[Prevalence of neurodevelopmental disorders in children from the rural population of Oaxaca evaluated by means of the Child Development Evaluation test]. / Prevalencia de alteraciones en el neurodesarrollo en niños de población rural de Oaxaca evaluados mediante la prueba Evaluación de Desarrollo Infantil.

INTRODUCTION: During child's growth, access to health, nutrition, opportunities for stimulation, and early learning are necessary for an optimal development of the central nervous system. In rural areas there is a lack of access to them, and this has an impact on children's neurodevelopment. OBJECTIVE: To identify the prevalence of lag or delay in the development of children in rural areas. SUBJECTS AND METHODS: A descriptive, cross-sectional and prospective study, with non-probabilistic convenience sampling, where 97 infants from 1 month of age to one day before their 5th birthday, all belonging to rural communities in the state of Oaxaca, Mexico, were applied the Child Development Evaluation, designed and validated for the Mexican population in the early detection of neurodevelopmental problems. RESULTS: The prevalence of developmental disorders was 43%, with predominance in the male sex. The area of development with the greatest affectation was language, with a total of 29%, and in second place gross motor skills, with 18%; however, neurological affectation as the only one occurred in 2% of the participants, the most prevalent risk factors were the urinary tract infections in 56% of mothers. CONCLUSION: There is a percentage greater than 30% of neurodevelopmental disorders in rural communities due to social risk factors that infants face, such as the difficult access to medical care, a poorly stimulating environment and bad nutrition.

TITLE: Prevalencia de alteraciones en el neurodesarrollo en niños de población rural de Oaxaca evaluados mediante la prueba Evaluación de Desarrollo Infantil.Introducción. Durante el desarrollo del niño, el acceso a la salud, la nutrición, las oportunidades de estimulación y el aprendizaje temprano son necesarios para un óptimo desarrollo del sistema nervioso central. En zonas rurales se denota la falta de acceso a ellas, y esto repercute en el neurodesarrollo de los niños. Objetivo. Identificar la prevalencia de rezago o retraso en el desarrollo de niños de población rural. Sujetos y métodos. Estudio descriptivo, transversal y prospectivo, con muestreo no probabilístico de conveniencia, en el que a 97 niños a partir de 1 mes de edad y hasta un día antes de cumplir los 5 años, pertenecientes a comunidades rurales del estado de Oaxaca, México, se les aplicó la Evaluación de Desarrollo Infantil, diseñada y validada para la población mexicana en la detección de problemas del neurodesarrollo. Resultados. La prevalencia de las alteraciones del desarrollo fue del 43%, con predominio en el sexo masculino. El área de desarrollo con mayor afectación fue el lenguaje, con un 29%, y en segundo lugar la motricidad gruesa, con un 18%; sin embargo, las afectaciones neurológicas sólo se presentaron en el 2% de los participantes. Los factores de riesgo de mayor prevalencia fueron las infecciones de las vías urinarias, presentes en el 56% de las madres. Conclusión. Existe un porcentaje mayor del 30% de alteraciones en el neurodesarrollo en comunidades rurales debido a los factores de riesgo social que viven los niños, como el difícil acceso a la atención médica, un ambiente poco estimulante y una mala nutrición.

Cancers of new appearance in liver transplant recipients: incidence and evolution.

OBJECTIVE: To investigate the incidence, time of appearance, treatment, and evolution of tumors appearing in liver transplant recipients at our hospital. MATERIAL AND METHODS: We undertook a retrospective analysis of our series of liver transplants between 1990 and 2005. Patients who died during the immediate postoperative period were excluded. RESULTS: Of the 515 patients, 25 died during the immediate postoperative period and therefore had no occasion to develop neoplasms. Of the remaining 490, 32 developed cancers (6.5%). The average age was 55.4 +/- 7.17 years. The reasons for transplant were alcoholic cirrhosis (n = 15), hepatitis C virus (2), hepatitis B virus (n = 1), alcoholic and viral cirrhosis (n = 7), primary biliary cirrhosis (n = 1), and cryptogenic cirrhosis (n = 1). Four patients developed multiple neoplasms. Most of the tumors were cutaneous: nine basal cell and six squamous cell carcinomas. Other locations were the lung, urothelium, stomach, thyroid, and brain. Eight patients presented metastasis at the time of diagnosis. The average tumor-free period was 3.36 years. Nine patients died as a result of the tumor. DISCUSSION: Patients with a liver transplant have a high risk of developing cancers as a result of the immunosuppression treatment, which is lifelong. Nevertheless, other factors can be involved, such as infection by cytomegalovirus or the original diagnosis leading to transplantation. The risk for developing cancers is significantly greater than in the general population, with a higher tendency to recurrence and later development of second neoplasms.

