Body mass index in offspring of mothers with diabetes mellitus: follow-up at 2, 4, 6, and 8 years of age / Índice de masa corporal en hijos de madres con diabetes mellitus: seguimiento a los 2, 4, 6 y 8 años de edad

Abstract Background: Offspring of mothers with diabetes mellitus (DM) during pregnancy may be at high risk for developmental alterations. This study aimed to identify the effects of maternal pre- and gestational diabetes on the body mass index of infants and children at two, four, six, and eight years of age. Methods: We studied children of mothers with type 1, type 2, and gestational diabetes and a control group. Maternal and neonatal variables were analyzed for associations with children overweight/obesity. Results: Mothers with DM were older than controls (32 ± 6 vs. 22 ± 6 years, p < 0.001). The frequency of preeclampsia in mothers with DM was 28%. Gestational age and weight at birth were lower in infants from the groups of mothers with DM in comparison with controls (32.8 ± 3.1 vs. 36.4 ± 2.2 weeks, p < 0.001, and 1,637 ± 600 vs. 2,208 ± 518 g, p < 0.001, respectively). At 8 years of age, 47% of the offspring of mothers with DM type 2 had overweight/obesity (odds ratio (OR 8.25) 95% confidence interval (CI) 1.3-51, p = 0.01), while 27% of offspring of mothers with type 1 DM had overweight/obesity, and 10% of offspring of mothers with gestational diabetes presented overweight/obesity. Conclusions: Offspring of pre-gestational DM mothers have a higher risk to develop overweight/obesity, as was observed with follow-up until school age, for which they require continuous vigilance.

Resumen Introducción: Los hijos de madres con diabetes mellitus durante el embarazo pueden tener un alto riesgo de alteraciones del desarrollo. El objetivo de este estudio fue buscar los efectos de la diabetes pregestacional y gestacional en el índice de masa corporal de niños a los 2, 4, 6 y 8 años de edad. Métodos: Se estudiaron los hijos de madres con diabetes tipo 1, 2 y gestacional, así como un grupo control. Se analizaron las variables maternas y neonatales en búsqueda de una asociación con sobrepeso u obesidad en los niños. Resultados: La edad de las madres con diabetes mellitus fue mayor que la del grupo control (32 ± 6 vs. 22 ± 6 años, p < 0.001). La frecuencia de preeclampsia en las madres con diabetes mellitus fue del 28%. La edad gestacional y el peso al nacer fueron menores en los hijos de las madres con diabetes en comparación con los controles (32.8 ± 3.1 vs 36.4 ± 2.2 semanas, p < 0.001, y 1,637 ± 600 vs. 2,208 ± 518 g, p < 0.001, respectivamente). A los 8 años, el 47% de los hijos de madres con diabetes tipo 2 tuvieron sobrepeso u obesidad (RM: 8.25; intervalo de confianza del 95%: 1.3-51; p = 0.01), frente al 27% de los hijos de madres con diabetes tipo 1 y el 10% de los hijos de madres con diabetes gestacional. Conclusiones: Los hijos de madres con diabetes pregestacional presentan un mayor riesgo de desarrollar sobrepeso u obesidad, como se observó en el seguimiento hasta la edad escolar, por lo que requieren una vigilancia continua.

Confinamiento e inseguridad alimentaria durante la pandemia por covid-19 en Chile

RESUMEN Introducción: El confinamiento por COVID-19, repercute en la situación socioeconómica, de salud y de seguridad alimentaria especialmente en población vulnerable, debido a la reducción de empleos, ingreso y acceso a los alimentos. Objetivo: Determinar la inseguridad alimentaria y la priorización de la compra de alimentos en hogares en situación de confinamiento, durante la pandemia por COVID-19 en Chile. Material y métodos: Estudio observacional analítico. Se envió cuestionario online a través de redes sociales, que incluía información sociodemográfica, prioridad de compra de algunos alimentos seleccionados, pérdida de alimentos en el hogar y una escala de seguridad alimentaria doméstica. Resultados: Participaron 1.114 personas, de ellos el 87,8% eran mujeres, el 80,9% de los participantes llevaba 4 o más semanas de confinamiento. A medida que aumentan las semanas de confinamiento, se incrementa la inseguridad alimentaria leve 26,9% a 36,1% y moderada, 1,7% a 7,8% y se disminuye la seguridad alimentaria 70,6% a 55,7%. Entre el 49,2% y 55,5% de los participantes, en la quinta semana de confinamiento priorización lácteos, arroz/pasta, harina, legumbres, aceite, papas y un 27,0% el azúcar/miel. No se priorizaron los alimentos frescos como las frutas y verduras (FV). Conclusión: El confinamiento genera un aumento progresivo de la inseguridad alimentaria leve y moderada. La priorización de compra en confinamiento se caracteriza por, alimentos con más tiempo de conservación, de mayor consumo, fáciles de preparar y que son ingredientes básicos de otras preparaciones. Alimentos frescos, como frutas y verduras no fueron priorizados. La priorización se relacionó con el nivel educativo.

ABSTRACT Introduction: COVID-19 lockdown affects socioeconomics, health and food security, especially in a vulnerable population, due to the reduction of jobs, income and access to food. Objective: To determine food insecurity and prioritization of food purchases in household in lockdown during the COVID-19 pandemic in Chile. Material and methods: Observational analytical study. An online questionnaire was sent through social networks, which included socio-demographic information, priority of purchase of selected foods, less food at home and a scale of household food security. Results: 1,114 people participated, 87.8% of them were women, 80.9% of the participants had been in quarantine for 4 or more weeks. As the weeks of quarantine increased, mild food insecurity increased from 26.9% to 36.1% and moderate from 1.7% to 7.8%. Food security decreased from 70.6% to 55.7%. Between 49.2% and 55.5% of the participants, in the fifth week of confinement, prioritized dairy, rice/pasta, flour, legumes, oil, potatoes and 27.0% sugar/honey. Fresh foods such as fruits and vegetables were not prioritized. Conclusion: Lockdown generated a progressive increase in mild and moderate food insecurity. The prioritization of purchase in lockdown was characterized by foods with a longer shelf life, more consumption, easy to prepare meals and foods which are basic ingredients of other preparations. Fresh foods like fruits and vegetables were not prioritized. Prioritization was related to educational level.

