Combining spaceborne lidar from the Global Ecosystem Dynamics Investigation with local knowledge for monitoring fragmented tropical landscapes: A case study in the forest-agriculture interface of Ucayali, Peru.

Improving our ability to monitor fragmented tropical ecosystems is a critical step in supporting the stewardship of these complex landscapes. We investigated the structural characteristics of vegetation classes in Ucayali, Peru, employing a co-production approach. The vegetation classes included three agricultural classes (mature oil palm, monocrop cacao, and agroforestry cacao plantations) and three forest regeneration classes (mature lowland forest, secondary lowland forest, and young lowland vegetation regrowth). We combined local knowledge with spaceborne lidar from NASA's Global Ecosystem Dynamics Investigation mission to classify vegetation and characterize the horizontal and vertical structure of each vegetation class. Mature lowland forest had consistently higher mean canopy height and lower canopy height variance than secondary lowland forest (µ = 29.40 m, sd = 6.89 m vs. µ = 20.82 m, sd = 9.15 m, respectively). The lower variance of mature forest could be attributed to the range of forest development ages in the secondary forest patches. However, secondary forests exhibited a similar vertical profile to mature forests, with each cumulative energy percentile increasing at similar rates. We also observed similar mean and standard deviations in relative height ratios (RH50/RH95) for mature forest, secondary forest, and oil palm even when removing the negative values from the relative height ratios and interpolating from above-ground returns only (mean RH50/RH95 of 0.58, 0.54, and 0.53 for mature forest, secondary forest, and oil palm, respectively) (p < .0001). This pattern differed from our original expectations based on local knowledge and existing tropical forest succession studies, pointing to opportunities for future work. Our findings suggest that lidar-based relative height metrics can complement local information and other remote sensing approaches that rely on optical imagery, which are limited by extensive cloud cover in the tropics. We show that characterizing ecosystem structure with a co-production approach can support addressing both the technical and social challenges of monitoring and managing fragmented tropical landscapes.

Outcomes and Associated Extracardiac Malformations in Neonates from Colombia with Severe Congenital Heart Disease.

Congenital heart disease (CHD) is a common structural anomaly, affecting ~ 1% of live births worldwide. Advancements in medical and surgical management have significantly improved survival for children with CHD, however, extracardiac malformations (ECM) continue to be a significant cause of morbidity and mortality. Despite clinical significance, there is limited literature available on ECM in neonates with CHD, especially from Latin America. A cross-sectional study of neonates with severe CHD evaluated by the medical-surgical board team at Fundación Cardiovascular de Colombia from 2014 to 2019 was completed to characterize morbidity, mortality, surgical outcomes, and ECM. Demographics and surgical outcomes were compared between neonates with and without ECM. Medical record data were abstracted and descriptive statistical analysis was performed. Of 378 neonates with CHD, 262 had isolated CHD (69.3%) and 116 had ECM (30.7%). The most common ECM was gastrointestinal (n = 18, 15.5%) followed by central nervous system (n = 14, 12%). Most neonates required a biventricular surgical approach (n = 220, 58.2%). Genetic testing was performed more often for neonates with ECM (n = 65, 56%) than neonates with isolated CHD (n = 14, 5.3%). Neonates with ECM had lower birth weight, longer hospital stays, and higher postsurgical complications rates. There was no difference in survival between groups. Overall, Screening for ECM in neonates with CHD is important and identification of ECM can guide clinical decision-making. These findings have important implications for pediatric healthcare providers, especially in low- and middle-income countries, where the burden of CHD is high and resources for managing CHD and extracardiac malformations may be limited.

[Critical points to implement an antibiotic form for management of surgical wound infection]. / Puntos críticos para implementar un formulario de antibióticos para el manejo de infección de herida quirúrgica.

