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INTRODUCTION: Mandibular Advancement Devices (MAD) have been reported to be an alternative treatment to CPAP in moderate to severe obstructive sleep apnea (OSA) cases. The design of MAD has a major influence on its success rate on the patient, and design features that have an influence on efficacy, tolerance, and compliance. The aim of this study was to determine the range of mandibular protrusion at different vertical points; 2, 5, 8 and 11 mm in a young adult population. METHODS: Fifty two students aged 19 to 23 years (mean 21.3 ± 1.7; 29 females and 23 males), with full permanent dentition participated in the study. The absolute range of maximal mandibular protrusion and retrusion was measured (mm) with the use of the George Gauge. Descriptive statistics, ANOVA and paired t-test using SPSS were used. RESULTS: Range of mandibular advancement was possible to be determined for the 4 levels of vertical opening with the gauges: 2 mm fork mean mandibular advance 13,10 mm ± 0.604; 5 mm mean 11.98 mm ± 1.075; 8 mm mean 11.20 mm ± 1.369; 11 mm mean 9.87 mm ± 1.886. No significant differences were found between class I, II, and III. CONCLUSIONS: There is an impact of increased inter-incisal distance of effective mandibular protrusion when constructing a MAD. As vertical dimension increases the mandible rotates posteriorly and places itself in a more retrusive location, and the range of mandibular advancement reduces (0.3 mm for every 1 mm of vertical increase).

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INTRODUCTION: Lysosomal acid lipase deficiency (LAL-D) causes progressive cholesteryl ester and triglyceride accumulation in the lysosomes of hepatocytes and monocyte-macrophage system cells, resulting in a systemic disease with various manifestations that may go unnoticed. It is indispensable to recognize the deficiency, which can present in patients at any age, so that specific treatment can be given. The aim of the present review was to offer a guide for physicians in understanding the fundamental diagnostic aspects of LAL-D, to successfully aid in its identification. METHODS: The review was designed by a group of Mexican experts and is presented as an orienting algorithm for the pediatrician, internist, gastroenterologist, endocrinologist, geneticist, pathologist, radiologist, and other specialists that could come across this disease in their patients. An up-to-date review of the literature in relation to the clinical manifestations of LAL-D and its diagnosis was performed. The statements were formulated based on said review and were then voted upon. The structured quantitative method employed for reaching consensus was the nominal group technique. RESULTS: A practical algorithm of the diagnostic process in LAL-D patients was proposed, based on clinical and laboratory data indicative of the disease and in accordance with the consensus established for each recommendation. CONCLUSION: The algorithm provides a sequence of clinical actions from different studies for optimizing the diagnostic process of patients suspected of having LAL-D.

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This is a cohort, retrospective, comparative study of all liver transplant recipients from a single center, from May 1998 to July 2015. Patients were divided into two groups according to the type of Epstein-Barr viral load monitoring. For group I (1998-2007), polymerase chain reaction (PCR) was not available or it was only qualitative with limited access. For group II (2008-2015), we used periodically scheduled quantitative PCR in plasma and leukocytes, with aggressive tapering of immunosuppression as soon as viral replication was detected. Ninety-eight recipients were included, 41 (41.8%) were Epstein-Barr virus (EBV) - seronegative before liver transplantation (LT). EBV replication was confirmed in 74 patients (75.5%), being more frequent in seronegative (87.8%) than seropositive patients (66.6%). Eight recipients (8.1%) developed post-transplantation lymphoproliferative disorder (PTLD) on average at 14.3 months post-LT, seven of eight were <3 years at LT, four of eight were D+/R- for EBV, and all had post-LT EBV replication confirmed by PCR. PTLD was classified as lymphoma (n = 4), polymorphic polyclonal (n = 3), and lymphoid hyperplasia (n = 1). Five patients died, and three cleared PTLD after immunosuppression tapering or interruption. There were no significant differences in the etiology, age at LT (5.6 vs. 7.3 years, P = .069), patients <4 years (53.2% vs. 35.3%, P = .103), or EBV seronegative recipients (44.7% vs. 37.3%, P = .54); however, the incidence of PTLD decreased from 14.9% to 1.9% (P = .026), and graft rejection from 51.1% to 29.4% (P = .039). One- and 5-year patient survival rates were 94.7% and 85%, respectively, with no differences between groups. This strategy dramatically decreased the incidence of PTLD (14.9% vs. 1.9%), without increasing the incidence of rejection; therefore, we recommend that it should be used in the follow-up of all pediatric LT recipients.

