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Family history of thyroid disease (FHTD) constitutes a possible risk factor for congenital hypothyroidism (CH) in the general population; however, FHTD possible relationship with CH in subjects with Down syndrome (DS) has not yet been explored.To determine whether FHTD is associated with an increased incidence of CH in neonates with DS.Hospital-based case-control study in 220 neonates with DS. Thyroid function tests of 37 infants with DS and positive FHTD (cases) were compared with those of 183 newborns with DS without FHTD (control group). Data were analyzed using multivariate logistic regression analysis and adjusted odds ratios (aORs) with their respective 95 % confidence intervals (CI) were calculated.Nine newborns with DS in our sample had CH (4.1 %). In the multivariate analysis, FHTD showed an association with CH in neonates with DS (aOR = 8.3, 95 % CI: 2.0-34.3), particularly in males (aOR = 9.0, 95 % CI: 1.6-49.6). In contrast, newborns with DS without FHTD were less likely to suffer from CH (aOR = 0.4, 95 % CI: 0.1-0.8).Newborns with DS and FHTD have an eight-fold higher risk for CH, particularly when the index case is male. FHTD detailed evaluation can be an easy and accessible strategy to identify those newborns with DS at higher risk for CH.La historia familiar de enfermedad tiroidea (HFET) como factor de riesgo para hipotiroidismo congénito (HC), en síndrome de Down (SD) aún no ha sido explorada.Determinar si la HFET está asociada a mayor riesgo de HC en neonatos con SD.Estudio de casos y controles en 220 neonatos con SD. Se compararon las pruebas de función tiroidea (PFT) de 37 con SD e HFET (casos), frente a las PFT de 183 recién nacidos con SD sin HFET (grupo de referencia). Se realizó análisis de regresión logística multivariante y se calculó la razón de momios (RM) y sus respectivos intervalos de confianza del 95 % (IC 95 %).Nueve casos HC (4.1 %). El HC mostró asociación con la HFET (RMa = 8.3, IC 95 %: 2.0-34.3), particularmente en los varones (RMa = 9.0, IC 95 %: 1.6-49.6). La ausencia de HFET tuvo una RM de protección para HC (RMa = 0.4, IC 95 %: 0.1-0.8).La HFET puede es una estrategia fácil y accesible para identificar pacientes con SD con mayor riesgo de HC.

High-density lipoprotein (HDL) is considered a complex plasma-circulating particle with subfractions that vary in function, size, and chemical composition. We sought to test the effects of HDL, and HDL subfractions on insulin secretion and cholesterol efflux in the β-cell line MIN-6.We used total HDL and HDL subfractions 2a, 2b, 3a, 3b, and 3c, isolated from human plasma, to test insulin secretion under different glucose concentrations as well as insulin content and cholesterol efflux in the insulinoma MIN-6 cell line.Incubation of MIN-6 cells with low glucose and total HDL increased insulin release two-fold. Meanwhile, when high glucose and HDL were used, insulin release increased more than five times. HDL subfractions 2a, 2b, 3a, 3b, and 3c elicited higher insulin secretion and cholesterol efflux than their respective controls, at both low and high glucose concentrations. The insulin content of the MIN-6 cells incubated with low glucose and any of the five HDL subclasses had a modest reduction compared with their controls. However, there were no statistically significant differences between each HDL subfraction on their capacity of eliciting insulin secretion, insulin content, or cholesterol efflux.HDL can trigger insulin secretion under low, normal, and high glucose conditions. We found that all HDL subfractions exhibit very similar capacity to increase insulin secretion and cholesterol efflux. This is the first report demonstrating that HDL subfractions act both as insulin secretagogues (under low glucose) and insulin secretion enhancers (under high glucose) in the MIN-6 cell line.

To determine whether a short 6-session protocol of tonic/ phasic exercises can enhance quality of life and muscular strength in patients with urinary incontinence (UI).A prospective before-after study was performed in 67 patients with UI referred to the Rehabilitation Department of the Santa Cristina University Hospital in Madrid, Spain. In the initial assessment, the patient's personal details, predisposing factors and type of UI were registered. Patients received lifestyle recommendations. The ICIQ-SF/I-QOL questionnaires/scales were completed at the beginning and end of treatment. The manometric evaluation was registered in the first and last assessment by the MYOMEDThe mean age was 52.1±12.7 years and 94% of the patients (n=63) were women. The maximum and mean strength of the pelvic floor contraction was 26.4±15.6 and 5.3±3.9mmHg, respectively, which significantly increased after treatment to 35.5±19.6 and 7.6±4.4mmHg (P.0001). The ICIQ-SF score was 10.1±5 and significantly decreased to 6.6±4.6 (P0.0001). The I-QOL score significantly increased from 66.1±21.9 to 77.9±18.1 points (P.0001). The I-QOL ALB subscale (avoidance and limiting behaviour) increased from 63.7±22.6 to 77.3±17.8 (P.0001); the I-QoL PSI subscale (psychosocial impact) increased from 73.8±23.9 to 82.5±18.7 (P=.0004); and the I-QOL SE subscale (social embarrassment) increased from 56.5±23.7 to 70.5±22.1 (P.0001).Manometric feedback reduces UI and improves both quality of life and manometric values. This short 6-session protocol could be applied in other public and private centres and could provide economic benefits to the health system and to patients.

