Highly pathogenic avian influenza H5N1 virus infections in pinnipeds and seabirds in Uruguay: Implications for bird-mammal transmission in South America.

The highly pathogenic avian influenza viruses of clade 2.3.4.4b have caused unprecedented deaths in South American wild birds, poultry, and marine mammals. In September 2023, pinnipeds and seabirds appeared dead on the Uruguayan Atlantic coast. Sixteen influenza virus strains were characterized by real-time reverse transcription PCR and genome sequencing in samples from sea lions (Otaria flavescens), fur seals (Arctocephalus australis), and terns (Sterna hirundinacea). Phylogenetic and ancestral reconstruction analysis showed that these strains have pinnipeds most likely as the ancestral host, representing a recent introduction of clade 2.3.4.4b in Uruguay. The Uruguayan and closely related strains from Peru (sea lions) and Chile (sea lions and a human case) carry mammalian adaptative residues 591K and 701N in the viral polymerase basic protein 2 (PB2). Our findings suggest that clade 2.3.4.4b strains in South America may have spread from mammals to mammals and seabirds, revealing a new transmission route.

The TG/HDL-c Lipid Ratio as a Cardiovascular Risk Marker in a Mexican Urban Middle-Class Population: Do We Need a Risk Score Tailored for Mexicans?

INTRODUCTION: Risk scores are essential in primary prevention to detect high-risk patients. The most common scores exclude hypertriglyceridemia and abdominal obesity in their risk assessment. We examined the triglyceride/HDL-cholesterol (TG/HDL-c) ratio as a cardiovascular (CV) risk marker in a middle-class urban Mexican population sample. AIM: Our aim was to test the concept of a scoring system reflecting Mexican population characteristics. METHODS: A total of 2602 healthy adults from the Lindavista primary prevention program were considered, evaluating gender, age, blood pressure, smoking, body mass index, waist circumference, lipid profile, and fasting glucose. According to the abnormality, a score from -3 to +3 was assigned. RESULTS: The summation of eleven variables yielded the Lindavista score (LS), which was calibrated versus the TG/HDL ratio and ACC ASCVD Risk Estimator Plus score to determine its correlation with risk categories. The TG/HDL-c ratio had a linear correlation with LS and high-risk ACC ASCVD categories. CONCLUSIONS: Compared with LS and TG/HDL-c, the ACC ASCVD system underestimates the high-risk category. The high prevalence of obesity and lipid triad in the Mexican population requires a scale that considers those traits. The TG/HDL-c ratio is a practical, easy, and economical instrument to categorize risk in Mexicans.

Microalgae Applications to Bone Repairing Processes: A Review.

Research on regeneration and accelerated recovery processes of bone tissue has driven a growing interest in the scientific community. Implementing natural materials to reduce rejections due to biocompatibility issues is an important trend. Biofunctionalization processes have been proposed to promote osseointegration in implant materials, and those substances able to generate an adequate environment for cell proliferation are the object of several studies. Because of their high protein content and their anti-inflammatory, antibacterial, antimicrobial, and healing properties, microalgae represent a natural source of bioactive compounds, and are proposed as candidates for tissue regeneration applications. In this paper microalgae are reviewed as a source of biofunctionalized materials focused on orthopedic applications.

Agavins Impact on Gastrointestinal Tolerability-Related Symptoms during a Five-Week Dose-Escalation Intervention in Lean and Obese Mexican Adults: Exploratory Randomized Clinical Trial.

Agavins are prebiotics and functional fiber that modulated the gut microbiota and metabolic status in obese mice. Here, we designed a placebo-controlled, double-blind, exploratory study to assess fluctuations in gastrointestinal (GI) tolerability-related symptoms to increasing doses of agavins in 38 lean and obese Mexican adults for five weeks and their impact on subjective appetite, satiety, metabolic markers, and body composition. All GI symptoms showed higher scores than placebo at almost every dose for both lean and obese groups. Flatulence caused an intense discomfort in the lean-agavins group at 7 g/day, while obese-agavins reported a mild-to-moderate effect for all five symptoms: no significant differences among 7, 10, and 12 g/day for flatulence, bloating, and diarrhea. Ratings for any GI symptom differed between 10 and 12 g/day in neither group. The inter-group comparison demonstrated a steady trend in GI symptoms scores in obese participants not seen for lean volunteers that could improve their adherence to larger trials. Only body weight after 10 g/day reduced from baseline conditions in obese-agavins, with changes in triglycerides and very-low-density lipoproteins compared to placebo at 5 g/day, and in total cholesterol for 10 g/day. Altogether, these results would help design future trials to evaluate agavins impact on obese adults.

