Impact of SARS-CoV-2 lockdown and de-escalation on air-quality parameters.

The SARS-CoV-2 health crisis has temporarily forced the lockdown of entire countries. This work reports the short-term effects on air quality of such unprecedented paralysis of industry and transport in different continental cities in Spain, one of the countries most affected by the virus and with the hardest confinement measures. The study takes into account sites with different sizes and diverse emission sources, such as traffic, residential or industrial emissions. This work reports new field measurement data for the studied pandemic period and assesses the air quality parameters within the historic trend of each pollutant and site. Thus, 2013-2020 data series from ground-air quality monitoring networks have been analysed to find out statistically significant changes in atmospheric pollutants during March-June 2020 due to this sudden paralysis of activity. The results show substantial concentration drops of primary pollutants, including NOx, CO, BTX, NMHC and NH3. Particulate matter changes were smaller due to the existence of other natural sources. During the lockdown the ozone patterns were different for each studied location, depending on the VOCs-NOx ratios, with concentration changes close to those expected from the historical series in each site and not statistically attributable to the health crisis effects. Finally, the gradual de-escalation and progressive increase of traffic density within cities reflects a slow recovery of primary pollutants. The results and conclusions for these cities, with different sizes and population, and specific emission sources, may serve as a behavioural model for other continental sites and help understand future crises.

Condición nutricional de escolares indígenas otomíes en situación de alta marginación / Nutritional status of indigenous Otomi schoolchildren in high marginal situation / Estado nutricional de população escolar de cultura indígena otomí em situação de alta marginalização

Resumen Introducción: El panorama de la salud y nutrición de la población mexicana se enmarca en la conjunción de desnutrición crónica infantil, sobre todo en el medio rural e indígena, y el incremento significativo del sobrepeso y obesidad. Esta información proveniente de encuestas arroja resultados generalizados, sin considerar las particularidades del contexto biosociocultural en que viven comunidades indígenas, codeterminante de la condición nutricional de éstas. Objetivo: Estudiar el estatus nutricional de un grupo de escolares de cultura otomí residentes en una comunidad de México en situación de marginación, considerando el contexto biosociocultural en el que viven. Métodos: Estudio prospectivo transversal realizado en una localidad del Estado de México. Muestra por conveniencia constituida por 214 menores, entre 6 y 12 años de edad. Se emplearon técnicas antropométricas internacionalmente aceptadas para recabar la estatura y el peso, y se calculó el IMC. El estatus de nutrición se estimó con base en el peso, la estatura y el IMC para la edad y se compararon con los referentes de la OMS. Resultados: La prevalencia de estatura baja para la edad y la desnutrición es menor, no así el sobrepeso/obesidad que afecta a un tercio de los menores. Solo para el IMC por edad y sexo hubo diferencias en ciertos grupos de edad. Las puntuaciones z de los tres indicadores son semejantes entre niños y niñas. Discusión y Conclusiones: En comparación con los parámetros nacional y estatal, los menores estudiados muestran prevalencia menor de sobrepeso y obesidad asociado a su contexto sociocultural.

Abstract Introduction: The health and nutrition outlook of the Mexican population may be framed in terms of chronic infant malnutrition, largely in the rural and indigenous sectors, and a significant increase in overweight and obesity. This general information is obtained from surveys without taking into account the biosociocultural context that is a codeterminant of the nutritional condition of many small indigenous communities. Objective: To study the nutritional status of Otomí school children living in a marginalized Mexican community from the perspective of the biosociocultural context in which they live. Methods: This is a prospective and transversal study carried out in a location of the state of México, México. The convenience sample was constituted by 214 children between 6 and 12 years old. Internationally accepted anthropometric techniques were used to collect data on the height and weight of these children. BMIs were calculated. The status of nutrition was estimated based on the expected weight, height, and BMI for each age. These data were compared with the corresponding WHO references. Results: The prevalence of low height and malnutrition related to the ages of these children was found to be low, but one in three of these children was found to be overweight or obese. There were some age groups differences regarding the BMI. The z scores of the three indicators are similar between boys and girls. Discussion and Conclusions: In comparison to the national and state parameters, the children studied showed a low prevalence of overweight and obesity associated with their sociocultural context.

