Dental, periodontal and salivary conditions in diabetic children associated with metabolic control variables and nutritional plan adherence.

AIM: Diabetes mellitus is a chronic disease that has manifestations other than alterations in endocrine regulation or in metabolic pathways. Several diseases of the oral cavity have been associated with diabetes mellitus type 1 and 2 in young people according to their evolution. Scarce information exists regarding the role of diabetes and its association with the oral health status in paediatric diabetic patients. The aims of the study were to assess the quality of saliva, saliva acidogenicity, dental caries experience, fluorosis and periodontal status in diabetic patients and to evaluate their relationship with metabolic control variables and nutritional plan adherence. MATERIALS AND METHODS: The study population consisted of 60 paediatric patients with both types of diabetes mellitus. Saliva testing included stimulated flow, pH (using pH indicator strips), buffer capacity and Snyder's Test. DMFT/dmft and dental caries experience were determined on the basis of ICDAS II codes. The periodontal status was assessed by PI and GI and fluorosis by FI. Nutritional plan adherence was established from the subscale "Dietary Control" of the Diabetes Self-Management Profile questionnaire. Medical Data was retrieved from the clinical registers in the Diabetic Clinic. RESULTS: We describe the main characteristics of the oral cavity related variables of our population that might guide the clinical practice in similar settings; we found a dmft/DMFT of 1.71 ± 1.74 and 0.64 ± 1.03, PI of 1.91 ± 0.75, GI of 0.50 ± 0.56 and a fluorosis prevalence of 61%. We identified several correlated variables, which indicate strong associations between the nutritional habits of the patients and co-occurrence of oral cavity physiopathological alterations. Several correlations were found between acidogenic activity of the saliva (Snyder Test) and the percentage of adherence to the nutritional plan and to the dmft index. Furthermore, a significant correlation between the buffering capacity of the saliva and the glycemic control of the participants was found. Neither an association nor a difference among means was found between treatment regime and the plaque index. CONCLUSION: The results of the present study concluded that there was a significant relationship between diabetes mellitus and an increased prevalence of oral cavity related diseases in the paediatric population. These are also associated with a poor adherence to the nutritional plan.

Clinical variables associated with the presence of inflammatory infiltrates in patients with dilated cardiomyopathy undergoing heart transplantation.

INTRODUCTION: Idiopathic dilated cardiomyopathy (DCM) is, together with ischemic heart disease, the major cause of end-stage heart failure leading to heart transplantation. However, an unknown percentage of patients with this diagnosis has inflammatory foci found in the histopathological study of the explanted heart. This fact suggests an undetected process of acute myocarditis as the cause of cardiac dysfunction. OBJECTIVE: The objective of this study was to identify clinical and echocardiographic variables related to the presence of myocardial infiltrates, as a potential guide to determine which patients should undergo endomyocardial biopsy in DCM. MATERIALS AND METHODS: We retrospectively analyzed 161 patients who underwent heart transplantation with a diagnosis of DCM between 1987 and 2007. The presence of inflammatory infiltrates was considered significant when the histopathological study of tissue blocks from the left ventricle showed 1 or more foci per cm(2) of perivascular or interstitial mononuclear or polymorphonuclear cells, whether or not in the presence of cytolysis. RESULTS: Seventeen patients (11%) had these inflammatory histological findings; of them, 6 (35%) showed preponderance of eosinophils and 7 (41%) showed areas of cytolysis. The DCM group with inflammatory infiltrates showed significant differences in terms of younger age (45 +/- 15 vs 50 +/- 11 years; P < .01) and smaller ventricular diameters (P < .05). Male gender was more frequent in this group, and the patients had a poorer clinical status and greater dependence on inotropic drugs. CONCLUSIONS: Inflammatory infiltrates are frequently present in DCM explanted hearts. Although there are no relevant clinical variables to identify subclinical myocarditis, these patients are younger and have smaller ventricular diameters and poorer functional status at the time of transplantation.

[Prevalence of antiretroviral drug genotypic resistance among HIV patients in Cuenca, Spain]. / Prevalencia de la resistencia genotípica a los fármacos antirretrovirales en pacientes VIH positivos en la provincia de Cuenca.

