Characteristics of the pediatric population with gender incongruence attending specialized care in Cali, Colombia: an observational, descriptive and retrospective study.

BACKGROUND: Gender incongruence can often manifest itself from early childhood [Olson KR, Gülgöz S. Child Dev Perspect. 2018;12:93-7. https://doi.org/10.1111/cdep.12268 ] with a significant psychological impact, altering social and school dynamics without the appropriate care.[Tordoff DM, et al. JAMA Netw Open. 2022;5(2): e220978. https://doi.org/10.1001/jamanetworkopen.2022.0978 ] Early identification and gender-affirming care are essential to reduce adverse mental health outcomes, such as depression and self-harm [Tordoff DM, et al. JAMA Netw Open. 2022;5(2): e220978. https://doi.org/10.1001/jamanetworkopen.2022.0978 ]..This study aims to analyze characteristics and to estimate relative frequencies of gender incongruence in a population of children and adolescents receiving gender-affirming care at a high-complexity university hospital located in the third largest city in Colombia. METHODS: This was a retrospective descriptive study of patients under 18 with gender incongruence that received gender-affirming care between January 2018 and June 2022 at Fundacion Valle del Lili in Cali, Colombia. Sociodemographic and clinical characteristics of 43 patients were assessed, as well as the relative frequencies of gender incongruence. Data analysis was performed with the statistical package STATA®. To determine significant differences between the characteristics of the patients who participated in the study, the Mann‒Whitney U test was performed for numerical variables with non-parametric distribution, while either Pearson's Chi-2 test or Fisher's exact test was performed for categorical variables. RESULTS: For every ten individuals assigned female at birth, who manifested gender incongruence, there were eight assigned male at birth. The median age of onset of gender incongruence was ten years (IQR: 5-13 years), and the median time elapsed between the reported onset of gender incongruence and the first consultation with a multidisciplinary gender-affirming team was three years (IQR: 1-10 years). The frequency of transgender identity was notable in participants with ages between 15 and 17 years. Depressive symptoms, anxiety, and psychotropic drug use were significantly higher in individuals assigned female at birth. Among 25 individuals assigned female at birth who participated in this study, 60% self-recognized as transgender men.18 individuals assigned male at birth, 67% self-recognized as transgender women. The most frequent treatment was a referral to mental health services (46.51%). CONCLUSION: Based on the cohort of our study, we can conclude that patients consult for gender-affirming treatment 3 years after the onset of gender incongruence. Anxiety and depression were higher in individuals assigned female at birth. Additionally, they presented at a later stage of sexual maturation, reducing the possibility of using puberty blockers.

High-Pressure Processing for Cold Brew Coffee: Safety and Quality Assessment under Refrigerated and Ambient Storage.

Cold brew coffee (CBC) has gained in popularity due to its distinct sensory experience. However, CBC can pose a risk for bacterial pathogens if not stored properly. High-Pressure Processing (HPP) is a nonthermal technology that can improve the safety of CBC while maintaining its quality. In this study, CBC made from ground roasted coffee grains was processed at 600 MPa for 3 min and stored at 4 or 23 °C for 90 days. The microbiological quality indicators remained stable throughout the study period. Physicochemical and quality parameters, such as pH, total dissolved solids, titratable acidity, color, total phenolic compounds and antioxidant activity, were not significantly affected by HPP. Both unprocessed and HPP CBC samples showed changes in pH, titratable acidity and color stability after 60 days at 23 °C. Unprocessed CBC samples spiked with Escherichia coli O157:H7, Listeria monocytogenes and Salmonella enterica showed decreased counts, but the pathogens were still detectable after 60 days at 4 °C and after 90 days at 23 °C. HPP achieved a >6-log10 reduction in the species tested, with non-detectable levels for at least 90 days at both storage temperatures. These findings suggest that HPP can effectively control vegetative pathogens and spoilage microorganisms in CBC while preserving its quality attributes.

High Pressure Processing Impact on Alternariol and Aflatoxins of Grape Juice and Fruit Juice-Milk Based Beverages.

