Developing a media- and school-based program for substance abuse prevention among Hispanic youth: a case study of Mirame!/Look at me!

Mirame!/Look at Me! is a substance abuse prevention program for low-income Mexican American youth 9 to 13 years of age. The theory-driven curriculum, developed for mass distribution via a satellite television network, features social models who demonstrate cognitive-behavioral skills and display conservative norms regarding substance abuse. An 18-session curriculum contains 5-minute videos that are assigned to be followed by discussion and social reinforcement from a teacher or volunteer. This case study reports the program development process and experiences in the initial dissemination of the program through national networks for schools and cable television subscribers.

Leuconostoc bacteremia after liver transplantation: another cause of vancomycin resistant gram-positive infection

Leuconostoc sp. are gram-positive bacteria intrinsically resistant to vancomycin, which can be confused with streptococci based on routine microbiological-characteristics. Infections secondary to Leuconostoc are uncommon, and usually affect patients with underlying diseases, prior use of vancomycin and those with central lines. The most common clinical presentation is fever secondary to a central line infection. We report the first case of Leuconostoc infection in a solid organ transplant recipient. The patient developed Leuconostoc bacteremia secondary to peritonitis, 60 d after undergoing liver transplantation. He was treated with clindamycin, gentamicin and underwent surgical debridement, but succumbed to other complications.

[Non operative treatment of liver and spleen trauma. Clinical experience]

BACKGROUND

There is a tendency towards conservative behaviours in the treatment of blunt abdominal trauma.

AIM

To perform a retrospective analysis of the results of conservative management of liver and spleen trauma.

PATIENTS AND METHODS

Clinical charts of 21 patients with traumatic lesions of liver or spleen that were not operated, seen between 1991 and 1996, were reviewed. Severity of trauma was assessed according to the Abbreviated injury scale of 1985 and CAT scan lesions were scored according to scale proposed by the American Association of Trauma Surgery.

RESULTS

Mean age of patients was 33.4 years old and 17 were male. Twelve patients had liver trauma, that had a mean severity index of 20.1. According to abdominal CAT scan, two patients had grade II lesions, 8 had grade III lesions and 2 had grade IV lesions. Two patients required transfusions and all had a successful recovery. Nine patients had spleen trauma, with a severity score of 24.4. Three patients required transfusions and one was subjected to a splenectomy. Mean hospital stay was 17.8 days for patients with liver trauma and 16 days for patients with spleen trauma.

CONCLUSIONS

Non operative management of liver and spleen trauma is feasible and safe in a selected group of patients, independent of the degree of injury and hemoperitoneum.

[The disease of admiral Christopher Columbus]

Based on diaries and relations, the fact that Admiral Cristobal Colon effectively suffered of gout is documented. This was a common disease in that times. The interpretations that gout as a disease has had in the course of medicine history, are also analyzed.

Preterm premature rupture of membranes: comparison between twin and singleton gestations

The purpose of this study was to evaluate the clinical characteristics and pregnancy outcomes of twin and singleton pregnancies complicated by preterm premature rupture of membranes (PROM) and to compare the groups to evaluate for differences in these areas. In this retrospective study, patients with a gestational age of < 36 weeks admitted between 1993 and 1996 with PROM were evaluated for their clinical characteristics and pregnancy outcomes. Twin and singleton pregnancies were compared and the results were evaluated for significant differences. Patients with lethal fetal anomalies, clinical chorioamnionitis at presentation, or fetal distress at presentation were excluded from analysis. Liberal use of tocolysis was provided to both groups of patients, as were serial doses of betamethasone and vitamin K. Twenty-eight sets of twins and 119 singleton pregnancies were included in the analysis. Differences were noted with respect to twin and singleton pregnancies for both latency period (4.26 days vs 8.6 days, P < 0.001) and birthweight (1,464 vs 1,698 g, P < 0.03). The birthweight for twins was an average of the pair. No differences were noted with respect to gestational age at time of rupture, maternal age, gravidity, parity, race, tocolytic use, steroid use, prophylactic antibiotics, or sexually transmitted diseases. The incidence of chorioamnionitis showed a trend for a higher occurrence in singleton pregnancies. The latency period for twin pregnancies complicated by preterm PROM is shorter than for singleton pregnancies. The incidence of chorioamnionitis may be higher in singleton pregnancies, but this may be related to their longer latency period. A knowledge of these differences may be of benefit when counseling these patients.

