Estrategias de cuidado de la hipoacusia prelingual en las Américas y sus implicancias socioeconómicas / Policy strategies for prelingual hearing loss in the Americas region an their socio economic implications

Si no se detecta y atiende a un niño con hipoacusia durante la etapa prelingual,es improbable que pueda adquirir de forma adecuada el lenguaje oral.ObjetivosRelevar la situación de las políticas asociadas a la hipoacusia prelingual yestimar los costos económicos para un conjunto de países de la región de lasAméricas.MétodosSe consideró un escenario de hipoacusia prelingual neurosensorial severaa profunda bilateral donde el niño es intervenido en forma oportuna y otroescenario donde el niño no es tratado y no desarrolla el habla. Se tuvieron encuenta los costos médicos (sanitarios y rehabilitación) y sociales (productividady erogaciones estatales).ResultadosPara el conjunto de países estudiados, el costo de la no intervención es mayoral costo de la intervención oportuna.ConclusionesSe espera que las estimaciones realizadas sirvan de base para impulsar en laregión el desarrollo de marcos nacionales integrales y oportunos dirigidos alcuidado de la audición.

Abruptio placentae and disseminated intravascular coagulation: use of thrombelastography and sonoclot analysis.

We report a case in which thrombelastography (TEG) and Sonoclot analysis were used for diagnosis and treatment decisions in a patient with abruptio placentae and disseminated intravascular coagulation. In addition to providing enough information for evaluation and treatment of this patient, the TEG and Sonoclot results were obtained more quickly, with smaller blood samples and with less expense to the patient in comparison to the standard coagulation tests in our institution. Although the TEG and Sonoclot results were assessed independently of the other test and each provided similar information in this case, the TEG may be the preferred tool in evaluating coagulopathies, based on computerization and strong literature support.

Vasa previa: prenatal diagnosis with transvaginal color Doppler flow imaging.

Vasa previa carries a significant risk for fetal exsanguination and death at the time of membrane rupture. The diagnosis is rarely made before the onset of vaginal bleeding. We report the prenatal diagnosis of vasa previa with transvaginal color Doppler flow imaging in an asymptomatic patient with a succenturiate placenta.

Bilateral tubal pregnancies after tubal sterilization.

Bilateral tubal pregnancies are a rare variety of ectopic gestation. Tubal sterilization has become an important cause of tubal pregnancy. To our knowledge, this is the first case report of a twin gestation resulting in bilateral tubal pregnancies after a modified Pomeroy tubal sterilization.

Repair studies utilizing a fly-pupariation model of postmitotic cell response.

Delay in pupariation of irradiated fly (and other insect) larvae results from a neuroendocrine disturbance and represents a dose-dependent response of differentiated postmitotic tissue. Many experimental manipulations (e.g. heating) may themselves upset timing, limiting usefulness of this phenomenon as a model of postmitotic tissue response. Doses greater than 20 Gy inhibit retraction of specific muscles at time of pupariation, leading to formation of elongate puparia. Degree of elongation (ratio of length: breadth) was also a function of dose. Peak sensitivity for elongation occurs later than that for delay, but both endpoints exhibit rapid kinetics for sparing effect of dose fractionations (sdf). With degree of elongation as endpoint, we demonstrated synergism between heat and radiation, and heat markedly inhibited sdf. Maintenance of irradiated larvae under wet conditions greatly prolonged the larval stage, and degree of elongation was reduced. This recovery, analogous to repair of potentially-lethal damage (PLD) in plateau-phase cell cultures, proceeds much more slowly than sdf.

Promethazine hydrochloride therapy in severely Rh-sensitized pregnancies.

Seventeen severely Rh-sensitized women were treated with promethazine hydrochloride (Phenergan) in 18 pregnancies, according to a protocol described by Gusdon et al. There was an unequivocal amelioration of the disease process in 10 of the pregnancies. In 9 of these 10 pregnancies, the infant survived. In 4 of the pregnancies, promethazine proved an unnecessary therapy as the infants were Rh negative. Promethazine may or may not have been helpful in 2 pregnancies, both of which resulted in live-born infants. One pregnancy resulted in intrauterine fetal death subsequent to an intrauterine transfusion. This infant was later shown to have multiple congenital anomalies incompatible with life. In a subsequent pregnancy, the mother was again treated with promethazine and had a normal infant who survived after exchange transfusions. The one loss of a live-born infant resulted from a cardiac arrest during an exchange transfusion. On the basis of these observations, the authors agree with Gusdon et al that promethazine does have an ameliorating effect on Rh-sensitized pregnancies.

Isolation and characterization of specialized transducing lambda phages carrying ribosomal protein genes of Escherichia coli.

Specialized transducing lambda phages have been isolated which carry the regions of the Escherichia coli chromosome containing the gene or gene-clusters for ribosomal proteins (r-proteins) S1, S6-S18-L9, S16-L19, and L28-L33. To investigate whether these phages also carry the genes for r-proteins S9, L13, L20, L31 and L34 whose gene locations are not known, cells irradiated with UV light were infected with these phages and the r-proteins synthesized were analyzed by two-dimensional gel electrophoresis. However, no synthesis of these r-proteins was stimulated, indicating that their genes are not located in the neighborhood of any of the above-mentioned genes or gene clusters. It was found that proteins S6 and S18 synthesized in the cells irradiated with UV light were not modified under these conditions in which no concomitant ribosome assembly took place.

Lipid binding by fragments of apolipoprotein C-III-1 obtained by thrombin cleavage.

We have used thrombin to cleave apolipoprotein C-III-1 into two fragments constituting residues 1-40 (apoLP-C-III-A) and 41-79 (apoLP-C-III-B). The lipid binding properties of these fragments with dimyristoyl- and 1-palmitoyl-2-oleoylphosphatidylcholines have been determined using circular dichroic and intrinsic tryptophan fluorescence spectroscopy. The peptide-phospholipid mixtures were fractionated by density gradients of cesium chloride. ApoLP-C-III-A showed disordered structure in the absence and presence of DMPC and no significant amount of peptide-phospholipid complex was isolated. ApoLP-C-III-B showed conformational changes in the circular dichroic spectrum and a shift in the intrinsic tryptophan fluorescence spectrum. Ultracentrifugation in cesium chloride gradients yielded peptide-phospholipid complexes isolated between density 1.10 and 1.18. The molar ratio of lipid to protein was 12:1. The results of these studies and the examination of space filling models of apoLP-C-III provide evidence that an amphipathic alpha helix which contains a nonpolar face and a polar face is the basic structural unit for binding of phospholipid by the plasma apolipoproteins. These results also provide direct evidence that the hydrophobicity of the nonpolar face is important in lipid binding since the nonpolar face of residues 1-40 is considerably less hydrophobic than the nonpolar face of residues 41-79.