Determination of Aflatoxin M1 in Raw Milk from Different Provinces of Ecuador.

Aflatoxin M1 (AFM1) is a mycotoxin from Aspergillus flavus and A. parasiticus, classified as carcinogenic and hepatotoxic. The objective of the present investigation was to determine its presence in raw milk from north-central Ecuador, constituted by the provinces of Pichincha, Manabí, and Santo Domingo de los Tsáchilas. These areas represent approximately 30% of Ecuadorian milk production. By the end of the investigation, a total of 209 raw milk samples were collected, obtained both during the dry (June and August) and rainy seasons (April and November) of 2019. AFM1 concentrations were measured with lateral flow immunochromatographic assays, and 100% of the samples were positive for this mycotoxin, presenting a mean value of 0.0774 µg/kg with a range of 0.023 to 0.751 µg/kg. These AFM1 levels exceeded the European Union regulatory limit of 0.05 µg/kg in 59.3% (124/209) of samples, while only 1.9% (4/209) exceeded the Ecuadorian legal limit of 0.5 µg/kg. By using non-parametric tests, significant differences were determined (p ≤ 0.05) between the provinces for months of study, climatic season (being higher in the dry season), and climatic region (greater in the coast region). On the other hand, there were no significant differences (p ≥ 0.05) between the types of producers or between production systems. Therefore, AFM1 contamination in raw milk does not present a serious public health problem in Ecuador, but a monitoring and surveillance program for this mycotoxin in milk should be developed to prevent consumer health problems.

Evaluación clínica detallada de una familia española con enfermedad de Anderson-Fabry, nueva mutación en GLA y fenotipo cardiaco grave / Comprehensive clinical evaluation of a large Spanish family with Anderson-Fabry disease, novel GLA mutation and severe cardiac phenotype

Background and objective: Fabry disease is an X-linked multisystemic lysosomal-storage condition. We describe a large family with a novel GLA mutation: p.M187R/g7219 T > G. Patients and methods: Anamnesis/physical-exam, blood/urine analysis, a-Gal-A activity and/or genetic study of at-risk individuals and multidisciplinary evaluation in confirmed cases. Results: 4 males and 13 heterozygous-females displayed the mutation. Cardiac/renal/neurological disease was diagnosed at a mean age of 41/29/39 years in males and 51/56/46 years in females. Onset mean age was 20 years versus 42 years. 9/15 had cardiomyopathy. Delta wave suggestive of accessory pathway was identified in 1 male and 2 females. 1 female had cardiac arrest (ventricular fibrillation, 61 years). 2 females and 1 male died suddenly (63, 64 and 57 years). Cardiac-subscore of Mainz Severity- Score-Index was severe for males and females over 40 years. 4/15(26%) developed early renal disease. 2 males needed dialysis. 1 male died at 69 years in spite of kidney-heart transplant. Conclusion: We describe the largest genetically confirmed Spanish family using multidisciplinary evaluation and MSSI calculation. The novel mutation p.M187R/g7219 T > G is associated with a particularly malignant cardiac phenotype in males and females over 40 years. Severity was higher than that of the largest Spanish FOS-cohort. Short-PR with delta is being reported for the first time (AU)

Fundamento y objetivo: La enfermedad de Fabry es un trastorno sistémico por depósito lisosomal ligado a X. Describimos una familia grande con una mutación nueva en GLA: p.M187R/g7219 T > G. Pacientes y Métodos: Anamnesis/exploración, análisis sangre/orina), actividad alfa-Gal-A y/o estudio genético a individuos en riesgo y evaluación multidisciplinar de casos confirmados. Resultados: Cuatro varones/12 mujeres presentaban la mutación. Se diagnosticó enfermedad cardiaca/ renal/neurológica a los 41/29/39 años como media en varones, y a los 51/56/46 años en mujeres. La media de inicio fue 20 años frente a 42. Presentaban miocardiopatı' a 9/15. Se identificó onda delta indicativa de vía accesoria en un varón y 2 mujeres. Una mujer sufrió parada cardiorrespiratoria (fibrilación ventricular, 61 años). Dos mujeres y un varón murieron súbitamente (63, 64 y 57 años, respectivamente). El subscore cardiaco del Mainz Severity Score Index (MSSI) fue grave en hombres y mujeres mayores de 40 años. Presentaron enfermedad renal temprana 4/15 (26%). Dos varones precisaron diálisis. Un varón murió a los 69 años pese a trasplante cardiorrenal. Conclusión: Describimos la mayor familia española confirmada gene' ticamente con evaluación multidisciplinar y cálculo del MSSI. La nueva mutación p.M187R/g7219 T > G asocia un fenotipo cardiaco especialmente grave en hombres y mujeres mayores de 40 años. La gravedad fue superior a la de la mayor cohorte-FOS española publicada. Se describen por primera vez ondas delta asociadas a PR-corto (AU)

