Defect-Driven Configurational Entropy in the High-Entropy Oxide Li1.5MO3-δ.

Layered lithiated oxides are promising materials for next generation Li-ion battery cathode materials; however, instability during cycling results in poor performance over time compared to the high capacities theoretically possible with these materials. Here we report the characterizations of a Li1.47Mn0.57Al0.13Fe0.095Co0.105Ni0.095O2.49 high-entropy layered oxide (HELO) with the Li2MO3 structure where M = Mn, Al, Fe, Co, and Ni. Using electron microscopy and X-ray spectroscopy, we identify a homogeneous Li2MO3 structure stabilized by the entropic contribution of oxygen vacancies. This defect-driven entropy would not be attainable in the LiMO2 structure sometimes observed in similar materials as a secondary phase owing to the presence of fewer O sites and a 3+ oxidation state for the metal site; instead, a Li2-γMO3-δ is produced. Beyond Li2MO3, this defect-driven entropy approach to stabilizing novel compositions and phases can be applied to a wide array of future cathode materials including spinel and rock salt structures.

Sexual and vegetative propagation of the medicinal Mexican species Phyllonoma laticuspis (Phyllonomaceae).

Phyllonoma laticuspis leaves are used in Carrizal de Bravo, Guerrero, Mexico, to heal skin lesions such as injuries and smallpox sequelae and to treat diabetes mellitus type 2, and organic extracts of these leaves have been reported to exert antibacterial effects. High demand of P. laticuspis as a medicinal plant has decreased its natural populations, and propagation of the species has not yet been reported. Therefore, the purpose of this study was to assess the vegetative propagation of the species through cutting and air layering, as well as its sexual propagation in a preserved population. For this, concentrations of 1 000, 4 000 and 6 000 ppm of a commercial root enhancer, with indole butyric acid (IBA), and a control treatment without IBA, were applied to the cuttings and air layers. Germination was evaluated under light and dark conditions using lots of freshly collected seeds and lots of seeds that had been stored for three months at 4 °C or 24 ± 2 °C. All experiments were performed in a completely randomized design. The cuttings did not develop roots in any concentration, whereas 100 % of the air layers rooted, displaying vigorous roots in the presence of 4 000 ppm IBA, after four month of treatment application. Regarding germination, more than 60 % of the freshly collected seeds germinated, whereas less than 20 % of the seeds stored at 4 °C, and close to 50 % of the seeds stored at 24 ± 2 °C germinated under light and dark conditions. No significant differences were observed between light and dark conditions, so they were categorized as indifferent photoblastic seeds. The observed moisture content of 13.5 % and germination behaviour as the response to cold storage, suggest that the resultant seed quality was intermediate. P. laticuspis propagation for short-term foliage production can be carried out in air layers, in populations with a high density of adult plants as a source of plant material and for the restoration of disturbed areas, in the same locality. On the other hand, large-scale seedling production, medium-term foliage production and preservation of species variability can be achieved using seeds.

Drug-induced life-threatening potassium disturbances detected by a pharmacovigilance program from laboratory signals.

PURPOSE: Detection and reporting of drug-induced life-threatening potassium disturbances and the study of associated factors under a Pharmacovigilance Program using Laboratory Signals at a Hospital (PPLSH) during a 2-year period. METHODS: All serum potassium levels <2 mmol/l or >7 mmol/l detected at admission to the hospital, including those of patients who died in the emergency ward or during hospitalization, were monitored prospectively from January 2009 through to December 2010. The incidence rate of each etiology of potassium disturbances was calculated. Factors associated with drug-induced potassium disturbances were detected using a multiple logistic regression model. RESULTS: The incidence of true life-threatening drug-induced hyper- and hypokalemia events was 3 and 4.32 (Poisson 95 % confidence interval 1.62-10.24), respectively, per 10,000 admissions. Of the severe potassium disturbances, 32.3 % were drug-induced, and 23 % were lethal. We identified previously undescribed pharmacological causes of hyperkalemia (risedronate, doxazosin) and hypokalemia (acyclovir, teicoplanin, cefepime, meropenem, dexketoprofen colistimethate). Significant predictor factors associated with drug-induced hyperkalemia were the use of polypharmacy (>5 drugs), age (>74 years), sex (female) and kidney disease (glomerular filtration rate <60 ml/min) with the presence of ≥4 comorbid conditions. The only predictor of drug-induced hypokalemia was the use of >5 drugs. The triggering factor associated with drug-induced hyperkalemia and hypokalemia was azotemia and hypoalbuminemia, respectively. CONCLUSIONS: Drug-induced life-threatening potassium disturbances remain a relevant problem. Potential strategies for prevention are to avoid polypharmacy, early discontinuation of treatment of drugs causing hyperkalemia or nephrotoxicity in cases of various clinical situations (cardiac descompensation, infection, hypovolemia) or obstructive causes, and insistence on albumin control during hospitalization.

