Stroke in young adults: Incidence rate, risk factors, treatment and prognosis. / Ictus en adultos jóvenes: incidencia, factores de riesgo, tratamiento y pronóstico.

OBJECTIVES: To analyse the incidence, risk factors, aetiology, treatment and clinical evolution of young patients with stroke. PATIENTS AND METHODS: Retrospective registry of patients aged 55 years or younger hospitalised in a stroke unit during 2014. We recorded the incidence rate for all strokes and analysed demographic data, risk factors, degree of stress, stroke type and aetiology, reperfusion treatments and clinical evolution. RESULTS: The study included 110 patients, the majority of whom were men (60.9%, 1.6:1 ratio). The incidence rate was 13.3% (110 of 830 strokes). Most of the patients had cardiovascular risk factors. Smoking was the most common risk factor (56.4%), followed by arterial hypertension (50%), dyslipidaemia (42.7%), obesity (33%), diabetes (18.2%) and emboligenic heart disease (12.7%). Some 64.3% of the heart disease cases and 51.1% of the dyslipidaemia cases were discovered during hospitalisation. Some 57.2% of the patients experienced psychosocial stress in the stage prior to the stroke. Some 83.6% of the stroke cases were ischaemic, 12.7% were haemorrhagic and 3.6% were venous sinus thrombosis. Of the ischaemic stroke cases, 30.4% were cryptogenic, 23.9% were lacunar, 16.3% were from uncommon causes, 15.2% were atherothrombotic and 14.1% were cardioembolic. Some 78.6% of the cerebral haemorrhage cases were hypertensive. Some 23.3% of the ischaemic stroke cases underwent reperfusion treatments in the acute phase, achieving levels of functional independence at 3 months of 62.5%. CONCLUSIONS: The majority of stroke events in patients 55 years of age or younger appear to be related to a high prevalence of classical cardiovascular risk factors and possibly to psychosocial stress.

La influencia de la desigualdad en la desnutrición de América Latina: una perspectiva desde la economía / The influence of inequality on undernutrition in Latin America: an economic perspective

En América Latina existe una gran desigualdad social y una gran polarización, que obviamente tienen un efecto en la desnutrición de la región. Consecuencia de una gran desigualdad es la pobreza, que es a su vez una de las causas fundamentales de inseguridad alimentaria. Este artículo trata la conexión entre desigualdad en la desnutrición de la región, haciendo hincapié en los aspectos económicos de la desigualdad social, las oportunidades de empleo y las de educación. La desigualdad social es un problema heredado del colonialismo, por lo que sería conveniente acometer medidas de tipo estructural, de tal forma que los más desfavorecidos que así lo necesiten puedan beneficiarse de oportunidades de educación y oportunidades laborales (AU)

In Latin America there is a significant social inequality and polarization, which obviously has an effect on the undernutrition in the region. The poverty, which is normally a consequence of inequality, is also one of the main causes of food insecurity. This paper deals with the connection between undernutrition inequality, the job and the education opportunities. The social inequality is a problem from the colonialism, therefore it would be convenient to undertake structural policies, so that the most deprived could benefit of education and labour opportunities (AU)

[Hypotonia and lethargy: initial manifestations of a new case of galactosemia]. / Hipotonía y letargia: manifestaciones iniciales de un nuevo caso de galactosemia.

INTRODUCTION: Galactosemia is a metabolic disease that is transmitted by autosomal recessive inheritance in which there is an enzymatic deficit that prevents the metabolism of galactose. Three enzymes could be involved, but the lack of galactose-1-phosphate uridyltransferase (GALT) is the most frequent. Incidence is two cases per 100,000 newborn infants. As a consequence of this enzymatic deficit, on ingesting milk the newborn infant will present a progressive neurological deterioration, cataracts and digestive tract and kidney disorders. An early diagnosis is essential so that galactose can be withdrawn from the diet as soon as possible, which in the newborn infant means discontinuing mother's milk and feeding with galactose-free milk. CASE REPORT: We report the case of a newborn female, the daughter of consanguineous parents (second cousins) from the gypsy ethnic group, who was diagnosed as suffering from galactosemia with a total GALT deficit. The patient was given normal milk for the first 10 days of her life and presented hypotonia, lethargy, jaundice, hepatomegaly, refusal to eat, low weight gain and a urinary infection caused by gram negative bacteria. Following diagnosis, galactose was withdrawn from the diet (she was given soy milk) and the physical exploration became progressively more normal. CONCLUSIONS: This is an extremely unusual pathology, but the patient's outcome is largely dependent on an early diagnosis and treatment.

Plasma concentrations of beta-endorphin and adrenocorticotropic hormone in women with and without childbirth preparation.

