Asunto(s)

RESUMEN

Mexican Americans (MAs) have been shown to have worse outcomes after stroke than non-Hispanic Whites (NHWs), but it is unknown if ethnic differences in stroke quality of care may contribute to these worse outcomes. We investigated ethnic differences in the quality of inpatient stroke care between MAs and NHWs within the population-based prospective Brain Attack Surveillance in Corpus Christi (BASIC) Project (February 2009- June 2012). Quality measures for inpatient stroke care, based on the 2008 Joint Commission Primary Stroke Center definitions were assessed from the medical record by a trained abstractor. Two summary measure of overall quality were also created (binary measure of defect-free care and the proportion of measures achieved for which the patient was eligible). 757 individuals were included (480 MAs and 277 NHWs). MAs were younger, more likely to have hypertension and diabetes, and less likely to have atrial fibrillation than NHWs. MAs were less likely than NHWs to receive tPA (RR: 0.72, 95% confidence interval (CI) 0.52, 0.98), and MAs with atrial fibrillation were less likely to receive anticoagulant medications at discharge than NHWs (RR 0.73, 95% CI 0.58, 0.94). There were no ethnic differences in the other individual quality measures, or in the two summary measures assessing overall quality. In conclusion, there were no ethnic differences in the overall quality of stroke care between MAs and NHWs, though ethnic differences were seen in the proportion of patients who received tPA and anticoagulant at discharge for atrial fibrillation.

RESUMEN

Ebola virus causes hemorrhagic fever with a high case fatality rate for which there is no approved therapy. Two human monoclonal antibodies, mAb100 and mAb114, in combination, protect nonhuman primates against all signs of Ebola virus disease, including viremia. Here, we demonstrate that mAb100 recognizes the base of the Ebola virus glycoprotein (GP) trimer, occludes access to the cathepsin-cleavage loop, and prevents the proteolytic cleavage of GP that is required for virus entry. We show that mAb114 interacts with the glycan cap and inner chalice of GP, remains associated after proteolytic removal of the glycan cap, and inhibits binding of cleaved GP to its receptor. These results define the basis of neutralization for two protective antibodies and may facilitate development of therapies and vaccines.

Asunto(s)

RESUMEN

We undertook a retrospective study of 50 consecutive patients (41 male, 9 female) with an infected nonunion and bone defect of the femoral shaft who had been treated by radical debridement and distraction osteogenesis. Their mean age was 29.9 years (9 to 58) and they had a mean of 3.8 (2 to 19) previous operations. They were followed for a mean of 5.9 years (2.0 to 19.0). The mean duration of the distraction osteogenesis was 24.5 months (2 to 39). Pin-track infection was observed in all patients. The range of knee movement was reduced and there was a mean residual leg-length discrepancy of 1.9 cm (0 to 8) after treatment. One patient required hip disarticulation to manage intractable sepsis. In all, 13 patients had persistent pain. Bony union was achieved in 49 patients at a mean of 20.7 months (12 to 35). Although distraction osteogenesis is commonly used for the treatment of infected femoral nonunion with bone defects, it is associated with a high rate of complications.

Asunto(s)

RESUMEN

Objective: There are many different techniques for finger arthrodesis our purpose is to compare the results of metarcophalangeal (MP) and proximal interphalangeal (PIP) joint arthrodesis, with tension band wire technique vs compression screw. Methods: Retrospective cohort study of patients with arthrodesis of the MP and PIP joint between 2006 and 2009, with a tension band wire technique (N = 28) and Mini-Acutrak screw (N = 29). We compared rates and times of union and the incidence of complications. Results: The union rate of the tension band group was 92.9 percent and 85.7 percent for the screw group, at 9.4 and 9.8 weeks respectively. The complications rate was 28.6 percent for tension band wire technique and 27.6 for the screw technique. The reoperation rate was 32.1 percent for the tension band wire technique and 3.6 percent for the screw group, with remove of 25 percent of the tension band. Discussion: Both surgical techniques had a similar rate of union and complications, but with significantly more re-operation to remove implants in the tension band group, which is an important factor to consider when choosing the surgical technique.

Objetivo: Existen múltiples técnicas de atrodesis de dedos, por lo que nuestro objetivo es compara resultados de artrodesis de metacarpofalángicas e interfalángicas proximales de los dedos mediante banda de tensión vs tornillo compresivo. Material y Método: Se realizó un estudio de cohorte retrospectivo, comparativo, de pacientes operados de artrodesis interfalángica proximal o metacarpofalángica de lo dedos primarias entre los años 2006 y 2009. Se analizaron 28 pacientes con banda de tensión y 29 con técnica de tornillo compresivo sin cabeza Mini-Acutrak, comparando tasas y tiempos de consolidación e incidencia de complicaciones. Resultados: Se obtuvo una tasa de consolidación de 92,9 por ciento para el grupo banda de tensión y 85,7 por ciento para el grupo de tornillos, a las 9,4 y 9,8 semanas respectivamente (sin diferencia significativa para ambas variables). La tasa de complicaciones fue de 28,6 por ciento para la bandea de tensión y de 27,6 por ciento para la técnica con tornillo. La tasa de reoperaciones fue de 32,1 por ciento para la técnica con banda de tensión y de 3,6 por ciento con tornillo, determinado por el 25 por ciento de las bandas de tensión, sin haber retiro de tornillos. Discusión; Ambas técnicas quirúrgicas muestran una similar tasa de consolidación y complicaciones, pero existe unna significativa mayor tasa de reoperaciones para el retiro de material de osteosíntesis en el grupo de banda de tensión, lo cual es un factor importante a considerar en la elección de la técnica quirúrgica, siendo en este sentido, el tornillo una mejor opción.