Association of kir2dl2 gene with anti-cyclic citrullinated protein antibodies for serodiagnosis in rheumatoid arthritis

Rheumatoid arthritis is a clinical autoimmune syndrome that causes joint damage. The positive or negative anti-cyclic citrullinated protein (CCP) antibodies serodiagnosis differentiates two subsets of the disease, each with different genetic background. Previous studies have identified associations between KIR genes and rheumatoid arthritis but not with anti-CCP serodiagnosis. Therefore, we investigated the proportion of patients seropositive and seronegative to anti-CCP and its possible association with KIR (killer cell immunoglobulin-like receptor) genes. We included 100 patients with rheumatoid arthritis from western Mexico, who were determined for anti-CCP serodiagnosis by ELISA, and 16 KIR genes were genotyped by PCR-SSP. The proportion of seropositive anti-CCP patients was 83%, and they presented a higher frequency of KIR2DL2 genes than the seronegative group (73.6% vs. 46.2%, p = 0.044) which, in turn, presented a higher KIR2DL2-/ KIR2DL3+ genotype frequency than the first ones (46.2% vs. 17.2%, p = 0.043). These results suggest different KIR genetic backgrounds for each subset of the disease according to anti-CCP serodiagnosis.

La artritis reumatoide es un síndrome clínico autoinmune que causa daño en las articulaciones. El serodiagnóstico positivo o negativo para anticuerpos proteicos anti-cíclicos citrulinados (CCP) diferencia dos subconjuntos de la enfermedad, cada uno con diferente fondo genético. Estudios previos han identificado asociaciones entre los genes killer cell immunoglobulin- like receptor (KIR) y la artritis reumatoide, pero no con el serodiagnóstico de anti-CCP. Por lo tanto, investigamos la proporción de seropositividad y seronegatividad anti-CCP y su posible asociación con genes KIR. Se incluyeron 100 pacientes con artritis reumatoide del occidente de México, a quienes se les determinó su serodiagnóstico anti-CCP por ELISA y también se les realizó genotipificación de 16 genes KIR por PCR-SSP. La proporción de pacientes seropositivos anti-CCP fue del 83% y presentaron una mayor frecuencia génica KIR2DL2 que el grupo seronegativo (73.6% vs. 46.2%, p = 0.044), estos últimos presentaron mayor frecuencia genotípica KIR2DL2-/KIR2DL3+ que los primeros (46.2% vs. 17.2%, p = 0.043). Los resultados sugieren diferente fondo genético KIR para cada subconjunto de la enfermedad, de acuerdo con el serodiagnóstico anti-CCP.

Imaginarios de sexualidad en estudiantes universitarios / The imagination of sexuality in graduate student

RESUMEN Objetivo Describir y explicar los imaginarios sobre sexualidad que tienen los estudiantes universitarios al comienzo de su formación profesional. Métodos Estudio con enfoque cualitativo, en el que se utilizó como metodología y método la teoría fundamentada; en total participaron 11 estudiantes que se encontraban matriculados en primer semestre en diferentes programas presenciales de pregrado; la recolección de la información se realizó mediante 25 entrevistas a profundidad, con un promedio de dos entrevistas por informante. Resultados A partir de los datos surgieron seis categorías: socialización de la sexualidad en la familia; socialización de la sexualidad en la escuela; socialización de la sexualidad en los medios de comunicación; socialización de la sexualidad con los pares; imaginario tradicional de sexualidad; imaginario liberal de la sexualidad. Finalmente, a partir de las categorías generales emergió la teoría sustantiva: imaginarios de sexualidad entre la adaptación y la resistencia. Discusión El planteamiento teórico, describe como los jóvenes van interiorizando los símbolos y visiones de la sexualidad que van aprendiendo antes de ingresar a la universidad, en los procesos de socialización en la familia, la escuela, los medios de comunicación, los pares y sus propias experiencias. Esta interiorización no es totalmente pasiva, sino que en el joven se van dando unos procesos de confrontación de estas visiones que los llevan a adaptarse o a resistirse.(AU)

ABSTRACT Objective To describe and explain imaginaries about sexuality that university students have at the beginning of their professional training. Methods Study with a qualitative approach, for which grounded theory was used as methodology and method. 11 students enrolled in the first semester of different undergraduate programs were included. The information was collected through 25 in-depth interviews, with an average of two interviews per reporter. Results Six categories emerged from the data: socialization of sexuality in the family; socialization of sexuality in the school; socialization of sexuality in the media; socialization of sexuality with peers; traditional imaginary of sexuality; and liberal imaginary of sexuality. The grounded theory emerged based on these general categories: "Sexuality imaginaries between adaptation and resistance". Discussion The theoretical approach describes how young people internalize the symbols and views of sexuality that they learn before entering university during socialization processes with their family, the school, the media, peers and own experiences. This internalization is not completely passive, as the youth go through some confrontation processes in relation to these visions that lead them to adapt or resist.(AU)

Factores socioeconómicos asociados a retraso en talla en preescolares asistentes a una institución educativa de Floridablanca, Colombia / Socioeconomic factors associated with stunting in preschool attending an educational institution of Floridablanca, Colombia

El retraso en talla es un indicador de pobreza y desarrollo social que ocasiona elevada carga económica a los países. El objetivo del presente estudio fue determinar la asociación entre factores socioeconómicos y puntaje z talla para la edad (PZ-TE) en preescolares de la Fundación Colombo-Alemana de Floridablanca, Colombia. Se realizó un estudio de corte transversal. Una muestra aleatoria de 112 (2-5 años) preescolares de una institución que tiende población de bajos recursos fue medida y pesada; sus pa-dres/cuidadores respondieron una encuesta. El promedio del PZ-TE en preescolares de hogares con más de un niño(a) menor de 7 años fue menor comparado con los hogares con un niño(a) menor de 7 años. Quienes vivían en viviendas con tenencia denominada "posesión sin título" obtuvieron en promedio menor PZ-TE comparado con la vivienda propia. Los niños(as) de hogares donde la madre es quien aporta para el hogar tuvieron mayor PZ-TE comparado con los hogares en donde el que aporta es el padre; está asociación se mantuvo en niños varones. En las niñas ninguna de las variables del modelo final se encontró asociada a PZ-TE. Es importante fortalecer los programas que buscan el mejoramiento de las condiciones socioeconómicas de las madres cabeza de hogar.