We studied plasma concentrations of beta-endorphin (beta-EP) and adrenocorticotropic hormone (ACTH) during dilation, expulsion and immediate puerperium in 47 primiparous women with an uneventful pregnancy and spontaneous vaginal delivery. Twenty-five women had received childbirth preparation with the Lamaze method, and 22 had received no preparation. Mean concentrations of beta-EP from the beginning of labor until puerperium were higher in women who had received preparation, but there was no significant difference between the two groups. When behavior during labor was evaluated regardless of which group the patient was assigned to, women whose behavior was unsatisfactory has significantly higher concentrations of ACTH at all times during childbirth. We discuss the role of childbirth preparation as a way to enhance beta-EP secretion. Levels of ACTH, on the other hand, appear to be more closely related with behavior during labor, regardless of whether the mother received preparation.

Constitutive secretion of interleukin-6 by human decidual stromal cells in culture. Regulatory effect of progesterone.

PROBLEM: Although several studies have demonstrated that decidual stromal cells (DSC) can secrete cytokines in culture, none of these studies documented the purity of the cultures. Since other cells of the decidua, such as macrophages and epithelial cells, also produce cytokines, it is important to ensure purity of the culture so that cytokine production can be ascribed with confidence to DSC. METHOD: DSC from early human pregnancies were highly purified and maintained in culture. Basal secretion by these cells of IL-6, together with other cytokines considered critical for pregnancy (IL-1 beta, TNF alpha and IFN gamma), was measured with immunological techniques. RESULTS: We found that DSC in culture produce insignificant quantities of IL-1 beta, TNF alpha and IFN gamma, but appreciable amounts of IL-6. The production of this later cytokine was, however, inhibited by the effect of progesterone. CONCLUSIONS: Basal production of IL-6 by DSC may be involved in physiological functions at the maternal-fetal interface. Nevertheless, the secretion of this cytokine is regulated by progesterone, probably to prevent excessive production of this cytokine from triggering an inflammatory response that might compromise pregnancy.

Prenatal sonographic appearance of foramina parietalia permagna.

Foramina parietalia permagna (FPP) is an extremely uncommon congenital defect, inherited as an autosomal dominant condition. Its characteristics are two symmetrical orifices in the parietal bones (not of fixed size) on both sides of the midline. This defect does not affect either the psychic or the physical development of the affected person. This paper describes the sonographic appearance of FPP in utero as an enlargement of the posterior fontanelle.

Plasma levels of beta-endorphin and ACTH during labor and immediate puerperium.

We measured concentrations of beta-endorphin (beta-EP) and adrenocorticotropic hormone (ACTH) in maternal peripheral plasma during dilation, the expulsive period and immediate puerperium, and in the umbilical vein. Plasma levels of both peptides increased markedly and were directly correlated during labor, and decreased 24 h after birth; they were no longer correlated during immediate puerperium. In the umbilical vein, beta-EP and ACTH were also directly correlated. Moreover, the concentration of each of the two peptides in maternal plasma during the expulsive period was correlated with the corresponding concentration in umbilical vein. We discuss the importance of placental corticotropin-releasing factor in the regulation of maternal and fetal stress.

Progestin challenge test in postmenopausal patients.

OBJECTIVES: The purpose of this study is to analyze the characteristics of patients identified with the progestin test. METHODS: We administered the progestin challenge test to 157 postmenopausal women and compared the characteristics of the patients who bled, with those who did not. RESULTS: Bleeding occurred in 14.01% of cases and we found that the number of patients who bled were significantly and independently more overweight, had higher levels of plasma estradiol, had a clear presence of superficial cells in the vaginal epithelium and had been menopausal for fewer years than those who did not bleed. CONCLUSIONS: We concluded that the test identifies women at risk from hormone-related endometrial cancer.

Alobar holoprosencephalic embryo detected via transvaginal sonography.

The incorporation of high-frequency transvaginal probes in commercial ultrasonic equipment allows now for the earlier detection of fetal malformations and the possibility of interrupting pregnancy when such an anomaly is incompatible with postnatal life. We describe here a case of alobar holoprosencephaly associated with serious facial anomalies, diagnosed via transvaginal sonography during the 10th week of amenorrhea. A cytogenetic study was carried out by transabdominal chorial biopsy and diagnostic confirmation by necropsy was made after termination. In order to be able to counsel patients on the advisability of future pregnancies we stress the importance of making a cytogenetic study of the embryo.

[Prenatal diagnosis of holoprosencephaly with postaxial polydactyly, cardiopathy with normal karyotype]. / Pränatale Diagnostik der Holoprosenzephalie mit postaxialer Polydaktylie, Kardiopathie bei normalem Karyotypus.

