Assessment of DDT levels in selected environmental media and biological samples from Mexico and Central America.

Taking into account the environmental persistence and the toxicity of DDT, the Pan American Health Organization (PAHO) organized a surveillance program in Mesoamerica which included the detection of residual DDT in environmental (soil) and biological samples (fish tissue and children's blood). This program was carried out in communities from Mexico, Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica and Panama. This paper presents the first report of that program. As expected, the results show that the levels for [summation operator] DDT in soil (outdoor or indoor) and fish samples in the majority of the locations studied are below guidelines. However, in some locations, we found children with high concentrations of DDT as in Mexico (mean level 50.2 ng/mL). Furthermore, in some communities and for some matrices, the DDT/DDE quotient is higher than one and this may reflect a recent DDT exposure. Therefore, more efforts are needed to avoid exposure and to prevent the reintroduction of DDT into the region. In this regard it is important to know that under the surveillance of PAHO and with the support of UNEP, a regional program in Mesoamerica for the collection and disposal of DDT and other POPs stockpiles is in progress.

Quiste del ligamento redondo, una lesión rara que simula una hernia inguinal: reporte de un caso / Round ligament cyst, a rare condition simulating inguinal hernia: case report

Cysts of the inguinal cord are disorders that simulate inguinal hernias and manifest as inguinal masses and, in some cases, are accompanied by pain that can simulate a complicated inguinal hernia. We report the third case of a round ligament cyst in a 21-year-old female with a mass in the right inguinal area with intermittent pain. The patient was subjected to surgical exploration of the right inguinal area where a round ligament cyst was found. The ligament was resected and reported as a serous cyst. The patient's outcome was excellent and she was discharged 24 h after surgery. She has been followed up for 3 months without recurrence. Round ligament cysts are very rare disorders, and the diagnosis is perioperative. Resection of the round ligament causes complete symptom relief, and every case requires inguinal hernioraphy.

[Metabolic changes and nutritional status in the spinal cord injured patient ASIA A. Evaluation and monitoring with routine laboratories, a feasible option]. / Cambios metabólicos y estado nutricional en el paciente lesionado raquimedular cervical ASIA A. Evaluación y monitoreo con laboratorios de rutina, una opción viable.

INTRODUCTION: Spinal Cord Injury ASIA A (tetraplegia) is a frequent pathology that may affect population regardless of age, sex or race, and that can induce metabolic abnormalities that may worsen the nutritional status of these patients. There are no existing specific protocols to treat these disorders in the specialized units in Mexico. MATERIAL AND METHODS: We analyzed 16 patients at the Spine Clinic SS-DF, 18 years or older without any drug treatment or any previous disease, known or diagnosed when admitted to the hospital. Laboratory samples were obtained as well as the nutritional status was calculated at their admittance and discharge. Individually calculated nutritional support was administered starting at their third day of hospital stay. RESULTS: 100% of the patients showed some type of metabolic disorder associated to the neurological injury. 50% of the patients were classified with severe malnutrition, 25% moderate and 25% mild, all improved at their discharge. CONCLUSIONS: We confirmed the presence of metabolic changes in these patients, the efficacy of routine laboratory in the Spine Clinic SS-DF for their evaluation, and that adequate nutritional support may help correct metabolic disorders in this patients.

[Round ligament cyst, a rare condition simulating inguinal hernia. Case report]. / Quiste del ligamento redondo, una lesión rara que simula una hernia inguinal. Reporte de un caso.

Cysts of the inguinal cord are disorders that simulate inguinal hernias and manifest as inguinal masses and, in some cases, are accompanied by pain that can simulate a complicated inguinal hernia. We report the third case of a round ligament cyst in a 21-year-old female with a mass in the right inguinal area with intermittent pain. The patient was subjected to surgical exploration of the right inguinal area where a round ligament cyst was found. The ligament was resected and reported as a serous cyst. The patient's outcome was excellent and she was discharged 24 h after surgery. She has been followed up for 3 months without recurrence. Round ligament cysts are very rare disorders, and the diagnosis is perioperative. Resection of the round ligament causes complete symptom relief, and every case requires inguinal hernioraphy.

Acceptability and perceived side effects of insecticide indoor residual spraying under different resistance management strategies.

OBJECTIVE: To assess household acceptability and perceived side effects of residual indoor pyrethroid (PYR), carbamate and organophosphate insecticides sprayed by annual rotation (ROT), spatial mosaic (MOS), and a single insecticide (DDT or PYR) in communities of the coastal plain of Chiapas, Mexico. MATERIAL AND METHODS: A questionnaire to assess the acceptability and perceived side effects of indoor insecticides was administered to one member of 30% of the families in eight villages of Chiapas. The association of different insecticide treatments with their responses was evaluated (Chi-square). The intensity of side effects indicated under different treatments was compared in an ordered logistic model, using a severity index as the response variable. RESULTS: Insecticide spraying as a probable cause of symptoms was identified by 2.1% of interviewees. A significantly high percentage of persons with blurred vision, dizziness, sneezing, coughing, numbness, watery eyes, and itching lived in villages under MOS and ROT and a high severity index was significantly associated with ROT treatment. Reduction of mosquito bites and cockroaches were the perceived main benefits, and most villagers that perceived no benefits lived in DDT treated villages. Most of the interviewees welcomed spraying (83.7%), but the smell and having to remove furniture from houses were the main arguments against it. CONCLUSIONS: Acceptability correlated with insecticide spray coverage, although the most frequent suggestion for improvement was to increase the understanding of the objectives of spraying in the communities. The frequency of side effects was low, but higher in localities where a combination of insecticides was applied. This is a limitation for the use of this type of resistance management strategy in public health.

