Associations between feeding behaviors collected from an automated milk feeder and disease in group-housed dairy calves in Ontario: A cross-sectional study.

The adoption of automated milk feeders and group housing of preweaning dairy calves has become more common in Canada; however, disease detection in group-housed calves remains a challenge. The aim of this cross-sectional study was to assess whether feeding behavior data collected from a single point in time could be used to aid in the detection of neonatal calf diarrhea (NCD), bovine respiratory disease (BRD), and general disease, in preweaning group-housed calves being fed via an automated milk feeder. The data used was collected in an earlier study. A total of 8 dairy farms recruited from an online survey of calf-management practices were enrolled into the study. There was a total of 523 observations with 130 events of NCD, 115 events of BRD, and 210 events of general disease. Each farm was visited once in each of the fall, winter, spring, and summer, when the calves' health was scored, and the data were collected from the automated milk feeders. Mixed linear regression models were used to identify associations between feeding behavior data (milk consumption, time spent at the feeder, drinking speed, and the number of rewarded and unrewarded visits) and the presence of NCD, BRD, or general disease (having one or more of NCD, BRD, or umbilical infection), on the day of health scoring. Generalized linear mixed models were used to analyze the percentage of milk the calf consumed from their daily milk allotment. Calves with BRD consumed 63% less of their daily allotment of milk, had 2 fewer unrewarded visits to the automated milk feeder, and drank milk 152 mL/min slower compared with calves without BRD. Calves with NCD consumed 57% less of their daily milk allotment, consumed 758 mL less per day, and drank 92 mL/min slower than calves compared with calves without NCD. Calves with general disease drank 50% less of their daily milk allowance, consumed 496 mL less per day, drank 80 mL/min slower, and had 2 fewer unrewarded visits to the automated milk feeder, when compared with calves without disease. No significant associations were found between the presence of NCD, BRD, or general disease and time spent at the feeder or number of rewarded visits. Sensitivity and specificity values for disease identification were low when evaluating the feeding behaviors individually, so parallel testing was completed. To do so, if any significant feeding behavior was below the optimal cut point for disease detection as determined using a ROC curve, the calf was considered positive for disease and the sensitivity and specificity were recalculated. Parallel testing resulted in a sensitivity of 0.82, 0.78, and 0.84, and a specificity of 0.26, 0.23, and 0.21, for BRD, NCD, and general disease, respectively. This suggests that automated milk feeders may serve as a useful preliminary tool in the detection of diseased calves. For example, producers could use feeding behavior data to identify calves requiring further inspection; however, they should not use feeding behavior data as a sole disease detection method.

A role for G protein-coupled receptor 137b in bone remodeling in mouse and zebrafish.

G protein-coupled receptor 137b (GPR137b) is an orphan seven-pass transmembrane receptor of unknown function. In mouse, Gpr137b is highly expressed in osteoclasts in vivo and is upregulated during in vitro differentiation. To elucidate the role that GPR137b plays in osteoclasts, we tested the effect of GPR137b deficiency on osteoclast maturation and resorbing activity. We used CRISPR/Cas9 gene editing in mouse-derived ER-Hoxb8 immortalized myeloid progenitors to generate GPR137b-deficient osteoclast precursors. Decreasing Gpr137b in these precursors led to increased osteoclast differentiation and bone resorption activity. To explore the role of GPR137b during skeletal development, we generated zebrafish deficient for the ortholog gpr137ba. Gpr137ba-deficient zebrafish are viable and fertile and do not display overt morphological defects as adults. However, analysis of osteoclast function in gpr137ba-/- mutants demonstrated increased bone resorption. Micro-computed tomography evaluation of vertebral bone mass and morphology demonstrated that gpr137ba-deficiency altered the angle of the neural arch, a skeletal site with high osteoclast activity. Vital staining of gpr137ba-/- fish with calcein and alizarin red indicated that bone formation in the mutants is also increased, suggesting high bone turnover. These results identify GPR137b as a conserved negative regulator of osteoclast activity essential for normal resorption and patterning of the skeleton. Further, these data suggest that coordination of osteoclast and osteoblast activity is a conserved process among vertebrates and may have similar regulation.

