Fotocoagulación láser guiada por ultrasonido para el tratamiento del secuestro broncopulmonar fetal. Reporte de dos casos exitosos en Venezuela / Ultrasound-guided laser photocoagulation for the treatment of fetal bronchopulmonary sequestration. Report of two successful cases in Venezuela

El secuestro broncopulmonar es una malformación del aparato respiratorio que consiste en tejido bronquial y pulmonar no funcionante, separado del árbol tráqueo-bronquial y alimentado por un vaso sanguíneo proveniente de la circulación sistémica. La incidencia es de 1 por cada 5000 nacimientos, comprende entre 0,15 % y 6,45 % de las patologías pulmonares. El pronóstico es, generalmente, favorable, reportándose regresión espontánea de la lesión en 50 % a 75 % de los pacientes. Puede ocasionar efecto de masa, comprimiendo el corazón y el pulmón hasta generar cambios hemodinámicos y falla cardíaca. Hay múltiples procedimientos para el tratamiento y manejo, principalmente en casos de gran tamaño y fetos hidrópicos, para mejorar el pronóstico perinatal. Se presentan los dos primeros casos de secuestro broncopulmonar tratados en Venezuela mediante fotocoagulación láser del vaso nutricio y su evolución perinatal, con sobrevida del 100 % y sin ninguna complicación registrada en el periodo perinatal(AU)

Bronchopulmonary sequestration is a malformation of the respiratory system consisting of non-functioning bronchial and pulmonary tissue, separated from the tracheo-bronchial tree and fed by a blood vessel from the systemic circulation. The incidence is 1 in 5000 births, ranging from 0.15% to 6.45% of pulmonary pathologies. The prognosis is generally favorable, with spontaneous regression of the lesion reported in 50% to 75% of patients. It can cause mass effect, compressing the heart and lung to the point of generating hemodynamic changes and heart failure. There are multiple procedures for treatment and management, mainly in large cases and hydropic fetuses, to improve perinatal prognosis. We present the first two cases of bronchopulmonary sequestration treated in Venezuela by laser photocoagulation of the nutrient vessel and their perinatal evolution, with 100% survival and without any complications recorded in the perinatal period(AU)

[Quality indicators in hip fracture care after the implementation of an orthogeriatrics team]. / Indicadores de calidad en atención a fractura de cadera tras la implementación de un equipo de ortogeriatría.

INTRODUCTION: The incidence of hip fracture will increase dramatically in the coming decades. It has been associated with high mortality and morbidity. Orthogeriatric programs have improved outcomes in fragility hip fracture worldwide. There is little evidence in Mexico on the impact of orthogeriatrics and adherence to quality indicators. OBJECTIVE: To compare adherence to quality indicators in hip fracture before and after the implementation of an orthogeriatrics team compared to the traditional model. MATERIAL AND METHODS: Quasi-experimental study conducted in León, Mexico. Adherence to quality indicators before and after an interconsultant orthogeriatrics team was compared. The indicators measured were: surgical delay, treatment for osteoporosis, early mobilization, type of implant and delirium. RESULTS: We included 83 patients. The surgical delay was reduced from 144 to 116 hours (28 hours), the percentage of patients with early surgery was increased from 7.9 to 18%, in addition the percentage of patients with treatment for osteoporosis was increased and the incidence of delirium was reduced. CONCLUSION: Adherence to indicators is low, however, it was possible to discreetly increase adherence to these indicators. Internal policies must be generated in public hospitals to improve this adherence and see its impact on long-term outcomes.

INTRODUCCIÓN: La incidencia de fractura de cadera se incrementará radicalmente en las siguientes décadas. Se ha asociado a una mortalidad y morbilidad elevada. Los programas de ortogeriatría en hospitales públicos han demostrado mejorar los resultados asistenciales. Hay poca evidencia en México sobre el impacto de la ortogeriatría y el apego a indicadores de calidad. OBJETIVO: Comparar el apego a indicadores de calidad en fractura de cadera antes y después de la implementación de un equipo de ortogeriatría comparado con el modelo tradicional. MATERIAL Y MÉTODOS: Estudio cuasiexperimental realizado en León, México. Se comparó la adherencia a indicadores de calidad antes y después de un equipo interconsultante de ortogeriatría. Los indicadores medidos fueron: demora quirúrgica, tratamiento para osteoporosis, movilización temprana, tipo de implante y delirium. RESULTADOS: Incluimos 83 pacientes. La demora quirúrgica se disminuyó de 144 a 116 horas (28 horas), se incrementó el porcentaje de pacientes con cirugía temprana de 7.9 a 18%, además se incrementó el porcentaje de pacientes con tratamiento para osteoporosis y se logró disminuir la incidencia de delirium. CONCLUSIÓN: El apego a indicadores es bajo; sin embargo, se logró incrementar discretamente el apego a estos indicadores. Se deben generar políticas internas en los hospitales públicos para mejorar esta adherencia y ver su impacto en los resultados a largo plazo.

