Estudio piloto sobre entrenamiento físico durante hemodiálisis / A pilot study on physical training of patients in hemodialysis

Background: Exercise training during the dialytical procedure may have positive cardiovascular effects and prevent or revert muscle wasting in patients undergoing chronic hemodialysis. Aim: To evaluate the effects of an exercise training program in patients undergoing chronic hemodialysis. Material and Methods: Fifteen patients on chronic hemodialysis aged 21 to 69 years (three females) were included in the study. Nine of these were included in an exercise training program. During 16 weeks, exercise sessions were carried out during each dialytical procedure that included a warm-up period, aerobic exercises done using standing cycles, and resistance exercises, performed using Thera-Band® elastic bands and loops. Borg scale was used to control the intensity of training. At baseline and at the end of the study, a blood sample prior and after the dialytical procedure was obtained to measure C reactive protein, tumor necrosis factor α and interleukin 6. Quadriceps muscle strength, six minutes´ walk and quality of life using the SF-36 questionnaire, were also measured. Results: Four experimental subjects did not complete the study period, two that withdrew before starting, one due to problems with the venous access and one that decided to withdraw after 1 month of training. Among the five patients that finished the training period, significant improvements in the six minutes´ walk and quadriceps strength were observed in the experimental group. No significant changes were observed among controls. No changes were observed in either group in C reactive protein, tumor necrosis factor and interleukin 6 levels or quality of life. Conclusions: Among patients undergoing chronic hemodialysis exercise training improves endurance and muscle strength.

Validación del cuestionario de calidad de vida (WHOQOL-BREF) en adultos mayores chilenos / Validation of the WHOQOL-BREF quality of life questionnaire among Chilean older people

Background: The WHOQOL-BREF is a generic questionnaire to measure quality of life created by the Study Group on Quality of Life of the World Health Organization. Aim: To adapt and evaluate the psychometric properties of the Spanish version of the WHOQOL-BREF instrument in a group of Chilean older subjects living in Metropolitan Santiago. Material and Methods: A linguistic-cultural adaptation of the Spanish version of the WHOQOL-BREF was performed and tested in a pilot study. Subsequently, the modified scale was applied to a group of 1186 older women aged 72 ± 8 years and 334 men aged 72 ± 7 years. The psychometric properties such as internal consistency, item-total correlation of responses, and construct validity were evaluated. A confirmatory factor analysis was done to check if the dimensions described in the original version, were evaluated. Analyses were performed with STA-TA statistical software 10.0 and LISREL 8.50. Results: Confirmatory factor analysis confirmed that the dimensionsphysical health, psychological, social relationships and environment, described by the authors in their original description, were maintained. The instrument had a good internal consistency with a Cronbach alpha of 0.88 for the total scale and rangingfrom 0.70 to 0.79 in each of the dimensions. Conclusions: The evaluated version of the WHOQOL-BREF has an acceptable reliability and validity, and suggests that it is suitable for the assessment of Quality of Life in elderly people in Chile.

Calidad de vida en pacientes operadas de bypass gástrico hace más de un año: Influencia del nivel socioeconómico / Quality of life of patients subjected to gastric bypass more than one year ago: Influence of socioeconomic status

Background: The study of the effects of bariatric surgery on quality of life in patients of different socioeconomic levels (SEL) is worthwhile. Aim: To study quality of life (QoL), eating behavior, depressive symptoms and sexuality in patients subjected to a gastric bypass (GBP) more than 1 year before. Material and methods: The sample was composed of 33 GPB patients (19 high SEL and 14 low SEL), and 27 non-operated women (18 high SEL and 9 low SEL) of similar weight and age, as controls. Assessment included medical history anthropometry radiological densitometry. Eating behavior was assessed using the three factor eating questionnaire, quality of life using SF-36 and the Bariatric Analysis of Reporting Outcome System (BAROS) depressive symptoms were assessed using the Beck scale version II and sexual behavior using the female sexual function index (FSFI). Results: QoL was lower in operated patients from low SEL, especially when compared to high SEL control women. Operated patients had a predominantly restrictive pattern of eating behavior. Eating behavior disorders were detected in 5 of 33 operated patients versus 4 of 27 controls (p =ns). Sexual function was absent or dysfunctional in 22 operated versus 8 controls (p =0,02). No significant differences were observed for depressive symptoms, between operated patients and controls. Conclusions: In the long term, QoL of bariatric patients, especially those from low SEL, is inferior to control women and Chilean general population. Operated patients have restrictive eating patterns and lower sexual satisfaction indexes. Frequency of depressive symptoms was high both in bariatric and control women.

