[Female adolescents with eating disordes: cardiac abnormalities]. / Trastornos de la conducta alimentaria: alteraciones cardiovasculares al ingreso y evolución a 3 meses.

BACKGROUND: Cardiovascular complications can occur in up to 80% of adolescent patients with eating disorders (ED) and account for 30% of their mortality. AIM: To evaluate cardiovascular complications in adolescents with ED and their evolution after refeeding. PATIENTS AND METHODS: In adolescents with ED admitted to treatment, we assessed the nutritional status, weight loss prior to consultation, presence of bradycardia (BC, defined as heart rate < 60 bpm), we performed an electrocardiogram (ECG) and an echocardiography and measured thyroid hormones. RESULTS: We studied 53 women aged 16.4 ± 2.3 years. Fifteen had a diagnosis of Anorexia Nervosa (AN), seven of Bulimia (BN), eight a not otherwise specified ED (ED-NOS), four a Binge Eating Disorder (BED), sixteen an Atypical Anorexia (AAN) and three an Atypical Bulimia (ABN). Thirty four percent were malnourished and 3.8% overweight. The most common cardiac problem was BC in 51%. In eight of 26 patients in whom an echocardiogram was done, it was abnormal. Six had a decreased ventricular mass, three a pericardial effusion and three valvular involvement. There was a significant association between bradycardia and malnutrition, weight loss and low free triiodothyronine levels. BC was significantly more common in patients with AN, but it also occurred in half of the patients with AAN and in one of three patients with other types of ED. At follow up, bradycardia significantly improved with refeeding. CONCLUSIONS: There is an association between all types of ED and bradycardia, as well as anatomical and functional cardiac anomalies.

Trastornos de la conducta alimentaria: alteraciones cardiovasculares al ingreso y evolución a 3 meses / Female adolescents with eating disordes: cardiac abnormalities

Background: Cardiovascular complications can occur in up to 80% of adolescent patients with eating disorders (ED) and account for 30% of their mortality. Aim: To evaluate cardiovascular complications in adolescents with ED and their evolution after refeeding. Patients and Methods: In adolescents with ED admitted to treatment, we assessed the nutritional status, weight loss prior to consultation, presence of bradycardia (BC, defined as heart rate < 60 bpm), we performed an electrocardiogram (ECG) and an echocardiography and measured thyroid hormones. Results: We studied 53 women aged 16.4 ± 2.3 years. Fifteen had a diagnosis of Anorexia Nervosa (AN), seven of Bulimia (BN), eight a not otherwise specified ED (ED-NOS), four a Binge Eating Disorder (BED), sixteen an Atypical Anorexia (AAN) and three an Atypical Bulimia (ABN). Thirty four percent were malnourished and 3.8% overweight. The most common cardiac problem was BC in 51%. In eight of 26 patients in whom an echocardiogram was done, it was abnormal. Six had a decreased ventricular mass, three a pericardial effusion and three valvular involvement. There was a significant association between bradycardia and malnutrition, weight loss and low free triiodothyronine levels. BC was significantly more common in patients with AN, but it also occurred in half of the patients with AAN and in one of three patients with other types of ED. At follow up, bradycardia significantly improved with refeeding. Conclusions: There is an association between all types of ED and bradycardia, as well as anatomical and functional cardiac anomalies.

Resultados maternos y perinatales en mujeres con diabetes gestacional según criterios de pesquisa / Maternal and perinatal health in women with gestational diabetes research results according to criteria

OBJETIVO: Conocer los resultados maternos y perinatales de mujeres con diabetes gestacional diagnosticada según los Criterios de la Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo y la Asociación Latinoamericana de Diabetes. MÉTODOS: Se estudiaron ciento veintidós embarazadas con diagnóstico de diabetes gestacional, aplicando los criterios Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo y Asociación Latinoamericana de Diabetes. Se compararon datos socio-demográficos, factores de riesgo para diabetes gestacional, parámetros clínicos y metabólicos durante el embarazo y la pesquisa posparto de diabetes en ambos grupos. Las determinaciones de glucemias de las pruebas de tolerancia oral a la glucosa se realizaron mediante el método enzimático. Se utilizó Chi cuadrado y t de Student para la asociación de variables. Se consideró significativo un valor de P < 0,05. RESULTADOS: Al usar los criterios de la Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo, el número de pacientes con diabetes gestacional aumentó 22,95 %. No hubo diferencias en cuanto a factores de riesgo para diabetes gestacional, resultados maternos y perinatales entre los dos grupos. En el grupo según los criterios Asociación Latinoamericana de Diabetes, las glucemias 2 horas poscarga en el posparto eran más altas (P< 0,02) y resultaron casos de prediabetes. CONCLUSIONES: Se incrementó la proporción de casos con diabetes gestacional, al emplear los criterios de la Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo y se detectaron más alteraciones glucémicas maternas en el posparto con los criterios Asociación Latinoamericana de Diabetes. Se requieren investigaciones ulteriores, cuyos resultados puedan contribuir a las decisiones institucionales sobre los criterios para la pesquisa de diabetes gestacional.

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Extracorporeal liver assist device to exchange albumin and remove endotoxin in acute liver failure: Results of a pivotal pre-clinical study.

