Ricardo O. Escárcega

Primary antiphospholipid syndrome in Latin American mestizo patients: clinical and immunologic characteristics and comparison with European patients

A great variety of clinical and immunological features have been described in patients with the antiphospholipid syndrome (APS), but information on their prevalence and characteristics in Latin American mestizo patients with the primary APS is scarce. To analyze the prevalence and characteristics of the main clinical and immunological manifestations in a cohort of patients with primary APS of mestizo origin from Latin America and to compare them with the European white patients, clinical and serological characteristics of 100 patients with primary APS from Colombia, Mexico, and Ecuador were collected in a protocol form that was identical to that used to study the “Euro-Phospholipid” cohort. The cohort consisted of 92 female patients (92.0%) and eight (8.0%) male patients. They were all mestizos. The most common manifestations were deep vein thrombosis (DVT; 23.0%), livedo reticularis (18.0%), migraine (18.0%), and stroke (18.0%). The most common pregnancy morbidity was early pregnancy losses (54.1% of pregnancies). Several clinical manifestations were more prevalent in the Latin American mestizo than in the European patients (transient global amnesia, pulmonary microthrombosis, arthralgias, and early pregnancy losses) and vice-versa (DVT, stroke, pulmonary embolism, and thrombocytopenia). Latin American mestizo patients with primary APS have a wide variety of clinical and immunological manifestations with several differences in their prevalence in comparison with European white patients.

Giant sigmoid colon diverticulum.

was approximately 15 cm long. The rest of the bowel exploration did not reveal any abnormalities. Diverticulectomy was deferred for proper bowel preparation. During diverticulectomy, a giant sigmoid colon diverticulum was localized ( fig. 2 ) and after careful dissection was excised. In addition to sigmoid colon resection, primary bowel anastomosis was performed. The surgical specimen measured 15 cm in length ( fig. 3 ) and was confirmed by our pathology department as a giant sigmoid colon diverticulum. A 73-year-old female was admitted to our centre because of signs and symptoms that suggested bowel obstruction and that persisted for 48 h. Her past medical history was uneventful except for multiple blood transfusions because of chronic iron deficiency anaemia. The abdominal X-ray ( fig. 1 ) taken at the time of first evaluation revealed an air-fluid level. The patient underwent an exploratory laparotomy through a supraand infraumbilical midline incision. During surgery, a giant sigmoid colon diverticulum was found incidentally which Published online: March 16, 2007

The Brugada syndrome.

The Brugada syndrome is an inherited cardiac disorder initially described in 1992 by Pedro and Josep Brugada, with variable electrocardiographic features characteristic of right bundle-branch block, persistent ST-segment elevation in the precordial leads (V1-V3) at rest and sudden cardiac death. The genetic abnormalities that cause Brugada syndrome have been linked to mutations in the ion channel gene SCN5A which encodes for the a-subunit of the cardiac sodium channel. A consensus conference report published in 2002 described the diagnostic criteria for the Brugada syndrome and described the three distinct types of Brugada syndrome. In 2005, a second consensus report was published which described the risk stratification and approaches to therapy. Two specific types of ST-segment elevation, coved and saddleback, are observed in the Brugada syndrome, the former of which is reported to relate to a higher incidence of ventricular tachycardia/ventricular fibrillation (VT/VF) and sudden cardiac death.The objective of this paper is to review the genetics and the molecular biology behind the Brugada syndrome, the diagnostic criteria, including clinical and electrocardiographic characteristics, and current management.

Consensus Statement on Mandatory Registration of Clinical Trials

ventions and research hypotheses, and basic methodology [2, 4] . The SJEG member journals will require registration of all prospective clinical trials as of July 1, 2007. Trials that begin after July 1, 2007 must register before enrollment of the first study subject, and trials that began before the deadline must register prior to editorial review. Submitted manuscripts must include the unique registration number in the abstract as evidence of registration. Authors submitting manuscripts reporting on unregistered clinical trials may request consideration of their papers if they can provide sufficient evidence of merit, although we anticipate that all clinical trials will be registered after July 1, 2007. The member journals of the Surgery Journal Editors Group (SJEG), in keeping with their commitment to high ethical standards and integrity in surgical publishing and surgical science, agree to adopt the position of the International Committee of Medical Journal Editors (ICMJE) [1, 2] requiring mandatory registration of all clinical trials, whether publicly-funded or commercially-sponsored, as a condition of consideration for publication. Additionally, the SJEG will require registration of Phase I and Phase II trials. Specifically, the SJEG supports the idea of promoting a publicly accessible clinical trial database as suggested by the World Health Organization (WHO) International Clinical Trials Registry Platform established in August 2005, which specifies 20 key study data reporting requirements [2] . The goal of the WHO initiative and this SJEG requirement, based on the ICMJE statement, is to promote transparency and honesty in reporting prospective clinical trial conduct and results (including negative results), to foster public trust, and to ensure that researchers behave in an ethically responsible manner toward patients and study participants [3] . The SJEG member journals will require all clinical trials that prospectively assign human subjects to medical interventions, comparison groups, or control groups for the purpose of examining the potential health effects of such interventions, to be registered in one of several free, publicly accessible, nonprofit electronically searchable databases such as the one administered by the National Library of Medicine (NLM), which is located at http://www.clinicaltrials.gov. The ICMJE defines medical interventions as those that include, among other things, drugs, surgical procedures, devices, behavioral treatments, and process-of-care changes [2] . The required minimal registration data set includes a unique trial number established by the registry, funding source(s), primary researcher and public contact person, ethics committee approval, trial recruitment information, interPublished online: March 27, 2007