Productos de apoyo para paciente con amputación transmetacarpiana / Support products for patient with transmetacarpal amputation

Propósito: Analizar propiedades funcionales y antropométricas de los PA, criterios de selección de diseño, procesos de confección y materiales de fabricación, para analizar las ventajas y/o desventajas que proporcionan y el impacto de esto sobre la CV, ya que los PA disponibles en el mercado no siempre se adaptan a requerimientos del individuo. Se demostrará a través de la presentación de un caso clínico con amputación transmetacarpiana izquierda, de 60 años sufrida el 24/11/2012. Metodología y Materiales: Mediciones antropométricas elementos termoplásticos y de descarte. Resultados: A partir del análisis de propiedades y características de los PA se podría establecer la forma en la cual éstos inciden en la CV de las personas en cuanto a confort, seguridad e independencia funcional, y a partir de ello conocer el grado de satisfacción del usuario respecto a su participación ocupacional en las AVD. Conclusiones: Respecto al desarrollo de PA, se están abriendo nuevas posibilidades para la mejora de la CV de la población en general. Si bien el avance tecnológico está orientado a potenciar la autonomía de los usuarios mediante nuevas y variadas estrategias se ha ido intensificando en campos como la rehabilitación y la antropometría, es necesario en más de una ocasión incorporar acciones que permitan al paciente mejorar su economía, funcionalidad, durabilidad y adecuación estética.

Purpose: Analyze SP functional and anthropometric properties, design selection criteria, preparation processes and manufacturing materials, to analyze the advantages and/or disadvantages that they have and their impact on the LQ, since the SP available in the market do not always adapt to the individual’s requirements. It will be demonstrated through the presentation of a clinical case with left transmetacarpal amputation, 60 years old, suffered on 11/24/2012. Methodology and Materials: anthropometric measures, thermoplastic and disposable items. Results: From the analysis of properties and characteristics of the SP it could be established the way in which they affect people’s LQ in terms of comfort, safety and functional independence, and considering this we can determine the degree of the user’s satisfaction regarding occupational participation in DLA. Conclusions: Regarding the SP development, new possibilities are appearing for the improvement of general population LQ. Even though the technological advance oriented to highlight the user’s autonomy through new and various strategies has been intensifying in some other fields like rehabilitation and anthropometry, it is necessary in more than one occasion to incorporate actions that allow the patient to enhance his functionality with economy criteria, functionality, durability and aesthetics as quality standards in design and construction.

Endemic pemphigus foliaceus in the Peruvian Amazon.

BACKGROUND: Endemic pemphigus foliaceus (EPF) is an organ-specific blistering disease of the epidermis characterized by the presence of IgG autoantibodies, specifically desmoglein (Dsg)1. This condition has been reported particularly in Brazil, Colombia, Tunisia and Peru. AIM: To characterize the humoral response against Dsg1 and Dsg3 autoantibodies of patients with EPF from the Peruvian Amazon region. METHODS: Blood samples were collected from 16 patients with a clinical diagnosis of EPF, and tested using indirect immunofluorescence (IIF), immunoprecipitation and ELISA (for IgG and its subclasses against Dsg1 and IgG against Dsg3). RESULTS: Autoantibodies against the intercellular spaces were detected by IIF in 82.5% and 87.5% of patients, using normal human skin and monkey oesophagus, respectively. Sera from all patients immunoprecipitated recombinant Dsg1, and three serum samples immunoprecipitated recombinant Dsg3 (6.25%). Using ELISA, anti-Dsg1 antibodies were detected in 13 patients (81.25%), and both IgG1 and IgG2 antibodies against Dsg1 in 12 patients (75%). All patients were positive for IgG4 autoantibodies, and only one patient was positive for IgG3 autoantibodies (6.25%). Anti-Dsg3 antibodies were detected in five patients (31.25%). CONCLUSIONS: EPF from Peru shares epidemiological, clinical and immunological characteristics with other forms of EPF that have been described in South America.

Behavioral changes in dairy cows with mastitis.

