Verbascoside production in long-term Buddleja cordata Kunth cell suspension cultures.

Previously, our group reported the establishment of a white callus cell line of Buddleja cordata Kunth that is a high producer of the secondary metabolite, verbascoside (VB, also named acteoside), under suspension culture conditions. Here, we present experimental evidence of the sustained ability of that cellular line to grow and produce high amounts of VB for 5 years of continuous culture. Cellular line profiles were determined at the early (at the beginning) and late stages (at the end of 5 years of continuous subculturing) by analyzing relevant parameters of culture growth, i.e., specific growth rate [µ], doubling time [dt], and growth index [GI], as well as VB production. Late-stage cultures exhibited a 61% faster growth rate than early-stage subcultures, and 25 and 3% lower doubling time and growth index. The extents of growth phases were found to be different. Similar amounts of biomass were found (9.5 g and 9.4 g L-1). Verbascoside production increased parallel to cell growth; maximal yield level occurred in the mid-exponential phase and lasted until the end of the stationary phase (i.e., from the 15th to the 25th day and from the 9th to the 21st day for the early and late stages, correspondingly). The content of VB was higher in the late-stage culture (1.43 ± 0945 g L-1) than in the early-stage culture (1.21 ± 0.0286 g L-1). Productivity values point out the potential use of B. cordata cell line in the biotechnological production of VB and for research focused on the biochemistry of secondary metabolism.

Epidemiologic analysis: Prophylaxis and multidrug-resistance in surgery. / Análisis epidemiológico: profilaxis y multirresistencia en cirugía.

BACKGROUND: Surgical site infection is defined as an infection related to the surgical procedure in the area of manipulation occurring within the first 30 postoperative days. The diagnostic criteria include: purulent drainage, isolation of microorganisms, and signs of infection. AIMS: To describe the epidemiologic characteristics and differences among the types of prophylactic regimens associated with hospital-acquired infections at the general surgery service of a tertiary care hospital. MATERIAL AND METHODS: The electronic case records of patients that underwent general surgery at a tertiary care hospital within the time frame of January 1, 2013 and December 31, 2014 were reviewed. A convenience sample of 728 patients was established and divided into the following groups: Group 1: n=728 for the epidemiologic study; Group 2: n=638 for the evaluation of antimicrobial prophylaxis; and Group 3: n=50 for the evaluation of multidrug-resistant bacterial strains in the intensive care unit. The statistical analysis was carried out with the SPSS 19 program, using the Mann-Whitney U test and the chi-square test. RESULTS: A total of 728 procedures were performed (65.9% were elective surgeries). Three hundred twelve of the patients were males and 416 were females. Only 3.98% of the patients complied with the recommended antimicrobial prophylaxis, and multidrug-resistant bacterial strains were found in the intensive care unit. DISCUSSION: A single prophylactic dose is effective, but adherence to this recommendation was not adequate. CONCLUSIONS: The prophylactic guidelines are not strictly adhered to in our environment. There was a significant association between the development of nosocomial infections from multidrug-resistant germs and admission to the intensive care unit.

Memoria colectiva e historia universal: figuras relevantes en estudiantes de Psicología / Collective memory and universal history: relevant figures in psychology students

Los estudios en memoria colectiva postulan que las percepciones, las emociones y las intenciones de los individuos tienen un impacto social que va más allá de lo interpersonal e individual (Páez et al., 2007). La historia se invoca como una reserva simbólica que permite construir una identidad personal y grupal (Liu & Hilton, 2005). El objetivo del presente trabajo es explorar en las representaciones sociales de la historia a partir de las figuras que un grupo de estudiantes menciona como más importantes al momento de contar la historia universal, la valoración que de ellas hacen y analizar probables posicionamientos diferenciales. Se utilizó un cuestionario auto-administrado, versión modificada del desarrollado por Liu et al. (2005) a una muestra intencional compuesta por 144 estudiantes de psicología. Los resultados muestran a líderes políticos como los personajes más nombrados, junto a promotores de la paz y representantes del ámbito científico.