Resumo Introdução: O panorama da saúde e nutrição da população mexicana se enquadra na conjunção de desnutrição infantil crónica, sobretudo no médio rural e indígena, e o incremento significativo do sobrepeso e obesidade. Esta informação vinda de enquetes gera resultados generalizados, sem considerar as particularidades do contexto biosociocultural em que vivem comunidades indígenas, co-determinante da condição nutricional destas. Objetivo: Estudar o estado nutricional de um grupo de escolares de cultura Otomí residentes em uma comunidade do México em situação de marginação, considerando o contexto biosociocultural em que vivem. Métodos: Estudo prospectivo transversal realizado em uma localidade do Estado do México. Amostra de conveniência constituída por 214 menores entre 6 e 12 anos de idade. Empregaram-se técnicas antropométricas internacionalmente aceitas para coletar a altura e o peso, e foi calculado o IMC. O estado de nutrição foi estimado com base no peso, a altura e o IMC para a idade e foram comparados com os referentes da OMS. Resultados: A prevalência da baixa altura para a idade e a desnutrição é menor, no entanto o sobrepeso/obesidade afeta a um terço dos meninos. Apenas para o IMC por grupos de idade e sexo houve diferenças em determinadas faixas etárias. As pontuações z dos três indicadores são semelhantes entre meninos e meninas. Discussão e Conclusões: Em comparação com os parâmetros nacionais e estaduais, os meninos estudados mostram menor prevalência de sobrepeso e obesidade associado ao seu contexto sociocultural.

Síndrome de Frey o síndrome auriculotemporal / Frey's syndrome or auriculotemporal syndrome

El síndrome de Frey o síndrome auriculotemporal es una entidad clínica poco conocida en Pediatría, lo que hace que muchas veces sea infradiagnosticada o confundida con una alergia. Presentamos el caso de una lactante de seis meses de edad, sin antecedentes de interés, cuyos padres acuden a la consulta de Pediatría por la aparición, de manera repetida y a los pocos minutos de comenzar la ingesta de papilla de frutas, de un eritema de color rojo tenue en ambas sienes. Este desaparece al cabo de unos minutos sin que el lactante muestre rechazo ni otra sintomatología. Creemos importante conocer esta entidad debido a que genera pruebas complementarias y derivaciones a consultas de atención de especializada innecesarias, siendo posible su manejo desde Atención Primaria (AU)

Frey´s syndrome or auriculotemporal syndrome is a rare disorder which is little known in Paediatrics, resulting often in a undiagnosed pathology or confuse it as a food allergy. We report the case case of a six-month-old breastfed baby with no relevant medical history, whose parents brought her to hospital due to a repeated bright erythema around the temples within seconds to minutes of ingesting fruit puree. The erythema resolves spontaneously within a few minutes, the baby does not reject the food and she does not show any other symptoms. We believe this is an important disorder to take into account since it generates additional tests and unnecessary visits to specialized departments, while it could be easily managed in a Primary Care center (AU)

Electrical stimulation therapy of the lower oesophageal sphincter for refractory gastro-oesophageal reflux disease - interim results of an international multicentre trial.

