Sex prediction by metric and non-metric analysis of the hard palate and the pyriform aperture.

BACKGROUND: Analysis of the bones and bone fragments of the cranium may be a useful tool for sex diagnosis in the identification of human remains which have been exposed to adverse conditions. The object of the present study was to evaluate sex prediction through metric and non-metric analysis of the hard palate (HP) and the pyriform aperture (PA), using macerated skulls of adult individuals. MATERIALS AND METHODS: We analysed 312 dry skulls of adult individuals of both sexes, studying the metric and non-metric characteristics of the HP and PA. The accuracy, sensitivity, specificity and positive and negative predictive values were evaluated. A binary logistic regression and a linear regression were performed. The receiver operating characteristic curve was constructed to analyse the perfor- mance of sex diagnosis. Measurements of the HP and the PA were analysed by ANOVA and Tukey's test. The SPSS v. 20.0 software was used, with a significance threshold of 5%. RESULTS: The shape of the PA presented 61.9% accuracy, 54.4% sensitivity and 65.7% specificity. The shape of the HP presented 51.5% accuracy, 65.6% sen- sitivity and 44.7% specificity. Only the height of the PA functioned as a good predictor of sex. CONCLUSIONS: The height of the PA produced good diagnostic performance (area under curve = 0.764). The height of the PA was the most reliable indicator for sex prediction, and could be used by forensic scientists to identify sex.

Pro-TRH and pro-CRF expression in paraventricular nucleus of small litter-reared fasted adult rats.

Neuroendocrine axes adapt to nutrient availability. During fasting, the function of the hypothalamus-pituitary-thyroid axis (HPT) is reduced, whereas that of the hypothalamus-pituitary-adrenal axis (HPA) is increased. Overfeeding-induced hyperleptinemia during lactation may alter the regulatory set point of neuroendocrine axes and their adaptability to fasting in adulthood. Hyperleptinemia is developed in rodents by litter size reduction during lactation; adult rats from small litters become overweight, but their paraventricular nucleus (PVN) TRH synthesis is unchanged. It is unclear whether peptide expression still responds to nutrient availability. PVN corticotropin-releasing factor (CRF) expression has not been evaluated in this model. We analyzed adaptability of HPT and HPA axes to fasting-induced low leptin levels of reduced-litter adult rats. Offspring litters were reduced to 2-3/dam (early-overfed) or maintained at 8/dam (controls, C). At 10 weeks old, a subset of animals from each group was fasted for 48 h and leptin, corticosterone, and thyroid hormones serum levels were analyzed. In brain, expressions of leptin receptor, NPY and SOCS3, were evaluated in arcuate nucleus, and those of proTRH and proCRF in PVN by real-time PCR. ProTRH expression in anterior and medial PVN subcompartments was assayed by in situ hybridization. Early-overfed adults developed hyperphagia and excessive weight, together with decreased proTRH expression in anterior PVN, supporting the anorexigenic effects of TRH. Early-overfed rats presented low PVN proTRH synthesis, whereas fasting did not induce a further reduction. Fasting-induced stress was unable to increase corticosterone levels, contributing to reduced body weight loss in early-overfed rats. We concluded that early overfeeding impaired the adaptability of HPT and HPA axes to excess weight and fasting in adults.

Royal dynasties as human inbreeding laboratories: the Habsburgs.

