Brain functional connectivity in takotsubo cardiomyopathy patients. A systematic review of magnetic resonance imaging studies / Conectividad funcional cerebral en pacientes con miocardiopatía de takotsubo: Revisión sistemática de estudios de imagen por resonancia magnética

Abstract Background: Functional neuroimaging studies may aid to our understanding of the pathophysiology of the takotsubo cardiomyopathy. Objective: The aim of the study was to review the available evidence of brain functional connectivity in takotsubo cardiomyopathy patients. Methods: This was a systematic review. We searched MEDLINE, LILACS, Ovid (Cochrane), Scopus, and Science Direct for studies conducting functional magnetic resonance imaging (fMRI) in takotsubo patients. After reviewing title/abstract and full text, we selected relevant studies, extracted methodological characteristics, and their main findings, and assessed their risk of bias with the Newcastle-Ottawa scale. We present a narrative review. Results: We included five case-control studies from 600 registries. The risk of bias was low; comparability was the main issue. Resting-state fMRI findings suggest significant differences for the hippocampus, the Insula, the amygdala, and the para-hippocampal gyrus. Task fMRI findings suggest significant differences for the Insula, the superior occipital gyrus, and the amygdala. Studies were heterogeneous about the laterality and directionality of these differences. Conclusion: Brain connectivity alterations involving elements relevant for autonomic control like the Insula and the Amygdala provide evidence in favor of the role of functional networks in the neurocardiology of stress-related cardiomyopathies. However, it is not possible to determine if this role is causal or consequential.

Resumen Antecedentes: Los estudios de neuroimagen funcional podrían ayudar a clarificar la fisiopatología de la miocardiopatía de takotsubo. Objetivo: Revisar la evidencia disponible sobre conectividad funcional cerebral en pacientes con cardiomiopatía de takotsubo. Métodos: Revisión sistemática. Se buscaron en MEDLINE, LILACS, Ovid (Cochrane), Scopus, y ScienceDirect estudios de imagen por resonancia magnética funcional (IRMf) en pacientes con cardiomiopatía de takotsubo. Tras revisar títulos, resúmenes y textos completos se seleccionaron los estudios relevantes, se extrajeron sus características metodológicas y resultados principales, y se valoró su riesgo de sesgo mediante la escala Newcastle-Ottawa. Se presenta revisión narrativa de los resultados. Resultados: Se incluyeron cinco estudios de casos y controles de entre 600 registros. El riesgo de sesgo fue bajo, la comparabilidad fue la principal limitante. Los estudios de IRMf en estado de reposo sugieren diferencias significativas en el Hipocampo, la Ínsula, la Amígdala y el Giro parahipocampal. Los estudios de IRMf bajo paradigma sugieren diferencias en la Ínsula, el Giro occipital superior y en la Amígdala. Los estudios fueron heterogéneos respecto a la lateralización y direccion de estas diferencias. Conclusión: Alteraciones en la conectividad cerebral de zonas relevantes para el control autonómico como la ínsula y la Amígdala provén evidencia a favor del rol de redes funcionales en la neurocardiología de miocardiopatías relacionadas con el estrés. Sin embargo, aún no es posible determinar si esto obedece a un rol causal o consecuencial.

Niveles de actividad física y tiempo sedente según ingreso económico en Chile: resultados de la Encuesta Nacional de Salud 2016-2017

Background: The Chilean population reports high levels of physical inactivity. The relationship between income level, physical activity (PA) and sedentary behaviors is not well known. Aim: To describe the levels of PA and sedentary time, according to income levels in the Chilean population. Material and Methods: Analysis of data from the Chilean National Health Survey 2016-2017, which included 5,130 participants (52.9% women). The levels of PA and sedentary time were measured by the Global Physical Activity Questionnaire. Income levels were established according to the self-reported income per capita of the households and presented as quintiles. PA levels according to income levels were estimated by linear regression analyses. Results: Transport-related PA was higher in the lowest income quintiles (p = 0.039). There were no trends for income levels and PA domains including moderate, vigorous, total, occupational and leisure PA. The prevalence of leisure and occupational physical inactivities were higher in the lowest quintiles of income. Sitting time was higher in the higher income levels (p < 0.01). Conclusions: People in the lowest quintile for income spent more time in transport-related PA and less time sitting. However, physical inactivity prevalence during leisure and work time were higher in people with lower income.

