Toxins from Physalia physalis (Cnidaria) raise the intracellular Ca(2+) of beta-cells and promote insulin secretion.

Physalia physalis is a marine cnidarian from which high molecular weight toxins with hemolytic and neurotoxic effects have been isolated. In the present work, two novel toxins, PpV9.4 and PpV19.3 were purified from P. physalis by bioactive guideline isolation. It involved two steps of column chromatography, gel filtration and RP-HPLC. The molecular weights were 550.7 and 4720.9 Da for PpV9.4 and PpV19.3, respectively. In the light of the Edman sequencing results, the structure of these toxins included the presence of modified amino acids. Both toxins increased the percentage of insulin secreting beta-cells and induced cytosolic Ca2+ elevation. To date, this is the first report of low molecular weight toxins increasing insulin secretion purified from cnidarians, by constituting a new approach to the study of beta-cells physiology.

Chemical composition of ice pops produced in a microindustry from hidalgo, Mexico / Composición quimica de paletas congeladas producidas en una microindustria de hidalgo, México

The chemical composition of water and milk based ice pops produced by a microindustry in Hidalgo, Mexico were determined. Fifteen samples of several flavors were analyzed. The proximate composition was carried out according AOAC techniques. The identification and quantification of fatty acids in the milk based ice pops was performed by Gas Chromatography provided with a flame ionization detector. Water based ice pops did not present a significant nutritional value. Regarding milk based ice pops all samples contained from 6.83 to 12.7% offat and some samples showed interesting contents of protein (3.55 and 4.21%). The fatty acid profile revealed higher contents of unsaturated fatty acids compared with saturated fatty acids. Trans fatty acids were detected in five of seven milk based samples, representing 20-60% of total fatty acids. Analysis showed that the mixes used to prepare ice pops are different according to their flavor, kind, and amount of fruit which alters their nutritional value and the levels of trans-fatty acids.

Se determinó la composición química de paletas congeladas, en base agua y en base láctea, producidas por una microindustria en Hidalgo, México. Se analizaron quince muestras de diferentes sabores. La composición proximal se llevó a cabo de acuerdo a las técnicas de la AOAC. La identificación y cuantificación de ácidos grasos en las paletas base láctea se realizó por cromatografía de gases con detector de ionización de llama. Las paletas base agua no presentaron un valor nutricional significativo. Con respecto a las paletas base láctea, se observaron contenidos de grasa de 6.83 a 12.7%; algunas presentaron valores interesantes de proteína (3.55 y 4.21%). El perfil de ácidos grasos reveló altos contenidos de ácidos grasos insaturados comparados con los saturados. Cinco de las siete paletas de base láctea analizadas presentaron ácidos grasos trans, representando 20-60% del total de ácidos grasos. Los análisis realizados han mostrado que las mezclas usadas para preparar las paletas son diferentes de acuerdo a su sabor, tipo y cantidad de fruta la cual modifica el valor nutricional y el nivel de ácidos grasos trans.

AUMENTO DEL CONTENIDO PROTEICO DE UNA BEBIDA A BASE DE AMARANTO (Amaranthus hypochondriacus) / INCREASING THE PROTEIN CONTENT OF AN AMARANTH (Amaranthus hypochondriacus) DRINK

The aim of this work was to increase the protein content ofan amaranth drink (Amarantole) with different proteins sources (chickpea, pea, lacto serum, powdered milk and soybean milk). Different mixtures of Amarantole-protein mix were prepared in four proportions (80:20,75:25,70:30 and 60:40). The best mixtures were selected according to the increase in the protein content and its sensory characteristics assayed by using degree of liking, preference and ranking test. Chemical and mineral composition was determined according to the AOAC techniques. Protein quality was determined by the Protein Efficiency Ratio test (PER) and in vivo digestibility. Amarantole-lacto serum show the highest percent cent in protein content (22.66 percent). The minerals more abundant in all the mixtures were Ca, K, Mg and Na. In general, all the mixtures presented highest values of PER (2.61 a 3.26) than the reference (casein PER=2.5) diet. Mixtures added of lactoserum and milk-lactoserum (88.19 y 86.0 percent) presented a similar digestibility to the casein diet (91.28 percent). In conclusion, Amarantole-lactoserum mixture showed the best characteristics concerning protein content, digestibility and PER value.

