Immunoproteomics of cow's milk allergy in Mexican pediatric patients.

Immunological mechanisms of non-IgE-mediated cow's milk protein allergy (CMPA) are not well understood. Such a circumstance requires attention with the aim of discovering new biomarkers that could lead to better diagnostic assays for early treatment. Here, we sought both to investigate the mechanism that underlies non-IgE-mediated CMPA and to identify cow's milk immunoreactive proteins in a Mexican pediatric patient group (n = 34). Hence, we determined the IgE and IgG1-4 subclass antibody levels against cow's milk proteins (CMP) by ELISA. Then, we performed 2D-Immunoblots using as first antibody immunoglobulins in the patients'serum that bound specifically against CMP together with CMP enrichment by ion-exchange chromatography. Immunoreactive proteins were identified by mass spectrometry-based proteomics. The serological test confirmed absence of specific IgE in the CMPA patients but showed significant increase in antigen-specific IgG1. Additionally, we identified 11 proteins that specifically bound to IgG1. We conclude that the detection of specific IgG1 together with an immunoproteomics approach is highly relevant to the understanding of CMPA's physiopathology and as a possible aid in making a prognosis since current evidence indicates IgG1 occurrence as an early signal of potential risk toward development of IgE-mediated food allergy. SIGNIFICANCE: Allergies are one of the most studied topics in the field of public health and novel protein allergens are found each year. Discovery of new principal and regional allergens has remarkable repercussions in precise molecular diagnostics, prognostics, and more specific immunotherapies. In this context, specific IgE is widely known to mediate physiopathology; however, allergies whose mechanism does not involve this immunoglobulin are poorly understood although their incidence has increased. Therefore, accurate diagnosis and adequate treatment are delayed with significant consequences on the health of pediatric patients. The study of type and subtypes of immunoglobulins associated with the immunoreactivity of cow's milk proteins together with an immunoproteomics approach allows better comprehension of physiopathology, brings the opportunity to discover new potential cow's milk protein allergens and may help in prognosis prediction (IgG1 occurrence as an early signal of possible risk toward development of IgE-mediated food allergy).

Parent-Teen Communication about Sexual and Reproductive Health: Cohort Differences by Race/Ethnicity and Nativity.

Parent-teen discussions about sexual and reproductive health (SRH) are associated with delayed sex and higher contraceptive use among teens. Using the National Survey of Family Growth, we conducted bivariate and multivariate analyses of different types of parent-teen SRH discussions among two cohorts of teens. We describe differences in patterns for males and females by race/ethnicity and nativity, and test for racial/ethnic interactions within each cohort. Analyses found that the prevalence of parent-teen discussions about SRH increased across cohorts. For males and females, there were increases in parent-teen discussions about condoms, and for males only, there were increases in any SRH discussions and discussions about contraception and STIs. Based on interactions, parent-teen discussions and STI discussions increased most for Hispanic females, and among Hispanics, increased most for the foreign-born. These data indicate increases in different types of parent-teen SRH discussions, particularly for males and foreign-born teens overall, and for Hispanic teen females regarding condom use. Future research should examine what factors are driving these changes, including changes in the structure of U.S. Hispanic communities and expansion of evidence-based teen pregnancy prevention programs.

Random forests to predict tumor recurrence following cervical cancer therapy using pre- and per-treatment 18F-FDG PET parameters.

