Organización más allá de los algoritmos en la vía aérea dificultosa. "PENSAR globalmente y ACTUAR localmente" / Organization beyond the algorithms in the airway difficult. "THINK globally and ACT locally "

Objetivo: Evaluar el impacto sobre la tasa de complicaciones en la intubación orotraqueal con la implementación de un protocolo de actuación en el manejo de la vía aérea. Materiales y Métodos: Pacientes admitidos al Servicio de Terapia Intensiva polivalente entre agosto de 2012 y marzo de 2014, que requirieron intubación orotraqueal. Se utilizó un protocolo de actuación "Pensar globalmente y Actuar localmente" durante el proceso de preintubación, intubación y posintubación, que incluye valoración de las vías aéreas, planes de seguridad, optimización cardiovascular y pulmonar. Las complicaciones fueron: 1) intubación dificultosa, 2) intubación esofágica, 3) traumatismo de la vía aérea superior, 4) broncoaspiración, 5) arritmias cardíacas, 6) paro cardiocirculatorio. Se compararon las tasas de complicaciones durante dos períodos: Período 1 (P1): de agosto de 2010 a julio de 2012, en el que se realizó la intubación orotraqueal mediante la Secuencia de Intubación Rápida, y Período 2 (P2): de agosto de 2012 a marzo de 2014, en el que se implementó el protocolo "Pensar globalmente y Actuar localmente". Se evaluaron características demográficas, puntajes APACHE II y SOFA, complicaciones de la intubación, estancia en Terapia Intensiva y mortalidad. El análisis estadístico se realizó utilizando la media, la desviación estándar y la prueba de Fisher para las variables cuantitativas y la prueba de χ2 para las variables dicotó- micas. Se consideró significativa una probabilidad de error <5% (p <0,05). Resultados: 374 pacientes requirieron intubación orotraqueal: 180 (48,1%) en el P1 y 194 (51,8%) en el P2; edad: 59 ± 18 años (P1) y 61 ± 18 años (P2); APACHE II: 18 (P1) y 16 (P2); SOFA: 8 ± 2 y 7 ± 3, respectivamente; complicaciones: P1, 24 (13%), P2, 7 (3,6%) (p <0,001); intubación dificultosa: P1, 8 (33,3%), P2, 1 (14,2%) (p <0,005); intubación esofágica: P1, 3 (12,5%), P2, 1 (14,2%); traumatismo de la vía aérea superior: P1, 5 (21,3%), P2, 2 (28,5%); broncoaspiración: P1, 4 (16,6%), P2, 1 (14,2%); arritmias: P1, 3 (12,5%), P2,2 (28,5%), paro cardiocirculatorio: P1, 1 (4,1%), P2: 0. Estancia en Terapia Intensiva: 13.5 ± 3 días (P1) y 12.8 ± 1.2 días (P2). Mortalidad 10% (P1) y 6,2% (P2) (NS). Conclusión: La aplicación de un protocolo para el manejo de la vía aérea redujo, con significación estadística, la tasa de complicaciones, en particular, la intubación dificultosa. (AR)

Objective: To evaluate the impact of a protocol for the management of the airway on the complication rate in tracheal intubation. Materials and Methods: Patients requiring orotracheal intubation admitted to the Intensive Care Unit from August 2012 to March 2014 were included. The "Think globally and Act locally" protocol was used during pre-intubation, intubation and after intubation, including assessment of the airway, safety plans, cardiovascular and pulmonary optimization. Complications: 1) difficult intubation, 2) esophageal intubation, 3) upper airway trauma, 4) aspiration, 5) arrhythmias, 6) cardiac arrest. Rates of complications were compared during two periods: Period 1 (P1): from August 2010 to July 2012 where orotracheal intubation was conducted through rapid sequence intubation, and Period 2 (P2) from August 2012 to March 2014, where "Think globally and Act locally" protocol was implemented. Demographic characteristics, APACHE II and SOFA scores, complications of intubation, length of stay in the Intensive Care Unit, and mortality were evaluated. Statistical analyses were performed using mean, standard deviation, and Fisher test for quantitative variables and chi square test for dichotomous variables; a probability of error <5% (p <0,05) was considered significant. Results: 374 patients required tracheal intubation: 180 (48.1%) during P1 and 194 (51.8%) during P2; mean age: 59 ± 18 years (P1) and 61 ± 18 years (P2); APACHE II score: 18 (P1) and 16 (P2); SOFA score: 8 ± 2 (P1) and 7 ± 3 (P2); complications: P1, 24 (13%); P2, 7 (3.6%) (p <0.001); difficult intubation: P1, 8 (33.3%), P2, 1 (14.2%) (p <0.005); esophageal intubation: P1, 3 (12.5%), P2, 1 (14.2%), upper airway trauma: P1, 5 (21.3%), P2, 2 (28.5%); aspiration: P1, 4 (16.6%), P2, 1 (14.2%); arrhythmias: P1, 3 (12.5%), P2, 2 (28.5%); cardiac arrest: P1, 1 (4.1%), P2, 0; stay in the Intensive Care Unit: 13.5 ± 3 (P1) and 12.8 ± 1.2 days (P2); mortality: 10% (P1) and 6.2% (P2) (NS). Conclusion: Implementation of a protocol for the management of the airway decreased complications with statistical significance, including difficult intubation.(AR)

Desenvolvimento de bezerros leiteiros alimentados com silagem de leite de transição: II - Órgãos internos / Development of dairy calves fed silage transition milk: II - Internal organs

Avaliou-se o tamanho absoluto e relativo dos órgãos internos de bezerros Holandeses aleitados com leite, silagem de leite de transição diluída em água ou misturada em leite. Foram utilizados 18 animais, machos, com 60 dias de idade e peso corporal médio de 70,3kg (±11,8kg). O delineamento experimental foi inteiramente ao acaso, com três tratamentos e seis repetições. Os animais foram abatidos aos dois meses de idade, sendo previamente submetidos a jejum alimentar de 16 horas. O aleitamento modificou os pesos dos órgãos internos e da gordura omental dos animais, exceto para rins e gordura mesentérica, e não alterou o consumo de alimentos sólidos. A silagem de leite de transição diluída em água comprometeu o desempenho dos bezerros, refletindo no peso dos órgãos internos e de gordura omental, e apresentou pesos absolutos para fígado, baço e gordura omental de 1.072, 186 e 133g, respectivamente. A silagem misturada em leite proporcionou resultados mais semelhantes ao fornecimento exclusivo de leite, demonstrando-se como opção para o aleitamento de bovinos jovens...

