Asunto(s)
Antitiroideos/efectos adversos , Hipotiroidismo Congénito , Bocio/inducido químicamente , Bocio/congénito , Enfermedad de Graves/tratamiento farmacológico , Hipotiroidismo/inducido químicamente , Complicaciones del Embarazo/tratamiento farmacológico , Propiltiouracilo/efectos adversos , Antitiroideos/uso terapéutico , Femenino , Bocio/diagnóstico , Humanos , Hipotiroidismo/diagnóstico , Recién Nacido , Intercambio Materno-Fetal , Embarazo , Propiltiouracilo/uso terapéuticoAsunto(s)
Mordeduras y Picaduras/terapia , Tratamiento de Urgencia , Traumatismos de la Mano/terapia , Rajidae , Adulto , Animales , Cuba , Humanos , MasculinoRESUMEN
The purpose of the analysis described here was to classify not-in-treatment drug users participating in the National Institute on Drug Abuse (NIDA)-sponsored Cooperative Agreement study into several "homogeneous" HIV risk groups using cluster analysis. Data for this analysis (N=17,778) were collected at 19 study sites in the United States and Puerto Rico. Measures selected for the cluster analysis were limited to (a) current drug use and HIV risk behaviors, (b) mutually exclusive behaviors, (c) behaviors directly related to HIV risk, and (d) behaviors that were not statistically rare. Eight homogeneous HIV risk clusters were produced. Crack cocaine use was the most distinguishing feature of three clusters. Another three clusters were distinguishable by drug injection and needle use practices. Two additional clusters could not be grouped with either the crack- or the injection-dominant clusters. Prostitution was the most distinguishing risk behavior of one of these clusters, and extremely high drug injection frequencies and relative rates of risky needle use characterized the other. Composition of the clusters varied significantly by gender, race/ethnicity, educational attainment, and drug use characteristics. In addition, perceptions and behaviors initiated to reduce the chances of becoming infected with HIV varied by cluster. Subjects in the crack-predominant clusters reported low perceptions of the chances of getting AIDS. Perceptions of the chances of becoming infected with HIV among subjects in the injection-predominant clusters were strongly related to injection frequency. Seroprevalence was also related to cluster. Higher rates of HIV infection were evident among the injection-predominant clusters, and higher rates were related to frequency of injection and the rate of risky needle use. Among the crack-predominant clusters, the relationship between drug use and sexual behaviors and HIV infection was less clear.
Asunto(s)
Infecciones por VIH/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/etiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Actitud Frente a la Salud , Brasil/epidemiología , Análisis por Conglomerados , Trastornos Relacionados con Cocaína/epidemiología , Trastornos Relacionados con Cocaína/prevención & control , Cocaína Crack , Femenino , Infecciones por VIH/etiología , Infecciones por VIH/prevención & control , Humanos , Cooperación Internacional , Masculino , Puerto Rico/epidemiología , Asunción de Riesgos , Trabajo Sexual/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/prevención & controlRESUMEN
This study examines the relationship between the patterns of use of alcohol and heroin by narcotics addicts, and evaluates the hypothesis--frequently reported during methadone maintenance--that this form of treatment can be causally implicated in an increased consumption of alcohol. Data were obtained on lifetime patterns of alcohol and heroin use of 375 Anglo and Chicano male addicts sampled from two treatment sources: the nonmethadone (drug-free) California Civil Addict Program (CAP) and several Southern California Methadone Maintenance (MM) programs. Repeated-measures MANOVAs revealed that alcohol and heroin consumption were inversely related throughout the addicts' careers. This pattern was evident in the addiction, treatment, and postdischarge stages of Anglo and Chicano addict careers, in both the CAP and MM samples. Consequently, the authors reject the hypothesis that increased alcohol consumption is caused solely by addicts' participation in methadone maintenance treatment. Rather, the findings suggest that addicts' alcohol use during methadone treatment reflects a lifetime pattern of increased alcohol use following any decline in heroin intake.
Asunto(s)
Consumo de Bebidas Alcohólicas , Dependencia de Heroína/rehabilitación , Metadona/uso terapéutico , Adulto , California , Hispánicos o Latinos , Humanos , Masculino , México/etnología , Población BlancaRESUMEN
Serum levels of thyroid stimulating hormone, thyroxine, triiodothyronine, free T4, thyroxine-binding globulin, reverse T3, and the TSH secretory areas and peak T3 after intravenous injection of 40 micrograms thyrotropin-releasing hormone were determined weekly from day 5 to 6 to 11 weeks of age in 42 unselected full-term and 61 preterm Belgian infants. The results on day 5 indicated a progressive deficit of thyroid function related to the degree of prematurity. In 92 infants this deficit progressively decreased with age and disappeared at 5 to 7 weeks. However, 11 infants developed biochemical evidence of overt but transient hypothyroidism. Belgian neonates are relatively iodine deficient, and this factor affects the constitution of iodine stores within the thyroid gland: (1) the urinary concentrations of iodine in the 103 infants studied in Belgium were markedly lower than in 30 infants from California; and (2) The iodine concentration of the thyroid gland in preterm infants who died during the 10 first days of life was almost three times lower in Brussels than in Toronto. The results indicate that, in Belgium, the effects of relative iodine deficiency on thyroid function are superimposed on and mask the physiologic state of tertiary hypothyroidism in prematurity.
