DIAGNOSTIC PERFORMANCE OF WAIST CIRCUMFERENCE MEASUREMENTS FOR PREDICTING CARDIOMETABOLIC RISK IN MEXICAN CHILDREN.

OBJECTIVE: The accumulation of abdominal fat is associated with cardiometabolic abnormalities. Waist circumference (WC) measurements allow an indirect evaluation of abdominal adiposity. However, controversy exists over which WC reference values are the most suitable for identifying the pediatric population at risk. The aim of the study was to evaluate the ability of various WC indices to identify abdominal obesity as diagnostic tools for predicting cardiometabolic risk in Mexican children and adolescents. METHODS: Anthropometric measurements were performed and biochemical profiles determined in a crosssectional study that included 366 children and adolescents. Four parameters were used to evaluate abdominal obesity in our study group: (1) WC >90th percentile, according to the Fernández reference in a Mexican-American population measured by the National Center for Health Statistics (NCHS) technique; (2) WC >90th percentile, according to the Klünder reference in a Mexican population (measured by the World Health Organization [WHO] technique); (3) waist-to-height ratio (WHtR) >0.5 according to WHO; and (4) WHtR >0.5 according to NCHS. The ability of each of the indices to discriminate cardiometabolic abnormalities (fasting plasma glucose, dyslipidemia, and hypertension) was assessed. RESULTS: WHtR >0.5 according to WHO or NCHS references showed greater sensitivity to detect metabolic abnormalities compared to percentile reference parameters (74.3 to 100% vs. 59.0 to 88.9%; P<.05). However, the percentiles displayed more specificity to identify these alterations (46.2 to 62.2 vs. 21.3 to 46.9; P<.05). Area under the curve analysis showed that WHtR >0.5 can more readily detect hypertriglyceridemia (0.642), hypoalphalipoproteinemia (0.700), and a combination of two or more metabolic abnormalities (0.661), whereas WC >90th percentile, according to Klünder, better detected hyperglycemia (0.555). CONCLUSION: WHtR >0.5 is a sensitive measure to identify pediatric patients with cardiometabolic alterations, despite its low specificity, and is a useful diagnostic tool to detect populations at risk. Based on the results of this study, we recommend preferential use of the Klünder waist circumference references over the Fernández method in Mexican pediatric populations. ABBREVIATIONS: AUC = area under the curve BMI = body mass index HDL = high-density lipoprotein IDF = International Diabetes Federation LDL = low-density lipoprotein MS = metabolic syndrome NCHS = National Center for Health Statistics ROC = receiver operating characteristic WC = waist circumference WHO = World Health Organization WHtR = waist-to-height ratio.

Mapping Sustainable Development Goals 8, 9, 12, 13 and 15 through a decolonial lens: falling short of 'transforming our world'.

The United Nations' Sustainable Development Goals (UN SDGs) aspire to be integrated and indivisible, balance the three dimensions of sustainable development and transform our world by going beyond previously agreed language. Focusing on decoloniality and equity, we explore whether these aspirations are met in analysing five goals, their targets and indicators interlinking especially the economy-ecology spheres: SDGs 8 (economic growth), 9 (industry and innovation), 12 (sustainable production and consumption), 13 (climate action) and 15 (life on land). We examine two interconnected foci. Having mapped the connections which exist, according to official UN data, between these goals' indicators, we examine definitions and delineations in SDGs 8, 9, 12, 13 and 15 through a decolonial lens, focusing on universality, absences and modernity-coloniality. A second step investigates the equity implications of these framings, using indicator data to illustrate abiding injustices. Our original contribution is thus retracing these connections and contradictions, their intellectual heritage and their equity implications in the detail of these five SDGs, their targets and indicators, combining the sustainable development and decolonial literatures in novel ways. We find that trade-offs, absences and justice shortcomings call into question the attainment of the SDGs' objectives of leaving no one behind while safeguarding advances for people, planet, prosperity, peace and prosperity. We recognize the SDGs' opportunity to rethink how we want to co-exist in this world. However, we argue that recognizing absences, trade-offs and equity shortcomings are key prerequisites to attain genuine transformations for justice and sustainability through the SDGs.