Association of neural tube defects in children of mothers with MTHFR 677TT genotype and abnormal carbohydrate metabolism risk: a case-control study.

Abnormalities in maternal folate and carbohydrate metabolism have both been shown to induce neural tube defects (NTD) in humans and animal models. However, the relationship between these two factors in the development of NTDs remains unclear. Data from mothers of children with spina bifida seen at the Unidad de Espina Bífida del Hospital Infantil Virgen del Rocío (case group) were compared to mothers of healthy children with no NTD (control group) who were randomly selected from patients seen at the outpatient ward in the same hospital. There were 25 individuals in the case group and 41 in the control group. Analysis of genotypes for the methylenetetrahydrofolate reductase (MTHFR) 677CT polymorphism in women with or without risk factors for abnormal carbohydrate metabolism revealed that mothers who were homozygous for the MTHFR 677TT polymorphism and at risk of abnormal carbohydrate metabolism were more likely to have offspring with spina bifida and high levels of homocysteine, compared to the control group. The increased incidence of NTDs in mothers homozygous for the MTHFR 677TT polymorphism and at risk of abnormal carbohydrate metabolism stresses the need for careful metabolic screening in pregnant women, and, if necessary, determination of the MTHFR 677CT genotype in those mothers at risk of developing abnormal carbohydrate metabolism.

Phytoremediation and removal mechanisms in Bouteloua curtipendula growing in sterile hydrocarbon spiked cultures.

Tolerance index and phytoremediation factors of side oats grama (Bouteloua curtipendula) with recalcitrant polycyclic aromatic hydrocarbons (PAH) phenanthrene (PHE), pyrene (PYR), and benzo[a]pyrene (BaP) and the resulting impact on phenotypic response, were evaluated in sterile conditions with whole plant growing in test-tube cultures with MS medium with PAH and compared with Tall fescue (Festuca arundinacea), control for this study. PAH mixture of PHE, PYR and BaP (1:1:1 w/w/w) blended with Maya crude oil (1:1 w/w), final concentration of 1500 mg kg(-1) was used. After 40 days, BaP removal, in the presence of Maya crude was superior compared with PHE and PYR removal Although the presence of PAH negatively affects the phenotypic response of the plants; sterile conditions experiments were helpful to evaluate phytoremediation factors to elucidate some important questions regarding phytoremediation mechanisms; in this study, B. curtipendula was able to phytostabilizate BaP associated to a significant hydrocarbon removal (57.4%) with high root accumulation but attenuated transport to stems, here reported as translocation factor. To our knowledge, this is the first time that quantifiable phytoremediation factors were used to evaluate the tolerance and removal capacity of a native semi-arid climate plant which is probably able to phytoremediate hydrocarbon contaminated soils.

Prosopis laevigata a potential chromium (VI) and cadmium (II) hyperaccumulator desert plant.

The bioaccumulation of Cr(VI) and Cd(II) in Prosopis laevigata and the effect of these heavy metals on plant growth were assessed. P. laevigata seeds were cultured during 50 days on modified Murashige-Skoog medium supplemented with four different concentrations of Cr(VI) (0-3.4mM) and Cd(II) (0-2.2mM), respectively. Heavy metals did not stop germination, but smaller plants with fewer leaves and secondary roots were produced. Seedlings showed an accumulation of 8176 and 21,437 mg Cd kg(-1) and of 5461 and 8090 mg Cr kg(-1) dry weight, in shoot and root, when cultured with 0.65 mM Cd(II) and 3.4mM Cr(VI), respectively. These results indicated that significant translocation from the roots unto aerial parts took place. A bioaccumulation factor greater than 100 for Cd and 24 for Cr was exhibited by the seedlings. P. laevigata can be considered as a potential hyperaccumulator of Cd(II) and Cr(VI) species and considered as a promising candidate for phytoremediation purposes.

