RESUMO
BACKGROUND: The rate of emergent groin hernia repair in developing countries is poorly understood. MATERIALS AND METHODS: A retrospective analysis of groin hernia repairs performed at a county hospital in Guatemala [Hospital Nacional de San Benito (HSNB)] was undertaken and compared to a literature review in developed countries. Patients with incarcerated hernias were interviewed to determine factors related to late presentation. RESULTS: Twenty-five percent of patients with groin hernias in this analysis presented at HNSB emergently (vs. 2.5-7.7% in developed countries). Most patients were male in their fifth decade of life. Ten percent of hernias were femoral. There was no delay in scheduling patients for surgery presenting for elective repair. Most patients lived within 20 miles of the hospital, but only 50% of patients returned for their follow-up appointment. Most patients with an incarcerated inguinal hernia (56%) did not seek medical attention because of family obligations, but when they did, this decision was influence by their children (66%). None of the patients presenting with an incarcerated hernia had education past secondary school. In fact, most (56%) did not have any form formal education. Nearly 90% of patients who had an incarcerated hernia repaired thought that the hospital provided good-to-excellent care. CONCLUSION: A high number of patients present emergently for groin hernia repair at a county hospital in Guatemala compared to developed countries. Our data suggest that emergent hernias are likely the result of patient-related issues rather than health care system limitations.
Assuntos
Hérnia Inguinal/epidemiologia , Hérnia Inguinal/cirurgia , Herniorrafia/estatística & dados numéricos , Acesso à Informação , Adulto , Idoso , Atenção à Saúde/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências/epidemiologia , Feminino , Virilha/cirurgia , Guatemala/epidemiologia , Pesquisas sobre Atenção à Saúde , Hérnia Femoral/complicações , Hérnia Femoral/epidemiologia , Hérnia Femoral/cirurgia , Hérnia Inguinal/complicações , Herniorrafia/efeitos adversos , Hospitais/estatística & dados numéricos , Hospitais de Condado/normas , Hospitais de Condado/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Abstract: Introduction: American guidelines for echocardiographic evaluation from 2015 determine an abnormal TAPSE value below 17 mm; a right ventricle ejection fraction (RVEF) below 45% measured by a three-dimensional method (3D) is considered abnormal, it's widely validated by Magnetic Resonance Imaging (MRI). Kawel-Boehm et al, through MRI has established the reference parameters for adults and children. For men between 20-68 years the minimum normal RVEF value is 52% (52-72% range, 61% medium); in women from the same age range the minimum normal RVEF value is 51% (51-71% range, medium 61%). Objective: To make a comparison between the RVEF obtained by an echocardiographic method as the result of multiply the 2.9 constant * TAPSE against the MRI´s volumetrically measured RVEF. Material and methods: The TAPSE measuring was made in M mode; the MRI RVEF was determined by a standardized method in steady-state free precession cinematic sequences. Results: We analyzed 32 consecutives patients; 18 were men and 14 were women. The calculated TAPSE was 19.2 ± 4.8; the RVEF with the 2.9*TAPSE formula was 55.7 ± 13.8% and through MRI (p 0.67) 53.2 ± 14.8%. The RVEF measured by the testing method in comparison with the reference method does not show significant statistically difference; there is a good correlation with both methods through the Bland-Altman method. Conclusions: The RVEF can be echocardiographically measured by multiplying the TAPSE value with the 2.9 constant.
Resumen: Introducción: Las Guías Americanas para la evaluación ecocardiográfica de 2015 determinan un valor TAPSE anormal inferior a 17 mm; una fracción de eyección del ventrículo derecho (FEVD) por debajo de 45% medido por un método en tres dimensiones (3D) se considera anormal, es ampliamente validado por imagen de resonancia magnética (RM). Kawel-Boehm et al, a través de la resonancia magnética ha establecido los parámetros de referencia para adultos y niños. Para los hombres entre 20-68 años, el valor normal mínimo de FEVD es 52% (rango 52-72%, 61% promedio); en mujeres de la misma franja etaria el valor normal mínimo de FEVD es 51% (rango 51-71%, promedio 61%). Objetivo: Hacer una comparación entre la FEVD obtenida por un método ecocardiográfico como el resultado de multiplicar la constante FEVD 2.9 * TAPSE, contra la medición volumétrica por RM. Material y métodos: La medición TAPSE se realizó en modo M; La FEVD por RM se determinó mediante un método estandarizado en secuencias cinemáticas de precesión libre en estado estacionario. Resultados: Se analizaron 32 pacientes consecutivos; 18 eran hombres y 14 eran mujeres. La TAPSE calculada fue de 19.2 ± 4.8; la FEVD con la fórmula 2.9 * TAPSE fue de 55.7 ± 13.8% y por medio de resonancia magnética (p 0.67) 53.2 ± 14.8%. La FEVD medida por el método de prueba en comparación con el método de referencia no muestra diferencia significativa estadísticamente; existe una buena correlación con ambos métodos a través del método de Bland-Altman. Conclusiones: La FEVD se puede medir ecocardiográficamente multiplicando el valor TAPSE por la constante 2.9.
