Extramammary Metastases to the Breast: A Clinical and Diagnostic Masquerader.

Although breast carcinoma is common, metastatic deposits to the breast from extramammary neoplasms are rare. Clinically and radiologically, metastatic neoplasms may mimic primary benign and malignant neoplasms of the breast. A correct diagnosis of metastasis to the breast is of considerable importance since the treatment of primary and secondary malignancies of the breast is different. We report 4 cases of extra mammary primary cancers metastasizing to the breast, diagnosed by biopsy, in a period of 5 years in our tertiary care centre. Each of the cases had different characteristics. A good knowledge of cytomorphology and histomorphology, together with clinical correlation and comparison with previous histopathological evidence, will prevent a misdiagnosis and aid in optimal management and therapy.

Tracking demands for seeking psychological help before and during the COVID-19 pandemic: a quanti-qualitative study

Abstract The COVID-19 pandemic has placed unprecedented burdens on individuals and communities around the world. The isolation, fear, and uncertainty caused by the virus has led to increased rates of anxiety, depression, and other mental health issues. The pandemic has also had a disproportionate impact on individuals and communities with low income and socioeconomic status. Objective To shed light on the consequences of the pandemic on individuals from minorities and low-income areas, we investigate the main reasons that led patients who were referred to a social clinic of a private university in Rio de Janeiro to seek psychological treatment before (2019) and during the pandemic (2020 and 2021). Methods We conducted a quanti-qualitative study with a lexical analysis that evaluated 549 complaint forms of patients seeking treatment in these two distinct periods. Our analyses included descending hierarchical analysis (DHA) and correspondence factor analysis (CFA). Results Family dynamics and communication factors play a dominant role in the reason for seeking therapy and psychological treatment. Additionally, our study suggested an increase in anxiety and panic attacks among other mental health issues associated with griefand losses during the pandemic years. Conclusion Based on these analyses, we can begin to identify a few changes in the main demand and redirection of complaints of patients during the period of COVID-19.

Endovascular Treatment of a Giant Renal Artery Aneurysm with High-Flow Renal Arteriovenous Malformation

Renal artery aneurysms (RAAs) are rare lesions with a prevalence of less than 1% in the general population. Renal arteriovenous malformations (AVMs) are rare lesions with an estimated incidence of less than 0.04%. The coexistence of these two clinical entities is extremely rare and narrows the available treatment options by endovascular or open surgery. We describe a case of a giant symptomatic RAA type III, which was combined with a high-flow renal AVM in the right kidney. Using two vascular plugs, the RAA was excluded successfully. The perfusion of the right kidney’s lower pole was preserved by implantation of two covered stents in the inferior segmental renal artery.

Effect of thymoquinone: the extract of nigella sativa in accelerating soft callus formation in fracture

Background: Excessive oxidative stress on fracture case can inhibit fracture healing and decrease time of bone healing. Thymoquinone, an active substance of Nigella sativa, the so-called black cumin in common, is a potent antioxidant and have been studied as an antiosteoporotic agent. Thymoquinone is expected to be the adjuvant alternative that enhance the recovery process of fracture cases by reducing oxidative stress and promotes osteoblast proliferation on callus formation.Methods: Among 32 male mice Wistar Strain divided into 2 groups, conducted tibia fracture and casted. Group 1 was the control group without supplementation of Nigella sativa while black-cummin extract were given in group 2 orally at a dose of 800 mg/kg for 14 days. On the 14th day, group 1 and 2 were sacrificed, each bone tissue was taken to measure the levels of MDA by utilizing TBARS method and calculate the number of osteoblasts under the microscope. Data analysis were done using independent t-test.Results: There are both decreased MDA levels and increased number of osteoblasts that are histologically significant to the groups administered by Nigella sativa extract containing Thymoquinone compared to the control groups (p <0.05) on day 14.Conclusions: The administration of Thymoquinone from the extract of Nigella sativa reduced oxidative stress in fractures as well as increase the number of the osteoblast and its differentiation in callus formation.

Youth Tobacco Survey among the School Going Adolescents in a Block of Vadodara District, Gujarat.