Hyperendemic H. pylori and tapeworm infections in a U.S.-Mexico border population.

OBJECTIVE: A higher incidence of infectious disease has been documented in U.S. regions bordering Mexico compared with non-border areas. We assessed the prevalence of important gastrointestinal infections in Ciudad Juarez, Mexico, and El Paso, Texas, the largest binational community along the U.S.-Mexico border. METHODS: Fecal specimens from a sample of the asymptomatic population representing all ages were tested for Helicobacter pylori (H. pylori), Cryptosporidium spp., Giardia spp., and other intestinal parasitic pathogens using flotation, immunoassays, and/or polymerase chain reaction. We also measured indicators of microbiological contamination of drinking water, hands of food preparers, and kitchen surfaces. RESULTS: Overall, of the 386 participants, H. pylori was present in 38.2%, Taenia spp. in 3.3%, Giardia spp. in 2.7%, Cryptosporidium spp. in 1.9%, Entamoeba dispar in 1.3%, and Ascaris lumbricoides and Necator americanus in 0.3% of the study subjects; Cyclospora spp. and Entamoeba histolytica were not found. H. pylori infection was associated with handwashing (prevalence ratio [PR] = 1.3, 95% confidence interval [CI] 1.0, 1.8). Taenia spp. was found more often on the U.S. side (PR=8.6, 95% CI 2.3, 30.8). We did not find an association between these infections and the occurrence of total coliforms or fecal coliforms on kitchen surfaces. In addition, Escherichia coli was not found in any drinking water sample. CONCLUSION: The study results indicated that H. pylori and Taenia spp. infections may be highly prevalent along the U.S.-Mexico border. Additional research is necessary to adequately characterize the prevalence, as well as determine whether interventions that reduce these infections are warranted.

Adjunctive micronutrient supplementation for pulmonary tuberculosis.

OBJECTIVE: To assess the effect of micronutrient supplementation on tuberculosis (TB) patient outcomes. MATERIAL AND METHODS: The randomized, double-blinded, placebo-controlled study was conducted in pulmonary TB patients undergoing directly observed treatment short course/ tratamiento acortado estrictamente supervisado (TAES/ DOTS) at IMSS in Ciudad Juarez, Chihuahua, Mexico, who were recruited during August 2005-July 2006. Consecutive patients received zinc and vitamin A supplements or matched placebo for four months. Dietary intake, blood zinc and vitamin A, immune response (IFN-gamma,TNF-alpha, and IL-10 mRNA), and sputum smear conversion were measured. RESULTS: The proportion of micronutrient compared to placebo group subjects with a negative sputum smear by month 3 was significantly increased (p= 0.03). This occurred subsequent to increased TNF-alpha and IFN-gamma and decreased IL-10 observed at month 2. Micronutrient supplementation appeared to accelerate the beneficial therapeutic effect of chemotherapy. CONCLUSIONS: The earlier elimination of bacilli from sputum was associated with improved zinc status and Th1 immune response. The therapeutic effect of vitamin A was less evident.

Rare case of bilateral anterolateral and symmetrical bowing of tibia successfully treated with a distal tibial opening wedge osteotomy.

The anterolateral bowing of the tibia is closely associated with the development of its pseudarthrosis. Roughly, all deformities are unilateral so the shortening and angulation are easy to identify. We present a 6-year-old boy with an exuberant bilateral anterolateral bowing of tíbia. He has short stature, disturbed gait and callosity at the lateral border of the foot. Deformity was successfully treated by opening wedge tibia osteotomy and filled the remaining gap with structural fibular graft. It was fixed with two crossed K-wires and cast immobilization for 6 weeks. We decided to correct it before skeletal maturity due to the significant disturbance of the gait and esthetic impairment. It was obtained a satisfactory morphological and functional result with a simple and fast technique.