Stunting is an indicator of human poverty and social develo-pment that causes high economic burden on countries. The objective of this study was to determine the association between socioeconomic factors and z score height for age (HAZ) in preschool of the Colombo-German Foundation of Floridablanca, Colombia. A cross-sectional study was conducted. A random sample of 112 (2 to 5 years old) preschool of a institution for low income population was measured and weighed; their parents / caregivers answered a survey. The mean HAZ in preschool who live in households with more than one child (a) under 7 was lower compared with households with a child (a) under 7 years. Children living in housing with tenure called "possession untit-led" scored lower mean HAZ compared with homeownership. Children living in households where the mother was the one who brings home were more HAZ compared with homes where the contributor was the father; this association remained in boys. In girls none of the variables of the final model was found associated with HAZ. It is important to strengthen programs aimed at improving the socioeconomic conditions of the mothers who are household heads.

Fenocopia del síndrome de larsen asociado al uso de misoprostol: reporte de caso / Phenocopy of larsen syndrome associated with misoprostol use: a case report

Resumen: el misoprostol es un análogo de la prostaglandina E1 con diversas utilidadesterapéuticas incluyendo el tratamiento de la úlcera péptica. En el campo de la obstetricia es ampliamente utilizado para la inducción del trabajo de parto en escenarios específicos, abortos médicos e incluso emergencias obstétricas como el sangrado posparto. Su amplia distribución en el mercado farmacéutico ha llevadoa que sea usado de manera indiscriminada con fines abortivos, desconociendo su potencial teratogénico durante la gestación. En este manuscrito se presenta el caso de un recién nacido, hijo de madre de 17 años, expuesto prenatalmente a misoprostol en dosis de 1.000 mcg vía vaginal y 1.800 mcg vía oral entre las semanas cuatro y 16 de gestación, que presentaba marcadas malformaciones articulares clínicamente compatibles con el síndrome de Larsen, entidad caracterizadapor la presencia de dislocaciones de cadera, rodilla y codos, y deformidades en pie equino varo; además de hipertelorismo, frente prominente y puente nasal deprimido. Después de un estudio clínico y paraclínico se descartaron las posibles entidades genéticas y se demostró que las anomalías presentadas eran una fenocopia del síndrome de Larsen causadas por el efecto teratogénico del misoprostol.En conclusión, el misoprostol es un medicamento teratogénico contraindicado durante el embarazo, que causa un amplio espectro de anomalías congénitas que producen fenocopias de diversas entidades genéticas. Esta situación hace que el paciente expuesto requiera un abordaje y estudio adecuado para llegar a un diagnósticoetiológico correcto que lleve a la mejor conducta terapéutica, con manejo inter y multidisciplinario.

Abstract: misoprostol is an analogue of prostaglandin E1 with various therapeutic utilities, including treatment for peptic ulcer. In the obstetrics field is widely used for induction of labor in specific scenarios, medical abortions, and even obstetric emergencies, such as postpartum bleeding. Its wide distribution in the pharmaceuticalmarket has facilitated another indiscriminate uses like non-medical abortion,ignoring their teratogenic potential during gestation. In this manuscript, it present the case of a newborn, born to a mother of 17 years, who was exposed prenatally to a misoprostol dose of 1,000 μg by vaginal route and 1,800 μg per mouth, between weeks four and 16 of gestation, that showed marked articular malformations clinically compatible with Larsen syndrome. This entity is characterizedby the presence of dislocations of the hip, knee and elbows, deformitiesin equine foot Varus, in addition to hypertelorism, prominent forehead, and depressed nasal bridge. After a clinical study are discarded the possible genetic entities and it was demonstrated that the abnormalities were a imitation of Larsen syndrome caused by the teratogenic effect of misoprostol. In conclusion, misoprostolis a teratogenic drug contraindicated during pregnancy that causes a broad spectrum of congenital abnormalities that can cause imitation of several entities of genetic origin. This situation makes that exposed patient requires an appropriateapproach and clinical study to reach a correct a etiological diagnosis, leading to a better therapeutic approach with an inter and multidisciplinary management.

Asociación entre factores socioeconómicos y el índice de masa corporal en preescolares de bajos ingresos de una institución educativa de Floridablanca, Colombia / Association between socioeconomic factors and body mass index among low-income preschoolers from an educational institution of Floridablanca, Colombia

We determined the association between socioeconomic factors and body mass index z-score (BMIZ) in preschoolers from the Colombo-German Foundation from Floridablanca, Colombia. Height and weight were measured in a random sample of 112 preschool children aged 2-5 years of age; their parents or care-giver answered a survey. The multiple generalized linear models showed in the whole sample that BMIZ significantly decreased with household's socioeconomic strata 1 and 2 compared with strata zero, and in high-income families. In girls, BMIZ significantly increased when another family member, neighbor, or friend was responsible for deciding about feeding on weekdays. In boys, BMIZ increased when they ate alone and when their grandmother was responsible for preparing food on weekdays. It is conceded that socioeconomic factors influencing BMIZ are similar to those that influence health inequity.

El objetivo del presente estudio fue determinar la asociación entre factores socioeconómicos y el puntaje z del Índice de Masa Corporal (IMCZ) en preescolares de la Fundación Colombo-Alemana de Floridablanca, Colombia. Una muestra aleatoria de 112 preescolares de 2 a 5 años fue medida y pesada; sus padres o cuidadores respondieron una encuesta. Los modelos lineales generalizados múltiples mostraron que en toda la muestra el IMCZ disminuyó significativamente en estratos socioeconómicos 1 y 2 comparado con estrato cero y en familias con ingresos altos. En niñas, aumentó significativamente cuando otro familiar, vecina o amiga decidía la alimentación de lunes a viernes y cuando la niña decidía. En niños, aumentó cuando comían solos y cuando la abuela era responsable de preparar los alimentos de lunes a viernes. Se concluye que los factores socioeconómicos que influyen sobre el IMCZ son similares a los que influyen en la inequidad en salud.

