Stroke incidence and risk factors in Havana and Matanzas, Cuba.

INTRODUCTION: Cerebrovascular disease is the third-leading cause of death and the second-leading cause of disability and dementia. OBJECTIVE: Determine stroke incidence and risk factors in a population of adults aged 65 and over in Cuba (Havana and Matanzas). MATERIAL AND METHODS: This prospective longitudinal study, completed between April 2008 and Abril 2011, re-evaluated 2916 elderly adults with an average follow-up time of 4 years. Cases included 2316 living subjects and 600 verbal autopsies. Study variables were age, sex, educational level, self-reported health, and description of chronic diseases and substance abuse. Laboratory tests included genotyping APOE. Stroke was diagnosed based on the World Health Organization definition. We calculated the global incidence rate for stroke, broken down by sex, age group, and risk factors for incident stroke. RESULTS: Stroke incidence was 786.2 in 100000 persons/year (95% CI: 672.3-906.4). History of alcohol consumption (HR: 3.5; 95% CI: 3.3-3.7), dementia (HR: 3.0; 95% CI, 1.6-5.5) and male sex (HR: 1.8; 95% CI, 1.2-2.8) were shown to be risk factors for incident stroke. CONCLUSIONS: Stroke incidence was similar to rates reported in developed countries and lower than that in low- to middle-income countries. Given that diabetes mellitus, heart disease, arterial hypertension, smoking, APOE4, etc. are associated with higher mortality rates, they will require separate analysis in a study of stroke risk factors.

Removal of chlorothalonil, methyl parathion and methamidophos from water by the Fenton reaction.

The efficiency of a dark Fenton system (H2O2/Fe2+) to remove chlorothalonil from water, alone and in the presence of the organophosphorous pesticides methyl parathion and methamidophos, was evaluated. Here we show that the process is rapid and efficient. Nearly complete degradation of chlorothalonil and methyl parathion (98%) was observed in less than 10 min whereas methamidophos showed similar levels of efficiency only after 40 to 90 min. Formulating agents did not appear to impair the degradation of active ingredients. Interactions during the degradation of mixtures of the three pesticides only appeared to affect methamidophos degradation.

[Sib-sib correlations of cardiovascular risk factors: the Cuenca study]. / Agregación entre hermanos de factores de riesgo cardiovascular: estudio de Cuenca.

UNLABELLED: To analyze the sib-sib correlation of the cardiovascular risk factors. SUBJECTS AND METHOD: A cross-sectional study was made in 115 sibling pairs. Sociodemographic variables, weight, height, body mass index, systolic blood pressure, diastolic blood pressure and fasting plasma total cholesterol, LDL-C, HDL-C, apo A-I, apo B and Lp(a) concentrations. Partial correlation coefficients adjusted for age and body mass index for plasmatic lipid and lipoprotein levels in sibling pairs showed positive values range from 0.27 for triglyceride to 0.53 for apo B/apo A-I ratio (p < 0.005). Likewise, the intraclass correlation coefficients ranged from 0.20 to 0.48. Both coefficient were higher in brother-brother pairs than in sister-sister pairs. The Quetelet index coefficients were slightly lower than lipid coefficients, and showed similar values among the different kinds of sibling pairs. Blood pressure coefficients were low (p > 0.05). CONCLUSIONS: An association for lipid and lipoprotein plasma concentrations has been evidenced in sibling pairs. This association is stronger in brother-brother pairs than in sister-sister pairs. This fact could indicate a sex linked heredability of lipid and lipoprotein levels. A weaker association for body mass index has been observed. Sib-sib aggregation of blood pressure levels is not significant.

Molecular basis of androgen resistance in a family with a qualitative abnormality of the androgen receptor and responsive to high-dose androgen therapy.

We have examined the nature of the mutant androgen receptor in a family with a severe defect in virilization associated with a qualitative defect in receptor function. The androgen receptor gene in this family contains two structural alterations: a single nucleotide substitution at position 2444 in exon 5 (adenosine----guanosine) that converts tyrosine 761 to a cysteine residue and a shortened glutamine homopolymeric segment in exon 1 that encodes 12 rather than the usual 20-22 glutamines. A family study was performed using polymerase chain reaction amplification of the glutamine-rich segment, and it was shown that the sister of the proband does not carry the mutant allele. The effects of these two mutations on the function of the androgen receptor were studied by introducing the changes, individually and in combination, into cDNAs encoding the normal human androgen receptor and analyzing the receptor protein produced after transfection of the cDNAs into eukaryotic cells. The presence of a cysteine residue at position 761 causes rapid dissociation of dihydrotestosterone from the receptor protein. Marked thermolability of the transfected receptor protein, however, was demonstrable only upon introduction of an androgen receptor cDNA containing both the partial deletion of the glutamine homopolymeric segment and a cysteine residue at position 761. Likewise, the ability of the receptor to stimulate a reporter gene is strikingly diminished only when both alterations are present, suggesting that the shortened glutamine homopolymeric segment amplifies the impairment of receptor function caused by the tyrosine to cysteine substitution.

Androgen resistance associated with a qualitative abnormality of the androgen receptor and responsive to high dose androgen therapy.

A 46,XY infant with perineoscrotal hypospadias and microphallus was identified in a family in which seven individuals have severe hypospadias that is inherited in a pattern compatible with an X-linked defect. The infant had small testes that were palpable in the labioscrotal folds, the proximal urethra was male in character, and there was no vagina. Serum testosterone rose from 0.5 to 5.1 nmol/L in response to hCG, and there was a negligible clinical response to a short term course of testosterone enanthate. A clinical diagnosis of male pseudohermaphroditism due to androgen resistance was made. Studies in cultured genital skin fibroblasts disclosed normal 5 alpha-reductase activity, a normal amount of high affinity dihydrotestosterone binding, and normal up-regulation of androgen receptors when monolayers were incubated with dihydrotestosterone or mibolerone. Fibroblast cytosol preparations contained a normal 7-8S sedimenting peak of androgen binding. However, androgen binding in monolayers decreased 60% when the assay temperature was raised from 30 to 41 C, and the dissociation rate of ligand from the receptor was enhanced 5-fold compared to the control value, establishing the diagnosis of androgen resistance due to a qualitative abnormality of the androgen receptor. Because of parental decision to raise the patient as a male, he was given two courses of high dose testosterone cypionate when he was 2.5 and 3.5 yr old (100 mg every 2 weeks for six doses). This treatment produced significant phallic growth, making it possible to undertake surgical correction of the hypospadias. We postulate that the impairment of androgen receptor function was overcome in part by the large dose of androgen.