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Background: Syphilis diagnosis relies on immunologic markers and clinical protocols. However, syphilitic lesions can be confused with other genital ulcer diseases., Methods: Using a PlexPCR VHS assay, we analyzed lesion DNA samples from 87 individuals who were clinically diagnosed with early syphilis infection and had at least 1 positive serologic test result. DNA was detected by the PlexPCR VHS multiplex assay and β-globin genes., Results: Among the participants, 99% (86/87) had a positive rapid treponemal test result. DNA was successfully detected in 91% (79/87) of the lesion samples. PlexPCR VHS identified 5 herpes simplex virus (HSV)/ Treponema pallidum coinfections (2 HSV-1 and 3 HSV-2), only T pallidum DNA in 62% (49/79), and only HSV-2 in 12.7% (10/79). While 19% (15/79) were negative for all pathogens, none were varicella zoster virus positive. The PlexPCR VHS had 68.4% agreement with the clinical diagnosis., Conclusions: Since the PlexPCR VHS detects multiple organisms simultaneously, it can help to confirm actual syphilis and identify other pathogen coinfections or the pathogen causing the ulcer., Competing Interests: Potential conflicts of interest. K. A. K. has worked for the Universidad Peruana Cayetano Heredia and University of California, Los Angeles, in the past year. All other authors report no potential conflicts., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background: The increasing prevalence of drug-resistant Neisseria gonorrhoeae (NG) infections has caused great concern. Ciprofloxacin remains the empiric antimicrobial recommended to treat NG infections in Peru disregarding the susceptibility profile of circulating NG strains. We report the prevalence of individuals infected with NG strains presenting mutations in the gyrA gene that confers ciprofloxacin resistance., Methods: We conducted a descriptive study assessing extragenital swab samples collected from a cohort of men who have sex with men and transgender women in Lima, Peru. Anal and pharyngeal NG positive swabs for Aptima Combo 2 assay (Hologic Inc., USA) were used for DNA extraction. We performed TaqMan real time PCR assays to detect a point mutation at codon Ser91 of the gyrase A ( gyr A) gene., Results: From 156 individuals who had at least one positive sample for NG reported by the Aptima assay, 80 individuals had at least one amplified DNA for the gyrA gene. We found that 67 of them (84.0%) were infected with a gyrA -mutated NG strain at the Ser91 codon., Conclusions: We report a high prevalence of gyrA mutation conferring ciprofloxacin resistance among individuals with extragenital NG infection. Empirical treatment of NG needs to be urgently updated in Peru in concordance with international guidelines.

Sequencing of most Treponema pallidum genomes excludes repeat regions in tp0470 and the tp0433 gene, encoding the acidic repeat protein ( arp ). As a first step to understanding the evolution and function of these genes and the proteins they encode, we developed a protocol to nanopore sequence tp0470 and arp genes from 212 clinical samples collected from ten countries on six continents. Both tp0470 and arp repeat structures recapitulate the whole genome phylogeny, with subclade-specific patterns emerging. The number of tp0470 repeats is on average appears to be higher in Nichols-like clade strains than in SS14-like clade strains. Consistent with previous studies, we found that 14-repeat arp sequences predominate across both major clades, but the combination and order of repeat type varies among subclades, with many arp sequence variants limited to a single subclade. Although strains that were closely related by whole genome sequencing frequently had the same arp repeat length, this was not always the case. Structural modeling of TP0470 suggested that the eight residue repeats form an extended α-helix, predicted to be periplasmic. Modeling of the ARP revealed a C-terminal sporulation-related repeat (SPOR) domain, predicted to bind denuded peptidoglycan, with repeat regions possibly incorporated into a highly charged β-sheet. Outside of the repeats, all TP0470 and ARP amino acid sequences were identical. Together, our data, along with functional considerations, suggests that both TP0470 and ARP proteins may be involved in T. pallidum cell envelope remodeling and homeostasis, with their highly plastic repeat regions playing as-yet-undetermined roles., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Lieberman, Armstrong, Chung, Pfalmer, Hennelly, Haynes, Romeis, Wang, Zhang, Kou, Ciccarese, Conte, Cusini, Drago, Nakayama, Lee, Ohnishi, Konda, Vargas, Eguiluz, Caceres, Klausner, Mitja, Rompalo, Mulcahy, Hook, Hoffman, Matoga, Zheng, Yang, Lopez-Medina, Ramirez, Radolf, Hawley, Salazar, Lukehart, Seña, Parr, Giacani and Greninger.)