Bases moleculares de alfa-talasemia en la Argentina

La α-talasemia, es uno de los desórdenes hereditarios más frecuentes mundialmente. Al presente, el diagnóstico molecular es la única herramienta que permite el diagnóstico certero. El propósito de este trabajo fue caracterizar las bases moleculares de estos síndromes en nuestro medio, y establecer relaciones genotipo-fenotipo. Mediante la complementación de distintas técnicas de biología molecular e hibridación fluorescente in situ (FISH), se logró poner en evidencia la presencia de mutaciones α-talasémicas en 145 de 184 (78.8%) pacientes estudiados con perfil hematológico compatible con α-talasemia. Dentro de este grupo, las deleciones correspondieron al defecto genético más frecuente, prevaleciendo la mutación -α3.7 en genotipos heterocigotas y homocigotas. Asimismo, en pacientes con fenotipo α0 las deleciones prevalentes fueron -MED y -CAL/CAMP. Este estudio permitió también describir una deleción de la región sub-telomérica en un paciente con α-talasemia y retraso mental. En el 7.6% de los pacientes caracterizados clínicamente como posibles α-talasémicos (microcitosis con valores de Hb A2 inferiores al 3.5%), se hallaron mutaciones β-talasémicas en estado heterocigota. Se lograron establecer perfiles hematológicos asociados a los genotipos α+ y α0 para pacientes adultos y niños. Esperamos que este trabajo pueda servir como guía para reconocer posibles portadores α-talasémicos. También permite destacar el trabajo en conjunto de médicos hematólogos, el laboratorio (bioquímico y de biología molecular) y de los médicos genetistas, con el fin de proporcionar adecuado consejo genético.

The α-thalassemia is one of the most common hereditary disorders worldwide. Currently, molecular diagnostics is the only available tool to achieve an accurate diagnosis. The purpose of this study was to characterize the molecular bases of these syndromes in our environment and to establish genotype-phenotype associations. Through a combination of different molecular techniques and fluorescent in situ hybridization (FISH),we were able to find α-thalassemic mutations in 145 of the 184 patients (78.8%) studied with hematological parameters compatible with α-thalassemia. Deletions of the a-globin genes resulted the major molecular cause of the disease, and the most frequent mutation was -α3.7, found in homozygous and heterozygous genotypes. In patients with α0 phenotypes, other prevalent mutations were -MED and -CAL/CAMP. The description of a sub-telomeric deletion in a patient with α-thalassemia and mental retardation was also achieved. β-thalassemic mutations in heterozygous state were found in 7.6% of the patients, who presented α-thalassemic clinical features (microcytosis and Hb A2 levels below 3.5%). Hematologic profiles for the α+ and α0 genotypes were established for adult and pediatric patients. Hopefully, this work will provide guidelines for the detection of possible α-thalassemic carriers. It also highlights the collaborative work of hematologists, the biochemical and molecular biology laboratory and genetists, in order to provide appropriate genetic counseling.

Determinantes de la subestimación de la percepción de los padres sobre el peso de sus hijos en hogares infantiles del ICBF de Floridablanca, Colombia, 2012 / Determinants of underestimation of parents' perceptions of their child's weight in children's homes belonging to ICBF from Floridablanca, Colombia, 2012

Objective: To identify the factors determining the underestimation of the actual weight of the children by the father and mother of preschooler users of Children's homes (CH) of the Colombian Family Welfare Institute located in the municipality of Floridablanca, Colombia. Subjects and Methods: A cross-sectional study was done in a random sample of 186 preschool children aged 3-6 years from 7 Floridablanca's CH. Researchers interviewed parents and measured weight and height of children, parents, and caregivers. The analysis was conducted by way of single and multiple binomial regression models. Results: Underestimating the weight of the children was 44.6%, 46.3%, 45% and 44.2% for the mother, father, grandparents and uncles, respectively. The underestimation was associated with the child' sex (mother: 1.59 95% CI 1.11-2.29 RP; father: PR2.00 95% CI 1.1-3.6), education (PR 1.42 95 1.05-1.92%), occupation (PR 1.05 95% CI 1.05-1.05) and obesity's history in the mother (PR 1.51 95% CI 1.10-2.08) and the current weight of the father (PR 2.31 95% CI 1.1 to 5.0). Conclusions: A high proportion of families of children do not perceive overweight and obesity. Issues such as the child's sex, occupation and education of the mother and obesity in both parents must be considered when we will educate parents on the recognition of obesity as a public health problem.

Objetivo: Identificar los factores determinantes de la subestimación del peso real de los niños por parte del padre y la madre de preescolares usuarios del programa de Hogares Infantiles (HI) del Instituto Colombiano de Bienestar Familiar (ICBF) localizados en el municipio de Floridablanca, Colombia. Sujetos y métodos. Se realizó un estudio de corte transversal en una muestra aleatoria de 186 preescolares de 3 a 6 años de 7 HI de Floridablanca. Se entrevistaron a los padres o cuidadores y se midió la talla de los niños, padres y cuidadores. El análisis se realizó mediante modelos de regresión binomial simple y múltiple. Resultados: La subestimación del peso de los niños fue de 44,6 %, 46,3 % 45 %, y 44,2 % para la madre, el padre, los abuelos y los tíos, respectivamente. La subestimación se asoció al sexo del niño (madre: RP 1,59 IC95 % 1,11-2,29; padre: RP 2,00 IC95 % 1,1-3,6), la escolaridad (RP 1,42 IC95% 1,05-1,92), ocupación (1,05 IC95 % 1,05-1,05) y antecedentes de obesidad de la madre (RP 1,51 IC95% 1,102,08) y con el peso actual del padre (RP 2,31 IC95% 1,1-5,0). Conclusiones: El sobrepeso y la obesidad no son percibidos por un elevado porcentaje de familiares de los niños. Aspectos como el sexo del niño, la ocupación y escolaridad de la madre y obesidad en ambos padres deben considerarse al momento de educar a los padres sobre el reconocimiento de la obesidad como un problema en salud pública.

