Application of bidimensional echocardiography in the diagnosis of ventricular septal defect]

Between 1985-1990 we studied by means of two-dimensional echocardiography 286 patients with isolated ventricular septal defect (VSD). A hundred and sixty three being male and 123 female, as a mean age of 5 +/- 3 months. Sixty two cases (22.3%) reveales associated anomalies and in other 63 (22.4%) there was in the evolution an aneurysm of the septum membranous. The projections used were apical 4-chamber, with or without aortic root; parasternal long-short axis of great arterias or at ventricular level; subcostal 4-chamber; right oblique outlet right outflow tract and left oblique outlet left and right outflow tracts. Patients with VSD smaller than 3 mm were excluded. Perimembranous defects, 189 cases (66%), were more frequent than muscular, 91 31.8%), and subarterial defects, 6 (2.1%). Only 19 (9 apical muscular, 6 perimembranous outlet and 4 perimembranous trabecular) were initially misclassified. The diameter of the VSD was large in subarterial (0.85 +/- 0.1 cm) and perimembranous outlet VSD (0.75 +/- 0.5 cm) compared with the rest. Each group of defects was more easily shown by one particular projection except trabecular muscular defect. In conclusion, we are able to state that two-dimensional echocardiography enables us to discover the size and situation of isolated ventricular defects.     

Prevalence and risk factors for gastroschisis in a public hospital from west México

Mexico is recognized as a country with a high prevalence of gastroschisis, although the cause of this remains unclear. We define the prevalence and potential risk factors for gastroschisis in a public hospital from west México. A case‐control study was conducted among 270 newborns, including 90 patients with nonsyndromic gastroschisis (cases) and 180 infants without birth defects (controls), born all during the period 2009 to 2013 at the Hospital Civil de Guadalajara “Dr. Juan I. Menchaca” (Guadalajara, Mexico), from a total of 51 145 live births. Potential maternal risk factors for gastroschisis were compared using multivariate logistic regression analysis to evaluate the deviance explained by different variables of interest. The overall prevalence of gastroschisis in live births was 17.6 per 10 000 births (95% confidence interval [CI] 14.0–21.2), whereas in offspring of women ≤19 years old was 29.9 per 10 000 births (95% CI 21.9–38.0). Mothers ≤19 years (adjusted odds ratio [aOR] 2.8: 95% CI 1.5–5.1), anemia during pregnancy (aOR 10.7; 95% CI 2.0–56.9), first‐trimester exposure to hormonal contraceptives (aOR 3.7; 95% CI 1.0–13.0), and first‐trimester alcohol consumption (aOR 3.4; 95% CI 1.6–7.3), were associated with gastroschisis. Contrarily, adjusted OR for pre‐pregnancy body mass index ≥25 kg/m² has protective odds (aOR 0.2; 95% CI 0.1–0.5). Our results suggest an increased risk for gastroschisis among mothers under the age of 20, with anemia during pregnancy, and those who used hormonal contraceptives or consumed alcohol during early pregnancy, whereas, pre‐pregnancy overweight has a protective OR, and they are discussed as clues in its pathogenesis.     

Selective depression of interferon-gamma and granulysin production with increase of proliferative response by Vgamma9/Vdelta2 T cells in children with tuberculosis

Vgamma9/Vdelta2 T cells can contribute to protective immune response against Mycobacterium tuberculosis, although the extent to which and mechanisms by which they could actually protect against human tuberculosis remain unclear. We have previously reported that Vgamma9/Vdelta2 T cells from tuberculin purified protein derivative (PPD)-positive children, either healthy or affected by different clinical forms of tuberculosis, strongly proliferate to different phosphoantigens in vitro, whereas Vgamma9/Vdelta2 T cells from PPD-negative healthy subjects proliferate very poorly. We report here that Vgamma9/Vdelta2 T cells from tuberculous children have an increased proliferative activity, but decreased interferon (IFN)-gamma production and granulysin expression. After successful chemotherapy, the Vgamma9/Vdelta2 T cell proliferative response strongly decreased, whereas IFN-gamma and granulysin production consistently increased. Disease-associated changes in Vgamma9/Vdelta2 T cell effector functions in patients with tuberculosis are consistent with the possibility that these T cells may play a protective role in immune response against M. tuberculosis infection.     

