Recovery from stunting and cognitive outcomes in young children: evidence from the South African Birth to Twenty Cohort Study.

In this study we analyse the implications for cognitive function of recovery from stunting in early childhood. More specifically, we test whether children who met the definition for stunted at age 2, but not at age 5, perform better in cognitive tests than children who remain stunted over this period. The sample is drawn from the Birth to Twenty Cohort Study, a prospective data set of children born in 1990 in urban South Africa. The measure of cognitive function that we use is based on the Revised Denver Prescreening Developmental Questionnaire implemented when the children were age 5. We employ multivariate regression in the analysis to control for child-specific characteristics, socio-economic status, the home environment and caregiver inputs. We find that recovery from stunting is not uncommon among young children in our sample. However, children who recover from stunting by age 5 still perform significantly worse on cognitive tests than children who do not experience early malnutrition, and almost as poorly as children who remain stunted. These findings suggest that the timing of nutritional inputs in the early years is key in a child's cognitive development, with implications for school readiness and achievement.

Reducción funcional y estética de los labios menores: labioplastia con técnica de resección con colgajos especulares en «S» / Functional and esthetic reduction of the labia minora: labioplasty with specular S-shaped resection

Las mujeres que presentan los labios menores hipertróficos o prominentes a menudo presentan trastornos funcionales y psicosociales. Se consideran labios menores hipertróficos aquellos que, en posición y condiciones normales, sobresalen notoriamente de los labios mayores, ocasionando irritación local, dificultades higiénicas, incomodidad mientras se camina o realizan algunas prácticas deportivas e interfiriendo en el desarrollo normal de las relaciones sexuales. Hay diversas técnicas quirúrgicas de labioplastia. Una de las más habituales es la amputación de aquellos segmentos de los labios menores que sobresalen de los labios mayores. Para evitar las complicaciones derivadas de esa técnica, nosotros hemos optado por realizar la labioplastia efectuando una resección con colgajos especulares en forma de «S», con una sutura interdigitada. De esta manera el resultado final es más natural, con bordes suaves y redondeados, lo que reduce en gran medida las complicaciones relacionadas con la contracción cicatricial. A continuación, presentamos nuestra experiencia tras haber aplicado con éxito esta técnica en 7 casos

Women with hypertrophic or enlarged labia minora usually have functional and psychosocial problems. Labial hypertrophy is defined as labia minora that extend beyond the labia majora when the woman is in a normal position. Many affected women have local irritation, interference with sexual intercourse, difficulty with hygiene, and discomfort during walking, sitting, biking or horse-riding. Several surgical techniques can be used to perform labioplasty. One of most common procedures is a simple and straight amputation of the protuberant segments and over sewing of the edge. To prevent the complications associated with this technique, we perform a specular S-shaped resection with interdigitated suturing of the protuberant labium. This technique results in a natural, softer, and more rounded labial edge, with fewer complications. We present our experience in 7 cases with successful outcomes

The association between stunting and psychosocial development among preschool children: a study using the South African Birth to Twenty cohort data.

BACKGROUND: A large literature in developing countries finds a strong association between stunting in early childhood and educational attainment and/or cognitive performance among children of school-going age. We contribute to the literature on the effects of stunting in childhood by exploring the links between linear growth retardation and measures of development among preschool-aged children. METHODS: We analyse the association between stunting (height-for-age z-score <-2) at age 2 years and children's scores on the Vineland Social Maturity Scale (VSMS) at age 4 years, a measure of social competence or 'daily living skills', and the Revised-Denver Prescreening Developmental Questionnaire (R-DPDQ) at age 5 years, a test which places greater emphasis on cognitive functioning. The sample is drawn from the Birth to Twenty cohort study, a prospective dataset of children born in 1990 in urban South Africa. We conduct multivariate regression analysis controlling for socio-economic status, various child-specific characteristics, home environment and caregiver inputs. RESULTS: No significant association between stunting and children's performance on the VSMS, but a large and significant association with the R-DPDQ scores, was found. A disaggregated analysis of the various components of the scores suggests that children with low height-for-age at 2 years do not fall behind in terms of daily living skills or social maturity, but do substantially worse on measures capturing higher order fine motor skills and cognitive functioning. CONCLUSIONS: Stunting in early childhood is strongly related to impaired cognitive functioning in children of preschool age, but does not seem to affect social maturity, at least as measured by the VSMS. These relationships between stunting at 2 years and psychosocial development at 4 and 5 years hold with extensive controls for socio-economic status, home environment, caregiver inputs and child characteristics included in the multivariate analysis.

[Effects on function of human lymphocytes exposed to electromagnetic fields with a frequency from 1,500 to 2,000 MHz]. / Effetti sulla funzionalità di linfociti umani esposti a campi elettromagnetici con frequenze da 1.500 a 2.000 MHz.

Normal human peripheral blood lymphocytes were irradiated for 10 or 5 min with frequencies from 1.5 to 2.0 GHz. The frequency of 1.8 GHz overlaps that of mobile phones and leads to a significant reduction of the T-cell mediated antibacterial activity.

Evaluation of the innate immune response in pups during canine parvovirus type 1 infection.

In two pups (A and B) naturally infected with canine parvovirus type 1 (CPV1) phagocytic responses were evaluated over a period of two weeks (day 0 = T0; day 3 = T1; day 7 = T2; day 14 = T3). CPV1 infection led to a marked reduction of monocyte (MO) phagocytosis in both pups. Also MO killing was impaired and in pup B this function was totally absent. Polymorphonuclear (PMN) phagocytosis values of both pups fluctuated within normal ranges, as well as PMN killing of pup A. In pup B, killing exerted by PMN was absent at T0, then increased but again dropped below normal ranges at T3. The described alterations of phagocytic functions may be regarded as possible viral mechanisms of immune evasion.