In spite of its immutable susceptibility to penicillin, Treponema pallidum (T. pallidum) subsp. pallidum continues to cause millions of cases of syphilis each year worldwide, resulting in significant morbidity and mortality and underscoring the urgency of developing an effective vaccine to curtail the spread of the infection. Several technical challenges, including absence of an in vitro culture system until very recently, have hampered efforts to catalog the diversity of strains collected worldwide. Here, we provide near-complete genomes from 196 T. pallidum strains-including 191 T. pallidum subsp. pallidum-sequenced directly from patient samples collected from 8 countries and 6 continents. Maximum likelihood phylogeny revealed that samples from most sites were predominantly SS14 clade. However, 99% (84/85) of the samples from Madagascar formed two of the five distinct Nichols subclades. Although recombination was uncommon in the evolution of modern circulating strains, we found multiple putative recombination events between T. pallidum subsp. pallidum and subsp. endemicum, shaping the genomes of several subclades. Temporal analysis dated the most recent common ancestor of Nichols and SS14 clades to 1717 (95% HPD: 1543-1869), in agreement with other recent studies. Rates of SNP accumulation varied significantly among subclades, particularly among different Nichols subclades, and was associated in the Nichols A subclade with a C394F substitution in TP0380, a ERCC3-like DNA repair helicase. Our data highlight the role played by variation in genes encoding putative surface-exposed outer membrane proteins in defining separate lineages, and provide a critical resource for the design of broadly protective syphilis vaccines targeting surface antigens., Competing Interests: The authors have declared that no competing interests exist.

Background: An effective syphilis vaccine should elicit antibodies to Treponema pallidum subsp. pallidum (T. p. pallidum) surface antigens to induce pathogen clearance through opsonophagocytosis. Although the combination of bioinformatics, structural, and functional analyses of T. p. pallidum genes to identify putative outer membrane proteins (OMPs) resulted in a list of potential vaccine candidates, still very little is known about whether and how transcription of these genes is regulated during infection. This knowledge gap is a limitation to vaccine design, as immunity generated to an antigen that can be down-regulated or even silenced at the transcriptional level without affecting virulence would not induce clearance of the pathogen, hence allowing disease progression., Principal Findings: We report here that tp1031, the T. p. pallidum gene encoding the putative OMP and vaccine candidate TprL is differentially expressed in several T. p. pallidum strains, suggesting transcriptional regulation. Experimental identification of the tprL transcriptional start site revealed that a homopolymeric G sequence of varying length resides within the tprL promoter and that its length affects promoter activity compatible with phase variation. Conversely, in the closely related pathogen T. p. subsp. pertenue, the agent of yaws, where a naturally-occurring deletion has eliminated the tprL promoter region, elements necessary for protein synthesis, and part of the gene ORF, tprL transcription level are negligible compared to T. p. pallidum strains. Accordingly, the humoral response to TprL is absent in yaws-infected laboratory animals and patients compared to syphilis-infected subjects., Conclusion: The ability of T. p. pallidum to stochastically vary tprL expression should be considered in any vaccine development effort that includes this antigen. The role of phase variation in contributing to T. p. pallidum antigenic diversity should be further studied., Competing Interests: The authors have declared that no competing interests exist.

Araucaria angustifolia is endemic to southern Brazil. Known as Brazilian pine, A. angustifolia is the only native conifer species with economic and social relevance in this country. Due to massive exploitation, it has suffered a significant population decline and currently is classified as critically endangered. This encouraged the scientific community to investigate genetic features in Brazilian pine to increase resources for management and preservation. In this work, RNA-Seq data was used to determine the complete nucleotide sequence of the A. angustifolia chloroplast genome (cpDNA). The cpDNA is 146,203 bp in length and contains 122 genes, including 80 protein-coding genes, 5 ribosomal RNA genes, and 37 tRNA genes. Coding regions comprise 45.02%, 4.96% correspond to rRNAs and tRNAs, and 50.02% of the genome encompasses non-coding regions. Genes found in the inverted repeat (IR) are present as single copy, with exception of the rrn5 and trnI-CAU loci. The typical LSC, SSC, IRa and IRb organization reported in several land-plant groups is not present in A. angustifolia cpDNA. Phylogenetic analyses using Bayesian and Maximum Likelihood methods clustered A. angustifolia in the Araucariaceae family, with A. heterophylla and A. columnaris as congeneric species. The screening of A. angustifolia cpDNA reveled 100 SSRs, 14 of them corresponding to tetrapolymer loci.