The European royal dynasties of the Early Modern Age provide a useful framework for human inbreeding research. In this article, consanguineous marriage, inbreeding depression and the purging of deleterious alleles within a consanguineous population are investigated in the Habsburgs, a royal dynasty with a long history of consanguinity over generations. Genealogical information from a number of historical sources was used to compute kinship and inbreeding coefficients for the Habsburgs. The marriages contracted by the Habsburgs from 1450 to 1750 presented an extremely high mean kinship (0.0628±0.009), which was the result of the matrimonial policy conducted by the dynasty to establish political alliances through marriage. A strong inbreeding depression for both infant and child survival was detected in the progeny of 71 Habsburg marriages in the period 1450-1800. The inbreeding load for child survival experienced a pronounced decrease from 3.98±0.87 in the period 1450-1600 to 0.93±0.62 in the period 1600-1800, but temporal changes in the inbreeding depression for infant survival were not detected. Such a reduction of inbreeding depression for child survival in a relatively small number of generations could be caused by elimination of deleterious alleles of a large effect according with predictions from purging models. The differential purging of the infant and child inbreeding loads suggest that the genetic basis of inbreeding depression was probably very different for infant and child survival in the Habsburg lineage. Our findings provide empirical support that human inbreeding depression for some fitness components might be purged by selection within consanguineous populations.

Quality of life of patients with rheumatoid arthritis in Argentina: reliability, validity, and sensitivity to change of a Spanish version of the Rheumatoid Arthritis Quality of Life questionnaire.

The Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire is the first needs-based instrument specifically designed to measure quality of life (QoL) of patients with rheumatoid arthritis (RA). The aims of our study were to develop an Argentinean version of the RAQoL and to determine its reproducibility, validity, and sensitivity to change in patients with RA. Translation process was performed according to internationally accepted methodology. Internal consistency and test-retest reliability were calculated. Criterion and construct validity were assessed by comparing the RAQoL with parameters of disease activity, the Health Assessment Questionnaire (HAQ), and the Medical Outcomes Study 36-item health survey (SF-36) questionnaire. Sensitivity to change was measured at 6-12 months using standardized response mean (SRM). The minimal important change was defined as a change of 1 or 1.96 times the standard error of measurement. A total of 97 patients with RA were included. Cronbach's α was 0.93, and test-retest reliability was 0.95. The RAQoL showed moderate to strong correlation with parameters of disease activity, the HAQ, and the SF-36. Functional status was the main determinant of patients' level of QoL. The SRM of the RAQoL was 0.24. Agreement between 20 % improvement in RAQoL and ACR20 response was moderate. Minimal important change was 2.2 (1 SEM) or 4.3 (1.96 SEM). The Argentinean version of the RAQoL is the first Spanish translation of this questionnaire. Our findings show it to be valid, reliable, and sensitive to changes in RA clinical status.

Validación de una versión argentina del Health Assessment Questionnaire-II (HAQ-II) / Validation of an Argentine version of the Health Assessment Questionnaire-II (HAQ-II)

La versión argentina de Health Assessment Questionnaire (HAQ-A) es un instrumento útil para documentar el estado clínico, la evolución y el pronóstico funcional de nuestros pacientes con Artritis Reumatoidea (AR). Sin embargo, presenta algunas limitaciones. Esto dio lugar a una versión más simple: el HAQ-II, el cual consta de 10 preguntas. Nuestro objetivo fue determinar la reproducibilidad y validez de una versión argentina del HAQ-II en pacientes con AR. Material y métodos: Se incluyeron pacientes consecutivos con diagnóstico de AR (ACR ‘87) de 4 centros reumatológicos de Argentina. La versión original del HAQ-II fue traducida por 3 reumatólogos argentinos y retraducida al inglés por un individuo bilingüe no relacionado. La reproducibilidad del cuestionario fue evaluada en el 30% de los pacientes con un segundo cuestionario completado dentro de los 3 a 7 días de la primera visita. La validez constructiva fue evaluada comparando el HAQ-II con parámetros clásicos de actividad de la enfermedad, capacidad funcional y compromiso radiológico (medido por el método de Sharp van der Heijde). Se evaluó también el tiempo y dificultad para realizarlo, así como la confiabilidad y correlación con HAQ-A. Resultados: 97 pacientes fueron incluidos, de los cuales el 82% eran mujeres, 95% seropositivas para factor reumatoideo, 87% erosivas y 22% nodulares. La reproducibilidad del HAQ-II fue buena (r=0,94). En la correlación intraítem se halló una única redundancia (entre la pregunta 8 y 9 (r=0,92)), por este motivo la pregunta 8 fue reemplazada manteniendo excelente correlación con la versión original (r=0,99). El HAQ-II tuvo buena correlación con EVA (escala visual análoga) para dolor, EVA para actividad y articulaciones dolorosas; regular correlación con recuento de articulaciones inflamadas, menor nivel educativo y eritrosedimentación (ERS). No se observó correlación con daño radiológico.