sn-1,2-diacylglycerol and choline increase after fertilization in Xenopus laevis

sn-1,2-Diacylglycerol (DAG) mass and translocation of protein kinase C alpha and beta to a membrane fraction increased approximately 7 min after insemination of Xenopus laevis eggs. The DAG mass increase of 48 pmol (from 62 to 110 pmol/cell) was greater than that for inositol 1,4,5-trisphosphate (IP3; an increase of approximately 170 fmol or approximately 280-fold smaller than the DAG increase), and DAG peaks approximately 5 min after IP3. Choline mass (a measure of phosphatidyl choline-specific phospholipase D) also peaked before DAG and the choline increase (134 pmol/cell) was greater than that of DAG. There was no detectable change in phosphocholine mass (a measure of phosphatidylcholine-specific phospholipase C). During first cleavage, DAG decreased, PKC translocation was low, and choline increased and peaked (whereas published work shows an increase in IP3 mass). Artificial elevation of intracellular calcium ([Ca2+]i) increased DAG levels but prevention of the [Ca2+]i increase after fertilization did not block DAG production. Thus, sperm stimulate production of DAG and choline through [Ca2+]i-independent and [Ca2+]i-dependent paths.

[An outbreak of hepatitis A among intravenous drug addicts in Oslo 1995-96]

Intravenous drug abuse is a well-known risk factor for acquiring hepatitis A infection. Among drug abusers most cases are sporadic, but epidemic outbreaks may occur occasionally. In this article we describe an epidemic outbreak including 144 serologically proved cases of hepatitis A among intravenous heroin and amphetamine abusers in Oslo. The outbreak lasted for 11 months. 59 (41%) of the patients were admitted to hospital. One of them died and seven developed severe but reversible acute hepatitis. We also registered 26 cases of hepatitis A among close contacts, 14 of whom were associated with a nosocomial outbreak that affected nurses, fellow patients and relatives. We do not know how the hepatitis A virus was introduced into the abuser population, but the further spread was probably dominated by a combination of faecal-oral transmission and parenteral transmission secondary to sharing needles. Although we were unable to detect hepatitis A virus in confiscated drug samples by means of polymerase chain reaction we cannot exclude that some abusers were infected by injection of contaminated amphetamine.

Evaluating the effectiveness of a pediatric trauma educational program in Central America

OBJECTIVE

To evaluate the effectiveness of a pediatric trauma course taught in a developing country.

STUDY DESIGN

A pediatric trauma course was designed with didactic presentations and reinforced with small group case discussions. Subjects included a general trauma overview, head trauma, airway/chest trauma, cervical spine trauma, abdominal trauma, shock, burns, and orthopedic injuries. Evaluation consisted of a pre- and post-course test and questionnaire assessing the participants' knowledge and level of comfort in managing trauma. Nine months after the course, the participants were evaluated with the same post-course test. Also a questionnaire was given to physician and nurse co-workers from the participating institutions, who themselves had not participated in the course, to assess the perceptual and attitudinal impact of the pediatric trauma course.

SETTING

Guatemala City, Guatemala.

PARTICIPANTS

Forty-three physicians from Central America.

RESULTS

Initial and nine-month post-test scores showed uniform improvement (P value < 0.05) when compared to pretest results using the Wilcoxon signed-ranks test. Analysis of the pre- and post-course questionnaires indicated that all participants felt more comfortable (scale 1 to 5) after the course managing pediatric trauma patients. All participants "strongly agreed" the course provided information that would improve their management of the pediatric trauma victim. Nine months after the course, 100% of their medical co-workers perceived physicians who participated in the pediatric trauma course to have better resuscitative skills, and 92% perceived these physicians to have a higher level of confidence.