BACKGROUND: A previous single-centre study showed that lower oesophageal sphincter electrical stimulation therapy (LES-EST) in gastro-oesophageal reflux disease (GERD) patients improves reflux symptoms and decreases oesophageal acid exposure. AIM: To evaluate safety and efficacy of LES-EST in GERD patients with incomplete response to proton pump inhibitors (PPIs) in a prospective, international, multicentre, open-label study. METHODS: GERD patients, partially responsive to PPIs, received LES-EST. GERD health-related quality of life (GERD-HRQL), daily symptom diaries, quality of life scores, oesophageal acid exposure, and LES resting and residual pressure were measured before and after initiation of LES-EST. Stimulation sessions were optimised based on residual symptoms and oesophageal acid exposure. RESULTS: Forty-four patients were enrolled and 6-month data from 41 patients are available. Hiatal repair was performed in 16 patients. One device-related, one procedure-related and one unrelated severe adverse event were reported. GERD-HRQL improved from 31.0 (IQR 26.2-36.8) off-PPI and 16.5 (IQR 9.0-22.8) on-PPI to 4 (IQR 1-8) at 3-month and 5 (IQR 3-9) at 6-month follow-up (P < 0.0001 vs. on- and off-PPI). Oesophageal acid exposure (pH < 4.0) improved from 10.0% (IQR 7.5-12.9) to 3.8% (IQR 1.9-12.3) at 3 months (P = 0.0027) and 4.4% (IQR 2.2-7.2) at 6 months (P < 0.0001). CONCLUSIONS: These interim results show an acceptable safety record of LES-EST to date, combined with good short-term efficacy in GERD patients who are partially responsive to PPI therapy. A remarkable reduction in regurgitation symptoms, without the risk of intervention-requiring dysphagia may prove to be an advantage compared with other anti-reflux procedures. ClinicalTrials.gov Identifier: NCT01574339.

Colecistostomía. Una técnica quirúrgica con indicación actual en pacientes de alto riesgo / Cholecystostomy. A surgical technique with current indication in high-risk patients

Objetivo: Demostrar que la colecistostomía es un procedimiento quirúrgico seguro y aplicable actualmente. Método: Descripción de dos casos con diagnóstico de colecistitis aguda y alto riesgo quirúrgico, a quienes se les realizó la colecistostomía. Una fue realizada con anestesia local en el área de la emergencia y la otra tuvo que realizarse en quirófano, en vista de fallas técnicas de las máquinas anestésicas, ambos casos tratados en el Hospital General del Oeste "Dr. José Gregorio Hernández" los Magallanes de Catia. Servicio de Cirugía I. Resultados: Ambos pacientes eran mayores de 60 años. Entre los resultados paraclínicos destaca la leucocitosis con desviación a la izquierda. Los pacientes fueron catalogados como ASA IV y ASA III. Ambos recibieron antibióticos endovenosos desde su ingreso, sin mejoría clínica ni paraclínica. Se realizó la colecistostomía quirúrgica, logrando conseguir la estabilidad hemodinámica. Posteriormente, fueron llevados a trata-miento quirúrgico definitivo de manera electiva, lográndose una evolución satisfactoria. Conclusión: En pacientes de edad avanzada con comorbilidades que condicionen un alto riesgo anestésico y quirúrgico en el contexto de un cuadro de colecistitis aguda sin respuesta al tratamiento médico, la colecistostomía proporciona una excelente alternativa quirúrgica temporal, para lograr la estabilidad hemodinámica y así disminuir la morbimortalidad(AU)

Objective: To demonstrate that cholecystostomy is a safe surgical procedure and applicable today. Method: Description of two cases with a diagnosis of acute cholecystitis and high surgical risk, who held the cholecystostomy. One was carried out under local anaesthesia in the area of the emergency and the other had to be done at operating room, in view of technical failures of the anaesthetic equipment, study done at Hospital General del Oeste "Dr. Jose Gregorio Hernandez" Magallanes de Catia, Caracas, Surgery service I. Results: Both patients were over the age of 60, the paraclinical findings include leukocytosis with left shift. The patients were classified as ASA III and IV. Both received intravenous antibiotics from your income, without clinical or paraclinical improvement. He was the surgical cholecystostomy, managing to achieve hemodynamic stability. Subsequently, were taken to definitive surgical treatment of elective way, with a satisfactory evolution. Conclusion: In older patients with comorbidities that determine high risk surgical and anesthetic in the context of acute cholecystitis with no response to medical treatment, the cholecystostomy provides an excellent temporary surgical alternative, to achieve hemodynamic stability and thus reduce morbidity and mortality(AU)

Anomalía congénita portal como causa de hemorragia digestiva alta / Congenital abnormality of the portal vein as cause of upper digestive tract bleeding

