El presente proyecto busca implementar un Centro Pediátrico Nutricional, en el distrito de Villa el Salvador, perteneciente a la zona sur de la capital de Lima, caracterizada por un desarrollo económico emergente y con necesidades crecientes de salud no cubiertas en cantidad y calidad. Mercado objetivo son los niños de 0-17 años de este distrito y de distritos aledaños. Actualmente la población se ve obligada a trasladarse a centros de atención fuera del distrito, perciben maltrato por los sistemas de salud públicos o privados de la zona, con filas enormes desde muy temprano para acceder a una consulta, las atenciones apresuradas o de corto tiempo que puede omitir condiciones riesgosas como masas abdominales (Hepatomas), renales (Tumor de Wilms), alteraciones visuales (estrabismo, ambliopía), trastornos de integración sensorial (TDAH) de abordaje oportuno. Además, en los establecimientos de salud no existe un lugar donde recibir orientación complementaria para la prevención, el cuidado y la instrucción nutricional del infante, que asegure una vida saludable futura. El presente proyecto tiene por objetivo ofrecer una alternativa de atención pediátrica integral y nutricional, donde no solo se brinde atención curativa o recuperativa, sino enfocadas en la mejora de hábitos y estilos de vida saludable así como en la prevención de enfermedades crónicas de la adultez, tales como obesidad, diabetes, hipertensión, síndrome metabólico (Pediatría Funcional). El futuro ciudadano presentara menos problemas de salud, un mejor desarrollo de sus potencialidades, debido a las intervenciones oportunas realizadas durante su niñez con un abordaje holístico, además de la asistencia emocional y física. Otra bondad de este proyecto es la innovación tecnológica en la atención al incluir las plataformas de asistencia digital, que favorecerán el acceso inmediato con el profesional médico, disminuyendo las automedicaciones y el tiempo que demanda una atención tradicional.. La proyección económica ha sido realizada en un horizonte de 10 años, el proyecto contará con un financiamiento por parte de los socios del 56.49% del total y el 43.51% a través de un crédito financiero por un periodo de 6 años. El periodo de recuperación de la inversión se ha calculado en 2.09 años. Los ratios financieros que indican que el proyecto es viable son un VAN positivo, un TIR del 48.69% y un WACC del 13.33%, siendo muy atractivo para los futuros inversionistas. / This project seeks to implement a Pediatric Nutrition Center, in the district of Villa el Salvador, belonging to the southern part of the capital of Lima, characterized by an emerging economic development and with growing health needs not covered in quantity and quality. The target audience is children from 0-17 years of age from this district and surrounding districts. Currently the population is forced to move to other care centers outside the district, they perceive the abuse by public or private health systems in the area, with huge lines from very early to access a medical consultation, hasty care or short time it can omit risky conditions such as abdominal masses (Hepatomas), renal (Wilms tumor), visual disturbances (strabismus, amblyopia) and sensory integration disorders (ADHD) of timely approach. In addition, in health centers, there is no place to receive complementary guidance for the prevention, the care and the nutritional instruction of the infant which ensures a healthy future life. The purpose of this project is to offer an alternative of comprehensive and nutritional pediatric care, where not only curative or recovery care is provided, but focused on improving healthy habits and lifestyles as well as on the prevention of chronic diseases of adulthood, such as obesity, diabetes, hypertension, metabolic syndrome (functional Pediatrics). The future citizen will present fewer health problems, a better development of their potential, due to the opportune interventions carried out during their childhood with a holistic approach, in addition to emotional and physical assistance. Another goodness of this project is technological innovation in care by including digital assistance platforms, which will favor direct access with the medical professional, reducing self-medication and the time required for traditional care. The economic projection has been carried out over a 10-year horizon, and the project will be financed by the partners of 56.49% of the total and 43.51% through a financial loan for a period of 6 years. The period of recovery of the investment has been calculated in 2.09 years. The financial ratios that indicate that the project is viable are a positive NPV, an IRR of 48.69% and a WACC of 13.33%, being very attractive for future investors. / Tesis

