Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management.

PURPOSE: Abdominal wall hernia secondary to open abdomen management represents a surgical challenge. The hernia worsens due to lateral muscle retraction. Our objective was to evaluate if Botulinum Toxin Type A (BTA) application in lateral abdominal wall muscles modifies its thickness and length. METHODS: A clinical trial of male trauma patients with hernia secondary to open abdomen management was performed from January 2009 to July 2011. Thickness and length of lateral abdominal muscles were measured by a basal Computed Tomography and 1 month after BTA application. A dosage of 250 units of BTA was applied at five points at each side between the external and internal oblique muscles under ultrasonographic guidance. Statistical analysis for differences between basal and after BTA application measures was performed by a paired Student's t test (significance: p < 0.05). RESULTS: Seventeen male patients with a mean age of 35 years were included. There were muscle measure modifications in all the patients. Left muscle thickness: mean reduction of 1 ± 0.55 cm (p < 0.001). Right muscle thickness: mean reduction of 1.00 ± 0.49 cm (p < 0.001). Left muscle length: mean increase of 2.44 ± 1.22 cm (p < 0.001). Right muscle length: mean increase of 2.59 ± 1.38 cm (p < 0.001). No complications secondary to BTA or recurrences at mean follow-up of 49 months were observed. CONCLUSIONS: BTA application in lateral abdominal muscles decreases its thickness and increases its length in abdominal wall hernia patients secondary to open abdomen management.

A longitudinal evaluation of growth outcomes at hospital discharge of very-low-birth-weight preterm infants.

BACKGROUND/OBJECTIVES: To quantify the rate of progressive failure of very-low-birth-weight (VLBW) infants over time in the neonatal intensive care unit to meet growth milestones. SUBJECTS/METHODS: In a prospective longitudinal study, 114 VLBW preterm infants (1500 g) of both sexes, with normal and/or low weight for gestational age were included. At the start, weight, length, mid-upper arm (MUAC), thigh and cephalic circumferences were measured. Weight/age (W/A), length/age and weight/length (±2 z-score) indices were calculated. All measurements were taken at inclusion, at 7, 15 and 30 days of hospitalization. Chi-square test, analysis of variance and repeated-measures tests were estimated. RESULTS: Thirteen cases (14%) died and were excluded soon after the first determinations. In all, 9 (8.9%) died during the study, 12 (11.9%) were discharged before 30 days of life and 80 (79.2%) completed the study. At 7 days, the percentage of preterm infants with an index of W/A <-2 z-scores increased from 44 to 67% (44-68 subjects; P<0.01), with no changes afterwards; the indicator MUAC <-2 z-scores increased at 7 days from 23 to 49% (23-49 subjects); at 15 from 23 to 65% (23-61 subjects) and at 30 days from 23 to 79% (23-63 subjects; P<0.001). CONCLUSIONS: Clinicians could use these indicators for earlier detection of growth failure in VLBW infants in order to target more aggressive nutrition early.

Effects of Hibiscus sabdariffa extract powder and preventive treatment (diet) on the lipid profiles of patients with metabolic syndrome (MeSy).

Insulin resistance, obesity, hypertension, and dyslipidemia are strongly associated with metabolic syndrome (MeSy), which is considered to be a reversible clinical stage before its evolution to coronary heart disease and diabetes. Currently, the antihypertensive and hypolipidemic properties of aqueous Hibiscus sabdariffa extracts (HSE) have been demonstrated in clinical trials and in vivo experiments. The aim of the present study was to evaluate the effects of a Hibiscus sabdariffa extract powder (HSEP) and a recognized preventive treatment (diet) on the lipid profiles of individuals with and without MeSy according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria. The protocol was a follow-up study carried out in a factorial, randomized design (T1=preventive treatment comprises Diet, T2=HSEP, T3=HSEP+preventive treatment (Diet) X MeSy, non-MeSy individuals). A total daily dose of 100 mg HSEP was orally administered in capsules for one month. The preventive treatment (diet) was selected according to NCEP-ATP III recommendations and adjusted individually. Total cholesterol, LDL-c, HDL-c, VLDL-c, triglycerides, glucose, urea, creatinine, AST, and ALT levels in the blood were determined in all individuals pre- and post-treatment. The MeSy patients treated with HSEP had significantly reduced glucose and total cholesterol levels, increased HDL-c levels, and an improved TAG/HDL-c ratio, a marker of insulin resistance (t-test p<0.05). Additionally, a triglyceride-lowering effect was observed in MeSy patients treated with HSEP plus diet, and in individuals without MeSy treated with HSEP. Significant differences in total cholesterol, HDL-c, and the TAG/HDL-c ratio were found when the means of absolute differences among treatments were compared (ANOVA p<0.02). Therefore, in addition to the well documented hypotensive effects of Hibiscus sabdariffa, we suggest the use of HSEP in individuals with dyslipidemia associated with MeSy.

