[Pattern of bone fractures in motorcycle accidents in a High Specialty Hospital]. / Patrón de fracturas óseas en accidentes de motocicleta en Hospital de Alta Especialidad.

INTRODUCTION: Motorcycle accidents are one of the leading causes of death and disability in Mexico's young population. There are no local studies describing the pattern of AO-based injuries. OBJECTIVE: Define the pattern and type of most common bone fractures in a Regional Hospital of High Specialty, from January to August 2017. MATERIAL AND METHODS: Descriptive, cross-sectional, observational, quantitative study of 98 patients who suffered motorcycle accidents and who merited surgical orthopedic treatment (94% men, 6% women, average age 29.7 years). RESULTS: The most frequent accidents included the following features: male drivers, motorcycle < 150 cm3, rural area, without helmet use (75.5%) collision against a moving object. The most common fractures corresponded to: tibia and fibula (28.9%), open fractures (52.3%), femur (25%) forearm (10.5%). Considering the AO classification the most common fractures were AO 42 B 3.3, AO 32A3.2 and AO 23B1.2. CONCLUSION: Motorcyclists use few protective measures. The injury pattern showed differences with what was reported nationally. According to the AO rating, much of the cases correspond to those of worst prognosis.

INTRODUCCIÓN: Los accidentes en motocicleta son una de las causas principales de muerte e incapacidad en la población joven de México. No hay estudios locales que describan el patrón de lesiones con base en la clasificación AO. OBJETIVO: Definir el patrón y tipo de fracturas óseas más frecuentes atendidas en un Hospital Regional de Alta Especialidad, de Enero a Agosto de 2017. MATERIAL Y MÉTODOS: Estudio descriptivo, transversal, observacional, cuantitativo de 98 pacientes que sufrieron accidente en motocicleta y que ameritaron tratamiento ortopédico quirúrgico (94% hombres, 6% mujeres, media de edad 29.7 años). RESULTADOS: Los accidentes más frecuentes incluyeron las siguientes características: conductores hombres, motocicleta < 150 cm3, área rural, sin uso de casco (75.5%) y colisión contra un objeto en movimiento. Las fracturas más frecuentes correspondieron a: tibia y peroné (28.9%), fracturas expuestas (52.3%), de fémur (25%) y antebrazo (10.5%). Considerando la clasificación AO las fracturas más frecuentes fueron AO 42 B 3.3, AO 32A3.2 y AO 23B1.2. CONCLUSIÓN: Los motociclistas utilizan escasas medidas de protección. El patrón de lesiones evidenció diferencias con lo reportado a nivel nacional. De acuerdo con la clasificación AO, buena parte de los casos corresponden a los de peor pronóstico.

Effects of alpha-tocopherol on oxidative status and metabolic profile in overweight women.

Despite extensive research, the effects of alpha-tocopherol supplementation remain controversial. Few studies have been focused on obese and overweight people. We examined the effects of alpha-tocopherol (AT) on the oxidative status and metabolic profile in overweight women. Sixteen overweight women between the ages of 40-60 years old, received AT, 800 IU/day during 12 weeks, followed by a 6-week washout period. Blood samples were taken at the beginning and then every 6 weeks until the end of the study. AT, retinol, malondialdehyde (MDA), total antioxidant status (TAS), selenium-dependent glutathione peroxidase (GPx) and CuZn-superoxide dismutase (SOD) were quantified to evaluate the oxidative stress. The metabolic profile was estimated by measuring glycated hemoglobin (HbA1c) in erythrocytes and glucose, phosphate, magnesium, lipid and lipoprotein concentrations in serum. Under AT administration HbA1c, serum- MDA levels and erythrocyte GPx activity were markedly reduced. TAS, AT and Mg2+ concentrations in serum and SOD activity in erythrocytes were higher after AT treatment. Body weight; glucose, lipid and retinol concentrations, or blood cells count were unchanged. Lipid peroxidation was considerably reduced in AT treated women and also improved serum antioxidant status was observed, but the imbalanced response between erythrocyte SOD and GPx activities could affect normal response to oxidative stress.

Arthrospira maxima prevents the acute fatty liver induced by the administration of simvastatin, ethanol and a hypercholesterolemic diet to mice.

