Caregiving and Obesity among Black American Adults.

Black American adults often report higher rates of obesity and caregiving compared with other racial or ethnic groups. Consequently, many Black American caregivers and care recipients are obese or have obesity-related chronic conditions (e.g., diabetes, hypertension). This study investigated associations between caregiving and obesity among Black Americans, including the role of health behaviors and chronic conditions. The sample included data from 2015 and 2017 Behavioral Risk Factor Surveillance System for non-Hispanic Black (NHB) or African American adult caregivers (n = 2,562) and noncaregivers (n = 7,027). The association between obesity (dependent variable) and caregiving status, fruit consumption, vegetable consumption, physical activity, and number of chronic conditions (independent variables) were evaluated using hierarchical binomial logistic regressions. Caregiving, being female, and chronic conditions were associated with higher odds of obesity, while physical activity was associated with lower odds of obesity. Physical activity, diet, and chronic conditions did not account for differences in obesity among caregiving and noncaregiving Black Americans. Increasing understanding of health behaviors and chronic disease burden of NHB caregivers has implications for programs aiming to improve obesity-related outcomes for caregivers and recipients. Future research should investigate multilevel factors that contribute to observed differences.

Autonomic cardiac function in children and adolescents with long COVID: a case-controlled study.

Although the mechanisms underlying the pathophysiology of long COVID condition are still debated, there is growing evidence that autonomic dysfunction may play a role in the long-term complications or persisting symptoms observed in a significant proportion of patients after SARS-CoV-2 infection. However, studies focused on autonomic dysfunction have primarily been conducted in adults, while autonomic function has not yet been investigated in pediatric subjects. In this study, for the first time, we assessed whether pediatric patients with long COVID present abnormalities in autonomic cardiac function. Fifty-six long COVID pediatric patients (mean age 10.3 ± 3.8 y) and 27 age-, sex-, and body surface area-matched healthy controls (mean age 10.4 ± 4.5y) underwent a standard 12-lead electrocardiography (ECG) and 24-h ECG Holter monitoring. Autonomic cardiac function was assessed by time-domain and frequency-domain heart rate variability parameters. A comprehensive echocardiographic study was also obtained by two-dimensional echocardiography and tissue Doppler imaging. Data analysis showed that pediatric patients with long COVID had significant changes in HRV variables compared to healthy controls: significantly lower r-MSSD (root mean square of successive RR interval differences, 47.4 ± 16.9 versus 60.4 ± 29.1, p = 0.02), significant higher values VLF (very low frequency, 2077.8 ± 1023.3 versus 494.3 ± 1015.5 ms, p = 0.000), LF (low frequency, 1340.3 ± 635.6 versus 354.6 ± 816.8 ms, p = 0.000), and HF (high frequency, 895.7 ± 575.8 versus 278.9 ± 616.7 ms, p = 0.000). No significant differences were observed between the two groups both in systolic and diastolic parameters by echocardiography.  Conclusion: These findings suggest that pediatric patients with long COVID have an imbalance of cardiac autonomic function toward a relative predominance of parasympathetic tone, as already reported in adult patients with long COVID. Further studies are needed to clarify the clinical significance of this autonomic dysfunction and demonstrate its role as a pathophysiological mechanism of long COVID, paving the way for effective therapeutic and preventive strategies. What is Known: • Long Covid in children has been described globally, but studies have mostly focused on collecting the temporal evolution of persisting symptoms. What is New: • Cardiac autonomic imbalance toward a relative predominance of parasympathetic tone is a mechanism underlying Long Covid in children, as also described in adults.

Adherence to the healthy eating index-2010 and alternative healthy eating index-2010 in relation to metabolic syndrome among African Americans in the Jackson heart study.

OBJECTIVE: The primary objective of this study was to determine whether Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) scores were associated with incident metabolic syndrome. DESIGN: This study is a secondary analysis of data from the Jackson Heart Study. HEI and AHEI scores were divided into quintiles and Cox proportional hazards regression models were analysed for 1864 African American adults free from metabolic syndrome at Exam 1 to examine the incidence of metabolic syndrome by quintile of dietary quality score. SETTING: Hinds, Madison and Rankin counties, Mississippi, USA. PARTICIPANTS: African American adults, ages 21-94 years, 60·9 % female. RESULTS: Over a mean follow-up time of 6·7 years, we observed 932 incident cases of metabolic syndrome. After adjusting for multiple covariates, a higher HEI score at Exam 1 was not associated with the risk of incident metabolic syndrome, except when looking at the trend analysis for the subgroup of adults with two metabolic syndrome components at Exam 1 (P-trend = 0·03). A higher AHEI score at Exam 1 was associated with the risk of incident metabolic syndrome (hazard ratio for those in the highest quintile compared to the lowest: 0·80 (95 % CI: 0·65, 0·99), P-trend = 0·03). CONCLUSION: These findings suggest that a dietary pattern that scores higher on the AHEI may help reduce the risk of metabolic syndrome, even for adults who already have two of the minimum of three components required for a diagnosis of metabolic syndrome.