La hemorragia digestiva alta (HDA), es aquella cuyo origen se encuentra en segmentos del tracto digestivo situados por encima del ángulo de Treitz. Entre sus posibles causas, destaca por su importancia la hipertensión portal. Presentamos el caso de un paciente de 4 años que debutó con hemorragia digestiva alta, como consecuencia de hipertensión portal prehepática secundaria a anomalía congénita de ramas portales (AU)

Upper gastrointestinal bleeding is the one whose origin is in the digestive tract segments located above the Treitz angle. Among the possible causes, noted for its importance portal hypertension. We report the case of a male 4 year old with upper gastrointestinal bleeding because of prehepatic portal hypertension secondary to congenital anomaly portal branches (AU)

[Bone transport with external fixator RALCA in chronic osteomyelitis. Case report]. / Transportación ósea con fijador externo RALCA en la osteomielitis crónica. Reporte de un caso.

OBJECTIVE: To present the results obtained in the treatment of chronic osteomyelitis of the distal third of the tibia using an external fixator. CLINICAL CASE: Male, young patient with chronic osteomyelitis of the left tibia resulting from a Gustilo IIIB complicated fracture. We performed resection of the osteomyelitis focus. RESULTS: Good clinical and radiologic results were obtained with this technique; a 9 cm effective bone transport was achieved. CONCLUSIONS: Bone transport is a very useful method for the treatment of osteomyelitis that involves bone resection; the RALCA external fixator is technically useful.

Antidepressant-like effects of an alkaloid extract of the aerial parts of Annona cherimolia in mice.

ETHNOPHARMACOLOGICAL RELEVANCE: Several species of Annona (Annonaceae) are used in traditional Mexican medicine by their anti-anxiety, anticonvulsant and tranquilizing properties. It has been reported that the alkaloids isolated from some species of the Annona have affinity to serotonergic 5-HT(1A) receptors and modulate dopaminergic transmission, which is involved in depressive disorders. AIM OF THE STUDY: To investigate the antidepressant-like effect of an alkaloid extract from the aerial parts of Annona cherimola (TA) in mice. MATERIALS AND METHODS: The antidepressant-like effect was evaluated in the forced swimming test. To elucidate a possible mechanism of action, experiments of synergism with antidepressant drugs, such as imipramine (IMI), clomipramine (CLIMI), and fluoxetine (FLX), were carried out. The neurotransmitter content (DA: dopamine, 5HT: serotonin and its metabolites, HVA: homovanillic acid and 5HIAA: 5-hydroxyindoleacetic) in the whole brain of mice were also determined by HPLC method. TA chemical composition was determined using high performance liquid chromatography-electrospray mass spectrometry. RESULTS: The results showed that repeated treatment with TA produced antidepressant-like effects in mice. This effect was not related to an increase in locomotor activity. Administration of TA facilitated the antidepressant effect of IMI and CLIMI as well as increased the turnover of DA and 5-HT. The alkaloids: 1,2-dimethoxy-5,6,6a,7-tetrahydro-4H-dibenzoquinoline-3,8,9,10-tetraol, anonaine, liriodenine, and nornuciferine were the main constituents of TA. CONCLUSIONS: Results showed that TA produces an antidepressant-like action from a generalized increase in monominergic turnover, supporting the use in tradicional medicine of Annona cherimolia, and strongly suggest its therapeutic potency as an antidepressant agent.

Rotura traqueal como complicación de una intubación endotraqueal / Tracheal rupture as complication after endotracheal intubation

La rotura traqueal postintubación (RTP) es una complicación infrecuente, que exige un alto grado de sospecha clínica debido a su elevada morbimortalidad. Debe sospecharse en los pacientes que presentan enfisema subcutáneo, neumotórax y/o neumomediastino tras la intubación. Actualmente no existe consenso sobre su tratamiento, quirúrgico o conservador. Presentamos un caso de RTP que respondió favorablemente al tratamiento conservador(AU)

Post-intubation tracheal rupture (PTR) is a rare complication that requires a high degree of clinical suspicion due to its high morbidity and mortality. It should be suspected in all patients who present subcutaneous emphysema, pneumothorax, and/or pneumomediastinum after intubation. There is no current consensus on surgical or conservative treatment. We report 1 case of PTR that responded favorably to conservative treatment(AU)