The knowledge about plant miRNAs has increased exponentially, with thousands of miRNAs been reported in different plant taxa using high throughput sequencing technologies and bioinformatic tools. Nevertheless, several groups of plants remain unexplored, and the gap of knowledge about conifer miRNAs is considerable. There is no sequence or functional information available on miRNAs in Araucariaceae. This group is represented in Brazil by only one species, Araucaria angustifolia , an endangered species known as Brazilian pine. In the present study, Brazilian pine has its transcriptome explored with respect to small RNAs, representing the first description in a member of the Araucariaceae family. The screening for conserved miRNAs in Brazilian pine revealed 115 sequences of 30 miRNA families. A total of 106 precursors sequences were predicted. Forty one comprised conserved miRNAs from 16 families, whereas 65 were annotated as novel miRNAs. The comparison of Brazilian pine precursors with sRNA libraries of other five conifer species indicates that 9 out 65 novel miRNAs are conserved among gymnosperms, while 56 seems to be specific for Brazilian pine or restricted to Araucariaceae family. Analysis comparing novel Brazilian pine miRNAs precursors and Araucaria cunninghamii RNA-seq data identified seven orthologs between both species. Mature miRNA identified by bioinformatics predictions were validated using stem-loop RT-qPCR assays. The expression pattern of conserved and novel miRNAs was analyzed in five different tissues of 3-month-old Araucaria seedlings. The present study provides insights about the nature and composition of miRNAs in an Araucariaceae species, with valuable information on miRNAs diversity and conservation in this taxon.

The adult Taenia solium, the pork tapeworm, usually lives as a single worm in the small intestine of humans, its only known definitive host. Mechanisms of genetic variation in T. solium are poorly understood. Using three microsatellite markers previously reported [1], this study explored the genetic variability of T. solium from cysts recovered from experimentally infected pigs. It then explored the genetic epidemiology and transmission in naturally infected pigs and adult tapeworms recovered from human carriers from an endemic rural community in Peru. In an initial study on experimental infection, two groups of three piglets were each infected with proglottids from one of two genetically different tapeworms for each of the microsatellites. After 7 weeks, pigs were slaughtered and necropsy performed. Thirty-six (92.3%) out of 39 cysts originated from one tapeworm, and 27 (100%) out of 27 cysts from the other had exactly the same genotype as the parental tapeworm. This suggests that the microsatellite markers may be a useful tool for studying the transmission of T. solium. In the second study, we analyzed the genetic variation of T. solium in cysts recovered from eight naturally infected pigs, and from adult tapeworms recovered from four human carriers; they showed genetic variability. Four pigs had cysts with only one genotype, and four pigs had cysts with two different genotypes, suggesting that multiple infections of genetically distinct parental tapeworms are possible. Six pigs harbored cysts with a genotype corresponding to one of the identified tapeworms from the human carriers. In the dendrogram, cysts appeared to cluster within the corresponding pigs as well as with the geographical origin, but this association was not statistically significant. We conclude that genotyping of microsatellite size polymorphisms is a potentially important tool to trace the spread of infection and pinpoint sources of infection as pigs spread cysts with a shared parental genotype.

Plinia trunciflora is a Brazilian native fruit tree from the Myrtaceae family, also known as jaboticaba. This species has great potential by its fruit production. Due to the high content of essential oils in their leaves and of anthocyanins in the fruits, there is also an increasing interest by the pharmaceutical industry. Nevertheless, there are few studies focusing on its molecular biology and genetic characterization. We herein report the complete chloroplast (cp) genome of P. trunciflora using high-throughput sequencing and compare it to other previously sequenced Myrtaceae genomes. The cp genome of P. trunciflora is 159,512 bp in size, comprising inverted repeats of 26,414 bp and single-copy regions of 88,097 bp (LSC) and 18,587 bp (SSC). The genome contains 111 single-copy genes (77 protein-coding, 30 tRNA and four rRNA genes). Phylogenetic analysis using 57 cp protein-coding genes demonstrated that P. trunciflora, Eugenia uniflora and Acca sellowiana form a cluster with closer relationship to Syzygium cumini than with Eucalyptus. The complete cp sequence reported here can be used in evolutionary and population genetics studies, contributing to resolve the complex taxonomy of this species and fill the gap in genetic characterization.