Long-Term Follow-Up of Anterior Spinal Fusion for Thoracolumbar/Lumbar Curves in Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Retrospective patient series analysis with update of long-term data. OBJECTIVE: To define the long-term prognosis of the thoracolumbar/lumbar correction after selective anterior spinal fusion (ASF) in adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: The ASF is a well-described procedure for the treatment of AIS. The correction reliability over time, the consequences in adjacent spinal levels and patient's quality of life are fundamental for the characterization of AIS treatment. METHODS: One hundred seven patients were submitted to single-rod ASF for thoracolumbar/lumbar (ThL/L) AIS between 1993 and 2016 in a single-surgeon experience. Seventy five were available for final follow-up evaluation 9 years ±4 (2-23) after surgery. A clinical and sequential radiographic evaluations were performed. RESULTS: The mean age at surgery was 16 years ±â€Š2.33 (14-20) and 94 (87%) were females. The mean final follow-up of the 75 patients available was 9 years ±â€Š4 (2-23). Sixty-five patients had a Lenke type 5C curve and 10 had a type 6C curve. The mean values of the Scoliosis Research Society 22 (SRS-22) questionnaire in Lenke 5C was 92 ±â€Š9 (71-109) and in Lenke 6C 90.3 ±â€Š9 (75-107). In Lenke 5C group, the mean preoperative ThL Cobb angle was 38.4°â€Š±â€Š9.3 (21-60) and the postoperative was 5.9°â€Š±â€Š4.5 (0-18; P < 0.001) being similar at the final follow-up (P > 0.05). In Lenke 6C group, the mean preoperative ThL Cobb angle was 58.6°â€Š±â€Š13.9 (40-90) and the postoperative ThL Cobb was 22.6°â€Š±â€Š14.5 (5-48, P < 0.001) being similar at the final follow-up (P > 0.05). The mean preoperative Thoracic (Th) Cobb angle was 39°â€Š±â€Š7.6 (30-50), the postoperative was 30.6°â€Š±â€Š10.1 (14-49, P < 0.008) and in the final follow-up was 29.3°â€Š±â€Š10.7 (11-48, P < 0.011). CONCLUSION: ASF is a safe procedure in the treatment of ThL/L with good long-term results and high rates of satisfaction among patients with AIS Lenke type 5C. The partial correction was frequent in Lenke type 6C despite the absence of progression in the non-instrumented curves. LEVEL OF EVIDENCE: 4.

[Risk factors in cesarean section]. / Factores de riesgo en la operación cesárea.

BACKGROUND: Improvement of surgical techniques, innovation, and technological development have increased the frequency of cesarean section. OBJECTIVE: To identify the sociodemographics, obstetrical, attention and medical practice factors of risk most frequently associated to cesarean section. PATIENTS AND METHOD: From January to June 2007, we carried out a study of cases and controls with 222 cases of cesarean section and 358 controls of vaginal childbirth in Hospital General no. 6 of Ciudad Juárez. We compared frequency of sociodemographics, obstetrical, attention, and medical practice variables, by means of chi2 and Fisher exact tests; association among these variables and cesarean section was considered with odds ratio. In all cases chosen confidence interval was 95%. RESULTS: Risk factors associated with cesarean section were: maternal age over 28 years, previous cesarean section, complicated pregnancy, fetal suffering, cephalopelvic disproportion, deficient prenatal care; fetal podalic version, oxytocin administration, abnormal amniotic fluid, double- or triple-circle umbilical cord; patient attended by a gynecologist with more than 16 years of experience and by a resident; and medical care in evening shift. There was no association with age, menarche, beginning of sexual relationships, body mass index, smoking, or addictions. CONCLUSIONS: Risk factors associated with cesarean section were: previous cesarean section and patient attended by a gynecologist with more than 16 years of experience and by a resident.

