Global Health Education and Mediatization of Care in Costa Rica.

Costa Rica has become a destination for global health education courses, while funding for global health has increased dramatically over the past thirty years. An examination of one Costa Rican group's efforts to market humanitarian discourses, focusing on website design, provides a window into the workings of global health education and details the sometimes-uncomfortable position of non-US health professionals in educational programming. This contributes to theorizations of the intersection of mediatization and care, and suggests links between the legitimation of global health as a discipline, on the one hand, and the reproduction of inequities, on the other.

"Human Life is Inviolable": Costa Rica's Human Rights Crucible.

The Costa Rican Constitutional Court banned in vitro fertilization in 2000, citing the inviolability of life. Conservatives hoped the ban would initiate a hemispheric movement to protect the unborn. But in 2012 the Inter-American Court of Human Rights ruled that reproductive rights are human rights and that women's rights take precedence over embryo rights. The episode precipitated a national identity crisis: how could a country that supports universal health care be labeled a human rights violator as a result of its efforts to protect nascent human life? Expanding the health and human rights framework helps us appreciate how IVF became Costa Rica's human rights crucible.

La política nacional de medicamentos en el contexto de América Latina / The National Drugs Policy in the context of Latin America

Introducción: Una Política Nacional de Medicamentos es un recurso formal que permite ordenar, priorizar, planificar, controlar y evaluar; los aspectos más relevantes del ciclo de los medicamentos en un país. Objetivo: Revisar documentación concerniente al tema de Política Nacional de Medicamentos en América Latina. Fuente de datos: Documentos disponibles en la web referidos con el tópico. Síntesis de los datos: Una política surge a partir de un proceso consultivo complejo con la pretensión de lograr beneficios para la población a partir de la toma de decisiones basadas en la evidencia científica, lo que impone que los diversos aspectos relacionados con la gestión de la política deben estar actualizados, para responder a las necesidades y los cambios que experimenta una sociedad. En América Latina algunos países disponen de una política nacional de medicamentos; sin embargo, otros solo disponen de listas de medicamentos esenciales. Conclusiones: Existen en América Latina, experiencias positivas en la construcción de las Políticas Nacionales de Medicamentos y oportunidades de mejora en varios países. A pesar de los avances logrados en la construcción e implementación de esas políticas, todavía hay personas sin acceso a medicamentos en algunas regiones y se requiere incluir aspectos relacionados con la medicina tradicional, herbolarios, fitofármacos y biotecnológicos; también se deben mejora la promoción científica y los estudios poscomercialización de los medicamentos. En el caso particular de Costa Rica, se tiene una larga tradición de utilización de una política de medicamentos esenciales en la Seguridad Social, pero se carece de la consecuente política nacional(AU)

Introduction: A National Drugs Policy is a formal resource that allows ordering, prioritizing, planning, controlling and evaluating the most relevant aspects of the medicines cycle in a country. Objective: To review documentation concerning the topic of National Drugs Policy in Latin America. Data sources: Documents available on the web referring to the topic. Data synthesis: A policy arises from a complex consultative process with the aim of achieving benefits for the population from the decision making based on scientific evidence, which requires that the various aspects related to the management of the policy should be updated to respond to the needs and changes that a society experiences. In Latin America, some countries have a national drugs policy; however, others only have lists of essential medicines. Conclusions: There are positive experiences in Latin America in the construction of National Drugs Policies and opportunities for improvement in several countries. Despite the progress made in the construction and implementation of these policies, there are still people without access to medicines in some regions and it is necessary to include aspects related to traditional medicine, herbalists, phytopharmaceuticals and biotechnology. Scientific promotion and post-marketing studies of medicines should also be improved. In the particular case of Costa Rica, there is a long tradition of using an essential medicines policy in Social Security, but they lack of the consequent national policy(AU)

La política nacional de medicamentos en el contexto de América Latina / The National Drugs Policy in the context of Latin America

