Hallazgos colonoscópicos en pacientes atendidos en una institución de salud del municipio de Barrancabermeja, Santander / Colonoscopy findings in patients attended at a health institution in the municipality of Barrancabermeja, Santander / Achados de colonoscopia em pacientes atendidos em uma instituição de saúde do município de Barrancabermeja, Santander

Introducción. La colonoscopia es una exploración visual de la mucosa del colon, la cual consiste en la introducción de una sonda óptica flexible por el ano. Dentro de sus objetivos está la localización de lesiones de una manera muy precisa, obtener biopsias para su análisis al microscopio, realizar diversos procedimientos terapéuticos o diagnosticar lesiones pequeñas no detectables por métodos imagenológicos tradicionales. El objetivo del presente artículo es describir los hallazgos colonoscópicos en pacientes adultos de una institución prestadora de servicios de salud. Metodología. Estudio observacional, transversal con componente analítico, la información se recolectó de manera retrospectiva, en pacientes mayores de 18 años en ambos sexos, a los cuales se les realizó colonoscopia en una institución prestadora de servicios de salud de segundo nivel. Resultados. Se practicaron 521 procedimientos colonoscópicos en 291 mujeres y 230 hombres con mediana de edad de 63 años (rango 18-99), la proporción fue bastante superior en las personas mayores de 50 años, la frecuencia del procedimiento en mujeres fue superior con un 57.0% vs. el 43% de los hombres. El número de colonoscopias con resultado normal, fue más frecuente en las personas menores de 50 años (54.8%) contra 45.2% del total de los de 50 años en adelante. Conclusiones. La colonoscopia es un instrumento de gran utilidad al momento de diagnóstico, seguimiento y tratamiento de una gran variedad de patologías gastrointestinales, ya que, a través de esta importante herramienta diagnóstica es posible determinar y descartar otro tipo de patologías que afectan el sistema gastrointestinal. Cómo citar: Rodriguez NH, Logreira JD, Sanabria DF, Uribe JC. Hallazgos colonoscópicos en pacientes atendidos en una institución de salud del municipio de Barrancabermeja, Santander. MedUNAB. 2020;23(2): 261-269. doi: 10.29375/01237047.3834

Introduction. Colonoscopy is a visual exploration of the colonic mucosa, which consists of the insertion of a flexible optic catheter through the anus. Its objectives include to locate lesions very precisely, to obtain biopsies for their microscopic analysis, to carry out different therapeutic procedures and to diagnose small lesions that cannot be detected by traditional imaging techniques. The aim of this article is to describe the colonoscopy findings in adult patients of a health care institution. Methodology. Observational, cross-sectional study with an analytical component. The information was collected retrospectively from patients aged over 18 years, of both sexes, on which a colonoscopy was performed in a secondary health care institution. Results. A total of 521 colonoscopy procedures were conducted on 291 women and 230 men with an average age of 63 years (age range: 18-99 years). The proportion was greater among people aged over 50 years. The frequency of the procedure in women was higher with 57.0%, compared to 43% in men. The number of colonoscopies with a normal result was more frequent in people aged under 50 years (54.8%) compared to 45.2% of the total of those aged 50 years and over. Conclusion. Colonoscopy is a very useful instrument when diagnosing, monitoring and treating a great variety of gastrointestinal pathologies, because through this important diagnostic tool, it is possible to determine the existence of or rule out other kinds of pathologies that affect the gastrointestinal system. Cómo citar: Rodriguez NH, Logreira JD, Sanabria DF, Uribe JC. Hallazgos colonoscópicos en pacientes atendidos en una institución de salud del municipio de Barrancabermeja, Santander. MedUNAB. 2020;23(2): 261-269. doi: 10.29375/01237047.3834