Background: Surgical site infection (SSI) is a major complication of surgical procedures and contributes to morbidity, mortality, and healthcare costs. It is commonly caused by Gram-negative bacteria and should be monitored in hospital units. Objective: To identify critical points to implement an antibiotic form for surgical wound infection management. Material and methods: Descriptive observational study in 100 cultures of wounds with SSI. The most common diagnosis, the microorganism involved, sensitivity to antibiotics and prescription consistency were identified. In addition, demographic variables were assessed and a questionnaire was applied to surgeons in order to identify the critical points to implement a local formulary of antibiotics. Results: 37% of cultures came from female patients. The most common diagnosis was hollow viscus perforation in 31%. The most common microorganism was Escherichia coli ESBL in 20% and 55% of these were sensitive to imipenem. The critical points observed were consistency in the prescription of antimicrobials, which reached only 29%, and that surgeons did not actively participate in strategies for the rational use of antibiotics. Conclusions: As a critical point to implement the antibiotic form, little involvement of surgeons with the hospital infection control team was found. The incidence of SSI was 2.4%, predominantly in emergency surgery. The presence of E. coli ESBL is frequent, with resistance to broad-spectrum antimicrobials.

Introducción: las infecciones del sitio quirúrgico (ISQ) son una complicación importante de los procedimientos quirúrgicos y contribuyen a la morbilidad, la mortalidad y los costos sanitarios. Comúnmente son causadas por bacterias Gram-negativas y deben ser monitoreadas en las unidades hospitalarias. Objetivo: identificar puntos críticos para implementar un formulario de antibióticos para el manejo de infección de herida quirúrgica. Material y métodos: estudio observacional descriptivo en 100 cultivos de heridas con ISQ. Se identificó el diagnóstico más común, el microorganismo involucrado, la sensibilidad a los antibióticos y la congruencia de la prescripción. Además, se evaluaron variables demográficas y se aplicó un cuestionario a cirujanos para identificar los puntos críticos para implementar un formulario local de antibióticos. Resultados: el 37% de los cultivos procedieron de pacientes mujeres. El diagnóstico más común fue perforación de víscera hueca en el 31%. El microrganismo más común fue Escherichia coli BLEE en el 20% y el 55% de estos fueron sensibles a imipenem. Los puntos críticos observados fueron la congruencia en la prescripción de antimicrobianos que alcanzó solo 29% y que los cirujanos no participaron activamente en las estrategias del uso razonado de antibióticos. Conclusiones: como punto crítico para implementar el formulario de antibióticos se encontró poca participación de los cirujanos con el equipo hospitalario de control de infecciones. La incidencia de ISQ fue del 2.4% y preedominaron en la cirugía de urgencia. La presencia de E. coli BLEE es frecuente, con resistencia en antimicrobianos de amplio espectro.

Somatic Support with Veno-venous ECMO in a Pregnant Woman with Brain Death: A Case Report.

Supporting homeostasis in a pregnant woman with brain death to achieve fetal viability is called somatic support. We present a case of young pregnant woman at 21 weeks' gestation who developed acute respiratory distress syndrome secondary to influenza A H2N3 infection requiring veno-venous extracorporeal membrane oxygenation (VV ECMO) support for refractory hypoxemia. The clinical course was complicated by intracranial hemorrhage and subsequent brain death. After multidisciplinary team discussion with her family, consensus was reached to continue somatic support with VV ECMO to enable fetal development to attain extrauterine viability. The challenging clinical, ethical, and legal concerns are discussed.

Factors associated with dehiscence of intestinal anastomosis.

