Cervical Artery Dissections with and without stroke, risk factors and prognosis: a Chilean prospective cohort.

We aimed to characterize spontaneous cervical artery dissection (CeAD) patients with and without stroke and describe risk factors for cerebrovascular complications in a Chilean prospective cohort. METHODS: Consecutive CeAD patients admitted to a Chilean center confirmed by neuroimaging. Logistic regression was used. RESULTS: 168 patients were included, median follow-up time was 157 days. Stroke occurred in 49 (29.2%) cases, 4 (2%) patients died, all of whom had a stroke, and 10 (6%) presented CeAD recurrence. In univariate analyses, men (odds ratio [OR] 3.97, 95% confidence interval [CI] 1.97-8.00, P < 0.001), internal carotid artery CeAD (OR 2.82, 95% CI 1.38-5.78, P = 0.005) and vessel occlusion (OR 4.45, 95% CI 1.38-14.38, P = 0.035) increased stroke risk. Conversely, vertebral artery dissection (OR 0.35, 95% CI 0.16-0.74, P = 0.006) and longer symptom onset to admission (O-A) time (OR 0.79, 95% CI 0.70-0.90, P < 0.001) were associated to decreased stroke risk. After multivariate analysis, men (OR 2.88, 95% CI 1.32-6.27, P = 0.008) and O-A time (OR 0.80, 95% CI 0.69-0.92, P = 0.002) remained independently associated with stroke. CONCLUSION: CeAD presented commonly as a non-stroke entity, with favorable prognosis. Albeit to a higher frequency of CeAD in women, stroke occurred predominantly in men, who were admitted earlier.

[Inherited bleeding disorders in adolescents with excessive menstrual bleeding. Should we evaluate the fibrinolytic pathway?] / Trastornos hereditarios de la coagulación en adolescentes con sangrado menstrual excesivo, ¿debemos evaluar la vía fibrinolítica?

INTRODUCTION: Heavy Menstrual Bleeding (EMB) is a frequent problem in adolescence. The prevalence of inherited bleeding disorders (IBD) as a cause of EMB is not well established and the involvement of fibri nolytic pathway defects has been poorly explored. OBJECTIVE: To determine the prevalence of IBD and fibrinolysis defects in adolescents with EMBs. PATIENTS AND METHOD: 93 adolescents (11 to 18 years old) were included. Personal and family history of bleeding were obtained through a standard ized questionnaire. The following lab tests were performed: prothrombin time (PT), activated partial thromboplastin time (aPTT), von Willebrand factor quantification, and platelet count and function. Those patients who were not diagnosed with IBD were further evaluated with clot lysis time assay. RESULTS: 41 patients (44%) were diagnosed as IBD (Von Willebrand disease n = 28, platelet func tion defects n=8, mild hemophilia n = 5. Decreased clot lysis time was found in 31 patients. 54% of patients diagnosed with IBD had EMB as the first hemorrhagic manifestation. CONCLUSION: These results support the need to evaluate the coagulation process, including the fibrinolytic pathway in the study of adolescents with EMB.

Dysregulation of mitochondrial function and biogenesis modulators in adipose tissue of obese children.

BACKGROUND/OBJECTIVES: We aimed to evaluate mitochondrial biogenesis (MB), structure, metabolism and dysfunction in abdominal adipose tissue from male pediatric patients with obesity. SUBJECTS/METHODS: Samples were collected from five children with obesity (percentile ⩾95) and five eutrophic boys (percentile ⩾5/⩽85) (8-12 years old) following parental informed consent. We analyzed the expression of key genes involved in MB (sirtuin-1 (SIRT1), peroxisome proliferator-activated receptor-γ (PPARγ), PPARγ coactivator-1α (PGC1α), nuclear respiratory factors 1 and 2 (NRF1, NRF2) and mitochondrial transcription factor A (TFAM) and surrogates for mitochondrial function/structure/metabolism (porin, TOMM20, complex I and V, UCP1, UCP2, SIRT3, SOD2) by western blot. Citrate synthase (CS), complex I (CI) activity, adenosine triphosphate (ATP) levels, mitochondrial DNA (mtDNA) content and oxidative stress end points were also determined. RESULTS: Most MB proteins were significantly decreased in samples from children with obesity except complex I, V and superoxide dismutase-2 (SOD2). Similarly, CS and CI activity showed a significant reduction, as well as ATP levels and mtDNA content. PPARγ, PGC1α, complex I and V and SOD2 were hyperacetylated compared with lean samples. Concurrently, in samples from children with obesity, we found decreased SOD2 activity and redox state imbalance highlighted by decreased reduced glutathione/oxidized glutathione (GSH/GSSG) ratio and significant increases in protein carbonylation. CONCLUSIONS: Adipose tissue from children with obesity demonstrates a dysregulation of key modulators of MB and organelle structure, and displays hyperacetylation of key proteins and altered expression of upstream regulators of cell metabolism.