[Physical activity and inactivity among female health service workers]. / Actividad e inactividad física en las mujeres que trabajan en los servicios de salud.

OBJECTIVE: To determine the prevalence of physical activity and inactivity among female health service workers. PATIENTS AND METHOD: Across-sectional study was conducted during the January-July 2005 period. We included 224 (37%) workers of the General Hospital of the Instituto Mexicano del Seguro Social in Colima, Mexico. We carried out a measurement of the physical activity and inactivity. The indicator was obtained from the international physical activity questionnaire. The obtained data were captured in a computer terminal and processed by means of an automated model. We calculated the frequencies distribution and the prevalence. RESULTS: From the 224 women, 24 (11%) carried out intense physical activity, 22 (10%) moderate, 81 (36%) insufficient, and 97 (43%) qualified as sedentary. CONCLUSIONS: The physical activity and inactivity prevalence among the female health service workers was of 21 and 79%, respectively.

Dynamics of Helicobacter pylori infection in a US-Mexico cohort during the first two years of life.

BACKGROUND: The Pasitos Cohort Study has followed children in El Paso, Texas and Ciudad Juarez, Mexico since 1998 to identify determinants of Helicobacter pylori infection. This paper describes patterns of acquisition and elimination of H. pylori infection in 468 children from birth to 24 months. METHODS: Mothers were recruited during pregnancy at maternal-child clinics; children were targeted for follow-up examinations every 6 months after birth. H. pylori infection was detected using the 13C-urea breath test, corrected for age-dependent variation in CO2 production. RESULTS: Test results were available for 359, 341, 269, and 215 children around target ages of 6, 12, 18, and 24 months, respectively. The person-time at risk of a first detectable infection was 7742 person-months; 128 first infections were detected, thus the incidence rate was 1.7% per month (95% confidence interval 1.4-2.0%). Rates were similar in boys and girls and on both sides of the border; evidence suggests, however, that this similarity could be due to selection bias. Among children with follow-up after a positive test, 77% tested negative at a later visit. CONCLUSIONS: The initial acquisition of detectable H. pylori infection occurred at a rate of 20% per year among Pasitos Cohort children from birth to 24 months of age. A key finding, with implications for clinical, community health, and research settings, is that most of these infections did not persist. The transient nature of early H. pylori infection should be considered when designing research or contemplating therapeutic intervention for this age group.

[Overweight and obesity among health-professional women]. / Sobrepeso y obesidad entre mujeres profesionales de la salud.

OBJECTIVE: To determine the prevalence of overweight and obesity among women health service workers. PATIENTS AND METHODS: A cross-sectional study was conducted during the 2002-2003 period. We included 487 workers of the Instituto Mexicano del Seguro Social in Colima, Mexico. We carried out a clinical measurement of weight and height. The indicator of overweight and obesity was obtained from the body mass index, that is, a person's weight in kilograms divided by height in meters squared. The used criteria were similar to the ones established by the WHO: well-nourished (BMI from 18.5 to 24.9), overweight (BMI from 25.0 to 29.9), and obesity (BMI = 30). The obtained data were captured in a computer terminal and processed by means of an automated model. We calculated the frequencies distribution and the prevalence. RESULTS: Of the 487 women, 121 (25%) had an appropriate weight, 210 (43%) showed overweight, and 156 (32%) had obesity. CONCLUSIONS: The overweight and obesity prevalence among the women health service workers was of 75%.

Establishment of a binational cohort to study Helicobacter pylori infection in children.

Chronic Helicobacter (H.) pylori infection, typically of childhood onset, causes upper digestive tract diseases of major impact among socioeconomically marginalized populations. This infection is common in children from ethnic minorities in the United States, and particularly so in immigrant children from Mexico. Prevention measures for H. pylori infection do not yet exist, given limited understanding of what causes either acute or persistent infection. To address this gap, we initiated the Pasitos Cohort Study to follow children from low-income families in the border region that includes El Paso County, Texas, and Ciudad Juarez, Chihuahua. The children were enrolled prior to birth, and are examined at 6-month intervals to observe the natural history of H. pylori infection, and to identify risk factors for acquisition, recurrence, and persistence. This report details the study methods, describes how the cohort was established, and discusses the challenges of compliance with follow up in the border setting. Between April 1998 and October 2000, 1,288 pregnant women were screened for eligibility; 807 of 994 eligible women consented to participate. Birth documentation was obtained for 615 infants, and 472 entered follow up. Successful follow up of this cohort requires resources, including a well-trained, dedicated staff, and incentives, to facilitate and motivate long-term participation. Future findings from this ongoing study will help to fill critical gaps in knowledge regarding the epidemiology of H. pylori infection, and will contribute to the identification of prevention strategies.