Evaluación a largo plazo del estado nutricional, composición corporal y densidad mineral ósea en mujeres operadas de bypass gástrico: impacto del nivel socioeconómico / Nutritional status, body composition and bone mineral density in gastric bypass females: impact of socioeconomic level

Background: Roux-en-Y gastric bypass (RYGBP) has had a positive impact on co-morbidities associated with obesity. However, in the long-term it can induce micronutrient deficiencies. Aim: To perform a complete nutritional assessment in a group of women previously operated of RYGBP, from different socioeconomic levéis (SEL). Patients and Methods: Thirty three women (19 high SEL and 14 low SEL), were assessed by dietary recalls, anthropometric measurements, muscle strength, bone mineral density, routine clinical laboratory, serum levéis of vitamin B12, 250H-vitamin D, Mate, calcium, ferritine, ceruloplasmin and indicators ofbone turnover (parathohormone, osteocalcin and urinary pyridinolines). Their valúes were compared to those of 30 control women (18 high SEL and 12 low SEL). Results: Low SEL operated women consumed fewer vitamin and mineral supplements compared with their high SEL pairs. No cases of vitamin B12, folie acid or copper deficiencies were detected. Frequency of iron deficieney was similar in patients and controls. Vitamin D insufficieney was higher amongpatients than in controls (p =0,04 7), regardless SEL. Patients had also a higher frequency of high serum PTH and osteocalcin and urinary pyridinoline levéis. However, no differences in bone mineral density were observed between operated women and controls. Conclusions: Vitamin and mineral deficiencies were lower than expected among operated women. However, problems associated with vitamin D deficieney were highly prevalent among patients operated of RYGBP, irrespective SEL. These alterations were only detectable through speciñe markers at this stage, because they did not transíate into lower bone mineral density (BMD) of surgicalpatients, probably due to the higher pre-operative BMD of these morbidobese patients.

Efecto del probiótico Saccharomyces boulardii en la prevención de la diarrea asociada con antibióticos en adultos ambulatorios en tratamiento con amoxicilina / Effect of probiotic Saccharomyces boulardii on prevention of antibiotic-associated diarrhea in adult outpatients with amoxicillin treatment

Background: Antibiotic-associated diarrhea is one of the most common adverse effects of antimicrobials. Any antimicrobial can potentially produce diarrhea but beta-lactamics have a higher risk. Among these, amoxicillin is widely indicated in ambulatory practice. One ofthe alternatives suggested to prevent antibiotic-associated diarrhea, is the use of the probiotic Saccharomyces boulardii. Aim: To evalúate whether the concomitant use of Saccharomyces boulardii and amoxicillin can prevent antibiotic associated diarrhea in ambulatory adults with acute infections diseases, without provoking other adverse effects. Material and Methods: Eighty six adults (aged 15 to 81 years) with acute infectious diseases, excluding those arising in the gastrointestinal tract, that received a prescription of oral amoxicillin for 5 to 10 days, were included. In a controlled randomized, double blind trial, 41 patients were assigned to receive lyophilized Saccharomyces boulardii (500 mg/day) duríng 12 days, and 45 patients were assigned to placebo for the same period. Results: Ten percent of patients (9/86) reported acute diarrhea, 9,8 percent (4/41) in the experimental group and 11.196 (5/45) in the control group (p = 100). No adverse effects were associated to the use of the probiotic. Conclusions: Saccharomyces boulardii (500 mg/day) did not prevent diarrhea related to amoxicillin.