Introdução. A colonoscopia é uma exploração visual da mucosa do cólon, que consiste na introdução de uma sonda óptica flexível através do ânus. Entre seus objetivos está a localização de lesões de maneira muito precisa, a obtenção de biópsias para análise ao microscópio, a realização de vários procedimentos terapêuticos ou o diagnóstico de pequenas lesões não detectáveis pelos métodos tradicionais de imagem. O objetivo deste artigo é descrever os achados de colonoscopia em pacientes adultos de uma instituição prestadora de serviços de saúde. Metodologia. Em estudo observacional, transversal, com componente analítico, as informações foram coletadas retrospectivamente em pacientes acima de 18 anos de ambos os sexos, submetidos à colonoscopia em instituição prestadora de serviços de saúde de segundo nível. Resultados. Foram realizados 521 procedimentos de colonoscopia em 291 mulheres e 230 homens com mediana de idade de 63 anos (variação de 18 a 99), a proporção foi muito maior em pessoas acima de 50 anos, a frequência do procedimento em mulheres foi maior em 57% vs. 43% nos homens. O número de colonoscopias com resultado normal foi mais frequente em pessoas com menos de 50 anos (54.8%) versus 45.2% do total das pessoas com 50 anos ou mais. Conclusão. A colonoscopia é um instrumento muito útil no diagnóstico, monitoramento e tratamento de uma ampla variedade de patologias gastrointestinais, pois, por meio desta importante ferramenta de diagnóstico, é possível determinar e descartar outros tipos de patologias que afetam o sistema gastrointestinal. Cómo citar: Rodriguez NH, Logreira JD, Sanabria DF, Uribe JC. Hallazgos colonoscópicos en pacientes atendidos en una institución de salud del municipio de Barrancabermeja, Santander. MedUNAB. 2020;23(2): 261-269. doi: 10.29375/01237047.3834

Re-emergence of rabies virus maintained by canid populations in Paraguay.

Paraguay has registered no human cases of rabies since 2004, and the last case in dogs, reported in 2009, was due to a variant maintained in the common vampire bat "Desmodus rotundus". In 2014, a dog was diagnosed as positive for rabies with aggression towards a boy and all required measures of control were successfully adopted. Epidemiological investigation revealed that the dog was not vaccinated and had been attacked by a crab-eating fox, "zorro" (Cerdocyon thous). The sample was diagnosed by the Official Veterinary Service of the Country and sent to the Center on Rabies Research from the University of São Paulo, Brazil, for antigenic and genetic characterization. A second sample from a dog positive for rabies in the same region in 2015 and 11 samples from a rabies outbreak from Asuncion in 1996 were also characterized. The antigenic profile of the samples, AgV2, was compatible with one of the variants maintained by dogs in Latin America. In genetic characterization, the samples segregated in the canine (domestic and wild species)-related group in an independent subgroup that also included samples from Argentina. These results and the epidemiology of the case indicate that even with the control of rabies in domestic animals, the virus can still circulate in wildlife and may be transmitted to domestic animals and humans, demonstrating the importance of continuous and improved surveillance and control of rabies, including in wild species, to prevent outbreaks in controlled areas.

Prevalencia del síndrome de Burnout en médicos anestesiólogos del Paraguay durante el año 2010 / Prevalence of Burnout syndrome in anesthesiologists of Paraguay during 2010

El síndrome de Burnout constituye un tipo de estrés laboral que se observa en profesionales de la salud que mantienen contacto directo y constante con otras personas. Para determinar su prevalencia en los médicos anestesiólogos del Paraguay, durante el 2010, se realizó un estudio observacional, descriptivo y de corte transverso en 146 médicos anestesiólogos del Paraguay mediante el cuestionario Maslash Burnout Inventory que evalúa las dimensiones del síndrome. Se identificó una prevalencia global de síndrome de Burnout de 72,6%. En el grupo de médicos residentes la prevalencia fue 88,6% (x2= 8,14 P<0,005). El cansancio emocional fue la dimensión más frecuente 60,9%. Los menores de 35 años padecieron el síndrome en mayor número 83,1% (x2= 8,14 P<0,005). Tener una pareja estable se identificó como un factor de protección (x2= 3,77 P<0,05). No se identificó relación significativa con el sexo y lugares de trabajo (medicina pública y privada). La prevalencia hallada fue alta en comparación a otros estudios. Ser médico residente, menor de 35 años, no tener una pareja estable y con sobrecarga de trabajo son los factores más frecuentes encontrados en el Síndrome de Burnout en los anestesiólogos del Paraguay.

