Eficacia diagnóstica de la impedancia basal nocturna media, un nuevo parámetro para el estudio de la enfermedad por reflujo gastroesofágico / Diagnostic efficacy of mean nocturnal basal impedance, a new parameter for the study of gastroesophageal reflux disease

Resumen Introducción y objetivos: el análisis de la impedancia basal nocturna media (IBNM) se ha propuesto para incrementar la precisión diagnóstica de enfermedad por reflujo erosiva (ERGE). Nuestro objetivo fue evaluar el rendimiento diagnóstico de esta prueba en un grupo de pacientes con ERGE conocida. Materiales y métodos: incluimos 123 individuos (58 con ERGE y 65 controles sanos) a quienes se les realizó pH-impedanciometría (pH-IMM) consecutiva entre enero de 2015 y junio de 2017. Todos los pacientes tenían endoscopia tomada en los 6 meses previos. El tiempo de exposición ácida (TEA) anormal (>4,2%) y la presencia de pirosis y/o regurgitación en los 6 meses previos fueron los criterios para el diagnóstico de ERGE. Se encontraron 58 pacientes con ERGE, 24 con enfermedad por reflujo erosiva (ERE) y 34 con enfermedad por reflujo no erosiva (ERNE). Los 65 restantes fueron controles sanos (CS) asintomáticos con EGD y pH-IMM normales. Todos los trazos de pH-IMM se reanalizaron para medir la IBNM por un segundo observador que desconocía los datos previos. El análisis estadístico incluyó pruebas múltiples de Bonferroni para comparar los grupos; regresión lineal para variables continuas; y análisis de curva ROC para buscar valor IBNM con mayor rendimiento. Para los diferentes parámetros de precisión diagnóstica se utilizó el punto de corte de la IBNM. Se usó significancia estadística con valor de p <0,01 e intervalos de confianza de 95% (IC 95%) para todos los cálculos. Resultados: los pacientes con ERE y ERNE presentaron valores de IBNM significativamente más bajos que el grupo control (p <0,01). Se observó una correlación negativa entre los valores de la IBNM y TEA (r = 0,59; p = <0,001), y también entre la IBNM y número de eventos de reflujo (r = 0,37; p = <0,001). En el análisis de curva ROC, el área bajo la curva de la IBNM fue de 0,941 (IC 95%: 0,894-0,987) y el punto de corte con mayor eficiencia 1102 ohms (sensibilidad 98,5%; especificidad 84,5%). Usando este valor (<1,102), la IBNM tuvo una sensibilidad para detectar ERGE de 91% (ERNE 86% y ERE 100%) y una especificidad de 98%. Conclusión: la IBNM tiene alta sensibilidad y especificidad para el diagnóstico de la ERGE. Adicionar esta prueba al análisis convencional de la pH-impedancia y a los métodos actuales de estudio de la ERGE puede mejorar significativamente nuestra capacidad para diagnosticar la enfermedad.

Abstract Introduction and Objectives: Analysis of nocturnal basal impedance (IBNM) has been proposed as a way to increase accuracy of GERD diagnosis. Our objective was to evaluate the diagnostic performance of this test in a group of patients known to have GERD. Materials and methods: We included 123 individuals: 58 with GERD and 65 healthy controls. They underwent consecutive pH-impedance monitoring between January 2015 and June 2017. All had undergone endoscopy in the 6 months prior to testing. Criteria used for diagnosis of GERD were abnormal acid exposure time (AET > 4.2%), pyrosis and/or regurgitation in the previous 6 months. We found 58 patients with GERD of whom 24 had erosive reflux disease (ERE) and 34 had non-erosive reflux disease (NERD). The remaining 65 were asymptomatic healthy controls with normal endoscopic results and pH impedance monitoring. A second observer who did not know the previous data measurements analyzed all pH impedance monitoring traces for IBMN. Statistical analysis included multiple Bonferroni tests for comparison between groups, linear regression for continuous variables, and receiver operating characteristic (ROC) curve analysis to find high performance IBNM values. The IBNM cutoff point was used for diagnostic precision parameters. Statistical significance was set at p <0.01, and 95% confidence intervals were used for all calculations. Results: IBNM measures were significantly lower for patients with ERE and NERD than for the control group (p <0.01). A negative correlation was observed between IBNM and acid exposure time values ​​(r = 0.59, p = <0.001) and also between IBNM and number of reflux events (r = 0.37, p = <0.001). ROC curve analysis found that the area under the curve for IBNM was 0.941 (95% CI: 0.894-0.987), and the cutoff point with the highest efficiency was 1,102 ohms (sensitivity 98.5%, specificity 84.5%). Using this value (<1.102), the IBNM had a sensitivity for detecting GERD of 91% (NERD 86% and ERE 100%) and a specificity of 98%. Conclusion: IBNM has high sensitivity and specificity for diagnosis of GERD. Addition of this test to conventional pH-impedance analysis and current methods for studying GERD can significantly improve our ability to diagnose this disease.