El objetivo de este trabajo fue aumentar el contenido proteico de una bebida a base de amaranto (Amaranto-le) mediante la adición de diferentes fuentes proteicas (garbanzo, alverja, lactosuero, leche en polvo, leche de soya). Se prepararon mezclas de Amarantole-fuente proteica en cuatro proporciones distintas (80:20, 75:25, 70:30 y 60:40). Las mejores mezclas fueron seleccionadas en base a su aumento en el contenido proteico y sus características organolépticas detectadas mediante pruebas de grado de satisfacción, de preferencia y de ordenamiento. La composición química y mineral de las mezclas seleccionadas fue determinada mediante técnicas del AOAC. La calidad proteica se determinó a través de la prueba de Relación de Eficiencia Proteica (REP) y la digestibilidad in vivo. Amarantole-lactosuero alcanzó el porcentaje de proteína más elevado (22.66 por ciento). Los minerales más abundantes en todas las mezclas fueron: Ca, K, Mg y Na. En general, todas las mezclas, presentaron valores de REP (2.61 a 3.26) superiores a la dieta de referencia (caseína REP=2.5). Las mezclas adicionadas de lactosuero y leche en polvo-lactosuero (88.19 y 86.0 por ciento) presentaron una digestibilidad similar a la dieta de caseína (91.28 por ciento). En conclusión, la muestra Amarantole-lactosuero fue la mezcla que presentó las mejores características en cuanto a contenido de proteína, digestibilidad y valor de REP.

Intervención educativa de enfermería para la rehabilitación de personas con una ostomia / Educative intervention of nursering in the rehabilitation of an ostomized person

Introducción: El incremento del número de personas poseedoras de un estoma, trae consigo la necesidad de contar con personal capacitado para proporcionarle los elementos necesarios para su reintegración a la vida social, familiar y laboral. Objetivo: Analizar el efecto que tiene la intervención educativa de enfermería para la rehabilitación de personas con una ostomia. Metodología: Se trata de un estudio de tipo cuasi-experimental, la muestra se constituyó de 110 personas ostomizadas de cuatro hospitales a las que se les aplicó un instrumento que fue validado por expertos en el área. Para el análisis de datos se utilizó estadística descriptiva e inferencial por medio de la X2. Resultados: En los resultados se observa diferencia estadísticamente significativa entre la intervención educativa y la rehabilitación laboral (p=0.000), también se observo diferencia estadísticamente significativa entre la intervención educativa y la rehabilitación social y familiar (p=0.000). Discusión: Coincidiendo con Montovani en donde afirma que la falta de información, educación y comunicación son la causa para que el paciente no pueda participar activamente en su autocuidado. De acuerdo con Boccardo se establece que la mayoría de los pacientes ostomizados no retornan totalmente al trabajo pero si parcialmentea sus actividades siendo ésta la parte más difícil de superar. Conclusiones: Se sustenta que la intervención educativa en personas ostomizadas planificada,estandarizada y evaluada, es fundamental para lograr su rehabilitación educativa, laboral, social y familiar.

Venous graft thrombosis in patients on peritoneal dialysis before transplantation.

BACKGROUND: It has been described that patients on peritoneal dialysis (PD) suffer from thrombotic events (vascular access, deep venous thrombosis, and graft thrombosis) more frequently after transplantation than other recipients. We analyzed the incidence of allograft thrombosis among patients transplanted in a 6-year period (January 1, 2000, to December 31, 2005) to identify etiological factors, such as inherited thrombophilia. MATERIALS AND METHODS: We performed 197 renal transplants in 189 patients, including 115 who had been on hemodialysis (HD), 44 on PD, and 30 preemptive. We recorded immunological and demographic data, studied graft and patient survivals, and evaluated the hypercoagulable state of those who experienced graft thrombosis. RESULTS: The mean age of the patients at transplantation was 49 years. There were no demographic or immunological differences between the three groups of patients, except for the number of previous blood transfusions and panel reactive antibodies (PRA) levels. Forty-seven grafts were lost in the first year; 14 suffered venous thrombosis, and there were 10 acute rejection epidoses (ARE), 7 death-censored graft failures, 3 chronic allograft nephropathies (CAN), 6 primary nonfunctions, 5 removed due to infection, 1 primary disease relapse, and 1 hemolytic-uremic syndrome. Of the 14 cases of thrombosis in 12 patients, 10 had been on PD and 4 on HD immediately before transplant. One-year graft and patient survivals were similar: 74% HD, 68% PD, 86% preemptive, and 93% HD, 95% PD, and 96% preemptive, respectively. The hypercoagulable state showed inherited thrombophilia patterns in some cases, but most of them were normal. CONCLUSION: Renal graft thrombosis was responsible for graft lost in PD patients within the first year, while in the HD group it was ARE and in the preemptive cohort, death with a functioning graft. The hypercoagulable state pretransplant should be more accurately studied to identify thrombotic factors other than those which are inherited.