Background: Infections with Taenia solium are the most common cause of adult acquired seizures worldwide, and are the leading cause of epilepsy in developing countries. A better understanding of the genetic diversity of T. solium will improve parasite diagnostics and transmission pathways in endemic areas thereby facilitating the design of future control measures and interventions. Microsatellite markers are useful genome features, which enable strain typing and identification in complex pathogen genomes. Here we describe microsatellite identification and characterization in T. solium, providing information that will assist in global efforts to control this important pathogen., Methods: For genome sequencing, T. solium cysts and proglottids were collected from Huancayo and Puno in Peru, respectively. Using next generation sequencing (NGS) and de novo assembly, we assembled two draft genomes and one hybrid genome. Microsatellite sequences were identified and 36 of them were selected for further analysis. Twenty T. solium isolates were collected from Tumbes in the northern region, and twenty from Puno in the southern region of Peru. The size-polymorphism of the selected microsatellites was determined with multi-capillary electrophoresis. We analyzed the association between microsatellite polymorphism and the geographic origin of the samples., Results: The predicted size of the hybrid (proglottid genome combined with cyst genome) T. solium genome was 111 MB with a GC content of 42.54%. A total of 7,979 contigs (>1,000 nt) were obtained. We identified 9,129 microsatellites in the Puno-proglottid genome and 9,936 in the Huancayo-cyst genome, with 5 or more repeats, ranging from mono- to hexa-nucleotide. Seven microsatellites were polymorphic and 29 were monomorphic within the analyzed isolates. T. solium tapeworms were classified into two genetic groups that correlated with the North/South geographic origin of the parasites., Conclusions/significance: The availability of draft genomes for T. solium represents a significant step towards the understanding the biology of the parasite. We report here a set of T. solium polymorphic microsatellite markers that appear promising for genetic epidemiology studies.

Objective: To validate the questionnaire "Gender Perspective in Health Research" (GPIHR) to assess the inclusion of gender perspective in research projects., Design: Validation study in two stages. Feasibility was analysed in the first, and reliability, internal consistence and validity in the second., Where: Aragón Institute of Health Science, Aragón, Spain., Participants: GPIHR was applied to 118 research projects funded in national and international competitive tenders from 2003 to 2012., Main Measurements: Analysis of inter- and intra-observer reliability with Kappa index and internal consistency with Cronbach's alpha. Content validity analysed through literature review and construct validity with an exploratory factor analysis., Results: Validated GPIHR has 10 questions: 3 in the introduction, 1 for objectives, 3 for methodology and 3 for research purpose. Average time of application was 13min Inter-observer reliability (Kappa) varied between 0.35 and 0.94 and intra-observer between 0.40 and 0.94. Theoretical construct is supported in the literature. Factor analysis identifies three levels of GP inclusion: "difference by sex", "gender sensitive" and "feminist research" with an internal consistency of 0.64, 0.87 and 0.81, respectively, which explain 74.78% of variance., Conclusions: GPIHR questionnaire is a valid tool to assess GP and useful for those researchers who would like to include GP in their projects., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

The genome of potato, a major global food crop, was recently sequenced. The work presented here details the integration of the potato reference genome (DM) with a new sequence-tagged site marker-based linkage map and other physical and genetic maps of potato and the closely related species tomato. Primary anchoring of the DM genome assembly was accomplished by the use of a diploid segregating population, which was genotyped with several types of molecular genetic markers to construct a new ~936 cM linkage map comprising 2469 marker loci. In silico anchoring approaches used genetic and physical maps from the diploid potato genotype RH89-039-16 (RH) and tomato. This combined approach has allowed 951 superscaffolds to be ordered into pseudomolecules corresponding to the 12 potato chromosomes. These pseudomolecules represent 674 Mb (~93%) of the 723 Mb genome assembly and 37,482 (~96%) of the 39,031 predicted genes. The superscaffold order and orientation within the pseudomolecules are closely collinear with independently constructed high density linkage maps. Comparisons between marker distribution and physical location reveal regions of greater and lesser recombination, as well as regions exhibiting significant segregation distortion. The work presented here has led to a greatly improved ordering of the potato reference genome superscaffolds into chromosomal "pseudomolecules".