An acenocoumarol dosing algorithm using clinical and pharmacogenetic data in Spanish patients with thromboembolic disease.

Appropriate dosing of coumarins is difficult to establish, due to significant inter-individual variability in the dose required to obtain stable anticoagulation. Several genetic and other clinical factors have been associated with the coumarins dose, and some pharmacogenetic-guided dosing algorithms for warfarin and acenocoumarol have been developed for mixed populations. We recruited 147 patients with thromboembolic disease who were on stable doses and with an international normalized ratio (INR) between 2 and 3. We ascertained the influence of clinical and genetic variables on the stable acenocoumarol dose by multiple linear regression analysis in a derivation cohort (DC; n = 117) and developed an algorithm for dosing that included clinical factors (age, body mass index and concomitant drugs) and genetic variations of VKORC1, CYP2C9, CYP4F2 and APOE. For purposes of comparison, a model including only clinical data was created. The clinical factors explained 22% of the dose variability, which increased to 60.6% when pharmacogenetic information was included (p<0.001); CYP4F2 and APOE variants explained 4.9% of this variability. The mean absolute error of the predicted acenocoumarol dose (mg/week) obtained with the pharmacogenetic algorithm was 3.63 vs. 5.08 mg/week with the clinical algorithm (95% CI: 0.88 to 2.04). In the testing cohort (n = 30), clinical factors explained a mere 7% of the dose variability, compared to 39% explained by the pharmacogenetic algorithm. Considering a more clinically relevant parameter, the pharmacogenetic algorithm correctly predicted the real stable dose in 59.8% of the cases (DC) vs. only 37.6% predicted by the clinical algorithm (95% CI: 10 to 35). Therefore the number of patients needed to genotype to avoid one over- or under-dosing was estimated to be 5.

Sexual and vegetative propagation of the medicinal Mexican species Phyllonoma laticuspis (Phyllonomaceae) / Propagación sexual y vegetativa de la especie medicinal mexicana Phyllonoma laticuspis (Phyllonomaceae)

Abstract:Phyllonoma laticuspis leaves are used in Carrizal de Bravo, Guerrero, Mexico, to heal skin lesions such as injuries and smallpox sequelae and to treat diabetes mellitus type 2, and organic extracts of these leaves have been reported to exert antibacterial effects. High demand of P. laticuspis as a medicinal plant has decreased its natural populations, and propagation of the species has not yet been reported. Therefore, the purpose of this study was to assess the vegetative propagation of the species through cutting and air layering, as well as its sexual propagation in a preserved population. For this, concentrations of 1 000, 4 000 and 6 000 ppm of a commercial root enhancer, with indole butyric acid (IBA), and a control treatment without IBA, were applied to the cuttings and air layers. Germination was evaluated under light and dark conditions using lots of freshly collected seeds and lots of seeds that had been stored for three months at 4 °C or 24 ± 2 °C. All experiments were performed in a completely randomized design. The cuttings did not develop roots in any concentration, whereas 100 % of the air layers rooted, displaying vigorous roots in the presence of 4 000 ppm IBA, after four month of treatment application. Regarding germination, more than 60 % of the freshly collected seeds germinated, whereas less than 20 % of the seeds stored at 4 °C, and close to 50 % of the seeds stored at 24 ± 2 °C germinated under light and dark conditions. No significant differences were observed between light and dark conditions, so they were categorized as indifferent photoblastic seeds. The observed moisture content of 13.5 % and germination behaviour as the response to cold storage, suggest that the resultant seed quality was intermediate. P. laticuspis propagation for short-term foliage production can be carried out in air layers, in populations with a high density of adult plants as a source of plant material and for the restoration of disturbed areas, in the same locality. On the other hand, large-scale seedling production, medium-term foliage production and preservation of species variability can be achieved using seeds. Rev. Biol. Trop. 65 (1): 9-19. Epub 2017 March 01.