Mastitis is a frequent and painful disease in dairy cows. However, pain detection and alleviation in mastitic cows has been overlooked. The objectives of this study were to measure behavioral changes in dairy cows with clinical mastitis and to investigate the effect of intramammary infusion of an antibiotic on lying behavior and behavior during milking. In experiment 1, 42 lactating cows were used: 14 mastitic cows and 28 control cows. Mastitic and control cows were subjected to an evaluation of pain responses on d 1 (mastitis detection day), and 2, 3, and 7d after the last antibiotic treatment (d 10+). The antibiotic treatment was administered to mastitic cows twice a day, starting on d 1, for at least 3 consecutive days. Behavioral changes were evaluated by measuring lying behavior, reactivity during milking (stepping, lifting, and kicking), weight distribution, and hock-to-hock distance. Overall, mastitic cows spent less time lying down on d 2 compared with control cows. The percentage of time lying on the mastitic quarter side did not differ significantly between mastitic and control cows. No differences were observed between control and mastitic cows on the number of steps per 24h on each day. Restless behavior during milking did not differ between treatments. Restless behaviors differed significantly within mastitic cows between days. Frequency of kicks per minute was higher on d 1 compared with d 2, frequency of lifts was higher on d 1 and 2 compared with d 10+, and frequency of steps was higher on d 2 compared with d 10+. The variability of weight that mastitic cows applied to the leg on the mastitic quarter side was higher on d 1 than on d 10+. For control cows, the variability in weight applied to the homologous leg of the mastitic quarter side leg was higher on d 1 compared with d 2 and 3. The hock-to-hock distance did not differ between treatments. Mild clinical mastitis might not cause sufficient pain to observe marked changes in behaviors. However, cows showed differences in lying time and reactivity during milking and slight differences in the laterality of lying. To further develop methodologies for assessing pain in mastitic cows, it is worth applying the methodologies used in this study to cows with moderate to severe mastitis, followed by their validation using analgesic treatment, to ensure that any change is a pain-specific behavior rather than a simple reflex. In experiment 2, no effect of intramammary infusion of the antibiotic was observed on lying behavior or behavior during milking. Cows with mild clinical mastitis present behavioral changes in lying behavior and at milking time, which could be associated with discomfort.

Global processing training to improve visuospatial memory deficits after right-brain stroke.

Visuospatial stimuli are normally perceived from the global structure to local details. A right-brain stroke often disrupts this perceptual organization, resulting in piecemeal encoding and thus poor visuospatial memory. Using a randomized controlled design, the present study examined whether promoting the global-to-local encoding improves retrieval accuracy in right-brain-damaged stroke survivors with visuospatial memory deficits. Eleven participants received a single session of the Global Processing Training (global-to-local encoding) or the Rote Repetition Training (no encoding strategy) to learn the Rey-Osterrieth Complex Figure. The result demonstrated that the Global Processing Training significantly improved visuospatial memory deficits after a right-brain stroke. On the other hand, rote practice without a step-by-step guidance limited the degree of memory improvement. The treatment effect was observed both immediately after the training procedure and 24 h post-training. Overall, the present findings are consistent with the long-standing principle in cognitive rehabilitation that an effective treatment is based on specific training aimed at improving specific neurocognitive deficits. Importantly, visuospatial memory deficits after a right-brain stroke may improve with treatments that promote global processing at encoding.

Orthostatic hypotension in treated hypertensive patients.

INTRODUCTION: Orthostatic hypotension (OH) is a risk factor for morbidity and mortality and one of the causes of non compliance to treatment among medicated hypertensive subjects. Our objective was to assess the prevalence of OH among treated hypertensive patients and its association with clinical characteristics and antihypertensive drug class. METHODS: This was a cross-sectional study in which we assessed the prevalence of OH, defined according to the American Autonomic Society and American Academy of Neurology guidelines, among adult treated hypertensive patients who performed a home blood pressure monitoring at our institution. We also determined the prevalence of OH according to age group (< 65, 65-79 and > 80), antihypertensive drug class, office and home hypertension control status. RESULTS: We included 302 medicated patients in the study. Mean age was 66.6 (+13.8), 67% were women. We found a 9.7% global prevalence of OH, which was significantly higher among older individuals (3.6% among patients < 65 years-old, 12.2% in the 65-79 year-old group and 16.7% among octogenarians, p = 0.02) and those who consumed alpha-blockers (75 vs. 8.5%, p < 0.01). Uncontrolled hypertensive patients at office and/or at home had also a significantly higher prevalence of OH: uncontrolled vs. controlled office blood pressure (BP), 14.3 vs. 6.5%, p = 0.03 and uncontrolled vs. controlled home BP, 15.1 vs. 6.6%, p = 0.02. Remarkably, 64% of patients with OH had their BP under control when considering office-standing BP. CONCLUSION: OH is a prevalent entity among treated hypertensive patients and systematic measurement of standing BP should be mandatory in the evaluation of these patients.

[Etiology and risk factors for a first episode of cerebral isquemia in young adults]. / Etiología y factores de riesgo para un primer episodio de isquemia cerebral en adultos jóvenes.

