RESUMO
Las fracturas triplanares de tibia distal, son fracturas complejas caracterizadas por afectación multiplanar, clasificándose como Salter Harris tipo IV, en el periodo de cierre fisiario. Son poco frecuentes, representando el 5-15% de las fracturas pediátricas. El mecanismo de lesión que ocurre con mayor frecuencia, consiste en supinación y rotación externa. La tomografía computarizada es actualmente el Gold Standard para el diagnóstico de este tipo de fractura, nos permite evaluar todos los planos, siendo la radiografía simple insuficiente para el diagnóstico ya que puede pasar desapercibida. Paciente de 14 años de edad con fractura triplanar en 2 partes de tibia distal, con resolución quirúrgica. Nuestro caso es un ejemplo de una fractura triplanar de tibia distal, la cual es de baja frecuencia, difícil diagnostico e interpretación. Presentamos imágenes preoperatorias, intraoperatorias y postoperatorias del manejo de esta lesión, obteniendo resultados satisfactorios clínicos, funcionales y en estudios de imágenes. Es indispensable lograr una reducción anatómica de la superficie articular para lograr una evolución satisfactoria. Se recomienda una tomografía computarizada para diagnosticar y manejar esta lesión de manera adecuada. El seguimiento postoperatorio es crucial para el manejo de este paciente, ya que se espera una discrepancia en la longitud de las extremidades y/o deformidad(AU)
Triplane fractures of the distal tibia are complex fractures characterized by multiplane effects. They are classified in the Salter-Harris system as type IV in the period of physeal closure. These fractures are rare and represent 5-15% of pediatric fractures. The most common mechanism of injury is supination and external rotation. Computed tomography is currently the Gold Standard for the diagnosis of this type of fracture since it allows us to evaluate all planes, while plain radiography is insufficient because the fracture can go unnoticed. The objective is to report the clinical case of a 14-year-old patient with triplanar fracture in 2 parts of the distal tibia with surgical resolution. This case is an example of a triplanar fracture of the distal tibia, which is of low frequency, and difficult to diagnose and interpret. Preoperative, intraoperative and postoperative images of the management of this lesion are presented, obtaining satisfactory clinical, functional and imaging study results. It is essential to achieve an anatomical reduction of the joint surface to achieve a satisfactory evolution. A CT scan is recommended to properly diagnose and manage this injury. Postoperative follow-up is crucial for the management of this patient, as a limb length discrepancy and/or deformity is expected(AU)
Assuntos
Humanos , Masculino , Adolescente , Rotação , Fraturas da Tíbia/cirurgia , SupinaçãoRESUMO
Factors limiting distribution range for most species are generally unknown regardless of whether they are native or invasive. We studied factors that could enable or restrict the distribution of two cosmopolitan invasive leafminer fly species, Liriomyza huidobrensis (Blanchard) and Liriomyza sativae (Blanchard) in their native niche. In order to test which ecological and environmental factors affect leafminer distribution we conducted thermal tolerance assays, sampled along elevation gradients and modeled species distribution. Findings from the field and rearing chambers showed a physiological restriction due to high temperatures for L. huidobrensis at 28-29 °C, above which adult emergence is compromised. We also found that maximum temperatures below 22 °C, typical of tropical highlands, favored L. huidobrensis. L. sativae was found across a wider temperature range (i.e., from 21 to 36 °C) in Guatemala. Our finding of a physiological threshold in temperature for L. huidobrensis may enable us to predict its invasive risk when combined with the environmental conditions at horticultural ports of entry and the global agricultural landscape. Further, it strengthens our predictions on shifts in distribution of the leafminer fly under future climate. We also found a temperature mediated competitive exclusion interaction between the two herbivore species, where L. sativae occurred at temperatures < 22 °C only in the absence of L. huidobrensis. We show that parasitoids had a negative effect on the leafminer flies, which varied with host plant. Finally, we show the importance of taking a multiaspect approach when investigating what limits distribution and invasiveness of a species.