José Benigno Hernández: el hermano ignorado / José Benigno Hernández: the ignored brother

El Dr. José Benigno Hernández fue medio hermano del Dr. José Gregorio Hernández, conocido este último por sus dotes cientificos y académicos, pero aún más por el ambiente mágico-religioso que rodea a su figura. Pero se da la situaciòn particular de quienes sostienen que en los dos escenarios, José Benigno se compara y -¿porque no? -supera a la figura del llamado "Siervo de Dios". El objetivo de este trabajo es dar a conocer a este gran profesional, polifacético, humilde y con una bondad infinita y tratar de determinar las causas que lo han colocado muy por detrás de su famoso hermano, misión nada facíl, pues José Gregorio Hernández se ha transformado en un ícono de la venezolanidad, llegando hasta el punto de considerarse ofensivo y hasta reo de herejía cualquier opinión en contra de lo que pareciera ser una versión de la "Historia Oficial" pero que, como hemos tratado de plasmar en esta tarea basada en testimonios personales de sus familiares, José Benigno no ha merecido el maltrato de ser ignorado por su propio país. Vale la pena recalcar que no es el único caso, en nuestra historia médica, que se olvida la obra de personajes que han estado por encima del común denominardor. A todos ellos nuestra comprensión y admiración.

Hipertensión intracraneal benigna. Experiencia en 18 años / Benign intracranial hypertension: Experience over 18 years

Introducción: Hay casos de hipertensión intracraneal (HTIC) transitoria, identificables en lactantes por abombamiento de fontanela y en niños mayores por papiledema. Se presenta una experiencia en HTIC benigna, excluidos traumatismos craneoencefálicos, encefalitis y meningitis. Resultados: Del total de la base de datos de neuropediatría, con 10.720 niños en 18 años, 31 casos tenían diagnóstico de HTIC benigna. Dieciséis tenían edades de entre 2,3 y 8,9 meses (el 75% eran varones), con abombamiento transitorio de fontanela y 15 tenían entre 4,4 y 13,7 años (el 73,3% eran mujeres), con papiledema. El 75% de los lactantes había finalizado recientemente tratamiento con corticoides por bronquitis. En los mayores, un caso asociaba excesiva ingesta de vitamina A y otro caso asociaba una mastoiditis. Se hizo ecografía transfontanelar o tomografía computarizada (TC) a todos los lactantes, TC o resonancia magnética (RM) a todos los mayores y punción lumbar a 7 lactantes y 13 niños mayores. Los lactantes evolucionaron favorablemente en pocos días y los niños mayores de una semana a 5 meses (algunos tras tratamiento). Discusión: La HTIC benigna, de habitual curso favorable, puede tardar en resolverse en niños mayores y presentar graves repercusiones visuales, incluso ceguera, por lo que precisa estrecho control oftalmológico. Es un diagnóstico evolutivo y de exclusión de otras causas de HTIC. En lactantes de evolución desfavorable y en todos los niños mayores debe hacerse RM y punción lumbar. Debe considerarse tratamiento con acetazolamida y furosemida, corticoides, punciones lumbares de repetición, derivación ventriculoperitoneal y descompresión de nervios ópticos (AU)

Introduction: There are transient intracranial hypertension cases, recognizable by bulging fontanelle in infants and by papilloedema in children. We present our experience in benign intracranial hypertension (BIH) cases, excluding traumatic brain injuries, encephalitis and meningitis. Results: Among the entire neuropaediatric database, with 10,720 children in 18 years, 31 cases had the diagnosis of BIH. Sixteen aged between 2.3 and 8.9 months (75% males), all of them with transient bulging fontanelle, and 15 aged between 4.4 and 13.7 years (73.3% females), all of them with papilloedema which was subsequently resolved. A total of 75% of infants had recently finished corticosteroid treatment for bronchitis. In the older children, there was 1 case associated with excessive vitamin A intake and 1 mastoiditis. Transfontanelle ultrasonography or CT was performed on all infants and CT or MRI in every child. Lumbar puncture was also performed on 7 infants and on 13 children. Infants developed favourably in a few days, and children did so between 1 week and 5 months, some with treatment. Discussion: BIH usually has a favourable outcome, although it may take longer in children than in infants, but it can have serious visual repercussions, even blindness, so ophthalmological control is necessary. It is normally diagnosed by exclusion of other intracranial hypertension causes. MRI and lumbar puncture must be done on all children or infants who do not progress favourably. Acetazolamide and furosemide, corticosteroids, repeated lumbar punctures and optic nerve sheath fenestration should be considered in those who do not progress well (AU)