YABBY transcription factor family in the octoploid Fragaria × ananassa and five diploid Fragaria species.

YABBY genes encode specific TFs of seed plants involved in development and formation of leaves, flowers, and fruit. In the present work, genome-wide and expression analyses of the YABBY gene family were performed in six species of the Fragaria genus: Fragaria × ananassa, F. daltoniana, F. nilgerrensis, F. pentaphylla, F. viridis, and F. vesca. The chromosomal location, synteny pattern, gene structure, and phylogenetic analyses were carried out. By combining RNA-seq data and RT-qPCR analysis we explored specific expression of YABBYs in F. × ananassa and F. vesca. We also analysed the promoter regions of FaYABBYs and performed MeJA application to F. × ananassa fruit to observe effects on gene expression. We identified and characterized 25 YABBY genes in F. × ananassa and six in each of the other five species, which belong to FIL/YAB3 (YABBY1), YAB2 (YABBY2), YAB5 (YABBY5), CRC, and INO clades previously described. Division of the YABBY1 clade into YABBY1.1 and YABBY1.2 subclades is reported. We observed differential expression according to tissue, where some FaYABBYs are expressed mainly in leaves and flowers and to a minor extent during fruit development of F. × ananassa. Specifically, the FaINO genes contain jasmonate-responsive cis-acting elements in their promoters which may be functional since FaINOs are upregulated in F. × ananassa fruit under MeJA treatment. This study suggests that YABBY TFs play an important role in the development- and environment-associated responses of the Fragaria genus.

Intra-arterial chemotherapy for retinoblastoma treatment in Chile: Experience and results 2013-2020.

OBJECTIVE: To establish the success rate of salvage intra-arterial chemotherapy (IAC), defined as the percentage of eyes that achieved tumoral remission and avoided enucleation. The second objective was the clinical characterization, catheterization results, and associated local and systemic complications. METHODS: Retrospective, interventional case series of 29 patients (35 eyes) with persistent or recurrent retinoblastoma. RESULTS: A total of 73 salvage IAC procedures with topotecan and melphalan were carried out. Success rate was 77% at a mean follow-up of 41.4 months. All patients with only one remaining eye avoided enucleation (10 cases). Catheterization was successful in 98.6% of cases. The types of catheterizations were as follows: 71.2% supraselective ophthalmic artery, 12.3% occlusion pump assisted supraselective ophthalmic artery, 16.4% selective external carotid with retrograde flow. 14% of patients suffered local adverse effects: 1 (2.8%) transitory ptosis, 1 (2.8%) transitory oculomotor nerve palsy, 2 (5.7%) aseptic cellulitis and 1 (2.8%) periorbitary pigmentation. 4.1% (3 cases) suffered neutropenia due to medullar chemosuppression. There were no cases of severe anemia or thrombocytopenia. There were no cerebral ischemic events or mortality associated to the procedure. CONCLUSION: IAC with melphalan and topotecan is a safe and effective treatment option for persistent or recurrent retinoblastoma, able to reduce enucleation rates.

Prevalence and Correlates of Injecting with Visitors from the United States Among People Who Inject Drugs in Tijuana, Mexico.