Biliodigestive anastomosis in liver transplantation: review of 13 years.

Hepaticojejunostomy is a good alternative technique for biliary reconstruction in liver transplantation. Among 517 liver transplants performed between March 1992 and July 2005, 33 involved hepaticojejunostomy, namely, 18 men and 12 women of average age: 44.8 years. The main cause for this technique was retransplant (n = 10), secondary biliary cirrhosis (n = 5), alcoholic cirrhosis (n = 5), HCV cirrhosis (n = 2), primary biliary cirrhosis (n = 1), cryptogenic cirrhosis (n = 1), sclerosing cholangitis (n = 3), fulminant liver failure (n = 1), autoimmune cirrhosis (n = 1), and insulinoma metastasis (n = 1). Choledochojejunostomy was performed for all Roux-en-Y loops, with an average cold ischemia time of 361.16 minutes (180-780). The biliary complications were biliary fistula in four cases (13.3%), including two who required surgery; stenosis of the anastomosis in two cases (6.6%) including one diagnosed by HIDA that resolved with medical treatment and the other, diagnosed by cholangio-MRI, requiring a new hepaticojejunostomy; and biliary peritonitis in three cases (10%), all of whom required surgery. The vascular complications were thrombosis of the hepatic artery (n = 1), which required retransplantation, and pseudoaneurysm of hepatic artery (n = 1). No biliary complications occurred. The 6-month patient survival was 80% and the 6-month graft survival was 77%; no patient died due to biliary complications. Hepaticojejunostomy is a technique with higher morbidity than choledocho-choledochostomy, but it is the best alternative when the latter is not possible.

A rise in NAD precursor nicotinamide mononucleotide (NMN) after injury promotes axon degeneration.

NAD metabolism regulates diverse biological processes, including ageing, circadian rhythm and axon survival. Axons depend on the activity of the central enzyme in NAD biosynthesis, nicotinamide mononucleotide adenylyltransferase 2 (NMNAT2), for their maintenance and degenerate rapidly when this activity is lost. However, whether axon survival is regulated by the supply of NAD or by another action of this enzyme remains unclear. Here we show that the nucleotide precursor of NAD, nicotinamide mononucleotide (NMN), accumulates after nerve injury and promotes axon degeneration. Inhibitors of NMN-synthesising enzyme NAMPT confer robust morphological and functional protection of injured axons and synapses despite lowering NAD. Exogenous NMN abolishes this protection, suggesting that NMN accumulation within axons after NMNAT2 degradation could promote degeneration. Ectopic expression of NMN deamidase, a bacterial NMN-scavenging enzyme, prolongs survival of injured axons, providing genetic evidence to support such a mechanism. NMN rises prior to degeneration and both the NAMPT inhibitor FK866 and the axon protective protein Wld(S) prevent this rise. These data indicate that the mechanism by which NMNAT and the related Wld(S) protein promote axon survival is by limiting NMN accumulation. They indicate a novel physiological function for NMN in mammals and reveal an unexpected link between new strategies for cancer chemotherapy and the treatment of axonopathies.

Occipital arteriovenous malformations: visual disturbances and presentation.