Asunto(s)

RESUMEN

In recent decades, rapid growth of the U.S. Hispanic population has raised concerns about immigrant adaptation, including fertility. Empirical research suggests that Hispanics, especially Mexicans, might not be following the historical European pattern of rapid intergenerational fertility decline (and convergence toward native levels). If confirmed, continued high Hispanic fertility could indicate a broader lack of assimilation into mainstream American society. In this paper, we reexamine the issue of Hispanic and Mexican fertility using an approach that combines biological and immigrant generations to more closely approximate a comparison of immigrant women with those of their daughters' and granddaughters' generation. Contrary to cross-sectional results, our new analyses show that Hispanic and Mexican fertility is converging with that of whites, and that it is similarly responsive to period conditions and to women's level of education. In addition, we employ a mathematical simulation to illustrate the conditions under which cross-sectional analyses can produce misleading results. Finally, we discuss the import of the fertility convergence we document for debates about immigrant assimilation.

Asunto(s)

RESUMEN

La colestasia intrahepática del embarazo (CIÉ) es un cuadro clínico caracterizado por prurito palmo plantar de predominio nocturno y elevación de ácidos biliares conjugados séricos en el tercer trimestre del embarazo. Esta patología puede asociarse a ictericia y complicaciones como la muerte fetal. Aunque el manejo obstétrico de la CIÉ es eminentemente clínico, el ácido ursodeoxicólico (UDCA) ha sido utilizado efectivamente en el tratamiento sintomático de esta patología y en la corrección de los marcadores bioquímicos de la enfermedad. Además se ha sugerido que su uso estaría asociado a una disminución de las complicaciones fetales. Esta revisión tiene por objeto verificar la validez del uso de UDCA para mejorar el pronóstico fetal. Para esto se realizó una búsqueda detallada de la bibliografía médica en diferentes bases de datos. Aplicando distintos criterios se seleccionaron finalmente 4 artículos que constituyen la base de esta revisión. Fundamentados en la evidencia, se concluye que no existen datos suficientes en la literatura que apoyen el uso de UDCA para mejorar en forma efectiva los resultados perinatales. A pesar de que algunos estudios evaluados proponen un mejor desenlace fetal en pacientes tratados con UDCA, éstos no cuentan con la validez y el poder estadístico necesario para modificar la conducta actual frente a esta patología.

Intrahepatic cholestasis of pregnancy (ICP) is a disease of the third trimester of pregnancy involving pruritus and elevated bile acid levels. Once thought to be benign for both mother and fetus, ICP has been associated with maternal jaundice and increased rates of fetal morbidity and mortality. However ursodeoxycholic acid (UDCA) has proved to be effective and safe in patients with ICP, attenuating pruritus and correcting some biochemical abnormalities in the mothers. The fetal outcome has also been suggested to improve in patients receiving UDCA. This review intends to verify the validity of the UDCA uses to reduce fetal morbidity and mortality. For this a detailed search of the medical bibliography was done in different data bases. Applying different criteria, 4 articles were finally selected and this constitutes the base of our review. Based on the research, one concludes that there is not enough evidence in the literature to support the use of UDCA to improve perinatal outcome. Although some studies propose an improved fetal outcome in patient using UDCA, these do not count with the validity and the statistical power to modify the present management of ICP.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

We have isolated temperature resistant revertants from temperature sensitive E. coli strains containing either a thermolabile glutaminyl-tRNA synthetase or leucyl-tRNA synthetase. Among the revertants which still contained the thermolabile leucyl-tRNA synthetase we found two classes of regulatory mutants (leuX and leu Y) which have elevated levels of this enzyme. The leuX mutation specifies an operator-promoter region adjacent to the structural gene (leuS) for the enzyme. The leuY gene maps away from the leuS gene and codes for a protein. Using these mutants we demonstrated that the levels of leucyl-tRNA are related to the derepression of the leucine and isoleucine-valine operons. Among the revertants which still contained the thermolabile glutaminyl-tRNA synthetase were characterized three classes of mutants, glnT, glnU, and glnR. The glnT and glnU mutants contain elevated levels of tRNAgln, while the glnR mutant possesses elevated levels of glutaminyl-tRNA synthetase. The level of glutamine synthetase, the enzyme responsible for the formation of glutamine, is also derepressed in the glnT and glnR mutants.

Asunto(s)

Asunto(s)