[Hypobaric spinal anesthesia in a large ventral hernia]. / Anestesia espinal hipobara en hernia supraumbilical de gran tamaño.

High abdominal wall surgery may require general anesthesia but, in patients with high risk of difficult airway and respiratory complications, local or regional anesthesia is the choice whenever possible. Spinal anesthesia usually used (both isobaric and hyperbaric) could compromise the respiratory function due to blockade of the T6 metamere or higher. Hypobaric spinal anesthesia (HSA) at low doses (3.6 cc of 0.1% hypobaric bupivacaine plus 0.2 cc of 0.005% fentanyl) achieves sufficient analgesia with minimal motor blockade. We present the case of a patient with a large supraumbilical hernia with high risk of difficult airway and respiratory complications, who went through HSA. The patient did not report pain or dyspnea during the surgical procedure thus, HSA at low doses is an option to be taken into account in high abdominal wall surgery despite not having been described for this use.

THE CONSUMPTION OF RED PUPUNHA (BACTRIS GASIPAES KUNTH) INCREASES HDL CHOLESTEROL AND REDUCES WEIGHT GAIN OF LACTATING AND POST-LACTATING WISTAR RATS.

INTRODUCTION: The lactating and post-lactating periods are marked by large metabolic change. Production of milk is 60% lipid dependent. We reported in a recent scientific meeting that Red pupunha palm tree fruit increases HDL cholesterol in lactating rats. This study evaluated if consumption of Red Pupunha by adult female rats has a beneficial impact on the lipid metabolism of lacting and post-lacting adult rats. OBJECTIVE: Evaluate if consumption of red pupunha has a beneficial effect in the lipid metabolism of lacting and post-lacting adult Wistar rats. RESEARCH METHODS: Four groups including two for control; (1) control adult lactating rats, (2) control adults post-lactating rats; and two experimental groups; (3) pupunha adults lactating rats and (4) pupunha adult post-lactating rats were evaluated and compared regarding: weight gain, food consumption, plasma total protein, glucose, total lipid, triglycerides, total cholesterol and HDL-cholesterol levels. The mean difference and its 95% confidence intervals were used for group comparisons. Group comparisons were evaluated by using analysis of variance (one-way ANOVA). The statistical significance of the pairwise differences among groups was assessed by using the two-sided Tukey test. RESULTS: There were no important differences in food consumption, plasma glucose, total lipids and triglycerides among groups. The red pupunha lactating group gain less weight showing lower body mass index (BMI) than controls (p < 0.05). Total cholesterol was lower in red pupunha lactating than in controls but not in the red pupunha post-lactating group as compared to controls. Triglycerides were lower in the post-lactating red pupunha group as compared to the control group (p = 0.039) but not for the lactating groups. Red pupunha lactating and post-lactating groups had higher HDL-cholesterol than their corresponding control groups (p ≤ 0.01). CONCLUSION: Original findings include the beneficial effect of red pupunha in post-lactating rats increasing the HDL-cholesterol and lowering the BMI. Red pupunha was confirmed to increase HDL-cholesterol in lactating rats. These results suggest that red pupunha is a healthy fruit to be consumed during lactating and post-lactating periods as it is related to better lipid profile and less body weight gain.

Riesgo de mantener obesidad desde la infancia hasta el final de la adolescencia / The risk of staying obese from childhood to the end of adolescence

Introducción: la obesidad es uno de los principales problemas de salud dada su asociación, a cualquier edad, con una extensa comorbilidad, destacando la enfermedad cardiovascular y la diabetes tipo 2. Su presencia en la infancia supone un riesgo de persistencia en edades posteriores. El objetivo de este estudio es conocer el riesgo que tienen los niños que son obesos según el Índice de Masa Corporal (IMC), a distintas edades, de mantener este estado cuando son jóvenes adultos. Pacientes y métodos: se realiza un estudio longitudinal de 153 niños nacidos en 1989, determinando su percentil de IMC por edad y sexo, a los 2, 3, 4, 6, 8, 11 y 14 años, e IMC a los 18 años. Se calcula el riesgo relativo que presentan los niños que son obesos a cada una de estas edades de presentar obesidad a los 18-19 años. Resultados: los niños que presentan obesidad a partir de los seis años tienen un riesgo claro (de 7 a 23) de mantener obesidad a los 18 años, siendo máximo este riesgo (23,8) a los 11 años: 40,9 en niñas y 11,7 en niños. La prevalencia de obesidad a los 18 años es del 7,18%, (intervalo de confianza del 95% [IC 95%]: 3,0-11,0) (6,25% en hombres y 7,86% en mujeres) y la de sobrepeso es del 18,3%, (IC 95%: 11,9-24,0), (26,56% en hombres y 12,35% en mujeres). Conclusiones: los niños que son obesos a partir de los seis años presentan riesgo de ser obesos a los 18-19 años (AU)