BACKGROUND: Occipital arteriovenous malformations (AVMs) cause a variety of visual disturbances and headaches. Early diagnosis may lead to treatment that reduces the risk of hemorrhages, visual field loss and other neurologic deficits, and death. METHODS: We reviewed the records of the 70 patients with occipital AVMs referred to New York University Medical Center to investigate the mode of presentation and the outcome of treatment. RESULTS: Sixty-eight patients presented with one or more symptoms, including homonymous visual disturbances in 39, headache in 39, seizures in 20, and hemorrhage in twenty-six. Visual field loss was more common (p = 0.0007) and more severe (p = 0.0002) in patients who bled than in those with unruptured AVMs (16/44). The frequency of visual field loss was not associated with calcarine artery supply to the AVM. Prior to treatment, the fields improved in five patients with visual loss associated with a hemorrhage. Forty-six patients were treated with embolization, surgery, radiosurgery, or a combination of therapies. The AVM was eliminated in 19 of 20 patients (nine with preoperative partial embolization) treated with surgery versus in 4 of 27 patients treated only with embolization. There were two AVM-associated deaths, two subarachnoid hemorrhages, and four new neurologic deficits after treatment. Visual fields were worse in 15 patients, unchanged in 22, and improved in eight. CONCLUSIONS: Whereas some features of headache and visual symptoms are similar for occipital AVMs and migraine, the two disorders are usually distinguishable. Visual field improvement can spontaneously occur in patients who have had loss secondary to an intracerebral bleed. Treatment with embolization or surgery, particularly with surgical excision of the AVM, can result in new or worse visual field loss.

Homonymous field defect as the first manifestation of Creutzfeldt-Jakob disease.

PURPOSE: Although in the early stage of Creutzfeldt-Jakob disease most patients have obvious dementia, we found that the disease can be diagnosed in patients solely on the basis of a visual system disorder. METHODS: We examined three patients who initially complained of a nonspecific, insidious visual disturbance. RESULTS: The three patients were found to have Creutzfeldt-Jakob disease, confirmed by histopathologic analysis. Each patient had a homonymous hemianopsia on the first neuro-ophthalmologic examination. The initial neurologic, neuroimaging, and electrophysiologic examinations were not conclusive. The subsequent rapid deterioration in the neurologic status, including dementia and typical electroencephalographic changes, was suggestive of Creutzfeldt-Jakob disease. CONCLUSION: At onset of Creutzfeldt-Jakob disease, patients may have a homonymous hemianopsia despite normal results of magnetic resonance imaging of the brain and neurologic examination.

Study of nitrophenols preconcentration using quinolin-8-ol immobilized on controlled-pore glass in the presence of iron(III). Chromatographic determination of dinoseb in lemon juice.

The efficiency of an adsorbent consisting of quinolin-8-ol immobilized on controlled-pore glass which was packed in a minicolumn to preconcentrate nitrophenols in the presence of iron(III) has been established. Retention was carried out at acidic pH in the presence of 20 mM iron(III). Methanol-30 mM formic acid-sodium formate aqueous solution (pH 4.2) (65:35) was used in a one-step elution. Determinations were carried out by using liquid chromatography with detection at 350 nm. Determination of trace amounts of dinoseb in lemon juice was carried out with a minimum sample preparation. Recoveries were between 89 and 100% at 200-33 micrograms l-1. The maximum admissible concentration in fruit juice dictated by the Spanish and European Community legislation can be measured.

The educator's point of view.

PIP: Education is considered as an important means of promoting social change, and within this context how population issues can be integrated into development planning and educational practices is discussed. Education is expected to have an impact in future years, and is a necessary means of creating awareness of population-related problems; education for all is a human right. New approaches to population education must include teacher training and creation of awareness about population issues that respect cultural identity and free choice and do not influence customs and values that would run counter to the society. Educators have an ethical responsibility to address issues of population and human life; when seeking outside expertise, the nation should not be "carried away by the pressures of financial agencies which respond to foreign interests." For instance, the psychosocial dynamics and practice of sexual intercourse in Central America are different from those in North America or Europe. Sexual education must be based on sound scientific approaches, but must also include ethical values. Population education must use a holistic, intersectoral approach. Nations have human, natural, and economic resources, which must have a balanced influence. Human development involves being both the object and planner of development. Pope John Paul II noted that development must include the biological, the psychosocial, and the spiritual and reach all men. Human rights must be guaranteed. In addition to equality for women everyone has the right to dignity, education, employment, health, housing, and leisure. Quality of life is a part of human development, and is achieved through a balance between man, his environment, and resources, and liberty and peace. Educational strategies involve macro planning for placement and number of schools and teachers, and decentralizing educational services in order to reach rural areas. Formal and informal education is required. Adult education is also important in reducing illiteracy and educating about family planning. Education is a lifelong process to foster the improvement in the quality of human life and develop humanity cognitively, socioaffectively, and with psychomotor skills. Educational methods can foster a democratic experience.^ieng

HNF-1alpha G574S is a functional variant with decreased transactivation activity.