Asunto(s)
Hipotiroidismo/fisiopatología , Enfermedades del Prematuro/fisiopatología , Glándula Tiroides/fisiología , Bélgica , Femenino , Humanos , Hipotiroidismo/sangre , Hipotiroidismo/terapia , Recién Nacido , Yodo/análisis , Estudios Longitudinales , Masculino , América del Norte , Tirotropina/sangre , Hormona Liberadora de Tirotropina/sangre , Tiroxina/sangre , Proteínas de Unión a Tiroxina/análisis , Triyodotironina/sangre , Triyodotironina Inversa/sangreRESUMEN
A radioenzymatic assay was used to measure plasma concentrations of the catecholamines, norepinephrine, and epinephrine in the perinatal period. Samples were obtained at birth from the umbilical artery and vein of infants born by vaginal and by cesarean section delivery; from peripheral venous samples of normal infants during the first 48 hours of life; and from peripheral venous samples of mothers prior to delivery. Concentrations of NE and E were elevated in umbilical samples, with umbilical artery levels exceeding umbilical venous concentrations. Umbilical plasma CAT concentrations were similar in vaginal and cesarean section delivered infants. Plasma concentrations of NE consistently predominated over E in all samples from neonates. Plasma CAT concentrations rapidly fell from cord levels within 15 minutes of delivery and remained at a lower plateau during the first three hours of life. By 12 hours of age plasma CAT concentrations fell to the levels of supine adult resting concentrations. Maternal plasma CAT concentration prior to delivery demonstrated a predominance of E over NE. These elevations of plasma CAT in the early neonatal period may play a rola in nonshivering heat production as well as in cardiovascular alterations associated with birth.
Asunto(s)
Epinefrina/sangre , Recién Nacido , Norepinefrina/sangre , Catecol O-Metiltransferasa , Parto Obstétrico/métodos , Femenino , Sangre Fetal , Humanos , Métodos , Embarazo , Factores de Tiempo , Arterias Umbilicales , Venas UmbilicalesRESUMEN
Pilot programs for screening of newborn infants for congenital hypothyroidism began in North America in 1972. To date, the five oldest programs (Quebec, Pittsburgh, Toronto, Oregon Regional, and New England Regional) have screened 1,046,362 infants. A total of 277 infants with congenital hypothyroidism have been detected and seven have been missed, resulting in a total of 284 affected infants in the screened population and an overall incidence of one in 3,684 live births. Of the affected infants, 246 were determined to have primary hypothyroidism, an incidence of one in 4,254 births. Ten infants with secondary-tertiary hypothyroidism were detected in Quebec, Oregon, and Toronto, an incidence of one in 68,200 births. Of all the infants with primary hypothyroidism who were adequately studied, 63% were determined to have aplastic or hypoplastic glands, 14% normal or enlarged glands, and 23% ectopic thyroid tissue. The estimated minimum incidence of infants with TBG deficiency is one in 8,913 births. Only 8 of the 277 detected infants were suspected clinically to have congenital hypothyroidism prior to the time of confirmation of the diagnosis at 4 to 8 weeks of age. The cost of screening varied from $0.70 to $1.60 per infant, depending on which costs were included in the estimate. Preliminary evidence from Quebec suggests that infants treated in the program have normal developmental testing scores at 18 months of age.
Asunto(s)
Hipotiroidismo Congénito , Tamizaje Masivo , alfa-Globulinas/deficiencia , Humanos , Hipotiroidismo/diagnóstico , Hipotiroidismo/epidemiología , Lactante , Recién Nacido , Tamizaje Masivo/economía , América del Norte , Proteínas de Unión a Tiroxina/deficiencia , Agencias Voluntarias de SaludRESUMEN
Cerebral gigantism is a syndrome consisting of characteristic dysmorphic features, accelerated growth in early childhood, and variable degrees of mental retardation. Its etiology and pathogenesis have not been defined. Three families are presented with multiple affected members. The vertical transmission of the trait and equal expression in both sexes in these families indicates a genetic etiology with a dominant pattern of inheritance, probably autosomal. As in previously reported cases, extensive endocrine evaluation failed to define the pathogenesis of the accelerated growth present in this disorder.
