The Genetic Diagnostics of Hemochromatosis: Disparities in Low- Versus High-Income Countries.

This study provides a comprehensive overview of hereditary hemochromatosis (HH), a genetic condition characterized by iron overload due to excessive iron absorption. It elucidates diverse inheritance patterns and clinical manifestations by exploring mutations in critical genes such as HFE (hemochromatosis), HJV (hemojuvelin), HAMP (hepcidin antimicrobial peptide), TfR2 (transferrin receptor 2), and FP (ferroportin). The significance of early screening, diagnosis, and personalized management strategies based on genetic classification is emphasized, particularly in terms of high-income vs. low-income countries. Addressing challenges in diagnosis, genetic testing accessibility, and healthcare disparities, the study highlights the importance of early detection, cost-effective screening strategies, and enhancing healthcare outcomes globally. Advanced genetic testing in high-income countries facilitates early diagnosis and management, reducing complications such as liver disease and cardiomyopathy. In contrast, low-income populations face several barriers, including limited access to genetic testing, high costs, and inadequate healthcare infrastructure. Cost-effective serum ferritin (SF) and transferrin saturation (TS) tests and emerging point-of-care (POC) tests offer affordable diagnostic options for low-resource settings. Additionally, the ongoing development of hepcidin measurement methods holds promise for enhancing diagnostic capabilities. Implementing these strategies can aid healthcare providers in improving global HH management and reducing the burden of iron overload complications. Furthermore, the study underscores the need for public health initiatives to raise awareness about HH, promote routine screenings, and advocate for equitable healthcare policies. Collaborative efforts between governments, healthcare organizations, and research institutions are crucial in addressing the global burden of HH. By fostering international cooperation and resource-sharing, it is possible to bridge the gap between high-income and low-income countries, ensuring all individuals have access to the necessary diagnostic and treatment options. This holistic approach can ultimately lead to better health outcomes and improved quality of life for individuals affected by HH worldwide. This comprehensive examination of HH not only illuminates the genetic and clinical aspects of the condition but also provides a roadmap for addressing the multifaceted challenges associated with its diagnosis and management.

Combining melatonin with dexmedetomidine improves anesthesia in rats.

Melatonin (ML) and dexmedetomidine (DM) are used separately as anesthetic premedication or as an anesthetic in humans and laboratory animals. In this study, we aimed to investigate the anesthetic properties of both drugs combined. The anesthetic effects of several combinations of ML (50 and 100 mg/kg) and DM (50 and 100 µg/kg) were evaluated in rats by observing behavioral manifestations and recording the duration and depth of anesthesia. Five anesthetic intervals were established according to the loss and recovery of reflexes. While each individual drug did not induce an appropriate anesthetic effect at the tested doses, ML50 + DM100, ML100 + DM50 and ML100 + DM100 combinations resulted in surgical anesthesia intervals of 60 to 360 min. Together, our results point that the use of ML allows to decrease the dose of DM, reducing the unwanted anesthetic effects of this α2-agonist.

Comparison of 4 laboratory tests for the detection of bovine rabies viral infection in Paraguay: fluorescent antibody test, rapid detection test, histologic lesions, and RT-PCR.

Rabies virus (RABV; Lyssavirus rabies) is a neurotropic virus that can be transmitted to mammals by the hematophagous bat Desmodus rotundus. An accurate, accessible method for the detection of RABV in cattle is necessary in Paraguay; thus, we evaluated the detection of RABV using 4 techniques: fluorescent antibody test (FAT), immunochromatography rapid detection test (RDT; Anigen Rapid Rabies Ag test kit; Bionote), a reverse-transcription PCR (RT-PCR) assay, and histologic lesions in different portions of the CNS of 49 Paraguayan cattle to determine the most sensitive and specific technique. By FAT and RDT, 15 of 49 (31%) samples were positive. By RT-PCR amplification of N and G genes, 13 of 49 (27%) and 12 of 49 (25%) were positive, respectively. RDT had high agreement with FAT (kappa = 1); sensitivity was 100% (95% CI: 97-100%) and specificity was 100% (95% CI: 99-100%). The amplification of the N and G genes resulted in substantial agreement (kappa of 0.9 and 0.8, respectively) compared with FAT, and the sensitivity and specificity of the N gene were 87% (95% CI: 66-100%) and 100% (95% CI: 98-100%), respectively, and those of the G gene were 80% (95% CI: 56-100%) and 100% (95% CI: 98-100%), respectively. Histologic lesions observed were lymphoplasmacytic meningoencephalitis, gliosis, and neuronophagia. The agreement observed between the FAT and RDT tests suggests that RDT is an accurate tool for the detection of RABV. Histopathology can be used to confirm lesions caused by RABV and to rule out other conditions; the RT-PCR assay is useful for molecular epidemiology studies.