A neural network based model for urban noise prediction.

Noise is a global problem. In 1972 the World Health Organization (WHO) classified noise as a pollutant. Since then, most industrialized countries have enacted laws and local regulations to prevent and reduce acoustic environmental pollution. A further aim is to alert people to the dangers of this type of pollution. In this context, urban planners need to have tools that allow them to evaluate the degree of acoustic pollution. Scientists in many countries have modeled urban noise, using a wide range of approaches, but their results have not been as good as expected. This paper describes a model developed for the prediction of environmental urban noise using Soft Computing techniques, namely Artificial Neural Networks (ANN). The model is based on the analysis of variables regarded as influential by experts in the field and was applied to data collected on different types of streets. The results were compared to those obtained with other models. The study found that the ANN system was able to predict urban noise with greater accuracy, and thus, was an improvement over those models. The principal component analysis (PCA) was also used to try to simplify the model. Although there was a slight decline in the accuracy of the results, the values obtained were also quite acceptable.

Fuzzy techniques for environmental-impact assessment in the mineral deposit of Punta Gorda (Moa, Cuba).

An Environmental-Impact Assessment (EIA) makes it possible to determine whether or not a project is compatible with nature, and thus whether the project qualifies to be executed. The Environmental-Impact Assessment is intended to establish a balance between the development of human activities and the environment. In this work, an Environmental-Impact Assessment of the mineral deposit of Punta Gorda (Moa, Cuba) is made, using fuzzy techniques. Two previous works have been combined: an appropriate linguistic model built with fuzzy techniques, providing a framework for handling qualitative and quantitative variables, and an environmental-impact assessment carried out according to a classical methodology.

The isoelectric focusing of keratins in hair followed by silver staining.

An isoelectric focusing method followed by silver staining has been developed for the study of keratins which is as effective as two-dimensional electrophoresis and fluorography for hair species identification. Hair from dogs, rabbits, horses, cows, guinea-pigs, donkeys, sheep and cats were successfully identified. Narrow pH ranges were used to observe heterogeneity in human hair. Although this heterogeneity may be affected by environmental conditions, it may be of use in criminalistics.

A silver staining method for the detection of polymorphic proteins in minute bloodstains after isoelectric focusing.

A silver staining method has been developed to study polymorphic proteins in bloodstains after isoelectric focusing. This method is highly sensitive and permits the detection of polymorphic proteins (i.e. alpha 1-antitrypsin, Gc and Tf C subtypes) in bloodstains as small as 0.2 microliter or less. The method is simple and reproducible and can be used after immunofixation. Blood stains can be identified after longer storage periods than is possible by using conventional staining methods.

Are artificial neural networks black boxes?

Artificial neural networks are efficient computing models which have shown their strengths in solving hard problems in artificial intelligence. They have also been shown to be universal approximators. Notwithstanding, one of the major criticisms is their being black boxes, since no satisfactory explanation of their behavior has been offered. In this paper, we provide such an interpretation of neural networks so that they will no longer be seen as black boxes. This is stated after establishing the equality between a certain class of neural nets and fuzzy rule-based systems. This interpretation is built with fuzzy rules using a new fuzzy logic operator which is defined after introducing the concept of f-duality. In addition, this interpretation offers an automated knowledge acquisition procedure.

[Hypertensive encephalopathy: contribution of magnetic resonance]. / Encefalopatía hipertensiva: aportación de la resonancia magnética.

We report a patient with hypertensive encephalopathy and we analyze his clinical and neurological imaging peculiarities. Computed tomography showed hypodense corticosubcortical lesions, whereas magnetic resonance scan disclosed extensive, wholly reversible enhanced signal lesions due to cerebral edema.