This study aimed to evaluate the absolute and relative size of internal organs of Holstein calves which suckled milk, silage transition milk diluted with water or mixed in milk. We used 18 male animals, 60 days old with a mean body weight of 70.3kg (± 11.8kg). The experimental design was completely randomized with three treatments and six replications. The animals were slaughtered at two months, and previously fasted for 16 hours. Breast feeding changed the weights of internal organs and omental fat of animals, except for kidney and mesenteric fat, and did not affect food intake solids. The silage transition milk diluted in water compromised the performance of the calves, reflecting on the weight of internal organs and omental fat, and showed absolute weights for liver, spleen and omental fat of 1072, 186 and 133g, respectively. The silage mixed with milk yielded results more similar to the exclusive milk supply, being an option for suckling calves...

Seleção genômica ampla para curvas de crescimento / Genome Wide Selection for growth curves

Foi proposta uma metodologia para avaliação genética de curvas de crescimento considerando-se informações de marcadores SNPs (Single Nucleotide Polymorphisms). Em um primeiro passo foram ajustados modelos de crescimento não lineares (logístico) aos dados de peso-idade de cada animal, e em um segundo passo as estimativas dos parâmetros de tais modelos foram consideradas como fenótipos em um modelo de regressão (LASSO Bayesiano - BL) cujas covariáveis foram os genótipos dos marcadores SNPs. Este enfoque possibilitou estimar os valores genéticos genômicos (GBV) para peso em qualquer tempo da trajetória de crescimento, refletindo na confecção de curvas de crescimento genômicas, as quais permitiram a identificação de grupos de indivíduos geneticamente superiores em relação à eficiência de crescimento. Os dados simulados utilizados neste estudo foram constituídos de 2000 indivíduos (1000 na população de treinamento e 1000 na população de validação) contendo 453 marcadores SNPs distribuídos sobre cinco cromossomos. Os resultados indicaram a alta eficiência do método BL em predizer GBVs da população de validação com base na população de treinamento (coeficientes de correlação variaram entre 0,79 e 0,93), bem como a alta eficiência na detecção de QTLs, uma vez que os marcadores com maiores efeitos estimados encontravam-se em posições dos cromossomos próximas àquelas nas quais se encontravam os verdadeiros QTLs postulados na simulação.

A methodology was proposed for the genetic evaluation of growth curves considering SNP (Single Nucleotide Polymorphisms) markers. At the first step, nonlinear regression growth models (Logistic) were fitted to the weight-age of each animal, and on second step the parameter estimates of the Logistic model were used as phenotype in a regression model (Bayesian LASSO - BL) which covariates were given by SNP genotypes. This approach allows the estimation of GBV (Genomic Breeding Values) for weight at either time of growth trajectory, allowing also the production of genomic growth curves, which selected groups of individuals with larger growth efficiency. The simulated data set was constituted of 2,000 individuals (being 1,000 in the training and 1,000 in the validation population) each one with 453 SNP markers distributed along 5 chromosomes. The results indicated high efficiency of the BL method to predict GBV in the validation population using information from the training population (correlation coefficients varying between 0.79 and 0.93). The BL also presented high efficiency to detect QTL, once the most expressive estimated SNP effects were located at positions closed to true QTL position fixed in the simulation.

Estudio Comparativo entre la Técnica de Anestesia Local Controlada por Computador y la Técnica de Anestesia Local Convencional / Comparative Study Between the Conventional Local Anesthetic Technique and the Computer-controlled Local Anesthetic

El control del dolor es uno de los aspectos más importantes para propiciar al paciente un comportamiento positivo en la consulta odontológica. Sin embargo, esto aún constituye un desafío para el cirujano dentista cuando trata pacientes ansiosos, ya que la administración de la anestesia local es lo que determina que muchos pacientes eviten el tratamiento odontológico. Con el propósito de disminuir la sensación dolorosa en pacientes y promover mayor comodidad, los profesionales han desarrollado un método de anestesia computarizada. El objetivo de esta investigación fue comparar la técnica de anestesia local convencional con la técnica de anestesia local controlada por computador. Participaron 30 pacientes voluntarios adultos que tenían indicación para exodoncia de terceros molares inferiores de ambos lados. Los pacientes, elegidos de forma aleatoria, fueron sometidos a las dos técnicas anestésicas mencionadas (convencional y controlada por computador). Aunque el grado de satisfacción de los profesionales con la técnica anestésica controlada por computador fue significativa, la mayoría declaró preferir el método convencional. No hubo cambios hemodinámicos significativos en cualquiera de los dos métodos utilizados en este estudio. La técnica anestésica controlada por computador se mostró sencilla, eficaz y segura. Los pacientes que participaron en este estudio respondieron mejor al método de anestesia controlada por computador, reportando menos dolor.