Reconstrucción total de labio superior con colgajo musculocutáneo nasolabial de orbicularis oris bilateral / Total reconstruction of upper lip with a bilateral nasolabial orbicularis oris Lip musculocutaneous flap

Labio Los defectos extensos de labio superior implican la reconstrucción funcional y estética de una estructura única en la cara. Diferentes alternativas se han propuesto para su reconstrucción que incluyen colgajos locales como colgajos libres, cada uno con ventajas y desventajas. Describimos la reconstrucción de grandes defectos de labio superior con colgajos musculocutáneos de oribularis oris modificando la técnica original descrita por Yotsuyanagi et al.

Surgery plastic Extensive upper lip defects require a functional and aesthetic reconstruction of a single structure on the face. Different alternatives have been proposed for its reconstruction, including local flaps and free flaps, each of which has its advantages and disadvantages. We describe the reconstruction of extensive defects of the upper lip with orbicularis oris musculocutaneous flaps using a modification of the original technique described by Yotsuyanagi, et al.

Colonic anastomosis and colonic polyp mucosal metastasis of signet ring cell gastric adenocarcinoma

The mucosal metastasis of adenocarcinomas located in colonic mucosa is not infrequent. We present a clinical report of a patient diagnosed with a gastric multifocal signet ring cell adenocarcinoma without any evidence of visceral dissemination with the exception of mucosal infiltration of signet ring cell adenocarcinoma in a colonic polyp and in the mucosa of previous colonic anastomosis. The histopathological study of suspect lesions in the colonic mucosa is necessary to correctly approach the treatment of these patients (AU)

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Anomalías vasculares congénitas óseas / Congenital vascular anomalies of the bone

El hueso no es un tejido habitualmente afectado por las anomalías vasculares; sin embargo, han sido descritas malformaciones venosas, arteriovenosas y linfáticas intraóseas aunque frecuentemente bajo denominaciones erróneas. El objetivo de la presente revisión es profundizar en las claves para la caracterización, diagnóstico precoz y tratamiento de las anomalía vasculares óseas en la infancia. Entre el año 2000 y 2008, han sido evaluados en el Departamento de Cirugía Pediátrica del Hospital Infantil La Paz 37 pacientes con anomalías vasculares óseas. El grupo más frecuente (24 pacientes) es el de las malformaciones linfáticas. Diez presentaban malformaciones venosas (incluyendo uno con simus pericráneo); 1) malformación linfático-venosa; y 2) malformaciones arteriovenosas. Las localizaciones y formas de presentación han sido heterogéneas ya fueran como trastornos de sobrecrecimiento o hipoplasia ósea. El diagnostico fue tardía en la mayoría de los casos. El tratamiento ha sido individualizado según el tipo de malformación y la localización. En los niños con infiltración linfática polióstica (síndrome de Gorham) el protocolo farmacológico establecido ha sido interferón y bifosfonatos. En resumen, el niño con anomalías vasculares óseas presenta unas peculiaridades clínicas que hacen que el diagnóstico sea difícil y el tratamiento complejo, por lo que debe ser evaluado por un equipo multidisciplinar pediátrico, quirúrgico, ortopédico, radiológico e histopatológico. El objetivo final debe ser evitar tratamientos innecesarios o erróneos y minimizar secuelas (AU)

Vascular anomalies involving the bone are uncommon. In addition, intraoseus venous, arteriovenous and lymphatic malformations have been widely described under confusing and wrong terminology. Our purpose is to review the epidemiology and management of vascular abnormalities in skeletal tissue. Between 2000 and 2008, 37 patients with vascular bone anomalies were seen in the Vascular Anomalies Center at La Paz Children Hospital. 24 lymphatic malformations, 10 venous malformations, (including one patient with sinus pericranii), one linfovenous and tow arteriovenous malformations have been reviewed. The location and presentation were heterogeneous including both, bone overgrowth or hypotrophy. Treatment has been individualized for each patient by a multidisciplinary team. Only patients with poliostotic lymphatic infiltration in Gorham syndrome received pharmacological therapy with Interferon and bisphosphonates. In our experience, diagnosis has been significantly delayed and treatment difficulted. As in the more common skin vascular anomalies the distinction between tumor and vascular malformation is essential for a proper therapeutical approach. Early diagnosis, appropriate therapy and close follow up are necessary in order to improve their management, avoid mistreatment and minimize secuelae (AU)

Espectro morfológico de las gónadas en los estados intersexuales en la edad pediátrica / No disponible