Tiroideopatías y deficiencia de yodo en una población de embarazadas / Thyroid disorders and iodine deficiency in a pregnant population

INTRODUCCION: La disfunción, autoinmunidad tiroidea (AIT) y el déficit de yodo en embarazo, conllevan a efectos adversos. En ausencia de datos de prevalencia y rangos de Tirotrofina (TSH) en cada trimestre en Argentina, se utilizan las guías internacionales de la American Thyroid Association (ATA).OBJETIVOS: Determinar a) prevalencia de AIT y deficiencia de yodo por pesquisa en embarazadas sanas y b) valores de referencia de TSH por trimestre y prevalencia de disfunción con valores propios. METODOS: Se estudió a 217 embarazadas sanas.Se determinó TSH, T4 y T3 total y libres, Anticuerpos a tiroperoxidasa (ATPO) y yoduria. Excluidas las ATPO positivos y disfunción clínica, se recalculó percentiles 5 y 95 y se establecieron rangos de TSH. Se establecieron porcentajes de valores patológicos de TSH según rangos publicados y propios. RESULTADOS: Los ATPO fueron positivos en 8% de las pacientes. Se halló bocio en 38%. La yoduria fue >150 μgr/dl en 58%. Los valores de TSH (mediana y rango) fueron: 0,95 uUI/ml (0,20-3,30), 1,50 uUI/ml (0,02-7,00) y 1,60 uUI/ml (0,21-4,90) para primer, segundo y tercer trimestre respectivamente. La TSH fue elevada según guías ATA en el 11% y disminuyó a 6,5% con nuestros rangos. Solo 1 paciente presentó hipotiroidismo clínico.CONCLUSIONES: La prevalencia de ATPO fue similar a la referida y casi el 40% presentó bocio leve, considerado adaptativo. Se registróhipotiroidismo clínico en 0,5% y subclínico en 11% según valoresde guías ATA, que descendió al 6,5% acorde a valores de este estudio. La mediana de la yoduria indicó suficiencia de yodo en la población.

INTRODUCTION: The dysfunction, thyroid autoimmunity (AIT) and iodine deficiency in pregnancy, leading toadverse effects. In the absence of prevalence data and ranges of Thyrotropin (TSH) in each quarter in Argentina, international guidelines of American Thyroid Association (ATA) are used. OBJECTIVES: To determine a) prevalence of AIT, thyroid dysfunctionand iodine deficiency by screening in healthy pregnant b) TSH reference values per quarter and prevalence of dysfunction with own values. METHODS: We studied 217 healthy pregnant. TSH, T4 and T3 total and free, antibodies to thyroid peroxidase (ATPO) and urinary iodine was determined. Excluding positive ATPO and clinical dysfunction, 5th and 95th TSH percentiles wasrecalculated and established own TSH ranges. Percentage of pathological TSH values was established according to published ranges and with own values. RESULTS: ATPO were positive in 8% of patients. Goiter was found in 38%. The iodine level was> 150 μgr / dl in 58%. TSH values (median and range) were: 0.95 mIU / ml (0.20- 3.30), 1.50 mIU / ml (0.02-7.00) and 1.60 mIU / ml (0.21-4.90) for the first quarter, the second and third respectively. The TSH was elevated as guides ATA in 11% and in 6.5% as own values. Only one patient had clinical hypothyroidism. CONCLUSIONS: The prevalence of ATPOwas similar to that reported, and almost 40% had mild goiter, considered adaptive. Clinical hypothyroidism was recorded at 0.5% and subclinical in 11% as guides ATA, which fell to 6.5%as own values. The median urinary iodine indicated iodine sufficiency in the population.