Evaluación de la morbimortalidad precoz de la quimiorradioterapia adyuvante en una serie de pacientes tratados por cáncer gástrico / Evaluation of early morbidity and mortality of adjuvant chemoradiation in patients with gastric cancer

Desde el año 2005, en el Hospital Clínico Regional Valdivia (HCRV), la terapia adyuvante para el cáncer gástrico es la quimiorradioterapia (QtRt). El objetivo del trabajo es describir las reacciones adversas de los pacientes con diagnóstico de Cáncer Gástrico sometidos a QtRt adyuvante en el HCRV. Se trata de un estudio descriptivo, de pacientes sometidos a QtRt (con 5FU+leucovorina+radioterapia con acelerador lineal al lecho gástrico) que fueron a gastrectomía en el HCRV, entre enero 2005 y diciembre 2006. No se incluyeron pacientes con cáncer gástrico incipiente, ni los con invasión a estructuras vecinas ni metástasis a distancia. La información se recopiló a partir de 2 registros prospectivos de pacientes de nuestro hospital y de la revisión de fichas clínicas. Algunas de las variables registradas fueron: edad, sexo, clasificación según TNM, toxicidad hematológica, gastrointestinales y mortalidad. El análisis de las variables se realizó mediante el Software STATA 9.0. La serie se compone de 37 pacientes, con edad promedio de 59 años y predominantemente de sexo masculino con un 70,3 por ciento. A 28 (75.68 por ciento) se les practicó una gastrectomía total; 30 pacientes (81,08por ciento) fueron clasificados como T3 y 8 (21,62 por ciento) como N3. El promedio de linfonodos resecados fue 34. Treinta pacientes (80por ciento) presentaron toxicidad gastrointestinal y 23 (62,61por ciento) hematológica. Sólo un paciente (2,7 por ciento) no presentó algún grado de toxicidad. Todos los pacientes etapificados como T3N3 presentaron toxicidad. No hubo mortalidad. En esta serie, la QtRt adyuvante para el tratamiento del cáncer gástrico en el HCRV es una terapia que conlleva un alto porcentaje de reacciones adversas de diversa magnitud.

In vitro evaluation of germination and growth of five plant species on medium supplemented with hydrocarbons associated with contaminated soils.

The effect of a hydrocarbon mixture (HCM) of three polycyclic aromatic hydrocarbons (PAH) and Maya crude oil on germination, growth and survival of four grasses (Bouteloua curtipendula, Cenchrus ciliaris, Echinochloa crusgalli and Rhynchelytrum repens) was studied and compared to a control (Festuca arundinacea) under in vitro conditions. The species were cultured on MS medium with different HCM initial concentrations. Germination was not affected for any assayed concentration; however, the length of the stems and roots decreased when HCM increased and the survival of the four species also diminished. Except for F. arundinacea, a direct link between hydrocarbon concentration and plant survival was observed. In vitro studies are clean and easy to handle techniques allowing isolation of the plant activity from that derived from associations with microorganisms in non-sterile cultures. To our knowledge, this is the first work towards phytoremediation assisted by in vitro plant cultivation.

Actividad antipalúdica de plantas procedentes de la Amazonía peruana / Activity antipalúdica of plants coming from the Peruvian Amazonía

El presente trabajo fue realizado con el objetivo de plantear la búsqueda de nuevos agentes antipalúdicos de origen natural a través de pruebas biológicas. Para la realización del mismo se utilizaron extractos crudos de plantas recolectadas en la Amazonia peruana. La evaluacion fue realizada por un método directo que es el modelo in vitro, en cultivo de Plasmodium falciparum F32 sensible a la Cloroquina y por un modelo indirecto que es el ensayo de la inhibición de la Biomineralización de la Ferriprotoporfina IX (FBIT). Los resultados obtenidos nos permiten clasificar a 7 extractos como activos en la prueba de Evaluación de la Actividad Antipalúdica por el método directo in vitro, y 14 por el método indirecto (FBIT), de todos estos solo a 4 presentan actividad por ambos métodos por lo que podemos afirmar que su mecanismo de acción es similar al de la Cloroquina, y los 3 restantes son los que mas interesan pues su mecanismo de acción es diferente al de la Cloroquina, y pordría ser de gran beneficio en cepas resistentes a esta droga. Todos estos extractos se encuentran actualmente en un proceso de purificación para una nueva evaluación a través de estudios químicos y biológicos.