Apolipoprotein E genotypes in Mexican patients with Parkinson's disease.

BACKGROUND: The association of the apolipoprotein (Apo E) -epsilon4 allele to neurodegenerative diseases such as Parkinson's disease (PD) has been analyzed in several studies. This association has been identified by amyloid deposits and neurofibrillary tangles in the brains of patients with neurodegenerative diseases. METHOD: In this study the possible relationship between Apo E alleles and PD patients was analyzed in 105 patients with PD and 107 healthy controls from a Mexican population. RESULTS: Allele analysis in PD vs. controls was: epsilon2 in 6% and 2.3%, respectively; epsilon3 in 73% and 88.3%; and epsilon4} in 21% and 9.4%. The epsilon3 allele showed a protective risk effect with an Odds ratio (OR) of 0.36 (95%CI 0.20-0.61) and p < 0.05; contrary results were observed for the epsilon4 allele, which showed an increased risk for PD, with an OR of 2.57(95% CI 1.42-4.79) and p < 0.05. Upon multivariate analysis showed PD risk was evident in patients who were carriers of the genotype epsilon3/epsilon4; age group (fifty or more years) and had exposure to pesticides and solvents (p < 0.05). CONCLUSIONS: The epsilon3/epsilon3}; epsilon3/epsilon4 genotypes of the Apo E, were positively associated with sporadic PD.

Incidence and predictive factors for cytomegalovirus infection in renal transplant recipients.

BACKGROUND: Cytomegalovirus (CMV) infection is a common cause of morbidity, graft loss, and mortality among kidney recipients due to its direct and indirect influences on organs and systems, namely, immunomodulation, which favors the appearance of opportunistic infections, vasculopathy, and decreased graft and patient survival. In Mexico the dimensions of this infection are unknown in kidney transplant recipients. We evaluated the incidence and predictive factors for CMV infection among renal transplant recipients of the Mexican Institute of Social Security in Guadalajara. METHODS: This prospective cohort analysis of patients >or=16 years of age of both genders, included transplantations from May 2006 to July 2007. Two hundred twenty-five patients were followed over 6 months to evaluate CMV infection or disease. We evaluated demographic, clinical, and paraclinical aspects, such as total lymphocyte count and quantitative CMV polymerase chain reactions (PCR). RESULTS: The overall incidence of CMV infection was 17.8%. CMV infections were associated with lymphopenia (relative risk [RR] 14.75; confidence interval [CI] 95%, 3.46-62.77), serostatus D+/R- (RR 5.53; CI 95%, 2.18-14.05), and fever (RR 4.57; CI 95%, 1.50-13.95). Receiver-operating characteristic (ROC) curves for lymphopenia versus PCR showed a sensitivity of 27% and a specificity of 98%. CONCLUSION: In our study, lymphopenia, serostatus D+/R-, and fever were good predictors of CMV infections among renal transplant recipients.

CYP1A1 *2B and *4 polymorphisms are associated with lung cancer susceptibility in Mexican patients.

BACKGROUND: CYP1A1 is a gene involved in the high aryl hydrocarbon hydroxylase -inducible phenotype, which is a genetically-determined variation among individuals that has been associated with lung cancer risk. More specifically, CYP1A1 *2B and *4 polymorphisms have been associated with high susceptibility to lung cancer among cigarette smokers. MATERIALS AND METHODS: DNA was obtained from blood samples and we studied by PCR-RFLP the distribution of CYP1A1 *2B (n=248) and *4 (n=222) polymorphisms in healthy controls and 222 lung cancer patients from a Mexican population. RESULTS: Comparisons between groups showed an increased risk for lung cancer patients of *2B/*2B (18%; OR 7.6; 95% CI 3.0-19.2) and *4/ *4 genotypes (15%; OR 11.45; 95% CI 2.19-59.85) compared to the control group (1% for *2B/ *2B and 4.4% for *4/ *4). A significant association between lung cancer and homozygous *2B/ *2B passive smokers and *4/*4 ever (cigarettes) and passive smokers was also observed (p<0.05). Multivariate analysis revealed an increased risk for the *2B/*2B genotype (OR 6.83), as well as for *4/*4 (OR 28.8). CONCLUSION: The results of the study indicate a significant association between *2B/*2B and *4/*4 genotypes and the risk of developing lung cancer among Mexicans.