Burnout Syndrome is a type of occupational stress observed health professionals who keep direct and constant contact with other persons. To determine its prevalence in anesthesiologist in 2010, this cross-sectional descriptive study was carried out in 146 Paraguayan anesthesiologist using the Maslash Burnout Inventory. This instrument evaluates the dimensions of the syndrome. A global prevalence of BS 72.6% was found. In the group of resident physician we found a prevalence of 88.6% (x2= 8.14 P<0.005). The most frequent dimension was the emotional exhaustion (60.9%). The syndrome was more frequent in the anesthesiologsts under 35 years of age (83.1%; x2= 8.14 P<0.005). Having a stable partner was identified as a protective factor (x2= 3.77 P<0.05). No significant relation was found with sex and working places (public and private medicine). The prevalence of BS found was high in comparison to other studies. Being a resident physician, under 35 year old, not having a stable partner and overload of work are the factors most frequently found in the Burnout Syndrome in Paraguayan anesthesiologysts.

Management of chronic kidney disease: primary health-care setting, self-care and multidisciplinary approach.

INTRODUCTION: End-stage renal disease (ESRD) is a growing problem, particularly in developing countries. Factors closely related with lifestyle and dietary habits that negatively affect kidney function are rarely modified by isolated medical intervention. Therefore, the present study was designed to determine the effect of an educational program with a multidisciplinary health-care approach supported by self-help groups on the lifestyle and dietary habits of patients at high risk of developing chronic kidney disease (CKD). PATIENTS: 51 patients with overweight/obesity, 45 with hypertension and 88 with Type 2 diabetes mellitus (DM2) from a Family Medicine Unit, who had failed to meet clinical practice recommendations, were studied over 6 months. Patients received educational intervention guided by a multidisciplinary health team for 4 weeks (including topics such as emotional management, nutritional patterns, exercise and health-related problems). Reinforcement of goals and group dynamics were performed every 3 months. Additionally, self-help groups were constituted during the first month, and functioned with free activities, selected by patients and supported by the health team, for the duration of the study. A lifestyle questionnaire was administered at baseline and the end of the study; clinical and biochemical evaluations were performed every 3 months. RESULTS: Baseline lifestyle and dietary habits were unhealthy in all groups, particularly with regard to diet and exercise, and clinical and biochemical variables were concordant with inadequate achievement of clinical practice recommendations. After 6 months experience within this program, many of the negative lifestyle characteristics significantly improved. All groups reported a notable improvement in nutritional and exercise habits, as well as in management of the emotions. Only diabetic and hypertensive patients significantly improved the knowledge of their disease and adherence to treatment. None of the groups managed to reduce smoking or to cut their alcohol intake habits; however, relatively few participants had displayed these behaviors at the start of the study. Compared to baseline, all the groups significantly reduced body mass index and waist circumference. Additionally, diabetics and overweight/ obese patients significantly reduced blood glucose and increased GFR, and hypertensive patients significantly decreased systolic blood pressure and tended, although not significantly, to increase GFR. Remarkably, all these changes were independent of drug treatment, because none of the therapeutic interventions that had been formerly prescribed by family physicians had been significantly changed by the end of the follow-up in any of the groups. CONCLUSIONS: The implementation of educational strategies comprising multiple interventions for patients, guided by health professionals (multidisciplinary teams including primary doctors, dietitians, nurses, social workers), and probably supported by self-help groups, may be very helpful in modifying negative lifestyle and dietary habits. Educational interventions by both doctors and patients should be adopted concurrently and may help to control the enormous and growing problem of ESRD.

