Prevalence of child maltreatment in Ecuador using the ICAST-R.

OBJECTIVES: While the link between childhood experiences of physical, emotional, and sexual abuse and mental health problems has been largely studied, there is limited information regarding the prevalence of child maltreatment in developing countries, particularly in South America. The present study is an effort to investigate the prevalence of child maltreatment in Ecuador using the ISPCAN Child Abuse Screening Tool Retrospective version (ICAST-R). METHOD: A student sample (males = 1579; females = 1554) from the seven largest universities in Quito, Ecuador, completed the ICAST-R. RESULTS: Our findings indicate that 69.6 % of participants experienced child maltreatment. Physical abuse was reported by 47.6 % of respondents; this commonly involved being beaten by parents. Emotional maltreatment was reported by 53 % of the participants; mostly through insults by same-sex peers and parents. Sexual abuse was reported by 15.5 % of the participants. The most prevalent forms of sexual abuse included being coerced into touching another person's genitals, having their genitals touched by others, or having someone expose their genitals to them. Sexual abuse was more prevalent amongst females (males = 12.9 %; females = 18.1 %, OR = 1.49; CI = 1.22-1.81), and physical abuse was more prevalent amongst males (males = 50.5 %; females = 44.6 %, OR = 0.79; CI = 0.69-0.91). CONCLUSIONS: Our study shows evidence of a high prevalence of child maltreatment in Ecuador. We also identify significant gender differences in the type of abuse experienced, and in the context in which this abuse takes place. These results are important given the negative consequences of child maltreatment. More research applying ICAST to different populations is recommended to further validate the present findings and facilitate international comparisons.

Respuesta hipertensiva exagerada al ejercicio e isquemia miocárdica en pacientes con enfermedad coronaria conocida o sospechada / Exaggerated hypertensive response to exercise and myocardial ischaemia in patients with known or suspected coronary artery disease

Objetivos. La asociación entre una respuesta hipertensiva exagerada al ejercicio (RHEE) y la probabilidad de isquemia en las pruebas de esfuerzo es controvertida. Nuestro propósito fue determinar la posible asociación entre una RHEE y el desarrollo de dolor torácico y de isquemia electrocardiográfica o ecocardiográfica con el ejercicio. Pacientes y métodos. Estudio retrospectivo y observacional de 10.047 pacientes con enfermedad coronaria conocida o sospechada referidos para una ecocardiografía de ejercicio. Un análisis de regresión logística evaluó el efecto del desarrollo de una RHEE (definida como una presión arterial sistólica máxima con el ejercicio ≥ 220mmHg) y la aparición de dolor torácico y de cambios electrocardiográficos y ecocardiográficos sugestivos de isquemia. Resultados. Un total de 402 pacientes desarrollaron una RHEE. Los porcentajes de dolor torácico anginoso, isquemia electrocardiográfica y ecocardiográfica entre los pacientes con RHEE fueron del 8,2, 16,2 y 22,6%, frente al 13,8, 14,7 y 27,5%, respectivamente, en pacientes sin RHEE (p=0,001, p=0,4, p=0,032). Tras un ajuste multivariado, la RHEE se asoció con una menor probabilidad de aparición de dolor torácico anginoso inducido por el esfuerzo (OR 0,44; IC 95% 0,30-0,65; p<0,001) y de isquemia ecocardiográfica (OR 0,63; IC 95% 0,48-0,83; p=0,001), pero no con el desarrollo de isquemia electrocardiográfica. Conclusiones. La RHEE se asocia con una menor prevalencia de dolor torácico anginoso e isquemia ecocardiográfica en pacientes con enfermedad coronaria conocida o sospechada (AU)