The aims were to assess the prevalence of resistances to antiretroviral drugs in HIV patients in the province of Cuenca and to determine the most frequently detected primary resistances. A total of 79 samples collected from April 2000 to July 2004 were analyzed. Resistance was detected using the genotypic technique VERSANTTM HIV1 (LiPA). Mutations more frequently found were M184V in the reverse transcriptase gene and V82A in the protease gene. The prevalence of primary resistances was 39.4%. Mutations more frequently detected were similar to those reported by other authors. The rate of primary resistance was higher than those found by other authors in Spain.

Prevalencia de la resistencia genotípica a los fármacos antirretrovirales en pacientes VIH positivos en la provincia de Cuenca / Prevalence of antiretroviral drug genotypic resistance among HIV patients in Cuenca, Spain

Los objetivos del estudio fueron determinar la prevalencia de la resistencia a los fármacos antirretrovirales en pacientes VIH positivos en la provincia de Cuenca y describir las resistencias primarias observadas con más frecuencia. Se analizaron en total 79 muestras remitidas desde abril de 2000 a julio de 2004. Las resistencias se detectaron utilizando la técnica genotípica VERSANTTM HIV1 (LiPA). Las mutaciones que más se detectaron fueron M184V para la región de la transcriptasa inversa y V82A para la región de la proteasa. La prevalencia de las resistencias primarias fue del 39,4%. Las mutaciones más observadas son similares a las detectadas por otros autores. El porcentaje de pacientes con resistencias primarias es superior a lo hallado por otros autores en España

The aims were to assess the prevalence of resistances to antiretroviral drugs in HIV patients in the province of Cuenca and to determine the most frequently detected primary resistances. A total of 79 samples collected from April 2000 to July 2004 were analyzed. Resistance was detected using the genotypic technique VERSANTTM HIV1 (LiPA). Mutations more frequently found were M184V in the reverse transcriptase gene and V82A in the protease gene. The prevalence of primary resistances was 39.4%. Mutations more frequently detected were similar to those reported by other authors. The rate of primary resistance was higher than those found by other authors in Spain

[Usefulness of geographic analysis in the study of deaths caused by motor vehicle injuries]. / Utilidad del análisis geográfico en el estudio de las muertes por atropellamiento.

OBJECTIVE: The purpose of this paper is to demonstrate the usefulness of geographic analysis to assess the distribution of fatal pedestrian run-over injuries. MATERIAL AND METHODS: Cross-sectional study of mortality due to pedestrian run-over injuries was conducted in year 2000. Data were abstracted from death certificates of pedestrians who died due to run-over injuries in Mexico City, during 1994-1997 (International Classification of Diseases code E814.7). Crude mortality rates were obtained by political district and gender. Georeferenced mortality data were mapped by different levels of aggregation, using the software program Map-Info. RESULTS: A total of 3,687 pedestrian fatalities were reported; 71% of them were Mexico City residents. Only 1,152 deaths (43.5%) were georeferenced, due to availability of the exact place of the event occurrence. Results by level of aggregation were: by political district level; Milpa Alta, Cuajimalpa and Cuauhtemoc had the highest death rates (23 per 100,000). At the next level (neighborhoods or colonias), ten colonias had over nine cases; and at the street level, one point at La Venta in Cuajimalpa presented 25 death cases due to pedestrian run-over injuries. CONCLUSIONS: This kind of analysis helps us to display the spatial relationship between pedestrian run-over sites and other city landmarks, to advance in the study and prevention of pedestrian run-over deaths.

[Risk factors for injuries caused by traffic accidents and the impact of an intervention on the road]. / Factores de riesgo de lesión por accidentes de tráfico y el impacto de una intervención sobre la carretera.

