Trombosis venosa y de senos cerebrales en recién nacidos y niños / Venous and cerebral sinus thrombosis in newborns and children

Resumen Introducción : La trombosis de venas y senos venosos cerebrales (TVSC) constituye una causa conocida, aun que subestimada de ictus en la infancia. Su diagnóstico requiere un alto índice de sospecha, una correcta in terpretación de la neuroimagen e interrelación entre el clínico y el radiólogo. Objetivo : Analizar las manifestaciones clínicas, fac tores de riesgo y neuroimagen de recién nacidos (RN) y niños menores de 15 años con TVSC. Métodos: Estudio descriptivo, retrospectivo, multi céntrico, de una serie consecutiva de casos de menores de 15 años que ingresaron por TVSC entre el 1 de enero del 2010 y el 1 de marzo de 2022. Resultados : El estudio incluyó 51 pacientes: 39% con síntomas agudos y 59% subagudos. En los RN predomi naron síntomas encefalopáticos y convulsiones, mien tras en los niños elementos de hipertensión endocranea na (HTEC). Se identificaron factores de riesgo en el 90% de los casos. La resonancia magnética con angiografía en tiempo venoso confirmó el diagnóstico en el 80%, siendo el seno recto el más afectado en RN y el seno lateral en niños. Se encontraron complicaciones hemorrágicas en 30.5%, siendo más frecuentes en los RN. Se inició anti coagulación en el 82% sin complicaciones. Las secuelas estuvieron presentes en 44.4% de RN y 37.9% de niños, siendo más frecuentes y graves en los RN. Conclusiones : Para realizar un diagnóstico precoz es fundamental pensar en TVSC en RN con síntomas en cefalopáticos y/o convulsiones y en mayores con clínica de HTEC en presencia de enfermedades predisponentes o desencadenantes.

Abstract Introduction : Cerebral venous sinus thrombosis (CVST) is a well-known, although underestimated, cause of stroke in childhood. Its diagnosis requires a high index of suspicion, a correct interpretation of neuroim aging studies and an interrelation between clinicians and radiologists. The clinical features, risk factors and neuroimaging of children under 15 years of age with CVST were analyzed. Methods : multicenter, retrospective, descriptive, study of a consecutive series of cases of children under 15 years of age, who were admitted due to CVST between January 1st, 2010, and March 1st, 2022. Results : The study included 51 patients: 39% with acute symptoms and 59% with subacute symptoms. Newborns predominantly presented encephalopathic symptoms and seizures, while children exhibited signs of intracranial hypertension (ICH). Risk factors were 96 identified in 90% of the cases. Magnetic resonance with angiography in venous time confirmed the diagnosis in 80% of the patients, with the straight sinus being the most affected in newborns and the lateral sinus in chil dren. Hemorrhagic complications were found in 30.5%, being more frequent in newborns. Anticoagulation was initiated in 82% without complications. Sequelae were present in 44.4% of newborns and 37.9% of children, being more frequent and severe in newborns. Conclusions : To make an early diagnosis, it is essen tial to consider CVST in newborns with encephalopathic symptoms and/or seizures, and in children with signs of ICH in the presence of predisposing or triggering conditions.

[Venous and cerebral sinus thrombosis in newborns and children]. / Trombosis venosa y de senos cerebrales en recién nacidos y niños.

INTRODUCTION: Cerebral venous sinus thrombosis (CVST) is a well-known, although underestimated, cause of stroke in childhood. Its diagnosis requires a high index of suspicion, a correct interpretation of neuroimaging studies and an interrelation between clinicians and radiologists. The clinical features, risk factors and neuroimaging of children under 15 years of age with CVST were analyzed. METHODS: multicenter, retrospective, descriptive, study of a consecutive series of cases of children under 15 years of age, who were admitted due to CVST between January 1st, 2010, and March 1st, 2022. RESULTS: The study included 51 patients: 39% with acute symptoms and 59% with subacute symptoms. Newborns predominantly presented encephalopathic symptoms and seizures, while children exhibited signs of intracranial hypertension (ICH). Risk factors were identified in 90% of the cases. Magnetic resonance with angiography in venous time confirmed the diagnosis in 80% of the patients, with the straight sinus being the most affected in newborns and the lateral sinus in children. Hemorrhagic complications were found in 30.5%, being more frequent in newborns. Anticoagulation was initiated in 82% without complications. Sequelae were present in 44.4% of newborns and 37.9% of children, being more frequent and severe in newborns. CONCLUSIONS: To make an early diagnosis, it is essential to consider CVST in newborns with encephalopathic symptoms and/or seizures, and in children with signs of ICH in the presence of predisposing or triggering conditions.

