Las tecnologías de la información y de la comunicación como herramientas para la enseñanza en la residencia de enfermería / Information and communication technologies as teaching tools in the nursing residency

Introducción: El uso de las tecnologías de la información y de la comunicación (TIC) en la residencia de enfermería de el Hospital de Pediatría Juan P. Garrahan, ha significado para los profesionales en formación la posibilidad de optimizar el tiempo disponible. Se observó la actividad de los residentes en la plataforma virtual y se les entregó una encuesta a fin de medir la satisfacción en el uso de la misma. Objetivo general: Describir el uso de las TIC en el proceso de aprendizaje en los residentes de enfermería de un hospital público pediátrico de alta complejidad. Materiales y métodos: Se trata de un estudio descriptivo y transversal en el que se incluyeron profesionales en formación de los tres años de la especialidad en enfermería del Hospital Garrahan, desde junio del 2018 a mayo del 2019, se incluyeron 22 residentes. Se diseñó una encuesta autoadministrada y anónima conformada por cuatro dominios, en la que se consultó sobre usos, necesidades y satisfacción en relación a la plataforma virtual, los datos obtenidos fueron cargados en la aplicación web REDCap. Resultados: El 73% de los encuestados reportó que había participado en algún sitio virtual de enseñanza y que accedieron con facilidad. El 64% respondió que dedicó entre 1-2 h/semana desde sus hogares a la plataforma virtual institucional. El 100% de los residentes accedió a la plataforma a través del celular. El 92% respondió que fue muy útil la plataforma virtual. Sugieren agregar en la plataforma un buscador, notas de exámenes y un calendario académico. Cada residente ha ingresado un promedio de 42±4 días en 195 días. El grupo de 2° año fue el que más utilizó dicha herramienta. Conclusión: Esta oportunidad de mejora permitió una evaluación constante de los procesos y efectuar cambios en la plataforma virtual a partir de las necesidades del residente (AU)

Introduction: The use of information and communication technologies (ICT) in the nursing residency at the Hospital de Pediatría Juan P. Garrahan, has allowed professionals in training to optimize their available time. The activity of the residents on the virtual platform was assessed and a survey was administered in order to measure user satisfaction. General objective: To describe the use of ICT in the learning process of nursing residents at a public tertiary-care pediatric hospital. Materials and methods: A descriptive and cross-sectional study was conducted including professionals in training in the 3-year nursing specialization course at the Garrahan Hospital, from June 2018 to May 2019; 22 residents were included. A selfadministered and anonymous survey was designed, consisting of four domains, assessing use, needs, and user satisfaction of the virtual platform; the data obtained were uploaded to the REDCap web application. Results: 73% of the respondents reported that they had participated in some virtual teaching activity and that access was easy. Of all the participants, 64% responded that they spent between 1-2 h/week on the institutional virtual platform from their homes; 100% of residents accessed the platform via cell phone and 92% responded that the virtual platform was very useful. Participants suggest adding a search engine, exam notes, and an academic calendar to the platform. Each resident logged in an average of 42±4 days over 195 days. The 2nd year group most often used the tool. Conclusion: This opportunity for improvement allowed for continuous evaluation of the processes and subsequent changes in the virtual platform based on the needs of the residents (AU)

Sección de Urgencias de Pediatría y Cuidados Intensivos pediátricos: Atención infantil integral ambulatoria y atención al paciente crítico / Pediatric Emergency and Pediatric Intensive Care Section: Comprehensive outpatient child care and critical patient care

El documento presenta la situación de la Sección de Urgencias-Cuidados Intensivos Pediátricos (CIP). Tras una introducción que pretende enmarcar la sección en su contexto histórico y demográfico, se describe la misión, visión, valores y la cartera de servicios de la sección. Posteriormente se detalla la actividad asistencial, la labor docente y los proyectos y líneas de investigación. Para finalizar, se explica brevemente nuestro compromiso con la calidad y seguridad del paciente y nuestras líneas estratégicas para la integración con atención primaria (AU)

The paper presents the status of the Section of Emergency-CIP. Alter an introductory section aims to frame the historical and demographic background, mission, vision, values and the range 01 services described in section. Subsequently those services, the teaching and research projects and detailed lines. To conclude briefly describes our commitment to quality and patient safety and lar our strategic integration lines with primary care (AU)