CONCLUSION

This course, when presented to physicians in a developing country, appears to be effective in improving their knowledge base regarding pediatric trauma and increasing their comfort level in managing major pediatric trauma.

[The fatal disease of Napoleon Bonaparte]

Napoleon Bonaparte, soldier, general and emperor, desired the European union. He abdicated twice and in 1814 was confined to Santa Helena island. From the biographic description of bis last exile, we have extracted a description of the disease that lead him to die. We postulate that he had a gastric lymphoma.

The antidiabetic drug metformin elevates receptor tyrosine kinase activity and inositol 1,4,5-trisphosphate mass in Xenopus oocytes

Although metformin is an important antidiabetic, its mechanism of action is still unknown. To study its mechanism, we examined metformin stimulation of insulin action on the Xenopus oocyte. Similar to therapeutic concentrations, maximal stimulation of insulin-induced meiotic cell division was achieved at about 1-10 microg/ml (or 7.7-77 /microM) metformin. An equivalent concentration of metformin was required to elevate receptor tyrosine kinase activity (in whole cells or a membrane-cortex preparation) and, through this tyrosine kinase activation, inositol 1,4,5-trisphosphate (IP3) production. With whole cells, the preincubation time for metformin stimulation of insulin action (approximately 1 h) was equivalent to the time required for metformin to maximize tyrosine phosphorylation and raise IP3, levels. With the membrane-cortex preparation, metformin was active within minutes; thus, metformin may act at an intracellular site. Since metformin can increase IP3, mass, we prevented elevation of calcium by prior microinjection of a calcium chelator or heparin (a drug that inhibits IP3 binding to the IP3 receptor). Both the chelator and heparin blocked metformin stimulation of insulin action on whole cells. Since microinjection of IP3, also stimulates insulin action, metformin may stimulate insulin action by elevation of intracellular calcium in addition to activation of the receptor tyrosine kinase.

[Systemic leptospirosis as a cause of multiple organ failure. Report of a case]

Leptospirosis is a world-spread zoonosis that is incidentally acquired by humans. It causes a diphasic febrile illness in which the Weil syndrome is its severest form, with renal, hepatic, clotting and central nervous system involvement. We report a 73 years old male, that was admitted to an intensive care unit with multiple organ failure due to leptospirosis. The clinical picture initially resembled a sepsis due to biliary tract obstruction and was operated, not finding a biliary tract obstruction. Considering the history of a fall to sewed waters, leptospirosis was suspected and treatment with penicillin was started, obtaining a full recovery of the patient.

[Study of volume and kinetics of gallbladder emptying in non-pregnant, pregnant, and puerperal women]

Gallbladder stasis apparently plays an important role in the patho-genesis of cholelithiasis during pregnancy. On the other hand, gallstones diagnosed immediately after delivery disappear spontaneously during late puerperium in one third of these patients. Gallbladder emptying was assessed by biliary scintigraphy and ultrasonography in normal, nulliparous volunteers. The two methods had an excellent correlation: thence, we used ultrasonography to determine gallbladder volume and contraction in pregnant and puerperal women. Fasting and postprandial residual volumes were significantly larger during pregnancy, while the kinetics f gallbladder emptying was similar in nulliparous and pregnant women. During puerperium, gallbladder volume returned to the values observed in nulliparae; but the kinetics of emptying was significantly faster, suggesting an increased sensitivity of gallbladder muscle to physiologic stimuli.