Assuntos
Dípteros , Ecossistema , Temperatura , Altitude , Animais , Clima , Produtos Agrícolas , GuatemalaRESUMO
BACKGROUND: Relapse rates in patients with acne after treatment with oral isotretinoin vary between 10% and 60% depending on the dosage regimen used, the length of follow-up, and the characteristics of the study population. The aim of this study was to determine the acne relapse rate within 2 years of completion of isotretinoin therapy and to identify the prognostic factors associated with relapse. MATERIAL AND METHODS: We studied a series of patients with cystic acne who had received a cumulative therapeutic dose of at least 120 mg/kg of oral isotretinoin. Data were analyzed using descriptive and analytical statistical methods. The relapse rate was expressed as the number of events divided by the amount of person-time. Factors predicting relapse were identified using multivariate Cox regression analysis. RESULTS: A total of 142 patients were followed up for 24 months or until relapse occurred. The relapse rate was 15 events per 100 person-years of follow-up. The risk of relapse was twice as high among men. The protective effect of maintenance treatment with topical retinoids was 32% for each month of use. The risk of relapse was 3.5 times higher among women not receiving antiandrogen therapy. CONCLUSIONS: The relapse rate in our study was high and similar to that reported in the literature, Maintenance treatment with topical retinoids in men and women and androgen treatment in women helped to prevent relapse.
Assuntos
Acne Vulgar/tratamento farmacológico , Acne Vulgar/epidemiologia , Fármacos Dermatológicos/administração & dosagem , Isotretinoína/administração & dosagem , Administração Oral , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Recidiva , Fatores de Tempo , Adulto JovemRESUMO
Magnetic nanoparticles were prepared by coprecipitating Fe(2+) and Fe(3+) ions in a sodium hydroxide solution and used as support for lipase. The lipase-coated particles were applied in a reactive extraction process that allowed separation of the products formed during transesterification. Kinetics data for triolein and ethanol consumption during biodiesel (ethyl oleate) synthesis together with a thermodynamic phase equilibrium model (liquid-liquid) were used for simulation of batch and continuous processes. The analysis demonstrated the possibility of applying this biocatalytic system in the reactive zone using external magnetic fields. This approach implies new advantages in efficient location and use of lipases in column reactors for producing biodiesel.
Assuntos
Biocombustíveis/análise , Biotecnologia/métodos , Enzimas Imobilizadas/metabolismo , Lipase/metabolismo , Magnetismo , Nanoestruturas/química , Algoritmos , Biocatálise , Reatores Biológicos , Etanol/química , Glicerol/química , Cinética , Ácidos Oleicos/química , Temperatura , Trioleína/químicaRESUMO
Lignocellulosic biomass is considered as the future feedstock for ethanol production because of its low cost and its huge availability. One of the major lignocellulosic materials found in great quantities to be considered, especially in tropical countries, is sugarcane bagasse (SCB). This work deals with its current and potential transformation to sugars and ethanol, considering pretreatment technologies, detoxification methods and biological transformation. Some modeling aspects are exposed briefly. Finally stability is discussed for considering the high nonlinear phenomena such as multiplicity and oscillations, which make more complex the control as a result of the inhibition problems during fermentation when furfural and formic acid from SCB hydrolysis are not absent.
Assuntos
Biotecnologia/métodos , Celulose/química , Saccharum/química , Adsorção , Carboidratos/química , Conservação dos Recursos Naturais , Eletroquímica/métodos , Etanol/química , Fermentação , Formiatos/química , Furaldeído/química , Íons , Lignina/química , Oxigênio/químicaRESUMO
The bean pod weevil (Apion godmani Wagner) is a serious insect pest of common beans (Phaseolus vulgaris L.) grown in Mexico and Central America that is best controlled by host-plant resistance available in Durango or Jalisco genotypes such as J-117. Given unreliable infestation by the insect, the use of marker-assisted selection is desirable. In the present study, we developed a set of nine molecular markers for Apion resistance and mapped them to loci on chromosomes 2, 3, 4 and 6 (linkage groups b01, b08, b07 and b11, respectively) based on genetic analysis of an F (5:10) susceptible x resistant recombinant inbred line population (Jamapa x J-117) and two reference mapping populations (DOR364 x G19833 and BAT93 x JaloEEP558) for which chromosome and linkage group designations are known. All the markers were derived from randomly amplified polymorphic DNA (RAPD) bands that were identified through bulked segregant analysis and cloned for conversion to sequence tagged site (STS) markers. One of the markers was dominant while four detected polymorphism upon digestion with restriction enzymes. The other markers were mapped as RAPD fragments. Phenotypic data for the population was based on the evaluation of percentage seed damage in replicated trials conducted over four seasons in Mexico. In single point regression analysis, individual markers explained from 3.5 to 22.5% of the variance for the resistance trait with the most significant markers overall being F10-500S, U1-1400R, R20-1200S, W9-1300S and Z4-800S, all markers that mapped to chromosome 2 (b01). Two additional significant markers, B1-1400R and W6-800R, were mapped to chromosome 6 (b11) and explained from 4.3 to 10.2% of variance depending on the season. The latter of these markers was a dominant STS marker that may find immediate utility in marker-assisted selection. The association of these two loci with the Agr and Agm genes is discussed as well as the possibility of additional resistance genes on chromosome 4 (b07) and chromosome 3 (b08). These are among the first specific markers developed for tagging insect resistance in common bean and are expected to be useful for evaluating the mechanism of resistance to A. godmani.
