Síndrome de tolosa hunt: presentación de caso clínico / Tolosa Hunt syndrome: case report

El síndrome de Tolosa-Hunt es una entidad poco frecuente cuya etiopatogenia y mecanismos fi- siopatológicos son controversiales, se caracteri- za por cefalea asociada a parálisis de uno o más nervios craneales, diplopía, estrabismo y ptosis palpebral, ocasionados por el compromiso del seno cavernoso o la fisura orbitaria superior. Su diagnóstico es un reto y se aborda dentro de los diagnósticos diferenciales de las oftalmoplejías dolorosas. Con el objetivo de describir y actua- lizar el conocimiento sobre esta enfermedad se presenta el caso de una paciente de 14 años que acudió a consulta por cefalea intensa, dolor ocu- lar y afección de nervios craneales. Los hallazgos clínicos y la resonancia magnética confirmaron el diagnóstico del síndrome de Tolosa Hunt...(AU)

Self-assembly of model short triblock amphiphiles in dilute solution.

In this work, a molecular theory is used to study the self-assembly of short diblock and triblock amphiphiles, with head-tail and head-linker-tail structures, respectively. The theory was used to systematically explore the effects of the molecular architecture and the affinity of the solvent for the linker and tail blocks on the relative stability of the different nanostructures formed by the amphiphiles in dilute solution, which include spherical micelles, cylindrical fibers and planar lamellas. Moreover, the theory predicts that each of these nanostructures can adopt two different types of internal organization: (i) normal nanostructures with a core composed of tail segments and a corona composed of head segments, and (ii) nanostructures with a core formed by linker segments and a corona formed by tail and head segments. The theory predicts the occurrence of a transition from micelle to fiber to lamella when increasing the length of the tail or the linker blocks, which is in qualitative agreement with the geometric packing theory and with experiments in the literature. The theory also predicts a transition from micelle to fiber to lamella as the affinity of the solvent for the tail or linker block is decreased. This result is also in qualitative agreement with experiments in the literature but cannot be explained in terms of the geometric packing theory. The molecular theory provides an explanation for this result in terms of the competition between solvophobic attractions among segments in the core and steric repulsions between segments in the corona for the different types of self-assembled nanostructures.

Factores de riesgo para las anormalidades de enzimas hepáticas de la nutrición parenteral en un hospital de referencia de México / Risk factors for abnormal liver function tests of parenteral nutrition in a referral hospital in Mexico

Introducción: Las anormalidades en las pruebas de funcionamiento hepático (APFH) y las complicaciones Hepáticas (CH) de la Nutrición Parenteral (NP) son frecuentes y a menudo multifactoriales. Aún no han sido evaluados dichos factores de riesgo en población mexicana adulta. Objetivo: Determinar si la dosis de lípidos prescrita de mayor a 1 g/kg es factor de riesgo para las anormalidades en pruebas de función hepática (APFH) de la NP. Material y métodos: Cohorte que incluyo pacientes mayores de 15 años de edad y excluyó aquellos que fueron manejados en la unidad de cuidados intensivos o con anormalidades en las enzimas hepáticas previo al inicio de NP. Los grupos expuesto (GE) y no expuesto (GNE) fueron aquellos que recibieron más de un gramo y un gramo o menos por kilo de peso de lípidos respectivamente. Las APFH fueron definidas como un incremento mayor al 50% de lo normal de AST, ALT, FA o Bilirubina Total. Resultados: La incidencia de APFH fue de 20 (47,6%) y15 (41,6%), en los GE y GNE respectivamente (RR 1,14IC 95% 0,69-1,88; p = 0,59). El patrón de daño hepático más común fue el colestásico, seguido del mixto y finalmente el hepatocelular. La dosis de lípidos prescrita de más de 1 g/kg, no se asoció con el desarrollo de CH de la APFH. A mayor dosis de proteínas menor frecuencia de APFH Conclusión: La dosis de lípidos prescrita de más de 1g/kg, no se asoció con el desarrollo de APFH de la NP en nuestra población. Estos hallazgos requieren ser confirmados en Ensayos clínicos (AU)

