Latin-American guidelines of recommendations at discharge from an acute coronary syndrome.

The diagnostic criteria, treatments at the time of admission, and drugs used in patients with acute coronary syndrome are well defined in countless guidelines. However, there is uncertainty about the measures to recommend during patient discharge planning. This document brings together the most recent evidence and the standardized and optimal treatment for patients at the time of discharge from hospitalization for an acute coronary syndrome, for comprehensive and safe care in the patient's transition between care from the acute event to the outpatient care, with the aim of optimizing the recovery of viable myocardium, guaranteeing the most appropriate secondary prevention, reducing the risk of a new coronary event and mortality, as well as the adequate reintegration of patients into daily life.

Los criterios diagnósticos, los tratamientos en el momento de la admisión y los fármacos utilizados en pacientes con síndrome coronario agudo están bien definidos en innumerables guías. Sin embargo, existe incertidumbre acerca de las medidas para recomendar durante la planificación del egreso de los pacientes. Este documento reúne las evidencias más recientes y el tratamiento estandarizado y óptimo para los pacientes al momento del egreso de una hospitalización por un síndrome coronario agudo, para un cuidado integral y seguro en la transición del paciente entre la atención del evento agudo y el cuidado ambulatorio, con el objetivo de optimizar la recuperación de miocardio viable, garantizar la prevención secundaria más adecuada, reducir el riesgo de un nuevo evento coronario y la mortalidad, así como la adecuada reinserción de los pacientes en la vida cotidiana.

Comparison of the design and methodology of Phase 3 clinical trials of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) and dolutegravir-based dual therapy (DTG) in HIV: a systematic review of the literature.

INTRODUCTION: Current recommended antiretroviral regimens include a combination of two (dual; DT) or three (triple; TT) antiretroviral drugs. This study aims to determine whether the quality of evidence from clinical trials of dolutegravir (dolutegravir/lamivudine [DTG/3TC] or dolutegravir/rilpivirine [DTG/RPV]) is methodologically comparable to that of clinical trials conducted with bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). AREAS COVERED: A systematic review of the medical literature was carried out in PubMed without date or language restrictions, following the PRISMA guidelines. All aspects of the methodological design of phase 3 randomized clinical trials (RCTs) of DT and TT, evaluated by the European Medicines Agency (registration trials), were reviewed. The quality of clinical trials was assessed using the Jadad scale. EXPERT OPINION: The search identified 5, 3 and 2 phase 3 RCTs with BIC/FTC/TAF, DTG/3TC and DTG/RPV, respectively, that met the inclusion criteria. The designs would not be comparable due to differences in pre-randomization losses, blinding, patient recruitment, as well as differences in methodological quality, with the average score of the RCTs conducted with BIC/FTC/TAF, DTG/3TC and DTG/RPV being 4.2 (high quality), 3.0 (medium quality) and 3.0 (medium quality), respectively. Due to methodological differences between the BIC/FTC/TAF, DTG/3TC and DTG/RPV RCTs, the results of these are not comparable.

Imaging findings of pulmonary contusions on multidetector CT: A retrospective study comparing adults and children.

To describe imaging findings of pulmonary contusions (PC) in adults and children using multidetector computed tomography (CT) scanners. We conducted a retrospective single center study. All chest multidetector computed tomography (MDCT) scans of victims of blunt trauma admitted to the emergency unit of a reference trauma center of Brazil between January 2015 and December 2016 were reviewed in search of opacities compatible with PC. The CT images were analyzed in conjunction with medical records, that provided demographic and clinical data. The obtained data were analyzed in the overall population and comparing children and adults. Significant P value was defined as <.05. 52.7% of patients presented bilateral opacities. Middle third, posterior and peripheral portions of the lungs were more frequently affected, in the craniocaudal, anteroposterior and axial axes, respectively. A vast majority of patients (80.6%) presented multiple opacities, whereas a minority showed subpleural sparing (26.9%) and fissure crossing (22.6%), with similar frequencies in children and adults. Children, although, more frequently presented consolidation and more diffuse lesions in the anteroposterior axis compared to adults, with statistically significant differences. PC usually are multiple and predominate in middle, posterior and peripheral portions of the lungs. Subpleural sparing and fissure crossing seems to be infrequent and have similar frequencies between children and adults. Although, there are differences between these age groups, as younger people tend to have more consolidation and diffuse opacities in the anteroposterior axis than older ones.