Cross-border infectious disease transmission is a concern related to drug tourism from the U.S. to Mexico. We assessed this risk among people who inject drugs (PWID) in Tijuana, Mexico. We measured the prevalence and identified correlates of injecting with PWID visiting from the U.S. among PWID in Tijuana using univariable and multivariable logistic regression. Of 727 participants, 18.5% injected during the past 6 months in Mexico with U.S. PWID described mostly as friends (63%) or acquaintances (26%). Injecting with U.S. PWID was independently associated with higher education [adjusted odds ratio (aOR) = 1.13/year], deportation from the U.S. (aOR = 1.70), younger age at first injection (aOR = 0.96/year), more lifetime overdoses (aOR = 1.08), and, in the past 6 months, backloading (aOR = 4.00), syringe confiscation by the police (aOR = 3.02) and paying for sex (aOR = 2.98; all p-values < 0.05). Nearly one-fifth of PWID in Tijuana recently injected with U.S. PWID, and their reported risk behaviors could facilitate cross-border disease transmission.

Breastfeeding's protection against illness-induced anorexia is mediated partially by docosahexaenoic acid.

OBJECTIVE: To test whether breastfeeding's protection against anorectic responses to infection is mediated by n-3 fatty acids' attenuation of interleukin (IL)-1beta and tumor necrosis factor (TNF)alpha. DESIGN: Experimental and observational studies. SETTING: A hospital-based study was conducted. SUBJECTS: Five groups of infants were followed; three in the experimental and two in the observational study. METHODS: Breast-fed- (BF-1), DHA-supplemented formula- (SFF-1), and non-DHA-supplemented formula-fed (FF-1) infants were studied before and after immunization against diphtheria, tetanus, pertussis and haemophilus influenzae type b. Pre- and post-immunization energy intakes (EI) and serum IL-1beta and TNFalpha were measured. The two other groups, breast-fed (BF-2) and formula-fed (FF-2) infants with pneumonia were followed throughout hospitalization. EI, IL-1beta and TNFalpha were measured at admission and discharge. Baseline erythrocyte fatty acid contents were determined. RESULTS: Both cytokines increased following immunization in all feeding groups. Post-immunization reductions in EI of SFF-1 infants (-11.8+/-5%, CI(95)=-23.3, 1.4%, P=0.07) were intermediate to those observed in BF-1 (-5.2+/-4.2%, CI(95)=-15.2, 5.9%, P=0.27) and FF-1 infants (-18+/-4.4%, CI(95)=-29%, -5.4%, P=0.02). In the observational study, TNFalpha (17.2+/-8.3 vs 3.4+/-3.0 ng/l, P=0.001) and decreases in EI (-31+/-43 vs -15+/-31%, CI(95)=-34%, 0.001%, P=0.056) were greater in FF-2 than in BF-2 infants at admission. Breastfeeding duration was associated positively with docosahexaenoic acid (DHA) erythrocyte contents, and negatively with admission TNFalpha. Decreases in EIs were associated with IL-1beta and TNFalpha concentrations. CONCLUSION: Reductions in EI following immunologic or infectious stimuli were associated with increases in IL-1beta and TNFalpha. Those reductions were attenuated by breastfeeding, and mediated in part by tissue DHA.

Otitis media tuberculosa pediátrica, un desafío diagnóstico. Revisión de la literatura a propósito de un caso

La tuberculosis es una de las principales causas de mortalidad infantil, alcanzando una tasa de mortalidad de hasta 40% en los casos entre 0 y 4 años. Una forma infrecuente es la otomastoiditis tuberculosa (TOM), siendo un desafío diagnóstico, con consecuencias severas como destrucción del oído medio, hipoacusia y diseminación intracraneal. Se presenta el caso de un lactante de 8 meses con mal control pediátrico, desnutrido, donde la tuberculosis ótica fue un hallazgo secundario a otorrea persistente en el contexto de tuberculosis diseminada y múltiples otras infecciones. El diagnóstico de TOM es desafío diagnóstico, dado lo inespecífico del cuadro. Clásicamente, se describe otorrea persistente pese a tratamiento, hipoacusia y parálisis facial, con microscopía con granulaciones pálidas y perforaciones timpánicas múltiples. Los métodos diagnósticos tradicionales tienen un mal rendimiento, el cultivo de Koch alcanza una sensibilidad de hasta un 35%, mientras que pruebas basadas en la detección de ADN de 95%. La instalación de terapia antituberculosa es fundamental para la prevención de complicaciones locales y diseminación, mientras que el abordaje quirúrgico se reservará para casos con complicaciones.