Introducción: Una Política Nacional de Medicamentos es un recurso formal que permite ordenar, priorizar, planificar, controlar y evaluar; los aspectos más relevantes del ciclo de los medicamentos en un país. Objetivo: Revisar documentación concerniente al tema de Política Nacional de Medicamentos en América Latina. Fuente de datos: Documentos disponibles en la web referidos con el tópico. Síntesis de los datos: Una política surge a partir de un proceso consultivo complejo con la pretensión de lograr beneficios para la población a partir de la toma de decisiones basadas en la evidencia científica, lo que impone que los diversos aspectos relacionados con la gestión de la política deben estar actualizados, para responder a las necesidades y los cambios que experimenta una sociedad. En América Latina algunos países disponen de una política nacional de medicamentos; sin embargo, otros solo disponen de listas de medicamentos esenciales. Conclusiones: Existen en América Latina, experiencias positivas en la construcción de las Políticas Nacionales de Medicamentos y oportunidades de mejora en varios países. A pesar de los avances logrados en la construcción e implementación de esas políticas, todavía hay personas sin acceso a medicamentos en algunas regiones y se requiere incluir aspectos relacionados con la medicina tradicional, herbolarios, fitofármacos y biotecnológicos; también se deben mejora la promoción científica y los estudios poscomercialización de los medicamentos. En el caso particular de Costa Rica, se tiene una larga tradición de utilización de una política de medicamentos esenciales en la Seguridad Social, pero se carece de la consecuente política nacional(AU)

Introduction: A National Drugs Policy is a formal resource that allows ordering, prioritizing, planning, controlling and evaluating the most relevant aspects of the medicines cycle in a country. Objective: To review documentation concerning the topic of National Drugs Policy in Latin America. Data sources: Documents available on the web referring to the topic. Data synthesis: A policy arises from a complex consultative process with the aim of achieving benefits for the population from the decision making based on scientific evidence, which requires that the various aspects related to the management of the policy should be updated to respond to the needs and changes that a society experiences. In Latin America, some countries have a national drugs policy; however, others only have lists of essential medicines. Conclusions: There are positive experiences in Latin America in the construction of National Drugs Policies and opportunities for improvement in several countries. Despite the progress made in the construction and implementation of these policies, there are still people without access to medicines in some regions and it is necessary to include aspects related to traditional medicine, herbalists, phytopharmaceuticals and biotechnology. Scientific promotion and post-marketing studies of medicines should also be improved. In the particular case of Costa Rica, there is a long tradition of using an essential medicines policy in Social Security, but they lack of the consequent national policy(AU)

Parental Action and Referral Patterns in Spatial Clusters of Childhood Autism Spectrum Disorder.

Sociodemographic factors have long been associated with disparities in autism spectrum disorder (ASD) diagnosis. Studies that identified spatial clustering of cases have suggested the importance of information about ASD moving through social networks of parents. Yet there is no direct evidence of this mechanism. This study explores the help-seeking behaviors and referral pathways of parents of diagnosed children in Costa Rica, one of two countries in which spatial clusters of cases have been identified. We interviewed the parents of 54 diagnosed children and focused on social network connections that influenced parents' help seeking and referral pathways that led to assessment. Spatial clusters of cases appear to be a result of seeking private rather than public care, and private clinics are more likely to refer cases to the diagnosing hospital. The referring clinic rather than information spread appears to explain the disparities.

Relevance of the ancestry for the variability of the Drug-Metabolizing Enzymes CYP2C9, CYP2C19 and CYP2D6 polymorphisms in a multiethnic Costa Rican population / Relevancia de la ancestría para la variabilidad de polimorfismos de las enzimas metabolizadoras de fármacos CYP2C9, CYP2C19 y CYP2D6 en una población multiétnica de Costa Rica

