Relación de IMC con marcadores de inflamación y hemoglobina glicosilada en niños y jóvenes con diabetes mellitus 1 / Relationship of BMI with markers of inflammation and glycosylated hemoglobin in children and young adults with diabetes mellitus 1

La diabetes mellitus tipo 1 (DM1) es una enfermedad autoinmune que genera dependencia exógena de insulina de forma permanente, presenta inflamación subclínica crónica lo que conlleva a una elevación de marcadores de inflamación como factor de necrosis tumoral alfa (TNF-α), proteína C reactiva (PCR) e interleuquina 6 (IL-6). OBJETIVO: determinar la relación entre el IMC sobre los marcadores de inflamación y el control metabólico en niños y jóvenes con DM1 entre 5 a 15 años de edad. METODOLOGÍA: Se realizó un estudio clínico, observacional, exploratorio. A partir de La recolección de datos de fichas clínicas y muestras de sangre en el Instituto de Investigaciones Materno Infantil (IDIMI) del Hospital San Borja Arriarán de la Universidad de Chile. Clasificación del estado nutricional utilizando datos registrados en ficha clínica. Marcadores de inflamación por medio de ELISA, hemoglobina glicosilada mediante métodos estándares. El análisis estadístico incluyó correlaciones mediante test de Spearman y diferencia de medias mediante test de Kruskal-Wallis seguido de post hoc Dunns. RESULTADOS: Un 30% de los pacientes con DM1 presentaron malnutrición por exceso. Al analizar la relación entre los niveles de marcadores inflamatorios y Hb glicosilada se observó la existencia de asociacion positiva entre usPCR y HbA1c (r= 0,30; p=0,0352) y entre IL-6 y HbA1c (r= - 0,038; p=0,0352). CONCLUSIONES: este estudio describe una posible asociación entre parámetros clásicos de inflamación con la hemoglobina glicosilada en las categorias de sobrepeso y obesidad en pacientes con DM1.

Type 1 diabetes mellitus (T1D) is an autoimmune disease that generates permanent exogenous insulin dependence, accompanied by chronic subclinical inflammation that leads to an elevation of inflammation markers such as tumor necrosis factor-alpha (TNF-α), C-reactive protein (CRP) and interleukin-6 (IL-6). OBJECTIVE: To determine the relationship between BMI on markers of inflammation and metabolic control in children and young people with T1D between 5 and 15 years of age. METHODOLOGY: A clinical, observational and exploratory study was carried out, based on the collection of data from clinical records and blood samples of children and adolescents with DM1 at the Instituto de Investigaciones Materno Infantil (IDIMI) of the Hospital San Borja Arriarán of the Universidad de Chile. Nutritional status, levels of inflammation markers and glycosylated hemoglobin were determined by standardized methods. Statistical analysis included correlations by Spearman test and mean difference by Kruskal-Wallis test followed by post hoc Dunns test. RESULTS: A total of 56 patients with T1D were analyzed, 30% of whom presented excess malnutrition. Those children or adolescents with obesity presented significantly higher usPCR levels compared to underweight patients or patients at risk of malnutrition (p=0.039). In addition, HbA1c levels were determined which were negatively associated with usPCR (r= 0.30; p=0.0352) and IL-6 (r= - 0.038; p=0.0352) levels. CONCLUSIONS: This study points out that nutritional status is associated with usPCR levels, in agreement with what is described in the literature and shows a possible association between classical parameters of inflammation with glycosylated hemoglobin in children and adolescents with nutritional diagnosis of overweight or obesity.

Associations of plasma lipids, lipoproteins, and cardiovascular outcomes with climatic variations in a large Brazilian population of Campinas, São Paulo state: an eight-year study

In this eight-year retrospective study, we evaluated the associations between climatic variations and the biological rhythms in plasma lipids and lipoproteins in a large population of Campinas, São Paulo state, Brazil, as well as temporal changes of outcomes of cardiovascular hospitalizations. Climatic variables were obtained at the Center for Meteorological and Climatic Research Applied to Agriculture (University of Campinas - Unicamp, Brazil). The plasma lipid databases surveyed were from 27,543 individuals who had their lipid profiles assessed at the state university referral hospital in Campinas (Unicamp). The frequency of hospitalizations was obtained from the Brazilian Public Health database (DATASUS). Temporal statistical analyses were performed using the methods Cosinor or Friedman (ARIMA) and the temporal series were compared by cross-correlation functions. In normolipidemic cases (n=11,892), significantly different rhythmicity was observed in low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol (C) both higher in winter and lower in summer. Dyslipidemia (n=15,651) increased the number and amplitude of lipid rhythms: LDL-C and HDL-C were higher in winter and lower in summer, and the opposite occurred with triglycerides. The number of hospitalizations showed maximum and minimum frequencies in winter and in summer, respectively. A coincident rhythmicity was observed of lower temperature and humidity rates with higher plasma LDL-C, and their temporal series were inversely cross-correlated. This study shows for the first time that variations of temperature, humidity, and daylight length were strongly associated with LDL-C and HDL-C seasonality, but moderately to lowly associated with rhythmicity of atherosclerotic outcomes. It also indicates unfavorable cardiovascular-related changes during wintertime.

Guía para un Plan de egreso en personas con secuelas por Enfermedad Vascular Cerebral / Discharge plan guides for persons with Cerebrovascular Disease Sequelae / Guia para um Plano de egresso em pessoas com sequelas por Doenças Vasculares Cerebrais

Resumen Introducción: Las personas que sufren un Evento Vascular Cerebral (EVC), generalmente quedan incapacitadas para la realización de sus actividades básicas, lo que conlleva a una dependencia. Por consiguiente, es importante la elaboración de un plan de egreso con amplia información sobre los cuidados que facilite al profesional de enfermería brindar educación para la salud, dirigida a familiares y enfermos sobre el cuidado en el hogar tras un EVC. Métodos: El procedimiento utilizado para esta propuesta constó de tres fases, en las cuales se realizó una revisión de la literatura, una delimitación con base en el tema central, para finalmente, elaborar el plan de egreso que aquí se presenta. Resultados: En la primera fase se analizaron 39 estudios, 16 de tipo cualitativo, 11 cuantitativos, ocho Guías de práctica clínica, tres mixtos y dos tesis; posteriormente, en la segunda fase se estableció la delimitación del tema con base en el criterio de evidencia científica y los diagnósticos enfermeros de la NANDA, y finalmente; en la tercera fase, se prescribieron las principales intervenciones de cuidado a implementar tras el egreso de pacientes con EVC. Discusión y conclusiones: El plan de egreso forma parte del cuidado integral y humanizado, requiere llevarse a cabo de forma habitual para facilitar el diálogo sobre las incertidumbres, dudas y angustias presentes, frecuentemente, en el cuidador primario y enfermo tras su egreso. A su vez, las guías de cuidado contribuyen a establecer el plan de egreso al enfermo, con el propósito de disminuir los reingresos hospitalarios, prevenir complicaciones y mejorar su calidad de vida, además de poder seguir innovando la práctica clínica de enfermería.

