustic parameters persisted abnormal as compared to matched normal hearing controls. AVT approach and regular hearing aid use seem to be safe and reliable clinical tools for improving voice quality of children with PFL.

l-Arginine depletion blunts antitumor T-cell responses by inducing myeloid-derived suppressor cells.

Enzymatic depletion of the nonessential amino acid l-Arginine (l-Arg) in patients with cancer by the administration of a pegylated form of the catabolic enzyme arginase I (peg-Arg I) has shown some promise as a therapeutic approach. However, l-Arg deprivation also suppresses T-cell responses in tumors. In this study, we sought to reconcile these observations by conducting a detailed analysis of the effects of peg-Arg I on normal T cells. Strikingly, we found that peg-Arg I blocked proliferation and cell-cycle progression in normal activated T cells without triggering apoptosis or blunting T-cell activation. These effects were associated with an inhibition of aerobic glycolysis in activated T cells, but not with significant alterations in mitochondrial oxidative respiration, which thereby regulated survival of T cells exposed to peg-Arg I. Further mechanistic investigations showed that the addition of citrulline, a metabolic precursor for l-Arg, rescued the antiproliferative effects of peg-Arg I on T cells in vitro. Moreover, serum levels of citrulline increased after in vivo administration of peg-Arg I. In support of the hypothesis that peg-Arg I acted indirectly to block T-cell responses in vivo, peg-Arg I inhibited T-cell proliferation in mice by inducing accumulation of myeloid-derived suppressor cells (MDSC). MDSC induction by peg-Arg I occurred through the general control nonrepressed-2 eIF2α kinase. Moreover, we found that peg-Arg I enhanced the growth of tumors in mice in a manner that correlated with higher MDSC numbers. Taken together, our results highlight the risks of the l-Arg-depleting therapy for cancer treatment and suggest a need for cotargeting MDSC in such therapeutic settings.

Evaluación de estructuras cerebrales por resonancia magnética en personas infectadas con el virus de la inmunodeficiencia humana (VIH) y adherentes al tratamiento antirretroviral / Evaluation by MRI of brain structures of HIV subjects with adherence to antiretroviral therapy

Introducción: los cambios estructurales del cerebro se pueden observar en fases tempranas de la infección por VIH y acelerarse en estadios avanzados, aunque queda por profundizar con más estudios clínicos la relación que pueda existir entre la adherencia al tratamiento antirretroviral y los cambios en los volúmenes de las estructuras cerebrales. Objetivo: identificar los cambios en estructurascerebrales de personas infectadas con VIH por medio de la resonancia magnética y explorar su relación con el tratamiento antirretroviral. Materiales y métodos: se eligieron 2 grupos, cada uno con 16 individuos; el primero conformado por personas infectadas con VIH y tratamiento adherente y el segundo con individuos no infectados (grupo control). Los volúmenes de las estructuras corticales, subcorticales, las regiones superficiales de la sustancia blanca y gris fueron calculados para los dos hemisferios, en los cuales se utilizaron algoritmos automáticos de la plataforma de análisis de imágenesFreeSurfer. Los datos anatómicos de los individuos fueron adquiridos en un equipo de resonancia magnética 3T en el Instituto de Alta Tecnología Médica (IATM), Medellín, Colombia. Resultados: el análisis de las estructuras corticales y subcorticales no arrojó diferencias significativas entre las volumetríasdel grupo control y los individuos infectados con VIH/adherentes al tratamiento. Conclusión: los hallazgos muestran que el cerebro puede estar posiblemente sin alteraciones en sus estructuras corticales y subcorticales en los individuos con VIH adherentes al tratamiento, en primera o segunda línea de tratamiento antirretroviral, y, a la vez, estos resultados pueden aportar nuevas estrategias de neuroprotección ante el autocuidado frente al esquema de tratamento.

