[Reflexions on some dilemmas in bioethics for the millennium]. / Reflexiones acerca de algunos dilemas en bioética para el próximo milenio.

With the end of the millennium, several proposals or propositions have been made about politics, culture, and economics for the world society. Science cannot be isolated from this well-recognized globalization process. Information through the Internet allows the spread of scientific data and knowledge among professional and no professional users to be exchanged and non shared, with the possibility of storing that information in a very fast manner. However, there are important differences in the availability and quality the information, especially in developing countries. On the other hand, it is clear that advances in technology in recent years are higher and faster than development in humanistic and philosophical areas. This situation points to the necessity of using some basic bioethical principles to deal with very important dilemmas such as euthanasia, assisted suicide, and new bioethical dilemmas such as technified death, restriction of economic resources in health care institutions, cloning and genetic manipulation, among others.

[Migrant erythema as clinical presentation of cutaneous larva migrans in Mexico City]. / Eritema migratorio como presentación clínica de larva migrans cutánea en la ciudad de México.

Cutaneous larva migrans (CLM) is a ubiquitous self-limited skin eruption, most frequently caused by the larvae of dog and cat hookworms. Although CLM is most frequent in tropical climates, the infection is becoming more common in urban areas. CLM has been frequently misdiagnosed and/or treated inappropriately, and mimics rheumatic, infectious, vascular, or dermatologic diseases. We here in report the clinical presentation and management of 18 cases of CLM.

Higher prevalence of diabetes in hypertensive subjects with upper body fat distribution.

OBJECTIVE: To analyze the association of hypertension and upper body fat distribution on the occurrence of non-insulin-dependent diabetes mellitus in Mexicans. MATERIAL AND METHODS: It was a population-based cross-sectional study in Cuajimalpa, a district of Mexico City. A total of 1066 subjects were home interviewed, and attended our clinic for fasting plasma glucose sampling, blood pressure and anthropometric measurements. Diabetes was defined according to the World Health Organization criteria, and hypertension as a blood pressure equal to or greater than 140/90. The ratio of upper to lower body skinfolds was used to estimate body fat distribution. RESULTS: The prevalence of diabetes was 12.0%. There was a significant positive trend in the age and sex adjusted prevalence of diabetes according to the magnitude of hypertension (p = 0.0006) and upper body fat distribution (p = 0.007). The age and sex adjusted prevalence in normotensive subjects with lower body fat distribution was 7.1% (95% confidence interval 5.9-8.2) whereas it was 19.9% (CI 17.0-22.8) in those with hypertension and upper body fat distribution. The prevalence of diabetes in Mexicans was high and it may be related to a genetic susceptibility for an insulin resistance syndrome. CONCLUSIONS: These results indicate that there is a dose response effect in the association of hypertension and upper body fat distribution with diabetes in Mexicans, and that there may be an interaction in the effect of hypertension and body fat distribution in this syndrome.

Survival after massive (>2000) Africanized honeybee stings.

We report the clinical case of a man who survived a massive attack of Africanized bees (>2000 bee stings). The man experienced anaphylactic shock and multisystem organ failure (neurologic, hepatic, renal, and hematologic failure). He was treated with administration of dopamine hydrochloride, antihistaminic agents, corticosteroids, fluid and electrolyte replenishment, peritoneal dialysis, and plasmapheresis. No sequelae have been observed during follow-up.

[Alternatives against environmental pollution. The focus of the internist]. / Alternativas contra la contaminación ambiental. El enfoque del internista.

Potential pathogenesis from pollution depends on the kind of contaminant, its concentration, its duration in environment and on host's characteristics. Faced to the threat of medical consequences of pollution, it is necessary to be alert to recognize them, with an anticipated description. Two syndromes can be distinguished, one acute and the other chronic, that may be useful as reference for an eventual epidemiologic surveillance.

[Thyroid function tests in healthy and ill elderly]. / Pruebas de función tiroidea en ancianos sanos y enfermos.

Thyroid function in the elderly has been a matter of discussion. The universe of the present study includes males and females 36 hospitalized with an average age of 72.97 +/- 8.70 years (group I) and 36 ambulatory asymptomatic elderly with 69.81 +/- 8.55 years of age (group II). Serum levels of T3, T4, T4L and TSH were measured in both groups. Mean values of T3 were significantly lower in the hospitalized patients than in the control group. The difference persisted on both, males and females, analyzed separately. Mean values of T4L were significantly lower in women of group II, while mean values of T3 were significantly lower in men of group I. The comparison of thyroid function tests in male and female showed that serum values of T3 and T4 were significantly lower in men of group I. By dividing results in age categories, serum levels of T4L in group II were significantly lower in the age group of 70 to 79 and 80 to 89. Thyroid function tests in asymptomatic ambulatory elderly tend to be normal, whereas the hospitalized patients showed a high proportion of alterations.