AIM: To assess the functional consequence of the hepatocyte nuclear factor 1alpha gene (HNF-1alpha) G574S variant previously proposed as a diabetes susceptibility allele, in a group of Mexican Type 2 diabetic patients with end-stage renal disease (ESRD). METHODS: The transcriptional activity of the HNF-1alpha G574S recombinant protein on the human insulin promoter was assessed by transfection assays in RINm5f and HepG2 cell lines. RESULTS: Two unrelated Mexican diabetic patients with no known African ancestry were found to carry the G574S variant. This substitution was not found among unrelated healthy control subjects. Whereas the G574S HNF-1alpha transcription activation of the human insulin promoter was 40% lower than that of the wild-type protein in RINm5f beta cells, no difference was found in a hepatic cell line (HepG2). CONCLUSIONS: G574S affects the transactivation potential of HNF-1alpha on the insulin promoter in pancreatic beta-cells. Although it has been difficult to prove its role in the development of diabetes in case-control association studies, this variant exhibits functional effects consistent with it being a potential diabetes susceptibility allele.

Genetic variability in mitochondrial DNA of the screwworm, Cochliomyia hominivorax (Diptera: Calliphoridae), from Brazil.

Restriction fragment length polymorphism (RFLP) analysis of mitochondrial DNA (mtDNA) was used to examine genetic variation and population structure of screwworm flies in four populations from São Paulo State, Brazil. The total DNA of 405 individuals was digested with 15 restriction endonucleases and probed with five cloned HindIII fragments representing the entire mitochondrial genome of Cochliomyia hominivorax. The survey revealed that four enzymes (HaeIII, HindIII, MspI, and PvuII) were suitable to detect mtDNA variation among all populations. Based on the fragment patterns obtained for these four enzymes, a total of 15 haplotypes in combination was detected. Heteroplasmic individuals for the PvuII pattern were obtained in one of the populations. The estimated average for nucleotide sequence divergence (delta) was 0.92%. The cladogram of the geographical distribution among the observed haplotypes suggests that the sampled screwworms probably belong to a single evolutionary lineage with populations interconnected by reduced gene flow.

[Methods for teaching problem-solving in medical schools]. / Métodos para la enseñanza de la solución de problemas en las escuelas de medicina.

The need to include in the medical curriculum instructional activities to promote the development of problem-solving abilities has been asserted at the national and international levels. In research on the mental process involved in the solution of problems in medicine, problem-solving has been defined as a hypothetical-deductive activity engaged in by experienced physicians, in which the early generation of hypotheses influences the subsequent gathering of information. This article comments briefly on research on the mental process by which medical problems are solved. It describes the methods that research has shown to be most applicable in instruction to develop problem-solving abilities, and presents some educational principles that justify their application. The "trail-following" approach is the method that has been most commonly used to study the physician's problem-solving behavior. The salient conclusions from this research are that in the problem-solving process the diagnostic hypothesis is generated very early on and with limited data; the number of hypotheses is small; the problem-solving approach is specific to the type of medical problem and case in hand; and the accumulation of medical knowledge and experience forms the basis of clinical competence. Four methods for teaching the solution of problems are described: case presentation, the rain of ideas, the nominal groups technique and decision-making consensus, the census and analysis of forces in the field, and the analysis of clinical decisions. These methods are carried out in small groups. The advantages of the small groups are that the students are active participants in the learning process, they receive formative evaluation of their performance in a setting conductive to learning, and are able to interact with their instructor if he makes proper use of the right questioning techniques. While no single problem-solving method can be useful to all students or in all the problems they encounter, teachers of medicine can improve their students' performance by adjusting these available methods to their particular needs and to those of their schools. The problem-solving methods described can help teachers shape the learning environment so as to develop in their students the most coherent, logical, concrete and complete set of skills possible. These methods can so be of value in improving the training of future doctors and the quality of their decisions to the benefit of their patients.

Radio Santa Maria: a case study of participatory evaluation.

