Extended composite index of anthropometric failure in Argentinean preschool and school children.

OBJECTIVE: The Composite Index of Anthropometric Failure (CIAF) can only be applied to children under 5 years of age and does not contemplate obesity. The aim of this study was to propose an Extended CIAF (ECIAF) that combines the characterization of malnutrition due to undernutrition and excess weight, and apply it in six Argentine provinces. DESIGN: ECIAF excludes children not in anthropometric failure (group A) and was calculated from a percentage of children included in malnutrition categories B: wasting only; C: wasting and underweight; D: wasting, stunting and underweight; E: stunting and underweight; F: stunting only; Y: underweight only; G: only weight excess; and H: stunting and weight excess. SETTING: Cross-sectional study conducted in Buenos Aires, Catamarca, Chubut, Jujuy, Mendoza and Misiones (Argentina). PARTICIPANTS: 10 879 children of both sexes aged between 3 and 13·99. RESULTS: ECIAF in preschool children (3 to 4·99 years) was 15·1 %. The highest prevalence was registered in Mendoza (16·7 %) and the lowest in Misiones (12·0 %). In school children (5 to 13·99 years) ECIAF was 28·6 %. Mendoza also recorded the highest rate (30·7 %), while Catamarca and Chubut had the lowest values (27·0 %). In the whole sample, about 25 % of the malnutrition was caused by undernutrition and 75 % by excess weight. CONCLUSIONS: The ECIAF summarizes anthropometric failure by both deficiency and excess weight and it highlights that a quarter of the malnutrition in the Argentine population was caused by undernutrition, although there are differences between Provinces (P < 0·05). ECIAF estimates are higher than those of CIAF or under-nutrition.

Nutritional status, body composition, and intestinal parasitism among the Mbyá-Guaraní communities of Misiones, Argentina.

Indigenous communities in Argentina represent socially and economically neglected populations. They are living in extreme poverty and environmental degradation conditions. New information about health status and socio-environmental features is urgently needed to be applied in future sanitary policies. Present study describes the nutritional status, body composition, and intestinal parasitism among Mbyá-Guaraní children from three communities in the Misiones Province. Anthropometric parameters were analyzed for 178 individuals (aged 1-14). Data were transformed to z-scores using NHANES I and II. Stunting showed the greatest prevalence (44.9%). Children were found to have low arm circumference and low arm muscle area, although with tricipital skinfold value near to the reference. They also tend to have shorter than normal lower limbs. Fecal samples and anal brushes (for Enterobius vermicularis) were collected in 45 children (aged 1-13). Ritchie's sedimentation and Willis' flotation techniques were used to determine parasitoses. Ninety five percent of children were infected with at least one species and 81.4% were polyparasitized. The higher prevalences corresponded to Blastocystis hominis, hookworms (Ancylostoma duodenale/Necator americanus), and Entamoeba coli. Associations occurred between hookworms with B. hominis/E. coli and B. hominis with nonpathogenic amoebas. Thirty nine percent of the children with stunting presented B. hominis, Strongyloides, and hookworms. Our results indicate that this indigenous population is subjected to extreme poverty conditions and is one of the most marginalized in this country. Severe growth stunting and parasitic infection are still quite common among Mbyá children affecting about half of them along with significant changes in body composition and proportions.

Sentinel node biopsy for high-risk cutaneous nonanogenital squamous cell carcinoma: a preliminary result.

BACKGROUND: Certain patients with squamous cell carcinoma (SCC) have much higher rates of regional nodal metastases than is often reported. This study aims to further validate sentinel lymph node biopsy (SNB) for SCC and the outcome of these patients following SNB. METHODS: 20 patients with high-risk nonanogenital SCC who underwent SNB between 1998 and 2007 were retrospectively reviewed. SNB was performed under local or general anesthesia following lymphoscintigraphy and blue dye injection. RESULTS: The median follow-up from SNB was 24 months. Tumor location included the head and neck (n = 11), extremities (n = 9) and trunk (n = 1). One patient had a positive sentinel node. This patient developed parotid metastases 13 months after refusing a complete neck dissection and is alive with progressive disease after 31 months. Two patients developed regional recurrence after negative SNB (1 is alive and disease free, the other died of progressive disease). Of the remaining patients, 15 are alive and disease free, 1 died of another malignancy and 1 was lost to follow-up. CONCLUSION: SNB for high-risk SCC is feasible and allows early detection and treatment of nodal metastases. Currently, SNB for SCC is not a standard treatment and requires further investigation to determine which patients would benefit best from this procedure.