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Genotypic differences in Helicobacter pylori play an important role in infection. We characterized the diversity of the cagA, cagE, babA2, and vacA genes in H. pylori strains isolated from pediatric patients and the relationship between these genes and clinical disease. Additionally, we employed the Neighbor-net algorithm to predict the behavior of the genotypes of the strains isolated from patients. Of 93 patients analyzed, 32 were positive for infection. A total of 160 H. pylori strains (five isolates per positive patient) were analyzed. A total of 91% and 83% of strains possessed the cagA and cagE genes, respectively. For the vacA gene, 84% of strains possessed the s1 allele, 15% the s2 allele, 81% the m1 allele and 13.8% the m2 allele. The babA2 gene was present in 79% of strains. Infection with H. pylori strains with the vacA (s1m1) genotype was associated with risk of esophagitis and gastritis (p=0.0001). The combination of cagA and vacA (s1m1) was significantly associated with abdominal pain (p=0.002); however, EPIYA type was not significantly associated with abdominal pain. A total of 16 different genotypes were identified; the most common genotype was vacAs1m1cagA+cagE+babA2+ (47.5%). A total of 84% of pediatric patients were infected by at least two and up to five different genotypes. The network recovered two genotype groups (A: strains with vacAs1 and B: strains with vacAs2). The presence of multiple paths in the network suggests that reticulate events, such as recombination or reinfection, have contributed to the observed genotypic diversity.

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Oxidative stress can play a key role in Cd-induced dysfunctions. Quercetin is a potent oxygen free radicals scavenger and a metal chelator. Our aim was to study the effect of quercetin on Cd-induced kidney damage and oxidative stress as well as its mechanism of action. Wistar rats were distributed in four experimental groups: control rats; Cd; quercetin and Cd+quercetin. Renal toxicity was evaluated by measuring urinary excretion of proteins, albumin, glucose and enzymes markers of tubular necrosis, as well as plasma concentration of creatinine. Plasma TBARS concentration and activity of antioxidant enzymes in kidney were also measured. Renal cell damage was assessed by electron microscopy. Animals that received both Cd and quercetin showed a better renal function than those receiving Cd alone. Cd-induced tubular lesions were markedly reduced in rats that also received quercetin. Cd-induced increase in plasma TBARS was prevented by the administration of quercetin. Total plasma antioxidants and renal superoxide dismutase and glutathione-reductase activities were higher in the group that received Cd and quercetin than in rats that received Cd alone. Quercetin administration does not modify the renal content or the urinary excretion of Cd. In conclusion, quercetin treatment prevents renal tubular damage and increased oxidative stress induced by chronic Cd administration, most probably throughout its antioxidant properties.

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Objetivo: evaluar la utilidad práctica de una herramienta que cuantifica de forma objetiva, numérica, el potencial sociofamiliar de cuidados domiciliarios en pacientes paliativos. Ensayar las condiciones y requisitos para plantear un estudio de validación. Método: la escala se basa en el formulario expuesto, que valora 5 dimensiones: Cuidadores, características del domicilio, situación socioeconómica, asistencia médica y otros apoyos sociales. Cada una de ellas, se desglosa en ítems, que se cuantifican numéricamente pudiendo oscilar el resultado total entre 0 y 100. Para su valoración numérica hemos desarrollado una sencilla aplicación informática, que se puede conseguir libremente en nuestra página Web: http://www.infonegocio.com/inssocial. En este trabajo hemos evaluado 50 registros, correspondientes a 48 pacientes no seleccionados ingresados en nuestra Unidad. Resultados: se detallan el estudio estadístico descriptivo de las puntuaciones globales obtenidas, la distribución de los resultados por frecuencia y porcentaje, así como los valores obtenidos en cada una de las dimensiones, consideradas individualmente. Subjetivamente, las puntuaciones resultantes nos parecen proporcionadas y acordes a las circunstancias observadas en pacientes concretos. En nuestra opinión es un instrumento útil en la identificación de problemas y objetivos a trabajar por el equipo, y es un índice dinámico, sensible y susceptible de variar en base a actuaciones concretas. Conclusiones: la Escala de Capacidad de Cuidados en Domicilio (ECCD) puede ser una herramienta útil en la valoración integral de nuestros enfermos. Algunos aspectos metodológicos deben ser discutidos, corregidos y consensuados por expertos. Es necesario un estudio de validación amplio y riguroso, que determine su valor real (AU)