Asociación entre factores ambientales y pautas de crianza con el Índice de Masa Corporal de preescolares de hogares infantiles de Floridablanca, Colombia / Relationship between environmental factors and child rearing practices on body mass index of preschool children residents of children's homes from Floridablanca, Colombia

The association of environmental factors and child rearing practices with body mass index z-score (BMIZ) in children residents of Children's Homes from Floridablanca, Colombia was studied. A random sample of 176 preschool children aged 3-6 years was weighed and measured, their parents or caregiver were also measured and they answered a survey. The generalized linear model showed that BMIZ increased significantly with children's age (β=0.02), children's sex (male β=0.27), mother's occupation (homemaker β=0.29), mother's overweight (β=0.20), person who accompanies children while they eat (relatives β=0,49; anyone or non-relative β=0.40), person who cooks (grandmother β=0.55), adequate time spent on eating by children (β=0.54), and overeating (0.51). BMIZ decreased significantly with mother's occupation (looking for a job or student β=-0.43), maternal history of hypertension (β=-0.26), motivation to eat (β=-0.59) and pressure to eat (β=-0.55).

El objetivo del estudio fue determinar la asociación de factores ambientales y estilos de crianza con el puntaje z del Indice de Masa Corporal (IMCZ) en preescolares de los Hogares Infantiles de Floridablanca, Colombia. Una muestra aleatoria de 176 preescolares de 3 a 6 años fueron medidos y pesados; sus padres o cuidadores fueron medidos y respondieron una encuesta. El modelo lineal generalizado mostró que el IMCZ aumenta significativamente con la edad (β=0,02) y sexo del preescolar (masculino β=0,27), ocupación (ama de casa β=0,29) y sobrepeso de la madre (β=0,20), persona que lo acompaña mientras come (familiares β=0,49; ninguno o no familiares β=0,40), persona que prepara los alimentos (abuela β=0,55), comer en un tiempo adecuado (β=0,54), y comer demasiado (0,51). El IMCZ disminuye significativamente con la ocupación de la madre (buscando trabajo o estudianteβ=-0,43), antecedentes de hipertensión arterial maternos (β=-0,26), motivación para comer (β=-0,59), y presión para comer (β=-0,55).

Risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures

BACKGROUND: Healthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce. OBJECTIVE: To identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures. METHODS: This case-control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences. RESULTS: During the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p = 0.03) and use of non-invasive ventilation was a protective factor (p = 0.048). Statistically significant difference was also observed for mechanical ventilation duration (p = 0.004), duration of non-invasive ventilation (p = 0.04), and parenteral nutrition duration (p = 0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p = 0.041). CONCLUSIONS: Shortening time on parenteral nutrition whenever possible and preference ...

Strength deficits of the shoulder complex during isokinetic testing in people with chronic stroke

OBJECTIVES: To examine the strength deficits of the shoulder complex after stroke and to characterize the pattern of weakness according to type of movement and type of isokinetic parameter. METHOD: Twelve chronic stroke survivors and 12 age-matched healthy controls had their shoulder strength measured using a Biodex isokinetic dynamometer. Concentric measures of peak torque and work during shoulder movements were obtained in random order at speeds of 60°/s for both groups and sides. Type of movement was defined as scapulothoracic (protraction and retraction), glenohumeral (shoulder internal and external rotation) or combined (shoulder flexion and extension). Type of isokinetic parameter was defined as maximum (peak torque) or sustained (work). Strength deficits were calculated using the control group as reference. RESULTS: The average strength deficit for the paretic upper limb was 52% for peak torque and 56% for work. Decreases observed in the non-paretic shoulder were 21% and 22%, respectively. Strength deficit of the scapulothoracic muscles was similar to the glenohumeral muscles, with a mean difference of 6% (95% CI -5 to 17). Ability to sustain torque throughout a given range of motion was decreased as much as the peak torque, with a mean difference of 4% (95% CI -2 to 10). CONCLUSIONS: The findings suggest that people after stroke might benefit from strengthening exercises directed at the paretic scapulothoracic muscles in addition to exercises of arm elevation. Clinicians should also prescribe different exercises to improve the ability to generate force and the ability to sustain the torque during a specific range of motion. .

Síndrome de plaqueta pegajosa / Sticky platelet síndrome

Resumen: El síndrome de plaqueta pegajosa es una trombofilia hereditaria, de carácter autosómico dominante, caracterizada por aumento in vitro de la agregación plaquetaria en respuesta a bajas concentraciones de epinefrina y/o adenosindifosfato (ADP) que se expresa como un estado protrombótico, tanto arterial como venoso. De acuerdo con el patrón de la agregometría plaquetariacon diferentes concentraciones de epinefrina y ADP, se presentan tres formas: síndrome de plaqueta pegajosa tipo I, hiperagregación plaquetaria con epinefrina y ADP; síndrome de plaqueta pegajosa tipo II, hiperagregación plaquetaria con epinefrina sola; y, síndrome de plaqueta pegajosa tipo III, hiperagregación plaquetaria con ADP solo. Las manifestaciones clínicas están relacionadas con la predisposición a trombosis arteriales o venosas, que se expresan como isquemia coronaria o cerebral, isquemia de vasos retinianos y trastornos de la microcirculación placentaria que puede asociarse con restricción del crecimiento intrauterino del feto, preeclampsia,eclampsia y pérdidas fetales, entre otras manifestaciones. El diagnóstico del síndrome de plaqueta pegajosa se establece mediante la agregación plaquetaria al demostrar la hiperagregación de las plaquetas inducida por pequeñas dosis de epinefrina y/o ADP. El tratamiento se basa en la administración de antiagregantes plaquetarios, siendo la aspirina a baja dosis la droga ideal y el clopidogrel cuando hay resistencia a la aspirina o esta está contraindicada. El objetivo de este módulo es revisar la literatura médica mundial sobre este nuevo síndrome que debe ser tenido en cuenta en el diagnóstico y manejo de la trombofilia como una nueva opción para el paciente afectado por uno de estos síntomas.