Neumomediastino espontáneo en un paciente con COVID-19. Reporte de caso / Spontaneous Pneumomediastinum In Patients With COVID-19. Case Report

Introducción: El neumomediastino es una patología poco frecuente y rara. Las manifestaciones radiológicas típicas en los pacientes en neumonía por SARS-CoV-2 consiste en la presencia de opacidades pulmonares bilaterales, de distribución periférica. En una reciente serie de pacientes con COVID-19 indica que el 1% de los pacientes pueden desarrollar neumomediastino espontáneo como complicación, generalmente es de curso benigno y no se aclara aún que ello puede suponer un indicador de agravamiento. Caso Clínico: Se trata de un paciente varón de 43 años que presentó un tiempo de enfermedad de 15 días caracterizado por dolor faríngeo, fiebre, dolor torácico y dificultad respiratoria, recibiendo múltiples esquemas de tratamiento tanto antiviral y antibióticos sin respuesta, por lo que acudió al Hospital Rebagliati donde se le encontró insuficiencia respiratoria, hipoxemia y sepsis. Su tomografía fue compatible con infiltrado en vidrio deslustrado, áreas de consolidación pulmonar bilateral y neumomediastino. No requirió tratamiento quirúrgico y evolucionó favorablemente a la neumonía con disminución de marcadores inflamatorios y remisión de neumomediastino en control tomográfico. Conclusión: Este reporte resalta que en la infección por COVID-19 las complicaciones pulmonares a tener en cuenta son la neumonía bilateral, coinfección bacteriana, sepsis y neumomediastino espontáneo.

Introduction: Pneumomediastinum is an infrequent and rare pathology. The typical radiological manifestations in patients with SARS-CoV-2 pneumonia consist of the presence of bilateral pulmonary opacities, of peripheral distribution. In a recent series of patients with COVID-19, it indicates that 1% of patients can develop spontaneous pneumomediastinum as a complication, it is generally benign and it is not yet clear that this may be an indicator of worsening. Clinical Case: This is a 43-year-old male patient who presented a 15-day illness characterized by pharyngeal pain, fever, chest pain and respiratory distress, receiving multiple antiviral and antibiotic treatment schemes without response, for which he attended to Rebagliati Hospital where he was found respiratory failure, hypoxemia and sepsis. His tomography was compatible with ground glass infiltrate, areas of bilateral lung consolidation, and pneumomediastinum. It did not require surgical treatment and it evolved favorably to pneumonia with a decrease in inflammatory markers and remission of pneumomediastinum in tomographic control. Conclusion: This report highlights that in COVID-19 infection the pulmonary complications to take into account are bilateral pneumonia, bacterial coinfection, sepsis and spontaneous pneumomediastinum.

Estudio Transversal Hispano-Ecuatoriano: Discapacidades derivadas de Ictus cerebral / Hispano- Ecuadorian Cross-Sectional Study: Disabilities derived from cerebral stroke

INTRODUCCIÓN: En la actualidad el ictus es considerado una de las principales causas de discapacidad en el mundo. Globalmente 5 millones de personas adquieren discapacidad permanente cada año por esta causa; hasta el 30% de los pacientes afectados padecen algún tipo de discapacidad. El manejo temprano del paciente puede disminuir las secuelas derivadas de las lesiones. El objetivo de este estudio es conocer si existen diferencias en las discapacidades derivadas de ictus entre las ciudades de Madrid (España) y Cuenca (Ecuador), en relación a una atención temprana programada. MATERIALES Y MÉTODOS: El presente, es un estudio observacional, descriptivo, de corte transversal, multicéntrico. La muestra estuvo conformada por 40 pacientes diagnosticados de ACV, 20 pertenecientes al Grupo Cuencano, de Ecuador (GC) y 20 al Grupo Matritense, de España (GM). Los datos fueron obtenidos de las historias clínicas. Se compararon ambos grupos mediante la prueba Chi-cuadrado (X2) de Pearson para cada variable estudiada. RESULTADOS: En el GM el 80% de los ACV fueron de origen isquémico, en el GC fueron el 90%, sin asociación significativa. En los dos grupos el mayor porcentaje de secuelas se dieron por afectación del territorio de la arteria cerebral media (ACM). No se evidenció diferencia significativa en el porcentaje de discapacidades derivadas de ictus entre los grupos, el grupo matritense de España presentó una menor tasa de discapacidades derivadas que fue del 45%, frente al grupo cuencano de Ecuador que tuvo un 76% de capacidades derivadas, pero la diferencia no fue significativa (p=0.069); sin embargo la asociación entre el porcentaje de exitus entre los grupos si tuvo asociación estadísticamente significativa (p=0.003). CONCLUSIÓN: No se encontró asociación significativa en cuanto a etiología, factores de riesgos y características clínicas del Ictus entre los grupos. No hay diferencias significativas en las secuelas derivadas de ictus entre los grupos, pero si hay diferencias significativas en relación al porcentaje de exitus con la aplicación de un programa tipo "Código Ictus".

