Association of tyrosine hydroxylase 01 (TH01) microsatellite and insulin gene (INS) variable number of tandem repeat (VNTR) with type 2 diabetes and fasting insulin secretion in Mexican population.

PURPOSE: A variable number of tandem repeats (VNTR) in the insulin gene (INS) control region may be involved in type 2 diabetes (T2D). The TH01 microsatellite is near INS and may regulate it. We investigated whether the TH01 microsatellite and INS VNTR, assessed via the surrogate marker single nucleotide polymorphism rs689, are associated with T2D and serum insulin levels in a Mexican population. METHODS: We analyzed a main case-control study (n = 1986) that used univariate and multivariate logistic regression models to calculate the risk conferred by TH01 and rs689 loci for T2D development; rs689 results were replicated in other case-control (n = 1188) and cross-sectional (n = 1914) studies. RESULTS: TH01 alleles 6, 8, 9, and 9.3 and allele A of rs689 were independently associated with T2D, with differences between sex and age at diagnosis. TH01 alleles with ≥ 8 repeats conferred an increased risk for T2D in males compared with ≤ 7 repeats (odds ratio, ≥ 1.46; 95% confidence interval, 1.1-1.95). In females, larger alleles conferred a 1.5-fold higher risk for T2D when diagnosed ≥ 46 years but conferred protection when diagnosed ≤ 45 years. Similarly, rs689 allele A was associated with T2D in these groups. In males, larger TH01 alleles and the rs689 A allele were associated with a significant decrease in median fasting plasma insulin concentration with age in T2D cases; the reverse occurred in controls. CONCLUSION: Larger TH01 alleles and rs689 A allele may potentiate insulin synthesis in males without T2D, a process disabled in those with T2D.

Efficacy of cement restrictors: Experimental study and development of a classification. / Eficacia de los restrictores de cemento: estudio experimental y desarrollo de una clasificación.

INTRODUCTION: Cement restrictors (CRs) are devices that allow occlusion of the femoral canal in order to obtain greater interdigitation of the cement between the bone and a better pressurization, which generates an increase in the survival of cemented stems. The aim of this study was to evaluate the efficacy of the different CRs used and propose a classification of this device. MATERIALS AND METHODS: An experimental study was carried out, where 7 CR references of different designs and manufacturers were taken. Later, tests were carried out on 9 chlorinated polyvinyl chloride tubes for each reference, to achieve a total of 63 tests. RESULTS: In our study, 34.9% of the CRs in ultra high molecular weight polyethylene failed, presenting migration and allowing cement to leak while none of the gelatin RC failed. CONCLUSION: The RC with an umbrella design proved to be the less effective, presented a higher incidence of migration and cement leakage, while the gelatin CRs were the best performers. Based on the results of this study, an analysis of the CR design was carried out and a classification was proposed that divides these devices into 2 types.

Efficacy of cement restrictors: Experimental study and development of a classification / Eficacia de los restrictores de cemento: estudio experimental y desarrollo de una clasificación

Introduction: Cement restrictors (CRs) are devices that allow occlusion of the femoral canal in order to obtain greater interdigitation of the cement between the bone and a better pressurization, which generates an increase in the survival of cemented stems. The aim of this study was to evaluate the efficacy of the different CRs used and propose a classification of this device. Materials and methods: An experimental study was carried out, where 7 CR references of different designs and manufacturers were taken. Later, tests were carried out on 9 chlorinated polyvinyl chloride tubes for each reference, to achieve a total of 63 tests. Results: In our study, 34.9% of the CRs in ultra high molecular weight polyethylene failed, presenting migration and allowing cement to leak while none of the gelatin RC failed. Conclusion: The RC with an umbrella design proved to be the less effective, presented a higher incidence of migration and cement leakage, while the gelatin CRs were the best performers. Based on the results of this study, an analysis of the CR design was carried out and a classification was proposed that divides these devices into 2 types.(AU)