Comprehensive clinical evaluation of a large Spanish family with Anderson-Fabry disease, novel GLA mutation and severe cardiac phenotype.

BACKGROUND AND OBJECTIVE: Fabry disease is an X-linked multisystemic lysosomal-storage condition. We describe a large family with a novel GLA mutation: p.M187R/g7219 T>G. PATIENTS AND METHODS: Anamnesis/physical-exam, blood/urine analysis, α-Gal-A activity and/or genetic study of at-risk individuals and multidisciplinary evaluation in confirmed cases. RESULTS: 4 males and 13 heterozygous-females displayed the mutation. Cardiac/renal/neurological disease was diagnosed at a mean age of 41/29/39 years in males and 51/56/46 years in females. Onset mean age was 20 years versus 42 years. 9/15 had cardiomyopathy. Delta wave suggestive of accessory pathway was identified in 1 male and 2 females. 1 female had cardiac arrest (ventricular fibrillation, 61 years). 2 females and 1 male died suddenly (63, 64 and 57 years). Cardiac-subscore of Mainz Severity-Score-Index was severe for males and females over 40 years. 4/15(26%) developed early renal disease. 2 males needed dialysis. 1 male died at 69 years in spite of kidney-heart transplant. CONCLUSION: We describe the largest genetically confirmed Spanish family using multidisciplinary evaluation and MSSI calculation. The novel mutation p.M187R/g7219 T>G is associated with a particularly malignant cardiac phenotype in males and females over 40 years. Severity was higher than that of the largest Spanish FOS-cohort. Short-PR with delta is being reported for the first time.

[Clinical guideline for detection and diagnosis of hypertensive pregnancy disease]. / Guía de práctica clínica. Enfermedades hipertensivas del embarazo.

Hypertensive disorders in pregnancy (HDP) are the main complication and cause of maternal and perinatal death. Pre-eclampsia represents a 34%, according to the Secretaría de Salud de México. To offer the family physicians tools for the opportune detection and diagnosis of HDP a clinical guideline was developmented. Clinical questions were formulated and structured. A standardized sequence to search for Practice Guidelines, based on the key words: hypertensive disorders in pregnancy, pre-eclampsia. Tripdatabase, MDConsult, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, National Institute for Health and Clinical Excellence were used. In addition, Cochrane Library Plus, Science Direct and OVID were used. Most of the recommendations were taken from guidelines selected and supplemented with the remaining material. The information is expressed in levels of evidence and grade of recommendation according to the characteristics of the study design and type of publications. To reduce morbidity and mortality from HDP health professionals should identify risk factors; conduct a close monitoring and early diagnosis. It is essential to provide information to the pregnant patient on alarm data and behavior to follow. This clinical practice guide offers current evidence for screening and diagnosis of HDP in primary care.

Burden of disease and costs of treating rotavirus diarrhea in Mexican children for the period 2001-2006.