Assuntos
Mapeamento Cromossômico , Phaseolus , Gorgulhos/patogenicidade , Animais , América Central , Cruzamentos Genéticos , Feminino , Ligação Genética , Marcadores Genéticos , México , Phaseolus/genética , Phaseolus/parasitologia , Polimorfismo Genético , Técnica de Amplificação ao Acaso de DNA PolimórficoRESUMO
AIMS: To describe the clinical characteristics, and estimate the prevalence of type 2 diabetes mellitus among Puerto Rican youth, 1995-2003. METHODS: All patients aged less than 20 years with a confirmed diagnosis of type 2 diabetes were identified from pediatric endocrinologists' medical practices. Medical records of each patient were reviewed to confirm the diagnosis, classify the type of diabetes, and gather sociodemographic and clinical characteristics. From 1995 to 2003 a total of 32,444 records were reviewed. A total of 2,800 children with diabetes were identified, of which 2,702 were type 1 and 93 type 2; typel/type 2 ratio was 29:1. Frequency distributions were obtained for categorical variables, and summary measures (mean +/- standard deviation) for quantitative measure were computed. RESULTS: Mean age at first visit was 14 years. The majority of cases were females (69), for a female/ male ratio of 2.2:1. 78.5had a family history of the disease, 74.2were overweight, and 48had acanthosis nigricans. 64.5of the cases were receiving some type of hypoglycemic therapy. 18.5of the cases had severe hypertension while 17.5had cholesterol levels considered at increased risk (e[quot ]200). The overall prevalence was 13.5 per 100,000 population. CONCLUSIONS: This study is the first that describes the frequency and clinical presentation of type 2 diabetes in children and adolescents in a sample of Puerto Ricans. Further investigations must be conducted to obtain a more precise estimate of the burden of type 2 diabetes in youth and to raise awareness of this condition among health care professionals.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Criança , /epidemiologia , Distribuição por Idade , Porto Rico/epidemiologia , Estudos Retrospectivos , Distribuição por SexoRESUMO
Choice of the targeted host developmental stage, regulation of parasitoid numbers released and introduction of food supplements are operational factors with a potential to influence the level of biological control. In a closed laboratory storage system maintained over two generations of the host, the impact of these three parameters on the control potential of the parasitoid Dinarmus basalis Rondani was investigated for high populations of larvae of Acanthoscelides obtectus (Say) feeding inside dry common bean seeds Phaseolus vulgaris. The beans were already infested with immature bruchids at the beginning of the storage period to simulate harvest conditions, characterized in a previous study. Treatments resulted in a reduction of 48-75% of the bruchid population within 16 weeks of storage. The best timing of parasitoid release was at the simulated harvest, as later releases reduced the bruchid population only by about half this percentage. Host feeding is postulated to be the key factor involved in the observed difference. The effect of increasing the number of parasitoids strongly depended on host age and food supplement. Addition of vials with honey had no direct effect on the bruchid population or on the parasitoid progeny. The ecological significance of these findings and implications for biological control are discussed.