Chromosomal instability and inflammation: a catch-22 for cancer cells.

Chromosomal instability (CIN), an increased rate of chromosomal segregation abnormalities, drives intratumor heterogeneity and affects most human cancers. In addition to chromosome copy number alterations, CIN results in chromosome(s) (fragments) being mislocalized into the cytoplasm in the form of micronuclei. Micronuclei can be detected by cGAS, a double-strand nucleic acid sensor, which will lead to the production of the second messenger 2'3'-cGAMP, activation of an inflammatory response, and downstream immune cell activation. However, the molecular network underlying the CIN-induced inflammatory response is still poorly understood. Furthermore, there is emerging evidence that cancers that display CIN circumvent this CIN-induced inflammatory response, and thus immune surveillance. The STAT1, STAT3, and NF-κB signaling cascades appear to play an important role in the CIN-induced inflammatory response. In this review, we discuss how these pathways are involved in signaling CIN in cells and how they are intertwined. A better understanding of how CIN is being signaled in cells and how cancer cells circumvent this is of the utmost importance for better and more selective cancer treatment.

Acute and chronic physical activity improves spatial memory in an immersive virtual reality task.

Physical activity benefits both fitness and cognition. However, its effect on long-term memory is unclear. In this study, we evaluated the effect of acute and chronic exercise on long-term spatial memory for a new virtual reality task. Participants were immersed in the virtual environment and navigated a wide arena that included target objects. We assessed spatial memory in two conditions (encoded targets separated by a short or long distance) and found that 25 min of cycling after encoding - but not before retrieval - was sufficient to improve the long-term memory retention for the short, but not for the long distance. Furthermore, we found that participants who engaged in regular physical activity showed memory for the short-distance condition whereas controls did not. Thus, physical activity could be a simple way to improve spatial memories.

Different Alternatives to Assess the Burden of Disease Using Attributable Fraction on a Disability Variable: The Case of Pain and Chronic Musculoskeletal Disorders in Chile.

OBJECTIVES: To estimate the burden of disease through 4 complementary procedures to years lived with disability (YLDs) using the concept of attributable fraction and including analysis of subdomains of disability. METHODS: We explored the burden on disability for 7 common musculoskeletal disorders (CMD) using the 2009 to 2010 Chilean National Health Survey, which included the Community Oriented Programme for the Control of Rheumatic Disease Core Questionnaire to identify cases with CMD, and an 8-domain questionnaire for health state descriptions. We calculated the proportion of disability attributable to pain in the general population and people with CMD. We also estimated the burden of CMD expressed as YLD and as the proportion of the disability in the general population attributable to people with CMD, with a particular focus in the pain domain of disability. Second order of uncertainty around point estimations was also characterized. RESULTS: Pain domain of disability accounted for 23.4% of the total disability in the general population, and between 20% (fibromyalgia) to 27.1% (osteoarthritis of the hip) in people with some of the selected CMD. People with chronic musculoskeletal pain accounted for 21.2% of total disability from general population, which generated 1.2 million of YLD (6679 YLD/100 000 inhabitants). Chronic low back pain and osteoarthritis of the knee were in the top position of specific CMDs, explaining the highest national burden. CONCLUSION: Pain is an essential component of disability in people with CMD and also in the general population. The approach used can be easily applied to other health conditions and other domains of disability.

El reconocimiento como proceso de interacción comunicativa: elementos para una reflexión desde la salud pública / Recognition as a process of communicative interaction: elements for a reflection from a public health perspective

RESUMEN La reflexión propuesta en las páginas siguientes tiene como objetivo retornar a las prácticas operacionales de reconocimiento en el campo de situaciones de comunicación complejas centradas en la reciprocidad. La perspectiva epistemológica propuesta es la de la psicología social socioconstructivista. El marco teórico-metodológico es el de las representaciones sociales. A partir del rol de los actores involucrados en el proceso, en el ensayo se describen las tres distintas clases de variables que, en opinión de los autores, influyen en el reconocimiento mutuo: las variables psicológicas, las variables cognitivas y las variables sociales. Las dimensiones subyacentes de cada una de las variables consideradas se analizan en detalle, subrayando los posibles efectos sobre las prácticas sociales relacionadas con los mismos. Estos muestran claramente que las influencias múltiples que entran en juego en la "situación comunicativa" de reconocimiento producen una realidad claramente compleja y ampliamente predeterminada por sistemas recíprocos de representación del otro, de la tarea y de la situación.