Tuberculosis is one of the leading causes of child mortality, with a mortality rate of up to 40% in cases between 0 and 4 years old. An uncommon form is tuberculous otomastoiditis (TOM), which poses a diagnostic challenge and has severe consequences such as destruction of the middle ear, hearing loss, and intracranial dissemination. Clinical case: We present the case of an 8-month-old infant with poor pediatric control and malnutrition, where otic tuberculosis was a secondary finding due to persistent otorrhea in the context of disseminated tuberculosis and multiple other infections. Discussion: The diagnosis of TOM is a diagnostic challenge given the nonspecific presentation. Classically, it is characterized by persistent otorrhea despite treatment, hearing loss, and facial paralysis, with microscopy showing pale granulations and multiple tympanic perforations. Traditional diagnostic methods have poor performance, with Koch's culture achieving a sensitivity of up to 35%, while DNA-based tests reach 95% sensitivity. The initiation of antituberculosis therapy is crucial for the prevention of local complications and dissemination, while surgical intervention is reserved for cases with complications.

Otoplastia en oreja prominente / Otoplasty in prominent ear

La oreja alada es la deformidad congénita más frecuente en cabeza y cuello, con una incidencia de 5% en la población caucásica. Queda definida por una distancia entre el hélix y la mastoides mayor a 21 mm o un ángulo mayor a 90° entre la concha auricular y la fosa escafoidea, siendo causada en el 70% de los casos por un antihélix mal plegado. Su corrección, a través de la otoplastia, se vuelve fundamental en prevenir los impactos psicológicos, siendo indicada antes de los 6 a 7 años, cuando la oreja ha alcanzado un ancho similar a la oreja adulta. El abordaje quirúrgico se divide en aquellas técnicas incisionales y no incisionales, cuya tasa de éxito y complicaciones como el otohematoma, necrosis de cartílago y deformidad irreversible, entre otras, son variables. La recidiva varía entre 6% a 12,5%, según el abordaje, no existiendo a la fecha una única técnica de elección. En el presente trabajo se discutirán cuatro técnicas principales: Incisionless, Furnas, mustardé y técnica de los pilares.

The prominent ear is the most common congenital deformity in head and neck, with an incidence of 5% in the Caucasian population. It is defined by a distance between the helix and the mastoid greater than 21 mm or an angle greater than 90° between the concha and the scaphoid fossa, being caused in 70% of the cases by a misfolded antihelix. Its correction, through the otoplasty, becomes essential in preventing psychological impact, being indicated before the age of 6 or 7, when the ear has reached a similar width of an adult ear. The surgical access is classified on incisionless and non-incisionless techniques, where the success rate and complications like hematoma, cartilage necrosis and irreversible deformity, among others, are variables. Recurrence varies between 6%-12.5%, depending on the approach, and to date there is no single technique of choice. In this revision, we will discuss the four principal techniques: Incisionless, Furnas, Mustardé and the abutment technique.

Puentes mucosos de la cuerda vocal, en la Unidad de Voz del Hospital Clínico de la Universidad de Chile: diagnóstico y manejo desafiante

Resumen Introducción: Los puentes mucosos (PM) corresponden a una banda de mucosa paralela al borde libre de la cuerda vocal, unido por anterior y posterior como un ojal. Su manejo no está estandarizado y la literatura al respecto es escueta, con cirugías con resultados no siempre predecibles. Objetivo: Descripción de las características clínicas de pacientes con PM y las técnicas quirúrgicas para su manejo, en la Unidad de Voz del Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile (HCUCH), discutiendo el desafío para su diagnóstico y manejo. Material y Método: Estudio retrospectivo, descriptivo, incluyendo pacientes con PM, entre los años 2013 y 2019 en HCUCH. La evaluación preoperatoria incluye anamnesis, examen físico, nasofibroscopía y/o telelaringoscopía, junto con estroboscopía. Resultados: Se incluyen 7 casos, con edad promedio de 37,4 años; todas mujeres, con diagnóstico realizado en pabellón, en una sola cuerda vocal. Se asoció a alteración estructural mínima (AEM) en el 100% de los casos y a patología benigna en 75%. Todos los pacientes consultaron por disfonía. El tratamiento fue elegido de acuerdo a cada paciente, con resección en todos los casos, con variadas técnicas de microcirugía laríngea, con infiltración de corticoides y/o grasa, además de fonoterapia. Conclusión: Los PM, deben sospecharse en disfonía crónica con respuesta no favorable a fonoterapia, en asociación a otras AEM, en particular en mujeres, con diagnóstico en el intraoperatorio con equipos adecuados, incluyendo consentimiento informado para eventual manejo quirúrgico. Es una patología poco frecuente, cuyo manejo no ha sido estandarizado, por lo que nuestra experiencia resulta relevante.