Thyroid function and abdominal surgery. A longitudinal study.

Surgical trauma produces complex metabolic changes and may be an excellent model for studying the effects of an acute insult on the circulating thyroid hormone concentrations. Abnormalities in thyroid function tests in patients with nonthyroidal illness can be divided into a low T3 syndrome, low T3 and T4 syndrome in more severe cases and elevated T4 syndrome. In this study 30 patients undergoing elective or urgent abdominal surgery were longitudinally evaluated with pre- and postoperative thyroid function tests. Comparing with preoperative values, a significant reduction in total T3 serum values in the immediate postoperative period was seen (p < 0.005). The rest of the variables did not show significant statistical differences between the three periods. Over half of the patients undergoing urgent surgery had a low T3 syndrome, whereas only a sixth of the patients scheduled for elective surgery suffered from this syndrome. In the late postoperative period half the patients submitted to urgent surgery persisted with alterations in thyroid function tests, whereas most of the patients scheduled for elective surgery showed an improvement in their thyroid hormone level in the same period of time. Abnormalities in thyroid hormone metabolism were more frequent in patients admitted for urgent surgery, reflecting the severity of their illness and favoring the concept that these syndromes can be used as prognostic markers.

[Captopril reduction of albuminuria in type-II diabetics with diabetic nephropathy]. / Reducción de albuminuria por captopril en diabéticos tipo II con nefropatía diabética.

This study was to search if captopril (C) reduces albuminuria in a group of type II diabetics with diabetic nephropathy (DN). Eleven type II diabetics with DN and hypertension, with albuminuria over 0.30 g/L/24th, fasten blood glucose under 250 mg/dL, serum albumin over 3 g/dL, without infection, cardiac failure or diuretic treatment, were treated with C for six months, as the only treatment for hypertension and albuminuria. Every month, albuminuria in a 24h urinary collection, medium arterial pressure (MAP), serum creatinine and fasten blood glucose were measured. Ten women and one man with 60 (50-70) years of average age (0 to 100th percentile), with 18 (8-35) years of diabetic disease, and 4 (1-7) years of clinic hypertension were studied. Before the treatment with C they had albuminuria of 6.9 (0.7 to 12.5) g/L/24h, MAP of 119.7 (93.2 to 139) mmHg, serum creatinine of 2.2 (0.7 to 7.5) mg/dL and glucose of 168 (78 to 250) mg/dL. After 6 months with C, they had albuminuria of 3.5 (0.2 to 9.6) g/L/24h (p less than 0.01), MAP of 113.4 (92.9 to 132.4) mmHg (p = 0.5), serum creatinine of 2.3 (0.5 to 6.4) mg/dL (p = 0.23) and glucose of 133 (87.5 to 239) mg/dL (p = 0.32). The MAP showed a predictive relation over albuminuria (p = less than 0.004). During the six months of study, C reduced albuminuria in type II diabetics with hypertension and diabetic nephropathy.

[A reconsideration of postoperative fever due to pulmonary atelectasis]. / Una reconsideración de la fiebre postoperatoria por atelectasia pulmonar.

Atelectasis has been reported as a common cause of fever in the first 48 hours after surgery. A group of one hundred patients programmed for elective abdominal surgery were studied with chest roentgenograms, both before and 48 hours after surgery. Thirty-one of them developed atelectasis and eighteen developed fever. Four of the patients with and fourteen without atelectasis, had fever. Five cases had unexplained fever, three of them with pulmonary atelectasis. These findings suggest that atelectasis can cause postoperative fever, but it is not the most common cause of fever in the first 48 hours after surgery.

[Thyroid function tests in a sample of hospitalized patients]. / Pruebas de función tiroidea en una muestra de pacientes hospitalizados.

In a sample of hospitalized patients, serum levels of T3, T4 and TSH were measured on the next day after admission. We included 26 patients admitted to Internal Medicine ward (group I) and 27 patients admitted to the intensive care unit (group II), comparing the results with those of 25 normal volunteers (group I). Mean values of T3 and T4 tend to be lower in patients than in healthy subjects, especially in those patients more aggravated, but differences were not statistically significant. In group II there were 5 patients with low T3, 4 with low T4 and two with both alterations. In group III, two patients had low T3, three had low T4 and 10 had both low T3 and low T4. The ratio between normal and abnormal results was significantly different between sick and healthy individuals, and between patient in the intensive care unit and the Internal Medicine ward, suggesting a correlation with gravity. 52.8% of patients hospitalized studied showed almost one alteration in the thyroid function tests.