ABSTRACT The aim of the reflection proposed in the following pages is to return operational recognition practices in the fold of complex communication situations centred on reciprocity. The proposed epistemological perspective is that of socioconstructivist social psychology. The theoretical-methodological framework is that of the Social Representations. Starting from the role of the actors involved in the process, the paper describes the three different kinds of variables that, in the opinion of the authors, influence mutual recognition: the psychological variables, the cognitive variables and the social variables. The dimensions underlying each of the variables considered are analysed in detail, underlining the possible effects on the social practices related to them. These clearly show that the multiple influences that come into play in the "communicative situation" of recognition, produce a clearly complex and largely predetermined reality by reciprocal systems of representation of the other, of the task and of the situation.

Validation of the adjusted global antiphospholipid syndrome score in systemic lupus erythematosus patients in Argentina.

INTRODUCTION: Assessment of risk both for pregnancy morbidity and thrombosis in the presence of anti-phospholipid antibodies (aPL) is still a challenge in Systemic Lupus Erythematosus (SLE) patients. The Global Antiphospholipid Syndrome Score (GAPSS) takes into account the aPL profile (criteria and non-criteria aPL), the conventional cardiovascular risk factors and the autoimmune antibody profile. An adjusted model of the score (aGAPSS) excluding anti-phosphatidylserine/Prothrombin (aPS/PT), suggests that the score is able to stratify patients for their rate of events making it widely applicable in daily clinical practice. OBJECTIVE: To validate the aGAPSS in a multicentric cohort of SLE patients in Argentina. PATIENTS AND METHODS: consecutive SLE patients with and with andwithout thrombotic events from seven Rheumatologist centers were included. Traditional cardiovascular risk factors, aPL antibodies and medications received (aspirin, hydroxychloroquine and anticoagulation) were collected. The score aGAPSS was calculated for each patient at the last visit by adding together the points corresponding to the risk factors: 1 for hypertension, 3 for dyslipidemia, 4 for LA and B2GPI (IgM or IgG) antibodies and 5 for aCL (IgM or IgG) antibodies. The discriminative ability of the aGAPSS was calculated by measuring the area under the receiver operating characteristic curve (AUC). Multivariate logistic regression analysis was performed to examine the impact of multiple cardiovascular risk factors and laboratory parameters on the occurrence of thrombosis. RESULTS: Two hundred and ninety-six SLE patients were included. One-hundred and twenty-one patients (40.9%) presented thrombotic and/or pregnancy complications. Median aGAPSS was significantly higher in patients who experienced an event (thrombosis and/or pregnancy morbidity) compared with those without [4 (IQR 1-9) versus 1 (IQR 0-5); p < 0.001]. The best cut off point for the diagnosis of thrombosis and/or pregnancy complications was aGAPSS ≥4. Multivariate logistic regression analysis showed that aCL antibodies [OR 2.1 (95% CI 1.16-3.90); p = 0.015] were an independent risk factors for thrombotic events. CONCLUSIONS: This score is a simple tool, easy to apply to SLE patients in daily practice. The use of the aGAPSS could change the non-pharmacologic and pharmacologic treatment in higher risk patients to improve their survival.

A Field Study of Serum, Colostrum, Milk Iodine, and Thyroid Hormone Concentrations in Postpartum Draft Mares and Foals.

Iodine, thyroxine (T4) and triiodothyronine (T3) are required for normal fetal growth, maturation, and neonatal survival. There is a lack of robust information on iodine levels found in colostrum, milk, and serum of mares and foals after a healthy pregnancy. Our objective was to characterize colostrum, milk, and serum iodine levels in healthy postpartum mares and foals (n = 10) and explore relationships with thyroid hormone concentrations. Colostrum, milk, and jugular blood samples from draft breed mares and foals with an estimated average iodine daily intake of 39 mg per mare during pregnancy were obtained at Day 0 (foaling date) and/or 10 days later. Parameters studied were (1) mare basal concentrations of serum: TT3, TT4, and iodine; (2) iodine in colostrum at Day 0 and milk iodine (Day 10); and (3) foal basal: TT3, TT4, and serum iodine (Days 0 and 10). Median ± median error colostrum iodine levels (165 ± 15.1 µg/L) were higher than milk (48 ± 5.6 µg/L; P = .007) levels. Median ± median error foal serum iodine (268.5 ± 7.6 µg/L), TT4 (1,225 ± 47.8 nmol/L), and TT3 (14.2 ± 1.1 nmol/L) at foaling date were higher than at 10 days (serum iodine: 70 ± 3.6 µg/L; TT4: 69.6. ± 20.4 nmol/L; and TT3: 5.4 ± 0.3 nmol/L). In conclusion, equine mammary tissue concentrates iodine beyond plasma levels, making colostrum and milk a significant source of iodine. Foal serum iodine levels are high in the neonatal period and are positively correlated with TT4, which is important for neonatal adaptation.