Assuntos
Fenômenos Fisiológicos da Nutrição Animal , Besouros/parasitologia , Comportamento Alimentar/fisiologia , Vespas/fisiologia , Fatores Etários , Análise de Variância , Animais , Besouros/fisiologia , Colômbia , Larva/parasitologia , Larva/fisiologia , Phaseolus , Densidade Demográfica , Dinâmica Populacional , Reprodução/fisiologia , Fatores de TempoRESUMO
A reproducible Agrobacterium tumefaciens-mediated genetic transformation method that delivers fertile and morphologically normal transgenic plants was developed for cultivated tepary bean (Phaseolus acutifolius L. Gray). Factors contributing to higher transformation efficiencies include (1) a low initial concentration of bacteria coupled with a longer cocultivation period with callus, (2) an initial selection of callus on a medium containing low levels of the selectable agent, (3) omission of the selectable agent from the medium during callus differentiation to shoots and (4) the efficient conversion of transgenic shoots into fertile plants. All plants regenerated with this procedure (T0) were stably transformed, and the introduced foreign genes were inherited in a Mendelian fashion in most of the 33 independent transformants. Integration, stable transmission and high expression levels of the transgenes were observed in the T1 and/or T3 progenies of the transgenic lines. The binary transformation vectors contained the beta-glucuronidase reporter gene, the neomycin phosphotransferase II selectable marker gene and either an arcelin 1 or an arcelin 5 gene. Arcelins are seed proteins that are very abundant in some wild P. vulgaris L. genotypes showing resistance to the storage insect Zabrotes subfasciatus (Boheman) (Coleoptera, Bruchidae). Transgenic beans from two different cultivated P. acutifolius genotypes with high arcelin levels were infested with Z. subfasciatus, but they were only marginally less susceptible to infestation than the non-transgenic P. acutifolius. Hence, the arcelin genes tested here are not major determinants of resistance against Z. subfasciatus.
Assuntos
Técnicas de Transferência de Genes , Glicoproteínas/metabolismo , Phaseolus/genética , Lectinas de Plantas/metabolismo , Transformação Genética/genética , Agrobacterium tumefaciens , Animais , Southern Blotting , Besouros/fisiologia , Vetores Genéticos/genética , Glucuronidase/genética , Glucuronidase/metabolismo , Glicoproteínas/genética , Imunidade Inata/genética , Canamicina Quinase/genética , Canamicina Quinase/metabolismo , Phaseolus/crescimento & desenvolvimento , Phaseolus/parasitologia , Lectinas de Plantas/genética , Plantas Geneticamente Modificadas , Transgenes/genéticaRESUMO
OBJECTIVE: To examine health disparities between diabetic patients receiving services in private and public health sectors. METHODS: Insureds with service claims for diabetes (ICD-9 250-259) from two private insurance companies and two public health groups were selected. Personnel of the participant insurance companies were responsible for identifying medical claims that met the study inclusion criteria and providing the information in a computerized database file. RESULTS: Overall prevalence was 4.9%. Prevalence in the public sector (5.8%) was higher than that of the private sector (3.7%) (p < 0.0001). The overall prevalence among females of the public sector was nearly twice (6.3%) the prevalence in the private sector (3.3%) (p < 0.0001). The prevalence of the majority of services analyzed was larger in the public sector. However, prevalence of specific services (glucose and glycosilated hemoglobin tests) was larger in the private sector. Differences between sectors in the prevalence of complications were also observed. Prevalence and service utilization also varied by age and sex in both sectors. CONCLUSIONS: Significant difference exists in the prevalence of diabetes and health service utilization between the private and the public sector.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Diabetes Mellitus/terapia , Atenção à Saúde/normas , Qualidade da Assistência à Saúde/normas , Seguro Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Prevalência , Porto Rico/epidemiologia , Serviços de SaúdeRESUMO
The review of several diabetes epidemiological studies confirms that diabetes is one of the most prevalent non-communicable diseases globally, and it is the fourth or fifth leading cause of death in most developed countries. Diabetes prevalence ranges from nearly 0% in New Guinea to 50% in the Indians of Arizona. No modifiable risk factors have been clearly established in persons with type 1 diabetes, but major environmental determinants have been suggested. Impaired glucose tolerance, gestational diabetes, insulin resistance, obesity and lack of physical activity have been consistently identified as risk factors for type 2 diabetes. The prevalence of diabetes increases with age, but a sex-specific tendency has not been consistent. In addition, the prevalence of diabetes is higher in African-Americans and Hispanics when compared to other ethnic groups. Diabetes affects almost all organs of the body and is the leading cause of blindness and amputations of legs, imposing both clinical and economic costs to patients and society.