Cardiovascular risk factors in a Mexican middle-class urban population: The Lindavista Study. Baseline data / Factores de riesgo cardiovascular en mexicanos de clase media: el estudio Lindavista. Datos basales

Introduction and objective: The aim of this communication is to describe the cardiovascular risk factors affecting a Mexican urban middle-class population. Methods: A convenience sample of 2602 middle class urban subjects composed the cohort of the Lindavista Study, a prospective study aimed to determine if conventional cardiovascular risks factors have the same prognosis impact as in other populations. For the baseline data, several measurements were done: obesity indexes, smoking, blood pressure, fasting serum glucose, total cholesterol, HDL-c, LDL-c and triglycerides. This paper presents the basal values of this population, which represents a sample of the Mexican growing urban middle-class. Results: The mean age in the sample was 50 years; 59% were females. Around 50% of the entire group were overweighed, while around 24% were obese. 32% smoked; 32% were hypertensive with a 20% rate of controlled pressure. 6% had diabetes, and 14% had impaired fasting glucose; 66% had total cholesterol ≥ 200mg/dL; 62% showed HDL-c levels <40mg/dL; 52% triglycerides > 150 mg/dL, and 34% levels of LDL-c ≥ 160 mg/dL. Half of the population studied had the metabolic syndrome. Conclusion: These data show a population with a high-risk profile, secondary to the agglomeration of several cardiovascular risk factors.

Introducción y objetivo: el objetivo de este comunicado es describir los factores de riesgo cardiovascular en la población urbana mexicana de clase media. Métodos: La cohorte del estudio Lindavista se compone de una muestra por conveniencia de 2,602 sujetos de clase media. El estudio es prospectivo y tiene como finalidad determinar si los factores de riesgo cardiovascular tienen el mismo factor pronóstico que en otras poblaciones. Para los datos basales, se hicieron varias determinaciones: índices de obesidad, consumo de tabaco, presión arterial, glucosa, colesterol total, c-HDL, c-LDL y triglicéridos en ayuno. Resultados: La media de edad fue de 50 años; el 59% fueron mujeres. Aproximadamente el 50% de la muestra presentó sobrepeso, mientras que el 24% eran obesos. El 32% fumaban, el 32% eran hipertensos con una tasa de control del 20%. El 6% tenían diabetes y el 14% resistencia a la insulina. El 66% tuvieron colesterol total ≥ 200 mg/dl; el 62% mostraron bajos niveles de c-HDL, el 52% triglicéridos > 150 mg/dl, y el 34% niveles de c-LDL ≥ 160 mg/dl. La mitad de la muestra tenía síndrome metabólico. Conclusión: Los datos revelan una población de alto riesgo cardiovascular debido a la aglomeración de diversos factores de riesgo.

Cardiovascular risk factors in a Mexican middle-class urban population. The Lindavista Study. Baseline data.

INTRODUCTION AND OBJECTIVE: The aim of this communication is to describe the cardiovascular risk factors affecting a Mexican urban middle-class population. METHODS: A convenience sample of 2602 middle class urban subjects composed the cohort of the Lindavista Study, a prospective study aimed to determine if conventional cardiovascular risks factors have the same prognosis impact as in other populations. For the baseline data, several measurements were done: obesity indexes, smoking, blood pressure, fasting serum glucose, total cholesterol, HDL-c, LDL-c and triglycerides. This paper presents the basal values of this population, which represents a sample of the Mexican growing urban middle-class. RESULTS: The mean age in the sample was 50 years; 59% were females. Around 50% of the entire group were overweighed, while around 24% were obese. 32% smoked; 32% were hypertensive with a 20% rate of controlled pressure. 6% had diabetes, and 14% had impaired fasting glucose; 66% had total cholesterol ≥ 200 mg/dL; 62% showed HDL-c levels<40 mg/dL; 52% triglycerides>150 mg/dL, and 34% levels of LDL-c ≥ 160 mg/dL. Half of the population studied had the metabolic syndrome. CONCLUSION: These data show a population with a high-risk profile, secondary to the agglomeration of several cardiovascular risk factors.

Prevalence and etiology of congenital hypothyroidism detected through an argentine neonatal screening program (1997-2010).