Cyclin A triggers Mitosis either via the Greatwall kinase pathway or Cyclin B.

Two mitotic cyclin types, cyclin A and B, exist in higher eukaryotes, but their specialised functions in mitosis are incompletely understood. Using degron tags for rapid inducible protein removal, we analyse how acute depletion of these proteins affects mitosis. Loss of cyclin A in G2-phase prevents mitotic entry. Cells lacking cyclin B can enter mitosis and phosphorylate most mitotic proteins, because of parallel PP2A:B55 phosphatase inactivation by Greatwall kinase. The final barrier to mitotic establishment corresponds to nuclear envelope breakdown, which requires a decisive shift in the balance of cyclin-dependent kinase Cdk1 and PP2A:B55 activity. Beyond this point, cyclin B/Cdk1 is essential for phosphorylation of a distinct subset of mitotic Cdk1 substrates that are essential to complete cell division. Our results identify how cyclin A, cyclin B and Greatwall kinase coordinate mitotic progression by increasing levels of Cdk1-dependent substrate phosphorylation.

Two Interlinked Bistable Switches Govern Mitotic Control in Mammalian Cells.

Distinct protein phosphorylation levels in interphase and M phase require tight regulation of Cdk1 activity [1, 2]. A bistable switch, based on positive feedback in the Cdk1 activation loop, has been proposed to generate different thresholds for transitions between these cell-cycle states [3-5]. Recently, the activity of the major Cdk1-counteracting phosphatase, PP2A:B55, has also been found to be bistable due to Greatwall kinase-dependent regulation [6]. However, the interplay of the regulation of Cdk1 and PP2A:B55 in vivo remains unexplored. Here, we combine quantitative cell biology assays with mathematical modeling to explore the interplay of mitotic kinase activation and phosphatase inactivation in human cells. By measuring mitotic entry and exit thresholds using ATP-analog-sensitive Cdk1 mutants, we find evidence that the mitotic switch displays hysteresis and bistability, responding differentially to Cdk1 inhibition in the mitotic and interphase states. Cdk1 activation by Wee1/Cdc25 feedback loops and PP2A:B55 inactivation by Greatwall independently contributes to this hysteretic switch system. However, elimination of both Cdk1 and PP2A:B55 inactivation fully abrogates bistability, suggesting that hysteresis is an emergent property of mutual inhibition between the Cdk1 and PP2A:B55 feedback loops. Our model of the two interlinked feedback systems predicts an intermediate but hidden steady state between interphase and M phase. This could be verified experimentally by Cdk1 inhibition during mitotic entry, supporting the predictive value of our model. Furthermore, we demonstrate that dual inhibition of Wee1 and Gwl kinases causes loss of cell-cycle memory and synthetic lethality, which could be further exploited therapeutically.

Incidence, prevalence and risk factors related to anxiety symptoms during pregnancy.

Symptoms of anxiety are one of the most prevalent emotional responses in women during their reproductive phase and especially during pregnancy. OBJECTIVE: Estimate the incidence and prevalence of anxiety throughout the three trimesters of pregnancy in addition to studying the possible risk factors associated with anxiety symptoms. METHOD: A sample of 385 pregnant women participated in a longitudinal study in which the GAD-7 questionnaire was used. RESULTS: Anxiety prevalence was 19.5% in the first trimester. In the second trimester, it was 16.8%, with an incidence of 0.048%. In the third trimester, it was 17.2%, with an incidence of 0.068%. The following predictive factors of anxiety symptoms were identified: being a smoker, presence of previous illness and changes in social relationships. CONCLUSIONS: High incidence and prevalence of anxiety symptoms occur during pregnancy; consequently, applicable preventive policies should be developed.

Adding landscape genetics and individual traits to the ecosystem function paradigm reveals the importance of species functional breadth.

Animal pollination mediates both reproduction and gene flow for the majority of plant species across the globe. However, past functional studies have focused largely on seed production; although useful, this focus on seed set does not provide information regarding species-specific contributions to pollen-mediated gene flow. Here we quantify pollen dispersal for individual pollinator species across more than 690 ha of tropical forest. Specifically, we examine visitation, seed production, and pollen-dispersal ability for the entire pollinator community of a common tropical tree using a series of individual-based pollinator-exclusion experiments followed by molecular-based fractional paternity analyses. We investigate the effects of pollinator body size, plant size (as a proxy of floral display), local plant density, and local plant kinship on seed production and pollen-dispersal distance. Our results show that while large-bodied pollinators set more seeds per visit, small-bodied bees visited flowers more frequently and were responsible for more than 49% of all long-distance (beyond 1 km) pollen-dispersal events. Thus, despite their size, small-bodied bees play a critical role in facilitating long-distance pollen-mediated gene flow. We also found that both plant size and local plant kinship negatively impact pollen dispersal and seed production. By incorporating genetic and trait-based data into the quantification of pollination services, we highlight the diversity in ecological function mediated by pollinators, the influential role that plant and population attributes play in driving service provision, and the unexpected importance of small-bodied pollinators in the recruitment of plant genetic diversity.