Introducción: Los restrictores de cemento (RC) son dispositivos que permiten la oclusión del canal femoral con el fin de obtener una mayor interdigitación del cemento en el hueso y una mejor presurización, lo que genera un incremento en la supervivencia de los vástagos cementados. El objetivo de este estudio fue evaluar la eficacia de los diferentes RC utilizados y proponer una clasificación de este dispositivo. Materiales y métodos: Se realizó un estudio experimental, donde se tomaron 7 referencias de RC de diferentes diseños y fabricantes. Posteriormente se hicieron pruebas en 9 tubos de policloruro de vinilo clorado por cada referencia para conseguir un total de 63 pruebas. Resultados: El 34,9% de los RC de nuestro estudio presentaron migración y permitieron la fuga de cemento; todos estos RC eran de polietileno de ultra alto peso molecular (PUAPM), mientras que ninguno de los RC de gelatina falló. Conclusión: Los RC con diseño en paraguas demostraron ser los menos eficaces, presentando una mayor incidencia de migración y fuga de cemento, mientras que los RC de gelatina fueron los de mejor desempeño. Basado en los resultados de este estudio, se realizó un análisis del diseño de los RC y se propuso una clasificación que divide estos dispositivos en 2 tipos.(AU)

Eficacia de los restrictores de cemento: estudio experimental y desarrollo de una clasificación / Efficacy of cement restrictors: Experimental study and development of a classification

Introducción: Los restrictores de cemento (RC) son dispositivos que permiten la oclusión del canal femoral con el fin de obtener una mayor interdigitación del cemento en el hueso y una mejor presurización, lo que genera un incremento en la supervivencia de los vástagos cementados. El objetivo de este estudio fue evaluar la eficacia de los diferentes RC utilizados y proponer una clasificación de este dispositivo. Materiales y métodos: Se realizó un estudio experimental, donde se tomaron 7 referencias de RC de diferentes diseños y fabricantes. Posteriormente se hicieron pruebas en 9 tubos de policloruro de vinilo clorado por cada referencia para conseguir un total de 63 pruebas. Resultados: El 34,9% de los RC de nuestro estudio presentaron migración y permitieron la fuga de cemento; todos estos RC eran de polietileno de ultra alto peso molecular (PUAPM), mientras que ninguno de los RC de gelatina falló. Conclusión: Los RC con diseño en paraguas demostraron ser los menos eficaces, presentando una mayor incidencia de migración y fuga de cemento, mientras que los RC de gelatina fueron los de mejor desempeño. Basado en los resultados de este estudio, se realizó un análisis del diseño de los RC y se propuso una clasificación que divide estos dispositivos en 2 tipos.(AU)

Introduction: Cement restrictors (CRs) are devices that allow occlusion of the femoral canal in order to obtain greater interdigitation of the cement between the bone and a better pressurization, which generates an increase in the survival of cemented stems. The aim of this study was to evaluate the efficacy of the different CRs used and propose a classification of this device. Materials and methods: An experimental study was carried out, where 7 CR references of different designs and manufacturers were taken. Later, tests were carried out on 9 chlorinated polyvinyl chloride tubes for each reference, to achieve a total of 63 tests. Results: In our study, 34.9% of the CRs in ultra high molecular weight polyethylene failed, presenting migration and allowing cement to leak while none of the gelatin RC failed. Conclusion: The RC with an umbrella design proved to be the less effective, presented a higher incidence of migration and cement leakage, while the gelatin CRs were the best performers. Based on the results of this study, an analysis of the CR design was carried out and a classification was proposed that divides these devices into 2 types.(AU)

Prevalencia y factores asociados a la adherencia al tratamiento no farmacológico en pacientes con hipertensión y diabetes en servicios de baja complejidad / Prevalence and factors associated with adherence to non-pharmacological treatment of hypertensive and diabetic patients at low complexity services / Prevalência e fatores associados à aderência ao tratamento não-farmacológico em pacientes com hipertensão e diabete em serviços de baixa complexidade