Objective: Gender perspective is a theoretical approach that developed from feminist theories and whose main focus is the analysis of gender inequalities. Integration of this perspective is central to promoting equity in health. The aim of our study was to devise a protocol/questionnaire to assess whether gender is present in research projects and thus help to fill the gap in assessment tools., Methods: We used a qualitative design with two techniques: group discussion and expert group meetings. The discussion group conducted a dialectical analysis of the basic concepts in research and gender and integrated the results of the discourse produced in the expert group meeting. The drafting of the protocol was organized around the pertinent questions that should be asked at each stage of a research project., Results: The protocol consists of 15 questions: four in the introduction section, two in goals and hypotheses, three in methodology, three in purpose of the study and three to be implemented throughout the research project., Conclusions: The protocol identifies projects that include a gender perspective. Use of this protocol will improve the quality of research and will help to reduce gender inequities., (Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: Prematurity is considered the main factor of neonatal mortality in developed countries (60 to 80% of cases)., Objective: To determine if obstetric morbidity and/or prematurity are associated with neonatal death., Patients and Methods: A cohort of 25,365 live newborns since January 1st 2000 to December 31st 2004 was studied. Neonatal mortality was compared according to the number of prenatal visits, single or multifetal pregnancy, the presence or not of preeclampsia/eclampsia, cesarean section or vaginal delivery, and duration of rupture of membranes, stratifying by weeks of gestational age or by preterm and term gestation, as it was convenient. Chi-square test and Odds Ratio (OR) with 95% Confidence Intervals were calculated (CI)., Results: There was not significant statistical difference in neonatal mortality at less number of prenatal visits, between single and twin pregnancies, in the presence of preeclampsia/eclampsia and pregnancies without complications, when they were stratified by group of gestational age. When it was controlled gestational age, malformations and maternal-fetal and obstetrical morbidity, there was not difference in mortality of neonates born vaginally or by cesarean section. It was observed an increased risk or neonatal mortality in preterm neonates with 48 hours or more of rupture of membranes (OR 3.05 CI 95% 1.64-5.66), Conclusions: Performing and stratified analysis, prematurity was the factor associated with neonatal mortality, and not the number of prenatal visits, multifetal pregnancy, preeclampsia/eclampsia, or cesarean section. The duration of rupture of membranes is an independent factor of prematurity for neonatal mortality.

Objective: Determine the prevalence of maternal risk factors and evaluate their impact on neonatal mortality in a regional perinatal center., Materials and Methods: A cohort of 25,365 live newborns was studied between January 1st 2000 and December 31st 2004. Maternal antecedents were registered in a data base: sociodemographic; medical history; obstetric antecedents of previous pregnancies; as well as evolution of current pregnancy and birth. Newborn birth weight, gestational age and condition at discharge were registered too. Neonates who died were considered cases and controls those discharged alive. Mortality was compared to the presence or absence of risk factors in maternal medical history. Prevalence, odds ratio (OR) with 95% confidence interval, and attributable fraction in the exposed and the population were calculated with the SPSS 8.0 and Epi Info 6.4 programs., Results: The most notable maternal factors associated with newborn mortality were maternal age > or = 30 years OR 1.5 (1.37-2.0), less than 7 prenatal exams OR 2.17 (1.52-3.09) (53.5% attributable fraction in the exposed and 23.3% in population), eclampsia OR 4.66 (2.82-7.64), type-II diabetes OR 5.41 (2.11-12.99), urinary tract infection OR 1.98 (1.40-2.78), positive serology to human immunodeficiency virus OR 41.75 (5.77-230.9), membrane rupture > or = 48 hours OR 22.99 (13.10-40.2), polyhydramnios OR 31.53 (19.12-51.6) and abruptio placentae OR 42.18 (21.06-83.1)., Conclusions: Transpartum risk factors had a larger impact on mortality than pregnancy or pregestational factors.

