RESUMEN
Abstract The family Chironomidae (Diptera) is the most widely distributed, most diverse, and often the most abundant of all families of benthic macroinvertebrates in aquatic ecosystems, including estuaries and other coastal marine ecosystems. Chironomid assemblages are likely to provide a useful measure of biotic integrity in estuaries of Costa Rica, which lack an intensive estuarine bioassessment tool to support environmental monitoring and regulatory programs. We characterized the taxonomic composition of Chironomidae, tested a Chironomidae Index of Biotic Integrity (CIBI) developed from extrinsic pollution tolerance values for its efficacy in evaluating the surface water quality and physical habitat, and made recommendations for increasing the sensitivity of the CIBI to detect differing degrees of stress across a range of estuaries in Costa Rica. Specifically, we selected nine estuaries within six different watersheds across a land use gradient located on the Caribbean coast of Costa Rica and collected Chironomidae surface-floating pupal exuviae (SFPE) samples biannually for two consecutive years (July 2012, Jan. 2013, July 2013, Jan. 2014). We identified 228 morphospecies and 70 genera from 17 071 Chironomidae pupal exuviae collected from nine estuaries, which ranked in the following order from lowest to highest biotic integrity based on CIBI scores: Estero Negro, Laguna Cuatro, Laguna Jalova, Laguna del Tortuguero, Río Parismina, Laguna Barra del Colorado, Río Pacuare, Río Bananito, and Río Estrella. The CIBI successfully differentiated between estuaries with poor versus good biotic integrity, indicating that CIBI could be used to evaluate the surface water quality and physical habitat of Costa Rican estuaries. We recommend that future studies refine our approach by developing regionally accurate genus and corresponding species-level tolerance values to improve the sensitivity of the CIBI for biological monitoring of Costa Rican estuaries. Rev. Biol. Trop. 66(3): 1118-1134. Epub 2018 September 01.
Resumen La familia Chironomidae (Diptera) es la más ampliamente distribuida, más diversa y a menudo, la más abundante de todas las familias de macroinvertebrados bentónicos en ecosistemas acuáticos, incluyendo estuarios y otros ecosistemas marinos. Probablemente, los ensambles de quironómidos proporcionen una medida útil de integridad biótica en estuarios de Costa Rica, los cuales carecen de una herramienta de evaluación biológica que respalde programas de monitoreo ambiental y programas regulatorios. Caracterizamos la composición taxonómica de Chironomidae, probamos un Índice de Integridad Biótica de Chironomidae (CIBI) desarrollado a partir de valores de tolerancia de contaminación extrínseca, por su eficacia en evaluar la calidad de la superficie del agua y el hábitat físico. Además, realizamos recomendaciones para incrementar la sensibilidad del CIBI para detectar diferentes grados de estrés en un rango de estuarios en Costa Rica. Específicamente, seleccionamos nueve estuarios dentro de seis cuencas diferentes a lo largo de un gradiente de uso de suelo en la costa Caribe de Costa Rica y recolectamos muestras de las exuvias pupales que flotan en la superficie (SFPE) por dos años consecutivos (Julio 2012, Enero 2013, Julio 2013, Enero 2014). Identificamos 228 morfoespecies y 70 géneros de 17 071 exuvias de pupas de Chironomidae recolectadas en nueve estuarios, los cuales se clasificaron en el siguiente orden de menor a mayor integridad biótica basado en los valores del CIBI: Estero Negro, Laguna Cuatro, Laguna Jalova, Laguna del Tortuguero, Río Parismina, Laguna Barra del Colorado, Río Pacuare, Río Bananito, y Río Estrella. El CIBI diferenció eficazmente entre estuarios con integridad biótica pobre versus buena, indicando que el CIBI puede ser usado para evaluar la calidad de la superficie del agua y el hábitat físico de estuarios de Costa Rica. Recomendamos que estudios futuros refinen nuestro planteamiento desarrollando valores de tolerancia de géneros precisos regionalmente y niveles correspondientes de especies para mejorar la sensibilidad del CIBI para el monitoreo de estuarios de Costa Rica.
