Efectividad de un programa de automanejo para cuidadores familiares / Effectiveness of a self-management program for family caregivers

INTRODUCCIÓN: La carga de cuidado en los cuidadores familiares (CF), tiene un efecto en la salud física y mental, relaciones familiares, laborales y estado financiero, aumentando la necesidad de intervenciones efectivas para mejorar el automanejo de su condición y el cuidado al familiar en el hogar. OBJETIVO: evaluar la efectividad de un programa para promover el automanejo en CF. METODOLOGÍA: de diseño cuasi experimental con mediciones pre y post intervención, en una muestra no probabilística, intencionada de 19 CF de personas mayores con nivel de dependencia. El programa "Trabajando juntos en colaboración" (TJC), implementado por facilitadores entrenados y certificados, promueve el automanejo y habilidades para cuidar a su familiar en casa. Para evaluar el efecto de la intervención se aplicó pre y post-test el Instrumento de "Automanejo en Cuidadores Familiares", la prueba Shapiro-Wilks, el análisis de diferencias por la t-Student y test de Wilcoxon, se calculó el tamaño del efecto y la potencia estadística (1- ß). RESULTADOS: se encontró una diferencia estadísticamente significativa entre el pre y post intervención, observando un incremento en el resultado de la sumatoria global y en las tres dimensiones del automanejo. Estas diferencias muestran un efecto relevante a considerar (>,80) y una potencia alta (>,80). CONCLUSIÓN: El Programa TJC, muestra efectividad en mejorar el automanejo en CF, con una potencia adecuada que podría permitir generalizar resultados en poblaciones similares. Siendo este un programa genérico, podría ser aplicado en cualquier caso de CF, independiente a la enfermedad o condición de su familiar.

INTRODUCTION: The caregiving burden on family caregivers (FC) has an impact on physical and mental health, family relationships, work, and financial status, increasing the need for effective interventions to improve self-management of their condition and care for the family member at home. OBJECTIVE: to evaluate the effectiveness of a program to promote self-management in FC. METHODOLOGY: The study employed a quasi-experimental design with pre- and post-intervention measurements in a non-probabilistic, purposive sample of 19 FC of older individuals with a level of dependency. The "Trabajando Juntos en Colaboración" (TJC) program, implemented by trained and certified facilitators, promotes self-management and skills to care for their family member at home. To assess the intervention's effect, pre and post-tests were administered using the "Automanejo en Cuidadores Familiares" instrument, along with the Shapiro-Wilks test, t-Student analysis of differences, and Wilcoxon test. Effect size and statistical power (1- ß) were calculated. RESULTS: indicated statistically significant differences between the pre- and post-intervention periods, with an observed increase in the overall sum and in all three dimensions of self-management. These differences demonstrate a relevant effect (>0.80) and high statistical power (>0.80). CONCLUSION: the TJC program proves effective in enhancing self-management in CF, with sufficient power to potentially generalize results to similar populations. As a generic program, it could be applied in any FC case, regardless of the disease or condition of their family member.

Efectos de la pandemia por COVID-19 en determinantes sociales de familias del área metropolitana de Bucaramanga

Introducción: La pandemia por COVID-19 trajo consigo grandes cambios a nivel socioeconómico, producto de las medidas tomadas para mitigar su expansión, que implicó cierre de colegios y dificultad para el acceso a servicios de salud. Sin embargo, no se cuenta con mucha información respecto al impacto que estas medidas han tenido en la salud y el bienestar de niños y adolescentes, por lo cual se desarrolló una encuesta virtual para conocer la dimensión de los efectos de la pandemia en el bienestar integral de los menores y sus familias. Metodología: Estudio observacional de corte transversal que se realizó mediante la aplicación de una encuesta en formato electrónico a padres de familia de niños y adolescentes del Área Metropolitana de Bucaramanga. Resultados: Se obtuvieron 960 respuestas. El 25,63 % de los encuestados refieren cancelación de citas médicas. El 98 % de los estudiantes pudo continuar las actividades académicas durante el aislamiento. El factor económico fue la principal causa de preocupación en el periodo de la encuesta. Discusión: Durante el periodo de aislamiento, los problemas de salud mental, las dificultades para el acceso a herramientas para la educación virtual y las barreras para la atención, propias de la emergencia sanitaria, causaron efectos significativos en la calidad de vida de los menores. Conclusiones: Ante emergencias sanitarias, se deben mantener los servicios de atención en salud de la misma forma que se hacía previo a la ocurrencia del evento, como los programas de vacunación, crecimiento y desarrollo, promoción y prevención, además de la continuidad de la escolaridad.

