Elías Jiménez

Iron-deficiency anemia has been associated with lowered scores on tests of mental and motor development in infancy. However, the long-term developmental outcome of infants with iron deficiency is unknown, because developmental tests in infancy do not predict later intellectual functioning.This study is a follow-up evaluation of a group of Costa Rican children whose iron status and treatment were documented in infancy. Eighty-five percent (163) of the 191 children in the original group underwent comprehensive clinical, nutritional, and psychoeducational assessments at five years of age. The developmental test battery consisted of the Wechsler Preschool and Primary Scale of Intelligence, the Spanish version of the Woodcock-Johnson Psycho-Educational Battery, the Beery Developmental Test of Visual-Motor Integration, the Goodenough-Harris Draw-a-Man Test, and the Bruininks-Oseretsky Test of Motor Proficiency.All the children had excellent hematologic status and growth at five years of age. However, children who had moderately severe iron-deficiency anemia as infants, with hemoglobin levels less than or equal to 100 g per liter, had lower scores on tests of mental and motor functioning at school entry than the rest of the children. Although these children also came from less socioeconomically advantaged homes, their test scores remained significantly lower than those of the other children after we controlled for a comprehensive set of background factors. For example, the mean (+/- SD) adjusted Woodcock-Johnson preschool cluster score for the children who had moderate anemia in infancy (n = 30) was 448.6 +/- 9.7, as compared with 452.9 +/- 9.2 for the rest of the children (n = 133) (P less than 0.01); the adjusted visual-motor integration score was 5.9 +/- 2.1, as compared with 6.7 +/- 2.3 (P less than 0.05).Children who have iron-deficiency anemia in infancy are at risk for long-lasting developmental disadvantage as compared with their peers with better iron status.

Objective. To determine the long-term effects of iron deficiency in infancy. Design. Longitudinal follow-up study of children who had been tested and treated for iron deficiency as infants. Setting. Periurban community near San Jose, Costa Rica. Participants. Of the original 191 participants, 87% were reevaluated at 11 to 14 years old (average age: 12.3 years). The children were free of iron deficiency and growing normally by US standards. Those who had chronic, severe iron deficiency in infancy (n = 48) were compared with those who had good iron status before and/or after iron therapy in infancy (n = 114). Outcome Measures. Comprehensive set of cognitive, socioemotional, and motor tests and measures of school functioning. Results. Children who had severe, chronic iron deficiency in infancy scored lower on measures of mental and motor functioning. After control for background factors, differences remained statistically significant in arithmetic achievement and written expression, motor functioning, and some specific cognitive processes (spatial memory, selective recall, and tachistoscopic threshold). More of the formerly iron-deficient children had repeated a grade and/or been referred for special services or tutoring. Their parents and teachers rated their behavior as more problematic in several areas, agreeing in increased concerns about anxiety/depression, social problems, and attention problems. Conclusions. Severe, chronic iron deficiency in infancy identifies children who continue at developmental and behavioral risk >10 years after iron treatment.

The behavioral effects of iron deficiency and its treatment were evaluated in a double-blind randomized controlled community-based study of 191 Costa Rican infants, 12 to 23 months of age, with various degrees of iron deficiency. The Bayley Scales of Infant Development were administered before and both 1 week and 3 months after IM or oral administration of iron. Appropriate placebo-treated control infants were also tested. Infants with iron deficiency anemia showed significantly lower mental and motor test scores, even after considering factors relating to birth, nutrition, family background, parental IQ, and the home environment. After 1 week, neither IM nor oral iron treatments differed from placebo treatment in effects on scores. After 3 months, lower mental and motor test scores were no longer observed among iron-deficient anemic infants whose anemia and iron deficiency were both corrected (36%). However, significantly lower mental and motor test scores persisted among the majority of initially anemic infants (64%) who had more severe or chronic iron deficiency. Although no longer anemic, they still showed biochemical evidence of iron deficiency after 3 months of treatment. These persistent lower scores suggest either that iron therapy adequate for correcting anemia is insufficient to reverse behavioral and developmental disturbances in many infants or that certain ill effects are long-lasting, depending on the timing, severity, or chronicity of iron deficiency anemia in infancy.

Objective: To assess change in cognitive functioning after iron

Iron deficiency in infancy negatively impacts a variety of neurodevelopmental processes at the time of nutrient insufficiency, with persistent central nervous system alterations and deficits in behavioral functioning, despite iron therapy. In rodent models, early iron deficiency impairs the hippocampus and the dopamine system. We examined the possibility that young adults who had experienced chronic, severe, iron deficiency as infants would exhibit deficits on neurocognitive tests with documented frontostriatal (Trail Making Test, Intra-/Extra-dimensional Shift, Stockings of Cambridge, Spatial Working Memory, Rapid Visual Information Processing) and hippocampal specificity (Pattern Recognition Memory, Spatial Recognition Memory). Participants with chronic, severe iron deficiency in infancy performed less well on frontostriatal-mediated executive functions, including inhibitory control, set-shifting, and planning. Participants also exhibited impairment on a hippocampus-based recognition memory task. We suggest that these deficits may result from the long-term effects of early iron deficiency on the dopamine system, the hippocampus, and their interaction.