Patología infecciosa pseudotumoral del sistema nervioso central en la infancia / Infections mimicking central nervous system(CNS)tumors in children

Las infecciones del sistema nervioso central(SNC)pueden presentarse como lesiones ocupantes seudotumorales con efecto de masa,principalmente en pacientes inmunosuprimidos,pudiendo ser la primera manifestación de la enfermedad.La mayoría de los casos publicados corresponden a adultos especialmente dentro de la población HIV.En un contexto clínico adecuado,lesiones de tipo tumoral en las neuroimágenes,deben plantear el diagnóstico diferencial con patología infecciosa.Nuestro objetivo es describir los hallazgos clínicos y de neuroimágenes de 16 pacientes con infecciones intracraneanas a forma seudotumoral que requieren cirugía con presunción diagnóstica de lesión neoplásica.En nuestra serie de 1.0005 lesiones expansivas intracraneales neuroquirúrgicas,excluyendo inmunosuprimidos,trasplantados y HIV conocidos(con riesgo potencial de absceso cerebral)se diagnosticaron en 16 biopsias cerebrales(1,6 por ciento)Infecciones por protozoarios(enfermedad de Chagas:2,toxoplasmosis:3,uno de ellos asociado a Mycobacterium avium intracellulare,amebas de via libre:2)cestodes(Cysticercus cellulosae:2,quiste hidiatídico Echinococcus granulosus:4 y tuberculomas:3.En casos clínicos estudiados y seleccionados algunas observaciones pueden ayudar a evitar procedimientos invasivos del SNC así como modificar la táctica y técnica quirúrgica

Patología infecciosa pseudotumoral del sistema nervioso central en la infancia / Infections mimicking central nervous system (CNS) tumors in children

Las infecciones del sistema nervioso central(SNC)pueden presentarse como lesiones ocupantes seudotumorales con efecto de masa,principalmente en pacientes inmunosuprimidos,pudiendo ser la primera manifestación de la enfermedad.La mayoría de los casos publicados corresponden a adultos especialmente dentro de la población HIV.En un contexto clínico adecuado,lesiones de tipo tumoral en las neuroimágenes,deben plantear el diagnóstico diferencial con patología infecciosa.Nuestro objetivo es describir los hallazgos clínicos y de neuroimágenes de 16 pacientes con infecciones intracraneanas a forma seudotumoral que requieren cirugía con presunción diagnóstica de lesión neoplásica.En nuestra serie de 1.0005 lesiones expansivas intracraneales neuroquirúrgicas,excluyendo inmunosuprimidos,trasplantados y HIV conocidos(con riesgo potencial de absceso cerebral)se diagnosticaron en 16 biopsias cerebrales(1,6 por ciento)Infecciones por protozoarios(enfermedad de Chagas:2,toxoplasmosis:3,uno de ellos asociado a Mycobacterium avium intracellulare,amebas de via libre:2)cestodes(Cysticercus cellulosae:2,quiste hidiatídico Echinococcus granulosus:4 y tuberculomas:3.En casos clínicos estudiados y seleccionados algunas observaciones pueden ayudar a evitar procedimientos invasivos del SNC así como modificar la táctica y técnica quirúrgica

Technology evaluation of a USA-Mexico health information system for epidemiological surveillance of Mexican migrant workers.