The aim of our study was to determine the frequency and type of associated congenital anomalies in patients with isolated gastroschisis born at the Dr. Juan I. Menchaca Civil Hospital of Guadalajara (Guadalajara, México), and to explore its possible association with the included outcome variables. One hundred-eight cases with isolated gastroschisis were reviewed from 2009 to 2014. The occurrence of intestinal and extraintestinal associated anomalies (either secondary or primary) was prospectively assessed. The type of gastroschisis, length of hospital stay (LOS), and in-hospital mortality were outcome variables for statistical analysis. Of infants with gastroschisis, 52 (48.1%) had one or more associated anomalies (AA), with increased odds in males (OR = 2.3, 95%CI: 1.1-5.0). AA classified, as secondary and primary were present in 34.3 and 5.6% of patients, respectively. Of secondary AA, 25.9% were intestinal anomalies, and 17.6% were extraintestinal. Primary AA were congenital heart disease (n = 3), meningomyelocele, and hydrocephaly and amniotic band sequence in one instance, respectively. Multivariate logistic regression showed that secondary AA (both intestinal and extraintestinal) were associated with complex gastroschisis, prolonged LOS, and in-hospital death, whereas primary AA were not related to a worse outcome. Our results highlight the pathogenic importance of properly investigating and categorizing the presence of others secondary or primary AA when diagnosis of gastroschisis is made.

To estimate, on the basis of anthropometric and demographic variables, the depth (Dp) and diameter (Dm) of femoral and jugular vessels, which have been located and measured by ultrasound, in pediatric patients.750 measurements of Dp and Dm of the femoral vein (FV), femoral artery (FA) and internal jugular vein (IJV) were made in 125 pediatric patients. The values were correlated with patients' sex, weight, age, size and body surface area (BSA).Mean Dp values were 0.72 (0.34) cm for FA, 0.79 (0.35) cm for FV and 0.77 (0.24) cm for IJV. Mean antero-posterior Dm values were 0.37 (0.17) cm for FA, 0.42 (0.22) cm for FV and 0.59 (0.23) cm for IJV. In the studied pediatric patients, femoral and jugular vessels depth correlated with age, size, weight and BSA (FV, FA and IJV depth and diameter correlated with weight, size, age and body surface area in the studied pediatric patients. Correlation was better for femoral than for jugular vessels. Depth could be estimated from patients' weight and size, while diameter could be estimated from the size. Such estimations may facilitate the choice of vessels to be cannulated, length and diameter of cannulation needles and the diameter of catheters to be used in pediatric patients.Calcolare in base a variabili antropometriche e demografiche, la profondita’ (P) e il diametro (D) dei vasi femorali e giugulari dei pazienti pediatrici in seguito alla loro localizzazione e misurazione ecografica.Sono state effettuatte 750 misurazioni della P e del D della vena femorale (VF), arteria femorale (AF) e della vena giugulare interna (VGI) in 125 pazienti pediatrici. I valori ottenuti sono stati relazionati con il sesso, il peso, l’eta’, l’altezza e la superficie corporea.La P media dell’ AF (PAF) è risultata di 0.72 (0.34) cm, quella della VF (PVF) di 0.79 (0.35) cm e quella della VGI (PVGI) di 0.77 (0.24) cm. Il D anteroposteriore medio dell’ AF (DAF) fu di 0.37 (0.17) cm, quello della VF (DVF) èrisultato di 0.42 (0.22) cm e quello della VGI (DVGI) di 0.59 (0.23) cm. Nei pazienti pediatrici analizzati, è stata riscontrata una relazione tra i parametri di eta’, peso, altezza e superficie corporea e quelli della profondita’ dei vasi femorali e giugulari (R = 0.46–0.60), che pùo essere stimata secondo peso e altezza (PAF: R = 0.71; PVF: R = 0.72; PVGI R = 0.53). La relazione con il diametro vascolare è risultata maggiore per l’ AF e la VF (R = 0.81–0.89) e piu’ bassa per la VGI (R = 0.42–0.51), che può essere stimata in base all’altezza del paziente (DAF: R = 0.89; DVF: R = 0.86; DVGI: R = 0.52).La profondita’ e il diametro della VF, dell’AF e della VGI si possono relazionare al peso, altezza, eta’ e superficie corporea nei pazienti pediatrici del nostro studio. Questa relazione e’ maggiore per i vasi femorali rispetto ai vasi giugulari, rendendo possibile il calcolo della loro profondita’ in base al peso e all’altezza e il calcolo del loro diametro vascolare in base all’altezza. Questi calcoli possono essere utili per la scelta adeguata del vaso da canalizzare, per la scelta del tipo e del calibro dell’ago e del catetere da usare nei pazienti pediatrici.