OBJETIVO: Identificar los factores asociados a dehiscencia de anastomosis de intestino delgado y grueso. MÉTODO: Se incluyeron 92 anastomosis de intestino delgado y grueso, en mayores de 18 años, realizadas en 2012-2016. Se evaluaron factores asociados en el preoperatorio, el transoperatorio y el posoperatorio. RESULTADOS: Se presentó dehiscencia de anastomosis en el 13% de los casos. Se encontró una asociación significativa con ingesta previa de medicamentos (p = 0.05; odds ratio [OR]: 1.17; IC 95%) y con anastomosis primaria (p = 0.05; OR: 3.6; 0.92-14.5). En los pacientes con dehiscencia se incrementó la estancia intrahospitalaria. CONCLUSIÓN: La presencia de dehiscencia de anastomosis fue similar a lo reportado en la literatura. Los factores asociados fueron la ingesta previa de medicamentos y la anastomosis primaria. OBJECTIVE: To identify the factors associated with dehiscence of anastomosis of the small and large intestine. METHOD: 92 anastomoses of the small and large intestine were included in patients over 18 years of age, performed in 2012-2016. Associated factors were evaluated in pre, trans and postoperative. RESULTS: Anastomosis dehiscence was presented in 13%. A significant association was found for previous medication intake (p = 0.05; odds ratio [OR]: 1.17; 1.024-1.33) and primary anastomosis (p = 0.05, OR: 3.6; 0.92-14.5). In patients with dehiscence, the hospital stay was increased. CONCLUSION: The presence of dehiscence of anastomosis was similar to that reported in the literature. The associated factors were previous medication intake, and primary anastomosis.

Funcionamiento del ciclo de Krebs durante la sepsis y el choque séptico. Una mirada al metabolismo intermediario durante condiciones de hipoxia / The krebs cycle during sepsis and septic shock: a look at intermediate metabolism in hypoxia

El choque séptico es una patología que involucra alteraciones hemodinámicas y compromiso de la microvasculatura que derivan en una disfunción celular que conlleva a la falla orgánica múltiple propia de esta enfermedad. Los protocolos de manejo actuales se centran en la normalización de variables macrohemodinámicas y biomarcadores relacionados con la hipoxia tisular, convirtiéndose en un desafío clínico que requiere el reconocimiento temprano, el control de la infección y la optimización del estado hemodinámico del paciente. En los últimos años se ha identificado que la disfunción multiorgánica que se observa en el choque séptico se encuentra relacionada con el desarrollo de disfunción mitocondrial. Se han planteado dos posibilidades para explicar el surgimiento de esta disfunción mitocondrial, que son el convectivo e inmunometabólico. Dentro del contexto metabólico se observa que el ciclo de Krebs puede funcionar en un entorno de hipoxia mediante la fragmentación y reorientación de sus reacciones enzimáticas, permitiendo la adaptación al metabolismo intermediario a la noxa séptica.

Septic shock is a condition involving hemodynamic alterations and microvascular dysfunction which lead to cellular dysfunction which is typically linked with multiple organ failure. Current management guidelines focus in reestablishing normal macro hemodynamics and biomarkers related with tissue hypoxia. This poses a clinical challenge requiring early recognition, effective infection control and optimization of hemodynamic status in the septic patient. Over the last years multiple organ involvement in septic shock has been correlated with impairment of mitochondrial function. Convective transport and immune cell metabolism have been proposed as two possible reasons for mitochondrial dysfunction during sepsis. Within the metabolic context it is evidenced that the Krebs cycle remains operational even in hypoxic environments by means of fragmentation and reprogramming of enzyme-mediated reactions, activating intermediate metabolism adaptation mechanisms in response to a septic noxa.

Reorganization and clinical management for hypertension control at primary healthcare / Reorganización y manejo clínico para el control de la hipertensión en el primer nivel

Background: In Mexico, 40% of hypertensive patients see their blood pressure under control. The evidence to keep hypertension (HT) under control is scarce, particularly in older adults who have the highest prevalence and require more health services. The objective was to determine the impact of a double intervention to increase the percentage of hypertensive patients with blood pressure levels under control and estimate differences among adults and older adults. Methods: Quasi-experimental design including reorganization and training to physicians using clinical guidelines in four primary healthcare units at the Instituto Mexicano del Seguro Social (IMSS). We included adults who participated whether in the intervention group (IG) or in the control group without equivalence (CGNE). We used regression models for longitudinal data for systolic pressure (SP) and diastolic pressure (DP) variables and proportion of patients with hypertension under control. Results: 530 participants, 272 in the IG; 57.5% were ≥ 60 years. In the IG decreased the SP, ß= −5.93 (95%CI −9.59, −2.28) and increased the proportion with blood pressure under control in young adults (OR 1.48, 95%CI 1.02, 2.14). In the elderly the intervention decreased the DP among those with HT and other comorbidities, ß= −3.57(95%CI −6.72, −0.41), p < 0.05. Conclusion: The interventions reduced SP among adults and DP among older adults with hypertension and other comorbidities. Actions of secondary prevention addressed to each group of age are needed to achieve the control of hypertension at IMSS.