OBJETIVO: determinar la prevalencia y los factores relacionados con la adherencia no farmacológica en pacientes con hipertensión arterial (HTA) y diabetes mellitus (DM). METODOLOGIA: estudio observacional transversal en pacientes adultos mayores de 35 años con diagnóstico de HTA o DM, atendidos en un programa de Renoprotección en cuidado primario en Cali, Colombia. Se excluyeron aquellos pacientes con enfermedad renal crónica en estadío KDOQI 4-5, los que presentaran comorbilidades adicionales que deterioraran la función renal o con trastornos neuropsiquiátricos diagnosticados previamente. La adherencia no farmacológica se determinó mediante un cuestionario de autoreporte y los factores asociados a la misma se determinaron mediante regresión de Poisson con varianza robusta. RESULTADOS : la prevalencia de la adherencia no farmacológica fue de 9,4%. La inactividad física estuvo presente en 75% de los pacientes, y más del 19% de la población consumía sal frecuentemente. Entre los diabéticos, 18% consumía carbohidratos con frecuencia. Los hombres mostraron ser menos adherentes que las mujeres (RP: 0,21; p = 0,002). Los factores asociados positivamente con la adherencia no farmacológica fueron: estar estudiando, desempleado o pensionado (RP: 4,42; p = 0,019), recibir apoyo del equipo de salud (RP: 3,17; p = 0,032), tener diagnóstico de diabetes (RP: 7,79; p = 0,000) y la función renal en KDOQI-3 (RP: 5,14; p = 0,008). CONCLUSION: la adherencia no farmacológica fue muy baja en la población de estudio, en particular en relación con la inactividad física. Los factores asociados positivamente a la adherencia fueron el sexo femenino, tener una ocupación diferente al hogar, diagnostico de diabetes, enfermedad renal en KDOQI-3 y contar con apoyo del equipo de salud.

OBJECTIVE: To determine the prevalence and factors associated with adherence to non-pharmacological treatment in patients with high blood pressure (HBP) and diabetes mellitus (DM). METHODOLOGY: A cross-sectional and observational study conducted with adult patients older than 35, diagnosed with HBP or DM and receiving health care in a primary care renal protection program in Cali, Colombia. Patients with chronic kidney disease at the KDOQI 4-5 stage, additional comorbidities which impair the renal function or with previously diagnosed neuropsychiatric disorders were excluded. Adherence to non-pharmacological treatment was determined using a self-report questionnaire. Factors associated with adherence were obtained through a Poisson regression with robust variance. RESULTS : The prevalence of patient adherence was 9.4%.Physical inactivity was present in 75% of the patients and 19% of the population often consumed salt. Among the diabetics, 18% often consumed carbohydrates. Men showed less adherence than women (RP: 0.21; p = 0.002). Factors positively associated with adherence to non-pharmacological treatment were: being a student, unemployed or retired(RP: 4.42; p = 0.019), getting help from the health care team (RP: 3.17; p = 0.032), being diagnosed with diabetes (RP: 7.79; p = 0.000) and having the renal function in the KDOQI-3 stage (RP: 5.14; p = 0.008). CONCLUSION: Adherence to non-pharmacological treatment was very low in the studied population, particularly in relation to physical inactivity. The factors positively associated with treatment adherence were being female, not being a housewife, having diabetes, having a renal disease at the KDOQI-3 stage and having the support of a health care team.

OBJETIVO: Determinar a prevalência e os fatores ligados à aderência não-farmacológica em pacientes com hipertensão arterial (HTA) e diabetes mellitus (DM). METODOLOGIA: Estudo observacional transversal em pacientes adultos maiores de 35 anos com diagnóstico de HTA ou DM, atendidos em um programa de Renoproteção em cuidado primário em Cali, Colômbia.Foram excluídos aqueles pacientes com doença renal crônica em etapa KSOQI 4-5, aqueles com comorbilidades adicionais que deterioram a função renal ou com transtornos neuropsiquiátricos diagnosticados previamente.A aderência não farmacológica foi determinada por meio de um questionário de auto-relato e os fatores associados a ela foram determinados por meio de regressão de poisson com variância robusta. RESULTADOS: A prevalência da aderência não farmacológica foi de 9.4%.A inatividade física esteve presente em 75% dos pacientes e mais de 19% da população consumia sal frequentemente.Entre os diabéticos 18% consumia frequentemente carboidratos. Os homens mostraram ser menos aderentes do que as mulheres (RP: 0,21; p = 0,002). Os fatores associados positivamente à aderência não farmacológica foram os fatos de estarem estudando, desempregados ou aposentados(RP: 4,42; p = 0,019), receber apoio da equipe de saúde (RP: 3,17; p = 0,032), ter diagnóstico de diabetes (RP: 7,79; p = 0,000) e a função renal em KDOQI-3 (RP: 5,14; p = 0,008). CONCLUSÃO: Aderência não farmacológica foi muito baixa na população analisada, em particular em relação com a atividade física.Os fatores associados positivamente à aderência foram o gênero feminino, ter uma ocupação diferente do lar, diagnóstico de diabetes, doença renal em KDOQI-3 e contar com apoio da equipe de saúde.