Abstract Introduction: Persons who suffer a stroke generally are not able to carry out their basic activities and thus become dependent. Because of this, designing discharge plans based on wide-scope information facilitating nursing staff provide healthcare education to victims of stroke and their families is of paramount importance. Methods: In the proposal three stages were considered: a literature review; a main topic delimitation; and a discharge plan, herein featured. Results: In the first stage, 39 studies were analyzed: 16 qualitative; 11 quantitative; 8 clinical practice guides; 3 mixed methods; and 2 dissertations. In the second stage, the main theme was established based on the scientific criteria and the NANDA nursing diagnostics. In the third stage, the main cerebrovascular disease care interventions were prescribed. Discussion and conclusions: The integral discharge plan requires being regularly carried out in order to foster dialogues on related uncertainties, doubts, and anxieties. These care guides can contribute to the establishment of discharge plans aimed at reducing hospital readmissions, preventing complications, and improving the quality of life of these patients.

Resumo Introdução: As pessoas que sofrem um Evento Vascular Cerebral (EVC), geralmente, ficam incapacitadas para a realização de suas atividades básicas, isto, envolve uma dependência, por isso é importante a elaboração de um plano de egresso com vasta informação sobre os cuidados, que facilite no profissional de enfermagem proporcionar educação para a saúde, dirigida a familiares e doentes sobre o cuidado no lar trás um EVC. Métodos: O procedimento utilizado para esta proposta consistiu três fases, nas quais, se realizou uma revisão da literatura, uma delimitação com base no tema central, para finalmente, elaborar o plano de egresso que aqui se apresenta. Resultados: Na primeira fase se analisaram 39 estudos, 16 de tipo qualitativo, 11 quantitativos, oito Guias de prática clínica, três mistos e duas teses; posteriormente, na segunda fase se estabeleceu a delimitação do tema com base no critério de evidencia científica e dos diagnósticos enfermeiros da NANDA, e finalmente; na terceira fase, prescreveram-se as principais intervenções de cuidado a implementar trás o egresso de pacientes com EVC. Discussão e conclusões: O plano de egresso forma parte do cuidado integral e humanizado, requer ser feito de forma habitual, para facilitar o diálogo sobre as incertezas, dúvidas e angústias presentes, frequentemente, no cuidador primário e o doente trás seu egresso. As guias de cuidado contribuem a estabelecer o plano de egresso para o doente, com o propósito, de diminuir os reingressos hospitalários, prevenir complicações e melhorar sua qualidade de vida, além de poder seguir inovando a prática clínica de enfermagem.

Cervical vertebral osteomyelitis secondary to Streptococcus equi infection in an adult horse - case report / Osteomielite vertebral cervical secundária à infecção por Streptococcus equi em um cavalo adulto - relato de caso

A 15-year-old, mixed breed, male horse was attended with a history of multiple abscesses in the cervical region with a three-year evolution. Upon admission, three fistulous tracts with drainage of purulent secretions in the cervical region, low body score, restriction of cervical movements, and painful sensitivity to palpation were observed. The horse was diagnosed with osteomyelitis secondary to Streptococcus equi infection. The initial treatment was antibiotic therapy and local curative. Owing to the lack of response, surgical debridement was performed. An initial favorable response was observed; however, after 4 months, drainage recurred, and the animal was euthanized. A post-mortem computed tomography scan was performed to obtain details of the injury. Cervical osteomyelitis is rare, and its occurrence through hematogenous spread in adult horses and the tomographic findings had not been reported previously. The long period of evolution, difficulty in performing an aggressive debridement, and the presence of multi-drug resistant bacteria contributed to the negative outcome.(AU)

Um equino macho, sem raça definida, de 15 anos de idade, foi atendido com histórico de múltiplos abscessos cervicais com evolução de três anos. Na admissão, foram observados: três trajetos fistulosos com drenagem de material purulento na região cervical; baixo escore corporal; restrição de movimentos cervicais; e sensibilidade dolorosa à palpação da região. Foi diagnosticada osteomielite vertebral cervical secundária à infecção por Streptococcus equi. O tratamento inicial consistiu na administração de antibióticos e curativo local. Na ausência de resposta à terapia, realizou-se o debridamento cirúrgico. Inicialmente, obteve-se uma resposta favorável, entretanto, após quatro meses, houve recidiva da lesão e o animal foi submetido à eutanásia. Realizou-se tomografia computadorizada no post mortem para detalhamento da lesão. A osteomielite vertebral cervical é rara, e sua ocorrência por meio de disseminação hematógena em animais adultos não foi previamente reportada. O longo período de evolução, aliado à dificuldade de realização de um debridamento agressivo, e a característica multirresistente do agente etiológico contribuíram para o desfecho negativo do caso.(AU)

Despistaje de infecciones de transmisión vertical durante el embarazo: Toxoplasmosis, VIH, Hepatitis B y C, Sífilis / Screening vertical transmission of infections during pregnancy: Toxoplasmosis, HIV, Hepatitis B and C, Syphilis

