Correlation between imaging findings and hormonal markers at the onset of puberty in girls.

INTRODUCTION: This study aimed to determine the diagnostic performance of transabdominal pelvic ultrasonography and bone age in identifying the onset of puberty in girls at the Clínica Las Américas in Medellín, Colombia. METHODS: We included girls aged ≤11 years referred to our clinic between March 2016 and March 2019 for signs of puberty. We compared the findings on pelvic and breast ultrasonography and bone age versus the baseline measurement of luteinizing hormone (LH) in serum, used as the reference standard for identifying the onset of puberty. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios, analyzing subgroups of patients of different ages. RESULTS: We analyzed 43 patients. Ultrasound assessment of breast development had the highest sensitivity (94.1%) of all the imaging parameters evaluated, but its specificity was low. However, characteristics such as the length of the body of the uterus >3.0 cm and the presence of endometrial echoes were highly specific for identifying the onset of puberty, particularly in patients aged ≤8 years. CONCLUSION: Pelvic ultrasonography, ultrasonographic assessment of Tanner stage of breast development, and the evaluation of bone age are useful tools for the imaging confirmation of the onset of puberty. The results of this study support the use of these techniques in clinical practice in the workup for pubertal disorders in girls.

Correlación entre hallazgos de imagen y marcadores hormonales en el inicio de la pubertad femenina / Correlation between imaging findings and hormonal markers at the onset of puberty in girls

Introducción El objetivo del estudio fue determinar el desempeño diagnóstico de la ecografía pélvica transabdominal, la evaluación del desarrollo mamario por ecografía y la edad ósea en la identificación del inicio de la pubertad, en población pediátrica femenina de la Clínica Las Américas, Medellín, Colombia. Métodos Se incluyeron pacientes femeninas de 11 años o menos, remitidas entre marzo de 2016 y marzo de 2019 por la aparición de signos de inicio de la pubertad. Se usó como estándar de referencia para el diagnóstico de pubertad la medición basal de hormona luteinizante (LH) sérica, con la cual se comparó la ultrasonografía pélvica y mamaria, así como la edad ósea. Se realizaron cálculos de sensibilidad, especificidad, valores predictivos positivo y negativo (VPP y VPN), razones de verosimilitud (LR+y LR-) y análisis por subgrupos de edades. Se analizaron 43 pacientes. La evaluación ecográfica del desarrollo mamario demostró la sensibilidad más alta (94,1%) dentro de todos los parámetros de imagen evaluados, aunque con baja especificidad. No obstante, características como la longitud del cuerpo del útero mayor de 3,0cm y la presencia de eco endometrial fueron altamente específicas para la identificación del inicio de la pubertad, particularmente en pacientes de 8 años o menos. Conclusión La ecografía pélvica, la valoración ecográfica del Tanner mamario y la evaluación de la edad ósea son herramientas útiles para la confirmación por imagen del inicio de la pubertad. Los resultados de este estudio apoyan su utilización en la práctica clínica, en el abordaje de trastornos puberales en niñas. (AU)

Introduction This study aimed to determine the diagnostic performance of transabdominal pelvic ultrasonography and bone age in identifying the onset of puberty in girls at the Clínica Las Américas in Medellín, Colombia. Methods We included girls aged ≤ 11 years referred to our clinic between March 2016 and March 2019 for signs of puberty. We compared the findings on pelvic and breast ultrasonography and bone age versus the baseline measurement of luteinizing hormone (LH) in serum, used as the reference standard for identifying the onset of puberty. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios, analyzing subgroups of patients of different ages. Results We analyzed 43 patients. Ultrasound assessment of breast development had the highest sensitivity (94.1%) of all the imaging parameters evaluated, but its specificity was low. However, characteristics such as the length of the body of the uterus> 3.0cm and the presence of endometrial echoes were highly specific for identifying the onset of puberty, particularly in patients aged ≤ 8 years. Conclusion Pelvic ultrasonography, ultrasonographic assessment of Tanner stage of breast development, and the evaluation of bone age are useful tools for the imaging confirmation of the onset of puberty. The results of this study support the use of these techniques in clinical practice in the workup for pubertal disorders in girls. (AU)

Correlation between imaging findings and hormonal markers at the onset of puberty in girls. / Correlación entre hallazgos de imagen y marcadores hormonales en el inicio de la pubertad femenina.