From 1994 through 1996, federal, state, and nongovernmental organizations in Mexico and in the United States of America developed and piloted a Binational Health Information System for Epidemiological Surveillance of Mexican migrant workers. The system allowed data exchange for epidemiological surveillance between the state of Guanajuato in Mexico and the Commonwealth (state) of Pennsylvania in the United States, for case detection, prevention, and treatment, through shared contact investigation and case management of communicable diseases. The target population consisted of migrant workers traveling between Guanajuato and Pennsylvania to work mainly in the mushroom industry, and their sexual partners in their Mexican communities of origin. Computerized migrant health information modules were set up in Guanajuato and in Pennsylvania. Patient information and epidemiological surveillance data were encrypted and communicated electronically between the modules, using the WONDER communications system of the U.S. Centers for Disease Control and Prevention. Evaluation of the Guanajuato-Pennsylvania Binational Health Information System showed that major barriers to binational epidemiological surveillance and control are: a) lack of communication binationally; b) interrupted medical care due to migration; c) inconsistent diagnosis and treatment criteria between the two countries; d) lack of referral clinical records from one country to the other; and e) deficient legal regulations concerning binational clinical data transfer. To our knowledge, this is the first project that has successfully demonstrated the technological feasibility of a binational disease control system linking a state in the interior of one country with a state in the interior of another country, rather than just states in the border region. The project also advanced the understanding of health service organizational issues that facilitate or hinder communication, outreach, disease prevention, and organization of health care services for migrant workers in both Mexico and the United States. Despite the unprecedented success and potential bilateral benefits demonstrated by this project, serious structural and organizational deficits in the public health systems of both countries must be addressed before epidemiological surveillance can be achieved binationally.

Lateral ventricle tumors in children: a series of 54 cases.

A series of 54 patients with lateral ventricle tumors diagnosed and surgically treated from 1988 to 1998 was reviewed. Neoplasms invading ventricles and originating beyond their walls were excluded. There were 35 male and 19 female patients. Their ages ranged from 15 days to 20 years, and two frequency peaks were observed, one at 2 and one at 11 years. The most frequent signs and symptoms were attributed to increased intracranial pressure. The 54 patients included 41 who developed hydrocephalus, but only 15 of these required shunting. The trigonal region and frontal horn were the most common sites of origin. Surgery was planned with due consideration for the localization of the tumor, its presumptive histology, its main feeding vessels, the parenchymal functionality, and the presence or absence of hydrocephalus. The most frequent tumor types were subependymal giant cell astrocytoma, choroid plexus tumors, ependymoma, and astrocytoma. The most common complications were intraventricular hemorrhage, cortical collapse, subdural collection and seizures. To conclude, tumors located within the lateral ventricles are often very voluminous and are predominantly benign, and the treatment of choice is total resection. In the case of malignancy, postsurgical radiotherapy and/or chemotherapy should be given.

Long-term therapy with policosanol improves treadmill exercise-ECG testing performance of coronary heart disease patients.

This study examined the effects of long-term lipid-lowering therapy with policosanol on the clinical evolution, and exercise-ECG testing responses of 45 coronary heart disease (CHD) patients with myocardial ischemia, documented by exercise 201T1-myocardial perfusion scintigraphy, in an overall randomized, double-blind, placebo-controlled trial, made for different test endpoints. Fifteen patients were treated with 5 mg of policosanol twice daily; another 15 patients were administered the same drug dose plus 125 mg aspirin; and the other 15 patients received placebo plus equal aspirin dose. They were followed for 20 months, previous baseline observations, with treadmill exercise-ECG, besides serum lipid test. Beneficial changes on proportions among the 2 policosanol groups and the placebo group, showed an increment on functional capacity class, a decrement on rest and exercise angina, and a significant decrease in cardiac events, and in ischemic ST segment response, especially in the policosanol plus aspirin group (p = 0.05, X2(2df) = 5.8; p = 0.04, p = 0.02; Fisher). After treatment, sets of mean changes revealed an increase on maximum oxygen uptake, and a decline on double product simultaneously in both policosanol groups (p < or = 0.02, p < or = 0.002; Pillais, Hotellings' T2), while the placebo group was impaired. Aerobic functional capacity percent showed an increment in policosanol groups (p < or = 0.05, paired T). Lipid levels improved as other endpoints already reported. A supposed ergogenic effect of octacosanol, policosanol's main active compound, was not detected with this design. These results show that policosanol-treated CHD patients improved clinical evolution, and exercise-ECG responses, owing to the amelioration of myocardial ischemia, even more when administered with aspirin.