To determine whether extended oral iron therapy corrects lower developmental test scores in infants with iron-deficiency anemia.Double-blind, controlled trial in Costa Rica involving 32 12- to 23-month-old infants with iron-deficiency anemia and 54 nonanemic control subjects. Anemic infants were treated with orally administered iron for 6 months; half the nonanemic children were treated with iron and half with placebo. Developmental test scores and hematologic status were evaluated before treatment, after 3 months, and after 6 months.Iron-deficient anemic infants received lower mental test scores than nonanemic infants at all three time points (p < 0.05 pretreatment and at 3 months, p = 0.07 at 6 months). There were no significant differences in motor test scores. More of the anemic infants were rated as unusually tearful and unhappy. Anemic infants came from families with lower maternal education and less support for child development and were less likely to be breast fed, were weaned earlier, and consumed more cow milk.Lower mental test scores persisted in infants with iron-deficiency anemia despite extended oral iron therapy and an excellent hematologic response. Iron-deficiency anemia may serve as a marker for a variety of nutritional and family disadvantages that may adversely affect infant development.

ObjectiveTo evaluate adulthood function following chronic iron deficiency in infancy.Study designAt 25 years, we compared 33 subjects with chronic iron deficiency in infancy to 89 who were iron-sufficient before and/or after iron therapy. Outcomes included education, employment, marital status, and physical and mental health.ResultsAdjusting for sex and socioeconomic status, a higher proportion of the group with chronic iron deficiency did not complete secondary school (58.1% vs 19.8% in iron-sufficient group; Wald value = 8.74; P = .003), were not pursuing further education/training (76.1% vs 31.5%; Wald value = 3.01; P = .08; suggestive trend), and were single (83.9% vs 23.7%, Wald value = 4.49; P = .03). They reported poorer emotional health and more negative emotions and feelings of dissociation/detachment. Results were similar in secondary analyses comparing the chronic iron-deficient group with subjects in the iron-sufficient group who had been iron-deficient before treatment in infancy. Path analysis showed direct paths for chronic iron deficiency in infancy and being single and more detachment/dissociation at 25 years. There were indirect paths for chronic iron deficiency and not completing secondary school via poorer cognitive functioning in early adolescence and more negative emotions via behavior problems in adolescence, indicating a cascade of adverse outcomes.ConclusionThe observational nature of this study limits our ability to draw causal inference, even when controlling for background factors. Nonetheless, our results indicate substantial loss of human potential. There may be broader societal implications, considering that many adults worldwide had chronic iron deficiency in infancy. Iron deficiency can be prevented or treated before it becomes chronic or severe. To evaluate adulthood function following chronic iron deficiency in infancy. At 25 years, we compared 33 subjects with chronic iron deficiency in infancy to 89 who were iron-sufficient before and/or after iron therapy. Outcomes included education, employment, marital status, and physical and mental health. Adjusting for sex and socioeconomic status, a higher proportion of the group with chronic iron deficiency did not complete secondary school (58.1% vs 19.8% in iron-sufficient group; Wald value = 8.74; P = .003), were not pursuing further education/training (76.1% vs 31.5%; Wald value = 3.01; P = .08; suggestive trend), and were single (83.9% vs 23.7%, Wald value = 4.49; P = .03). They reported poorer emotional health and more negative emotions and feelings of dissociation/detachment. Results were similar in secondary analyses comparing the chronic iron-deficient group with subjects in the iron-sufficient group who had been iron-deficient before treatment in infancy. Path analysis showed direct paths for chronic iron deficiency in infancy and being single and more detachment/dissociation at 25 years. There were indirect paths for chronic iron deficiency and not completing secondary school via poorer cognitive functioning in early adolescence and more negative emotions via behavior problems in adolescence, indicating a cascade of adverse outcomes. The observational nature of this study limits our ability to draw causal inference, even when controlling for background factors. Nonetheless, our results indicate substantial loss of human potential. There may be broader societal implications, considering that many adults worldwide had chronic iron deficiency in infancy. Iron deficiency can be prevented or treated before it becomes chronic or severe.

Objective This study examined externalizing and internalizing behavior problem trajectories as a function of both iron status in infancy and infant characteristics. Methods A sample of 185 healthy Costa Rican children who either had chronic, severe iron deficiency or good iron status in infancy were followed for 19 years. Results Mother ratings of externalizing and internalizing problems from age 5 to 11–14 years were higher for the chronic iron deficiency group compared with those with the good iron status. Iron deficiency in infancy predicted persisting externalizing problems over this time period, especially for those with low physical activity in infancy. Beyond adolescence, youth in the chronic iron deficiency group did not report more problems than those in the good iron group. Conclusions These findings underscore the importance of considering infant iron status along with early behavioral characteristics to better identify those children at greatest risk for persisting long-term behavior problems.

This longitudinal study of the effects of iron deficiency in infancy assessed motor development over time in 185 healthy Costa Rican children who varied in iron status at 12-23 months. Longitudinal analyses (hierarchical linear modeling) used the Bayley Psychomotor Index before and both 1 week and 3 months after iron treatment in infancy and the Bruninks-Oseretsky Test of Motor Proficiency - long form at 5 years and short form at 11-14 years. Children with chronic severe iron deficiency in infancy had lower motor scores at the beginning of the study and a lower but parallel trajectory for motor scores through early adolescence. Thus, there was no evidence of catch-up in motor development, despite iron therapy in infancy that corrected iron deficiency anemia in all cases.