INTRODUCTION: To determinate the etiology and risk factors for a first episode of cerebral ischemia in young adults at three hospitals of Lima and Callao-Peru. METHODS: Multicentric study carried out at three national hospitals in Lima. The sample included 30 patients with a first episode of stroke and 60 controls matched by age and sex 2:1 with the patients. Serum biochemistry studies, EKGs and echocardiograms were done. Etiologies were classified based on the classification of Baltimore-Washington Cooperative Young Stroke Study. RESULTS: The most frequent etiologies were cardiac embolism and atherosclerotic valvular heart disease, which were 30% of the cases (9 patients) each one. Hypertriglyceridemia (p=0.014), valvular heart disease (p=0.001) and hormonal contraception/replacement therapy (p=0.002) were independent risk factors for a first episode of cerebral ischemia in peruvian young adults. Motor deficiency was the most frequent presentation (50.0%). Intracraneal hypertension and urinary tract infection were the most frequent complications during acute ischemia and mortality was raised up to 10%. CONCLUSIONS: The hypertriglyceridemia, valvular heart disease and the use of oral contraceptives are independent risk factors for a first episode of ischemia in young adults from three hospitals of Lima and Callao. The most frequent etiologies were cardiac embolism and atheroesclerotic valvular heart disease.

Etiología y factores de riesgo para un primer episodio de isquemia cerebral en adultos jóvenes / Etiology and risk factors for a first episode of cerebral isquemia in young adults

Introducción: Determinar la etiología y factores de riesgo para un primer episodio de isquemia cerebral en adultos jóvenes de tres hospitales de Lima y Callao-Perú. Métodos.Estudio de casos y controles, multicéntrico realizado en el Hospital Nacional Dos de Mayo, Hospital Nacional Daniel Alcides Carrión y Hospital EsSalud Alberto Sabogal Sologuren. La muestra estuvo constituida por 30 pacientes con un primer episodio de enfermedad cerebrovascular y 60 controles pareados por edad y sexo 2:1 con los pacientes. A todos se les realizó estudios de bioquímica sérica y evaluación cardiovascular (electrocardiograma y ecocardiografía). Las etiologías fueron clasificadas de acuerdo a la clasificación de Baltimore-Washington Cooperative Young Stroke Study. Resultados: Las etiologías más frecuentes fueron el cardioembolismo y la vasculopatía aterosclerótica con un 30% de casos (9 pacientes) cada uno. Los factores de riesgo independientes para un primer episodio de isquemia cerebral fueron la hipertrigliceridemia (p=0,014), la enfermedad valvular cardiaca (p=0,001) y la anticoncepción/reemplazo hormonal (p=0,002). El déficit motor fue la forma de presentación más frecuente (50,0%); la hipertensión endocraneana y la infección del tracto urinario fueron las principales complicaciones durante el episodio agudo y la mortalidad fue del 10%.Conclusiones: La hipertrigliceridemia, enfermedad valvular cardiaca y el uso de anticonceptivos/reemplazo hormonal constituyen factores de riesgo independientes para un primer episodio de isquemia en adultos jóvenes de tres hospitales de Lima y Callao, siendo las etiologías más frecuentes el cardioembolismo y la vasculopatía aterosclerótica (AU)

Introduction: To determinate the etiology and risk factors for a first episode of cerebral ischemia in young adults at three hospitals of Lima and Callao-Peru.Methods: Multicentric study carried out at three national hospitals in Lima. The sample included 30 patients with a first episode of stroke and 60 controls matched by age and sex 2:1 with the patients. Serum biochemistry studies, EKGs and echocardiograms were done. Etiologies were classified based on the classification of Baltimore-Washington Cooperative Young Stroke Study. Results: The most frequent etiologies were cardiac embolism and atherosclerotic valvular heart disease, which were 30% of the cases (9 patients) each one. Hypertriglyceridemia (p=0.014), valvular heart disease (p=0.001) and hormonal contraception/replacement therapy (p=0.002) were independent risk factors for a first episode of cerebral ischemia in peruvian young adults. Motor deficiency was the most frequent presentation (50.0%). Intracraneal hypertension and urinary tract infection were the most frequent complications during acute ischemia and mortality was raised up to 10%. Conclusions: The hypertriglyceridemia, valvular heart disease and the use of oral contraceptives are independent risk factors for a first episode of ischemia in young adults from three hospitals of Lima and Callao. The most frequent etiologies were cardiac embolism and atheroesclerotic valvular heart disease (AU)

Noninfectious dermatological diseases associated with chronic exposure to mine tailings in a Peruvian district.