Background: Perinatal clinical picture allows identifying psychosocial features in pregnant women, them medical, obstetrical, and pregnancy history, present delivery, and neonatal mortality risk factors., Objective: To know prevalence of maternal risk factors and evaluates them impact on neonatal mortality., Materials and Methods: A cohort of 25,365 live newborns was studied between January 1st 2000 and December 31st 2004. Maternal sociodemographic and obstetrical history was registered in a database; as well as weight, gestational age, and neonate discharge condition. Dead neonates were considered cases and controls those discharged alive. Mortality was compared with maternal history. Prevalence, odds ratio (OR) with 95% confidence interval, and exposed and population attributable fraction were calculated with the SPSS 8.0 and Epi Info 6.4 applications., Results: Maternal factors associated with newborn mortality were: maternal age > or = 30 years OR 1.5 (1.37-2.0), less than seven prenatal consultations OR 2.17 (1.52-3.09), 53.5% of attributable fraction in exposed and 23.3% in population, eclampsia OR 4.66 (2.82-7.64), type 2 diabetes OR 5.41 (2.11-12.99), urinary tract infection OR 1.98 (1.40-2.78), positive serology to HIV OR 41.75 (5.77-230.9), membrane rupture > or = 48 hours OR 22.99 (13.10-40.2), polyhydramnios OR 31.53 (19.12-51.6) and premature separation of the placenta OR 42.18 (21.06-83.1)., Conclusions: Risk factors history during delivery has a larger impact on mortality than pregnancy or pregestational factors.

Objective: To analyze the causes of neonatal mortality, its distribution, the moment of appearance and risk factors., Patients and Method: We studied a cohort of 46,297 live newborns born at the mentioned hospital, weighing 500 g or more. In a database we registered: birth weight, gestational age, days of hospital stay, discharged condition, one and five Apgar minute score, morbidity, death causes, moment of death, reducible death/reducible difficult death rate presented in less than 24 hours, 1 to 6 days, and 7 to 27 postnatal days. We compared morbidity, mortality, and risk factors in a three-year period to facilitate the analysis., Results: Mortality increased with the lesser one minute Apgar score: 0.2, 9.7 and 42.9% when score was 7-10, 4-6, or 0-3, respectively, and 0.6, 41.9 and 62.9% at five minute Apgar score. Malformations were the first cause of death, which increased from 28.6 to 40.3%. Respiratory distress syndrome mortality decreased 34% and that of meconium aspiration syndrome 53%. Reducible death/hardly reducible death rate occurred from 1 to 6 days decreased 67%, from 5.2 to 1.7 (reference value 1)., Conclusions: Preventable causes of death decreased significantly, particularly those related to perinatal causes, although they are still high compared with developed countries.

Objective: To evaluate the neonatal mortality and the specific neonatal mortality rates by groups of birthweight and gestacional age, at the Ignacio García Téllez National Medical Center which is a reference tertiary perinatal center of the Social Security Mexican Institute for the Yucatan Peninsula, along the period of 1995-2004., Material and Methods: A cohort of 46,297 live newborns was studied with birtweight of 500 grams or more, that were discharged between January 1st 1995 and December 31st 2004. Birthweight, gestational age, length of hospitalization, condition at discharge were captured in a data base. Triennial analysis of mortality was done., Results: The proportion of neonates with birthweight <2,500 g increased and 19% neonates <1,000 g 50%, the increment was 21% for preterm neonates, 46% for immature, and 40% for those extremely immature. The early neonatal mortality rate diminished from 7.0 to 6.9, the late mortality from 3.0 to 2.2, the neonatal from 10.0 to 9.2/1,000 live newborn, the survival increased 232% in neonates with birthweight between 500-749 g, 25% between 750-999 g, 5.8% between 1,000-1,249 g, 8.2% between 1,250-1,499 g. The neonatal mortality decreased 31.8% from the expected, because the adjusted neonatal mortality rate was 13.5 compared with the observed 9.2/1,000 live newborn., Conclusions: There was a significant increase of the survival with lesser birthweight and gestational age, although it was not reflected in the brut neonatal mortality rate because there was an increase of the risk population.

