Crosslinker-Free Hyaluronic Acid Aerogels.

Aerogels based on hyaluronic acid (HA) were prepared without any chemical crosslinking by polymer dissolution, network formation via nonsolvent-induced phase separation, and supercritical CO2 drying. The influence of solution pH, concentration of HA, and type of nonsolvent on network volume shrinkage, aerogel density, morphology, and specific surface area was investigated. A marked dependence of aerogel properties on solution pH was observed: aerogels with the highest specific surface area, 510 m2/g, and the lowest density, 0.057 g/cm3, were obtained when the HA solution was at its isoelectric point (pH 2.5). This work reports the first results ever on neat HA aerogels and constitutes the background for their use as advanced materials for biomedical applications.

Sobrepeso, obesidad e hipertensión arterial en niños, una aproximación al problema / An approach to overweight/obesity and hypertension in children / Uma abordagem ao problema do sobrepeso/obesidade e hipertensão em crianças

Resumen: Los factores de riesgo como la hipertensión arterial (HTA) y la obesidad están presentes desde edades tempranas y tienden a persistir hasta la edad adulta. La detección precoz de estos factores de riesgo es clave para establecer estrategias preventivas eficaces. El propósito de este estudio es determinar la prevalencia de HTA en niños escolares de 10 a 13 años en escuelas públicas de Montevideo, conocer la prevalencia de sobrepeso y obesidad y su posible vínculo con la HTA. Población y método: se realiza un estudio transversal en una muestra representativa de escolares entre 10 y 13 años de escuelas públicas de Montevideo entre octubre de 2015 y junio de 2016. Se mide la presión arterial (PA) y se registra el estado nutricional a través de las siguientes medidas antropométricas: peso, talla, circunferencia de cintura. Se establecen los diagnósticos siguiendo las recomendaciones del cuarto reporte para el diagnóstico, evaluación y tratamiento de la HTA en niños y adolescentes. Se diagnostica estado nutricional en base al índice de masa corporal (IMC) según criterios de la Organización Mundial de la Salud (OMS) 2007 y circunferencia de cintura (CC) según las referencias de Fernández J y colaboradores. Resultados: se relevan 1.346 niños en 48 escuelas. Participan del estudio 1.297 niños, 708 de sexo femenino, con una edad media de 11,8 años. En la muestra se constata normotensión en 1.120 niños, prehipertensión (pre-HTA) en 79 e HTA en 98. Con respecto al estado nutricional se encuentra peso normal en 783 niños, sobrepeso en 347, obesidad en 148 y obesidad severa en 24 niños. La prevalencia estimada para niños de 10 a 13 años en escuelas públicas de Montevideo de pre-HTA es de 7,3% (IC: 5,6-8,9) y de HTA es de 7,8% (IC: 6,1-9,6). No se encuentran diferencias estadísticamente significativas en la prevalencia de pre-HTA e HTA con respecto a sexo, edad o estrato sociocultural. La prevalencia de pre-HTA e HTA en los niños con peso normal es 11,4% frente a los niños con exceso de peso que muestran 21,9% (p=0,003). Se encuentra asociación estadísticamente significativa entre CC mayor al percentil 90 (P90) y la presencia de cifras alteradas de PA. Conclusiones: este estudio encuentra una elevada prevalencia de pre-HTA e HTA que supera las de reportes nacionales previos. Se constata una asociación positiva de pre-HTA e HTA con sobrepeso y obesidad valorado por IMC, así como con la CC mayor al P90 en la franja etaria estudiada.

