Association between vitamin D deficiency and common variants of Vitamin D binding protein gene among Mexican Mestizo and indigenous postmenopausal women.

PURPOSE: Vitamin D deficiency (VDD) and polymorphisms in the group-specific component (GC) gene are known to be associated in different populations. However, the effects of such genetic variants may vary across different populations. Thus, the objective of this study was to estimate the association between Vitamin D-Binding Protein (VDBP) haplotypes and VDD in mestizo postmenopausal women and Mexican Amerindian ethnic groups. METHODS: This was a cross-sectional study of 726 postmenopausal Mexican women from the Health Workers Cohort Study (HWCS) and 166 postmenopausal women from the Metabolic Analysis in an Indigenous Sample (MAIS) cohort in Mexico. GC polymorphisms (rs7045 and rs4588) were analyzed by TaqMan probes. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured by Chemiluminescent Microparticle Immuno Assay. RESULTS: The prevalence of VDD serum 25(OH)D < 20 ng/mL was 43.7% in mestizo women and 44.6% in indigenous women. In HWCS, the single nucleotide polymorphisms (SNPs) rs7041 and rs4588 were associated with VDD. In addition, women from the HWCS, carrying the haplotypes GC2/2 and GC1f/2 had higher odds of VDD (OR = 2.83, 95% CI 1.14, 7.02; and OR = 2.30, 95% CI 1.40, 3.78, respectively) compared to women with haplotype 1f/1 s. These associations were not statistically significant in the MAIS cohort. CONCLUSIONS: Our results show genetic association of the analyzed SNPs and related haplotypes, on the GC gene, with VDD in mestizo Mexican postmenopausal women. Moreover, a high prevalence of VDD with high genetic variability within the country was observed. Our results support the need for national policies for preventing VDD.

Photodynamic therapy for the treatment of complex anal fistula.

BACKGROUND: Photodynamic therapy (PDT) is a new procedure for the treatment of anal fistula. This preliminary study was designed to investigate the safety and effectiveness of this new technique in the treatment of anal fistula. METHODS: Ten patients were treated with PDT. Intralesional 5-aminolevulinic acid (ALA) 2% was directly injected into the fistula. The internal and external orifices were closed. After an incubation period of 2 h, the fistula was irradiated using an optical fibre connected to a red laser (MULTIDIODE 630 PDT, INTERmedic, Spain) operating at 1 W/cm for 3 min (180 Joules). Patient demographics, operation notes and complications were recorded. RESULTS: There were no complications. The average length of patient follow-up was 14.9 months (range 12-20 months). We could observe primary healing in eight patients (80%). Two patients (20%) showed persistence of suppuration after the operation. No patient reported incontinence postoperatively. CONCLUSIONS: PDT is a potential sphincter-saving procedure that is safe, simple and minimally invasive and has a high success rate.

[18F]-Sodium fluoride uptake in Takayasu arteritis.

BACKGROUND: While 18F-fluorodeoxyglucose and 18F-sodium fluoride with positron emission tomography relate with inflammation and calcification, their role in the assessment of patients with Takayasu arteritis has not yet been studied. METHODS: We present 5 patients with suspected active metabolic disease who underwent PET with 18F-fluorodeoxyglucose and 18F-sodium fluoride in order to explore the locations and correlations of 18F-fluorodeoxyglucose and 18F-sodium fluoride uptakes. Diagnosis of metabolic active disease was based on 18F-fluorodeoxyglucose uptake. RESULTS: We studied 3 female patients and 2 male patients. Median age was 29 years (min: 19 max: 63). In areas with atherosclerotic plaques, we found a negative correlation between 18F-sodium fluoride and 18F-fluorodeoxyglucose uptakes (r = -0.78) (P = .001). Meanwhile, in areas with only metabolic active disease, we found a positive correlation between 18F-sodium fluoride and 18F-fluorodeoxyglucose uptakes (r = 0.94) (P = .019). CONCLUSIONS: In Takayasu arteritis, 18F-sodium fluoride uptake can document different stages of metabolic disease, even in the absence of active metabolic disease or symptoms.

Obesity, Cardiorespiratory Fitness, and Self-Reported Sleep Patterns in Chilean School-Aged Children.

The aims were to examine the association of sleep patterns with being overweight or obese and to analyze the association of cardiorespiratory fitness (CRF) with sleep patterns in children. The study involved 395 schoolchildren (12-13 years old). Sleep patterns were assessed with the Sleep Self-Report (SSR) questionnaire, grouped into four subscales: sleep quality, sleep-related anxiety, bedtime refusal, and sleep routines. CRF was predicted by the 20-m shuttle-run test. Logistic regression models showed that sleep-related anxiety problems predicted being overweight or obese in both sexes, and sleep quality problems predicted being overweight or obese in girls. Also, girls who had better CRF levels were less susceptible to sleep-related anxiety problems. Studies are required to determine if increasing CRF could be a possible strategy for improving sleep quality.

[Physical activity, screen time and sleep patterns in Chilean girls]. / Actividad física, tiempo de pantalla y patrones de sueño en niñas chilenas.