Relevance of chronic kidney disease classification (K/DOQI) in renal transplant patients.

The National Kidney Foundation has developed guidelines for diagnosis and classification of chronic kidney disease (CKD) but it is not known whether they are applicable to renal transplant patients. This study analyzed the prevalence, the complications, and the influence of the CKD stage on the presence of complications in 506 stable transplant recipients. The mean age of the patients was 52.9 +/- 12 years, 34% were men, and the mean time after transplantation was 9.56 +/- 6.18 years. CKD was present in 90.3% with 9.9% were in CKD stages 4 or 5 with glomerular filtration rates lower than 30 mL/min per 1.73 m(2). The prevalence of anemia, phospho-calcium metabolism disorders, hypertriglyceridemia, and hypertension increased with the stage of CKD. We concluded that CKD and the complications of CKD were highly prevalent in renal transplant recipients. The classification of renal transplant patients by CKD stage may help clinicians to identify patients at increased risk and to target appropriate therapy to improve outcomes.

[Microscopic polyangiitis in a patient with rheumatoid arthritis]. / Poliangeítis microscópica en paciente con artritis reumatoide.

Rheumatoid arthritis (RA) is a systemic disorder that primary involves joints, although renal disease has also been associated it is not common that rapidly progressive glomerulonephritis (RPGN) appears. We report the case of a patient with nodular and aggressive RA who had an acut renal failure secondary to ANCA positive RPGN due to a Microscopic polyangiitis who was not responsive to steroids and cyclophosphamide therapy.

Poliangeítis microscópica en paciente con artritis reumatoide / Microscopic polyangiitis in a patient with rheumatoid arthritis

La artritis reumatoide (AR) es una enfermedad sistémica que afecta principalmente a las articulaciones, puede producir afectación renal aunque es poco frecuente que lo haga en forma de glomerulonefritis rápidamente progresiva (GNRP). Presentamos el caso de una paciente con AR nodular de larga evolución que presentó un fracaso renal agudo secundario a GNRP con ANCA+ en el seno de una poliangeítis microscópica (PM) con mala evolución a pesar del tratamiento

Rheumatoid arthritis (RA) is a systemic disorder that primary involves joints, although renal disease has also been associated it is not common that rapidly progressive glomerulonephritis (RPGN) appears. We report the case of a patient with nodular and aggressive RA who had an acut renal failure secondary to ANCA positive RPGN due to a Microscopic polyangiitis who was not responsive to steroids and cyclophosphamide therapy

Impact of HLA antibodies on transplant glomerulopathy.

The influence of humoral rejection on the development of chronic allograft nephropathy (CAN) is controversial, especially in relation to transplant glomerulopathy. The aim of our study was to analyse the influence of anti-HLA antibodies on the development of transplant glomerulopathy (cg0, cg1, cg2, and cg3; Banff'97). We selected all renal transplants patients from 1975 to 2003 who had a functioning graft for at least 6 months and a clinically indicated graft biopsy with CAN and chronic glomerular changes (case group). We studied the presence of anti-HLA antibodies (Ab) in the last serum taken while the graft was functioning and divided them into three groups according to the severity of glomerular lesions. We also selected 52 contemporary and comparable cases without transplant glomerulopathy (control group). A total of 77 case had transplant glomerulopathy: 39 cg1, 29 cg2, and 9 cg3. Pretransplant Ab titers and number of previous blood transfusions were higher among the subgroup with the most severe glomerulopathy. Patients who developed posttransplant anti-HLA Ab more frequently showed transplant glomerulopathy. Serum creatinine and proteinuria were higher among cases with chronic glomerulopathy, and more grafts were lost in that group. Thus, the presence of HLA-Ab is a key factor in the development of transplant glomerulopathy and chronic allograft rejection.

[Clinical suspicion of vertebral osteomielitis: back pain in patients with hemodyalisis by catheter related infection]. / Sospecha clínica de osteomielitis vertebral: dolor de espalda en los pacientes con infección asociada a catéter de hemodiálisis.