T2-weighted imaging hypointensity in an ovarian lesion: is it a benign finding?

OBJECTIVE: To evaluate whether the presence of a hypointense signal at T2-weighted imaging in a solid ovarian lesion on magnetic resonance imaging is a predictor of stability and benignity. METHODS: This is a single center study, prospectively read with retrospective acquired data. The database was searched for patients who underwent magnetic resonance imaging between January 2008 and October 2019 and whose reports mentioned solid ovarian lesions with low signal on T2-weighted imaging. A total of 47 nodules were included. A radiologist who was blinded to the clinical indication for magnetic resonance imaging and original reports evaluated the cases. Objective and subjective criteria of ovarian lesions in magnetic resonance imaging were evaluated. RESULTS: Thirty-five nodules were considered benign/stable and 12 were considered non-stable. The analysis showed that the non-stable lesions showed statistically more hyperintensity at T1-weighted imaging compared to the stable lesions. CONCLUSION: T2-weighted imaging hypointensity can be considered a predictor of stability in solid ovarian lesions when associated with iso/hypointensity in T1-weighted imaging.

A simple and scalable 3D printing methodology for generating aligned and extended human and murine skeletal muscle tissues.

Preclinical biomedical and pharmaceutical research on disease causes, drug targets, and side effects increasingly relies onin vitromodels of human tissue. 3D printing offers unique opportunities for generating models of superior physiological accuracy, as well as for automating their fabrication. Towards these goals, we here describe a simple and scalable methodology for generating physiologically relevant models of skeletal muscle. Our approach relies on dual-material micro-extrusion of two types of gelatin hydrogel into patterned soft substrates with locally alternating stiffness. We identify minimally complex patterns capable of guiding the large-scale self-assembly of aligned, extended, and contractile human and murine skeletal myotubes. Interestingly, we find high-resolution patterning is not required, as even patterns with feature sizes of several hundred micrometers is sufficient. Consequently, the procedure is rapid and compatible with any low-cost extrusion-based 3D printer. The generated myotubes easily span several millimeters, and various myotube patterns can be generated in a predictable and reproducible manner. The compliant nature and adjustable thickness of the hydrogel substrates, serves to enable extended culture of contractile myotubes. The method is further readily compatible with standard cell-culturing platforms as well as commercially available electrodes for electrically induced exercise and monitoring of the myotubes.

T2-weighted imaging hypointensity in an ovarian lesion: is it a benign finding?

ABSTRACT Objective To evaluate whether the presence of a hypointense signal at T2-weighted imaging in a solid ovarian lesion on magnetic resonance imaging is a predictor of stability and benignity. Methods This is a single center study, prospectively read with retrospective acquired data. The database was searched for patients who underwent magnetic resonance imaging between January 2008 and October 2019 and whose reports mentioned solid ovarian lesions with low signal on T2-weighted imaging. A total of 47 nodules were included. A radiologist who was blinded to the clinical indication for magnetic resonance imaging and original reports evaluated the cases. Objective and subjective criteria of ovarian lesions in magnetic resonance imaging were evaluated. Results Thirty-five nodules were considered benign/stable and 12 were considered non-stable. The analysis showed that the non-stable lesions showed statistically more hyperintensity at T1-weighted imaging compared to the stable lesions. Conclusion T2-weighted imaging hypointensity can be considered a predictor of stability in solid ovarian lesions when associated with iso/hypointensity in T1-weighted imaging.