OBJECTIVE: To evaluate the effect of interventions at a highway, in the occurrence and severity of injuries by traffic accidents. METHOD: It was made a comparative analysis of two cross-sectional studies in 1994 and 1996. RESULTS: In 1994 the rate was 7.96 accidents/ 100,000 vehicles and in 1996 8.49 / 100,000 vehicles. The increase was not significant (p>0.05). The rate of injured drivers in 1994 was of 2.10 / 100,000 vehicles and of 1.35 / 100,000 vehicles in 1996, which was a significant decrease (p<0.000). The self-report of use of seat belt (63.46% versus 76.6%), the small vehicles involved in accidents (7.9% versus 37.7%), nocturnal schedule (23.7% versus 31.8%) and in Mexico-Cuernavaca direction (45% versus 66.7%), were more frequent in 1996 (p<0.05). The risk of injury, using a logistic regression model, between drivers exposed to the interventions (1996) and those that were not exposed (1994) adjusted by: age, speed, use of seat belt, alcohol intake and external cause, showed a protective effect of the interventions at the highway (OR 0.42 CI95% 0.27-0.66). CONCLUSION: There is an evident need of multisectorial approaches in the study and evaluation of the interventions in the field of the traffic accidents. The present research is a clear example of the repercussions over health of interventions developed by the transportation sector at the highway.

A randomized, blinded, comparative trial of one pepsin-digested and two whole IgG antivenoms for Bothrops snake bites in Uraba, Colombia. The Regional Group on Antivenom Therapy Research (REGATHER).

The therapeutic efficacy and the incidence of early antivenom reactions (EARs) were compared in a clinical trial performed in 79 patients bitten by Bothrops sp. in Urabá, Colombia. Patients were randomized into three groups according to the antivenom administered: A (n = 30, Butantan polyspecific, pepsin-digested Bothrops antivenom); B (n = 27, Butantan polyspecific, whole IgG Bothrops antivenom); and C (n = 22, Colombian commercial, monovalent, whole IgG Bothrops antivenom). The groups were comparable in all clinical and epidemiologic aspects; 33 patients had mild, 22 moderate, and 24 severe envenoming. At the doses used (two, four, and six vials [10 ml/vial] for mild, moderate, and severe envenomings, respectively) there were no differences between the antivenoms in restoring normal hemostatic parameters within 24 hr. The evolution of local envenoming was comparable in the three groups. Serum venom/antivenom kinetics determined by ELISA showed a complete clearance of venom levels 1 hr after treatment in mild/moderate envenomings. In severe cases, venom levels remained detectable up to 24 hr and recurrence of antigenemia was observed in some cases. Antivenom concentrations remained at high levels up to 24 hr of treatment. The incidence of EARs was significantly different in the groups: A (36.7%), B (11.1.%), and C (81.8%). There were no life-threatening anaphylactic reactions. We conclude that the efficacy of the three antivenoms was similar in neutralizing human Bothrops envenomings and that the production of whole IgG antivenoms by caprylic acid fractionation is a good alternative for reducing the incidence of EARs.

[Methodological aspects of measuring injuries from traffic accidents at the site of occurrence]. / Aspectos metodologicos de la medición en el sitio de ocurrencia de lesiones por accidentes de tráfico.

Traffic accidents are a well-known public health problem worldwide. In Mexico research into risk factors for motor involving vehicles accidents and their consequences has recently been taken into account. The relevant literature does not normally describe the methodological aspects involved in the collection of primary data, since most studies have used secondary data the good quality and validity of which are assumed. The paper presented seeks to discuss and share with researchers in this field, some of the methodological aspects to be considered in the attempt to recreate the scene of the accident and obtain information approximating to reality. The measurements in situ of, such traffic accident variables as injury, use of seat belt, speed and alcohol intake are discussed.

ACP and PGM1 polymorphisms in a Chilean population.

A random sample of 140 individuals from the population of Valparaíso, Chile, was studied for 2 polymorphic genetic markers. The gene frequency estimates were: ACP*A = 0.246 +/- 0.026 and PGM1*2 = 0.235 +/- 0.025. The comparison of ACP with data obtained from other populations indicates a similarity with Mongoloid groups whereas for PGM1, the comparison with the data obtained shows no significant difference from Caucasoid populations. These results indicate that the Valparaíso population is the result of genetic admixture of various populations.