Prevalencia de trastornos mentales en una población que demanda servicios de salud en una IPS de baja complejidad y su asociación con la ideación suicida y la discapacidad percibida / Prevalence of mental disorders in a population requesting health services at a primary health care center and its association with suicidal ideation and perceived disability

Objetivo: conocer los trastornos mentales más frecuentes y el impacto en la percepción de discapacidad e ideación suicida en una Institución prestadora de servicios de salud de baja complejidad en Cali. Metodología: se realizó un estudio transversal con 254 pacientes a los que se les aplicó el instrumento prime-md. En el análisis se utilizó estadística descriptiva para determinar los trastornos más frecuentes y un análisis múltiple por regresiones logística y de Poisson con varianza robusta para determinar la influencia de los trastornos mentales en la discapacidad e ideación suicida. Resultados: la mayoría de los pacientes eran del sexo femenino, adultos jóvenes y maduros. La depresión estuvo presente en 66.8% de los casos, seguido del trastorno de somatización y la ansiedad. Casi la mitad de los pacientes habían tenido ideas suicidas alguna vez en la vida y 3 de cada 4 refirieron algún tipo de discapacidad. Después de ajustar por covariables, los trastornos ansiosos-depresivos mostraron una alta asociación con la ideación suicida y la discapacidad percibida, que es sobrestimada por la regresión logística. Conclusión: la depresión y la ansiedad son los trastornos mas frecuentes y tienen una alta asociación con la ideación suicida y la discapacidad y es por esto necesario realizar tamizaciones en la atención del adulto en servicios de baja complejidad. Se recomienda considerar el uso de la regresión de Poisson con varianza robusta en los estudios transversales en los servicios de salud.

OBJECTIVE: this study's goal was to determine the most prevalent mental disorders and the impact on the perception of disability and suicidal ideation among the population from a primary health care center in the city of Cali.METHODOLOGY: a cross sectional study was conducted on 254 patients who were screened with the PRIME–MD instrument. Descriptive statistics was used in the analysis to determine the most frequent disorders. Similarly, a multiple analysis with logistic and Poisson regressions using robust variance was conducted to determine the influence of mental disorders on disability and suicidal ideation.RESULTS: most patients were female, young, and mature adults. Depression was present in 66,8% of all cases, followed by somatization disorder and anxiety. Half of the patients had had suicidal ideations at some point in their lives, and three out of four patients claimed to suffer from some kind of disability. Upon adjusting for the covariables, depression and anxiety disorders had a strong association with suicidal ideation and perceived disability that was overestimated by the logistic regression.CONCLUSION: depression and anxiety were the most common disorders and showed a strong association with suicidal ideation and disability. This is why it is necessary to screen for those disorders among adults using primary health care services. Likewise, we suggest considering Poisson regression with robust variance in cross–sectional studies in health services.

Cajal y las genealogías intelectuales / Cajal and the intellectual genealogies

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Valores hematológicos en pollos de engorde expuestos de forma contínua a bajas dosis de aflatoxina B1 en el estado Zulia Venezuela / Haematological values in broiler chicks during long time low level exposure to aflatoxin B1 in Zulia state Venezuela