Abstract Introduction: Mucosal bridges (MB) correspond to a mucosa loop parallel to the free edge of the vocal fold, which is joined forward and backward. There is not a standardized procedure for its treatment and the literature in this regard is scarce and surgical management have not resulted in predictable outcomes. Aim: Description of clinical characteristics of patients with MB and the surgical techniques, in the Otorhinolaryngology Service at the Clinical Hospital Universidad de Chile (HCUCH), reflecting upon the challenge for its diagnosis and management. Material and Method: Retrospective and descriptive study, including patients with diagnosis of MB, between 2013 and 2019 in HCUCH. The preoperative evaluation includes anamnesis, physical examination, nasofibroscopy and/or telelaryngoscopy, along with the use of stroboscopy. Results: 7 cases were included, with an average age of 37.4 years; all women, with diagnosis made in the operating room, on a single vocal fold. It was associated with another minimal structural abnormality (MSA) in 100% of the cases, and with benign pathology in 75% of them. Dysphonia was the main symptom. The treatment was chosen individually, with resection in all cases, various laryngeal microsurgery techniques, infiltration of steroids and/or fat, in addition to speech therapy. Conclusion: MB should be suspected in cases of chronic dysphonia with an unfavorable response to speech therapy, in association with other MSAs, particularly in women, diagnosed intraoperatively with adequate equipment, including informed consent for eventual surgical management. It is a rare pathology, whose management has not been standardized therefore our experience is relevant.

Trastornos hereditarios de la coagulación en adolescentes con sangrado menstrual excesivo, ¿debemos evaluar la vía fibrinolítica? / Inherited bleeding disorders in adolescents with excessive menstrual bleeding: should we evaluate the fibrinolytic pathway?

Resumen: Introducción: El Sangrado Menstrual Excesivo (SME) es un problema frecuente en la adolescencia. La prevalencia de trastornos hereditarios de la coagulación (THC) como causa del SME no está bien establecida y la participación de defectos de la vía fibrinolítica ha sido poco explorada. Objetivo: Determinar la prevalencia de THC y defectos de la fibrinólisis en adolescentes con SME. Pacientes y Método: Se incluyeron 93 adolescentes, edad 11 a 18 años. Los antecedentes personales y familiares de sangra do se obtuvieron con un cuestionario estandarizado. Se controló exámenes: tiempo de protrom- bina (TP), tiempo de tromboplastina parcial activada (TTPa), estudio del factor Von Willebrand, recuento y función plaquetaria. Los pacientes que no fueron diagnosticados como THC, se evaluaron adicionalmente con el tiempo de lisis del coágulo. Resultados: 41 pacientes (44%) fueron diagnos ticados como THC: Enfermedad de Von Willebrand n = 28, defectos de la función plaquetaria n = 8, hemofilia leve n = 5. Se confirmó disminución del tiempo de lisis del coágulo en 31 pacientes. El 54% de pacientes diagnosticado como THC, tuvo SME como la primera manifestación hemorrágica. Conclusión: Estos resultados apoyan la necesidad de evaluación de la coagulación, incluyendo la vía fibrinolítica, en el estudio de adolescentes con SME.