To measure the depth (D p) and diameter (D m) of the internal jugular vein (IJV), femoral vein (FV), and femoral artery (FA) in pediatric patients to evaluate the clinical implications. This study included 125 pediatric patients. All of them underwent bilateral ultrasound study of vessels and were classified into three groups based on anthropometric and demographic parameters. Measured mean D p values were: 0.72 (0.34) cm for the FA, 0.79 (0.35) cm for the FV, and 0.77 (0.24) cm for the IJV. Mean antero-posterior D m values were: 0.37 (0.17) cm for the FA, 0.42 (0.22) cm for the FV, and 0.59 (0.23) cm for the IJV. D p and D m increased with age (A), weight (W), height (H), and body surface area (BSA). In the lower ranges of these variables, D p was similar for all three studied vessels (0.6–0.7 cm). In the higher ranges, femoral vessel D p values (1.1–1.2 cm) were larger than jugular ones (0.9 cm). Additionally, in these low ranges, IJV D m values were larger than femoral ones (0.45–0.50 vs. 0.25 cm). In the higher ranges, diameter values were similar (0.6–0.7 cm). In pediatric patients, major vessels can be located and their depth and diameter measured by vascular ultrasound. In younger patients, jugular and femoral vessels had similar depth values; in older ones, they had similar diameters. Ultrasound measurements in pediatric patients could facilitate the choice of the vessel to be cannulated, the catheter diameter, and the length of the needle to be used. Vascular canalization of IJV may be recommended as the first choice because of its low depth and large diameter.

Mucosal immune responses are an early and important line of defense against pathogens. The current understanding of the mucosal immune system allows us to consider the use of nasal immunization for induction of antigen-specific immune responses at the mucosal surface and the systemic compartment. Mucosal adjuvants are key for developing novel mucosal vaccines and represent 1 approach to improving mucosal and systemic immunity. However, few mucosal vaccine adjuvants are currently approved for human use. Neisseria meningitidis B proteoliposome-derived cochleate (AFCo1 — Adjuvant Finlay Cochleate 1) has been demonstrated to be a potent mucosal adjuvant. The present work demonstrates that intranasal immunization of 3 doses of tetanus toxoid (TT) coadministered with AFCo1 in mice promotes high systemic and mucosal responses. The anti-TT IgG serum titers and the mucosal anti-TT IgA in saliva and vaginal wash were significantly higher than TT alone. The analysis of antibody subclasses showed that intranasal administration of AFCo1 + TT induced not only IgG1 but also IgG2a anti-TT antibodies at levels comparable to those obtained with TT vaccine (vax-TET). These data support the fact that AFCo1 is a potent mucosal adjuvant in nasal immunization to a coadministered protein antigen.

Turner syndrome is diagnosed by the combination of certain phenotypic characteristics with the absence of one of the X chromosome. This absence may be total or partial, as occurs in isochromosomes Xq. The phenotypic consequences of these depend on two factors: the characteristics of the lost genes and the percentage of cells 45, X in mosaicisms. The clinical features also change with the cytogenetic pattern. Short stature is the most common phenotypic manifestation, as it is due to the haploinsufficiency of the SHOX gene on the short arm of X chromosomes. Thus, when there is isochromosomes on the long arms, short stature is always present. However, the typical features of this syndrome could be absent, and the diagnosis can be delayed. This occurred in our patients, who will not be able to obtain optimum benefits with growth hormone treatment.

The Health Administration Agencies of many municipalities in Greater Buenos Aires (GBA) receive frequent reports on triatomines in houses. The aim of this work was to identify and describe the dispersal foci of Triatoma infestans in an urban neighborhood of GBA, and contribute to the knowledge of the epidemiological situation in the region. In June 1998, potentially infested places were entomologically evaluated. T. infestans was only detected in a hen building for egg production, which housed approximately 6,000 birds. A total of 2,930 insects were collected. Density was about 9 triatomines/m(2). The proportions of fifth instar nymphs and adults were significantly higher than those of the other stages (p0.001). The number of triatomines collected largely exceeded the highest domestic infestation found in one house from rural endemic areas of Argentina. Though triatomines were negative for Trypanosoma cruzi, they could acquire the parasite by coming in contact with infected people living in GBA. Besides, the numerous and widely distributed places housing hens and chickens, would favor the settlement of the vector. Together, both facts may constitute a risk of parasitic vectorial transmission. It is recommended to intensify systematic activities of vector search and case detection in GBA.

Dengue (family Flaviridae, genus Flavivirus, DENV) and dengue hemorrhagic fever (DHF) are presently important public health problems in Costa Rica. The primary strategy for disease control is based on reducing population densities of the main mosquito vector Aedes aegypti (L.) (Diptera: Culicidae). This is heavily dependent on use of chemical insecticides, thus the development of resistance is a frequent threat to control program effectiveness. The objective of this study was to determine the levels of insecticide resistance and the metabolic resistance mechanisms involved in two Ae. aegypti strains collected from two provinces (Puntarenas and Limon) in Costa Rica. Bioassays with larvae were performed according to World Health Organization guidelines and resistance in adults was measured through standard bottle assays. The activities of beta-esterases, cytochrome P450 monooxygenases, and glutathione S-transferases (GST), were assayed through synergists and biochemical tests, wherein the threshold criteria for each enzyme was established using the susceptible Rockefeller strain. The results showed higher resistance levels to the organophosphate (OP) temephos and the pyrethroid deltamethrin in larvae. The efficacy of commercial formulations of temephos in controlling Ae. aegypti populations was 100% mortality up to 11 and 12 d posttreatment with daily water replacements in test containers. Temephos and deltamethrin resistance in larvae were associated with high esterase activity, but not to cytochrome P450 monooxygenase or GST activities. Adult mosquitoes were resistant to deltamethrin, and susceptible to bendiocarb, chlorpyrifos, and cypermethrin. Because temephos and deltamethrin resistance are emerging at the studied sites, alternative insecticides should be considered. The insecticides chlorpyrifos and cypermethrin could be good candidates to use as alternatives for Ae. aegypti control.