Introducción: La trombosis de venas y senos venosos cerebrales (TVSC) constituye una causa conocida, aunque subestimada de ictus en la infancia. Su diagnóstico requiere un alto índice de sospecha, una correcta interpretación de la neuroimagen e interrelación entre el clínico y el radiólogo. OBJETIVO: Analizar las manifestaciones clínicas, factores de riesgo y neuroimagen de recién nacidos (RN) y niños menores de 15 años con TVSC. Métodos: Estudio descriptivo, retrospectivo, multicéntrico, de una serie consecutiva de casos de menores de 15 años que ingresaron por TVSC entre el 1 de enero del 2010 y el 1 de marzo de 2022. RESULTADOS: El estudio incluyó 51 pacientes: 39% con síntomas agudos y 59% subagudos. En los RN predominaron síntomas encefalopáticos y convulsiones, mientras en los niños elementos de hipertensión endocraneana (HTEC). Se identificaron factores de riesgo en el 90% de los casos. La resonancia magnética con angiografía en tiempo venoso confirmó el diagnóstico en el 80%, siendo el seno recto el más afectado en RN y el seno lateral en niños. Se encontraron complicaciones hemorrágicas en 30.5%, siendo más frecuentes en los RN. Se inició anticoagulación en el 82% sin complicaciones. Las secuelas estuvieron presentes en 44.4% de RN y 37.9% de niños, siendo más frecuentes y graves en los RN. CONCLUSIONES: Para realizar un diagnóstico precoz es fundamental pensar en TVSC en RN con síntomas encefalopáticos y/o convulsiones y en mayores con clínica de HTEC en presencia de enfermedades predisponentes o desencadenantes.

Mentalización, estilo de apego y afrontamiento al estrés en una muestra poblacional de la Costa Atlántica colombiana durante la cuarentena por el COvID-19 / Mentalizing, Attachment Style, and Coping During the COvID-19 Quarantine in Colombia / Mentalização, estilo de apego e enfrentamento do estresse em uma amostra populacional da Costa Atlântica colombiana durante a quarentena causada pelo COvID-19

El objetivo de este artículo es describir la relación de la mentalización y el estilo de apego sobre el afrontamiento del estrés durante la cuarentena por COVID-19 en Colombia. En el estudio participaron 253 personas, de las cuales 68 fueron hombres, 184 mujeres y 1 se identificó como otro. Los participantes se eligieron mediante un muestreo no probabilístico de tipo bola de nieve y el cuestionario de datos se distribuyó por redes sociales. Como instrumentos de investigación se utilizó el Cuestionario de Afrontamiento frente al Estrés (CAE) ­la forma revisada de la EEC-R­, medida de autoinforme diseñada para evaluar siete estilos básicos de afrontamiento; el Cuestionario de Experiencias en Relaciones Cercanas-revisado (ECR) y el Cuestionario de Función Reflexiva (RfQ-8). En los resultados se encontraron correlaciones entre el estilo de apego y la mentalización con el estilo de afrontamiento frente al estrés durante el aislamiento por la pandemia de COVID-19. Se evidenció que un estilo de apego seguro facilita estilos de afrontamiento más adaptativos, a diferencia de los estilos de apego ansioso y evitativo que están más relacionados con estilos de afrontamiento como la auto focalización negativa y la evitación.

This study aimed to describe the relationship between mentalization and attachment style in coping with stress during the COVID-19 quarantine in Colombia. In this study 253 people participated of which 68 were men, 184 were women and 1 was defined as other; the partici- pants were chosen through a non-probabilistic snowball sampling where the questionnaire was distributed in social networks. As instruments, the CAE is the revised form of the EEC-R; a self-report measure designed to assess seven basic coping styles, the Experiences in Close Relationships-Revised (ECR) questionnaire and the Reflective Function Questionnaire (RfQ-8) were used. The results found correlations between attachment style and mentalization with coping style in the face of stress during the COVID-19 pandemic isolation. Finding that a secure attachment style facilitates more adaptive coping styles, as opposed to anxious and avoidant attachment styles that are more related to coping styles such as negative self-focus and avoidance.