Objectives. The association between an exaggerated hypertensive response to exercise (EHRE) and the probability of ischaemia in stress tests is controversial. Our purpose was to determine the possible association between an EHRE and the development of chest pain and electrocardiographic or echocardiographic ischaemia with exercise. Patients and methods. A retrospective observational study was conducted of 10,047 patients with known or suspected coronary artery disease referred for exercise echocardiography. A logistic regression analysis assessed the effect of developing an EHRE (defined as a maximum systolic blood pressure with exercise ≥220mmHg) and the onset of chest pain and electrocardiographic and echocardiographic changes suggestive of ischaemia. Results. A total of 402 patients developed an EHRE. The rates of angina, electrocardiographic ischaemia and echocardiographic ischaemia among the patients with an EHRE were 8.2, 16.2 and 22.6% versus 13.8, 14.7 and 27.5%, respectively, for patients without an EHRE (p=.001, p=.4, p=.032). After a multivariate fit, EHRE was associated with a lower probability of exercise-induced angina (OR, 0.44; 95% CI 0.30-0.65; p<.001) and echocardiographic ischaemia (OR, 0.63; 95% CI 0.48-0.83; p=.001) but not with the onset of electrocardiographic ischaemia. Conclusions. EHRE is associated with a lower prevalence of angina and echocardiographic ischaemia in patients with known or suspected coronary artery disease (AU)

Exaggerated hypertensive response to exercise and myocardial ischaemia in patients with known or suspected coronary artery disease. / Respuesta hipertensiva exagerada al ejercicio e isquemia miocárdica en pacientes con enfermedad coronaria conocida o sospechada.

OBJECTIVES: The association between an exaggerated hypertensive response to exercise (EHRE) and the probability of ischaemia in stress tests is controversial. Our purpose was to determine the possible association between an EHRE and the development of chest pain and electrocardiographic or echocardiographic ischaemia with exercise. PATIENTS AND METHODS: A retrospective observational study was conducted of 10,047 patients with known or suspected coronary artery disease referred for exercise echocardiography. A logistic regression analysis assessed the effect of developing an EHRE (defined as a maximum systolic blood pressure with exercise ≥220mmHg) and the onset of chest pain and electrocardiographic and echocardiographic changes suggestive of ischaemia. RESULTS: A total of 402 patients developed an EHRE. The rates of angina, electrocardiographic ischaemia and echocardiographic ischaemia among the patients with an EHRE were 8.2, 16.2 and 22.6% versus 13.8, 14.7 and 27.5%, respectively, for patients without an EHRE (p=.001, p=.4, p=.032). After a multivariate fit, EHRE was associated with a lower probability of exercise-induced angina (OR, 0.44; 95% CI 0.30-0.65; p<.001) and echocardiographic ischaemia (OR, 0.63; 95% CI 0.48-0.83; p=.001) but not with the onset of electrocardiographic ischaemia. CONCLUSIONS: EHRE is associated with a lower prevalence of angina and echocardiographic ischaemia in patients with known or suspected coronary artery disease.

Localized high-grade gastroenteropancreatic neuroendocrine tumors: Defining prognostic and therapeutic factors for a disease of increasing clinical significance.

BACKGROUND: Due to the limited sample size in the existing series, the natural history and management of high-grade gastroenteropancreatic neuroendocrine tumors (GEP-NET) is poorly understood. In order to better understand high-grade GEP-NET, a large cohort study was undertaken. OBJECTIVE: To determine the prognostic factors associated with high-grade GEP-NET. METHODS: Patients diagnosed with non-metastatic high-grade GEP-NET from 1988 to 2010 were identified in SEER. RESULTS: Incidence of high-grade GEP-NETs increased from 0.03 to 0.19/100,000 over the study period. The median age was 65 years, and the majority of the patients were white and females. The most common primary site was colorectal, and the most frequent T classification was T3. Surgical resection was performed in 89% of patients that varied by site (p < 0.0001). Nodal involvement was frequent and varied by site (p = 0.0002). The 5-year disease-specific survival was 63.3% and was the greatest for small bowel (p = 0.0003). Survival was associated with age, node status and surgery (p < 0.05). On multivariate analysis, the node status, surgery, and site continued to be associated with survival (p < 0.05); however, age (p = 0.08) no longer influenced the patient's survival. CONCLUSION: High-grade GEP-NETs are neoplasms with exponentially increasing in incidence. Tumor location and nodal status are predictors of survival. Surgery is associated with a survival advantage and could be considered for localized disease.

Stochastic relevance analysis of epileptic EEG signals for channel selection and classification.

