ABSTRACT
Early childhood obesity increases the risk of developing metabolic diseases. We examined the early introduction of exercise in small-litter obese-induced rats (SL) on glucose metabolism in the epididymal adipose tissue (AT) and soleus muscle (SM). On day 3 post-birth, pups were divided into groups of ten or three (SL). On day 22, rats were split into sedentary (S and SLS) and exercise (E and SLE) groups. The rats swam three times/week carrying a load for 30 min. In the first week, they swam without a load; in the 2nd week, they carried a load equivalent to 2% of their body weight; from the 3rd week to the final week, they carried a 5% body load. At 85 days of age, an insulin tolerance test was performed in some rats. At 90 days of age, rats were killed, and blood was harvested for plasma glucose, cholesterol, and triacylglycerol measurements. Mesenteric, epididymal, retroperitoneal, and brown adipose tissues were removed and weighed. SM and AT were incubated in the Krebs-Ringer bicarbonate buffer, 5.5 mM glucose for 1 h with or without 10 mU/mL insulin. Comparison between the groups was performed by 3-way ANOVA followed by the Tukey post-hoc test. Sedentary, overfed rats had greater body mass, more visceral fat, lower lactate production, and insulin resistance. Early introduction of exercise reduced plasma cholesterol and contained the deposition of white adipose tissue and insulin resistance. In conclusion, the early introduction of exercise prevents the effects of obesity on glucose metabolism in adulthood in this rat model.
ABSTRACT
BACKGROUND:Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality and surgical complications.OBJECTIVE:To determine the efficacy of the SSC using data from randomised controlled trials (RCTs). METHODS:This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42015017546). A comprehensive search of six databases was conducted using the OvidSP search engine.RESULTS:Four hundred and sixty-four citations revealed three eligible trials conducted in tertiary hospitals and a community hospital; with a total of 6 060 patients. All trials had allocation concealment bias and a lack of blinding of participants and personnel. A single trial that contributed 5 295 of the 6 060 patients to the meta-analysis had no detection; attrition or reporting biases. The SSC was associated with significantly decreased mortality (risk ratio (RR) 0.59; 95% confidence interval (CI) 0.42 - 0.85; p=0.0004; I2=0%) and surgical complications (RR 0.64; 95% CI 0.57 - 0.71; petlt;0.00001; I2=0%). The efficacy of the SSC on specific surgical complications was as follows: respiratory complications RR 0.59; 95% CI 0.21 - 1.70; p=0.33; cardiac complications RR 0.74; 95% CI 0.28 - 1.95; p=0.54; infectious complications RR 0.61; 95% CI 0.29 - 1.27; p=0.18; and perioperative bleeding RR 0.36; 95% CI 0.23 - 0.56; petlt;0.00001.CONCLUSIONS:There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However; randomised evidence of the efficacy of the SSC at rural hospital level is absent
Subject(s)
Checklist , Preoperative Care , Surgical Procedures, OperativeABSTRACT
Introducción: Las manifestaciones dermatológicas en el momento del diagnóstico de fibrosis quística son infrecuentes. Objetivo: Describir el caso de una lactante con una presentación dermatológica no habitual de fibrosis quística. Caso Clínico: Lactante que a los 2 meses de edad presenta un mal incremento pondoestatural. A los 4 meses presenta exantema cutáneo, edema y pelo gris. Dentro de su estudio se evidencia hipoproteinemia y anemia, y se confirma el diagnóstico de fibrosis quística mediante el estudio genético. Las alteraciones dermatológicas se revirtieron completamente tras la instauración de la terapia de reemplazo con enzimas pancreáticas. Este es el segundo caso reportado de pelo gris en niños con esta enfermedad. Conclusión: En niños con malnutrición que desarrollan alteraciones de la piel y fanéreos debemos sospechar enfermedades metabólicas como fibrosis quística.
Introduction: Cutaneous manifestations at the time of CF diagnosis are rare. Objective: To describe the case of an infant with an unusual cutaneous presentation of cystic fibrosis. Case report: The case is presented of an infant with delayed physical growth at two months, and at the age of four months, presented with a skin rash and gray hair. Tests revealed the presence of hypoproteinemia and anemia, with the diagnosis of Cystic Fibrosis being confirmed by genetic testing. The rash was completely resolved after pancreatic enzyme replacement therapy. This is the second gray hair case reported in children with this disease. Conclusion Metabolic diseases such as cystic fibrosis should be suspected in malnourished children who develop skin disorders.
