Neonatal Hyperglycemia due to Transient Neonatal Diabetes Mellitus in Puerto Rico.

Neonatal hyperglycemia is a metabolic disorder found in the neonatal intensive care units. Neonatal diabetes mellitus (NDM) is a very uncommon cause of hyperglycemia in the newborn, occurring in 1 in every 400,000 births. There are two subtypes of neonatal diabetes mellitus: permanent neonatal diabetes mellitus (PNDM) and transient neonatal diabetes mellitus (TNDM). We describe a term, small for gestational age, female neonate with transient neonatal diabetes mellitus who presented with poor feeding tolerance and vomiting associated with hyperglycemia (385 mg/dL), glycosuria, and metabolic acidosis within the first 12 hours of life. The neonate was treated with intravenous insulin, obtaining a slight control of hyperglycemia. An adequate glycemia was achieved at 5 weeks of life. The molecular studies showed complete loss of maternal methylation at the TND differentially methylated region on chromosome 6q24. The etiology of this neonate's hyperglycemia was a hypomethylation of the maternal TND locus. A rare cause of neonatal diabetes mellitus must be considered if a neonate presents refractory hyperglycemia. To our knowledge, this is the first case reported in Puerto Rico of transient neonatal mellitus due to the uncommon mechanism of maternal hypomethylation of the TND locus. Its prevalence in Puerto Rico is unknown.

Rate of weight gain in very-low birth weight Puerto Rican neonates

BACKGROUND: Small for gestational age neonates have a higher risk of growth delay. The purpose of the study is to determine if there are differences in their early weight gain patterns that persist after adjusting for confounding variables. METHODS: Two-hundred sixteen neonates born between 1999 and 2003 were included. The group for analysis was derived by matching all the SGA infants with AGA infants by sex, year of birth, and birth weight. The period of observation was from birth to date of discharge. Weight gain rate was defined as grams gained per kilogram of birth weight per day. Two sample T-test was used to determine the difference in growth rate between the groups. Simple regression was used to establish the effect of morbidities on weight gain rate. RESULTS: The total mean birth weight was 1105 g (+/- 223 g), the mean gestational age was 30 weeks (+/- 2.7 weeks), and the mean weight gain rate was 13.4 g/kg/d (+/- 6.8 g/kg/d). The mean weight gain rate for the adequate for gestational age group was lower (11.9 g/kg/d +/- 7.6g versus 14.9 g/kg/d +/- 5.5 g) (P < 0.001). When all variables were analyzed using the lineal regression model, only having a low APGAR score (P = 0.02) and being small for gestational age (P = 0.0004) were significant. CONCLUSIONS: We conclude that the growth patterns of very low birth weight neonates are different based on the adequacy of their birth weight, and that the disparity in growth rate is not explained by the differences in the incidence of morbidities that affect growth.

Respiratory syncytial virus-related bronchiolitis in Puerto Rico

BACKGROUND: Respiratory syncytial virus (RSV) is an important cause of respiratory tract disease in infants and young children. Immunoprophylaxis is available for high-risk infants. This study reviews infants with bronchiolitis at three primary care hospitals to describe the epidemiology of RSV infection in Puerto Rico. METHODS: We analyzed data from 2 hospitals by obtaining the number of infants diagnosed with bronchiolitis and estimating the percentage of cases due to RSV. A third hospital included patients with confirmed RSV infection. RESULTS: There were 4,557 patients in the study. RSV infection occurred throughout the year. Data shows a progressive decrease in RSV-positive infections. CONCLUSIONS: Data confirms year-round incidence of RSV in Puerto Rico. A standardized surveillance system in Puerto Rico is imperative to determine RSV epidemiology. The decrease in positive RSV infections may be due to the introduction of immunoprophylaxis to high-risk patients.

[Central serous chorioretinopathy versus sympathetic ophthalmia. Case report]. / Coroidopatía serosa central versus oftalmía simpática. A propósito de un caso.