Background: Tobacco use is the leading cause of Preventable death, Tobacco use during adolescence increases the risk of persistent addiction, leading to regular and sustained tobacco use in adulthood. Objective: To assess the prevalence and practice of tobacco use among the school going adolescents in a block of Vadodara district, Gujarat. Material & Methods: Multiphase sampling was done to select the sample students (13 to 17 years) from private and government schools in a selected block of Vadodara. A cross-sectional study including 1045 students was carried out using a pre-designed and pre-tested proforma. Results: Out of 1045 students, 3% (n=32) tried cigarette smoking ever, one or two puffs and 1.8% (19 students) of students were current cigarette or beedi smokers. Around 27.9% students and 23% students admitted that at least one of their parents and friends smoked cigarettes, respectively. About 24% and 44% of the students were exposed to passive smoking at home and outside home, respectively. Conclusions: Present study provides the baseline information of prevalence of smoking and attitude of school going adolescents towards smoking in Gujarat. The result gives an alarm to work upon tobacco control among adolescents and make them aware about the hazards.

Ultrasound guided rectus sheath blockade compared to peri-operative local anesthetic infiltration in infants undergoing supraumbilical pyloromyotomy

Provision of appropriate analgesia for supraumbilical pyloromyotomy in infants is limited by concerns about sensitivity to opioids and other medication groups, due to immature metabolism. Local anesthetic infiltration and ultrasound guided rectus sheath blockade are two techniques commonly employed to provide perioperative analgesia. The aim of this review was to compare the quality of post-operative analgesia afforded by these two techniques. A retrospective chart analysis of hospital records of all patients who underwent supraumbilical pyloromyotomy at a tertiary pediatric hospital between March 2009 and February 2011. Analysis of the anesthetic technique employed and post-operative acetaminophen requirements were performed. Additional information as to time to first post-operative feed, any complications and time of discharge from the hospital were collected by reviewing the post-operative nursing notes. A total of 30 patients underwent supraumbilical pyloromyotomy during this period. A total of 18 received local anesthetic infiltration at the end of the procedure and 12 patients underwent ultrasound guided pre-incisional rectus sheath block for post-operative analgesia. Patients who had post-operative local anesthetic infiltration had a median [range] of 2 [1-3] doses of acetaminophen in the first 24 h. In the group of patients who received a rectus sheath block, the median [range] number of doses of acetaminophen in the first 24 h was also 2 [1-3]. There were no differences in time to first feed and time to hospital discharge between the groups. The volume of local anesthetic administered was significantly smaller in the group receiving analgesia via rectus sheath block. Local anesthetic infiltration and pre-incisional ultrasound guided rectus sheath block provide similar degrees of post-operative analgesia. There were no differences between the two groups in time for first post-operative feed and time to hospital discharge.

psychosocial impact of diabetes in adolescents: a review

Type 1 Diabetes mellitus is known to have a major psychological impact on adolescents. Different types of therapies have been developed to support the patient as well as their families to deal with this impact. These include Behavioral Family Systems Therapy and Cognitive Behavioral Therapy. However, studies conducted recently, though few in numbers have shown a direct relationship between general psychological functioning and metabolic control. Self-management of diabetes and its complication therefore, is an integral part of these program. This review looks into the various studies carried out that decide the best approach towards addressing the psychological aspect of type 1 Diabetes Mellitus

The ABCs of molecular dynamics simulations on B-DNA, circa 2012.

This article provides a retrospective on the ABC initiative in the area of all-atom molecular dynamics (MD) simulations including explicit solvent on all tetranucleotide steps of duplex B-form DNA duplex, ca. 2012. The ABC consortium has completed two phases of simulations, the most current being a set of 50–100 trajectories based on the AMBER ff99 force field together with the parmbsc0 modification. Some general perspectives on the field of MD on DNA and sequence effects on DNA structure are provided, followed by an overview our MD results, including a detailed comparison of the ff99/parmbsc0 results with crystal and NMR structures available for d(CGCGAATTCGCG). Some projects inspired by or related to the ABC initiative and database are also reviewed, including methods for the trajectory analyses, informatics of dealing with the large database of results, compressions of trajectories for efficacy of distribution, DNA solvation by water and ions, parameterization of coarse-grained models with applications and gene finding and genome annotation.