CYP1A1 *2B and *4 polymorphisms are associated with lung cancer susceptibility in Mexican patients.

BACKGROUND: CYP1A1 is a gene involved in the high aryl hydrocarbon hydroxylase -inducible phenotype, which is a genetically-determined variation among individuals that has been associated with lung cancer risk. More specifically, CYP1A1*2B and *4 polymorphisms have been associated with high susceptibility to lung cancer among cigarette smokers. MATERIALS AND METHODS: DNA was obtained from blood samples and we studied by PCR-RFLP the distribution of CYP1A1*2B (n=248) and *4 (n=222) polymorphisms in healthy controls and 222 lung cancer patients from a Mexican population. RESULTS: Comparisons between groups showed an increased risk for lung cancer patients of *2B/*2B (18%; OR 7.6; 95% CI 3.0-19.2) and *4/*4 genotypes (15%; OR 11.45; 95% CI 2.19-59.85) compared to the control group (1% for *2B/*2B and 4.4% for *4/*4). A significant association between lung cancer and homozygous *2B/*2B passive smokers and *4/*4 ever (cigarettes) and passive smokers was also observed (p<0.05). Multivariate analysis revealed an increased risk for the *2B/2B genotype (OR 6.83), as well as for *4/*4 (OR 28.8). CONCLUSION: The results of the study indicate a significant association between *2B/*2B and *4/*4 genotypes and the risk of developing lung cancer among Mexicans.

[Effectiveness of the modify tomographic severity index in patients with severe acute pancreatitis.]. / Eficacia del índice de gravedad tomográficomodificado en enfermos con pancreatitisaguda grave.

INTRODUCTION: Acute pancreatitis (AP) is a very important cause of morbidity and mortality in Mexico.In 2001 AP was the 17th cause of death. Since 1994,the computed tomography (CT) scan was accepted for the screening of the severity (a) according to the Computed Tomography Severity Index (CTSI). In 2004 Mortele et al., developed a new tomography classification, Modified Computed Tomography Severity Index (MCTSI) including pancreatic and extra pancreatic disease, obtaining a very good correlation with those with organ failure. This study proposes compare the tomography classifications as indicators of severity. METHODS: Cross-sectional study. Were included 30 patients with acute pancreatitis; APACHE II >= 8, non improvement with medical treatment and with initial mild pancreatitis,with addition of signs of complication in the first 72 hours of evolution, under CT scan, CTSIM and CTSI were compared. Statistical analysis using X2 test was calculated, kappa concordance coefficient(k) for the severity classifications. RESULTS: AP prevalence was 51.07%.Of the 30 patients including,19 man with mean age of 39.0 years (18-58 years),and 11 woman, with mean age of 50.9 years (22-82 years). The main causes were biliary pancreatitis in 16 cases (53.3%), and the second was alcohol,8 cases (26.7%). The kappa concordance coefficient for both tomography scans was 0.48 (p <= 0.003). For the CTSIM and CTSI sensitivity was 61% vs. 38%,specificity 66% vs. 100% and positive predictive value of 81% vs. 100%, respectively. CONCLUSIONS: The CTSIM is more useful for the screening in patients with severe acute pancreatitis than CTSI.

Effect of Breathwalk on body composition, metabolic and mood state in chronic hepatitis C patients with insulin resistance syndrome.

