Violations of the International Code of Marketing of Breast-milk Substitutes: a multi-country analysis.

The marketing of formula milk as a substitute for breast milk continues to be ubiquitous and multifaceted despite passage by the World Health Assembly of the International Code of Marketing of Breast-milk Substitutes (the Code) in 1981. In this paper, we summarized reports of the Code violations from eight studies using the WHO/UNICEF NetCode protocol. Among 3,124 pregnant women and mothers with young children, in eight countries, 64% reported exposure to promotion of products covered under the Code in the previous 6 months, primarily from advertisements seen outside of health facilities (62%). Nearly 20% of mothers with an infant < 6 months reported that a health care provider had advised them to feed their child food or drink other than breast milk, and 21% of providers reported contact with a representative of a formula company in the previous 6 months to distribute promotional materials, samples, or free supplies (range 2%-53%). Of the 389 retail stores and pharmacies surveyed, promotions were observed in 63% (range 0-100%), and of 1,206 labels and inserts of products reviewed, nearly half included health and/or nutrition claims (range 0-100%). A strong, though non-significant, linear relationship between the composite violations score and quality of Code legislation was found; countries with the lowest percentage of violations had the strongest Code legislation. In Latin America, over 50% of health care providers reported no knowledge of the Code, and 50% reported no knowledge of national legislation. Our study highlights three key facts: 1) the marketing of BMS is ubiquitous and multifaceted, 2) the high variability of promotion across countries generally reflects the comprehensiveness of Code legislation, and 3) health care providers have poor knowledge of the Code and national legislation.

Prevalence and factors associated to peanut allergy in Mexican school children

BACKGROUND: In our country, the prevalence and the factors associated to peanut allergy are unknown, a health problem that has been emerging worldwide. OBJECTIVE: To establish the prevalence and the factors that are associated to peanut allergy amongst school children. METHODS: This is a population-based cross-sectional study. We included 756 children aged 6-7 years. The children's parents were questioned about their peanut intake habits. A structured questionnaire was applied, it included questions regarding peanut intake; family and personal history of asthma; rhinitis; and atopic dermatitis. Allergic reactions to peanuts were registered as: probable, convincing and systematic. The statistical analyses included logistical regression models to look for associated factors. RESULTS: Males were 356/756 (47.1%). Peanut allergy prevalence: probable reaction: 14/756 (1.8%), convincing reaction: 8/756 (1.1%) and systemic reaction: 3/756 (0.4%). Through multivariate analysis, the presence of symptoms of allergic rhinitis (OR = 4.2 95% CI 1.3-13.2) and atopic dermatitis (OR = 5.2; 95% CI 1.4-19.5) during the previous year, showed significant association to probable peanut reaction. The former year, the presence of atopic dermatitis was the only variable that was substantially associated to a convincing reaction (OR = 7.5; 95% CI 1.4-38.4) and to a systematic reaction (OR = 45.1; 95% CI 4.0-510.0), respectively. CONCLUSIONS: The reported prevalence of peanut allergy was consistent with that found in previous studies; symptoms of allergic rhinitis and atopic dermatitis were identified as associated factors to peanut allergy

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Prevalence and factors associated to peanut allergy in Mexican school children.

BACKGROUND: In our country, the prevalence and the factors associated to peanut allergy are unknown, a health problem that has been emerging worldwide. OBJECTIVE: To establish the prevalence and the factors that are associated to peanut allergy amongst school children. METHODS: This is a population-based cross-sectional study. We included 756 children aged 6-7 years. The children's parents were questioned about their peanut intake habits. A structured questionnaire was applied, it included questions regarding peanut intake; family and personal history of asthma; rhinitis; and atopic dermatitis. Allergic reactions to peanuts were registered as: probable, convincing and systematic. The statistical analyses included logistical regression models to look for associated factors. RESULTS: Males were 356/756 (47.1%). Peanut allergy prevalence: probable reaction: 14/756 (1.8%), convincing reaction: 8/756 (1.1%) and systemic reaction: 3/756 (0.4%). Through multivariate analysis, the presence of symptoms of allergic rhinitis (OR=4.2 95% CI 1.3-13.2) and atopic dermatitis (OR=5.2; 95% CI 1.4-19.5) during the previous year, showed significant association to probable peanut reaction. The former year, the presence of atopic dermatitis was the only variable that was substantially associated to a convincing reaction (OR=7.5; 95% CI 1.4-38.4) and to a systematic reaction (OR=45.1; 95% CI 4.0-510.0), respectively. CONCLUSIONS: The reported prevalence of peanut allergy was consistent with that found in previous studies; symptoms of allergic rhinitis and atopic dermatitis were identified as associated factors to peanut allergy.