BACKGROUND: Currently, stroke is one of the main causes of disability in the world. Globally 5 million people acquire permanent disability each year for this cause; up to 30% of affected patients suffer from some type of disability. Early management of the patient can reduce the sequelae derived from the injury. The aim of this study is to find out if there are differences in disabilities derived from strokes, between the cities of Madrid (Spain) and Cuenca (Ecuador), in association with programmed early patient care. METHODS: This is an observational, descriptive, cross-sectional, multicenter study. The sample consisted of 40 patients diagnosed with stroke, 20 from Cuenca, Ecuador, and 20 from Madrid, Spain. Data was obtained from the patient's medical records. Both groups were compared using Pearson's Chi-square test (Χ2) for each studied variable. RESULTS: in the Madrid Group 80% of the strokes were ischemic, in the Cuenca Group 90% of the strokes were ischemic, there is not significant association. In both groups the highest percentage of sequelae occurred due to injury of the middle cerebral artery (MCA). There was no significant difference in the percentage of disabilities derived from stroke between the groups, the Madrid Group had a lower rate of derived disabilities (45%), compared to Cuenca Group (76%), but the differences was not significant (p=0.069); however, the association between the death percentage among the groups was statistically significant (p=0.003). CONCLUSION: No significant association was found in terms of etiology, risk factors and clinical characteristics of stroke between the groups. There are no significant differences in the sequelae derived from stroke between the groups, but there is significant difference in terms of death percentage between the groups, with the application of "Código Ictus" type of program.

Cáncer de nasofaringe, una revisión de la literatura / Nasopharyngeal Cancer, a literature review

Resumen Introducción: El cáncer de nasofaringe es una patología poco común que tiene gran impacto en la calidad de vida de los pacientes. Con el advenimiento de nuevos esquemas de tratamiento se ha logrado mejorar el pronóstico con un menor índice de morbilidad. Esta revisión describe la perspectiva actual del cáncer de nasofaringe, basado en la literatura reciente y la disponibilidad de recursos para su tratamiento en una institución médica de Medellín, Colombia. Materiales y Método: Se realizó una búsqueda bibliográfica que incluyó artículos desde 1986 hasta 2018 en diferentes bases de datos como MEDLINE, EBSCO y LILACS. Se incluyó literatura escrita en inglés o español, utilizando como términos MESH neoplasias de nasofaringe, diagnóstico y terapéutica. Resultados: La evaluación diagnóstica oportuna del cáncer de nasofaringe es de vital importancia al proporcionar una estrategia de tratamiento efectiva con menor morbimortalidad. Según la experiencia institucional de los autores, en las etapas clínicas tempranas, se sugiere la radioterapia radical como modalidad única y en etapas intermedias-avanzadas los tratamientos combinados con quimioterapia-radioterapia concomitante o secuencial dependiendo de cada paciente y quimioterapia única en pacientes metastásicos a distancia. Conclusiones: Acorde con el análisis de la literatura y evidencia existente, las estrategias utilizadas son adaptadas a los alcances de la institución como ente de alto nivel en el sector salud. La cirugía representa un papel relevante en la enfermedad recurrente resecable ya sea con técnica endoscópica o abierta. Es importante recordar que la morbilidad postoperatoria no es inocua, y en ocasiones sobrepasa el beneficio obtenido.

Introduction: Nasopharyngeal cáncer is a rare disease that has a huge impact on the quality of life. Survival rates are steadily improving due to new treatments with a lower morbidity index. This review describes the current perspective of nasopharyngeal cancer, based on recent literature and the availability of resources for treatment in the different specialties of an institution in Medellin, Colombia. Materials and Method: A literature review was carried out, including articles from 1986 to 2017 in different databases such as MEDLINE, EBSCO and LILACS. Written literature in English or Spanish was included, using MESH terms as Nasopharyngeal, diagnostic and therapeutic neoplasms. Results: Nasopharyngeal cancer timely diagnostic is of vital importance. According to the institutional experience, in early clinical stage radiotherapy is suggested as a single modality. Intermediate stages treatments options are concurrent chemo radiotherapy or sequential radiotherapy according to each patient case. In distant metastatic stage single chemotherapy is used. Conclusions: According to existing evidence strategies used are adapted to the scope of the institution as a high-level entity in health sector. Surgery represents a relevant role in recurrent resecable disease with either endoscopic or open technique. It is important to remember that postoperative morbidity is not harmless, and sometimes exceeds the benefit obtained.