Abstract:CYP2C9, CYP2C19 and CYP2D6 metabolize around 40 % of drugs and their genes vary across populations. The Costa Rican population has a trihybrid ancestry and its key geographic location turns it into a suitable scenario to evaluate interethnic differences across populations. This study aims to describe the diversity of CYP2C9, CYP2C19 and CYP2D6 polymorphisms in Costa Rican populations in the context of their ancestry. A total of 448 healthy individuals were included in the study: Bribri (n= 47), Cabécar (n= 27), Maleku (n= 16), Guaymí (n= 30), Huetar (n= 48), Chorotega (n= 41), Admixed/Mestizos from the Central Valley/Guanacaste (n= 189), and Afro-Caribbeans (n= 50) from Limón. CYP2C9 (alleles *2, *3, *6) and CYP2C19 (*2, *3, *4, *5, *17) genotypes were determined by Real-Time PCR. African, European and Native American ancestry were inferred using 87 ancestry informative markers. The frequency of the decreased activity allele CYP2C9*2 is lower in the self-reported Amerindian groups compared to the admixed population, and the highest frequencies of CYP2C19*2 (null activity) and the CYP2C19*17 (increased activity) were found in the self-reported AfroCaribbean population. Moreover, a frequency of 0.7 % CYP2C9 gPMs in the Admixed population and a variable frequency of CYP2C19 gUMs (0.0-32.6 %, more prevalent in Afro-Caribbeans) in Costa Rican populations, was found. Finally, the following alleles were positively correlated with genomic African ancestry and negatively correlated with genomic Native American ancestry: CYP2D6*5 (null activity), CYP2D6*17 (decreased activity), CYP2D6*29 (decreased activity) and CYP2C19*17 (increased activity). No correlation for CYP2C9 polymorphisms and genomic ancestry was found. Further studies assessing the CYP2C9 and CYP2C19 sequence in these populations, preferentially by sequencing these genes, are warranted. Rev. Biol. Trop. 64 (3): 1067-1076. Epub 2016 September 01.

ResumenCYP2C9, CYP2C19 y CYP2D6 metabolizan aproximadamente el 40 % de los fármacos y los genes que las codifican varían en las distintas poblaciones humanas. La población costarricense posee ancestría trihíbrida y su posición geográfica estratégica la convierten en un escenario idóneo para evaluar la variabilidad interétnica en sus poblaciones multiétnicas. El presente estudio tiene como objetivo describir la diversidad de los polimorfismos CYP2C9, CYP2C19 y CYP2D6 en las poblaciones costarricenses en el contexto de su ancestría. Un total de 448 individuos sanos fueron incluidos: Bribri (n= 47), Cabécar (n= 27), Maleku (n= 16), Guaymí (n= 30), Huetar (n= 48), Chorotega (n= 41), mestizos del Valle Central y Guanacaste (n= 189) y afrocaribeños de Limón (n= 50). Los genotipos CYP2C9 (alelos *2, *3, *6) y CYP2C19 (*2, *3, *4, *5 y *17) fueron determinados mediante PCR tiempo real. Las ancestrías africana, europea y nativa americana fueron inferidas usando 87 marcadores informativos de ancestría. La frecuencia del alelo de actividad disminuida CYP2C9*2 fue menor en los grupos autodefinidos de amerindios que en la población mestiza y las frecuencias más altas de CYP2C19*2 (actividad nula) y CYP2C19*17 (actividad incrementada) se encontraron en la población autodefinida afrocaribeña. Asimismo, se encontró una frecuencia de gPMs CYP2C9 de 0.7 % en la población mestiza y una frecuencia variable de gUMs CYP2C19 (0.0 a 32.6 %, más prevalente en afrocaribeños) en las poblaciones costarricenses. Por último, los siguientes alelos fueron positivamente correlacionados con la ancestría africana y negativamente con la ancestría nativa americana: CYP2D6*5 (actividad nula), CYP2D6*17, CYP2D6*29 (ambos de actividad disminuida) y CYP2C19*17 (actividad incrementada). No se encontró correlación entre los polimorfismos CYP2C9 y la ancestría. Se requieren estudios posteriores que evalúen la secuencia de CYP2C9 y CYP2C19 en estas poblaciones, preferiblemente mediante la secuenciación de estos genes.