Accidente cerebrovascular pediátrico secundario a displasia fibromuscular / Pediatric cerebrovascular accident secondary to fibromuscular dysplasia

Presentamos el caso de un varón de 13 años diagnosticado de displasia fibromuscular (DFM) por estudio angiográfico, con imagen “arrosariada” de la carótida interna, tras presentar 2 ictus isquémicos en 9 días. Se decidió tratamiento conservador con ácido acetilsalicílico en dosis antiagregantes. Veinte meses después, la evolución clínica es favorable, sin que haya presentado nuevos episodios. La DFM es una causa muy poco frecuente de ictus en la infancia. Se conoce poco acerca de su etiología. A pesar de tratarse de una entidad habitualmente asintomática, debemos pensar en su existencia ante ictus repetidos o no explicables por otra causa. Su pronóstico y tratamiento son controvertidos debido al escaso número de pacientes en edad pediátrica con esta enfermedad (AU)

We present the case of a 13 year-old patient diagnosed with fibromuscular dysplasia (FMD) by angiographic study, with “string of beads” image of internal carotid, after undergoing two ischemic strokes in nine days. Conservative treatment with acetylsalicylic acid at antiaggregant doses was decided. Twenty months later the clinical progress is favorable without presenting any new episodes. FMD is a very uncommon cause of stroke in childhood. Little is known about its etiology. In spite of it usually being an asymptomatic disease, it must be considered in cases of repeated or inexplicable strokes. Its prognosis and treatment is controversial, due to the limited number of pediatric patients with this pathology (AU)

[Pediatric cerebrovascular accident secondary to fibromuscular dysplasia]. / Accidente cerebrovascular pediátrico secundario a displasia fibromuscular.

We present the case of a 13 year-old patient diagnosed with fibromuscular dysplasia (FMD) by angiographic study, with "string of beads" image of internal carotid, after undergoing two ischemic strokes in nine days. Conservative treatment with acetylsalicylic acid at antiaggregant doses was decided. Twenty months later the clinical progress is favorable without presenting any new episodes. FMD is a very uncommon cause of stroke in childhood. Little is known about its etiology. In spite of it usually being an asymptomatic disease, it must be considered in cases of repeated or inexplicable strokes. Its prognosis and treatment is controversial, due to the limited number of pediatric patients with this pathology.

[Benign intracranial hypertension: experience over 18 years]. / Hipertensión intracraneal benigna. Experiencia en 18 años.

INTRODUCTION: There are transient intracranial hypertension cases, recognizable by bulging fontanelle in infants and by papilloedema in children. We present our experience in benign intracranial hypertension (BIH) cases, excluding traumatic brain injuries, encephalitis and meningitis. RESULTS: Among the entire neuropaediatric database, with 10,720 children in 18 years, 31 cases had the diagnosis of BIH. Sixteen aged between 2.3 and 8.9 months (75% males), all of them with transient bulging fontanelle, and 15 aged between 4.4 and 13.7 years (73.3% females), all of them with papilloedema which was subsequently resolved. A total of 75% of infants had recently finished corticosteroid treatment for bronchitis. In the older children, there was 1 case associated with excessive vitamin A intake and 1 mastoiditis. Transfontanelle ultrasonography or CT was performed on all infants and CT or MRI in every child. Lumbar puncture was also performed on 7 infants and on 13 children. Infants developed favourably in a few days, and children did so between 1 week and 5 months, some with treatment. DISCUSSION: BIH usually has a favourable outcome, although it may take longer in children than in infants, but it can have serious visual repercussions, even blindness, so ophthalmological control is necessary. It is normally diagnosed by exclusion of other intracranial hypertension causes. MRI and lumbar puncture must be done on all children or infants who do not progress favourably. Acetazolamide and furosemide, corticosteroids, repeated lumbar punctures and optic nerve sheath fenestration should be considered in those who do not progress well.