Clustering Disjoint HJ-Biplot: A new tool for identifying pollution patterns in geochemical studies.

This paper introduces a new mathematical algorithm termed Clustering Disjoint HJ-Biplot (CDBiplot), which searches for the underlying data structure in order to find the best classification of the object groups in a reduced space. To this end, disjoint factorial axes are generated, in which each variable only contributes to the formation of one factorial axis. A graphical representation of the individuals and variables is performed using the HJ-Biplot method. In order to facilitate the use of this new method within any practical context, a function in the language R has been developed. This work applies the CDBiplot to study an environmental geochemistry case involving environmental pollution in river surface sediments. The study focuses on an area close to an important mining and metallurgical site, where sediments share a similar geological origin and chemical composition. The algorithm permitted a detailed study of the geochemical interactions and performed an excellent separation of the samples. Thus, the groups obtained were formed according to a similar geological origin, location, and nature of the anthropogenic inputs based only on chemical composition data. These results allowed clear identification of the sources of pollution and the delimitation of the polluted zones. All things considered, we conclude that the proposed algorithm is a powerful tool for studying environmental geochemistry data sets, and suggest that the application of this methodology be extended to other research fields.

Isolation of Naegleria fowleri from a domestic water tank associated with a fatal encephalitis in a 4 month-old Venezuelan child.

This study describes the association of household water system contamination with the pathogenic Free-Living Amoeba (FLA) Naegleria fowleri and a case of fatal Primary Amoebic Meningoencephalitis (PAM) in a child from the state of Monagas in Venezuela. Amoebae were initially identified by microscopy from a sample of cerebrospinal fluid (CSF) from the child. Direct DNA extraction and specific PCR/sequencing for N. fowleri was also carried out from the same CSF sample. In order to determine a possible environmental source of infection, water samples from the water tank of the child's home and also water bodies recently visited by the child and his family, were examined for the presence of N. fowleri by culture and PCR/sequencing. The results obtained from the collected water samples revealed that only the water tank of the house was positive for N. fowleri. PCR/sequencing showed that the strains isolated from the patient and the water tanks were 100 % identical. Therefore, the house water tank was confirmed as the source of infection in this case, possibly as a result of the occasional immersion of the child´s head under the water while bathing. This case highlights a novel source of thermally polluted water and another threat of N. fowleri infection.

Transactivation activity and nucleocytoplasmic transport of ß-catenin are independently regulated by its C-terminal end.

The key protein in the canonical Wnt pathway is ß-catenin, which is phosphorylated both in absence and presence of Wnt signals by different kinases. Upon activation in the cytoplasm, ß-catenin can enter into the nucleus to transactivate target gene expression, many of which are cancer-related genes. The mechanism governing ß-catenin's nucleocytoplasmic transport has been recently unvealed, although phosphorylation at its C-terminal end and its functional consequences are not completely understood. Serine 646 of ß-catenin is a putative CK2 phosphorylation site and lies in a region which has been proposed to be important for its nucleocytoplasmic transport and transactivation activity. This residue was mutated to aspartic acid mimicking CK2-phosphorylation and its effects on ß-catenin activity as well as localization were explored. ß-Catenin S6464D did not show significant differences in both transcriptional activity and nuclear localization compared to the wild-type form, but displayed a characteristic granular nuclear pattern. Three-dimensional models of nuclei were constructed which showed differences in number and volume of granules, being those from ß-catenin S646D more and smaller than the wild-type form. FRAP microscopy was used to compare nuclear export of both proteins which showed a slightly higher but not significant retention of ß-catenin S646D. Altogether, these results show that C-terminal phosphorylation of ß-catenin seems to be related with its nucleocytoplasmic transport but not transactivation activity.