Abstract: Sticky platelet syndrome is an autosomal dominant inherited thrombophilia, characterizedby increased in vitro platelet aggregation in response to low concentrations of epinephrine or adenosine diphosphate (ADP). It is present as a prothrombotic state, both arterial and venous. According to platelet aggregation pattern, with the different ADP and epinephrine concentrations,three types of the syndrome can be identified: sticky platelet syndrome type I, platelet hyperaggregation with both reagents; sticky platelet syndrome type II, platelet hyperaggregation with epinephrine alone; and, sticky platelet syndrome type III, platelet hyperaggregation with ADP alone. The clinical manifestations are associated with predisposition to venous and arterial thrombosis, including cardiac or cerebral ischemia, retinal vein ischemia, and placental microcirculationdisorders, associated with intrauterine growth restriction, preeclampsia, eclampsia, and fetal loss, among others. Sticky platelet syndrome is diagnosed by platelet aggregation test, where is found a platelet hyperaggregation in response to low doses of epinephrine and ADP. Treatment includes the use of platelet antiaggregation agents, being low-dose aspirin therapy the best choice and clopidogrel in the cases of resistance or contradiction for aspirin. The aim of this module is to review the medical literature about this new syndrome, which it should take into account in the diagnosis and management of thrombophilia as a possible option to a patient affected by these symptoms.

Distribución de energía y macronutrientes en hogares colombianos / Intra-household distribution of energy and macronutrients in Colombian households

Introducción. Conocer la distribución del consumo dietético en el hogar es útil para establecer la política alimentaria. Objetivos. Estimar la distribución de la energía y los macronutrientes en hogares colombianos, según el parentesco. Materiales y métodos. Se aplicaron dos cuestionarios sobre el consumo dietético de las últimas 24 horas ( 24 Hours Dietary Recall , R24H) en 1.505 sujetos residentes en 432 hogares. Se calcularon la ingestión usual para cada individuo, la ingestión agregada para cada hogar y el porcentaje de participación de los integrantes del hogar. La participación en el consumo en el hogar se ajustó en modelos lineales por edad, sexo, índice de masa corporal, necesidad de energía, nivel socioeconómico, escolaridad y tamaño del hogar. Resultados. El jefe del hogar part icipa en promedio en 27,4 % (IC 95% : 26,5-28,2) del total de la energía, sin diferencia por sexo o si aporta a los ingresos del hogar o no. La participación de los sujetos sin parentesco, 30,3 % (IC 95% : 25,3-35,3), y de los hermanos del jefe, 26,0% (IC 95% : 22,7- 29,3), es equivalente a la del jefe. Al ajustar la participación, el nieto cobra importancia, 29,8% (IC 95% : 27,4-30,9). Los hombres participan más que las mujeres (p<0,05). Aun en hogares pequeños, la participación es menor si el nivel económico es bajo y reciben ayuda alimentaria (p<0,05). Conclusión. Surge la necesidad de una intervención cultural con fines nutricionales para modificar los principios de contribución, necesidad, equidad y demanda, a la luz de las estructuras de poder y autoridad. Se evidencia desigualdad en la distribución.

Introduction: Knowing the intra-household distribution of dietary intake is useful to establish food policy. Objective: To estimate the intra-household distribution of energy and macronutrients by kinship in Colombian households. Material and methods: We applied two recalls of dietary intake for the last 24 hours (R24H) in 1,505 subjects living in 432 households. Usual intake was calculated for each subject, aggregated for each household and calculated the share (%) for each of its members. Participation data was adjusted in linear models for age, gender, body mass index, energy requirement, socioeconomic levels, education and household size. Results: The head of the household participates on average in 27.4% (95% CI: 26.5 to 28.2) of the total energy, without sex differences or if they contribute to the household income or not. The participation of unrelated subjects was 30.3% (95% CI: 25.3 to 35.3), and 26.0% (95% CI: 22.7 to 29.3) of the siblings of the head of the household, which is equivalent to that of the head of the household. By adjusting participation, the grandson becomes important with 29.8% (95% CI: 27.4 to 30.9). Men participate more than women (p<0.05). Even in smaller households, participation is lower if the economic level is low and they are receiving food aids (p<0.05). Conclusion: In the context of the structures of power and authority, the need for a cultural intervention with nutritional purposes to modify the principles of contribution, necessity, equity and demand emerges. Inequality is evident in the distribution.

Concurrent validity of the pressure biofeedback unit and surface electromyography in measuring transversus abdominis muscle activity in patients with chronic nonspecific low back pain / Validade concorrente da unidade de biofeedback pressórico e eletromiografia de superfície na mensuração da atividade muscular do transverso abdominal em pacientes com dor lombar crônica inespecífica

BACKGROUND: The Pressure biofeedback unit (PBU) is an assessment tool used in clinical practice and research aimed to indirectly analyze the transversus abdominis (TrA) muscle activity. The concurrent validity of the PBU in a clinically relevant sample is still unclear. OBJECTIVE: The purpose of this study was to evaluate the concurrent validity and diagnostic accuracy of the PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain. METHOD: This study was performed using a validation, cross-sectional design. Fifty patients with chronic nonspecific low back pain were recruited for this study. To test the concurrent validity both PBU measures (index test) and superficial electromyographic measures (reference-standard test) were compared and collected by a physical therapist in a series of voluntary contraction maneuvers of TrA muscle. RESULTS: Participants were on average 22 years old, weighed 63.7 kilos, 1.70 meters height and mean low back pain duration was 1.9 years. It was observed a weak and non-significant Phi coefficient (r=0.2, p<0.20). With regards to diagnostic accuracy tests, our results suggest a low sensitivity (60%) and specificity (60%) of the PBU. The positive predictive value was high (0.8) and negative predictive value was low (0.2). Conclusions: Concurrent validity of the PBU in measuring TrA muscle activity in patients with chronic nonspecific low back pain is poor given the low correlation and diagnostic accuracy with superficial EMG.

CONTEXTUALIZAÇÃO: A Unidade de Biofeedback Pressórico (UBP) é uma ferramenta de avaliação usada na prática clínica e pesquisa científica para analisar indiretamente a atividade muscular do transverso abdominal (TrA). A validade concorrente da UBP em uma amostra clinicamente relevante ainda não está esclarecida. OBJETIVO: Avaliar a validade concorrente e acurácia diagnóstica da UBP em mensurar a atividade muscular do TrA em pacientes com dor lombar crônica inespecífica. MÉTODO: Este estudo foi realizado usando um delineamento de validação. Cinquenta pacientes com dor lombar crônica inespecífica foram recrutados. Para testar a validade concorrente, ambas as medidas pressóricas (teste índice) e eletromiográficas superficiais (teste padrão de referência) foram comparadas e coletadas por um fisioterapeuta a partir de uma manobra de contração voluntária do músculo TrA. RESULTADOS: Os participantes tinham em média 22 anos, 63,7 kg, 1,70 m de altura, e a duração média de dor lombar era de 1,9 ano. Observou-se um coeficiente Phi fraco e não significativo (r=0,2; p<0,20). Com relação aos testes de acurácia diagnóstica, os resultados sugerem uma baixa sensibilidade (60%) e especificidade (60%) da UBP. O valor preditivo positivo foi elevado (0,8), e o valor preditivo negativo foi baixo (0,2). Conclusões: A validade concorrente da UBP em mensurar a atividade muscular do TrA em pacientes com dor lombar crônica inespecífica é pobre, considerando a baixa correlação e acurácia diagnóstica com a EMG de superfície.