Transjugular intrahepatic portosystemic shunt for the management of hepatic hydrothorax in the absence of ascites.

Hepatic hydrothorax in the absence of clinical ascites (HHAA) is a somewhat rare complication in decompensated cirrhosis. Patients with HHAA have a congenital defect in the tendinous portion of the diaphragm allowing rapid leakage of ascites into pleural cavity because of the cyclical negative intrathoracic pressure. Although several therapeutic approaches, including peritoneovenous shunt and chemical or surgical pleurodesis, have been attempted in these patients the results are largely unsatisfactory. A poor-risk surgical cirrhotic woman who was also considered not suitable for liver transplantation underwent transjugular intrahepatic portosystemic shunt (TIPS) for palliation of HHAA. After TIPS procedure hydrothorax completely resolved. TIPS can offer an attractive alternative to standard therapy in cirrhotic patients with HHAA.

[Safety belt use and severity of injuries in traffic accidents]. / Cinturón de seguridad y gravedad de lesiones en accidentes de tráfico en carretera.

OBJECTIVE: To analyze the association between the severity of car accident injuries and the use of safety belts. MATERIAL AND METHODS: The unit of observation and analysis was car drivers in the Mexico-Cuernavaca toll highway. Variables included were those of car drivers, the vehicles and the physical environment at the accident site. Statistical analysis was carried out by means of chi square, odds ratios, 95% confidence intervals and logistic regression. Data was collected in 422 questionnaires for 324 accident events. RESULTS: There were 177 injured people, including 12 deaths, with rates of 67.5 injuries and 4.58 deaths per 10 000 kilometers driven. Variables associated with not using a safety belt (p < 0.05) were: alcohol drinking, vehicle size, night-time and road section. Risk factors for severe injuries were: not using a safety belt (raw OR 4.9, 95% CI 2.2-10.8, adjusted OR 2.94, 95% CI 1.13-7.66); age < 25 years (OR 3.6, 95% CI 1.0-12.7) and > 54 (OR 6.0, 95% CI 1.4-25.0); alcohol drinking (OR 10.8, 95% CI 3.8-30.4); and night time (OR 2.8, 95% CI 1.4-5.8). CONCLUSIONS: Theses findings suggest the need to formulate interventions aimed at enforcing the use of safety belts and prevention of related factors.

[Mortality by homicide, the fatal consequences of violence. The case of Mexico, 1979-1992]. / Muertes por homicidio, consecuencia fatal de la violencia. El caso de Mexico, 1979-1992.

UNLABELLED: A study of homicide in the population of Mexico, was undertaken for the purpose of discovering the mortality panorama by this cause during 1979-1992. Homicide mortality trends were analyzed, as well as the main causes by age and sex. Rate by cause and sex were also analyzed using a Poisson Regression model. The variables were: age, sex, year, external cause of intentional injuries ICD 9th. E960-E969. RESULTS: The total number of deaths due to homicide was 198,485. Each day 35 persons die in Mexico as a result of homicide. Men were more affected than women with a RR of 10.1 and CI (95%) 14.9-16.0, adjusted for age. The main cause 56% was homicide by fire-arms and explosives. The high relative risk was for those aged from 35 to 39 with an RR of 15.4 CI 14.9-16.0. To the cause assault by other and unspecified means, the elderly population has a RR of 21.2 IC 19.7-22.9. Further research in the area and prevention should make use of a multidisciplinary approach in considering the multiple causes and solutions to this problem.

[Mother's work and severity of accidental injuries in children]. / El trabajo materno y la gravedad de lesiones accidentales en niños.

A study was conducted in children under five years old, in order to establish the association between the mother's work and the severity of unintentional injuries. The study was carried out at the emergency room of six pediatric hospitals in Mexico City. Cases were children with major injuries that required hospitalization, intensive care, surgery, or who died as a result of the injury. Controls were children of similar age, with minor injuries resolved at the emergency room. Sample size was 350 cases and 350 controls. Variables were grouped according to: mother's occupation; characteristics of the child, socioeconomic status, child care, and those related with home risk factors. Results showed a protective effect on severity of injuries when the mother worked outside home in comparison to mothers who do not work, (or 0.79, 95%CI 0.57-1.07). No differences were found with respect to sex and age of children. Mother age under 24 years old and low schooling (< 3 years of elementary school) were statistically significant with a risk of major injuries (or 2.30, 95%CI 1.5-3.4). Delay of demand of medical care after 60 minutes of injury occurrence is related with a risk of major injury (or 1.68, 95% CI 1.2-2.3). No differences related with household risk factors were found. Results provide valuable information about risk factors related with injury severity and the association with mother's work.