Comparación entre el auto-reporte de actividad física y la medición con acelerómetro según factores sociodemográficos / Comparison of self-reported and accelerometer-measured physical activity according to sociodemographic factors

RESUMEN Introducción: La determinación del nivel de actividad física (AF) puede realizarse a través de acelerómetro o mediante cuestionario de auto-reporte. El objetivo de este estudio fue comparar los niveles de AF entre un cuestionario de auto-reporte y la medición con acelerómetro de movimiento según factores sociodemográficos en la población chilena. Métodos: Estudio de corte transversal que incluyó a 230 adultos chilenos participantes del proyecto Genes, Ambiente, Diabetes y Obesidad (GENADIO). Niveles de AF fueron medidos mediante el cuestionario Internacional Physical Activity Questionnaire (IPAQ) y acelerómetro de movimiento (ActiGraph). Resultados: IPAQ subestimó los niveles de AF total en comparación a la medición con acelerómetro (delta [IPAQ-Acel.]= −55,7 min/día). Según nivel educacional, se evidenció que el cuestionario IPAQ sobreestimó los niveles de AF total en personas con bajo nivel educacional (delta [IPAQ-Acel.]= 70,4 min/día), pero subestimó la AF total en personas con enseñanza media o técnico universitaria (delta [IPAQ-Acel.]= −67,9 y −135,6 min/día, respectivamente). Resultados similares fueron observados para los distintos niveles de ingreso socioeconómico (NSE). Conclusión: El cuestionario de auto-reporte IPAQ subestimó los niveles de AF total en comparación a la medición por acelerómetro; sin embargo, estas diferencias variaron según factores sociodemográficos.

ABSTRACT Introduction: Determining level of physical activitY (PA) can be done with objective measurement, through accelerometer, or by subjective measurement through self-report questionnaire. The aim of this study was to compare PA measurements derived from a self-reported questionnaire and accelerometer according to sociodemographic factors in the Chilean population. Methods: This was a cross-sectional study which included 230 Chilean adults participating in the GENADIO study (Genes, Environment, Diabetes and Obesity). PA levels were measured through the International Physical Activity Questionnaire (IPAQ) and GT1M accelerometer (ActiTrainer, ActiGraph). Results: IPAQ questionnaire underestimated the total PA levels compared to the accelerometer measurement (delta[IPAQ-Acel.]= −55.7 min/day). According to educational level, IPAQ questionnaire overestimated PA level in people with low educational level (delta[IPAQ-Accel.]= 70.4 min/day), but underestimated total PA in people with secondary education or university technician (delta[IPAQ-Accel.]=-67.9 and-135.6 min/day, respectively). Similar results were observed for the different levels of socioeconomic income. Conclusion: The IPAQ questionnaire underestimated total PA levels compared to accelerometer; however, these differences varied according to sociodemographic factors.

Auto reporte de la velocidad de marcha y su asociación con marcadores de adiposidad y riesgo cardiovascular en Chile / Association of self-reported walking speed with markers of adiposity and cardiovascular risk in Chile

Background Walking speed is a strong predictor of non-communicable diseases and mortality. Aim To investigate the association of self-reported walking pace with adiposity, metabolic and cardiovascular markers in the Chilean population. Material and Methods Analysis of data from 5,077 participants of the 2009-2010 National Health Survey (ENS 2009-2010). Walking speed was self-reported as average or slow pace. Body mass index (BMI), waist circumference (WC), blood pressure, blood glucose, glycosylated hemoglobin and lipid profile were the outcome. Results In Chile, 11% (95% confidence intervals [CI]: 10.0; 12.7) of the population reported a slow walking pace. Compared with average walking people, those reporting a slow pace had a higher body weight (difference (∆) 5.65 kg [95% CI: 3.22; 8.09], p < 0.01), BMI (D 2.48 kg/m 2 [95% CI: 1.53; 3.44], p < 0.01), WC (D 6.23 cm [95% CI: 4.12; 8.34], p < 0.01), serum triglycerides (D 30,9 mg/dl [95% CI: 5,31; 57,5], p = 0.018), and lower HDL cholesterol (D -2.32 mg/dl [95% CI: -4,24; -0,34], p = 0.022). Those reporting a slow pace had also a higher odd of being obese (odds ratio (OR): 2.46 [95% CI: 1.82; 3.33], p < 0.01), being diabetic (OR: 1.54 [95% CI: 1.02; 2.40], p = 0.018) and having metabolic syndrome (OR: 2.03 [95% CI: 1.30; 3.18], p = 0.002). Conclusions In Chilean adults, slow walking pace is associated with and unfavorable adiposity and lipid profile, including a higher probability of being obese, diabetic and having metabolic syndrome.

Comparación de los niveles de actividad física medidos con cuestionario de autorreporte (IPAQ) con medición de acelerometría según estado nutricional / Comparison between self-reported and device measured physical activity according to nutritional status