ResumenLas hojas de Phyllonoma laticuspis se utilizan en Carrizal de Bravo, Gro. México, para curar lesiones de la piel como heridas, secuelas de viruela y afecciones de la diabetes mellitus tipo 2. Los extractos orgánicos de hojas, mostraron efectos antibacterianos. La gran demanda de P. laticuspis como planta medicinal, ha disminuido sus poblaciones naturales, y no existen reportes de la propagación de la especie. Por lo tanto, el propósito del presente trabajo fue evaluar la propagación vegetativa de la especie a través de estacas y acodos, y su propagación sexual en una población conservada. En la propagación por estacas y acodos se aplicaron concentraciones de 1 000, 4 000 y 6 000 ppm de un enraizador comercial con ácido indolbutírico (AIB), y un tratamiento control sin AIB. La germinación se evaluó en luz y oscuridad mediante el uso de lotes de semillas recién recolectadas y lotes de semillas almacenadas por tres meses a 4 °C y a 24 ± 2 ºC. Todos los experimentos se realizaron en un diseño completamente al azar. Las estacas no desarrollaron raíces en ninguna de las concentraciones, mientras que el 100 % de los acodos enraizaron, produciendo raíces vigorosas con la concentración de 4 000 ppm de AIB, a los cuatro meses de la aplicación. Con respecto a la germinación bajo condiciones de luz y oscuridad, las semillas recién recolectadas germinaron más del 60 %, mientras que las semillas almacenadas a 4 ºC menos del 20 % y las almacenadas a 24 ± 2 ºC cerca del 50 %. No hubieron diferencias significativas entre la germinación en luz y oscuridad, por lo que se consideraron como semillas fotoblásticas indiferentes. El contenido de humedad de 13.5 % y el comportamiento de la germinación en respuesta al almacenamiento en frío, sugieren la cualidad de semillas de tipo intermedias. La propagación de P. laticuspis para la producción de follaje a corto tiempo, puede hacerse por acodos en poblaciones con alta densidad de plantas adultas como fuente de material vegetal y para la restauración de áreas alteradas en la misma localidad. Mientras que la producción de follaje a mediano plazo y la conservación de la variabilidad de la especie, se puede lograr con la obtención masiva de plántulas a través de semillas.

Overuse of PPIs in patients at admission, during treatment, and at discharge in a tertiary Spanish hospital.

BACKGROUND: The first generic PPI was introduced in Spain in 2001, and since then their prescriptions have increased steadily by about 200%. AIM: To evaluate the frequency of use and the appropriateness of indications of PPIs in hospitalised patients, and possible factors predicting their use. We also evaluated relevant PPI-drug interactions and serious adverse drug reactions (SADRs). METHODS: This was a cross-sectional, prescription-indication drug-utilisation study in hospitalised patients with follow-up until discharge. Sampling was random and stratified by services, and was calculated to obtain an error in the precision of prescription of ±4% with a 95% confidence interval with maximum variability (50%). RESULTS: 328 patients were included; 28.65% were prescribed a PPI at admission, 82.62% were prescribed a PPI during hospitalisation, and 54.75% at discharge, with inappropriate indications in 74.47%, 61.25% and 80.24% respectively. The OR of being discharged with PPIs was 3.01(95% CI:2.17-4.18, p=0.000). The inappropriate indication most frequently seen at admission and at discharge was antiplatelet therapy. During hospitalisation it was prophylaxis for stress ulcer in patients at low risk. PPI prescription at admission remained at discharge in 75.90% of cases, 73.02% without an acceptable indication. Being >64 years old, taking >4 drugs, co-medication (NSAIDs, antiaggregation and anticoagulation), certain hospital departments and length of stay >15 days predicted 83.7% of prescriptions at discharge. Four relevant PPI-drug interactions were found, and 2 resulted in SADRs, thus the incidence per 1, 000 patients was 2.66 (Poisson 95% CI:0.62-7.23). CONCLUSIONS: There was a very high frequency of overuse of PPIs in inpatients and outpatients. Hospitalisation did not represent an opportunity for better prescription of PPIs.