Caracterización de los pacientes con epilepsia refractaria de un hospital de tercer nivel en Costa Rica / Characteristics of patients with refractory epilepsy attended in a tertiary referral center in Costa Rica

Introducción. El 30% de los pacientes con epilepsia presenta convulsiones recurrentes, porcentaje que representa aproximadamente a 15 millones de personas en el mundo y constituye una población escasamente descrita. Objetivo. Caracterizar sociodemográfica y clínicamente la población de pacientes diagnosticados con epilepsia refractaria en un hospital terciario de Costa Rica. Pacientes y métodos. Se analizan los registros médicos de los pacientes con epilepsia refractaria valorados en la unidad de epilepsia del Hospital San Juan de Dios de la Caja Costarricense del Seguro Social desde agosto de 2012 a octubre de 2014. Resultados. Se incluyen los expedientes clínicos de 91 pacientes. La edad media de inicio fue de 13,1 ± 11,1 años. Las crisis secundariamente generalizadas constituyen el tipo predominante (81,3%), la etiología más frecuente es la esclerosis mesial temporal (48,3%) y la mayoría de los pacientes presentaba exámenes neurológicos normales y valoraciones neuropsicológicas normales o bajas. Alrededor de la mitad (48,8%) de los pacientes había sido medicada con un rango de 4-6 fármacos antiepilépticos, y los más prescritos fueron lamotrigina, carbamacepina, ácido valproico y fenitoína. Las principales recomendaciones en estos pacientes fueron: optimización de tratamiento, neurocirugía y reingreso. Se observan diferencias entre la edad de inicio y el sexo, la frecuencia de las crisis y el sexo, el tiempo de evolución de la patología y la cantidad de tratamientos fallidos, y el tiempo de evolución de la enfermedad y la ocupación. Conclusiones. Las características sociodemográficas, el manejo de los pacientes, los fármacos antiepilépticos utilizados y las diferencias encontradas son similares a las descritas en otras latitudes (AU)

Introduction. Thirty percent of patients with epilepsy have recurrent seizures, representing fifteen million people in the world. This population has been scarcely described. Aim. To characterize sociodemographic and clinically the patients diagnosed with refractory epilepsy in a tertiary referral hospital of the Costa Rican social security. Patients and methods. This study presents an analysis of all cases of refractory epilepsy evaluated at the epilepsy unit of San Juan de Dios Hospital from August, 2012 to October, 2014. Results. Clinical records of 91 patients were studied; patients with psychogenic seizures were analyzed separately. The mean age of onset was 13.1 ± 11.1 years, secondary generalized seizures were the predominant type (81.3%), the most frequent etiology was mesial temporal sclerosis (48.3%) and the majority had normal neurological exams and normal or low neuropsychological assessments. Around half (48.8%) of the patients had been medicated with a range of 4-6 antiepileptic drugs, being lamotrigine, carbamazepine, valproic acid and phenytoin the most prescribed. Treatment optimization, neurosurgery, and further analysis were standard recommendations. Sociodemographic characteristics, patient management, and antiepileptic drugs used are similar to the described in other latitudes. Differences between the age of onset and gender; seizure frequency and gender; age of onset and failed treatments and time of evolution of the disease and employment were observed. The percentage and characteristics of recurrent seizures of psychogenic nature found are comparable to other refractory epilepsy studies. Conclusion. Sociodemographic characteristics, management of patients, antiepileptic drugs used and the differences observed are similar to those previously described (AU)

Relevance of the ancestry for the variability of the Drug-Metabolizing Enzymes CYP2C9, CYP2C19 and CYP2D6 polymorphisms in a multiethnic Costa Rican population.