Análisis digital comparativo de diferentes hábitos cristalinos de fenitoina / Comparative digital analysis of different phenytoin crystal habits

Background: Description of the external shape of the particles for pharmaceutical use has usually been subjective, cumbersome or slow, even when the techniques have used digital image processing. This study sought to evaluate the crystal habit of raw material of phenytoin by two digital techniques, one of them based on the edges definition of particles images, using conventional geometric descriptors, and the other one describing the surface texture. These estimates were optimized using multivariate statistical analysis. Objective: The purpose of this study was to evaluate an appropriate way to characterize the crystalline habit of raw materials used in the pharmaceutical industry, from information obtained when it used some digital measuring techniques. Methods: Classical and mathematical descriptors were used, in addition to a modified method of texture analysis technique based on the gray levels co-occurrence matrix (GLCM). Phenytoin was used as the raw material model, since this showed different crystal habits when some conditions were changed in the recrystallization process. The evaluation of measurements was made previously calibrating the meaning of the descriptors with different geometric shapes, and then solving it with the help of multivariate analysis techniques such as principal component analysis (PCA) and hierarchical cluster analysis (ACJ). Results: Calibration figures were grouped into two descriptors based on the degree of homogenization depicted in images of the particles. The crystal habits of phenytoin were defined by compaction and by elongation and irregularity, which was also found with the technique of Matrix Co-occurrence of gray levels of texture measurement. Conclusion: It decreased the subjectivity of the definition of crystalline habits of phenytoin when using a combination of less than four classical and mathematical descriptors, obtained through multivariate analysis.

Comparisons of the Nottingham Health Profile and the SF-36 health survey for the assessment of quality of life in individuals with chronic stroke / Comparação do perfil de saúde de Nottingham e SF-36 na avaliação da qualidade de vida de indivíduos com acidente vascular encefálico crônico

BACKGROUND: Appropriate instruments for the assessment of health-related quality of life (HRQOL) domains are useful for planning therapeutic interventions for individuals with stroke. The generic quality of life (QOL) instruments, Short Form Health Survey-36 (SF-36) and Nottingham Health Profile (NHP), have been frequently employed in the Brazilian literature. However, the literature is still scarce regarding their psychometric properties when applied to stroke individuals. OBJECTIVES: To compare the Brazilian versions of the SF-36 and the NHP to verify which had better psychometric properties for the assessment of HRQOL in 120 individuals with chronic stroke. METHOD: Spearman correlation coefficients were calculated to examine the comparable domains and total scores of the SF-36 and the NPH; Cronbach's alpha coefficients, to evaluate internal consistency; intra-class correlation coefficients, to assess reliability; and Bland-Altman plots, to assess the levels of agreement, with a significance level of 5%. RESULTS: Significant positive associations were observed between the common domains and the total scores of the SF-36 and the NPH. Ceiling effects were more frequent for the NPH. The total scores of both instruments achieved adequate reliability levels, and the agreement levels were within the normal limits in 95% of the cases. CONCLUSIONS: The SF-36 and the NPH were shown to measure similar constructs and proved to be useful measures for the assessment of QOL of chronic stroke subjects. However, the SF-36 yielded better results and appeared to be more appropriate.

CONTEXTUALIZAÇÃO: Instrumentos adequados para avaliar os vários domínios da qualidade de vida (QV) relacionada à saúde (QVRS) constituem uma importante abordagem para o planejamento terapêutico e, assim, melhor assistir os indivíduos acometidos pelo acidente vascular encefálico (AVE). Na literatura brasileira, os instrumentos genéricos Formulário Abreviado de Avaliação de Saúde 36 (SF-36) e Perfil de Saúde de Nottingham (PSN) têm sido bastante empregados, entretanto, ainda existem lacunas relativas às suas propriedades psicométricas quando aplicados em indivíduos pós-AVE. OBJETIVOS: Comparar as versões brasileiras dos instrumentos SF-36 e PSN e verificar qual deles apresenta melhores propriedades psicométricas para avaliar a QVRS de 120 indivíduos na fase crônica pós-AVE. MÉTODO: A comparação entre os domínios comuns e escores totais do SF-36 e PSN foi realizada pelo Coeficiente de Correlação de Spearman, Coeficiente Alpha de Cronbach, para avaliar a consistência interna; Coeficiente de Correlação Intraclasse, para mensurar a confiabilidade, e o teste de plotagem Bland-Altman para a concordância, com nível de significância de 5% em todos os cálculos. RESULTADOS: Todas as correlações entre o SF-36 e o PSN, escores totais e domínios comuns, foram positivas e estatisticamente significativas. Observou-se maior frequência de efeito teto no PSN. Os escores totais de ambos atingiram níveis adequados de confiabilidade, e os níveis de concordância estavam dentro dos limites normais em 95% dos casos. CONCLUSÕES: SF-36 e PSN mensuraram constructos semelhantes e demonstraram ser úteis para avaliar QV de indivíduos pós-AVE crônico. No entanto, o SF-36 proporcionou melhores resultados e pareceu ser mais apropriado.

El poder organizador de la imagen / The organizing power of the image / Le pouvoir organisateur de l’image

Se trata de examinar la teoría del estadio del espejo de Lacan, en los dos tiempos de su cons-trucción (1936 y 1949) con las referencias utiliza-das para tal fin. Estas conciernen a fenómenos, problemas y nociones como: imagen (sensorial, corporal y especular), imago, imaginario, psico-génesis del cuerpo y del yo, unidad del yo, ges-talt, prematuración y fetalización humana, que provienen del mismo psicoanálisis (Freud, Klein, Schilder), así como de campos del saber tales como la psicología infantil (Wallon y Balwin); la teoría de la Gestalt y su utilización por parte de la misma psicología infantil (Bühler), la fenomeno-logía y la filosofía (Hussell, Kojève, Sartre, Mer-leau-Ponty), la etología (Kõhler, Lorenz); la biolo-gía (Uexküll); la anatomía (Bolk)...