The overall incidence of vertebral osteomyelitis is increasing due to, the increasing rates of bacteraemia due to intravascular devices. We report a patient with end-stage renal failure under hemodialysis by internal jugular catheters who started with back pain after several episodes of Staphylococcus aureus bacteraemia, and whose magnetic resonance imaging was showed signs suggestive of spondylodiscitis. Other 4 similar cases from our service have been analysed, thereby we can conclude the most effective treatment of vertebral osteomyelitis and/or epidural abscess is premature diagnosis of these pathologies. Magnetic resonance imaging is the most sensitive radiologic technique whom we have. Treatment of vertebral osteomyelitis must be preceded by a correct bacteriological diagnosis. Surgery plays a central role in the successful treatment and should be performed as soon as neurological problems are apparent.

Effects of aqueous extracts of Halimeda incrassata (Ellis) Lamouroux and Bryothamnion triquetrum (S.G.Gmelim) Howe on hydrogen peroxide and methyl mercury-induced oxidative stress in GT1-7 mouse hypothalamic immortalized cells.

The current investigation focuses attention on the neuroprotective and antioxidant properties of aqueous extracts from Halimeda incrassata (Hi) and Bryothamniom triquetrum (Bt) in the mouse immortalized hypothalamic GT1-7 cell line. Under basal oxidative conditions, Hi extract reduces intracellular reactive oxygen species production, as assessed by 2',7'-dichlorofluorescein fluorescence, while Bt extract does not contribute to basal ROS generation. Both extracts, at concentrations higher than 0.20 mg/ml, exert protection against hydrogen peroxide-mediated cell death, although only Hi extract can additionally prevent hydrogen peroxide-induced ROS production. The two seaweed aqueous extracts, at concentrations higher than 0.05 mg/ml, also display protection against neuronal death induced by methyl mercury chloride, as well as against methyl mercury chloride-mediated ROS generation. None of the extracts increase GSH intracellular pools, in basal conditions, after depleting its levels with either hydrogen peroxide or methyl mercury chloride. Some comments on the probable targets of the neuroprotection exerted by these two extracts are included in this paper.

Tolerability profiles of rofecoxib (Vioxx) and Arthrotec. A comparison of six weeks treatment in patients with osteoarthritis.

OBJECTIVE: To compare the incidence of selected spontaneously reported adverse events (AEs) in patients with osteoarthritis (OA) treated with rofecoxib (VIOXX, 12.5 mg qd) or Arthrotec (diclofenac 50 mg/misoprostol 200 mcg bid). METHODS: Double-blind, parallel-group, 6-week study of patients aged > or = 40 years with a clinical diagnosis of OA treated with rofecoxib or Arthrotec. Primary endpoint: self-reported diarrhea; secondary endpoints: abdominal pain, discontinuations due to AEs, GI AEs and NSAID-type GI AEs (ie., acid reflux, dyspepsia, epigastric discomfort, heartburn, nausea, vomiting). RESULTS: Among 483 patients (80.3% females, mean age 62.1), the rofecoxib group vs the Arthrotec group respectively reported diarrhea 6.2% vs 16.2% (p<0.001); drug-related diarrhea 3.7% vs 16.2% (p<0.001); one or more clinical AEs 52.9% vs 73.0% (p<0.001); GI AEs 28.9% vs 48.5% (p<0.001); NSAID-type GI AEs 18.6% vs 29.9% (p=0.004); discontinuations due to abdominal pain 0.4% vs 3.7% (p<0.05); and discontinuations due to any AE 4.1% vs 9.1% (p=0.029). No significant differences were observed in efficacy. CONCLUSION: Rofecoxib 12.5 mg qd has improved GI tolerability and similar efficacy compared to Arthrotec (diclofenac 50 mg/misoprostol 200 mcg bid).

A randomized trial of the efficacy and tolerability of the COX-2 inhibitor rofecoxib vs ibuprofen in patients with osteoarthritis. Rofecoxib/Ibuprofen Comparator Study Group.