INTRODUCTION: This study aimed to determine the diagnostic performance of transabdominal pelvic ultrasonography and bone age in identifying the onset of puberty in girls at the Clínica Las Américas in Medellín, Colombia. METHODS: We included girls aged ≤ 11 years referred to our clinic between March 2016 and March 2019 for signs of puberty. We compared the findings on pelvic and breast ultrasonography and bone age versus the baseline measurement of luteinizing hormone (LH) in serum, used as the reference standard for identifying the onset of puberty. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios, analyzing subgroups of patients of different ages. RESULTS: We analyzed 43 patients. Ultrasound assessment of breast development had the highest sensitivity (94.1%) of all the imaging parameters evaluated, but its specificity was low. However, characteristics such as the length of the body of the uterus> 3.0cm and the presence of endometrial echoes were highly specific for identifying the onset of puberty, particularly in patients aged ≤ 8 years. CONCLUSION: Pelvic ultrasonography, ultrasonographic assessment of Tanner stage of breast development, and the evaluation of bone age are useful tools for the imaging confirmation of the onset of puberty. The results of this study support the use of these techniques in clinical practice in the workup for pubertal disorders in girls.

Fentanyl vapor self-administration model in mice to study opioid addiction.

Intravenous drug self-administration is considered the "gold standard" model to investigate the neurobiology of drug addiction in rodents. However, its use in mice is limited by frequent complications of intravenous catheterization. Given the many advantages of using mice in biomedical research, we developed a noninvasive mouse model of opioid self-administration using vaporized fentanyl. Mice readily self-administered fentanyl vapor, titrated their drug intake, and exhibited addiction-like behaviors, including escalation of drug intake, somatic signs of withdrawal, drug intake despite punishment, and reinstatement of drug seeking. Electrophysiological recordings from ventral tegmental area dopamine neurons showed a lower amplitude of GABAB receptor-dependent currents during protracted abstinence from fentanyl vapor self-administration. This mouse model of fentanyl self-administration recapitulates key features of opioid addiction, overcomes limitations of the intravenous model, and allows investigation of the neurobiology of opioid addiction in unprecedented ways.

Unnecessary overuse. Study of "inadvisable practices" for patients with atrial fibrillation. / Sobreutilización innecesaria. Estudio de los «no hacer¼ en pacientes con fibrilación auricular.

OBJECTIVE: To identify overuse (diagnostic, therapeutic and self-care practices that represent risks that outweigh the potential benefits) in patients with atrial fibrillation. METHOD: The study was based on qualitative research techniques. Using the "Metaplan" technique, we identified and ordered potentially inappropriate, ineffective and inefficient practices. By means of a consensus conference, we then established a number of "inadvisable practice" measures (relatively common practices that should be eliminated based on the scientific evidence or clinical experience). Professionals from the specialties of cardiology, haematology, neurology, internal medicine, family medicine and nursing participated in the consensus. RESULTS: We developed a catalogue of 19 "inadvisable practices" related to the diagnosis, treatment and care of anticoagulated patients that were inappropriate, had questionable effectiveness or were ineffective, as well as 13 beliefs or behaviours for anticoagulated patients that could result in injury or were useless or inefficient. CONCLUSION: The "inadvisable practices" approach helps identify practices that represent greater risks than benefits for patients. It seems appropriate to include algorithms in the clinical decision-making support systems that consider this information for the diagnosis, treatment and for home care. For this last case, recommendations have also been prepared that define specific contents for the healthcare education of these patients.

Analysis of the interaction between transcription factor 7-like 2 genetic variants with nopal and wholegrain fibre intake: effects on anthropometric and metabolic characteristics in type 2 diabetes patients.