Actividad larvicida de extractos vegetales acuosos en larvas de Aedes aegypti (primeros ensayos) / Larvicidal activity of aqueous plants extracts on Aedes aegypti larva (first trials)

El dengue es una enfermedad epidémica muy común en regiones tropicales y sub tropicales. La eliminación de criaderos y el control vectorial se encuentran entre las medidas en la lucha contra la enfermedad. Se han desarrollado diversas estrategias para mantener bajo índice poblacional del mosquito. Diversas investigaciones se han enfocado a la búsqueda de nuevos productos naturales, con actividad insecticida y larvicida, que puedan controlar la población de mosquitos, sin presentar riesgos al humano y animales domésticos. Realizamos una serie de bioensayos con extractos acuosos de plantas paraguayas, Annona muricata (chirimoya); Bulnesia sarmentoi (palo santo); Melia azederach (paraíso); Zanthoxylum chiloperone var. Angustifolium (tembetary hú) y Bixa orellana (urukú), para comprobar en cada planta, su actividad y eficacia como larvicida, contralarvas del mosquito Aedes agypti. Dichas larvas, fueron colectadas de diversas zonas de Asunción y el Gran Asunción, durante la epidemia de fiebre amarilla del año 2007. Las semillas de la Annona mucricata (chirimoya), presentaron una buena actividad larvicida, ya que a la mínima concentración del 5%, han tenido un efecto mortal para las larvas, comparable al observado en los controles positivos (que contenían temefos 1%). En cambio, M. aezsederach (paraíso) y Z. chiloperone (tembetary hú) no mostraron actividad larvicida a esa dosis, ni aún a otras superiores. Por otro lado B. sarmientoi (palo santo) y B. orellana (urukú), presentaron cierto efecto larvicida, eliminando al 18% de larvas a las 72 horas post-exposición. Se observó una marcada diferencia de actividad, entre el extracto de semillas chirimoya con los demás extractos probados

Dengue is an common epidemic disease in tropical and subtropical regions. The elimination of breeding sites and vector control are among the most widely used measures in the fight against the disease. Many strategies have been developed to keep low rates of mosquito populations. Several research studies have been focused on finding natural products with insecticide and larvicide activity that could effectively control these mosquito populations without risks for the human populations and domestic animals. In this work, we have performed a series of bioassays with aqueous extracts of Paraguayan plants: Annona muricata (cherimoya), Bulnesia sarmentoi (palo santo), Melia azederach (paradise), Zanthoxylum chiloperone var. Angustifolium (tembetary hú) and Bixa orellana (uruku) in order to check the effectiveness and activity as larvicide of each plant gainst Aedes aegypti larvae. The larvae were collected in various areas of Asuncion and Great Asuncion during the yellow fever outbreak of 2007. The seeds of A. mucricata (cherimoya or custard apple) showed good larvicidal activity, i.e. at the minimum concentration of 5%, showed lethality against larvae comparable to that observed in positive controls (containing 1% temephos). On the other hand, M. azederach (paradise) and Z. chiloperone (tembetary hú) did not show any larvicidal activity at the same dose and even at higher doses. B. sarmientoi (palo santo) and Bixa orellana (uruku) showed some larvicidal effect killing larva (18%) at 72 hours post-exposure. There was a marked difference in activity between the cherimoya seeds extract and the other extracts tested

Actividad larvicida de extractos vegetales acuosos en larvas de Aedesaegypti: primeros ensayos / Larvicidal activity of aqueous plants extracts on Aedes aegypti larva: first trials

El dengue es una enfermedad epidémica muy común en regiones tropicales y subtropicales. La eliminación de criaderos y el control vectorial se encuentran entre las medidas en la lucha contra la enfermedad. Se han desarrollado diversas estrategias para mantener bajo índice poblacional del mosquito. Diversas investigaciones se han enfocado a la búsqueda de nuevos productos naturales, con actividad insecticida y larvicida, que puedan controlar la población de mosquitos, sin presentar riesgos al humano y animales domésticos. Realizamos una serie de bioensayos con extractos acuosos de plantas paraguayas, Annona muricata (chirimoya); Bulnesia sarmentoi (palo santo); Melia azederach (paraíso); Zanthoxylum chiloperone var. Angustifolium (tembetary hú) y Bixaorellana (urukú), para comprobar en cada planta, su actividad y eficacia como larvicida, contra larvas del mosquito Aedes agypti. Dichas larvas, fueron colectadas de diversas zonas de Asunción y el Gran Asunción, durante la epidemia de fiebre amarilla del año 2007. Las semillas de la Annona mucricata (chirimoya), presentaron una buena actividad larvicida, ya que a la mínima concentración del 5%, han tenido un efecto mortal para las larvas, comparable al observado en los controles positivos (que contenían temefos 1%). En cambio, M. aezsederach (paraíso) y Z. chiloperone (tembetary hú) no mostraron actividad larvicida a esa dosis, ni aún a otras superiores. Por otro lado B. sarmientoi (palo santo) y B. orellana (urukú), presentaron cierto efecto larvicida, eliminando al 18% delarvas a las 72 horas post-exposición. Se observó una marcada diferencia de actividad, entre el extracto de semillas chirimoya con los demás extractos probados.