Pain control is one of the most important aspects contributing that the patient has a positive behavior in the dental office. However, this still constitutes a challenge for the dentist when treating anxious patients, because the administration of local anesthesia is the cause of many patients to avoid dental treatment. With the purpose of reducing pain sensation for patients and promote greater comfort for patients and professionals was developed a computerized anesthesia injection method. The aim of this investigation was to compare the conventional local anesthetic technique with the computer-controlled local anesthetic. Participated in this study 30 volunteers patients who had indication for bilateral surgical extraction of lower third molars. The patients, randomly selected, were subjected to each of the two mentioned anesthetic techniques (conventional and computer-controlled). Although the degree of professional satisfaction with the computer-controlled local anesthetic technique has been significant, the most of them reported to prefer the conventional method. There was no significant hemodynamic changes in any of the two methods used in this study. The computer-controlled local anesthetic technique was simple, effective and safe. The patients enrolled in this study responded better to the computer-controlled local anesthetic technique, reporting less pain.

Medidas de resucitación precoz durante la pandemia de gripe A (H1N1). ¿Se beneficiaron los pacientes? / Resuscitation measures early in the pandemic of influenza A (H1N1). HE benefited the patients?

Objetivo. Evaluar el impacto del uso de un protocolo de medidas de detección y resucitación precoz durante la pandemia de gripe A (H1N1) sobre el ingreso de pacientes en el Servicio de Terapia Intensiva (STI). Diseño. Estudio de observación y retrospectivo de pacientes críticos. Ámbito. Un STI médico-quirúrgico. Pacientes. Adultos que ingresaron en el STI desde el Servicio de Urgencia entre el 28 de abril de 2009 y el 4 de septiembre de 2009. Variables de interés principal. Sexo, edad, comorbilidades, APACHE II, SOFA al ingreso en el STI, sintomatología clínica, imágenes radiográficas, necesidad de asistencia respiratoria mecánica (ARM), ácido láctico (AL), creatinfosfoquinasa (CPK), lactato deshidrogenasa (LDH), leucocitosis, saturación de O2 (SatO2) y PaO2/FiO2 al ingresar en el STI, presión al final de la espiración (PEEP), días de ARM, tratamiento con oseltamivir (dosis/tiempo), aislamiento bacteriológico y virológico en secreción bronquial, tratamiento con corticoides, estadía en el STI y mortalidad. Resultados. Se incluyeron 13 pacientes que ingresaron en el STI durante el período estudiado; media de la edad 45 ± 3; mujeres: 8 (61,5%), comorbilidades (n = 7, 53,8%): enfermedad pulmonar obstructiva crónica (n = 3), diabetes (n = 2), insuficiencia cardíaca (n = 1), cirrosis (n = 1), APACHE II: 18, SOFA: 9 ± 2. La sintomatología clínica predominante fue la siguiente: fiebre (n = 13, 100%), tos (n = 11, 84,6%), disnea (n = 9, 69,2%), infiltrados intersticiales (5/13, 38,4%), opacidades alveolares (6/13, 46,1%), opacidades mixtas (2/13, 15,3%), cuatro cuadrantes (9/13, 69,2%) y dos cuadrantes (4/13, 30,7%); se hallaron los siguientes valores medios: AL 25 mg/dl, CPK 480 U/l (p <0,05), LDH 2100 U/l (p <0,001), leucocitosis 12.500 mm3 , PEEP 18 cm H2O, SatO2 <91% (n = 11, 84,6%), PaO2/FiO2 <150 (n = 11, 84,6%), necesidad de ARM (n = 11, 84,6%), días de ARM 9,5 ± 3 días. Oseltamivir: dosis 150 mg/12 h; aislamiento bacteriológico: neumococo (n = 7, 53,8%); aislamiento virológico: H1N1 (n = 5, 38,4%); duración: 9,5 ± 3 días, corticoides (n = 8, 61,5%). Tiempo en el STI: 11 ± 4. No hubo muertes.    Conclusión. La aplicación de un protocolo inicial en el que además se evalúo la gravedad benefició la correcta evaluación y resucitación inicial en el grupo estudiado. Los valores de CPK y de LDH se acompañaron de hipoxemia severa y mayor compromiso pulmonar en la radiología de tórax(AU)

Objective. To evaluate the impact of a protocol for screening and resuscitation measures during the pandemic H1N1 on patients´ admission to the Intensive Care Unit (ICU). Design. Retrospective observational study of critically ill patients. Place. A medical-surgical Intensive Care Unit (ICU). Patients. Adults admitted to the ICU from the Emergency Department from April 28th 2009 to September 4th 2009. Variables of primary interest. Sex, age, comorbidities, APACHE II, SOFA at admission to the ICU, clinical symptoms, radiographic images, need for mechanical ventilation (MV), lactic acid (AL), creatine kinase (CPK), lactate dehydrogenase (LDH), leukocytosis, O2 saturation (O2Sat) and PaO2/FiO2 at admission to the ICU, end-expiratory pressure (PEEP), days of MV (DMV), oseltamivir (dose/time), bacteriological and virological isolations in bronchial secretions, corticosteroid treatment, stay in the ICU and mortality. Results. We included 13 patients admitted to ICU during the study period; mean age: 45 ± 3; females: 8 (61.5%); comorbidities (n = 7, 53.8%): COPD (n = 3), diabetes (n = 2), heart failure (n = 1), cirrhosis (n = 1), APACHE II: 18, SOFA: 9 ±-2. Clinical symptoms were: fever (n = 13, 100%), cough (n = 11, 84.6%), dyspnea (n = 9, 69.2%), interstitial infiltrates (5/13, 38.4%), alveolar opacities (6/13, 46.1%), mixed opacities (2/13, 15.3%), four quadrants (9/13, 69.2%) and two quadrants (4/13, 30.7%), average measures: AL 25 mg/dL, CPK 480 U/L (p <0.05), LDH 2,100 U/L (p <0.001), leukocytosis 12,500 mm3 , PEEP 18 cm H2O, O2Sat <91% (n = 11, 84.6%), PaO2/FiO2 <150 (n = 11, 84.6%), MV (n = 11, 84.6%), DMV: 9.5 ± 3; oseltamivir: 150 mg/12 hours; bacteriological isolation (Pneumococcus: n = 7, 53.8%), virological isolation (H1N1: n = 5, 38.4%); length: 9.5 ± 3 days, corticosteroids (n = 8, 61.5%); ICU stay 11 ± 4; no deaths were reported. Conclusion. The application of a protocol in which severity was also evaluated benefited in the correct assessment and initial resuscitation. The values of CPK and LDH were associated with severe hypoxemia and lung involvement in the thorax xrays. (AU)