Introducción: en México, 40% de hipertensos observan la tensión arterial (TA) bajo control. La evidencia de intervenciones para controlar la hipertensión (HTA) es aún escasa, particularmente en adultos mayores que tienen mayor prevalencia y uso de servicios de salud. El objetivo fue determinar el impacto de una doble intervención para incrementar la proporción de pacientes con cifras de TA controladas y estimar las diferencias en el control de la TA entre adultos y adultos mayores. Métodos: estudio cuasi experimental que incluyó reorganización gerencial y capacitación clínica a médicos de cuatro unidades del IMSS. Se incluyeron adultos y adultos mayores que participaron en el grupo intervención (GI) o en el grupo control no equivalente (GCNE). Se usaron modelos de regresión para datos longitudinales para las variables de tensión arterial sistólica y diastólica y proporción con cifras TA controladas. Resultados: hubo 530 participantes, 272 en el GI y 258 en GCNE, 57.5% mayores de 60 años. En el GI disminuyó la TAS, ß = −5.93 (IC al 95% entre −9.59 y −2.28) e incrementó la proporción con TA en control entre los adultos jóvenes RM 1.48 (IC al 95% 1.02-2.14); en el grupo de adultos mayores, la intervención redujó niveles de TA diastólica de aquellos con HTA y otras comorbilidades, ß = −3.57(IC 95% entre −6.72 y −0.41), p < 0.05. Conclusión: las intervenciones redujeron la TA sistólica en adultos jóvenes y la TA diastólica en ancianos con HTA y otras comorbilidades. Son necesarias acciones de prevención secundaria para cada grupo de edad a fin de lograr el control de la HTA en el IMSS.

Mamíferos y aves silvestres usados por los pobladores de la cuenca del río Abujao (Ucayali, Perú)

La Amazonia peruana esta clasificada como un ecosistema mega-diverso. La riqueza de especies de fauna y flora acrecienta la diversidad de la población humana. La cuenca del río Abujao está poblada por mestizos y grupos indígenas Ashéninka y Shipibo-Conibo, los cuales todavía guardan parte de sus tradiciones, conocimientos ancestrales y ecológicos. Esta investigación se realizó con la finalidad de conocer el uso de especies de mamíferos y aves silvestres por la población indígena y mestiza en la cuenca del río Abujao. Se determinaron categorías de uso; entre las categorías determinadas predomina el mayor conocimiento de mamíferos y aves silvestres para el uso alimenticio, medicinal y comercial; relativamente pocas especies y parte de estas son para uso ritual, mágico y ornamental debido a la pérdida de conocimientos y tradiciones ancestrales. Rescatando estos conocimientos el presente trabajo tiene una gran importancia en la conservación de aves y mamíferos y el conocimiento ecológico de la Amazonía Peruana

The Peruvian Amazon is classified as one of the mega-diverse ecosystem of the world. Local populations have benefited from the uses of its richness of fauna and flora, promoting the emergence of a wide variety of uses. The Abujao river basin, located in the Peruvian Amazon, is home for mestizos and indigenous groups of Ashéninka and Shipibo-Conibo, whose traditions, and ancestral and ecological knowledge are still alive and closely related to their natural environments. This research was carried out to determine how and to what extent present groups of indigenous and mestizo in the Abujao river basin have been using the wild species of mammals and birds in their locations. Categories of its uses were determined. Among of all defined categories, the most predominant one was the use of wild animals for human consumption, traditional medicine and commercial trades. In contrast, relatively few species, in whole or part, were still used for rituals, and ornamental due to the loss of some ancestral knowledge and traditions on these uses. Revaluing this set of knowledge and uses has a great importance in the conservation of birds and mammals as well as the ecological knowledge of local populations in the Peruvian Amazon

Delphinidin-Rich Maqui Berry Extract (Delphinol®) Lowers Fasting and Postprandial Glycemia and Insulinemia in Prediabetic Individuals during Oral Glucose Tolerance Tests.