[From writer's cramp to butcher's spasms: a case of interprofessional dystonia]. / Del calambre del escribiente al espasmo del carnicero: un caso de distonía interprofesional.

INTRODUCTION: Occupational or professional dystonia is a focal motor dystonic disorder which affect motor programs necessaries for the exercise of the patient's profession. Clinical case. A patient with writer's cramp in the childhood presented at the age of 22 years a new dystonia, which we name 'butcher's spasm', giving rise to a laboral incapacity. Neurological exam was normal except for right arm distal (writer's cramp) and proximal dystonias (butcher's cramp), with intentional tremor in the upper extremities. We classified, after complementary exams, the disease as idiopathic. CONCLUSIONS: Idiopathic focal dystonias can progress to segmentary or multifocal dystonias, and, in exceptional cases as ours, can interfere with two different professional activities.

[Long chronic course of hemiparkinson-plus with l-dopa maintained response]. / Hemiparkinson plus de larga evolución y con respuesta mantenida a L-Dopa.

UNLABELLED: OBJECTIVE AND CLINICAL CASE: We describe and present a video film of a patient with a hemiparkinsonian illness associated with hemidystonia and pyramidalism, which responded to continuous L-Dopa treatment for twenty years, with no fluctuation or deterioration at the end of the dose-effect. CT and MR studies were normal. CONCLUSIONS: The characteristics of this case with probable static unilateral dysfunction, basically presynaptic, of the nigrostriate via, make it reasonable to include it in the hemiparkinson-hemiatrophy group.

[Syndromes of continuous muscular activity: report of a central case (stiff-man) and a peripheral case (neuromyotonia) associated with neuroborreliosis]. / Síndromes de actividad muscular continua: presentación de un caso central (stiff-man) y uno periférico (neuromiotonía) asociado a neuroborreliosis.

We describe two cases of continuous muscular activity: one which is central (the stiff-man syndrome), and another which is peripheral (neuromiotony), the latter in a patient suffering from diabetic neuropathy and with positive Borrellia burgdorferi serology in the bloodstream, as well as CSF. Both cases reacted favourably to medical treatment. In the first case botulinic toxin was used as a simultaneous treatment for focal pseudodystonia in one foot. Response was good.

[Pseudotumor cerebri secondary to cerebral venous defects not identified by magnetic resonance]. / Pseudotumor cerebri secundario a defectos de drenaje venoso cerebral no identificados mediante resonancia magnética.

Pseudotumour cerebri is the name of a syndrome characterized by headache and papilloedema, with normal cerebral CT/MR studies and CSF with a high pressure and normal laboratory findings. We describe four patients who fulfilled the diagnostic criteria of this condition (including normal 0.5T MR studies). They all had cerebral angiograms showing minor abnormalities localized to the level of the superior longitudinal sinus. All improved on treatment with anticoagulants and steroids. In view of these findings we consider that in cases of pseudotumour cerebri without a clear aetiological factor, an angio MR study should be done, or if this technique is not available, a cerebral angiogram should be done, to exclude cerebral venous drainage defects.

[Coma associated with migraine]. / Coma asociado a migraña.

INTRODUCTION: Basilar migraine is a particular form of migraine with an aura in which crises of headache are accompanied by symptoms of dysfunction in the vertebro-basilar territory, including alteration of consciousness in the form of stupor or coma. CLINICAL CASES: We report four patients, three men of 14, 17 and 83 years of age and one woman of 21. All had previous histories of migraine and presented with transitory episodes of coma. During the coma, the woman woke up spontaneously with intense bulimia. In the three men, it was seen, on injecting flumazenil, that the state of consciousness and the EEG returned to normal transiently. Neuroimaging studies (CT and MR) were normal in all patients. CONCLUSIONS: Migraine-coma is an exceptional, emergency condition in which structural, infectious, toxic and metabolic pathology of the Central Nervous System should be ruled out. As well as in patients with basilar migraine, the association of migraine and coma may also be seen in patients with familial hemiplegic migraine and CADASIL and MELAS syndromes. It may be that gabaergic mechanisms are involved in the theoretical dysfunction of the ascending reticular activating system causing alteration of consciousness, since in the three patients in whom flumazenil was injected, there was a response.

