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Deep Brain Stimulation (DBS) is a recognized treatment for different dystonia subtypes and has been approved by the Food and Drug Administration (FDA) since 2003. The European Federation of Neurological Societies (EFNS) and the International Parkinson and Movement Disorders Society (MDS) recommend DBS for dystonia after failure of botulinum toxin (BoNT) and other oral medications for dystonia treatment. In addition, several long-term studies have demonstrated the continuous efficacy of DBS on motor and quality of life (QoL) scores. However, there are only a few reports comparing the overall impact of surgical treatment in BoNT protocols (e.g., dosage and number of selected muscles before and after surgery). This retrospective multicenter chart-review study analyzed botulinum toxin total dosage and dosage per muscle in 23 dystonic patients before and after DBS surgery. The study’s primary outcome was to analyze whether there was a reduction in BoNT dosage after DBS surgery. The mean BoNT dosages difference between baseline and post-surgery was 293.4 units for 6 months, 292.6 units for 12 months, and 295.2 units at the last visit. The median total dose of BoNT in the preoperative period was 800 units (N = 23). At the last visit, the median was 700 units (p = 0.05). This represents a 12.5% reduction in BoNT median dosage. In conclusion, despite the limitations of this retrospective study, there was a significant reduction in BoNT doses after DBS surgery in patients with generalized dystonia.

Introduction. Although incisional hernia is a rare condition in pediatric patients, it is relevant because of its possible complications and esthetic and functional impact. Case presentation. A 14-year-old boy with a history of acute appendicitis with generalized peritonitis required multiple surgical interventions in July 2020 and was readmitted to the emergency department of a secondary care hospital located in the department of Boyacá (Colombia) two months later due to intestinal obstruction. Despite receiving conservative management, no improvement was observed, so he was referred to a university hospital located in Boyacá, where he underwent an exploratory laparoscopy after 7 days of treatment, during which lysis of abdominal adhesions and the resection of a segment of the intestine were performed. In October 2020, the patient was taken again to the emergency department due to intestinal obstruction, requiring surgical treatment (lysis of multiple peritoneal adhesions and abdominal adhesions in the proximal ileum). Six months later, during the second postoperative follow-up, an incisional hernia of 10cm in diameter was evidenced. Given the large size of the hernia and its characteristics, it was decided to repair it surgically using the Rives-Stoppa technique including the administration of botulinum toxin type A as a preoperative adjuvant, achieving the recovery of the abdominal wall anatomy without any complications. Conclusion. While currently there is no treatment of choice for the repair of incisional hernias in pediatric patients, the Rives-Stoppa technique is an effective and safe therapeutic option. Likewise, botulinum toxin type A has proven to be an effective preoperative adjuvant for reducing the risk of complications. Introducción. Si bien la hernia incisional es una condición poco frecuente en pacientes pediátricos, es relevante por sus posibles complicaciones e impacto estético y funcional. Presentación del caso. Niño de 14 años con antecedente de apendicitis aguda con peritonitis generalizada que en julio de 2020 requirió múltiples intervenciones quirúrgicas y quien dos meses después fue reingresado al servicio de urgencias de un hospital de segundo nivel del departamento de Boyacá (Colombia) por obstrucción intestinal, donde, a pesar de recibir manejo conservador, no se observó mejoría, por lo cual fue remitido a un hospital universitario de Boyacá, donde, luego de 7 días de manejo médico, fue llevado a laparoscopia exploratoria en la que se realizó lisis de adherencias abdominales y resección de un segmento del intestino. En octubre de 2020 fue llevado nuevamente al servicio de urgencias por obstrucción intestinal, requiriendo de nuevo manejo quirúrgico (lisis de múltiples adherencias peritoneales y adherencias abdominales en el íleon proximal). Durante el segundo control postoperatorio, 6 meses después, se evidenció hernia incisional de 10cm de diámetro. Dado el gran tamaño de la hernia y sus características, se decidió reparar quirúrgicamente con técnica de Rives-Stoppa con aplicación de toxina botulínica de tipo A como adyuvante prequirúrgico, logrando recuperación de la anatomía de la pared abdominal sin complicaciones. Conclusión. Si bien actualmente no hay un tratamiento de elección para la reparación de hernias incisionales en pacientes pediátricos, la técnica de Rives-Stoppa representa una opción terapéutica eficaz y segura. Igualmente, la toxina botulínica de tipo A demostró ser un adyuvante prequirúrgico efectivo para la reducción del riesgo de complicaciones.