Despite substantial controversy regarding the blood levels at which lead adversely affects neurobehavioral development, public health policy in some industrialized countries is prescribing ever more stringent screening criteria for all ages. This study addressed the question of ill effects of lead exposure at the new lower levels, specifically during the late infancy period, which has been targeted for maximum surveillance in pediatric practice. The sample of 184 participants consisted of 12- to 23-month-old healthy infants and toddlers who participated in a community-based study in a developing Central American country (Costa Rica) where extensive family and developmental information was collected. The mean infant blood lead level was 11.0 micrograms/dL, ranging from 5.4 to 37.0 micrograms/dL. Lead levels were not related to the Mental or Psychomotor Developmental Index of the Bayley Scales of Infant Development. When the children were 5 years old, they were reevaluated with complete physical and psychological testing. Blood lead levels in infancy did not predict any of the developmental outcome measures. Thus, among a group of healthy toddlers in a developing country, no ill effects on development of low blood lead levels were observed.

To determine the effects of iron therapy on blood lead levels in infants with mildly elevated lead levels and varied iron status.Infants from a community-derived sample in Costa Rica were categorized into five groups. Group 1 had iron-deficiency anemia with hemoglobin levels <or=105 g/L. Infants in group 2 were iron-deficient with intermediate hemoglobin levels (between 106-119 g/L). These groups were treated with intramuscular iron or 3 months of oral iron. Group 3 (nonanemic iron-deficient) and group 4 (nonanemic iron-depleted) were treated with 3 months of oral iron. Group 5 (iron-sufficient) received oral placebo.After 3 months of oral iron therapy, nonanemic iron-depleted infants had the greatest decrease in lead levels, followed by nonanemic iron-deficient infants and iron-deficient infants with hemoglobin levels <120 g/L. Lead levels increased among iron-deficient infants with hemoglobin levels <120 g/L who received intramuscular iron and iron-sufficient nonanemic infants who received placebo.Changes in lead levels corresponded closely to changes in iron status and were plausible in terms of absorption mechanisms for lead and iron. Correcting and/or preventing iron deficiency appear to be rapid and effective means of improving infant lead levels, even in nonanemic infants.

Patients (pts) with aggressive lymphomas in refractory relapse are often considered for an alloSCT pursuing a graft-vs-lymphoma effect. While reduced intensity conditioning regimens have increased its safety, aggressive lymphomas often progress rapidly, partly due to tumor growth outpacing GVL. Outcomes are particularly poor for patients with active disease at alloSCT. Thus, development of safe more effective conditioning regimens for aggressive lymphomas is a major need. To this end we developed a new myeloablative regimen of Gem/Clo/Bu, which showed high activity and reduced toxicity for alloSCT (as reported in a separate abstract). We wished to compare the outcomes of pts enrolled in this trial with matched controls receiving Flu/Mel. We compared EFS and OS of pts with aggressive lymphomas enrolled in a phase I/II trial of Gem/Clo/Bu for matched donor alloSCT to our own concurrent controls treated with Flu/Mel. We utilized propensity score matching including the following variables: sex, age, donor type, diagnosis, response at alloSCT, disease risk and No. prior therapy lines. After matching, we estimated the survival curves by Kaplan-Meier, compared groups by log rank, and used the Cox proportional hazard model on the weighted sample to estimate the relative hazard ratios. We compared 64 pts enrolled in the Gem/Clo/Bu trial between 11/2012-04/2021 to 113 controls treated with Flu/Mel between 01/2008-03/2022 (Table). The median follow-up of Gem/Clo/Bu pts was 80 months (mo) (range, 72-107) vs. 54 months (45-125) for controls. The median EFS times of Gem/Clo/Bu and control Flu/Mel patients were 12 mo (8-25.5) and 3.3 mo (2.8-10.6), respectively; their respective median OS times were 25 mo (15.5-N/A) vs 7.0 mo (3.3-37.7). The following were independent favorable outcome predictors: receiving Gem/Clo/Bu [hazard ratio (HR)0.38 (0.23,0.62), P=0.001 for EFS; HR 0.45 (0.27,0.73), P=0.01 for OS], Hodgkin diagnosis [HR 0.29 (0.12, 0.72), P=0.008 for OS], and response to prior salvage therapy [HR 0.35 (0.21,0.58), P<0.001 for EFS; HR 0.50 (0.31,0.83), P=0.007 for OS]. Conversely, >3 prior therapy lines [HR 2.13 (1.23, 3.70), P=0.007) was independently associated with worse EFS. Gem/Clo/Bu results in improved EFS and OS as compared with Flu/Mel for pts with aggressive relapsed lymphoma receiving a matched alloSCT.

El propósito de esta investigación es explorar el impacto negativo de ciertos programas de televisión en los adolescentes, específicamente en lo que respecta a la vulneración de sus derechos fundamentales, como la dignidad y la intimidad, en contraposición al derecho a la información y a la libertad de expresión que ostentan los medios de comunicación. La pregunta central que guía este estudio es: ¿Cómo se puede evaluar si los programas de televisión de señal abierta afectan los derechos a la dignidad e intimidad de los adolescentes en el distrito de Castilla - Piura durante los años 2016-2017? El objetivo principal es determinar si los programas de televisión de señal abierta inciden en la violación de los derechos a la dignidad e intimidad de los adolescentes en el mencionado distrito durante los años 2017-2019. La hipótesis propuesta establece que, al evaluar los programas de televisión de señal abierta, se podrá determinar si afectan los derechos a la dignidad e intimidad de los adolescentes en Castilla. Este estudio adopta un enfoque descriptivo, explicativo y correlacional, con un diseño transversal y un enfoque mixto que combina la recolección de datos directamente de los sujetos de investigación.