An evident fatty liver, corroborated morphologically and chemically, was produced in CD-1 mice after five daily doses of simvastatin 75 mg/Kg body weight, a hypercholesterolemic diet and 20 percent ethanol in the drinking water. After treating the animals, they presented serum triacylglycerols levels five times higher than the control mice, total lipids, cholesterol and triacylglycerols in the liver were 2, 2 and 1.5 times higher, respectively, than in control animals. When Arthrospira maxima was given with diet two weeks prior the onset of fatty liver induction, there was a decrement of liver total lipids (40%), liver triacylglycerols (50%) and serum triacylglycerols (50%) compared to the animals with the same treatment but without Arthrospira maxima. In addition to the mentioned protective effect, the administration of this algae, produced a significant increase (45%) in serum high density lipoproteins. The mechanism for this protective effect was not established in these experiments.

Hypoglycemic action of Cucurbita ficifolia on Type 2 diabetic patients with moderately high blood glucose levels.

Ten Type 2 diabetic patients with moderately hyperglycemia, received a raw extract of Cucurbita ficifolia or potable water in a single dose of 4 ml/Kg body weight, in two different sessions at least separated by 1 week. Blood glucose levels were followed in both parts of the study by a period of 5 h. The patients had stopped their pharmacologic medication 24 h prior to each part of the study. As expected, no significant changes on blood glucose were observed after giving the vehicle; however, the oral administration of C. ficifolia was followed by a significant decrease in blood glucose levels, from 12.07+/-1.69 mM (217.2+/-30.4 mg/dl) to 9.42+/-1.96 mM (169.6+/-35.3 mg/dl) 3 h after and to 8.37+/-1.74 mM (150.8+/-31.3 mg/dl) 5 h after the extract administration. The hypoglycemic action of Cucurbita ficifolia agrees with its effects previously observed in laboratory animals. The results of this preliminary study do not give indications for the mechanism of this hypoglycemic effect.

Spirulina maxima prevents fatty liver formation in CD-1 male and female mice with experimental diabetes.

The dietary administration of 5% Spirulina maxima (SM) during four weeks to diabetic mice, starting one week after a single dose of alloxan, 250 mg/Kg body weight, prevented fatty liver production in male and female animals. The main action of SM was on triacylglycerol levels in serum and liver. There was also a moderate hypoglycemia in male mice. The thiobarbituric acid reactive substances also decreased in serum and liver after SM administration. There was also a decrease in the percentage of HDL in diabetic mice that was reverted by the SM administration. The sum of LDL + VLDL percentages was also partially normalized in diabetic animals by the SM administration. An additional observation was the lower incidence of adherences between the liver and the intestine loops in the diabetic mice treated with SM compared with diabetic mice without SM. Male and female mice showed differences to diabetes susceptibility and response to SM, the female being more resistant to diabetes induction by alloxan and more responsive to the beneficial effects of SM. It is worth future work of SM on humans looking for better quality of life and longer survival of diabetic patients.

Effects of the ethanolic extract of Spirulina maxima on endothelium dependent vasomotor responses of rat aortic rings.

Dietary Spirulina decreases, endothelium-dependently, the responses to vasoconstrictor agonists and increases the endothelium-dependent, agonist-induced, vasodilator responses of rat aorta rings. The aim of this study was to analyze, in vitro, the effects of a raw ethanolic extract of Spirulina maxima on the vasomotor responses of rat aortic rings to phenylephrine and to carbachol. On rings with endothelium, the extract produced the following effects: (a) a concentration-dependent (60-1000 microg/ml) decrease of the contractile response to phenylephrine; (b) a rightward shift and a decrease in maximal developed tension, of the concentration--response curve to phenylephrine; (c) a concentration dependent relaxation of phenylephrine-precontracted rings. These effects were blocked by L-NAME, and not modified by indomethacin. The extract had no effect on the concentration-response curve to carbachol of rings with endothelium. On endothelium-denuded rings the extract caused a significant rightward shift of the concentration response curve to phenylephrine without any effect on maximal tension development. In the presence of the extract, indomethacin induced a marked decrease in the maximal phenylephrine-induced tension of endothelium-denuded rings. These results suggest that the extract increases the basal synthesis/release of NO by the endothelium and, also, the synthesis/release of a cyclooxygenase-dependent vasoconstricting prostanoid by vascular smooth muscle cells.

Comparative toxicity of high doses of vastatins currently used by clinicians, in CD-1 male mice fed with a hypercholesterolemic diet.