Summary: The purpose of this study is to determine HBP prevalence in school children from 10 to 13 years of age at public schools in Montevideo and to learn about the link between the prevalence of excess weight/obesity and HBP. Population and sampling methods: transversal trial carried out in a representative sample of Montevideo public school children of 10-13 years of age from October 2015 to June 2016. We measured HBP and monitored nutritional status though the measurement of: weight, height and waist circumference. Diagnoses were carried out as per the recommendations of the Fourth Report on the Diagnosis, Evaluation, and Treatment of high Blood Pressure in Children and Adolescents. Their nutritional status based on Body Mass Index BMI was diagnosed as per the WHO 2007 criteria, and Waist Circumference WC as per the references provided by Fernández J, et al. Results: 1,346 children were surveyed in 48 schools and 1,297 participated in the survey, 708 girls of a median age of 11.8 years of age. Normal BP was detected in 1,120 children, pre-hypertension (preHTA) in 79 and HTA in 98. Normal weight was detected in 783 niños, overweight in 347, obesity in 148 and severe obesity in 24 children. Early Stage HBP prevalence was found in 7,3% (IC: 5,6-8,9) and HBP in 7,8% (IC: 6,1-9,6). No statistically significant differences regarding Early Stage HBP or HBP prevalence were found regarding gender, age or social or cultural level. Early Stage HBP and HBP prevalence in normal weighted children was 11.4%, compared to that of overweight children which was 21.9 % (p=0.003). A more significant link was found between WC higher than 90 and altered BP. Conclusions: This trial found a higher prevalence of early stage HBP and HBP than that of previous national reports. We found a positive link between Early Stage HBP, HBP and overweight and obesity, assessed through BMI, WC higher than 90 in the age group surveyed.

Resumo: Os fatores de risco como a hipertensão arterial (HAS) e a obesidade estão presentes nas crianças desde cedo e persistem até a idade adulta. A detecção precoce desses fatores de risco é fundamental para o estabelecimento de estratégias preventivas eficazes. O objetivo deste estudo é determinar a prevalência da hipertensão arterial em escolares de 10 a 13 anos de idade em escolas públicas de Montevidéu, para conhecer a prevalência de sobrepeso e obesidade e sua possível relação com a hipertensão. População e métodos: realizamos um estudo transversal com amostra representativa de escolares entre 10 e 13 anos de escolas públicas em Montevidéu, entre outubro de 2015 e junho de 2016. Medimos a pressão arterial (PA) e o estado nutricional a partir das seguintes medidas antropométricas: peso, altura e circunferência da cintura. Os diagnósticos foram estabelecidos seguindo as recomendações do Quarto Relatório para o Diagnóstico, Avaliação e Tratamento da Hipertensão Arterial em Crianças e Adolescentes. O estado nutricional foi diagnosticado com base no Índice de Massa Corporal (IMC) de acordo com os critérios da OMS de 2007 e circunferência da cintura (CC) de acordo com as referências de Fernández J, et al. Resultados: 1346 crianças foram pesquisadas em 48 escolas. O estudo incluiu 1297 crianças, 708 do sexo feminino, com uma idade média de 11,8 anos. 1120 crianças mostraram tensão arterial normal, pré-hipertensão (pré-HTA) 79 e HTA 98. O estado nutricional é o peso foi normal em 783 crianças, 347 tiveram excesso de peso, e 148 em 24 crianças tiveram obesidade ou obesidade severa. A prevalência de pré-HTA para crianças de 10 a 13 anos de escolas públicas de Montevidéu foi 7,3% (IC: 5,6 a 8,9) e a prevalência de hipertensão foi de 7,8% (IC: 6,1-9 6). Não foram encontradas diferenças estatisticamente significantes na prevalência de pré-HTA e HTA com relação a sexo, idade ou estrato sociocultural. A prevalência de pré-HTA e HTA em crianças com peso normal foi de 11,4% em comparação com crianças com excesso de peso que mostram 21,9% (p = 0,003). Encontramos uma associação estatisticamente significativa entre CC maior que P90 e a presença de valores alterados de PA. Conclusões: Este estudo encontrou uma alta prevalência de pré-HTA e HTA, maior ainda que os dados dos relatórios nacionais anteriores. Confirmamos uma associação positiva entre pré-HTA e HTA e sobrepeso e a obesidade, avaliada pelo IMC, e com CC maior que P90 na crianças da faixa etária estudada.

Visual Hallucinations as Incidental Negative Effects of Virtual Reality on Parkinson's Disease Patients: A Link with Neurodegeneration?

We followed up a series of 23 Parkinson's disease (PD) patients who had performed an immersive virtual reality (VR) protocol eight years before. On that occasion, six patients incidentally described visual hallucinations (VH) with occurrences of images not included in the virtual environment. Curiously, in the following years, only these patients reported the appearance of VH later in their clinical history, while the rest of the group did not. Even considering the limited sample size, we may argue that VR immersive systems can induce unpleasant effects in PD patients who are predisposed to a cognitive impairment.

Behaviour of motor disabilities and appearance of visual hallucinations in patients with Parkinson's disease in a virtual environment.