INTRODUCTION: We retrospectively assessed the incidence of congenital hypothyroidism (CH) detected through our neonatal screening program between 1997 and 2010. We describe the diagnostic characteristics of the detected population and verify the impact of a TSH cutoff (CO) change. PATIENTS AND METHODS: Screening was based on TSH determination on dried blood spot on filter paper samples (IFMA) using a 15 mU/l blood CO until 12/2002 (P1) and 10 mU/l thereafter (P2). Patients were classified as having transient or permanent CH (athyreotic, ectopic, eutopic, with goiter and unknown etiology). Global and diagnostic-related incidences were calculated for the whole studied period with the same CO, and P1 and P2 were compared. RESULTS: Incidences of permanent CH were 1:3,108 (P1) and 1:2,367 (P2). The lower CO detected 22 extra CH, 13 of them definitive (70% with eutopic glands). Only a significant increase (p < 0.05) in eutopic CH was found, partially related to the lower CO applied. A statistically significant association with time was seen for total definitive and ectopic cases (p < 0.05). CONCLUSION: Our findings revealed some changes in the detected population partially related to the CO applied, with only eutopic dysfunctional disorders being more prevalent in the later years. Total permanent CH and ectopic thyroid disorders showed a trend toward higher detection over time, but their prevalence has not changed significantly in our screening program.

Digestive peritoneum in Wistar rat (Rattus norvegicus) / Peritoneo del aparato digestivo de la rata Wistar (Rattus norvegicus)

La rata de laboratorio (Rattus norvegicus albinus) ha sido usada como modelo para investigaciones médicas, biológicas y moleculares, desde hace mucho tiempo. Sin embargo, no existen descripciones detalladas del peritoneo digestivo de la rata wistar. El objetivo de este trabajo es definir en forma clara y acorde a los principios de la Nómina Anatómica Veterinaria el peritoneo en esta especie de mamífero de laboratorio. Se utilizaron ochenta y ocho ratas (Rattus norvegicus albinus) de entre 250 y 450 g. Fueron disecadas en fresco luego de ser eutanasiadas por sobredosis de tiopental sódico intraperitoneal. Se realizó una incisión paramediana que se extendía desde el cartílago xifoides del esternón hasta el pubis y otra sobre cada arco costal hacia dorsal.

The laboratory rat (Rattus norvegicus albinus) has been used as a model for medical, biological and molecular research, for a long time. It is an interesting fact that there are no detailed descriptions of the gross anatomy of the liver and its ways of fixation. The aim of this study is to define clearly and according to the Nomina Anatomica Veterinaria principles, the liver and its way of fixation in this species of laboratory mammal. Eighty-eight rats (Rattus norvegicus albinus) were used, with a weight between 250 and 450 g. They were dissected in fresh, after been euthanized by an overdose of thiopental sodium intraperitoneal. An incision from the xiphoid cartilage up to the pubic region was made and another on each costal arch toward dorsal.

Gross anatomy of the heart in the western grey kangaroo (Macropus fuliginosus) / Anatomía macroscópica del corazón en el canguro gris occidental (Macropus fuliginosus)

The aim of this study was provide a description of the macroscopic heart anatomy of the kangaroo Macropus fuliginosus. The terms of the Nomina Anatomica Veterinaria were employed. Heart did not have interventricular sulcus. Auricles were located in both faces of the heart. Right ventricle had slight septomarginal trabecula that extended between papilar muscles and the parietal wall. Right ventricle parietal wall had plenty of trabecula carneae. Septal wall was smooth and had three papilar muscles. Papilar muscles of left ventricle were two and they were located over parietal wall. Septal walls and parietal of left ventricle were full of trabecula carneae that surrounded papilar muscles. Two vessels derived from the aorta, right and left sinus coronary arteries and a septal artery. Septal artery gave irrigation to interventricular septum and derived from left sinus of the aorta and their lumen had a higher diameter than the left coronary artery. Coronary arteries had intra myocardic route.

El objetivo de este estudio fue proporcionar una descripción de la anatomía macroscópica de corazón el canguro Macropus fuliginosus. Fueron empleados los términos de la Nomina Anatómica Veterinaria. El corazón no tuvo surco interventricular. Las aurículas se encontraban en ambas caras del corazón. El ventrículo derecho presentó una trabécula septomarginal delgada que se extendía entre los músculos de la pared papilar y parietal. La pared parietal del ventrículo derecho presentó un montón de trabéculas carnosas. La pared septal era lisa y tenía tres músculos papilares. Los músculos papilares del ventrículo izquierdo fueron dos y se encontraron en la pared parietal. Las paredes septal y parietal del ventrículo izquierdo estaban llenas de trabéculas carnosas que rodeaban los músculos papilares. Dos vasos procedentes desde la aorta, arterias del seno coronario derecho e izquierdo, y la arteria septal. La arteria septal dio irrigación al septo interventricular y derivada desde el seno izquierdo de la aorta y su lumen tuvo un mayor diámetro que la arteria coronaria izquierda. Las arterias coronarias presentaron un trayecto intramiocardico.