Objective: the objective was to evaluate the practical utility of a tool to objectively and numerically quantitate the socio-familial potential of home care for patients on palliative care, and also to rehearse conditions and requirements in order to outline a validation study. Method: the scale is based on the shown form, which assesses 5 dimensions: caregivers, home characteristics, socio-economic status, medical care, and other social support. Each one of them is made up by quantified items whose results may oscillate between 0 and 100. For their numeric valuation we developed a simple computer application that you can download free of charge from our Web page: http://www.infonegocio.com/inssocial. In this work we have evaluated 50 registrations, corresponding to 48 non-selected patients hospitalized in our Unit. Results: we detail the descriptive statistical study of the overall scores obtained, the distribution of results according to frequency and percentage, and the values obtained for each individual dimension. Subjectively, we find the resulting scores proportionate and in accordance with the circumstances seen in specific patients. In our opinion this is a useful tool for the identification of problems and objectives for the team to work upon, as well as a dynamic and sensitive index that may vary depending on specific procedures. Conclusions: Escala de Capacidad de Cuidados en Domicilio (ECCD)(Home Care Capacity Scale-HCCS) may be a useful tool for the integral assessment of patients. Some methodological aspects should be discussed, corrected, and agreed upon by experts. An extensive, rigorous validation study is needed to establish its real worth (AU)

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Orthotopic liver transplantation (OLT) has been very difficult to develop in Mexico and for many years its occurrence was anecdotal. This report presents the results of a pediatric liver transplant program, analyzing the variables that affect outcomes. Between June 1998 and March 2004, 35 OLT were performed in 34 recipients including 80% cadaveric whole-organ grafts and 20% segmental grafts, with 11% from cadaveric and 9% from living donors. Most of the recipients were infants or toddlers weighing less than 15 kg. There was only 1 case of arterial thrombosis (2.8%); the graft was saved with a Kasai procedure. Biliary complications were present in 22% of cases, all resolved with reoperations. Posttransplant cytomegalovirus infection or reactivation (28%), acute rejection (25%), or posttransplant lymphoproliferative disorders (5.7%) were not a cause of graft or patient loss. Overall, 1- and 5-year patient survival rates are 77.1% and 74.2%, respectively; however, when the 1998-2000 cohort was compared with the 2001-2004 cohort, there was a significant difference in survival (P = .004). The 1-year patient survival for the later group is 91.6%. We performed the first successful living donor liver transplantation and the first simultaneous liver-kidney transplantation in a child in our country. Our results demonstrate that pediatric liver transplantation is a feasible undertaking in Mexico, with survival rates comparable to those of foreign centers.

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Mediterranean diet has been related to a low risk of coronary hearth disease. In the present study, we have evaluated the effect of substituting 120 g of meat by 120 g of acorn-fed Iberian ham (one of the meat components of the Mediterranean diet) on body weight, blood pressure (MAP), plasma lipids and oxidant-antioxidant equilibrium in 13 males and 8 females with an average age of 71. Study was performed in three periods: basal diet evaluations (BD1), ham diet for 6 weeks (HD), and basal diet again for 6 weeks (BD2). MAP significantly diminished from 96 mmHg in BD1 to 89 mmHg after HD. After BD2, MAP remained in the same value. Plasma total antioxidant substances increased from 0.791 mmol/L in BD1, to 1.525 in HD, and to 1.213 in BD2. Glutathione reductase significantly increased from 49.5 U/L in BD1 to 57 in HD and decreased to 49.2 in BD2. Glutathione peroxidase rose from 33 U/gHb in BD1 to 72 in HD and decreased to 52 in BD2. Superoxide dismutase increased from 401 U/gHb in BD1 to 723 in HD and decreased to 433 in BD2. Plasma thiobarbituric acid reacting substances (TBARS) fall from 1.65 mmol/l in BD1 to 1.38 in HD and to 1.47 in BD2. TBARS in erythrocyte membranes also diminished but only in BD2. It can be concluded that including acorn-fed Iberian ham in the diet increased the antioxidant substances and decrease lipid peroxidation, with its subsequent beneficial effects on the atherogenic risk factors.