Ocorrência de Salmonella spp. e Staphylococcus coagulase positiva em pescado no nordeste, Brasil / Occurrence of Salmonella spp. and coagulse positive Staphylococcus in fish and crustaceans in the northeast of Brazil

O presente estudo foi conduzido com o objetivo de verificar a ocorrência de Salmonella spp. e Staphylococcus coagulase positiva em pescados e crustáceos provenientes da região nordeste no período de fevereiro de 2004 a dezembro de 2005. Das 143 amostras de peixes e crustáceos (camarão congelado e cauda de lagosta), 5 (3,5%) apresentaram-se positivas para Salmonella spp. Enquanto nas amostras de peixe e cauda de lagosta a contagem de Staphylococcus coagulase positiva foi < 1,0 x 102UFC/g estimado, nas amostras de camarão congelado, em duas a contagem foi 1,0 x 101UFC/g estimado e em uma 2,6 x 101UFC/g estimado, as demais <1,0 x 101UFC/g estimado. Com base nos resultados obtidos conclui-se que as amostras analisadas apresentaram baixos níveis de ocorrência de Salmonella spp. e Staphylococcus coagulase positiva e que, mesmo com estes baixos índices, constantemente deve-se buscar uma melhora na qualidade dos produtos da pesca, melhora esta que passa pelo treinamento constante em boas práticas de fabricação, procedimentos padrões de higienização e análise de perigos e pontos críticos de controle do pessoal que trabalha na pesca ou em fazendas de criação de camarão, bem como dos funcionários das indústrias.

The present study was carried out to evaluate the occurrence of Salmonella spp. and coagulase-positive Staphylococcus in fish and crustaceans from the Brazilian Northeast. Five out of the 143 samples (3.5%) were positive for Salmonella spp. While none of the fish and lobster tail samples were positive for coagulase positive Staphylococcus, two shrimp samples presented an estimated count of 1.0 x 101colony forming units per gram (cfu/g), and one presented 2.6 x 101 cfu/g. The results showed a low level of Salmonella and coagulase positive Staphylococcus occurrence. However, even with these low levels of bacterial numbers in fish and crustaceans we should search look for an improvement in their quality. This improvement should be associated to constant training for good manufacturing practice, a standard procedure of hygiene and analysis of hazards and critical control points related to employees that work as fishers or on shrimp farms, as well as those working in the industry as a whole.

Capacidad de la memoria de trabajo verbal: Validez y fiabilidad de una tarea de amplitud de lectura / Verbal working memory capacity: Reliability and validity of the reading span task

La memoria de trabajo se refiere a todos aquellos mecanismos o procesos implicados en el control, regulación y mantenimiento activo de información relevante para la ejecución de tareas cognitivas complejas (Miyake & Shah, 1999); es uno de los principales factores limitantes de las capacidades de alto nivel jerárquico, como el razonamiento o la comprensión lectora. En este trabajo se informa un estudio en el que se analizaron las propiedades psicométricas de una de las tareas más conocidas para la evaluación de la capacidad de la memoria de trabajo, la Tarea de Amplitud de Lectura de Daneman y Carpenter (1980). La tarea consiste en leer un conjunto de oraciones no relacionadas entre sí, mientras se retienen sus palabras finales, y determina el máximo número de palabras finales que un participante puede recordar, que se identifica con su amplitud o span. La prueba se adaptó al español rioplatense partiendo de versiones españolas (Elosúa, Gutiérrez, García Madruga, Luque & Gárate, 1996; Gutiérrez, Jiménez & Castillo, 1996) y se administró en sesión individual a 132 voluntarios, conjuntamente con pruebas estandarizadas de memoria de corto plazo y de trabajo, tales como Amplitud de Dígitos y Amplitud Viso-Espacial de la Wechsler Memory Scale - Revised (WMS - R, Wechsler & Stone, 1987) y Ordenamiento Dígito-Letra de la Wechsler Adult Intelligence Scale III (WAIS III - Wechsler, 1987). La tarea de Amplitud de Lectura mostró una alta fiabilidad. Con respecto a su validez, se obtuvieron correlaciones significativas con tareas de memoria verbal, pero no así con tareas de memoria viso-espacial.