Neonatal screening for congenital adrenal hyperplasia: experience and results in Argentina.

AIM: To report the experience of the neonatal screening program for congenital adrenal hyperplasia (CAH) carried out in Buenos Aires, Argentina, from 1997 to 2006. POPULATION AND METHODS: 17-Hydroxyprogesterone (17OHP) was measured with an immunofluorometric assay in filter paper blood samples collected at neonatal maternity discharge. Filter paper blood levels <40 nmol/l were considered normal. 17OHP levels from 40-90 nmol/l triggered a new assessment to decide on a course of action. Confirmation of CAH was made with levels >90 nmol/l. This led to clinical follow up. For preterm (PT) infants, data were adjusted according to percentiles for gestational age and/or birth weight. RESULTS: From 80,436 screened newborns (46.8% girls), 8848 (11%) were PT. 15 term (T) and 3 PT infants were recalled (0.022%). Nine were confirmed as having CAH (8 T and 1 PT) (female/male: 0.8; incidence 1:8937). Mean ages of screening and treatment were 5.7 and 13 days. Only 33% of affected children were clinically suspected of having CAH prior to screening. Four boys and two girls presented salt-wasting forms and severe adrenal insufficiency crises were prevented as a result of the screening. CONCLUSIONS: Our findings confirm the benefits of CAH neonatal screening in our country with a high incidence of the classical form. Established criteria of screening and follow up allowed us to detect unrecognized affected males and females and to successfully prevent salt-wasting crises.

Celiac disease screening by immunochromatographic visual assays: results of a multicenter study.

OBJECTIVE: To assay the efficiency for celiac disease (CD) screening of 2 immunochromatographic visual stick assays based on human recombinant tissue transglutaminase (tTG). One was the antitissue transglutaminase antibodies (AtTGA) stick for IgA/G antibodies to tTG detection, the other was the AtTGA/antigliadin antibodies (AGA) stick for IgA antibodies for tTG and/or gliadins. PATIENTS AND METHODS: In a prospective multicenter study, 4 pediatric gastroenterology units from Spain and 2 from Latin America enrolled 72 control children with a normal small bowel mucosa and 113 untreated patients with CD with Marsh type 3 lesions. RESULTS: Evaluation of results by the gastroenterologists and by 2 independent observers at the coordination center showed a remarkably low interobserver variability. For the AtTGA stick, sensitivity was 96.5% and specificity was 98.6%. The AtTGA/AGA stick displayed a sensitivity of 94.5% and a specificity of 98.6% for AtTGA and a sensitivity of 63.1% and a specificity of 95.2% for AGA. The highest efficiency and positive likelihood ratio was obtained for the AtTGA stick, higher than for IgA AtTGA by enzyme-linked immunosorbent assay. One additional advantage was that previous investigation of total serum IgA levels could be eluded. The IgA AtTGA/AGA stick, with an efficiency of 95.1%, compared with 89.2% when the combined results of the 2 enzyme-linked immunosorbent assays were considered, turned out to be an excellent diagnostic tool for infants with no IgA deficiency. CONCLUSION: These 2 assays are extremely efficient for CD screening, by combining a high diagnostic accuracy with the simplicity and rapidity of visual methods.

Pesquisa neonatal de hipotiroidismo congénito: supervisión del déficit de yodo en la provincia de Misiones / Screening neonatal for congenital hypothyroidism: surveillance of iodine deficiency in Misiones