Long-bone biomechanics in mice selected for body conformation.

Two lines of mice divergently selected from the control strain (CBi) against the positive phenotypic correlation between body weight (b.w.) and tail (skeletal) length were obtained (CBi/C: high weight, short tail; CBi/L: low weight, long tail). The selected animals showed a different relationship between body and skeletal masses. To compare the adequacy between biomass and load-bearing ability of the skeleton, and to describe the eventual role of bone mechanostat in the production of these changes, cross-sectional and bending properties of both femur diaphyses were determined in CBi, CBi/C, and CBi/L adult mice of both genders. Cortical bone material quality (elastic modulus) was reduced in the selected lines (p < 0.001), significantly less in CBi/C than in CBi/L. In contrast, cross-sectional design (b.w.-adjusted values of moment of inertia, CSMI) was largely improved (p < 0.001), significantly more in CBi/C than in CBi/L. These effects determined a greater stiffness and strength in CBi/C than in CBi/L or CBi weight-paired mice. The elevations of the negative regression lines between elastic modulus and CSMI ("distribution/quality" curves) decreased in the order CBi/C > CBi/L > CBi. Data show that selection improved diaphyseal stiffness and strength in CBi/C animals because of an architectural overcompensation for the reduced bone material quality. Therefore, an inadequate control of long-bone architectural design as a function of the mechanical quality of cortical bone and b.w. bearing could have been induced in that line. Assuming bone mechanostatic regulation to be genetically programmed, some of the corresponding biological determinants should be transmitted independently, because artificial selection separately affected material quality and architectural design. The possibility of transmission of an inadequate mechanostatic function (inability to adapt bone modeling to bone material quality as a function of the biomass to be supported) was also shown, as some genotypes could express architectural modifications that largely exceed bone material quality deterioration.

Salmonella gastroenteritis outbreak among workers from a tertiary care hospital in Mexico City.

OBJECTIVE: To describe an outbreak of Salmonella gastroenteritis among employees of the National Institute of Nutrition (INNSZ) of Mexico City during July, 1994. METHODS: Employees who developed diarrhea or fever associated with gastrointestinal symptoms starting on July 14th were included for study as well as 50 healthy controls. A questionnaire was applied to all, and they also provided a stool sample, along with other 80 asymptomatic people (included the kitchen workers) in whom only stool culture was done. RESULTS: Ninety-seven employees that ate regularly at the Hospital's cafeteria were affected by the outbreak, and 67 of them (69%) could be evaluated. Most of them were nurses (34%), and handymen (27%). Most common symptoms were abdominal pain (97%), diarrhea (95%), nausea (91%), and fever (89%). Cultures from suspicious food items were all negative, but stool cultures from 10/70 cases were positive for Salmonella enteritidis vs. 0/133 in the controls. The ten S. enteritidis isolates resulted identical either by serotyping and by rapid amplified polymorphic DNA (RAPD) analysis. Cultures from all kitchen employees were negative for S. enteritidis. Breakfast meal on July 14th was associated with the development of gastroenteritis (61/67 cases vs 26/50 controls, p < 0.001), and particularly with an egg-covered meat plate (61/62 vs 13/26 controls, p < 0.0001). CONCLUSIONS: This outbreak was probably caused by eggs contaminated with Salmonella, since no one of the kitchen personnel was found to be an asymptomatic carrier, and the implicated recipe allows for inappropriate cooking. Recommendations to improve cooking procedures must be added to the usual regulations to diminish the frequency of foodborne disease outbreaks in hospitals.

Brain single-photon emission tomography with technetium-99m hexamethylpropylene amine oxime in adolescents with initial-stage schizophrenia.