Asunto(s)
Animales , Fauna Béntica/análisis , Chironomidae/clasificación , Chironomidae/fisiología , Ecosistema , Estuarios , Costa Rica , BiotaAsunto(s)
Hamartoma/patología , Enfermedades de la Piel/patología , Adolescente , Dorso/patología , Humanos , MasculinoRESUMEN
OBJECTIVE: Black individuals are at an increased risk of myocardial infarction and stroke, 2 vascular diseases with strong thrombotic components. Platelet activation is a key step in platelet clot formation leading to myocardial infarction and stroke, and recent work supports a racial difference in platelet aggregation through the thrombin protease-activated receptors (PARs). The underlying mechanism for this racial difference, however, has not been established. Determining where in the signaling cascade these racial differences emerge will aid in understanding why individuals of differing racial ancestry may possess an inherent difference in their responsiveness to antiplatelet therapies. APPROACH AND RESULTS: Washed human platelets from black volunteers were hyperaggregable in response to PAR4-mediated platelet stimulation compared with whites. Interestingly, the racial difference in PAR4-mediated platelet aggregation persisted in platelets treated ex vivo with aspirin and 2MeSAMP (2-methylthioadenosine 5'-monophosphate triethylammonium salt hydrate), suggesting that the racial difference is independent of secondary feedback. Furthermore, stimulation of platelets from black donors with PAR4-activating peptide showed a potentiated level of activation through the Gq pathway compared with platelets from white donors. Differences in signaling included increased Ca(2+) mobilization, Rap1 (Ras-related protein 1) activation, and integrin αIIbß3 activation with no observed difference in platelet protein expression between the groups tested. CONCLUSIONS: Our study is the first to demonstrate that the Gq pathway is differentially regulated by race after PAR4 stimulation in human platelets. Furthermore, the racial difference in PAR4-mediated platelet aggregation persisted in the presence of cyclooxygenase and P2Y12 receptor dual inhibition, suggesting that current antiplatelet therapy may provide less protection to blacks than whites.
Asunto(s)
Población Negra , Subunidades alfa de la Proteína de Unión al GTP Gq-G11/sangre , Activación Plaquetaria/fisiología , Receptores de Trombina/sangre , Población Blanca , Adulto , Señalización del Calcio , Inhibidores de la Ciclooxigenasa/farmacología , Femenino , Humanos , Masculino , Activación Plaquetaria/efectos de los fármacos , Agregación Plaquetaria/fisiología , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/metabolismo , Prostaglandina-Endoperóxido Sintasas/sangre , Proteína Quinasa C/sangre , Antagonistas del Receptor Purinérgico P2Y/farmacología , Receptores Purinérgicos P2Y12/sangre , Complejo Shelterina , Transducción de Señal , Proteínas de Unión a Telómeros/sangreRESUMEN
Estudios indican que más del 50 por ciento de la población ha padecido alguna vez manifestaciones clínicas relacionadas a trastornos temporomandibulares (TTM). La prevalencia de consultas odontológicas por dolor orofacial ha aumentado, y la edad de inicio de la sintomatología es cada vez más temprana. La etiología de este cuadro es multifactorial, debida entre otros a hábitos parafuncionales. La onicofagia es una parafunción prevalente en niños. Está relacionada a la tensión psíquica, por lo cual el sujeto puede presentar el hábito parafuncional de manera continua o por períodos exacerbados por estrés. Esto justifica su alta prevalencia en la sociedad actual. El objetivo de nuestro estudio fue recopilar de manera clara y actualizada la información disponible y concluir si la literatura científica relaciona la onicofagia y las manifestaciones clínicas de TTM en niños con dentición mixta, primera y/o segunda fase. Gracias a esto surgió la siguiente pregunta clínica: ¿Relaciona la literatura científica actual, el mal hábito de onicofagia con las manifestaciones clínicas de TTM en individuos con dentición mixta primera y/o segunda fase? En cuanto a la metodología utilizada, se procedió al análisis acucioso de cada referencia, dónde se analizó: La calidad de la información, la validez y su consecuente grado de recomendación. Por último, concluimos que para contestar nuestra pregunta clínica y analizar medidas de salud pública, es necesario realizar más estudios sobre el tema. Para lograr generar un impacto a nivel poblacional, es necesario educar y crear consciencia a nivel social, y capacitar más profesionales para tratar estas alteraciones tempranamente.