BACKGROUND & AIMS: In acute liver failure, severity of liver injury and clinical progression of disease are in part consequent upon activation of the innate immune system. Endotoxaemia contributes to innate immune system activation and the detoxifying function of albumin, critical to recovery from liver injury, is irreversibly destroyed in acute liver failure. University College London-Liver Dialysis Device is a novel artificial extracorporeal liver assist device, which is used with albumin infusion, to achieve removal and replacement of dysfunctional albumin and reduction in endotoxaemia. We aimed to test the effect of this device on survival in a pig model of acetaminophen-induced acute liver failure. METHODS: Pigs were randomised to three groups: Acetaminophen plus University College London-Liver Dialysis Device (n=9); Acetaminophen plus Control Device (n=7); and Control plus Control Device (n=4). Device treatment was initiated two h after onset of irreversible acute liver failure. RESULTS: The Liver Dialysis Device resulted in 67% reduced risk of death in acetaminophen-induced acute liver failure compared to Control Device (hazard ratio=0.33, p=0.0439). This was associated with 27% decrease in circulating irreversibly oxidised human non-mercaptalbumin-2 throughout treatment (p=0.046); 54% reduction in overall severity of endotoxaemia (p=0.024); delay in development of vasoplegia and acute lung injury; and delay in systemic activation of the TLR4 signalling pathway. Liver Dialysis Device-associated adverse clinical effects were not seen. CONCLUSIONS: The survival benefit and lack of adverse effects would support clinical trials of University College London-Liver Dialysis Device in acute liver failure patients.

Epidemiology of Haemophilus influenzae serotype a, North American Arctic, 2000-2005.

Before the introduction of Haemophilus influenzae type b (Hib) conjugate vaccines, rates of invasive H. influenzae disease among indigenous people of the North American Arctic were among the highest in the world. Routine vaccination reduced rates to low levels; however, serotype replacement with non-type b strains may result in a reemergence of invasive disease in children. We reviewed population-based data on invasive H. influenzae in Alaska and northern Canada from 2000-2005; 138 cases were reported. Among 88 typeable isolates, 42 (48%) were H. influenzae type a (Hia); 35 (83%) occurred in indigenous peoples. Among Hia patients, median age was 1.1 years; 62% were male; 1 adult died. Common clinical manifestations included meningitis, pneumonia, and septic arthritis. Overall annual incidence was 0.9 cases per 100,000 population. Incidence among indigenous children <2 years of age in Alaska and northern Canada was 21 and 102, respectively. Serotype a is now the most common H. influenzae serotype in the North American Arctic; the highest rates are among indigenous children.

Initial management of an outbreak of the HTLV-1 virus in Nunavut, Canada.

BACKGROUND: HTLV-1 is a retrovirus known to be endemic in Japan, the Caribbean, and parts of Africa. HTLV-1 infection is rare in Canada. The last known cases prior to the present cluster in Nunavut occurred in 1993, when three Aboriginal patients with neurological symptoms in British Columbia were found to be infected with HTLV-1. The Dept. of Health and Social Services in Nunavut became aware of the presence of this virus in the Nunavut population in early June, 2005 when an individual infected with HTLV-1 died from Acute T-cell leukemia. STUDY DESIGN: A report of the interventions done by the Department in response to this outbreak. METHODS: Interviews with the key informants in the Department. A review of the record of meetings, community consultations, expert consultations and communiqués was conducted. Key information points were summarized. RESULTS: A Nunavut Dept. of Health and Social Services Task Force on HTLV-1 was established. Investigation of the population in the community in which the index case was found using blood samples to identify the virus in the carriers and for antibodies in first-degree relatives of the carriers. A literature review and summary of the epidemiology of the cluster was performed. An intense educational and counseling program regarding HTLV-1 infection was initiated for the (200) health care workers in the Territory and residents in the affected communities. A territory wide publicity and educational package was developed and implemented via meetings, press conferences, and telehealth sessions. Clinical protocols for monitoring the health status of infected individuals have been implemented. Ante-natal screening for HTLV-1 has been initiated, Territory-wide. An unlinked, anonymous HTLV-1 seroprevalence study began in early 2006. To date, approximately 300 persons have been tested for HTLV-1 in Nunavut. The number of infected individuals is less than 20. CONCLUSIONS: HTLV-1 infection is present in Nunavut. The prevalence is unknown. There has been at least one death from Acute T-cell leukemia in an individual infected. Prenatal screening and the seroprevalence study should provide important information on the breadth of the problem and allow the Department to implement appropriate measures to better manage the spread of the virus and the clinical cases of those infected with it.

Sporotrichosis in childhood: clinical and therapeutic experience in 25 patients.

Sporotrichosis in an uncommon mycoses in childhood and is generally associated with injuries received as a consequence of farm work. We undertook a retrospective study of sporotrichosis in children and adolescents seen over a 10-year period, focusing on their clinical, epidemiologic, and mycologic features as well as treatment. We included 25 children with a mean age of 9.3 years. Most of those affected were schoolchildren (84%) from rural areas. The main clinical variety of sporotrichosis seen was the lymphocutaneous form (64%), followed by the fixed cutaneous form (36%), and one instance of the disseminated cutaneous form. Most lesions were located on the upper limbs (40%) and the face (36%). Sporothrix schenckii was isolated in all patients and 24 of 25 had a positive sporotrichin skin test. Nineteen patients were treated and cured clinically and mycologically with potassium iodide, three were cured with itraconazole and one with heat therapy.

Medallion-like dermal dendrocyte hamartoma: a new clinically and histopathologically distinct lesion.

Dermal dendrocyte hamartomas are extremely rare; only two examples have been described with clinical features different from our cases and with incomplete immunohistochemical characterization. We report three female patients presenting a medallion-shaped, well-defined, slightly atrophic and asymptomatic congenital lesion. All 3 patients showed a fusiform-cell proliferation. Immunohistochemistry was positive for CD34, factor XIIIa, and fascin. Electron microscopy showed typical features of dermal dendrocytes. We believe that the lesions described represent a new, clinically and histopathologically distinct lesion originating in dermal dendrocytes. We propose to name it medallion-like dermal dendrocyte hamartoma.