Syncope in adolescents. Diagnostic and therapeutic approach

Syncopal episodes are frequent in adolescence. Syncope is usually a benign, self-limiting condition but it may be a warning sign of serious disease that must be diagnosed and appropriately treated. The present article provides a review of the basic principles of the differential diagnosis of syncope in the adolescent patient and treatment recommendations.     

Perinatal results following the prenatal ultrasound diagnosis of single umbilical artery

OBJECTIVE. To study the perinatal results in our population, following the prenatal ultrasound diagnosis of a single umbilical artery (SUA), as this alteration is associated with fetal malformations, chromosomal abnormality, and poor perinatal results. MATERIALS AND METHODS. A retrospective review of all obstetric ultrasounds carried out between October 2000 and December 2003 in our service, obtaining the postnatal results of the fetuses diagnosed with an SUA. RESULTS. From a total of 5,987 pregnant patients examined by ultrasound scan at 20th week, an SUA was found in 40 cases, representing an incidence of 0.7%. Of these, 84.6% were normal pregnancies at birth and 15.4% presented other malformations and/or chromosomal abnormalities. No aneuploidy was found in pregnancies where there were no other associated findings in the ultrasound scan at 20 weeks. All cases with serious congenital malformations accompanying the SUA were diagnosed prenatally. There was a 5% of perinatal mortality rate among our fetuses with SUA, which represents a mortality rate 10 times greater than the overall rate among our patients. CONCLUSIONS. The ultrasound discovery of an SUA implies the meticulous search for other associated malformations, and in the absence of these, the risk of a chromosomal abnormality is very low, unless it is a high-risk patient. However, the growth and wellbeing of the fetus must be carefully monitored in the last 3 months, although the ultrasound scan does not show any other associated alterations.     

Differential expression of two RXR/ultraspiracle isoforms during the life cycle of the hemimetabolous insect Blattella germanica (Dictyoptera, Blattellidae)

In insects, the molecular basis of ecdysteroid action has been analysed in great detail in flies and moths, but rarely in primitive orders. Using the primitive hemimetabolous insect Blattella germanica, the German cockroach, as a model, we isolated two cDNAs of RXR/USP, a component of the heterodimeric ecdysone receptor. These two cDNAs correspond to two isoforms, named BgRXR-S (short form) and BgRXR-L (long form). Both are identical except for a 23-amino acid deletion/insertion located in the loop between helices H1 and H3 of the ligand-binding domain. Pattern expression studies show that the two isoforms are differentially expressed throughout the life cycle of B. germanica. During embryogenesis, BgRXR-L occurs in early embryos, whereas BgRXR-S is highly expressed in middle and late embryogenesis. In the penultimate and last larval instars, BgRXR-S mRNA is the predominant form in the fat body and in the prothoracic gland. In the adult female, BgRXR-S mRNA predominates in the fat body, whereas BgRXR-L mRNA predominates in the ovary. Experiments performed with fat body and embryo cells incubated in vitro showed that the expression of BgRXR-S and BgRXR-L is not affected by 20-hydroxyecdysone or by juvenile hormone III.     

Prevalence of rheumatoid arthritis in the South-Transdanubian region of Hungary based on a representative survey of 10,000 inhabitants

OBJECTIVE: To assess the prevalence of rheumatoid arthritis (RA) in a representative study of the South Transdanubian region of Hungary. METHODS: Ten thousand individuals aged between 14-65 years were interviewed. The stratified sample was representative for age, sex and urban/rural residence structure of the regional population of the South-West Hungarian region. As a second step, all individuals with possible RA were asked to undergo a clinical investigation to confirm the diagnosis of RA according to the American Rheumatism Association (ARA) 1987 criteria. Of 10,000 interviewed individuals, 632 reported having RA or symptoms including digital pain, stiffness, and/or swelling. Two hundred and twenty-four individuals were investigated clinically. Individuals fulfilling the 1987 ARA criteria were considered as having definite RA, and their clinical data were evaluated. RESULTS: RA was confirmed in 13 cases. The male/female ratio was 3/10. The prevalence of RA among individuals aged 14-65 years was 0.37% (95% confidence interval, CI: 0.26-0.51), 0.23% (95% CI: 0.15-0.35) in men and 0.48% (95% CI: 0.35-0.64) in women. CONCLUSION: The prevalence of RA in the South Transdanubian region of Hungary is similar to those of other recent studies from other regions around the world.     

Aerobic fitness, body mass index, and CVD risk factors among adolescents: the Québec family study

PURPOSE: The purpose of this study was to examine the association of body mass index (BMI) and aerobic fitness on cardiovascular disease (CVD) risk factors in adolescents. METHODS: The sample included 416 boys and 345 girls 9-18 y of age from the Québec Family Study. Participants were cross-tabulated into four groups using a median split of age-adjusted physical working capacity (PWC) and body mass index (BMI). Group differences in age-adjusted CVD risk factors (blood pressures, fasting total cholesterol (CHOL), LDL -C, HDL-C, HDL/CHOL, triglycerides, glucose, and a composite risk factor score) were examined by two-way ANOVA. RESULTS: Several CVD risk factors showed significant main effects for PWC, BMI and/or the PWC by BMI interaction. In general, low fit males and females had higher blood lipids and glucose compared to their high fit counterparts within BMI categories although none of the differences reached statistical significance. The high fit/low BMI group showed the best CVD risk factor profile while the low fit/high BMI showed a poorer profile as evidenced by several significant differences between these two groups. Other significant differences occurred for various risk factors between groups. CONCLUSION: Both aerobic fitness and BMI show an independent association with CVD risk factors in adolescents.