BACKGROUND: Mine tailings are metallic wastes which are deposited in the environment due to mining activity. Long-term exposure to these metals is harmful to human health. OBJECTIVE: To determine if chronic exposure to mine tailings constitutes a risk factor for the development of dermatological diseases in the district of San Mateo de Huanchor (Lima, Peru). METHODS: An observational case-control study was carried out in the communities of Mayoc, Daza and Tamboraque (exposed to mine tailings, case group) located in the district of San Mateo de Huanchor, and also in the communities of Choccna and Caruya (not exposed to mine tailings, control group) located in the same district. Out of 230 adults, 121 were exposed and 109 were not exposed to mine tailings and out of 135 children, 71 were exposed and 64 were not exposed to mine tailings. RESULTS: In the adult group, 71% of the exposed cases had some noninfectious dermatological disease while in the nonexposed group the frequency was 34% [P < 0.001; odds ratio (OR) 5.40; 95% confidence interval (CI) 3.02-9.68]. A statistically significant difference between groups was found for arsenical dermatitis, nonpruritic papulovesicular eruption, atopic dermatitis, contact dermatitis, seborrhoeic dermatitis and xerosis. In the paediatric population, 71 exposed and 64 nonexposed children were evaluated. Sixty-nine per cent of the exposed group had some noninfectious dermatological disease vs. 30% in the nonexposed group (P < 0.001; OR 6.00; 95% CI 2.71-13.31). A statistically significant difference between groups was found for xerosis and atopic dermatitis. CONCLUSION: Chronic exposure to mine tailings represents a risk factor for development of noninfectious dermatological diseases in both adults and children.

Antiphospholipid syndrome in Latin American patients: clinical and immunologic characteristics and comparison with European patients.

The objective of this study was to analyse the prevalence and characteristics of the main clinical and immunological manifestations at the onset and during the evolution of the disease in a cohort of patients from Latin America (mainly of mestizo origin) and to compare the Latin American with the European patients. Clinical and serological characteristics of 100 APS patients from Mexico and Ecuador were collected in a protocol form that was identical to that used to study the ;Euro-Phospholipid' cohort. The cohort consisted of 93 female patients (93.0%) and seven (7.0%) male patients. There were 91 mestizos (91.0%), seven whites (7.0%) and two Amerindians (2.0%). The most common manifestations were livedo reticularis (40.0%), migraine (35.0%), inferior extremity deep vein thrombosis (32.0%), thrombocytopenia (28.0%) and hemolytic anemia (20.0%). Several clinical manifestations were more prevalent in Latin American than in European patients and they included mainly neurological (migraine, transient global amnesia, acute ischemic encephalopathy, amaurosis fugax) and cutaneous (livedo reticularis, skin ulcerations, superficial cutaneous necrosis, multiple subungual splinter hemorrhages) manifestations as well as hemolytic anemia. The APS has a wide variety of clinical and immunological manifestations at the onset and during the evolution of the disease and the ethnic origin in addition to environmental and socioeconomic factors can modify the disease expression.

[Prevention of cardiovascular diseases by an antihypertensive program in the elderly, a cohort study]. / Prevención de eventos cardiovasculares en hipertensos mayores de 65 años bajo el cuidado de un programa de control. Estudio de cohorte.

INTRODUCTION: We started on year 2000 a Complex Intervention Program addressed at hypertension control among our patients. AIM: To compare the risk of cardiovascular events and of dying in hypertensive patients under Program care. METHOD: We started follow-up of a cohort of 1922 patients over 65 years in August 2000. Hipertension diagnosis was ascertained if patient reported to be hypertensive, or was under anti hypertensive treatment or if he/she had two blood pressure measurements = 140/90 mm Hg. Cardiovascular events were considered to be admissions due to coronary disease, cardiac insufficiency or stroke. Incidence is reported by 100 person years follow-up. Relative risks between hypertensive and normotensive patients were calculated and Cox regresión was used to adjust for potential confounders. We compared time to first cardiovascular event and to death with Log Rank Test. RESULTS: Fourty eight point three percent of patients were hypertensive and differed from normotensive patients as to age (79 (5) years vs. 77 (5) p < 0.001), proportion of diabetic patients (16.1% vs. 7.6% p < 0.001). Mean follow-up time was 28 months. Mortality RR was 1.04 (95% CI 0.69-1.58). As to incidence of cardiovascular events it was 1.86 in normotensive vs. 3.02 (RR 1.62 95% CI 1.09-2.42). When adjusted by age, sex, smoking, dislipemia and diabetes, OR was 1.3 (95% CI 0.86-1.98). CONCLUSIONS: Hypertension did not increase the risk in cardiovascular events among our hypertensive patients at 2.3 years follow-up.