To describe the factors associated to morbidity-mortality in pediatric patients with severe head injury (SHI).A review was made of the patients admitted to the Pediatric Intensive Care Unit (PICU) with SHI between July 1983 and December 2009.Of the 389 patients with head injuries, 174 (45%) presented SHI. The mean age of these subjects was 67 (9) months, with a Glasgow Coma Score (GCS) of 5.5 (1.8) and a PRISM score of 10.6 (6.7). Thirty-nine percent of the patients showed diffuse encephalic injury (DEI) in the computed tomography (CT) study. Seventy-nine percent of the patients subjected to intracranial pressure monitoring (ICP) presented intracranial hypertension. These patients had a greater incidence of serious sequelae (66.7 vs. 23.1%; p=0.01). Sequelae of clinical relevance were recorded in 59 patients (34%), and proved serious in 64% of the cases. The mortality rate among the patients with SHI was 24.7%, and mortality was significantly associated with a lower GCS score, hyperglycemia, intracranial hypertension and the presence of mydriasis or shock. The mortality rate associated to severe DEI was significantly higher than in the case of mild-moderate DEI (87.5 vs. 7.2%; p0.001). The independent mortality risk factors in the pediatric patients with SHI were found to be the presence of mydriasis (OR: 31.27), intracranial hypertension (OR: 13.23) and hyperglycemia (OR: 3.10).a) SHI in pediatric patients was associated with high morbidity-mortality; b) intracranial hypertension was associated to the development of serious sequelae; c) independent mortality risk factors were the existence of mydriasis, intracranial hypertension and hyperglycemia.

To describe the epidemiology, clinical manifestations and evolutive characteristics of pediatric patients with severe head injury (SHI).A review was made of the patients admitted to the pediatric intensive care unit (PICU) with SHI between July 1983 and December 2009.Of the 389 patients with head injuries admitted to the PICU during the study period, 174 (45%) presented SHI. The mean age in this group was of 67±9 months, with a Glasgow Coma Score (GCS) of 5.5±1.8 and a PRISM score of 10.7±6.7. The most frequent etiology of SHI was traffic accidents (56%), though these have decreased significantly in the last decade (58.5% vs 45.3%; P.001). Twenty-one percent of the patients required evacuation of the lesions detected by computed tomography (CT), and 39% presented severe diffuse encephalic injury (DEI). Seventy-nine percent of the patients in whom intracranial pressure (ICP) was monitored presented intracranial hypertension. Sequelae of clinical relevance were recorded in 59 patients (39%), and proved serious in 64% of the cases. The mortality rate in this patient series was 24.7%. Intracranial hypertension decreased significantly in the last decade (88% vs 54%; P.05), and clinical recovery has improved (23.3% vs 63.1%; P.001).a) The incidence of traffic accidents has decreased in the last decade in the studied population; b) patients with SHI in which ICP was monitored showed a high incidence of intracranial hypertension; c) morbidity-mortality among pediatric patients with SHI has decreased over the course of the study period.

The characteristics of social settings are increasingly being recognized as important factors influencing the health of individuals. This study examines the association of neighborhood physical and social disorganization with alcohol consumption in a sample of adolescents 12- to 15-years-old residing in communities of the San Juan metropolitan area with high availability of illicit drugs.The sampling frame was developed encompassing all census sectors in three municipalities of the San Juan metropolitan area with outdoor illegal drug-selling areas operating within them. Consent from parents and their adolescent offspring was obtained from 691 of these households for a response rate of 96%. Alcohol use was measured by asking adolescents if they had consumed alcohol during the last 12 months. Neighborhood social disorganization included hearing gunfire in the neighborhood, seeing neighbors selling stolen merchandise and drugs, vandalism, neighbors using alcohol and drugs, and seeing persons carrying weapons. Neighborhood physical disorganization included the presence of abandoned vehicles and buildings in the neighborhood, graffiti, and places where people go to inject drugs.Multiple logistic regression analysis revealed that older participants were more likely to use alcohol. Neighborhood social disorder was significantly associated with alcohol use. The strong positive gradient between neighborhood social disorder and alcohol use remained highly significant after controlling by sociodemographic characteristics. In contrast, neighborhood physical disorder was not significantly associated with alcohol use.These findings suggest that social signs of neighborhood disorganization have a more direct influence over adolescents' behaviors than the physical signs. Health professionals need to be cognizant of the strong effects that social environments have on adolescents and develop strategies to address these when intervening with adolescents.