El despistaje de infecciones mediante pruebas de laboratorio permite disminuir el riesgo de morbimortalidad perinatales y maternas. El objetivo del estudio fue identificar la presencia de infecciones de transmisión vertical: toxoplasmosis, VIH, sífilis, Hepatitis B y C, durante el periodo noviembre 2013 a mayo 2014. Estudio descriptivo, muestra conformada por 175 embarazadas entre 14 a 43 años, a las cuales se les descarto Toxoplasmosis, Anticuerpos Reagínicos por VDRL cualitativa, VIH, hepatitis B (Anti-HBsAg, HBsAg, anti-Core); hepatitis C (Anticuerpos totales), a través de ultramicroELISA (UMELISA). Los resultados arrojaron Anticuerpos Anti Toxoplasma gondii positivas en 27,4%, donde el 31,2% de estas embarazadas presentaron títulos de anticuerpos de 1/512. Los Anticuerpos Anti-VIH resultaron positivos en 0,6%. El 99,4% mostraron un VDRL No Reactivo. El 38,9% tuvo un resultado positivo para anticuerpos contra el antígeno de superficie de la hepatitis B, los marcadores HBsAg y Anti-Core resultaron negativos en un 100%; el 1,7% fue positivo para anticuerpos totales contra el virus de la Hepatitis C. Se concluye que el despistaje de enfermedades infecciosas que representan factores de riesgo de transmisión vertical en embarazadas, constituye uno de los medios más oportuno para diagnosticar estas patologías y prevenir la morbimortalidad materna e infantil.

The screening for infection diseases in pregnancy by laboratory tests can reduce the risk of perinatal and maternal morbidity and mortality. The objective of this study was to identify the presence of vertically transmitted infections: toxoplasmosis, HIV, syphilis, hepatitis B and C, for the period November 2013 to May 2014. Descriptive study, the sample consisted of 175 pregnant women between 14 to 43 years, women who were discarded for Toxoplasmosis, Reaginic Antibodies by qualitative VDRL, HIV, hepatitis B (Anti-HBsAg Anti-HBsAg, anti-Core); hepatitis C (Total antibodies), through ultramicroELISA (UMELISA). The results showed 27.4% positive for Anti- Toxoplasma gondii antibodies, with 31.2% of these pregnant women having antibody titers of 1/512. Anti-HIV antibodies were positive by 0.6%. 99.4% showed Nonreactive VDRL. 38.9% were positive for antibodies against the hepatitis B surface antigen, the markers HBsAg and anti-Core were negative by 100%; 1.7% were positive for total antibodies against Hepatitis C. It is concluded that the screening of infectious diseases that represent risk factors for vertically transmission infections during pregnancy, is one of the most appropriate tools to diagnose these diseases and prevent maternal and infant morbidity and mortality.

Frecuencia de anticuerpos anti-transglutaminasa y antiendomisio en pacientes con diabetes tipo 1 / Association of type 1 diabetes mellitus with celiac disease

Background: Type 1 diabetes mellitus and celiac disease share common genetic and immunological aspects and celiac disease is more common among type 1 diabetic patients. Aim: To determine the frequency of anti endomysial and anti transglutaminase antibodies among patients with type 1 diabetes. Material and Methods: Anti endomysialantibodies determined by indirect immunofluorescence an anti transglutaminase antibodies determined by ELISA were measured in 410 serum samples of patients with type 1 diabetes. Results: Seventy one samples (17 percent) had positive anti transglutaminase antibodies. Among these, 17 had also positive anti endomysial antibodies. In 11 of these 17 patients, the presence of celiac disease was confirmed. Conclusions: Among patients with type 1 diabetes mellitus, the frequency of celiac disease is three times higher than in the general population.

Uso da técnica de swim-up para a remoção do Vírus da Artrite Encefalite Caprina do sêmen de reprodutores infectados / Use of swim-up technique for removal of the Caprine Arthritis Encephalitis Virus in the semen of infect bucks

Neste estudo, 67 ejaculados foram avaliados, antes e depois da técnica de swim-up, em relação à qualidade seminal e à presença do CAEV. Das 67 amostras testadas por PCRn, antes do swim-up, 47 (70,15%) foram positivas para o DNA pró-viral. No entanto, quatro amostras adicionais foram positivas ao RT-nested PCR após o swim-up, o que permite dizer que, pelo menos, 76,12% (51/67) delas estavam infectadas antes da lavagem. Todavia, em 23,88% (16/67) das amostras não foi detectada a presença do CAEV. Após a aplicação da técnica de swim-up, constatou-se, pela PCRn e RT-nested PCR, que houve uma redução significativa (χ²= 9,078; p<0,001) da presença do CAEV nas amostras seminais, pois 28 de 51 amostras positivas resultaram livres do vírus (54,90%), tanto para DNA pró-viral quanto para o vírus livre. Em relação à motilidade individual progressiva (MIP) e vigor espermático obtidos antes e depois da técnica de swim-up, observou-se uma diminuição significativa em suas médias, sendo o MIP de 86,42% para 71,49%, já o vigor espermático de 4,16 para 3,93. Conclui-se que a eliminação do CAEV no sêmen é de caráter intermitente, e que a associação da PCRn e RT-nested PCR é uma opção segura para a certificação sanitária individual das amostras seminais quanto à presença ou ausência do CAEV. Finalmente, a técnica de swim-up promove uma redução na infectividade de amostras de sêmen contaminadas, e, além disso, é possível promover a recuperação de espermatozoides viáveis.

In this study, 67 ejaculates were assessed before and after the swim-up technique in relation to semen quality and presence of CAEV. Of the 67 samples tested by Nested PCR, before swim-up 47 (70.15%) were positive for viral DNA. Furthermore, four additional samples were positive for RT-nested PCR after swim-up, which allows us to affirm that at least 76.12% (51/67) were infected before washing. However, 23.88% (16/67) of the samples did not detect the presence of CAEV. After application of the swim-up technique it was found, by Nested PCR and RT-nested PCR, that there was a significant decrease (χ² = 9.078, p <0.001) in the presence of CAEV in semen samples, once 28 of 51 positive samples were free from the virus (54.90%) for both proviral DNA and the free form of the virus. Regarding individual progressive motility (IPM) and spermatic vigor obtained before and after the swim-up technique, a significant decrease was observed in the average, being 86.42% of the IPM to 71.49% and the spermatic vigor from 4.16 for the 3.93. It is concluded that the removal of CAEV in semen has an intermittent character, and the combination of PCR and RT-nested PCR is a safe option for health certification of individual semen samples for the presence or absence of CAEV. Finally, the swim-up technique promotes a reduction in the infectivity of contaminated semen samples, and it is possible to promote the recovery of high individual progressive motility sperm and sperm vigor.