During a healthcare visit, children report fear of injections. Virtual Reality (VR) has been identified as a possible tool that can help decrease pain associated with receiving injections. The purpose of this study was to examine the effects of VR on decreasing pain children experience when receiving an injection. Children, 4 to 12 years old, were randomly assigned to either a VR group or a control group. In the intervention group, children engaged in VR before and during their injection as a tool for distraction.The control group received standard care. Pain was assessed through self-report, parent observations, and researcher observations. Children who experienced VR distraction displayed significantly less pain, as observed by both parents and an observer. VR appears to be an effective tool to help minimize pain in pediatric patients experiencing an injection. Therefore, pediatricians should consider providing VR as a distraction during injections.

Indiana University-Purdue University Indianapolis (IUPUI) / Nearly 18% of children are diagnosed with developmental disabilities. Autism spectrum disorders (ASDs) and attention deficit hyperactivity disorder (ADHD) are increasingly common developmental disabilities, but neither is well understood. ADHD and ASD are both prevalent in the genetic disorder Neurofibromatosis type 1 (NF1) which impairs the Ras-MAPK/ERK pathway through mutation of the neurofibromin gene (NF1+/−). More broadly, syndromic forms of developmental disorders are often caused by mutations of proteins in pathways interconnected with Ras including TSC1/2, FMR1, and SynGAP. Of NF1 patients, around 30-50% are diagnosed with ASDs and more than 60% with ADHD. These studies are the first to show that male mice haploinsufficient for the Nf1 gene (Nf1+/−) exhibit deficits in behavioral inhibition in multiple contexts, a key feature of ADHD. They exhibit hyperactivity and impulsivity in an open field, delay discounting task, and cliff avoidance reaction test, rescuable through treatment with the clinically effective ADHD drug, guanfacine (α2A adrenergic receptor agonist). Previous experiments in our lab identified social deficits including deficits in consolidation of social memory. Using optogenetics and awake behaving electrode recordings, we explored the role of the cortico-striatal-limbic circuitry in impulsivity and in social deficits in male Nf1+/− mice. Manipulation of the prefrontal cortex, nucleus accumbens, or basolateral amygdala through optogenetics rescued social deficits. These studies are the first to record brain activity in a preclinical model of NF1 during impulsive behavior, finding broad spectrum changes across slow, delta, theta, and gamma oscillatory frequencies and decreased synchrony of the prefrontal cortex and nucleus accumbens during a delay discounting task. Overall, Nf1+/− male mice with deletion of a single NF1 gene recapitulate cognitive phenotypes of NF1 patients and are a useful model system to identify alterations in neural circuitry associated with ASD and ADHD.

Indiana University-Purdue University Indianapolis (IUPUI) / Severe malaria, primarily caused by Plasmodium falciparum infection, is among the leading causes of childhood mortality globally. A key virulence factor and source of antigenic variation and immune evasion during infection is P. falciparum erythrocyte membrane protein 1 (PfEMP1). Encoded for by approximately 60 var genes, this complex protein mediates cytoadherence of infected erythrocytes to the host endothelium and is a prominent immune target for the anti-malarial immune response in children. During severe malaria, specific domains of PfEMP1 that bind to endothelial protein C receptor (EPCR) and intercellular adhesion molecule-1 (ICAM-1) on host endothelial cells, are more prevalently expressed. The interaction of these proteins and infected erythrocytes mediates the sequestration of infected erythrocytes and plays a role in severe malaria pathogenesis. Antibodies to these domains develop over time with exposure to the parasite and are thought to contribute to immunity against severe malaria in children. In this study, whole blood samples from children with different forms of severe malaria, enrolled in two observational prospective cohort studies were used to quantify the expression of PfEMP1 domains using RT-qPCR and to measure the antibody response to PfEMP1 domains via a bead-based multiplex immunoassay. Using these samples, we demonstrated that although the expression of var transcripts encoding PfEMP1 domains was generally similar across children with different forms of severe malaria, the expression of variants encoding specific EPCR-binding domains was associated with thrombocytopenia and severe anemia. The antibody response to PfEMP1 domains in children with severe malaria was highest in children with SMA and children with asymptomatic parasitemia, but not associated with decreased risk of additional malaria episodes. Overall, the results of this study suggest that PfEMP1 is acting similarly across different forms of severe malaria but that it can be related to pathogenesis and severe malaria immunity.