The objective of this study was to search for regional cerebral blood flow (rCBF) abnormalities in adolescents with initial-stage schizophrenia by means of brain single-photon emission tomography (SPET) using technetium-99m hexamethylpropylene amine oxime (HMPAO). SPET studies were performed on a homogeneous sample of 15 carefully selected adolescents with a recent diagnosis of schizophrenia, and without previous electroconvulsive or antipsychotic drug treatment. Computed tomography (CT) and electro-encephalographic (EEG) studies were performed in all patients. Qualitative and semiquantitative analysis of 99mTc-HMPAO SPET studies showed an impaired rCBF in 12 patients (80%). The most common pattern was a decreased uptake of 99mTc-HMPAO in the frontal lobes, usually in the left hemisphere. Conventional and quantitative EEG was positive in 12 (80%) and 15 (100%) patients, respectively. CT findings were positive in two patients (13%). There was a high level of concordance between SPET and EEG results and between SPET and clinical features (P>0.05). This study suggests that previously untreated patients in the first stages of schizophrenia present functional abnormalities that are revealed by brain SPET.

Utilization of health services along the Arizona-Sonora border: the providers' perspective.

Under the proposed North American Free Trade Agreement between Mexico, Canada, and the United States, issues of health policy and health care delivery will have to be addressed. People at the U.S.-Mexico border have been using health care providers on either side of the border for many years. Studying how the movement of patients has been taking place, and how it has affected health care providers' practices, is the first step towards the understanding and organization of health care services for the border region. This paper reports on the results of a health care provider survey conducted between 1987 and 1989 in Arizona and Sonora border towns. The paper includes information on the characteristics of border health care providers (98 residing on the U.S. side of the border and 249 on the Mexican side) and the demographics and diagnosis of patients who engage in border crossing behavior. The opinions of health care providers about why patients from the neighboring country come to their offices; the existing communication system between providers in both nations; and some of the problems that result from attending patients residing in the neighboring nation are also reported. Results from the survey demonstrate that although the border constitutes a region in itself, health services at the border are not structured to recognize this regional orientation. Improved communication between health care providers on both sides of the border, the establishment of health care protocols with quality assurance programs, and suitable health care financing mechanisms are some of the issues that require immediate attention if the health care delivery system at the border is to function more efficiently and to the satisfaction of health care providers and consumers.

Metformin therapy in polycystic ovary syndrome reduces hyperinsulinemia, insulin resistance, hyperandrogenemia, and systolic blood pressure, while facilitating normal menses and pregnancy.

Using polycystic ovary syndrome (PCOS) as a model of insulin resistance and hyperandrogenism, our specific aim was to assess the effect of Metformin on lipoproteins, sex hormones, gonadotropins, and blood pressure in 26 women with PCOS who were studied at baseline, received Metformin 1.5 g/d for 8 weeks, and were then restudied. None of the women had normal menstrual cycles, 100% had multiple subcapsular follicules by pelvic ultrasound, 90% were hirsute, and 85% had high free testosterone. Comparing post-Metformin versus baseline levels, the Quetelet Index (QI) decreased 1.5% (P = .04) and the waist to hip ratio (WHR) decreased 2.8% (P = .003). After covariance adjusting for changes in the QI and WHR, on Metformin the area under the insulin curve (IA) during oral glucose tolerance testing decreased 35% (P = .04), and the insulin area to glucose area ratio decreased 31% (P = .03). On Metformin, covariance-adjusted systolic blood pressure (SBP) decreased (P = .04) and apo A-1 increased (P = .05). On Metformin, with improvement in insulin sensitivity, there were sharp reductions in covariance-adjusted luteinizing hormone ([LH] P = .0007), total testosterone ([T] P = .0004), free T (P = .0001), androstenedione (P = .002), dehydroepiandrosterone sulfate ([DHEAS] P = .006), and the free androgen index ([FAI] P = .0005), with increments in follicle-stimulating hormone ([FSH] P = .04) and sex hormone-binding globulin ([SHBG] P = .04).(ABSTRACT TRUNCATED AT 250 WORDS)