Comparative genomic hybridization of oocytes and first polar bodies from young donors.

Chromosome abnormalities are common in oocytes derived from patients undergoing IVF treatment. The proportion of oocytes displaying aneuploidy is closely related to maternal age and may exceed 60% in patients over 40 years old. However, little information currently exists concerning the incidence of such anomalies in oocytes derived from young fertile women. A total of 121 metaphase II oocytes and their corresponding first polar bodies (PB) were analysed with the use of a comprehensive cytogenetic method, comparative genomic hybridization (CGH). The oocytes were donated from 13 young women (average age 22 years) without any known fertility problems. All oocytes were mature at the time of retrieval and were unexposed to spermatozoa. A low aneuploidy rate (3%) was detected. These results clearly indicate that meiosis I segregation errors are not frequent in oocytes of young fertile women. The higher aneuploidy rates reported in embryos derived from donor oocytes could be due to aggressive hormonal stimulation, in combination with male factors. However a definite contributing factor remains to be elucidated. The data obtained during this study also illustrate that CGH accurately and efficiently detects aneuploidy, confirming that it is suitable for application in a clinical setting for the assessment of oocytes, via PB analysis.

Array comparative genomic hybridization in prenatal diagnosis: another experience.

OBJECTIVES: Etiologic diagnosis of multiple congenital abnormalities (MCAs) is often lacking. Large chromosome abnormalities can be detected by conventional cytogenetic methods, but more subtle chromosome micro-rearrangements and/or de novo abnormalities require multi-FISH analysis, which is hampered by the amount of material available in prenatal testing. METHODS: We used the comparative genomic hybridization (CGH) array, Genosensor Array 300, to screen for classic microdeletion syndromes and subtelomeric rearrangements in 39 consecutive fetuses with MCAs, after termination of pregnancy, in a prospective study. Thirty-seven of them had a normal karyotype, and two had a de novo unbalanced karyotype that could not be characterized with conventional cytogenetic methods. RESULTS: Two de novo unbalanced karyotypes were characterized by array CGH, and four additional abnormalities were diagnosed: an unbalanced inherited cryptic translocation, a deletion in band 22q11.2, a 1p36 deletion, and a 6p12.1-21.2 duplication. CONCLUSION: Chromosomal imbalances were therefore detected and/or characterized in 6 of 39 (15.4%) fetuses, indicating the value of routine array CGH in cases of MCAs and in uncharacterized chromosome rearrangements. Extension to all prenatal diagnoses may be warranted when copy number variation is identified and all FISH probes are commercially available.

Citomegalovirus congénito neonatal. Comunicación de un caso y revisión / Neonatal congenital cytomegalovirus. Case report and

El citomegalovirus congénito es la etiología más frecuente de infección congénita viral y la principal causa de deficiencia neurosensorial adquirida intraútero. La infección derivada de una primoinfección materna tiene consecuencias más graves que las recurrentes en cuanto a la tasa de transmisión vertical, gravedad del cuadro clínico y secuelas a largo plazo. Se comunica una nueva observación de citomegalovirus congénito neonatal, en la que el diagnóstico se sospechó ante la presencia de un retraso de crecimiento intrauterino armónico, con clínica neurológica y alteraciones neurorradiológicas características, y se revisan los principales aspectos clínicos y epidemiológicos de la afección (AU)

Title: Neonatal congenital cytomegalovirus. Case report and review Summary. Congenital cytomegalovirus is the most frequent congenital viral infection etiology and the main cause of acquired intrauterine neurosensorial failure. The infection derived from a maternal primo-infection has more serious consequences than the recurrent ones as regards to the vertical transmission rate, severity of the clinical case and long-term after effects. A new observation of neonatal congenital cytomegalovirus is reported, whose diagnosis was suspected before the presence of harmonic intrauterine growth retardation, similar to the neurological clinic and characteristic neuroradiologic alterations. The main clinical and epidemiologic aspects of the infection are reviewed (AU)

Open label, prospective, randomized controlled trial of an endoscopic duodenal-jejunal bypass sleeve versus low calorie diet for pre-operative weight loss in bariatric surgery.