OBJECTIVES: To estimate the health impact and the costs of treatment associated with rotavirus diarrhea in six yearly cohorts (2001-2006) of Mexican infants. METHODS: The perspective of study is from the health care system. We estimated the effect of rotavirus diarrhea on disability adjusted life years (DALYS) and diarrhea treatment costs in hypothetical cohorts of infants who are followed from birth up to five years of age beginning in years from 2001 to 2006. We used information from administrative databases on mortality and health care from the National System of Information on Health and from the Mexican Institute for Social Security to feed a decision analysis to project the burden of disease and costs of treatment. RESULTS: Estimates of DALYS were 19,426 in 2001 and decreased by 28.9% for 2006 meanwhile costs of treatment were relatively constant, estimated at US$ 38.7 million and increased only by 5%. CONCLUSION: Rotavirus diarrhea in Mexican children is a major disease burden, presenting significant treatment costs. Rotavirus diarrhea mortality is decreasing; however this has not led to a steady decrease in treatment costs in the 6 years period of analysis. A sensitivity analysis showed that incidences of rotavirus diarrhea as well as the parameters associated with health-care access were the main factors, which had a significant effect on the projected burden of disease and costs.

Direct costs associated with the appropriateness of hospital stay in elderly population.

BACKGROUND: Ageing of Mexican population implies greater demand of hospital services. Nevertheless, the available resources are used inadequately. In this study, the direct medical costs associated with the appropriateness of elderly populations hospital stay are estimated. METHODS: Appropriateness of hospital stay was evaluated with the Appropriateness Evaluation Protocol (AEP). Direct medical costs associated with hospital stay under the third-party payer's institutional perspective were estimated, using as information source the clinical files of 60 years of age and older patients, hospitalized during year 2004 in a Regional Hospital from the Mexican Social Security Institute (IMSS), in Mexico City. RESULTS: The sample consisted of 724 clinical files, with a mean of 5.3 days (95% CI = 4.9-5.8) of hospital stay, of which 12.4% (n = 90) were classified with at least one inappropriate patient day, with a mean of 2.2 days (95% CI = 1.6-2.7). The main cause of inappropriateness days was the inexistence of a diagnostic and/or treatment plan, 98.9% (n = 89). The mean cost for an appropriate hospitalization per patient resulted in US$1,497.2 (95% CI = US$323.2-US$4,931.4), while the corresponding mean cost for an inappropriate hospitalization per patient resulted in US$2,323.3 (95% CI = US$471.7-US$6,198.3), (p < 0.001). CONCLUSION: Elderly patients who were inappropriately hospitalized had a higher rate of inappropriate patient days. The average of inappropriate patient days cost is considerably higher than appropriate days. In this study, inappropriate hospital-stay causes could be attributable to physicians and current organizational management.

Trombosis de la vena ovárica con extensión a la vena cava inferior en el posparto / Ovarian vein thrombosis spreading to the inferior vena cava

La trombosis de la vena ovárica es una complicación que puede aparecer durante el puerperio o después de una intervención quirúrgica pélvica. Es una entidad poco frecuente pero potencialmente grave, de ahí la importancia del diagnóstico y el tratamiento temprano. Debe sospecharse ante la aparición de fiebre y dolor abdominal agudo en los primeros días posparto. La prueba diagnóstica de elección sigue siendo la tomografía computarizada (TC) con contraste. Tras la administración de antibióticos de amplio espectro y heparina, la mejoría clínica es inmediata.Presentamos un caso de trombosis de la vena ovárica que aparece como complicación tras la realización de una cesárea (AU)

Ovarian vein thrombosis is a complication that can appear during the postpartum period or after pelvic surgery. This complication is a rare but serious entity requiring early diagnosis and treatment and should be suspected in patients with fever and acute abdominal pain at the beginning of the postpartum. Imaging diagnosis with contrast computed tomography remains the gold standard. Administration of broad-spectrum antibiotics and heparin therapy produces immediate clinical improvement.We report a case of ovarian vein thrombosis after a cesarean delivery (AU)

Una mirada desde los servicios de salud a la nutrición de la niñez mexicana: III. Carga económica y en salud de la obesidad en niños mexicanos. Proyecciones de largo plazo / A look from health services to the nutrition of Mexican childhood: III. Economic and health burden of Mexican childhood obesity. Long-term projections