Introduction: obesity is one of the most important problems in public health. It’s associated, at any age, with extensive comorbidity, notably cardiovascular disease and type2 diabetes. When present in childhood, obesity poses a risk of remaining at later ages. The objective of this study is to know the risk of children who are obese (according to Body Mass Index: BMI) at different stages of childhood, to stay obese when they become young adults. Subjects and methods: a long-term study of 153 children born in 1989 is carried out, calculating their BMI at 2, 3, 4, 6, 8, 11, 14, and 18 years old. The relative risk of the children who are obese at each one of those ages to remain obese at 18-19 was calculated. Results: children who are obese at 6, or later, showed an evident risk (from 7 to 23) to stay obese at 18. This risk peaks (23.8) at 11 years old, with figures of 40.9 in girls and 11.7 in boys. The prevalence of obesity at 18 is 7.18% (CI: 3.0-11.0) (6.25% in males, and 7.86 in females); the prevalence of overweight is 18.3% (CI: 11.9-24.0) (26.56% in males and 12.35% in females). Conclusions: children who are obese at age 6, or older, show a higher risk of remaining obese at 18-19 years old (AU)

Transmission of Hansen's disease and unscreened household contacts.

INTRODUCTION: Leprosy household contact investigation has been recommended as an epidemiological surveillance strategy for more than 50 years. OBJECTIVE: The purpose of this study was to estimate the yield that could be achieved in case detection if four contacts could be examined for every case found. METHODS: For the estimation of the number of cases not detected (lost) and yield per contact investigation in Mato Grosso, the incidence rates and yield calculations from a cohort study conducted in Rio de Janeiro by Matos et al (1999) were applied to data from the state of Mato Grosso. Also, to identify high-risk groups for leprosy, a cross-sectional study was conducted in which leprosy cases found as a result of a contact investigation were compared with index cases detected by other means. RESULTS: The lost cases among household contacts were at least 4 per every 10 new cases detected. This is the result of insufficient contact investigations--it being 0.8 instead of 4 contact investigations per each case as recommended by the Brazilian Ministry of Health. Up to 60% of the incidence of leprosy could be explained by the high number of lost cases among household contacts not examined. Women and children are more likely to be contacts. CONCLUSION: The lost cases due to insufficient contact investigation represent lost opportunities in early detection and treatment, thus losing the opportunity to reduce leprosy transmission.

Risk factors for atopic dermatitis in southern Puerto Rico

BACKGROUND: Little is known about the risk factors and exposures to aeroallergens in subjects with atopic dermatitis (AD) in Southern Puerto Rico. The objective was to determine the prevalence of skin reactions to aeroallergens and to analyze self-reported risk factors in AD patients and a nonallergic control population. METHODS: A cross-sectional study was conducted which included 726 AD patients and 313 nonallergic control subjects. Skin tests were conducted and a questionnaire was self-applied to all participants. RESULTS: Seventy six percent of the AD patients showed at least one positive skin reactions to aeroallergens. Of these, half had positive skin reactions to dust mites, and one third to Periplaneta americana. A low prevalence of positive skin reactions to dog, cat, plant and fungal allergens was detected. Co-sensitivitity between mites and cockroaches was 30%. The maximum skin reactivity to mites was at 10-19 years of age declining thereafter while skin reactivity to dogs, and plants increased with age. No significant differences in the prevalence of skin reactions was observed between the male and female AD population. CONCLUSIONS. Of the aeroallergens tested, those derived from dust mites are the most frequent sensitizing agents in the AD patients. Data also showed that the mites B. tropicalis and E. maynei are also important sources of sensitization. Our study show that young patients specially those between the age of 10-19 age group are the most allergic. Being female, or having an asthmatic father are significant risk factors associated with allergen sensitivity in the AD population.

Anestesia en el síndrome de May-Hegglin / No disponible

No disponible

Alfa 1 antitrypsin and protease levels in Puerto Rican asthmatics: a pilot study

A cross-sectional pilot study was conducted on a population of 119 asthmatics who had been recruited from the Emergency Room Department of a major hospital in Ponce, Puerto Rico. The purpose of the study was to determine the frequency of the MM, MS, and SS a-i-antiprotease variants. Also, we analyzed the serum levels of the alpha-1-antiprotease inhibitor, quantified the levels of serine proteases in homes of the asthmatic volunteers, and determined whether environmental levels of proteases, regardless of their sources, had any association with either asthma symptoms or alpha-1-antiprotease inhibitor phenotypes. Our results do not support the role of the alpha-1-antiprotease as a risk factor for asthma in the study population as previously reported. Patients who had visited the ED due to asthma on 3 or more occasions had significantly higher trypsin levels than those who had done so 2 or fewer times. Of those asthmatic patients who had daily symptoms, 40had been exposed to high levels of elastase, and 33.3to trypsin. Similarly, 52.9of the patients with 2 or more hospitalizations a year had been exposed to high elastase levels, and 40.5of asthma patients who had nocturnal asthma more than 3 times a week had been exposed to high levels of elastase.

