Adrián Poblano

Sensorineural hearing loss in high school teenagers in Mexico City and its relationship with recreational noise

The aim of this study was to measure the frequency of hearing loss in a sample of typical public high-school students exposed to recreational noise, and determine associated risk factors. The sample was made up of 214 teenagers from a high-school in Mexico City; subjects were selected randomly per strata. We applied a questionnaire to identify risk factors for hearing loss and performed a battery of audiologic tests consisting of otoscopy, tympanometry, and pure-tone audiometry. The mean age of the sample was 16 +/- 1.07 years; 73% were male and 27%, female. Hearing loss was found in 21% of students. The main hearing loss-related risk factor was exposure to recreational noise: frequent attendance at discotheques and pop-music concerts; use of personal stereos; and noise exposure in school workshops. The high frequency of hearing loss in high school students from one Mexico City school (nearly one fifth of the sample) was found to be related to noise exposure mainly during recreational activities.

Apnea in Infants

ObjectiveThe main objective of this study was to describe frequency of risk factors in newborns who present different types of apnea in polysomnographic (PSG) recordings in neonatal care units.MethodsThe study was carried out in neonatal care units of a perinatal tertiary level institution in Mexico City between August 2002 and August 2003. Infants were selected from among 223 infants if they presented any type of apnea event in sleep PSG recordings.ResultsNearly 25% of patients from a neonatal care unit presented apnea events. Infants with apnea showed lower values of age, weight, and cephalic perimeter at birth than infants without apnea, but did not show more neurologic risk factors. Central apnea events were more frequent in infants with preterm birth (birthweight <1,500 g), obstructive apnea events were observed in infants with hyperbilirubinemia and gastro-esophageal reflux, while mixed events were seen in infants with sepsis, and hyperbilirubinemia. Sleep PSG recordings detected that 36% of infants with apnea have no previous clinic suspicion of the problem.ConclusionCentral events of apnea were found more frequent in infants with preterm birth, obstructive events in newborns with hyperbilirubinemia and gastroesophagic reflux, while infants mixed apnea had more frequent hyperbilirubinemai and sepsis.

Correlation between sleep disorder screening and executive dysfunction in children with attention deficit-hyperactivity disorder

OBJECTIVEnTo compare frequency of sleep disorders (SD) and executive dysfunction (ED) in children with attention deficit-hyperactivity disorder (ADHD) and a control group.nnnMETHODnWe studied 156 children with ADHD with a mean age of 8.5 years, and a control group with 111 children with a mean age of 8.3 years. We utilized the Pediatric Sleep Questionnaire (PSQ) to screen SD and the working memory measurement from the Wechsler intelligence scale for children (WISC-IV) to screen ED.nnnRESULTSnWe did not observe an increased frequency of SD in children with ADHD compared with the controls. However, we did identify ED in children with ADHD; additionally a significant correlation was observed between the type of ADHD and SD and among ED, WISC-IV measurements, and type of SD in children with ADHD.nnnCONCLUSIONnAn increase of SD frequency in children with ADHD was not observed, but we did identify ED in children with ADHD. Additionally, a correlation among ADHD types, SD, ED, and WISC-IV measurements was observed in children with ADHD.

Frecuencia de factores de riesgo para problemas de aprendizaje en preescolares de bajo nivel socioeconómico en la Ciudad de México

Este estudo objetivou identificar a frequencia de fatores de risco para dificuldade de aprendizagem (DA) em criancas com baixo nivel socioeconomico, na Cidade do Mexico. A escala de inteligencia Wechsler, desenho da figura humana e o teste gestaltico visomotor de Bender foram utilizados. A idade media do grupo masculino foi de 5,6±0,9 anos e do grupo feminino 5,4±0,5 anos. O quociente intelectual total (QI-T) foi de 98±12 no grupo masculino e 99±12,2 no grupo feminino. No teste de Bender, os meninos apresentaram idade mental e visomotora um ano abaixo da idade cronologica, enquanto que as meninas apresentaram idade mental e visomotora 7-8 meses abaixo do normal. As caracteristicas de alto risco que apresentaram maior frequencia, tanto nos meninos como nas meninas, no teste do desenho de figura humana, foram: autoisolamento 25%, timidez 22,4 e controle interno deficiente 22%. Concluindo, alta frequencia de fatores de risco para DA foi encontrada em criancas de baixo nivel socioeconomico. E importante destacar a importância de se identificar pre-escolares em risco de DA.The objective was to identify the frequency of risk factors for Learning Disabilities (LD) in low socioeconomic level children in Mexico City. We studied children by means of: Wechsler, Bender-Gestalt, and Human drawing tests. Average age of male subjects was 5.6±0.9 years, while that of the female group was 5.4±0.5 years. In male subjects, average Total intelligence quotient (T-IQ) score was 98±12.2 while, in the female group, this was 99±12.2. On the Bender-Gestalt test, male subjects had a mental and visual-motor average age of <1 year under chronological age. Female subjects had a mental and visual-motor age 8-7 months under the norm. On the Human drawing test, in male and female subjects, the most frequent at-risk features comprised: self-isolation in 25% of subjects, shyness in 22.4%, and poor internal controls in 22%. In conclusion, we found a high at-risk factor frequency for LD in children of low socioeconomic strata. We highlight the importance of screening children before they attain school age.