Abstract: Introduction: Heavy Menstrual Bleeding (EMB) is a frequent problem in adolescence. The prevalence of inherited bleeding disorders (IBD) as a cause of EMB is not well established and the involvement of fibri nolytic pathway defects has been poorly explored. Objective: To determine the prevalence of IBD and fibrinolysis defects in adolescents with EMBs. Patients and Method: 93 adolescents (11 to 18 years old) were included. Personal and family history of bleeding were obtained through a standard ized questionnaire. The following lab tests were performed: prothrombin time (PT), activated partial thromboplastin time (aPTT), von Willebrand factor quantification, and platelet count and function. Those patients who were not diagnosed with IBD were further evaluated with clot lysis time assay. Results: 41 patients (44%) were diagnosed as IBD (Von Willebrand disease n = 28, platelet func tion defects n=8, mild hemophilia n = 5. Decreased clot lysis time was found in 31 patients. 54% of patients diagnosed with IBD had EMB as the first hemorrhagic manifestation. Conclusion: These results support the need to evaluate the coagulation process, including the fibrinolytic pathway in the study of adolescents with EMB.

A fluorimetric method for red blood cell sorbitol dehydrogenase activity.

A new fluorimetric method for the quantification of red blood cell (RBC) sorbitol dehydrogenase is described. It is based on the oxidation of sorbitol to fructose, in presence of NAD+, catalysed by the RBC-sorbitol dehydrogenase. The quantity of NADH formed is then measured in a filter fluorimeter. Comparison with an indirect spectrophotometric assay yielded good correlation; however, the present method offers several advantages: it is more rapid, simple and inexpensive. It should be useful to screen for sorbitol dehydrogenase deficiency in large numbers of individuals, particularly patients with diabetes or cataracts.

Risk factors for herpes simplex virus type 2 infection among female commercial sex workers in Mexico City.

A scarce number of studies have been carried out to determine the epidemiology of herpes simplex virus type 2 (HSV-2) infection in female sex workers (FSWs). The objective of this study was to examine the correlates of infection for HSV-2 with socioeconomic and demographic characteristics, sexual behaviour and history of sexually transmitted diseases (STDs) among FSWs in Mexico City. A sample frame of commercial sex work sites was constructed during the fall of 1992. Sites identified were streets, bars and massage parlours. During 1993 we surveyed 757 FSWs aged 18-76 years, from a random sample of sites. Participating women provided a blood sample and answered a standardized questionnaire. HSV-2 antibodies were identified based on a Western blot assay, using type-specific recombinant glycoprotein gG2. In a multivariate analysis, the presence of HSV-2 antibodies was correlated (P < 0.005) with increasing age and time working as prostitutes, low education, street working site and positive serology for syphilis. The results showed that the working site and the education level are contextual variables related to the risk of HSV-2 infection, where poorly educated and street FSWs had the highest probability of infection. Characteristics that represent periods of exposure to the virus as age and time working in prostitution were predictors of the HSV-2 infection.

PIP: The authors investigated the relationship between herpes simplex virus type 2 (HSV-2) infection and socioeconomic and demographic characteristics, sexual behavior, and history of STDs among female prostitutes in Mexico City. During 1993, 757 female prostitutes aged 18-76 years, of mean age 28.5 years, from a random selection of prostitution sites provided blood samples and answered a standardized questionnaire. The presence of HSV-2 antibodies was identified through Western blot assay, using type-specific recombinant glycoprotein gG2. Overall seroprevalences for the study population were 65.1%, 0.6%, 3%, and 6.4% for HSV-2, HIV, hepatitis B virus, and syphilis, respectively. There was no significant correlation between HIV and HSV-2 serological results, although all 5 HIV-seropositive women were HSV-2 seropositive. In a multivariate analysis, the presence of HSV-2 antibodies was correlated with relatively higher age and longer time working as prostitutes, low education, prostitution at a street site, and positive serology for syphilis.

Parental attitude and practice regarding physical punishment of school children in Santiago de Chile.