Introduction: The COVID-19 pandemic has brought great changes along with, some of those were at the socioeconomic level, as a result of the actions taken to mitigate the virus expansion, which involved the closure of schools and restriction in accessing to some health services. However, there is not much information regarding the impact that these measures have had on the health and well-being of children and adolescents, for this reason, a virtual survey was developed to find out the dimension of the pandemic's effect on the comprehensive welfare of minors and families. Methodology: Cross-sectional observational study, which was carried out by applying a survey in electronic format to parents of children and adolescents in the Metropolitan Area of Bucaramanga. Results: A total of 960 responses were obtained. Of those surveyed, 25,63% refer cancellation of medical appointments. The 98% of students were able to continue academic activities during isolation. The economic factor was the main cause of concern in the survey period. Discussion: During the isolation period, mental health problems, difficulties in accessing tools for virtual education and barriers to care, typical of the health emergency, caused a significant effects on the quality of life of youngsters. Conclusions: In the event of health emergencies, health care services should be maintained in the same way as before the occurrence of the event, such as vaccination, growth and development, promotion and prevention programs, in addition to the continuity of schooling.

Incidence of Latent Tuberculosis Infection in a Study of School Contacts Comparing Two Cut-off Points of the Tuberculin Test / Incidencia de infección tuberculosa latente en un estudio de contactos escolares comparando dos puntos de corte de la prueba de tuberculina

Introduction: The risk of tuberculosis infection is associated with close and prolonged contact. Daily contact, poorly ventilated classrooms or delay in diagnosing the index case in a school setting could contribute to contagion. Objective: To know the incidence of latent tuberculosis infection (LTBI) in school contacts comparing two cut-off points of the tuberculin test (PPD, Purified Protein Derivative): ≥ 10mm and ≥ 5mm. To determine the degree of compliance with the performance of control and chemoprophylaxis (ChP) studies. Materials and Methods: We carried out a retrospective analysis of bacillary TB school contacts in teenagers between 12 and 19 years old of the Programmatic Area of the Hospital Parmenio Piñero between February 2016 and December 2017. The evaluation included chest x-ray, lab tests and PPD. We analyzed 2 cut-off points of the PPD: ≥ 10mm and ≥ 5mm, and repeated the test after 3 months in cases with negative results. Primary ChP with isoniazid was indicated for all the contacts, and secondary ChP for those with basal PPD+ or conversion at the third month. We considered ChP compliance in cases where patients followed > 80% of the indicated regime. Results: 331 (89%) of 373 students to be evaluated participated in the study. TB was diagnosed in 4 students (1.2%) through chest x-ray, and they were excluded. Within the remaining 327, the mean age was 15 ± 1.6 years, and 132 (40%) were male. The basal PPD was ≥ 10mm in 20 cases (6.1%), being more frequent in the group of 16-19 years versus the 12-15 years: 10.7% vs. 3.1%; p = 0.004. There wasn't any significant difference regarding sex. 135 contacts (45%) did the second PPD, and 3 conversions were found (2.2%). Primary ChP was indicated for everyone, and secondary ChP for 23 contacts, with 75% and 26% compliance respectively, and without any significant association with age or sex. 4 adverse events were reported (1.2%): polineuritis (n=2), skin allergy and food intolerance. 63 contacts (19.3%) were positive PPD, with PPD ≥ 5mm, being more frequent in males: 26.5% vs. 14.4%, p = 0.006; and in 16-19 vs. 12-15 years: 28.2% vs. 13.2%; p < 0.001. With the second PPD we observed 3 conversions (2.2%). Conclusion: We found 6.1% of LTBI considering a PPD+ ≥ 10mm and 19.3% with PPD ≥ 5mm. Compliance with the second PPD and the secondary ChP scheme was low.

Bebidas endulzadas en adultos jóvenes y su asociación con adiposidad y riesgo metabólico / Sweetened beverages in young adults and its association to adiposity and metabolic risk

Resumen: Objetivo: Estimar la asociación entre consumo de bebidas endulzadas (BE) con indicadores de adiposidad y riesgo metabólico en adultos jóvenes. Material y métodos: Se analizó la frecuencia de consumo de alimentos, índice de masa corporal (IMC), circunferencia de cintura (CC), grasa corporal (PGC), glicemia y triglicéridos de 931 participantes seleccionados aleatoriamente (Región de Valparaíso, Chile), mediante modelos de regresión múltiple, controlando factores de confusión. Resultados: La mediana de edad fue 24.9 años; 94% (IC95% :92.3-95.3) de los participantes consumía BE, 33.1% de ellos consumía más de dos porciones (≥500 ml) diarias, que se asoció con incremento en glicemia (ambos sexos) (β=2.17; p=0.007) y con IMC (β=1.48, p=0.04), CC (β=4.50; p=0.009) y PGC (β=3.02; p<0.001) sólo en mujeres. Conclusión: La alta ingesta de BE incrementa la glicemia en adultos jóvenes y los indicadores de adiposidad en mujeres, antecedentes relevantes para formular políticas que disminuyan el consumo de BE y sus consecuencias.

Abstract: Objective: To estimate the association between sweetened beverages (SB) consumption with adiposity indicators and metabolic status among young Chilean adults. Materials and methods: We analyzed food frequency consumption, body mass index (BMC), waist circumference (WC), body fat percentage (BFP), glucose and triglycerides in 931 young adults randomly selected from Valparaiso Region using multivariate regression models controlling confusion and interactions factors. Results: The median age was 24.9 years; (95%CI: 92.3-95.3) reported SB consumption, 33.1% received more than two portions (≥500 ml) daily what was associated with an increase in glycemia (β=2.40; p=0.024) (both sexes), with BMI (β=1.48, p=0.04), WC (β= 4.50; p=0.009) and BFP (β=3.02, p< 0.001) only in women. Conclusion: High consumption of SB increases glycemia in young adults and only in women, indicators of adiposity, relevant antecedents to formulate policies that decrease SB consumption and its consequences.