The CD-1 male-mouse model was employed to evaluate comparatively the toxicity of four vastatins (VTS) currently used in clinical medicine: lovastatin (LVT), simvastatin (SVT), pravastatin (PVT) and fluvastatin (FVT). Each vastatin was used orally in doses of 500 mg/Kg body weight/day, in animals with a hypercholesterolemic diet (HD) 5 days, or with a control diet (CD) 30 days. The association of high doses of VTS + HD produced a significant increase in liver weight and liver weight to body weight ratio in animals with SVT and FVT. Cholesterol (Chol) and triacylglycerols (TAG) in the liver increased significantly with FVT but not with the other VTS; Chol increased and TAG decreased in serum very significantly with FVT and SVT. The serum aminotransferases increased quite significantly with FVT but not with other VTS. In the experiment with high doses of VTS + CD, the animals receiving SVT or FVT showed a moderate loss of body weight. Liver weight and liver weight to body weight ratios were similar among all groups. Liver Chol showed a significant decrease with all VTS. Serum Chol decreased moderately with LVT and FVT. TAG in serum and liver showed a moderate decrease with all VTS. The serum aminotransferases were not modified by any vastatin. Our results indicate that high doses of VTS in male mice with a hypercholesterolemic diet result in a decreasing toxicity as follows: FVT>SVT>LVT>PVT.

High lovastatin doses combined with hypercholesterolemic diet induce hepatic damage and are lethal to the CD-1 mouse.

The addition of 1% lovastatin (LVT) to hypercholesterolemic diets [1% cholesterol or 1% cholesterol plus 0.1% sodium deoxycholate (HD)] induced hepatic damage and was lethal to CD-1 mice in the first days of treatment; the females were more resistant than males. LVT or HD administered alone was harmless to male or female mice. After a 3-day treatment all groups that received LVT (1%, 0.1% or 0.05%) plus HD showed a higher percentage of liver weight, with respect to whole body weight. Cholesterol serum levels increased in males with HD, but remained low in female mice. In the liver, total lipids and cholesterol levels increased in male mice with HD, but cholesterol remained unchanged in females. The addition of LVT to HD prevented the increase of serum and liver cholesterol levels in male mice. These results allow us to propose the CD-1 male-mouse as a model to evaluate the toxicity of LVT or other vastatins.

Most "sporadic" cases of X-linked ichthyosis are not de novo mutations.

X-linked ichthyosis is an inherited disease with dark, regular and adherent scales as clinical characteristics. It is caused by a deficiency of the steroid sulphatase enzyme. Steroid sulphatase assay is a relative easy tool that enables correct diagnosis of X-linked ichthyosis patients and carriers. A large number of X-linked ichthyosis patients correspond to non-familial cases that seem to represent de novo mutations. In this study, we examined the X-linked ichthyosis carrier state of the mothers of 42 non-familial cases to determine whether their children corresponded to de novo mutations. To classify patients and carriers, a steroid sulphatase assay was performed in leukocytes using 7-[3H]-dehydroepiandrosterone sulphate as substrate. In 36 mothers (85%) we found steroid sulphatase activity compatible with the carrier state of X-linked ichthyosis. This data suggest that most of the mothers of these patients present the primary gene defect, excluding de novo mutations in the patients.

Studies on the preventive effect of Spirulina maxima on fatty liver development induced by carbon tetrachloride, in the rat.

The aim of the present work was to assess if the feeding of either the oil extract of Spirulina maxima or of its defatted fraction would prevent fatty liver development, induced in rats by a single intraperitoneal dose of carbon tetrachloride (CCl4). Liver and serum lipids were evaluated 4 days after treatment with this agent. Concentration of liver lipids did not differ in rats fed on a purified diet either without or with one of the fractions of Spirulina, except for total cholesterol, which showed a slight increase in the group receiving the oil extract of Spirulina. However, after CCl4 treatment, liver total lipids and triacylglycerols were significantly lower in rats fed on a diet containing any fraction of Spirulina (defatted or the oil fraction) than in rats without Spirulina in their diet. Furthermore, the increased liver cholesterol values, induced by CCl4 treatment, were not observed in rats receiving Spirulina. In addition, rats receiving whole Spirulina in their diet and treated only with the vehicle showed an increase in the percentage of HDL values. The changes in VLDL and LDL induced by CCl4 treatment were not observed in the whole Spirulina group. Furthermore, after CCl4 treatment the values of the liver microsomal thiobarbituric acid-reactive substances were lower in the whole Spirulina group than in the control group. These results support the potential hepatoprotective role of Spirulina.