[CAA 19-9 and carcinoembryonic antigen in gallbladder cancer]

The aim of this work was to assess the diagnostic yield of serum tumoral markers, Ca 19-9 and carcinoembryonic antigen, in patients with gallbladder cancer. We studied 54 patients of whom 33 had gallbladder cancer and in 21 the tumor was removed previously and were presently free of disease. Twenty one patients with cholelithiasis were used as controls. Ca 19-9 was over 37 U/ml in 22 (65%) patients with cancer, in two patients free of disease and in two controls. The sensitivity and specificity of Ca 19-9 was 0.66 and 0.90 respectively. Carcinoembryonic antigen was over 2.5 ng/ml in 25 patients with cancer (56%) and its sensitivity and specificity was 0.75 and 0.71 respectively. Using a cutoff point of 4 ng/ml, these figures were 0.51 and 0.9 respectively. The better predictive capacity was given by a Ca 19-9 over 37 U/ml or a carcinoembryonic antigen over 4 ng/ml. It is concluded that, although the sensitivity and specificity of these markers was adequate in this work, one must bear in mind that studied patients had advanced tumors.

Silicone breast implant--associated musculoskeletal manifestations

Three hundred consecutive women with silicone breast implants (SBI), referred to the arthritis clinic with a variety of musculoskeletal complaints, were evaluated for the presence of underlying connective tissue disease. A complete history and physical examination were performed, as well as laboratory testing for C-reactive protein, rheumatoid factor; and autoantibody determination by indirect immunofluorescence and immunodiffusion. The group mean age was 44.4 years (range 25-69), the mean time from initial implant surgery to appearance of symptoms was 6.8 years (range: 6m-19y) and 83.3% of women studied had clinical manifestations highly suggestive of an underlying connective tissue disorder. Fifty-four percent met criteria for fibromyalgia and/or chronic fatigue syndrome, distinct connective tissue diseases was detected in 11%, undifferentiated connective tissue disease or human adjuvant disease was found in 10.6%, and a variety of disorders such as angioneurotic oedema, frozen shoulder, multiple sclerosis-like syndrome were present. Several other miscellaneous conditions including recurrent unexplained low grade fever, hair loss, skin rash, sicca symptoms, Raynaud's phenomenon, carpal tunnel syndrome, memory loss, headaches, chest pain, and shortness of breath were also seen accompanying specific and non-specific conditions. Seventy percent of patients who underwent explanation of the implants reported improvement of their systemic symptomatology. A significant proportion of SBI patients referred for rheumatic evaluation have clinical manifestations highly suggestive of an underlying connective tissue disease. Furthermore, improvement of their symptomatology follows explanation of the implants in over half of the patients.

[The death of Moctezuma II]

Moctezuma was the Aztec emperor when Spaniards arrived in Mexico in 1519. After his entrance in Tenochtitlan, Cortés held the emperor hostage, forcing him to govern under conditions in his own palace. The psychic evolution experienced by Moctezuma until his death in 1520 is analyzed based on testimonial reports of Benal Diaz del Castillo and historian contributions. Although there is evidence that Moctezuma was stoned and wounded by an arrow, we propose the hypothesis that the emperor was affected by a Major Depression.

[Blunt trauma of the liver: treatment and results in 45 patients]

We report a retrospective analysis of 45 patients (41 male) aged between 14 and 57 years, with a blunt liver trauma seen between 1984 and 1993. Sixty two percent had complex liver lesions and 73% extraabdominal injuries. Peritoneal lavage and abdominal ultrasound appeared as useful diagnosis tools. Five patients were not operated and had a satisfactory evolution. Among operated patients, liver lesions were corrected with simple measures in 60%, hepatotomy in 7.5% and resection in 17.5%. As additional measures, tamponade was used in 4, resuscitation thoracotomy in 4, porto caval shunt in 2 and Marimoto balloon in 1. Eighteen percent of patients died and 32% had postoperative complications.

[Late splenic rupture: a risk of conservative treatment]

We report a 33 year old male admitted after a traffic accident with a painful abdomen and an open ankle fracture. An abdominal CAT scan showed a splenic laceration and free ascites. A conservative treatment was decided considering that the patient was hemodynamically stabilized. Seven days later, the patient appeared hypotense and with severe pain and was operated. During surgical intervention, a massive hemoperitoneum due to splenic bleeding from the spleen was found and a splenectomy was performed. Postoperative outcome was uneventful. The therapeutic approach to splenic traumatism ranges from splenectomy to medical treatment. The report case is an example of a complication of this later approach.