Paratiroidectomía en pacientes renales crónicos en Argentina: estudios prequirúrgicos, tipos de cirugía, recurrencia y persistencia / Parathyroidectomy in chronic kidney disease patients in Argentina: pre surgical studies, types of surgery, recurrence and persistence

La paratiroidectomía (PTx) es el tratamiento de elección en pacientes con HPT 2º severo, refractario al tratamiento médico. Se cuenta con muy poca información en Argentina de este procedimiento, por lo cual se realizó este estudio. Material y Métodos: Se incluyeron 255 pacientes con PTx entre el año 2003 al 2007 de un registro voluntario. Se evaluaron los estudios de localización prequirúrgicos, de laboratorio de metabolismo fosfocálcico previo y posterior a la cirugía y el tipo de técnica quirúrgica utilizada. Se analizó la persistencia y recidiva del HPT postcirugía. Resultados: La tasa de PTx fue de 2,7/1000 pacientes año. 83% de los pacientes tuvieron ecografía de cuello y 59% Sesta Mibi con Tc 99. Hubo una correlación positiva (p<0.001) entre el número de glándulas detectadas por ecografía y Sesta Mibi. La paratiroidectomía realizada fue: subtotal en 77%, total con autoimplante en 14% y total sin autoimplante en 9%. Hubo descensos significativos de Ca y P, fosfatasa alcalina y PTH (1744 ± 788 pg/ml a 247 ±450 pg/ml; p<0.0001) postcirugía. A los 2,4 ±2,5 meses de la PTx, el 72% de los pacientes tenía PTH <250 pg/ml, 19,8% tenía persistencia y 8,3% había recidivado. De acuerdo al tipo de cirugía la persistencia y recidiva fueron para PTx subtotal 22% y 8,3%, PTx total con implante 11% y 11% y PTx total sin autoimplante 13% y 4% respectivamente. La realización de Sesta Mibi no influyó en los resultados de la PTx. No se observaron diferencias entre los centros en relación con persistencia y recidiva. Conclusiones: La tasa de PTx fue muy baja, la ecografía fue el método de localización prequirúrgico preferido y la PTX subtotal la técnica quirúrgica más utilizada. La PTx fue exitosa en la mayoría de los pacientes y la persistencia y recidiva no estuvieron relacionadas con la técnica.

Parathyroidectomy (PTx) is the selecte treatment for patients with severe secondary hyperparathyroidism, refractory to medical treatment. There is not enough information about this procedure in Argentina, that is the reason why we performed this study. Material and Methods: 255 patients with PTx were included from the year 2003 to 2007 on a voluntary register. Studies of pre-surgical localization, phosphocalcic metabolism laboratories before and after surgery were evaluated, and the type of surgical technique used. The persistence and recurrence of post-surgical hyperparathyroidism was analyzed. Results: The PTx rate was 2,7/1000 patients year. 83% of the patients had neck echography and 59% Sestamibi scans with Tc 99. There was a positive correlation (p<0,001) between the number of detected glands by echography and Sestamibi. The parathyroidectomy performed was: subtotal in 77%, total with self-implant in 14% and total without self-implant in 9%. There were significant falls of Ca and P, Alkaline Phosphatase and PTH (1744±788 pg/ml to 247±450 pg/ml; p<0.0001) post-surgical. 2.4 ±2,5 months after the PTx, 72% of patients had PTH <250 pg/ml, 19,8% had persistence and 8,3% had recurrence. According to the type of surgery, the persistence and recurrence were for subtotal PTx 22% and 8,3%, total PTx with implant 11% and 11%, and total PTx without selfimplant 13% and 4% respectively. The performance of the Sestamibi scan did not affect the PTx results. No noticeable differences were observed among the centers for persistence and recurrence. Conclusions: The PTx rate was very low, echography was the preferred method of pre-surgical localization, and subtotal PTx was the most used surgical technique. PTx was successful in most of the patients, and persistence and recurrence were not related to the technique.