Parental occupation and neural tube defect-affected pregnancies among Mexican Americans

In a case-control study, we examined whether parental occupational exposures were related to neural tube defect (NTD)-affected pregnancies among Mexican Americans living along the Texas-Mexico border. Case women were 184 Mexican-American women with NTD-affected pregnancies; control women were 225 study-area residents who delivered normal babies during the same period as the case women. The women were interviewed in person about maternal and paternal occupations and work exposures during the periconceptional period. Compared with control women, case women were more likely to have had occupational exposures to solvents (odds ratio [OR], infinity; 95% confidence interval [CI], 2.4-infinity) and also were more likely to have worked in cleaning (OR 9.5; 95% CI, 1.1 to 82.2) or health care occupations (OR 3.0; 95% CI, 1.0 to 9.0) than control women. No compelling associations were found between paternal work exposures or occupations and NTDs in offspring in this population.     

Practical nursing training in the University School of Nursing of the Community of Madrid. Opinion of students and health professionals. Qualitative study with discussion groups

BACKGROUND: In the nursing schools, the contrast between what is taught in the classrooms and what is practiced at the health care centers usually creates a great deal of confusion on the part of the students. The objective of this research is to ascertain the opinion of the students and of the professionals at the health care centers where they are doing their training with regard thereto in order to detect their problems and see what differences exist between primary and specialized care. METHODS: This research was conducted throughout the first half of 2000 employing qualitative methodology, by means of four discussion groups comprised of students, former students, primary care training advisors and nursing professionals at the hospitals where the students of the school in question are doing their nursing training. The initial involvement employed was indirect. RESULTS: The comments of the nursing students and of their training advisors with regard to the practice nursing during the diploma studies reveal dissatisfaction on the part of both of these groups. In all of the groups point out anxiety as the leading factor involved in their teaching as well as learning activities and during professional training. The lack of identification as a group of professionals seems to be related to the lack of recognition on the part of the others, the demand for a degree being granted for their college studies and for the setting up of specialities would contribute to their social recognition and, as a result thereof, to their identification as a professional group. CONCLUSIONS: Until a solution is provided to the anxiety which the nursing professionals feel with regard to their professional practice, which they pass on to their students during nursing training, it will not be possible to achieve a higher degree of satisfaction with nursing training experiences either on the part of the training advisors or on the part of the students.     

Home visit to the newborn and the post-natal mother. Role of the paediatrician and the nurse

Based on our experience over many years, and on the experience of others, we can deduce that home visits to the newborn and the mother are highly positive. In absolute terms, this is an efficient and necessary visit that is broadly accepted by the population, and its implantation amongst the services offered by the public health services has therefore been a correct move; carrying out such a visit should be obligatory and it should be considered as a basic aim within the health programs. The success of the visit depends not only on the personal treatment of the health personnel who take part, but also on their qualification and professionalism, since the visit requires a high level of preparation and dedication, as well as the support of the administration itself.     

Splenic vein thrombosis: an unusual case of gastric bleeding.

Acute and/or recurrent gastrointestinal bleeding due to ruptured gastric varices from an isolated thrombosed splenic vein is a distinct entity. Incidence of this syndrome is probably less than 1%. Typical clinical features of this syndrome include evidence of splenic hypertension without liver disease and no demonstrable cause of gastrointestinal hemorrhage. Diagnosis can easily be missed unless the surgeon is familiar with this syndrome. Typical findings at the time of surgery are an enlarged spleen, varicose veins usually involving the upper third of the stomach, and pancreatic and peripancreatic inflammation. Portal vein and portal pressure will be normal. Meso-portography is a convenient and safe procedure and will lend support to suspicion when a retrograde nonfilling of the splenic vein is present. Splenectomy offers the expectation of a long-range cure. A representative case of a 39-year-old man is discussed. He had at least six episodes of gastric bleeding in less than 3 years. At a previous laparotomy, the cause of bleeding could not be determined. A splenectomy in December 1970 has been able to control the gastric bleeding since then.