Time-frequency decompositions (TFDs) are well known techniques that permit to extract useful information or features from EEG signals, being necessary to distinguish between irrelevant information and the features effectively representing the subjacent physiological phenomena, according to some evaluation measure. This work introduces a new method to obtain relevant features extracted from time-frequency plane for epileptic EEG signals. Particularly, EEG features are extracted by common spectral methods such as short time Fourier transform (STFT), wavelets transform and Empirical Mode Decomposition (EMD). Then, each method is evaluated by Stochastic Relevance Analysis (SRA) that is further used for EEG classification and channel selection. The classification measures are carried out based on the performance of the k-NN classifier, while the channels selected are validated by visual inspection and topographic scalp map. The study uses real and multi-channel EEG data and all the experiments have been supervised by an expert neurologist. Results obtained in this paper show that SRA is a good alternative for automatic seizure detection and also opens the possibility of formulating new criteria to select, classify or analyze abnormal EEG channels.

14C tebuconazole degradation in Colombian soils.

Tebuconazole is a fungicide used on onion crops (Allium Fistulosum L) in Colombia. Persistence of pesticides in soils is characterized by the half-life (DT50), which is influenced by their chemical structure, the physical and chemical properties of the soil and the previous soil history. Based on its structural and chemical properties, tebuconazole should be expected to be relatively persistent in soils. Laboratory incubation studies were conducted to evaluate persistence and bond residues of 14C tebuconazole in three soils, two inceptisol (I) and one histosol (H). Textural classifications were: loam (101), loamy sand (102) and loam (H03), respectively. Data obtained followed a first-order degradation kinetics (R2 > or = 0.899) with DT50 values between 158 and 198 days. The production of 14CO2 from the 14C-ring-labelled test chemicals was very low and increased slightly during 63 days in all cases. The methanol extractable 14C-residues were higher than aqueous ones and both decreased over incubation time for the three soils. The formation of bound 14C-residues increased with time and final values were 11.3; 5.55 and 7.87% for 101, 102 and H03 respectively. Soil 101 showed the lowest mineralization rate and the highest bound residues formation, which might be explained by the clay fraction content. In contrast, an inverse behavior was found for soils 102 and H03, these results might be explained by the higher soil organic carbon content.

DETECCIÓN DE Brucella abortus POR PCR EN MUESTRAS DE SANGRE Y LECHE DE VACUNOS / DETECTION OF Brucella abortus IN BLOOD AND MILK OF DAIRY CATTLE BY PCR METHOD

Objetivo. Evaluar el uso de la Reacción en Cadena de la Polimerasa (PCR) para la detección de Brucella abortus en muestras de sangre y leche de vacunos. Materiales y métodos. Este estudio de tipo descriptivo fue realizado durante los años 2004 y 2005. Se analizaron 136 animales de tres fincas localizadas en el municipio de Durania, Norte de Santander, Colombia. Se evaluó la presencia de anticuerpos en la leche mediante la prueba del anillo (PAL). Se amplificó el fragmento de 223pb del gen BCSP31. Se emplearon los cebadores B4 y B5 de la región interna de la secuencia del gen BCSP31 (GenBank, número M20404). Resultados. En aquellos animales positivos se obtuvo una muestra de sangre y leche para el análisis por PCR, la sangre no fue analizada por serología. Se evaluaron diferentes métodos de extracción de ADN. Se encontró que un 13.2% (18/136) de las muestras de leche fueron positivas a la PAL. Se analizaron 33 muestras de leche negativas por PAL de las cuales el 30.3% (10/33) resultaron positivas por PCR. Al analizar las muestras de sangre de los animales positivos por PAL el 94.1% (16/17) fueron positivas por PCR, mientras que el 47% (8/17) de las muestras de leche positivas por PAL, fueron positivas por PCR. Conclusiones. Se demostró la amplificación de un fragmento de ADN de Brucella abortus en muestras de sangre y leche de vacunos. Los resultados preliminares demostraron que es posible usar PCR como prueba diagnóstica de brucelosis en Colombia.