Metabolic syndrome in Argentinean patients with systemic lupus erythematosus.

The objective was to determine the prevalence of the metabolic syndrome (MS) in patients with systemic lupus erythematosus (SLE) in Argentina, to assess the factors associated to it, and to compare the results with a control group with non-inflammatory disorders. The study included 147 patients with SLE and 119 controls. MS was defined according to criteria by the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) Scientific Statement. Demographic characteristics, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) were assessed as well as administration, maximum dose and cumulative dose of prednisone and hydroxychloroquine (HCQ). MS prevalence was 28.6% (CI 95%: 21.4-36.6) in patients with SLE and 16% in controls (P = 0.0019). Patients with SLE presented higher arterial hypertension frequency compared with controls (43 vs 25%, P = 0.007). When comparing lupus patients with MS (n = 41) and without MS (n = 106), no significant differences were observed regarding duration of the disease, SLEDAI or cumulative prednisone dose. Cumulative damage was associated independently with MS (OR 1.98; P = 0.021), whereas HCQ use was found to be protective (OR 0.13; P = 0.015). Patients with lupus presented higher MS prevalence than controls with non-inflammatory disorders, and occurrence of arterial hypertension was also higher. MS was associated with cumulative damage; the use of HCQ showed to be protective against presence of MS.

[Prevalence of Helicobacter pylori infection in the healthy population of Madrid (Spain)]. / Prevalencia de la infección por Helicobacter pylori en población sana en la Comunidad de Madrid.

OBJECTIVE: To determine the prevalence of Helicobacter pylori infection in the healthy population of Madrid Autonomous Community (AC). MATERIAL AND METHODS: A descriptive, cross-sectional study where Helicobacter pylori infection is diagnosed by means of the 13C-urea breath test. RESULTS: A total of 618 subjects were studied. Among these, 481 were considered evaluable with a prevalence of Helicobacter pylori infection of 60.3%. In this cohort 36.4% were men and 63.6% were women, with a prevalence of 60.6 and 60.1%, respectively, and no relevant differences between both subgroups. The median age of patients was 37.5 years (range 4-82), and a statistically significant linear relationship between Helicobacter pylori infection and age (linear chi2 =33.31; p < 0.001) was established -chances of infection increase with age. Prevalence increases with age and peaks at 60 to 69 years (83.3% infected). For 169 subjects (35.1%) education level was unknown, and no relationship between this level and Helicobacter pylori infection was found. CONCLUSIONS: The study shows that the prevalence of Helicobacter pylori infection in the healthy population of Madrid AC is high (60.3%), progressively increases with age, and peaks in people in their sixties. The sample showed no differences regarding sex or education level.

Prevalencia de la infección por Helicobacter pylori en población sana en la Comunidad de Madrid / Prevalence of Helicobacter pylori infection in the healthy population of the Community of Madrid

