Ideal Cardiovascular Health in the southern cone of Latin America.

OBJECTIVE: The American Heart Association developed the concept of 'Ideal Cardiovascular Health', which is based on the presence of ideal levels across seven health factors. The goal of this study is to assess the prevalence of Ideal Cardiovascular Health in the Southern Cone of Latin America. STUDY DESIGN: We conducted a cross-sectional analysis as part of CESCAS I cohort. METHODS: This report included 5458 participants aged between 35 and 75 years who were selected using stratified multistage probability sampling in Argentina, Chile and Uruguay. Interviews included demographic information, the International Physical Activity Questionnaire, and a food frequency questionnaire on dietary habits. Participants were classified as current, former or non-smokers. Weight, height and blood pressure were measured by trained personnel, and fasting cholesterol and glucose plasma levels were measured. RESULTS: Only 0.1% (95% confidence interval [CI]: 0.0-0.2) met the seven criteria that define the Ideal Cardiovascular Health. The least prevalent healthy behaviour was having a healthy diet: 0.5% (95% CI: 0.3-0.7), while the least prevalent health factor was having blood pressure < 120/80 mmHg: 23.6% (95% CI: 22.1-25.0). CONCLUSIONS: The prevalence of Ideal Cardiovascular Health is very low in a representative sample of population from the Southern Cone of Latin America, and the levels of healthy lifestyle behaviours are even lower than ideal biochemical parameters. These results highlight the challenge of developing strategies to improve the levels of Ideal Cardiovascular Health at primary prevention levels.

Determinants and geographical variation in the distribution of depression in the Southern cone of Latin America: A population-based survey in four cities in Argentina, Chile and Uruguay.

BACKGROUND: Depression is one of the major contributors to the global burden of diseases; however, population-based data in South America are limited. METHODS: We conducted a population-based cross sectional study with 7524 participants, aged 35-74 years old, recruited between February 2010 and December 2011 from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). Major Depressive Episode (MDE) was assessed using the Patient Health Questionnaire (PHQ) - 9. RESULTS: The overall prevalence of MDE was 14.6% (95% CI: 13.6, 15.6). However, there was a geographical variability of up to 3.7 folds between different cities being 5.6% (95% CI: 4.6, 6.7) in Marcos Paz, Argentina; 9.5% (95% CI: 8.2, 10.9) in Bariloche, Argentina; 18.1% (95% CI: 16.3, 20.0) in Temuco, Chile, and 18.2 (95% CI: 16.3, 20.2) in Pando-Barros Blancos, Uruguay. The multivariate model showed that, adjusted by location, being female, being between 35 and 44 years old, having experienced at least one stressful life event, currently smoking, and having a history of chronic medical diseases were independently associated with an increased risk of MDE, while having higher education and being married or living with a partner reduced the risk of MDE. LIMITATIONS: These results are representative of the selected cities included in the study. As such extrapolation to the general populations of Argentina, Chile, and Uruguay should be done with caution CONCLUSIONS: This study showed a high prevalence and variability of MDE in the Southern Cone of Latin America.

Experiencias y desafios en la formación en investigación en el primer nivel de atención / Experiences and challenges in research training at the first level of attention

INTRODUCCIÓN: Desde el Departamento de Medicina Familiar y Comunitaria (MFYC) (Facultad de Medicina, UDELAR) se está trabajando en forma sistemática desde el año 2010 OBJECTIVO: con el objetivo de fortalecer la formación en metodología científica para contribuir favorablemente a este proceso. En el mismo período se ha puesto en marcha el Nuevo Plan de Estudios que integra metodología científica en la currícula de los estudiantes de medicina y el nuevo reglamento de concurso para el cargo docente grado 2 que incluye una prueba en esta materia. MÉTODO: En este contexto se ha desarrollado la formación en metodología de la investigación mediante diversas estrategias. Con estudiantes de grado se han implementado Cursos Optativos: el curso CESCAS, con una modalidad de pasantía, el curso PCAT, con un componente teórico y otro de campo, y se han ofrecido temas y tutoría en el primer nivel para el curso curricular de Metodología Científica II. CONCLUSIÓN: Con studiantes de posgrado se ha rediseñado el curso curricular de Metodología de la Investigación a partir de 2012 en base a dos lineamientos principales: la instrumentación básica con herramientas de la metodología, teniendo en cuenta que son generaciones de profesionales que no tuvieron formación de grado en esta materia, y la adecuación a las posibilidades y necesidades de cada grupo de posgrados. Con los docentes se inició un espacio informal destinado a la preparación del concurso de Grado 2; partir de 2013 se constituyó un Taller de Lectura Crítica, espacio formal del Departamento de MFYC, abierto, que actualmente transita su tercera edición.

Comparison of diameter and perimeter methods for tumor volume calculation.