The ability to predict tumor recurrence after chemoradiotherapy of locally advanced cervical cancer is a crucial clinical issue to intensify the treatment of the most high-risk patients. The objective of this study was to investigate tumor metabolism characteristics extracted from pre- and per-treatment 18F-FDG PET images to predict 3-year overall recurrence (OR). A total of 53 locally advanced cervical cancer patients underwent pre- and per-treatment 18F-FDG PET (respectively PET1 and PET2). Tumor metabolism was characterized through several delineations using different thresholds, based on a percentage of the maximum uptake, and applied by region-growing. The SUV distribution in PET1 and PET2 within each segmented region was characterized through 7 intensity and histogram-based parameters, 9 shape descriptors and 16 textural features for a total of 1026 parameters. Predictive capability of the extracted parameters was assessed using the area under the receiver operating curve (AUC) associated to univariate logistic regression models and random forest (RF) classifier. In univariate analyses, 36 parameters were highly significant predictors of 3-year OR (p<;0.01), AUC ranging from 0.72 to 0.83. With RF, the Out-of-Bag (OOB) error rate using the totality of the extracted parameters was 26.42% (AUC=0.72). By recursively eliminating the less important variables, OOB error rate of the RF classifier using the nine most important parameters was 13.21% (AUC=0.90). Results suggest that both pre- and per-treatment 18F-FDG PET exams provide meaningful information to predict the tumor recurrence. RF classifier is able to handle a very large number of extracted features and allows the combination of the most prognostic parameters to improve the prediction.

Slice correspondence estimation using SURF descriptors and context-based search for prostate whole-mount histology MRI registration.

Registration of histopathology volumes to Magnetic Resonance Images(MRI) is a crucial step for finding correlations in Prostate Cancer (PCa) and assessing tumor agressivity. This paper proposes a two-stage framework aimed at registering both modalities. Firstly, Speeded-Up Robust Features (SURF) algorithm and a context-based search is used to automatically determine slice correspondences between MRI and histology volumes. This step initializes a multimodal nonrigid registration strategy, which allows to propagate histology slices to MRI. Evaluation was performed on 5 prospective studies using a slice index score and landmark distances. With respect to a manual ground truth, the first stage of the framework exhibited an average error of 1,54 slice index and 3,51 mm in the prostate specimen. The reconstruction of a three-dimensional Whole-Mount Histology (WMH) shows promising results aimed to perform later PCa pattern detection and staging.

The use of fertility awareness methods (FAM) among young adult Latina and black women: what do they know and how well do they use it? Use of FAM among Latina and black women in the United States.

OBJECTIVES: Although a sizeable percentage of minority women use fertility awareness methods (FAM), little is known about their use in the United States. We sought to fill this gap by examining FAM use among Latina and black women -- groups that have high rates of unintended childbearing and FAM use -- focusing on knowledge, sources of information and accuracy of use. Unlike other methods, accurate use of FAM requires relatively high levels of knowledge. STUDY DESIGN: In-depth, semistructured interviews were conducted with 58 Latina and black women who were current or past users of FAM. Participants were recruited through local clinics and ads posted in neighborhoods and local Web sites. A purposive sample design was used to ensure that the sample included individuals with characteristics associated with FAM use. An inductive approach was used in the data analysis. RESULTS: Women learned about FAM from family, professionals and the Internet. In general, what they learned fell into one of two levels of information -- basic or in-depth -- and many women possessed moderate to low levels of knowledge. By decomposing accuracy of use into its components, we find that it is driven largely by knowledge. While the vast majority of women were abstaining from unprotected sex during what they believed to be their fertile window, only 34 of the 58 participants accurately identified their fertile period. CONCLUSIONS: Findings speak to a gap in reproductive literacy that has important implications for FAM users. The gap between behavior and knowledge could help account for high failure rates associated with FAM use.

"Because you're on birth control, it automatically makes you promiscuous or something": Latina women's perceptions of parental approval to use reproductive health care.