Lupus nephritis is associated with an unfavorable outcome. Its incidence is higher in children. It has been the impression of pediatric nephrologists and rheumatologists in Puerto Rico that the clinical manifestations in Puerto Rican children differ from what has been described in other geographic regions. The potential deleterious effects of sun exposure could suggest that Puerto Rican children living in the Island are at high risk for severe nephritis.To describe the manifestations and identify predictors of patient and renal survival, we reviewed the medical charts of children diagnosed with lupus nephritis in Puerto Rico between 1987-2001.Mesangial glomerulonephritis (Type II) was the most common histopathological lesion observed. We observed a high incidence of nephritis among males, with a male: female ratio of 1:1.9.The presence of type IV nephritis and need for acute dialysis at presentation were identified as predictors of poor clinical outcome (development of end stage renal disease or death).

Hemolytic Uremic Syndrome (HUS) consists ofa triad of acquired hemolytic anemia, thrombocytopenia, and renal failure that occurs acutely in otherwise healthy individuals. HUS may be divided into two broad categories, typical, preceded by a diarrheal prodrome, and atypical. The clinical symptoms of HUS as well as its course, prognosis, and response to treatment appear to be significantly influenced by a number of factors, including age at onset, type and severity of underlying infections, and/or systemic diseases. A retrospective case series review of five patients diagnosed with Hemolytic Uremic Syndrome at the Pediatric University Hospital in Puerto Rico between 1997-2007 was performed. The study showed that the incidence of HUS in children in Puerto Rico is lower than other countries. However, the majority of cases have an atypical presentation, which places our patients at higher risk for life-threatening complications.

Apply a sedoanalgesic (SA) protocol for invasive procedures (PI) in pediatric patients and evaluate its effectiveness and safety.Prospective observational study.Pediatric Intensive Care Unit (PICU) of third level hospital.A total of 110 children subjected to invasive procedures under sedoanalgesia with propofol and fentanyl.Sedoanalgesic protocol for invasive procedure was applied with: fentanyl (1-2 mcg/kg with maximum dose of 100 mcg for first dose and 50 mcg for the next) and propofol (1-2 mg/kg with maximum of 100 mg for first dose and 50 mg for the next). The objective was to reach III-IV sedoanalgesic grade for modified Ramsay scale and amnesia related to invasive procedure. MAIN ENDPOINTS: a) time to sedoanalgesia and recovery, length for invasive procedure and stay in the Pediatric Intensive Care Unit; b) mean dose of drug; c) sedoanalgesic grade and amnesia related to invasive procedure and d) adverse events.Five hundreds SA were made for 634 IP in 110 children. The most common conditions were oncohematologics (91%), the spinal tap for intrathecal treatment was the most frequent IP (48.5%). Most of the patients (96.8%) did not recall the procedure and an optimum SA was obtained in 93.4%. Patients profoundly sedated presented a significant fall of systolic arterial pressure (88 +/- 19 vs 98 +/- 14 mmHg, p0.001) compared to those with minor SA level, as well as heart rate (88 +/- 17 vs 91 +/- 25 bpm, p0.05) and respiratory rate (19 +/- 6 vs 23 +/- 11 bpm, p0.05). Mean time to reach adequate sedation was 4.62 +/- 3.69 minutes and stay time in PICU 41.8 +/- 19. Complication incidence was 6.6% (apnea, hypotension, bradycardia), these were resolved with manual ventilation and/or volume expansion.SA protocol reached its goal of: a) effectiveness: SA achieved was optimal, with amnesia of the procedure in almost all patients and b) safety: complications were controlled due to monitorization and stabilization measurements.

To show that the ceramic produced at the Institute for Materials Research, National Autonomous University of Mexico, is an appropriate replacement of bone graft in patients with bone tumors, benign tumors, pseudoarthrosis and arthrodesis treated at "General Ignacio Zaragoza" Regional Hospital.An experimental, longitudinal study using bovine ceramic xenoimplants in patients covered by the Security and Social Services Institute for Civil Servants (ISSSTE), regardless of age and gender, all of whom consented to receiving the ceramic xenoimplant. Patients who did not consent or who discontinued treatment were excluded. A total of 24 patients were enrolled from March 1st to August 31st, 2006; two patients were withdrawn due to treatment discontinuation. They underwent X-ray evaluation of bone healing using the Montoya classification.The sample is composed of 14 male and 8 female patients, with a mean age of 46.6 years, and a standard deviation (s=) of 13.8. The most frequent indication was arthrodesis in 10 patients (45.45%), pseudoarthrosis in 6 (27.27%), benign tumors in 3 (13.63%), and bone defects in 3 (13.63%). Type II to type IV bone healing was observed in the sample.The use of ceramic xenoimplants is appropriate as a replacement of bone graft in patients with arthrodesis and bone defects, thus avoiding the need for autologous bone graft. This results in a decreased patient morbidity.