Occurrence of intestinal parasites in Mayan children from Yucatán, Mexico.

Parasitic intestinal infections occur worldwide and affect the poorest and deprived populations. In Mexico, indigenous peoples live with the highest levels of poverty and marginalization. This study aimed to analyze the occurrence of intestinal parasites among Mayan children from the villages of Xkalakdzonot and Paraíso in Yucatán State. Stool samples from 83 children were examined using two coproparasitological tests (formalin-ethyl acetate concentration and FLOTAC Pellet techniques). The overall prevalence of intestinal parasites in children was 65.1%. Six protozoa and four helminths were identified. Blastocystis sp. (44.6%), Giardia intestinalis (26.5%), and Entamoeba coli (26.5%) were the most prevalent parasites. The prevalence of helminth infections (7.1%) was lower in children from Xkalakdzonot than in Paraíso (29.3%). The study provides relevant information on the occurrence of intestinal parasites in Mayan children from two villages. This data, therefore, can be used by local health authorities to plan appropriate programs for parasite control, considering suitable drug therapies and health education.

A cross-sectional study of intestinal parasitoses in dogs and children of the periurban area of La Plata (Buenos Aires, Argentina): Zoonotic importance and implications in public health.

A cross-sectional study was performed between school term dates 2014 and 2015 to diagnose intestinal parasites in dogs and children living with them. The socio-environmental characteristics and hygiene practices of the children were also evaluated in terms of risk factors for parasitic infection of periurban neighbourhoods of La Plata (Buenos Aires, Argentina). Serial coproparasitological samples of 78 dogs and 211 children were analysed by means of concentration and flotation techniques. Socio-environmental variables and hygiene practices of children were evaluated through semi-structured questionnaires which were answered by every family. The study showed that 82.1% of dogs were parasitized. The specific richness was of 11 species; Ancylostoma caninum (69.2%), Uncinaria stenocephala (41.0%), Trichuris vulpis (28.2%) and Toxocara canis (21.8%) were the most prevalent. The study also revealed that 67.8% of children were positive. Also, 11 species were identified and the most prevalent were Blastocystis sp. (36.0%), Enterobius vermicularis (27.5%) and Giardia lamblia (21.3%). The risk for parasitosis was higher in 6-year-old children and older (OR = 1.9, 95% IC: 1.0-3.7) and in those who did not wash their hands or did it occasionally after playing with their pets (OR = 2.8, 95% IC: 1.4-5.5). Blastocystis sp. and Entamoeba coli infection risks were greater in children whose parents had a basic level of education (OR = 3.4, 95% IC: 1.3-8.7 and OR = 3.6, 95% IC: 0.8-15.9, respectively). In addition, the risk of infection for E. coli was higher in children who lived in floodable houses (OR = 4.4, 95% IC: 0.9-16.6). Likewise, the risk of infection for E. vermicularis was greater in children with onychophagia (OR = 1.6, 95% IC: 0.7-3.7) and in 6 year olds and older whose parents completed only primary studies (OR = 3.6, 95% IC: 1.4-9.1). The results obtained show the existence of a worrying epidemiological scenario that stresses the importance of zoonotic parasitosis as a serious problem of public health.

Frequency of Chlamydia trachomatis infection in cervical intraepithelial lesions and the status of cytological p16/Ki-67 dual-staining.

BACKGROUND: Chlamydia trachomatis (Ct) is not a disease subject to mandatory reporting in Brazil, and the prevalence rate of this genital infection varies according to the region in which studies are conducted, as well as by the detection technique employed. Ct has been associated with persistence of Human papillomavirus (HPV) infection and the facilitation of cervical carcinoma development. We evaluated the Chlamydia trachomatis infection and its association with cytology, p16/Ki-67 dual-stained cytology and cervical intraepithelial lesions status in a screening cohort in Brazil. METHODS: This was a cross-sectional study of 1481 cervical samples from asymptomatic women aged 18 to 64. Samples were collected for liquid-based cytology and Ct detection by polymerase chain reaction. p16/Ki-67 double staining was performed on samples with abnormal cytology. Statistical analysis was by chi-square and likelihood-ratio tests. Odds ratio (OR) and 95% confidence intervals (95% CI) were determined. RESULTS: The frequency of Ct was 15.6% and its presence was not associated with detection of p16/Ki-67 [OR = 1.35 (0.5-3.4)]. There was also no association between abnormal cervical cytology and Ct-positivity [OR = 1.21 (0.46-3.2)]. Associations were observed between p16/Ki-67 and high-grade lesions detected by cytology and in biopsies [OR = 3.55 (1.50-8.42) and OR = 19.00 (0.6-7.2), respectively]. CONCLUSIONS: The asymptomatic women in our study had a high frequency of Ct infection but this was not associated with p16/Ki-67 detection in samples with abnormal cytology. The expression of p16/Ki-67 was highest in women with high-grade CIN (p = 0.003).