Central serous chorioretinopathy secondary to trauma

The first case of central serous chorioretinopathy secondary to blunt trauma is presented. Optical coherence tomography performed on presentation, 3 days after trauma, demonstrated a neurosensory detachment of the macular, thus confirming clinical findings. At 3 months after injury, the retina had spontaneously flattened at the macular and vision had returned to normal

Ventricular myocyte contraction, intracellular calcium and expression of genes encoding cardiac muscle proteins in young and ageing Zucker diabetic fatty rat heart

Diabetes mellitus and its complications is a serious global health problem and the total number of people with this disease is projected to rise from 171 million in 2000 to 366 million in 2030. A recent study among Emirati citizens reported age-standardized rates for diabetes mellitus [diagnosed and undiagnosed] and pre-diabetes in those 30-64 years old as 29.0% and 24.2%, respectively. The association between type 2 diabetes mellitus and obesity is very strong and cardiovascular disease is the leading cause of morbidity and mortality among diabetic patients. The changes in ventricular myocyte contraction, intracellular calcium and the expression of genes encoding cardiac muscle proteins that take place in young [9-13 weeks] and ageing [30-34 weeks] Zucker diabetic fatty [ZDF] rat heart have been reviewed. Diabetes mellitus was associated with a fourfold elevation in non-fasting blood glucose in young and ageing ZDF rat compared with age-matched Zucker lean controls. Amplitude of shortening was unaltered in myocytes from young and ageing ZDF rats. Time to peak and time to half relaxation of shortening was prolonged in myocytes from young ZDF rats and was unaltered in myocytes from ageing ZDF rats compared with controls. Amplitude of the Ca[2+] transient was unaltered in myocytes from young and ageing ZDF rats. Time to peak Ca[2+] transient was prolonged in myocytes from young and ageing ZDF rats. L-type Ca[2+] current was significantly reduced in myocytes from young and ageing ZDF rats. Sarcoplasmic reticulum Ca[2+] transport did not appear to be altered in myocytes from young or ageing ZDF rats. Expression of genes encoding L-type Ca[2+] channel proteins, plasma membrane transporters, sarcoplasmic reticulum Ca[2+] and regulatory proteins and cardiac muscle proteins were variously up-regulated, down-regulated or unaltered in ventricles from young and ageing ZDF rats. Up-regulated genes in young ZDF rat heart included CACNA[1C], CACNA1G, CACNA1H, ATP1A1 and MYH7, whereas down-regulated genes in young ZDF rat heart included ATP1B1, SLC9A1, ATP2A2, CALM1, MYH6, MYL2, ACTC1, TNNI3, TNNT2 and TNNC1. Up-regulated genes in ageing ZDF rat heart included CACNA1G, CACNA1H, ATP2A1 and MYL2, whereas down-regulated genes in ageing ZDF rat heart included CACNA2D3, SLC9A1, ATP2A2, MYH6 and TNNT2. Subtle changes in expression of genes encoding various cardiac muscle proteins may underlie functional changes in hearts of young and ageing ZDF rats compared with age-matched controls

A saúde e estresse ocupacional em médicos / The health and occupational stress in physicians

