[Regional distribution of the body fat: use of image techniques as tools for nutritional diagnosis]. / Distribución regional de la grasa corporal: uso de técnicas de imagen como herramienta de diagnóstico nutricional.

Fat mass is the most variable component in the human body, both when comparing several individuals and when considering changes in the same person throughout life. Obesity is characterized by an excess of body fat that affects health and well-being of individuals. Risk associated with excess body fat is due, in part, to location of fat rather than to total amount. Today is stated that causes and metabolic consequences of regional distribution of fat are of particular clinical importance. To identify a compartment of morbid adipose tissue and to be able to act on it is one of the main aims of the present research. In this review, we have revised the existing literature on location and characteristics of total body fat in human adult. We have focused on abdominal region, basing this review on the use of modern imaging techniques available nowadays, such as computerized tomography and magnetic resonance imaging, with their advantages and limitations. The purpose of this review is to assess whether it is possible to know the body composition and fat distribution on the basis of image methods. Computed tomography technique was first applied in studies of obesity, but today, due to the inconvenience of irradiating the patient, this technique is being replaced by magnetic resonance that, in addition to avoid radiation, provides images of extraordinary quality. Both methods allow to subdivide the classic general fat depots in others more specific. Subcutaneous fat depot can be superficial or deep, while visceral can be divided in mesenteric, omental or epiploic, retroperitoneal and perirrenal fat. In addition, these modern techniques of imaging permit to study muscular fat, considered by some authors as the new fat compartment. Muscular fat includes fat located between skeletal muscle fibers, called extramyocellular fat, as well as lipids located within skeletal muscle fibers (intramyocellular fat). Its importance lies not only in size, similar to visceral fat, but on its pathophysiological implications. Finally, techniques of image analysis have prove to be extremely useful in studying the location and extent of abdominal fat compartments, becoming reference to validate equations obtained from the so-called "indirect methods".

Distribution of capsular types and antimicrobial susceptibility of invasive isolates of Streptococcus pneumoniae in Colombian children. Pneumococcal Study Group in Colombia.

Streptococcus pneumoniae is the leading bacterial cause of childhood pneumonia in the developing world. This study describes the type distribution and antimicrobial susceptibility of invasive pneumococcal isolates from Colombian children and is part of the Sistema Regional de Vacunas (SIREVA), a PAHO regional initiative designed to determine the ideal serotype composition of a protein polysaccharide pneumococcal conjugate vaccine for use in children less than 5 years old in Latin America. In Colombia, during the study period, centres in Bogota, Medellin, and Cali collected 324 S. pneumoniae isolates from invasive diseases, 238 (73.5%) from children under the age of 2. Pneumonia was the clinical diagnosis in 41.3% cases, meningitis in 41%, and sepsis in 11.2%. The seven most frequent types included 14(21.9%), 5(10.5%), 23F(9.6%), 1(9%), 6B(9%), 19F(7.1%), and 6A(6.2%). The frequency of diminished susceptibility to penicillin (DSP) was 12%, with 8.9% of isolates showing intermediate level resistance and 3.1% showing high level resistance. Among DSP isolates, 23% were also resistant to cefotaxime, 33.3% to erythromycin, 48.7% to chloramphenicol, and 74.3% to trimethoprim/sulfamethoxazole. Multiple resistance was detected in 59% of the isolates that have DSP. Penicillin resistance was associated with types 23F (53.8%) and 14 (25.6%). These data provides information on capsular types prevalent in Colombia that will not only allow the formulation of an ideal vaccine for the region but also reinforce the need for ongoing regional surveillance.

Sexually transmitted diseases: meeting the 1990 objectives--a challenge for the 1980s.

Sexually transmitted diseases (STDs) represent a major public health problem in the country, cause patients enormous suffering, and cost the nation billions of dollars annually. Demographic, sociological, and behavioral changes in our society during the past decade are important contributors to the growing complexity and scope of the STD problem. Several agencies in the Public Health Service are engaged in the Federal effort against STDs. The Centers for Disease Control, as the lead agency, assists State and local health departments in their STD control efforts. In fiscal year 1981, federally supported syphilis and gonorrhea control efforts--based on prevention of an estimated 209,400 new cases--saved the taxpayers approximately $150 million. To meet the 1990 objectives, both the public and private medical sectors must recognize the STD problem of the 1980s. Without the support of the professional community and involvement of the private sector, the incidence of STDs will continue to increase at alarming proportions during this decade. The opportunity for promoting health, preventing human suffering, and reducing costs to society is great. Making the best of this opportunity is our challenge during this decade.