Repercusión del proyecto neoliberal en la educación superior en Colombia / Repercussion of the neoliberal project on the higher Colombian education

El presente escrito derivado de investigación, prestan algunas de las políticas macroeconómicas implementadas en Colombia, impuestas por las Instituciones Financieras Internacionales, caso específico, del Fondo Monetario Internacional ysu acuerdo extendido con Colombia, y cómo éstas, han afectado el desarrollo del bienestar de la población, haciendo especial énfasis en la manera en cómo se han afectado las políticas que vienen imponiéndose en la Educación Superior.

The present article, derived from a piece of research, provides some of themacroeconomic policies implemented in Colombia, imposed by the internationalfinancial institutions, the specific case being the International Monetary Fund and its extended agreement with Colombia, and how these have affected the development of the well-being of the population, making special emphasis on how the policies that have been imposed on Higher Education, have been affected.

Histopathologic characteristics of gastric adenocarcinoma in Mexican patients: a 10-year experience at the Hospital Juárez of Mexico.

BACKGROUND: Gastric cancer is the second cause of death by cancer worldwide. Histologic classification may predict tumor biology, clinical behavior, and outcome. According to the Lauren classification, the disease is divided into 2 types, diffuse and intestinal, and the latter has a better prognosis. AIM: To determine the frequency of gastric adenocarcinoma and compare the histopathologic characteristics of intestinal and diffuse-type gastric adenocarcinoma in Mexican patients treated at a tertiary referral hospital. METHODOLOGY: A retrospective study evaluated the pathology reports of patients with gastric adenocarcinoma corresponding to the time frame of January 2003 to December 2012. Adenocarcinomas of the gastric cardia were excluded. Frequencies were expressed as percentages and the categorical variables were compared with the chi-square test. Statistical significance was set at a P<.05. RESULTS: A total of 417 cases of gastric adenocarcinoma were found, 230 (55.2%) of which were diffuse-type and 118 (28.2%) were intestinal-type. The mean age of the patients with diffuse type gastric cancer was 54.02±14.93 and 119 (51.3%) of those patients were men. The mean age of the patients with intestinal-type gastric cancer was 63.43±13.78, and 69 (62.2%) were men. Ninety-two of the diffuse-type patients were under the age of 50 years, compared with 22 of the patients with intestinal-type carcinoma. CONCLUSIONS: This is the first study on the Mexican population to analyze the differences in the histologic types of adenocarcinoma. Diffuse-type gastric carcinoma was the most frequent subtype in our study population and it is associated with worse outcome.

[Food consumption in and around the school]. / Consumo alimentario dentro y fuera de la escuela.

BACKGROUND: elementary school students usually stay in school 4.5 hours a day in Mexico. The main food consumption is outside school. The objective was to explore behaviors on food consumption beyond the school environment. METHODS: descriptive trial that included 173 children, both sexes, from public elementary school in Mexico City. Eating habits were obtained through questionnaire and anthropometric characteristics from physical measurement. RESULTS: participants reported to consume soft drinks and canned juices at high frequency and quantity (80 %) and low consumption of animal foods. They also eat industrialized dairy products with high caloric content and low in protein. Moreover, 30 % of children eat 4 or 5 times a day, whereas 10 % eat one or two times a day. These results were associated with the somatometric characteristics of the children, 37.6 % of whom presented as overweight or obese while 12 % were underweight. CONCLUSIONS: it is necessary that health education involves teachers, parents and children in programs for obesity prevention with the objective of increasing healthy behaviors.