Radiographic changes of cervical spine in rheumatoid arthritis.

INTRODUCTION: The involvement of the cervical spine is a common feature of rheumatoid arthritis (RA). OBJECTIVE: To study the prevalence of radiographic changes of the cervical spine in patients with RA and their association with clinical and serological profiles of the disease. METHODS: We analysed lateral (neutral position, hyperextension, hyperflexion) and transoral views of cervical spine radiographs from 80 individuals with RA to investigate the presence of atlanto-axial subluxation (AAS), basilar invagination (BI), and subaxial instability (SAI). Demographic, clinical (nodules, interstitial pneumonitis, secondary Sjögren's syndrome, medications etc.), and serologic (rheumatoid factor--RF, cyclic citrullinated peptide antibody--anti-CCP, and antinuclear factor--ANF) data were obtained from the clinical records. RESULTS: Cervical spine misalignments were identified in 26/80 (32.5%) participants; AAS occurred in 12/80 (15%) participants, BI in 6/80 (7.5%), and SAI in 13/80 (32.5%). Odontoid erosions were identified in 16/80 (20.0%) participants. Cervical spine misalignment exhibited associations with age at onset and disease duration (P = 0.03 and 0.02, respectively). No associations were identified between the cervical spine changes and the participants' ethnicity or gender, presence of nodules, interstitial pneumonitis, secondary Sjögren's syndrome, RF, ANF, or anti-CCP. The participants with cervical spine misalignment exhibited higher frequencies of odontoid erosion (P = 0.03). CONCLUSIONS: Cervical spine misalignment was a common radiographic finding and occurred more frequently in participants with earlier onset and longer length of RA.

Alterações radiográficas de coluna cervical em artrite reumatoide / Radiographic changes of cervical spine in rheumatoid arthritis

INTRODUÇÃO: O envolvimento da coluna cervical é comum na artrite reumatoide (AR). OBJETIVO: Estudar a prevalência das alterações radiológicas de coluna cervical em pacientes com AR e sua associação com perfil clinico e sorológico da doença. MÉTODOS: Analisaram-se as radiografias de coluna cervical em perfil neutro hiperextensão, hiperflexão e transoral de 80 pacientes com AR para presença de subluxação atlanto-axial (LAA), invaginação basilar (IB) e instabilidade subaxial (ISA). Dados de perfil demográfico, clínico (nódulos, pneumonite intersticial, síndrome Sjögren secundária, uso de medicamentos etc.) e sorológico (FR, anti-CCP e FAN) foram obtidos por revisão de prontuários. RESULTADOS: Havia alguma alteração de eixo de coluna cervical em 26/80 (32,5%); em 12/80 (15%) havia LAA; em 6/80(7,5%) existia IB; em 13/80 (16,2%) existia ISA. Erosões em odontoide foram vistas 16/80 (20,0%). As alterações do eixo cervical estavam associadas com idade de início da doença e duração da mesma (P = 0,03 e 0,02, respectivamente). Não se encontrou associação das alterações em coluna cervical com raça, gênero, nódulos, pneumonite intersticial, Sjögren secundário, FR, FAN ou anti-CCP. Pacientes com alterações do eixo cervical apresentavam mais erosões de odontoide (P = 0,03). CONCLUSÕES: Alterações radiológicas em eixo de coluna cervical são comuns e aparecem mais frequentemente em indivíduos com diagnóstico mais precoce de AR e maior tempo de doença.