High-pressure processing (HPP) has emerged over the last 2 decades as a good alternative to traditional thermal treatment for food safety and shelf-life extension, supplying foods with similar characteristics to those of fresh products. Currently, HPP has also been proposed as a useful tool to reduce food contaminants, such as pesticides and mycotoxins. The aim of the present study is to explore the effect of HPP technology at 600 MPa during 5 min at room temperature on alternariol (AOH) and aflatoxin B1 (AFB1) mycotoxins reduction in different juice models. The effect of HPP has also been compared with a thermal treatment performed at 90 °C during 21 s. For this, different juice models, orange juice/milk beverage, strawberry juice/milk beverage and grape juice, were prepared and spiked individually with AOH and AFB1 at a concentration of 100 µg/L. After HPP and thermal treatments, mycotoxins were extracted from treated samples and controls by dispersive liquid-liquid microextraction (DLLME) and determined by HPLC-MS/MS-IT. The results obtained revealed reduction percentages up to 24% for AFB1 and 37% for AOH. Comparing between different juice models, significant differences were observed for AFB1 residues in orange juice/milk versus strawberry juice/milk beverages after HPP treatment. Moreover, HPP resulted as more effective than thermal treatment, being an effective tool to incorporate to food industry in order to reach mycotoxins reductions.

Assessing the pressure resistance of Escherichia coli O157:H7, Listeria monocytogenes and Salmonella enterica to high pressure processing (HPP) in citric acid model solutions for process validation.

Despite the commercial success of high pressure processing (HPP) in the juice industry, some regulatory agencies still require process validation. However, there is a lack of consensus on various aspects regarding validation protocols, including the selection of representative strains to be used in challenge tests. This study characterized the variable response of Escherichia coli O157:H7 (34 strains), Listeria monocytogenes (44 strains) and Salmonella enterica (45 strains) to HPP, and identified potential candidates to use in process validation. Stationary phase cells were submitted to 500 MPa for 1 min at 10 °C in model solutions consisting of tryptic soy broth + 0.6% yeast extract (TSBYE) adjusted to pH 4.5 and 6.0 with citric acid. At pH 6.0, pressure resistance widely varied between species and within strains of the same species. E. coli O157:H7 and L. monocytogenes were the most pressure resistant and showed high variability at strain level, as the total count range given by minimum and maximum counts spread between 2.0 and 6.5 log10 CFU/ml. S. enterica was the least resistant pathogen with more than 82% of the isolates displaying non-detectable counts after HPP. Recovery through storage at 12 °C was also variable for all pathogens, but eventually most strains recovered with median counts on day 14 between 8.3 and 8.9 log10 CFU/ml. For pH 4.5 solutions, 26 E. coli O157:H7 strains displayed survivors after HPP but did not adapt, registering non-detectable counts in the next sampling dates. None of the L. monocytogenes and S. enterica strains survived HPP or incubation at pH 4.5 (<2.0 log10 CFU/ml), suggesting that citric acid at 4.16 g/l is a safe barrier for pathogen control under moderate HPP conditions. Principal component and cluster analyses served to propose strain cocktails for each species based on their pressure resistant and adaptation phenotypes. Additionally, S. enterica was identified as less pressure resistant and less prone to recover following HPP than E. coli O157:H7 and L. monocytogenes, so its relevance in process validation for juices should be questioned. Future work will validate the proposed strain cocktails on real food systems.

Methylation Status of GLP2R, LEP and IRS2 in Small for Gestational Age Children with and without Catch-up Growth

Objective: In small for gestational age (SGA) children, catch-up growth could be influenced by methylation of several genes involved in metabolism. Epigenetics may influence the development of metabolic diseases in adulthood. To compare the methylation of leptin (LEP), glucagon-like peptide-2 receptor (GLP2R), insulin receptor substrate-2 (IRS2) in SGA patients with and without catch-up growth. Methods: Observational prospective study of SGA children. Demographical and clinical variables were collected from clinical records and parents' questionnaire. Methylation status of LEP, IRS2, and GLP2R promoters was evaluated in DNA extracted from patient and one parent saliva samples. Results: Forty-eight SGA patients were included. Twenty-six (54.2%) had catch-up growth phenotype and 22 (45.8%) did not. The median age was 5.2 years [RIC 4.1-6.8] without difference between groups (p=0.306). The catch-up group had increased appetite (42.3% vs 9.1%, p=0.008), family history of dyslipidemia (42.3% vs 27.3%) and diabetes (34.6% vs 22.7%) compared to non-catch-up group. Catch-up patients had significantly larger waist circumference compared to non-catch-up group (median 55 cm [RIC 52-58] versus median 49.5 cm [RIC46-52]; p<0.001). LEP and GLP2R were methylated in all samples. IRS2 was methylated in 60% of SGA patients without difference between groups (p=0.520). Conclusion: There is no association between IRS2 methylation and catch-up growth among SGA patients. LEP and GLP2R were methylated in all SGA patients. Gene methylation may be implicated in metabolic disease later in life. More studies should be performed to confirm this hypothesis.