Prevención de eventos cardiovasculares en hipertensos mayores de 65 años bajo el cuidado de un programa de control. Estudio de cohorte / Prevention of cardiovascular diseases by an antihypertensive program in the elderly. Cohort study

Introducción: Iniciamos en el 2000 un programa de control para la hipertensión arterial. Objetivo: Conocer el riesgo de morir y de presentar eventos cardiovasculares en los hipertensos bajo el cuidado del programa. Método: Se conformó una cohorte de 1.922 mayores de 65 años en agosto del 2000. Se consideró hipertenso si se conocía como tal, si recibía fármacos antihipertensivos o si tenía dos tomas de presión ≥ 140/90mmHg. Evento cardiovascular a las internaciones por enfermedad coronaria, insuficiencia cardiaca y accidente cerebrovascular. Expresamos densidad de incidencia (DI) de mortalidad y de eventos cardiovasculares cada100 persona-años en hipertensos y en no hipertensos y practicamos regresión de cox para ajustar por factores de riesgo en estudio. Se compara el tiempo al primer evento cardiovascular y a la muerte con Log Rank Test. Resultados: Edad 77,6 (± 5,4) años, 73,9% mujeres, el 48,3% eran hipertensos, diferentes significativamente con respecto a los normotensos en edad 79 (± 5) vs. 77 (± 5) p < 0,001, porcentaje de diabéticos (16,1 vs. 7,6%) p < 0,001. La DI del total de eventos fue de 1,86 vs. 3,02 (RR1,62, IC95% 1,09-2,42) La DI de mortalidad fue de 2,2 vs. 2,1 (RR 1.04,IC95% 0,69-1,58) Tiempo promedio de seguimiento 28 meses, el porcentaje de pacientes libre de eventos a este tiempo fue de 93% (hta) vs.96% (no hta) (p < 0,001). En el multivariado fueron significativas: diabetes,dislipidemia, tabaquismo, edad y sexo, perdiendo peso la hipertensión arterial, OR 1.30 (IC95% 0,86-1,98). Conclusiones: La hipertensión no incrementó el riesgo de presentar eventos cardiovasculares en nuestros hipertensos a 2,3 años

Introduction: We started on year 2000 a Complex Intervention Program addressed at hypertension control among our patients. Aim: To compare the risk of cardiovascular events and of dying inhypertensive patients under Program care. Method: We started follow-up of a cohort of 1922 patients over 65 years in August 2000. Hipertension diagnosis was ascertained if patient reported to be hypertensive, or was under anti hypertensive treatment or if he/she had two blood pressure measurements ≥ 140/90 mm Hg. Cardiovascular events were considered to be admissions due to coronary disease, cardiac insufficiency or stroke. Incidence is reported by 100 person years follow-up. Relative risks between hypertensive and normotensive patients were calculated and Cox regresión was used to adjust for potential confounders. We compared time to first cardiovascular event and to death with Log Rank Test. Results: Fourty eight point three percent of patients were hypertensiveand differed from normotensive patients as to age (79 (5) years vs. 77 (5) p< 0.001), proportion of diabetic patients (16.1% vs. 7.6% p < 0.001). Mean follow-up time was 28 months. Mortality RR was 1.04 (95% CI 0.69-1.58). As to incidence of cardiovascular events it was 1.86 in normotensive vs. 3.02 (RR 1.62 95% CI 1.09-2.42). When adjusted by age, sex, smoking,dislipemia and diabetes, OR was 1.3 (95% CI 0.86-1.98) Conclusions: Hypertension did not increase the risk in cardiovascular events among our hypertensive patients at 2.3 years follow-up

Ambulatory blood pressure monitoring after recovery from hemolytic uremic syndrome.

The outcome of acute renal failure due to diarrhea-associated hemolytic uremic syndrome (D+ HUS) is generally predicted to be good. However, there are only a few long-term observations with detailed reports on long-term sequelae. Specifically, adequate long-term blood pressure (BP) evaluations are scarce. The present study evaluated BP in pediatric patients after childhood D+ HUS. The study group comprised 28 patients (20 males) aged 6-23.5 years (median 10.1 years). All patients had a history of D+ HUS at a median age of 1.1 years (range 0.5-6 years). Based on the duration of oliguria and/or anuria, the primary disease was classified as mild (n=6), moderate (n=6), or severe (n=16). The BP in these patients was studied at a median time of 8.4 years (range 2.3-22.9 years) after manifestation of D+ HUS by means of office BP measurements and 24-h ambulatory BP monitoring (ABPM) using a Spacelabs 90207 oscillometric monitor. Measurements were compared with normal values of published standards for healthy children and adolescents. Conventional office BP measurements were above the 95th percentile in 1 patient. By ABPM, 2 patients were diagnosed to have mean systolic daytime and nighttime values in the hypertensive range, and systolic and diastolic hypertension was confirmed in the first patient. All these patients had a severe form of D+ HUS in the past. By applying ABPM, BP anomalies were detected in 5 additional patients. Elevated systolic BP loads were found in 4 patients, and daytime systolic and diastolic hypertension in the other 1. At the time of the study, 2 of them were classified as "recovered." The late outcome of D+ HUS may be worse than anticipated. BP anomalies as long-term sequelae of D+ HUS could be identified by ABPM but not by office BP measurements. These findings may represent an isolated sign of residual renal disturbance.