INTRODUCTION: The involvement of the cervical spine is a common feature of rheumatoid arthritis (RA). OBJECTIVE: To study the prevalence of radiographic changes of the cervical spine in patients with RA and their association with clinical and serological profiles of the disease. METHODS: We analysed lateral (neutral position, hyperextension, hyperflexion) and transoral views of cervical spine radiographs from 80 individuals with RA to investigate the presence of atlanto-axial subluxation (AAS), basilar invagination (BI), and subaxial instability (SAI). Demographic, clinical (nodules, interstitial pneumonitis, secondary Sjögren's syndrome, medications etc.), and serologic (rheumatoid factor - RF, cyclic citrullinated peptide antibody - anti-CCP, and antinuclear factor - ANF) data were obtained from the clinical records. RESULTS: Cervical spine misalignments were identified in 26/80 (32.5%) participants; AAS occurred in 12/80 (15%) participants, BI in 6/80 (7.5%), and SAI in 13/80 (32.5%). Odontoid erosions were identified in 16/80 (20.0%) participants. Cervical spine misalignment exhibited associations with age at onset and disease duration (P = 0.03 and 0.02, respectively). No associations were identified between the cervical spine changes and the participants' ethnicity or gender, presence of nodules, interstitial pneumonitis, secondary Sjögren's syndrome, RF, ANF, or anti-CCP. The participants with cervical spine misalignment exhibited higher frequencies of odontoid erosion (P = 0.03). CONCLUSIONS: Cervical spine misalignment was a common radiographic finding and occurred more frequently in participants with earlier onset and longer length of RA.

Análise do perfil epidemiológico da mortalidade de 2009 a 2010 de um hospital geral de Curitiba / Epidemiology of hospitalar mortality from 2009 to 2010 in a general hospital in Curitiba

Descrever o perfil dos óbitos ocorridos no hospital, determinar a taxa de mortalidade(TM) hospitalar, determinar a taxa de mortalidade em cada setor de internamento e determinar o índice de letalidade por grupo de doenças do CID-10. Estudo descritivo, retrospectivo através da análise dos prontuários de todos os internamentos ocorridos no Hospital Universitário Evangélico de Curitiba (HUEC) no período de janeiro de 2009 a dezembro de 2010. Ocorreram 64799 internamentos nesse período e, destes, 2499 foram a óbito. As doenças do aparelho circulatório foram as responsáveis pelo maior número de óbitos no HUEC, 21,13% do total. 40,12% dos óbitos ocorridos foram considerados evitáveis. A TM hospitalar foi de 3,92. O grupo de doenças que apresentou a maior taxa de mortalidade foi o de "causas externas de morbidade e mortalidade", com 19,21%. Entre os setores de internamento, as unidades de terapia intensiva (UTI) apresentaram as maiores TM

To describe the profile of the deaths that took place in the hospital, to determine the hospital mortality rate(MR), to determine the mortality rate in each hospitalization sector and to determine the lethality rate per ICD-10 disease group. A descriptive, retrospective research was developed, through the analysis of the medical records of every hospitalization that occurred in the Hospital Universitário Evangélico de Curitiba (HUEC) in the period from January 2009 to December 2010. In this period, there were 64799 hospitalizations, of which 2499 died. Diseases of the circulatory system were responsible for the majority of deaths in the HUEC, 21,13% of the total. 40,12% of the deaths that occurred were considered avoidable. The hospital MR was 3,92%. The group of diseases that presented the highest mortality rate was the "external causes of morbidity and mortality", with 19, 21%. Between the hospitalization sectors, the intensive care unities (ICU) were the ones that showed the highest MR

Escherichia coli producing SHV-type extended-spectrum beta-lactamase is a significant cause of community-acquired infection.