PIP: Radio Santa Maria (RSM), established by the Catholic Church in the Dominican Republic in 1964, broadcasts programs leading to certificates at the primary and intermediate levels and stresses education as a tool to help individuals cope with their environment. This article describes the history of an evaluation of RSM based on the participation of RSM personnel. RSM staff carried out the field work, while members of the expatriate evaluation team helped to design the survey instruments, trained staff in evaluation techniques, and conducted the statistical analyses. A 1975 policy document served as the basis of the evaluation. An important advantage of the self-study approach was that the evaluation process itself resulted in program improvements during the study period. As active participants in the process, RSM staff developed important evaluation skills and a computerized information retrieval system was installed. A disadvantage of the participatory approach to program evaluation is the time required to build personnel relations and transfer technical skills. Compromises may be necessary that undermine professional standards and reduce data reliability. On the other hand, self-study can provide data of more depth than external evaluations. It can overcome the neglect of inputs and processes that characterizes traditional output-oriented evaluations. It is concluded that if the purpose of an evaluation is to improve an organization, it is useful to involve the entire organization in the process.^ieng

Ophthalmoplegia as a presenting manifestation of internal carotid artery dissection.

We present the case of a patient with an ipsilateral ophthalmoplegia as the presentation of a traumatic dissection of the internal carotid artery. We hypothesize that the cranial nerves dysfunction occurred because of interruption of the vascular supply to the nerves in the cavernous sinus from the inferolateral trunk of the cavernous carotid artery.

[Adaptation and validation of a test on knowledge about diabetes mellitus]. / Adaptación y validación de un test de conocimientos sobre la diabetes mellitus.

OBJECTIVE: To adapt and validate a Spanish language medium test, of theoretical general knowledge of diabetes mellitus (questionnaire from the University of Michigan). To determine the validity of the concurrent and discriminatory content and establish reliability. DESIGN: The study was observational. Validity was verified prior to data collection. To analyse the concurrent and discriminatory validity, a questionnaire was used in personal interview with the patients, and the degree of knowledge evaluated on certain variables. SETTING: Hospital outpatient endocrinology consultations. PATIENTS: 167 diabetic patients were chosen at random, from the outpatient visits. 14 patients who had developed hearing, or language problems, or who had problems of a psychological nature, were excluded. Only 1 patient refused to answer the questionnaire. MAIN MEASUREMENTS AND RESULTS: Validity of the content was confirmed after careful analysis of the questions on the questionnaire by medical specialists in endocrinology. It was found that the test had adequate concurrence (p less than 0.01) when the average general knowledge levels of certain group of patients are compared. It also had acceptable discriminatory validity (r = 0.56: p less than 0.0001) and reliability (alpha: 0.84; p less than 0.45). CONCLUSIONS: Adaptation and validation has been obtained for a test of theoretical general knowledge on diabetes mellitus, and the test was found to be applicable to the population under study.

Endovascular treatment of giant aneurysms which cause visual loss.

BACKGROUND: Progressive visual loss that results when a giant cerebral aneurysm compresses the anterior visual pathway requires treatment. When surgical clipping is not safely feasible, percutaneous methods of embolization of the aneurysm can be visual or life saving. METHODS: Endovascular techniques were used to treat 19 of 26 consecutive inoperable giant aneurysms in patients with visual loss, which included optic neuropathy (monocular in 13 patients and bilateral in 8) and optic tract dysfunction in five patients. Embolization of the aneurysm was performed with detachable balloons in 12 patients and with Guglielmi detachable electrocoils in 7. RESULTS: After treatment, vision improved in 7 patients, was unchanged in 11, and worsened in 1. Neurologic complications with balloons were temporary in four patients and severe and permanent in three. In contrast, only one temporary complication occurred with Guglielmi detachable electrocoils. The treatment results are contrasted with the outcome in the seven patients who refused intervention: three hemorrhaged (1 death); monocular blindness with dementia developed in two; a complete homonymous hemianopia and dementia developed in one; and one became bilaterally blind. CONCLUSION: Inoperable symptomatic giant aneurysms can be successfully treated with endovascular treatment.

Enhanced sensitivity to N-methyl-D-aspartate receptor activation in transgenic and knockin mouse models of Huntington's disease.