Assuntos
Diabetes Mellitus/epidemiologia , Saúde Pública , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Complicações do Diabetes , Diabetes Mellitus/economia , Diabetes Mellitus/prevenção & controle , Humanos , Prevalência , Fatores de RiscoRESUMO
OBJECTIVE: The purpose of this study was to determine the prevalence of diabetes mellitus in persons covered by a health insurance company. METHODS: The medical claims of persons insured with Triple S Health Insurance Co. of Puerto Rico, whose main diagnosis was diabetes (ICD9-250.0-9), were selected for analysis. Prevalence and medical utilization rates were estimated. General characteristics and services utilization were compared by age and sex using the chi-square distribution. RESULTS: Overall prevalence was 4.73%. Prevalence in the male population (5.07%) was higher than that of females (4.43%) in all age groups, but the difference was not statistically significant (p > 0.05). The proportion of diabetic cases was larger in the > 60 age group. 64% of the cases had 1 or more visits to a physician office, 2% were hospitalized, and almost 3% had emergency room visits. 29% of the cases had insulin prescriptions while 59% had oral prescriptions. The younger age group (< or = 44 years) had a larger utilization rate of emergency room and hospital admissions. Health service utilization varied by age and sex, however, the only significant difference was observed in glucose test services utilization (p < 0.05). CONCLUSIONS: The prevalence of diabetes in this group was lower than the prevalence reported in the Behavioral Risk Factor Surveillance System. This may be partially explained by the fact that the study group did not represent the composition of the Puerto Rican population. Prevalence studies using other groups will be helpful to determine the prevalence of diabetes in Puerto Rico.
Assuntos
Diabetes Mellitus/epidemiologia , Seguro Saúde , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Porto RicoRESUMO
OBJECTIVE: To compare the prevalence and health services utilization patterns of diabetes mellitus in a group of insured under the Puerto Rico Health Reform Act and the private sector of the same insurance company. METHODS: The medical claims of the public sector insured whose main diagnosis was diabetes mellitus (ICD9-250.0-9) were selected for analysis. Prevalence and medical utilization rates were estimated. General characteristics and services utilization were compared by age and sex using the chi-square distribution. RESULTS: A total of 38,139 diabetic cases were identified during the study period. Overall prevalence was 6.23% (95% CI: 6.17%-6.29%); 5.22% among males (95% CI: 5.14-5.30) and 7.09% among females (95% CI: 7.00%-7.18%). The proportion of cases was larger in persons aged 65 years or more (60.3%) and females (61.6%). Overall, 84.7% of insured diabetics had medical office visits, while 7.8% had emergency room services and 1.3% had hospital admissions. Female cases had more physician office visits (62%) and insulin prescriptions (65%) compared to males (p < 0.05). The most reported complication was cerebrovascular accident (4.4%). The prevalence of diabetes was higher in the public sector (6.23%) when compared to the private sector (4.73%) (p < 0.01). The mean number of oral hypoglycemic (32.77 +/- 0.40) and insulin (40.99 +/- 0.54) prescriptions were higher in the public sector (p < 0.01). Emergency room utilization rate was larger among males in the younger age groups of the private sector. However, hospital admissions were larger in both sexes of the younger age group of the public sector when compared with the private sector. CONCLUSIONS: A higher prevalence of diabetes and mean service utilization was observed in the public sector. An in-depth analysis of the health care of patients with diabetes in the public sector is needed.