INTRODUCTION: Physical activity (PA), screen time (ST), and sleep are modifiable lifestyle habits for health. The objectives of this study were: a) to examine the association between PA, ST, and both, on sleep patterns; and b) to determine the influence of PA and ST on sleep problems in Chilean girls. PATIENTS AND METHODS: The study involved 196 children (12.2 years). Patterns and sleep problems were assessed using the Spanish version of the Sleep Self-Report, and the PA through the Physical Activity Questionnaire for Adolescents (PAQ-A), both in Castilian. The ST was assessed using several questions about television, game console and computer use. RESULTS: The ST recommendation (2h a day) was exceeded by 63.2% of the girls. In general, the most active girls (last quartile) that did not exceed the recommendations of ST reported higher sleep quality and total score values compared to those who did not meet both. The logistic regression analysis showed that girls who did not meet both habits were more likely to have sleep quality (odds ratio=17.8, P=.018), and general sleep problems (odds ratio=7.85, P=.025). CONCLUSIONS: Parents need to set limits on sedentary leisure time and encourage more active habits, as sleep is a parameter closely linked to a better health profile in youth.

First Report of Beet mild curly top virus Infection of Chile Pepper in North-Central Mexico.

During the 2005 growing season, widespread virus-like symptoms were observed in pepper (Capsicum annuum) fields in north-central Mexico. Early in the season, plants were chlorotic and stunted with thickened, elongated leaves. From mid to late season, the affected plants showed severe yellowing, upwardly rolled, small leaves, and a few deformed fruits. Symptoms were similar to those described for curtoviruses in pepper (1). The leafhopper vector of curtoviruses, Circulifer tenellus, was first reported in the area in 1953 (3) (its presence was confirmed again in January 2008). Pepper fields were sampled in the states of Aguascalientes and Zacatecas, and five symptomatic plants from Zacatecas tested positive for the presence of curtoviruses by PCR using primers to the coat protein (CP) coding region (2). PCR amplicons from three samples of Ancho and Mirasol pepper types from Zacatecas, which also tested positive by PCR using the rep coding region (2), were sequenced and compared with reported curtoviruses. The samples showed 91% identity with the CP coding region and 93% identity with the rep coding region of Beet mild curly top virus (formerly the Worland strain). A survey of pepper fields from Aguascalientes and Zacatecas based on symptomatic plants was conducted from July to August of 2005. Forty-three fields of different types of pepper, including those growing under mulch and drip irrigation, were surveyed. Twenty-five plants in each of five contiguous rows were inspected for the symptoms described above. Disease symptoms were noted in Mirasol, Ancho, Pasilla, and Guajillo pepper types, and the average disease incidence was 9.87% (range: 1.6 to 48%), 15.2% (range: 6.4 to 25.6%), 7.85% (range: 2.4 to 15.2%), and 20.8% (range: 8 to 33.6%), respectively. To our knowledge, this is the first report of curtovirus infection of chile pepper in this region of Mexico. The moderate level of curtovirus infection found here suggests the need to initiate management strategies for this disease. References: (1) L. L. Black et al. Page 98 in: Pepper Diseases. A Field Guide. AVRDC, Taiwan, 1991. (2) R. Creamer et al. Plant Dis. 89:480, 2005. (3) D. A. Young and N. W. Frazier. Hilgardia 23:25, 1954.

Comparison of stereoscopy, light microscopy and ultrastructural methods for evaluation of bovine embryos.

The most important point in embryo transfer success is the evaluation of the stage of development and quality of embryos. Therefore, the purpose of this study was to compare the morphological evaluation of embryos using stereoscopy, light microscopy and electron microscopy in order to establish the accuracy of former method compared with more invasive and accurate procedures. For this purpose, 23 Brahman x Swiss cows were used and synchronized with Norgestomet 6 mg plus, 5 mg Estradiol valerate (Syncromate B(R), Rhone Merieux, Mexico, Mexico City) and superovulated with Folltropin-V 240 mg (Vetrepharm, Mexico, Mexico City). Non-surgical embryo collection was performed 7.5 days after insemination. Descriptive statistics analysis was used to assess the data. Seventy-eight embryos were collected and classified by stereoscopic microscopy, finding 51.2% (40) of good quality, 25.6% (20) fair and 24.3% (19) poor. Later, under light microscopy observation, evaluation of the same embryos resulted in 25.6% (20) good, 32.0% (25) fair and 42.3% poor quality. Finally, in the evaluation of embryos under electron microscopy 24.3% (19) were found to be of good quality, 29.3% (23) fair and 46.1% (36) poor. Evaluation of embryos with stereoscopic microscopy was found to be very subjective, as nearly 50% of embryos classified by this method as good quality, showed features of degenerative stages under light and electron microscopy. Embryos with these features are generally frozen and transferred, which could be one of the reasons for having low fertility rate in embryo transfer programmes.

Posttraumatic lymphocyte response: a comparison between peripheral blood T cells and tissue T cells.