The transcription factor 7-like 2 (TCF7L2) genetic variants have shown differential effect on low-fat and high-fat diet in obese subjects. Nopal is a Mexican variety of cactus that is a traditional food and has been used in the treatment of diabetes. Its hypoglycaemic effect may be because of its soluble fibre (mucopolysaccharide) content. This study analysed the effects of the rs7903146 and rs12255372 TCF7L2 variants on anthropometric, metabolic and hormonal parameters in type 2 diabetes mellitus patients who consumed fibre from either nopal tortilla or wholegrain bread for 8 weeks. We followed-up seventy-four patients who consumed an individualised isoenergetic diet that included nopal tortilla (Diet 1) and sixty-three patients with a diet that included wholegrain bread (Diet 2). Anthropometric, metabolic and hormonal measures were collected at baseline and final intervention. The size effect and carry-over effect were estimated. To assess the interaction of genotype and diets, we used a general linear model repeated-measures analysis. Minor allele frequency of rs7903146T was 0·27 and for rs12255372T it was 0·13. At 8 weeks after Diet 1 intake, weight, BMI, waist and hip circumference decreased (P=0·00015) in rs7903146CC and rs12255372GG genotypes. In particular, patients carrying of the rs7903146CC and consuming Diet 1 showed a reduction in waist circumference of more than 2·5 cm compared with Diet 2 (P<0·001). No significant interaction between rs7903146 or rs12255372 and diet was seen in this study. In conclusion, in the carriers of the rs7903146CC and rs12255372GG wild types, significant changes in all anthropometric measures were observed, and had better response to both diets.

Diagnóstico de tuberculosis bovina por aislamiento bacteriológico o histopatológico de vacunos reactores a la prueba de tuberculina / Diagnosis of bovine tuberculosis by bacteriological or histopathological isolation of bovine reactors to the tuberculin test

La tuberculosis bovina es una enfermedad causada por una bacteria llamada Mycobacterium bovis, pertenece al grupo de las enfermedades zoonóticas, es cosmopolita, afecta a los animales domésticos mayormente de explotación pecuaria: especialmente a bovinos, caprinos, alpacas y porcinos: produce detrimentos considerables tanto en animales como en salud pública; el hombre se contamina por ingestión o inhalación. Esta enfermedad tiene un impacto directo en la eficiencia de los sistemas productivos y en la industria del sector pecuario, ello porque provoca importantes pérdidas en la producción de carne, leche y sus derivados, igualmente es una restricción muy severa en el comercio internacional tanto de animales como de productos y subproductos de origen pecuario. La finalidad de este trabajo es mostrar opciones de diagnóstico de laboratorio, pasando de un primer período de diagnóstico histopatológico, al aislamiento (gold standard), permitiendo de esta manera un soporte en la toma de decisiones y acciones en el control y erradicación de la Tuberculosis Bovina. Este estudio vincula los resultados del trabajo de tesis intitulada “Estudio Histopatológico de Ganglios Linfáticos de Vacunos Positivos a la Prueba de Tuberculina, procesados en laboratorio de SENASA, Lima, procedentes de las Regiones de Piura, Lambayeque, La Libertad y Lima (1997-2003)” a los resultados obtenidos del procesamiento de las muestras remitidas al mismo laboratorio en el período 2007-2008 para el descarte de Tuberculosis bovina. En la primera parte se determinó que 13 muestras, histológicamente presentaban lesiones compatibles con Tuberculosis bovina; y en la segunda etapa se logró el aislamiento del Mycobacterium bovis en 19 muestras remitidas.

[Electrophoresis of cerebrospinal fluid proteins in patients with ischemic cerebrovascular disease]. / Electroforesis de proteínas del líquido cefalorraquídeo en pacientes con enfermedad cerebrovascular isquémica.