Hyperhomocysteinemia in stable pediatric, adolescents, and young adult renal transplant recipients.

BACKGROUND: High total plasma homocysteine (tHcy) levels are accompanied by an increased risk for premature development of atherosclerosis and atherothrombosis. Adult renal transplant recipients have elevated tHcy levels. Corresponding data in pediatric, adolescent, and young adult renal transplant recipients are scarce. We investigated whether tHcy levels were elevated in stable renal transplant recipients who received kidney grafts before age 18. METHODS: This cross-sectional study was conducted during routine posttransplantation follow-up. Fasting tHcy levels, serum creatinine, and lipoprotein profile were measured in 38 clinically stable renal transplant recipients with different degrees of renal function. No patient was receiving B vitamin or folic acid supplementation. Estimated glomerular filtration rate (GFR) was assessed according to Schwartz's formula. All patients followed a triple-drug immunosuppressive regimen, with the exception of three patients (deflazacort and azathioprine). Forty-one apparently healthy subjects constituted the control group. tHcy levels were determined by fluorescence polarization immunoassay in an IMx analyzer. RESULTS: Mean tHcy levels in transplant recipients were significantly higher than in controls (16.8+/-8.7 micromol/L and 9.5+/-2.3 micromol/L, respectively; P<0.01). A significant positive correlation between tHcy and serum creatinine levels was observed for both transplant recipients (rS=0.70, P<0.01) and controls (rS=0.54, P<0.01). In transplant recipients, tHcy correlated negatively with estimated GFR (rS=[minus]0.47, P<0.05). Fasting tHcy levels in excess of 14.6 micromol/L (>95th percentile in controls) were present in 19 (50%) patients; 14 of these patients had an estimated GFR<60 ml/min per 1.73 m2. When the renal transplant recipients were analyzed by renal function, mean tHcy was significantly higher in patients with an estimated GFR<60 ml/min per 1.73 m2 compared with patients with an estimated GFR> or =60 ml/min per 1.73 m2 (20.5+/-9.9 vs. 13.2+/-5.8 micromol/L, P<0.01). Both groups were significantly different from controls (P<0.01). No relationship was found between tHcy level and either cumulative cyclosporine or cumulative methylprednisone doses. No differences were observed in tHcy levels or lipoprotein profile between patients who were receiving deflazacort and those on methylprednisone. CONCLUSIONS: Hyperhomocysteinemia in renal transplant recipients is a common condition. Testing for fasting tHcy level might be a useful tool to identify patients at increased risk for development of vascular disease.

Unsuspected hyperhomocysteinemia in chronically anticoagulated patients.

Hyperhomocysteinemia is a risk factor for arterial and venous thrombosis. The aim of this study was to evaluate plasmatic homocysteine levels in patients under chronic anticoagulant treatment with dietary restriction of green vegetables. This kind of food is a very important source not only of vitamin K but also of folates, which are involved in Hcy metabolism. It is known that the lower the folate levels, the higher the Hcy concentration, so we suspected that these patients could show hyperhomocysteinemia. A group of patients receiving oral anticoagulant treatment and a restricted diet (Group I, n = 20) was compared with a group of untreated subjects of a similar age that were not on a restricted diet (Group II, n = 35). Group I showed significantly higher levels of plasmatic Hcy and significantly lower levels of serum folate than Group II. Therefore, a diet restricted in vitamin K applied to oral anticoagulated patients could induce an unwanted increase of homocysteine levels.

Validation of an enzyme immunoassay for the determination of total homocysteine in plasma.

In recent years, the determination of homocysteine (Hcy) has become increasingly important, since high levels of Hcy in plasma or serum represent an independent risk factor for occlusive vascular diseases. Nowadays, clinical laboratories use several analytical techniques to measure Hcy, of which high-performance liquid chromatography (HPLC) is the most popular. Recently, assays for Hcy quantification based on enzyme immunoassays (EIA) have become commercially available. Our group carried out the validation of the Axis method and compared results with those obtained by an established HPLC assay. Intra- and inter-assay coefficients of variation were < or = 8.5%. Compared with HPLC, linear regression analysis showed r=0.984, slope=0.952, intercept = 1.24 /mol/l; Bland-Altman procedure, the mean of the difference EIA-HPLC results = 0.5 micromol/l. Our results suggest that Hcy determinations by both methods are equivalent, and that the Axis assay provides reproducible and reliable data.