Introdução: A prática da Medicina sofreu alterações relevantes nas últimas décadas e está atualmente associadaa condições desgastantes de trabalho, como carga horária excessiva, perda de autonomia, redução de salários e exposição a situações estressantes, que aumentam a vulnerabilidade desses profissionais para adoecimento,depressão, abuso de substâncias e suicídio. Objetivos: Identificar e analisar publicações sobre o estresse ocupacional e a saúde do médico. Métodos: Os artigos foram identificados nas bases de dados MedLine, LILACS e SciElo. Foram utilizadas as palavras-chave: saúde, médicos, estresse, trabalho. O período pesquisado foi de 1999 a 2009. Resultados: As publicações identificadas associam o trabalho médico com situações geradoras de ansiedade e estresse, que podem aumentar a vulnerabilidade para a Síndrome de Burnout, principalmente em profissionais que atuam em situações de emergência, cuidados intensivos, psiquiatria e oncologia. Abordam também a relação entre estresse e saúde, destacando a adoção de estratégias de enfrentamento inadequadas como a automedicação, abuso do álcool ou outras substâncias e tabagismo. Discussão: A alta demanda emocional e física do trabalho médico está associada a altos níveis de estresse e baixa freqüência hábitos saudáveis, como alimentação adequada, prática regular de atividade física, tempo para lazer e para a convivência com a família, o que afeta não só a saúde física e mental do médico, mas a qualidade dos serviços por ele prestados. Conclusão: Pesquisas sobre estratégias de enfrentamento para o estresse em médicos brasileiros ainda são importantes e o desenvolvimento de modelos de prevenção e intervenção é necessário para diminuir a vulnerabilidade desses profissionais ao adoecimento.

Introduction: In the last decades, Medicine practice has had great changes, and this is currently associatedwith bad working conditions such as wok overload, loss of autonomy, low salary and stress situations that expose physicians to sickness, depression, substance addiction and suicide. Background: To identify and evaluate publications about occupational stress and health of physicians. Methods: The papers were selected from Medline, SciELO and LILACS, using the keywords health, physicians, stress and work. The research comprised related papers of the the period from 1999 to 2009. Results: In these papers, the physician´s work was associated with conditions resulting stress situations which can increase the risk of Burnout Syndrome in professionals who work with Emergency, Intensive Care, Psychiatry and Oncology. They also reported the relationship between stress and health, pointing out the use of inadequate coping strategies such as selfmedication, alcohol or drug addiction and smoking habits. Discussion: The physicians´ high emotional and physical working overload creates stress and can produce low frequency of healthy habits such as adequate nutrition, physical exercises, spare time and familial contact. This can affect the physicians´ physical and mental health and also damage their service quality. Conclusion: Further research on strategies coping stress addressing Brazilian physicians are still important, and models of stress prevention and intervention are needed to reduce the vulnerability of these professionals to illness.

Cancer disparities between mainland and island Puerto Ricans / Disparidades en la incidencia de cáncer en puertorriqueños residentes en los Estados Unidos y Puerto Rico

OBJECTIVES: Examination of cancer rates in a single Hispanic subgroup-Puerto Ricans-and comparison of incidence rates among mainland Puerto Ricans living in the United States, island Puerto Ricans in Puerto Rico, and U.S. non-Hispanic whites to reveal ethnic-specific cancer patterns and disparities in Puerto Ricans. METHODS: Incidence data were obtained from the cancer registries of Puerto Rico and three U.S. northeastern states (New York, New Jersey, and Connecticut) with a high density of mainland Puerto Ricans. Age-adjusted rates were compared by standardized rate ratios (SRRs). RESULTS: Total cancer incidence was the lowest in island Puerto Ricans, intermediate for mainland Puerto Ricans, and highest in U.S. non-Hispanic whites. Compared to mainland Puerto Ricans, islanders had significantly lower rates (p < 0.05) for major cancers-lung (SRRs = 0.36 in males and 0.29 in females), prostate (SRR = 0.71), female breast (SRR = 0.73), and colon-rectum (SRRs = 0.74 in males and 0.65 in females)-as well as several less common cancers (urinary bladder; non-Hodgkin lymphoma; liver; kidney and renal pelvis; pancreas; thyroid; leukemia; and skin melanoma). Overall cancer rates in mainland Puerto Ricans were modestly lower than those in U.S. non-Hispanic whites, but mainland Puerto Ricans had the highest rates for stomach, liver, and cervical cancers among the three populations. CONCLUSION: Despite socioeconomic disadvantages, island Puerto Ricans have relatively low cancer incidence. Identifying contributing factors would be informative for cancer research, and understanding the reasons for increased cancer risk in their mainland counterparts would facilitate the development of ethnic-specific intervention programs.