Dengue is an common epidemic disease in tropical and subtropical regions. Theelimination of breeding sites and vector control are among the most widely usedmeasures in the fight against the disease. Many strategies have been developed to keep low rates of mosquito populations. Several research studies have been focused on findingnatural products with insecticide and larvicide activity that could effectively control these mosquito populations without risks for the human populations and domestic animals. In this work, we have performed a series of bioassays with aqueous extracts of Paraguayan plants: Annona muricata (cherimoya), Bulnesia sarmentoi (palo santo), Melia azederach (paradise), Zanthoxylum chiloperone var. Angustifolium (tembetary hú) and Bixa orellana(uruku) in order to check the effectiveness and activity as larvicide of each plant gainst Aedes aegypti larvae. The larvae were collected in various areas of Asuncion and Great Asuncion during the yellow fever outbreak of 2007. The seeds of A. mucricata (cherimoya or custard apple) showed good larvicidal activity, i.e. at the minimum concentration of 5%, showed lethality against larvae comparable to that observed in positive controls(containing 1% temephos). On the other hand, M. azederach (paradise) and Z. chiloperone (tembetary hú) did not show any larvicidal activity at the same dose and even at higher doses. B. sarmientoi (palo santo) and Bixa orellana (uruku) showed somelarvicidal effect killing larva (18%) at 72 hours post-exposure. There was a marked difference in activity between the cherimoya seeds extract and the other extracts tested.

El tipo de transporte peritoneal puede ser diferente en las distintas poblaciones de diálisis peritoneal de México / Transport and peritoneal dialysis

Introducción: La prueba de equilibrio peritoneal (PEP) esla más utilizada para clasificar el transporte peritoneal(TP). Los valores de referencia para población mexicanase establecieron en el Instituto Nacional de Nutrición SalvadorZubirán (INNSZ) hace más de 10 años. El objetivode este estudio fue evaluar el TP en población del occidentedel país, y comparar los resultados con los de Twardowskiy colaboradores y del INNSZ.Resultados: Se realizaron 159 pruebas; 48% pacienteseran diabéticos y 62% hombres. La edad fue 46±16años, peso 66.8±17.0 kg, y superficie corporal1.70±0.23 m2. No hubo diferencias entre grupos endiabetes ni peritonitis. El tiempo en diálisis fue menor ennuestro estudio que en del INNSZ (14.6±17.8 vs20.8±21.4 meses; p<0.05). Comparados con Twardowskie INNSZ, las D/P de creatinina 0, 2 y 4-h fueronmayores, y las D/D0 2 y 4-h, así como el volumen drenadofueron menores en el presente estudio. Utilizandovalores de referencia propios, el transporte alto (A) seobservó en 18%, promedio alto (PA) en 33%, promediobajo (PB) en 34% y bajo (B) en 15%, mientras que usandovalores del INNSZ el transporte A fue 23%, PA 36%,PB 33% y B 8%. Conclusión: Los pacientes de la población estudiada tuvieronvalores promedio de transporte peritoneal más altos que losde otros estudios, incluyendo población mexicana. En condicionesideales, es recomendable determinar valores de referenciaen cada centro, puesto que extrapolarlos de otrasregiones podría llevar a errores en el diagnóstico del tipo de TP