Resilience amongst Older Colombians Living in Poverty: an Ecological Approach.

Older Colombians face significant adversities: poverty, violence and displacement. However, there is evidence that Latinos are often resilient. We examine resilience in older Colombians living in poverty using an ecological framework that identifies three levels: individual; community; and societal. In this paper we examine data from 16 semi-structured interviews with older Colombians that explore resilience within the context of poverty. We analyze our data using three stages: (1) modified grounded theory; (2) assignment of resilience status; (3) identification of components of the ecological framework which contribute to resilience in these participants. The most striking feature is that some participants are able to adapt to their situation, demonstrating resilience, whilst others are not. Individual characteristics such as psychological and material resources contribute to resilience. At the community level, family, social support, participation and cohesion promote resilience. Finally, at the societal level, social and welfare services, finance, religion and social policy, are important factors. These different levels of resilience are co-dependent, and we illustrate how this is so. We suggest that older Colombians living in poverty often demonstrate resilience, but that more can be done to enhance their lives. This includes interventions at the individual and community levels alongside changes in social policy.

Vigilancia de la sensibilidad a antimicrobianos de Escherichia coli productor de infecciones del tracto urinario comunitarias en Galicia / Surveillance of antimicrobial susceptibility of Escherichia coli producing urinary tract infections in Galicia (Spain)

Introducción. Escherichia coli es el microorganismo responsable de la mayoría de las infecciones del tracto urinario (ITU) comunitarias. Nuestro propósito fue conocer la sensibilidad de E. coli asociado a ITU en Galicia y considerar los antibióticos más apropiados para su tratamiento empírico. Métodos. Estudio retrospectivo durante el período 2011-2012 de los aislamientos de E. coli en muestras de orina procedentes de prácticamente toda la población gallega. Se recogieron variables demográficas, concentración mínima inhibitoria y categoría de interpretación para: amoxicilina/clavulánico, cefotaxima, gentamicina, amikacina, ciprofloxacino, cotrimoxazol, fosfomicina y nitrofurantoína. La identificación y estudios de sensibilidad se realizaron principalmente mediante sistemas automatizados. La interpretación de los resultados se realizó de acuerdo con los criterios de CLSI. Resultados: En el período estudiado se aislaron 55.046 E. coli en ITU. Los porcentajes de resistencia fueron: cotrimoxazol 30%; ciprofloxacino 33%; amoxicilina/clavulánico 23% y del 10% para cefalosporinas de 3ª generación. Fosfomicina y nitrofurantoína son los que mantienen mayor actividad, con más de un 96% de sensibilidad en nuestro estudio. La tendencia lineal de las resistencias en relación a la edad fue estadísticamente significativa (p<0,0001) y también lo fue en relación al sexo masculino (p<0,00001) para todos los antibióticos. Conclusiones. En Galicia los antibióticos más activos frente a E. coli asociado a ITU son fosfomicina y nitrofurantoína por lo que deberían ser considerados como tratamiento empírico de elección de la ITU comunitaria no complicada por E. coli (AU)

Introduction. Escherichia coli is the microorganism responsible for most of the community-acquired urinary tract infections (UTI). Our purpose was to determine the susceptibility of E. coli associated with UTI in Galicia and consider the most appropriate antibiotics for empirical treatment. Methods. Retrospective study during the period 2011-2012 of the isolation of E. coli in urine samples from almost all the Galician population. Demographic variables, minimum inhibitory concentration, and reading data were collected: amoxicillin-clavulanate, cefotaxime, gentamicin, amikacin, ciprofloxacin, cotrimoxazole, nitrofurantoin and fosfomycin. The identification and susceptibility studies were mainly conducted by automated systems. The interpretation of the results was performed according to CLSI criteria. Results. During the study period 55,046 E. coli were isolated in UTI. The percentages of resistance were: cotrimoxazole, 30%; ciprofloxacin, 33%; amoxicillin-clavulanate, 23% and 10% for 3rd generation cephalosporins. Fosfomycin and nitrofurantoin showed the highest activity with more than 96% of susceptibility in our study. The linear trend of resistance regarding age was statistically significant (p <0.0001) as it was regarding males (p <0.00001) for all antibiotics. Conclusions. In Galicia, the most active antibiotics against E. coli associated with UTI are fosfomycin and nitrofurantoin so they should be considered as empirical treatment of choice by the community-acquired UTI not complicated by E. coli (AU)

[Surveillance of antimicrobial susceptibility of Escherichia coli producing urinary tract infections in Galicia (Spain)]. / Vigilancia de la sensibilidad a antimicrobianos de Escherichia coli productor de infecciones del tracto urinario comunitarias en Galicia.