RESUMO
BACKGROUND: The objective of the present study was to assess bone mineral content (BMC) of the whole skeleton in pre-term and full-term healthy infants and the factors influencing BMC, such as bone area, birth weight, birth length, current weight, current length, gender, and gestational age. METHODS: Forty-eight healthy full-term infants and 34 healthy premature infants fed predominantly with intact human milk were studied. BMC was measured monthly with dual energy X-ray absorptiometry (DEXA). At the same time, length and weight were measured and registered. Pre-term infants were studied at 60-day intervals. RESULTS: For both full-term and pre-term infants, BMC increased during the first months of life. However, the values of pre-term infants never reached the values of full-term infants, even after correcting for age and weight. For both full-term and pre-term infants, BMC was significantly correlated at the second month with birth weight (r = 0.901), birth length (r = 0.860), gestational age (r = 0.803), bone area (r = 0.960), current weight (r = 0.920), and current length (r = 0.840, p <0.001 for all correlation coefficients). Multivariate analysis revealed that bone area was the most important factor in predicting BMC. CONCLUSIONS: Pre-term children have lower BMC than full-term children. The main factor explaining this apparent osteopenia is bone area. Pre-term children have a higher daily mineralization rate than full-term children, but this catch-up mineralization is not enough to reach BMC levels seen in full-term children.
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Densidade Óssea/fisiologia , Desenvolvimento Ósseo/fisiologia , Doenças Ósseas Metabólicas/congênito , Recém-Nascido de Baixo Peso/crescimento & desenvolvimento , Recém-Nascido/crescimento & desenvolvimento , Recém-Nascido Prematuro/crescimento & desenvolvimento , Osteogênese/fisiologia , Absorciometria de Fóton , Peso ao Nascer , Estatura , Peso Corporal , Aleitamento Materno , Cálcio/análise , Feminino , Seguimentos , Humanos , Lactente , Cinética , Masculino , México , Valores de ReferênciaRESUMO
OBJECTIVE: To analyze perinatal births and deaths recording at the Mexican Institute of Social Security (MISS), and to evaluate the correct classification of perinatal deaths. MATERIAL AND METHODS: From January to March 2000, data were collected from the 37 MISS districts on the total number of births and deaths occurring during 1999, deaths occurring before the seventh day of life, and gestational age and weight at birth. Early neonatal and infant mortality rates were analyzed including or separating newborns with < 1,000 g and < 28 weeks of gestational age. RESULTS: During 1999 there were 634,892 live births--whose gestational age and birth weight are unknown- and 3,984 stillbirths > or = 28 gestation weeks. There were 4,556 newborns who died before the seventh day of extrauterine life; 1,385 of them (30.4%) weighted less than 1,000 g and had a gestational age < 28 weeks. The analysis of mortality with and without these newborns shows a decrease of two points in early neonatal and infant mortality rates. CONCLUSIONS: This study shows that classification and reporting of perinatal mortality are inappropriate. A proposal is made to develop information systems that include weight and gestational age of all births. A new perinatal death certificate replacing current fetal and general death certificates would allow proper mortality classification and comparisons between countries.
