Rowell syndrome complicated with macrophage activation syndrome in a child.

Rowell syndrome (RS) is a rare disease characterized by the association of systemic lupus erythematosus (SLE) or cutaneous lupus with lesions similar to erythema multiforme and the presence of autoantibodies including ANA, SSA, SSB, or rheumatoid factor. Due to the low incidence of this disease, the epidemiology of RS is not clear. So far there are 95 cases reported in the literature; of these, only seven cases are pediatric patients. Macrophage activation syndrome (MAS) is an increasingly recognized complication of SLE, although its true prevalence in childhood is still unknown. We describe a unique pediatric patient with RS who developed MAS.

Origin, distribution, and geochemistry of arsenic in the Altiplano-Puna plateau of Argentina, Bolivia, Chile, and Perú.

Elevated concentrations of arsenic in water supplies represent a worldwide health concern. In at least 14 countries of South America, high levels have been detected relative to international standards and guidelines. Within these countries, the high plateau referred to as the "Altiplano-Puna", encompassing areas of Argentina, Bolivia, Chile, and Perú, exhibits high arsenic concentrations that could be affecting 3 million inhabitants. The origins of arsenic in the Altiplano-Puna plateau are diverse and are mainly natural in origin. Of the natural sources, the most important correspond to mineral deposits, brines, hot springs, and volcanic rocks, whereas anthropogenic sources are related to mining activities and the release of acid mine drainage (AMD). Arsenic is found in all water types of the Altiplano-Puna plateau over a wide range of concentrations (0.01 mg·L-1 < As in water > 10 mg·L-1) which in decreasing order correspond to: AMD, brines, saline waters, hot springs, rivers affected by AMD, rivers and lakes, and groundwater. Despite the few studies which report As speciation, this metalloid appears mostly in its oxidized form (As[V]) and its mobility is highly susceptible to the influence of dry and wet seasons. Once arsenic is released from its natural sources, it also precipitates in secondary minerals where it is generally stable in the form of saline precipitates and Fe oxides. In relation to human health, arsenic adaptation has been detected in some aboriginal communities of the Puna together with an efficient metabolism of this metalloid. Also, the inefficient methylation of inorganic As in women of the Altiplano might lead to adverse health effects such as cancer. Despite the health risks of living in this arsenic-rich environment with limited water resources, not all of the Altiplano-Puna is properly characterized and there exists a lack of information regarding the basic geochemistry of arsenic in the region.

Determinación del daño genotóxico de niños en relación a las mujeres en edad reproductiva por exposición a plomo y arsénico en Alto Lima - La Paz / Determination of the genotoxic harm of children with regard to the women of childbearing age by exposure to lead and arsenic in High *Lima - La Paz

Estudios epidemiológicos demostraron que la exposición ocupacional o accidental al plomo está asociada con mayor incidencia a tumores renales y cancer de pulmon y estómago. estudios in vivo mostraron un aumento de aberraciones cromosómicas y frecuencia de intercambio entre cromatides hermanas (ICH) en linfocitos de trabajadores expuestos a plomo, disminución de la fidelidad de la síntesis o reparación del ADN.

Patrón de apoptosis de células blancas de sangre de cordón umbilical (CBSCU) en cultivos in vitro producido por la carbamacepina, Metotrexate y Acido Fólico / Pattern of apoptosis of white cells of blood of umbilical cord (CBSCU) in cultivations in vitro taken place by the carbamacepina, Metotrexate and Folic Acid

Se evaluó el patrón de apoptosis de células blancas de sangre de cordón umbilical producido por la carbamecepina y metotrexate de potencial teratógénico conocido y ácido fólico con efecto protector de defectos de tubo neural, en cultivos in vitro. Se empleó un diseño completamente al azar con 9 repeticiones, el cual responde a un modelo lineal aditivo. Se estudió la acción protectora de ácido fólico en presencia de MTX y CBZ en cultivos in vitro de células blancas de cordón umbilical. Se demopstró que el anticonvulsivante CBZ y el agente anti-inflamatorio MTX inducen apoptosis a 100uM y 50uM respectivamente (dosis terapéutica). En este estudio se encontró que la presencia de ACF (o,1 - 10uM) protege a las células blancas de cordón umbilical contra la inducción de la apoptosis producida por la CBZ y MXT. Por el contrario el ACF no suprime la muerte celular debida al tiempo de cultivo. Entonces el ACF tiene un efecto robusto de protección contra la apoptosis en células blancas de cordón umbilical, esta propiedad provee una nueva vía para el estudio de los mecanismos moleculares y celulares de esta vitamina. Los datos reportados en este estudio son los primeros resultados generados sobre el efecto del MTX, CBZ y ACF y co-cultivos CBZ + ACF, MTX +ACF en cultivos de células blancas de sangre de cordón umbilical humano, demostándose que esta metodología in vitro es capaz de detectar el efecto de agentes protectores y teratogénicos justificándose estudios posteriores de validación de la técnica y evaluación de otros medicamentos para su aplicación.