Resección transanal de un adenoma velloso rectal a través de un trocar monopuerto / Excision of a rectal villous adenoma using a transanal single port trocar

Single port access for minimally invasive surgery is feasible nowadays. We report a 55 years old female presenting with hematochezia. During a colonoscopy, a villous adenoma of 2 cm in diameter located 5 cm above the anal margin, was found. This lesion was excised through the anus, using a single port trocar. The procedure lasted 45 minutes, the postoperative evolution was uneventful and the patient was discharged 24 hours after the procedure.

Posterior al advenimiento de la cirugía laparoscópica colorrectal, desde comienzos de la década de los 90, se han desarrollado diversos tipos de accesos minimamente invasivos, siendo hoy en día el acceso por un puerto único una alternativa factible. Se presenta el caso clínico de una paciente de 55 años, a la cual por sintomatología se le diagnóstica una lesión rectal, la que luego de ser estudiada endoscópica y endosonográficamente, es resecada por monopuerto via anal. La cirugía duró 45 minutos y no presentó eventos adversos intraoperatorios. Su evolución quirúrgica fue satisfactoria con alta hospitalaria al día siguiente de la cirugía.

Fabrication and characterization of new Yb-doped zirconia-germano-alumino silicate phase-separated nano-particles based fibers.

New zirconia-germano-alumino silicate, nano-particles based, Ytterbium doped fibers are obtained through the conventional modified chemical vapour deposition and solution doping techniques. The start fiber preforms are characterized by means of electron micro probe, energy dispersive x-ray, and electron diffraction analyses, revealing the presence of phase-separated nano-sized Ytterbium-rich areas in the core, while the final fibers are inspected in the sense of spectroscopy and laser properties.

Enhancement of antiferromagnetic coupling in magnetic multilayers by low energy ion beam substrate nanopatterning.

Ion beam irradiation has been shown to be an interesting tool for tailoring the magnetic properties of thin films and multilayers. The modified properties include magnetic anisotropy, interlayer exchange coupling, exchange bias, magnetic domain structure and magnetization reversal. In this work, new results are shown concerning the enhancement, by one order of magnitude, of the antiferromagnetic coupling strength in amorphous CoSi/Si multilayers by irradiating Si(100) substrates with 1 keV Ar(+) ions. The ion beam exposure induces an increase of the substrate roughness, from 0.07 to 0.88 nm, which enhances antiferromagnetic coupling in the magnetic multilayers grown on top. One possible mechanism governing this enhancement is discussed, related to the formation of magnetic/non-magnetic regions where dipolar interactions could stabilize the antiferromagnetic alignment. The presence of non-magnetic regions is suggested by the observed trend to superparamagnetism, and is expected since the Curie temperature of the amorphous CoSi alloy used is slightly above but very close to room temperature. Accordingly, small fluctuations in the local composition, leading to an enrichment of Si, would produce non-magnetic regions enabling dipolar interactions to take place. Furthermore, the ion beam induced increase of roughness makes surface diffusion of the atoms arriving at the sample difficult, favoring the formation of local non-magnetic inhomogeneities. Finally, the role of other possible mechanisms to enhance antiferromagnetic coupling is also briefly discussed.

Prevalencia de anticuerpos anticitoplasma de neutrófilos en pacientes con artritis psoriática / Prevalence of antibodies anticytoplasm of neutrophils in patients with Psoriatic Arthritis

Los anticuerpos anticitoplasma de neutrófilos (ANCA) han cobrado relevancia en distintas patologías. Recientemente se ha reportado un elevado porcentaje (79%) de ANCAp en pacientes con Artropatía Psoriática (APs). Los objetivos de este estudio fueron evaluar la prevalencia ANCAp en pacientes con APs y compararlo con pacientes con artritis reumatoidea (AR), espondilitis anquilosante (EA), psoriasis cutánea (Ps) y controles sanos (CS). Material y métodos: Se incluyeron pacientes consecutivos con APs según criterios CASPAR, AR (criterios ACR 87), EA (criterios de NY modificados); los CS fueron personas de la población general sin antecedentes o evidencias de enfermedades inmunológicas. Se excluyeron pacientes con antecedentes oncológicos, infecciosos, sarcoidosis u otras enfermedades del tejido conectivo y/o vasculitis. Se consignaron datos demográficos, clínicos, radiológicos, antecedentes familiares y terapéutica actual. Se realizaron cuestionarios de actividad de enfermedad y capacidad funcional: BASDAI, BASFI, PASI y HAQ. Se extrajeron muestras de sangre para determinación de ANCA por IFI en etanol que posteriormente fueron confirmadas por IFI en formol. Se realizó además laboratorio general de rutina. Análisis estadístico: Las variables continuas fueron comparadas por ANOVA o test Student y las variables categóricas por Chi-cuadrado o test de Fisher. Resultados: Se incluyeron 148 pacientes (APs = 43, EA = 22, AR = 41, Controles = 38, Psoriasis cutánea = 4). La mediana de edad fue de 52 años (RIQ: 39,5-59), 66% eran mujeres. En el análisis intergrupo, las EA eran más jóvenes y más frecuentemente (87%) de sexo masculino. El resto de los grupos eran comparables para todas las variables demográficas. 57 pacientes mostraron fluorescencia positiva en etanol: AR: 25 (61%), APs: 14 (32,6%), EA: 11 (50%), CS: 6 (15,8%) y Ps: 1 (25%).