Assuntos
Diabetes Mellitus/epidemiologia , Serviços de Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Adulto , Idoso , Diabetes Mellitus/terapia , Feminino , Reforma dos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Setor Privado , Porto Rico/epidemiologiaRESUMO
OBJECTIVE: To estimate the self-reported weighted prevalence of diabetes mellitus among different population subgroups and determine associated factors in Puerto Rico. METHODS: Data gathered from the Behavioral Risk Factor Surveillance Survey (BRFSS) during 1999 was analyzed. RESULTS: The weighted prevalence in Puerto Rico in 1999 was 9.6% (95% CI: 8.5%-10.7%), highest than reported nationally. It was higher among individuals with increasing age, female sex, decreasing annual income, decreasing educational attainment, being non-employed, having a health care coverage, high blood pressure, high blood cholesterol, and increasing body mass index. Health behaviors and co-morbid conditions significantly associated with diabetes among individuals aged less than 65 years were high blood pressure, high blood cholesterol, obesity and low educational attainment. However, the only significant characteristic associated with diabetes in individuals aged 65 years or more was female sex. Analysis of the data gathered in the diabetes module revealed that nearly 35% were using insulin, 57.4% were using insulin once a day, 14.4% self-monitored their blood glucose one to three times per day, 18.3% reported they have heard of the glycosylated hemoglobin test, and of these, 71.8% had their test performed between one and six times within the past year. Nearly 42% reported their feet were checked and 54.1% had a dilated eye examination last year. CONCLUSION: The high prevalence of diabetes in Puerto Rico underscores the need for developing integrated management strategies for improving quality of diabetes care.
Assuntos
Diabetes Mellitus/epidemiologia , Assunção de Riscos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Porto Rico , Fatores de RiscoRESUMO
High levels of resistance to Apion godinani Wagner have been reported in bean, Phaseolus vulgaris L., landraces from Mexico. We report on the role of hypersensitivity to A. godmani in five resistant and three susceptible bean genotypes. In susceptible genotypes (cultivars 'Canario 107','Jamapa', and 'Zacatecas 45'), the eggs and first instars of A. godmani were embedded in the pod mesocarp and usually were surrounded by healthy tissue. In contrast, in resistant landraces ('Amarillo 154', 'Amarillo 155', 'J-117', 'Puebla 36', and 'Pinto 168'), necrotic tissues developed concentrically around the oviposition site, encapsulating eggs and dead larvae. An inverse relationship between percentage egg and larval encapsulation at the early immature pod stages and percentage of damaged seeds at harvest was found. Results indicate that hypersensitivity in developing pods plays an important role in antibiosis to A. godmani in beans. This information will facilitate future genetic and biochemical research and provide much needed information concerning the phenotypic basis of resistance to A. godmani in bean.
Assuntos
Besouros/fisiologia , Fabaceae/fisiologia , Controle Biológico de Vetores , Animais , SementesRESUMO
OBJECTIVE: To describe the natural history and estimate the incidence of premature thelarche in girls aged 6 months to 8 years living in Puerto Rico and diagnosed between 1990 and 1995. BACKGROUND: In the 1970s and 1980s, several pediatric endocrinologists, based on their clinical experience, acknowledged a dramatic increase in the number of cases of precocious sexual development in Puerto Rico. In 1987, the Puerto Rico Health Department developed the Registry of Premature Thelarche and Precocious Sexual Development, which began to operate in 1989. Data regarding the long-term outcomes of girls diagnosed with premature thelarche are insufficient. Knowledge about the natural history of this condition is relevant for predicting the long-term prognosis and therapeutic management of the affected population. METHODS: Of 2,716 cases of precocious sexual development reported to the Premature Thelarche and Precocious Sexual Development Registry, 1,916 (70.5%) were premature thelarche. The clinical characteristics and evolution during follow-up of premature thelarche cases were described and compared by age group at diagnosis. RESULTS: Incidences were 6.2 and 1.62 per 1,000 live births for girls aged < 2 years and 2 to 8 years, respectively. These estimates were 10 and 15 times higher than those reported in Olmsted, MN. When the average change in mammary tissue diameter during follow-up was evaluated, a slight reduction in girls aged < 2 years was observed; however, it remained constant for girls aged 2 to 8 years. CONCLUSIONS: The results of this study underscore the need to continue an active search of premature thelarche cases and to perform analytical investigations of precocious sexual development to expand the understanding of the etiology of this important public health problem.