Progress toward the 1990 objectives for sexually transmitted diseases: good news and bad.

The problem of sexually transmitted diseases (STDs) in the United States has been growing, in both scope and complexity, at an alarming rate. As evidence of the emergence of these diseases as a primary national concern, the Surgeon General has designated them as 1 of 15 priority areas in which further actions are required to improve the health of the American people. The key targets for the 1990 objectives for the nation in the STD area include reducing the incidence of gonorrhea; gonococcal pelvic inflammatory disease; and primary, secondary, and congenital syphilis. This report updates progress toward these objectives. There is good news with respect to the continuing success of proven methods in preventing and controlling both gonorrhea and syphilis. However, the picture is less bright with respect to control of other STDs that have gained new prominence--Chlamydia, herpesvirus, human papillomavirus, and human T-cell lymphotropic virus type III infections. Escalating interest in STDs reflects more recent appreciation of their relation to reproductive outcomes. STD organisms clearly have a far-reaching effect on the nation's population, including the capacity to reproduce, the rate of perinatal infection, the incidence of genital cancers, and the occurrence of acquired immune deficiency syndrome (AIDS). Some major hurdles still must be faced before the 1990 objectives can be successfully met. The population at risk will remain large, fueling the STD epidemic and taxing existing resources. Public sector support may not keep up with inflation, much less keep pace with the expanding spectrum of sexually transmitted disease. From a public health vantage, however, the opportunities for further advances in controlling STDs have never been greater.

An overview of the effectiveness and efficiency of HIV prevention programs.

Because of the enormity of the HIV-AIDS epidemic and the urgency for preventing transmission, HIV prevention programs are a high priority for careful and timely evaluations. Information on program effectiveness and efficiency is needed for decision-making about future HIV prevention priorities. General characteristics of successful HIV prevention programs, programs empirically evaluated and found to change (or not change) high-risk behaviors or in need of further empirical study, and economic evaluations of certain programs are described and summarized with attention limited to programs that have a behavioral basis. HIV prevention programs have an impact on averting or reducing risk behaviors, particularly when they are delivered with sufficient resources, intensity, and cultural competency and are based on a firm foundation of behavioral and social science theory and past research. Economic evaluations have found that some of these behaviorally based programs yield net economic benefits to society, and others are likely cost-effective (even if not cost-saving) relative to other health programs. Still, specific improvements should be made in certain HIV prevention programs.

Características de la infección por virus papiloma humano en la adolescencia y su manejo / Human papilloma virus in adolescents: characteristics and management

El virus papiloma humano es una infección de transmisión sexual frecuente en las adolescentes. En la mayoría de los casos la infección es asintomática. Sin embargo en un porcentaje de los casos, la infección produce manifestaciones clínicas como verrugas genitales, alteraciones citológicas e histológicas cuyo manejo es distinto que en las mujeres adultas debido a las características especificas de la infección por HPV en este grupo etario.

Human papilloma virus is a frecuent sexually transmitted disease in adolescents. The infection is asintomatic in most cases and needs no treatment spontaneously eliminated. However, in a few cases, the infection produces clinical manifestations as genital warts, citological and histologycal abnormalities whose management differs from adult women because of especific characteristics of HPV infection in adolescents.

Control of sexually transmitted diseases: view from the United States of America.

Past sexually transmitted disease (STD) control efforts in the United States of America have generally permitted a timely response to changes in intervention technology, antibiotic resistance, public funding, and media interest. Today, however, the expansion of STD organisms and syndromes at logarithmic rates has taxed our traditional labour intensive control approaches. We describe briefly the history of STD control strategies in the United States, discuss the seven components upon which current efforts are based, and speculate about our future programme initiatives.

Hernia diafragmática, diagnóstico prenatal y seguimiento / Diaphragmatic hernia, prenatal diagnosis and follow up

La hernia diafragmática congénita es un defecto del diafragma que permite el desplazamiento de los órganos abdominales hacia la cavidad torácica. A pesar de los avances en el manejo prenatal y postnatal, esta malformación se asocia a una elevada mortalidad. Se presenta una revisión de los casos clínicos con diagnóstico prenatal de hernia diafragmática ingresados al CERPO durante el período 2003-2005. Se analiza en cada caso la edad gestacional al diagnóstico, lado afectado, compromiso hepático, asociación con otras malformaciones y cromosomopatías, resultado perinatal, cirugía y evolución.