O objetivo do estudo foi descrever a relação entre mentalização e estilo de apego no enfrentamento do estresse durante a quarentena da COVID-19 na Colôm- bia. Neste estudo, participaram 253 pessoas, das quais 68 eram homens, 184 eram mulheres e 1 definido como outro; os participantes foram escolhidos por meio de uma amostragem não probabilística em bola de neve onde o questionário foi distribuído nas redes sociais. Como instrumentos foram usados, o CAE, que é a forma revisada do EEC-R; medida de autorrelato projetada para avaliar sete estilos básicos de enfren- tamento, o questionário Experiencias em Relaciona- mentos Próximos-revisado (ECR) e o Questionário de Funcionamento Reflexivo (RfQ-8). Nos resultados, foram encontradas correlações entre o estilo de apego e a mentalização com o estilo de enfrentamento do estresse durante o isolamento devido à pandemia de COVID-19. Descobriu-se que um estilo de apego seguro facilita estilos de enfrentamento mais adaptativos, ao contrário dos estilos de apego ansioso e evitativo, que estão mais relacionados a estilos de enfrentamento, como autofoco negativo e evitação.

Predictors of HIV Molecular Cluster Membership and Implications for Partner Services.

Public health surveillance data used in HIV molecular cluster analyses lack contextual information that is available from partner services (PS) data. Integrating these data sources in retrospective analyses can enrich understanding of the risk profile of people in clusters. In this study, HIV molecular clusters were identified and matched to information on partners and other information gleaned at the time of diagnosis, including coinfection with syphilis. We aimed to produce a more complete understanding of molecular cluster membership in Houston, Texas, a city ranking ninth nationally in rate of new HIV diagnoses that may benefit from retrospective matched analyses between molecular and PS data to inform future intervention. Data from PS were matched to molecular HIV records of people newly diagnosed from 2012 to 2018. By conducting analyses in HIV-TRACE (TRAnsmission Cluster Engine) using viral genetic sequences, molecular clusters were detected. Multivariable logistic regression models were used to estimate the association between molecular cluster membership and completion of a PS interview, number of named partners, and syphilis coinfection. Using data from 4,035 people who had a viral genetic sequence and matched PS records, molecular cluster membership was not significantly associated with completion of a PS interview. Among those with sequences who completed a PS interview (n = 3,869), 45.3% (n = 1,753) clustered. Molecular cluster membership was significantly associated with naming 1 or 3+ partners compared with not naming any partners [adjusted odds ratio, aOR: 1.27 (95% confidence interval, CI: 1.08-1.50), p = .003 and aOR: 1.38 (95% CI: 1.06-1.81), p = .02]. Alone, coinfection with syphilis was not significantly associated with molecular cluster membership. Syphilis coinfection was associated with molecular cluster membership when coupled with incarceration [aOR: 1.91 (95% CI: 1.08-3.38), p = .03], a risk for treatment interruption. Enhanced intervention among those with similar profiles, such as people coinfected with other risks, may be warranted.

Impact of molecular sequence data completeness on HIV cluster detection and a network science approach to enhance detection.

Detection of viral transmission clusters using molecular epidemiology is critical to the response pillar of the Ending the HIV Epidemic initiative. Here, we studied whether inference with an incomplete dataset would influence the accuracy of the reconstructed molecular transmission network. We analyzed viral sequence data available from ~ 13,000 individuals with diagnosed HIV (2012-2019) from Houston Health Department surveillance data with 53% completeness (n = 6852 individuals with sequences). We extracted random subsamples and compared the resulting reconstructed networks versus the full-size network. Increasing simulated completeness was associated with an increase in the number of detected clusters. We also subsampled based on the network node influence in the transmission of the virus where we measured Expected Force (ExF) for each node in the network. We simulated the removal of nodes with the highest and then lowest ExF from the full dataset and discovered that 4.7% and 60% of priority clusters were detected respectively. These results highlight the non-uniform impact of capturing high influence nodes in identifying transmission clusters. Although increasing sequence reporting completeness is the way to fully detect HIV transmission patterns, reaching high completeness has remained challenging in the real world. Hence, we suggest taking a network science approach to enhance performance of molecular cluster detection, augmented by node influence information.