CYP2C9, CYP2C19 and CYP2D6 metabolize around 40% of drugs and their genes vary across populations. The Costa Rican population has a trihybrid ancestry and its key geographic location turns it into a suitable scenario to evaluate interethnic differences across populations. This study aims to describe the diversity of CYP2C9, CYP2C19 and CYP2D6 polymorphisms in Costa Rican populations in the context of their ancestry. A total of 448 healthy individuals were included in the study: Bribri (n= 47), Cabécar (n= 27), Maleku (n= 16), Guaymí (n= 30), Huetar (n= 48), Chorotega (n= 41), Admixed/Mestizos from the Central Valley/Guanacaste (n= 189), and Afro-Caribbeans (n= 50) from Limón. CYP2C9 (alleles *2, *3, *6) and CYP2C19 (*2, *3, *4, *5, *17) genotypes were determined by Real-Time PCR. African, European and Native American ancestry were inferred using 87 ancestry informative markers. The frequency of the decreased activity allele CYP2C9*2 is lower in the self-reported Amerindian groups compared to the admixed population, and the highest frequencies of CYP2C19*2 (null activity) and the CYP2C19*17 (increased activity) were found in the self-reported Afro-Caribbean population. Moreover, a frequency of 0.7 % CYP2C9 gPMs in the Admixed population and a variable frequency of CYP2C19 gUMs (0.0-32.6 %, more prevalent in Afro-Caribbeans) in Costa Rican populations, was found. Finally, the following alleles were positively correlated with genomic African ancestry and negatively correlated with genomic Native American ancestry: CYP2D6*5 (null activity), CYP2D6*17 (decreased activity), CYP2D6*29 (decreased activity) and CYP2C19*17 (increased activity). No correlation for CYP2C9 polymorphisms and genomic ancestry was found. Further studies assessing the CYP2C9 and CYP2C19 sequence in these populations, preferentially by sequencing these genes, are warranted.

Trombosis venosa séptica profunda secundaria a osteomielitis aguda, artritis séptica y piomiositis por Staphylococcus aureus en 3 niños de Costa Rica / Septic deep venous thrombosis secondary to acute osteomyelitis, septic arthritis and piomyositis due to Staphylococcus aureus in 3 Costa Rican children

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La Viagra nuestra de cada día. Consumo recreacional y angustias masculinas con respecto a su potencia eréctil / O Viagra nosso de cada dia. Consumo recreativo e angústias masculinas em relação à sua potência erétil / Give us this day our daily Viagra. Recreational use and male anxieties over erectile power

El presente artículo pone en discusión el consumo de pastillas para crear erecciones a través de medicamentos como Viagra y otros similares, principalmente entre hombres jóvenes de Costa Rica. Aunque no existen cifras contundentes de cuántos varones hacen uso recreacional de este tipo de fármaco, la temática sigue siendo poco explorada en América Latina. Se toma como marco de referencia la teoría foucaltiana y se analizan entrevistas realizadas a hombres consumidores de estas pastillas, así como extractos de comentarios sobre las angustias eréctiles masculinas escritos en un blog. Surge del análisis la idea de que en la actualidad, el pene es representado como un trabajador potencialmente cansado y enfermo, necesitado de ayudas externas para poder "laborar" adecuadamente. Los discursos que se presentan por medio de casas farmacéuticas así como de hombres de diferentes edades, muestran al llamado miembro viril como una parte del cuerpo que necesita asistencias y que obtiene modelos para actuar a través de la pornografía, los video-juegos y/o las caricaturas...

O presente artigo coloca em discussão o consumo de pílulas para criar ereções através de medicamentos como o Viagra e outros parecidos, principalmente em homens jovens da Costa Rica. Embora não existam números contundentes de quantos homens fazem uso recreativo deste tipo de fármaco, esta temática continua sendo pouco explorada na América Latina. Toma-se como marco de referência a teoria foucaultiana, e se analisam entrevistas realizadas com homens consumidores destas pílulas assim como trechos de comentários sobre as angústias eréteis masculinas escritos em um blog. Depreende-se da análise a ideia de que hoje em dia o pênis é representado como um trabalhador potencialmente cansado e doente, necessitado de ajudas externas para poder "trabalhar" adequadamente. Os discursos que se apresentam através de farmácias assim como de homens de diferentes idades mostram o chamado membro viril como uma parte do corpo que necessita de assistências e que obtém modelos para atuar através da pornografia, dos vídeos-jogos e/ou das caricaturas...