El déficit de yodo (IDD) es un problema de la Salud Pública que afecta a millones de personas en todo el mundo y es causante de alteraciones en la neuromaduración que pueden ser evitados si se realiza una yodoprofilaxis adecuada. Objetivo: Realizar un monitoreo de IDD en la localidad de Wanda, provincia de Misiones, por su ubicación geográfica y hábitos alimentarios con posible consumo regional de sal no iodada. Se estudiaron en 502 escolares de 5 a 14 años de vida , se evaluaron: peso, talla , BMI y palpación tiroidea. En 114 de ellos se determinó la yoduria en muestras casuales de orina. Se analizaron los niveles de TSH de la pesquisa neonatal de los 18 meses previos al estudio, realizados por métodos sensibles (IFMA-DELFIA). Se aplicaron los criterios de suficiencia establecidos por la OMS/ ICCDD. Resultados: La prevalencia de bocio en la región fue de 6.2 %. Los niveles de yoduria tuvieron una mediana de 239 ug/l. El valor de TSH neonatal mediano fue 1.25 uU/ml. Sólo el 1.4 % de las muestras estaban por encima de 5 uU/ml . Cuando se aplicaron los criterios de la OMS pudo observarse que la prevalencia de bocio superaba levemente lo esperado para una zona suficiente, pero no así los niveles de ioduria ni la distribución de TSH neonatal. Conclusión: El aporte iodado de la región evaluada es suficiente como lo demuestran la ioduria y los niveles de TSH neonatal. La presencia de bociógenos como la mandioca en la dieta puede explicar el leve aumento en la prevalencia de bocio. La utilización de la pesquisa neonatal de hipotiroidismo congénito en la supervisión de la deficiencia de yodo añade un beneficio al objetivo primario que es la prevención del retraso mental.

O b j e c t i v e : To estimate the adequacy of iodide intake in Wanda Misiones through the conventional parameters of ioduria and goiter prevalence in scholars as well as with the distribution of TSH neonatal levels as performed for the hypothyroidism screening program in newborns. Population and methods: Height , and BMI and weight were assessed in 502 scholars aged 5 to 14 and expressed as SDS. In 419 of them (215 female) thyro i d volume was evaluated and classified according to WHO (9). In 114 children iodide urinary concentration was measured in casual urine samples by Sandell y Kolthof method modified by Pino (17). Neonatal screening program for congenital hypothyroidism is carried out in the region measuring TSH in filter paper samples with IFMA DELFIA. Since 2000 7.102 newborn have been screened. TSH level's distribution of the 18 months prior to this study (n 267) were evaluated. Criteria suggested by WHO to indicate iodide deficiency were applied. Results: Height, weight and BMI were normal for the chronological age according to Argentinean population parameters. Goitre prevalence was 6.2 % (7.3 % in girls and 5.3 % in boys), higher that expected for a iodide sufficient area. Iodide urine median levels were 239 ug/l with a distribution that excluded iodide deficiency. Neonatal screening program detected 5 congenital hypothyroid children out of the 7102 newborn studied. All of them were early and adequately treated. Only 1.4 % of the 267 samples were > 5 µU/ml, excluding iodide deficiency. Conclusion: Iodide intake in Wanda, Misiones, is adequate as shown by the findings of iodide urine concentration and TSH neonatal levels. A higher prevalence of goitre than expected for this situation, could be explained by dietary intake of goitrogen food as mandioca. Congenital hypothyroidism screening program in this region was extremely effective. The possibility of using its results for iodide intake supervision is an additional benefit to the one of early prevention of mental retardation.

Esofagitis cáustica. Estenosis esofágica y su tratamiento con dilataciones / Caustic esophageal injuries. Esophageal stenosis and its treatment with dilation

La ingestión accidental de sustancias cáusticas en pediatría es frecuente. La estenosis esofágica (EE) secundaria a esofagitis cáustica (EC) es una grave complicación. El tratamiento de elección de la EE es la dilatación endoscópica con balón neumático. La mayoría de los pacientes tienen una buena respuesta pero requieren dilataciones reiteradas La falla del mismo obliga al tratamiento quirúrgico. En este estudio se analizó en forma retrospectiva la evolución de los niños con EC y el tratamiento de aquellos que presentaron EE. Ingresaron al estudio todos los niños con EC del Servicio de Endoscopia del Hospital Pereira Rossell entre enero de 1997 y diciembre de 2002. Se incluyeron 92 pacientes en los que se diagnosticó esofagitis. La edad promedio fue 2,8 años; 61 varones. La sustancia ingerida con mayor frecuencia fue alcalina. Los grados de EC fueron: grado I, 35 (38 por ciento); grado IIa, 23 (25 por ciento); grado IIb, 16 (17 por ciento); grado IIIa, 10 (10,8 por ciento ) y grado IIIb , 8 (8,7 por ciento). Nueve evolucionaron a estenosis (dos con esofagitis grado IIb, dos con esofagitis grado IIIa y cinco con lesión grado IIIb). El número total de dilataciones fue 168 (promedio 18,6). Cinco niños no requir ieron más dilataciones, dos continúan en tratamiento y dos necesitaron cirugía (promedio de seguimiento 10,5 meses). Si bien el número de niños es pequeño, se concluye que las esofagitis cáusticas moderadas y severas (grado II y III respectivamente) evolucionaron con mayor frecuencia a la estenosis, el tratamiento con balón neumático logró solucionarla y se acompañó de un bajo número de complicaciones. Destacamos la importancia de las medidas de prevención.