In the study of human behavior, working memory has been seen as a central construct (Conway, Kane, Bunting, Hambrick, Wilhelm, & Engle, 2005) since the cognitive revolution took place. Working memory refers to those mechanisms or processes that are involved in the control, regulation, and active maintenance of task-relevant information in the service of complex cognition (Miyake & Shah, 1999), and is considered one of the main limiting factors for complex abilities such as reasoning or reading comprehension. Methodologically, the Reading Span Task (Daneman & Carpenter, 1980) has proven to be both a reliable and valid measure of working memory capacity, and is a widely used measure. The purpose of this study was to develop a local adaptation of the Reading Span Task, based on two previous Spanish versions (Gutiérrez, Jiménez, & Castillo, 1996; Elo súa, Gutiérrez, García Madruga, Luque, & Gárate, 1996), whose psychometric properties were not known. In both cases, the Reading Span capacity was significantly correlated with measures of reading comprehension. However, the psychometric properties of the Reading Span Task were not analyzed. The task requires participants to read a set of unrelated sentences, each of which is between 12 and 14 words long, one sentence at a time, at their own pace. Sentences are arranged in 4 sets of 2, 3, 4, and 5 sentences. There are three different trials at each set-size (number of sentences) level. After having read all the sentences in each set, participants try to recall the final word of each sentence. Working memory capacity is both the maximum number of sentences for which the participant can recall the final word (Span) and the total number of sentence-final words recalled (Conway et al., 2005). The task was administered in one session to 132 undergraduates at the University of Buenos Aires (UBA), along with other standardized short-term and working memory tests, Digit Span and Visuo-Spatial Span from the Wechsler Memory Scale - Revised (Wechsler & Stone, 1987), and Letter- Number Sequencing from the Wechsler Adult Intelligence Scale III (Wechsler, 2003). The Reading Span Task showed high reliability (α = .95). The percentile analysis shows that those participants that obtained a Span of 2 or recalled 6 words fall in the 25th percentile, while those that obtained scores above a Span of 3.5 and recalled more than 24 words fall above the 75th percentile. The correlation analysis shows that the Reading Span Task has positive and significant correlations with verbal memory tasks (measured by Span, Forward Digit Span r = .408; p < .01; Backward Digit Span r = .502; p < .01; Letter-Number Sequencing r = .504; p < .01; measure by Number of sentencefinal words recalled, Forward Digit Span r = .416; p < .01; Backward Digit Span r = .496; p < .01; Letter-Number Sequencing r = .489; p < .01) , but not with visuo-spatial memory tasks (measure by Span, Forward Visuo-Spatial Span r = .169; p = n.s.; Backward Visuo-Spatial Span r = .018; p = n.s.; measure by Number of sentence-final words recalled, Forward Visuo-Spatial Span r = .189; p < .05; Backward Viso- Spatial Span r = .032; p = n.s.). A factor analysis showed the separation of the two factors involved in the tasks: a verbal factor whose capacity is affected by the Reading Span Task, Digit Span and Letter - Number Sequencing tasks, and a visuo-spatial factor whose capacity is affected by the visuo-spatial amplitude tasks. Results indicate that the Reading Span Task can be considered an appropriate, valid and reliable measure of the capacity of verbal working memory, useful for doing research on cognitive processes and for neuropsychological assessment.

Marcadores de alergia alimentaria en enfermedad péptica / Food allergy markers in peptic disease

Background: The double-blind food challenge is the gold standard for diagnosis of food allergy, even though it is difficult to standardize and execute. An increase in allergy prevalence worldwide accentuates the importance of evaluating food allergy markers, in order to help the diagnosis. Objective: Elaboration of an operational definition for food hypersensitivity (FH) and evaluate the role of allergy markers, endoscopic and histological findings, gastric mucosa cytokines and personal/family history of allergy in children. Method: Enrollment of children with suspected peptic disease referred for endoscopy. We obtained antral biopsies for histological evaluation (eosinophil and mast cell count) and measurement of mucosal cytokines through an ELISA test. Patients were evaluated with Prick test, total serum IgE and clinical questionnaires for allergies. They were divided into two groups; children with and without food hypersensitivity. Results: 97 children were enrolled (mean: 11.7 +/- 3, range 3-18). 4 percent of children had FH. The endoscopic findings did not correlate with the presence of FH. 74.1 percent of patients without FH had eosinophils in the gastric mucosa compared to groups with FH which had 100 percent) (p < 0.05). Only IL-2 among the evaluated cytokines was found in a greater concentration in patients without FH. 33 percent> of patients considered themselves having history of personal allergies versus 11.8 percent of people without FH (p < 0.05). Conclusions: 12,4 percent of children with digestive symptoms referred to endoscopy have FH. There are no clinical, endoscopic or histological differences between patients with or without FH.

Introducción: El diagnóstico de alergia a alimentos se fundamenta en la prueba de provocación oral doble ciego, de difícil estandarización y ejecución. El aumento de la prevalencia de alergia hace necesario la evaluación de marcadores de alergia a alimentos para facilitar el diagnóstico. Objetivo: Evaluar en niños, a partir de una definición operacional de hipersensibilidad a alimentos (HA), el rol de algunos marcadores de hipersensibilidad, hallazgos endoscópicos e histológicos, citoquinas de mucosa gástrica, y antecedentes personales y familiares de alergia. Métodos: Se enrolaron niños referidos a endoscopia por sospecha de enfermedad péptica. Se obtuvieron biopsias antrales para evaluación histológica (incluyendo eosinófilos y mastocitos) y citoquinas mediante ELISA. Se les realizó test cutáneo (TC), IgE total sérica y cuestionarios clínicos de alergia. Se dividió en 2 grupos, niños con y sin HA según criterio establecido. Resultados: Se reclutaron 97 niños (promedio: 11,7 +/- 3 años, rango 3 a 18). Un 12,4 por ciento de los niños presentó HA. Los hallazgos endoscópicos no se relacionaron con la presencia de HA. Un 74,1 por ciento de los pacientes sin HA presentó eosinófilos en la mucosa gástrica comparado con un 100 por ciento en el grupo con HA (p < 0,05). Sólo IL-2 se encontró en mayor concentración en pacientes sin HA. Un 33,3 por ciento de la población con HA consideró tener antecedentes personales de AA versus un 11,8 por ciento de los sin HA (p < 0,05). Conclusiones: La HA en niños referidos a endoscopia por síntomas digestivos está presente en un 12,4 por ciento, sin elementos clínicos, endoscópicos o histológicos que los diferencien de niños sin HA.