Four hundred and twenty-three parents from two free, nonconfessional, public schools placed in medium and low income areas, and 104 parents from a private, for-pay Catholic school in a medium and high income zone filled out an anonymous self-applied survey to learn attitudes and practices regarding child physical punishment. In the for-pay school parents declared better education. Child battering was admitted by 80.4% (public schools) and 56.7% (private school) despite that 34.1% (public schools) and 51.9% (at the private school) declared that battering should never be used. Females admitted and justified physical punishment in higher proportions than males. Poor school performance, defiance, and running away from home were the preferred reasons to justify battering at public schools, while defiance was preferred at the private school where poor performance was sent to the fourth place. To check parents data and get children's opinions, 192 seventh and eighth grades students were surveyed in one public school (n = 84) and the private school (n = 98). At the public school, 85.7% of children, and 54.1% of the children at the private school admitted to having been physically punished, with no sex differences. Stronger rejections to this punishment were found at the private school. Mother (87 [5%] at the public school and 77 [4%] at the private) and father (36 [1%], and 67 [9%], respectively) were singled out as leading users of physical punishment. Physical punishment differences according to social environment were detected while eradication seems difficult given its cultural basis.

[Prevalence of antibodies to Pneumocystis carinii in subjects with high risk behavior for AIDS]. / Prevalencia de anticuerpos contra Pneumocystis carinii en sujetos con prácticas de alto riesgo de SIDA.

P. carinii pneumonia affects more than 80% of patients with AIDS in developed countries. In Mexico this complication has been described in 12 to 23% of patients with AIDS, and it has been proposed that competitive disease such as TB and the low life expectancy of AIDS patients in Mexico are the possible explanations of this low percentage. However, in Mexico the frequency with which the population at risk of contracting AIDS is exposed to P. carinii is unknown. Therefore, we looked for P. carinii antibodies in a group of blood samples obtained in an AIDS detection center in Mexico City. A Western blot analysis was performed on 157 blood samples from homosexual and bisexual men and on 21 from female partners of HIV positive men. Positive results were obtained for 76.9% of the samples. No difference was observed in the frequency of P. carinii antibodies between HIV positive and negative individuals. Also, no differences by sex or age were found. Prevalence of P. carinii antibodies in this group is 76.9%, similar to that found in a comparable group in the U.S.

[Zidovudine plus didanosine in HIV infected asymptomatic patients previously treated with zidovudine]. / Zidovudina más didanosina en pacientes asintomáticos infectados por VIH previamente tratados con zidovudina.

OBJECTIVE: To evaluate if the combination of AZT/ddl offered any advantages in surrogate markers among HIV infected asymptomatic patients previously treated with AZT for at least six months. METHODS: We used a prospective cohort of 269 asymptomatic HIV patients with CD4+ cell counts between 200 and 500 cells/microL. They were given didanosine (ddl 400 mg/d) in addition to AZT (500 mg/d) and had received AZT monotherapy for an average of 20 months. End points were progression to AIDS, death, or toxicity. RESULTS: Median CD4+ cell count at the start of the combination therapy was 339 cells/microL which increased at three months to 451 and subsequently declined at 6, 12 and 18 months of followup (medians of 392, 360, 307 cells/microL respectively). Five patients progressed to AIDS, six developed toxicity (myelosuppression, hepatitis or pancreatitis) and 26 had minor side effects that required only dose reduction. CONCLUSIONS: The addition of ddl to patients with prolonged ZDV monotherapy can be useful. CD4+ T cell counts showed a significant increase at 3 months with a gradual subsequent decline to below baseline at 18 months. Adverse effect of the drugs, although frequent, did not stop therapy in most patients.

[Seroprevalence of various viruses and sociodemographic characteristics of women seeking HIV screening]. / Seroprevalencias a diversos virus y características sociodemográficas en mujeres que buscan detectarse VIH.