The Notch ligand DLL4 specifically marks human hematoendothelial progenitors and regulates their hematopoietic fate.

Notch signaling is essential for definitive hematopoiesis, but its role in human embryonic hematopoiesis is largely unknown. We show that in hESCs the expression of the Notch ligand DLL4 is induced during hematopoietic differentiation. We found that DLL4 is only expressed in a sub-population of bipotent hematoendothelial progenitors (HEPs) and segregates their hematopoietic versus endothelial potential. We demonstrate at the clonal level and through transcriptome analyses that DLL4(high) HEPs are enriched in endothelial potential, whereas DLL4(low/-) HEPs are committed to the hematopoietic lineage, albeit both populations still contain bipotent cells. Moreover, DLL4 stimulation enhances hematopoietic differentiation of HEPs and increases the amount of clonogenic hematopoietic progenitors. Confocal microscopy analysis of whole differentiating embryoid bodies revealed that DLL4(high) HEPs are located close to DLL4(low/-) HEPs, and at the base of clusters of CD45+ cells, resembling intra-aortic hematopoietic clusters found in mouse embryos. We propose a model for human embryonic hematopoiesis in which DLL4(low/-) cells within hemogenic endothelium receive Notch-activating signals from DLL4(high) cells, resulting in an endothelial-to-hematopoietic transition and their differentiation into CD45+ hematopoietic cells.

Impacto económico de la atención del niño expuesto a VIH, con antirretrovirales durante el embarazo, Hospital Roosevelt Guatemala año 2011 / Economic impact of child care exposed to HIV, antiretroviral during pregnancy, Roosevelt Hospital Guatemala 2011

En el 2002 la Clínica de Enfermedades Infecciosas, inició en el departamento de Ginecoobstetricia del Hospital Roosevelt, la atención a madres embarazadas para prevenir la transmisión vertical del VIH, hepatitis B y sífilis, a través del tamizaje universal y seguimiento de los casos detectados. En el año 2006 se inicia la atención a niños expuestos en clínica pediátrica de consulta externa. Atendiendo de esta manera a la madre y el seguimiento de madres VIH positivo y niños expuestos nacidos en el Hospital Roosevelt y casos referidos de otras instituciones, públicas y privadas...

Mesenchymal stem cells facilitate the derivation of human embryonic stem cells from cryopreserved poor-quality embryos.

BACKGROUND: Human embryonic stem cells (hESCs) have opened up a new area of research in biomedicine. The efficiency of hESC derivation from frozen poor-quality embryos is low and normally achieved by plating embryos on mouse or human foreskin feeders (HFFs). We attempted to optimize embryo survival and hESC derivation. METHODS: Three conditions were tested on frozen poor-quality embryos: (i) embryo treatment with the Rho-associated kinase (ROCK) inhibitor, Y-27632; (ii) use of human mesenchymal stem cells (hMSCs) as feeders; and (iii) laser drilling (LD) for inner cell mass (ICM) isolation. Two hundred and nineteen thawed embryos were randomly treated with (n = 110) or without (n = 109) 10 microM Y-27632. Surviving embryos that developed to blastocyst stage (n = 50) were randomly co-cultured on HFFs (n = 21) or hMSCs (n = 29). ICM isolation was either by whole-blastocyst culture (WBC) or WBC plus LD. RESULTS: Embryo survival was 52% higher with Y-27632. hMSCs appeared to facilitate ICM outgrowth and hESC derivation: three hESC lines were derived on hMSCs (10.3% efficiency) whereas no hESC line was derived on HFFs. ROCK inhibition and ICM isolation method did not affect hESC efficiency. The lines derived on hMSCs (AND-1, -2, -3) were characterized and showed typical hESC morphology, euploidy, surface marker and transcription factor expression and multilineage developmental potential. The hESC lines have been stable for over 38 passages on hMSCs. CONCLUSION: Our data suggest that Y-27632 increases post-thaw embryo survival and that hMSCs may facilitate the efficiency of hESC derivation from frozen poor-quality embryos.

Use of fluorogestone acetate after breeding to reduce the effect of premature luteal regression in dairy goats when superovulation is induced with FSH.