Indicadores antropométricos, composición corporal y limitaciones funcionales en ancianos / Anthropometry, body composition and functional limitations in the elderly

Background: Functional limitations limit the independence and jeopardize the quality of life of elderly subjects. Aim: To assess the association between anthropometric measures and body composition with functional íimitations in community-living older people. Material and Methods: Cross-sectional survey of 377 people >6 5 years old (238 women), randomly selected from the SABE/Chile project. Complete anthropometric measurements were done. Handgrip muscle strength was measured using dynamometers. Body composition was determined using Dual-Energy X-Ray Absorptiometry. Functional limitations were assessed using self reported and observed activities. Results: Body mass index was strongly associated with fat mass (men r =0.87; women r =0.91) and with lean mass (men r =0.55; women r =0.62). Males had significantly greater lean mass (48.9 kg vs 34.9 kg), and bone mass than females (2.6 kg vs 1.8 kg) and women had higher fat mass than men (26.3 kg vs 22.9 kg). The prevalence of functional íimitations was high, affecting more women than men (63.7 percent vs 37.5 percent, p <0.01). Functional íimitations were associated with lower handgrip strength in both sexes. In the multiple regression models, with functional íimitations as dependent variable and anthropometric measures as contributing variables, only hand grip strength had a significant association (negative) with functional íimitation in both genders. Age was also a significant risk factor for functional íimitations among women. Conclusions: Hand grip strength was strongly and inversely associated with functional íimitations. Handgrip dynamometry is an easy, cheap and low time-consuming indicator for the assessment of functional íimitations and the evaluation of geriatric interventions aimed to improve functional ability.

Determinación de los índices glicémicos y de insulina en fórmulas para alimentación enteral en adultos sanos / Glycemic and insulin indices of tube feeding formulas in healthy adults

Background: In acute illnesses, plasma glucose levels are often increased and generally parallel the severity of stress. Hyperglycemia caused by reduced insulin sensitivity and reduced insulin secretion is associated with increased susceptibility to infections. Maintaining blood glucose levels at or below 110 mg/dl reduces morbidity and mortality in critically ill patients. Aim: To measure the glucose and insulin responses of four commercially available enteral formulas compared with a standard meal reference product. Material and Methods: The glycemic index (GI) and the insulin index (II) were determined in a randomized, cross over protocol in 38 healthy volunteers between 18 and 46 years of age. Each subject underwent five tests: three with the standard meal (bread) and two with the study products. The enteral formulas were Clinutren HPR (whole protein of high protein value), Crucial® (casein peptide based formula), Peptamen®, (whey peptide based formula), Glytrol® (formula for diabetics with whole protein with fiber). Each study product was evaluated 10 times. Results: The diabetic formula and the high protein energy dense formulas induced a significantly lower GI (p <0.02) compared with the standard meal. The GI response did not appear to be due to enhanced insulin secretion. The other tested formulas had lower GI than the standard meal, but in addition they exhibited increased II The whey based peptide formulation produced the highest insulin response (p <0.03). Conclusions: Both GI and II are related to the concentration, form and type of protein contained in the enteral formula. The whey peptide formulation produced a low GI with the highest insulin index. Based on the low GI of these enteral products, all can be useful to provide nutritional support during metabolic stress, without adding an additional challenge to blood glucose management.

Insulinemia en ayunas como marcador simple de resistencia a la insulina en hipertensos / Fasting insulinemia as simple marker of insulin resistance in hypertensive patients

Insulin resistance is associated to hypertension, obesity and diabetes and may be an independent cardiovascular risk factor. The exact assessment of insulin resistance requires complex metabolic studies. However, there is a good correlation between this parameter and fasting serum insulin levels. The aim of this work was to study fasting serum insulin levels by ratio immuno analysis in 43 hypertensive patients aged 56 ñ 5.5 years old (27 male, 17 obese and 8 diabetics) and 20 normotensive controls aged 50 ñ 4.8 years old (13 male). Insulin levels were 3.8 UI/L in controls, 12.1 UI/L in normal weight, 15.5 UI/L in obese and 18.3 UI/L in diabetic hypertensives (ANOVA p<0.001). These levels were above two standard deviation of control values in 50 percent of normal weigth, 66 percent of obese and 62 percent diabetic hypertensives. It is conclude that normal weigth, obese and diabetic hypertensive subjects have high fasting insulin levels