Introducción: en México, los niños de primaria permanecen aproximadamente 4.5 horas en la escuela, por lo que fuera de ese espacio es donde consumen la mayor parte de sus alimentos. El objetivo de esta investigación fue explorar las conductas alimentarias más allá del entorno escolar que pudieran favorecer la obesidad. Métodos: estudio descriptivo de niños de una escuela primaria oficial en el Distrito Federal. Los hábitos alimentarios se conocieron por un cuestionario y las características antropométricas, por medición física. Resultados: los participantes indicaron consumir refrescos y jugos enlatados con alta frecuencia y en cantidades importantes (80 %), así como productos lácteos industrializados con alto valor calórico y bajo contenido de proteínas; ingerían pocos alimentos de origen animal; 30 % comía cuatro o cinco veces al día y 10 %, una o dos veces. Los resultados se asociaron con las características omatométricas de los niños, 37.6 % de los cuales presentó sobrepeso u obesidad y 12 %, bajo peso. Conclusiones: para la prevención de la obesidad son necesarios programas de educación que involucren a profesores, padres de familia y escolares, para obtener conductas saludables y preservar la salud.

Limited impact of palliative chemotherapy on survival in advanced solid tumours in patients with poor performance status.

AIM: Oncologists should carefully weigh up the risks and benefits of palliative chemotherapy in patients with advanced solid tumours (AST) and poor general status from the standpoint both of medical and ethical issues and of healthcare resources required. This study is intended to assess the impact on overall survival of palliative chemotherapy in patients with AST and admitted to hospital as a result of their poor ECOG status. MATERIALS AND METHODS: We performed a retrospective analysis of 92 hospitalised patients with AST, ECOG 3-4, who were treated with palliative chemotherapy. Uni- and multivariate statistical analyses were conducted to determine the impact of clinical and disease variables (number of previous chemotherapy lines, presence of comorbidities, presentation of anorexia-cachexia syndrome, delirium, dyspnoea, ascitis, brain metastases, T-cell count, albumin, haemoglobin and LDH) on survival in this patient population. RESULTS: Mean age was 54 years (range 15-80). No chemotherapy had been given for advanced disease in 74%, 13% had received one line, 6% 2 lines and 7% ≥3 lines. Median survival, i.e., after initiation of chemotherapy to death, in these patients was 33 days (range 1-1390). The median of chemotherapy cycles was 1. In the multivariate analysis, no previous chemotherapy, and absence of anorexia-cachexia syndrome and of comorbidities was associated with significantly improved survival in patients. Forty-nine percent of patients died within 30 days of therapy, 28% died between days 30 and 90, and only 23% of patients lived longer than 90 days. Grade 3-4 toxicities mainly entailed blood disorders, namely anaemia 8%, neutropenia 13% and thrombocytopenia 8%. Six patients (5%) developed sepsis after therapy; of these, 3 died from this toxicity, 1 patient suffered cardiac toxicity, one patient leukoencephalopathy and 1 patient acute pulmonary thromboembolism. CONCLUSION: Palliative chemotherapy given to patients with AST and ECOG 3-4 with short life expectancy provided no benefit for survival. As a result, we may be over-treating these patients and contributing to poor-quality care.

Ouabain-insensitive, Na(+)-stimulated ATPase of several rat tissues: activity during a 24 h period.

Rhythmic daily changes in the Na,K-ATPase activity have been previously described for rat kidney cortex, showing two peaks: at 0900 h and 2100 h, and two valleys: at 1500 h and 0100 h -0300 h. The oscillations in Na,K-ATPase activity are produced by an inhibitor, which binds the enzyme and is present in the rat blood plasma at valley times and absent or at very low concentrations at peak times. Since it has been demonstrated that active Na(+) extrusion from the cells of several tissues depends not only on the Na,K-ATPase but also on the ouabain-insensitive Na-ATPase, we studied the activity of this latter enzyme of several rat tissues, i.e., kidney cortex, small intestine, liver, heart and red blood cells along the day. None of these tissues showed any variation of their Na-ATPase activity along the day. Preincubation of kidney cortex homogenates obtained at 0900 h, with blood plasma drawn at 0900 h and 1500 h, did not modify the Na-ATPase activity. Our results indicate that the Na-ATPase activity does not oscillate along the day. These results are in agreement with the idea that the Na-ATPase could partially compensate the Na(+) transport affected by oscillations of the Na,K-ATPase activity.

