[Chronic end-stage kidney failure in Mexico]. / Algunas reflexiones sobre la insuficiencia renal crónica terminal en México.

Chronic renal failure is an expanding and complex problem in Mexico. This work analyzes its current situation and finds a clear imbalance between supply and demand for specialized services, that favors the latter. To explain said imbalance, it invokes four factors: the recent innovation in nephrology and parallel disciplines; educational deficit of medical schools; high costs of rehabilitation of the uremic patient, and the absence of specifically designed mechanisms for financing the treatment of this disease.

[An analysis of bone mass and remodeling in women with pharmacological inhibition of ovarian function. The response to nasal calcitonin]. / Análisis de masa y remodelado óseo en mujeres con inhibición farmacológica de función ovárica. Respuesta a calcitonina nasal.

Pharmacological inhibition of ovarian function (PIOF) in young women is associated with hypoestrogenism and very low estrogen levels. These alterations can trigger osteopenia, either by delayed peak bone mass or by active bone destruction, and therefore, an increased risk of osteoporosis at later years. Twenty-one women (mean age: 32 years) with diagnosis of endometriosis, who were submitted to PIOF with leuprolide acetate, were prospectively studied. As a result of treatment for bone resorption with nasal spray salmon calcitonin, 200 UI/day, a decreased femoral and lumbar bone mass density was identified in these women through densitometry. Regarding bone remodelling biochemistry, changes were seen in urinary markers suggesting bone destruction inhibition, while bone formation markers showed stimulation. Biochemical markers of bone turnover and bone mass measurements are useful during follow-up of young women with osteopenia.

[Infections caused by gram negative anaerobic bacteria and other associated bacterial strains]. / Infecciones por anaerobios gram-negativos y otras especies bacterianas asociadas.

Between November 1975--December 1977, in the Laboratory of Microbiology, National Institute of Nutrition, Mexico, 156 cultures for anaerobic bacteria were grown on 118 cases with a clinical picture suggestive of anaerobic infection. There were 42 positive cultures (26.9%) from which 18 (42.8%) grew a mixed flora (aerobicanaerobic). Those 42 cultures came from 35 patients (29.6%) and the 18 mixed cultures came from 18 cases (15.25% global and 51.42% of the cases with anaerobic flora). The highest positive marks were obtained from material provenient from the abdominal cavity, and lesser indexes were obtained from lungs, blood, bone and sinovial cavities. The overall mortality was registered in 24 cases (20.33%) but only in 6 cases (5.8% global and 25% of the total cases) a positive anaerobic culture was obtained. In these 6 cases the cause of death was secondary to the principal disease, and only in one case the patient died from septicemia. The diagnosis of anaerobic infection resides mainly in the clinical findings, secondly in a positive gram stain, and thirdly in the identification of the etiologic agent, that will aid in the choice of a more specific therapy, which must include a surgical excision of the affected tissues.

[Dysgeusias]. / Disgeusias.

This is a review of multiple pathologic conditions associated with altered taste perception and identification. We stated the steps and the molecular basis of this sense. This paper includes two cases that exemplify two distinct types of dysgeusia; case, 1 a 48 year old man who had clinical manifestations of hypogeusia and dysgeusia for one year, probably secondary to air pollutants. Case 2, a 37 year old man who worked in the same factory and also had dysgeusia; we concluded that it was secondary to thermal and chemical agression of the oropharynx; his plasma and urinary levels of zinc were normal. Many medications and contaminants of air and water are related with changes in serum and urine levels of zinc, which is a determinant at several levels for the correct integration of the taste system. Namely it is important for synthesis of the metalloprotein, gustin, a parotid gland protein secreted into saliva, which in turns is very important to make union of the sapid substance (SS) with its receptor in the surface of the gustatory epithelium a the taste buds. Zinc is also related with neurotransmission of the electrical stimulus generated in the bud cell and ending in the central nervous system. There is an acute zinc loss syndrome, seen in patients treated with histidine, which simulates the steps in which taste sensation is integrated. A clinical approach for diagnosis of hypogeusic or dysgeusic patients must include a careful evaluation of the diat elements, an assesment of hereditary disorders, the type of work and contact with pollutants known to be related with dysgeusia. A special care regarding physical examination must be considered in particular a meticulous review of the oropharynx in order to diagnose inflammatory, neoplastic or neurological disorders. The levels of perception an identification of flavors: sweet, bitter, sour and salt, must be determined using the forced scale triple choice technic. Serum and urinary levels of zinc should be determined in each patient using a flameless atomic absorption spectrophotometer. A quantification of the activity of leucocyte alkaline phosphatase, a zinc metalloenzyme, is a useful aid, liver function tests. 13 and 14 determinations and serum protein electrophoresis are mandatory because many pathologic states of these organ systems are known to be related with disorders of taste. We wish to remark the important function of zinc in the taste system, the role of essential trace elements is receiving increased atention and these alterations are good examples of their clinical importance.