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Atestado de Óbito , Documentação/normas , Mortalidade Infantil , Humanos , Recém-Nascido , MéxicoRESUMO
Fermentation conditions and microorganisms were determined, based on acid production, glucose concentration as carbohydrate source. Inoculation levels to obtain a stable shrimp waste silage were also determined. Shrimp waste ensilation was an efficient method of preservation, allowing the recovery of chitin and another added-value products such as pigments, proteins and enzymes. From the various lactic acid bacteria tested, Lactobacillus pentosus and Lactobacillus sp. (B2) were the best lactic acid producers, although small quantities of acetic acid were detected in samples inoculated with Lactobacillus pentosus. Therefore B2 was chosen for the analysis of glucose consumption as well as for the determination of optimum inoculation levels. The best results were obtained at 10% (w/w wet basis) and 5% (v/w wet basis) respectively. Presence of starters and initial glucose concentration were critical factors in the fermentation of shrimp waste. High initial glucose and starter concentrations reduced the time and increased the amount of lactic acid produced. The fermentation pattern changed during ensilation from hetero to homofermentative. Shrimp waste ensilation prevented the growth of spoilage microorganisms keeping their microbial counts steady and pH values within the acid region.
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BACKGROUND: The infant's own mother's milk, fortified with proteins, minerals, and vitamins, is considered the best food for low-birth-weight infants. This paper describes the process to obtain a liquid human milk fortifier. METHODS: The fortifier comprises a protein concentrate, calcium, phosphate, and zinc salts, as well as vitamins A and D. A powdered whey protein extracted from bovine milk was concentrated from 31.5-76.8 g/100 g using repetitive dialysis. The protein concentrate was dissolved in a 0.2 M phosphate buffer pH 7.4 and mixed with calcium-glycerophosphate and calcium-gluconate, vitamins A and D, folic acid, and zinc. Each 10 mL of this liquid fortifier has 0.78 g protein, 53 mg calcium, 36 mg phosphate, and 0.93 mg zinc. RESULTS: Repetitive dialysis did not modify the protein structure as demonstrated by electrophoresis. A total of 95% of lactose content was discarded. Enriching human milk using this human milk fortifier increased the concentration per deciliter of all added nutrients; proteins increased from 1.68-2.35 g, calcium from 26-90 mg, and phosphorus, from 15-51 mg. CONCLUSIONS: A liquid human milk fortifier was successfully manufactured using a noncomplex procedure. An intake of 180-200 mL/kg/day of the fortified human milk by the premature infant would satisfy the infant's nutritional requirements and achieve expected growth and development.
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Proteínas Alimentares/administração & dosagem , Alimentos Fortificados , Glicerofosfatos/administração & dosagem , Alimentos Infantis , Recém-Nascido Prematuro , Leite Humano , Vitamina A/análogos & derivados , Vitaminas/administração & dosagem , Gluconato de Cálcio/administração & dosagem , Química Farmacêutica/métodos , Colecalciferol/administração & dosagem , Diálise , Diterpenos , Feminino , Ácido Fólico/administração & dosagem , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Necessidades Nutricionais , Fosfatos/administração & dosagem , Ésteres de Retinil , Vitamina A/administração & dosagem , Sulfato de Zinco/administração & dosagemRESUMO
Attenuated Salmonella typhi are attractive for use as live vector vaccines to express protozoal antigens and deliver them to the human immune system. The gene encoding the mature form of Leishmania mexicana mexicana gp63 under control of tac promoter was integrated into the delta aroC locus of the chromosome of attenuated delta aroC, delta aroD S. typhi strain CVD 908. After oral immunization of BALB/c mice with two 1 x 10(9) colony forming unit doses given 21 days apart, CVD 908 omega (delta aroC::Ptac-gp63) elicited a broad T cell-mediated immune response against L. m. mexicana gp63 as demonstrated by: (1) lymphoproliferative response to fixed whole L. m. mexicana promastigotes; (2) activation of IL-2 (but not IL-4)-producing lymphocytes; (3) appearance of cytotoxic T cells against mouse mastocytoma cells expressing gp63. This T-cell mediated immune response was associated with significant protection in F1 (BALB/cXC57Bl/6) mice challenged in their footpads with a wild type strain of L. m. mexicana.