Uso da técnica de swim-up para a remoção do Vírus da Artrite Encefalite Caprina do sêmen de reprodutores infectados / Use of swim-up technique for removal of the Caprine Arthritis Encephalitis Virus in the semen of infect bucks

Neste estudo, 67 ejaculados foram avaliados, antes e depois da técnica de swim-up, em relação à qualidade seminal e à presença do CAEV. Das 67 amostras testadas por PCRn, antes do swim-up, 47 (70,15%) foram positivas para o DNA pró-viral. No entanto, quatro amostras adicionais foram positivas ao RT-nested PCR após o swim-up, o que permite dizer que, pelo menos, 76,12% (51/67) delas estavam infectadas antes da lavagem. Todavia, em 23,88% (16/67) das amostras não foi detectada a presença do CAEV. Após a aplicação da técnica de swim-up, constatou-se, pela PCRn e RT-nested PCR, que houve uma redução significativa (²= 9,078, p<0,001) da presença do CAEV nas amostras seminais, pois 28 de 51 amostras positivas resultaram livres do vírus (54,90%), tanto para DNA pró-viral quanto para o vírus livre. Em relação à motilidade individual progressiva (MIP) e vigor espermático obtidos antes e depois da técnica de swim-up, observou-se uma diminuição significativa em suas médias, sendo o MIP de 86,42% para 71,49%, já o vigor espermático de 4,16 para 3,93. Conclui-se que a eliminação do CAEV no sêmen é de caráter intermitente, e que a associação da PCRn e RT-nested PCR é uma opção segura para a certificação sanitária individual das amostras seminais quanto à presença ou ausência do CAEV. Finalmente, a técnica de swim-up promove uma redução na infectividade de amostras de sêmen contaminadas, e, além disso, é possível promover a recuperação de espermatozoides viáveis.

In this study, 67 ejaculates were assessed before and after the swim-up technique in relation to semen quality and presence of CAEV. Of the 67 samples tested by Nested PCR, before swim-up 47 (70.15%) were positive for viral DNA. Furthermore, four additional samples were positive for RT-nested PCR after swim-up, which allows us to affirm that at least 76.12% (51/67) were infected before washing. However, 23.88% (16/67) of the samples did not detect the presence of CAEV. After application of the swim-up technique it was found, by Nested PCR and RT-nested PCR, that there was a significant decrease (² = 9.078, p <0.001) in the presence of CAEV in semen samples, once 28 of 51 positive samples were free from the virus (54.90%) for both proviral DNA and the free form of the virus. Regarding individual progressive motility (IPM) and spermatic vigor obtained before and after the swim-up technique, a significant decrease was observed in the average, being 86.42% of the IPM to 71.49% and the spermatic vigor from 4.16 for the 3.93. It is concluded that the removal of CAEV in semen has an intermittent character, and the combination of PCR and RT-nested PCR is a safe option for health certification of individual semen samples for the presence or absence of CAEV. Finally, the swim-up technique promotes a reduction in the infectivity of contaminated semen samples, and it is possible to promote the recovery of high individual progressive motility sperm and sperm vigor.

Estudio de la composición de nutrientes en el etiquetado nutricional de productos alimenticios industrializados, tipo snack / Study of the nutrient composition in nutritional labeling of industrialized foods, type snack

El etiquetado es el punto más visible de la información de un alimento y constituye uno de los pilares básicos en los que se apoya su comercialización. El objetivo de este trabajo fue estudiar la composición de nutrientes en el etiquetado nutricional de productos industrializados, tipo snacks, que se comercializan en grandes cadenas de supermercados en Caracas, Venezuela. Se recolectaron en total 472 etiquetados nutricionales de alimentos industrializados (nacionales e importados). Se clasificó a los productos alimenticios en 5 grupos, de acuerdo al nombre descriptivo expresado por la empresa fabricante en el etiquetado nutricional: a base de Cereales, a base de Plátanos-Tubérculos, a base de Frutos Secos, Bebidas y Golosinas. Debido a que los valores del etiquetado nutricional se basan en la ración o porción a consumir, y ya que diferían para cada producto, se calculó el contenido nutricional sobre la base de 100 gramos de peso comestible; esto con la finalidad de unificar todos los datos a una misma base para poder compararlos, y promediarlos entre sí. Se muestran los valores de ración y contenido neto; así como, el aporte calórico y de macronutrientes de los 44 subgrupos de alimentos evaluados. Este trabajo representa una contribución para el análisis de la composición nutricional del etiquetado de los productos industrializados, tipo snacks; permite su uso para la evaluación nutricional de individuos y colectivos, además de asentar las bases para la creación de una guía de etiquetados nutricionales.

The labeling is the most visible point of the information of a food and constitutes one of the basic pillars that support its marketing. The aim of this work was to study the composition of nutrients in nutrition labeling of processed products, type snacks, than sold in large supermarket chains in Caracas, Venezuela. 472 nutritional labeling of processed foods were collected in total (domestic and imported). Food products were classified into 5 groups, according to the descriptive name expressed by the manufacturer in nutrition labeling: based on Cereals, based on Plantains-Tubers, based on Nuts, Drinks and Treats. Because nutrition labeling values are based on the serving or portion size, the nutritional content based on 100 grams of edible weight was calculated; this in order to unify all data to a common basis for comparison, and average them together. Tables show the values of ration and net content, as well as, the caloric and macronutrient values of the 44 food subgroups evaluated. This work represents a contribution to the analysis of the nutritional composition labeling of industrial product, type snacks; allows its use for nutritional assessment of individuals and groups, as well as lay the groundwork for the creation of a nutritional labeling guide.