Antibodies ANCA are important diagnostic tools in different diseases. Recently it has been shown that these antibodies can be observed in 79% of patients with Psoriatic Arthritis (PsA). The purpose of our study was to determine the prevalence of ANCA in patients with PsA and compared to patients with Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Psoriasis (Ps) and healthy controls (HC). Material and methods: Consecutive patients with PsA (CASPAR criteria), RA (ACR ’87) and AS (New York criteria) were included. HC were people of the general population without evidence of immunological diseases. Patients with a previous history of oncologic, infectious diseases and sarcoidosis were excluded. Demographic, clinical, radiological and therapeutic data were collected. Disease activity and functional capacity were evaluated using validated and specific questionnaires (BASDAI, BASFI, PASI, and HAQ). ANCAs were determined by indirect immunofluorescence (IIF) on ethanol. Then, the positive ones were confirmed by IIF on formol. Student test, ANOVA, Chi square and Fisher exact test were used for Statistical analysis. Results: 148 patients were included (PsA = 43, AS = 22, RA = 41, Ps = 4 y HC = 38). Median age was 52 years (IQR: 39.5 – 59), 66% were women. AS patients were younger and more frequently men. Other variables were comparable between groups. 57 patients exhibited positive ethanol fluorescence: RA: 25 (61%), PsA: 14 (32.6%), AS: 11 (50%), HC: 6 (15.8%) and Ps: 1 (25%). However only 5 patients showed formol fluorescence: AS: 4/22 (ANCAp = 2, ANCAc = 2) y RA: 1/41 (ANCAp). The frequency of positive ANCA was significantly greater in AS vs. RA (p = 0.046).

Prevalencia de anticuerpos anticitoplasma de neutrófilos en pacientes con artritis psoriática / Prevalence of antibodies anticytoplasm of neutrophils in patients with Psoriatic Arthritis

Los anticuerpos anticitoplasma de neutrófilos (ANCA) han cobrado relevancia en distintas patologías. Recientemente se ha reportado un elevado porcentaje (79%) de ANCAp en pacientes con Artropatía Psoriática (APs). Los objetivos de este estudio fueron evaluar la prevalencia ANCAp en pacientes con APs y compararlo con pacientes con artritis reumatoidea (AR), espondilitis anquilosante (EA), psoriasis cutánea (Ps) y controles sanos (CS). Material y métodos: Se incluyeron pacientes consecutivos con APs según criterios CASPAR, AR (criterios ACR 87), EA (criterios de NY modificados); los CS fueron personas de la población general sin antecedentes o evidencias de enfermedades inmunológicas. Se excluyeron pacientes con antecedentes oncológicos, infecciosos, sarcoidosis u otras enfermedades del tejido conectivo y/o vasculitis. Se consignaron datos demográficos, clínicos, radiológicos, antecedentes familiares y terapéutica actual. Se realizaron cuestionarios de actividad de enfermedad y capacidad funcional: BASDAI, BASFI, PASI y HAQ. Se extrajeron muestras de sangre para determinación de ANCA por IFI en etanol que posteriormente fueron confirmadas por IFI en formol. Se realizó además laboratorio general de rutina. Análisis estadístico: Las variables continuas fueron comparadas por ANOVA o test Student y las variables categóricas por Chi-cuadrado o test de Fisher. Resultados: Se incluyeron 148 pacientes (APs = 43, EA = 22, AR = 41, Controles = 38, Psoriasis cutánea = 4). La mediana de edad fue de 52 años (RIQ: 39,5-59), 66% eran mujeres. En el análisis intergrupo, las EA eran más jóvenes y más frecuentemente (87%) de sexo masculino. El resto de los grupos eran comparables para todas las variables demográficas. 57 pacientes mostraron fluorescencia positiva en etanol: AR: 25 (61%), APs: 14 (32,6%), EA: 11 (50%), CS: 6 (15,8%) y Ps: 1 (25%).(AU)

