Arsenic in public water supplies and cardiovascular mortality in Spain.

BACKGROUND: High-chronic arsenic exposure in drinking water is associated with increased cardiovascular disease risk. At low-chronic levels, as those present in Spain, evidence is scarce. In this ecological study, we evaluated the association of municipal drinking water arsenic concentrations during the period 1998-2002 with cardiovascular mortality in the population of Spain. METHODS: Arsenic concentrations in drinking water were available for 1721 municipalities, covering 24.8 million people. Standardized mortality ratios (SMRs) for cardiovascular (361,750 deaths), coronary (113,000 deaths), and cerebrovascular (103,590 deaths) disease were analyzed for the period 1999-2003. Two-level hierarchical Poisson models were used to evaluate the association of municipal drinking water arsenic concentrations with mortality adjusting for social determinants, cardiovascular risk factors, diet, and water characteristics at municipal or provincial level in 651 municipalities (200,376 cardiovascular deaths) with complete covariate information. RESULTS: Mean municipal drinking water arsenic concentrations ranged from <1 to 118 microg/L. Compared to the overall Spanish population, sex- and age-adjusted mortality rates for cardiovascular (SMR 1.10), coronary (SMR 1.18), and cerebrovascular (SMR 1.04) disease were increased in municipalities with arsenic concentrations in drinking water > 10 microg/L. Compared to municipalities with arsenic concentrations < 1 microg/L, fully adjusted cardiovascular mortality rates were increased by 2.2% (-0.9% to 5.5%) and 2.6% (-2.0% to 7.5%) in municipalities with arsenic concentrations between 1-10 and >10 microg/L, respectively (P-value for trend 0.032). The corresponding figures were 5.2% (0.8% to 9.8%) and 1.5% (-4.5% to 7.9%) for coronary heart disease mortality, and 0.3% (-4.1% to 4.9%) and 1.7% (-4.9% to 8.8%) for cerebrovascular disease mortality. CONCLUSIONS: In this ecological study, elevated low-to-moderate arsenic concentrations in drinking water were associated with increased cardiovascular mortality at the municipal level. Prospective cohort studies with individual measures of arsenic exposure, standardized cardiovascular outcomes, and adequate adjustment for confounders are needed to confirm these ecological findings. Our study, however, reinforces the need to implement arsenic remediation treatments in water supply systems above the World Health Organization safety standard of 10 microg/L.

Carcinoide biliar intrahepático / Intrahepatic biliary carcinoid

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Hiperplasia linfoide nodular hepática. Pseudolinfoma hepático / Nodular lymphoid hyperplasia of the liver. Hepatic pseudolymphoma

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¿Se puede mejorar el postoperatorio de la hemorroidectomía? Estudio comparativo del dispositivo Ligasure® frente a la hemorroidectomía con diatermia / Can posthemorrhoidectomy pain be improved? Ligasure® vs diathermy hemorrhoidectomy

Introducción. La hemorroidectomía es una técnica de uso frecuente y con una importante morbilidad, fundamentalmente en forma de dolor postoperatorio.El presente trabajo tiene el objetivo de comparar, en términos de dolor postoperatorio, un nuevo tipo de hemorroidectomía mediante el empleo del sellador de vasos Ligasure®.Pacientes y métodos. Cincuenta pacientes consecutivos intervenidos de hemorroides grados II, III y IV fueron aleatorizados en 2 grupos: en 24 pacientes se realizó una hemorroidectomía abierta con Ligasure®y en 26, como grupo control, una hemorroidectomía con diatermia. Se valoró el dolor postoperatorio mediante escala analógica visual en el primer, tercer y séptimo días, en la tercera semana y en el tercer mes.Un investigador independiente realizó una encuesta de satisfacción al final del estudio.Resultados. Treinta y tres mujeres (66 por ciento) y 17 varones (34 por ciento) con una edad media de 54 años fueron intervenidos de hemorroides: 24 con el dispositivo Ligasure® y 26 con técnica de diatermia. La distribución por grados fue de 4 pacientes con grado II, 28 con grado III y 18 con grado IV. El número de paquetes intervenidos fue de un paquete en 2 pacientes, dos en 7 pacientes, tres en 39 y cuatro en 2. No se detectaron diferencias entre los grupos en relación con la edad (p = 0,724), el sexo (p = 0,556), el grado hemorroidal (p = 0,39), el número de paquetes (p = 0,25), el tiempo de intervención (p = 0,122), la escala analógica visual al primer, tercer y séptimo días postoperatorios (p = 0,850, 0,595 y 0,969, respectivamente), el tacto rectal a la tercera semana y el tercer mes (p = 0,931) así como el número y el tipo de complicaciones.Conclusiones. En nuestra experiencia, en términos de dolor postoperatorio, no hay diferencias entre la cirugía hemorroidal con diatermia y el empleo del Ligasure® (AU)

Quality of life in low-income menopausal women attending primary care clinics.