This article addresses the use of drugs like Viagra and others of the kind to produce erections, mainly among young men from Costa Rica. Although there is no hard data on how many men make recreational use of these drugs, this issue remains largely unexplored in Latin America. This article takes Foucauldian theory as its framework to analyse interviews with male consumers of these pills, and extracts of comments written on a blog about male erectile anxieties. From the analysis emerges the idea that, today, the penis is represented as a potentially tired and sick worker, needing outside help to "labor" properly. Discourses presented by pharmaceutical companies as well, as men of different ages, show the so-called 'virile member' as a part of the body that needs assistance and that gets its action models from pornography, video games, or cartoons...

Changelings: transformative perceptions of San José's street children, 1965-1981.

Between 1965 and 1981, Costa Ricans changed their perceptions of which characteristics they thought defined appropriate urban childhoods. By 1981, the model of a modern, urban Costa Rican child was that of a child who attended school, did not work on the streets, and played in specifically designated places. Children who did not fit this mold began, in the late 1970s and early 1980s, to be viewed as dangerous to society and as evidencing social pathology. Whereas children who worked on the streets during the 1960s were considered part of the urban landscape, and their childhoods, though difficult, were not perceived as deviant, these same children, two decades later, were viewed as marginal and problematic. To trace this change, this article focuses on the changing perceptions about children on the streets that writers for and public contributors to La Nación, one of the preeminent Costa Rican newspapers, show during the sixteen-year period under analysis.

Subcutaneous dematiaceous fungal infection.

Subcutaneous dematiaceous fungal infections, which include chromoblastomycosis and phaeohyphomycosis, are a heterogeneous group of clinical entities that are caused by dematiaceous or pigmented fungi found in soil. These infections have a wide spectrum of clinical presentations that depend largely on the specific causative organism and on the integrity of the host's immune response. Treatment is challenging and involves a highly individualized plan that often combines both surgical and long-term medical treatment.

Lack of association to a NRG1 missense polymorphism in schizophrenia or bipolar disorder in a Costa Rican population.

A missense polymorphism in the NRG1 gene, Val>Leu in exon 11, was reported to increase the risk of schizophrenia in selected families from the Central Valley region of Costa Rica (CVCR). The present study investigated the relationship between three NRG1 genetic variants, rs6994992, rs3924999, and Val>Leu missense polymorphism in exon 11, in cases and selected controls from an isolated population from the CVCR. Isolated populations can have less genetic heterogeneity and increase power to detect risk variants in candidate genes. Subjects with bipolar disorder (BD, n=358), schizophrenia (SZ, n=273), or unrelated controls (CO, n=479) were genotyped for three NRG1 variants. The NRG1 promoter polymorphism (rs6994992) was related to altered expression of NRG1 Type IV in other studies. The expression of NRG1 type IV in the dorsolateral prefrontal cortex (DLPFC) and the effect of the rs6994992 genotype on expression were explored in a postmortem cohort of BD, SZ, major depressive disorder (MDD) cases, and controls. The missense polymorphism Val>Leu in exon 11 was not significantly associated with schizophrenia as previously reported in a family sample from this population, the minor allele frequency is 4%, thus our sample size is not large enough to detect an association. We observed however an association of rs6994992 with NRG1 type IV expression in DLPFC and a significantly decreased expression in MDD compared to controls. The present results while negative do not rule out a genetic association of these SNPs with BD and SZ in CVCR, perhaps due to small risk effects that we were unable to detect and potential intergenic epistasis. The previous genetic relationship between expression of a putative brain-specific isoform of NRG1 type IV and SNP variation was replicated in postmortem samples in our preliminary study.

Pampered sons, (wo)manly men, or do-nothing machos? Costa Rican men coming of age under neoliberalism.