Objetivo. Estimar la carga económica y en salud de la obesidad en niños mexicanos en un horizonte de largo plazo. Estimación de costos médicos atribuibles a la obesidad en niños mexicanos durante 2006-2050. Una cohorte hipotética de 5-11 años de edad obesa se modeló con base en prevalencia, incidencia y evolución clínica. Los costos considerados fueron por diabetes mellitus tipo 2 e hipertensión arterial. En 2015 se presentarían los primeros casos de diabetes mellitus y de hipertensión arterial. Cuando el primer grupo de niños cumpla 40 años aumentarán considerablemente las complicaciones de la obesidad. Para 2050, 67.3% de la cohorte tendría obesidad. El costo de atención a la obesidad será de $57 678 millones de pesos. La magnitud de la obesidad se reporta en niveles preocupantes en todas las edades, con costos que consumirán buena parte de los recursos del sistema de salud.

Objective. To estimate the economic and health burden of childhood obesity in Mexican population over the long term. This study estimates healthcare costs due to child obesity in Mexican children from 2006-2050. A hypothetic 5-11-year-old obese cohort based on prevalence, incidence, and clinical development data was modelled. Cost allocation considerations include type 2 diabetes mellitus and high blood pressure. The first cases of diabetes mellitus and with a risk of high blood pressure appears in the year 2015. When the first group of children is 40 years old, there is a considerable increase in obesity-related complications. A total of 67.3% of the cohort would have obesity in the year 2050. The cost of obesity care would be $57 678 million Mexican pesos. The magnitude of obesity reported is at worrisome levels in all age groups, showing costs that would consume a high percentage of the health system’s resources.

Economic family burden of metabolic control in children and adolescents with type 1 diabetes mellitus.

AIM: To appraise the economic burden for families of patients with type 1 diabetes mellitus (DM1) at the Instituto Nacional de Pediatria in Mexico City. PATIENTS AND METHODS: DM1 family direct costs were obtained from a standardized economic survey in 59 children with no chronic severe complications such as kidney failure in 2002-3. RESULTS: Mean family annual direct cost of treatment and monitoring was US $1689.87 which includes government funding given to both outpatients and inpatients. Despite this, DM1 out-of-pocket cost for families is very high compared to the minimum official wage of approximately $4.00 dollar/day versus $4.06 cost DM1/day. No correlation between parents' age, education or socio-economic level and direct cost was statistically significant. CONCLUSIONS: The highest economic burden was due to self-monitoring of blood glucose (SMBG) 53.0% and insulin 14.8%. The costs were higher in children with poor metabolic control who performed SMBG less often.

Biotin deficiency affects both synthesis and degradation of pyruvate carboxylase in rat primary hepatocyte cultures.

Pyruvate carboxylase (PC) is a biotin-dependent enzyme that plays a crucial role in gluconeogenesis, lipogenesis, Krebs cycle anaplerosis and amino acid catabolism. Biotin deficiency reduces its mass besides its activity. Enzyme mass is the result of its cellular turnover, i.e., its rates of synthesis and degradation. We have now investigated, by a pulse and chase approach in cultured primary hepatocytes, the effects of biotin deficiency on these rates. Wistar rats were fed a biotin-deficient diet and the controls were fed the same diet supplemented with biotin; their biotin status was monitored measuring lymphocytes propionyl-CoA carboxylase activity and urinary 3-hydroxyisovaleric acid. After 6-7 weeks primary hepatocytes were cultured in biotin-deficient or complete DMEM. PC activity was determined by measuring the incorporation of (14)C-bicarbonate into acid-non-volatile products, and its mass by streptavidin Western blots. Its synthesis rate was estimated from [(35)S] methionine incorporation into anti-PC antibody immunoprecipitate. Its degradation rate was calculated from the loss of radioactivity from previously labeled hepatocytes, in a medium containing an excess of non-radioactive methionine. PC synthesis rate in biotin-deficient hepatocytes was approximately 4.5-fold lower than in the controls, and its degradation rate was 5.1-fold higher. Therefore, the decrement of PC mass during biotin deficiency results both from a decrease in its synthesis and an increase in its degradation rates. To our knowledge, this is the first instance where a mammalian enzyme cofactor is necessary to sustain both processes.