Antibodies ANCA are important diagnostic tools in different diseases. Recently it has been shown that these antibodies can be observed in 79% of patients with Psoriatic Arthritis (PsA). The purpose of our study was to determine the prevalence of ANCA in patients with PsA and compared to patients with Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Psoriasis (Ps) and healthy controls (HC). Material and methods: Consecutive patients with PsA (CASPAR criteria), RA (ACR 87) and AS (New York criteria) were included. HC were people of the general population without evidence of immunological diseases. Patients with a previous history of oncologic, infectious diseases and sarcoidosis were excluded. Demographic, clinical, radiological and therapeutic data were collected. Disease activity and functional capacity were evaluated using validated and specific questionnaires (BASDAI, BASFI, PASI, and HAQ). ANCAs were determined by indirect immunofluorescence (IIF) on ethanol. Then, the positive ones were confirmed by IIF on formol. Student test, ANOVA, Chi square and Fisher exact test were used for Statistical analysis. Results: 148 patients were included (PsA = 43, AS = 22, RA = 41, Ps = 4 y HC = 38). Median age was 52 years (IQR: 39.5 ¹ 59), 66% were women. AS patients were younger and more frequently men. Other variables were comparable between groups. 57 patients exhibited positive ethanol fluorescence: RA: 25 (61%), PsA: 14 (32.6%), AS: 11 (50%), HC: 6 (15.8%) and Ps: 1 (25%). However only 5 patients showed formol fluorescence: AS: 4/22 (ANCAp = 2, ANCAc = 2) y RA: 1/41 (ANCAp). The frequency of positive ANCA was significantly greater in AS vs. RA (p = 0.046).(AU)

Endometriomas de la pared abdominal. Revisión de una serie de 17 casos / Abdominal wall endometriomas. Report of 17 cases

Introducción: La endometriosis se caracteriza por la presencia de tejido endometrial fuera del cuerpo uterino. Su frecuencia oscila del 3 al 15% de las mujeres en edad fértil. La localización más habitual es la intraabdominal, pero puede presentarse en forma de nódulos dolorosos en la pared abdominal, cicatrices de intervenciones previas, fundamentalmente ginecológicas u obstétricas, o como nódulos inguinales o umbilicales. El objetivo del presente trabajo es revisar su incidencia, localización, clínica y tratamiento. Pacientes y métodos: A partir de un nuevo caso de endometrioma, originado en una cicatriz de Pfannenstiel, se revisan 17 casos diagnosticados desde 1990, analizando su forma de presentación y características clínicas, así como las diferentes teorías etiopatogénicas. Resultados: Desde 1990 se han intervenido 17 casos de endometriomas de pared abdominal, 2 localizados a nivel umbilical, 4 en la región inguinal y 11 tumoraciones en cicatrices de intervenciones quirúrgicas previas, ginecológicas u obstétricas. En la mayoría de los casos se trató de un hallazgo casual dentro del acto quirúrgico y en 4 casos se realizó una tomografía computarizada (TC) abdominal previa al tratamiento quirúrgico. El tratamiento consistió en exéresis amplia de la lesión. Posteriormente todas las pacientes fueron derivadas al servicio de ginecología para completar su estudio y tratamiento. Conclusiones: A pesar de que la incidencia de endometriomas de pared abdominal es baja, ante cualquier nódulo de características anómalas en la región inguinal o umbilical, o tumoración sobre cicatriz ginecológica u obstétrica en una mujer de edad fértil, se ha de sospechar la presencia de un endometrioma. La TC abdominal y la punción-aspiración con aguja fina pueden ayudar al diagnóstico. El tratamiento es quirúrgico (AU)