PURPOSE: Lesion volume is often used as an end point in clinical trials of oncology therapy. We sought to compare the common method of using orthogonal diameters to estimate lesion volume (the diameter method) with a computer-assisted planimetric technique (the perimeter method). METHODS: Radiologists reviewed 825 magnetic resonance imaging studies from 219 patients with glioblastoma multiforme. Each study had lesion volume independently estimated via the diameter and perimeter methods. Cystic areas were subtracted out or excluded from the outlined lesion. Inter- and intrareader variability was measured by using multiple readings on 48 cases. Where serial studies were available in noncystic cases, a mock response analysis was used. RESULTS: The perimeter method had a reduced interreader and intrareader variability compared with the diameter method (using SD of differences): intrareader, 1.76 mL v 7.38 mL (P < .001); interreader, 2.51 mL v 9.07 mL (P < .001) for perimeter and diameter results, respectively. Of the 121 noncystic cases, 23 had serial data. In six (26.1%) of those 23, a classification difference occurred when the perimeter method was used versus the diameter method. CONCLUSION: Variability of measurements was reduced with the computer-assisted perimeter method compared with the diameter method, which suggests that changes in volume can be detected more accurately with the perimeter method. The differences between these techniques seem large enough to have an impact on grading the response to therapy.

Assessment of cerebral perfusion and arterial anatomy in hyperacute stroke with three-dimensional functional CT: early clinical results.

PURPOSE: Our purpose was to determine the clinical feasibility of quantitative three-dimensional functional CT in patients with hyperacute stroke. METHODS: Twenty-two patients who underwent clinically indicated CT angiography were studied: nine patients had no stroke, eight had mature stroke, and five had hyperacute stroke (less than 3 hours since ictus). Maps were obtained of perfused cerebral blood volume (PBV), and CT angiograms were generated by using standard techniques. RESULTS: Normal PBV values (mean +/- SEM) were 4.6 +/- 0.15% in the gray matter, 1.75 +/- 0.09% in the white matter, 2.91 +/- 0.20% in the cerebellum, 3.18 +/- 0.10% in the caudate, 2.84 +/- 0.23% in the putamen, 2.92 +/- 0.29% in the thalamus, and 1.66 +/- 0.03% in the brain stem. For patients with mature stroke, ischemic changes were visible on noncontrast, contrast-enhanced, and PBV scans. In patients with hyperacute stroke, ischemic changes were either absent or subtle before contrast administration, but became apparent on contrast-enhanced scans. Quantitative PBV maps confirmed reduced regional perfusion. CT angiograms in the hyperacute group showed occlusion of vessels in locations appropriate to the PBV deficits seen. CONCLUSION: Quantitative three-dimensional functional CT is feasible for patients with hyperacute stroke. It is performed by using helical CT techniques, and yields measures of cerebrovascular physiological function, which are useful in this patient population.

Simple structured model for alpha-amylase synthesis by Bacillus amyloliquefaciens.

A predictive, simple, structured model describing the synthesis of alpha-amylase by Bacillus amyloliquefaciens was formulated. Three key intracellular processes were identified (i.e, translation, and excretion) along with two key intracellular components (i.e., mRNA and the intracellular form of the alpha-amylase enzyme). Nearly all the model parameters were estimated by means of performing independent experiments, primarily fed-batch experiments. The model was shown to predict transient system behavior in batch and in fed-batch operation with some limitation and minor model parameter revisions. Since a principal objective was to demonstrate that independent experimental parameter determination can be used to construct the predictive model, further fine-tuning of the parameters may be necessary before application for optimization and control purposes.

Use of the glucose clamp technique for confirmation of insulinoma autonomous hyperinsulinism.

The diagnosis of insulinoma on the basis of persistent hypoglycemia requires further confirmation. The insulin suppression test has been used to support this diagnosis prior to surgical intervention. In this study the euglycemic clamp technique was used to compare five control volunteers with four hypoglycemic patients with suspected insulinoma. Insulin was infused over successive two-hour periods at 2, 4, and 8 mU/kg/min. Plasma glucose levels were clamped at 80 mg/dL (4.4 mmol/L) using an artificial pancreas. High insulin levels were measured in all subjects, ranging from 225 +/- 30 microU/mL (1614 +/- 215 pmol/L) to 1018 +/- 239 microU/mL (7304 +/- 1714 pmol/L). Levels of C peptide fell to 0.1 ng/mL (0.028 nmol/L) in control subjects but remained at high levels in the patients. Insulinoma was confirmed on laparotomy in all four patients. In two patients tested after removal of the tumor the results were found to have returned to normal.

[Surgery of insulinomas using an artificial pancreas]. / La chirurgie des insulinomes sous pancréas artificiel.