OBJECTIVE: To examine the quality of life and health status of a population of menopausal age primary care attendees that demographically has not been well represented in previous studies, and to describe the relationships between population characteristics and outcomes. DESIGN: Cross-sectional. SETTING: Community primary care clinics. PATIENT(S): Women 45-60 years of age within 5 years of their last period. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Participants provided demographic information and completed a series of questionnaires, including the Menopause Quality of Life Instrument (MENQOL) and the Short Form-36 health survey (SF-36). RESULT(S): Women who were employed, had higher levels of education, or higher levels of income reported better overall health and fewer menopausal symptoms. The study population scored significantly lower than the national norms on a summary survey of mental and physical health. There were no significant differences between ethnic groups with respect to either menopausal quality of life or health status. CONCLUSION(S): In a generally low income, poorly educated menopausal population, ethnicity did not significantly affect quality of life. Socioeconomic characteristics (less education and lower income) were associated with increased menopausal symptoms.

Histories of childhood trauma and the effects on risky HIV behaviors in a sample of women drug users.

A cross-sectional study was conducted to examine the association between childhood trauma and current human immunodeficiency virus (HIV) risk behaviors of 181 active illicit-drug-using women in San Antonio, Texas. We found very few statistically significant associations, which could he explained by (a) childhood trauma subtypes not being mutually exclusive, (b) clustering of mild-to-severe forms of abuse. and (c) childhood trauma having an indirect, rather than direct, effect on HIV risk behavior. Public health implications from this study are that prevention programs need to consider past and current individual and environmental factors that influence HIV sexual risk behaviors in women drug users.

Prevalence of childhood trauma in a community sample of substance-abusing women.

The purpose of this study was to estimate the prevalence of positive trauma histories in a community sample of intravenous drug using (IVDU) women for five subsets of childhood trauma (emotional abuse or neglect, physical abuse or neglect, and sexual abuse) and to compare demographic variables between the abused versus nonabused groups. Of the 181 women who completed the Childhood Trauma Questionnaire (CTQ), 109 (60.2%) were sexually abused, 100 (55.2%) were physically abused, 83 (45.9%) were emotionally abused, 151 (83.4%) were emotionally neglected, and 108 (59.7%) were physically neglected. There were no statistically significant findings for age, ethnicity, and educational level. Those subjects that were physically neglected were more likely not to be in a current relationship compared to those subjects that were not abused (p = .036). The findings suggest that the prevalence of all five childhood traumas was higher than what has been reported in the general population, and that physical neglect of individuals may predict lack of current significant relationships.

[Massive fecal impaction in a patient with osteogenesis imperfecta]. / Impactación fecal masiva en un paciente con osteogénesis imperfecta.

The case of a 22 year old male with massive faecal impaction and anorectal mechanical stenosis caused by multiples bone fractures and pelvic deformities secondary to imperfect osteogenesis is reported. The patient was treated with subtotal colectomy and permanent colostomy.

DBH, MHPG, and MAO in children with depressive, anxiety, and conduct disorders: relationship to diagnosis and symptom ratings.

Plasma 3-methoxy-4-hydroxyphenylglycol (MHPG), plasma dopamine-beta-hydroxylase (DBH) activity, and platelet monoamine oxidase (MAO) were obtained in 42 boys (7-14 years old) consecutively evaluated at a community mental health clinic. The boys were diagnosed according to DSM-III criteria by a child psychiatrist using a semistructured interview with the parent and child. The Revised Behavior Problem Checklist (RBPC) and the Revised Children's Manifest Anxiety Scale (RCMAS) were consecutively obtained on the last 24 subjects. No relationship of any of the plasma measures was found with respect to the DSM-III diagnoses. Plasma MHPG was positively correlated with the parent's rating of the child's anxiety on the Anxiety-Withdrawal factor of the RBPC. Plasma MHPG as well as platelet MAO activity, correlated positively with the child's self-rating of anxiety on the RCMAS. Children classified by the RBPC as having high conduct symptoms and low anxiety symptoms had significantly lower plasma MHPG than those subjects with low conduct problems and high anxiety. Platelet MAO activity was found to be negatively correlated to the child's score on the Lie Scale of the RCMAS.

Partial 2p deletion in a girl with a complex chromosome rearrangement involving chromosomes 2, 6, 11, and 21.

We describe the clinical and cytogenetic findings of a 9 1/2 month old girl with a complex chromosome rearrangement resulting in a probable deletion of band 2p14. She does not resemble other reported cases of del(2p).