Peripartum cardiomyopathy is an entity within the spectrum of heart failure that is related to pregnancy, which can debut with a clinical variety whose diagnosis in many cases is late. Because the diagnosis is usually of exclusion, it is of interest to the physician, a high clinical suspicion is required to initiate management and avoid irreversible sequelae.

Objective To determine whether longer breastfeeding is associated with higher infant lead concentrations. Study design Data were analyzed from 3 studies of developmental effects of iron deficiency in infancy: Costa Rica (1981-1984), Chile (1991-1996), and Detroit (2002-2003). The relation between duration of breastfeeding and lead levels was assessed with Pearson product-moment or partial correlation coefficients. Results More than 93% of the Costa Rica and Chile samples was breastfed (179 and 323 breastfed infants, respectively; mean weaning age, 8-10 months), as was 35.6% of the Detroit sample (53 breastfed infants; mean weaning age, 4.5 months). Lead concentrations averaged 10.8 μg/dL (Costa Rica, 12-23 months), 7.8 μg/dL (Chile, 12 months), and 2.5 μg/dL (Detroit, 9-10 months). Duration of breastfeeding as sole milk source and total breastfeeding correlated with lead concentration in all samples (r values = 0.14-0.57; P values = .06-<.0001). Conclusions Longer breastfeeding was associated with higher infant lead concentration in 3 countries, in 3 different decades, in settings differing in breastfeeding patterns, environmental lead sources, and infant lead levels. The results suggest that monitoring lead concentrations in breastfed infants be considered. To determine whether longer breastfeeding is associated with higher infant lead concentrations. Data were analyzed from 3 studies of developmental effects of iron deficiency in infancy: Costa Rica (1981-1984), Chile (1991-1996), and Detroit (2002-2003). The relation between duration of breastfeeding and lead levels was assessed with Pearson product-moment or partial correlation coefficients. More than 93% of the Costa Rica and Chile samples was breastfed (179 and 323 breastfed infants, respectively; mean weaning age, 8-10 months), as was 35.6% of the Detroit sample (53 breastfed infants; mean weaning age, 4.5 months). Lead concentrations averaged 10.8 μg/dL (Costa Rica, 12-23 months), 7.8 μg/dL (Chile, 12 months), and 2.5 μg/dL (Detroit, 9-10 months). Duration of breastfeeding as sole milk source and total breastfeeding correlated with lead concentration in all samples (r values = 0.14-0.57; P values = .06-<.0001). Longer breastfeeding was associated with higher infant lead concentration in 3 countries, in 3 different decades, in settings differing in breastfeeding patterns, environmental lead sources, and infant lead levels. The results suggest that monitoring lead concentrations in breastfed infants be considered.

Serum prolactin may reflect CNS dopaminergic function. Because iron deficiency (ID) alters brain dopamine in rats, serum prolactin levels were previously investigated in infants with varied iron status. High serum prolactin levels correlated with behaviors typical of chronic ID. The objective of this study was to determine the effect of infant iron status on serum prolactin levels after a stressor in early adolescence. One hundred fifty-nine of 191 children enrolled in infancy (chronic ID, n = 46; good iron comparison group, n = 113) had serum prolactin measurements after catheter placement at 11–14 y of age. Serum prolactin levels were compared by sex, pubertal status and infant iron status and the pattern of change over time was compared by infant iron status controlling for pubertal stage and background factors. Males and less mature adolescents had lower serum prolactin concentrations than females and more mature adolescents. Controlling for these factors, the serum prolactin response pattern differed significantly by infant iron status. Serum prolactin declined earlier for the chronic ID group. In conclusion, an altered serum prolactin response pattern was observed 10 y after chronic ID in infancy and may suggest a long-lasting effect of ID on the regulation of prolactin.

Streptococcus pneumoniae (SP) is the leading cause of vaccine-preventable death in children <5 years of age, globally. This surveillance determined incidence rates of invasive pneumococcal disease (IPD), clinical and chest radiograph-confirmed pneumonia (CXR+Pn); and SP serotype distribution and antimicrobial susceptibility in children in San José, Costa Rica.This was a 2-year prospective, population-based surveillance conducted in 2007-2009 in children aged 28 days to 36 months presenting to participating healthcare centers. Eligibility criteria for study inclusion were as follows: temperature ≥ 39.0°C within 24h and/or clinical suspicion of IPD or pneumonia.8801 subjects were enrolled. Median age: 14.5 months. A total of 25 children had invasive pneumococcal disease with S. pneumoniae isolated from nonduplicative cultures (22) or detected solely by PCR and a clinical picture consistent with IPD (3). Sources of positive cultures (some children had >1 positive culture) were: blood (20), pleural fluid (4), and cerebrospinal fluid (3). Of the 3 cases detected solely by PCR, 2 were from cerebrospinal fluid and 1 from pleural fluid. The overall IPD incidence rates for culture-positive only cases for children aged 28 days to <3 years was 33.7/100,000 per year for years 1 and 2 combined. Age stratification of culture-positive only subjects showed a peak during year 1 (106.8/100,000) in children 28 days to <6 months of age group, and in year 2 (45.5/100,000) in children 12 months to <24 months of age group. Most common serotypes were 14 (28.6%), followed by 3, 4, 6A, 19A, and 22F (9.5% each). Of 22 nonduplicative IPD isolates, 42.9% were penicillin- and trimethoprim/sulfamethoxazole nonsusceptible isolates. Consideration of PCR-positive cases increases the incidence of IPD for children aged 28 days to <3 years to 46.0/100,000. Overall incidence of clinical pneumonia and CXR+Pn was 1968/100,000 and 551/100,000, respectively.There is a considerable burden of IPD and pneumonia in children in San José. These epidemiologic data serve as a baseline to evaluate the effectiveness of the incorporation of new conjugate pneumococcal vaccines into the National Immunization Program in Costa Rican children.