The risks of failure of conventional treatment of insulinomas should be reduced, it seems, when the surgical operation is carried out using an artificial pancreas. The Biostator, used with feed back controlled glucose infusion in 32 cases of which two personal effectively allows one firstly to operate in complete security since it is programmed to maintain a pre-determined glycaemia during the various stages of the operation; it also allows one to put into evidence an occult tumour in a segment rendered suspect due to the sudden hypoglycaemia observed during its mobilisation; it finally allows one by the appearance of a post-excision hyperglycaemia peak to find out whether the procedure has been complete.

Liquid chromatographic determination of lidocaine in serum.

A method is described for the quantitation of lidocaine in serum by high performance liquid chromatography (HPLC). The analysis utilizes UV detection at 210 nm with a Whatman ODS-3 5-micron analytical column and reverse phase precolumn held at 60 degrees C. The mobile phase consists of acetonitrile, potassium dihydrogen phosphate buffer, phosphoric acid and water. One hundred microlitres of serum sample are required and the analysis time is rapid, at eight minutes. Serum extraction is a two-step process using chloroform, sodium carbonate and hydrochloric acid. This method provides selectivity and sensitivity with a precision of 2.0%, recovery of 97.4%, average accuracy of 98.6% and no interference from eighteen commonly administered drugs.

Determination of disopyramide phosphate in serum by high-performance liquid chromatography.

A method is described for the quantitation of disopyramide phosphate (Norpace) in serum by high-performance liquid chromatography. The analysis utilizes ultraviolet detection at 254 nm with a 5-micrometers reversed-phase column and a mobile phase consisting of acetonitrile, ammonium dihydrogen phosphate buffer, acetic acid, and water. The determination requires 100 microliters of serum sample and the analysis time (9 min) is rapid. Serum extraction is a two-step process using chloroform, sodium carbonate, and hydrochloric acid. Although acid is used, columns produced sharp peaks with consistent retention times for 6-8 months. This method provides selectivity and sensitivity with a precision of 3.8%, average recovery of 92.9% and no interference from 18 commonly administered drugs.

Improved stability of methanolic Wright's stain solution with dual additives.

Degradation of methanolic Wright's stain solutions was greatly diminished with the addition of diethylamine hydrochloride and dimethylamine hydrochloride as costabilizers. Precipitation problems were eliminated by the dual additives. The stabilized stain solutions demonstrated good staining performance on blood smears. Methods for predicting the shelf life using calculated analytical parameters are described. Using these methods, the shelf life of a control stain solution was predicted to be 0.7 years; predicted shelf life was more than tripled with the addition of diethylamine hydrochloride and was increased approximately 27 times with the addition of both diethylamine hydrochloride and dimethylamine hydrochloride.

Improved stability of methanolic wright's stain with additive reagents.

Additive reagents have been investigated to improve the stability of methanolic Wright's stain. The addition of ammonium halides, monoalkylamine hydrochlorides, dialkylamine hydrochlorides or trialkylamine hydrochlorides to methanolic Wright's stain was found to enhance the stability of stain components in methanol. No change in performance is observed with these additives present. Random precipitation in the stain solution was still observed with the addition of ammonium halides and monoalkylamine hydrochlorides. No precipitation was found in stain solutions containing hydrochlorides of most dialkylamines and trialkylamines. Of the compounds evaluated, 0.6% diethylamine hydrochloride added to methanolic stain solutions produced the most desirable overall results. Mechanisms of stabilization and precipitation in these stain solutions are proposed. Essentially, separation of the thiazine-eosinate ion pair through interaction with an appropriate additive increases stain stability. The solubilities of thiazine-eosinate or additive cation-eosinate ion pairs in methanol determine the formation of precipitate in such stain solutions.

Descentralización para la formación médica: Facultad de Medicina en Canelones al Este, 2008-2014 / Decentralization for medical training: Faculty of Medicine in Canelones East, 2008-2014

INTRODUCCIÓN: El trabajo interinstitucional entre Facultad de Medicina y Comuna Canaria permitió que se contara con apoyo del Gobierno Departamental para financiar los primeros cargos docentes radicados en el Departamento de Canelones durante dos años (Convenio de instalación del CCSA). Entonces la Facultad asumió el compromiso de dar continuidad a éstos a partir de 2010. Llegado el plazo la Facultad de Medicina no solo pudo dar continuidad a los cargos inciales sino incrementar notablemente el número en la zona Este y otras de Canelones, a través del Programa UDA. CONCLUSIÓN: Esta evolución cuantitativa ha estado acompañada de un crecimiento cualitativo. De una especialidad médica se pasó a cinco (mfyc, pediatría, ginecología, psiquiatría y epidemiología) y otras dos disciplinas (psicología y nutrición). Las actividades asistenciales se han diversificado incorporando para la enseñana ámbitos propios del primer nivel de atención como la actividad domiciliaria y espacios de coordinación interinstitucional para abordaje en equipo de situaciones complejas, así como el servicio de emergencia.