OBJECTIVE: Escherichia coli is the microorganism responsible for most of the community-acquired urinary tract infections (UTI). Our purpose was to determine the susceptibility of E. coli associated with UTI in Galicia and consider the most appropriate antibiotics for empirical treatment. METHODS: Retrospective study during the period 2011- 2012 of the isolation of E. coli in urine samples from almost all the Galician population. Demographic variables, minimum inhibitory concentration, and reading data were collected: amoxicillin-clavulanate, cefotaxime, gentamicin, amikacin, ciprofloxacin, cotrimoxazole, nitrofurantoin and fosfomycin. The identification and susceptibility studies were mainly conducted by automated systems. The interpretation of the results was performed according to CLSI criteria. RESULTS: During the study period 55,046 E. coli were isolated in UTI. The percentages of resistance were: cotrimoxazole, 30%; ciprofloxacin, 33%; amoxicillin-clavulanate, 23% and 10% for 3rd generation cephalosporins. Fosfomycin and nitrofurantoin showed the highest activity with more than 96% of susceptibility in our study. The linear trend of resistance regarding age was statistically significant (p <0.0001) as it was regarding males (p <0.00001) for all antibiotics. CONCLUSIONS: In Galicia, the most active antibiotics against E. coli associated with UTI are fosfomycin and nitrofurantoin so they should be considered as empirical treatment of choice by the community-acquired UTI not complicated by E. coli.

Postdural puncture headache: impact of needle type, a randomized trial.

BACKGROUND CONTEXT: The most common adverse event after a lumbar puncture (LP) is a headache: In anaesthesiology, well studied is the protective effect of atraumatic spinal needles, and they are routinely used. However, this is less well known in diagnostic LP, and neurologists use atraumatic needles in less than 2% of times. PURPOSE: The purpose of this study was to define the impact of needle type, atraumatic (Sprotte [S]) versus traumatic (Quincke [Q]) on postdural puncture headache (PDPH) incidence. STUDY DESIGN: The study is based on a prospective, randomized, and simple-blinded clinical trial. PATIENT SAMPLE: Patients older than 14 years were scheduled for a diagnostic or therapeutic LP. OUTCOME MEASURES: The outcome measure included the development of PDPH according to the International Headache Association criteria. METHODS: Patients fulfilling eligibility criteria were randomly allocated to one of two kinds of spinal needle: atraumatic or S-type or traumatic or Q-type. They were interviewed on days 2 and 7 about the development of PDPH. RESULTS: The incidence of PDPH was 22.43% with Q-type needle and 8.51% with S-type needle, p=.04. The duration of PDPH in patients in the S-type was 1 day or less, compared with a median of 4.14 days in the Q-type (p=.00). In the logistic regression model, the S-type needle together with the age of the patient were the only two statistically significant factors in the development of postlumbar puncture headache (PLPH), both of them being protective. CONCLUSIONS: We found a lower incidence of PDPH with atraumatic needles, and it was statistically significant compared with the traumatic needles. Our study confirms the effectiveness of the atraumatic needles to prevent PDPH.

Daño coronario secundario a enfermedad de Kawasaki / Coronary Lesions in Kawasaki Disease