This article explores how young men in Costa Rica negotiate ideas of manhood under neoliberalism. We draw on interview data involving 23 men, ages 15­35, residing in one Costa Rican city. Comparing men across three different class locations, we find diverse "markers of manhood." Our data suggest an emerging globally dominant masculine ideal among an elite class of men, a declining locally dominant masculine ideal among working-class men, and a cynical, possibly counter-cultural masculine ideal among poor men. We conclude that masculinities are not only fluid, but tied to changing economic circumstances and class structures.

An investigation of habitual and incidental physical activity among Costa Rican and Costa Rican American teenage girls.

A comparative survey design was used to examine habitual and incidental physical activity among native Costa Rican (CR) and Costa Rican American (CRA) adolescent girls. The purposive sample included 17 girls (ages 12-19 years) living in Limon, Costa Rica (n = 11), and the metropolitan New York/New Jersey area (n = 6). Participants in the CR group had significantly higher levels of habitual (p = .04), incidental (p = .02), and combined (p = .03) physical activity as compared with those on the CRA group. Dance was a preferred form of activity for both groups. The relationship between habitual and incidental physical activity was not significant, underscoring the need to address both variables in assessment of total physical activity. The findings suggest a need to prioritize the promotion of physical activity among immigrant teenage girls using culturally valued methods.

Genome-wide linkage analysis of pulmonary function in families of children with asthma in Costa Rica.

BACKGROUND: Although asthma is highly prevalent among certain Hispanic subgroups, genetic determinants of asthma and asthma-related traits have not been conclusively identified in Hispanic populations. A study was undertaken to identify genomic regions containing susceptibility loci for pulmonary function and bronchodilator responsiveness (BDR) in Costa Ricans. METHODS: Eight extended pedigrees were ascertained through schoolchildren with asthma in the Central Valley of Costa Rica. Short tandem repeat (STR) markers were genotyped throughout the genome at an average spacing of 8.2 cM. Multipoint variance component linkage analyses of forced expiratory volume in 1 second (FEV(1)) and FEV(1)/ forced vital capacity (FVC; both pre-bronchodilator and post-bronchodilator) and BDR were performed in these eight families (pre-bronchodilator spirometry, n = 640; post-bronchodilator spirometry and BDR, n = 624). Nine additional STR markers were genotyped on chromosome 7. Secondary analyses were repeated after stratification by cigarette smoking. RESULTS: Among all subjects, the highest logarithm of the odds of linkage (LOD) score for FEV(1) (post-bronchodilator) was found on chromosome 7q34-35 (LOD = 2.45, including the additional markers). The highest LOD scores for FEV(1)/FVC (pre-bronchodilator) and BDR were found on chromosomes 2q (LOD = 1.53) and 9p (LOD = 1.53), respectively. Among former and current smokers there was near-significant evidence of linkage to FEV(1)/FVC (post-bronchodilator) on chromosome 5p (LOD = 3.27) and suggestive evidence of linkage to FEV(1) on chromosomes 3q (pre-bronchodilator, LOD = 2.74) and 4q (post-bronchodilator, LOD = 2.66). CONCLUSIONS: In eight families of children with asthma in Costa Rica, there is suggestive evidence of linkage to FEV(1) on chromosome 7q34-35. In these families, FEV(1)/FVC may be influenced by an interaction between cigarette smoking and a locus (loci) on chromosome 5p.

Anti-HIV activity of dibenzylbutyrolactone-type lignans from Phenax species endemic in Costa Rica.

Previously, we isolated two new dibenzylbutyrolactone-type lignans, named phenaxolactones and, from the leaves of Phenax angustifolius Wedd. (Urticaceae). In this investigation three new dibenzylbutyrolactone lignans (phenaxolactones), together with phenaxolactone, and flavones vitexin, isovitexin, were isolated from Phenax rugosus Wedd. leaves collected in Santa Ana, Costa Rica. The structures were elucidated using 1D and 2D NMR spectroscopy as well as mass spectrometry. Phenaxolactones and flavones and were evaluated for their inhibitory activity against HIV-1MN in infected C8166 cells. The most promising compound was phenaxolactone with an EC50 value of 3.0 microM, no cytotoxicity at 112 microM and a therapeutic index value of 37.3.