Acceptability and perceived side effects of insecticide indoor residual spraying under different resistance management strategies

OBJETIVO: Evaluar la aceptabilidad y los efectos secundarios del rociado intradomiciliar de insecticidas pyrethroides (PYR), carbamato y organophosphato rociados en rotación anual (ROT), en mosaico espacial (MOS), o solos (DDT o PYR) en hogares de comunidades de la costa de Chiapas. México.MATERIAL Y MÉTODOS: Se aplicó un cuestionario a un miembro de 30% de las familias de ocho localidades de Chiapas para evaluar aceptabilidad y efectos secundarios del rociado. Se usaron análisis de ji cuadrada para determinar la asociación de los insecticidas rociados con las respuestas y se comparó la intensidad de efectos secundarios referidos bajo los diferentes tratamientos en un modelo logístico ordenado usando un índice de severidad como variable de respuesta.RESULTADOS: Los insecticidas rociados como causa probable de síntomas fueron referidos por 2.1% de entrevistados, pero 12% de ellos asociaron los síntomas con otras causas. Un porcentaje significativamente alto de personas que refirieron visión borrosa, vértigo, estornudos, tos, entumecimiento, lagrimeo y comezón vivía en bajo MOS y ROT, mientras que el índice de severidad se asoció con el rociado ROT. La reducción en la picadura de mosquitos y en el número de cucarachas fueron los principales beneficios percibidos, y la mayoría de los lugareños que no percibieron los beneficios vivía en localidades tratadas con DDT. La mayoría de entrevistados aceptaron bien el rociado (83.7%), pero el mal olor y tener que sacar los muebles de las casas fueron los argumentos principales en contra.CONCLUSIONES: La cobertura de rociado correlacionó con la aceptabilidad, aunque la sugerencia más frecuente para incrementarla fue la de explicar los objetivos del rociado en las comunidades. La frecuencia de efectos secundarios fue baja, pero mayor en localidades donde se aplicó una combinación de insecticidas, lo que representa una limitación para el uso de esta estrategia de manejo de resistencia a estos químicos en salud pública.

Mielolipoma adrenal vinculado a colecistitis litiásica, hernia hiatal y esofagitis / Adrenal myelolipioma associated to lithiasic cholecystitis, hiatal hernia and esophagitis

Los mielolipomas adrenales son tumores poco frecuentes, generalmente son asintomáticos, unilaterales y no funcionales y en la mayoría de las ocasiones se descubren incidentalmente. Objetivo: presentar un caso clínico de mielolipoma adrenal asociado a colecistitis litiásica. Caso clínico: femenino de 30 años de edad, obesa, con dolor crónico abdominal, motivo por el cual se le realizó serie esofagogastroduodenal encontrando hernia hiatal y esofagitis. Un ultrasonido de vesícula y vías biliares demostró litiasis vesicular e incidentalmente se halló un tumor de 9.3 x 8 x 7 cm que se encontraba entre el riñón derecho y el hígado. En la tomografía computada de abdomen se corroboró colelitiasis, además de una tumoración poco vascularizada, de composición adiposa, de 9.2 x 6 x 5 cm sobre el polo superior del riñón derecho. Se realizó colecistectomía y resección de la tumoración. El estudio histopatológico del tumor reportó tejido adrenal normal, adiposo maduro y hematopoyético con todas sus series.Conclusión: el mielolipoma adrenal vinculado a colecistitis litiásica es poco común, todo parece indicar que fue una condición fortuita. Con las nuevos métodos de imagen se puede realizar con cierta seguridad el diagnóstico de mielolipoma adrenal

Manejo quirúrgico oportuno de la pancreatitis biliar: la importancia del factor tiempo / Timely management of gallstone pancreatitis: importance ot eh time factor

Objetivo: Establecer cuál es el momento más oportuno para interrumpir la patogenia de la pancreatitis de origen biliar mediante cirugía. Sede: Hospital Central Norte de Petróleos Mexicanos, México, D.F. Diseño: estudio retrospectivo, observacional, comparativo y transversal de 29 pacientes consecutivos con pancreatitis biliar y que fueron divididos en 2 grupos; el grupo I, pacientes manejados "agresivamente" y operados en las primeras 48 horas de ingreso; y el grupo II, pacientes manejados médicamente en un principio y operados pasadas las primeras 48 horas de internamiento. Resultados: El grupo I incluyó 12 casos y el II a 17. Ambos fueron comparativos ya que no hubo diferencias estadísticamente significativas en cuanto a factores de riesgo, severidad del cuadro o tipo de operación efectuada. La morbilidad, mortalidad y estancia hospitalaria fueron mayores para el grupo I, aunque sin significado estadístico; no así la tasa de reintervenciones, que fue de 16.6 por ciento para el grupo I y 0 por ciento para el II. Conclusión: Recomendamos operar a este tipo de pacientes sólo hasta que el cuadro agudo dé muestras de remisión, pues no prolonga su estancia hospitalaria y sí, en cambio, permite evitar reintervenciones y mejorar las condiciones generales del paciente