OBJETIVOS: Se analizaron las tasas de cáncer en un subgrupo de hispanos residentes en los Estados Unidos de América -los puertorriqueños (PRREUA) y se compararon sus tasas de incidencia con las de los puertorriqueños que residen en Puerto Rico (PRRPR) y la población estadounidense blanca sin ascendencia hispana (EUBNH) a fin de encontrar patrones de cáncer y disparidades de orden étnico específicos para los puertorriqueños. MÉTODOS: Se obtuvieron los datos de incidencia de los registros de cáncer de Puerto Rico y tres estados del nordeste de los Estados Unidos (New York, New Jersey y Connecticut) que tienen una elevada densidad de PRREUA. Se compararon las tasas ajustadas por la edad mediante las razones de las tasas estandarizadas (SRR). RESULTADOS: La incidencia total de cáncer fue menor en los PRRPR, intermedia en los PRREUA y mayor en los EUBNH. Los PRRPR presentaron tasas significativamente menores que los PRREUA (P < 0,05) en los principales tipos de cáncer -de pulmón (SRR = 0,36 en hombres; SRR = 0,29 en mujeres), próstata (SRR = 0,71), mama (SRR = 0,73) y colorrectal (SRR = 0,74 en hombres y SRR = 0,65 en mujeres)- así como en algunos tipos de cáncer menos frecuentes (de vejiga, hígado, riñón y pelvis renal, páncreas, tiroides, linfomas no Hodgkin, leucemia y melanoma de piel). En general, las tasas de cáncer en los PRREUA fueron ligeramente menores que las de los EUBNH, aunque de las tres poblaciones los PRREUA tuvieron las mayores tasas de cáncer de estómago, hígado y cervicouterino. CONCLUSIONES: A pesar de las desventajas socioeconómicas, los PRRPR tienen una menor incidencia relativa de cáncer. La identificación de los factores que contribuyen a ello podría ayudar en las investigaciones sobre cáncer, y comprender las razones del mayor riesgo de cáncer en los PRREUA podría facilitar el desarrollo de programas de intervención específicos para esta población.

Resistencia a las fluoroquinolonas y otros antimicrobianos en cepas de Salmonella spp. aisladas en el procesamiento de pollo entero / Fluoroquinolone resistance and other drugs in Salmonella spp. strains isolates from whole chicken processing

El objetivo de este estudio fue determinar patrones de resistencia y multirresistencia de cepas de Salmonella spp. Aisladas de una planta procesadora de aves, hacia las quinolonas y fluoroquinolonas (ácido nalidíxico=Na, ciprofloxacina=Cf y enrofloxacina= Ex), así como a otros antimicrobianos: tetraciclinas (T), oxitetraciclina (O), neomicina (N), nitrofurantoina (Nf), trimetoprim (Tr) y cloranfenicol (C). Un total de 146 aislamientos de Salmonella spp. fueron obtenidos de diferentes fuentes: 34 cepas provenientes de mezclas de vísceras blancas (colón, ciegos) y vísceras rojas (hígado y bazo); 87 cepas aisladas de las canales en los procesos de desplume, eviscerado, enfriamiento y empacado; 8 cepas obtenidas de subproductos comestibles (patas, cuellos, hígados y mollejas) y 19 cepas de muestras de ambientes (agua, hielo y superficies de equipos). Se utilizaron técnicas microbiológicas convencionales, pruebas bioquímicas, serológicas y pruebas de susceptibilidad a los antibióticos por difusión en agar. Los resultados revelaron una alta resistencia para Na (73,3 por ciento; 107/146), Nf (60,2 por ciento; 88/146), T (56,2 por ciento; 82/146), O (54,8 por ciento; 80/146), Tr (54,1 por ciento; 79/146) y una menor resistencia a Ex (6.2 por ciento; 9/146), Cf (2,7por ciento; 4/146), N (2,0 por ciento; 3/146) y C (2,5por ciento; 4/146). Se encontró un porcentaje elevado de multirresistencia (65,0 por ciento; 95/146) y dentro de ellos, los más notorios fueron: NaNfTTr (42,1 por ciento), NaNfTr (26,3 por ciento) y NaNfT (10,5 por ciento). No se observó relación significativa (P>0,05) entre los patrones de resistencia y multirresistencia encontrados con el origen de las diferentes cepas de Salmonella. Estos resultados evidencian el surgimiento de cepas de Salmonellas resistentes a las quinolonas y la necesidad de programas de vigilancia de resistencia antimicrobiana.