Introduction: structural brain changes can be detected in early stages of HIV infection and may be accelerated in advanced stages, however it still important to have more clinic studies for analyze the relationship between the adherence to antiretroviral therapy and changes in the volume of brain structures. Objective: To identify changes in brain structures from HIV subjects by using Magnetic Resonance Imaging (MRI) and to correlate the findings with the antiretroviral treatment. Materials and methods: Two groups with 16 subjects were chosen: a HIV group of subjects with medication adherence and healthy subjects (control group). By using the automatic segmentation software for brain Freesurfer, cortical and subcortical structures volumes as well as grey and white matter surface area were calculated for both brain hemispheres. Data were acquired through 3T MRI scanner in the Instituto de Alta Tecnología Médica (IATM) from Medellin (Colombia). Results: There were not statistically significant differences in cortical and subcortical structures between control group and subjects HIV infected with adherence to treatment. Conclusion: These findings show that subjects infectedwith VIH in first or second line of antiretroviral treatment probably do not have any change on the brain cortical and subcortical structures. In addition, this allows developing new neuroprotection and self-care strategies during the current treatment plans.

Utilidad diagnóstica del reflejo acústico para predecir audición en población pediátrica / Diagnostic utility of the acoustic reflex in predicting hearing in paediatric populations

Introducción y objetivos: La sensibilidad de predicción del reflejo acústico determina el nivel de pérdida auditiva, útil sobre todo en población pediátrica. Se basa en la diferencia entre el umbral del reflejo estapedial con tono puro y con ruido blanco contralateral. El umbral con ruido blanco es de 60 dB y con tono puro de 80 dB. El objetivo de este estudio fue determinar la utilidad diagnóstica de la sensibilidad de predicción del reflejo acústico. Métodos: Previo consentimiento informado, se estudió a niños menores de 10 años, de octubre del 2011 a mayo del 2012, midiendo el reflejo estapedial con ruido blanco y tono puro. Se realizaron pruebas de contraste con χ2 y t de Student. La concordancia se midió con kappa. Se consideró significativo un valor de p ≤ 0,05. El proyecto fue aprobado por el Comité de Ética. En todos los casos se obtuvo el consentimiento informado de los padres. Resultados: Predicción de audición normal: 0,84 para el oído derecho y 0,78 en el oído izquierdo y para hipoacusia sin especificar el grado: 0,98 para el oído derecho y 0,96 en el oído izquierdo. Valor de kappa de 0,7 para el oído derecho y 0,6 para el oído izquierdo. Conclusiones: La utilidad diagnóstica del reflejo acústico tiene muy poco valor para predecir el grado de pérdida auditiva, pero predice en más del 80% la audición normal. Por lo que se sugiere utilizar como una prueba objetiva obligada como parte del Cribado auditivo (AU)

Introduction and objectives: The sensitivity of prediction of acoustic reflex, in determining the level of hearing loss, is especially useful in paediatric populations. It is based on the difference between the pure tone stapedius reflex threshold and contralateral white noise. The white noise threshold was 60 dB and that of pure tone was 80 dB. Our objective was to determine the diagnostic sensitivity of the prediction of the acoustic reflex. Methods: We studied children aged <10 years, from October 2011 to May 2012, by measuring the acoustic reflex with white noise and pure tone. We used contrast tests, with X2 and student t-test. Concordance was measured with Kappa. Results were considered significant at P≤.05. Our protocol was approved by Institutional Ethics Committee. Informed consent was obtained from the parents in all cases. Results: Prediction of normal hearing was 0.84 for the right ear and 0.78 in left ear, while for hearing loss of an unspecified grade, it was 0.98 for the right ear and 0.96 in the left ear. Kappa value was 0.7 to 0.6 for the right ear and left ear. Conclusions: The acoustic reflex is of little diagnostic utility in predicting the degree of hearing loss, but it predicts more than 80% of normal hearing. The clinical utility of the reflex is indisputable, as it is an objective method, simple and rapid to use, that can be performed from birth and whose results are independent of the cooperation and willingness of the subject. It is proposed as an obligatory part of hearing screening (AU)

Diagnostic utility of the acoustic reflex in predicting hearing in paediatric populations.