Effect of late-onset fetal growth restriction on organization of behavioral state in infants.

The aim of this study was to analyze whether late‐onset fetal growth restriction (FGR) alters regulatory capability in infants, and whether this can be detected using both the neonatal behavior assessment scale (NBAS) and brainstem auditory‐evoked potentials (BAEP).

Correlation between the neonatal EEG and the neurological examination in the first year of life in infants with bacterial meningitis

OBJECTIVEnTo assess the contribution of neonatal electroencephalogram (EEG) and its correlation with the neurological examination at age of 9 months in newborns with bacterial neonatal meningitis.nnnMETHODnTwenty seven infants were studied with positive cerebrospinal fluid (CSF) culture for bacteria. We used the worse EEG result during acute phase of meningitis, and performed neurologic follow-up after discharge from hospital. Background cerebral activity was classified as normal or mildly, moderately, or markedly abnormal. Neurologic examination outcomes was classified normal, mild abnormalities, moderate abnormalities and severe abnormalities.nnnRESULTSnEEG performed in the neonatal period during acute bacterial meningitis predicts adverse outcome early at age of 9 months, and had a significant correlation with cephalic perimeter and active tone alterations.nnnCONCLUSIONnNeonatal EEG is useful for predicting abnormal outcomes, especially cephalic perimeter and active tone abnormalities at 9 months of age in infants with bacterial neonatal meningitis.

Sleep architecture alterations in patients with periodic limb movements disorder during sleep and sleep breathing disorders

Introduction Sleep movement disorders includes mainly periodic limb movement and others. The more frequent breathing disorders are: obstructive sleep apnea-hypopnea syndrome and primary snoring. Objective To compare sleep architecture in periodic limb movements and breathing disorders of different severity, and weight their interactions. Methods We compared sleep architecture in 160 patients, divided in six groups: periodic limb movements (n=25), obstructive apnea only (n=30), periodic limb movements/snoring (n=30), periodic limb movements/mild apnea (n=25), periodic limb movements/moderate apnea (n=25), periodic limb movements/severe apnea (n=26). Polysomnographic variables were compared by analysis of variance and Tukey test. Results We observed an increase of percentage of awakenings in the group with periodic limb movements/severe apnea. We found an increase of percentage of light sleep in the group with obstructive apnea only with respect to periodic limb movements group. The group with obstructive apnea only presented less rapid eye movements sleep in relation with group with periodic limb movements. We found an increase of awakenings in the group with periodic limb movements/severe apnea to the group with periodic limb movements only. Oxygen saturation showed a decrease in the group with periodic limb movements/severe apnea and obstructive apnea only group to periodic limb movements only group. Conclusions Periodic limb movements and breathing disorders, resulted in more additive changes in sleep architecture alterations, than as separately disorders, in a complex interaction. Research in these relations deserve more investigations.

Decrease of respiratory events in patients with obstructive sleep apnea-hypopnea syndrome using a mandibular advancement device assessed with split night polysomnography

Introduction Mandibular advancement device (MAD) may represent a feasible choice in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS), in well selected patients. Objective The aim of this study is to assess the efficacy of MAD in patients with OSAHS, using split night polysomnography (SNP) Method We performed an auto controlled clinical trial to assess the efficacy of MAD in 30 patients with snoring and OSAHS. Clinical evaluation was made every 2 weeks to adjust treatment and observe changes in clinical symptoms. Three-months after placement of the MAD, a SNP was performed, using the MAD in the second half of the night, in order to compare the respiratory results. Results SNP show significant changes with use of MAD (p<0.05) such as: Decrease in Snore index (from 159.95 to 32.46/h) and in Apnea-hypopnea index (AHI, from 22.45 to 4.63/h), increase in oxygen saturation (SaO2, from 89.98% to 91.39%) and somnolence improvement, using the Epworth Sleepiness Scale (from 14.4 to 4.6 points). Conclusion Our data supports that the use of MAD is an alternative in the management of OSAHS, in well selected patients, used in a multidisciplinary fashion, and evaluated using a SNP.