¿Cuántas víctimas se necesitan para definir un desastre? / How many victims are needed to define a disaster?

Objetivo. Describir una situación de atención de víctimas múltiples. Analizar las características particulares del síndrome de inhalación de humo (SIH). Material y Métodos. Se evaluaron 5 pacientes (pts), ingresados al Servicio de Emergencias del HRRG en Noviembre del 2006, de los cuales tres ingresaron al Servicio de Terapia Intensiva (STI), único en la zona norte de la Provincia de Tierra del Fuego. La capacidad instalada del Hospital es de 5 camas de Terapia Intensiva con 5 respiradores microprocesador y con un ingreso anual de 300 pts con un índice de ocupación de camas de 5.4 pts/día. Los motivos de ingreso al STI fueron: Síndrome de Inhalación de Humo (SIH) e Insuficiencia Respiratoria Aguda. Se dividió a las Lesiones de la Inhalación de Humo (LIH) en: Lesión Térmica de la Vía Aérea (LTVA), Asfixia (A) y Lesiones por Gases Irritantes (LGI)*. Se evaluaron: Índice Trauma Pediátrico (ITP), APACHE II, características demográficas, estadía en TI (ETI), déficit de base en las 48 hs (DB/48) y mortalidad (M). Resultados. De los 5 pts (2 mujeres y 3 hombres), la edad promedio fue 8,6 años (rango 3-16), el APACHE II (promedio): 24.6 puntos (rango 2230), la ETI (promedio): 11,6 días (rango 1-18), ITP (promedio): 0 (-4 a +4) y el DB 48 (promedio) 11.4 mEq (rango -6 a -19). La mortalidad global fue del 40%. Tres pacientes presentaron LTVA, A y LGI, mientras que los dos restantes presentaron LTVA y A. Conclusión. La recepción de los 5 pts superó, en forma inmediata, los recursos en el sistema local hospitalario, cumpliendo con la definición de desastre. La acidosis metabólica durante las primeras 48 hs en el contexto del SIH se acompañó de mayor morbimortalidad.(AU)

How many victims are necessary to define a disaster? Objective. Describe a situation of care of multiple victims. Analyse the particular characteristics of smoke inhalation syndrome (SIH). Material and methods. 5 patients (pt) admitted to the Emergency Service of HRRG in November 2006 were evaluated. Three patients were admitted to the Intensive Care Unit, the only Service in the northern province of Tierra del Fuego. The Intensive Care Unit has 5 beds and 5 critical care ventilators to assit patients with respiratory failure. We admitted roughly 300 patients each year. The reasons for the admision were: Smoke inhalation Syndrome (SIH) and acute respiratory failure Injuries because inhaling smoke (LIH) were classified in: Thermal Injury of the Air (LTVA), Asphyxia (A) and Gas Injures Irritants (LGI). We consigned Pediatric Trauma Index (ITP), Apache II score, demographics, length of stay in STI, the basic deficit within 48 hours (DB/48) and mortality (M). Results. Of the 5 pt (2 women and 3 men), age was 8.6 years (range 3-16), the Apache II: 24.6 (range 22-30), length of stay 11.6 days (range 1-18), ITP: 0 (-4 to +4) and DB 48 (average) - 11.4 mEq (-6 to -19 range). The mortality rate was 40%. Three patients had LTVA, A and LGI, while the remaining two, both presented LTVA and A Conclusion. The admission of the 5 pt exceeded, immediately, resources in the local hospital system, fulfilling with the definition of disaster. The metabolic acidosis during the first 48 hours in the context of SIH was associated with increased morbidity and mortality(AU)

Caracterización fisicoquímica de peciólos del pangue (Gunnera tinctoria) / Physicochemical characterization of petioles of pangue (Gunnera tinctoria)

The petioles of pangue (Gunnera tinctoria) are foods with a very pleasant acid flavor and constitute an important non-wood forests product (NWFP) of Chile which may be an alternative for the formulation of new food products. The objectives of this work were to determine its proximal chemical composition, to establish its energy contribution and to define some of their physiochemical and biochemical properties. The content of proteins, lipids, moisture, fiber, ashes, carbohydrates, ascorbic acid, soluble solids, and water activity were determined. The activities of the enzymes peroxidase and poliphenoloxidase were also measured. The results show that the commodity possesses a high content of moisture and water activity, and a reduced contribution of energy and ascorbic acid. The petioles present an intense green color in the nearby portion of rhizome. They have a reduced pH that permits to classify them as an acid food. The results give an orientation on the possible strategies of processing of this vegetable to obtain food products with a shelf life that permit their commercialization.

Los pecíolos del pangue (Gunnera tinctoria) son comestibles con un sabor ácido muy agradable y constituyen un importante producto forestal no maderable (PFNM) de Chile. Sin embargo, no existen antecedentes sobre las características de este vegetal que permitan un uso industrial alternativo que puede ser la formulación de nuevos productos alimentarios. Los objetivos de este trabajo fueron determinar la composición químico proximal, el aporte energético y algunas propiedades fisicoquímicas y bioquímicas de los pecíolos del pangue. Se determinó el contenido de proteínas, lípidos, humedad, fibra, cenizas, carbohidratos por diferencia, pH, ácido ascórbico, actividad de agua, sólidos solubles, color y enzimas peroxidasa y polifenoloxidasa. Los resultados muestran que la materia prima posee un elevado contenido de humedad y actividad de agua, un reducido aporte energético y trazas de ácido ascórbico. El color de los pecíolos presenta una coloración verde más intensa en la porción cercana al rizoma. Asimismo, posee un pH reducido que permite clasificarlo como un alimento ácido y presenta actividad de la enzima peroxidasa. Los resultados entregan una orientación sobre las posibles estrategias de procesamiento de este vegetal para obtener productos alimentarios con una vida útil que permita su comercialización.