PURPOSE: To explore the perceptions of Latina women and healthcare providers about the role of parents in the young women's access to sexual and reproductive healthcare services. METHODS: This qualitative study drew on 11 focus groups conducted with 95 young adult Latina women (ages 18-24 years) and 3 focus groups with 24 health providers recruited from clinics and programs with large Latino client-bases. The data were analyzed using an inductive approach. RESULTS: Young adult Latinas and providers emphasized that parents play an important role in young adults' access to sexual and reproductive health services. Some young women perceived parental support to access these services while others did not. The primary reason young adult Latinas and providers felt parents did not provide support was due to parental transmission of cultural values and beliefs, specifically: (1) a high value placed on virginity; (2) a presumption that unmarried women are not sexually active and therefore do not require sexual and reproductive health services; and (3) a belief that conversations about sex and reproductive health services encourage sexual activity and promiscuity. CONCLUSIONS: Findings suggest that young adult Latinas perceive parents as playing an important role in their sexual and reproductive health seeking behaviors into adulthood. Parents appear to influence their young adult daughters by transmitting the cultural values they have on virginity and familismo, which stresses the importance of family, familial solidarity, and adherence to traditional gender roles within the family structure.

Unintended births: patterns by race and ethnicity and relationship type.

CONTEXT: Childbearing intentions vary by race and ethnicity and by relationship type. However, few studies have examined whether they differ by race and ethnicity within relationship type. METHODS: Data from the Early Childhood Longitudinal Study were used to examine the childbearing intentions of 9,100 mothers of a cohort of children born in 2001. Multivariate and multinomial regression analyses were conducted to examine whether relationship type (married, cohabiting or neither) helps explain racial and ethnic differences in childbearing intentions and whether associations between race and ethnicity and childbearing intentions vary by relationship type. RESULTS: Blacks were more likely than whites to have had an unintended birth (odds ratio, 2.5); the relationship held among married (2.6), but not unmarried, mothers. For most relationship types, black mothers had higher relative risks than whites of having had an unwanted birth, rather than an intended or a mistimed one. Asian married mothers were more likely than their white counterparts to have had an unwanted, rather than intended, birth (1.9). The odds of an unintended birth were lower among foreign-born Hispanic cohabiting women than among white cohabiting women (0.6), a finding driven by the lower risk of unwanted than of other births among foreign-born Hispanics (0.3­0.5). Few differences were apparent between native-born Hispanics and white mothers. CONCLUSIONS: Racial and ethnic differences in childbearing intentions are frequently contingent on relationship context. Differences between whites and blacks are largely attributable to married women. Assessment of childbearing intendedness among Hispanics should take nativity into account.

Magnetic fields and acute leukemia in children with Down syndrome.

BACKGROUND: : We analyzed effects of exposure to magnetic fields on the expression of acute leukemia in children with Down syndrome (who have a 20-fold higher risk of leukemia). METHODS: : We performed a case-control study that included 42 children with both acute leukemia and Down syndrome as cases and 124 healthy children with Down syndrome as controls. We obtained demographic information concerning the children and took spot measurements of magnetic fields at each residence. RESULTS: : The odds ratio for direct measurements of magnetic fields >/=6.00 mG was 3.7 (95% confidence interval = 1.05-13.1). CONCLUSION: : The association between magnetic fields and leukemia in children with Down syndrome suggests the possibility of a causal role for magnetic fields in the etiology of leukemia among a genetically susceptible subgroup of children.

Estudio piloto: efectos de un programa de hatha-yoga sobre variables psicológicas, funcionales y físicas, en pacientes con demencia tipo alzheimer / Pilot study: effects of a program of yoga- hatha on psychological variables, functional, physical in patients with alzheimer type dementia

El objetivo de esta investigación fue determinar el efecto de un programa de Hatha-Yoga sobre variables psicológicas (calidad de vida, ansiedad, depresión, memoria de trabajo y velocidad de procesamiento), físicas (equilibrio y flexibilidad) y funcionales (actividades básicas e instrumentales), en un grupo de pacientes con Demencia Tipo Alzheimer (DTA) de Bogotá. En la investigación participaron ocho adultos mayores con diagnóstico de DTA de 60 años, diagnosticados por el equipo médico de la Fundación Cardio Infantil y con una puntuación de 5 en la Escala de Deterioro Global de Reisberg (GDS). Para el análisis de resultados se utilizó estadística descriptiva para establecer comparaciones intraparticipante en las mediciones realizadas antes y después del programa de Hatha-Yoga y además, se usó estadística inferencial para la prueba de hipótesis a partir de la prueba de signos Wilcoxon encontrándose mejoría en las variables físicas de equilibrio y flexibilidad.