As part of an epidemiological study on cardiovascular risk factors among children and adolescent in Navarra, arterial blood pressure (BP) readings were taken in 5,829 children. These children, both males and females, between the ages of 4 and 17 years, were selected at random from the public and private school population in our community. The correlation between systolic blood pressure and diastolic blood pressure with anthropometric and biochemical parameters was analyzed. The correlation coefficient for systolic BP readings were always higher than those for diastolic BP. The highest correlations for both BP scores were found with weight, followed by height. Correlation with total weight parameters is superior to that found with body fat parameters. There were no significant correlations between BP and the lipid parameters. When analyzing multiple regression equations, we find that with only the child's weight and age, both systolic and diastolic BP can be predicted with correlation coefficients of 0.597 and 0.492, respectively. When doing a partial correlation analysis, the correlation between systolic BP and age, at a fixed height value, disappears; while the correlation of systolic BP with height remains when using a set age. This suggest that the best definition for hypertension is based on BP-height percentile, rather than BP-age.

As part of an epidemiological study on cardiovascular risk factors among children and adolescents in Navarra, 5,829 children were studied. These children, of both sexes, were between 4 and 17 years of age and were selected at random from the public and private school population in Navarra. The prevalence of hypertension (HT) was 7.17 +/- 0.34%, hyperlipemia (LDL/HDL > 2.2) 15.70 +/- 0.49% and obesity (Quetelet I) 3.96 +/- 0.26%. Of the children and adolescents in Navarra 23.68% show some of these three associated risk factors. Obesity was significantly associated with HT and hyperlipemia, measured by LDL/HDL > 2.2 (but not when defined by cholesterol > 200 mg/dl). This association was greater when the pathology was defined by the Quetelet Index, rather than by the skinfold thickness. Hypertension was not associated with hypercholesterolemia (defined as LDL/HDL > 2.2). The association with hyperlipemia (measured by LDL/HDL) disappeared when the obesity effect was eliminated. It is deduced from these factors that if we don't take preventative health measures, the present children and adolescents from Navarra will suffer a high cardiovascular morbi-mortality when they become adults.

As part of an epidemiological study on cardiovascular risk factors among children and adolescents in Navarra, lipids and lipoproteins were analyzed in 5,829 children of both sexes, between 4-17 years of age, and selected at random from the school population in our community. In this article, we analyze the different definitions for lipid risk during childhood, whether based on percentile values, according to age and sex of the child, of cholesterol, LDL/cholesterol, or risk quotients (C/HDL, LDL/HDL), or even on the absolute values of all of these parameters. An appropriate definition for hyperlipemia during childhood, once we know the average variations in the levels of lipids and lipoproteins according to age and sex, as well as the variations of the lipid risk prevalence according to its definition, would be: 1. Previous screening according to cholesterol serum levels: Values higher than the 70th percentile for each group according to age and sex: or higher than 185 mg/dl for children age 4 to 12 and 170 mg/dl for children age 13 to 17. 2. To calculate the LDL/HDL quotient among those selected children included in the definition of hyperlipemia when the quotient is higher than the 85th percentile for the patients age and sex, or it is higher than 2.2.

As part of an epidemiological study on cardiovascular risk factors among children and adolescents in Navarra, the following parameters: total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and C/HDL and LDL/HDL risk quotients were determined in 5,829 children. These children, of both sexes and between the ages of 4 and 17 years, were selected at random from the school population in our community. Average values and percentiles of these parameters were obtained for each group according to age and sex as a previous step to define the health condition or "lipid risk" in our population. When determining the correlation of these biochemical parameters with the anthropometrical parameters of BP, age, weight, height, Quetelet Index, body mass surface, skinfold thickness and the percentage of subcutaneous fat (after the necessary logarithmic transformations, adjusted to each age and sex group by Z-scores) we find that none of the correlation coefficients are significant. The triglycerides and the HDL-cholesterol have a low, but significant. The triglycerides and the HDL-cholesterol have a low, but significantly, correlation with the other lipid parameters. The lipid risk quotient (C/HDL, LDL/HDL) shows a higher correlation with LDL-cholesterol than with total cholesterol.