CLINICAL CASE: A 29 year old patient with a history of sutured corneal wound treated with oral antibiotics and steroids. After stopping steroid treatment, he referred reduced visual acuity in the non-traumatized eye. Previous treatment was reintroduced and he was referred to our hospital diagnosed with sympathetic ophthalmia. Bilateral macular folds, white and yellowish lesions, and subretinal fluid were found. DISCUSSION: The association of stress, anxious personality, and steroid use can favor atypical presentations of central serous chorioretinopathy.

Determination of monoterpene hydrocarbons and alcohols in Majorana hortensis Moench by micellar electrokinetic capillary chromatographic.

Micellar electrokinetic capillary chromatography was used to determine the essential oils obtained by steam distillation of different samples of marjoram (Majorana hortensis Moench) dried leaves and flowers. The electrophoretic method consisted of a running buffer of 10 mM NaH2PO4, 6 mM Na2B4O7, 50 mM SDS, 7 mM gamma-cyclodextrin, and 10% acetonitrile, adjusted to pH 8.0 by the addition of 0.1 M H3PO4. The following monoterpene hydrocarbons and alcohol compounds were extracted from real samples and determined by the method proposed: alpha-pinene, gamma-terpinene, alpha-terpinene, terpinolene, p-cymene, linalool, alpha-terpineol, and terpinen-4-ol. The most prominent component of dried leaves, flowers, and commercial samples was terpinen-4-ol in four of the samples analyzed; only in one sample was alpha-terpineol present as the major compound.

Persistence of vaccine-derived poliovirus following a mass vaccination campaign in Cuba: implications for stopping polio vaccination after global eradication.

BACKGROUND: With substantial progress made toward polio eradication, developing the appropriate strategy for discontinuing global oral poliovirus vaccine (OPV) after global eradication becomes increasingly important. At issue is the theoretical risk of independent circulation of potentially virulent OPV-derived strains. Because Cuba uses OPV only in mass campaigns, it represents an ideal site to assess vaccine-derived poliovirus persistence. METHODS: Infants born after the 1997 biannual mass campaigns were evaluated for past (neutralizing antibody) or current (virus excretion) evidence of vaccine-derived poliovirus exposure. We obtained sera and/or stool specimens from 861 infants; a second serum from 218 infants. RESULTS: All stool specimens were poliovirus negative. Of 762 infants, 113 (14.8%) had initially detectable poliovirus type 1 antibody, 193 (25.3%) type 2, and 94 (12.3%) type 3. A precipitous antibody decline occurred in initially positive sera. CONCLUSIONS: Our results suggest that in a country with high population immunity, vaccine-derived virus is unlikely to establish ongoing circulation.

Use of eosin as a fluorophore in capillary electrophoresis with laser detection.

Eosin has been used to generate the background signal for indirect fluorimetric detection of inorganic and organic ions, simultaneously separated by capillary zone electrophoresis (CZE). This reagent provides constant fluorescence over the pH range of 5-10 and is compatible with the excitation by an argon ion laser at 488 nm with emission at 520 nm. The use of esosine as fluorophore, H3BO3, and Na2B4O7 as electrolyte and diethylentriamine as modifier of the electroosmotic flow in CZE were optimised. The analytical potential of the studied buffer was tested on a group of 12 anions, used as model compounds. Both, hydrodynamic and electrokinetic injection mode were optimised. The detection limits determined by the last injection mode, were in the range 0.008-0.037 mg l(-1). By using this method, the quantitation of the common anions in tap and mineral water has been carried out successfully.

Effect of prenatal T4 treatment in neonatal morbidity: preliminary findings.