INTRODUCTION AND OBJECTIVES: The sensitivity of prediction of acoustic reflex, in determining the level of hearing loss, is especially useful in paediatric populations. It is based on the difference between the pure tone stapedius reflex threshold and contralateral white noise. The white noise threshold was 60 dB and that of pure tone was 80 dB. Our objective was to determine the diagnostic sensitivity of the prediction of the acoustic reflex. METHODS: We studied children aged <10 years, from October 2011 to May 2012, by measuring the acoustic reflex with white noise and pure tone. We used contrast tests, with X2 and student t-test. Concordance was measured with Kappa. Results were considered significant at P≤.05. Our protocol was approved by Institutional Ethics Committee. Informed consent was obtained from the parents in all cases. RESULTS: Prediction of normal hearing was 0.84 for the right ear and 0.78 in left ear, while for hearing loss of an unspecified grade, it was 0.98 for the right ear and 0.96 in the left ear. Kappa value was 0.7 to 0.6 for the right ear and left ear. CONCLUSIONS: The acoustic reflex is of little diagnostic utility in predicting the degree of hearing loss, but it predicts more than 80% of normal hearing. The clinical utility of the reflex is indisputable, as it is an objective method, simple and rapid to use, that can be performed from birth and whose results are independent of the cooperation and willingness of the subject. It is proposed as an obligatory part of hearing screening.

Subpopulations of myeloid-derived suppressor cells impair T cell responses through independent nitric oxide-related pathways.

The accumulation of myeloid-derived suppressor cells (MDSC) in tumor-bearing hosts is a hallmark of malignancy-associated inflammation and a major mediator for the induction of T cell suppression in cancer. MDSC can be divided phenotypically into granulocytic (G-MDSC) and monocytic (Mo-MDSC) subgroups. Several mechanisms mediate the induction of T cell anergy by MDSC; however, the specific role of these pathways in the inhibitory activity of MDSC subpopulations remains unclear. Therefore, we aimed to determine the effector mechanisms by which subsets of tumor-infiltrating MDSC block T cell function. We found that G-MDSC had a higher ability to impair proliferation and expression of effector molecules in activated T cells, as compared to Mo-MDSC. Interestingly, both MDSC subgroups inhibited T cells through nitric oxide (NO)-related pathways, but expressed different effector inhibitory mechanisms. Specifically, G-MDSC impaired T cells through the production of peroxynitrites (PNT), while Mo-MDSC suppressed by the release of NO. The production of PNT in G-MDSC depended on the expression of gp91(phox) and endothelial NO synthase (eNOS), while inducible NO synthase (iNOS) mediated the generation of NO in Mo-MDSC. Deletion of eNOS and gp91(phox) or scavenging of PNT blocked the suppressive function of G-MDSC and induced anti-tumoral effects, without altering Mo-MDSC inhibitory activity. Furthermore, NO-scavenging or iNOS knockdown prevented Mo-MDSC function, but did not affect PNT production or suppression by G-MDSC. These results suggest that MDSC subpopulations utilize independent effector mechanisms to regulate T cell function. Inhibition of these pathways is expected to specifically block MDSC subsets and overcome immune suppression in cancer.

[Induced abortion and labor activity. Reflections for discussion]. / Aborto voluntario y actividad laboral. Reflexiones para el debate.

The induced abortion is a global phenomenon that according to various authors respond to socially constructed patterns of behavior and where they influence social realities of each country. This phenomenon requires the information necessary to understand the complex process leading to the decision of women to opt for abortion and able to understand the social, economic and health that can explain this requirement. For this purpose is presented for discussion, some considerations on voluntary abortion and labor activity of women who opt for this practice, with special mention of the situation in Spain. The arguments are supported by statistical analysis of the voluntary interruption of pregnancy (IVE) reported by the Ministry of Health and Social Policy, participation of women in the labor market in Spain obtained from the National Statistics Institute (INE), the research results on the association between employment status of women and voluntary termination of pregnancy and comprehensive review of scientific literature on the different perspectives of the approach of voluntary abortion. Analysis deserves special importance of women's work activity as a possible factor in the decision of women to terminate their pregnancies, a variable that has been identified in most of the investigations as a socioeconomic condition for women who choose for that alternative, considering that pregnancy interferes with the employment of women or, rather, prevents them from use.