[Isolated hemi-ataxia as a sign of mesencephalic lacunar infarction]. / Hemiataxia aislada como manifestación de infarto lacunar mesencefálico.

INTRODUCTION: Lesions of the dento-rubro-thalamo-cortical pathway may cause homolateral or contralateral hemiataxia, depending on whether they are found above or below the decussation which occurs at the level of the inferior colliculus. Most mesencephalic infarctions causing hemiataxia also show oculomotor involvement with nuclear or fascicular lesions of the third cranial nerves. This was not seen in the case we report. CLINICAL CASE: We describe the case of a diabetic patient with a permanent right appendicular hemiataxia, without oculomotor involvement, caused by a lacunar infarct shown on MR imaging which was situated in the antero-external part of the left superior mesencephalum. CONCLUSIONS: This case helps to clarify the topography of the thalamic radiations of the mesencephalic calotte, including the decussated superior dento-rubro-thalamic pathway to the red nucleus. Involvement of this, situated in the mesencephalic lateral vascular territory causes contralateral hemiataxia.

[Malignant prolactinoma with intra- and extracranial metastasis: clinico-radiologic study]. / Prolactinoma maligno con metástasis intra y extracraneales: estudio clínico-radiológico.

Malignant prolactinomas are very rare pituitary neoplasms which can be identified not from the hystopathologic nor neuroimaging aspects but only retrospectively from the presence of distant metastases. A 32-year-old male patient was diagnosed of a pituitary prolactinoma because of bitemporal hemianopsia on the basis of cranial MRI aspect and raised blood prolactin level. Visual signs improved under bromocriptine treatment but after surgical and X-ray therapies patient developed paralysis of V and XII left cranial nerves and suffered from medulocerebelous angle, vertebrae, spinal epidural space, lung, liver, suprarenal and femoral metastases. Patient died 3 years after the diagnosis time. Prolactin levels raised 2000 ng/ml. This is the first case of malignant prolactinoma described in the spanish literature and the more large one in number of metastatic localizations between the malignant prolactinomas from the literature. These kind of neoplasms can be partially ameliorated under X-ray and bromocriptine treatment but there is not, by the moment, a curative chemotherapy.

Trichogenic trichoblastoma. An unusual neoplasm of hair germ.

Tumors of hair germ are a very rare group of primary cutaneous neoplasms that have been divided into two groups: epithelial and mesenchymal. Epithelial neoplasms of hair germ are further subdivided into those that are purely epithelial (trichoblastomas) and into epithelial neoplasms with mesenchymal components that may cause inductive changes toward the earliest phase of hair follicle differentiation (trichoblastic fibroma) or a more advanced and complete hair follicle formation (trichogenic trichoblastoma). We herein report an ulcerated trichogenic trichoblastoma whose epithelial and mesenchymal components recapitulated the formation of numerous primitive dermal papillae of the hair bulb because there were numerous strands of small polygonal epithelial cells that delimited areas of a dense and abundantly cellular connective tissue in a hair papilla-like pattern.

[Disorders of neuronal migration: clinical and radiological signs in 21 patients]. / Trastornos de la migración neuronal: manifestaciones clínicas y de neuroimagen en 21 pacientes.

We describe 21 patients affected by neuronal migration disorders. The main clinical manifestations were epilepsy, hemiparesis with hemiatrophy and psychomotor retardation. The neuronal migration disorders most frequently diagnosed were various forms of heterotopia and schizencephaly. Magnetic resonance imaging was more sensitive and specific that computed tomography in the diagnosis of these disorders. Schizencephaly correlates well with hemiparesis and hemiatrophy, as does nodular heterotopia with focal epilepsy and diffuse neuronal migration disorders with severe encephalopathies.