Synthesis, crystal structure, Hirshfeld surface analysis, MEP study and mol-ecular docking of N-{3-[(4-meth-oxy-phen-yl)carbamo-yl]phen-yl}-3-nitro-benzamide as a promising inhibitor of hfXa.

The title compound, C21H17N3O5, consists of three rings, A, B and C, linked by amide bonds with the benzene rings A and C being inclined to the mean plane of the central benzene ring B by 2.99 (18) and 4.57 (18)°, respectively. In the crystal, mol-ecules are linked via N-H⋯O and C-H⋯O hydrogen bonds, forming fused R 2 2(18), R 3 4(30), R 4 4(38) rings running along [0] and R 3 3(37) and R 3 3(15) rings along [001]. Hirshfeld analysis was undertaken to study the inter-molecular contacts in the crystal, showing that the most significant contacts are H⋯O/O⋯H (30.5%), H⋯C/C⋯H (28.2%) and H⋯H (29.0%). Two zones with positive (50.98 and 42.92 kcal mol-1) potentials and two zones with negative (-42.22 and -34.63 kcal mol-1) potentials promote the N-H⋯O inter-actions in the crystal. An evaluation of the mol-ecular coupling of the title compound and the protein with enzymatic properties known as human coagulation factor Xa (hfXa) showed the potential for coupling in three arrangements with a similar minimum binding energy, which differs by approximately 3 kcal mol-1 from the value for the mol-ecule Apixaban, which was used as a positive control inhibitor. This suggests the title compound exhibits inhibitory activity.

Evaluation of factors influencing the growth of non-toxigenic Clostridium botulinum type E and Clostridium sp. in high-pressure processed and conditioned tender coconut water from Thailand.

Bacterial spores survive high pressure processing (HPP). Group II Clostridium botulinum is an obligate anaerobe spore-forming pathogen that can produce the botulinum neurotoxin under refrigeration. This study assessed nontoxigenic type E C. botulinum and Group II Clostridium sp. growth in raw and HPP (550 MPa, 3 min, 10 °C) Thai coconut water (CCW; pH 5.2). No spore germination or growth occurred in HPP CCW inoculated with 105 CFU/ml after 61 days regardless of oxygen concentration (<0.5 - 11 mg/l) or storage temperature (4 and 20 °C). Spore concentration decreased by 3.0 ± 0.1 log CFU/ml in a worst-case scenario consisting of non-HPP filter-sterilized CCW (pH 7.0) under anoxic incubation at 30 °C during 61 days, suggesting spore germination followed by cellular death. Supplementing filter-sterilized CCW (pH 7.0) with selected germinants and free amino acids did not support spore development, but the addition of nutrient-rich laboratory media (TPGY broth) at low concentrations (6.25%) promoted growth, suggesting that a lack of nutrients prevents C. botulinum development in CCW. Further risk assessment will require evaluating other CCW varieties and toxin production.

Prenatal exposure of a girl with autism spectrum disorder to 'horsetail' (Equisetum arvense) herbal remedy and alcohol: a case report.

INTRODUCTION: Autism is a complex neurodevelopmental disorder in which the interactions of genetic, epigenetic and environmental influences are thought to play a causal role. In humans, throughout embryonic and fetal life, brain development is exquisitely susceptible to injury caused by exposure to toxic chemicals present in the environment. Although the use of herbal supplements during pregnancy is relatively common, little information is available on their association with fetal neurodevelopment. This is, to the best of our knowledge, the first report in the literature to associate a new plausible mechanism of neurodevelopmental toxicity with a case of autism spectrum disorder through a vitamin deficiency potentiated by concomitant use of herbal supplements and ethanol exposure. CASE PRESENTATION: We describe the pediatric environmental history of a three-year-old Caucasian girl with an autism spectrum disorder. We utilized her pediatric environmental history to evaluate constitutional, genetic, and environmental factors pertinent to manifestation of neurodevelopment disorders. Both parents reported prenatal exposure to several risk factors of interest. A year prior to conception the mother began a weight loss diet and ingested 1200 mg/day of 'horsetail' (Equisetum arvense) herbal remedies containing thiaminase, an enzyme that with long-term use can lead to vitamin deficiency. The mother reported a significant weight loss during the pregnancy and a deficiency of B-complex vitamins. Thiamine (vitamin B1) deficiency could have been potentiated by the horsetail's thiaminase activity and ethanol exposure during pregnancy. No other risk factors were identified. CONCLUSIONS: A detailed and careful pediatric environmental history, which includes daily intake, herbal remedies and ethanol exposure, should be obtained from all patients with autism spectrum disorder. Maternal consumption of ethanol and of herbal supplements with suspected or potential toxicity should be avoided during pregnancy. The prospective parents should perform preconception planning before pregnancy.