As part of an epidemiological study on cardiovascular risk factors among children and adolescents in Navarra, lipids and lipoproteins were analyzed in 5,829 children of both sexes. The subjects were between 4 and 17 years of age and were selected at random from the school population in our community. In this article we analyze the variations in HDL-cholesterol and cholesterol/HDL and LDL/HDL risk quotients according to age and sex. Beginning at the age of 10, the HDL decreases in both sexes, although this decrease is more evident among males and they obtain levels lower than those during early childhood. Among females older than 14 there is a slight increase. Apparently the decrease in HDL among male adolescents is due to an increase in the production of testosterone during this stage of life. Both risk quotients decrease until the children are 10 years of age, after which they increase among males and stabilize or slightly decrease among females. For this reason, scores are higher for males during the last years of adolescence. The cardiovascular lipid risk increases with age and during adolescence in higher among males and depends more on the variations in HDL than on variations in cholesterol or LDL. We believe that the best definition for cardiovascular lipid risk during the infancy or adolescents is one which is based on the risk quotients.

As part of an epidemiological study on cardiovascular risk factors among children and adolescents in Navarra, lipids and lipoproteins were analyzed in 5,829 children of both sexes. These children were between 4 and 17 years of age and were randomly selected from the school population of our community. In this article, we analyze the prevalence of lipid risk, according to its different definitions, among children and adolescents in Navarra, and its variations related to age, sex and sanitary area. The prevalence of hypercholesterolemia (C > 200 mg/dl) among children and adolescents, aged 4 to 17 years, is very high: 21.07% +/- 0.54%. In spite of having high serum levels of HDL, the lipid risk measured by the risk quotient LDL/HDL > 2.2 is still very high: 15-70% +/- 0.49%. If we define the lipid risk during childhood and adolescence by the quotient LDL/HDL > 2.2, male adolescents turn out to be the group with the highest risk. This phenomenon coincides with the results of the epidemiological studies made among adults. Nevertheless, they do not coincide with these results if the lipid risk is defined by C > 200 mg/dl. In our opinion, during infancy and adolescence, the lipid risk is better defined by the quotient LDL/HDL > 2.2.

As part of an epidemiological study on cardiovascular risk factors among children and adolescents in Navarra, arterial blood pressure (BP) readings were taken in 5,829 children, including both sexes and aged between 4 and 17 years. The subjects were randomly selected from the public and private school population in our community. BP-age and BP-height percentiles were obtained for each sex and the physiological variations in BP according to these parameters was also analyzed. Systolic BP increased with age in both sexes throughout childhood. During adolescence, there is almost no variation in BP among girls, but in boys older than 13 years, there is a sudden increase. For this reason, boys have higher values than girls. Diastolic BP shows a linear increase in both sexes. BP increases with height in both sexes. In spite of the sudden rise in systolic BP among the boys taller than 145 cm, the increase in systolic BP in relationship to height is smaller and more homogeneous than the increase seen with age. As the BP variations with height are smaller and more homogeneous than those related to age, it is preferable to evaluate this parameter by BP-height rather than by BP-age.

As part of an epidemiological study on cardiovascular risk factors among children and adolescents in Navarra, lipids and lipoproteins were analysed in 5,829 children. The study group was selected at random from the school population in our community and included students of both sexes between 4 and 17 years of age. In this article we describe the variations from 4 to 10 years of age in both sexes and decrease from that age on. Among males older than 14, they continue decreasing, while they become stable in females. For this reason, values during childhood are higher than during adolescence in both sexes, and within this period, males show lower levels than girls. Variations in LDL serum levels according to age and sex are similar to those recorded with cholesterol. The triglyceride serum levels increase in line with age among boys. With girls, something similar happens until they are 13. Starting from this age, there is an inversion showing lower levels than the male adolescents. In both sexes, levels during adolescence are higher than during childhood.

Although nowadays there is still quite a controversy when it comes to accept that cardiovascular risk factors, e.g. hyperlipemias, exist right from paediatric age, we have already enough data to confirm this fact. First of all, it has been proved the presence of early atheroma injuries since paediatric age, as well as the relationship between lipid and lipoprotein serum levels and those injuries. Secondly, a clear tracking of those lipids during childhood reinforces this fact. And finally, the strong cholesterol and serum lipoproteins family aggregation actually confirm that hyperlipemias are a cardiovascular risk factor right from childhood.

Two cases of patent ductus arteriosus in preterm newborns who were operated on are reported. Several physiopathologic and clinical aspects of importance for the diagnosis and treatment of this entity are pointed out.