Aborto voluntario y actividad laboral. Reflexiones para el debate / Induced abortion and labor activity. Reflections for discussion

El aborto voluntario es un fenómeno global que según distintos autores responde a patrones de comportamientos construidos socialmente y donde influyen las realidades sociales particulares de cada país. Este fenómeno requiere la información necesaria para comprender el complejo proceso que conduce a la decisión de la mujer para optar por la interrupción del embarazo y saber entender las circunstancias sociales, económicas y sanitarias que pueden explicar esta determinación. Con este propósito se presenta para el debate, algunas consideraciones sobre el aborto voluntario y la actividad laboral de las mujeres que optan por esta práctica, con especial mención la situación en España. Los argumentos están sustentados en el análisis de las estadísticas de interrupción Voluntaria del embarazo (IVE) reportadas por el Ministerio de Sanidad y Política Social, la participación de la mujer en el mercado laboral en España obtenidas del Instituto Nacional de Estadística (INE), los resultados de investigación sobre la asociación entre la situación laboral de la mujer y la Interrupción Voluntaria del embarazo y la revisión exhaustiva de las literatura científica sobre las distintas perspectivas del abordaje del aborto voluntario. Merece especial importancia el análisis de la actividad laboral de la mujer, como un posible determinante en la decisión de la mujer para interrumpir su embarazo, variable que ha sido identificada en la mayoría de las investigaciones como una de las condiciones socioeconómicas en las mujeres que optan por esa alternativa, al considerar que el embarazo interfiere con el empleo de las mujeres o, bien, les impide emplearse.

The induced abortion is a global phenomenon that according to various authors respond to socially constructed patterns of behavior and where they influence social realities of each country. This phenomenon requires the information necessary to understand the complex process leading to the decision of women to opt for abortion and able to understand the social, economic and health that can explain this requirement. For this purpose is presented for discussion, some considerations on voluntary abortion and labor activity of women who opt for this practice, with special mention of the situation in Spain. The arguments are supported by statistical analysis of the voluntary interruption of pregnancy (IVE) reported by the Ministry of Health and Social Policy, participation of women in the labor market in Spain obtained from the National Statistics Institute (INE), the research results on the association between employment status of women and voluntary termination of pregnancy and comprehensive review of scientific literature on the different perspectives of the approach of voluntary abortion. Analysis deserves special importance of women's work activity as a possible factor in the decision of women to terminate their pregnancies, a variable that has been identified in most of the investigations as a socioeconomic condition for women who choose for that alternative, considering that pregnancy interferes with the employment of women or, rather, prevents them from use.

27-hydroxycholesterol induces the transition of MCF7 cells into a mesenchymal phenotype.

A decrease in the expression of E-cadherin and ß-catenin, paralleling the loss of adherens junction complex, was observed in MCF7 cells exposed for longer than 48 h to 2 µM 27-hydroxycholesterol (27OHC), indicating an epithelial-mesenchymal transition (EMT). Upon removal of 27OHC from the culture medium, the cells released by the exposure of 72 h to the oxysterol grew as loosely packed cell groups. In these cells, accumulation of E-cadherin and ß-catenin in the cytoplasm and the prolonged expression of epidermal growth factor receptor 2 (EGFR2/neu) in the plasma membrane were observed, suggesting that the acquired phenotype was related to the expression of this tyrosine kinase-growth factor receptor. The results presented here are discussed on the basis of the claimed relationship between 27OHC, hypercholesterolemia, macrophage infiltration and therapy-resistant ERα+ breast cancer incidence.

IFNgamma response to Mycobacterium tuberculosis, risk of infection and disease in household contacts of tuberculosis patients in Colombia.