To study several aspects of puberal development in obese adolescent girls, and the influence of weight loss on these aspects.A longitudinal retrospective study was performed of a sample of 26 adolescent girls with normal weight and 46 obese adolescent girls at the onset of puberty. The obese teenagers were further divided into two groups (normal and obese) according to their body mass index (BMI) at the end of puberty. Height, chronological and bone age, and growth velocity were evaluated in both groups.Of the teenagers who were obese at the onset of puberty, 63 % remained obese at the end of puberty. The obese teenagers were significantly taller than non-obese teenagers at the onset of puberty (143.2 +/- 6.96 vs 138.9 +/- 5.95 cm, respectively; p0.01). However, there were no differences between the two groups in final height. No differences were found between obese teenagers who lost weight and those who did not. There were no differences in chronological or bone age throughout puberal development in any of the groups. The mean growth velocity during puberty was significantly lower in obese teenagers than in non-obese teenagers (6.18 +/- 1.94 and 6.90 +/- 127 cm/year, respectively; p0.02). However, there were no differences between obese teenagers who lost weight and those who did not.Height gain in obese girls is greater in childhood but lower in adolescence. Final height is similar in both groups. Chronological age at the onset and end of puberty and bone maturation are similar in both groups. Weight loss during puberty does not modify growth pattern during this period of development.

Heart transplantation currently provides the most effective treatment for advanced heart failure. However, medical therapy for this condition has also improved, heart donors are scarce and the cost of the procedure is high. Therefore the indications and management of these patients need reevaluation.To analyze the results of 24 patients submitted to heart transplantation for end-stage heart failure needing repeated hospitalizations and i.v. inotropes for compensation.The group was comprised by 21 men and 3 women with a mean age of 36.8 years, mean left ventricular ejection fraction 19 +/- 4.5%, mean systolic pulmonary artery pressure 48 +/- 13 mmHg (24-70) and mean pulmonary vascular resistance 2.6 Wood Units (1-5). Fourteen patients (58%) had a previous median sternotomy. Immunosuppression did not include induction therapy and steroids were discontinued early.Operative mortality was 4% at 30 days. Actuarial survival at one year was 90% and at 5 years 72%. Freedom from rejection at one year was 76% and at 5 years 50%. Freedom from infection was 70% at one year and 56.5% at five years. All patients with more than 3 months of follow-up were in functional class I.These results justify the proposed modifications for transplantation protocols.

It has been proved that there is an inspiratory muscle dysfunction in mitral stenosis; Although its causes still remain unknown.To evaluate the effect of percutaneous balloon mitral valvuloplasty (PMV) on inspiratory muscle performance (IMP) in patients with mitral stenosis (mitral area1.5 cm2).We studied IMP in 8 patients (35 +/- 10 years) before and 3 months after successful PMV. Inspiratory muscle strength was studied by measuring maximal statistical inspiratory mouth pressure (MIP). Endurance was evaluated using a two minute incremental threshold loading test in order to obtain the maximal sustainable inspiratory pressure (SIP), with the maximal sustainable load (MSL) the patients could sustain for 2 minutes.Mitral valvuloplasty increased mean cardiac index from 3.1 +/- 0.3 to 4.15 +/- 0.3 l/min/m2 (p0.01), and significantly decreased mean pulmonary and capillary pressures. The MIP value(118 +/- 6 cmH2O), similar to that of normal group, increased to 137 +/- 7 cmH2O (p0.01). SIP and maximal sustainable load were 52 +/- 3 cmH2O and 294 +/- 29 g respectively, lower than normal subjects (p0.05). They increased after PMV to 80 +/- 3 cmH2O and 463 +/- 26 g respectively (p0.001).PMV improved inspiratory muscle function in patients with severe mitral stenosis, probably secondary to a decrease work of breath and improvement of ventricular function.

Progressive limitation of occular motility, accompanied by ptosis but usually without diplopia, occurs in many pathologic states, including mitochondrial diseases. A case with chronic progressive external ophthalmoplegia with onset during childhood, associated with proximal myopathy and dysphasia is presented. The muscle biopsy showed a myopathic pattern and abnormal subsarcolemmal mitochondrial deposits. Muscle biopsy for important in the correct diagnosis of this entity.

To study of antileukotrienes with participation in the genesis of the asthma appeared in the last years.17 children with a mean age of 10.29 years, male seven and ten girls. They were tried with montelukast 5 mg/day the 12-year-old smellers and with 10 mg/day the such age greats, during a period middle to 5.7 months. Ten of they had a concomitant treatment fluticasona, budesonide, salmeterol or formoterol. Was valued the clinic improvement, the saving in medication and the sound effects.a) Clinic improvement in 82.3%; b) elimination of medication associated in 90% and c) sound effects: in a case drowsiness and in other abdominal pain.Montelukast seems be a very useful product in the treatment of the bronchial asthma in children since generates a saving of corticoids and longtime beta 2 in the mild or moderate asthma, associate or not with the inmunoterapia.

We evaluated the CT scans of 13 patients with spontaneous subcapsular or perinephric hemorrhage (SPH) associated with these underlying causes: 4 angiomyolipomas, 2 renal cell carcinomas, 1 renal metastatic malignant melanoma, 1 ruptured renal artery aneurysm, 1 adrenal myelolipoma, 1 ruptured renal abscess, 2 ruptured hemorrhagic cysts, and 1 patient with undiagnosed coagulation disorder. Our objective was to ascertain whether an underlying cause of SPH was identifiable by CT, and to determine the extension of the hematomas. Computed tomography identified the hematoma in all 13 cases (sensitivity 100 %). In all 12 cases in which there was a renal or adrenal anatomic lesion, the underlying cause was identified with CT (100 %), with correct diagnosis in 11 cases (91.6 %). The case in which no lesion was identified was the undiagnosed coagulation disorder. We conclude that CT is a useful technique for the initial evaluation of SPH, permitting diagnosis of hemorrhage and identification of the underlying cause.