AIM: To identify the anthropometric, metabolic and mood state in hepatitis C virus (HCV)-infected patients from the west of Mexico and to evaluate the effect of Breathwalk (BW), a combination of walking, synchronized breathing and focussed attention, on those patients. METHODS: In an experimental study, 17 patients with serological and molecular diagnosis of HCV, not receiving pharmacological treatment, were studied. One hour sessions of BW were practiced 3 times at week for six months. Body composition was assessed by electric impedance. Biochemical profiles and insulin resistance (IR) risk was assessed by conventional methods. Mood state was evaluated with specific and open questions at the beginning and at the end of the program. RESULTS: Seventy percent of patients were overweight or obese, and 77% of the patients presented with IR at the beginning of the study. Improvements were observed at the 3rd mo, and statistically significant differences were recorded at the 6th mo using the fitness score (76 vs 83, P < 0.01), in alanine aminotransferase (ALT) (106 +/- 93 U/L vs 59 +/- 32 U/L, P < 0.01), total bilirubin (0.09 +/- 1 mg/dL vs 0.62 +/- 0.2 mg/dL, P < 0.01), ALT/AST ratio (1.04 vs 0.70, P < 0.01), triglycerides (165 +/- 86 mg/dL vs 124 +/- 49 mg/dL, P < 0.01) and the IR risk (4.0 vs 2.7). Most patients (88%) indicated to feel better at the end of BW (P < 0.01). CONCLUSION: Breathwalk has an important effect on body composition, lipid profile and liver enzymes. It is also easy, inexpensive and has a beneficial effect on metabolic and mood state in HCV patients.

Cytotoxic effect of curcumin on Giardia lamblia trophozoites.

Giardia lamblia is one of the most important worldwide causes of intestinal infections produced by protozoa. Thus, the search for new alternative therapeutic approaches for this parasitic disease is very important. Common drugs used to control and eradicate this infection, frequently exhibit side effects that force patients to abandon treatment. The present work evaluates the anti-protozoan activity of curcumin, the main constituent of turmeric. Axenic G. lamblia (Portland 1 strain) cultures were exposed to different concentrations of curcumin. Its effects were evaluated on parasite growth, adhesion capacity and parasite morphology. We also evaluated the capacity of curcumin to induce an apoptosis-like effect. All curcumin concentrations inhibited trophozoite growth and adhesion in more than 50% in dose and time dependent manner. Morphological changes were described as protrusions formed under the cytoplasmic membrane, deformation due to swelling and cell agglutination. Curcumin induced apoptosis-like nuclear staining in dose and time dependent manner. In conclusion, curcumin exhibited a cytotoxic effect in G. lamblia inhibiting the parasite growth and adherent capacity, induced morphological alterations, provoked apoptosis-like changes. Future in vitro and in vivo experiments are endowed to elucidate the effect of curcumin in an experimental model of G. lamblia infection, analyze the involvement of ion channels in the swelling effect of curcumin during an apparent osmotic deregulation in G. lamblia trophozoites. This will lead to the proposal of the action mechanism of curcumin as well as the description of mechanism involved during the activation process for the apoptotic-like effect.

Reproducibility and cost of blood pressure self-measurement using the 'Loaned Self-measurement Equipment Model'.

OBJECTIVE: To determine the reproducibility and the cost of the Loaned Self-measurement Equipment Model for blood pressure. SUBJECTS: Seventy-five subjects with non-complicated essential hypertension, having an average age of 56.2 +/- 11 years, were evaluated. METHODS: The Loaned Self-measurement Equipment Model consists of a set of sphygmomanometers belonging to the clinic, loaned to patients for 3-day periods for them to carry out 27 readings, and then returned. Using a mercury sphygmomanometer, a nurse carried out office blood pressure readings during two visits. A month later, the same procedure was repeated under the same clinical conditions. The agreement between studies was assessed by correlation coefficients, coefficients of variation and standard deviation of the differences (SDD). RESULTS: The office blood pressure was 147 +/- 17/89 +/- 12 mmHg during visit A, and 145 +/- 16/88 +/- 11 mmHg during visit B. The self-measurement blood pressure was 139 +/- 16/84 +/- 10 mmHg during the first visit, and 136 +/- 15/84 +/- 11 mmHg during the second visit. In neither of the cases were the differences statistically significant. The correlation coefficients for the office and self-measurement systolic blood pressure were statistically significant (P = 0.018), while those for the diastolic blood pressure were not statistically significant. The SDD for self-measurement systolic blood pressure was 10.7, compared to 15.0 for the office blood pressure (P < 0.01). The comparison in the case of diastolic blood pressure was not significant. The cost of each loan was $5.85 (US dollars). CONCLUSIONS: The Loaned Self-measurement Equipment Model has a good short-term reproducibility, and the cost is reasonable.