Introduction: the abnormalities in liver function tests (LFTs) and liver complications (LC) from parenteral nutrition (PN) are common and usually multi-factorial. These factors have not yet been assessed in the adult Mexican population. Objective: To determine whether the dose prescribed >1 g/kg is a risk factor for the abnormalities in liver function tests (LFTs) from PN. Material and methods: Cohort study including patients older than 15 years and excluding those managed at the intensive care unit or with abnormalities in liver enzymes before the start of PN. The exposed and non-exposed groups were those receiving > 1 g of lipids per kg of bodyweight or < 1 g/kg, respectively. LFTs were defined as an increase higher than 50% of the normal range for AST,ALT, AF or total bilirrubin. Results: the incidence of LFTs abnormalities was 20(47.6%) and 15 (41.6%) in the exposed and non-exposed groups, respectively (RR 1.14 95% IC: 0.69-1.88; p =0.59). The most frequent liver damage pattern was cholestatic, followed by the mixed pattern and then hepatocellular. The dose of prescribed lipids > 1 g/kg was not associated with the development of LC from LFTs abnormalities. The higher the dose of proteins the lower the frequency of LFTs abnormalities. Conclusion: The dose of lipids prescribed >1 g/kg was not associated with the development of LFTs abnormalities from PN in our sample population. These findings should be confirmed in clinical trials (AU)

[Risk factors for abnormal liver function tests of parenteral nutrition in a referral hospital in Mexico]. / Factores de riesgo para las anormalidades de enzimas hepáticas de la nutrición parenteral en un hospital de referencia de México.

INTRODUCTION: the abnormalities in liver function tests (LFTs) and liver complications (LC) from parenteral nutrition (PN) are common and usually multifactorial. These factors have not yet been assessed in the adult Mexican population. OBJECTIVE: To determine whether the dose prescribed > 1 g/kg is a risk factor for the abnormalities in liver function tests (LFTs) from PN. MATERIAL AND METHODS: Cohort study including patients older than 15 years and excluding those managed at the intensive car unit or with abnormalities in liver enzymes before the start of PN. The exposed and non-exposed groups were those receiving > 1 g of lipids per kg of body weight or < 1 g/kg, respectively. LFTs were defined as an increase higher than 50% of the normal range for AST, ALT, AF or total bilirrubin. RESULTS: the incidence of LFTs abnormalities was 20 (47.6%) and 15 (41.6%) in the exposed and non-exposed groups, respectively (RR 1.14 95% IC: 0.69-1.88; p = 0.59). The most frequent liver damage pattern was cholestatic, followed by the mixed pattern and then hepatocellular. The dose of prescribed lipids > 1 g/kg was not associated with the development of LC from LFTs abnormalities. The higher the dose of proteins the lower the frequency of LFTs abnormalities. CONCLUSION: The dose of lipids prescribed >1 g/kg was not associated with the development of LFTs abnormalities from PN in our sample population. These findings should be confirmed in clinical trials.

Alterations in dendritic morphology of prefrontal cortical and nucleus accumbens neurons in post-pubertal rats after neonatal excitotoxic lesions of the ventral hippocampus.

Neonatal ventral hippocampal (nVH) lesions in rats result in adult onset of a number of behavioral and cognitive abnormalities analogous to those seen in schizophrenia, including hyperresponsiveness to stress and psychostimulants and deficits in working memory, sensorimotor gating and social interaction. Molecular and neurochemical alterations in the prefrontal cortex (PFC) and nucleus accumbens (NAcc) of nVH-lesioned animals suggest developmental reorganization of these structures following neonatal lesions. To determine whether nVH lesions lead to neuronal morphological changes, we investigated the effect of nVH lesion on dendritic structure and spine density of pyramidal neurons of the PFC and medium spiny neurons of the NAcc. Bilateral ibotenic acid-induced lesion of the VH was made in Sprague-Dawley pups at postnatal day 7 (P7); and at P70, neuronal morphology was quantified by modified Golgi-Cox staining. The results show that length of basilar dendrites and branching and the density of dendritic spines on layer 3 pyramidal neurons were significantly decreased in rats with nVH lesions. Medium spiny neurons from the NAcc showed a decrease in the density of dendritic spines without significant changes in dendritic length or arborization. The data, comparable to those observed in the PFC of schizophrenic patients, suggest that developmental loss of excitatory projections from the VH may lead to altered neuronal plasticity in the PFC and the NAcc that may contribute to the behavioral changes in these animals.