Background: Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus. This finding occurs in 3 to 15% of women of reproductive age, and is most frequently located in the abdominal cavity. Occasionally, endometriosis is present as a painful mass in the abdominal wall, near a surgical scar, or in the umbilical or inguinal area. The aim of the present study was to review the incidence, location, symptoms and treatment of abdominal wall endometriomas in our center. Patients and methods: Prompted by a new case of endometrioma arising from a Pfannenstiel scar, we reviewed 17 cases of abdominal wall endometrioma (AWE) diagnosed since 1990, Symptoms, location, clinical findings, and the various etiopathogenic theories were analyzed. Results: Since 1990, 17 patients with AWE underwent surgery. Two endometriomas were located in the umbilical area, 4 in the inguinal region, and 11 arose from surgical scar sites from prior gynecological or obstetric surgery. Most of the tumors were incidental findings during surgical procedures. Preoperative diagnosis with computed tomography (CT) scan was made in 4 patients. Treatment was wide surgical excision. All patients were subsequently referred to the gynecology service for follow-up and further treatment. Conclusions: Although AWE are uncommon, these tumors should be suspected in women of reproductive age with any mass in the inguinal or umbilical region, or near a gynecologic or obstetric scar. Abdominal CT scanning and fine-needle biopsy may confirm the diagnosis. Treatment consists of surgical excision (AU)

Massive myeloid sarcoma affecting the central nervous system, mediastinum, retroperitoneum, liver, and rectum associated with acute myeloblastic leukaemia: a case report.

Myeloid sarcomas are extramedullary tumours with granulocytic precursors. When associated with acute myelogenous leukaemia (AML), these tumours usually affect no more than two different extramedullary regions. This report describes a myeloid sarcoma associated with AML with tumour formation at five anatomical sites. The patient was a 37 year old man admitted in September 1999 with a two month history of weight loss, symptoms of anaemia, rectal bleeding, and left facial nerve palsy. The anatomical sites affected were: the rectum, the right lobe of the liver, the mediastinum, the retroperitoneum, and the central nervous system. A bone marrow smear was compatible with AML M2. Flow cytometry showed that the peripheral blood was positive for CD4, CD11, CD13, CD14, CD33, CD45, and HLA-DR. A karyotypic study of the bone marrow revealed an 8;21 translocation. The presence of multiple solid tumours in AML is a rare event. Enhanced expression of cell adhesion molecules may be the reason why some patients develop myeloid sarcomas.

[Recommendations for the use of ambulatory blood pressure monitoring. Consensus document of the Chilean Hypertension Society]. / Recomendaciones sobre el uso de la monitorización ambulatoria de presión arterial. Documento de consenso de la Sociedad Chilena de Hipertensión.

Continuous ambulatory blood pressure monitoring is a diagnostic technique devised as a consequence of the great variations in blood pressure measurements. It allows multiple daily measurements, nocturnal monitoring, avoids the stress of blood pressure measurements, gives a picture of pressure behavior during 24 hours and reduces observer related errors. The equipment used must be accurate and validated using international protocols. Accepted indications for continuous ambulatory blood pressure monitoring are white coat hypertension, episodic hypertension, resistance to medications and assessment of symptoms or autonomic dysfunction. Other indications with less clear cut usefulness, are high risk cardiac, renal or pregnant patients and an accurate blood pressure control. We describe equipment calibration, elements that must be considered in the reports, result interpretation and conclusions. Normal blood pressure ranges for children and pregnant women are also reported.

Abdominal rescue using the vacuum extractor after entrapment of the aftercoming head.

BACKGROUND: Fetal replacement into the uterus for ceasarean delivery after failed vaginal delivery has been reported for both vertex and breech presentations. Although an option, this mode of delivery frequently is the last maneuver to deliver a viable infant after other methods to allow vaginal delivery have failed. We report the adjunctive use of a vacuum extractor to facilitate abdominal rescue after entrapment of the aftercoming head during an attempted vaginal breech delivery. CASE: A multiparous woman presented at term with two fetal feet bulging through the membranes at the introitus. During vaginal breech delivery, the aftercoming head became entrapped. Unsuccessful maneuvers to facilitate descent included Dührssen incisions, the Mauriceau maneuver, placement of Piper forceps, and halothane administration. At emergency ceasarean delivery, the infant was pushed upward from below, and rapid, successful delivery of a 2530-g neonate was accomplished with assistance by a vacuum extractor. Apgar scores were 3, 6, and 7 at 1, 5, and 10 minutes, respectively. Umbilical artery blood gas revealed a pH of 7.18 and base excess of -6. A head sonogram and electroencephalogram were normal. Both mother and infant were discharged without complications. CONCLUSION: After entrapment of the aftercoming head during attempted vaginal breech delivery, use of the vacuum extractor may expedite the abdominal rescue and ceasarean.