Studies indicate that over 50 percent of the population has ever had symptoms related to temporomandibular disorders (TMD). The prevalence of dental visits for orofacial pain has increased and the age of onset of symptoms is increasingly early. The etiology of this condition is multifactorial, due to parafunctional habits, among others. Onychophagia is prevalent in children. It is related to mental stress, so the subject may have continuous parafunctional habits or periods exacerbated by stress. This justifies its high prevalence in modern society. The aim of this study was to compile the available information in the literature to conclude whether onychophagia is related to clinical manifestations of TMD in children with mixed dentition, first and/or second phase. This brought the following clinical question: Does the current literature relate onychophagia with clinical manifestations of TMD in individuals with mixed dentition first and / or second phase? Regarding the methodology, we proceeded to review each reference, where the quality of information, validity and consequent degree of recommendation were analyzed. Finally, we conclude that to answer our question, more clinical studies and public health measures are needed on the subject. To achieve an impact on the population it is necessary to educate and raise awareness at a social level, and train more professionals to treat these disorders early.
Asunto(s)
Humanos , Dentición Mixta , Hábito de Comerse las Uñas , Trastornos de la Articulación Temporomandibular/epidemiologíaRESUMEN
OBJECTIVE: The transportation of critically ill patients in the French West Indies represents a real challenge; in order to ensure territorial continuity of health care provision, the cardiac surgical department of the Fort-de-France Hospital created a mobile ECMO/ECLS unit. The aim of our work is to describe the logistical, technical and financial aspects of the interhospital transfer of ECMO/ECLS-assisted patients in the French Caribbean. PATIENTS AND METHODS: All ECMO/ECLS-assisted patients in the French Antilles-Guyane area subsequently repatriated towards the Fort-de-France Hospital were included from December 29th, 2009 to September 30th, 2011. Indication and type of the extracorporeal assistance used, location of departure, type of transport vehicle, complications during transfer, survival after hospital discharge and direct costs were collected. RESULTS: Nineteen patients were supported by our mobile unit far away from our centre (sex-ratio 0.63, median age 34years old [16-64]). Twelve were assisted by ECMO for a refractory ARDS, and seven were assisted by ECLS for a refractory cardiogenic shock. Four patients were transferred by ambulance (7-29km), seven by helicopter (190-440km), and eight by plane (440-1430km). No patient died during transfer. No major adverse event occurred during these transfers. Fifteen patients survived. An economic assessment was conducted. CONCLUSION: Interhospital transfer of ECMO/ECLS-assisted patients by land or air is technically feasible under perfectly secure conditions in our area. Prior coordination of this activity has helped to make it affordable.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Unidades Móviles de Salud , Transferencia de Pacientes/organización & administración , Transporte de Pacientes/métodos , Adulto , Aeronaves/economía , Ambulancias/economía , Servicio de Cardiología en Hospital/organización & administración , Áreas de Influencia de Salud , Costos y Análisis de Costo , Equipo Médico Durable/economía , Equipo Médico Durable/estadística & datos numéricos , Ergonomía , Oxigenación por Membrana Extracorpórea/instrumentación , Femenino , Guyana Francesa , Guadalupe , Sustancias Peligrosas , Hospitales Universitarios/economía , Hospitales Universitarios/organización & administración , Humanos , Masculino , Martinica , Persona de Mediana Edad , Unidades Móviles de Salud/economía , Transferencia de Pacientes/economía , Servicio de Cirugía en Hospital/organización & administración , Transporte de Pacientes/economía , Transporte de Pacientes/estadística & datos numéricos , Pesos y Medidas , Indias OccidentalesRESUMEN