Tratamiento del dolor en los estudios de enfermería / Management of pain in nursing studies

No disponible

Tuberculosis: what is the yield of associate investigations in non-BCG-immunized children with positive tuberculin skin tests?

SETTING: Urban county health department in Tarrant County, Texas, USA. OBJECTIVE: To determine the yield of associate investigations in non-bacille Calmette-Guerin (BCG) immunized children with positive tuberculin skin tests (TSTs). DESIGN: We compared the results of associate investigations of the contacts of 38 TST-positive, non-BCG-immunized pre-school children with the results of contact investigations of 290 culture-confirmed persons with tuberculosis (TB). RESULTS: Associate investigations were more likely than contact investigations to identify persons with culture-confirmed TB and positive TSTs. Contacts identified through associate investigation of non-BCG-immunized pre-school children were 9.4 (95%CI 4.2-22.5) times more likely to have culture-confirmed TB and 2.3 (95%CI 2.0-2.7) times more likely to have positive TSTs than contacts of persons with culture-confirmed TB. CONCLUSION: While conducting associate investigations is labor intensive, these data indicate that associate investigation of pre-school non-BCG-immunized children should be assigned priority in TB control activities, at least equal to the importance of investigating the contacts of culture-proven TB.

Comparative prevalence of sensitization to common animal, plant and mould allergens in subjects with asthma, or atopic dermatitis and/or allergic rhinitis living in a tropical environment.

BACKGROUND AND OBJECTIVES: Current information suggests that the expression of allergic diseases is determined by the exposure and nature of the allergen. The objectives of the present study were to determine if the nature of allergenic exposition to animal, plant or fungal allergens influenced the clinical manifestations of atopic dermatitis (AD), allergic rhinitis (AR) or asthma (AS) in patients living in a tropical environment. The prevalence and degree of sensitization to these allergens were analysed by age and gender. SUBJECTS AND METHODS: A total of 1496 atopic cases, grouped according to the primary diagnosis of AD or AR or AS, were skin tested using a standardized allergen panel. Participants were categorized by age groups. The atopic index (AI) and mean weal diameter (MWD) as well as the prevalence of positive skin tests were determined for each of the patient groups and compared by age groups. RESULTS: The prevalence of atopy as well as the AI and the MWD peaked at 6-15 years of age and declined thereafter. In all the patients tested, the prevalence of sensitization was, in decreasing order; dust mites 94.3%, cockroach 41.5%, pets 31.5%, plant allergens 31.1% and fungal 19.4%. Eight hundred and ninety-three atopic patients were exclusively sensitized only to animal allergens. Of these, 38.4% had AD, 31.3% had AR and 30.5% with AS. CONCLUSION: These data demonstrate that for patients with AD, AR and AS living in a tropical environment, the prevalence of positive skin reactions to animal allergens is highest followed by plant and fungal allergens. We did not observe any association between the type of allergen and clinical manifestations. The index of atopy was similar for both sexes. The prevalence and degree of sensitization were shown to peak in young adults independent of the allergen in AD and AR patients.

The dynamics of interactions between Plasmodium and the mosquito: a study of the infectivity of Plasmodium berghei and Plasmodium gallinaceum, and their transmission by Anopheles stephensi, Anopheles gambiae and Aedes aegypti.

Knowledge of parasite-mosquito interactions is essential to develop strategies that will reduce malaria transmission through the mosquito vector. In this study we investigated the development of two model malaria parasites, Plasmodium berghei and Plasmodium gallinaceum, in three mosquito species Anopheles stephensi, Anopheles gambiae and Aedes aegypti. New methods to study gamete production in vivo in combination with GFP-expressing ookinetes were employed to measure the large losses incurred by the parasites during infection of mosquitoes. All three mosquito species transmitted P. gallinaceum; P. berghei was only transmitted by Anopheles spp. Plasmodium gallinaceum initiates gamete production with high efficiency equally in the three mosquito species. By contrast P. berghei is less efficiently activated to produce gametes, and in Ae. aegypti microgamete formation is almost totally suppressed. In all parasite/vector combinations ookinete development is inefficient, 500-100,000-fold losses were encountered. Losses during ookinete-to-oocyst transformation range from fivefold in compatible vector parasite combinations (P. berghei/An. stephensi), through >100-fold in poor vector/parasite combinations (P. gallinaceum/An. stephensi), to complete blockade (>1,500 fold) in others (P. berghei/Ae. aegypti). Plasmodium berghei ookinetes survive poorly in the bloodmeal of Ae. aegypti and are unable to invade the midgut epithelium. Cultured mature ookinetes of P. berghei injected directly into the mosquito haemocoele produced salivary gland sporozoites in An. stephensi, but not in Ae. aegypti, suggesting that further species-specific incompatibilities occur downstream of the midgut epithelium in Ae. aegypti. These results show that in these parasite-mosquito combinations the susceptibility to malarial infection is regulated at multiple steps during the development of the parasites. Understanding these at the molecular level may contribute to the development of rational strategies to reduce the vector competence of malarial vectors.