Early post-larval development of the endoparasitic platyhelminth Mesocestoides corti: trypsin provokes reversible tegumental damage leading to serum-induced cell proliferation and growth.

Mesocestoides corti is a suitable in vitro model for studying the development of human endoparasitic platyhelminthes. Treatment with trypsin, supplemented with fetal bovine serum (FBS), induces M. corti development from larvae (tetrathyridia) to segmented adult worm; however, the role of this protease and of FBS in post-larval development induction remains unknown. To characterize the participation of trypsin enzymatic activity and of FBS in the induction of tetrathyridia growth and development, both stimuli were added to the larvae either together or sequentially. Additionally, specific inhibition of trypsin activity was also monitored. Finally, the effect of the enzyme on the parasite tegument as well as the proliferative activity and location of proliferating cells after induction of tetrathyridia development were also studied. We conclude that trypsin-induced tetrathyridia development to adult worm is FBS-dependent and that the effect of serum factors is dependent upon a previous trypsin-induced reversible damage to the larva tegument. In dividing and non-dividing tetrathyridia, proliferative activity of cells is mainly located within the apical massif in the anterior region and nerve cords of larvae, respectively. In tetrathyridia stimulated to develop to adult worms, an intense proliferative activity is evident along the nerve cords. Our results suggest that in natural infections the tetrathyridia tegument is temporally made permeable to growth factors by proteolytic enzyme activity in the intestine juice of the definitive host, thus leading to development to adult worms.

Regionalization of DNA and protein synthesis in developing stages of the parasitic platyhelminth Echinococcus granulosus.

Echinococcus granulosus is a parasitic platyhelminth, which causes cystid hydatid disease, a major zoonosis involving canids as definitive hosts, and both human and herbivorous domestic animals as intermediate hosts. The disease is caused in intermediate hosts by hydatid cysts, formed upon ingestion of E. granulosus eggs excreted by canids. Protoscoleces, the developmental forms of the parasite infective to canids, are formed in the germinal cellular layer of hydatid cysts. We have found that protoscoleces develop from patches of proliferating cells present in the germinal layer of the hydatid cyst, while most of the other cells of the germinal layer are in a resting state. Further, patches of proliferating cells form buds, which elongate and develop a separate population of cycling cells. In these elongated buds, cell differentiation leads to the main structures of the protoscolex. Protein synthesis is very active among cells of early buds and coincides with their proliferating activity. By contrast, protein synthesis presents a much lower activity in the resting cells of the germinal layer surrounding the growing protoscoleces. In elongated buds at different stages of development, protein synthesis is found mainly close to cellular territories in which cell differentiation occurs. In free infective protoscoleces, cells in DNA synthesis are concentrated in the body of the larva while protein synthesis occurs in the entire larva. This is the first description of the regionalization of DNA and protein synthesis in developing stages of E. granulosus.

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.

[Impact of vaccination against Haemophilus influenzae type b in Cuba]. / Impacto de la vacunación contra Haemophilus influenzae tipo b en Cuba.

OBJECTIVE: To assess the effectiveness of mass vaccination in Cuba of children under 2 years of age against Haemophilus influenzae type b (Hib), the most common causative pathogen of bacterial meningitis. METHODS: The availability of effective Hib conjugate vaccines led to a nationwide vaccination program in 1999 targeting all children under 2 years of age, with a 97% coverage rate achieved. To assess the program's impact, data from 1998 and 1999 from the National Bacterial Meningitis Reporting System were used. RESULTS: Vaccination efficacy was estimated at 99%. The overall incidence of Hib meningitis declined 46.1%, from 1.3 to 0.6 cases per 100,000 population. The greatest overall reduction, of 56.1%, occurred among children under 5 years of age. Among children under 1 year of age, the reduction was 70.5%, and among the rest of the age groups of children under 5, incidence decreased between 25.9% and 49.6%. In the group targeted for vaccination, incidence decreased 61.1%. Among children in the target group who contracted Hib meningitis, only 8 cases (24.2%) had been vaccinated, most with a single dose applied 1 month before becoming ill. CONCLUSIONS: Hib vaccination of all children under 2 years of age in Cuba greatly reduced the incidence of Hib meningitis, as measured by the National Bacterial Meningitis Reporting System.