Background: It is unknown if nutritional status could influence the accuracy of self-reported physical activity (PA) levels. Aim: To compare PA measured using the international physical activity questionnaire (IPAQ) and by accelerometry (ActiGraph) according to nutritional status in Chilean adults. Material and Methods: This is an observational cross-sectional study that used information from the GENADIO project carried out in Chile between 2009-2011. The sample consisted of 322 people. PA levels and sitting time were determined through the IPAQ self-report questionnaire and ActiGraph accelerometers (GTM1). The nutritional status was determined according to body mass index (BMI). Results: Compared with the measurement made with accelerometry, the IPAQ self-report questionnaire underestimated the levels of light PA, total PA and sedentary time in −171.5, −54.8 and −40.6 min / day, respectively. However, IPAQ overestimated the levels of moderate PA and vigorous PA in 91.0 and 47.3 min/day respectively, compared with accelerometry. Compared with normal weight, obese subjects reported higher levels of moderate PA (105.5 and 48.9 min/day, respectively) and vigorous PA (54.1 and 38.3 min/day respectively). Total PA had a greater delta of underestimation between IPAQ and accelerometer measurements in normal weight than in obese subjects (-122.1 vs −16.5 min/day, respectively). Conclusions: The measurement of PA by means of a self-report questionnaire was discrepant with its objective measurement with an accelerometer. The discrepancy is even higher in obese people.

Influencia de la edad sobre el cumplimiento de las recomendaciones de actividad física: Resultados de la Encuesta Nacional de Salud en Chile 2009-2010 / Adherence to physical activity recommendations across age categories: Findings from the 2009-2010 Chilean National Health Survey

RESUMEN A pesar de que la actividad física (AF) es un factor protector contra las enfermedades crónicas no transmisibles, un gran porcentaje de la población no cumple los niveles mínimos recomendados. El objetivo fue investigar como varían los niveles de práctica de AF entre los diferentes grupos etarios en la población chilena. Se incluyeron 5.133 participantes de la Encuesta Nacional de Salud 2009-2010. La AF fue determinada utilizando el cuestionario GPAQ. La inactividad física fue definida como <600 MET/min/semana de AF moderada a vigorosa. La asociación entre AF y edad fue investigada por sexo mediante regresión logística. Las mujeres presentaron una mayor probabilidad de ser físicamente inactivas en comparación a los hombres (p<0,0001). Al analizar la prevalencia de inactividad física por sexo y grupo etario, esta cambió ligeramente entre los 20 a 59 años, pero a partir de los 60 se observó un incremento importante en la prevalencia llegando a 63% y 56% para mujeres y hombres >80 años, respectivamente. Los resultados obtenidos confirman la necesidad de seguir fomentando la práctica regular de AF física a través de todo el ciclo vital, pero en especial sobre los 60 años, ya que este grupo presenta una mayor probabilidad de ser físicamente inactivo.

ABSTRACT Although physical activity (PA) is a protective factor against non-communicable diseases, there is an important proportion of the population who do not meet PA guidelines. Our aim was to investigate how adherence to PA guidelines varies across different age groups in the Chilean population. 5,133 participants from the 2009-2010 Chilean Health Survey were included in this study. PA was measured using the Global Physical Activity Questionnaire (GPAQ). Physical inactivity was defined as <600 MET/min/week of moderate to vigorous intensity PA. Logistic regression was used to investigate the association of PA with age. The main finding of this shows that women were more likely to be inactive than men (p<0.0001). Physical inactivity prevalence varied slightly between 20 and 59 years. However, among those individuals aged >60 years the prevalence increased markedly, reaching 63% and 56% for women and men aged >80 years, respectively. These findings confirm the necessity of promoting PA across the lifespan, but more importantly, these results suggest that more promotion and opportunities for engaging in PA should be created especially for older adults, who are more likely to be physically inactive.

Asociación entre el polimorfismo rs9939609 del gen FTO y marcadores de adiposidad en población adulta chilena / Association between FTO (ns9939609) genotype and adiposity markers in Chilean adults

Background: Numerous studies have identified the role of Fat-mass-associated-gene (FTO) in the development of obesity. Aim: To investigate the association of FTO gene with adiposity markers in Chilean adults. Material and Methods: 409 participants were included in this cross-sectional study. The association between FTO (rs9939609) genotype and adiposity markers was determined using linear regression analyses. Adiposity markers included were: body weight, body mass index, fat mass, waist circumference, hip circumference and waist/hip ratio. Results: A fully adjusted model showed a significant association between FTO genotype and body weight (2.16 kg per each extra copy of the risk allele [95% confidence intervals (CI): 0.45 to 3.87], p = 0.014), body mass index (0.61 kg.m-2 [95% CI: 0.12 to 1.20], p = 0.050) and fat mass (1.14% [95% CI: 0.39 to 1.89], p = 0.010). The greater magnitude of association was found between the FTO gene and fat mass when the outcomes were standardized to z-score. Conclusions: This study confirms an association between the FTO gene and adiposity markers in Chilean adults, which is independent of major confounding factors.