Objective. To evaluate the use of Polymerase Chain Reaction in the detection of Brucella abortus in cattle blood and milk samples. Materials and methods. Between 2004 and 2005 a descriptive study was carried out. One hundred and thirty six females from three different herds located in Durania, Norte de Santander, Colombia were used. The antibodies to Brucella were detected using ring test (RT). Primers B4 and B5 of internal region of gen BCSP31 (GenBank, number access M20404) were used. From those RT positive animals, blood and milk samples were obtained and along with 33 negative milk samples were evaluated by PCR. Blood samples were not analyzed for antibody detection. Different DNA extraction protocols were evaluated and a Brucella abortus gene was amplified using specific primers. Results. The 13.2% of milk samples were positive to RT (18/136), 30.3% (10/33) of negative samples for RT and 94.1% (16/17) of positive samples were both positive by PCR. It was demonstrated that PCR is an useful tool to detect Brucella abortus DNA, either in milk and blood samples. Conclusions. It was determined by PCR a DNA fragment of Brucella abortus in blood and milk of cattle. The preliminary results showed that it is possible to perform PCR as diagnostic test of brucellosis in Colombia.

Seroprevalence of and risk factors for HIV-1 infection among female commercial sex workers in South America.

OBJECTIVE: Assessment of HIV prevalence and associated risk behaviours among female commercial sex workers (FCSW) across major cities in South America. METHODS: Seroepidemiological, cross sectional studies of 13 600 FCSW were conducted in nine countries of South America during the years 1999-2002. Participants were recruited in brothels, massage parlours, hotels, and streets where anonymous questionnaires and blood samples were collected. HIV infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot confirmatory tests. RESULTS: The overall HIV seroprevalence was 1.2% (range 0.0%-4.5%). The highest HIV seroprevalences were reported in Argentina (4.5%) and Paraguay (2.6%); no HIV infected FCSW were detected in Venezuela and Chile. Consistent predictors of HIV seropositivity were: (1) a previous history of sexually transmitted infections (STI, AORs = 3.8-8.3), and (2) 10 years or more in commercial sex work (AORs = 2.2-24.8). In addition, multiple (> or =3) sexual contacts (AOR = 5.0), sex with foreigners (AOR = 6.9), use of illegal drugs (AOR = 3.2), and marijuana use (AOR = 8.2) were associated with HIV seropositivity in Southern Cone countries. CONCLUSIONS: Consistently low HIV seroprevalences were detected among FCSW in South America, particularly in the Andean region. Predictors of HIV infection across the continent were STI and length of commercial sex work; however, use of illegal drugs, especially marijuana, and sexual contacts with foreigners were also found to be associated risk factors in the Southern Cone region. Interventions for the control of HIV and other STI need to be region and country specific; drug use appears to have an ever increasing role in the spread of HIV among heterosexually active populations.

Prenatal diagnosis of severe structural congenital malformations in Europe.

OBJECTIVES: To assess at a population-based level the frequency with which severe structural congenital malformations are detected prenatally in Europe and the gestational age at detection, and to describe regional variation in these indicators. METHODS: In the period 1995-1999, data were obtained from 17 European population-based registries of congenital malformations (EUROCAT). Included were all live births, fetal deaths and terminations of pregnancy diagnosed with one or more of the following malformations: anencephalus, encephalocele, spina bifida, hydrocephalus, transposition of great arteries, hypoplastic left heart, limb reduction defect, bilateral renal agenesis, diaphragmatic hernia, omphalocele and gastroschisis. RESULTS: The 17 registries reported 4366 cases diagnosed with the 11 severe structural malformations and of these 2300 were live births (53%), 181 were fetal deaths (4%) and 1863 were terminations of pregnancy (43%); in 22 cases pregnancy outcome was unknown. The overall prenatal detection rate was 64% (range, 25-88% across regions). The proportion of terminations of pregnancy varied between regions from 15% to 59% of all cases. Gestational age at discovery for prenatally diagnosed cases was less than 24 weeks for 68% (range, 36-88%) of cases. There was a significant relationship between high prenatal detection rate and early diagnosis (P < 0.0001). For individual malformations, the prenatal detection rate was highest for anencephalus (469/498, 94%) and lowest for transposition of the great arteries (89/324, 27%). Termination of pregnancy was performed in more than half of the prenatally diagnosed cases, except for those with transposition of the great arteries, diaphragmatic hernia and gastroschisis, in which 30-40% of the pregnancies with a prenatal diagnosis were terminated. CONCLUSION: European countries currently vary widely in the provision and uptake of prenatal screening and its quality, as well as the "culture" in terms of decision to continue the pregnancy. This inevitably contributes to variation between countries in perinatal and infant mortality and in childhood prevalence and cost to health services of congenital anomalies.