Introducción: La enfermedad de Kawasaki, una vasculitis aguda de origen desconocido, es actualmente la principal causa de cardiopatía adquirida durante la infancia y sus principales secuelas están relacionadas con las arterias coronarias, por lo que el reconocimiento temprano de la probabilidad de daño coronario posibilita el tratamiento oportuno para disminuir su ocurrencia. Objetivos: Determinar la probabilidad de sufrir daño coronario en pacientes con enfermedad de Kawasaki, reconocer los factores de riesgo para el desarrollo de lesión coronaria y la evolución a largo plazo de estos pacientes. Material y métodos: Se diagnosticó enfermedad de Kawasaki en 245 niños (octubre 1988 - diciembre 2013) con edad media de 3,48 años. Las variables analizadas fueron: edad, sexo, criterios clínicos y de laboratorio de enfermedad de Kawasaki, hallazgos ecocardiográficos y evolución a largo plazo. Se calculó el odds ratio para evaluar las diferentes variables analizadas como probables factores de riesgo de enfermedad coronaria. Resultados: Presentaron daño coronario 39 pacientes: 25 varones y 14 mujeres; edad media: 2,05 años. Se identificaron como factores de riesgo la edad < 3 años, la fiebre prolongada = 6 días, la eritrosedimentación > 50 mm/h, la proteína C reactiva > 100 mg/L y el hematocrito < 30%. Trece pacientes mostraron dilatación transitoria de las arterias coronarias, 12 pacientes aneurismas solitarios de tamaño pequeño o mediano, 7 pacientes aneurismas coronarios múltiples, 6 pacientes aneurismas coronarios gigantes y uno infarto agudo de miocardio por lesión obstructiva grave. La mortalidad hospitalaria fue del 4ë. Conclusiones: La probabilidad de presentar daño coronario en pacientes con enfermedad de Kawasaki fue del 15,91%. Los factores de riesgo para lesión coronaria detectados fueron: edad menor de 3 años, 6 o más días de fiebre, eritrosedimentación > 50 mm/h, proteína C reactiva > 100 mg/L y hematocrito < 30%. En los pacientes con daño coronario residual persistente tratados en forma convencional no hubo eventos adversos durante el seguimiento a mediano y a largo plazos.(AU)

Background: Kawasaki disease, a vasculitis of unknown origin, is currently the main cause of acquired heart disease during childhood and its main sequelae are associated with coronary arteries. Therefore, early identification of possible coronary lesions enables adequate treatment to decrease their occurrence. Objectives: The aims of this study were to determine the probability of coronary injury in patients with Kawasaki disease, to identify the risk factors for developing coronary lesions and the long-term outcome of these patients. Methods: A total of 245 children with mean age of 3.48 years were diagnosed with Kawasaki disease between October 1988 and December 2013. Age, sex, clinical and laboratory criteria of Kawasaki disease, echocardiographic findings and long-term outcome were analyzed, and the odds ratio was used to assess their participation as probable risk factors for coronary lesions. Results: Thirty-nine patients presented coronary lesions: 25 male and 14 female patients with mean age of 2.05 years. Risk factors were: age < 3 years; prolonged fever = 6 days, erythrocyte sedimentation rate > 50 mm/hr; C-reactive protein > 100 mg/l and hematocrit < 30%. Thirteen patients showed transient coronary artery dilation, 12 solitary small or medium-sized aneurysms, 7 multiple coronary aneurysms, 6 giant coronary aneurysms and one myocardial infarction by severe obstructive lesion. In-hospital mortality was 4ë. Conclusions: Risk of coronary artery lesions in patients with Kawasaki disease was 15.91%. Risk factors were age under 3 years, fever lasting more than 6 days, erythrocyte sedimentation rate > 50 mm/hr; C-reactive protein > 100 mg/L and hematocrit < 30%. In patients with persistent residual coronary lesions treated conventionally there were no adverse events in the mid- and long-term follow-up.(AU)

Daño coronario secundario a enfermedad de Kawasaki / Coronary Lesions in Kawasaki Disease

Introducción: La enfermedad de Kawasaki, una vasculitis aguda de origen desconocido, es actualmente la principal causa de cardiopatía adquirida durante la infancia y sus principales secuelas están relacionadas con las arterias coronarias, por lo que el reconocimiento temprano de la probabilidad de daño coronario posibilita el tratamiento oportuno para disminuir su ocurrencia. Objetivos: Determinar la probabilidad de sufrir daño coronario en pacientes con enfermedad de Kawasaki, reconocer los factores de riesgo para el desarrollo de lesión coronaria y la evolución a largo plazo de estos pacientes. Material y métodos: Se diagnosticó enfermedad de Kawasaki en 245 niños (octubre 1988 - diciembre 2013) con edad media de 3,48 años. Las variables analizadas fueron: edad, sexo, criterios clínicos y de laboratorio de enfermedad de Kawasaki, hallazgos ecocardiográficos y evolución a largo plazo. Se calculó el odds ratio para evaluar las diferentes variables analizadas como probables factores de riesgo de enfermedad coronaria. Resultados: Presentaron daño coronario 39 pacientes: 25 varones y 14 mujeres; edad media: 2,05 años. Se identificaron como factores de riesgo la edad < 3 años, la fiebre prolongada = 6 días, la eritrosedimentación > 50 mm/h, la proteína C reactiva > 100 mg/L y el hematocrito < 30%. Trece pacientes mostraron dilatación transitoria de las arterias coronarias, 12 pacientes aneurismas solitarios de tamaño pequeño o mediano, 7 pacientes aneurismas coronarios múltiples, 6 pacientes aneurismas coronarios gigantes y uno infarto agudo de miocardio por lesión obstructiva grave. La mortalidad hospitalaria fue del 4‰. Conclusiones: La probabilidad de presentar daño coronario en pacientes con enfermedad de Kawasaki fue del 15,91%. Los factores de riesgo para lesión coronaria detectados fueron: edad menor de 3 años, 6 o más días de fiebre, eritrosedimentación > 50 mm/h, proteína C reactiva > 100 mg/L y hematocrito < 30%. En los pacientes con daño coronario residual persistente tratados en forma convencional no hubo eventos adversos durante el seguimiento a mediano y a largo plazos.