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CC-chemokine receptors: a potential therapeutic target for Trypanosoma cruzi-elicited myocarditis

The comprehension of the pathogenesis of Trypanosoma cruzi-elicited myocarditis is crucial to delineate new therapeutic strategies aiming to ameliorate the inflammation that leads to heart dysfunction, without hampering parasite control. The augmented expression of CCL5/RANTES and CCL3/MIP-1alpha, and their receptor CCR5, in the heart of T. cruzi-infected mice suggests a role for CC-chemokines and their receptors in the pathogenesis of T. cruzi-elicited myocarditis. Herein, we discuss our recent results using a CC-chemokine receptor inhibitor (Met-RANTES), showing the participation of CC-chemokines in T. cruzi infection and unraveling CC-chemokine receptors as an attractive therapeutic target for further evaluation in Chagas disease.

Trypanosoma cruzi infection: a continuous invader-host cell cross talk with participation of extracellular matrix and adhesion and chemoattractant molecules

Several lines of evidence have shown that Trypanosoma cruzi interacts with host extracellular matrix (ECM) components producing breakdown products that play an important role in parasite mobilization and infectivity. Parasite-released antigens also modulate ECM expression that could participate in cell-cell and/or cell-parasite interactions. Increased expression of ECM components has been described in the cardiac tissue of chronic chagasic patients and diverse target tissues including heart, thymus, central nervous system and skeletal muscle of experimentally T. cruzi-infected mice. ECM components may adsorb parasite antigens and cytokines that could contribute to the establishment and perpetuation of inflammation. Furthermore, T. cruzi-infected mammalian cells produce cytokines and chemokines that not only participate in the control of parasitism but also contribute to the establishment of chronic inflammatory lesions in several target tissues and most frequently lead to severe myocarditis. T. cruzi-driven cytokines and chemokines may also modulate VCAM-1 and ICAM-1 adhesion molecules on endothelial cells of target tissues and play a key role in cell recruitment, especially of activated VLA-4+LFA-1+CD8+ T lymphocytes, resulting in a predominance of this cell population in the inflamed heart, central nervous system and skeletal muscle. The VLA-4+-invading cells are surrounded by a fine network of fibronectin that could contribute to cell anchorage, activation and effector functions. Since persistent "danger signals" triggered by the parasite and its antigens are required for the establishment of inflammation and ECM alterations, therapeutic interventions that control parasitism and selectively modulate cell migration improve ECM abnormalities, paving the way for the development of new therapeutic strategies improving the prognosis of T. cruzi-infected individuals

Utilidad de la determinación de PTH entera y del cociente PTH 1-84/7-84 en el diagnóstico no invasivo de osteodistrofia de bajo recambio / Whole PTH and 1-84/7-84 PTH ratio for the non invasive determination of low bone turnover in renal osteodystrophy

Los ensayos convencionales de PTH intacta detectan tanto la PTH 1-84 como fragmentos inactivos (como la PTH 7-84) que se acumula en insuficiencia renal. Recientemente se ha desarrollado un nuevo ensayo de PTH que mide solo la verdadera PTH 1-84 (PTH entera, Whole PTH o CAP assay, Scantibodies). Como el fragmento PTH 7-84 es antagónico sobre los efectos óseos de la PTH 1-84, Moniere-Faugere han sugerido que un cociente PTH 1-84/7-84 menor a 1 podría predecir bajo recambio óseo. Nosotros evaluamos la utilidad del ensayo de PTH entera y de la relación PTH 1-84/7-84 como marcadores de recambio óseo en un grupo de 24 pacientes en diálisis peritoneal (DP). Los pacientes se clasificaron como que presentaban bajo recambio óseo si tenían una PTH total (ensayo similar a la PTH intacta) de menos de 100 pg/ml. También medimos los Crosslaps (CTX) séricos como otro marcador de resorción. Los pacientes tuvieron una media de PTH entera de 95,5 pg/ml y una media de PTH total de 155,4 pg/ml (rango 9 a 900). La PTH entera representó el 69,1% de la PTH total. Quince pacientes (62,5%) tuvieron una PTH total menor a 100. Estos pacientes tuvieron cociente PTH 1-84/7-84 de 1,9 ± 1,8 mientras que 9 pacientes con una PTH total mayor a 100 tuvieron un cociente de 1,29 ± 0,6 (p = NS). Hubo una estrecha correlación entre PTH entera y PTH total 9 r = 0,98; p < 0,0001) y con los CTX séricos (r = 0,78; p < 0,0001). Nosotros concluimos que el cociente 1-84/7-84 no parece ser útil en la predicción bajo recambio óseo y que la PTH total no parece ser más útil que la PTH intacta en la predicción del recambio óseo en esta población. Futuros estudios deberán correlacionar estos marcadores con mediciones directas del recambio óseo en biopsias óseas para demostrar su utilidad en la predicción del tipo de osteodistrofia renal