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit both cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2). It is not known whether a specific inhibitor of COX-2 will provide efficacy in osteoarthritis (OA) comparable with NSAIDs. Therefore, we compared the efficacy and safety of the rofecoxib, which specifically inhibits COX-2, with those of the NSAID ibuprofen in patients with OA. OBJECTIVE: To compare the clinical efficacy and tolerability of rofecoxib (12.5 and 25 mg once daily) with ibuprofen (800 mg 3 times daily). METHODS: A randomized, double-blind trial of 809 adults with OA was conducted. Patients with OA in whom the knee or hip was the primary source of pain were randomized to 1 of 4 treatment groups on demonstration of disease activity: placebo; rofecoxib, 12.5 or 25 mg once daily; or ibuprofen, 800 mg 3 times daily. Clinical efficacy and safety were monitored during a 6-week treatment period. RESULTS: Both doses of rofecoxib demonstrated efficacy clinically comparable with ibuprofen as assessed by 3 primary end points (pain walking on a flat surface [Western Ontario and McMaster Universities Osteoarthritis Index], patient global assessment of response to therapy, and investigator global assessment of disease status) according to predefined comparability criteria. Both rofecoxib doses and the ibuprofen dose provided significantly (P<.001) greater efficacy than placebo on all primary end points. Results from secondary end points were consistent with those of the primary end points. All treatments were well tolerated; the overall incidence rates of clinical adverse experiences were not significantly different (P>.05) among the treatment groups. CONCLUSION: Rofecoxib was well tolerated and provided clinical efficacy comparable with a high dose of the NSAID ibuprofen.

HLA-DRB and HLA-DQB loci in the genetic susceptibility to develop glaucoma in Mexicans.

PURPOSE: Glaucoma is a clinically heterogeneous disease with a pathophysiology that may include genetic susceptibility, possibly associated with an immunologic disorder. The aim of this study was to determine whether the DNA polymorphisms located in the HLA-DRB1 and HLA-DQB1 genes show a specific association pattern in Mexican mestizo patients with primary open-angle glaucoma. METHODS: This was a cross-sectional, case-control, multicenter study. We analyzed the HLA-DRB1 and DQB1 loci of 81 Mexican mestizo nonrelated patients with primary open-angle glaucoma and 98 healthy ethnic matched control subjects. Patients were diagnosed clinically and by visual fields examination. HLA typing was performed by PCR-SSO reverse dot blot. RESULTS: We documented increased frequencies of HLA-DRB1*0301, DRB1*1101, DRB1*0701, DRB1*1402, DQB1*0302, and DQB1*0301; however, none of them were significantly different from normal control subjects. Haplotype analysis showed that the HLA-DRB1*0407-DQB1*0302 haplotype is significantly increased in patients compared with control subjects (P = .0001). CONCLUSIONS: The haplotype HLA-DRB1*0407-DQB1*0302 is common among Mexican mestizo (haplotype frequency = 0.102), and it was increased in our patients (haplotype frequency = 0.259, P = .0001). This may reflect an independent association of this haplotype with the disease as the result of linkage disequilibrium or the influence of a neighboring gene. The pathophysiology of this illness is uncertain, and further studies are needed regarding the genetic susceptibility to develop primary open-angle glaucoma.

A potassium-channel toxin from the sea anemone Bunodosoma granulifera, an inhibitor for Kv1 channels. Revision of the amino acid sequence, disulfide-bridge assignment, chemical synthesis, and biological activity.

The potassium channel toxin secreted by the sea anemone Bunodosoma granulifera (BgK) is a 37-amino-acid peptide containing three disulfide bridges. Because a synthetic peptide corresponding to the reported sequence of BgK was found not to fold properly, the sequence was determined again. The new sequence differed from the previous one in the C-terminal tetrapeptide, which contains two cysteines involved in disulfide bridging. The revised sequence is: V C R D W F K E T A C R H A K S L G N C R T S Q K Y R A N C A K T C E L C. The toxin BgK was synthesized according to the new sequence and folded successfully. Disulfide bridges were assigned by peptide mapping on both natural and synthetic forms to be between Cys2-Cys37, Cys11-Cys30 and Cys20-Cys34. The toxin contains a C-terminal free carboxylate as shown by comparing the native toxin with two synthetic peptides containing the C-terminus in either the carboxylate or carboxamido form. Synthetic BgK inhibits binding of 125I-alpha-dendrotoxin to rat brain synaptosomal membranes, similarly to natural BgK (nanomolar range). No activity was observed on maxi-K+ channels incorporated into planar lipid bilayers. The ability of BgK to block voltage-dependent K+ channels was determined from recordings of whole cell currents in Xenopus oocytes injected with cRNA encoding three cloned Kv1 channels (Kv1.1, Kv1.2, Kv1.3) and one Kv3 (Kv3.1) channel. The Shaker-related Kv1 channels are equally affected by BgK, while the Shaw-related channel Kv3.1 is insensitive up to 0.125 microM toxin. Indeed, half blockage of the current through the three Kv1 channels tested occurred in the same concentration range (Kd = 6 nM for Kv1.1, 15 nM for Kv1.2, 10 nM for Kv1.3). The specificity of BgK for the Shaker-related K+ channels indicates that BgK is able to discriminate a large group of neuronal Kv1 channels in situ. The sequence, the disulfide bridge pattern, the secondary structure and the biological activity of BgK demonstrated that the sea anemone toxins, i.e. BgK, ShK and Kaliseptine, constitute novel molecular probes useful for investigating K+ channel properties.