[Prevalence of domestic violence in the city of Durango]. / Prevalencia de violencia doméstica en la ciudad de Durango.

OBJECTIVE: To characterize and determine the prevalence of the different types of gender-associated violence in the city of Durango, Mexico. MATERIAL AND METHODS: With a transversal design, 384 women residents of the city of Durango, either living with or having lived with someone before, were interviewed. The sample was proportionately distributed in 6 city sectors which were randomly chosen and representative of the high middle and low socioeconomic levels. Sixty-four interviews were conducted in each city sector. The questionnaire consisted of 184 closed and 22 open questions, including identification, sociodemographic and reproductive data, as well as specific questions on physical, emotional and sexual violence. RESULTS: Median age of the studied group was 41.5 years, ranging from 12 to 48 years. Prevalence of domestic violence was: sexual 42%; physical 40%; emotional 39%. CONCLUSIONS: The problem of violence, in its different forms, is a highly prevalent factor which jeopardizes the welfare of the family nucleus. Higher prevalence values of domestic violence were detected in the presence of factors such as violence antecedents, alcoholism and/or drug consumption by some member of the family.

[Colposcopy and cervical biopsy in patients with routine Papanicolaou smear]. / Colposcopía y biopsia cervical en pacientes con papanicolaou de rutina.

The objective of this report was to assess the sensitivity and specificity of Pap smear and to evaluate if routine colposcopy can improve cervical screening. One hundred and fifty patients undergoing routine cervical cytologic screening in our outpatient clinic were randomly selected. All patients were evaluated by colposcopy and cervical punch biopsy. Pap smears and biopsies specimens were interpreted independently. Colposcopy was performed and interpreted without knowledge of cytologic or histologic findings. The statistical analysis was carried out with a chi square (chi 2) test. A P value of less than 0.05 was considered significant. Twenty three patients (15.3%) who had biopsy proved to have cervical pathology. Pap smear identified only 4/23 (17%) of these patients. Colposcopy noted atypical transformation zones in 20/23 (97%), P < 0.001). Fifteen of 27 patients (55.5%) with negative Pap smears had colposcopic anormalities and histologically proved cervical intraepithelial neoplasia (CIN). We concluded that it is necessary to improve sensitivity and that colposcopy may enhance cervical screening particularly in women with otherwise negative Papapnicolaou smears.

[Factors possibly associated with the age at the onset of menopause. Multicenter study]. / Factores que pueden estar asociados con la edad de presentación de la menopausia. Estudio multicéntrico.

A transversal study was performed in 1987 to examine 9,844 postmenopausal women aging from 39 to 59 years, residents from the cities of Durango, Monterrey, Guadalajara and Leon. They had their last menstruation at least 12 months before the interview and they were not pregnant. The objective was to know if the menarche, number of deliveries, use of contraceptive methods and smoking could affect the age of menopause. A case control analysis was performed. Based on frequency distribution of the age on which the menopause appeared, cases were classified as early and late menopause when a median value minus 2 SD and plus 2 SD were found, respectively. For control subjects a median + 1 SD was selected. Two and three controls were randomly assigned for early and late menopause, respectively. In total 1,610 subjects were studied. As a measure of association it was used the odds ratio with a confidence level of 95%. It was performed an analysis of confusion and interaction of variables in this study. The most relevant results were; a significant association between smoking 15 packages of cigarettes a year with an OR of 2.31 (1.05-5.17), to have more than five pregnancies with an OR of Mantel and Haenzel of 0.51 (0.33-0.76) for the early menopause. No association with late menopause was observed. It was found that the mean age of menopause was 45.5 years + 4.5 SD (n = 9,844).

Airways obstruction, coal mining, and disability.