We studied 23 Parkinson's disease (PD) non-demented patients and 15 controls in Virtual Reality (VR) environments reproducing usual daily living situations. In VR sessions, PD patients performed their actions worse than controls, in terms of time of execution in exploration and pointing, precision as objects avoiding, and in semantic incidental memory task. We observed clear differences of performances between on and off status medication, with a global worsening during off phase. Moreover, all six patients with motor fluctuations described visual hallucinations during off state, with occurrence of images not included in the virtual environment.

Access to diagnosis and treatment of Chagas disease/infection in endemic and non-endemic countries in the XXI century

In this article, Médicos Sin Fronteras (MSF) Spain faces the challenge of selecting, piecing together, and conveying in the clearest possible way, the main lessons learnt over the course of the last seven years in the world of medical care for Chagas disease. More than two thousand children under the age of 14 have been treated; the majority of whom come from rural Latin American areas with difficult access. It is based on these lessons learnt, through mistakes and successes, that MSF advocates that medical care for patients with Chagas disease be a reality, in a manner which is inclusive (not exclusive), integrated (with medical, psychological, social, and educational components), and in which the patient is actively followed. This must be a multi-disease approach with permanent quality controls in place based on primary health care (PHC). Rapid diagnostic tests and new medications should be available, as well as therapeutic plans and patient management (including side effects) with standardised flows for medical care for patients within PHC in relation to secondary and tertiary level, inclusive of epidemiological surveillance systems.

Access to diagnosis and treatment of Chagas disease/infection in endemic and non-endemic countries in the XXI century.

In this article, Médicos Sin Fronteras (MSF) Spain faces the challenge of selecting, piecing together, and conveying in the clearest possible way, the main lessons learnt over the course of the last seven years in the world of medical care for Chagas disease. More than two thousand children under the age of 14 have been treated; the majority of whom come from rural Latin American areas with difficult access. It is based on these lessons learnt, through mistakes and successes, that MSF advocates that medical care for patients with Chagas disease be a reality, in a manner which is inclusive (not exclusive), integrated (with medical, psychological, social, and educational components), and in which the patient is actively followed. This must be a multi-disease approach with permanent quality controls in place based on primary health care (PHC). Rapid diagnostic tests and new medications should be available, as well as therapeutic plans and patient management (including side effects) with standardised flows for medical care for patients within PHC in relation to secondary and tertiary level, inclusive of epidemiological surveillance systems.

The use of technology-supported mental imagery in neurological rehabilitation: a research protocol.

The human brain can simulate motor actions without physically executing them, and there is a neuro-psychological relationship between imaging and performing a movement. These are shared opinions. In fact there is scientific evidence showing that the mental simulation of an action is correlated to a subliminal activation of the motor system. There is also evidence that virtual stimulation can enhance the acquisition of simple motor sequences. In some situations, virtual training was found to be as beneficial as real training and more beneficial than workbook and no training in teaching complex motor skills to people with learning disabilities. Moreover, studies of brain-injured hemiplegics patients suggest that these patients retain the ability to generate accurate motor images even of actions that they cannot perform. Combined with evidence indicating that motor imagery and motor planning share common neural mechanisms, these observations suggest that supporting mental imagery through non-immersive, low-cost virtual reality (VR) applications may be a potentially effective intervention in the rehabilitation of brain-injured patients. Starting from this background, our goal is to design and develop a new technique for the acquisition of new motor abilities- "imagery enhanced learning" (or I-learning)-to be used in neuro-psychological rehabilitation. A key feature of I-learning is the use of potentially low-cost, Virtual Reality enhanced technology to facilitate motor imagery creating a compelling sense of presence. This paper will discuss the rationale and a preliminary rehabilitation protocol for investigating mental imagery as a means of promoting motor recovery in patients with a neurological disorder. The treatment strategy aims at evoking powerful imaginative responses using an innovative technique which makes no attempt to simulate the real-world motor behavior, but draws the patient's attention to its underlying dynamic structure. This is done by displaying highly stylized sketches of the motor behavior on a computer screen and gradually increasing the perceptual realism of the visualization. This strategy assumes that optimal learning will be achieved when the patient is allowed to elaborate his own schema and sequences of movements, thereby constructing his own personal image of the motor behavior to be trained.