Risk indicator of dust exposure and health effects in cement plant workers.

A frequent practical problem of research in developing countries is the lack of reliable records on occupational hazards. To improve this situation, this article suggests and evaluates a two-phase method for estimating particle exposure. The first phase uses the focal group, or homogeneous group, technique to reconstruct the production process and estimate the level of dust exposure. The second phase applies the technique of individual history of exposure to hazards at work, an index that accumulates current and previous exposure. This method was introduced in a Portland cement plant to assess the dust-exposure levels of workers and to evaluate its usefulness in the association between estimated exposure levels and the frequency of health effects--particularly respiratory effects--that occurred as a result of such exposures. The results obtained from the analysis of the production process and of the exposure levels determined by the cement workers showed that it is possible to reconstruct the history of exposure to cement dust during each worker's occupational history. The results also showed that estimated exposure is related to respiratory damage; higher exposure resulted in more serious diseases. This supports the usefulness of the suggested methodology.

[Trypanosoma cruzi genome: transcriptional mapping and karyotype correlation; molecular characterization of a surface antigen from the Tc13 family]. / Genoma del Trypanosoma cruzi. Correlación entre el mapa transcripcional y el cariotipo caracterización molecular de un antígeno de superficie de la familia TC13.

We describe herein the genome mapping of Trypanosoma cruzi, the etiological agent of Chagas' disease, by hybridization of a cosmid library gridded in high density filters with cDNA from an epimastigote expression library as probes. We also show the correlation of some cosmid contigs with parasite chromosomal bands. With libraries from the T. cruzi Genome Project we have characterized a new member of the Tc13 family belonging to the superfamily of trypomastigote surface antigens. Starting with a Tulahuén strain (Tul 2 stock) clone, homologous to these antigens, we have sequenced and characterized the complete gene in the CL Strain (CL Brener clone). We have also found homologies with different ESTs which characterization would lead to further knowledge of this antigen family.

Guías para el manejo del niño con enfermedad diarreica aguda

Objetivos: En las últimas décadas se ha observado una disminución en la mortalidad por diarrea en la población infantil, que se atribuye al incremento en el número de casos manejados adecuadamente. Sin embargo, se estima que la proporción de casos con manejo adecuado es aún baja. El objetivo de esta guía es emitir recomendaciones prácticas para la evaluación y el manejo de niños entre un mes y cinco años de edad que presentan diarrea aguda (DA) definida como la presencia de cuatro o más deposiciones líquidas en u período de 24 horas y con menos de 14 días de duración. Estas guias están dirigidas al personal médico, de enfermería y de otras profesiones de salud que tiene que manejar estos casos en diferentes centros de atención. Opciones: Se consideran las opciones para el manejo del niño con DA: 1) la evaluación clínica; 2) el uso de pruebas diagnósticas complementarias; 3) la prevención o la corrección de la deshidratación; 4) el manejo nutricional; y 5) las intervenciones farmacológicas. Desenlace: Se presentan las características operativas de las estrategias diagnósticas, y el impacto de la intervención terapéutica en término de la duración y el volumen de la diarrea, la duración de la hospitalización y el porcentaje de fracaso durante el tratamiento. Evidencia: Se adelantaron búsquedas de la literatura para cada tópico, con énfasis en guías de práctica clínica, en revisiones sistemáticas de la literatura y en ensayos controlados aleatorios. Dado que existen recomendaciones adecuadas de la Academia Americana de Pediatría, de los Centros de Control de Enfermedades y de Prevención de los Estados Unidos, de la Sociedad Canadiense de Pediatría y de la Organización Mundial de la Salud, se actualizó la información incorporando los hallazgos de estudios clínicos recientes y los aspectos pertinentes para niños en países en desarrollo. Para ello se consideran los resultados de cuatro meta-ánalisis de la literatura publicada en los últimos seis años, así como de múltiples ensayos controlados aleatorios. Valores: Discusiones en grupo por los autores permitieron alcanzar consenso en los desenlaces más importantes. No se consideraron directamente las preferencias de los pacientes o de sus padres. Recomendaciones: Pese a que no está adecuadamente valida, se propone adoptar una escala para la evaluación clínica de la presencia y la severidad de la deshidratación en niños con DA