The aim of this study was to determine the resistance and multi-resistance patterns of strains of Salmonella spp. isolated in a poultry processing plant in Zulia State, to quinolones and fluoroquinolones (Nalidixic acid=Na, ciprofloxacin=Cf, and enrofloxacin=Ex), as well as other antimicrobial drugs: tetracycline (T), oxitetracycline (O), neomycin (N), nitrofurantoine (Nf), trimetropim (Tr) and chloranfenicol (C). A total of 146 Salmonella isolates were obtained from different sources: 34 strains from pools of Intestines (duodenal and colon) and internal organs (liver and spleen); 87 strains of carcass samples collected in four different phases: carcasses after defeathering, evisceration, chilling, and final packed products; 8 strains from edible by-products (neck, liver, gizzard and legs) and 19 strains from environmental samples (water, ice, and equipment surfaces). The detection analyses were performed using conventional microbiological techniques, biochemical tests, serological and agar diffusion methods for antimicrobial susceptibility. The results showed a high resistance to Na (73.3%; 107/146), Nf (60.2%; 88/147), T (56.2%; 82/146), O (54.8%; 80/146), Tr (54.1%; 79/146) and low resistance to Ex (6.2%; 9/146), Cf (2.7%; 4/146), N (2.0%; 3/146) and C (2.7%; 4/146). There was observed a high percentage of multi-resistant strains (65.0%; 95/146) and within of them, the most common patterns were: NaNfTTr (42.1%), NaNfTr (26.3%) and NaNfT (10.5%). No significant relationship was observed (P>0.05) between resistance and multi-resistance patterns with the source of the Salmonella strains. These results are evidence of the emergence of resistant Salmonella strains to fluoroquinolones and the necessity of programs for antimicrobial resistance surveillance.

Área valvar mitral através de medidas de meia-pressão em átrio esquerdo e capilar pulmonar / Determination of mitral valve area through pressure half-time measurements in the left atrium and pulmonary capillary wedge

OBJETIVO: Testar a validade do cálculo da área valvar mitral (AVM) aplicando o método de meia-pressão do Doppler (MP) diretamente às curvas de pressão de átrio esquerdo (AE) e capilar pulmonar (Cap). MÉTODOS: Trinta e cinco pacientes com estenose valvar mitral (EVM) foram submetidos a valvotomia mitral percutânea pela técnica de Cribier com monitorização por cálculos de AVM feitos pelos métodos tradicionais (Gorlin e Eco-Doppler) e pelo proposto. Os valores de AVM calculados antes e após os procedimentos foram comparados entre si e foi aplicado modelo de regressão linear para cálculos recíprocos de AVM. RESULTADOS: Observou-se correlação entre os valores calculados por todos os métodos. O método proposto correlacionou-se fortemente com os demais (p< 0,05) notadamente antes da abertura valvar. Foram encontradas fórmulas simples para cálculo recíproco de AVM. CONCLUSÃO: O método proposto para cálculo de AVM seja sobre a curva pressórica de AE ou Cap mostrou-se preciso e simples monitorizando com segurança os procedimentos de valvotomoa mitral percutânea.

OBJECTIVE: To confirm the validity of the calculation in MVA applying the method of Doppler pressure half-time directly in left atrial (LA) and pulmonary capillary pressure curve. METHODS: Thirty-five patients with mitral valve stenosis underwent percutaneous mitral valvotomy (PMV) using the Cribier method with MVA measurement made using the traditional methods (Gorlin and echo-Doppler) and this propose. MVA values obtained were compared and a linear regression model was used to obtain formula for reciprocal calculations of the mitral valve area. RESULTS: A statistically correlation was found between the calculated values by all methods. The proposed method showed a strong correlation (p< 0.05) with the others mainly before valve opening. Simple reciprocal calculation formulas were found for mitral valve area assessment. CONCLUSION: The proposed method for the calculation of mitral valve area using LA or Cap proved to be highly accurate and simple making it possible to safely monitor valvotomy procedures.