Geographic treatments of the etiology of obesity tend to turn on the obesogenic environment thesis and investigate the relationship between urban form and obesity. With their emphasis on environmental features that mediate eating and exercise activities, these explorations fundamentally rest on behavioral models of obesogenesis. As such, they tend to black-box the biological body as the site where excess calories are putatively metabolized into fat and made unhealthy. Drawing on critical political ecology, this article discusses the limitations of this dominant approach. First it provides some anomalies not well explained by the energy balance model. Then it reports on emerging biomedical research regarding the role of the endocrine system and endocrine-disrupting chemicals in transforming body ecologies to make them more susceptible to adiposity, regardless of caloric intake. This research also points to the active role of adipose tissue in regulating fat. In light of this evidence, the article argues for a rethinking of current geographical approaches to obesity and health more generally, with due attention to the ecologies of bodies as well as the interpretation of science.

Hemos tenido la oportunidad de leer su carta relacionada con nuestro artículo de revisión: “Medicamentos bioterapeúticos: uso de toxinas botulínicas en la era de biosimilares” (1). Queremos manifestar nuestro acuerdo con sus comentarios sobre la relevancia del tema en nuestro medio, así como con sus reflexiones sobre la intercambiabilidad de medicamentos y la necesidad de precisar muy bien los conceptos en la materia. En particular, usted hace referencia a la confusión que puede generar la frase de nuestra conclusión: “los medicamentos biológicos no son intercambiables entre sí, aunque demuestren bioequivalencia” Con interés leímos cómo muchos de los compañeros se confundieron con la última parte de la frase pues resulta contradictorio, ya que como usted menciona clásicamente “los estudios de bioequivalencia se realizan para demostrar que el medicamento genérico es equivalente e intercambiable con el medicamento original”.

The use of botulinum toxin (BTX) represents an effective and safe approach in treating the gummy smile, reducing excessive gum exposure during smiling. This minimally invasive procedure can yield remarkable aesthetic results and contribute to an increase in the patient's self-confidence. The aim of this study is to report a clinical case of a female patient undergoing treatment to correct a gummy smile. The case study involves a 21-year-old patient with excessive gum exposure (5 mm when smiling) who sought dental treatment. The origin of her gummy smile was mixed, and the treatment involved the application of 6 units of BTX type A at three specific points on the face. No complications were observed during the three-month follow-up period. Based on the case report, it can be concluded that BTX application for gummy smile treatment proved to be effective, safe, and comfortable in terms of recovery. The BTX approach to correcting a gummy smile is considered safe and entails straightforward recovery, producing satisfactory results that contribute to the improvement of aesthetics and the patient's well-being. El uso de toxina botulínica (BTX) representa un enfoque eficaz y seguro para el tratamiento de las sonrisas gingivales, reduciendo la exposición excesiva de las encías durante la sonrisa. Este procedimiento mínimamente invasivo puede producir resultados estéticos notables y contribuir a aumentar la confianza del paciente en sí mismo. El objetivo de este estudio es presentar el caso clínico de una paciente que se sometió a un tratamiento para corregir una sonrisa gingival. Se trata de una paciente de 21 años con una exposición gingival excesiva (5mm al sonreír) que solicitó tratamiento odontológico. El origen de su sonrisa gingival era mixto y el tratamiento consistió en la aplicación de 6 unidades de BTX tipo A en tres puntos concretos de la cara. No se observaron complicaciones durante los tres meses de seguimiento. Basándonos en el informe del caso, se puede concluir que la aplicación de BTX para el tratamiento de la sonrisa gingival demostró ser eficaz, segura y cómoda en términos de recuperación. El enfoque de BTX para la corrección de la sonrisa gingival se considera seguro y de fácil recuperación, y produce resultados satisfactorios que contribuyen a mejorar la estética y el bienestar del paciente.