OBJECTIVES: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasingly significant cause of community-acquired infection worldwide. The epidemiological features of CTX-M- and SHV-producing ESBLEC causing community-acquired infections are compared. METHODS: A multicentre cohort study including all community-acquired infections caused by ESBLEC in four geographical areas of Spain was carried out. ESBL characterization was by isoelectric focusing, PCR and sequencing. Demographics, previous healthcare contact, co-morbidity, use of antimicrobials, invasive procedures and type of infection were collected for all patients. Patients with CTX-M- and SHV-producing isolates were compared using logistic regression. RESULTS: One hundred and twenty-two cases (95% urinary tract infections) were included. ESBLs were characterized in 112 isolates; 77 isolates (69%) produced CTX-M, 36 (32%) produced SHV and 7 (6%) produced TEM enzymes (8 produced >1 ESBL). Patients with isolates producing CTX-M enzymes only (CTX-M group, n = 70) and SHV enzymes only (SHV group, n = 31) were compared. There were no differences in terms of underlying disease, previous healthcare contact, invasive procedures, antibiotic use or type of infection. Multivariate analysis including geographical area showed that a Charlson Index score of >2 (OR = 4.0; 95% CI = 1.2-12.6) was associated with SHV isolates, while age >60 (4.7; 1.7-12.5) was associated with CTX-M isolates. CONCLUSIONS: SHV-producing ESBLEC is a significant cause of community-acquired infection in Spain; the clinical epidemiology of such isolates seems very similar to that of CTX-M-producing E. coli.

[Comparative in vitro activity of daptomycin against gram-positive microorganisms: SENTRY surveillance program, Spain (2002-2006)]. / Actividad comparativa de daptomicina frente a microorganismos grampositivos: programa SENTRY España (2002-2006).

INTRODUCTION AND OBJECTIVE: Daptomycin is a bactericidal lipopeptide antibiotic, active against gram-positive bacteria. In this study, the comparative in vitro activity of daptomycin and other antimicrobial agents against isolates recovered in 3 Spanish hospitals from 2002 to 2006 was determined as part of the international SENTRY antimicrobial resistance surveillance program. The possible therapeutic role of daptomycin is addressed in the light of Spanish susceptibility data. METHODS: Antimicrobial susceptibility testing was performed by the microdilution method with 1398 consecutively recovered gram-positive isolates. RESULTS: All the staphylococci (n = 1024), enterococci (n = 228), and streptococci (n = 146) studied were susceptible to daptomycin. The highest MIC values were 1, 4, and 0.5 microg/mL, respectively, regardless of methicillin, vancomycin, or penicillin resistance status. All Staphylococcus aureus isolates were also susceptible to vancomycin, teicoplanin, linezolid, and quinupristin-dalfopristin. Coagulase-negative staphylococci were susceptible to vancomycin, linezolid, and quinupristin-dalfopristin. Only daptomycin and linezolid were active against all enterococcal isolates. In addition, vancomycin, teicoplanin, and ampicillin were fully active against Enterococcus faecalis. Daptomycin, vancomycin, teicoplanin, linezolid, and quinupristin-dalfopristin were active against all Streptococcus pyogenes, S. agalactiae, and S. viridans group isolates. The distribution of daptomycin MIC values in S. aureus and enterococci was homogeneously sustained along the 5-year study period. CONCLUSION: The sustained antimicrobial activity of daptomycin against staphylococci, enterococci, and streptococci in Spain makes this antibiotic an excellent therapeutic option in severe infection caused by gram-positive microorganisms, including those with multiresistance.

Actividad comparativa de daptomicina frente a microorganismos grampositivos: programa SENTRY España (2002-2006) / Comparative in vitro activity of daptomycin against gram-positive microorganisms: SENTRY surveillance program, Spain (2002-2006)