Performance of on-line chemical property estimation methods with TSCA premanufacture notice chemicals.

CHEMEST is an interactive on-line system for estimating chemical properties important in environmental fate assessment. In 1988 we described an extensive validation study of CHEMEST. That study showed that for existing chemicals, most properties could be estimated with accuracy sufficient for screening-level assessment. Reported here are the results of a study of system performance with "new" chemicals, for which Premanufacture Notices (PMNs) must be submitted under the Toxic Substances Control Act. Measured values of key properties were retrieved for more than 300 PMN chemicals having discrete structures, which represented the majority of notices with submitted data that were received by the U.S. Environmental Protection Agency during the period 1979-1990. The measured values were compared to estimates from AUTOCHEM, an automated version of CHEMEST. Errors were generally greater than those for existing chemicals, as expected. Water solubility and the octanol/water partition coefficient (Kow) were estimated with acceptable accuracy, but the results for melting point and boiling point indicate that additional effort is needed to improve the estimation methods.

Workload contribution of a physician assistant in an ambulatory care setting.

To evaluate the workload contribution of a Physician Assistant (PA) in an Ambulatory Care-Walk-in setting the number of patients registered, seen by the PA, and by the Supervising Physician (SP) was used. The simple average was drawn for comparison purposes. Quality of care assessment done by record review of patients seen. The workload contribution of the PA was 10.8%, that of the SP was 11.6%, with a joint contribution of 22.5%. The non supervising physician average was 11.2%. The quality of care assessment showed 100% compliance with the first four, and 93% compliance with the last three criteria. A PA makes an efficient workload contribution in this setting, not endangering the workload contribution of the supervising physician, who is able to maintain a similar workload contribution to that of a non supervising physician.

[Experiences of the urbanization process in Venezuela]. / Incidencias del proceso de urbanizacion en Venezuela

PIP: The process of urbanization and urban growth in relation to economic development in Venezuela is analyzed. Four periods are considered: the period prior to the discovery of oil in Venezuela, which ended in the early 1940s; from the 1940s to the early 1970s; from the 1970s to 1983; and the present. Information is provided for the period 1936-1981 on total and urban population growth and on the size and number of urban centers.^ieng

Influence of a nutrition education program (EFNEP) on infant nutrition in East Harlem.

An assessment of the effectiveness of aides working in the Expanded Food and Nutrition Education Program (EFNEP) to improve the nutritional status of infants was conducted with a group of 118 infants attending a well-baby clinic in a low-income area of New York City. In addition to clinic care, the fifty-seven study infants received home visits from a nutrition aide whose role was to reinforce nutritional advice received at the clinic. The sixty-one control infants received only regular clinic care. The benefits of having an aide were suggested by three observations: Reduction in the practice of introducing whole cow's milk to young infants, familiarizing older infants with a variety of foods, and reducing the prevalence of iron-deficiency anemia. Few of the differences between study and control infants achieved statistical significance, although trends consistently indicated that the presence of aides was beneficial. The problems of assessing the effectiveness of nutrition education programs with healthy infants are discussed.

Infant feeding practices in East Harlem.

Infant feeding practices among low-income infants in East Harlem were surveyed prior to undertaking a nutrition education program. Data were obtained from 24-hr. recalls on 153 infants seen in a well-baby clinic. Intakes of energy, protein, fat, ascorbic acid, iron, and sodium showed wide variations among infants of similar ages. Nutrient intakes were similar for black and Puerto Rican infants, although some ethnic differences were observed in the types of milk and solid foods consumed. Black infants received formula for a longer period, while Puerto Rican infants were transferred to whole cow's milk at a younger age. In contrast black infants were introduced to table foods earlier.