OBJECTIVES: Household contacts (HHCs) of pulmonary tuberculosis patients are at high risk of Mycobacterium tuberculosis infection and early disease development. Identification of individuals at risk of tuberculosis disease is a desirable goal for tuberculosis control. Interferon-gamma release assays (IGRAs) using specific M. tuberculosis antigens provide an alternative to tuberculin skin testing (TST) for infection detection. Additionally, the levels of IFNgamma produced in response to these antigens may have prognostic value. We estimated the prevalence of M. tuberculosis infection by IGRA and TST in HHCs and their source population (SP), and assessed whether IFNgamma levels in HHCs correlate with tuberculosis development. METHODS: A cohort of 2060 HHCs was followed for 2-3 years after exposure to a tuberculosis case. Besides TST, IFNgamma responses to mycobacterial antigens: CFP, CFP-10, HspX and Ag85A were assessed in 7-days whole blood cultures and compared to 766 individuals from the SP in Medellín, Colombia. Isoniazid prophylaxis was not offered to child contacts because Colombian tuberculosis regulations consider it only in children under 5 years, TST positive without BCG vaccination. RESULTS: Using TST 65.9% of HHCs and 42.7% subjects from the SP were positive (OR 2.60, p<0.0001). IFNgamma response to CFP-10, a biomarker of M. tuberculosis infection, tested positive in 66.3% HHCs and 24.3% from the SP (OR = 6.07, p<0.0001). Tuberculosis incidence rate was 7.0/1000 person years. Children <5 years accounted for 21.6% of incident cases. No significant difference was found between positive and negative IFNgamma responders to CFP-10 (HR 1.82 95% CI 0.79-4.20 p = 0.16). However, a significant trend for tuberculosis development amongst high HHC IFNgamma producers was observed (trend Log rank p = 0.007). DISCUSSION: CFP-10-induced IFNgamma production is useful to establish tuberculosis infection prevalence amongst HHC and identify those at highest risk of disease. The high tuberculosis incidence amongst children supports administration of chemoprophylaxis to child contacts regardless of BCG vaccination.

Species identification after treatment for human taeniasis.

Identification of species of human tapeworms is crucial because the consequences of infection by Taenia solium and T saginata are very different. However, evacuation of species-identifiable tapeworms is uncommon and Taenia spp eggs are indistinguishable under the microscope. Treatment of taeniasis consists of niclosamide followed by a purgative. Recently, we adopted preniclosamide and postniclosamide electrolyte-polyethyleneglycol salt (EPS) purges to improve bowel cleaning. Retrospective comparison of traditional castor oil with EPS purge showed that recovery of the tapeworm scolex was significantly improved (20 of 68 vs none of 46, p=0.0001) in the EPS group. Furthermore, 42 of 68 (62%) individuals receiving EPS excreted identifiable gravid proglottids. EPS treatment helps the visual identification of Taenia spp.

Estudios moleculares en pacientes colombianos con Fibrosis quística

La fibrosis quística (FQ), la enfermedad autosómica recesiva más frecuente en poblaciones caucásicas, tiene una incidencia promedio de 1/2.500 recién nacidos

Effects of training on body composition and subcutaneous fat distribution in women gymnasts.

Repeated measurements of body composition and subcutaneous fat distribution were obtained in female gymnasts to test the hypothesis of a selective response from localized fat deposits to intense physical training. Repeated measurements were obtained on the members of three nationally ranked collegiate gymnastic teams: at the beginning and peak of the training season. The highest ranked team was measured a third time, three weeks after the end of the competitive season. Body composition was estimated using anthropometry and bioelectric impedance; subcutaneous fat thickness was measured using skinfold calipers and ultrasound images of adipose tissue thickness (ATT). The mean difference between baseline and peak measurements were statistically significant (P ⩽ .05) for the triceps and suprailiac skinfolds, and for the adipose tissue thickness at the suprailiac and hypogastric sites. There were no significant changes in weight, percentage of body fat, circumferences, or subcutaneous fat thickness at the subscapular, calf or medial thigh sites. In the team with three sets of measurements, only the triceps skinfold and the suprailiac ATT showed a statistically significant effect of training. © 1993 Wiley-Liss, Inc.