Efficacy of congenital hypothyroidism neonatal screening in preterms less than 32 weeks of gestational age: more evidence.

OBJECTIVE: To evaluate the double screening performed for congenital hypothyroidism (CH) to preterm infants <32 weeks of gestational age (GA) between 1994 and 2003. INFANTS AND METHODS: TSH was assessed by IFMA. Infants were classified as: term (T) (>37 weeks GA); preterm (PT) (33-37 weeks GA); and very preterm (VPT) (< or =32 weeks GA). RESULTS: In 585,221 screened infants, CH was confirmed in 228 T, 23 PT and seven VPT. An increasing incidence of CH was found with decreasing GA, affecting 1:1,603 PT and 1:585 VPT. PT infants had 1.5 times more risk than full-term infants of suffering CH, and VPT 4 times more. Only 4/7 affected VPT had an adequate double screening as requested. Three had elevated TSH values in the first sample and in one a normal TSH (10.3 mIU/l) at 3 days rose to 240 mIU/l after day 15. In the remaining three VPT, TSH in the unique filter paper sample (21 to 34 days) was markedly elevated. CONCLUSIONS: Our findings reinforce the need for awareness in neonatal settings for adequate screening of VPT infants. Screening in the first week of life was effective in detection of most but not all affected VPT. Larger studies are needed in order to establish accurate screening recommendations for VPT newborns. Until this step is reached, repeated screening is advised in these infants.

Neonatal TSH levels as an index of iodine sufficiency: differences related to time of screening sampling and methodology.

INTRODUCTION: Current WHO guidelines consider that under adequate iodine intake <3% of newborns should have neonatal TSH levels of >5 mU/l blood when screening is performed in cord blood or at 3 days to 3 weeks of age. OBJECTIVE: To estimate whether this absolute criterion when applied to newborns older than 48 h of age and native to Buenos Aires coincides with the traditional ones (goiter and urinary iodine in school-age children (SAC)), and if the evaluation varies with either the methodology used for TSH measurements and/or the time of specimen sampling. POPULATION AND METHODS: TSH was measured by an immunofluorometric assay (IFMA) on filter paper blood spots of 186 cord blood samples, 112 babies <48 h of age and 1,500 newborns >48 h of age, and by immunoradiometric assay (IRMA) in 238 newborns. The WHO ICCIDD absolute criteria were applied to each population. Thyroid volume was assessed by direct palpation in 500 SAC, and in 100 of them urinary iodine levels were measured. RESULTS: TSH levels were >5 mU/l blood in 11.3% of the cord blood samples and in 3.6% of the samples from babies <48 h of age, suggesting mild iodine deficiency. TSH was >5 mU/l in 2.7% of newborns >48 h of age tested by IFMA (iodine sufficient) and in 30% measured by IRMA (moderate iodine insufficiency). Median urinary iodine and goiter prevalence in SAC were 143 mug/l and 4.5%, respectively, as expected in an iodine-sufficient area. conclusion: The TSH levels in Buenos Aires conform with the WHO criterion that defines iodine sufficiency. Application of this criterion, however, to cord blood samples or samples from babies <48 h old and the use of different methodologies may lead to erroneous conclusions.

