Unusual Presentation of an Uncommon Disease: 24-Hour Cyclic Esotropia.

Cyclic esotropia is an extremely uncommon form of strabismus. Classically, it follows a 48-hour cycle with 24 hours of orthotropia and 24 hours of manifest esotropia. We are reporting the first case of cyclic esotropia with a 24-hour cycle. A 7-year-old hyperopic female was seen with an esotropia of 6-month duration. Hyperopic glasses were prescribed by another ophthalmologist prior to our evaluation of the patient. While wearing her glasses, esotropia occurred during the morning and early afternoon. After 3.00pm, her eyes were "straight." Many photographs were reviewed, confirming the esotropia pattern. Neurological evaluation was normal, including imaging and blood work to rule out thyroid pathology and myasthenia. After seeing the patient multiple times at different hours on different days, the diagnosis of cyclic esotropia was made. Bimedial recessions were performed with good results. The patient was still "straight" at distance and near 2 years after surgery.

Prenatal testosterone excess reduces sperm count and motility.

The reproductive system is extremely susceptible to insults from exposure to exogenous steroids during development. Excess prenatal testosterone exposure programs neuroendocrine, ovarian, and metabolic deficits in the female, features seen in women with polycystic ovary disease. The objective of this study was to determine whether prenatal testosterone excess also disrupts the male reproductive system, using sheep as a model system. The extent of reproductive disruption was tested by assessing sperm quantity and quality as well as Leydig cell responsiveness to human chorionic gonadotropin. Males born to mothers treated with 30 mg testosterone propionate twice weekly from d 30 to 90 and with 40 mg testosterone propionate from d 90 to 120 of pregnancy (T-males) showed a significant reduction (P < 0.05) in body weight, scrotal circumference, and sperm count compared with control males. Mean straight line velocity of sperms was also lower in T-males (P < 0.05). Circulating testosterone levels in response to the human chorionic gonadotropin did not differ between groups. These findings demonstrate that exposure to excess testosterone during fetal development has a negative impact on reproductive health of the male offspring, raising concerns relative to unintended human exposure to steroidal mimics in the environment.

PID controllers' fragility.

In this paper, an index for measuring fragility of proportional integral derivative (PID) controllers is proposed. This index relates the losses of robustness of the control loop when controller parameters change, to the nominal robustness of the control loop. Furthermore, it defines when a PID controller is fragile, nonfragile or resilient.

Conocimiento del médico acerca del tratado de libre comercio en el sector salud costarricense / Knowledge of the doctor about the Free Trade Agreement in the sector Costa Rican health

Justificación: Al ser la salud un derecho en sí misma y tener relación recíproca con el crecimiento económico de un país, adquiere relevancia el análisis de las repercusiones del Tratado de Libre Comercio con EEUU (TLC) en el sector salud costarricense. El objetivo de este trabajo es determinar el conocimiento de médicos trabajadores de la CCSS acerca de los posibles efectos del TLC sobre el sector salud. Metodología: Se elaboró un cuestionario compuesto por preguntas abiertas y cerradas, el cual se aplicó a 60 médicos, entre abril y mayo de 2006, en tres hospitales nacionales de la CCSS, esoecíficamente: Hospital San Juan de Dios, Hospital "Dr. Rafael A. Calderón Guardia" y Hospital de las Mujeres "Dr. Adolfo Carit Eva". Resultados: De los sesenta médicos entrevistados, un 37 por ciento fueron mujeres y un 63 por ciento hombres. El 83 por ciento mencionó conocer el TLC, un 75 por ciento por los medios de comunicación y un 53 por ciento había sido informado acerca del contenido sobre propiedad intelectual. Los efectos sobre la salud más frecuentemente mencionados fueron: el acceso a los medicamentos genéricos (60 por ciento), la accesibilidad a los servicios de salud (50 por ciento) y las oportunidades laborales (40 por ciento), solo un 15 por ciento no reconoció ningún efecto. Conclusión: Los médicos, como profesionales, como trabajadores de la CCSS y como consumidores deben conocer sobre los contenidos del TLC que pueden afectar su desempeño laboral. Este estudio demuestra que muchos de los entrevistados no tienen un adecuado conocimiento del TLC ni de sus implicaciones o efectos en el sistema de salud costarricense.