BREAST-FEEDING has been implicated as a necessary factor in the pathogenesis of hemorrhagic disease of the newborn infant, ~ but little is known of its role in coagulation abnormalities beyond the neonatal period. Vitamin K is approximately four times more concentrated in cow milk than in breast milkfl and clotting factors depending on this vitamin are decreased in normal term infants, and even more reduced in premature infants. 3.4 Deficiency of vitamin K-dependent clotting factors with clinical bleeding has occasionally been reported in breast-fed infants older than one month, but these infants usually had also had diarrhea or had received antibiotic therapy? ,6 Since the levels ot ~ vitamin K-dependent clotting factors in healthy older breast-fed infants have not been systematically assessed, vitamin deficiency cannot be attributed to breast-feeding per se. To determine if breast-feeding during the first month of infancy is associated with an increased risk of bleeding caused by vitamin K deficiency, the present investigation compared coagulation studies and the levels of vitamin K-dependent clotting factors in normal breast-fed and bottle-fed infants.

Rotavirus is the leading cause of severe diarrheal disease and dehydration in infants in both developed and developing countries. Vaccines have recently been developed, but detailed epidemiological information, which is needed for decisions about how and where to introduce vaccination, was lacking for many Latin American countries. The primary objective of this study was to measure the incidence and disease burden of rotavirus in young children presenting to Latin American hospitals with gastroenteritis. In addition it allowed to setting up the methodology to further conduct a large phase III trial with a rotavirus vaccine in the region. This was a prospective, multi-center surveillance study of gastroenteritis in children <3 years old presenting to hospitals in 11 Latin American countries. Questionnaires and stool samples were collected from 6521 of 8031 enrolled cases (73% inpatients). Among these, 3122 (49%) were rotavirus positive. Of the rotavirus-positive cases, 12% were <6 months, 48% <1 year and 87% <2 years old; 23% received antibiotics before diagnosis. Median hospital stay was 2 days, 78% received intravenous rehydration. Overall strain distribution was G1 (59%), G2 (1%), G3 (12%), G4 (20%), G9 (6%), G12 (1%), untypable (7%) with large local variations. The direct economic impact on families was considerable: 48% of caregivers lost time from paid work and 69% of families were financially affected by their child's illness. This study confirms the high disease burden of rotavirus gastroenteritis among children in Latin America, which might be reduced by the use of effective vaccines.

Los fallecimientos por traumatismo tienen una gran importancia social por los costes morales, corporales, materiales y años de vida prematura perdidos que implican. Por ello, su estudio epidemiológico autópsico puede constituir una herramienta clave en la estimulación de medidas preventivas y correctoras de la calidad asistencial traumatológica Estudio transversal prospectivo analítico de mortalidad. Del 1 de enero de 1996 al 31 de diciembre de 2000, hemos realizado un estudio epidemiológico autópsico de todos los fallecidos por traumatismo que, consecutivamente, se han producido en Guipúzcoa. Se ha determinado la severidad de las lesiones, descritas en la autopsia, mediante la aplicación de los índices de gravedad Injury Severity Score (ISSa) y Abbreviated Injury Scale (AISa) versión 90 Hemos estudiado 784 fallecimientos por traumatismo, lo que supone 26.148 años potenciales de vida perdidos (APVP), (778,1; APVP/100.000 habitantes/año). El 50,3% de los APVP estaba ocasionado por la muerte de jóvenes entre 16 y 30 años. La edad media era de 45,1 (21,3) años, y el 79,5% varones. Las muertes fueron provocadas por automóvil (31,4%), precipitación (14,5%), atropello (13,7%), accidente laboral (9,1%) y otras causas. El 77,5% no superó las 24 horas postraumatismo y el 54,5% falleció in situ En 612 casos (78%) se dispuso del informe autópsico, siendo el ISSa medio de 58,9 (21,1) puntos. La estructura craneal resultó afectada con lesiones vitales (AISa > 3 puntos) en un 41%, el tórax en el 30,4% y el abdomen en un 25,1%. Las lesiones principales causantes del fallecimiento fueron plurietiológica (21%), estallido craneal (19%), hemorragia cerebral (14%) y rotura de grandes vasos (13%) Consideramos que los estudios epidemiológico y autópsico de los 784 fallecimientos traumáticos constituyen un soporte válido para estudios de prevención primaria y secundaria, así como para la evaluación de la calidad asistencial Epidemiological autopsy study of 784 deaths from trauma. the poliguitania project. Deaths resulting from trauma are of great social importance due to their moral, corporeal and material costs. They also have a high costs in terms of years of life lost. Consequently, epidemiological autopsy study of such deaths could be a key element in stimulating preventive measures and in improving the quality of treatment Cross-sectional prospective, analytical study of mortality. From 1 January 1996 to 31 December 2000; we performed an epidemiological autopsy study of all consecutive deaths from trauma in Guipúzcoa (Spain). The severity of the injuries described in the autopsy was determined throught application of the Injury Severity Score (ISS) and the Abbreviated Injury Scale (AIS) version 90 We studied 784 deaths from trauma, representing 26,148 potential years of life lost (PYLL) /778,1 PYLL/100,000 inhabitants/year). A total of 50.3% of PYLL were caused by the death of young people aged between 16 and 30 years old. The mean age was 45,1 (21,3) years and 79,5% were male. The deaths were provoked by automobiles (31,4%), falls (14,5%), being run over (13,7%), occupational accidents (9,1%) and other causes. A total of 77.5% died within 24 hours of injury and 5.45% died in situ An autopsy report was available in 612 deaths (78%) with a mean ISS of 58.9 (21,1) points. Lethal injuries affected the head (AIS > 3 points) in 41%, the thorax in 30.4% and the abdomen in 25,1%. The main causes of death were multiple trauma (21%), traumatic brain injury (19%), cerebral hemorrhage (14%), and rupture of the great vessels (13%) We believe that both epidemiological and autopsy studies of these 784 deaths from trauma make a valid contribution to primary and secondary prevention studies as well as to the evaluation of the quality of traumatological care