The aim of the present study was to determine the effect of fluorogestone acetate (FGA) administered after mating, on embryo production in the dairy goat subjected to conventional superovulatory and embryo recovery protocols. Adult does, most of them of the French Alpine breed, were randomly assigned after a FSH-superovulatory estrus and fertile matings to a control group (n=20) or to a treated group (n=20) in which intravaginal sponges impregnated with FGA were inserted after mating and remove before embryo collection (day 6). Blood samples were collected every 12h from days 1 to 7 post-estrus and serum progesterone concentrations were determined. The FGA-group had a lesser percentage of does with normal corpora lutea (CL) and a greater percentage of animals with CL in regression or mixed (normal and in regression) when compared with the control group (13.3 and 64.7%, 53.3 and 23.5%, and 33.3 and 11.8%, respectively; P<0.05). Mean number of normal CL per doe was less and mean number of regressed CL greater in FGA as compared with the control group (4.2 compared with 10.7 and 8.5 compared with 3.6, respectively; P<0.05). There were no differences (P>0.05) in recovery rate, total number of CL, total recovered structures, oocytes and transferable and non-transferable embryos between groups. Serum progesterone concentrations from day 5 to 7 post-estrus were lower (P<0.05) in FGA as compared with the control group. Percentage of does with luteal failure on day 6 post-estrus was greater in FGA as compared with the control group (86.6 compared with 33.3%; P<0.01). When considering only does with luteal failure on day 6 post-estrus, mean total recovered structures, transferable embryos and percentage of does rendering > or =3 transferable embryos were greater in the FGA compared with the control group (6.3 and 1.3 structures, 4.5 and 1.2 embryos, 67 and 17%, respectively; P<0.05). In does not having luteal failure, FGA administration did not appear to affect embryo production or embryo survival. These results indicate that FGA administration after mating improves embryo recovery in dairy goats with luteal failure after superovulatory treatment. However, it also increases the incidence of luteal regression when administered early in the estrous cycle.

Startle reactivity and PTSD symptoms in a community sample of women.

Exaggerated startle and PTSD symptoms have been investigated primarily in relation to acute or Type I stressors. The present study examined PTSD symptoms and startle eyeblink response in relation to chronic or Type II stressors. Type II stressors were operationally defined as high levels of childhood corporal punishment and high levels of current partner aggression. This study recruited a sample of 52 women from a metropolitan community and administered several questionnaires assessing experience of corporal punishment in childhood, current intimate partner aggression and level of PTSD symptoms. Following questionnaires, women were presented with eight auditory startle probes (white noise). Results showed that both childhood corporal punishment and intimate partner aggression were associated with women's PTSD symptom scores. However, only PTSD symptom scores were associated with reduced startle. Results are discussed in light of Type I and Type II stressors, and recent suggestions in the PTSD literature that a subgroup of individuals may experience physiological suppression rather than heightened physiological reactivity.

Glucocorticoid resistance caused by reduced expression of the glucocorticoid receptor in cells from human vascular lesions.

Mechanisms that control the balance between cell proliferation and death are important in the development of vascular lesions. Rat primary smooth muscle cells were 80% inhibited by low microgram doses of hydrocortisone (HC) and 50% inhibited by nanogram concentrations of transforming growth factor-beta1 (TGF-beta1), although some lines acquired resistance in late passage. However, comparable doses of HC, or TGF-beta1, failed to inhibit most human lesion-derived cell (LDC) lines. In sensitive LDC, HC (10 microg/mL) inhibited proliferation by up to 50%, with obvious apoptosis in some lines, and TGF-beta1 inhibited proliferation by more than 90%. Collagen production, as measured by [3H]proline incorporation or RIA for type III pro-collagen, was either unaffected or increased in the LDCs by HC. These divergent responses between LDC lines were partially explained by the absence of the glucocorticoid receptor (GR) and heat shock protein 90 mRNA in 10 of 12 LDC lines, but the presence of the mineralocorticoid receptor and 11beta-hydroxysteroid dehydrogenase type II. Western blot analysis confirmed the absence of the GR protein in cells lacking GR mRNA. Immunohistochemistry of human carotid lesions showed high levels of GR in the tunica media, but large areas lacking GR in the fibrous lesion. Considering the absence of the GR in most lines, the effects of HC may be elicited through the mineralocorticoid receptor. Functional resistance to the antiproliferative and antifibrotic effects of HC may contribute to excessive wound repair in atherosclerosis and restenosis.

Hepatitis B en una Unidad de Hemato-Oncología Pedi trica: transmisión horizontal como riesgo nosocomial / Hepatitis B infection in the Hematology-Oncology Pediatric Unit: horizontal transmission as a nosocomial risks