Subject(s)
Humans , Female , Infant , Zinc/deficiency , Acrodermatitis/etiology , Hair Color , Cystic Fibrosis/diagnosis , Enzyme Replacement Therapy/methods , Genetic Testing/methods , Cystic Fibrosis/complications , Hypoproteinemia/etiology , Anemia/etiologySubject(s)
Humans , Female , Child , Fingers , Fibroma/diagnosis , Fibroma/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/pathologySubject(s)
Humans , Male , Child , Purpura/diagnosis , Purpura/pathology , Pigmentation Disorders/diagnosis , Pigmentation Disorders/pathologyABSTRACT
Acute infant hemorragic edema is a benign condition that affects children between 4 month and 2 years of age. Quick onset inflammatory edema and generalized ring shaped symmetric purpura are characteristic. Histology is of leucocitoclastic vasculitis. Clinical case: 9 month old child with a respiratory tract affection 2 weeks previous, consulting for left leg edema and fever, afterwards cutaneous and enteral mucosa purpura. Discussion: Acute hemorrhagic edema is a benign and self-limited illness. Lhe main differential diagnosis is Schonlein Henoch Purpura, and a careful evaluation and clinical follow-up is neccesary.
Introducción: El Edema Hemorrágico Agudo del Lactante (EHAL) es una condición benigna que afecta a niños entre 4 meses y 2 años, de inicio brusco, con edema inflamatorio y lesiones cutáneas del tipo purpúrico, anulares generalizadas y simétricas. A la histología los hallazgos son compatibles con una vasculitis leucocitoclástica. Caso clínico: Lactante de 9 meses de edad, que cursó con cuadro respiratorio 2 semanas previas y que consulta por aumento de volumen de la extremidad inferior izquierda y fiebre, agregándose en forma progresiva lesiones cutáneas purpúricas, compromiso de mucosas y gastrointestinal. Discusión: El EHAL es una condición benigna y autolimitada, cuyo principal diagnóstico diferencial es Púrpura de Schonlein-Henoch, la cual requiere una cuidadosa evaluación y segumiento clínico.
Subject(s)
Humans , Male , Infant , Edema/diagnosis , Hemorrhage/diagnosis , Vasculitis/diagnosis , Acute Disease , Diagnosis, Differential , IgA Vasculitis/diagnosisABSTRACT
La Enfermedad de Heck (EH) o Hiperplasia Epitelial Focal (HEF) es una proliferación benigna poco frecuente de la mucosa oral, generalmente asintomática, causada por el Virus Papiloma Humano (VPH), en su mayoría VPH 13 y 32. Afecta principalmente a niños, predominantemente de sexo femenino. En general se resuelve en forma espontánea, pero en algunos casos por su sintomatología o extenso compromiso se requiere de tratamiento. Existen múltiples modalidades terapéuticas, destacando entre ellas el Imiquimod. Describimos el caso de una paciente de ocho años de edad con una EH que presentó buena respuesta al tratamiento con Imiquimod 5 por ciento.
Hecks Disease (HD) or Focal Epithelial Hyperplasia (FEH) is a rare benign proliferation of the oral mucosa, usually asymptomatic, caused by Human Papilloma Virus (HPV), especially HPV 13 and 32. Affects mainly children, predominantly female.FEH generally resolves spontaneously, but some cases, either because of intensity or extension of symptoms may require treatment. There are several therapeutic alternatives, being Imiquimod the most successful. We report the case of a 8-year old with a HD that present good response to treatment with Imiquimod 5 percent.
Subject(s)
Humans , Female , Child , Aminoquinolines/administration & dosage , Focal Epithelial Hyperplasia/diagnosis , Focal Epithelial Hyperplasia/drug therapy , Administration, TopicalABSTRACT
Marfan syndrome (MS) is a dominant autosomal disease caused by mutations in chromosome 15, the locus controlling fibrillin 1 synthesis, and may exhibit skeletal, ocular, cardiovascular, and other manifestations. Pulse wave velocity (PWV) is used to measure arterial elasticity and stiffness and is related to the elastic properties of the vascular wall. Since the practice of exercise is limited in MS patients, it was of interest to analyze the acute effect of submaximal exercise on aortic distensibility using PWV and other hemodynamic variables in patients with MS with either mild or no aortic dilatation. PWV and physiological variables were evaluated before and after submaximal exercise in 33 patients with MS and 18 controls. PWV was 8.51 ± 0.58 at rest and 9.10 ± 0.63 m/s at the end of exercise (P = 0.002) in the group with MS and 8.07 ± 0.35 and 8.98 ± 0.56 m/s in the control group, respectively (P = 0.004). Comparative group analysis regarding PWV at rest and at the end of exercise revealed no statistically significant differences. The same was true for the group that used â-blockers and the one that did not. The final heart rate was 10 percent higher in the control group than in the MS group (P = 0.01). Final systolic arterial pressure was higher in the control group (P = 0.02). PWV in MS patients with mild or no aortic dilatation did not differ from the control group after submaximal effort.