[Characterization of hypotonia-hyporesponsiveness after pentavalent vaccine and neurodevelopmental screening in children under 6 years of age, 2013-2018, Uruguay]. / Caracterización de la hipotonía-hiporrespuesta post vacuna pentavalente y tamizaje del neurodesarrollo en niños bajo 6 años de edad, 2013-2018, Uruguay.

BACKGROUND: Hypotonic-hyporesponsive episodes (HHE) is one frequently reported neurologic adverse effect supposedly attributable to vaccination and immunization. Its long-term impact on neurodevelopment is not completely known. AIM: To characterize the post-pentavalent vaccine HHE events reported to the Uruguayan Ministry of Health (M of H) between 2014 and 2018. To perform neurodevelopment screening of those who were under 6 years of age at the time of evaluation. METHODS: Descriptive study of the reports made to the National Farmacosurveillance System of the M of H. Neurodevelopment screening was performed using the National Guidelines for Developmental Surveillance. RESULTS: 30 cases were studied. Most cases occurred after the first doses, were of short duration and during the first hours after vaccination, with spontaneous recovery. Median time between the event and this evaluation was 2 years and 2 months. Screening tests were normal in 15. Delay in the language area was detected in one case. CONCLUSIONS: HHE events had similar characteristics to those described in the literature, with no severe short-term complications. Despite the limitations of the present study, no delays nor deviations were found in the development of the children who were evaluated.

Caracterización de la hipotonía-hiporrespuesta post vacuna pentavalente y tamizaje del neurodesarrollo en niños bajo 6 años de edad, 2013-2018, Uruguay / Characterization of hypotonia-hyporesponsiveness after pentavalent vaccine and neurodevelopmental screening in children under 6 years of age, 2013-2018, Uruguay

INTRODUCCIÓN: La hipotonía-hiporrespuesta (HHR) es uno de los efectos adversos supuestamente atribuibles a la vacunación e inmunización de tipo neurológico más notificados. El impacto a largo plazo a nivel del neurodesarrollo no es completamente conocida. OBJETIVO: Caracterizar los eventos de HHR post vacuna pentavalente notificados entre 2014 y 2018 al Ministerio de Salud Pública (MSP) de Uruguay. Realizar el tamizaje del neurodesarrollo de los que al momento de la evaluación tenían menos de 6 años de edad. METODOLOGÍA: Estudio descriptivo de las notificaciones al Sistema Nacional de Farmacovigilancia del MSP. Se realizó el tamizaje del neurodesarrollo con la Guía Nacional para la Vigilancia del Desarrollo. RESULTADOS: 30 casos, la mayoría de breve duración, en las primeras horas post primera dosis y con recuperación espontánea. Requirieron hospitalización 29. Se realizó el tamizaje del neurodesarrollo en 16. La media de tiempo entre el evento y esta evaluación fue 2 años y 2 meses. Fue normal la prueba de tamizaje en 15. En uno se detectó un retraso del lenguaje. CONCLUSIONES: Los episodios de HHR se presentaron con características similares a las descritas en la bibliografía. A pesar de las limitaciones del estudio, no se encontraron retrasos ni desvíos del desarrollo en los niños evaluados.

BACKGROUND: Hypotonic-hyporesponsive episodes (HHE) is one frequently reported neurologic adverse effect supposedly attributable to vaccination and immunization. Its long-term impact on neurodevelopment is not completely known. AIM: To characterize the post-pentavalent vaccine HHE events reported to the Uruguayan Ministry of Health (M of H) between 2014 and 2018. To perform neurodevelopment screening of those who were under 6 years of age at the time of evaluation. METHODS: Descriptive study of the reports made to the National Farmacosurveillance System of the M of H. Neurodevelopment screening was performed using the National Guidelines for Developmental Surveillance. RESULTS: 30 cases were studied. Most cases occurred after the first doses, were of short duration and during the first hours after vaccination, with spontaneous recovery. Median time between the event and this evaluation was 2 years and 2 months. Screening tests were normal in 15. Delay in the language area was detected in one case. CONCLUSIONS: HHE events had similar characteristics to those described in the literature, with no severe short-term complications. Despite the limitations of the present study, no delays nor deviations were found in the development of the children who were evaluated.

Methodological synthesis of Bayesian phylodynamics, HIV-TRACE, and GEE: HIV-1 transmission epidemiology in a racially/ethnically diverse Southern U.S. context.