It has recently been suggested that the inhalation of coal in the absence of complicated coal workers' pneumoconiosis (CWP) or smoking can lead to disabling airways obstruction. The cause of such obstruction has been variously attributed to emphysema or bronchitis. The frequency of significant airways obstruction in a group of United States coal miners seeking compensation for occupationally induced pulmonary impairment was therefore determined. In a sample of 611 "Black Lung" claimants there was only one subject who was a non-smoker and who in the absence of other non-occupationally related diseases,--for example, asthma and bronchiectasis--had sufficient airways obstruction to render it difficult for him to carry out hard labour. An alternative explanation for his reduced ventilatory capacity other than coal dust or smoking may be available. If the inhalation of coal dust in the absence of smoking and complicated CWP ever induces sufficient ventilatory impairment to preclude a miner from working, it is indeed rare.

[Safety, efficacy and control of the menstrual cycle by a monophasic oral contraceptive containing 75 mcg of gestodene and 30 mcg of ethynyl estradiol]. / Seguridad, efectividad y control del ciclo menstrual de una preparación anticonceptiva oral monofásica con 75 mcg de gestodeno y 30 mcg de etinilestradiol.

Al oral monophasic contraceptive formulation containing gestodene (75 mcg) and ethynilestradiol (30 mcg) is evaluated concerning its safety, efficacy and cycle-control. Sixty-seven healthy women were included, allowing a total of 574 evaluable cycles. This formulation showed a high degree of efficacy, with no pregnancies after its utilization. Side affects were similar or lower to other reported with another hormonal contraceptive oral formulations. Hematologic, biochemical or urinary parameters were not altered. An acceptable menstrual pattern was maintained. In conclusion, this formulation constitutes an oral contraceptive with a high efficacy rate, a well degree of acceptability and with a side effects profile similar or lower than those produced by other oral contraceptives.

[Practical training in primary care for nursing students: evaluation assessment by nurses' satisfaction]. / Formación práctica de los alumnos de enfermería en atención primaria: evaluación a través de una encuesta de satisfacción.

OBJECTIVE: To show that nursing skills and activities are acquired by third-year nursing students while they are doing their Primary Care practicals in the Health Centres and to discover the level of satisfaction of the students after these practicals. DESIGN: A descriptive study, using a questionnaire on the level of satisfaction. SETTING: Huerta del Rey Health Centre, Valladolid. PARTICIPANTS: Twenty-four third-year nursing students doing Primary Care practicals during the teaching year 1991-2. MEASUREMENTS AND MAIN RESULTS: Before their practical studies in the Health Centre, 50% or more of the students defined as unknown or little-known the following nursing skills: taking out ear-plugs, extraction of blood, respiratory physiotherapy and stitching. After the nurses had finished the practicals, the items which reflected general satisfaction obtained positive percentages above 72.2%. CONCLUSIONS: Nursing skills and activities which are specific to Primary Care are unknown to most nursing students before their period of practical work in a Health Centre. The same occurs with certain basic nursing skills and activities. Students were highly satisfied.

Blood gas analysis as a determinant of occupationally related disability.

Arterial blood gas analysis is one of the criteria used by the Department of Labor to award total and permanent disability for coal workers' pneumoconiosis (Black Lung). We have observed that Black Lung claimants often undergo several blood gas analyses with widely differing results that sometimes range from complete normality to life-threatening hypoxemia in the same subject. We concluded that blood gas analysis in occupationally related disability determination is unreliable, in that quality control and instrumentation are variable; that severe hypoxemia is rare in coal workers' pneumoconiosis; and that such hypoxemia is nonspecific and correlates poorly with breathlessness.

Prenatal diagnosis of neural tube defects by measurement of serum alpha-fetoprotein in Havana City.

Prenatal screening was carried out in Havana City, Cuba, as part of a National Medical Genetics Programme, in order to detect elevated alpha-fetoprotein concentration in maternal serum (MS-AFP). A total of 97,900 pregnant women between 15 and 19 weeks of pregnancy were tested from 1982 to 1985. A double-antibody-sandwich technique was used. 173 malformed fetuses were detected. Confirmation was by ultrasonography, elevated AFP values in a second serum sample and in amniotic fluid and acetylcholinesterase. No termination of a normal pregnancy occurred. The screening of all pregnancies is easy, economical and useful for detecting not only fetuses suffering from open Neural Tube Defects (NTDs) and other severe disorders but also pregnancies at risk of further complications.