Risk Factor Frequency for Learning Disabilities in Low Socioeconomic Level Preschool Children in Mexico City

Este estudo objetivou identificar a frequencia de fatores de risco para dificuldade de aprendizagem (DA) em criancas com baixo nivel socioeconomico, na Cidade do Mexico. A escala de inteligencia Wechsler, desenho da figura humana e o teste gestaltico visomotor de Bender foram utilizados. A idade media do grupo masculino foi de 5,6±0,9 anos e do grupo feminino 5,4±0,5 anos. O quociente intelectual total (QI-T) foi de 98±12 no grupo masculino e 99±12,2 no grupo feminino. No teste de Bender, os meninos apresentaram idade mental e visomotora um ano abaixo da idade cronologica, enquanto que as meninas apresentaram idade mental e visomotora 7-8 meses abaixo do normal. As caracteristicas de alto risco que apresentaram maior frequencia, tanto nos meninos como nas meninas, no teste do desenho de figura humana, foram: autoisolamento 25%, timidez 22,4 e controle interno deficiente 22%. Concluindo, alta frequencia de fatores de risco para DA foi encontrada em criancas de baixo nivel socioeconomico. E importante destacar a importância de se identificar pre-escolares em risco de DA.The objective was to identify the frequency of risk factors for Learning Disabilities (LD) in low socioeconomic level children in Mexico City. We studied children by means of: Wechsler, Bender-Gestalt, and Human drawing tests. Average age of male subjects was 5.6±0.9 years, while that of the female group was 5.4±0.5 years. In male subjects, average Total intelligence quotient (T-IQ) score was 98±12.2 while, in the female group, this was 99±12.2. On the Bender-Gestalt test, male subjects had a mental and visual-motor average age of <1 year under chronological age. Female subjects had a mental and visual-motor age 8-7 months under the norm. On the Human drawing test, in male and female subjects, the most frequent at-risk features comprised: self-isolation in 25% of subjects, shyness in 22.4%, and poor internal controls in 22%. In conclusion, we found a high at-risk factor frequency for LD in children of low socioeconomic strata. We highlight the importance of screening children before they attain school age.

Cyclic alternating pattern in infants with congenital hypothyroidism

Congenital hypothyroidism is defined as thyroid hormone deficiency present at birth which is crucial for brain development. Recently, the cyclic alternating pattern, a rhythm present in electroencephalography recordings in non-Rapid eye movement sleep, has been related to brain development and cognition in different pediatric conditions. Therefore, we evaluated the cyclic alternating pattern rate in infants with congenital hypothyroidism, thyroxine supplementation, and healthy controls. The parameters of the cyclic alternating pattern were evaluated in 19 healthy infants (10 female, mean age 25.5u202f±u202f15.5u202fmonths) and 21 infants diagnosed with congenital hypothyroidism (19 female, mean age 24.3u202f±u202f19.0u202fmonths). We considered the transient electro-cortical activations (phase A of the cycle) in non-Rapid eye movement sleep and the subdivisions of the A phase in: A1, A2 and A3, based on their frequency content. All subjects were subjected to polysomnography recording in a standard laboratory setting. Sleep data were stored computer following the International 10-20 System. Data showed that congenital hypothyroidism infants exhibited higher frequency of central apnea, hypopnea, and arousals in comparison to controls. Particularly, central apnea index decreased with age in the control group but not in congenital hypothyroidism group. Regarding to cyclic alternating pattern measurements, congenital hypothyroidism infants exhibit a higher frequency in the percentage of A3 subtype (electroencephalographic desynchrony) and conversely a lower percentage of A1 subtype (electroencephalographic synchrony), than healthy infants. An important finding of this study is the positive correlation between A1 mean duration and age, which is bigger in control group than in congenital hypothyroidism group (time duration in control group (0.52u202fs/month) versus congenital hypothyroidism group (0.1u202fs/month). Infants with congenital hypothyroidism showed an increase of A3 subtype, of central apnea, and of arousals. The reduction of percentage and mean duration of A1 subtype could be a valuable indicator of sleep development in patients with congenital hypothyroidism and healthy infants.