Steroid sulfatase activity in leukocytes: a comparative study in 45,X; 46,Xi(Xq) and carriers of steroid sulfatase deficiency.

The enzyme steroid sulfatase (STS) hydrolyses 3-beta-hydroxysteroid sulfates. The female-male STS activity ratio is 1.04-1.7:1 in several cell lines in adults and reaches 2:1 in prepubertal subjects. In fibroblasts, STS values in X-chromosome abnormalities show a partial positive correlation according to the number of X-chromosomes. X-linked ichthyosis (XLI) carriers, with only one copy of the STS gene, present lower STS levels than normal controls. This study analyzes the STS activity in leukocytes of 46,Xi(Xq); 45,X; XLI carriers and normal controls using 7-[3H]-dehydroepiandrosterone sulfate as substrate. X-monosomy (1.07 +/- 0.18 pmol/mg protein/h), Xq isochromosome (1.02 +/- 0.12 pmol/mg protein/h) and normal females (1.03 +/- 0.11 pmol/mg protein/h) had similar STS values (p > 0.05). XLI-carriers and males showed the lowest STS levels (0.34 +/- 0.04 pmol/mg protein/h, p < 0.001 and 0.82 +/- 0.14 pmol/mg protein/h, p < 0.05, respectively). Female-male STS activity ratio in leukocytes was 1.3:1. These data indicate that a complex mechanism regulates the STS expression depending on each type of cell line.

Spirulina maxima prevents induction of fatty liver by carbon tetrachloride in the rat.

The aim of the present work was to assess the capacity of Spirulina maxima to prevent fatty liver development induced in rats by an intraperitoneal single dose (1 ml/kg) of carbon tetrachloride. Liver and serum lipids were quantified two or four days after treatment with this agent. Liver lipid concentration did not differ in rats fed on a purified diet with or without Spirulina. However, after carbon tetrachloride treatment, liver triacylglycerols were significantly lower in rats fed on a diet with Spirulina 5% than in rats without Spirulina in their diet (P < 0.05). Furthermore, the increased liver cholesterol values, induced by carbon tetrachloride treatment, were not observed in rats that received Spirulina. These results support the potential hepatoprotective role of Spirulina.

X-linked ichthyosis in Mexico: high frequency of deletions in the steroid sulfatase encoding gene.

The present study analyzes the frequency of molecular deletions in the steroid sulfatase (STS) encoding gene in a sample of 50 Mexican subjects with biochemical diagnosis of X-linked ichthyosis (XLI). To establish the correct diagnosis, STS activity was determined in leukocytes using 7-(3)H-dehydroepiandrosterone sulfate as the substrate. No amplification of the 3' and 5' ends of the STS gene by PCR was detected in the DNA of 49 patients, whereas only one sample of 50 presented a normal amplification. This report shows a very high frequency of deletions in the human STS encoding gene in a representative sample of the Mexican population, and it defines the characteristics of XLI in patients whose STS gene has a complete deletion as a major molecular defect.

Análisis bioquímico y molecular de pacientes con ictiosis ligada al X y detección de portadoras / Biochemical and molecular analysis of patients and carriers of X-linked ichthyosis

La ictiosis ligada al X es una genodermatosis causada por la deficiencia de la sulfatasa esteroidea. Tiene una frecuencia de 1 por 2,000-6,000 recién nacidos vivos masculinos. Se inicia al nacimiento y se caracteriza por presentar escamas oscuras, adherentes, regulares con predominio en tronco y estremidades. El diagnóstico diferencial se realiza con la ictiosis vulgar, que tienen una frecuencia de 1 por 250 recién nacidos vivos. La determinación de la sulfatasa esteroidea clasifica a pacientes y portadoras con ictiosis ligada al X. El objetivo del presente trabajo fue establecer el diagnóstico correcto de pacientes y detección de portadoras en 10 familias con ictiosis ligada al X, amplificando mediante reacción en cadena de la polimerasa los extremos 5' y 3' del gen de la sulfatasa esteroidea y determinando la actividad de esta enzima en leucocitos utilizando el sulfato de 7-[3H]-dehidroepiandrosterona como substrato. Ningún paciente amplificó los extremos 5' y 3' del gen de la sulfatasa esteroidea, indicando la pérdida del gen en todos los casos. La determinación de la actividad de la sulfatasa esteroidea clasificó adecuadamente a pacientes (0.0 pmol/mg proteína/h) y portadoras (0.20 ñ 0.06 pmol/mg proteína/h versus 0.84 ñ 0.10 de controles sanos y pacientes con ictiosis vulgar) de ictiosis ligada al X. De esta manera, se establece la necesidad de realizar el ensayo de la sulfatasa esteroidea para el diagnóstico correcto de ictiosis ligada al X y para diferenciarla de la ictiosis vulgar e identificar a posibles portadoras de ictiosis ligada al X

Effects of dietary Spirulina maxima on endothelium dependent vasomotor responses of rat aortic rings.