1. The electrophysiological effects of CI-980, a new tubulin-binding agent that inhibits assembly of cytoplasmic microtubules, on transmembrane action potential characteristics were studied in right ventricular papillary muscles from guinea-pig hearts. 2. In papillary muscles driven at 1 Hz, CI-980 at concentrationsor = 10(-5) M produced a concentration-dependent increase in the maximum upstroke velocity (Vmax) and a lengthening of the action potential duration at 50% (APD50) and 90% (APD90) of repolarization without affecting the resting membrane potential. Prolongation of the APD90 was accompanied by a parallel lengthening of the effective refractory period (ERP) so that the ERP/APD90 ratio remained unaltered at all drug concentrations tested. 3. CI-980 exhibits a reverse use-dependent effect on APD90 values, that is, drug-induced APD90 prolongation become exagerated at slow rates and attenuated at fast rates. 4. CI-980 at concentrationsor = 10(-6) M lengthened the APD of the slow action potentials elicited by isoprenaline in papillary muscles depolarized by high K+ (27 mM) solution. 5. At 10(-5) M, CI-980 produced a small tonic Vmax block. However, in muscles driven at rates between 0.5 and 3 Hz it produced an exponential decline in Vmax (use-dependent Vmax block) which was augmented at higher rates of stimulation. At 3 Hz the onset kinetics of the use-dependent Vmax block was fitted by a monoexponential function with a K value 0.07 +/- 0.01 per AP. The recovery time constant (tau re) from the use-dependent Vmax block was prolonged from 21.6 +/- 2.6 ms to 3.5 +/- 0.2 s. 6. The curve relating membrane potential and Vmax was shifted by CI-980 (10(-5) M) in the hyperpolarizing direction by 2.3 +/- 1.1 mV. 7. It is concluded that in guinea-pig papillary muscles, CI-980 produces a use-dependent inhibition of Vmax and a reverse use-dependent prolongation of the ventricular action potential, thus exhibiting class I and class III antiarrhythmic actions, respectively. From the onset and offset kinetics of use-dependent Vmax block, CI-980 can be considered to be an intermediate kinetics (IA) Na+ channel blocker.

This study looked at the incidence of infection complications, in relation to central vein catheterisation as a provisional HD access, by means of the establishment of a nursing protocol for the handling of these catheters. Central vein catheterisation is a classical technique in Nephrology.

To evaluate the presence of anomalies of the autonomic reflex cardiovascular response in patients with chronic sickle-cell anaemia.The study was extended to 30 patients with sickle-cell anaemia, 10 patients with iron-lack anaemia and 30 healthy subjects. Age and sex distribution was similar in each group. To be included in the study, patients should have had no painful crisis or blood transfusion in the 6 months previous to the assay. Clinico-laboratory survey, chest x-ray and EKG were performed in every case. Blood cell count and abnormal haemoglobin study on cellulose acetate were carried out as well. The evaluation of reflex autonomic responses was performed by means of active orthostatism, cold pressor test, Valsalva maneuver and urine catecholamine output. The statistical analysis was performed with the variance analysis (ANOVA) for multiple groups.The following abnormalities were found: 12 patients had haemoglobin SS, 8 had haemoglobin SS and F, 3 had haemoglobin SC, 2 had haemoglobin S and beta-thalassaemia, and 5 had combined haemoglobin SS,F and A2. Systolic pressure and heart frequency in the supine position were similar in all groups. Diastolic pressure was lower in the sickle-cell anaemia group with respect to the normals. Patients with sickle-cell disease had lower heart frequency in the active orthostatism test with regard to the other groups, along with paradoxal changes in systolic pressure and lesser increase of the diastolic pressure. Significantly lower response to the cold pressor test was seen in the sickle-cell patients as compared with the iron-lack cases and the normal controls. Reduced sympathetic tachycardia was seen with the Valsalva maneuver, whereas the bradycardia was similar to the other groups. The urine noradrenaline in output was significantly lower in the sickle-cell patients, it was normal in the other groups (p0.01).These results suggest a defective sympathetic activity of heart and arteries in patients with sickle-cell anaemia.

A prospective study is performed in patients who sought for medical care at 2 selected medical offices from "26 de Julio" Teaching Polyclinics, Playa municipality, during July 1st, 1991 and July 31, 1992. These patients presented with acute cervicitis and had vaginal smears with positive cultures of some kind of infection. A study group and a control group were formed and the study was double-blind according to a random sample created for that purpose. Vaginal dressings using 5% propolis were applied to the study group, while daily dressings with Lugol were applied to the control group for 10 consecutive days. A survey was designed and results collected. It is concluded that all patients from the study group did not present with any other symptoms after treatment was completed since negative results were attained in 100% of the smears and 90% achieved a total epithelization of the cervix within 10 days of treatment. The importance of nursing care for the success of treatment is highlighted.