No cumplir con las recomendaciones de actividad física se asocia a mayores niveles de obesidad, diabetes, hipertensión y síndrome metabólico en población chilena / Association of physical inactivity with obesity, diabetes, hypertension and metabolic syndrome in the chilean population

Background: Physical inactivity is an important cardiovascular risk factor. Aim: To investigate the association of physical inactivity with obesity, metabolic markers, type 2 diabetes mellitus, hypertension and metabolic syndrome in Chilean adults. Material and Methods: Participants from the National Health Survey 2009-10 (n = 5,157) were included in this study. Body mass index, waist circumference, metabolic markers (blood glucose, glycosylated hemoglobin and lipid profile) were the outcomes. Type 2 diabetes, hypertension and metabolic syndrome were determined using international criteria. Physical activity levels were determined using the Global Physical Activity Questionnaire and physical inactivity was defined as < 600 METs/minutes/week. Results: Compared to their physically active peers, inactive men and women had a higher odds ratio (OR) for obesity (OR: 1.77 [95% confidence intervals (CI): 1.29-2.42], p < 0.01 and 1.25 [95% CI: 102-1.54], p < 0.035, respectively), diabetes (OR: 2.47 [1.80-3.38], p < 0.01 and 1.72 [1.35-2.19], p = 0.002, respectively) and hypertension (OR: 1.66 [1.31-2.09], p < 0.01 and 1.83 [1.54-2.18] respectively. An association of physical inactivity with central obesity and metabolic syndrome was observed only in men (OR: 1.92 [1.42- 2.58], p < 0.01 and 1.74 [1.23-2.47], p < 0.01, respectively). Conclusions: Not meeting the physical activity recommendations is associated with obesity, diabetes, hypertension and metabolic syndrome, which are important cardiovascular risk factors.

Efectos de la actividad física sobre la asociación entre obesidad y diabetes mellitus tipo 2: resultados de la Encuesta Nacional de Salud 2009-2010 / The association between adiposity and diabetes is modified by physical activity

Background Physical inactivity and obesity are major risk factors for type 2 diabetes (T2D). Aim To investigate whether if the association between obesity and diabetes is modified by levels of physical activity in the Chilean population. Material and Methods Cross-sectional study including 4,712 participants from the 2009-2010 National Health Survey. Diabetes was determined when participants referred having the disease or had a fasting glucose ≥ 126 mg/dl. Physical activity level was assessed using the Global Physical Activity Questionnaire. The association between diabetes, obesity and physical activity was determined using logistic regression analysis. Results Compare to active and normal weight subjects (reference group), the risk for T2D was higher in active individuals with overweight (Odds ratio (OR): 2.85 [95% confidence intervals (CI): 1.76- 4.61] p < 0.01). The risk among inactive but normal weight participants (OR: 2.12 [95% CI: 1.49- 3.01], p < 0.01) was of lower magnitude and was even higher among inactive and overweight individuals (OR: 3.22 [95% CI: 2.10 - 4.93], p < 0.01). Similar results were found for obesity and central obesity. Conclusions Individuals who are physically inactive and have a high adiposity level have an increased risk for T2D compared to active individuals with normal BMI.

Factores asociados a inactividad física en Chile: resultados de la Encuesta Nacional de Salud 2009-2010 / Correlates of physical inactivity: Findings from the Chilean National Health Survey 2009-2010

Background: Physical inactivity is an important risk factor for cardiovascular diseases. Aim: To identify factors associated with physical inactivity in Chilean adults. Material and Methods: Participants from the Chilean Health Survey (5,133 individuals) were included in this study. Physical activity was measured using the Global physical activity questionnaire (GPAQ). Physical inactivity was defined as < 600 MET. min.week−1 of moderate to vigorous intensity physical activity. Logistic regression was used to identify correlates of physical inactivity. Results: The main finding of this study were that women (odds ratio (OR): 1.51 [95% confidence intervals (CI): 1.32-1.72]) were more likely to be inactive compared to men and that older adults were more likely to be inactive than their younger or middle age counterparts (OR: 3.06 [95% CI: 2.45-3.82]). Other correlates of physical inactivity were individuals with obesity (OR: 1.43 [95% CI: 1.20-1.70]), diabetes (OR: 1.96 [95% CI: 1.61-2.38]), hypertension (OR: 1.72 [95% CI: 1.50-1.97]), metabolic syndrome (OR: 1.42 [95% IC: 1.18-1.70]), a low education level (OR: 1.26 [95% CI: 1.06-1.49]) and higher levels of sedentary behavior (OR: 2.77 [95% CI: 2.36-3.25]). Conclusions: Women, older people and sedentary subjects with chronic non-transmissible conditions are at higher risk of being physically inactive.