Cytosolic calcium oscillations in astrocytes may regulate exocytotic release of glutamate.

To obtain insights into the spatiotemporal characteristics and mechanism of Ca(2+)-dependent glutamate release from astrocytes, we developed a new experimental approach using human embryonic kidney (HEK) 293 cells transfected with the NMDA receptor (NMDAR), which act as glutamate biosensors, plated on cultured astrocytes. We here show that oscillations of intracellular Ca(2+) concentration ([Ca(2+)](i)) in astrocytes trigger synchronous and repetitive [Ca(2+)](i) elevations in sensor HEK cells, and that these elevations are sensitive to NMDAR inhibition. By whole-cell patch-clamp recordings, we demonstrate that the activation of NMDARs in HEK cells results in inward currents that often have extremely fast kinetics, comparable with those of glutamate-mediated NMDAR currents in postsynaptic neurons. We also show that the release of glutamate from stimulated astrocytes is drastically reduced by agents that are known to reduce neuronal exocytosis, i.e., tetanus toxin and bafilomycin A(1). We conclude that [Ca(2+)](i) oscillations represent a frequency-encoded signaling system that controls a pulsatile release of glutamate from astrocytes. The fast activation of NMDARs in the sensor cells and the dependence of glutamate release on the functional integrity of both synaptobrevin and vacuolar H(+) ATPase suggest that astrocytes are endowed with an exocytotic mechanism of glutamate release that resembles that of neurons.

Major mediastinal injury from crossbow bolt.

We treated a 26-year-old male who sustained a self-inflicted injury to the mediastinum with a crossbow bolt. Injuries involved penetration of the sternum 1 cm below the sternomanubrial joint, right lung, pericardium, ascending aorta, right pulmonary artery, esophagus, and azygos vein. He was treated successfully with cardiopulmonary bypass and hypothermia. Exposure was achieved with a combination of a sternotomy and right thoracotomy.

[Treatment of spasticity: an update]. / Tratamento da espasticidade. Uma atualização.

We present an update about the treatment of spasticity, stressing the pharmacological treatment, physical therapy and botulinum toxin therapy.

Lymphoscintigraphy in clinical routine practice: reproducibility and accuracy in melanoma patients with a long-term follow-up.

INTRODUCTION: The sentinel node status is the most important single factor determining overall survival for patients with localized melanoma. Preoperative lymphoscintigraphy (LS) is essential in locating the correct sentinel lymph node (SN) and the reproducibility of the method determines the accuracy of the sentinel node biopsy (SNB). This study aims at determining the reproducibility and accuracy of LS in routine clinical practice after long-term follow-up. PATIENTS AND METHODS: One hundred and eight melanoma patients with clinically unpredictable lymphatic drainage were prospectively enrolled to undergo two LS. The first LS was performed to determine the site and number of the lymphatic basins to plan SNB anesthesia and the second preoperative LS was to allow SN localization intra-operatively. RESULTS: Lymphatic drainage was demonstrated in all patients. In 84 of 108 cases, both LSs were concordant in terms of site and number of nodal basins visualized. After a median follow-up of 80 months, no nodal recurrence was observed in the five patients with a decreased number of lymph node basins. In the group with increased number of lymph node basins, one patient developed nodal metastases in the same regional lymph node basin visualized by both LS studies. CONCLUSION: LS is an accurate and reproducible method to determine the localization of the sentinel node in the day-to-day routine to clinical practice when primary melanoma is also located in body sites with variable lymphatic drainage.