Marcadores de inflamación y autoinmunidad en pacientes con diabetes tipo 1 / And inflammation markers in patients with diabetes autoimmunity type 1

To determine the serological levels of inflammatory markers and autoimmunity in patients with T1D compared with controls, and determined its relation to the duration of diabetes. Methods: We selected 139 patients with T1D without chronic complications of diabetes, and 110 control subjects without family history of diabetes. Serological ultrasensitive C-reactive protein levels (usCRP), interleukin- 6 and adhesion protein VCAM through ELISA assay were determined. Autoimmune profile was also analyzed through GAD65, IA-2 and ZnT8 autoantibodies. Results: Increased levels of usCRP 1.74 (0.10 to 13.6) vs 1.08 (0.40 to 3.70) ng/ml (p < 0.03), VCAM 236.0 (122.2 to 693.5) vs 185.4 (101.3 to 421.3) ng/ml, p < 0.02 and IL-6 1.73 (0.40 to 9.10) vs 1.28 (0.30 to 4.60) ng/ml, p < 0.05 was found in the group of T1D patients compared with the control group. When analyzing inflammatory markers according to age groups (0-10 years and > 10 years), the values of usCRP were higher in the second group. There was no significant association between patients with DM1 and autoimmune positive profile with a higher frequency of markers of inflammation. Conclusions: These results suggest the presence of pro-inflammatory state is considerably more frequent in patients with T1D. The increased level of usCRP and IL -6 and according to age of the patients could indicate a possible role of adiposity and weight gain during the adolescence in the higher frequency of inflammatory markers in T1D patients...

Efecto del consumo de casabe venezolano sobre la absorción de minerales en un modelo experimental con ratas / Effect of consumption of Venezuelan casabe on mineral absorption in a experimental model with rats

El principal producto derivado de la yuca en Venezuela es el casabe, el cual es valorado por su contenido calórico, riqueza en Fibra Dietética (FD) y minerales. En este estudio se determinó el efecto del consumo de diferentes variedades de casabe venezolano sobre la absorción de hierro, cobre y zinc, en un modelo experimental, con 20 ratas machos adultas, cepa Sprague Dawley, las cuales fueron divididas en 4 grupos: un control sin fibra y tres grupos experimentales en los que se sustituyó el almidón de maíz por una variedad de casabe, identificados por su procedencia como: “Casabe Miranda”, “Casabe Sucre” y “Casabe Amazonas”. Las dietas con inclusión de casabe tuvieron un mayor contenido mineral, en comparación con la dieta control. El contenido de FD total y su fracción soluble fueron significativamente mayores en las variedades de casabe Sucre y Amazonas (p<0,05). La inclusión de casabe a las dietas produjo un incremento significativo en la excreción fecal de hierro y cobre(p<0,05). La absorción de los minerales se incrementó para el hierro en las variedades Miranda (3,5%) y Sucre (6%); para el cobre en el grupo Amazonas (32%); mientras que el Zinc fue menos afectado en su absorción a lo largo del ensayo. Los resultados de este estudio señalan que el efecto de la adición de casabe a las dietas sobre la absorción de hierro, cobre y zinc, fue diferente para cada mineral y estuvo relacionado con la dieta que consumieron los animales, dependiendo de la variedad de casabe utilizada.

The main product from cassava in Venezuela is the Casabe, which is valued for its caloric content, and rich in dietary fiber (DF) and minerals. This study determined the effect of consumption of different varieties of Venezuelan cassava on absorption of iron, cooper and zinc, in an experimental model, with 20 adult males rats, strain Sprague Dawley, which were divided into 4 groups: a control without fiber and three experimental groups with substitution of cornstarch by a variety of casabe, identified by their origin as:“ Casabe Miranda”, “Casabe Sucre” y “Casabe Amazonas”. Casabe diets had a higher mineral content, compared to the control diet. Total and soluble dietary fiber content were significantly higher in Sucre and Amazonas casabe varieties(p<0,05). The inclusion of casabe to diets resulted in a significant increase in the fecal excretion of iron and copper (p<0,05).The mineral absorption increased for iron in Miranda (3.5%) and Sucre (6%) varieties; for copper in the Amazonas group (32%); while the zinc absorption was less affected throughout the trial. The results of this study indicates that the effect of adding casabe to diets on absorption of iron, copper and zinc, was different for each mineral and was related to the diet consumed by the animals, depending of casabe variety used.

Evaluación del estado del Hierro y la Vitamina A en niños de la etnia Warao del estado Sucre, Venezuela / Assessing ofIronand Vitamin A status in children of Warao ethnic group of Sucre state in Venezuela

El propósito del estudio fue evaluar el estado del hierro y la vitamina A, en niños de la etnia Warao, perteneciente a las comunidades de María López y Los Barrancos, del estado Sucre. Se evaluó el consumo de alimentos,indicadores bioquímicos y antropométricos a 64 niños Warao en edades comprendidas entre los 3 y 10 años. Se encontró una adecuación deficiente del consumo de hierroen 56,8%,la mayoría provino defuentes no hem: cereales (37,8%), harina de maíz precocida fortificada (33,47%), harina de trigo (2,72%) y casabe (32,98%); el hierro hémico provino de pescados (37,49%). Se presentó déficit en la adecuación del consumo de la vitamina A en 97,3%, las fuentes fueron cereales (harina de maíz precocida), huevos y lácteos. El diagnóstico nutricional antropométrico por combinación de indicadores de dimensión corporal, arrojó que el 75,0% se encuentra en normalidad. Para los estudios bioquímicos: el 93,76% tiene deficiencia de retinol; 40,63% deficiencia severa. El 100% y 70,3% presentó niveles normales de hierro y ferritina sérica, respectivamente. La concentración de hemoglobina, reveló 70,3% de anemia. Existe prevalencia de 92,45% de parasitosis intestinal (Trichuristrichura, Ascarislumbricoides y Ancylostomideos). Se observaron diferencias estadísticamente significativas de niveles séricos de ferritina y asociaciones parasitarias. La alta prevalencia de anemia, deficiencia de vitamina A y parasitosis, indican la existencia de un déficit nutricional en cuanto al hierro y la vitamina A, que puede deberse a la baja disponibilidad de alimentos, el consumo insuficiente de nutrientes y un aprovechamiento biológico disminuido.