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BACKGROUND: The social problematic one of the patient often conditions the medical therapeutic attitude, being able to force the hospital admission, to be able to guarantee its attention. In spite of its frequency, we do not have objective procedures that they allow us to quantify and to value its severity. OBJECTIVES: 1 degree: To define the concept of social insufficiency (SI). 2 degrees: To enunciate a formula that allows us to quantify it objectively. 3 degrees: To make a practical validation of the procedure. METHODS: We did not find in the bibliographical revision, a similar descriptive term neither procedures in order to quantify it. For that reason, we elaborated our own scale of social valuation, applying it within a protocol that also includes clinical aspects, valuations functional physical, mental and cognitive. The SI was considered like the quotient, between the functional capacity of the patient and the degree of social support. RESULTS: The SI could be defined as the incapacity of the socioeconomic and familiar surroundings of a patient, in order to guarantee the satisfy all the necessities derived from their pathological state, views from an integral perspective. The relationship between functional capacity (determined by means of the scale of the Red Cross of Valuation of Incapacity) and social support (evaluated by means of our scale) in quotient form, could be used to detect and quantify the SI objectively, being in our opinion a simple and practical procedure. We described to its frequency and severity, as well as the clinical and epidemiological characteristics to whom it is associated with greater statistical significance to that the existence in our means. CONCLUSIONS: The SI is a frequent problem, being necessary to establish their concept and forms of quantification. We propose a formal definition. The relationship between functional capacity and social support, expressed in quotient form, could be used can serve to value the SI objectively.

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Introducción: La problemática social del paciente a menudo condiciona la actitud terapéutica médica, pudiendo obligar al ingreso hospitalario, para poder garantizar su atención. Pese a su frecuencia, no disponemos de procedimientos objetivos que nos permitan cuantificar y valorar su severidad. Objetivos: 1º: Definir el concepto de insuficiencia social (IS). 2º: Enunciar una fórmula que nos permita cuantificarla objetivamente. 3º: Realizar una validación práctica del procedimiento. Métodos: No hallamos en la revisión bibliográfica, un término descriptivo similar ni procedimientos para cuantificarlo. Por ello, elaboramos nuestra propia escala de valoración social, aplicándola dentro de un protocolo que recoge también aspectos clínicos, valoraciones funcionales física, mental y cognitiva. La IS se estimó como el cociente, entre la capacidad funcional del paciente y el grado de apoyo social. Resultados: La IS podría definirse como la incapacidad del entorno socioeconómico y familiar de un paciente, para garantizar el satisfacer todas las necesidades derivadas de su estado patológico, vistas desde una perspectiva integral. La relación entre capacidad funcional (determinada mediante la escala de Cruz Roja de Valoración de Incapacidad) y apoyo social (evaluado mediante nuestra escala) en forma de cociente, puede servir para detectar y cuantificar objetivamente la IS, siendo en nuestra opinión un procedimiento sencillo y práctico. Describimos su frecuencia y severidad, así como los rasgos clínicos y epidemiológicos a los que se asocia con mayor significación estadística su existencia en nuestro medio. Conclusiones: La IS es un problema frecuente, siendo preciso establecer su concepto y formas de cuantificación. Proponemos una definición formal. La relación entre capacidad funcional y apoyo social, expresada en forma de cociente, puede servir para valorar objetivamente la IS (AU)

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Hepatic fibrosis or increased liver collagen contents drive functional abnormalities that, when extensive, may be life threatening. The purpose of this study was to assess the effects of the chronic stimulation or inhibition of nitric oxide synthesis in rats with hepatic fibrosis induced by permanent common bile duct ligation (3 weeks) and the role of expression of the different nitric oxide synthase isoforms. Bile duct ligation led to an important accumulation of collagen in the hepatic parenchyma, as shown both histologically and by the hydroxyproline contents of livers. Bilirubin and serum enzyme activities (measured as markers of cholestasis) increased several-fold after bile duct ligation. The area of fibrotic tissue, liver hydroxyproline content and serum markers of cholestasis were clearly related in obstructed rats. The absence of modifications in haemodynamic parameters excludes circulatory changes from being responsible for the development of liver alterations. In animals treated with NG-nitro-L-arginine methyl ester (L-NAME) the area of fibrosis was similar to that of untreated animals, the signs of cholestasis and cellular injury being more evident. In rats treated with L-arginine the area of fibrosis was almost three times larger than that found in bile duct ligated rats and in L-NAME-treated bile duct ligated rats, although the observed biochemical changes were similar to those seen in rats treated with L-NAME. Our results with inducible nitric oxide synthase, obtained by Western blots and immunohistochemistry, indicate a greater expression of the inducible enzyme in bile duct ligated and L-arginine-treated animals and a lower expression in the L-NAME and control groups. Constitutive nitric oxide synthase expression, obtained by Western blots, was very similar in all groups, except for the L-arginine-treated rats in which it was lower. These results suggest that nitric oxide production may be a key factor in the development of fibrosis in bile duct ligated rats. They also support the hypothesis of a dual role for nitric oxide; one beneficial, mediated by its circulatory effects, and the second negative, through its local toxic effects.