High-molecular-weight adiponectin in children born small- or appropriate-for-gestational-age.

Longitudinal data collected from children ages 2 until 6 years, who were born appropriate-for-gestational-age or small-for-gestational-age, indicate that the latter have a normal body fat fraction and normal high-molecular-weight adiponectinemia at age 2 years and that they accumulate excess adipose tissue and have low adiponectin levels by age 4 to 6 years.

Relación entre los niveles de carga viral y los niveles de linfocitos CD4 en el diagnóstico de Cryptosporidium spp. en heces de niños de la Clínica Pediátrica de VIH/SIDA del Hospital Universitario del Valle, Cali, Colombia / Relation between viral load and CD4 versus Cryptosporidium spp. in feces of children with AIDS

Introducción: Cryptosporidium spp. (C. spp.) causa morbimortalidad en niños con SIDA. Objetivo: Identificar la asociación entre carga viral, CD4 y C. spp. en heces de niños con SIDA. Materiales y métodos: Estudio observacional en niños del Hospital Universitario del Valle de Cali. Se tomaron datos como edad, género, procedencia, consanguinidad, tratamiento, estadio, supervivencia materna y peso. Se analizaron las heces por la técnica de Ziehl-Neelsen modificada. Se midieron carga viral y niveles de linfocitos ayudadores TCD4. La estadística incluyó análisis estratificado, modelos de regresión logística, pruebas t de Student, X2, y prueba de Fisher, con p significativa <0.05. Resultados: Ingresaron 72 niños entre 0 y 15 años, 52.7% masculinos, 50% consanguíneos y con madre viva, 54.2% del área urbana, 69.1% institucionalizados, 36.1% grado C de severidad, 73.6% con análogo nucleósido con inhibidor de proteasa, 55% con >100,000 copias de carga viral y >100,000 células CD4. La prevalencia de C. spp. fue 51.4%, siendo más afectados entre los 5-10 años; con mayor proporción de niños positivos para C. spp. con grado severo para SIDA (p = 0.03). Con intervalo de confianza de 95%, los >2 años tuvieron un riesgo 8 veces mayor de ser positivos en heces para C. spp. (1.6-40.1); para edad, género y procedencia rural, 7.7 (1.5-38.9); para madre viva y estar institucionalizado, 6.1 (1.1-32.7), y para severidad de la enfermedad y peso, 5.7 (1-32.3). Conclusión: La prevalencia para C. spp. fue 51.4%, con factores de riesgo edad >2 años y grado de severidad C, sin diferencias significativas en peso, carga viral y niveles de CD4.

Introduction: Cryptosporidium spp. (C. spp.) cause morbi-mortality in children with AIDS. Objective: To identify the association between viral load, CD4 levels and C. spp., presence in feces of children with AIDS. Materials and methods: Observacional study in children of the Hospital Universitario del Valle of Cali. Data like age, gender, origin, consanguinity, treatment, stage, maternal survival and weight, were taken. Feces were analyzed by the technique of Ziehl-Neelsen modified. Viral load and CD4 levels were measured. Statistic included stratified analysis, models of logistic regression, and tests, t Student, X2, and Fisher’s, being significant p <0.05. Results: Were analized 72 children between 0 and 15 years, 52.7% masculine ones, 50% consanguinity and with alive mother, 54.2% of the urban area, 69.1% institutionalized ones, 36.1% severity degree C, 73.6% with analog nucleoside with protease inhibitor, 55% with >100,000 copies of viral load and >100,000 cells CD4. The prevalence of C. spp. was 51.4%, being more affected between 5 to 10 years; with a greater proportion of positive children for C. spp. with severe degree for AIDS (p = 0.03). With interval of confidence of 95%, >2 years had a greater risk 8 times to be positive in feces for C spp. (1.6-40.1); for age, gender and rural origin, 7.7 (1.5-38.9); alive mother and to be institutionalized, 6.1 (1.1-32.7), and for severity of the disease and weight, 5.7 (1-32.3). Conclusion: The prevalence for C. spp. was 51.4%, with risk factors age >2 years and degree of severity C, without significant differences in weight, viral load and CD4 levels.