Holoprosencephaly is a malformation complex, in which the foetal forebrain (prosencephalon) fails to cleave. The aetiology of holoprosencephaly is heterogeneous. In the last years, a new malformation syndrome has been described, including holoprosencephaly, postaxial polydactyly, congenital heart defects and normal karyotype. In this report, a new case of this syndrome, prenatally diagnosed, is discussed, based on ultrasound and foetal blood sampling. The important implications are pointed out in relation to adequate genetic counselling.

Prenatal ultrasound semiography of anencephaly: sonographic-pathological correlations.

A better understanding of the ultrasound findings in each of the different types of fetal anencephaly can help to reduce the number of false-negative diagnoses of this condition during the prenatal period. Errors in the estimation of the remaining cerebral tissue (angiomatous stroma, area cerebrovasculosa) can cause false-negative diagnoses or diagnostic confusion with cases of microcephaly or incomplete ossification of the cranial vault. In a retrospective study, 30 fetuses with anencephaly (diagnosed at 13-38 weeks of gestation) were grouped, in terms of their ultrasound results, according to the Nanagas classification. The ultrasound diagnoses were then correlated with those found through autopsy, to identify any errors in the ultrasound classification.

Short-lived suppressor cell activity during normal human pregnancy.

Short-lived suppressor cell (SLSC) activity was determined in normal pregnant women. This activity was significantly increased in all three trimesters of pregnancy and during the first week postpartum. When pregnant women were divided into primiparous and multiparous groups, no significant differences were found between the two groups in any of the periods studied. These results suggest that increased SLSC activity may play a role in the materno-fetal tolerance and that parity has no influence on this activity.

Decreased levels of circulating CD4+ T lymphocytes during normal human pregnancy.

Peripheral blood mononuclear cell (PBMC) populations during human pregnancy have been investigated by many authors, although the different results obtained, principally in relation to T cells, are very discrepant. In this study we aimed to exclude all the possible causes of these discrepancies: small sample size; diurnal rhythm of CD4+ T cells; smoking habits; haemodilution which occurs during pregnancy and inappropriate statistical analysis; in order to determine whether gestation has a definite effect on PBMC populations. We found that the percentage of CD4+ T lymphocytes decreases in the first and second trimesters, returns to the non-pregnant level in the third trimester and remains there in the postpartum period. The percentages of CD3+ T lymphocytes run parallel to those of CD4+ while CD8+ T lymphocytes do not vary. The proportion of CD16+ cells, which include mature NK cells, diminishes in the second trimester and this reduction is maintained in the third trimester and the puerperium. No variation was found in the other PBMC studied (CD20+ lymphocytes, CD14+ monocytes and D/DR+ cells). When parity was considered no difference was seen between primiparous and multiparous women in any of the cell populations tested.

Ultrastructure of the oviductal mucosa of the rat. III. Basal and peg cells.

In an E.M. analysis of the rat oviduct the authors report the morphology of the so-called indifferent basal cells and peg cells. The hallmark of the former are desmosomes and clear cytoplasm; these elements may detach themselves from the basal membrane, migrating towards the lumen and showing prominent ciliogenesis. Peg cells appear to be the morphological image of necrobiotic cells, either ciliatd or secretory.

[Electronmicroscopical aspects of endometrial distrophy induced by oral contraceptives (author's transl)]. / Aspectos electromicroscópicos de la distrofia endometrial producida por anticonceptivos orales

An electron-optical study on the endometrium of 5 controls and 25 patients subjected during 3-12 months to 0.25 mg norgestrel + 0.05 mg etinil-estradiol association treatment is performed. The most prominent electronmicroscopical features of endometrial changes are described, such as the asynchronical maturation of the epithelium and the stroma, the shorthening of the proliferative and secretory phases and the epithelial involution towards the last days of the cycle. Special emphasis is placed on the zonal distribution of these changes. An increase of the nostocitosis phenomena is reported and its significance as a complementary contraceptive mechanism is discussed.

PIP: The results of electron microscope studies on the endometrium of 30 women are reported. 25 took a dose of .25 mg norgestrel and .05 mg ethinyl estradiol as an oral contraceptive for a minimum of 3 months and a maximum of 12; the other 5 served as controls. Examinations were made on the 5th, 10th, 19th, and 25th days of the cycle. The authors intended to establish the electron microscopic basis of changes in the endometrium occurring as a result of taking oral contraceptives, to discuss the findings of others in light of their results, and to discuss the possible role of endometrial modifications on the contraceptive effe ct of the drugs. The most prominent endometrial changes are described, such as the asynchronal maturation of the epithelium and the stroma, the shortening of the proliferative and secretory phases and the epithelial involution toward the last days of the cycle. Special emphasis is placed on the zonal distribution of these changes. An increase in the nostocitosis phenomena is reported and its significance as a complementary contraceptive mechanism discussed.