We report our experience with the use of intra-amniotic thyroxine to accelerate fetal maturation in preterm delivered infants. One hundred and fourteen infants who had received 500 micrograms of thyroxine weekly prenatally until an L/S ratio greater or equal to 2.0 was achieved, were compared to 113 premature infants who had not been given thyroxine or steroids prenatally. After stratification by weight, the relative incidence of respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC) and intraventricular hemorrhage (IVH) were compared. A decrease in the incidence of RDS was observed in the infants with birth weight between 1000 and 1500 g who had received more than one dose of intra-amniotic thyroxine. No difference in the incidence of RDS was observed in infants with birth weight of less than 1000 g or over 1500 g. One dose of thyroxine had no effect in decreasing the incidence of RDS, PDA, NEC, and IVH in any of the groups. We conclude intra-amniotic thyroxine seems to decreases the incidence of RDS in very low birth weight infants.

Effect of prenatal T4 treatment in neonatal morbidity: preliminary findings

We report our experience with the use of intra-amniotic thyroxine to accelerate fetal maturation in preterm delivered infants. One hundred and fourteen infants who had received 500 micrograms of thyroxine weekly prenatally until an L/S ratio greater or equal to 2.0 was achieved, were compared to 113 premature infants who had not been given thyroxine or steroids prenatally. After stratification by weight, the relative incidence of respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC) and intraventricular hemorrhage (IVH) were compared. A decrease in the incidence of RDS was observed in the infants with birth weight between 1000 and 1500 g who had received more than one dose of intra-amniotic thyroxine. No difference in the incidence of RDS was observed in infants with birth weight of less than 1000 g or over 1500 g. One dose of thyroxine had no effect in decreasing the incidence of RDS, PDA, NEC, and IVH in any of the groups. We conclude intra-amniotic thyroxine seems to decreases the incidence of RDS in very low birth weight infants

Diagnostic exposure in a primary care clinic during pediatric training.

A retrospective and descriptive study was done in a general pediatric training site with the purpose of identifying the diagnoses to which the trainees have been exposed, as well as the changes in the pattern of these diagnoses. The number of patient-doctor contacts, type of patient visit, and frequency of diagnoses were compared. A total of 66,054 patient-doctor contacts occurred during the years 1979 to 1989, comprising 79.6 percent scheduled health visits and 20.4 percent emergency visits. The main diagnoses were: healthy child/adolescent (HV), well baby (WB), upper respiratory infection, skin diseases, bronchial asthma, acute gastroenteritis, otitis media, anemia, incomplete immunization, psychosocial problems, nutritional/linear growth problems, psychosomatic disturbances, parasitosis, and pneumonia. There was a significant decrease (P < .005) in the diagnosis of infectious diseases and a significant increase (P < .005) in the proportion of WB and HV. The latter were the two most common diagnoses in the year 1989.

Abnormal hemoglobins detected in screening of Puerto Rican population.

Cinco mil cuatrocientos setenta y tres personas, incluyendo neonatos, adolescentes, mujeres embarazadas y varones adultos de San Juan y pueblos cercanos fueron examinados para detectar hemoglobinopatias por electroforesis en 1977-78. Se encontraron 210 casos (3.90 por ciento) de hemoglobinas anormales, incluyendo 190 (3.5 por ciento) de Hb S y 20 (0.4 por ciento) de Hb C. La prevalencia de Hb S y C entre los adolescentes del area de San Juan fue de 4.2 por ciento. Pero la prevalencia en adolescentes del pueblo de Loiza fue de 8.7 por ciento. Los datos indican que la prevalencia de Hb AS y AC en la poblacion cercana, excluyendo a Loiza, es de 3.1 por ciento, la cual es claramente distinta a la prevalencia en la comunidad de Loiza (8.7 por ciento). El hallazgo de 210 casos de hemoglobinas anormales incluyendo dos de Hb SS entre 5,473 personas cernidas y 177 de Hb AS entre 512 personas referidas indican que hay una necesidad para continuar proveyendo educacion deteccion y consejeria sobre hemoglobinopatias en la poblacion puertorriquena