Noninvasive versus histologic detection of gastric atrophy in a Hispanic population in North America.

BACKGROUND & AIMS: Cancer risk is directly correlated with the severity and extent of mucosal atrophy, making identification of atrophy a goal in cancer prevention programs. The aim of this study was to compare targeted histology with noninvasive testing for the identification of antral and/or corpus atrophy in North America. METHODS: In a cross-sectional study of a random sample of households, 8 gastric biopsy specimens were obtained from defined locations in the antrum and corpus. Biopsies were scored for the presence of Helicobacter pylori and gastric atrophy (defined as loss of normal glandular components). Atrophy was scored by using the Sydney system and a system based on the number and location of corpus biopsies with atrophy. Patients' sera were examined for pepsinogen I, pepsinogen II, and gastrin-17 (fasting and stimulated). RESULTS: One hundred eighty volunteers, approximately 30 per age group and ranging in age from 18-82 years, participated. There were 76 men. The overall weighted prevalence of a corpus atrophy was 4.7% (95% confidence interval, 2.3-7.0). There was a significant inverse relationship between the grade of corpus atrophy and the pepsinogen I/pepsinogen II ratio (R = -0.31, P < .01). We failed to confirm the usefulness of the proposed algorithm by using gastrin-17, H. pylori serology, and serum pepsinogens to categorize the gastric histology. The Sydney system underestimated the prevalence of corpus atrophy by approximately 25%. CONCLUSION: Noninvasive testing is both possible and practical by using pepsinogen assays for the identification of the precancerous condition of moderate to severe corpus atrophy in North American Hispanic patients.

Adjunctive micronutrient supplementation for pulmonary tuberculosis / Suplementación con micronutrientes como tratamiento adjunto para tuberculosis pulmonar

OBJECTIVE: To assess the effect of micronutrient supplementation on tuberculosis (TB) patient outcomes. MATERIAL AND METHODS: The randomized, double-blinded, placebo-controlled study was conducted in pulmonary TB patients undergoing directly observed treatment short course/ tratamiento acortado estrictamente supervisado (TAES/ DOTS) at IMSS in Ciudad Juarez, Chihuahua, Mexico, who were recruited during August 2005-July 2006. Consecutive patients received zinc and vitamin A supplements or matched placebo for four months. Dietary intake, blood zinc and vitamin A, immune response (IFN-γ,TNF-α, and IL-10 mRNA), and sputum smear conversion were measured. RESULTS: The proportion of micronutrient compared to placebo group subjects with a negative sputum smear by month 3 was significantly increased (p= 0.03). This occurred subsequent to increased TNF-α and IFN-γ and decreased IL-'0 observed at month 2. Micronutrient supplementation appeared to accelerate the beneficial therapeutic effect of chemotherapy. CONCLUSIONS: The earlier elimination of bacilli from sputum was associated with improved zinc status and Th' immune response. The therapeutic effect of vitamin A was less evident.

OBJETIVO: Determinar el efecto de la suplementación con zinc y vitamina A o placebo en pacientes tratados por tuberculosis (TB). MATERIAL Y MÉTODOS: Se realizó un ensayo aleatorizado en pacientes tuberculosos que iniciaron el tratamiento acortado estrictamente supervisado/ directly observed treatment short course (TAES/DOTS) en las clínicas del IMSS, Ciudad Juárez, Chihuahua, México, reclutados durante agosto 2005-julio 2006. A cada paciente en forma aleatoria se le designó un código para recibir ya sea micronutrientes o placebo por cuatro meses, bajo el diseño doble ciego. Se evaluó la ingesta dietética, niveles de zinc y vitamina A en sangre, respuesta inmune (IFN-γ,TNF-α, IL-l0 mRNA en sangre) y bacilo ácido alcohol resistente (BAAR) en esputo. RESULTADOS: Al tercer mes de la suplementación, la proporción de sujetos con BAAR negativo en el grupo de micronutrientes aumentó significativamente en relación con el grupo placebo (p= 0.03), que va asociado al previo (segundo mes) incremento de los niveles de TNF-α, e IFN-γ y disminución de los niveles de IL-10. CONCLUSIONES: Suplementación con los micronutrientes aparentemente aceleran el efecto terapéutico de la quimioterapia. La negativización temprana del BAAR en esputo se asoció con la recuperación del estatus de zinc y la respuesta Thl. El efecto terapéutico de vitamina A es menos evidente.