Fecal estradiol and progesterone metabolite levels in the three-toed sloth (Bradypus variegatus)

The present study was carried out to assess the possibility of measuring fecal steroid hormone metabolites as a noninvasive technique for monitoring reproductive function in the three-toed sloth, Bradypus variegatus. Levels of the estradiol (E2) and progesterone (P4) metabolites were measured by radioimmunoassay in fecal samples collected over 12 weeks from 4 captive female B. variegatus sloths. The validation of the radioimmunoassay for evaluation of fecal steroid metabolites was carried out by collecting 10 blood samples on the same day as defecation. There was a significant direct correlation between the plasma and fecal E2 and P4 levels (P < 0.05, Pearson's test), thereby validating this noninvasive technique for the study of the estrous cycle in these animals. Ovulation was detected in two sloths (SL03 and SL04) whose E2 levels reached 2237.43 and 6713.26 pg/g wet feces weight, respectively, for over four weeks, followed by an increase in P4 metabolites reaching 33.54 and 3242.68 ng/g wet feces weight, respectively. Interestingly, SL04, which presented higher levels of E2 and P4 metabolites, later gave birth to a healthy baby sloth. The results obtained indicate that this is a reliable technique for recording gonadal steroid secretion and thereby reproduction in sloths.

Helicobacter pylori en niños / Helicobacter pylori in children

El Helicobacter Pylori (HP) es el agente causal de una infección de distribución mundial, con alta prevalencia en países en desarrollo. Está relacionado a gastritis crónica en niños y adultos y a cáncer gástrico en adultos infectados durante la infancia. En nuestro país no existen datos sobre HP en niños, lo que motivó este estudio, cuyo objetivo fue obtener información sobre la infección con HP y sus formas de presentación en la edad pediátrica. El presente es un estudio retrospectivo, observacional descriptivo, de corte transverso; que abarcó 80 pacientes de 1-17 años de edad, que consultaron en el Hospital Nacional entre enero de 2000 y julio de 2005, en los que se realizó Endoscopía Digestiva Alta y biopsia gástrica. Se encontró HP positivo en 15% de los pacientes, con una edad media de 12 años. El síntoma más frecuente fue dolor abdominal y los hallazgos endoscópicos fueron los habituales

Electrocardiographic studies of the three-toed sloth, Bradypus variegatus

Electrocardiograms (ECG) obtained with standard limb leads and augmented unipolar limb leads were recorded from 17 unanesthetized adult sloths. The animals were held in their habitual position in an experimental chair. We determined heart rate and rhythm from the R-R intervals, the amplitude and duration of each wave, and the duration of the segments and intervals of the ECG. The mean electrical axes of P and T waves and QRS complex were calculated on the basis of the amplitude of these waves in leads I, II, III, aV R, aV L, and aV F. The P wave appeared positive in most tracings with low amplitude in lead II, the QRS complex was generally negative in leads aV R, III and aV F, and no arrhythmias were observed. With a mean ± SD heart rate for all recordings of 81 ± 18 bpm, the duration of P and T waves, QRS complex, and PR, QT and RR intervals averaged 0.05 ± 0.02, 0.15 ± 0.05, 0.07 ± 0.02, 0.13 ± 0.02, 0.38 ± 0.04, and 0.74 ± 0.17 s, respectively. The ECG shape had a definite configuration on each lead. The angles of the mean ± SD electrical axes for atrial and ventricular depolarization and ventricular repolarization in the horizontal plane were +34 ± 68°, -35 ± 63°, and -23 ± 68°, respectively. All electrical axes showed great variations and their mean values suggest that, when the sloth is in a seated position, the heart could be displaced by the diaphragm to a semi-horizontal position.

Nociones y experiencias en promoción de la salud y prevención de la enfermedad de bacteriologos y laboratoristas clínicos egresados de la Universidad de Antioquia / Notions and experiences on health promotion and disease prevention by bacteriologists and clinical laboratory technicians graduated in the University of Antioquia in Medellín, Colombia

El nuevo paradigma del proceso salud-enfermedad incluye acciones interdisciplinarias encaminadas a la promoción, prevención y diagnóstico. La tradición ha mostrado que la formación y el quehacer profesional del bacteriólogo se han orientado a la asistencia clínica y no al cambio social desde su saber, hacer y ser. Objetivo: describir las experiencias de bacteriólogos y laboratoristas clínicos egresados de la Universidad de Antioquia dedicados a la promoción de la salud y prevención de la enfermedad. Metodología: se realizó una entrevista semiestructurada a bacteriólogos que se han desempeñado en este campo de trabajo, cuyos resultados fueron ordenados en matrices categoriales y contrastados mediante un grupo focal. Algunas categorías emergentes fueron: 1) nociones sobre la promoción y la prevención: los bacteriólogos conciben la promoción y la prevención como empoderamiento comunitario, ejercicio educativo, control de factores de riesgo, mercadeo de la salud y como conceptos interrelacionados y poco delimitados; 2) competencias: los bacteriólogos señalan que se requieren habilidades pedagógicas y comunicativas, capacidad para liderar proyectos y trabajar en equipo, manejo de políticas públicas y conocimientos en mercadeo, costos y auditoría; 3) estrategias metodológicas: la educación y el trabajo interdisciplinario son las estrategias más utilizadas con la acción comunicativa como eje transversal para la realización de estos dos procesos; 4) interdisciplinariedad: el equipo interdisciplinario es necesario para planear y estructurar programas de promoción y prevención, y orientar y fomentar la autodeterminación en la comunidad. Resultados: se obtienen resultados que permiten contribuir a la reflexión sobre el sentido social del bacteriólogo, a la vez que brindan elementos para el currículo de los programas de formación.