[Hepatitis A in Oslo]

During the last six years we have registered 237 persons with acute hepatitis A in Oslo, 96 of them with non-Scandinavian names. The number with non-Scandinavian names is increasing. Almost all the hepatitis A patients with non-Scandinavian names are children, and two of three had been infected in Pakistan. Adult immigrants from countries where hepatitis A is endemic do not need any prophylaxis against hepatitis A. 29,800 travellers were given human normal immunoglobulin at our department during the last five years and none of them acquired hepatitis A. To prevent import of hepatitis A it is of particular importance to give human normal immunoglobulin or hepatitis A vaccine to all children of immigrants before they visit their parents' country.

Sperm increase inositol 1,4,5-trisphosphate mass in Xenopus laevis eggs preinjected with calcium buffers or heparin

Although it is known that all fertilization events are due to elevated intracellular calcium ([Ca2+]i), it is not known how sperm induce an increase in zygote [Ca2+]i. We report that sperm can increase inositol 1,4,5-trisphosphate in Xenopus laevis eggs that have been preinjected with calcium buffers to prevent the increase in [Ca2+]i (both the initial increase and the subsequent wave) after fertilization. After buffering [Ca2+]i to levels well below basal, IP3 production was not blocked, whereas IP3 metabolism may be inhibited. Also, heparin (an inhibitor of inositol 1,4,5-trisphosphate action and the fertilization response) does not prevent a normal increase in IP3 after fertilization. Conditions that produce various levels of polyspermy are associated with IP3 increases similar to those noted after monospermic fertilization. These data suggest a specific order of fertilization events: sperm utilize an initial production of inositol 1,4,5-trisphosphate to produce the [Ca2+]i increase at fertilization.

[Usefulness of magnetic resonance imaging in the diagnosis of diaphragmatic rupture in 3 cases]

We report three male patients in whom the diagnosis of diaphragmatic rupture was raised. Conventional X ray examination showed an unilateal bulging of the diaphragmatic dome in two and the association of basal atelectasis in the third. Magnetic resonance imaging confirmed the diagnosis of diaphragmatic rupture in all. The diaphragmatic rupture was repaired surgically in two patients and the other was managed medically.

[Evaluation of prostatic specific antigen after a digital rectal examination: experience with 36 patients]

Levels of prostatic specific antigen may be modified with procedures over the prostatic gland. We measured this antigen in 36 hospitalized patients before and immediately after a digital rectal examination. Antigen levels were 8.3 +/- 21.3 ng/ml before and 13.8 +/- 27.5 ng/ml after the examination (NS). It is concluded that digital rectal examination did not modify antigen levels in our sample.

Quantitation of soluble HLA class I heterodimers and beta 2-microglobulin in patients with active pulmonary tuberculosis

Beta 2m serum levels have been shown to be increased in patients with tuberculosis and HIV infection. We determined the stability of beta 2m and of sHLA-I dimers in serum, and then determined the levels of both molecules in 60 non-HIV-infected patients with active pulmonary tuberculosis and in 55 adult controls. The levels of sHLA-I in samples kept at room temperature declined by 8% at 30 minutes, 16% at 60 minutes, and 36% at 120 minutes. Beta 2m levels remained stable at all times tested. Mean sHLA-I levels were 0.99 +/- 0.16 micrograms/ml in controls and 1.34 +/- 0.11 micrograms/ml in patients with tuberculosis (P < 0.0001). Beta 2m levels were 1.23 +/- 0.26 micrograms/ml in controls and 2.26 +/- 0.64 micrograms/ml in patients with tuberculosis (P < 0.0001). All patients with tuberculosis had elevation of sHLA-I and/or beta 2m above 1 standard deviation of normal values. However, there was no correlation between sHLA-I and beta 2m levels in individual samples. Evaluation of sHLA-I holds the promise of further understanding of the biology and genetic regulation of the immune response to mycobacterial infection.