Biochemical indicators of nutritional status and dietary intake in Costa Rican Cabécar Indian adolescents.

The purpose of this study was to determine the blood levels of selected nutritional status indicators and the dietary intake of Costa Rican Cabécar Indians aged 10 to 16 years. The results showed that 65% of the adolescents had an adequate body mass index (BMI) for their age, and 32% had a BMI < 5th percentile. Likewise, the study revealed a high prevalence of anemia (57%), deficient serum folate levels (54%), deficient vitamin B12 levels (31%), and subclinical vitamin A deficiency (10%). Additionally, the youngsters had elevated prevalences of high triglyceride levels (77%), borderline high-density lipoprotein (HDL) cholesterol levels (46%), homocysteine levels > 10 micromol/L (29%), and homozygous mutation of methylenetetrahydrofolate reductase (MTHFR) (49%). The diet was poor, being high in saturated fat and low in polyunsaturated fat, fiber, and several micronutrients. The dietary intakes of more than 55% of the adolescents did not meet 50% of the estimated average requirements (EAR) for zinc, vitamin A, vitamin C, vitamin B12, vitamin B2, and folate. Furthermore, a high prevalence of parasitosis was found (68%). Our results show an adolescent Cabécar population with a mosaic of nutritional deficiencies and cardiovascular risk factors.

Clinical and electrophysiological characteristics of autosomal recessive axonal Charcot-Marie-Tooth disease (ARCMT2B) that maps to chromosome 19q13.3.

Charcot-Marie-Tooth disease (CMT) comprises a heterogeneous group of hereditary motor and sensory peripheral neuropathies. The autosomal recessive axonal form of CMT (ARCMT2) is rare. Eight patients of a large consanguineous family of Spanish ancestry in Costa Rica were diagnosed with ARCMT2B; previous genetic studies of this family revealed linkage to chromosome 19q13.3. The clinical and electrophysiological features of these patients are reported. All patients presented with a symmetric motor and sensory neuropathy, which was more pronounced in the lower limbs. Further, distal muscle wasting and impaired deep tendon reflexes were found. Age at onset was between 26 and 42 years, and the disease duration ranged from 2 to 19 years. Electrophysiological studies revealed a primary axonal degenerative process. The clinical characteristics of this family differed in several aspects from previously reported families with ARCMT2.

Comorbidity of bipolar disorder and substance abuse in Costa Rica: pedigree- and population-based studies.

BACKGROUND: The purpose of this study was to determine the prevalence of substance use disorders (substance abuse or substance dependence: SA/SD) in a large sample of Bipolar Type I (BPI) patients drawn from the Costa Rican population and to describe the effects of SA/SD on the course of their bipolar disorder. METHOD: 110 subjects from two high-risk (for BPI) Costa Rican pedigrees and 205 unrelated Costa Rican BPI subjects were assessed using structured interviews and a best estimate process. Chi(2) and survival analyses were performed to assess the effect of gender on comorbidity risk, and the effect of comorbidity on the clinical course of BPI. RESULTS: SA/SD (primarily alcohol dependence) occurred in 17% of the BPI patients from the population sample and 35% of the BPI patients from the pedigree sample. Comorbid SA/SD was strongly associated with gender chi(2) = 16.84, P = 0.00004). In comorbid subjects, alcohol dependence tended to predate the first manic episode (chi(2) = 6.54, P < 0.025). History of SA/SD did not significantly alter the prevalence of psychosis or age of onset of mania in BPI subjects. CONCLUSIONS: These results suggest that SA/SD comorbidity rates are lower in this type of population than in BPI patient populations in the US. Gender is a strong predictor of comorbidity prevalence in BPI patients from this population. Although SA/SD may be a risk factor for precipitating BPI in those at risk, in this population comorbid BPI subjects do not have a different onset or course of BPI in comparison to BPI patients without comorbidity.