The purpose of this study was to assess the iron and vitamin A status in children of Warao ethnic group, belonging to communitiesMaríaLópez and Los Barrancos in Sucre State. We evaluated food intake, anthropometric and biochemical markers in 64 Warao children with ages between 3 and 10 years. A deficient consumption of iron was found in 56,8%, most from non-heme sources: cereals (37,8%), corn flour fortified (33,47%), wheat flour (2,72%) andcasabe (32,98%);heme iron came from fish(37,49%).In the intake of vitamin A the deficit was presented in97,3%,sources were cereals (corn flour fortified), eggs and dairy. The anthropometric-nutritional diagnosis by combination of body dimension indicators showed that 75.0% is in normality.For biochemical studies: 93.76% has retinol deficiency;40,63% severe deficiency. The 100% and 70.3% had normal levels of serum iron and ferritin, respectively. The hemoglobin concentration revealed 70.3% of anemia. There was a high prevalence (92,45%) of intestinal parasitosis (Trichuristrichura, Ascarislumbricoides y Ancylostomideos). There were statistically significant differences in serum ferritin and parasitic associations.The high prevalence of anemia, vitamin A deficiency and parasitosis,indicate the existence of nutritional deficit in iron and vitamin A,which may be due to the low availability of food, insufficient consumption of nutrients and biological utilization decreased.

Efecto del consumo de dietas con frijol blanco (Vigna unguiculata) con y sin cáscara sobre los lípidos plasmáticos en ratas hipercolesterolémicas / Effect of consumption of diets with cowpea (Vigna unguiculata) with and without hull on plasma lipids in hypercholesterolemic rats

Las leguminosas constituyen un componente importante de la dieta regular del venezolano. Algunos estudios han demostrado que los granos de varias leguminosas tienen un efecto hipocolesterolémico. En este estudio se evaluó el efecto del consumo de frijol blanco Vigna unguiculata con y sin cáscara sobre los lípidos plasmáticas en ratas hipercolesterolémicas. Treinta ratas machos adultas, cepa Sprague Dawley, fueron estudiadas en dos etapas. Una primera de tres semanas en la que mediante manipulación dietética, se transformaron ratas normales en hipercolesterolémicas. En la segunda etapa se diseñaron 4 grupos, un control normocolesterolémico sin dieta experimental, un hipercolesterolémico sin dieta experimental, un hipercolesterolémico alimentado con frijol con cáscara y uno hipercolesterolémico alimentado con frijol sin cáscara durante tres semanas. Las dietas con frijol blanco Vigna unguiculata produjeron una disminución significativa de colesterol total y triglicéridos de un 35.01% y 39.48% respectivamente, en comparación con el grupo hipercolesterolémico sin frijol. Para la fracción del colesterol-LDL la disminución fue de 59%, sin encontrarse diferencias significativas entre los grupos alimentados con frijol con y sin cáscara. Un hallazgo interesante fue el incremento significativo del colesterol-HDL de 29.66% en el grupo alimentado con frijol con cáscara, lo cual es un factor de prevención para la aparición de Enfermedades Cardiovasculares. Los resultados de este estudio señalan que el consumo de frijol blanco con o sin cáscara tuvo efecto beneficioso en el perfil lipídico, en este modelo experimental. En estudios futuros podría considerarse su uso en la dietoterapia de las hiperlipidemias.

Legumes are important components of Venezuelan diet. Several studies have shown that grains of legumes have a hypocholesterolemic effect. This study evaluated the effect of consumption of white beans Vigna unguiculata with and without hull on plasma lipids in hypercholesterolemic rats. Thirty adult male Sprague-Dawley rats, were studied in two stages. The first of three weeks, by means of dietary manipulation, normal rats became hypercholesterolemic. In the second stage, 4 groups were designed, one normocholesterolemic control without experimental diet, one hypercholesterolemic without experimental diet, one hypercholesterolemic fed with bean with hull and one hypercholesterolemic fed with bean without hull for three weeks. Diets with white beans Vigna unguiculata produced a significant decrease in total cholesterol and triglycerides of 35.01% and 39.48% respectively, compared with the hypercholesterolemic group without beans. The fraction of LDL-cholesterol showed a reduction of 59%, without significant differences between the groups fed with beans with and without hull. An interesting finding was the significant increase of HDL-cholesterol of 29.66% in the group fed with bean with hull, which is a preventive factor for cardiovascular diseases. The results of this study indicate that consumption of white beans with or without hull had beneficial effect on lipid profile, in this experimental model. In future studies it could be considered for using in diet therapy of human hyperlipidemia.

Uso de ácido tranexámico en el postoperatorio de cirugía cardiaca / Use of tranexamic acid in postoperative cardiac surgery

El objetivo de este estudio prospectivo, doble ciego y aleatorizado fue evaluar el impacto de la administración de ácido tranexámico (AT) después de cirugía cardiaca con circulación extracorpórea en el sangrado postoperatorio. Material y Método: Durante la inducción de la anestesia los pacientes recibieron un bolo de 10 mg•kg-1 de AT, más 50 mg en el cebado de la máquina de circulación extracorpórea, seguido de una infusión continua de 1 mg•kg-1•h-1 hasta el término de la cirugía. En ese momento los pacientes fueron aleatoriamente distribuidos en 2 grupos: el grupo control recibió 10 ml•h-1 de suero fisiológico, y el grupo de estudio una dosis de 1 mg•kg-1•h-1 de AT, en ambos casos durante el trascurso de 10 horas. El objetivo primario fue observar alguna diferencia en el sangrado durante el primer día de postoperatorio. El objetivo secundario fue observar alguna diferencia en la transfusión de sangre (glóbulos rojos, plaquetas) durante el primer día del postoperatorio y en la incidencia de reoperaciones. Tanto el anestesista como el cirujano fueron ciegos a la distribución de los pacientes en cada grupo. Se utilizó el t-test para el análisis de diferencias en las medias de las variables continuas y el z-test para las proporciones. Se consideró estadísticamente significativo un valor de p < 0,05. Se efectuó análisis de regresión múltiple para encontrar variables capaces de predecir sangrado durante el primer día postoperatorio...