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Antígenos de Protozoários/genética , Leishmania mexicana/genética , Leishmania mexicana/imunologia , Metaloendopeptidases/genética , Metaloendopeptidases/imunologia , Proteínas de Protozoários/genética , Proteínas de Protozoários/imunologia , Vacinas Protozoárias/genética , Vacinas Protozoárias/imunologia , Salmonella typhi/genética , Salmonella typhi/imunologia , Vacinas Sintéticas/genética , Vacinas Sintéticas/imunologia , Administração Oral , Animais , Sequência de Bases , Citotoxicidade Imunológica , Primers do DNA/genética , Genes de Protozoários , Vetores Genéticos , Humanos , Técnicas In Vitro , Interleucina-2/biossíntese , Leishmaniose Cutânea/imunologia , Leishmaniose Cutânea/prevenção & controle , Ativação Linfocitária , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Vacinas Protozoárias/administração & dosagem , Proteínas Recombinantes/genética , Proteínas Recombinantes/imunologia , Linfócitos T/imunologia , Vacinas Sintéticas/administração & dosagemRESUMO
Two cases of submucosal colonic lipomas presenting as rectal prolapse are described. Both of them required resection by laparotomy. Colonic lipomas are a uncommon entity and they have not been documented as a cause of rectal prolapse.
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Neoplasias do Colo/complicações , Lipoma/complicações , Prolapso Retal/etiologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The milk composition of women on a typical rural Mexican diet was compared with that secreted by American women, consuming a diet typical of affluent countries. Milk concentrations of free fatty acids, cholesterol, total amino acids, and selected key minerals were analyzed at 4 or 6 months postpartum. The total milk fat concentration was lower in the Otomi (22.7 +/- 6.7 mg/g milk) than in the American women (31.3 +/- 5.4 mg/g milk, p = 0.001). Although the absolute concentration did not differ, cholesterol, expressed in terms of total lipid, was higher in the Otomi milk (3.9 +/- 1.1 vs. 3.1 +/- 0.7 mg/g fat, p = 0.005). Saturated medium-chain (C10:0-C14:0) and unsaturated intermediate-chain fatty acids (C16:1 and C18:2) were higher in the Otomi than in the American milk (p < 0.03). The concentrations of C16:0, C18:0, and C18:1 were significantly lower in Otomi than in American milk. The milk concentrations of protein and nonprotein nitrogen were comparable between the two groups. The concentrations of serine, proline, cystine, methionine, and tryptophan were higher in the Otomi than in the American milk (p < 0.05-0.001). The concentrations of valine and isoleucine were significantly lower in the Otomi milk (p = 0.05). Expressed per gram of milk protein, the cystine, methionine, lysine, and tryptophan concentrations were higher, and the glutamine/glutamate, valine, isoleucine, and arginine levels were lower in the Otomi milk. The concentrations of phosphorus and copper were lower in the Otomi than in the American milk at 4 months postpartum (p = 0.05). These differences in milk fatty acid and amino acid patterns and mineral content are unlikely to affect infant growth, but may have other biological consequences yet to be ascertained.
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Aminoácidos/análise , Dieta , Ácidos Graxos/análise , Leite Humano/química , Minerais/análise , Zea mays , Aminoácidos/classificação , Colesterol/análise , Estudos de Coortes , Ácidos Graxos/classificação , Feminino , Humanos , México , Minerais/classificação , Minerais/metabolismo , População Rural , Fatores de Tempo , Estados UnidosRESUMO
BACKGROUND: This study was designed to describe the longitudinal changes in the casein and whey fractions and the total and nonprotein nitrogen contents of preterm human milk for the first 10 days postpartum. METHODS: Eleven mothers delivering at 30 to 34 weeks of gestation were studied, six throughout the first 10 days and five on the first postpartum day. Four milk samples were collected every day by expression of one breast with an electric breast pump. Casein and whey protein were separated from the defatted milk by isoelectric precipitation in calcium chloride and by subsequent ultracentrifugation. The milk nitrogen content was determined before and after acid precipitation. Whey protein and casein were characterized by electrophoresis in polyacrylamide gel. RESULTS: Total and protein nitrogen showed a sharp decrease during the first 3 postpartum days, whereas the nonprotein nitrogen did not change markedly (mean concentration, 0.58 mg.ml-1). Casein content expressed as nitrogen in preterm human milk was 0.35 mg.ml-1 between days 3 and 5 and 0.60 mg.ml-1 between days 6 and 10. The whey protein-casein ratio before day 2, was 100:0, at day 3, 86:14, at day 5, 76:24, and at day 10, 70:30. Three days after delivery, casein levels rose progressively, increasing markedly after day 6. CONCLUSIONS: These findings suggest that delivering before term affects neither casein production nor its chemical characteristics.