Lesões cervicais e infecção pelo papilomavirus humano no sistema prisional da cidade de São Paulo, Brasil / Cervical lesions and human papillomavirus infection in women at a prisional system in São Paulo city, Brazil

A relação entre o câncer cervical e a infecção pelo Papilomavírus Humano (HPV) está bem estabelecida. Múltiplos parceiros e múltiplas práticas sexuais são os fatores de risco associados à infecção pelo HPV. Existe uma grande probabilidade em que as mulheres internas em presídios tenham uma maior suscetibilidade de adquirir a infecção genital. A avaliação de alterações celulares, pelo exame de Papanicolaou, e identificação molecular de DNA-HPV de alto risco são utilizadas para a detecção e prevenção do câncer cervical. Quatrocentas e nove amostras cervicais de mulheres internas, nopresídio feminino da cidade de São Paulo, com idade entre 18 e 60 anos, foram analisadas, em 2006. Os achados celulares foram classificados com base no Sistema Bethesda (2001). O DNA-HPV foi identificado pelo PCR convencional, empregando os primersuniversais MY09/11, e os tipos identificados por PCR/RFLP, utilizando enzimas de restrição. Vinte e sete (6,60%) dos 409 esfregaços das internas do sistema penal revelaramLesões Escamosas Intraepiteliais de Baixo Grau (LSIL), 3 (11,11%) mostram alterações compatíveis com Lesões Escamosas Intraepiteliais de Alto Grau (HSIL), 5 (18,53%) exibiram Atipias Escamosas de Significado Indeterminado (ASC-US), 1 (3,70%) mostrou Células Glandulares Atípicas (CGA) e 1 (3,70%) revelou Carcinoma de Células Escamosas. DNA-HPV de alto risco foi identificado em 12 (44,43%) amostras (HPV 16, 18, 31, 33, 34, 39 e 61). Oito (29,62%) amostras revelaram infecção por HPV de baixo risco (HPV 6b). O presente estudo detectou uma alta prevalência de LSIL e HSIL associada à presença de DNA-HPV de alto risco, nas mulheres internas no sistema prisional.

The association between cervical cancer and Human PapillomavirusInfection (HPV) has been determinated. Multiple partners andmultiple sexual practices are risk factors associated with HPVinfection. There is a high probability that women resident in prisionscould be more susceptible to acquire genital HPV infection. Thescreening of cellular changes by pap-smear and the molecularidentification of high risk DNA-HPV is usefull for the detection andprevention of cervical cancer. Four hundred nine samples of cervicalsmear from women resident in a prisional system in São Paulo,between 18 to 60 years old were analyzed in 2006. The cellularresults were reported according to the Bethesda System Terminology,2001. The DNA-HPV detection was made by Conventional PCR usingConsensus Primers MY 09/11 and the HPV types were identify byPCR-RFLP using restriction endonuclease enzymes.Twenty seven(6,60%) out of 409 pap-smears samples showed pre malignant lesion.Seventeen (62,96%) out of these 27 samples revealed Low Squamous Intraepitheal Lesion (LSIL), 3 (11,11%) showed changessuggestive of High Squamous Intraepithelial Lesion (HSIL), 5(18,53%) samples presented Atypical Squamous Cells ofUndetermined Significance (ASC-US), 1 (3,70%) sample had AtypicalGlandular Cells (AGC), and 1 (3,70%) sample showed CervicalSquamous Carcinoma. High Risk DNA-HPV was identified in 12(44,43%) (HPV 16, 18, 31, 33, 34, 39 and 61). Eight (29,62%) samplesrevealed the low risk for neoplasic lesion subtype HPV-6b. Thepresent study reveal a high prevalence of LSIL and HSIL associatedwith the presence of High-risk DNA-HPV in women resident in aprisional system.

Correlação entre colpocitologia inflamatória e detecção do papilomavírus humano por reação em cadeia pela polimerase (PCR) / Correlation between inflammatory citology e Papillomavirus Human detection by Polymerase chain reaction

Nas últimas duas décadas, a incidência de casos de infecção pelo Papilomavírus humano (HPV) vem aumentando progressivamente, o que lhe confere um caráter epidêmico e o posiciona como a doença sexualmente transmissível mais comum. O aumento do câncer genital está diretamente associado ao HPV de alto risco. O presente trabalho objetivou identificar a presença de tipos dePapilomavírus (HPV) através da reação em cadeia pela polimerase (PCR), em esfregaços cérvico-vaginais classificados como inflamatórios(Bethesda,2001). Concluindo, no presente trabalho foi verificada a existência de DNA viral de alto risco em amostras citológica com padrão inflamatório sem evidências de sinais citopatológicos da ação viral...