Background: Kawasaki disease, a vasculitis of unknown origin, is currently the main cause of acquired heart disease during childhood and its main sequelae are associated with coronary arteries. Therefore, early identification of possible coronary lesions enables adequate treatment to decrease their occurrence. Objectives: The aims of this study were to determine the probability of coronary injury in patients with Kawasaki disease, to identify the risk factors for developing coronary lesions and the long-term outcome of these patients. Methods: A total of 245 children with mean age of 3.48 years were diagnosed with Kawasaki disease between October 1988 and December 2013. Age, sex, clinical and laboratory criteria of Kawasaki disease, echocardiographic findings and long-term outcome were analyzed, and the odds ratio was used to assess their participation as probable risk factors for coronary lesions. Results: Thirty-nine patients presented coronary lesions: 25 male and 14 female patients with mean age of 2.05 years. Risk factors were: age < 3 years; prolonged fever = 6 days, erythrocyte sedimentation rate > 50 mm/hr; C-reactive protein > 100 mg/l and hematocrit < 30%. Thirteen patients showed transient coronary artery dilation, 12 solitary small or medium-sized aneurysms, 7 multiple coronary aneurysms, 6 giant coronary aneurysms and one myocardial infarction by severe obstructive lesion. In-hospital mortality was 4‰. Conclusions: Risk of coronary artery lesions in patients with Kawasaki disease was 15.91%. Risk factors were age under 3 years, fever lasting more than 6 days, erythrocyte sedimentation rate > 50 mm/hr; C-reactive protein > 100 mg/L and hematocrit < 30%. In patients with persistent residual coronary lesions treated conventionally there were no adverse events in the mid- and long-term follow-up.

Tiroideopatías, deficiencia de yodo, de vitamina d y dislipidemias en una población de embarazadas / ThTyroid disorders, iodine deficiency, vitamin d deficiency and dyslipidemia in a pregnant population

INTRODUCCIÓN La disfunción y autoinmunidad tiroideas, el déficit de yodo, de vitamina D y la dislipidemia en el embarazo conllevan importantes efectos en la salud. No se cuenta con datos al respecto sobre la población estudiada. OBJETIVOS Determinar la prevalencia de endocrinopatías detectadas por pesquisa en embarazadas sanas y compararlas en grupos de alto y bajo riesgo obstétrico. Establecer la relación de TSH neonatal con parámetros maternos tiroideos. MÉTODOS Se estudió a 217 embarazadas sanas, con subdivisión en alto y bajo riesgo obstétrico. Se determinó TSH, T4 y T3 total y libre, anticuerpos a tiroperoxidasa, colesterol HDL, LDL, TAG y 25 OH Vitamina D (VD). Se tomó una muestra casual de orina para yoduria. Se establecieron los porcentajes de valores patológicos y se compararon entre embarazadas de alto y bajo riesgo. RESULTADOS Los ATPO fueron positivos en el 8%, el bocio en 38%, yoduria baja en el 58% y TSH elevada (según valor de corte de ATA) en el 11%. El 99% presentó niveles de VD<30 ng/mL, el 74,5%<20 ng/mL, el 24,2% entre 20 y 30 ng/mL y el 20,5%<10 ng/mL. Un 57% del total tuvo al menos un valor de lípidos fuera del rango de pacientes no embarazadas, el 37% LDL>130 mg/dL y el 33% TAG>150mg/dL; ambos aumentaron al avanzar el embarazo. La comparación entre los grupos de alto y bajo riesgo obstétrico sólo mostró una diferencia significativa en T4L. La yoduria se correlacionó con TSH neonatal. DISCUSIÓN La alta prevalencia de disfunción tiroidea calculada con rangos de ATA es francamente menor si se evalúa con el rango obtenido del presente estudio, lo cual remarca la importancia de lograr valores propios. La alta prevalencia de déficit de vitamina D supone un beneficio en la suplementación en las embarazadas. Es importante determinar valores normales de lípidos