This study examined the relationship between serum prolactin levels and behavior in infants and toddlers who experienced two potentially stressful experiences (developmental testing and venipuncture). Serum prolactin levels showed considerable consistency over a 3-month period (r = 0.64 between study entry and three months, p < 0.001, n = 50). There was also stability in having either a normal or a high value (> or = 25 ng/ml). Among children who had a normal value on initial testing, 97% also has a normal value after 3 months; 55% of those with initial high values continued to have high values (chi 2 = 19.26, p < 0.001). Children with high serum prolactin levels were more likely to be rated as unusually hesitant and unhappy during developmental testing. Overall, 53% of the children with serum prolactin levels > or = 25 ng/ml were considered abnormal in affect, compared to 20% of those with lower serum prolactin values (total n = 138, chi 2 = 13.56, p < 0.001). These results suggest that, even in early life, serum prolactin levels may reflect characteristic individual behavioral and neuroendocrine responses to stress.

A cytogenetic and/or cytochemical study was performed in 166 individuals with leukemia or related disorders, in two major Costa Rican hospitals. In those patients treated at an adult's hospital (14 years old and over), acute leukemias represented 66% of all cases. In that hospital the most frequent types of disorders were, in decreasing order: ANLL (> M1), ALL, CML (all of them showed the Ph chromosome) and MDS. In the cases from a childrens' hospital (< 14 years old) acute leukemias were 98%. Among them the order of frequency was: ALL (70%): ALL-1 (84%), ALL-2 (16%) and ANLL (27%): M5a > M3 > M4 > M5b. In ALL 85% were type B and occurred mostly in women while 15% of them were type T and more frequent in males. There was 5.6% infant leukemia, which presented a similar number of acute lymphoids and myeloids. The cytogenetic pattern was similar among Costa Rica and other tropical and temperate countries.

Several bacteria cause community-acquired invasive bacterial disease in children; many are vaccine preventable. Knowledge of pathogens causing community-acquired invasive bacterial disease is important when selecting antimicrobial therapy and implementing vaccine prevention strategies. We describe bacteriology of community-acquired invasive disease observed among 31,641 blood and sterile fluid cultures from children aged 28 days to 36 months in 3 Latin American countries over 2 years.

Background and aim: Streptococcus pneumoniae is globally the leading cause of vaccine-preventable death in children below 5 years of age. Methods: Between 20...

Background Streptococcus pneumoniae (SP) is the leading cause of vaccine-preventable death in children <5 years of age, globally. This surveillance determined incidence rates of invasive pneumococcal disease (IPD), clinical and chest radiograph-confirmed pneumonia (CXR + Pn); and SP serotype distribution and antimicrobial susceptibility in children in San Jose, Costa Rica. Methods This was a 2-year prospective, population-based surveillance conducted in 2007–2009 in children aged 28 days to 36 months presenting to participating healthcare centers. Eligibility criteria for study inclusion were as follows: temperature ≥ 39.0 °C within 24 h and/or clinical suspicion of IPD or pneumonia. Results 8801 subjects were enrolled. Median age: 14.5 months. A total of 25 children had invasive pneumococcal disease with S. pneumoniae isolated from nonduplicative cultures (22) or detected solely by PCR and a clinical picture consistent with IPD (3). Sources of positive cultures (some children had >1 positive culture) were: blood (20), pleural fluid (4), and cerebrospinal fluid (3). Of the 3 cases detected solely by PCR, 2 were from cerebrospinal fluid and 1 from pleural fluid. The overall IPD incidence rates for culture-positive only cases for children aged 28 days to <3 years was 33.7/100,000 per year for years 1 and 2 combined. Age stratification of culture-positive only subjects showed a peak during year 1 (106.8/100,000) in children 28 days to <6 months of age group, and in year 2 (45.5/100,000) in children 12 months to <24 months of age group. Most common serotypes were 14 (28.6%), followed by 3, 4, 6A, 19A, and 22F (9.5% each). Of 22 nonduplicative IPD isolates, 42.9% were penicillin- and trimethoprim/sulfamethoxazole nonsusceptible isolates. Consideration of PCR-positive cases increases the incidence of IPD for children aged 28 days to <3 years to 46.0/100,000. Overall incidence of clinical pneumonia and CXR + Pn was 1968/100,000 and 551/100,000, respectively. Conclusions There is a considerable burden of IPD and pneumonia in children in San Jose. These epidemiologic data serve as a baseline to evaluate the effectiveness of the incorporation of new conjugate pneumococcal vaccines into the National Immunization Program in Costa Rican children.