[Eradication of measles in Cuba]. / La eliminación del sarampión en Cuba.

The vaccine against measles came into use in Cuba in 1971. During the seventies, a new early strategy for measles control was established, and it was followed by further efforts in the early eighties. Despite improvements to the control program, disease outbreaks continued to occur. In 1986, after examining the experience acquired through the control initiatives that were already in place, a new measles vaccination strategy was adopted. In time, the new vaccination strategy against measles came to have three main components: first, a single vaccination "catching-up" campaign targeting children 1 to 14 years of age. Second, efforts were made to achieve and maintain high vaccine coverage through mandatory vaccination services for 12-month-old children ("maintenance vaccination"). Finally, periodic "follow-up" campaigns were carried out for children 2 to 6 years of age. Steps were taken, for the purpose of monitoring the progress made so far toward eliminating measles, to strengthen disease surveillance systems, including the screening of suspected cases. The "catching-up" and "follow-up" campaigns both achieved greater than 98% coverage within targeted age groups. The routine vaccination program has also maintained high coverage. The high population immunity against measles that has been attained through these vaccination strategies has resulted in a rapid decrease in the incidence of the disease. From 1989 to 1992, less than 20 laboratory-confirmed cases were reported annually. In Cuba, the last case confirmed through serologic screening was reported in July 1993. Cuba's strategy for measles elimination has interrupted disease transmission and kept the causal virus from circulating on the island. Cuba's experience with measles elimination suggests that if an appropriate vaccination strategy is applied, measles can be globally eradicated.

[Cardiac rupture in acute myocardial infarct. Presentation of 20 postmortem cases]. / Ruptura cardiaca en el infarto agudo del miocardio. Presentación de 20 casos postmortem.

With the advancement of the Coronary Care Units in the past three decades, there had been an important reduction in mortality secondary to arrhythmias in acute myocardial infarction (AMI): been now days, cardiogenic shock and cardiac rupture the first and second causes of in-hospital death in these patients. The purpose of this report is to know the anatomoclinical characteristics in our hospital of cardiac rupture and to look for risk factors that may be considered to diagnose at the precise time this complication that might cause sudden death secondary to hemodynamic and electromechanical changes. From 300 postmortem cases with AMI proved clinical, and by anatomopathological studies, 20 cases with cardiac rupture were obtained, among which: 11 (55%) were males with an average age of 61.7 years and 9 (45%) females, with an average age of 60 years. The following coronary risk factors were detected: systemic hypertension in 15 (75%) cases; cigarette smoking in 13 (65%) cases and diabetes mellitus in 11 (55%) cases. Long lasting or recurrent history of chest pain previous to death was present in 14 (70%) cases. Conduction disturbances were detected in 13 (65%) cases; among them, 7 (35%) had third degree heart block in whom permanent pacemaker was inserted; 4 (20%) had CRBBB and 2 (10%) ASB. The average heart weight was 478 gr. in males and 434 gr. in females. Evidence of an old MI was present in 7 (35%) cases. All patients had transmural MI. Free cardiac wall rupture was seen in 14 (70%) cases and from the ventricular septum, 6 (30%) cases. Hemopericardium was present in all cases (100%) with an average amount of 425 ml of blood. Pericarditis in 3 (15%). The average time of evolution since the beginning of the AMI until death were 4 days and the main causes of death were cardiogenic shock in 17 (85%) and congestive heart failure in 3 (15%).