Application of the polymerase chain reaction to the epidemiology of pathogenic and nonpathogenic Entamoeba histolytica.

We used the polymerase chain reaction (PCR) to study the epidemiology of pathogenic and nonpathogenic Entamoeba histolytica in a rural community in Mexico. Formalin-fixed stool samples were used for extraction of DNA. The PCR amplifications were performed using two sets of primers that discriminate between pathogenic or non-pathogenic E. histolytica. A total of 201 randomly selected individuals were studied. Among them, 25 (12%) were diagnosed to be infected with E. histolytica by microscopy; PCR identified 24 of these as positive (sensitivity = 0.96) and of 176 negative individuals, only three were identified as positive (specificity = 0.98). The PCR analysis defined three populations: 14 cases were positive for both pathogenic and nonpathogenic E. histolytica, nine cases were positive for pathogenic and negative for nonpathogenic E. histolytica, and only one case was negative for pathogenic and positive for nonpathogenic E. histolytica. Infection by E. histolytica was strongly associated to infection with Entamoeba coli (odds ratio [OR] = 9.41, 95% confidence interval [CI] = 3.09, 28.65, P < 0.0004) and Endolimax nana (OR = 6.15, 95% CI = 2.03, 18.17, P < 0.0004). This new technique has high specificity and sensitivity; it is simple, reproducible, fast, avoids the need to culture trophozoites, and can be applied in the field for epidemiologic studies.

Trichinosis with severe myopathic involvement mimicking polymyositis. Report of a family outbreak.

We describe an outbreak of trichinosis in 3 members of a rural family. In the 3 patients eating raw pork was the source of infection. They presented with myalgias and severe proximal muscle weakness mimicking polymyositis. The diagnosis was made by demonstration of larvae of Trichinella spiralis in the muscle biopsy and also by the presence of anti-Trichinella antibodies detected by double immunodiffusion in their sera. We call attention to the unusual clinical presentation of trichinosis in our patients that was manifested by severe muscle weakness that may be confused with polymyositis.

Clinical and epidemiologic studies of Chagas' disease in rural communities of Oaxaca, Mexico, and an eight-year followup: II. Chila.

A seroepidemiologic survey conducted in 1971 in the rural Pacific coastal community of Chila in the Mexican state of Oaxaca showed an unusually high prevalence of antibody against the Chagas' disease agent Trypanosoma cruzi. Further studies were undertaken in 1973 and 1981 to (1) determine the pathologic impact of T. cruzi infection in humans, (2) investigate the natural history of the disease, (3) confirm that serologically positive persons were parasitologically positive, and (4) evaluate whether T. cruzi transmission continued into the next decade. This article reports results derived from those studies.

PIP: In 1971, health workers drew blood samples from 238 people living in the rural Pacific coastal village of Chile in Oaxaca State, Mexico to determine seroprevalence of antibodies against Trypanosoma cruzi--the parasite responsible for Chagas' disease. Seroprevalence was 5% in 16 year old children, but increased from 41% to 62% to a peak of 78% for 16-19, 20-29, and 30-39 year olds respectively then fell to 68% for 40-49 year olds only to climb again to 75% in 50-59 year olds and fell again to 47% for =or 60 year olds. Overall seroprevalence for adults was 67%. By 1981, adult seroprevalence had fallen to 33% and childhood prevalence to 0.7%. The very low levels of T. cruzi antibodies in children corresponded with insecticide (DDT) spraying for malaria control and with the disappearance of triatomine bugs from Chile. Medical histories revealed that seropositive individuals were more likely to exhibit acute signs and symptoms of initial bite lesions (Romana's sign), furuncle like skin lesions (Chagoma), and facial or body edema (p.05). They also tended to suffer from chronic fatigue and difficult breathing while lying down (p.05). 1973 electrocardiogram (ECG) results showed that seropositive individuals were significantly more likely to have complete right bundle branch block (p.005) and premature ventricular contractions (p.05) than seronegative individuals. There were no seroconversions among 57 people examined with ECGs between 1971-1983. Even though more seropositives (21%) experienced a progression of ECG abnormalities (3% rate/year) than seronegatives (7%), the difference was not significant. Despite reductions in seroprevalence and in triatomine bug population, serologic surveillance and monitoring to detect repopulation of houses by the bugs should be maintained.