Assuntos
Mama/crescimento & desenvolvimento , Puberdade Precoce/fisiopatologia , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Hormônio Foliculoestimulante/sangue , Seguimentos , Humanos , Incidência , Lactente , Hormônio Luteinizante/sangue , Distribuição de Poisson , Puberdade Precoce/sangue , Puberdade Precoce/epidemiologia , Porto Rico/epidemiologia , Útero/anatomia & histologiaRESUMO
OBJECTIVE: To determine the characteristics and trends of diabetes mortality among the Puerto Rican population from 1980 through 1997. METHODS: Death certificates for Puerto Rican residents whose underlying cause of death was diabetes mellitus (ICD-9-250.0) were reviewed, and sociodemographic information was abstracted. The proportion mortality ratio (PMR) and 95% confidence intervals were calculated by gender, age group, educational level and period of time. Trend analysis in mortality was performed using a Poisson regression model. RESULTS: A total of 26,193 deaths (5.8%) were primarily attributed to diabetes mellitus in the study period. Females accounted for 55.8% of all diabetes related deaths. Diabetes accounted for a higher proportion of deaths among persons aged 60-64 years (8.14%), persons aged 65-74 (8.12%), females (7.73%) and those with 1-6 years of education (7.08%). The PMR steadily increased from 4.55% in the 1980-85 period to 6.91% in the 1992-97 period. There was a higher mortality in male diabetic subjects aged < or = 64 than in females during the 18 year period. Between 1980 and 1991, females aged 65-74 had a higher mortality than males, however, mortality increased in males of the same age group during 1992-97. When the oldest age group (> or = 75) was examined, males had a higher mortality between 1986 and 1997, whereas females had a slightly higher rate between 1980 and 1985. CONCLUSIONS: Our results indicate that diabetes mortality has been markedly increasing in the Puerto Rican population, primarily in persons aged 65 years or more. Further analysis is needed to evaluate the determinants of mortality in diabetes.
Assuntos
Diabetes Mellitus/mortalidade , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Intervalos de Confiança , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Distribuição por SexoRESUMO
SETTING: Puerto Rico. OBJECTIVE: To describe the characteristics and survival experience of AIDS patients with tuberculosis (TB) from 1981 through 1998. DESIGN: A population based study using the AIDS Surveillance System, including survival analysis. RESULTS: During the period studied, 1000 AIDS cases were reported with TB, representing 4.3% of total cases. Of these, males accounted for 82.1%, and 84% were diagnosed with pulmonary TB. Approximately 71% of the cases were reported as having died. AIDS cases who were intravenous drug users (IDU) accounted for 63.7% of the cases. The median survival of AIDS/TB cases was 21.4 months, and did not differ by sex or TB site (P > 0.05). IDUs with TB had a longer survival than IDUs with other AIDS-defining conditions; however, AIDS/TB cases with a CD4 count < 200/mm3 had a poorer survival (23.4 months) than those with a count of > or = 200/mm3 (47.9 months). CONCLUSIONS: The overall prevalence of TB in AIDS patients in Puerto Rico is low compared with other countries. As in other studies, the variable that explained poorer survival among AIDS/TB cases was the CD4+ lymphocyte count. Further prospective studies regarding survival in the Hispanic population are needed to confirm these findings.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Síndrome da Imunodeficiência Adquirida/mortalidade , Tuberculose/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/imunologia , Adulto , Contagem de Linfócito CD4 , Feminino , Humanos , Masculino , Prevalência , Prognóstico , Porto Rico/epidemiologia , Abuso de Substâncias por Via Intravenosa/complicações , Análise de Sobrevida , Tuberculose/etiologia , Tuberculose/mortalidadeRESUMO
The present study described the frequency of animal bites and attacks in the municipality of San Juan, Puerto Rico between the fiscal years 1996 through 1998. A total of 275 cases were reported to the San Juan Local Office of Environmental Health. The distribution of cases by gender was equal, and persons aged 18 years or older had the highest frequency of animal bites and attacks (52.9%). The animal species reported to be involved in the majority of animal bites was the dog (81.1%). Upper extremities were involved in 43% of these injuries. Animal bites caused by dogs were more often reported among male victims (87.4%) (p = 0.031). Approximately 41% of dog bites and attacks and 75% of bites and attacks caused by other animal species were documented as provoked (p = 0.002). More than 75% of the injuries in the head, face or neck involved children < 13 years whereas 65.9% of the injuries in the upper extremities involved adults (> 18 years) (p = 0.001). Animal bites and attacks in the upper extremities were more prominent among injuries caused by an animal species different to the dog (71%) (p < 0.001). We conclude that animal bites and attacks is a public health concern in light of the increasing pet population. Therefore, educational strategies towards the general population must stress careful supervision of the human-animal interaction as well as the general procedures to follow in case of an injury.