No description available.

Background and hypothesis: Valvar pulmonary stenosis is a common congenital heart defect. Progression of stenosis over time, even when mild initially, has been shown by serial cardiac catheterization studies in children and adults. We studied the natural history of asymptomatic valvar pulmonary stenosis diagnosed in infancy with two-dimensional echocardiography and Doppler method. Methods: Between November 1986 and March 1993, 51 infants in the Northeast Tennessee and Southwest Virginia region were clinically diagnosed to have isolated valvar pulmonary stenosis. In 40 patients, the diagnosis was confirmed by two-dimensional echocardiogram/Doppler and color- flow mapping study at the time of presentation, and only their course is reported. Of 40 infants, six asymptomatic infants (15%) showed rapid progression of pulmonary stenosis over a relatively short period of time. Within the first 6 months of life, three of the six infants showed worsening of the stenosis needing intervention (one had surgical vulvectomy and the others had percutaneous balloon valvuloplasty). The three other infants showed a more gradual increase of pulmonary stenosis over the first 2 years of life. Results: Pulmonary stenosis even when mild can worsen in infancy, and it is not possible to predict which patients will follow this course. In our group of asymptomatic infants with initial mild pulmonary stenosis, 15% developed significant stenosis that needed intervention. Conclusion: We recommend frequent follow-up of asymptomatic infants with mild pulmonary stenosis during the first 2 years of life to detect rapid progression that may need intervention.

We report our experience with asymptomatic valvar aortic stenosis diagnosed during infancy. During the period between November 1, 1986 and October 31, 1992 a total of 13 infants were diagnosed with asymptomatic aortic stenosis, 5 of whom showed rapid progression over the first 2 years of life. Two of these asymptomatic infants had severe aortic stenosis by 2 months of age, requiring intervention. We agree that aortic stenosis is a progressive lesion even in mild cases, but we emphasize the need for close clinical and echocardiographic follow-up of these asymptomatic children during infancy to prevent congestive heart failure and sudden death.

Objective: To examine the relationship between pre-pregnancy weight and body image concerns and smoking status in late pregnancy. Methods: Participants included 172 pregnant smokers. Pre-pregnancy weight and body image concerns were assessed during first trimester via the Weight Concern Scale and Body Image Concern Inventory. Smoking status was evaluated at third trimester via self-report. Results: Logistic regression analyses revealed that weight concerns played a significant role in smoking continuation in late pregnancy. Conclusions: Beliefs about weight control properties of cigarettes may play an important role in smoking continuation among pregnant women. These findings suggest assessing weight concerns with pregnant women who smoke in an effort to facilitate successful cessation.

Objective: To examine the relationship between pre-pregnancy weight and body image concerns and smoking status in late pregnancy. Methods: Participants included 172 pregnant smokers. Pre-pregnancy weight and body image concerns were assessed during first trimester via the Weight Concern Scale and Body Image Concern Inventory. Smoking status was evaluated at third trimester via self-report. Results: Logistic regression analyses revealed that weight concerns played a significant role in smoking continuation in late pregnancy. Conclusions: Beliefs about weight control properties of cigarettes may play an important role in smoking continuation among pregnant women. These findings suggest assessing weight concerns with pregnant women who smoke in an effort to facilitate successful cessation.

No description available.