The aim of this study was to evaluate the effects of Spirulina maxima on vasomotor responses of aorta rings from male Wistar rats fed on a purified diet. For this purpose, the animals (weighing 200-240 g) were allocated randomly in two groups. One receiving purified control diet (A) and the other receiving purified diet containing 5% Spirulina (B). Purified diets were according to American Institute of Nutrition guidelines and adjusted to Spirulina protein content. All animals were fed (20 g/day/rat) during two weeks, receiving water ad libitum and 12 h. light-dark cycles. Spirulina maxima effects were evaluated by concentration-response (CR) curves of aorta rings with or without endothelium to phenylephrine (PE), both in presence and absence of indomethacin (Indom) or indomethacin plus L-NAME (Indom. + L-NAME), and to carbachol (CCh). Aorta rings with endothelium from group B showed, relative to corresponding rings from group A: 1) a significant decrease in the maximal tension developed in response to PE. 2) this decrease was reverted by Indom. 3) Indom. + L-NAME induced an additional increase in the contractile responses to PE. 4) a significant shift to the left of the CR curve to CCh. No significant differences were observed in the tension developed in response to PE in rings without endothelium from either group. These results suggest that Spirulina maxima may decrease vascular tone by increasing the synthesis and release of both a vasodilating cyclooxygenase-dependent product of arachidonic acid and nitric oxide, as well as by decreasing the synthesis and release of a vasoconstricting eicosanoid from the endothelial cells.

Accuracy of the clinical diagnosis of recessive X-linked ichthyosis vs ichthyosis vulgaris.

The present study analyzes the accuracy of the clinical diagnosis of X-linked ichthyosis (XLI) vs ichthyosis vulgaris (IV), in a sample of Mexican patients. The study was double blind, using steroid sulfatase (STS) activity as the golden standard. Twenty male patients were included; 16 corresponded to XLI and 4 to IV. The clinical diagnosis was correct in 9 of the 16 XLI cases (56%) and in 2 of the 4 IV cases (50%). Some clinical findings in XLI, such as cryptorchidism in patients and delayed labor in their mothers, were important features for diagnosis. Statistical analysis of the results showed: among physicians (n = 2) Kappa value 0.50, specific concordance 0.40, and absolute concordance 0.75; other values were sensibility 0.56, specificity 0.50, positive predictive value 0.82, negative predictive value 0.22, accuracy 0.55, prevalence 0.80. In conclusion, the differential diagnosis of XLI and IV is very difficult, and we consider that this is not explained either by personal skills or by other conditions. It could be attributed to the similarities in skin manifestations of these two diseases. The performance of the STS assay is imperative in order to correctly diagnose the disease and offer adequate genetic counseling.

The biochemical identification of carrier state in mothers of sporadic cases of X-linked recessive ichthyosis.

X-linked recessive ichthyosis (XLI) is an inherited inborn error of metabolism due to steroid sulfatase (STS) deficiency. The STS activity was studied in 13 families that were referred to the Genetic Department, General Hospital of Mexico City, as being affected by ichthyosis. The study was specially focused on five apparently on familial cases and their mothers, in order to identify carrier status and provide adequate genetic counseling. STS activity was determined in leucocytes using 7-[3H]-dehydroepiandrosterone sulfate as substrate. None of the XLI patients showed STS activity (pmol/mg protein/h), four mothers had an activity compatible with a carrier state (0.19 +/- 0.02 vs 0.66 +/- 0.14 males or 0.90 +/- 0.30 females pmol/mg protein/h, p < 0.001) and only one mother showed a normal pattern, indicating that her son had a de novo mutation. It is important to determine the STS activity in the propositus mother of apparently non familial cases of XLI to identify the carrier state and provide and accurate genetic counseling, as most of these seem to correspond to inherited cases.