The conventional intact PTH assays detect not only PTH 1-84 but also inactive fragments (as PTH 7-84) that accumulate in renal failure. There has been a recent development of a new PTH assay that measures only true 1-84 PTH (Whole PTH or CAP assay, Scantibodies). As 7-84 PTH fragment is antagonistic on bone effects of 1-84 PTH, Moniere-Faugere has suggested that 1-84/7-84 PTH ratio less than 1 is predictive of low turnover. We evaluated the usefulness of CAP assay and the 1-84/7-84 PTH ratio as markers of bone turnover in a groups of 24 patients in peritoneal dialysis (PD). Patients were classified as having low bone turn over if they had a Total PTH (similar to intact PTH) of less than 100 pg/ml. We also measured serum CrossLaps (CTX) as another serum resorption marker. Patients had a mean Whole PTH of 95.5 pg/ml and a mesan total PTH of 155.4 pg/l (range 9 to 900). Whole PTH represented 69.1% of total PTH. Fifteen patients (62.5%) had a total PTH of less than 100. These patients had a 1-84/7-84 relationship of 1.9 ± 1.8 while 9 patients with Total PTH more than 100 had a relationship of 1.29 ± 0.6 (p = NS). There was a tight correlation between Whole PTH and total PTH ( r = 0.98; p < 0.0001) and with serum CTX ( r = 0,78; p < 0,0001). We conclude that 1-84/7-84 ratio does not seem useful in the prediction of low bone turnover and that Whole PTH does not seem to be more useful than intact PTH in the prediction of bone turnover in this population. Future studies should correlate this markers with direct measurements of bone turnover in bone biosies to demonstrate their usefulness in the prediction of the type of renal osteodystrophy

Estimación de la prevalencia de osteodistrofia renal de bajo recambio a través de marcadores bioquímicos en una población en diálisis peritoneal / Estimation of the prevalence of adynamic bone disease using biochemical markers

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Representación social del proceso salud enfermedad en comunidades del resguardo de puerto Córdoba (yucunas) y del yaigoje apaporis (Bajo Apaporis), Amazonas-Colombia / Social representation of the health-disease process in the Indians of the Amazon, Colombia

La presente investigación de tipo cualitativo, desarrollaba en las comunidades indígenas de la Amazonía Colombiana, se propuso identificar y analizar las representaciones sociales del proceso salud-enfermedad y los métodos de curación y prevención, con el fin de adecuar y rescatar antiguas prácticas indígenas en salud. La metodología utilizada fue de corte cualitativo, enmarcando en la Investigación Acción Participativa IAP, con técnicas como: observación participante, acción participante, diarios de campo, entrevistas semiestructuradas, charlas educativas y talleres, por medio de las cuales se encontró que las comunidades indígenas amazónicas aún conservan sus métodos de curación y prevención, aunque algunos de sus pobladores han ido perdiendo sus creencias, debido principalmente a la cercanía del hombre blanco. Esta visión del mundo indígena frente al saber tradicional lleva a plantear que la representación social de la salud y la enfermedad está ligada a las creencias milenarias, a la funcionalidad y, definitivamente , al complejo cuerpo-espíritu-medio ambiente.

Insulinoma pancreático: experiencia del Servicio de Cirugía del Hospital San Juan de Dios / Pancreatic insulinoma: experience at the surgical service at San Juan de Dios Hospital

En el período comprendido entre 1986 y 1996 se trataron 5 pacientes con diagnóstico de insulinoma pancreático. En todos ellos el diagnóstico se confirmó a través de la demostración de hipoglicemia más hiperinsulinemia inapropiada en ayuno prolongado. El estudio imagenológico preoperatorio incluyó al menos 2 de los siguientes métodos: ecotomografía, tomografía axial computarizada, resonancia nuclear magnética y arteriografía selectiva, sin que en ninguno de los casos se logrará localizar la lesión pancreática. Todos los pacientes fueron explorados quirúrgicamente, en 3 de ellos se detectó el tumor mediante palpación, en los otros 2 pacientes no fue posible ubicar la lesión en la primera intervención debiendo reexplorarse por la persistencia de hipoglicemias sintomáticas. La cirugía consistió en pancreatectomía distal en 3 casos, enucleación en uno y pancreatectomía distal más enucleación en otro. No hubo mortalidad operatoria, pero la morbilidad fue significativa. La anatomía patológica fue sugerente de malignidad en uno de los casos. Tres de los pacientes están actualmente asintomáticos, uno evolucionó con una diabetes insulino-dependiente y otra con hipoglicemias graves persistentes secundarias a recurrencia peritoneal de la enfermedad