Introduction: Peritoneal equilibration test (PET) is the mostcommon test to classify peritoneal transport (PT). Referencevalues from Mexican population were established in the InstitutoNacional de la Nutrición Salvador Zubirán (INNSZ)more than 10 years ago. The aims of this study were to evaluatePT in a west of Mexico population (Hospital de Especialidades,Centro Médico Nacional de Occidente [HE,CMNO]), and to compare results with those obtained byTwardowski et al and in the INNSZ.Results: One-hundred fifty-nine PETs were performed; 48%patients were diabetics and 62% were male. Mean age was46±16 years, weight 66.8±17.0 kg and body surface area1.70±0.23 m2. There were no differences between groupsregarding diabetes or peritonitis frequency. Time on dialysis wasshorter in the present study than in the INNSZ (14.6±17.8 vs20.8±21.4 months; p<0.05). Compared to the Twardowskiand INNSZ studies, creatinine D/P ratio at 0, 2 and 4-h werehigher, and the D/D0 ratio at 2 and 4-h, and drained volumewere lower in our population. Using values obtained in the presentstudy, high transport (H) was present in 18%, high average(HA) in 33%, low average (LA) in 34% and low (L) in 15%,whereas employing the INNSZ reference values, H was presentin 23%, HA in 36%, LA in 33% and L in 8%. Conclusions: Patients from this studied population hadmean peritoneal transport values higher than those obtainedin other studies, including Mexican values. Ideally, it isrecommendable to determine reference values in every center,as extrapolating results from other regions may lead toerrors in diagnosing the peritoneal transport type

Complicaciones pre y post tiroidectomía en hipertiroideos preparados con propanolol o antitiroideos / Thyroid patients preparaded with propanolol or antithyroid drugs

Establece las posibles implicancias sobre el evento quirurgico, de una preparación preoperatoria en base a dos modalidades terapéuticas llevadas a cabo en dos cátedras del Hospital de Clínicas de Asunción, para lo cual fueron revisados 149 expedientes clínicos de pacientes con hipertiroidismo que fueron agrupados en a) preoperatorio con propanolol sin antitiroideos y b) propanolol con antitiroideos

Nematodes of armadillos in Paraguay: a description of a new species Aspidodera esperanzae (Nematoda: Aspidoderidae).

Twelve species of nematodes comprising 9 genera were recovered from the gastrointestinal tract of 2 Euphractus sexcinctus and 2 Dasypus novemcinctus captured in the Department of San Pedro, Paraguay. All armadillos were infected with 1 or more species of nematode. The following nematodes were recovered: Mazzia mazzia, Spirura guianensis, Trichohelix tuberculata, Ancylostoma sp., Moennigia complexus, Moennigia pintoi, Ascaris dasypodina, Cruzia tentaculata, Aspidodera fasciata, Aspidodera scoleciformis, Aspidodera esperanzae n. sp., and Heterakinae gen. sp. This report describes a new species of the Aspidodera nematode, Aspidodera esperanzae n. sp., the first species to be reported bearing cephalic cordons made up of 7 longitudinal loops in the subfamily of Aspidoderinae. This study also documents a new host record for S. guianensis and shows a new geographical distribution in Paraguay for M. mazzia, S. guianensis, T. tuberculata, M. complexus, and M. pintoi.

Characterization of Paraguayan Trypanosoma cruzi strains isolated from acute patients of Chagas disease.

Five Paraguayan Trypanosoma cruzi strains, isolated from acute chagasic patients, were studied by their behavior in BALB/c mice, metacyelogenesis, bio-metry of metacyclic forms and lectin agglutination. Early and intermediate parasitemic peaks were observed and the strains did not show high virulence. Metacyclogenesis capacity was not higher than 50% in all cases and there were no considerable differences in the biometry. They all belong to WGA-type strains according to the lectin agglutination assays except for one strain that agglutinated with WGA and PNA lectins. Although previous schizodeme analysis of these strains showed rather homogeneous profiles, biological features were quite heterogeneous.

Serum insulin in clomiphene responders and nonresponders with polycystic ovarian disease.