INTRODUCTION: Cerebral infarction (CI) increases vascular permeability because of a torrent of molecular events that take place. It frequently leads to oedema, haemorrhage and neuronal death. Free radicals and proteases are also formed, which cause lesions in the blood vessels, and microvascular integrity is lost through degradation of the basal lamina and the extracellular matrix. As a result rupture of the blood brain barrier takes place. AIMS. To compare the electrophoretograms of patients with ischemic cerebrovascular disease (ICVD) with those of controls and to link the alterations in the proteinogram with the ICVD subtypes. PATIENTS AND METHODS: The CSF of 55 controls and 136 patients with ICVD was examined. The total protein (TP) concentration was determined and a polyacrylamide gel electrophoretogram was produced using Coomassie blue stain. Parallel to this, serum was prepared for haptoglobin staining. RESULTS: The TP in patients CSF rose to a significantly higher level than that of controls. Blood brain barrier damage (BBBD) was observed in 28.7% of the patients studied with CI and in 10.3% in transient ischemic attacks (TIA), while 16.2% presented oligoclonal bands. There was a difference between the two sexes: men were found to have higher TP levels, lower percentages of prealbumin 1 and more BBBD than women. CONCLUSIONS: BBBD is more frequent in infarctions than in TIA, and is predominant in men with thrombotic cerebral infarction.

Electroforesis de proteínas del líquido cefalorraquídeo en pacientes con enfermedad cerebrovascular isquémica / Electrophoresis of cerebrospinal fluid proteins in patients with ischemic cerebrovascular disease

Introducción. El infarto cerebral (IC) aumenta la permeabilidad vascular al ocurrir toda una cascada de eventos moleculares, y aparece con frecuencia edema, hemorragia y muerte neuronal. También ocurre la formación de radicales libres y proteasas que causan lesiones a los vasos sanguíneos, y se pierde la integridad microvascular por degradación de la lámina basal y la matriz extracelular; todo esto conduce a la ruptura de la barrera hematoencefálica. Objetivos. Comparar el electroforetograma de pacientes con enfermedad cerebrovascular isquémica (ECVI) con los controles y asociar las alteraciones del proteinograma con los subtipos de ECVI. Pacientes y métodos. Se estudió el LCR de 55 controles y 136 pacientes con ECVI. Se determinó la concentración de proteínas totales (PT) y el electroforetograma en geles de disco de poliacrilamida con tinción de Coomassie; el suero se procesó en paralelo para tinción de haptoglobinas. Resultados. Las PT en el LCR de los pacientes se elevaron significativamente más que en los controles. El daño de barrera hematoencefálica (DBHE) se observó en el 28,7 por ciento de los pacientes estudiados con IC y en el 10,3 por ciento en los ataques isquémicos transitorios, mientras que el 16,2 por ciento presentaron bandas oligoclonales. Hubo diferencia entre ambos sexos: los hombres tuvieron los niveles de PT elevados, menor porcentaje de prealbúmina-1 y más DBHE que las mujeres. Conclusión. El DBHE es más frecuente en los infartos que en los AIT, y predominan en los hombres con infarto cerebral trombótico (AU)

Effectiveness of screening instruments in detecting substance use disorders among prisoners.

This study examined the effectiveness of several screening instruments in detecting substance use disorders among prison inmates. A sample of 400 male inmates were administered eight different substance abuse screening instruments and the Structured Clinical Interview for DSM-IV (SCID-IV), Version 2.0, Substance Abuse Disorders module. The latter was used as a diagnostic criterion measure to determine the presence of substance use disorders. Based on positive predictive value, sensitivity, and overall accuracy, the Texas Christian University Drug Screen, the Simple Screening Instrument, and a combined instrument-Alcohol Dependence Scale/Addiction Severity Index-Drug Use section were found to be the most effective in identifying substance abuse and dependence disorders.

Prevalence of DSM-IV substance abuse and dependence disorders among prison inmates.

The study examined the 30-day and lifetime prevalence of DSM-IV alcohol and drug disorders among state prison inmates. A sample of 400 inmates consecutively admitted to a state prison reception center were assessed for alcohol and drug disorders using the Structured Clinical Interview for DSM-IV (SCID-IV). Test-retest reliabilities were calculated for the SCID-IV. Lifetime substance abuse or dependence disorders were detected among 74% of inmates, including over half who were dependent on alcohol or drugs. For the 30 days prior to incarceration, over half of the sample were diagnosed as having substance abuse or dependence disorders, including 46% who were dependent on alcohol or drugs. Black inmates were significantly less likely to be diagnosed as alcohol dependent than whites or Hispanics. The high rates of substance use disorders are consistent with previous findings from other studies conducted in correctional settings and reflect the need to expand treatment capacity in prisons.