Objetivo: conocer la prevalencia de la infección por Helicobacterpylori en población sana en la Comunidad de Madrid.Material y métodos: estudio transversal descriptivo en el quese realiza el diagnóstico de la infección por Helicobacter pylorimediante la prueba del test del aliento con 13C-urea.Resultados: se estudian un total de 618 sujetos. De estos,481 son considerados evaluables con una prevalencia de infecciónpor Helicobacter pylori del 60,3%. En esta cohorte el36,4% eran varones y el 63,6% mujeres con una prevalencia del60,6 y 60,1% respectivamente sin diferencias significativas. Lamediana de edad de los pacientes evaluados fue de 37,5 años(rango 4-82) estableciéndose que existe una relación lineal consignificación estadística entre la infección por Helicobacter pyloriy la edad (X2 lineal = 33,31; p < 0,001): a mayor edad mayorprobabilidad de infección. La prevalencia aumenta con la edadsiendo máxima entre los 60 y 69 años (83,3% infectados). En169 sujetos (35,1%) se conoce el nivel de estudios sin que existarelación entre este y la infección por Helicobacter pylori.Conclusión: el estudio muestra que la prevalencia de la infecciónpor Helicobacter pylori en población sana en Madrid es elevada(60,3%), y aumenta progresivamente a lo largo de la vida paraalcanzar un pico máximo en la 6ª década. No se encuentran diferenciasen la muestra en función del sexo ni del nivel de estudios

Objective: to determine the prevalence of Helicobacter pyloriinfection in the healthy population of Madrid Autonomous Community(AC).Material and methods: a descriptive, cross-sectional studywhere Helicobacter pylori infection is diagnosed by means of the13C-urea breath test.Results: a total of 618 subjects were studied. Among these,481 were considered evaluable with a prevalence of Helicobacterpylori infection of 60.3%. In this cohort 36.4% were men and63.6% were women, with a prevalence of 60.6 and 60.1%, respectively,and no relevant differences between both subgroups.The median age of patients was 37.5 years (range 4-82), and astatistically significant linear relationship between Helicobacter pyloriinfection and age (linear X2 =33.31; p < 0.001) was established–chances of infection increase with age. Prevalence increaseswith age and peaks at 60 to 69 years (83.3% infected). For 169subjects (35.1%) education level was unknown, and no relationshipbetween this level and Helicobacter pylori infection was found.Conclusions: the study shows that the prevalence of Helicobacterpylori infection in the healthy population of Madrid AC ishigh (60.3%), progressively increases with age, and peaks in peoplein their sixties. The sample showed no differences regardingsex or education level

[Guidelines for quality management of dialysis solutions]. / Guías de gestión de calidad del líquido de diálisis (LD).

A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. The Guideline was based on the European pharmacopoeia, the Real Farmacopea Española, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group. Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate. Regular use of ultra pure dialysate is necessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins: [table: see text] Monitoring frequency, maintenance and corrective actions were specified. Methods of sampling and analysis were described in appendix (Anexos). For microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35 degrees C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org

Guías de Gestión de Calidad del Líquido de Diálisis (LD) / No disponible

La Sociedad Española de Nefrología ha elaborado una Guía sobre la calidad del líquido de diálisis. La guía establece recomendaciones sobre los estándares necesarios para preparar el dializado: agua, concentrado y los sistemas necesarios para su elaboración.. Esta guía se fundamenta en la Farmacopea Europea, la Real Farmacopea Española, los estándares y recomendaciones prácticas de la AAMI, las Guías Europeas para hemodiálisis (sección VI) y revisión de la literatura acompañado de su nivel de evidencia, así como la opinión del Comité de expertos que ha elaborado la guía. Se han definido dos niveles de calidad del agua: purificada y altamente purificada (ultrapura) y para el dializado: dializado estandar y dializado ultrapuro. La utilización de un dializado ultrapuro es necesario para la hemofiltración y hemodiafiltración en línea y deseable en la hemodiálisis de alto flujo para prevenir complicaciones: inflamación, malnutrición, anemia y amiloidosis. Se definen los niveles máximos de contaminantes requeridos en la calidad del agua, concentrados y dializados: químicos (1.1.2), microbiológicos y endotoxinas. Simultáneamente se especifican la frecuencia de monitorización, mantenimiento, así como los mecanismos para su corrección. En los apéndices se describen los métodos de recogida de las muestras y su análisis. Para la monitorización microbiológica se recomiendan los medios TSA o R2A, con un periodo de incubación de 5 días a una temperatura de 30-35 ºC. La calidad del dializado involucra a todo el personal de diálisis y su control requiere protocolos estrictos. Los nefrólogos encargados de la diálisis tienen la última responsabilidad en la calidad del dializado. Todas las sugerencias y preguntas relacionadas con esta guía serán atendidas en www.senefro.org (AU)

