Chronic inflammatory demyelinating polyradiculoneuropathy in a boy with systemic lupus erythematosus.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired, autoimmune peripheral neuropathy. Systemic lupus erythematosus (SLE) is a multisystemic, autoimmune disease that can affect the central nervous system in about 40% of patients, with prevalence and incidence unknown in the pediatric population due to lack of multicenter studies. We report the case of a 13-year-old Mexican boy, diagnosed with CIDP at the onset of SLE, beginning with progressive muscle weakness of lower and upper limbs, without affection of the central nervous system. The patient had positive ANA, antiDNAdc, antiBeta2glycoprotein, anti-cardiolipin, ANCA-C and X. He received intravenous immunoglobulin, cyclophosphamide, steroids, and azathioprine and showed clinical improvement. It is important to take into account the presence of peripheral neurological disorders in patients with pediatric SLE, considering CIDP as an uncommon presentation, making the diagnosis important for better treatment and evolution.

Heavy metal content in soils under different wastewater irrigation patterns in Chihuahua, Mexico.

An area near the city of Chihuahua has been traditionally irrigated with wastewater to grow forage crops. It has been hypothesized that metal levels could be found in these soils high enough to cause potential health problems to the population. The objective of this study was to determine heavy metal concentrations in different soils due to irrigation practices. Four soil types were evaluated; a soil with a past and present history of wastewater irrigation (S1), a soil with a history of wastewater irrigation until 2003 (S2), a soil with no irrigation history (S3), and a soil similar to S1 and adjacent to the river where the wastewater is transported (S11). Three soil depths were evaluated; 0-15, 15-30 and 30-50 cm. Consequently, a total of 150 soil samples were analyzed evaluating pH, EC, OM and the following elements; Na, K, Cd, Pb, Ni, Cr, Cu and Fe. The pH (P=0.000) and EC (P=0.000) were different for each soil type but no differences were noted for soil depth and the interaction. Maximum pH levels were noted in S3 with a value of 8.74 while maximum EC was observed in S1 with a value of 0.850 dSm-1. The OM level was different for soil type (P=0.000), soil depth (P=0.005) and the interaction (P=0.014). S1 and S11 obtained maximum levels of OM while minimum levels were noted in S3. Maximum OM levels were observed at the 0-15 cm depth followed by the 15-30 cm depth and finally at the 30-50 cm depth. The highest concentration of metals was as follows: K in S1 (359.3 mg kg-1); Cd in S1 (4.48 mg kg-1); Pb in S11 (155.83 mg kg-1); Ni in S1 (10.74 mg kg-1); Cu in S1 (51.36 mg kg-1); B in S3 (41.5 mg kg-1); Fe in S3 (20,313.0 mg kg-1), Cr in S3 (44.26 mg kg-1) and Na in S3 (203.0 mg kg-1). The conclusion is that some metals are present in the soils due to anthropogenic activities but others are present in natural forms.

Los examenes de opcion multiple en las instituciones de salud. / The multiple-choice test in health institutions

Los docentes en ciencias de la salud, en virtud de su formacion academica, carecen de metodologia y entrenamiento para realizar el proceso de ensenanza-aprendizaje como profesores de carrera y al realizar los examenes a los alumnos solo llevan el proposito de asignar calificaciones por lo que se han convertido en sucesos angustiantes para el alumno. Los examenes llamados tambien mediciones, tienen ventajes y desventajas, asi como indicaciones precisas. En el presente trabajo se revisa el examen de opcion multiple, con sus caracteristicas e indicaciones, haciendo hincapie en como mejorarlo, proporniendo por parte de los autores un ordenamiento para realizar preguntas en un examen de opcion multiple, asi como sugerencias para mejorar los reactivos, el analisis minimo estadistico que debe llevarse hasta la formacion de un banco de preguntas, sencillo y economico y al alcance de cualquier docente