Diffuse-adhering Escherichia coli (DAEC) as a putative cause of diarrhea in Mayan children in Mexico.

Diarrhea is a major cause of infantile morbidity and mortality in developing countries. A community-based, case control study was conducted in a southern Mexican Mayan village for 3 weeks during the peak diarrhea period to prospectively identify the infectious agents associated with childhood diarrheal disease. Several enteropathogens were isolated from stools of 34 of 58 cases, although none was significantly associated with diarrhea. For the 24 cases from which no enteropathogens were isolated, diffuse-adhering Escherichia coli (DAEC) strains were significantly associated with diarrheal disease (P less than .02; odds ratio = 6; 95% confidence limit, 1.08-99.0). DAEC were highly heterogeneous with respect to plasmid content and serotype. Three DNA probes designed to differentiate E. coli exhibiting localized, diffuse, or aggregative adherence were compared with results from a standard HeLa cell binding assay to assess the utility of these probes in the field. This study provides evidence for the potential pathogenic capacity of DAEC and underscores the variety of diarrheal agents operating within a community.

[The antihypertensive response to prazosin, a selective vascular alpha blocker. A multicenter study]. / Respuesta antihipertensiv a al prazosin, un alfa bloqueador vascular selectivo. Estudio multicéntrico.

The efficacy and safety of oral prazosin was assessed in 108 ambulatory mild (91-104 mmHg diastolic pressure) to moderate (104-114 mmHg) essential hypertensive patients. After a 2 week no-drug control period, prazosin, 2, 4, 8 or 10 mg per day was given in 2 weeks periods as needed to obtain control of blood pressure. A seating diastolic pressure of < or = 90 mmHg was defined as adequate response. Satisfactory blood pressure response was obtained in 86% of patients, with doses of 4 mg or less in 70%. Treatment results were not related to initial blood pressure level, but obese patients were more resistant to drug effect (p < 0.05). Heart rate and laboratory parameters did not change. Adverse effects, mainly headache, dizziness and palpitations, were noticed in 46 patients (43%) and occurred with the lower dose in 78% of them. Adverse effects were slight or moderated and lasted from 1 day to 2 weeks in most patients. Treatment was discontinued in 2 patients, one because of persistent dizziness which was promptly relieved after stopping the drug and another due to syncope occurring immediately after a dose increase. We conclude that oral prazosin at low doses is an effective and well-tolerated drug which should be considered in the treatment of mild to moderate hypertension.

[Risk factors for acute infantile diarrhea in a rural community in Chiapas, Mexico. A strategy for intervention]. / Factores de riesgo de diarrea infantil aguda en una communidad rural de Chiapas, México. Una estrategia de intervención.

A community-based, case-control study was conducted during the summer peak season for diarrhea in the highlands of Chiapas, Mexico, to identify risk and protective factors associated with acute diarrhea in children less than 6 years of age. To estimate the diarrheal morbidity rate, the community was divided into 13 sectors, each of about 20 households. A resident (volunteer mother) made daily visits to every household in her sector to identify new cases of diarrhea. During 3 weeks of surveillance, 63 children with diarrhea and 48 control children were identified. The diarrheal attack rate during this period for children less than 6 years of age was 30%. Analysis of 29 neighborhood-matched case-control pairs showed that children with diarrhea were more likely than their controls to have had a mother with diarrhea in the 2 weeks preceding the onset of the child's diarrhea (P less than 0.05; relative risk = 10). The association of childhood diarrhea with maternal diarrhea may serve as a focus for more detailed studies as well as an intervention that may be appropriate and effective for this community.