Subject(s)
Female , Humans , Male , Young Adult , Aorta/physiology , Exercise Test , Exercise Tolerance/physiology , Marfan Syndrome/physiopathology , Vasodilation/physiology , Blood Flow Velocity/physiology , Blood Pressure/physiology , Case-Control Studies , Cross-Sectional Studies , Pulsatile Flow/physiology , Young AdultABSTRACT
Patients with metabolic syndrome are at high-risk for development of atherosclerosis and cardiovascular events. The objective of this study was to examine the major determinants of coronary disease severity, including those coronary risk factors associated with metabolic syndrome, during the early period after an acute coronary episode. We tested the hypothesis that inflammatory markers, especially highly sensitive C-reactive protein (hsCRP), are related to coronary atherosclerosis, in addition to traditional coronary risk factors. Subjects of both genders aged 30 to 75 years (N = 116) were prospectively included if they had suffered a recent acute coronary syndrome (acute myocardial infarction or unstable angina pectoris requiring hospitalization) and if they had metabolic syndrome diagnosed according to the National Cholesterol Education Program/Adult Treatment Panel III. Patients were submitted to a coronary angiography and the burden of atherosclerosis was estimated by the Gensini score. The severity of coronary disease was correlated (Spearmans or Pearsons coefficient) with gender (r = 0.291, P = 0.008), age (r = 0.218, P = 0.048), hsCRP (r = 0.256, P = 0.020), ApoB/ApoA ratio (r = 0.233, P = 0.041), and carotid intima-media thickness (r = 0.236, P = 0.041). After multiple linear regression, only male gender (P = 0.046) and hsCRP (P = 0.012) remained independently associated with the Gensini score. In this high-risk population, male gender and high levels of hsCRP, two variables that can be easily obtained, were associated with more extensive coronary disease, identifying patients with the highest potential of developing new coronary events.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Acute Coronary Syndrome/blood , C-Reactive Protein/metabolism , Metabolic Syndrome/blood , Severity of Illness Index , Acute Coronary Syndrome/etiology , Biomarkers/blood , Coronary Angiography , Metabolic Syndrome/complications , Prospective Studies , Risk Factors , Sensitivity and Specificity , Sex FactorsABSTRACT
Se presentan dos escolares con síndrome de Stevens Johnson asociado a un cuadro respiratorio agudo en los que se demostró infección por M. pneumoniae. Nos parece de interés destacar la importancia de investigar este agente como causa de síndrome de Stevens Johnson dado que actualmente se dispone de técnicas serológicas confiables que permiten su rápido diagnóstico. Ambos pacientes fueron tratados con claritromicina, además de las medidas generales, con muy buena evolución clínica
Subject(s)
Humans , Male , Female , Mycoplasma pneumoniae/pathogenicity , Stevens-Johnson Syndrome/microbiology , Clarithromycin/therapeutic use , Erythema Multiforme/microbiology , Eye Diseases/etiology , Skin Diseases/etiologyABSTRACT
Se revisaron las fichas clínicas de 536 pacientes con diagnóstico de meningitis bacteriana aguda que egresaron del Hospital Exequiel González Cortés en un período de 10 años (1983-1992). Los menores de 2 años constituyeron el grupo más afectado (72,6 por ciento). El diagnóstico bacteriológico se confirmo en el 78.0 por ciento, siendo los agentes más frecuentes H. influenzae, N. meningitidis y S. pneumoniae. Se destaca el aumento creciente de la frecuencia de N. meningitidis en los últimos años. La letalidad global fue de 14,7 por ciento, cifra que incluye 29 pacientes que fallecieron en las primeras 24 horas de su ingreso