Delphinidin anthocyanins have previously been associated with the inhibition of glucose absorption. Blood glucose lowering effects have been ascribed to maqui berry (Aristotelia chilensis) extracts in humans after boiled rice consumption. In this study, we aimed to explore whether a standardized delphinidin-rich extract from maqui berry (Delphinol) affects glucose metabolism in prediabetic humans based on glycemia and insulinemia curves obtained from an oral glucose tolerance test (OGTT) after a challenge with pure glucose. Volunteers underwent four consecutive OGTTs with at least one week washout period, in which different doses of Delphinol were administered one hour before glucose intake. Delphinol significantly and dose-dependently lowered basal glycemia and insulinemia. Lower doses delayed postprandial glycemic and insulinemic peaks, while higher doses reversed this tendency. Glycemia peaks were dose-dependently lowered, while insulinemia peaks were higher for the lowest dose and lower for other doses. The total glucose available in blood was unaffected by treatments, while the total insulin availability was increased by low doses and decreased by the highest dose. Taken together, these open exploratory results suggest that Delphinol could be acting through three possible mechanisms: by inhibition of intestinal glucose transporters, by an incretin-mediated effect, or by improving insulin sensitivity.

The sweetest thing: the influence of angularity, symmetry, and the number of elements on shape-valence and shape-taste matches.

A within-participants experiment was conducted in two countries (the UK and Colombia) in order to investigate the matching of shapes to taste words. Comparing the two countries allowed us to explore some of the cultural differences that have been reported thus far solely in terms of people's visual preferences. In particular, we addressed the question of whether properties other than angularity influence shape-valence and shape-taste matching (crossmodal correspondences). The participants in the present study repeatedly matched eight shapes, varying in terms of their angularity, symmetry, and number of elements to one of two words-pleasant or unpleasant and sweet or sour. Participants' choices, as well as the latency of their responses, and their hand movements, were evaluated. The participants were more likely to judge those shapes that were rounder, symmetrical, and those shapes that had fewer elements as both pleasant and sweet. Those shapes that were more angular, asymmetrical, and that had a greater number of elements, were more likely to be judged as both unpleasant and sour instead. The evidence presented here therefore suggests that aside from angularity and roundness, both symmetry/asymmetry and the number of elements present in a shape also influence valence and taste categorizations.

Assessment of the effect of time in the repeatability of the stabilometric parameters in diabetic and non-diabetic subjects during bipedal standing using the LorAn pressure distribution measurement system.

This study was designed to assess the effect of time on the repeatability of the LorAn pressure distribution measurement system, and evaluate the variability of plantar pressure and postural balance, during barefoot standing in diabetic and non-diabetic subjects, for future diabetic foot clinical evaluation. Fourteen subjects were evaluated (8 females, 6 males, 8 non-diabetics and 6 diabetics, age range 30-70 years) and had no musculoskeletal symptoms. Four variables were measured with the platform in the barefoot standing position. Ten measurements were taken using two different techniques for feet and posture positioning, during three sessions, once a week. The MANOVA test confirmed that the platform measurements are reproducible for variables body baricenter (x) and foot baricenter (x) through time, being the coefficients of variation, with a 99% confidence interval, lower than 1.6% for body baricenter (x), and lower than 2.06% for foot baricenter (x), for all studied conditions. For the remaining variables, the results were not stabilized through time, which makes necessary to standardize the measurement protocol that guarantees the repeatability in all variables.