[Mortality due to homicide in children. Mexico, 1979-1990]. / Mortalidad por homicidio en niños. México, 1979-1990.

A study of homicides in children under five years old was conducted in order to define the mortality panorama by this cause during 1979-1990 in Mexico. Trends of homicide mortality were analyzed, as well as the main causes by age and sex. Rate ratio (RR) by cause and sex were analyzed too. The variables were age, sex, year and external cause of intentional injuries which were analyzed according to the International Classification of Diseases, 9th Revision E960-E969. The total number of deaths due to homicide were 2,939. Each day one children under five years of age died in Mexico due to homicide. The trend of homicide is b = 0.126. Thirty per cent of deaths occurred in children under one year old. Boys were most affected than girls in the causes by age: strangulation < 1 year old RR 21, confidence interval (CI) 15-30; fire arm in two years old children RR 3.1 CI 2.0-5.7; drowning in three years old children RR 2.6 CI 1.7-4.8 and assault by other and unspecified means. Further research in the area and prevention should involve the use of a multidisciplinary approach in considering the multiple causes and solutions to this problem.

[The risk factors for home accidents in children. A case-control study]. / Factores de riesgo de accidentes en el hogar en niños. Estudio de casos y controles.

INTRODUCTION: The main objective was to determine the risk factors involved in unintentional injuries in children under 10 years old occurring at home. MATERIAL AND METHODS: A Case Control study was conducted in the emergency room of three pediatrics hospitals in Mexico City. The sample size was 160 cases and 320 controls. RESULTS: Boys were more affected than girls (OR) 1.7, C.I. (95%) 1.2-2.5. The age group more affected was two-three years old (OR) 1.6, C.I.1.1-2.2. When children play outside home (roof, stairs, patio) the risk was OR 2.48, C.I. 1.63-3.76. If mother is not encharged of children care (OR) 2.9, C.I. 1.8-4.8. The age > 40 years old of the person encharged of children care (OR) 2.2, C.I. 1.4-3.5. CONCLUSIONS: The results showed us how necessary is to develop injury prevention programs especially to implement passive measures, with target populations people encharged of children care.

[Profile of the elderly in a metropolitan area of southeastern Brazil: results of a domiciliary survey]. / Perfil do idoso em área metropolitana na região sudeste do Brasil: resultados de inquérito domiciliar.

A multicentre study concerned with the health needs of the elderly population living in urban areas and coordinated by the Panamerican Health Organization was undertaken in 6 Latin-American countries. In Brazil, 1,602 elderly residents (of 60 years of age and over) in the District of S. Paulo, constituting a multistage random sample stratified by socioeconomic status, participated in a household survey using a multidemensional functional assessment questionnaire. The results showed a highly deprived population (70% had a per capita income of less than US $ 100 per month), living mostly in multigenerational households (59% were living with children and/or grandchildren), with a high prevalence of chronic physical illnesses (only 14% referred no illness) and psychiatric disorders (27% were considered psychiatric cases), a high proportion of them showing a loss of autonomy (47% needed help in performing at least one of the activities of daily living). The results are put into perspective concerning future needs in terms of specialized health services and social support for the growing population of elderly people in Brazil.

[Home accidents in children less than 10 years of age: causes and consequences]. / Acccidentes en el hogar en niños menores de 10 años. Causas y consecuencias.