Hazardous alcohol consumption and risk of alcohol dependence present different neurophysiological correlates. / El consumo de riesgo de alcohol y el riesgo de dependencia al alcohol presentan correlatos neurofisiologicos diferentes.

INTRODUCTION: Hazardous alcohol consumption (HAC) is a pattern of alcohol use that may result in harm for the user and/or for those around them. Prior research has suggested that HAC and alcohol dependence share some neurophysiological features but differ in others. AIM: To determine whether HAC and alcohol dependence presented different neurophysiological correlates. SUBJECTS AND METHODS: Two hundred subjects were screened for HAC or alcohol dependence. A quantitative electroencephalo-graphic analysis of delta, theta, alpha and beta absolute power, relative power and mean frequency in subjects with HAC but not alcohol dependence, subjects with risk of alcohol dependence and controls was performed. RESULTS: One hundred and fourteen subjects met inclusion criteria. The HAC group presented with higher beta absolute power and relative power, as well as a lower beta mean frequency than the control group, while the group with risk of alcohol dependence presented lower delta absolute power than controls. CONCLUSIONS: HAC and risk of alcohol dependence present different neurophysiological correlates. There is an important effect of the severity of alcohol dependence on neurophysiological correlates of this condition. Our results support the existence of two different types of behavioral disinhibition.

TITLE: El consumo de riesgo de alcohol y el riesgo de dependencia al alcohol presentan correlatos neurofisiologicos diferentes.Introduccion. El consumo de riesgo de alcohol (CRA) es un patron de consumo que puede resultar dañino para el usuario o para los demas. Investigaciones previas sugieren que el CRA y la dependencia al alcohol comparten algunas caracteristicas neurofisiologicas, pero difieren en otras. Objetivo. Determinar si el CRA y la dependencia al alcohol presentan correlatos neurofisiologicos diferentes. Sujetos y metodos. Doscientos sujetos realizaron la prueba de deteccion de CRA y riesgo de dependencia al alcohol (DEP). Se realizo un estudio de electroencefalografia cuantitativa para determinar la potencia absoluta, la potencia relativa y la frecuencia media de las bandas delta, theta, alfa y beta en sujetos con CRA, con DEP y controles. Resultados. Un total de 114 sujetos cumplio los criterios de inclusion. El grupo con CRA presento mayor potencia absoluta, mayor potencia relativa y menor frecuencia media de la banda beta en comparacion con los controles, mientras que el grupo con DEP presento menor potencia absoluta de la banda delta que los controles. Conclusiones. El DEP y el CRA presentan diferentes correlatos neurofisiologicos. Hay un efecto importante de la gravedad de la dependencia al alcohol sobre sus correlatos neurofisiologicos. Nuestros resultados apoyan la existencia de dos tipos distintos de desinhibicion conductual.

Plasma cytokines as potential biomarkers of kidney damage in patients with systemic lupus erythematosus.

BACKGROUND: Systemic lupus erythematosus is a heterogeneous chronic inflammatory autoimmune disorder characterized by an exacerbated expression of cytokines and chemokines in different tissues and organs. Renal involvement is a significant contributor to the morbidity and mortality of systemic lupus erythematosus, and its diagnosis is based on renal biopsy, an invasive procedure with a high risk of complications. Therefore, the development of alternative, non-invasive diagnostic tests for kidney disease in patients with systemic lupus erythematosus is a priority. AIM: To evaluate the plasma levels of a panel of cytokines and chemokines using multiplex xMAP technology in a cohort of Colombian patients with active and inactive systemic lupus erythematosus, and to evaluate their potential as biomarkers of renal involvement. RESULTS: Plasma from 40 systemic lupus erythematosus non-nephritis patients and 80 lupus nephritis patients with different levels of renal involvement were analyzed for 39 cytokines using Luminex xMAP technology. Lupus nephritis patients had significantly increased plasma eotaxin, TNF-α, interleukin-17-α, interleukin-10, and interleukin-15 as compared to the systemic lupus erythematosus non-nephritis group. Macrophage-derived chemokine, growth regulated oncogene alpha, and epidermal growth factor were significantly elevated in systemic lupus erythematosus non-nephritis patients when compared to lupus nephritis individuals. Plasma eotaxin levels allowed a discrimination between systemic lupus erythematosus non-nephritis and lupus nephritis patients, for which we performed a receiver operating characteristic curve to confirm. We observed a correlation of eotaxin levels with active nephritis (Systemic Lupus Erythematosus Disease Activity Index). Our data indicate that circulating cytokines and chemokines could be considered good predictors of renal involvement in individuals with systemic lupus erythematosus.