Utilización del stent pospérdida tardía en la angioplastia con balón en pacientes con cardiolatía isquemica crónica spostar / Stent utilization for late loss following balloon angioplasty in patients with chronic ischemic heart disease

La cardiopatía isquémica de origen ateroesclerótico tiene indicación de tratamiento farmacológico, de angioplastia con balón y colocación de stent coronario o la cirugía de revascularización. Evaluar la necesidad de stent coronario pospérdida tardía en la angioplastia con balón en pacientes con cardiopatía isquémica crónica. Se determinó la pérdida tardía posangioplastia con balón, en diferentes tiempos, con el ultrasonido coronario (IVUS) y angiográfico. Se estudiaron prospectivamente 21 pacientes con cardiopatía isquémica crónica ateroesclerótica (B2, C), en ASCARDIO, de febrero 2002 a julio 2008. Se realizó angiografía coronaria y IVUS. Se utilizó programa SPSS versión 15.0; para el análisis de datos: frecuencias, porcentajes, promedios, desviación estándar; t de Student, prueba de Wilcoxon (z), con 0,05 de significación estadística. Hubo predominio de género masculino, con 49 a 58 años. Como factores de riesgo: hipertensión arterial sistémica (85,7%), dislipidemia (80,9%), consumo de tabaco (47,6%), diabetes mellitus tipo 2 (38,1%). La arteria descendente anterior fue la más tratada. Se encontró lesión arterial coronaria B2 (47,6%), C (52,4%) con alta producción de disecciones posangioplastia con balón clase A (19,0%),B (33,3%), C (19,0%). Con incidencia de retroceso elástico de 29,5%. Todos requirieron Stent. El severo grado ateroesclerótico de las lesiones coronarias de 21 pacientes explicaría el alto grado de complicaciones posterior a la angioplastia con balón y el alto porcentaje de retroceso elástico hallado. Se evidencia la utilidad del uso del IVUS para la obtención de un mejor diagnóstico y cuantificación de la lesión, escogencia del tamaño del stent e impactación adecuada en el vaso coronario.

Ischemic heart disease of atherosclerotic origin is an indication for drug treatment, balloon angioplasty and coronary stenting or bypass surgery. To evaluate the need forcoronary stent use for late loss following balloon angioplasty in patients with chronic ischemic heart disease. Llate loss was determined post-balloon angioplasty, at different times, with coronary ultrasound(IVUS) and angiography. We prospectively studied 21 patients with chronic atherosclerotic coronary artery disease (B2,C), ASCARDIO, from February 2002 to July 2008. We performed coronary angiography and IVUS. We used SPSS version 15.0, fordata analysis: frequencies, percentages, averages, standard deviation,Student t test, Wilcoxon test (z), with 0.05 statistical significance.There was a male predominance, from 49 to 58 years ofage. Risk factors: systemic hypertension (85.7%), dyslipidaemia(80.9%), tobacco use (47.6%), and Type 2 diabetes (38.1 %). The anterior descending artery was treated the most. The following coronary arterial lesions were found: B2 (47.6%), C (52.4%) witha high occurrence of dissections post-balloon angioplasty class A(19,0%), B (33.3%), C (19.0%). The incidence of elastic recoilwas 29.5%. All required stents. The degree of severe atherosclerotic coronary lesions in 21 patients explains the high rate of complications after balloon angioplasty and the high percentage of elastic recoil found. This study demonstrates the utility of using IVUS to obtain a better diagnosis, quantification of the injury, choice of stent size and proper implantation in the coronary vessel.

Relación entre el índice de masa corporal y las cifras de tensión arterial en adolescentes