Circulating recombinant form CRF02_AG in South America.

With the objective of monitoring the distribution of HIV-1 subtypes and circulating recombinant forms (CRFs)in South America, population-based surveillance studies were performed in seven countries. Peripheral blood mononuclear cell, filter paper, fresh blood, and cocultivation samples were collected from HIV-positive patients from Colombia, Ecuador, Peru, Bolivia, Chile, Argentina, and Uruguay, during a 7-year period(1995-2001). DNA was prepared and HIV envelope subtypes were determined by heteroduplex mobility as-say and DNA sequencing from 1289 HIV-positive samples. While subtypes B and F were the most commonly observed subtypes, two CRF02_AG strains were detected, in Ecuador. This is the first report of the existence of this CRF in South America.

Legal abortion in Asturias (Spain) after the 1985 law: sociodemographic characteristics of women applying for abortion.

STUDY OBJECTIVE: To describe the use of induced abortion (IA) in Asturias after its legalisation as well as the socio-demographic characteristics of women applying for abortion. DESIGN AND SETTING: Descriptive study, population-based, using data collected by the regional abortion surveillance system for the period 1988 1994. MAIN RESULTS: The number of IA and the abortion rate (AR) (10 per 1000 women aged 15-49) have been stable in Asturias during the study period. The highest ARs were found for women in the age group 20-34, for divorced/separated, for women with a higher educational level and for women with only one child. The proportion of pregnancies which ended in abortion was one in four; for teenagers and women over 34 years it was one in two. This proportion was also higher for women not married, students and women with two or more children. Ninety-eight percent of all abortions took place in private clinics, the woman's physical/mental health being the medical indication for these abortions. Abortion was most often performed within eight weeks of gestation (65%). Late abortion ocurred more frequently among teenagers and women of low educational level. Eighteen percent of women had repeated abortions. A high proportion (61%) of women applying for abortion had not used the Family Planning (FP) services in the previous two years; adolescents and women of low educational level had the lowest frequencies of FP use. CONCLUSIONS: Compared with that of other European countries, the AR in Asturias was intermediate. The results regarding adolescents show the need for evaluation and promotion of sex education and contraceptive programmes. The lower and later use of abortion by women of low educational level shows inequalities that call for specific action.

Diagnostic accuracy of the cytologic diagnosis of anal human papillomavirus infection compared with DNA hybridization studies.

During the years 1990 to 1991, smears taken from the anal canal of 45 randomly selected homosexual males were studied. Several cytological criteria were used to study infection by human papillomavirus (HPV). The cytological study and an anoscopy was performed and a swab was taken for HPV-DNA hybridization, using labelled RNA probes for HPV-DNA: 6,11,16,18,31,33, and 35. In our study we observed the existence of a high proportion (9.5%) of inadequate smears that did not contain glandular cells and/or metaplasia. A sensitivity of 78% and a specificity of 72% was obtained. Sensitivity and specificity were 68% and 91%, respectively, when these criteria were restricted to the presence of koilocytes and/or dyskeratocytes. The high rate of occult infections obtained in our study lead us to suggest the simultaneous use of cytology, molecular hybridization, and anoscopy for suitable care of those patients with a high risk of contracting HPV infections of the anal canal.

[Preventing the recurrence of febrile seizures: intermittent prevention with rectal diazepam compared with continuous treatment with sodium valproate]. / Prevención de la recurrencia de crisis febriles: profilaxis intermitente con diacepam rectal comparada con tratamiento continuo con valproato sódico.

Sixty nine children suffering from a first febrile seizure without evidence of neurologic disorder or associated risk factors were randomly assigned to one of three groups: no treatment; intermittent rectal diazepam; or continuous oral sodium valproate. All patients were followed for two years. Periodical controls were performed every three months in order to record febrile episodes, recurrent seizures, and treatment side affects. Rate of recurrent febrile seizures was 16% in control group, and 5.5% in diazepam group. Sodium valproate group showed no recurrences in the follow-up period. The low relapsing rate in control group suggests that prophylaxis should not be established even if it is requested by certain parental attitudes.