Cardiovascular responses to locomotor activity and feeding in unrestrained three-toed sloths, Bradypus variegatus

Heart rate (HR) and systolic (SBP), diastolic (DBP) and mean (MBP) blood pressure were recorded by biotelemetry in nine conscious unrestrained sloths for 1 min every 15 min over a 24-h period. The animals were allowed to freely move in an acoustically isolated and temperature-controlled (24 ± 1ºC) experimental room with light-dark cycle (12/12 h). Behavior was closely monitored through a unidirectional visor and classified as resting (sitting or suspended), feeding (chewing and swallowing embauba leaves, Cecropia adenops), or locomotor activity around the tree trunk or on the room floor. Locomotor activity caused statistically significant increases in SBP (+8 percent, from 121 ± 22 to 131 ± 18 mmHg), DBP (+7 percent, from 86 ± 17 to 92 ± 10 mmHg), MBP (+8 percent, from 97 ± 19 to 105 ± 12 mmHg), and HR (+14 percent, from 84 ± 15 to 96 ± 15 bpm) compared to resting values, indicating a possible major influence of the autonomic nervous system on the modulation of cardiac function during this behavior. During feeding, the increase in blood pressure was even higher (SBP +27 percent, from 119 ± 21 to 151 ± 21 mmHg; DBP +21 percent, from 85 ± 16 to 103 ± 15 mmHg; MBP +24 percent, from 96 ± 17 to 119 ± 17 mmHg), while HR remained at 14 percent (from 84 ± 15 to 96 ± 10 bpm) above resting values. The proportionally greater increase in blood pressure than in HR during feeding suggests an increase in peripheral vascular resistance as part of the overall response to this behavior.

Circadian rhythms in blood pressure in free-ranging three-toed sloths (Bradypus variegatus)

Blood pressure (BP) profiles were monitored in nine free-ranging sloths (Bradypus variegatus) by coupling one common carotid artery to a BP telemetry transmitter. Animals moved freely in an isolated and temperature-controlled room (24ºC) with 12/12-h artificial light-dark cycles and behaviors were observed during resting, eating and moving. Systolic (SBP) and diastolic (DBP) blood pressures were sampled for 1 min every 15 min for 24 h. BP rhythm over 24 h was analyzed by the cosinor method and the mesor, amplitude, acrophase and percent rhythm were calculated. A total of 764 measurements were made in the light cycle and 721 in the dark cycle. Twenty-four-hour values (mean ± SD) were obtained for SBP (121 ± 22 mmHg), DBP (86 ± 17 mmHg), mean BP (MBP, 98 ± 18 mmHg) and heart rate (73 ± 16 bpm). The SBP, DBP and MBP were significantly higher (unpaired Student t-test) during the light period (125 ± 21, 88 ± 15 and 100 ± 17 mmHg, respectively) than during the dark period (120 ± 21, 85 ± 17 and 97 ± 17 mmHg, respectively) and the acrophase occurred between 16:00 and 17:45 h. This circadian variation is similar to that observed in cats, dogs and marmosets. The BP decreased during "behavioral sleep" (MBP down from 110 ± 19 to 90 ± 19 mmHg at 21:00 to 8:00 h). Both feeding and moving induced an increase in MBP (96 ± 17 to 119 ± 17 mmHg at 17:00 h and 97 ± 19 to 105 ± 12 mmHg at 15:00 h, respectively). The results show that conscious sloths present biphasic circadian fluctuations in BP levels, which are higher during the light period and are mainly synchronized with feeding

The effect of feeding on the respiratory activity of the sloth

The aim of the present study was to confirm whether feeding influences the resting breathing rate and to observe possible alterations in blood gas and pH levels produced by feeding in unanesthetized sloths (Bradypus variegatus). Five adult male sloths (4.1 ± 0.6 kg) were placed daily in an experimental chair for a period of at least 4 h for sitting adaptation. Five measurements were made for each sloth. However, the sloths one, two and five were studied once and the sloths three and four were studied twice. Breathing rate was determined with an impedance meter and the output signal was digitized. Arterial blood samples were collected for blood gas analysis with a BGE electrolytes analyzer and adjusted for the animal's body temperature and hemoglobin content. The data are reported as mean ± SD and were collected during the resting period (8:00-10:00 h) and during the feeding period (16:00-18:00 h). The mean breathing rate increased during mastication of ymbahuba leaves (rest: 5.0 ± 1, feeding: 10 ± 1 bpm). No significant alterations were observed in arterial pH (rest: 7.42 ± 0.05, feeding: 7.45 ± 0.03), PCO2 (rest: 35.2 ± 5.3, feeding: 33.3 ± 4.4 mmHg) or PO2 (rest: 77.5 ± 8.2, feeding: 78.4 ± 5.2 mmHg) levels. These results indicate that in unanesthetized sloths 1) feeding evokes an increase in breathing rate without a significant change in arterial pH, PCO2 or PO2 levels, and 2) the increase in breathing rate produced by feeding probably is due to the act of mastication

Sloth biology: an update on their physiological ecology, behavior and role as vectors of arthropods and arboviruses

This is a review of the research undertaken since 1971 on the behavior and physiological ecology of sloths. The animals exhibit numerous fascinating features. Sloth hair is extremely specialized for a wet tropical environment and contains symbiotic algae. Activity shows circadian and seasonal variation. Nutrients derived from the food, particularly in Bradypus, only barely match the requirements for energy expenditure. Sloths are hosts to a fascinating array of commensal and parasitic arthropods and are carriers of various arthropod-borne viruses. Sloths are known reservoirs of the flagellate protozoan which causes leishmaniasis in humans, and may also carry trypanosomes and the protozoan Pneumocystis carinii