OBJECTIVES: By using tracer techniques, we explored the metabolic mechanisms by which pioglitazone treatment for 16 weeks improves oral glucose tolerance in patients with type 2 diabetes when compared to subjects without diabetes. METHODS: In all subjects, before and after treatment, we measured rates of tissue glucose clearance (MCR), oral glucose appearance (RaO) and endogenous glucose production (EGP) during a (4-h) double tracer oral glucose tolerance test (OGTT) (1-(14)C-glucose orally and 3-(3)H-glucose intravenously). Basal hepatic insulin resistance index (HepIR) was calculated as EGPxFPI. beta-cell function was assessed as the incremental ratio of insulin to glucose (DeltaI/DeltaG) during the OGTT. RESULTS: Pioglitazone decreased fasting plasma glucose concentration (10.5 +/- 0.7 to 7.8 +/- 0.6 mM, P < 0.0003) and HbA1c (9.7 +/- 0.7 to 7.5 +/- 0.5%, P < 0.003) despite increased body weight and no change in plasma insulin concentrations. This was determined by a decrease both in fasting EGP (20.0 +/- 1.1 to 17.3 +/- 0.8 micromol/kg(ffm) min, P < 0.005) and HepIR (from 8194 declined by 49% to 3989, P < 0.002). During the OGTT, total glucose Ra during the 0- to 120-min time period following glucose ingestion decreased significantly because of a reduction in EGP. During the 0- to 240-min time period, pioglitazone caused only a modest increase in MCR (P < 0.07) but markedly increased DeltaI/DeltaG (P = 0.003). The decrease in 2h-postprandial hyperglycaemia correlated closely with the increase in DeltaI/DeltaG (r = -0.76, P = 0.004) and tissue clearance (r = -0.74, P = 0.006) and with the decrease in HepIR (r = 0.62, P = 0.006). CONCLUSIONS: In diabetic subjects with poor glycaemic control, pioglitazone improves oral glucose tolerance mainly by enhancing the suppression of EGP and improving beta-cell function.
Asunto(s)
Diabetes Mellitus Tipo 2/prevención & control , Hiperglucemia/prevención & control , Americanos Mexicanos , Tiazolidinedionas/uso terapéutico , Glucemia/metabolismo , Radioisótopos de Carbono/farmacocinética , Diabetes Mellitus Tipo 2/sangre , Ayuno/sangre , Femenino , Glucosa/farmacocinética , Prueba de Tolerancia a la Glucosa/métodos , Humanos , Hiperglucemia/sangre , Insulina/sangre , Masculino , Tasa de Depuración Metabólica , Persona de Mediana Edad , Pioglitazona , Texas , Resultado del Tratamiento , Tritio/farmacocinéticaRESUMEN
OBJECTIVE: To determine the relationship of intravenous (IVGTT) and oral (OGTT) glucose tolerance tests abnormalities to diabetes development in a high-risk pre-diabetic cohort and to identify an optimal testing strategy for detecting preclinical diabetes. STUDY DESIGN: Diabetes Prevention Trial-Type 1 Diabetes (DPT-1) randomized subjects to oral (n = 372) and parenteral (n = 339) insulin prevention trials. Subjects were followed with IVGTTs and OGTTs. Factors associated with progression to diabetes were evaluated. RESULTS: Survival analysis revealed that higher quartiles of 2-hour glucose and lower quartiles of first phase insulin response (FPIR) at baseline were associated with decreased diabetes-free survival. Cox proportional hazards modeling showed that baseline body mass index (BMI), FPIR, and 2-hour glucose levels were significantly associated with an increased hazard for diabetes. On testing performed within 6 months of diabetes diagnosis, 3% (1/32) had normal FPIR and normal 2-hour glucose on OGTT. The sensitivities for impaired glucose tolerance (IGT) and low FPIR performed within 6 months of diabetes diagnosis were equivalent (76% vs 73%). CONCLUSIONS: Most (97%) subjects had abnormal IVGTTs and/or OGTTs before the development of diabetes. The highest sensitivity is achieved using both tests.