Introducción y objetivo. La daptomicina es un antibiótico lipopeptídico bactericida frente a microorganismos grampositivos. En este trabajo estudiamos la actividad in vitro de daptomicina comparativamente con otros antibióticos frente a aislados de tres hospitales españoles recogidos durante el período 2002-2006, en el marco del programa internacional de vigilancia de la resistencia, SENTRY, para establecer sus posibilidades terapéuticas con datos específicos de España. Métodos. Los antibióticos se estudiaron por la técnica de microdilución frente a 1.398 microorganismos grampositivos aislados consecutivamente. Resultados. Todos los estafilococos (n = 1.024), enterococos (n = 228) y estreptococos (n = 146) fueron sensibles a daptomicina y presentaban valores máximos de concentraciones inhibitorias mínimas (CIM) de 1, 4 y 0,5 mg/ml, respectivamente, con independencia de la resistencia a meticilina, vancomicina o penicilina. Staphylococcus aureus fue también sensible a vancomicina, teicoplanina, linezolid y quinupristina-dalfopristina y los estafilococos coagulasa negativa (SCN) a vancomicina, linezolid y quinupristina-dalfopristina. Frente a enterococos, sólo daptomicina y linezolid fueron activos frente a la totalidad de éstos. Además, vancomicina, teicoplanina y ampicilina fueron totalmente efectivos frente a Enterococcus faecalis. Frente a Streptococcus pyogenes, Streptococcus agalactiae y estreptococos del grupo viridans, daptomicina, vancomicina, teicoplanina, linezolid y quinupristina dalfopristina fueron plenamente activos. La distribución de las CIM de daptomicina a través de los 5 años fue homogénea en S. aureus y enterococos. Conclusión. La actividad de daptomicina frente a estafilococos, enterococos y estreptococos, mantenida a lo largo de los años en España, la convierte en una excelente opción terapéutica en infecciones graves por microorganismos grampositivos, incluyendo los multirresistentes (AU)

INTRODUCTION AND OBJECTIVE. Daptomycin is a bactericidal lipopeptide antibiotic, active against gram-positive bacteria. In this study, the comparative in vitro activity of daptomycin and other antimicrobial agents against isolates recovered in 3 Spanish hospitals from 2002 to 2006 was determined as part of the international SENTRY antimicrobial resistance surveillance program. The possible therapeutic role of daptomycin is addressed in the light of Spanish susceptibility data. METHODS. Antimicrobial susceptibility testing was performed by the microdilution method with 1398 consecutively recovered gram-positive isolates. RESULTS. All the staphylococci (n 1024), enterococci (n 228), and streptococci (n 146) studied were susceptible to daptomycin. The highest MIC values were 1, 4, and 0.5 g/mL, respectively, regardless of methicillin, vancomycin, or penicillin resistance status. All Staphylococcus aureus isolates were also susceptible to vancomycin, teicoplanin, linezolid, and quinupristin-dalfopristin. Coagulase-negative staphylococci were susceptible to vancomycin, linezolid, and quinupristin-dalfopristin. Only daptomycin and linezolid were active against all enterococcal isolates. In addition, vancomycin, teicoplanin, and ampicillin were fully active against Enterococcus faecalis. Daptomycin, vancomycin, teicoplanin, linezolid, and quinupristin-dalfopristin were active against all Streptococcus pyogenes, S. agalactiae, and S. viridans group isolates. The distribution of daptomycin MIC values in S. aureus and enterococci was homogeneously sustained along the 5-year study period CONCLUSION. The sustained antimicrobial activity of daptomycin against staphylococci, enterococci, and streptococci in Spain makes this antibiotic an excellent therapeutic option in severe infection caused by gram-positive microorganisms, including those with multiresistance (AU)

Community infections caused by extended-spectrum beta-lactamase-producing Escherichia coli.

BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli is an increasingly important group of community pathogens worldwide. These organisms are frequently resistant to many of the antimicrobial agents usually recommended for the treatment of infections caused by E coli, such as penicillins, cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole. Data concerning risk factors, clinical features, and therapeutic options for such infections are scarce. METHODS: A case-control study was performed to investigate the risk factors for all types of community-acquired infections caused by ESBL-producing E coli in 11 Spanish hospitals from February 2002 to May 2003. Controls were randomly chosen from among outpatients with a clinical sample not yielding ESBL-producing E coli. The clinical features of these infections were investigated in the case patients. The efficacy of fosfomycin tromethamine and amoxicillin-clavulanate potassium was observationally studied in patients with cystitis. RESULTS: A total of 122 cases were included. Risk factors selected by multivariate analysis included the following: age older than 60 years; female sex; diabetes mellitus; recurrent urinary tract infections (UTIs); previous invasive procedures of the urinary tract; follow-up in outpatient clinic; and previous receipt of aminopenicillins, cephalosporins, and fluoroquinolones. Urinary tract infections accounted for 93% of the cases; 6% of the patients were bacteremic and 10% needed hospitalization. The cure rate of patients with cystitis was 93% with fosfomycin therapy (all isolates were susceptible); among patients treated with amoxicillin-clavulanate, cure rates were 93% for those with susceptible isolates (minimum inhibitory concentration < or =8 microg/mL) and 56% for those with intermediate or resistant isolates (minimum inhibitory concentration > or =16 microg/mL) (P = .02). CONCLUSIONS: In predisposed patients, ESBL-producing E coli is a notable cause of community-acquired infection, and particularly UTI. Fosfomycin and amoxicillin-clavulanate appear to be effective for cystitis caused by susceptible isolates.

Lesiones graves en las manos debido a artefactos pirotécnicos y/o explosivos / Serious injuries on the hands because of pyrotechnics and / or explosives

Las lesiones ocacionadas por artefactos pirotécnicos y/o explosivos son altamente incapacitantes, constituyendo un problema de salud pública. Se estudiaron 25 paciente, 96 por ciento del sexo masculino, el grupo etario mas afectado estuvo entre 16 y 25 años con 40 por ciento. 92 por ciento eran dextromanos: la mano izquierda se lesionó en un 72 por ciento. Las lesiones más frecuentes fueron las amputaciones parciales en el 19,23 por ciento y las heridas del espacio interdigital en 17,95 por ciento; el pulgar fue afectado en el 96 por ciento. La influencia del alcohol estuvo presente en el 80 por ciento, siendo estos procedencia ilegal en el 84 por ciento.

Catch-up growth in infants born small for gestational age--a longitudinal study.

BACKGROUND: Epidemiological studies correlate low birth weight and the subsequent development of diabetes mellitus (DM). Early changes in insulin resistance in infants with catch-up growth (CUG) have not been evaluated in our population. AIM: To identify dietary and metabolic features associated with CUG in infants born small for gestational age (SGA) at 1 year old. METHODS: In a cohort study of 88 term infants (44 SGA and 44 appropriate for gestational age [AGA]), breastfeeding and weaning age were registered. Anthropometric measurements, glucose, insulin, and leptin concentrations were measured at birth and at 1 year old. RESULTS: A history of DM in a second-degree relative (p = 0.01) and complementary breastfeeding (p = 0.0003) were higher in SGA compared to AGA infants. Ten (13.6%) infants showed CUG in length and weight combined. They had lower weight, glucose, IR index, and leptin concentrations at birth than those without CUG. After logistic regression analysis for factors related to weight CUG, gender, weaning age, birth weight and leptin concentration at birth were included in the model (R2 = 0.31; p = 0.00004). CONCLUSIONS: Female gender, early weaning, lower birth weight, and lower leptin concentration at birth are related to weight CUG in Mexican infants.

Insulina y crisis hipertensiva / Hypertensive crisis and insulin

Dado el conocimiento de la asociación entre insulinorresistencia, y en consecuencia, de la hiperinsulinemia, con la hipertensión arterial, se determinó el comportamiento de la insulina durante la crisis hipertensiva, en una población de 29 pacientes. Para ello se cuantificaron las concentraciones plasmáticas de insulina y glucosa, y se calculó el cociente insulina/glucosa, durante la crisis hipertensiva y en el período post crisis. Y se intentó establecer si las crisis hipertensivas se correlacionaron con concentraciones de insulina elevadas, respecto a aquellas del paríodo post crisis, y en cada caso, en relación a la concentración de glucosa