Objetivo: Establecer los factores de riesgo para la infección por VHB en la Unidad de Hemato-Oncología pedi trica del Hospital Roosevelt. Métodos: A través de un estudio de corte se investigó por medio de una boleta de recolección de información, los datos clínicos-epidemiológicos en 27 expedientes de pacientes afectados por la infección de VHB y 27 no afectados de la Unidad de Hemato-Oncología pedi trica del período de junio de 1994 a enero de 1996. Resultados: Se encontró un caso índice (primer caso), en quien se detectó HBsAg en saliva, y se observó una probable relación que el haber estado hospitalizado en el mismo período que el caso índice era un riesgo significativo de adquirir la hepatitis B(p<0.0007051 y RR:2.51), no así el número de transfusiones, que fue similar en ambos grupos.Observaciones: la presencia de HBsAg en saliva en los casos de HBV crónicos es fluctuante y en todos los casos agudos se detectó presencia de HBsAg en saliva sea un marcador de alta replicación viral, por si mismo. Se debe investigar el nivel de HBV/ADN en sangre o saliva también.Discusión:La posibilidad de transmisión horizontal del VHB en Unidades donde se atienden niños inmuno-comprometidos, es un hecho real, por lo que medidas preventivas adecuadas deben ser implementadas, no atribuyendo solamente a las transfusiones el riesgo de adquirir HBV

Influencia de la ingesta de alcohol en los accidentes; estudio de 500 casos / Alcohol ingestions in accidents : study of 500 cases

Mediante un estudio prospectivo de tipo poblacional se realizó una investigación en 500 pacientes que se presentaron durante el año de 1990 a la emergencia del hospital Dr. Dario Contreras, con la finalidad de determinar la influencia del consumo de alcohol en la provocación de accidentes. Los resultados de esta investigación coinciden en su gran mayoría con los reportados por los autores internacionales. Se determinó en este estudio que el riesgo de accidentes aumenta con el consumo de alcohol, que es el factor de mayor causa de morbi-mortalidad por accidentes en el mundo y en nuestro país hay un incremento del consumo del alcohol, lo que es demostrado por un 46 por ciento de este fenómeno en los pacientes estudiados

Historia natural y evolución clínica de la neurocisticercosis / Neurocysticercosis: natural history and clinical evolution

La cisticercosis cerebral constituye un problema sanitario en Guatemala. Desde el advenimiento e introducción de la tomografía computada se ha facilitado el diagnóstico de muchos casos que previamente se diagnoticaron como "síndrome convulsivo idiop tico". Presentamos un total de 33 pacientes con cisticercosis cerebral, comprendido en las edades de 2 a 49 años, quienes fueron observados por períodos de 6 semanas a 6 años. Se encontraron lesiones únicas en 16 pacientes, múltiples en 15 pacientes y edema difuso en 2. Las formas de presentación clínica fueron: síndrome convulsivo en 22 pacientes, síndrome de hipertensión endocraneana en 6 pacientes y par lisis en 3 de ellos. Los pacientes recibieron tratamiento sintom tico con anticonvulsivantes y/o esteroides, así como analgésicos, logr ndose una resolución clínica y radiológica en 33 y 30 pacientes respectivamente. En ninguno de los casos se utilizó Praziquantel u otro antiparasitario como tratamiento. El pronóstico de la enfermedaad es generalmente bueno, ya que la neurocisticercosis es un proceso clínico autolimitado en la mayoría de los casos. (Rev. Me Intern 1991, 2:3-6. La teniasis es causada por la presencia de Taenia solium en el intestino humano. La Cisticercosis es causada por el estado larvario en el tejido humano. La Taenia solium est distribuída ampliamente en diversas regiones del mundo. En los países occidentales altamente desarrollados la infestación es rara, aunque a principios de siglo era endémica en muchas de estas regiones del mundo. En Berlín, por ejemplo en la época de Rudolph Virchow era un hallazgo común de necropsia (2/100 del total de necropsias) (1,2,3) (Rev Med Inter 1991; 2:3-6)

Impacto económico de la infección nosocomial en Intensivo Hospital Roosevelt / Nosocomial infections at the intensive care unit and the economical impact in Hospital Roosevelt

Los servicios de terapia intensiva admiten pacientes criticamente enfermos que requieren procedimientos invasivos tanto diagnósticos como terapéuticos que los hacen m s susceptibles a adquirir infecciones nosocomiales,los cuales inciden indudablemente en la economía hospitalaria. Realizamos un estudio prospectivo en 51 pacientes ingresados en forma consecutiva a la sala de Intensivo del Hospital Roosevelt en el mes de abril de 1990. Se determinó las diferencias en gastos entre los pacientes que adquirieron y los que no adquirieron infección, evaluando los siguientes par metros: Hora/hombre, uso de monitor, ex menes de laboratorio, procedimientos, consumo de oxígeno, transfusiones, etc. Se demostró un incremento global del 1025/100 en los costos de los pacientes que adquirieron infección nosocomial, lo cual nos obliga a observar m s estrictamente las normas de control de infección nosocomial con el fin de utilizar m s racionalmente los recursos de los hospitales.(Rev Med Intern 1991; 2:7-10)