This study introduces an innovative methodological approach to identify potential drivers of structuring HIV-1 transmission clustering patterns between different subpopulations in the culturally and racially/ethnically diverse context of Houston, TX, the largest city in the Southern United States. Using 6332 HIV-1 pol sequences from persons newly diagnosed with HIV during the period 2010-2018, we reconstructed HIV-1 transmission clusters, using the HIV-TRAnsmission Cluster Engine (HIV-TRACE); inferred demographic and risk parameters on HIV-1 transmission dynamics by jointly estimating viral transmission rates across racial/ethnic, age, and transmission risk groups; and modeled the degree of network connectivity by using generalized estimating equations (GEE). Our results indicate that Hispanics/Latinos are most vulnerable to the structure of transmission clusters and serve as a bridge population, acting as recipients of transmissions from Whites (3.0 state changes/year) and from Blacks (2.6 state changes/year) as well as sources of transmissions to Whites (1.8 state changes/year) and to Blacks (1.2 state changes/year). There were high rates of transmission and high network connectivity between younger and older Hispanics/Latinos as well as between younger and older Blacks. Prevention and intervention efforts are needed for transmission clusters that involve younger racial/ethnic minorities, in particular Hispanic/Latino youth, to reduce onward transmission of HIV in Houston.

Thrombocytopenia with Absent Radii (TAR) Syndrome Without Significant Thrombocytopenia.

Thrombocytopenia with absent radii (TAR) syndrome is a rare genetic syndrome that occurs with a frequency of about 0.42 cases per 100,000 live births. It is characterized by hypo-megakaryocytic thrombocytopenia with bilateral absent radii and the presence of both thumbs. The thrombocytopenia is initially very severe, manifesting in the first few weeks to months of life, but subsequently improves with time to reach near normal values by one to two years of age. We present a case of a newborn with TAR syndrome with an atypical presentation of mild thrombocytopenia in the first week of life, with early normalization of platelet counts in the neonatal period. The patient deviates from the normal pattern in which 95% of patients with TAR syndrome usually develop significant thrombocytopenia (platelet counts of less than 50 x 10 9 platelets/L) within the first four months of life. Additionally, the absence of hypo-megakaryocytes on peripheral smear sets this patient apart from the typical cases of TAR syndrome. TAR syndrome is often associated with significant morbidity and mortality secondary to severe thrombocytopenia, which occurs with the highest frequency in the first 14 months of life. The most common cause of mortality is due to a severe hemorrhagic event occurring in the brain, gastrointestinal tract, and other organs. Therefore, all patients with TAR syndrome should be monitored closely for symptomatic thrombocytopenia with platelet transfusions being implemented as the first-line therapy for the treatment of severe or symptomatic disease.

Mentalización: encuentros y divergencias con conceptos afines. Una revisión / Mentalization: Encounters and divergences with related concepts. A review

Resumen El objetivo de esta revisión es presentar una delimitación del concepto de Mentalización dentro del campo de la psicología. Se describen antecedentes históricos y teóricos del tema y se establecen diferencias y similitudes entre éste y otros constructos psicológicos similares como la Teoría de la Mente (ToM), Mindfulness y la Conciencia Afectiva (AC). Por último, se revisan intervenciones clínicas aplicables a la población colombiana.

Summary The purpose of this study is to present a delimitation of the concept of Mentalization in the field of Psychology. The topic's theorical and historical backgrounds are described, and differences and similarities are established between this and other similar psychological constructs such as Theory of Mind (ToM), Mindfulness, and Affective Consciousness (AC). Finally, clinical interventions applicable to the Colombian population, are reviewed.

Neuropatía motora multifocal: reporte de un caso / Multifocal motor neuropathy: a case report

Las neuropatías agrupan un gran número de patologías de nervio periférico; estas pueden ser adquiridas o hereditarias, de origen sistémico o restringidas a un número de nervios. Las neuropatías son causa de dolor e incapacidad y requieren un manejo multidisciplinar para mejorar la calidad de vida de los pacientes. Dentro de ellas tenemos la neuropatía motora multifocal (NMM), también denominada 'neuropatía motora multifocal con bloqueo de conducción' (NMMCB), la cual es una neuropatía adquirida, inflamatoria, poco frecuente, caracterizada por debilidad en las extremidades, sin pérdida sensorial, progresiva y asimétrica. Se presenta además un bloqueo persistente de la conducción nerviosa que afecta las fibras motoras de forma selectiva.