The objective of this prospective, double blind, randomized trial is to evaluate the impact of tranexamic acid (TA) administration after cardiac surgery with cardiopulmonary bypass in postoperative bleeding. Materials and Methods: During induction of general anesthesia, patients received a bolus of TA of 10 mg•kg-1 plus 50 mg in the CPB priming followed by a continuous infusion of 1 mg•kg-1•h-1 until the end of the surgery. Then, patients were randomly allocated into one of two groups: the isotonic saline (IS) group received 10 ml•h-1 of isotonic saline and the TA group received an infusion of 1 mg•kg-1•h-1 of TA. Both groups received their infusions for 10 hours. Primary outcome was bleeding during first postoperative day (POD1). Secondary outcomes were blood transfusion (PRBC, platelets) during POD1 and surgical re-exploration. Anesthesiologists and surgeons were blind to patient allocation. A t-test was used to analyze differences in means of continuous variables and z-test for proportions. A p value < 0.05was considered statistically significant. Multiple regression analysis was performed to find variables able to predict bleeding in the POD1. Results: 273 patients were included, there were 15 lost per group. 125 patients in the TA group and 118 patients in the IS group were analyzed. Both groups were compared in their demographics characteristics, comorbidity and lab tests and no significant differences were found. No statistically significant differences between groups in the primary and secondary outcomes were found. Multiple regression analysis establishes the variable minutes in cardiopulmonary bypass was able to predict bleeding in the POD1. Conclusions: Postoperative infusion of TA does not decrease bleeding, transfusions and re-explorations during the POD1 of cardiac surgery with cardiopulmonary bypass...

Reversión de la anticoagulación en pacientes con dosis altas de heparina: protamina en dosis standard versus dosis reducidas / Reversal anticoagulation in patients with high doses heparin: protamine in standard doses versus small doses

Evaluar y comparar, en pacientes sometidos a circulación extracorpórea (CEC), la reversión de la anticoagulación con dos dosis distintas de protamina: una dada en forma proporcional a la heparina usada versus una dosis calculada según peso del paciente, independiente de la heparina administrada. Material y Método: Se incorporaron los pacientes que para la CEC requirieron una dosis de heparina superior a 300 U•kg-1. Los criterios de exclusión fueron: alteraciones de las pruebas de coagulación preoperatorias y paro circulatorio hipotérmico. La técnica anestésica, el uso de fármacos y el uso de hemoderivados fue de decisión del anestesista. Para la reversión con protamina los pacientes fueron aleatorizados en dos grupos: Grupo A o dosis estándar: Reversión con 0,8 mg protamina por cada 100 U de heparina usada. Grupo B o dosis reducida: Reversión con 2,4 mg protamina•kg-1, independiente de la dosis de heparina usada. La protamina fue preparada por una persona ajena al pabellón y el equipo tratante era ciego al grupo del paciente. El seguimiento de los pacientes las primeras 24 h en UTI fue realizado por una persona ciega al grupo del paciente. Resultados: Hubo solamente una diferencia demográfica: más mujeres en el grupo B (p = 0,029). En el preoperatorio no hubo diferencias en hematocrito, recuento de plaquetas, tratamiento anticoagulante oral (TACO) y heparina preoperatoria, tipo de cirugía y uso de aspirina. En el intraoperatoriono hubo diferencias en el tiempo de coagulación activada (TCA) basal, hematocritos en CEC, TCA en CEC y duración de CEC. La dosis de heparina por kg de peso fue mayor en el grupo B (p = 0,0433). La relación protamina/heparina total fue 0,81 para el Grupo A y 0,44 para el Grupo B, las que fueron diferentes (por el diseño del estudio)...

Objective: To evaluate and compare reversal of anticoagulation with different dose regimens of protamine in patients undergoing to CPB (cardiopulmonary bypass), one given according to the heparin dose administered and another calculated according to patient’s weight. Patients y Methods: Patients subjected to CPB and receiving a heparin dose greater than 300 IU/kg were enrolled. Exclusion criterias were: preoperative coagulopathy and hypothermic circulatory arrest. The anesthetic technic, drugs given and blood products transfusion were decided by the attending anesthesiologist. Patients were randomized to: Group A or standard dose: Reversal with 0.8 mg of protamine for each 100 IU of heparin given. Group B or reduced dose: Reversal with 2.4 mg of protamine per kilogram of patient’s weight, independent of heparin dose used. The protamine was prepared for a person blinded to group allocation, same as the team taking care of the patient. The patient’s follow up in the ICU during the first 24 hours was also done by someone blinded to group allocation. Results: There was only one demographic difference at baseline: more women in Group B (p = 0.029). There were no differences among the preoperative: hematocrit, platelets count, oral anticoagulant treatment, heparin administration, aspirin consumption and surgical plan. In the intraoperative course there were no differences in the baseline ACT, hematocrit during CBP, ACT in CBP and CBP duration. The average heparin dose (adjusted per kilogram) was greater in Group B (p = 0.0433).The protamine/heparin ratios were different among groups (Group A 0.81; Group B 0.44), as expected in this study design. The activated coagulation time (ACT)...

Uso de bloqueo paravertebral torácico bilateral en cirugía cardiaca para extubación postoperatoria inmediata: serie de casos clínicos / Use of paravertebral block thoracic bilateral in cardiac surgery to extubation Immediate postoperative: clinical case series

El desarrollo de protocolos de extubación precoz en cirugía cardiaca se basa en el uso de técnicas anestésicas que persiguen el objetivo de tener un paciente con un estado de vigilia adecuado y una vía aérea segura durante el período de emergencia de la anestesia. Se diseñó un estudio prospectivo y descriptivo con el objetivo de evaluar si el uso de bloqueo paravertebral torácico bilateral (BPVTB) previo a una cirugía cardiaca en adultos disminuye los requerimientos intraoperatorios (IO) de opioides, y aumentando con ello la posibilidad de extubación segura en el pabellón y, además, evaluar la calidad analgésica postoperatoria (PO). Material y Método: Los pacientes deben ser adultos sometidos a una cirugía cardiaca por esternotomía. Los criterios de exclusión fueron: cirugía larga y compleja, paro circulatorio, hipotermia profunda, insuficiencia cardiaca, hipertensión pulmonar severa, obesidad > grado II, enfermedad pulmonar severa y coagulopatía. Los pacientes seleccionados fueron sometidos a un BPVTB, y luego se indujo anestesia general no estandarizada. Tras realizar la cirugía prevista, al inicio del cierre de la piel se suspende el agente anestésico inhalatorio, se realiza prueba de ventilación espontánea y se extuba en pabellón si cumple criterios establecidos. Posteriormente se evaluó PaO2 y PaCO2(ingreso UCI), se aplicó escala visual análoga (EVA) para medir intensidad del dolor (6 h del PO) y al finalizar el primer día de PO se consignó el consumo de opioides, la incidencia de náuseas y vómitos y la necesidad de usar ventilación mecánica invasiva (VMI) o no invasiva (VMNI)...