We used two mouse models of Huntington's disease (HD) to examine changes in glutamate receptor sensitivity and striatal electrophysiology. One model, a transgenic, consisted of mice expressing exon 1 of the human HD gene and carrying 141-157 CAG repeat sequences (R6/2 line). The second model, a CAG repeat "knockin," consisted of mice with different lengths of CAG repeats (CAG71 and CAG94 repeats). The effects of glutamate receptor activation were examined by visualizing neurons in brain slices with infrared videomicroscopy and differential interference contrast optics to determine changes in somatic area (cell swelling). Striatal and cortical neurons in both models (R6/2 and CAG94) displayed more rapid and increased swelling to N-methyl-D-aspartate (NMDA) than those in controls. This effect was specific as there were no consistent group differences after exposure to alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA) or kainate (KA). Intracellular recordings revealed that resting membrane potentials (RMPs) in the R6/2 transgenics were significantly more depolarized than those in their respective controls. RMPs in CAG94 mice also were more depolarized than those in CAG71 mice or their controls in a subset of striatal neurons. Confirming previous results, R6/2 mice expressed behavioral abnormalities and nuclear inclusions. However, CAG71 and CAG94 knockins did not, suggesting that increased sensitivity to NMDA may occur early in the disease process. These findings imply that NMDA antagonists or compounds that alter sensitivity of NMDA receptors may be useful in the treatment of HD.

Preconcentration of pentachlorophenol from sawdust using quinolin-8-ol immobilized on controlled-pore glass and determination by liquid chromatography.

A method for quantitative evaluation of pentachlorophenol (PCP) in sawdust has been developed. Pentachlorophenol is extracted from the solid matrix with 0.5 M sodium hydroxide and preconcentration was carried out using quinolin-8-ol immobilized on controlled pore glass. Determination was carried out by using liquid chromatography with detection at 240 nm. Recoveries were between 84 and 97% at 1-3 microg/g.

Métodos para la enseñanza de la solución de problemas en las escuelas de medicina / Methods for teaching problem-solving in medical schools

The need to include in the medical curriculum instructional activities to promote the development of problem-solving abilities has been asserted at the national and international levels. In research on the mental process involved in the solution of problems in medicine, problem-solving has been defined as a hypothetical-deductive activity engaged in by experienced physicians, in which the early generation of hypotheses influences the subsequent gathering of information. This article comments briefly on research on the mental process by which medical problems are solved. It describes the methods that research has shown to be most applicable in instruction to develop problem-solving abilities, and presents some educational principles that justify their application. The «trail-following» approach is the method that has been most commonly used to study the physician's problem-solving behavior. The salient conclusions from this research are that in the problem-solving process the diagnostic hypothesis is generated very early on and with limited data; the number of hypotheses is small; the problem-solving approach is specific to the type of medical problem and case in hand; and the accumulation of medical knowledge and experience forms the basis of clinical competence. Four methods for teaching the solution of problems are described: case presentation, the rain of ideas, the nominal groups technique and decision-making consensus, the census and analysis of forces in the field, and the analysis of clinical decisions. These methods are carried out in small groups. The advantages of the small groups are that the students are active participants in the learning process, they receive formative evaluation of their performance in a setting conductive to learning, and are able to interact with their instructor if he makes proper use of the right questioning techniques. While no single problem-solving method can be useful to all students or in all the problems they encounter, teachers of medicine can improve their students' performance by adjusting these available methods to their particular needs and to those of their schools. The problem-solving methods described can help teachers shape the learning environment so as to develop in their students the most coherent, logical, concrete and complete set of skills possible. These methods can so be of value in improving the training of future doctors and the quality of their decisions to the benefit of their patients (Au)

Tratamiento de las alteraciones en la consolidación diafisaria con fijación interna y aplicación percutánea de médula ósea / Treatment of alterations in bone-union of diaphyseal fractures by internal fixation and percutaneous bone-marrow application

Se presenta una serie de 5 casos que tenían alteraciones de la consolidación, que fue pseudoartrosis en 4 y retardo de consolidación en uno. El tratamiento consistió en aplicación percutánea de médula ósea autóloga en el foco de fractura. El resultado que se obtuvo después de 12 semanas fue satisfactorio clínicamente en 4 y regular en uno, mientras que el resultado radiológico fue satisfactorio solamente en 2 y regular en 3.