Neuropathies group a large number of peripheral nerve pathologies; these can be acquired or hereditary, of systemic origin or restricted to a number of nerves. Neuropathies cause pain and disability and require multidisciplinary management to improve the quality of life of patients. Among them we have multifocal motor neuropathy (MMN), also called 'multifocal motor neuropathy with conduction block' (MMPNB), which is an acquired, inflammatory, rare neuropathy, characterized by weakness in the extremities, without sensory loss, progressive and asymmetric. There is also a persistent nerve conduction block that selectively affects motor fibers.

Manifestaciones cardiacas de la infección por Covid-19 y su enfoque rehabilitador. Revisión narrativa / Cardiac manifestations of Covid-19 infection and its rehabilitative approach. Narrative review

La infección por el nuevo coronavirus (Covid-19), descrita desde diciembre de 2019, ha ocasionado una pandemia de gran magnitud con consecuencias devastadoras a nivel mundial e implicaciones en la salud de las personas que la padecen y presentan síntomas, lo cual genera complicaciones a corto y a largo plazo, éstas últimas aún desconocidas en su totalidad. Se han descrito complicaciones cardiovasculares secundarias a la infección por Covid -19 entre las que se cuenta la aparición de arritmias, infarto agudo del miocardio, miocarditis y eventos trombótico. Sin embargo, las complicaciones a largo plazo aún no se dilucidan en su totalidad teniendo en cuenta el corto periodo de evolución de la enfermedad. A pesar de esto, es clara la asociación que existe entre las enfermedades cardiovasculares previas y la coinfección por Covid-19, lo cual favorece la aparición de enfermedades severas y peores desenlaces en las personas que las presentan. Teniendo en cuenta esta asociación, es importante crear o fortalecer programas de rehabilitación cardiaca que utilicen herramientas tecnológicas para favorecer la telerrehablitación y así mejorar la calidad de vida de las personas, favoreciendo su independencia.

The infection by the new coronavirus (Covid-19), described since December 2019, has caused a pandemic of great magnitude with devastating consequences worldwide and implications in the health of people who suffer from it and present symptoms, which generates short and long term complications, the latter still unknown in its entirety. Cardiovascular complications secondary to Covid-19 infection have been described, including arrhythmias, acute myocardial infarction, myocarditis and thrombotic events. However, long-term complications are not yet fully elucidated considering the short evolution period of the disease. Despite this, there is a clear association between previous cardiovascular disease and Covid-19 coinfection, which favors the onset of severe disease and worse outcomes in those who present it. Taking this association into account, it is important to create or strengthen cardiac rehabilitation programs that use technological tools to favor telerehablitation and thus improve the quality of life of people, favoring their independence.

Macronutrient Composition or Social Determinants? Impact on Infant Outcomes With Gestational Diabetes Mellitus.

The purpose of this study was to examine, through a randomized, controlled trial, the effects of a maternal carbohydrate-restricted diet on maternal and infant outcomes in gestational diabetes mellitus (GDM). Women diagnosed with GDM were randomly allocated into one of two groups: an intervention group that was placed on a lower-carbohydrate diet (35-40% of total calories) or a control group that was placed on the usual pregnancy diet (50-55% carbohydrate). A convenience sample of participants diagnosed with GDM (ages 18-45 years) was recruited from two different sites: one urban and low-income and the other suburban and more affluent. Individual face-to-face diet instruction occurred with certified diabetes educators at both sites. Participants tested their blood glucose four times daily. Specific socioeconomic status indicators included enrollment in the Supplemental Nutrition Program for Women, Infants and Children or Medicaid-funded health insurance, as well as cross-sectional census data. All analyses were based on an intention to treat. Although there were no differences found between the lower-carbohydrate and usual-care diets in terms of blood glucose or maternal-infant outcomes, there were significant differences noted between the two sites. There was a lower mean postprandial blood glucose (100.59 ± 7.3 mg/dL) at the suburban site compared to the urban site (116.3 ± 15 mg/dL) (P <0.01), even though there was no difference in carbohydrate intake. There were increased amounts of protein and fat consumed at the suburban site (P <0.01), as well as lower infant complications (P <0.01). Further research is needed to determine whether these disparities in outcomes were the result of macronutrient proportions or environmental conditions.