Se realizó un estudio para determinar el efecto de bajas concentraciones (70 µg/kg de Aflatoxina B1 purificada (AFB1) sobre los valores hematológicos de pollos de engorde, la exposición a niveles subclínicos de AFB1 es causa de bajo rendimiento en la industria avícola a consecuencia de sintomatología que va desde anemia hasta un comprometimiento de la respuesta inmune. Se utilizaron 480 pollos de la línea Hubbard x Hubard de un día de edad y se dividieron en dos grupos de 240 animales: Control (T1) alimento comercial sin niveles detectables de AFB1 y Tratamiento (T2) alimento contaminado con 70 µg/kg de AFB1. El día 42 se tomaron muestras de sangre de 32 aves de cada grupo para determinar: Proteínas Totales (PT) Hematocrito (Hcto), Hemoglobina (Hem), Recuento de Glóbulos Rojos (GR), Recuento de Glóbulos Blancos (GB) y Hemograma (DIF). La base de datos fue analizada para un diseño completamente aleatorizado a través de un análisis de la variancia y comparaciones de medias utilizando la opción GLM del SAS. Los valores para el T1 fueron: (PT) 3,18 ± 0,42 g/dl; (Hcto) 28,9 ± 2,48 por ciento); (Hem) 9,05 ± 1,10 g/dl; (GR) 2,65 ± 0,41 millones/mL; (GB) 6951,56 ± 3435 glóbulos/mL, los cuales no difieren de los resultados del T2. Todas las aves del ensayo presentaron linfopenia, heterolilia y monocitosis, lo que es compatible con un hemograma de stress calorico. Se concluye que 70 µg/kg AFB1 durante seis semanas no es capaz de afectar significativamente la respuesta hematológica en pollos de engorde

Prevalence, detection and treatment of anxiety, depression, and delirium in the adult critical care unit.

This study assesses the levels of depression, anxiety, and delirium during admission to three adult critical care units (CCU) and the performance of CCU staff with respect to detection and treatment. During a 1-month period, 96 consecutive patients were evaluated on the first day of admission by an independent rater, using the Hospital Anxiety Depression Scale and the Confusional Assessment Method. Frequency of alcohol use and demographic data were recorded. CCU teams rarely made diagnoses of anxiety, depression, or delirium. On at least one screening test, 29.2% of patients were positive. Delirium was present in 7.3%, depression in 13.7%, anxiety in 24%, and possible problem drinking in 37.9%. Although some form of psychiatric treatment was offered to 58%, there was low agreement between psychiatric diagnoses made by the independent rater and the diagnoses made and treatments used by CCU staff. This suggests that the CCU staff are using psychotropic medications without any clear documentation and perhaps clear understanding of the psychiatric diagnoses they are treating. In summary, we found high rates of psychiatric disorders in adult CCU patients but low rates of detection and only moderate rates of treatment by CCU staff.

Quality of life measures in the Miami HIV-1 infected drug abusers cohort: relationship to gender and disease status.

PURPOSE: This study examined activity, daily living, health, support, and outlook in HIV+ drug users. METHODS: Using the physician-administered Spitzer Index, the study assessed 75 HIV-1 seropositive men (n = 51) and women (n = 24) enrolled in the Miami HIV-1 Infected Drug Abusers Study (MIDAS). RESULTS: Total composite scores were significantly lower in the HIV-1 infected women than the men (p = .03). Significant gender differences were observed in activity assessment, independent of disease status, with women six times as likely to have lower activity scores (p = .0038). Most women (45%) in this category were homeless or marginally housed, compared to 11 percent of the men. Additionally, women with low activity scores had less social support than women with high activity scores. Cocaine use was significantly related to reports of normal activity, and varied across genders; more men used cocaine than women (p = .03). Compared to non-AIDS participants, AIDS patients were more likely to have lower scores in health (p = .009) and poorer outlook (p = .03). IMPLICATIONS: These findings reveal specific deficits in areas of psychosocial capacity, particularly in HIV-1 infected women who abuse drugs, that may need to be strengthened in order to enhance function and adherence to treatment, as well as well-being.

Exercise in frail elderly men decreases natural killer cell activity.

Six frail male outpatients 70 years and older deemed at risk for fall, but not suffering from serious medical problems nor receiving immune-altering drugs, received an exercise intervention of increasing strenuousness for 60 minutes 3 times a week for 3 months in comparison with 7 controls having no intervention. Psychosocial and immunologic assessments were made at baseline (Time 1), and after 6 (Time 2) and 12 (Time 3) weeks of physical conditioning. Cytotoxic activity of natural killer (NK) cells significantly decreased during the course of the study, in spite of transient exercise-induced increases at times 2 and 3. Despite the many known benefits of exercise, this report suggests its possible adverse effects on NK cell cytotoxicity in the very frail elderly. Mild overexertion in frail old people may be clinically significant in view of the now recognized role of NK cells in the prevention of metastasis.