Immune responses to fungal infections and therapeutic implications.

Host responses to fungi result from a coordinate interplay between innate and adaptative immune system. Neutrophils and monocytes are involved in the non specific clearance of yeasts (e.g. Candida albicans and Cryptococcus neoformans), while T helper 1 type responses are protective via release of interferon gamma. By contrast, T helper 2 responses (IL-4 and IL 10 release) correlate with disease exacerbation and pathology. IL-12 production which enhances T helper 1 type responses seem to exert a beneficial role in the course of Candida infection. In particular, its production from neutrophilis may support memory T helper 1 cell responses of the fungus. With respect to anti-Candida vaccines several approaches are in progress, such as use of heat-killed Candida albicans in combination with adjuvants, purified peptides and proteins and immunogenic peptide-lipid conjugates. Furthermore, exogenous IL-12 may play an important role in inducing a T helper 1 anticandidal response, also replacing neutrophils in neutropenic patients. At the same time, granulocyte-colony stimulating factor has exhibited therapeutic efficacy in experimental and human models of fungal infection.

Long-term results of heart valve replacement with bileaflet prostheses.

Bileaflet cardiac prostheses (St. Jude, CarboMedics, Duromedics, Bicarbon, Jyros) have shown a low incidence of complications and good haemodynamic performance. In the last twelve years, 783 bileaflet prostheses were implanted in 690 patients at our Institution. The population of our study comprises 591 bileaflet prostheses (418 CarboMedics, 124 St. Jude, 49 Bicarbon) implanted in the mitral (MVR) (n = 305) or aortic (AVR), (n = 286) position. The follow-up study evaluated 292 male and 295 female patients with age ranging from 13 and 79 years (mean 50.4 +/- 14.7 years). Hospital mortality was 6.6%. Follow-up was 97% complete, with 1822 +/- 33 patient/years and a mean follow-up of 37 months (range 1 to 144 months). Twelve years actuarial freedom from complication according to prosthetic site were calculated as follows (linearized rates in parentheses): late mortality AVR 97.6% +/- 0.6% (2.3%), MVR 96% +/- 0.5% (2.1%); thrombosis AVR 100%, MVR 96% +/- 0.9% (0.8%); embolism AVR 97% +/- 0.5% (1.5%), MVR 96.6% +/- 0.7% (1.8%). Global freedom from anticoagulant-related haemorrhage was 95% +/- 1.2% (2.3%) and 94.5% +/- 0.7% (2.2%) following AVR, 94 +/- 0.6% (2.1%) following MVR. The difference of the haemorrhagic risk for prosthetic site was not significant (p > 0.05). Functional improvement was confirmed by the low postoperative NYHA functional class. According to our results, cumulative experience with bileaflet valves has shown very good long-term results in term of low rate of complication, long-term survival and quality of life.

Intermediate term evaluation of Starr-Edwards ball valves in the mitral position.

The Model 6120 ball valve prosthesis introduced in 1965 is still strongly supported as a mitral valve substitute in many centers around the world. A current reassessment of the performance of this prosthesis is therefore pertinent to current medical practice. In this institution since 1974, 227 Starr-Edwards caged ball valves have been implanted in the mitral position during isolated valve replacement. Two models of caged ball valves were used concurrently: the silastic ball valve in 108 patients (48%) and the composite strut "tract" valve in 119 (52%). Hospital mortality was 7%, and 8-year survival (standard error) was 74 (6%), with 100% follow-up, documenting 752 total patient-years. No late deaths were known to be valve related, and there were no cases of prosthetic thrombosis. The actuarial estimate of patients free from thromboembolism at 8 years was 89 (4%) with a linearized rate of 1.3% per year. At the most recent follow-up, 95% of the patients were in the New York Heart Association (NYHA) Classes I or II. These good results were partly due to an awareness at operation of ventricular outflow tract size requirements and to strict control of postoperative anticoagulation. We conclude that the Starr-Edwards ball valve is the mitral valve of choice in the young patient who is able to take anticoagulation drugs and has a left ventricular outflow tract of satisfactory size.

[Surgical treatment of biliary lithiasis associated with acquired valvulopathy]. / Il trattamento chirurgico della litiasi biliare associata a valvulopatie acquisite.

Personal experience in the treatment of acquired valvulopathies and biliary calculosis in one operating stage is reported. After examination the risk factors determining onset of bile calculosis in valvulopathic patients, the surgical techniques adopted and the special advantages obtained by associating the two operations at the same session are illustrated.

Manual de obras sanitarias domiciliarias e industriales

Trata de obras sanitarias, instalaciones externas de provisión de agua potable y desagues, instalaciones sanitarias domiciliarias, provisión de agua fria, provisión de agua caliente, desagues cloacales y aguas servidas, desagues pluviales, desarrollo de un proyecto de instalación domiciliario, instalaciones industriales y saneamiento rural

Manual de obras sanitarias domiciliarias e industriales

Trata de obras sanitarias, instalaciones externas de provisión de agua potable y desagues, instalaciones sanitarias domiciliarias, provisión de agua fria, provisión de agua caliente, desagues cloacales y aguas servidas, desagues pluviales, desarrollo de un proyecto de instalación domiciliario, instalaciones industriales y saneamiento rural