Perspectives of pregnant and postpartum latino women on diabetes, physical activity, and health.

Impaired glucose tolerance and diabetes are prevalent among Latino women of childbearing age. Physical activity during and after pregnancy may contribute to weight control and improved metabolic status, but recommended activities may not be perceived as appropriate or feasible. To plan realistic and acceptable interventions, pregnant and postpartum Latino women in Detroit met in a focus group series to discuss their beliefs about diabetes and factors influencing their participation in regular physical activity during pregnancy and postpartum. Women believed that diabetes was primarily related to heredity and diet but not to physical activity. Exercise was believed to reduce stress and improve general health. Women suggested an organized group intervention, in a respected location, that offered safe physical activities within the context of a variety of activities for women and children. This strategy reduced concerns about safety and social acceptability while addressing their primary interest in social support.     

Microscopic colitis: a new cause of chronic diarrhea in children?

From a retrospective study on children who underwent colonoscopy or rectosigmoidoscopy with multiple level biopsies, we selected five patients whose rectocolonic endoscopic aspect was normal and contrasting with the presence of a microscopic colitis on biopsies. These five children had chronic diarrhea (mean duration of 14 months), associated with vomiting (three cases), abdominal pain (two cases), anorexia (two cases), abdominal distension (two cases), and weight loss (four cases). Symptomatic treatment was used in all children: loperamide (one case), trimebutine (three cases), and aluminium and magnesium silicate (two cases). One child received sulfasalazine for 2 months. After 1 year, all patients had normal stools. Rectosigmoidoscopy was performed in four patients and was normal. Biopsies obtained in three cases were normal in two cases and showed a persistent microscopic colitis in one case. Microscopic colitis may be a distinct cause of chronic diarrhea in children.     

Increase in lung volume originated by extrinsic PEEP in patients with auto-PEEP

The use of extrinsic positive end expiratory pressure (PEEPe) in patients with auto-PEEP (AP) can reduce the respiratory work during weaning from mechanical ventilation. However, the application of PEEPe produce a certain level of hyperinflation, an undesirable effect which can limit the efficacy of the reduction of respiratory work. The objective of the present study has been to determine if the encrease in end expiratory lung volume (EELV) originated by the PEEPe is related to static lung compliance (SLC). We have studied 14 patients on mechanical ventilation in whom an AP of between 4 and 12 cmH₂O was detected. On applying PEEPe equal to half the AP, the EELV increased slightly (77±64 ml) and was not related to pulmonary compliance. When PEEPe equal to the AP was applied, the EELV increased by 178±110 ml (range 45–375 ml,p<0.05), and there was a significant correlation with SLC (r=0.659,p<0.05). In conclusion, the application of PEEPe equal to the AP causes a moderate increace in EELV. However, in patients with high pulmonary compliance this increase can be more important and must be taken into account when considering the use of PEEPe during weaning.     

Streptococcal toxic shock-like syndrome as a rare surgical disease

Summary. In recent years there has been an increasing incidence of streptococcal toxic shock-like syndrome (TSLS) in otherwise healthy adults. It is characterized by fever, rash, hypotension and early shock with consecutive organ failure and a mortality rate of about 30 %. This paper describes the history of two patients with severe streptococcal TSLS. Various aspects of the pathophysiology, diagnosis and therapy are discussed. Only early, aggressive and repeated surgical debridement can reduce the bacterial load and decrease circulating exotoxins and thereby, in combination with antibiotic therapy, decrease the high mortality of this entity.