The main interest of this research was to determine the effect of Hatha Yoga program on psychological (quality of life, anxiety, depression, working memory and processing speed), physical (balance and flexibility) and functional (basic and instrumental activities) variables in Alzheimer patient group from Bogota. Eight adults 60 years old diagnosed with Moderate Alzheimer Dementia by health team from Fundación Cardio Infantil and with score of 5 in the Global Deterioration Scale (GDS) participated in this study Descriptive statistics was used to make comparisons in measurements taken before and after the Hatha Yoga program and inferential statistics were used to test hypotheses. Increases in balance and flexibility was found with Wilcoxon test.

Psoríase invertida infantil extensa - abordagem do manejo / An approach to the management of childhood extensive inverse psoriasis

Introdução: Entre as afecções dermatológicas imunomediadas a psoríase merece destaque, por representar cerca de 4% de todas as dermatoses em menores de 16 anos e acometer 3,5% de toda a população mundial. Apresenta diversas variantes clínicas e quanto mais precoce, mais grave tende a ser sua evolução. Na infância pode ser classificada em três grupos: psoríase infantil (doença autolimitada da infância), psoríase de início precoce (com persistência do quadro na idade adulta); e com acometimento articular. Relato: Paciente feminino com 10 anos de idade, queixa de aparecimento de placas eritêmato-descamativas pruriginosas há seis meses, que se iniciaram na cabeça e progrediram para as áreas flexurais, axilas e região inguinal. A biópsia confirmou o diagnóstico de psoríase. Foi iniciado o uso de clobetasol tópico para as lesões da pele com melhora dos focos. Seis meses depois apresentou piora do quadro, apresentando placas eritêmato-descamativas grandes nas regiões cervical, lateral do tronco e inguinal, porém sem acometimento articular ou ungueal. Resultados: Novamente medicada, desta vez, com a combinação de calcipotriol e ácido salicílico, uma vez ao dia, e betametasona, duas aplicações ao dia, com melhora significativa das lesões em quatro semanas. Conclusão: Apesar das diferenças entre a psoríase infantil e do adulto, a terapia utilizada no tratamento de ambas é a mesma, tendo apenas sua dose e potência ajustadas para tratamento pediátrico. Na grande maioria das vezes, a doença pode ser tratada efetivamente com medicação tópica...

Biology, clinical, and hematologic features of acute megakaryoblastic leukemia in children.

To assess the incidence, clinical features at presentation, hematologic, immunophenotypic, and cytogenetic characteristics of AMKL in children we prospectively studied 834 consecutive non selected children with newly diagnosed acute leukemia (AL) admitted to the Hematology Department at the Instituto Nacional de Pediatría (INP), Mexico, D.F. We found 682 cases (81.8%) with a typical ALL immunophenotype, and the remaining 152 (18.2%) were considered to have AML. In 29 of the 152 patients with AML studied, a diagnosis of AMKL was established. These 29 cases represented 19.1% of the cases of AML and 3.48% of the total cases of AL during the time span covered by the study. Twenty-four percent of the cases occurred in infants 2 years old or younger and 41.4% occurred in children 41 months of age or younger. In contrast, in only 18.6% of the patients with AML (M0-M6), the diagnosis was established before 42 months of age and in 17% before their second year of life. Clinical presentation was not strikingly different than that observed in patients with other types of AML, and the time interval from onset of symptoms to diagnosis was also similar, though in a small subset of patients, the clinical course was characterized by a chronic slowly progressive disorder extending over weeks or months resembling smoldering leukemia or chronic myelofibrosis with agnogenic myeloid metaplasia. Bone marrow (BM) fibrosis was a constant features in our patients; 75% of the patients studied showed this complication at the time of diagnosis. Some rather unusual findings in this study were intense skeletal pains from multiple osteolytic lesions, the presence of soft-tissue tumor, and the presence of cohesive scanty clusters of primitive-looking blast cells in BM aspirates. Several interesting cytogenetic findings in our study were t(1;22)(p13;q13) in a 14-year-old boy, t(9;22)(q34;q11) in one patient, and monosomy 7 in two patients. Another important finding in our study was the clinical association with colonic adenocarcinoma in one patient, an association that to our knowledge has not been reported previously. In conclusion, our data suggest that the incidence of AMKL in Mexico might be higher than those reported in Caucasian white pediatric population, and that biologic and cytogenetic profile may differ from those of western countries, but more studies are needed to corroborate cytogenetic heterogeneity, ethnic and geographic diversity. Early onset of the disease, low WBC counts, slight thrombocytopenia or normal platelet counts, and BM fibrosis were characteristic distinctive features of at least half of the patients with this subtype of AML.