[Factors related to mortality in neonatal tetanus in the rural area of Jalisco]. / Factores asociados a la mortalidad por tétanos neonatal en el área rural de Jalisco.

In this article, we report the results of a survey taken in towns with less than 2,500 inhabitants in the rural tetanigenic zone of the State of Jalisco. The purpose was to know the Infant Mortality Rate (IMR), the Neonatal Tetanus Mortality Rate (NTMR), the incidence of neonatal tetanus, and a partial register of these indicators, as well as the identification of the risk factors associated with fatalities from this disease. The sampling was multistaged with random selection of the conglomerates. The results were as follows: 75 deaths in children of less than one year of age with an IMR of 34.7 per 1,000 Live Births Registered (LBR), 40 deaths in those of less than 29 days old (Neonatal Mortality Rate of 18.5 per 1,000 LBR), eight deaths by neonatal tetanus (NTMR of 3.7 per 1,000 LBR), the estimated annual incidence rate of neonatal tetanus was 4.6 per 1,000 LBR, and the proportion of neonatal deaths due to tetanus was 20 per cent. The main factors studied which were statistically found to be significantly associated with the mortality rate from neonatal tetanus were: a maternal history of two or more prior child deaths having an Odds Ratio (OR) of seven; the existence of cramped living conditions greater than 3.5 persons per room (OR = 7.93); maternal illiteracy (OR = 7.22); and birth at the home (OR = 17.89). When the logistics model was used to control some of the misleading factors and obtain adjusted OR estimates, place of birth and the maternal history or two or more prior child deaths were found to be significant.

Modelo experimental para la corrección de estenosis subglótica con colgajo mioperióstico del esternocleidomastoideo / Experimental model for the correction subglotic stenosis with myoperiostic flap of the sternoceidomastoide

Se tomaron ocho conejos californianos de criadero con peso aproximado de 2.000 gr., los cuales fueron sometidos a estenosis subglótica mediante resección de la pared anterior del anillo cricoideo de la mucosa. Posteriormente la estenosis subglótica fue corregida mediante un colgajo mioperiostico de esternocleidomastoideo. El grupo fue evaluado durante tres meses sin encontrar signos de dificultad respiratoria en reposo o en actividad. Las radiografías del cuello con tecnica para partes blandas y la tomografía axial computarizada demostraron una vía aerea estable sin signos de estenosis en ocho casos y zonas de calcificación en la pared anterior del anillo cricoideo en siete casos. La histopatología mostró depósitos de calcio, espículas óseas, metaplasia condroide y tejido mesenquimal en la pared anterior del cartílago cricoides en el 87 por ciento de los casos; y en el caso restante se evidenció tejido fibrotico sin formación de hueso y sin estenosis. Esta tecnica quirurgica se convierte en un recurso mas para el manejo de esta patología

[Seasonal predominance in the date of birth in schizophrenia and affective disease]. / Predominancia estacional en la fecha de nacimiento en esquizofrenia y enfermedad afectiva.

Since 1929 a world-wide winter predomination of schizophrenic births has been described. A spring predomination for affective disorders has been suggested. A seasonal tendency of births between 1891 and 1967 of 1086 patients fulfilling the ICD-9 criteria for schizophrenia and affective disorders (with the respective subtypes) has been undertaken at the National Institute of Neurology. The control group was made up of patients with neurological diseases paired by age and sex. Analysis was submitted to the Pike and Morrow method. A predomination of births in fall was found for male paranoid schizophrenics. No seasonal tendency was found weather in affective disorders nor in other subgroups. There are various theories which explain these results (atmosphere influence, conception habits, genetic particularities, etc.) The interest rests on the potential prevention and the adequate nosography. Professor Dionisio Nieto proposed this study at the time that he ruled the Psychiatric Division of the National Institute of Neurology and Neurosurgery. We dedicate it to his memory.