BACKGROUND: T-cell response to trauma has been assessed primarily by sampling peripheral blood lymphocytes. We hypothesized that lymphocytes residing in tissue and traveling through lymph vessels are more likely to be activated by tissue injury and hemorrhage-induced hypoperfusion. We compared peripheral blood T-cell response with tissue or lymph T-cell response in an ovine model of multiple injury. METHODS: Anesthetized adult sheep instrumented with a chronic prefemoral lymph fistula were subjected to lower-extremity fractures, fixed-volume hemorrhage, resuscitation, and fracture stabilization. Peripheral blood and tissue T-cell receptor expression was determined at baseline and after injury. RESULTS: At baseline, we found significant differences in the expression of CD4, CD8, and L selectin between peripheral blood T cells and tissue T cells. After trauma, the percentage of tissue T cells expressing CD8 decreased from 19 +/- 9 to 14 +/- 5 (p < 0.05) and the percentage expressing gammadelta-TcR receptors decreased from 12 +/- 4 to 7 +/- 2 (p < 0.05). T-cell phenotype composition in peripheral blood was not affected by trauma. CONCLUSION: Peripheral blood T-cell composition differs from tissue T-cell composition before and after trauma. Trauma produced changes in tissue T-cell phenotypes but not in peripheral blood T-cell phenotypes.

Video-assisted thoracic surgery in the treatment of posttraumatic empyema.

BACKGROUND: Video-assisted thoracic surgery (VATS) appears to be replacing open thoracotomy for the treatment of posttraumatic thoracic complications. OBJECTIVE: To compare operative times, complication rates, and outcomes in patients who underwent VATS vs open thoracotomy. DESIGN: Retrospective review. SETTING: University hospital, level I trauma center. PATIENTS: Trauma patients who between December 1993 and May 1997 underwent open thoracotomy or VATS to drain a persistent thoracic collection. METHODS: Medical records were reviewed for demographic data, operative times, and clinical outcomes. RESULTS: Of the 524 trauma patients requiring tube thoracostomy, 22 underwent 23 procedures to drain empyema (17 VATS, 6 thoracotomies [based on surgeon preferencel). There were no differences in age, Injury Severity Score, or mechanism of injury between the 2 groups. Three patients who underwent VATS (18%) required conversion to open thoracotomy for adequate drainage. All remaining patients who underwent VATS had successful treatment of their empyema. Complication rates (VATS=29%, open thoracotomy=33%; P=.99), operative times (VATS=3.4+/-1.3 hours [mean+/-SD], open thoracotomy=3.0+/-1.5 hours; P=.46), postoperative epidural catheter use (VATS=31%, open thoracotomy=50%; P=.63), duration of chest tube drainage (VATS=5.1+/-1.7 days [mean+/-SD], open thoracotomy=4.5+/-1.5 days; P=.48), and hospital stay after the procedure (VATS=16+/-14 days [mean+/-SD], open thoracotomy=11+/-5 days; P=.39) were similar for both groups. CONCLUSIONS: Video-assisted thoracic surgery was a safe and effective operative strategy for the treatment of posttraumatic empyema. Therefore, because VATS has been shown in nontrauma patients to reduce morbidity and because it provides better cosmesis, we believe that it should be the initial operative approach to trauma patients with suspected posttraumatic empyema.

Posttraumatic empyema. Risk factor analysis.

BACKGROUND: Empyema remains a distressing complication after thoracic injury. OBJECTIVE: To identify high-risk factors associated with the development of empyema. DESIGN: Retrospective cohort review. SETTING: University hospital, level I trauma center. PATIENTS: Trauma patients who required tube thoracostomy (TT) between January 1, 1991, and November 31, 1993 (n = 584). METHODS: Data (demographic characteristics, injuries, chest x-ray film reports, and setting of TT) were assessed using a stepwise logistic regression analysis to identify risk factors associated with the development of post-traumatic empyema. RESULTS: Empyema that required decortication developed in 25 patients (4%). Factors predictive of development of empyema were retained hemothorax (odds ratio, 12.5; 95% confidence interval, 0.96-163), pulmonary contusion (odds ratio, 6.3; 95% confidence interval, 1.53-25.8), and multiple chest tube placement (odds ratio, 2.5; 95% confidence interval, 1.91-3.28); factors not predictive of empyema were severity of injury, mechanism of injury, setting in which TT was performed, number of days chest tubes were in place, and antibiotic drugs at the time of TT. CONCLUSIONS: The extent of pulmonary injury (pulmonary contusion) is an important predictor of empyema development. Previously implicated factors such as setting in which a TT was performed and mechanism of injury did not correlate with the development of posttraumatic empyema. Based on the results of our study, we recommend early drainage of the pleural space with video-assisted thoracoscopic techniques in patients at risk of empyema, which may spare them the morbidity of a thoracotomy.

Recent advances in continuous renal replacement therapy: citrate anticoagulated continuous arteriovenous hemodialysis.

Trisodium citrate was used as a regional anticoagulant on 24 patients on continuous arteriovenous hemodialysis (CAVHD), obviating the need for systemic heparinization. Principles of CAVHD, potential complications, and nursing responsibilities are addressed. Clearances, blood flow rate, ultrafiltration and filter patency compare favorably with heparin CAVHD. Citrate anticoagulated CAVHD avoids heparin-associated complications in the critically ill uremic patient.