Gestión clínica por procesos. Aplicación alsubproceso "cuidados para la inmunizacióndel niño sano"

Objetivo. Diseñar mediante la metodología de la gestión estratégica por procesos (GEP) el subproceso enfermero "cuidados para la inmunización del niño sano". Material y método. Siguiendo la metodología de la GEP, se han desplegado las fases y etapas de movilización, estabilización, así como la definición de las métricas que nos permite el control de gestión para la evaluación de dicho subproceso. Para la norma-guía de actuación, se ha aplicado una combinación entre el proceso de atención de enfermería (PAE) con el método de gestión de la calidad ABM/ABC (gestión basada en la actividad y costes basados en la actividad). Este método introduce a la enfermería en la calidad de la práctica clínica mediante la gestión de los cuidados basados en la evidencia. Resultados. Se ha documentado el subproceso enfermero, identificando a los clientes junto con sus expectativas; la misión de la enfermería; los límites del proceso; las competencias; los criterios e indicadores para la evaluación y el coste estándar del subproceso. La información de estos datos nos permite medir, en el dominio enfermero, la eficacia, la efectividad y la eficiencia de la gestión clínica (AU)

Necropsy by magnetic resonance in a case of conjoined thoracopagus twins.

A case of thoracopagus conjoined stillborn twins studied with magnetic resonance imaging (MRI) is presented. Due to the parents' denial of authorization for an autopsy of the fetuses, the MRI study was performed as an alternative to necropsy. High-resolution images of the fetuses demonstrated relevant anatomic features, providing noninvasive pathological insight with preservation of the fetal specimen. J. Magn. Reson. Imaging 2001;13:976-981.

Tolerance of nonsteroidal antiinflammatory drugs in patients with inflammatory bowel disease.

OBJECTIVE: We sought to examine whether use of nonsteroidal antiinflammatory drugs (NSAIDs) in an outpatient inflammatory bowel disease (IBD) population is associated with an increased likelihood of active disease. METHODS: We reviewed records of initial outpatient visits of IBD patients to the principal author from June 1995 to December 1997, with regard to use of aspirin and other NSAIDs and disease activity. RESULTS: Of 40 Crohn's patients seen with active disease, three (7.5%) were using NSAIDs; 14 of 72 (19.4%) Crohn's patients seen with inactive disease were using NSAIDs. Fifty-eight ulcerative colitis patients were seen with active disease, with eight (13.7%) using NSAIDs. Among 21 UC patients initially seen while in remission, five (23.8%) were using NSAIDs. CONCLUSIONS: Among this group of outpatients, NSAID use was not associated with a higher likelihood of active IBD. NSAID use in IBD deserves further study before recommending that patients refrain from their use under all circumstances.

The Onchocerciasis Elimination Program for the Americas: a history of partnership.

The decision in 1987 by the pharmaceutical firm Merck & Co. to provide Mectizan (ivermectin) free of charge to river blindness control programs has challenged the international public health community to find effective ways to distribute the drug to rural populations most affected by onchocerciasis. In the Americas, PAHO responded to that challenge by calling for the elimination of all morbidity from onchocerciasis from the Region by the year 2007 through mass distribution of ivermectin. Since 1991, a multinational, multiagency partnership (consisting of PAHO, the endemic countries, nongovernmental development organizations, the Centers for Disease Control and Prevention in Atlanta, Georgia, as well as academic institutions and funding agencies) has developed the political, financial, and technical support needed to move toward the realization of that goal. This partnership is embodied in the Onchocerciasis Elimination Program for the Americas (OEPA), which is supported by the River Blindness Foundation (RBF) and now by the Carter Center. OEPA was conceived as a means of maintaining a regional initiative to eliminate what is otherwise a low priority disease. Since its inception in 1993, the OEPA has provided more than US$ 2 million in financial, managerial, and technical assistance to stimulate and/or support programs in Brazil, Colombia, Ecuador, Guatemala, Mexico, and Venezuela, so as to take full advantage of the Merck donation. Now halfway into a five-year, US$ 4 million grant provided through the Inter-American Development Bank, the OEPA's capacity to support the regional initiative is assured through 1999.