The development of early extubation protocols in cardiac surgery are based on anesthesic techniques able to have the appropriate anesthesia depth and a secured airway during the emergence of anesthesia. A prospective study was design in adults subjected to cardiac surgery in order to evaluate the effectiveness of preoperative bilateral paravertebral thoracic block (BPVTB) in decreasing intraoperative opiods doses and allow a safe extubation in the operating room (OR) and, even more, give a good quality postoperative (PO) analgesia. Material and Methods: Patients subjected to a cardiac surgery with sternotomy. Exclusion criteria were: long and complex surgery, circulatory arrest, deep hypothermia, cardiac failure, severe pulmonary hypertension, obesity grade II or greater, severe lung disease and coagulophaty. A cohort of patients were subjected to a BPVTB, then general anesthesia was induced (no standarized technique). After cardiac surgery, at the beginning of skin suture, inhaled anesthetics were discontinued and after successful spontaneous breathing test, the patient was extubated in the operating room. PaO2 y PaCO2 was evaluated at the arrival to the ICU. Visual analogue scale (VAS) was applied every 6 hours to measure pain level. At the end of the first day opiod dose, PONV and ventilation support (invasive and noinvasive) was registered...(AU)

Tránsito hepatotorácico, complicación evolutiva de la hidatidosis hepática: características clínicas y morbilidad de una serie prospectiva de pacientes intervenidos quirúrgicamente / Hepatothoracic transit, evolutionary complications of hepatic echinoccocosis

Introduction: Hepatothoracic transit (HTT) is one of the evolutionary complications of hepatic echinoccocosis (HH). The aim of this study is to describe clinical characteristics and morbidity of a series of patients with HTT surgically treated. Material and Methods: Prospective series of cases. Patients operated by HTT between 1997 and 2007 in Regional Hospital of Temuco, Chile, with a minimum follow-up of 12 months and clinical controls at months 1,6, 12, 24, 36, 48 and 60. End point was "development of morbidity". Descriptive statistic was used, applying central tendency and dispersion measured. In addition confidence intervals of 95 percent was calculated. Results: The series is composed by 23 patients with HTT with a median age of 48 years (16 to 75 years) and 56 percent femenine. Median cyst diameter was 20 cm (8 to 30 cm) 78.3 percent of the lesions were located in the right lobe of the liver. The most frequent surgical technique used was subtotal cystectomy (78.3 percent); residual cavity were treated preferably by capitonage (30.4 percent) or epiploplasty (34.8 percent). With a median follow-up of 71 months (12 to 122 months), one verified that no patient required surgical reintervencion; mortality rate was 4.3 percent (one patient) and registered morbidity was 26.0 percent (6 patients). Conclusion: HTT is associated to considerable values of post-operative morbidity and mortality.

Introducción: Una de las complicaciones evolutivas de la hidatidosis hepática (HH) es el tránsito hepatotorácico (THT). El objetivo de este estudio es describir características clínicas y morbilidad de una serie de pacientes con THT intervenidos quirúrgicamente. Material y Método: Serie de casos prospectiva. Pacientes intervenidos por THT entre 1997 y 2007 en el Hospital Regional de Temuco, Chile, con seguimiento mínimo de 12 meses y controles clínicos en los meses 1, 6, 12, 24, 36, 48 y 60. La variable resultado fue "desarrollo de morbilidad". Se utilizó estadística descriptiva, aplicando medidas de tendencia central y dispersión e intervalos de confianza del 95 por ciento. Resultados: La serie está compuesta por 23 pacientes con THT, con una mediana de edad 48 años (16 a 75 años) y 56 por ciento de género femenino. El diámetro quístico tuvo una mediana de 20 cm (8 a 30 cm), y el 78,3 por ciento de ellos se localizó en el lóbulo derecho del hígado. La técnica quirúrgica utilizada con mayor frecuencia fue quistectomía subtotal (78,3 por ciento); la cavidad residual se trató preferentemente mediante capitonaje (30,4 por ciento) o epiploplastía (34,8 por ciento). Con una mediana de seguimiento de 71 meses (12 a 122 meses), se verificó que: ningún paciente requirió de reintervención quirúrgica; se registró una morbilidad de 26,0 por ciento (6 pacientes) y una mortalidad de 4,3 por ciento (un paciente). Conclusión: El THT es una entidad asociada a morbilidad y mortalidad postoperatoria relevante.

Avaliação da leishmaniose visceral canina em Poxoréo, Estado do Mato Grosso, Brazil / Canine visceral leishmaniasis evaluation in Poxoréo, Mato Grosso State, Brazil

O cão doméstico desempenha importante papel como reservatório na transmissão da leishmaniose visceral ao homem, zoonose de grande importância em saúde pública. Realizou-se avaliação epidemiológica da leishmaniose visceral em 1.112 cães domiciliados no município de Poxoréo, estado do Mato Grosso e observou-se prevalência de 7,8 por cento. Observou-se ainda associação estatisticamente significativa entre a prevalência de leishmaniose visceral canina e as variáveis faixa etária, presença de sinais clínicos e presença de outra espécie animal co-habitando com os cães avaliados, tendo sido as galinhas mais freqüentemente observadas entre os animais soropositivos. O sexo, a coleta de lixo domiciliar bem como a renda familiar não apresentaram associação estatisticamente significativa com a prevalência da leishmaniose visceral canina. A análise dos resultados sugere que cães com idade superior a sete anos e a , presença de outra espécie animal co-habitando com os cães podem ser fatores de risco para a leishmaniose visceral canina.

Dogs play an important role as reservoir in the domestic cycle of visceral leishmaniasis, a serious public health problem. An epidemiological survey in 1,112 dogs was conducted at the Municipality of Poxoréo State of Mato Grosso, Brazil, using indirect immunofluorescence antibody test where the prevalence was 7.8 percent. Significant association was found between prevalence of canine visceral leishmaniasis and age of the dogs. Clinical signs and presence of other animals in the backyard, like chicken being more likely associated with seropositivity. Gender, garbage collection in the residence and family financial income were not associated with visceral leishmaniasis prevalence. Analysis of the results suggests that dogs aging more than 7 years and presence of another animal species co-inhabiting with the dogs may be risk factors for canine visceral leishmaniasis.