Health disparities between island and mainland Puerto Ricans

OBJETIVO: Detectar disparidades de salud entre tres poblaciones: puertorriqueños que viven en Puerto Rico, así como puertorriqueños y personas no hispanas de raza blanca que viven en tierra firme estadounidense. MÉTODOS: Se analizaron los datos obtenidos mediante dos encuestas de similar diseño que se realizaron en 1999–2000. El Sistema de Vigilancia de Factores de Riesgo Conductuales proporcionó datos acerca de los puertorriqueños radicados en la isla y de residentes de Estados Unidos de raza blanca que no son hispanos. Otra encuesta de puertorriqueños radicados en la Ciudad de Nueva York aportó datos acerca de los puertorriqueños que residían en tierra firme estadounidense. Se usaron las razones de las tasas estandarizadas (standardized rate ratios, SRR) para hacer las comparaciones interpoblacionales de las prevalencias ponderadas, estandarizadas por edad y sexo, de varios parámetros (obesidad, diabetes, tabaquismo y dolencias físicas) y de indicadores de acceso a la atención sanitaria (frecuencia de los exámenes de rutina y de la atención de la diabetes). RESULTADOS: Los puertorriqueños que vivían en tierra firme estadounidense y los que vivían en la isla tuvieron una prevalencia de obesidad parecida (21% a 22%). Comparados con los habitantes de la isla, los puertorriqueños radicados en tierra firme tuvieron una prevalencia de diabetes más alta (SRR = 1,4; intervalo de confianza de 95% [IC95%]: 1,01 a 2,0); los que tenían diabetes también mostraron una mayor prevalencia de tabaquismo (SRR = 4,2; IC 95%: 2,3 a 7,7) y de dolencias físicas (SRR = 1,5%; IC95%: 1,1 a 2,0) que los puertorriqueños que vivían en la isla. Mientras que los puertorriqueños en tierra firme se asemejaron a los blancos que no eran hispanos en cuanto a la utilización de servicios de prevención primaria y de atención de la diabetes, los puertorriqueños en la isla tenían cifras de utilización mucho más bajas...

The co-development of liver and kidney transplantation (1955-1967).

Between 1955 and the end of 1967, the framework of clinical transplantation that exists today was established in a small number of centers in continental Europe, Great Britain, and the United States. At first, the primary organ was the kidney, but efforts to transplant the kidney soon strongly influenced the development of liver and ultimately all other kinds of organ transplantation. This paper reviews the pertinent history of these developments as outlined in a lecture given in January 2003 in Bangkok on the occasion of the Prince Mahidol Award for a life's work in the field of organ transplantation.

Transcatheter closure of patent ductus arteriosus in adults using the Amplatzer duct occluder: initial results and follow-up.

BACKGROUND: Surgical closure of patent ductus arteriosus in adult patients may be problematic. Transcatheter closure of patent ductus arteriosus is an established procedure. Recently, transcatheter closure of patent ductus arteriosus using the Amplatzer duct occluder has been shown to be safe and efficacious. We present our experience with this device in adults. METHODS AND RESULTS: Between January 2000 and January 2002,41 adult patients (31 females and 10 males) with a patent ductus arteriosus were referred for closure with the Amplatzer duct occluder. The median age was 35.6 years (range 18-70.7 years) and the median weight was 65.8 kg (range 32.7-164.5 kg). Of these 41 patients, 37 underwent attempted closure of the patent ductus arteriosus using the Amplatzer duct occluder. The device was successfully deployed in all patients except 1. Complete angiographic closure was seen Immediately after device deployment in 29 out of 36 patients (81%). Complete echocardiographic closure was demonstrated within 24 hours post-procedure in 34 out of 36 patients (94%), and at 6-month follow-up in 35 out of 36 patients (97%). No complications related to device implantation occurred in any patient. CONCLUSIONS: Closure of patent ductus arteriosus using the Amplatzer duct occluder is safe and effective in adults.