Objetivos: Investigar la relación entre el índice de masa corporal (IMC) y las cifras de tensión arterial en adolescentes de la ciudad de Mérida, dada su asociación con el desarrollo de enfermedades crónicas no trasmisibles en el adulto. Métodos: Se estudiaron 385 adolescentes, 62,3% de sexo femenino y 37,7% de masculino, entre 12 y 15 años de edad, con promedio de 15,17±1,71 años. Se les tomaron las medidas antropométricas, para el cálculo del IMC, y la tensión arterial (TA) en posición sentada. Se consideraron normales el IMC y la TA comprendida entre los percentiles 10 y 90 para las curvas venezolanas, de acuerdo a edad y sexo; se consideró sobrepeso y obesidad sobre el pc 90 y Pre-hipertensión (Pre-HTA) e hipertensión arterial (HTA) sobre el pc 90. Resultados: El 75,3% de los adolescentes presentaron un IMC normal, el 11,2% un IMC bajo y el 13,6% sobrepeso y obesidad. El 1,1% presentò TA sistólica sobre el pc 90 y el 6,3% presentó TA diastólica sobre la norma. No se observó asociación del IMC y de la TA con el sexo ni el estrato socio-económico. Se encontró una alta y significativa asociación entre el sobrepeso/obesidad y la Pre-HTA/HTA (p=0,0001). El riesgo de un adolescente con IMC sobre el pc 90 de presentar Pre-HTA o HTA fue 9,76 veces mayor (Odss ratio) que el adolescente con IMC menor al pc 90 (IC 95%: 4,09-23,27; p=0,0001). Conclusión: Se comprobó una asociación estadística entre el IMC y los valores de TA sistólica y diastólica, por lo que adolescentes que tengan IMC altos deben ser seguidos y sometidos a algún tipo de intervención tendiente a disminuir la incidencia de enfermedades crónicas no transmisibles en la edad adulta.

Objective: To investigate the relationship between body mass index (BMI) and the blood pressure (BP) values in adolescents of the city of Mérida, given its association with the development of non-transmissible chronic diseases in adults. Methods: We studied 385 adolescents, 62.3% female and 37.7% male, between 12 and 15 years of age, with average of 15.17 ± 1.71 years. Anthropometric measures and blood pressure (BP) were taken. The body mass index (BMI) was calculated. BMI and BP between 10th and 90th percentile from Venezuelan curves, according to age and sex, were considered normal. Obesity/overweight and pre-hypertension/hypertension (Pre-HTA/HTA) were considered when the BMI and the BP were located above the 90th percentile. Results: A total of 75.3% of the adolescents had a normal BMI, 11.2% a low BMI and 13.6% had overweight and obesity. The systolic BP was above the 90th percentile in 1.1% and the diastolic BP in 6.3% of the adolescents. No association was observed between BMI and BP with the sex and socio-economic stratum. It was found a high and significant association between overweight/obesity and Pre-HTA/HTA (p=0.0001). The risk for Pre-HTA/HTA of an adolescent with a BMI over 90th percentile was 9.76 times higher (Odss ratio) than in adolescents with a BMI less than 90th percentile (95% CI 4.09-23.27; p = 0.0001). Conclusion: It was found a statistical association between BMI and the values of systolic and diastolic BP. Those adolescents with high BMI should be monitored and subject to any intervention aimed at reducing the incidence of non-transmissible chronic diseases in adulthood.

Distrofia muscular de Duchenne, presentación clínica / Duchenne muscular dystrophy clinical presentation

Background: Duchenne Muscular Dystrophy is an X-link recessive disorder that affects 1 per 3.500 males. Becker Muscular Dystrophy is less common, affecting approximately 1 per 30 000 males. Both diseases are the result of a mutation in the Xp21 gene that encodes for dystrophin. Objective: Describe the clinical manifestations of Duchenne Muscular Dystrophy in patients at our institution. Method: Observational and descriptive study, in which clinical records of 8 patients with Duchenne Muscular Dystrophy were reviewed, with description of their clinical aspects. Results: The mean age at diagnosis was 5 years-old. 6 boys presented developmental delay and 7 deambulation difficulties, being the main reason for medical attendance. 3 patients died during the study period. Conclusions: A multidisciplinary management is required to delay the disease evolution, while it does not have a curative treatment. It is necessary to know the clinical aspects representative of this disease, in order to perform an early diagnosis.