OBJECTIVES: To study the seroprevalence of syphilis, herpes simplex-2, hepatitis B and HIV, and main sociodemographic characteristics and sexual behavior in women seeking testing for human immunodeficiency virus (HIV) in Mexico City. METHODOLOGY: A self-applied questionnaire was used in 454 women; and a blood sample was taken for the detection of markers for syphilis, herpes simplex virus-2 (HSV-2)), antibodies against core and surface antigens for hepatitis B virus (HBV), and ELISA and Western blot for HIV. RESULTS: Seroprevalences for antibodies against T. pallidum, HSV-2, HBV and HIV were 4.6%, 29.3%, 3.5% and 4.0%, respectively. Forty-six percent of the women were 20 to 29 years old; 70% reported complete junior high school or higher education level; 75% were sexually active; 56% reported at least one stable male sexual partner, 17% reported at least one occasional male sexual partner in the last three months, and 60% had had at least one sexual relation in the last three months; of these, only 18% (n = 82) reported the use of a condom as a preventive measure. Almost 30% of the HIV positive women had a history of blood transfusion, while less than 10% of the HIV negative women had received a transfusion. In addition, 10.6% said that one of their sexual partners was infected with HIV or had AIDS. CONCLUSIONS: Risks of HIV/STD transmission for this group of self-selected women were linked to blood transfusion, low education and, most important, the risk from male sexual partners who were HIV seropositive. It is expected that these results will contribute to the improvement and development of strategies for the control and prevention of STD among this population group, as well as the general population in Mexico.

[Prevalence of antitreponemal antibodies in 3,098 female prostitutes in Mexico City]. / Prevalencia de anticuerpos antitreponémicos en 3098 mujeres dedicadas a la prostitución en la ciudad de México.

This paper describes a serological survey applied to 3098 female commercial sex workers, in order to determine the prevalence of syphilis. The women attend regularly an AIDS orientation center sponsored by CONASIDA in Mexico City. The laboratory tests included the rapid plasma reagin assay (presumptive analysis) and the fluorescent treponemal antibody-absorption technique (confirmatory test). No primary syphilis cases were detected and the prevalence of latent asymptomatic syphilis was 8.2% (255/3098). The sensitivity and specificity of the presumptive test compared to the confirmatory test were 74% and 98% respectively, and the positive predictive value was 77% and the negative predictive value 98%. All seropositive women received the standard penicillin treatment for syphilis. Considerations of importance are offered regarding interpretation and usefulness of this kind of research.

Quantitative impact of using different criteria for the laboratory diagnosis of type 1 von Willebrand disease.

INTRODUCTION: Only ± 50% of patients with type 1 von Willebrand disease (VWD) have recognized molecular defects and diagnosis still rests on demonstrating low plasma von Willebrand factor (VWF) protein/function. However, no generalized consensus exists regarding the type and number of VWF variables that should be considered for diagnosis. AIM: To compare the quantitative impact of four different criteria to diagnose type 1 VWD. METHODS: We tested four laboratory criteria on 4298 laboratory studies during a 5-year period. The first was the National Heart, Lung, and Blood Institute recommendation, which diagnoses type 1 VWD with plasma VWF antigen (VWF:Ag) and VWF ristocetin cofactor (VWF:RCo) < 30 IU dL(-1) and possible VWD/'low VWF' with values between 30 and 50 IU dL(-1) . Second, diagnosis was established when two of three variables, VWF:Ag, VWF:RCo, VWF collagen binding assay (VWF:CB), were ≤ 2.5th percentile. Diagnostic criterion for possible VWD/'low VWF' using percentiles was also described. The third criterion (European Group on von Willebrand Disease, EUVWD), uses a plasma level of VWF:RCo (or VWF:CB) ≤ 40 IU dL(-1) for diagnosis. Finally, the Zimmerman Program for the Molecular and Clinical Biology of VWD (ZPMCBVWD) diagnoses VWD if VWF:Ag or VWF:RCo are ≤ 40 IU dL(-1) . RESULTS: The three assays had high correlation and excellent agreement at levels < 120 IU dL(-1) . The National Heart, Lung, and Blood Institute recommendation was followed to diagnose 122 (2.8%) patients with type 1 VWD and 704 (16.4%) with possible VWD/'low VWF.' Using percentiles, the diagnosis of type 1 VWD increased to 280 (6.5%) patients; 169 (3.9%) patients had possible VWD and 180 (4.2%) patients had 'low VWF.' Diagnoses using EUVWD and ZPMCBVWD criteria increased to 339 (7.9%) and 357 (8.3%) patients, respectively. DISCUSSION: Identical data, analyzed using different criteria, led to almost three-fold difference (2.8-8.3%) in diagnostic rate. This increase is mostly explained by increasing the cut-off values of VWF measurements from < 30 to ≈ 40 IU dL(-1) . Further refinement of the laboratory diagnosis of type 1 VWD is a priority.