The joint effect of ethnicity and gender on occupational segregation. An approach based on the Mutual Information Index.

In this article, we study the effects of ethnicity and gender on occupational segregation. Traditionally, researchers have examined the two sources of segregation separately. In contrast, we measure their joint effect by applying a multigroup segregation index-the Mutual Information or M index-to the product of the seven ethnic groups and two genders distinguished in our 2001 Census data for England and Wales. We exploit M's additive decomposability property to pose the following two questions: (i) Is there an interaction effect? (ii) How much does each source contribute to occupational segregation, controlling for the effect of the other? Although the role of ethnicity is non-negligible in the areas where minorities are concentrated, our findings confirm the greater importance of gender over ethnicity as a source of segregation. Moreover, we find a small "dwindling" interaction effect between the two sources of segregation: ethnicity slightly weakens the segregating power of gender and vice versa.

Bilateral prominent schwalbe ring in the anterior chamber in a patient with axenfeld-rieger syndrome and megalocornea.

PURPOSE: To report the unusual presentation of bilateral Schwalbe rings suspended in the anterior chambers of a patient with Axenfeld-Rieger syndrome. METHODS: A 37-year-old man with bilateral decreasing visual acuity underwent slit-lamp examination, dark room gonioscopy, and photographic documentation. RESULTS: Prominent bilateral Schwalbe rings and peripheral iridocorneal strands were observed in both anterior chambers. No systemic abnormalities were found. CONCLUSIONS: The position of the Schwalbe ring in patients with Axenfeld-Rieger syndrome can vary in appearance from almost normal to displaced markedly. It remains to be seen whether these variations reflect genetic differences.

Baerveldt glaucoma implant insertion in the posterior chamber sulcus.

AIM: To report the clinical outcome of a surgical technique for insertion of the silicone tube of a Baerveldt glaucoma implant (BGI) in the posterior chamber sulcus. METHODS: Non-comparative, interventional case series. Eight eyes of eight patients, with a follow-up of at least 18 months, who underwent insertion of a BGI with the silicone tube placed in the posterior chamber sulcus between 1998 and 2005 were included. Control of intraocular pressure (IOP), number of pressure-lowering medications, visual acuity and surgical complications were recorded. RESULTS: Eight eyes of eight patients (mean (range) age 76.4 (62-94) years) were included in the study. The IOP was reduced from a preoperative mean (SD) of 28.2 (14.4) to 12.6 (5.8) mm Hg at 18 months. The mean (SD) number of preoperative medications for IOP control was reduced from 2.8 (1.5) to 1.3 (1.5) medications in the same period. No complications were observed during surgery or follow-up. CONCLUSION: Placement of the silicone tube in the posterior chamber sulcus is a safe and effective alternative technique for IOP control in patients with pseudophakia. Sulcus placement may reduce the likelihood of corneal endothelial loss and avoid the need for pars-plana vitrectomy and posterior segment tube insertion in complicated eyes.

Ritmo de sudoración como mejor indicador de aclimatación al calor / Sweat rate as best indicator of heat aclimation

Objetivo: Determinar cual de los tres índices de aclimatación comúnmente utilizados (temperatura timpánica, ritmo de sudoración, o frecuencia cardiaca) es el más sensible y reproducible. Material y métodos: Siete jóvenes estudiantes universitarios (28+/- asños y 4,2+/-0,6 L/min VO2max) pedalearon a una intensidad del 60% del VO2max durante 60 minutos por 7 días (2 días de descanso máximo) en una cámara climática a 34,4+/-0,3ºC y 27,7+/-0,1% de humedad relativa, con 0,2 m/s de velocidad de viento. Este proceso de aclimatación se repitió 3 veces (A1, A2 y A3) espacidas por 3 meses para estudiar la reproducibilidad de las respuestas. Resultados: Tras 3 días de aclimatación el ritmo de sudoración (RS) subió por encima del ritmo del día 1 en todas las aclimataciones (p<0.05) pero no alcanzó un estado estable tras 7 días. La reproducibilidad entre aclimataciones fue alta para el ritmo de sudoración (R1=0.90), y frecuencia cardiaca final (R1=0.71). Conclusiones: El ritmo de sudoración es el índice más sensible y reproducible de aclimatación y recomendamos su uso en vez de frecuencia cardíaca o temperatura timpánica. Aunque los efectos de una semana de aclimatación al calor se pierden en 3 mese (día 1 de A1, A2 y A3 son similares) las respuestas son altamente reproducibles. Por último, confirmamos datos anteriores que más de 7 días son necesarios para alcanzar la máxima adaptación en ritmo de sudoración y frecuencia cardíaca