Safe taste memory consolidation is disrupted by a protein synthesis inhibitor in the nucleus accumbens shell.

Consolidation is the process by which a new memory is stabilized over time, and is dependent on de novo protein synthesis. A useful model for studying memory formation is gustatory memory, a type of memory in which a novel taste may become either safe by not being followed by negative consequences (attenuation of neophobia, AN), or aversive by being followed by post-digestive malaise (conditioned taste aversion, CTA). Here we evaluated the effects of the administration of a protein synthesis inhibitor in the nucleus accumbens (NAc) shell for either safe or aversive taste memory trace consolidation. To test the effects on CTA and AN of protein synthesis inhibition, anisomycin (100microg/microl) was bilaterally infused into the NAc shell of Wistar rats' brains. We found that post-trial protein synthesis blockade impaired the long-term safe taste memory. However, protein synthesis inhibition failed to disrupt the long-term memory of CTA. In addition, we infused anisomycin in the NAc shell after the pre-exposure to saccharin in a latent inhibition of aversive taste. We found that the protein synthesis inhibition impaired the consolidation of safe taste memory, allowing the aversive taste memory to form and consolidate. Our results suggest that protein synthesis is required in the NAc shell for consolidation of safe but not aversive taste memories, supporting the notion that consolidation of taste memory is processed in several brain regions in parallel, and implying that inhibitory interactions between both taste memory traces do occur.

Diabetes, obesity and non-optimum blood pressure levels in a group of employees of the University of Puerto Rico, Medical Sciences Campus, 2003

OBJECTIVE: To estimate the proportion of diabetes, obesity and non-optimum blood pressure levels in a group of employees of the University of Puerto Rico Medical Sciences Campus that participated in a diabetes health fair at the [quot ]Centro de Diabetes para Puerto Rico[quot ]. METHODS: A total of 113 participants of the diabetes health fair completed a questionnaire to obtain demographic characteristics and the frequency of self-reported diabetes. The nursing staff examined the participants in order to obtain the following clinical characteristics: body mass index, blood pressure and blood glucose levels. RESULTS: The proportion of self-reported diabetes, obesity (> or = 30 kg/m2) and non-optimum blood pressure levels (systolic > or = 20 mm/Hg or diastolic > or = 80 mm/Hg) were 15.4(95CI: 8.5- 25.7), 80.0(95CI: 70.8-86.9) and 70.5(95CI: 61.1-78.6), respectively. Although it was not statistically significant, diabetes was higher among females (15.4) compared to males (12.0). All participants with self-reported diabetes were overweight or obese, and 91.7showed non-optimum blood pressure levels. A significant positive correlation (p < 0.001) was observed between blood pressure levels and body mass index (r = 0.3). CONCLUSIONS: The percentage of persons with diabetes, obesity, and non-optimum blood pressure levels in this sample of Medical Sciences Campus employees underscores the need for confirming these results in a larger study and developing strategies focused on reducing health risks in this population.

Type 2 diabetes mellitus among youth in Puerto Rico, 2003

AIMS: To describe the clinical characteristics, and estimate the prevalence of type 2 diabetes mellitus among Puerto Rican youth, 1995-2003. METHODS: All patients aged less than 20 years with a confirmed diagnosis of type 2 diabetes were identified from pediatric endocrinologists' medical practices. Medical records of each patient were reviewed to confirm the diagnosis, classify the type of diabetes, and gather sociodemographic and clinical characteristics. From 1995 to 2003 a total of 32,444 records were reviewed. A total of 2,800 children with diabetes were identified, of which 2,702 were type 1 and 93 type 2; typel/type 2 ratio was 29:1. Frequency distributions were obtained for categorical variables, and summary measures (mean +/- standard deviation) for quantitative measure were computed. RESULTS: Mean age at first visit was 14 years. The majority of cases were females (69), for a female/ male ratio of 2.2:1. 78.5had a family history of the disease, 74.2were overweight, and 48had acanthosis nigricans. 64.5of the cases were receiving some type of hypoglycemic therapy. 18.5of the cases had severe hypertension while 17.5had cholesterol levels considered at increased risk (e[quot ]200). The overall prevalence was 13.5 per 100,000 population. CONCLUSIONS: This study is the first that describes the frequency and clinical presentation of type 2 diabetes in children and adolescents in a sample of Puerto Ricans. Further investigations must be conducted to obtain a more precise estimate of the burden of type 2 diabetes in youth and to raise awareness of this condition among health care professionals.