Chlorpyrifos (CPF) is a pesticide widely used in Colombia´s agriculture, including crops, farm animals and pets, despite it has been banned for use in the European Union and the United States. Studies demonstrate that even low blood levels of CPF -which do not inhibit blood acetylcholinesterase- can lead to child developmental and neurological disorders such as smaller head circumference and brain alterations, and psychomotor and cognitive deficits related to learning ability, attention and memory. In adults, CPF is an endocrine disruptor and breast carcinogen. High direct and indirect economic costs have been associated with CPF exposure. Not only farmers and their families -who have the highest exposures- but the general population consuming crops sprayed with CPF are also at risk. For these reasons CPF was recently banned by the European Union (2020) and the USA (2021). Pesticide regulation policies vary greatly depending on which and how scientific studies are used to assess health risks. Pesticide evaluations funded by the chemical industry should be rectified to avoid conflicts of interest. Furthermore, political alignment with the interests of the industry should not take precedence over independent scientific evidence. It is discouraging, to say the least, that until stricter health laws are passed in Colombia, CPFs and related pesticides will continue to be imported from those countries that have already banned them. Colombian scientists should raise their voice to challenge blind acceptance of profits over unintended consequences, and efforts to prevent pesticide´s abuse should be encouraged.

Introducción: las toxinas botulínicas son medicamentos bioterapéuticos con grandes aplicaciones en el campo de la neurología, como la cefalea y los movimientos anormales. Debido a la importancia médica y al incremento de las indicaciones terapéuticas de la toxina botulínica, este artículo pretende hacer claridad acerca de la terminología básica con respecto a la naturaleza de este medicamento, a las diferencias estructurales con medicamentos convencionales y aspectos importantes en relación con su potencia biológica e inmunogenicidad, para así comprender las potenciales diferencias entre las toxinas disponibles y conceptuar en torno a la no intercambiabilidad o sustitución de una toxina por otra. Materiales y métodos: revisión no sistemática, según lo recomendado en la Escala para la Verificación de los Artículos Revisiones Narrativas (Sanra). Conclusiones: los medicamentos biológicos no son intercambiables entre sí, aunque demuestren bioequivalencia. No cumplen con la definición de biosimilar de la FDA; no se pueden evaluar como medicamentos genéricos intercambiables porque son biológicos; no existen estudios comparativos cabeza a cabeza; son diferentes, debido al proceso individual de manufactura.

Background: Corn is, quantitatively, one of the most important world crops (ranking second only after wheat) and a key ingredient in animal feeds. Objective: to assess and compare corn quality, mycotoxin content, chemical composition and apparent metabolizable energy (AME) of domestic and imported corn. Methods: Grain quality (USDA grading system) was determined in 30 samples of domestic and 21 samples of imported corn. From each origin, 15 samples were subjected to proximal analysis and 10 were used to determine fatty acid composition. Mycotoxin analysis was conducted on 30 samples of domestic and 23 of imported corn. Results: six of the 30 domestic samples corresponded to US1 grade (highest quality) vs. none of the imported. In the “sample grade” category (lowest quality), 10 and 6 samples corresponded to imported and domestic corn, respectively. Soybeans were found as contaminant in 15 of the 21 imported corn samples. Aspergillus spp. mycotoxins such as ochratoxin A were not detected, and aflatoxins were found in only a few samples at very low levels. Fusariotoxins such as deoxynivalenol and zearalenone were found in 61 and 43% of imported samples, respectively, but in none of the domestic samples. Domestic corn had lower carbohydrate content compared with imported corn (85.4 vs. 86.7%), but higher crude fat (3.8 vs. 3.1%). The AME values for domestic and imported corn were 3,697 and 3,378 kcal/kg, respectively. The fatty acid profiles from both corn types were similar. Conclusion: This study found significant differences between locally-grown and imported corn, particularly in terms of crude fat, AME content, fusariotoxins, and contaminant seeds (soybeans). These findings suggest that locally-grown corn might have nutritional and toxicological advantages over corn imported from the United States.