Purpose: to determine which of three commonly used indexed to evaluate acclimation (tympanic temperature, sweat rate, or heart rat is the most sensitive and reliable). Material and methods: seven young University students (28+/-8 years and 4.2+/-0.6 L/min VO2max) pedalled at 60% del VO2max for 60 minutes during 7 days (maximum of 2 rest days in between) in a climatic chamber set at 34.4+/-0.3ºC and 27.7+/-0.1% of relative humidity with 0.2 m/s of wind speed. This acclimation protocol was repeated in 3 occasions () A1, A2 y A3) separated by 3 months to study reliability. Results: After 3 days of acclimation sweat rate was higher than on day 1 in all (p<0.05) although a steady-state was not achieved at day 7. Tympanic temperature at the end of exercise was unchanged with no effect of days of acclimation. Heart rate at the end of exercise was lower than the day 1 after 5-6 days in all acclimations (p<0.05) without reaching a steady-state. There were a high reliability in sweat rate (R1=0.90) and heart rate (R1=0.84) but moderate for tympanic temperature (R1=0.71). Conclusions: Sweat rate is the most sensitive indication of acclimatation and we recommended its use over heart rate or tympanic temperature. Although the effects 1 week acclimation are lost within 3 months (day 1 of A1, A2, and A3 are similar) the responses are highly reliable. Finally, we confirm previous reports that indicates that indicate that over 7 days are needed to reach a steady-state response in sweat rate and heart rate

Assessment of a race-specific normative HRT-III database to differentiate glaucomatous from normal eyes.

PURPOSE: To determine if a new, normative, race-specific database enhances the ability of confocal scanning laser ophthalmoscopy to differentiate normal from glaucomatous eyes. METHODS: One eye of eligible normal and glaucoma patients was enrolled. All subjects underwent a complete ophthalmologic examination, standard achromatic perimetry (SITA-SAP, 24-2), and confocal scanning laser ophthalmoscopy [Heidelberg retinal tomograph (HRT-II)] within 1 month of enrollment. Racial groups were defined by self-report. Glaucoma was defined by the existence of reproducible SAP loss (pattern standard deviation <5% and/or Glaucoma Hemifield Test outside normal limits) on 2 consecutive fields. Normal subjects had 2 normal visual fields (pattern standard deviation >5% and Glaucoma Hemifield Test within 97% normal limits) and a normal clinical examination. HRT-II examinations were exported to the HRT-III software, which includes a large race-specific normative database consisting of 733 white and 215 black eyes. Moorfields regression analysis (MRA) for the most abnormal optic disc sector was compared between the HRT-II (MRA2) and the HRT-III software before (MRA3-B) and after (MRA3-A) adjustment for race. Sectors outside the 99.9% confidence interval limits ("outside normal limits") were determined to be abnormal. RESULTS: We enrolled 124 black (52 glaucoma, 72 normal) and 96 white (32 glaucoma, 64 normal) subjects. Mean age was 51+/-13 years and 50+/-16 years for blacks and whites, respectively (P = 0.45). Visual field mean deviation was -7.3+/-6.7 db for glaucomatous eyes and -0.4+/-1.1 db for normal eyes (P < 0.001). Sensitivity and specificity for the HRT-II was 71.9% and 95.3%, respectively, for white subjects and 50.0% and 98.6%, respectively, for black subjects. Using the expanded HRT-III database, analysis yielded a sensitivity of 81.3% and specificity of 93.8% for whites and a sensitivity of 71.2% and specificity of 86.1% for blacks. After an adjustment for black ethnicity was made in the HRT-III program, the sensitivity and specificity for blacks was 65.4% and 90.3%, respectively. CONCLUSIONS: A new, larger, race-specific HRT-III database increases sensitivity while maintaining specificity for whites and increases sensitivity but decreases specificity for blacks. New software and databases based on race require careful scrutiny before use in clinical practice.