One hundred and twenty-five febrile episodes in 82 children with acute leukemia were studied; 46% of the patients were from urban and 54% from rural areas. The origin of the fever was identified in 91% of the episodes, prevailing pneumonia, septicemia, chickenpox and herpes zoster. The etiological agent was identified in 46% of the cases. A viral predominance was evident, and among them varicela-zoster, following in importance gram-negative bacteria. Histoplasma capsulatum and Pneumocystis carinii were isolated in two occassions each. Sepsis was found more frequently in children with active leukemia than in those in remission (p less than 0.001). Forty-four febrile episodes occurred in patients with less than 1,000 neutrophils/ul. The daily-risk rate of infection was higher in children fom rural than in those from urban areas (p less than 0.001). After clinical and laboratory studies, methicillin and gentamicin were used, in addition to carbenicillin or trimethoprim-sulfamethoxazole is selected cases. This treatment was effective in 86% of the cases. Twelve (15%) children died, 6 of whom were in remission at that moment.

Sickle cell disorders (SCD) and depression are both chronic illnesses of global significance. Past research on SCD and depression struggles to make sense of statistical associations, essentializes depression within the person with SCD, and treats stigma as an automatic correlate of chronic illness. A mixed methods study (March 2012–April 2014) was undertaken with people living with SCD and depression in Lagos, Nigeria, examining depression-as disease (questionnaires); depression-as-illness-experience (individual depth interviews), and depression-as-societal-sickness (focus groups). 103 people with SCD attending an outpatients clinic were administered the Patient Health Questionnaire-9, and 82 self-identified with some level of depression. Fifteen were subsequently interviewed about their illness experience. Their lives were characterized by being extensively subjected to vicious discriminatory remarks, including from significant others, negative experiences they felt contributed to their depression and even to suicidal thoughts and actions. Contrary to misconceptions of the relational nature of stigma, respondents recognized that stigma resulted not from their SCD but from assumed broken social norms and expectations, norms to do with educability, employability and parenthood. They recounted either that they successfully met such expectations in their own lives, or that they could conceivably do so with reasonable societal adjustments. Ten respondents with SCD and depression further took part in two series of three focus groups with five people in each series of groups. In groups people living with SCD were able to challenge negative assumptions about themselves; to begin to recognize collective social interests as a group, and to rehearse backstage, in discussions between themselves, social actions that they might engage in frontstage, out in wider society, to challenge discriminatory societal arrangements they held to contribute to their depression. To the extent that depression in SCD has social origins, then social interventions, such as anti-discrimination laws and policies, are key resources in improving mental health.

Three hundred and seventy-one children below 16 years, with newly diagnosed acute myeloid leukaemia, were included in six consecutive GATLA/GLATHEM protocols, from November 1967 to December 1987. The study was divided in three periods: 1967 to 1975, 1976 to 1982, and 1983 to 1987. Three induction schedules were used during the first two periods, and different maintenance schemes alternating with monthly consolidations were explored; the value of immunotherapy with C. Parvum and androgen therapy with stanozolol was also tested. Protocol 3-AML-83, representing the third period, included a four-week induction phase with vincristine, adriamycin, cytosine-arabinoside, prednisone and 6-mercaptopurine, followed by a consolidation phase with cyclophosphamide, cytosine-arabinoside and 6-mercaptopurine for four weeks. Maintenance phase included daily, oral 6-mercaptopurine, and monthly cytosine-arabinoside, both during two years, and adriamycin every eighth week, for one year. Complete remission rates for the first two periods of therapy were 40% and 55%, whereas that of the last period was 74%. The overall results of the period 1967-1982, showed actuarial duration rates of complete remission, event-free survival and survival, at 60 months, between 2% and 6%, their median duration being of 9, 8 and 10 months respectively. No significant difference was observed between the first two periods or protocols. Protocol 3-AML-83, activated in March 1983, achieved actuarial rates of continuous complete remission, event-free survival, and survival of 51%, 37% and 39% respectively, at 48 months. The difference between the first two periods and the last one was highly significant (P less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