BACKGROUND: The duodenal-jejunal bypass sleeve (DJBS) has been shown to achieve a completely endoscopic duodenal exclusion without the need for stapling. This report is the first randomized controlled trial for weight loss. METHODS: In a 12-week, prospective, randomized study, subjects received either a low fat diet and the DJBS or a low fat diet control (no device). Twenty-five patients were implanted with the device and 14 received the control. The groups were demographically similar. Both groups received counseling at baseline only, which consisted of a low calorie diet, and exercise/behavior modification advice. No additional counseling occurred in either group. Measurements included starting and monthly body weight and serum blood tests. The device group also had a plain abdominal film post implant, a monthly KUB and a 4-week post explant EGD. RESULTS: Twenty device (80%) subjects maintained the DJBS without a significant adverse event for the 12-week duration. At 12 weeks, the mean excess weight loss was 22% and 5% for the device and control groups, respectively (p < 0.001). Five subjects (20%) were endoscopically explanted early secondary to upper GI (UGI) bleeding (n = 3), anchor migration (n = 1) and sleeve obstruction (n = 1). The UGI bleeding occurred at a mean of 13.8 days post implant. EGD was performed in each of these cases with no distinct bleeding source identified. No blood transfusion was required. The migration occurred on day 47 and manifested as abdominal pain. The subject with the sleeve obstruction presented with abdominal pain and vomiting on day 30. Eight subjects (40%) underwent the 4 week post explant EGD at which time mild degrees of residual duodenal inflammation was noted. CONCLUSION: The DJBS achieves noninvasive duodenal exclusion and short term weight loss efficacy. Longer term randomized controlled sham trials for weight loss and treatment of T2DM are underway.

Gastrojejunal anastomotic stricture after Roux-en-Y gastric bypass: ambulatory management with the Savary-Gilliard dilator.

BACKGROUND: Roux-en-Y gastric bypass (RYGBP) is currently one of the most frequently performed procedures for the surgical treatment of morbid obesity. The success of this procedure's restrictive component requires a small gastrojejunostomy (GJ), which occasionally results in stenosis. The treatment of choice for this complication is balloon dilation. This study aimed to evaluate the feasibility and safety of ambulatory management for stenosis of the GJ using endoscopically guided Savary-Gilliard dilators. METHODS: Between January 1998 and October 2003, 769 patients underwent RYGBP. The mean age of these patients was 38 +/- 12 years, and their mean body mass index (BMI) was 43 +/- 6 kg/m2. Of these 769 patients, 520 (68%) underwent open surgery and 249 (32%) underwent laparoscopic RYGBP. Patients suspected of GJ stenosis were referred for upper gastrointestinal endoscopy. Those who presented with stenosis were managed endoscopically with Savary-Gilliard dilators. RESULTS: Stenosis at the GJ was confirmed in 53 patients (6.9%). A total of 71 dilations were performed for these patients, resulting in a mean of 1.3 dilations per patient. One dilation was needed for 41 patients (75.5%), two dilations for 9 patients (16.9%), three dilations for 3 patients (5.7%), and four dilations 1 patient (1.9%). The patients subjected to open RYGBP required a mean of 1.57 dilations, and those who had laparoscopic RYGBP required mean of 1.08 dilations. The mean time for the first dilation was 51 +/- 28 days after surgery (range, 20-178 days). All the dilations were performed in ambulatory settings. One patient (1.9%) was admitted after GJ dilation for pain. He was discharged without symptoms after 2 days with no need for invasive procedures. CONCLUSIONS: The management and treatment of GJ stenosis after RYGBP can be effectively accomplished in ambulatory settings using endoscopically guided Savary-Gilliard dilators, with good and safe results.