Asunto(s)
Glucemia/metabolismo , Diabetes Mellitus Tipo 1/diagnóstico , Glucosa , Síndrome Metabólico/sangre , Edulcorantes , Administración Oral , Adolescente , Niño , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/etiología , Femenino , Glucosa/administración & dosificación , Prueba de Tolerancia a la Glucosa/métodos , Humanos , Masculino , Síndrome Metabólico/complicaciones , Modelos de Riesgos Proporcionales , Reproducibilidad de los Resultados , Edulcorantes/administración & dosificaciónRESUMEN
The rational evaluation of hair disorders requires familiarity with follicular anatomy. Hair structure can be easily examined by studying clipped hair shafts, entire hairs gently pulled or forcibly plucked from the scalp, and scalp biopsies (sectioned vertically or transversely). Anatomic features will be different depending on whether a given hair is in the anagen, catagen, or telogen phase. Follicle size will also vary, from the minute vellus hair to the long, thick terminal hair. Each follicle can be divided into distinct regions--bulb, suprabulbar zone, isthmus, and infundibulum. Activity growing (anagen) hairs are characterized by a hair matrix surrounding a dermal papilla; inner and outer root sheaths are present and well developed. A catagen hair can be identified by its markedly thickened vitreous layer and fibrous root sheath, which surrounds an epithelial column; above this column, the presumptive club forms. A telogen hair is distinguished by its fully keratinized club, which is surrounded by an epithelial sac. Below this lies the secondary hair germ and condensed dermal papilla, waiting for the mysterious signal that initiates a new life cycle.
Asunto(s)
Humanos , Cabello/anatomía & histología , Cabello/crecimiento & desarrollo , Cabello/embriología , Cabello/patología , Enfermedades del Cabello/diagnóstico , Enfermedades del Cabello/patología , Manejo de EspecímenesRESUMEN
We report on 21 male patients who presented after 28 days of age with ornithine transcarbamylase (OTC) deficiency, which we define as late-onset OTC deficiency. These patients appeared normal at birth, but irritability, vomiting, and lethargy, which were often episodic, later developed. The age at presentation ranged from 2 months to 44 years. Biochemical testing revealed hyperammonemia, hyperglutaminemia, hypocitrullinemia, increased urinary orotate excretion, and decreased liver OTC activity measured in vitro, which ranged from 0% to 15% of normal. Male patients who were older at presentation had a somewhat different pattern of presenting symptoms and were more likely to die. These data illustrate the phenotypic variability of OTC deficiency. Unexplained episodes of repetitive or protracted vomiting in association with progressive alterations in behavior or neurologic findings should suggest the diagnosis of a urea cycle defect (or another symptomatic inborn error of metabolism), regardless of the age or medical history of the patient.
Asunto(s)
Errores Innatos del Metabolismo/diagnóstico , Enfermedad por Deficiencia de Ornitina Carbamoiltransferasa , Adolescente , Adulto , Niño , Preescolar , Protocolos Clínicos , Humanos , Lactante , Masculino , Errores Innatos del Metabolismo/genética , Errores Innatos del Metabolismo/fisiopatología , Linaje , Fenotipo , Factores Sexuales , Factores de TiempoRESUMEN
A cohort of 129 infants with birth weights less than or equal to 1250 gm was followed for more than 4 1/2 years (mean +/- SD: 60 +/- 10 months) to determine the independent effects of two medical risk factors--intracranial hemorrhage and severe chronic lung disease--and a parenting risk factor (abuse or neglect) on neurodevelopmental outcome. In infants without any intracranial hemorrhage or parenting risk factors, severe chronic lung disease was not related to neurologic or cognitive outcome. Infants with increasing grades of intracranial hemorrhage had increasing rates of neurologic and cognitive abnormalities. However, the factor associated with the highest incidence of later abnormality was the parenting risk factor. We conclude that infants with medical risk factors may have additional social risk factors, and that both of these influences must be considered in an examination of the long-term sequelae of neonatal complications.