The idea is to analyze the Lacan’s theory of the mirror stage, in the two periods of its construction (1936 and 1949) with the references used for reaching such purpose. These references corre-spond to phenomena, problems and notions like: image (sensorial, corporal and speculate), imago, imaginary, body and ego psychogenesis, ego unity, gestalt, human prematurity and fetal posi-tion, which come from psychoanalysis itself (Freud, Klein, Schilder), as well as fields of knowledge such as children psychology (Wallon y Balwin); Gestalt’s theory and its use by children psychology itself (Bühler); phenomenology and philosophy (Hussell, Kojeve, Sartre, Merleau-Ponty); ethology (Kohler, Lorenz); biology (Uexkull); anatomy (Bolk)...

Il s’agit ici d’examiner la théorie du stade du mi-roir de Lacan, dans les deux temps de sa cons-truction (1936-1949) avec les références utilisées à ce fin. Celles-ci concernent des phénomènes, problèmes et notions tels que: image (sensorielle, corporelle et spéculaire), imago, imaginaire, psy-chogenèses du corps et du Moi, unité du Moi, gestalt, prématuration, fœtalisation humaine, qui provient du même psychanalyse (Freud, Klein, Schilder), ainsi que de domaines du savoir telles que la psychologie infantile (Wallon et Balwin); la théorie de Gestalt et son usage de la part de la psychologie infantile (Buhler), la phénoménologie et la philosophie (Hussell, Kojève, Sartre, Mer-leau-Ponty), l’éthologie (Kõhler, Lorenz); la biolo-gie (Uexküll), l’anatomie (Bolk)...

Análisis del efecto de las interacciones de tres variables de proceso para la producción de exopolisacáridos en la microalga Scenedesmus obliquus (UTEX 393) / Analysis of the effect of the interactions among three processing variables for the production of exopolysaccharides in the microalgae Scenedesmus obliquus (UTEX 393)

Microalgae are capable of producing biomolecules that have a wide variety of applications in agriculture, food industry, and medicine. In this study, three process variables are evaluated in order to determine its incidence on biomass and exopolysaccharides production. The effect of light intensity, agitation and carbon concentration on Scenedesmus obliquus (UTEX 393) growth and expolysaccaharides production is evaluated using 23 factorial design through the screening methodology. The simultaneous effect of level variation for three different experimental variables is examined in the present study in three levels for each parameter (Light intensity: 80, 130, 180 µE m-2 s-1, Agitation: 0, 600, 1200 rpm, carbon concentration 0, 2, 4% v/v Air-CO2). Specific growth rate and the exopolysaccharides concentration are the selected response variables. Results show that the optimal conditions for the two response variables correspond to the maximum levels of the three experimental variables (180 µE m-2 s-1, 4% air-CO2, and 1200 rpm), obtaining a specific growth rate of 0.64 d-1 and a exopolysaccharides concentration of 24.7 mg L-1. A significant interaction between the variables is observed, which has direct effects on cellular growth and exopolysaccharides production. The EPS production is facilitated by the turbulent flow (agitation maximum level), which is associated with a higher availability and better distribution of energy sources (light) and carbon dioxide. The validation of polynomials models verifies the relevance of the analysis performed.

Utilidad clínica de la agregometría plaquetaria / Clinical utility of platelet aggregometry

Resumen: La acción de las plaquetas en la hemostasia primaria comprende la adhesión a losvasos sanguíneos afectados, la activación, la secreción del contenido granular, y posteriormente,la agregación plaquetaria para la formación del tapón hemostático primario. Bajo las condicionesfisiológicas de flujo vascular, estos procesos requieren la acción sinérgica de varias proteínasy receptores plaquetarios, como también de agonistas que inducen la activación plaquetaria.Por ello, las mutaciones de los genes que codifican para moléculas y receptores de superficieimplicados en estos procesos darán origen a desórdenes hemorrágicos como la enfermedad devon Willebrand, la trombastenia de Glanzmann, el síndrome de Bernard Soulier y la deficienciade gránulos plaquetarios, entre otros. El diagnóstico de estas enfermedades se realiza medianteensayos de función plaquetaria que simulan los procesos fisiológicos de activación, adhesión,liberación del contenido granular y agregación. Una de las pruebas de función plaquetaria másutilizada es la agregometría. En este artículo de revisión se describe la utilidad de esta prueba parael diagnóstico de desórdenes hemorrágicos hereditarios y del síndrome de la plaqueta pegajosa,un desorden trombótico hereditario caracterizado por hiperagregabilidad. Adicionalmente, se revisa el fundamento de esta prueba, las condiciones preanalíticas, analíticas y posaanaliticas, analiticas y poanaliticas las indicaciones las contraindicaciones y la interpetación de los resultados.

Abstract: The role of platelets in primary hemostasis involves their adherence to sites of vessel injury, activation, secretion of platelet granule content, and finally, aggregation to form the primaryhemostatic plug. Under physiologic conditions of vascular flow, these processes require thesynergistic action of several proteins and platelet receptors, and also the action of physiologicalagonists that stimulate the activation of the platelets. As a result, hereditary mutations of genescodifying for molecules and surface receptors implied in primary hemostasis will be expressedas hemorrhagic disorders, including von Willebrand disease, Glanzmann thrombasthenia,Bernard Soulier syndrome, storage pool diseases, among others. The diagnosis of these diseases is possible through platelet function assays that resemble the physiological processesof activation, adhesion, release of granule content, and aggregation. Platelet aggregometry isone of the most frequently used tests. This review article intends to describe the utility of plateletaggregometry for the diagnosis of hereditary hemostatic disorders and sticky platelet syndrome, a hereditary thrombotic disorder characterized by increased platelet aggregability. In addition, the fundamentals of the test, the pre-analytical, analytical and post-analytical conditions, the test indications, contraindications and results interpretation are discussed.