Introducción: La distrofia muscular de Duchenne es una alteración ligada al X recesiva que afecta 1 en 3 500 varones. La distrofia muscular de Becker es menos común, afectando aproximadamente 1 en 30 000 varones. Ambas resultan de la mutación de un gen localizado en Xp21, el cual codifica a la distrofina. Objetivos: Describir el comportamiento clínico de la distrofia muscular de Duchenne en pacientes evaluados en nuestra institución. Pacientes y Métodos: Se realizó un estudio de tipo observacional y descriptivo, donde se revisaron las historias clínicas de ocho pacientes con el diagnóstico de distrofia muscular de Duchenne, donde se describieron los aspectos clínicos y paraclínicos de la entidad. Resultados: El promedio de la edad para el momento del diagnóstico fue de cinco años. Seis presentaron retardo del desarrollo psicomotor y la marcha se encontró alterada en siete pacientes siendo este el principal motivo de consulta junto a caídas frecuentes. Tres pacientes habían fallecido al final del período en estudio. Conclusiones: Se requiere de un tratamiento multidisciplinario para retrasar la evolución de la enfermedad, mientras no se disponga de un tratamiento curativo. Es necesario conocer los aspectos representativos de esta enfermedad para realizar su diagnóstico precoz.

Evidence of subpopulations with different levels of insulin resistance in women with polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is non-uniformly associated with insulin resistance (IR). We examined IR in women with PCOS. METHODS: Sixty-nine PCOS women were subjected to the insulin suppression test (IST) to determine their steady-state plasma glucose (SSPG) as a direct measure of insulin sensitivity. RESULTS: SSPG exhibited a multimodal distribution suggesting the existence of subpopulations. The heterogeneous distribution of plasma glucose at 180 min (P = 0.011), with three modes, suggested differences in the plasma glucose level trajectories during the IST. Hence, the population was separated into three groups: (i) (n = 33), subjects with SSPG < or = 152.5 mg/dl, corresponding to the first to fifth deciles; (ii) (n = 29), subjects in the interval 152.5 mg/dl < SSPG < or = 300 mg/dl; (iii) (n = 7), subjects with SSPG > 300 mg/dl, corresponding to the tenth decile. Plasma glucose distributions at 180 min showed differences in their mean values and ranges among groups (P < 0.0001). The trajectories of the groups differed significantly during the IST (P < 0.0001). CONCLUSIONS: insulin sensitivity in our patients exhibited a discontinuous distribution, implying that PCOS is a heterogeneous disorder possessing subpopulations regarding IR.

An unusual presentation of chest pain.

Cardiac disease is common among patients with Systemic Lupus Erythematosus (SLE). Pericardial, myocardial, valvular, and coronary artery involvement have been extensively reported. The three major coronary abnormalities associated with myocardial injury in SLE are premature atherosclerosis, coronary arteritis and, less frequently, coronary aneurysms. A 26-year-old black male patient with a 5-year history of anti-phospholipid syndrome sustained a lateral wall myocardial infarct associated to angiographic evidences of multiple, diffuse, saccular coronary aneurysms without evidence of atherosclerotic occlusive disease in all three coronary arteries. Serologic studies were consistent with active SLE. Lupus-associated nephritis was also present. Radiographic studies showed no evidence of brain or thoracic aneurysms. A transthoracic echocardiogram showed an estimated ejection fraction of 35% and a moderate pericardial effusion. High dose i.v. steroids were started along with systemic anticoagulation. The patient had an uneventful clinical course and was discharged by the fourteenth day on high doses of oral steroids (60 mg daily), statins, oral anticoagulation (warfarin 5 mg), antihypertensives and aspirin. The patient was lost to follow-up and developed steroid-induced hyperglycemia, 20 pound weight gain and warfarin intoxication. A three-month follow up coronary angiography showed complete resolution of the aneurysms and serologic studies showed no active autoimmune disorder at that time. Coronary artery aneurysms have previously been reported in 15 cases of patients with SLE. An extensive Medline search of the literature revealed no previous reports of diffuse saccular coronary aneurysms involving all three coronary arteries associated with active SLE. This case highlights the unusual presentation of acute SLE in a young patient complicated by multiple aneurysms and acute myocardial infarction. In this case, we believe that a direct causal association exists between acute SLE-associated aneurysms and myocardial ischemic injury. Early recognition and prompt treatment with large doses of corticosteroids may decrease the mortality and morbidity associated with this condition.