Asunto(s)
Genes Dominantes , Gigantismo/genética , Adolescente , Adulto , Preescolar , Craneosinostosis/genética , Femenino , Humanos , Lactante , Discapacidad Intelectual/genética , Masculino , Linaje , Prognatismo/genética , CráneoRESUMEN
Thyroxine levels were measured in cord blood sera from 2,1800 healthy infants born of "low-risk" mothers in Los Angeles. Variations of T4 with gestational age, birth weight, ponderosity (size related to weight), sex, and race were studied, as well as the variation of W and P with GA. Over the range of GA 30 to 47 weeks, serum T4 concentrations, W, and P each increase with GA, leveling off to approximately constant values from 42 to 47 weeks; the increases are 12, 66, and 20%, respectively. For a fixed GA, T4 increases with increasing W but is not correlated with P; W, GA, and their product are useful measurements for predicting T4, but P is not. Formulas for predicting cord T4 are given for possible use in improving computer-assisted screening programs for congenital hypothyroidism; mean T4 values (+/- I SD) are tabulated against W and GA.
Asunto(s)
Peso al Nacer , Edad Gestacional , Tiroxina/sangre , Etnicidad , Femenino , Humanos , Recién Nacido , Masculino , Factores SexualesRESUMEN
Serum T4 was measured in cord blood of 2,683 infants of gestational ages 30 to 45 weeks and birth weights of 1,460 to 5,250 gm. In addition, serum TBG was measured in 180, and serum TSH in 125 of these infants. Mean serum T4 increased with gestational age from 9.4 microng/dl at 30 weeks to 11.7 at 45 weeks. TBG varied from 3.1 to 11.4 mg/dl but showed no correlation with gestational age. There was a positive correlation between T4 and TBG. Serum TSH levels showed a significant negative correlation with gestational age, decreasing from 15 micronU/ml at 30 weeks to 7 micronU/ml at 45 weeks, while the serum T4/TSH ratio increased from 0.6 to 1.6. The results indicate that cord, T4 varies mainly with TBG, and to a lesser extent with gestational age.
Asunto(s)
Recién Nacido , Glándula Tiroides/fisiología , Sangre Fetal/análisis , Edad Gestacional , Humanos , Recien Nacido Prematuro , Tirotropina/sangre , Tiroxina/sangre , Proteínas de Unión a Tiroxina/análisisRESUMEN
Normal term newborn infants have been studied during the first four hours after birth. Cord blood and brachial venous blood samples were collected for measurement of serum prolactin (n = 15; 11 vaginal delivery; four cesarean section delivery), thyrotropin (n=8), growth hormone (n=7), tri-iodothyronine (n=7) and thyroxine (n=7). The mean cord serum TSH concentration was 12 +/- 2 muU/ml and peaked in all infants 30 minutes after birth (67 +/- 7 muU/ml). Blood PRL also increased in all of the 15 infants studied; the mean cord blood value of 165 +/- 15 ng/ml increased significantly to a mean of 214 +/- 22 ng/ml at 30 minutes and 204 +/- 17 ng/ml at 60 minutes. The peak blood PRL concentration was observed at 30 minutes in eight newborn infants, at 60 minutes in three, and at 120 minutes in four. Mean serum GH concentrations were statistically similar during the first four hours but there was a tendency for serum levels to fall somewhat during the first hour after birth. The mean cord serum T3 concentration (47 +/- 5 mug/ml) increased significantly to a peak value of 227 +/- 38 ng/dl at 120 minutes. The increase in T4 from a mean of 15.3 +/- 1.2 mug/dl to a mean of 17.9 +/- 2.6 mug/dl at four hours was less dramatic. These data are consistent with the possibility that the same mechanism responsible for the neonatal TSH surge may be responsible for a significant but lesser PRL surge during the early minutes after birth.
Asunto(s)
Hormona del Crecimiento/sangre , Recién Nacido , Prolactina/sangre , Tirotropina/sangre , Cesárea , Femenino , Sangre Fetal/análisis , Humanos , Masculino , Tiroxina/sangre , Factores de Tiempo , Triyodotironina/sangreRESUMEN
Total and free T3 and T4 concentrations were measured in human amniotic fluid and in fetal and maternal blood. Before 20 weeks, the mean AF-T4 level was 0.24 mug/dl; there is a progressive increase in concentration with gestational age. At term, the mean AF total T4 level was much less (0.64 mug/dl) than in fetal or maternal serum (9.3 and 11.3 mug/dl, respectively). Most of the T4 (99.4%) in AF is protein bound, presumably to TBG as in serum, but the mean FT4 concentration in AF at term (4.13 ng/dl) was significantly greater than the levels in fetal or maternal serum (2.67 or 2.56 ng/dl, respectively). The mean TBG level in AF at term was 0.26 mg/dl. T3 was not measurable in AF (less than 15 ng/dl). There were no significant correlations between the total or free T4 concentrations in maternal or fetal sera and in amniotic fluid. Thus AF thyroid hormone concentrations in the euthyroid fetus do not reliably reflect fetal serum T4 or T3 concentrations.