Mayores niveles de transporte activo se asocian a un menor nivel de adiposidad y menor riesgo de obesidad: resultados de la Encuesta Nacional de Salud 2009-2010 / Association of active commuting with obesity: findings from the Chilean National Health Survey 2009-2010

Background: Active commuting is associated with a lower risk for obesity in developed countries. Aim: To investigate the association between active commuting and obesity risk in Chile. Material and Methods: Active commuting was measured using the Global Physical Activity Questionnaire (GPAQ v2) in 5,293 participants from the Chilean National Health Survey 2009-2010. Body mass index (BMI) and waist circumference (WC) were the study outcomes. The association between active commuting and obesity was investigated using linear and logistic regression analysis. Results: Thirty four percent of responders [95% confidence intervals (CI): 32.6-35.1] were passive commuters. Active commuters had a lower BMI and WC than their passive counterparts. Thirty minutes increment in active commuting were associated with a −0.20 kg.m-2 lower BMI [95% CI: −0.33 to −0.07, p < 0.01] and a −076 cm lower WC [95% CI: −1.08 to −0.43, p < 0.01]. The odds of having a BMI > 25 kg.m-2 was 0.93 [95% CI: 0.88 to 0.98, p = 0.01] per every 30 minutes' increment in active commuting, whereas the odds for central obesity was 0.87 [95% CI: 0.82 to 0.92, p < 0.01]. Conclusions: Active commuting is associated with a lower adiposity and lower risk for obesity in Chilean adults.

Funduplicarura laparoscópica en pediatría: Reporte de 4 casos / Laparoscopic fundoplication in pediatrics: Report of 4 cases

La Enfermedad por Reflujo Gastroesofagico es una condición que se desarrolla debido a reflujo gástrico persistente lo cual causa alteraciones nutricionales, síntomas molestos específicos, enfermedad respiratoria secundaria y daño en la anatomía e histología del esófago. El objetivo del tratamiento quirúrgico consiste en restablecer o reforzar los mecanismos de barrera anti reflujo. Se realizó funduplicatura laparoscópica por técnica de Nissen a cuatro pacientes, con edades comprendidas entre 2 y 5 años que presentaban Enfermedad por Reflujo Gastroesofagico. Dos pacientes presentaban daño neurológico y se les realizó gastrostomía en el mismo tiempo quirúrgico, formando parte éste procedimiento del abordaje laparoscópico. No se presentaron complicaciones en el post-operatorio inmediato ni mediato y todos los pacientes permanecen sin síntomas respiratorios ni gastrointestinales después de doce meses de seguimiento posterior el acto quirúrgico. La funduplicatura laparoscópica constituye una alternativa segura, provista de muchas ventajas en comparación con la cirugía abierta y debe ser el método de elección para el tratamiento de la Enfermedad por Reflujo Gastroesofagico cuando existe fracaso en el manejo medico.

The Gastroesophageal Reflux Disease is a condition that develops persistent gastric reflux causing nutritional disorders, specific troublesome symptoms, respiratory disease and secondary damage to the anatomy and histology of the esophagus. The goal of surgery is to restore or strengthen mechanisms for anti reflux barrier. Laparoscopic Nissen fundoplication was performed in four patients, aged between 2 and 5 years and who had gastroesophageal reflux disease. Two patients had neurological damage and a gastrostomy was performed during the laparoscopic procedure. No immediate and mediate complications in the postoperative period where seen, all patients remain symptom free during the twelve months of follow-up. Laparoscopic fundoplication is a safe alternative and provide many advantages over open surgery and should be the method of choice for the treatment of gastroesophageal reflux disease when there is failure of medical management.

Hábitos orales en niños de 6-10 años de la escuela itsin de san juan de pasto

Introducción: Los hábitos orales son acciones repetidas en la cavidad oral, algunas de ellos pueden originar parafunciones. Estos son actos conscientes que pueden pasar a actos inconscientes. Algunos de ellos son innatos del individuo, y otros adquiridos. Según algunas investigaciones, reportes, análisis estadísticos y control de variables de diferentes países, características ambientales, sociales, culturales, pueden influir en la prevalencia de hábitos orales en niños. Por lo tanto, el objetivo de este estudio fue determinar la prevalencia de hábitos orales en niños. Metodología: Se diseñó un tipo de estudio descriptivo de corte transversal donde se evaluaron 511 escolares de estrato bajo de 6 a 10 años de la Escuela ITSIN de San Juan de Pasto y se tomaron variables como edad y género. Resultados: 186 niños (36%) tuvieron hábitos orales, de estos 43% fueron niñas y 57% niños. Según edad, los hábitos orales fueron más frecuentes en niños de 8 años. Con respecto a género, la interposición lingual fue más frecuente en niñas y la onicofagia en niños. Conclusiones: La prevalencia de hábitos orales en estos niños fue menor en relación con otras comunidades, sin embargo, se recalca que estos se presentan en mayores edades en comparación con otros estudios.