A Best Practice Guideline about Dialysis fluid purity has been developed under the leadership of the Spanish Society of Nephrology. The Guideline has established recommendations for standards for preparing dialysate: water, concentrates and hemodialysis proportioning systems. The Guideline was based on the European pharmacopoeia, the Real Farmacopea Espa- ñola, the AAMI Standards and Recommended Practices, European Best Practice Guidelines for Haemodialysis (Section IV), literature reviews, according to their level of evidence, and the opinion of the expert spanish group. Two levels of quality of water were defined: purified water and high purified water (Ultra pure) and for dialysate: standard dialysate and ultra pure dialysate. Regular use of ultra pure dialysate is neccessary for hemofiltration and hemodiafiltration on-line and desirable for high-flux hemodialysis to prevent and delay the occurrence of complications: inflammation, malnutrition, anemia and amyloidosis. Water, concentrates and dialysate quality requirements are defined as maximum allowable contaminant levels: chemicals (1.1.2), microbial and endotoxins microbiological monitoring, TSA or R2A medium are recommended, incubated during 5 days at a temperature of 30-35º C. The dialysate quality assurance process involves all dialysis staff members and requires strict protocols. The physician in charge of hemodialysis has the ultimate responsibility for dialysate quality. All suggestions and questions about this Guideline are wellcome to www.senefro.org (AU)

[Prevalence of neurocysticercosis in individuals affected by epilepsy]. / Prevalencia de neurocisticercosis en individuos afectados de epilepsia.

INTRODUCTION: In this investigations, was carried out a neurocysticercosis (NC) prevalence study during seven months in the Instituto Neurológico de Antioquia with the purpose of known neurocysticercosis frequency as cause of epilepsy in patients older than ten years that we attended in our institute. MATERIAL AND METHODS: Computerized tomographies (CT) were made to 503 patients, with epilepsy, 24.7% of them were CT positive for NC. Cysticercosis enzyme linked immunoelectrotransfer blot (EITB) and enzyme linked immunoabsorbent assay (ELISA) test were made to 178 patients, 19.6% were EITB positive for NC and 5% ELISA positive for NC. Results. From this result it is possible to infer that about 8% of the 503 patients with epilepsy had cysticercosis, according to EITB that is the golden assay for NC. The CT and ELISA test had 94.3% and 27.7% sensitivity, respectively, according to EITB. The specificity of the CT for NC was 49.2% and specificity for ELISA test was 100% as compared to EITB. The multivariate analysis with logistic regression allowed to establish association of positive EITB with factors such as male sex, eating pork, headaches and multiple lesions in CT. CONCLUSIONS: Prevention and education actions are necessary for the interruption of the neurocysticercosis transmission chain in order to diminish the high prevalence of epilepsy in the country and its complication and consequences.

[Renal hydatid cysts: our experience]. / Quistes hidatídicos renales: nuestra experiencia.

Retrospective review of r.h.c. (renal hydatid cysts) cases, since the opening of our hospital in March 1974 through December 1989. Four cases diagnosed with r.h.c., aged between 11 and 58 years, out of a total 15,700 patients seen in this centre throughout that time are presented. Emphasis is made on the rarity of this condition in spite of it being endemic in this area. The variety of its clinical forms together with the youth of two of the patients, have encouraged us to review, and make an in-depth reflection upon a subject about which there is an ever decreasing number of references to be found. We contribute the diagnostic value of the modern and highly demonstrative radiological image tests, echography and CAT.