Eritropoyetina en el tratamiento de la anemia en niños en hemodiálisis / Erythropoietin in the treatment of anemic children in hemodialysis

La anemia de la insuficiencia renal tiene origen multifactorial; el más importane es la disminución de la producción de eritropoyetina por las células renales peritubulares. La administración de esta hormona permite corregir la anemia. Se trató la anemia de siete niños en hemodiálisis con eritropoyetina recombinante humana. La dosis inicial fue de 150-250 U/kg/semana y la dosis de mantenimiento 100-200 U/kg/semana. La hemoglobina se elevó de 5.8 g/dL a 10 g/dL en promedio; tres pacientes presentaron ferropenia y falta de respuesta transitoria a la hormona a pesar del uso profiláctico de hierro. Mejoró la calidad de vida al corregirse la anemia y los pacientes no requirieron transfusiones después de 20 semanas. Tres pacientes desarrollaron trombosis en el sitio del acceso vascular; no hubo otros efectos colaterales. La eritropoyetina es útil en el tratamiento de la anemia de la insuficiencia renal con pocos efectos colaterales en niños

Púrpura fulminante idiopática / Purpura fulminans idiopatic

Introducción. La púrpura fulminante (PF) es una enfermedad rara que se caracteriza por la aparición súbita de hemorragia cutánea, formación de bulas y flictenas, necrosis de la piel y tejido subcutáneo. La evolución espectacular, rápidamente progresiva y la propagación por oleadas orientan acerca de la índole grave de la enfermedad. Material y métodos. Se analizan las características clínicas y hematológicas, y la evolución de 10 pacientes con diagnóstico de PF admitidos al Servicio de Hematología del Instituto Nacional de Pediatría en el período 1979-1993. Resultados. Se observó una distribución similar de acuerdo al sexo. La edad de presentación más frecuente fue la preescolar (60 por ciento), con una frecuencia similar en la lactancia y en la edad escolar. La mayor frecuencia de la enfermedad se observó en primavera y verano. Sólo 3 pacientes presentaron alteraciones hemostáticas compatibles con coagulopatía por consumo en el momento del diagnóstico. Todos los pacientes recibieron heparina, esteroides y antibióticos y algunas otras medidas adicionales por un período promedio de 7 días, con variaciones de 5 a 14 días. La evolución fue excelente en el 60 por ciento de los pacientes que no presentaron ningún tipo de secuelas. Se practicó amputación en 4 de los pacientes. En uno de los pacientes amputados se observó colonización e infección sistémica subcecuente a Aeromonas shigelloides y Pseudomonas sp, sucumbiendo a la infección. Un diagnóstico erróneo en otras instituciones y la institución de un tratamiento anticoagulante tardío fue el responsable de las secuelas irreversibles observadas en 2 pacientes. Conclusiones. La PF es una enfermedad de la niñez de curso clínico agresivo, que hacen de ella una verdadera urgencia hematológica. La incapacidad para sospechar el diagnóstico tiene una influencia pronóstica desfavorable y contribuye a una morbimortalidad elevada