Sensibilidad y especificidad de los anticuerpos antigliadina y antiendomisio realizados en el Laboratorio de Inmunología del Centro Hospitalario Pereira Rossell / The sensibility and specificity of tests using antigliadin and antiendomisin antibodies in the Immunology Laboratory of the Pereira Rossell Hospital Centre

La enfermedad celíaca se presenta con una gran heterogeneidad: formas sintomáticas, silentes y latentes. La determinación de anticuerpos antigliadina y antiendomisio es útil para definir a qué pacientes realizar biopsia de intestino delgado y para el seguimiento de los celíacos ya conocidos. Estas técnicas fueron incorporadas en 1994 en el Centro Hospitalario Pereira Rossell. Objetivo: Conocer la sensibilidad y especificidad de los anticuerpos antigliadina (IgG) y antiendomisio (IgA) para el diagnóstico de enfermedad celíaca, determinados por técnica de inmunofluorescencia en la Sección de Inmunología del Laboratorio Central del Centro Hospitalario Pereira Rossell y aplicados a población hospitalaria. Se evaluaron los resultados de la serología tomando como patrón de oro la anatomía patológica de la biopsia de intestino delgado. Para el diagnóstico de enfermedad celíaca se siguieron los criterios de 1990 de la Sociedad Europea de Gastroenterología Pediátrica y Nutrición. Se evaluó la serología de 65 niños que recibían gluten al momento de la extracción de sangre: 50 celíacos y 15 no celíacos (con biopsia normal). La sensibilidad y la especificidad fueron de 94 por ciento y 80 por ciento para los anticuerpos antigliadina y de 94 por ciento y 93 por ciento para los antiendomisio respectivamente. Estos resultados son similares a los comunicados por los mejores laboratorios a nivel internacional.

Programa piloto de pesquisa neonatal de fibrosis quística / Pilot neonatal screening program for cystic fibrosis

El diagnóstico precoz de la fibrosis quística mejora la evolución de la enfermedad. Comunicamos los resultados del programa de pesquisa neonatal realizado de 1997 a 2001. Se evaluaron 64330 recién nacidos con tripsina inmunorreactiva (IRT) en sangre seca en papel de filtro por inmunofluorometría (nivel de corte: 70 ng/ml), con estrategia IRT/IRT/ADN y prueba del sudor. inicialmente se estudiaron las mutaciones F508 y G542X en ADN en sangre seca de los niños con2 IRT elevadas y, desde junio de 2001, 20 mutaciones con ARMS. Se detectaron 21 pacientes afectados (1:3063). Los 386 niños (0,59 por ciento) con IRT elevada fueron citados nuevamente; 50 tenían IRT elevada en la segunda muestra. En el 42 por ciento de ellos, se confirmó el diagnóstico. El 66,66 por ciento de ellos eran heterocigotas compuestos; las mutaciones predominantes fueron F508 y G542X. Se hallaron mutaciones en ambos alelos en el 71,5 por ciento de los casos y, en 1 de ellos, en el 28,5 por ciento restante. la estrategia elegida para la detección neonatal de fibrosis quística fue útil y eficaz, y confirmó la alta frecuencia de la enfermedad en nuestro medio, la heterogeneidad de la población, la ausencia de signos clínicos en el período neonatal y una evolución adecuada de los pacientes detectados. Todo esto justifica implementar la pesquisa neonatal

Programa piloto de pesquisa neonatal de fibrosis quística / Pilot neonatal screening program for cystic fibrosis

El diagnóstico precoz de la fibrosis quística mejora la evolución de la enfermedad. Comunicamos los resultados del programa de pesquisa neonatal realizado de 1997 a 2001. Se evaluaron 64330 recién nacidos con tripsina inmunorreactiva (IRT) en sangre seca en papel de filtro por inmunofluorometría (nivel de corte: 70 ng/ml), con estrategia IRT/IRT/ADN y prueba del sudor. inicialmente se estudiaron las mutaciones F508 y G542X en ADN en sangre seca de los niños con2 IRT elevadas y, desde junio de 2001, 20 mutaciones con ARMS. Se detectaron 21 pacientes afectados (1:3063). Los 386 niños (0,59 por ciento) con IRT elevada fueron citados nuevamente; 50 tenían IRT elevada en la segunda muestra. En el 42 por ciento de ellos, se confirmó el diagnóstico. El 66,66 por ciento de ellos eran heterocigotas compuestos; las mutaciones predominantes fueron F508 y G542X. Se hallaron mutaciones en ambos alelos en el 71,5 por ciento de los casos y, en 1 de ellos, en el 28,5 por ciento restante. la estrategia elegida para la detección neonatal de fibrosis quística fue útil y eficaz, y confirmó la alta frecuencia de la enfermedad en nuestro medio, la heterogeneidad de la población, la ausencia de signos clínicos en el período neonatal y una evolución adecuada de los pacientes detectados. Todo esto justifica implementar la pesquisa neonatal(AU)