Asunto(s)
Hemorragia Cerebral/fisiopatología , Maltrato a los Niños/fisiopatología , Desarrollo Infantil , Recién Nacido de Bajo Peso , Recien Nacido Prematuro , Trastornos Respiratorios/fisiopatología , Preescolar , Cognición , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Masculino , Examen Neurológico , Pronóstico , Análisis de Regresión , Factores de Riesgo , Factores SocioeconómicosRESUMEN
This report summarizes our experience with DNA analysis using a complementary DNA probe for ornithine transcarbamylase in 24 individuals or families with deficiency of this enzyme. In four cases, including three reported elsewhere, a Taql restriction site alteration directly detected the mutation. In 10 additional cases, only an affected male was available, and results of DNA analysis using the Taql enzyme were normal. In 10 cases, family studies were performed with the use of restriction fragment length polymorphisms. Prenatal diagnostic studies were performed for three informative pregnancies, and two affected male fetuses were identified. Analysis of two restriction fragment length polymorphisms, Mspla and BamHl, was informative in 14 of 19 (74%) known carrier females and in 21 of 35 (60%) females (the total number studied). One female previously predicted to be a noncarrier by protein-loading test was determined to be a carrier by analysis of restriction fragment length polymorphisms. The frequency of Taql site alterations was 4 of 24 families (17%). These data illustrate the importance of DNA analysis, pedigree analysis, and biochemical testing in families with ornithine transcarbamylase deficiency to detect carriers and establish the diagnosis prenatally.
Asunto(s)
Tamización de Portadores Genéticos , Enfermedad por Deficiencia de Ornitina Carbamoiltransferasa , Diagnóstico Prenatal , Southern Blotting , ADN/análisis , Femenino , Humanos , Masculino , Linaje , Polimorfismo de Longitud del Fragmento de Restricción , EmbarazoRESUMEN
The natural history of Williams syndrome, including medical complications, growth patterns, and problems in adulthood, was investigated. A growth pattern characterized by delay in the first 4 years of life, catch-up growth in childhood, and low ultimate adult height was found. Despite multiple medical problems in infancy, including feeding problems, failure to thrive, colic, and otitis media, mean age at diagnosis was 6.4 years. Developmental disabilities and cardiovascular disease were the major concerns in childhood. The older children developed progressive joint limitation and hypertonia. Adult patients were handicapped by their developmental disabilities. Hypertension, and gastrointestinal and genitourinary problems occurred frequently. Independent living and competitive employment were limited less by the individual's physical problems than by the psychologic and adaptive limitations. Williams syndrome is a progressive disorder with multisystem involvement.
Asunto(s)
Anomalías Múltiples , Trastornos del Crecimiento , Discapacidad Intelectual , Anomalías Múltiples/patología , Adolescente , Adulto , Niño , Preescolar , Discapacidades del Desarrollo , Cara , Femenino , Trastornos del Crecimiento/patología , Humanos , Lactante , Masculino , Pronóstico , SíndromeRESUMEN
Nine patients with achondroplasia who were seen over a three-year period developed significant respiratory complications. Eight had sleep-disordered breathing, including obstructive sleep apnea in five, for which two required tracheostomy. Of the seven patients with significant hypoxemia, five had clinical evidence of cor pulmonale and recurrent pulmonary infiltrates. Two patients died, one with autopsy findings of compression of the medulla at the level of the foramen magnum and one with respiratory and cardiac failure. Appropriate therapy for our patients depended on recognition of the mechanisms that led to the respiratory complications, including (1) chest deformity, (2) upper airway obstruction and sleep-disordered breathing, (3) neurologic complications, and (4) coincidental chronic pulmonary conditions such as asthma.