Bifurcated stents: giving to Caesar what is Caesar’s

Since its earlier days, procedural and technical difficulties allied topoor immediate and long-term outcomes have turned the percutaneoustreatment of bifurcated coronary lesions into one of the mostchallenging scenarios of interventional cardiology1,2.In the mid 1980’s, when balloon angioplasty was the standardpercutaneous approach, the treatment of bifurcation lesions wasconsidered a procedure of exception for carrying a high risk of acuteischaemic complications (e.g. acute coronary thrombosis) andrestenosis. Usually, kissing-balloon was the preferred technique tominimise plaque shift to the side branch and improve immediateoutcomes3,4.In the early 1990’s, the use athero-ablative techniques (rotationaland directional atherectomy) decreased the need for repeat lesionrevascularisation but increased the procedural complications afterpercutaneous approach of bifurcations5-7.In the mid 1990’s, coronary stenting, through its scaffolding properties,became the treatment of choice for bifurcated lesions, mainlybecause of its impact in reducing acute complications. However, itwas yet to be determined which was the best technical approach toreduce restenosis and improve long term outcomes in that specificpopulation. Basically, the remaining issue was how to achieve thebest results in the main branch while preserving the side branch. Inthe bare metal stent era, several reports investigating the outcomeof stenting solely the main vessel versus stenting main vessel andside branches, reported dissimilar results; although both techniquesproved to be safe and feasible, substantial restenosis ratesof up to 40% were observed8,9. Of note, among those receivingstents in both branches, T-stenting was superior to Y-stenting inreducing adverse events (86.3% vs. 30.4%, p=0.004).

Expression of granulocyte-macrophage colony stimulating factor (GM-CSF) in male germ cells: GM-CSF enhances sperm motility.

The granulocyte-macrophage colony stimulating factor (GM-CSF) is a pleiotropic cytokine capable of stimulating proliferation, maturation and function of hematopoietic cells. Receptors for this cytokine are composed of two subunits, alpha and beta, and are expressed on myeloid progenitors and mature mononuclear phagocytes, monocytes, eosinophils and neutrophils, as well as in other nonhematopietic cells. We have recently demonstrated that bull spermatozoa express functional GM-CSF receptors that signal for increased glucose and Vitamin C uptake. In this study, we analyzed the expression of GM-CSF in bovine and human germ cells and its influence in bovine sperm motility. Reverse transcription-polymerase chain reaction (RT-PCR), in situ hybridization and immunoblotting analysis demonstrated that adult bovine and human testes expressed GM-CSF. In addition, immunolocalization studies confirmed the presence of GM-CSF in the germ cell line in bovine and human testes. Computer-assisted evaluation of patterns of sperm motility demonstrated that the addition of GM-CSF enhances several parameters of sperm motility in the presence of glucose or fructose substrates.

Fertilization efficiency of in vitro matured oocytes transferred to oviducts of inseminated goats: a model to assess in vivo fertilization performance of goat spermatozoa.

An alternative to conventional in vivo validation of sperm assays might be to assess the fertilization rate of multiple oocytes transferred to the oviducts of inseminated females. Increasing the number of oocytes increases the egg-sperm ratio in the oviduct under an unaltered endocrine milieu, setting the basis for picking up statistical differences between treatments in small populations. The study evaluated the model by transferring oocytes to females inseminated under conditions that are known to modify the fertilization rate in the field. The study then evaluated the use of cattle oocytes to replace goat oocytes for assessing sperm function under this model. In Experiment 1, 12 females were inseminated at estrus with either 100 or 300 million spermatozoa 20 h before transferring homologous oocytes into the oviduct ipsilateral to the ovulation point. In Experiment 2, 10 females were inseminated either once or twice; 10-20 h later, homologous oocytes were transferred into the oviduct ipsilateral to the ovulation point. In Experiment 3, 13 bilateral-ovulated females were inseminated and 20 h later goat and cattle oocytes were transferred to contralateral oviducts. Then, 16-20 h later, oocytes were flushed from the oviduct, cleaned of spermatozoa and stained to assess the fertilization rate. The fertilization rate was improved by increasing sperm numbers at insemination (P < 0.04) and by increasing the number of inseminations (P < 0.02). The results in Experiment 3 showed that fertilization rates were similar for goat and cattle oocyte (P > 0.05) and that fertilization values were highly correlated (r = 0.811, P < 0.001). Results suggest that the model can be used for in vivo validation of in vitro sperm assays by facilitating the expression of statistical differences in small number of animals. In addition, cattle oocytes can be used to replace goat oocytes to study in vivo sperm function in goats.