The public health burden of diabetes: a comprehensive review.

The review of several diabetes epidemiological studies confirms that diabetes is one of the most prevalent non-communicable diseases globally, and it is the fourth or fifth leading cause of death in most developed countries. Diabetes prevalence ranges from nearly 0% in New Guinea to 50% in the Indians of Arizona. No modifiable risk factors have been clearly established in persons with type 1 diabetes, but major environmental determinants have been suggested. Impaired glucose tolerance, gestational diabetes, insulin resistance, obesity and lack of physical activity have been consistently identified as risk factors for type 2 diabetes. The prevalence of diabetes increases with age, but a sex-specific tendency has not been consistent. In addition, the prevalence of diabetes is higher in African-Americans and Hispanics when compared to other ethnic groups. Diabetes affects almost all organs of the body and is the leading cause of blindness and amputations of legs, imposing both clinical and economic costs to patients and society.

Prevalence of diabetes mellitus among insured of a health insurance company in Puerto Rico: 1997-1998.

OBJECTIVE: The purpose of this study was to determine the prevalence of diabetes mellitus in persons covered by a health insurance company. METHODS: The medical claims of persons insured with Triple S Health Insurance Co. of Puerto Rico, whose main diagnosis was diabetes (ICD9-250.0-9), were selected for analysis. Prevalence and medical utilization rates were estimated. General characteristics and services utilization were compared by age and sex using the chi-square distribution. RESULTS: Overall prevalence was 4.73%. Prevalence in the male population (5.07%) was higher than that of females (4.43%) in all age groups, but the difference was not statistically significant (p > 0.05). The proportion of diabetic cases was larger in the > 60 age group. 64% of the cases had 1 or more visits to a physician office, 2% were hospitalized, and almost 3% had emergency room visits. 29% of the cases had insulin prescriptions while 59% had oral prescriptions. The younger age group (< or = 44 years) had a larger utilization rate of emergency room and hospital admissions. Health service utilization varied by age and sex, however, the only significant difference was observed in glucose test services utilization (p < 0.05). CONCLUSIONS: The prevalence of diabetes in this group was lower than the prevalence reported in the Behavioral Risk Factor Surveillance System. This may be partially explained by the fact that the study group did not represent the composition of the Puerto Rican population. Prevalence studies using other groups will be helpful to determine the prevalence of diabetes in Puerto Rico.

Prevalence of diabetes and patterns of health services utilization: a comparative analysis between a private and a health reform group of insured, 1997-1998.

OBJECTIVE: To compare the prevalence and health services utilization patterns of diabetes mellitus in a group of insured under the Puerto Rico Health Reform Act and the private sector of the same insurance company. METHODS: The medical claims of the public sector insured whose main diagnosis was diabetes mellitus (ICD9-250.0-9) were selected for analysis. Prevalence and medical utilization rates were estimated. General characteristics and services utilization were compared by age and sex using the chi-square distribution. RESULTS: A total of 38,139 diabetic cases were identified during the study period. Overall prevalence was 6.23% (95% CI: 6.17%-6.29%); 5.22% among males (95% CI: 5.14-5.30) and 7.09% among females (95% CI: 7.00%-7.18%). The proportion of cases was larger in persons aged 65 years or more (60.3%) and females (61.6%). Overall, 84.7% of insured diabetics had medical office visits, while 7.8% had emergency room services and 1.3% had hospital admissions. Female cases had more physician office visits (62%) and insulin prescriptions (65%) compared to males (p < 0.05). The most reported complication was cerebrovascular accident (4.4%). The prevalence of diabetes was higher in the public sector (6.23%) when compared to the private sector (4.73%) (p < 0.01). The mean number of oral hypoglycemic (32.77 +/- 0.40) and insulin (40.99 +/- 0.54) prescriptions were higher in the public sector (p < 0.01). Emergency room utilization rate was larger among males in the younger age groups of the private sector. However, hospital admissions were larger in both sexes of the younger age group of the public sector when compared with the private sector. CONCLUSIONS: A higher prevalence of diabetes and mean service utilization was observed in the public sector. An in-depth analysis of the health care of patients with diabetes in the public sector is needed.

Cortical cholinergic activity is related to the novelty of the stimulus.