Helicobacter pylori infection in pregnant women from a U.S.-Mexico border population.

Helicobacter pylori infection causes chronic digestive diseases that disproportionately affect Hispanics and other immigrant groups in the United States. Information on the epidemiology of H. pylori infection in pregnant women who reside along the U.S.-Mexico border is critical to understanding the dynamics of current H. pylori transmission patterns within families along the border. We describe the epidemiology of H. pylori infection in pregnant women recruited from Women, Infants, and Children (WIC) clinics in El Paso, Texas, and Mexican Social Security Institute maternal-child clinics in Ciudad Juarez, Mexico, from April 1998 to October 2000. We interviewed participants regarding environmental factors and tested their serum for IgG antibodies. We used logistic regression to estimate associations between environmental exposures and the odds of H. pylori prevalence. Definitive serological tests were available from 751 women. Seroprevalence was 74% in Juarez women and 56% in El Paso women. Prevalence increased with age, crowding, poor sanitation, and residence in Mexico, decreased with education, and was not associated with the woman's number of living children. In the U.S.-Mexico border region, women of reproductive age have a high prevalence of H. pylori infection, apparently related to poor socioeconomic conditions.

Relación entre consultas a urgencias por enfermedad respiratoria y contaminación atmosférica en Ciudad Juárez, Chihuahua / Relationship between emergency room visits for respiratory disease and atmospheric pollution in Ciudad Juárez, Chihuahua

Objetivo. Analizar la relación entre las concentraciones ambientales de partículas de diámetro =10 µm (PM10) y de ozono con el número diario de consultas al servicio de urgencias por enfermedades respiratorias agudas y asma en niños menores de 15 años, residentes de Ciudad Juárez, Chihuahua, México. Material y métodos. Este estudio se realizó durante los años de 1998 y 1999, utilizando un diseño de tipo ecológico. Los datos atmosféricos se obtuvieron de la base de datos de la Agencia de Protección al Ambiente (EPA), provenientes de ocho estaciones de monitoreo ubicadas en Ciudad Juárez y en El Paso, Texas. Los datos de consultas al servicio de urgencias por causas respiratorias se obtuvieron de los registros médicos de dos hospitales del Instituto Mexicano del Seguro Social (IMSS), en Ciudad Juárez, Chihuahua, de julio de 1997 a diciembre de 1998. Los diagnósticos se clasificaron en dos grupos: a) asma, y b) infecciones respiratorias altas, conforme a la Clasificación Internacional de Enfer-medades (CIE-9 o CIE-10). El análisis se realizó con la utilización de la metodología de series de tiempo que emplea regresión Poisson. Resultados. Durante el periodo de estudio la media de 24 horas de PM10 fue de 34.46 µg/m3 (DE=17.99) y la media de los niveles de ozono fue de 51.60 partes por billón (ppb) (DE=20.70). El modelo propuesto estima que un incremento de 20 µg/m3 en el promedio de 24 horas, en la exposición a PM10, se relaciona con un incremento de 4.97 por ciento (IC 95 por ciento 0.97-9.13) en las consultas por asma con un retraso de cinco días y con un incremento de 9 por ciento (IC 95 por ciento 1.8-16.8) cuando se considera a la exposición acumulada de cinco días anteriores. Respecto a enfermedades respiratorias altas se encontró un aumento de 2.95 por ciento en las consultas a urgencias por cada 20 µm/m3 de incremento en el promedio de 24 horas en la exposición a PM10. Se observó que el impacto de PM10 sobre las visitas de urgencia por asma fue más severo en los días en que los niveles de ozono excedían los 49 ppb (nivel de la mediana) en el ambiente. Conclusiones. Se encontraron asociaciones positivas entre las concentraciones de PM10 y el número de consultas por asma y enfermedades respiratorias aun cuando los niveles alcanzados no excedían las normas ambientales mexicanas. Asimismo, se detectó un efecto sinérgico entre ozono y PM10.