[Nutrients in 39 Mexican coastal lagoons]. / Nutrientes en 39 lagunas costeras mexicanas.

An analysis of 39 Mexican coastal lagoons most in tropical environments, shows no nutrient limitation for primary productivity: even minimum nutrient values are higher than those of similar systems (mostly of temperate zones). In some cases, nutrient variations are large and indicative of heterogeneity. The N:P ratio is more important than simple nutrient concentrations. Using this ratio, coastal lagoons are classified as limited in nitrogen (< 5) or phosphorus (> 10).

Characterization of a potassium channel toxin from the Caribbean Sea anemone Stichodactyla helianthus.

A peptide toxin, ShK, that blocks voltage-dependent potassium channels was isolated from the whole body extract of the Caribbean sea anemone Stichodactyla helianthus. It competes with dendrotoxin I and alpha-dendrotoxin for binding to synaptosomal membranes of rat brain, facilities acetylcholine release at an avian neuromuscular junction and suppresses K+ currents in rat dorsal root ganglion neurones in culture. Its amino acid sequence is R1SCIDTIPKS10RCTAFQCKHS20MKYRLSFCRK30TCGTC35. There is no homology with other K+ channel-blocking peptides, except for BgK from the sea anemone Bunodosoma granulifera. ShK and BgK appear to be in a different structural class from other toxins affecting K+ channels.

[Diabetic neuropathy. Current concepts on etiopathogenesis, diagnosis, and treatment]. / Neuropatía diabética. Conceptos actuales sobre etiopatogénesis, diagnóstico y tratamiento.

Diabetic neuropathy (DN) is chronic complication which occurs in 50% of long standing diabetes mellitus. DN is a consequence of hyperglycemia probably through the following mechanisms: a) activation of aldose-reductase, intracellular sorbitol accumulation and myoinositol depletion, reduced activity of Na+/K+ATPase, loss of Na+ channels and demyelination; b) proteins glycation; c) microangiopathy; the first mechanism being the best known and the most reliable. DN may be subclinical or clinical. The main clinical picture is a peripheral, bilateral, symmetric polyneuropathy with a "socks and gloves" sensory impairment, muscular weakness, hyporeflexia, plantar ulcers and arthropathy. Less frequent syndromes are proximal motor neuropathy and mononeuropathy of cranial nerves or thoraco-abdominal roots. Diagnosis is based on clinical data, and may be sustained on impaired nerve conduction velocity, abnormal evoked somatosensory potentials, or sural nerve biopsy. These methods are highly sensitive but unspecific. Etiopathogenic treatment is based on glycemic control and aldose reductase inhibitors. Improvement in clinical, electrophysiologic and histopathologic data have been obtained with the latter. Symptomatic treatment includes carbamazepin, phenytoin, tricyclic antidepressives and a phenotiazin. Mononeuropathies tend to complete recovery in less than 6 months. Polyneuropathy is thought to be irreversible and progressive; however, with excellent glycemic control or with aldose reductase inhibitors nerve damage may be stabilized or even reversed.

Sternoclavicular brucellar arthritis: a report of 7 cases and a review of the literature.

OBJECTIVE: To describe the clinical features of sternoclavicular arthritis. METHODS: Medical records review of patients with sternoclavicular brucellar arthritis diagnosed and treated in a University Hospital in Lima, Peru. RESULTS: Over a 21-year period, 1,729 cases of brucellosis were diagnosed and treated. Seven patients with sternoclavicular arthritis were identified; 5 had an acute course with current or past evidence of systemic infection. Four patients had involvement of another joint and one of the 7 developed a chest wall abscess. All patients recovered without sequelae. CONCLUSION: Recovery without sequelae is expected if patients with sternoclavicular brucellar arthritis are promptly diagnosed and treated.