A case-control study was carried out, aimed at identifying and defining the individual, family, household and childcare social support network characteristics, more likely to be associated with the occurrence of accidental home injuries in 0-9 year-old children. This study was carried out in the emergency units of three pediatric hospitals in the Federal District. In this article we report the results of the descriptive analysis only of the cases. The results were as follows: male children (62%) and the one and two year-old children group (37%) were the most affected. Contusions, head injuries and fractures occupied the first three places, the main three causes being falls from one level to another (mainly in stairways and off the bed) falls on the same level (sliding, tripping or stumbling) and burns with boiling liquids (most frequently boiling water for bathing). A history of injuries was documented in only 15% of cases. Thirty nine percent of cases requested medical attention after one hour of the accident; 51% of these were hospitalized. In 25% of cases, the mother worked outside the home, being absent from 6 to 12 hours. Risk factors occurring most frequently were: unprotected electricity inlets (40%); products within reach of children: cleaning products (38%), makeup products (34%), plastic bags (30%) and tools (30%); lack of protection rails for cradles (30%) and for staircases (48%), and free access to roofs (44%). In 62 percent of cases some care was provided in the house of the injured child; twenty six percent counted on a support network, and 3 percent were by themselves. We present some proposals for epidemiologic and health services research, and stress the necessity to implement health education, social security and health services policies to favorably influence the solution of these problems.

Effect of injection sclerosis with alcohol on the rebleeding rate of gastroduodenal peptic ulcers with nonbleeding visible vessels: a prospective, controlled trial.

To assess the efficacy of injection therapy with alcohol on prevent rebleeding and emergency surgery in patients with gastroduodenal ulcers and nonbleeding visible vessels, we have performed a prospective controlled trial involving 39 patients who were classified into two groups according to the time of the day on which emergency endoscopy was performed: group 1 (25 patients) in which endoscopic hemostasis with absolute alcohol was performed, and group 2 (14 patients) in which conventional therapy was applied (blood transfusions, antacids, and ranitidine). The two groups were comparable with regard to age, sex, and type of bleeding. The rebleeding rate/emergency surgery rate of 8%/4%, respectively, for group 1 was lower than the 57%/50% for group 2 (p less than 0.001). Our results suggest that endoscopic hemostasis with alcohol should be considered as the initial treatment of choice in patients who present with major upper gastrointestinal hemorrhage and are found to have an ulcer with a nonbleeding visible vessel.

[An analysis in traumatic lesions of the demand for emergency services at 12 pediatric hospitals of the city of Mexico]. / Análisis de la demanda por lesiones traumáticas a servicios de urgencia de 12 hospitales pediátricos de la ciudad de México.

A study on damages to a child's good health caused by injuries (accidents and violence), has been mainly directed towards the analysis of mortality. In reference to morbidity, very few studies have been carried out in our country. One of the primordial objectives of these studies was to explore morbidity through the demand of hospital emergency services. The study was designed using a questionnaire applied to patients during the months of September-October of 1988 while admitted in 12 pediatric hospital emergency wards. The analysis was done using a representative sample per hospital, applying the finite population formula, with a Zc = 90% and a interval of 0.05. The total number of cases studied was 3,294. The most important variables studied were: type of demand, traumatic lesion, place of occurrence, external cause, age groups, sex, day and shift of the demand, hospitalization and number of days in the ward. The results give an overall view of this health problem concerning morbidity, besides offering a basis for future investigations dealing with the identification of risk factors or the application of concrete interventions for their prevention.

[Accidents, violence and traumatic lesions. A new look at the use and conceptual analysis of the terminology]. / Accidentes, violencias y lesiones traumáticas. Nuevo enfoque para el uso y análisis conceptual de los términos.

One of the barriers that has arisen for the prevention of injuries provoked by accidents and violence has been precisely that of the consideration of these terms as a health problem in and of itself; in actuality, they only constitute the mechanisms through which said injuries arise. At the moment, the usefulness of these terms is based on the fact that they offer the possibility of identifying the injury as either inadvertent of deliberate. Likewise, one of the goals of this work is to reflect upon the problems that arise from the inadequate use of these terms, as well as the implications and limitations of their use. This has had an effect on prevention and on the partial approach to the real cause of this health problem which turns out to be traumatic lesions, one of the prime causes of death and illness in infants, young persons, and the middle age in our country.