Orthopedic deformations of the feet play an important role in the etiology of the foot ulcers of diabetic patients, together with neuropathy and vascular impairment. The employment of new techniques in the treatment of diabetic foot has considerably improved its prognosis. These are the transient circulatory blockade (TCB) and the regional intravenous antibiotic administration (RAA). This paper reports on the usage of these techniques in the treatment of 24 diabetic patients, 8 women with ages between 41 and 75 (mean 54.7) years, and 16 men with ages between 41 and 75 (mean 59.3) years who were operated on 29 opportunities because of foot ulcer. Most of the patients had different grades of foot infection. Neuropathy was present in all cases and a distal type of arterial occlusion was diagnosed in 8 cases. Foot surgery was performed under regional i.v. anesthesia associated with regional i.v. injection of 1 g Cefotaxine (Calaforan) in 250 ml saline solution which was administered through the same butterfly needle used for the regional anesthesia. The drainage of the foot infection was performed simultaneously with the orthopedic correction of the foot deformities. All patients healed without complications attributable to the bone surgery. Patients operated upon while complicated with foot phlegmons remained longer (31 days) in the hospital than those without infection (18 days). After a follow-up period of 4.7 (1 to 8) years there were 2 recurrencies and 3 patients developed new foot ulcers. All patients were using a normal, soft shoe. We conclude that the TCB and the RAA facilitate orthopedic surgery in diabetic patients with foot ulcers improving their life quality and prognosis.

The strength and endurance of the inspiratory muscles was assessed in 14 patients with severe mitral valve stenosis uncomplicated by other diseases. Strength was evaluated measuring the maximal static inspiratory pressure (MIP). Endurance was measured using a two minute weight incremental test, to obtain the maximal sustainable pressure (SIP), which is the highest pressure that a subject can generate to mobilize air with incremental weight during inspiration. MIP was similar to that of 8 normal subjects (110 +/- 21 and 128 +/- 27 cm H2O respectively p = NS). SIP, maximal sustainable weight and SIP as percentage of MIP were 47 +/- 10 cm H2O, 261 +/- 81 g and 43 +/- 6% respectively, all lower than in normal subjects (89 +/- 25 cm H2O, 525 +/- 167 g and 71 +/- 15% respectively) We conclude that patients with severe mitral valve stenosis have decreased inspiratory muscle endurance compared to normal subjects and this feature may be related to their decreased exercise tolerance.

We characterized the acute manifestations of gastroesophageal reflux in 46 patients attending an emergency ward. 43 were females and the mean age was 41 +/- 14. The diagnosis of G-E reflux was confirmed in all by the acid reflux test; esophagitis was present in 55% of patients submitted to endoscopy; the Bernstein test was positive in 43%. The population represents 3% of all emergency consults and 8% of gastroenterological consults. Severe epigastric pain, usually burning or constrictive and radiating to the dorsum, left hypochondrium and sternal region was the presenting form in 55% of patients. Pain was refractory to antispasmodic agents but was relieved by antacids. Dyspnea or bronchial obstruction was the main symptom in 16% of cases, heartburn in 13%, hematemesis in 6%. Among these patients a prolonged history of chronic G-E reflux was common. Surgical correction was undertaken in 6%, with some symptoms persisting in 17%.

A mild anemia (hemoglobin 9 g/dl) was found in a patient from Seville (Spain) with marked morphological abnormalities in the peripheral blood smear. The red cell osmotic fragility showed a mild resistance curve with a mean cell fragility (MCF) of 0.375% NaCl (normal = 0.450). Chemical Chemical and thermal instability test and search for inclusion bodies gave positive results. Hemoglobin electrophoresis at pH 8.9 revealed absence of Hb A, a major component of fast mobility (94%), and increased Hb F and Hb A2 levels (1.5% and 4.6%, respectively). The fast fraction, isolated and purified by means of cellulose acetate electrophoresis, precipitated in acid acetone and treated with urea 8 M and mercaptoethanol, revealed an anomalous beta chain. Trypsin-digested globin peptides were separated by high-voltage electrophoresis at pH 6.4 and ascendant chromatography. With differential staining, an extra peptide was detected in an unusual site, more anodic than alpha Tp4 but in lower position. Peptide map of the fast beta chain, stained with ninhydrin, and also for Tyr, confirmed the position of the new peptide and the absence of the usual beta Tp13. The new peptide, separated by high-voltage electrophoresis at pH 3.5, revealed absence of Val and the presence of an additional Glu residue, which should appear only in position beta 126. The diagnosis of Hb Hofu (alpha 2 beta 2 126 Val----Glu; H4) was reached, thus interpreting its increase and the absence of Hb A, as an association with beta o-thalassemia, producing a mild hemolytic anemia. Evidence was obtained that Hb Hofu is a mild unstable hemoglobin variant.

Among eleven convalescent patients of Argentine hemorragic fever an electro-ballistocardiographic study was effected which led to the following conclusions: a) In 2 over 11 studied cases, electro-ballistocardiographic modifications of probable myocardial injury could be detected. b) The greatest percentage of the modifications was interpreted as normal variants of the electrocardiogram.