Contribution of stroke volume to the change in pulse pressure pattern with age.

This study investigated the effect of age on pulse pressure and its underlying mechanisms in unmedicated hypertensive men with the same level of mean arterial pressure. We included 77 men 17 to 76 years old with daytime mean arterial pressure between 95 and 114 mm Hg. In the supine position, pulse pressure showed a significant widening in young (<30 years) and older (>/=60 years) patients. Pulse pressure decreased in parallel with stroke index from age >30 to 40 to 49 years. Upright posture, however, eliminated this difference through a larger orthostatic fall in stroke index and pulse pressure in the youngest patients. After age 50 years, pulse pressure exhibited a progressive widening despite the further age-related decrease in stroke index. Supine, upright, and 24-hour pulse pressure fitted a curvilinear correlation with age (r=0.55, 0.56, and 0.68, respectively, P<0.001), with a transition at age 50 years. Before age 50 years, 24-hour pulse pressure correlated positively with stroke volume (r=0.5, P<0.001) and negatively with arterial compliance (SV/PP ratio, r=-0.37, P<0.01). In contrast, in men >/=50 years old, 24-hour pulse pressure correlated negatively with the SV/PP ratio (r=-0.5; P<0.01), without significant influence of stroke volume. Thus, in hypertensive men, the age-related change in stroke volume significantly accounted for the change in clinic and ambulatory pulse pressure during young adulthood, but its contribution decreased after the fifth decade.

[PREVALENCE OF HBsAg AND anti-HBs CARRIERS IN PREGNANT WOMEN WHO RESIDE IN DIFFERENT ENDEMIC AREAS LOCATED IN CENTRAL-SOUTHERN DEPARTAMENTS OF PERU] / Prevalencia de Portadoras de HBsAg y anti -HBs en Gestantes Residentes en Areas de Diferente Endemicidad de HVB en Departamentos del Centro - Sur del Perú

The present study was performed to estimate the prevalence of HBV in pregnant women (mean age among groups 25,0 6,9) who live in areas of different endemicity, and located in the Departments of Lima, Junin, Apurimac, and Ayacucho in Peru. All studies were carried out using radioimmunological techniques. In the Instituto Materno Perinatal in Lima, located in a low endemical area, 2086 pregnant women whose ages ranged between 14 and 44 years were evaluated (for laboratory tests) at their first prenatal examination. A prevalence of 9,38% (HbsAG+), 0,38% (Ratio), and 3,18% (HBsAg+, anti-HBsAg+) was found, corresponding to 107 HBsAg+ pregnant women whose treated newborn wouId prevent the HBV chronic infection of approximate 21 newborn each year. 63% HBsAg+ pregnant women were born in Departments other than Lima. In the Hospital de Apoyo La Merced, located in Chanchamayo, Junin, which is a medium endemic area, 217 pregnant women whose ages ranged between 14 and 48 years were evaluated. The prevalence found in this Hospital was of 1,38% (HBsAg+), 1,2% (Ratio), and 17,8% (HBsAg+, anti-HBs+). All positive HBsAg were negative for HBeAg. The projection of results corresponded to a total of 9 HbsAg+ pregnant women and 2 newborn preventive of chronic disease per year. In the Guillermo D az de la Vega Hospital in Abancay, Apurimac, located in a medium to high endemic area, 221 pregnant women whose ages ranged between 15 and 46 years were evaluated. A prevalence of 1,36% (HBsAg+), 1,0% (Ratio), and 36,16% (HBsAg+, anti-HBs+) was found. All positive HBsAg were negative for HBeAg. Projected results corresponded to a total of 37 HBsAg+ pregnant carriers and 7 newborn preventive of chronic disease per year. The Hospital General de Huanta, in Ayacucho, located in a high endemicity area, presented a prevalence of 3,2% (HBsAg+), 1,9% (Ratio), and 76,2% (HBsAg+, anti-HBs+) from 126 pregnant women evaluated with ages between 15 and 48 years old. These results gave a total projection per year of 39 HBsAg+ pregnant women and 8 newborn preventive of chronic hepatic disease. Among a total of 4 positive HBsAg cases, 3 positive pregnant women were studied for HBeAg. All 3 were negative. These results establish the prevalence of HbsAg and antiHBs in pregnant women from different endemical areas with significant prevalence in the Departments of Ayacucho (Huanta), and Apurimac (Abancay). They also contribute towards the costbenefit analysis for the prevention of HBV chronic infection.