Introduction: The oral habits are repeated actions in the mouth; some of them might cause parafunctions. They are also conscious acts that could become unconscious at some point. Some of them are innate in the individuals and others are acquired. According to some researches, reports, statistical analysis and variables control in different countries; environmental, social, and cultural characteristics may influence on the prevalence of oral habits in children. Therefore, the aim of this study was to determine the prevalence of oral habits in children at ITSIN elementary school from San Juan de Pasto, Nariño. Methodology: A descriptive cross-sectional study was designed to evaluate 511 low-income children from 6 to 10 years old. Variables such as age and gender were used. Results: 186 children (36%) had oral habits. 43% of these were girls and 57% were boys. According to age, oral habits were more frequent in 8 year-old children. Regarding the gender, tongue thrust was more common in girls and oral habits such as onychophagia was more frequent in boys. Conclusions: The prevalence of oral habits in these children was less than in other communities; however, these habits were presented in older children in comparison to other studies.

Controle genético da regeneração in vitro em progênies de Eucalyptus grandis / Genetic control of in vitro regeneration of Eucalyptus grandis

Com o objetivo de avaliar o controle genético da regeneração direta in vitro a partir de plântulas de Eucalyptus grandis, foram utilizadas sementes de 10 progênies de polinização aberta da população base, origem Atherton, localizada em Anhembi, Estado de São Paulo. Vinte dias de cultivo após a germinação, 196 segmentos distais dos hipocótilos por progênie foram inoculados in vitro num Delineamento em Blocos Completos Aleatorizado Generalizado, com duas unidades experimentais por bloco e sete repetições por bloco, usando a interação blocos por progênie como estimadora do erro experimental. Após 14 semanas de cultivo, foram feitas avaliações da regeneração. Houve diferenças significativas de regeneração entre as progênies (P<0,0001) com extremos de regeneração de 11 por cento a 60 por cento. A herdabilidade no sentido restrito entre as médias das unidades experimentais do caráter foi alta (h2m=0,94), indicando que houve um forte controle genético na regeneração in vitro dentro da população. Houve também alta variabilidade dentro da amostra estudada, assim como um forte efeito do progenitor materno sobre a regeneração.

The genetic control of in vitro direct regeneration was tested on seedlings of ten open-pollinated progenies from the base population of Atherton origin of Eucalyptus grandis at University of São Paulo (Brazil). Seeds were germinated in vitro, after twenty days, distal hypocotyls segments from 196 seedlings per progeny were inoculated in culture media at Generalized Complete Randomized Block Design, with two experimental units per block and seven repetitions, using the interaction blocks by progenies as an estimate of the experimental error. At week 14 from the inoculation bud induction was evaluated. Regeneration among progenies were significantly different (P<0.0001). Regeneration varied from 11 to 60 percent. The narrow-sense heritability between means of experimental units for in vitro regeneration was height. (h2m=0.94), indicating a strong genetic control of the trait within the population and also a high maternal effect. High variability within the study sample was found.

Bypass gástrico por laparoscopia para la obesidad mórbida: técnica y resultados en 150 pacientes con seguimiento de 3 a 48 meses / Laparoscopic gastric bypass for morbid obesity: technical and results in 150 patients with pursuit of 3 a 48 menses

Se presenta una serie prospectiva de 150 pacientes sometidos a bypass gástrico por laparoscopia debido a obesidad mórbida. En 98 mujeres y 52 hombres con índice de masa corporal promedio de 43,3 kg/m² se realizó un bypass gástrico en "Y" de Roux antecólico, con dos técnicas de anastomosis gastroyeyunal. La morbilidad temprana (< 1 mes) fue de 5,3 por ciento representada principalmente por hemorragia intraabdominal, mientras que la tardía (> 1 mes) fue de 13,8 por ciento, debida en la mayoría de los casos a estenosis de la gastroyeyunoanastomosis. No hubo mortalidad en la serie. Con un seguimiento del 70 por ciento, encontramos pérdidas de exceso de peso del 84 por ciento al año de posoperatorio (valor promedio), con mejoría de comorbilidades de 92,5 por ciento en hipertensión arterial y 59,9 por ciento en diabetes. Se concluye que la técnica de bypass gástrico por laparoscopia, representa una alternativa factible, segura y efectiva para los pacientes con obesidad mórbida.

A prospective series of 150 patients submitted to laparoscopic gastric bypass for morbid obesity is presented. In 92 women and 58 men with a median body mass index of 43.3 kg/m² an antecolic Roux en Y gastric bypass was performed using two techniques of gastrojejunostomy. The early morbidity (< 1 month) was of 5.3 percent mainly represented by intraabdominal bleeding, while the late morbidity (> 1 month) was of 13.8 percent, and in most cases due to stenosis of the gastrojejunal anastomosis. No mortality occurred in the series. With a 70 percent follow up, we found an excess weight loss of 84 percent at first postoperative year (mean value), with co-morbidities improvement of 92.5 percent on hypertension and 59.9 percent on diabetes. We concluded that the technique of laparoscopic gastric bypass is a feasible, safe, and effective alternative for patients with morbid obesity.