A number of studies have related cholinergic activity to the mediation of learning and memory. However, the acetylcholine (ACh) participation has been recently implicated in the early stages of memory formation but not during retrieval. The aim of the present study is to evaluate ACh release in the insular cortex (IC) during presentation of different taste stimuli and during their re-exposition by means of the free-moving microdialysis technique. We evaluated the changes in ACh release when a novel taste, saccharin or quinine was presented to the rat and after several presentations of saccharin. Unilateral microdialysis was performed in the IC 1 h before and 1 h after the presentation of: (1) a familiar stimulus (water), (2) a novel taste (quinine), (3) another novel taste (saccharin), (4) a second presentation, (5) a third presentation, and (6) a fourth presentation of saccharin. The volume consumed by the animals was registered as a behavioral parameter. The ACh levels from the microdialysis fractions were analyzed by an HPLC-ED system. Biochemical results showed a significant increment in the cortical ACh release induced by a novel stimulus compared with the release observed during the presentation of a familiar stimulus. The ACh release observed after several presentations of the stimuli decreased to the same levels as those produced by the familiar taste, indicating an inverse relationship between familiarity and cortical ACh release. These results suggest that the cholinergic system plays an important role in the identification and characterization of different kinds of stimuli.

Catheter related infections in Damas Hospital

The purpose of this study is to investigate the extent of catheter-related infections in our Institution. We examined retrospectively 89 medical records of patients in whom an intravascular catheter tip culture were obtained during January through December 1991. Forty-seven catheter related infections were identified in 43 patients. There were 33 multiple lumen infected catheters and 14 single lumen. Catheters for hemodialysis were infected in 38.3 of the patients. Twenty catheters were inserted into the subclavian vein. Fifty percent of the reinserted catheters were placed in the same site, of which 28.6 became infected. Staphylococcus epidermis was isolated in 28.1 of the patients, while in 50 of the patients with Staphylococcus aureus, bacteremia was identified. Staphylococci and Enterococci were more sensitive to Vancomycin than to any other antibiotic

Catheter related infections in Damas Hospital.

The purpose of this study is to investigate the extent of catheter-related infections in our Institution. We examined retrospectively 89 medical records of patients in whom an intravascular catheter tip culture were obtained during January through December 1991. Forty-seven catheter related infections were identified in 43 patients. There were 33 multiple lumen infected catheters and 14 single lumen. Catheters for hemodialysis were infected in 38.3% of the patients. Twenty catheters were inserted into the subclavian vein. Fifty percent of the reinserted catheters were placed in the same site, of which 28.6% became infected. Staphylococcus epidermis was isolated in 28.1% of the patients, while in 50% of the patients with Staphylococcus aureus, bacteremia was identified. Staphylococci and Enterococci were more sensitive to Vancomycin than to any other antibiotic.

Exercise and physical activity of adolescents.

Multiple studies point toward the beneficial role of regular exercise in preventing cardiovascular disease. The purpose of this study is to determine the prevalence of physical activity and exercise among adolescents from the only high school in Cataño, Puerto Rico. An open-ended, multiple choice questionnaire was administered to 106 students who were randomly chosen. Questions included frequency of exercise, type of sports which they practiced and would like to practice. Results were statistically analyzed. The study revealed that 53% of the participants did not exercise regularly, exercising less than once a week. Those who did exercise were involved in a competitive team sport (35% of females: volleyball; 65.8% of males: basketball). Approximately 1/3 of the females and of the males replied they would like to practice noncompetitive sports which should be incorporated into their lifestyles through early intervention in the school, home and through the primary care physician.

Eficacia clinica de la cefoperazona: estudio multicentrico en infecciones variadas / Clinical efficacy of cefoperazone: multicenter study in different infections

Se evaluó, en infecciones mixta por microorganismos aerobios y anaerobios, la eficacia y tolerancia del tratamiento combinado de Cefoperazona(2g/dia) y tinidazol (0.8g/d), administrando por via intravenosa en 36 pacientes (rango de edad 13-65 anos, 20 mujeres y 16 hombres) durante 5-17 dias (promedio 7.8 dias) con las siguientes infecciones severas: peritonitis(n=18), sepsis(n=2) abceso de pared abdominal(n=3), enfermedades inflamatoria pelviana(n=3) neumonia (n=2) colecistitis(n=1), osteomielitis(n=1), abceso subfrenico(n=3), abceso hepatico, tubo-ovarico y gangrena de miembros inferiores(1caso c/u). Los microorganismos sensibles a cefoperazona y/o tinidazol aislados fueron: E. Coli, Acinetobacter, sp., Bacteroides, sp., P.aeruginosa, k. pneumoniae, peptoestreptococcus, Enterocoicos, P.vulgaris,