El deporte es una de las actividades que más se realiza en el tiempo libre por los adolescentes, sin embargo los comportamientos estereotipados durante su práctica pueden influir en la actividad deportiva. El objetivo de esta investigación desarrollada en la ciudad de Bolonia (Italia), ha sido analizar los prejuicios y actitudes de los adolescentes que hacen deporte en su tiempo libre. Para ello, hemos aplicado el cuestionario “Sport e Integrazione sociale. Indagine sulle suole secundarie di secondo grado in Italia” (Caruso, G, et.al. 2018) a un grupo de adolescentes italianos (N=286) con edades comprendida entre los 12 y 15 años (M =12,72). Los resultados nos muestran diferencias significativas en sexo, discriminación y origen (r= .307) (Sig=.000). Género y discriminación hacia la mujer (r= .133) (Sig.=.25); género y aspecto físico (r= .182) (Sig.=.029) y, en mejorar tu aspecto físico (M=.416) (p=.012) frente a los hábitos de un grupo sedentario. En conclusión, todavía se confirman las imágenes estereotipadas a través del deporte respecto al género y al desarrollo de la actividad que se cuestionan continuamente. &#x0D; Abstract. One of the activities that teenagers practice more often is sport in their free time, having said that stereotypical behaviours during their practice can influence sports activity. The aim of the present study has been to look into the different perceptions that adolescents have about social, ethnic, sports and gender stereotypes about prejudices and attitudes during sports activity as an inclusive environment; using the “Sport e Integrazione sociale. Indagine sulle suole secundarie di secondo grado in Italia” (Caruso, G, et.al. 2018) instrument. This study has been carried out in Bologna (Italy), with participants (N = 286) between 12 and 15 years old (M= 12.72). The results show that there are differences in gender, discrimination and origin (r= .307) (Sig=.000); gender and discrimination towards women (r = .133) (Sig. =. 25); gender and physical appearance (r = .182) (Sig. =. 029); and improving your physical appearance (M= .416) (p = .012) versus the habits of a sedentary group. In conclusion, the stereotyped images through sport regarding gender and the development of the activity that are continually questioned are still confirmed.

In eighty nine anemic children, aged from 6 months to 13 years, the etiology of their anemia was studied: 67(75%) of the cases presented iron deficiency, 18(20%) iron and folate deficiency and 4 megaloblastic anemia (2 folate and 2 vitamin B12 deficiency). Patients with vitamin B12 deficiency showed severe pancytopenia and megaloblastic changes in bone marrow; but no morphological difference, either in circulating blood or bone marrow was found in patients with iron deficiency, compared to iron plus folate deficiency. The seric measurement of iron, folate and B12 were essential in order to establish the etiology of nutritional anemias. The majority of the children were accepted to the hospital for other causes than anemia, such as diarrhea (58%) and respiratory diseases (18%). Clinical features and the high incidence of anemia in children under two years of age are also discussed.

The study included 30 children with anemia and significant infectious process. The hematologic characteristics of this anemia were identified in their evolution and these findings were correlated with levels of serum iron to disclose whether variations are present to support the diagnosis of mixed etiology of the anemic syndrome. Transferrin saturation index was found to be the best parameter to diagnose iron deficiency in cases of anemia associated to infectious processes and due to the fact that 50% of these cases showed mixed etiology anemia, it seems reasonable that further integral studies should be carried out in this anemic syndrome.

To continue the quest of newer anticancer agents, herein a novel class of 1,4-Dihydroindenopyrazole linked oxadiazole conjugates 9(a-r) was designed, synthesized and experimented for their anti-proliferative activities against four different cancer cell lines (human) such as MDA MB-231 (breast), PANC-1 (pancreatic), MCF-7 (breast), and Caco-2 (Colorectal) by using MTT assay. Among the series compound 9h and 9 m demonstrated significant potency against the PANC-1 (human pancreatic cancer cells) with IC50 value 7.4 μM and 4.3 μM respectively. While compound 9 m was found to be equipotent to standard Gomitabine (IC50 = 4.2 μM). The detailed biological assays revealed S phase cell cycle arrest and their ability to propagate apoptosis by activating caspase 3 and 9 enzymes which was confirmed by Annexin-FITC assay and caspase assay. Moreover, docking study suggested their binding modes and interactions with caspase-3. In addition, in silico studies revealed that they exhibit good pharmacokinetics and drug likeliness properties. Furthermore, 3D-QSAR was carried out to achieve a pharmacophoric model with CoMFA (q2 = 0.631, r2 = 0.977) and CoMSIA (q2 = 0.686, r2 = 0.954) on PANC-1 cancer cells which were established, generated and validated to be reliable models for further design and optimization of newer molecules with enhanced anticancer activity.

The purpose of the proposed study was to identify nutritional and social influences on IDA in infancy. A community project in Costa Rica on the behavioral effects of IDA provided an unusual opportunity to examine such influences, since the 191 12-to 23-month-old infants were all healthy, with birth weights ≥ 2.5kg, without previous iron therapy, and living in a country in which breast feeding was the norm and iron-fortified formula or cereal extraordinarily rare. Factors that were hypothesized to effect IDA (defined as a Hb ≤ 10.5 g/dl and a low ferritin and either a high FEP or low transferrin saturation) were grouped conceptually into five stages on the basis of their remote to immediate influence on IDA: family background, neonatal factors, age and sex, caregiving conditions, and current physiologic status of the child, using weight/length percentile and whole blood lead level. Structural modeling (LISREL) was used to develop and test a model of direct and indirect effects. Direct effects were that infants with IDA had lower birth weights (p=0.03), consumed greater amounts of cow's milk/day (p=0.01), were breast fed for shorter times (p=0.02), had poorer home environments (HOME scale) (p<0.01), and had their grandparents in the home (p=0.02). Indirect effects were that the lower the mother's IQ the poorer the quality of home and the more likely for grandparents to be living in the household; younger mothers were more likely to live with their parents. These results suggest that preventing and treating IDA requires not only appropriate doses of medicinal iron but also attention to feeding practices and disadvantaged conditions in the home environment.

Etude faite chez les enfants de 12 a 23 mois dans une communaute urbaine de San Jose au Costa Rica. L'incidence est de 63,5%. Le traitement a base de fer est plus efficace par voie orale que par voie intramusculaire