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The present report describes opportunistic infections found at 74 autopsies of pediatric HIV/AIDS patients performed at several hospitals in Latin American countries. Fungal infections were the most common (53 cases), Candida sp. (39.18%) and Pneumocystis carinii (20.27%) being the most frequently recognized. Other fungal diseases included histoplasmosis, aspergillosis, and cryptococcosis. Viral infections were present in 31 cases, 38.7% being due to cytomegalovirus. Other viruses recognized included herpes simplex and adenovirus. Additional opportunistic infections were due to Mycobacterium avium-intracellulare, toxoplasmosis, and tuberculosis. Nonspecific bacterial bronchopneumonia was present in 11 cases. Cytomegalovirus and P. carinii coinfection was the most common association found. In this series patients died at a younger age (72% at or younger than 1 year old) and there was a slightly higher number of cases of histoplasmosis and brain toxoplasmosis than in other previously published series of infants and children.

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The purpose of this study was to describe the detailed anatomy and histology of the right atrioventricular valve apparatus in the chicken. Newborn and adult chicken hearts were studied by anatomic description, light and scanning electron microscopy, and histologic (Masson's trichrome stain) and histochemical (Sirius Red stain) techniques. Our findings indicate the presence of an incomplete fibrous annulus, a great mural leaflet, and multiple microleaflets in the right atrioventricular apparatus of the chicken heart. The great mural leaflet, essentially muscular in structure, extended from the anterior and posterior juxtaseptal commissures and was subdivided into an anterior and a posterolateral region by the attachment of the anterolateral papillary muscle. The posterolateral region presented an intermediate cleft, subdividing this region into an anterior and a posterior portion. Multiple microleaflets, which adhered to the upper right side of the ventricular septum adjacent to the right atrioventricular orifice, inserted directly into the ventricular septum via short chordae tendineae, without papillary muscles. The microleaflets were composed of smooth subendocardial connective tissue, with varying amounts of type I, II and III collagen. In addition, we observed a central fibrous body, leading to fibrous continuity between the mitral and aortic valves and the mitral and right atrioventricular valves. An atrioventricular septum was also present.(ABSTRACT TRUNCATED AT 250 WORDS)

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The neuropathological manifestations of AIDS in children vary widely and includes, among others: cerebral atrophy, basal ganglia calcification, corticospinal tract demyelinization, and HIV encephalomyelitis with multinucleated cells. The purpose of this work is to inform the postmortem CNS findings in 14 pediatric AIDS patients which were studied from January 1986 to February 1992, at the Hospital Infantil de México Federico Gómez. Basal ganglia vascular calcification, HIV multinucleated cells, and corticospinal tract demyelinization, were significantly less frequent (P < 0.01) in our patients than those informed in the literature. Opportunistic CNS infections found in our patients were produced by microorganisms commonly described in adults. We think that these differences may be explained because the majority of our patients acquired the infection trough blood transfusion at an age in which the CNS is fully developed. The pattern of HIV transmission in our country has been changing recently with an increase in the number of perinatal cases. We also think that in the near future we will observe a change in the neuropathological findings of our pediatric AIDS population.

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Several renal and renal-related disturbances have been described in patients with AIDS (acquired immune deficiency syndrome), in adults and children as well. These are mainly electrolyte and acid-base imbalance, acute renal failure and nephrotic syndrome. The latter is usually steroid non-responder. The renal histopathological lesions described more commonly are minimal change, mesangial hyperplasia and focal segmental glomerulosclerosis. Herein, we describe a 5 year-old with AIDS, that developed nephrotic syndrome, characterized by edema, ascites, hypoalbuminemia and massive proteinuria. A percutaneous renal biopsy showed mesangial proliferation. She did not respond to a 6 week treatment with prednisone. She died with sepsis after several viral and bacterial infections.

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Oral manifestations of HIV infection in children include oral candidiasis, herpetic stomatitis, oral hairy leukoplakia, parotid gland swelling, and other bacterial, viral and mycotic infections. The frequency and natural history of those disorders are not fully defined. The purpose of this work is to inform the oral findings in 57 HIV infected children studied at the Hospital Infantil de Mexico. All 57 patients presented nonspecific gingivitis; however it was not feasible to associate it with the HIV infection; in 28 oral candidiasis was observed, and in 3 cases herpetic stomatitis was documented. Oral candidiasis was found regardless the patient's sex, age, clinical stage, treatment, and mode of transmission of the HIV infection. It has been considered that oral candidiasis is a good marker of immunodeficiency; however, in our patients this correlation was not observed. Also, other HIV-associated oral manifestations were not observed in these cases. The severity and rapid clinical course presented by our patients, may explain both, the lack of correlation between candidiasis and immunodeficiency as well as the absence of other lesions.

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