OBJECTIVE: To investigate insulin levels in women with polycystic ovarian disease (PCOD) who are responders or nonresponders to clomiphene citrate (CC). DESIGN: Open and prospective study. SETTING: Outpatient infertility clinic of a third level medical institution. PATIENTS: Ten healthy women (group 1) and 35 PCOD women classified as responders (group 2 n = 10) or nonresponders (group 3 n = 25) on the basis of serum progesterone > or = 19 nmol/L in response to CC repeatedly administered in doses up to 250 mg/day for five days; they were further subdivided if body mass index (BMI) was below (N) or above (H) mean + 3 SD of group 1. INTERVENTIONS: Blood samples were obtained in a 100-g, 2-hours oral glucose tolerance test (OGTT). MAIN OUTCOME MEASURES: Serum glucose, insulin, free testosterone (free-T), dehydroepiandrosterone sulphate (DHEA-S), and androstenedione (A) were determined in the samples OGTT and the areas under the curve (AUC) were calculated. RESULTS: Group 3 had higher BMI, basal LH, and insulin and AUC insulin than groups 1 and 2; free-T was higher in groups 2 and 3 than in group 1, and basal PRL was higher in group 2 compared to groups 1 and 3. When BMI < or = 25.4 kg/m2 (mean + 1 SD of group 1) 77% of the PCOD cases responded (10 out of 13) whereas none with BMI > 25.4 responded to CC (n = 22) irrespectively of basal insulin concentration or AUC insulin. CONCLUSION: Moderate to excessive overweight seems more frequently and closely associated to a negative CC response in women with PCOD than hyperinsulinemia.

Animal reservoirs for Trypanosoma cruzi infection in an endemic area in Paraguay.

Animal reservoirs for Trypanosoma cruzi infection were investigated in 5 communities in the Department of San Pedro, currently one of Paraguay's most highly endemic areas. A total of 112 domestic animals (37 cattle, 2 horses, 1 ass, 20 pigs, 44 dogs and 8 cats) and 4 wild animals (1 white-eared opossum, 2 yellow armadillos and 1 common long-nosed armadillo) were examined for blood. Although no trypomastigotes were found by 2 direct observation methods, the microhaematocrit and Giemsa stained thick and thin smears methods, several forms of trypanosoma flagellates morphologically identical to T. cruzi were detected in the liver infusion tryptose (LIT) medium from a single sample taken from a yellow armadillo, Euphractus sexicintus. When serum samples of all the animals were examined for antibody to T. cruzi by direct agglutination (DA) test, 3 cattle, 2 pigs, 16 dogs and 3 cats had positive titers (1:32 or greater), but no wild animals showed positive reactions. T. cruzi was not found by culture nor microscopic examination of samples from any of the seropositive animals. However, domestic animals such as cattle, pigs, dogs and cats which were found to be seropositive in this study, possibly act as an animal reservoir in this endemic area as well as armadillos in which T. cruzi was observed.

Chest expansion in healthy adolescents and patients with the seronegative enthesopathy and arthropathy syndrome or juvenile ankylosing spondylitis.

OBJECTIVE: To determine chest expansion measurements in healthy children and those with juvenile spondyloarthropathies. METHODS: Chest expansion, as defined by the difference between maximal inspiration and maximal expiration was measured in 157 healthy adolescents (112 boys and 45 girls) aged 11 to 15 years, 20 patients with the seronegative enthesopathy and arthropathy (SEA) syndrome and 15 with juvenile ankylosing spondylitis (AS). RESULTS: The median and mean chest expansion (+/- 2 SD) were 5.0 cm and 5.6 cm (+/- 3.52) for the whole group of healthy adolescents, 6.0 cm and 5.9 cm (+/- 3.64) for boys and 5.0 cm and 4.8 cm (+/- 2.69) for girls. The frequency distribution of the values was leptokurtic and skewed to the right and did not follow the normal pattern; nearly 90% of the measurements fell within the interval from 3 to 9 cm. Of all variables analyzed (age, height, weight, sex and health/disease status), only height correlated with chest expansion (r = 0.20, p = 0.01). Even so, the effect of all these variables explained only 13% of the total variance of the measurements. Interobserver and intraobserver intraclass correlation coefficients were moderate (0.58 and 0.67, respectively). Mean values and cumulative frequency distribution in asymptomatic and symptomatic SEA syndrome and patients with juvenile AS were similar to those from healthy adolescents. CONCLUSION: Measuring chest expansion does not seem to be a useful method for the rare cases of early involvement of the chest joints in SEA syndrome and juvenile AS.