Autophagy protects against neural cell death induced by piperidine alkaloids present in Prosopis juliflora (Mesquite)

ABSTRACT Prosopis juliflora is a shrub that has been used to feed animals and humans. However, a synergistic action of piperidine alkaloids has been suggested to be responsible for neurotoxic damage observed in animals. We investigated the involvement of programmed cell death (PCD) and autophagy on the mechanism of cell death induced by a total extract (TAE) of alkaloids and fraction (F32) from P. juliflora leaves composed majoritary of juliprosopine in a model of neuron/glial cell co-culture. We saw that TAE (30 µg/mL) and F32 (7.5 µg/mL) induced reduction in ATP levels and changes in mitochondrial membrane potential at 12 h exposure. Moreover, TAE and F32 induced caspase-9 activation, nuclear condensation and neuronal death at 16 h exposure. After 4 h, they induced autophagy characterized by decreases of P62 protein level, increase of LC3II expression and increase in number of GFP-LC3 cells. Interestingly, we demonstrated that inhibition of autophagy by bafilomycin and vinblastine increased the cell death induced by TAE and autophagy induced by serum deprivation and rapamycin reduced cell death induced by F32 at 24 h. These results indicate that the mechanism neural cell death induced by these alkaloids involves PCD via caspase-9 activation and autophagy, which seems to be an important protective mechanism.

Observation of sex chromatin in exhumed bones, evaluation of their diagnosis value / Observación de la cromatina sexual en osamentas exhumadas, evaluación de su valor diagnóstico

Observation of sexual chromatin has shown to be very helpful in gender forensic diagnosis. In the present study we analyzed the diagnosis performance of the method in, non-treated or treated with conventional bone techniques, exhumed bone pieces. We used long bones of male and female individuals, the method applied is described in Suazo et al. (2010). In the non-treated exhumed pieces, the general accuracy of the method was 75 percent, while in the treated pieces the method was inapplicable due to the lack of cells in the tissue. Our results suggest that it is possible to determine the sex of aged human bones buried under different conditions through a fast and simple histological method, but the treatment with physical and chemical means eliminates the remaining cells in the bone tissue.

La observación de la cromatina sexual ha demostrado ser útil en el diagnóstico forense del sexo. En este estudio analizamos el rendimiento diagnóstico del método en piezas óseas exhumadas no tratadas y tratadas mediante osteotécnica convencional. Utilizamos muestras de huesos largos de individuos de sexo masculino y femenino, el método se aplicó de acuerdo a lo descrito por Suazo et al., (2010). En las piezas exhumadas no tratadas la exactitud general del método fue del 75 por ciento, mientras que en las piezas tratadas el método resultó inaplicable, debido a la ausencia de células en el tejido. Nuestros resultados sugieren que es posible determinar el sexo en osamentas humanas exhumadas de larga data y en diferentes condiciones de enterramiento, mediante un método histológico rápido y sencillo, pero que el tratamiento por medios físicos y químicos elimina las células remanentes en el tejido óseo.

Esporotricosis linfocutánea en niños: a propósito de un caso / Lymphocutaneous sporotrichosis in children: apropos of a case

Introducción: La esporotricosis linfocutánea es una micosis subcutánea de evolución sub-aguda o crónica, que es más frecuente en adultos entre los 16 y 30 años de edad pero que también se presenta en la niñez, sobre todo en áreas rurales. Se caracteriza por nódulos que se reblandecen y luego se ulceran, lo cual constituye el chancro inicial. Dos o tres semanas después se observan nódulos eritematovioláceos, no dolorosos siguiendo el trayecto linfático regional. El diagnóstico definitivo se realiza al aislar el agente causal mediante cultivo. En nuestro país el tratamiento usual y eficaz sigue siendo el yoduro de potasio. Caso Clínico: Se presenta el caso de un paciente masculino de 2 años de edad, con dermatosis de 2 semanas de evolución con historia de trauma 2 semanas antes del inicio de las lesiones, caracterizada por úlcera costrosa en dorso de mano derecha con presencia de adenopatías blandas, no dolorosas siguiendo la cadena ganglionar de antebrazo y brazo derecho. Conclusiones: La esporotricosis puede presentarse a cualquier edad aún en niños tan pequeños como este paciente de 2 años. La solución saturada de yoduro de potasio es muy eficaz en el manejo de esta patología por lo que aunado a su bajo costo sigue siendo de elección en países en vías de desarrollo...

Puente al trasplante de 4 semanas utilizando el sistema de asistencia ventricular Levitronix Centrimag® en el shock cardiogénico post-infarto al miocardio: Caso clínico / Four-week Levitronix Centrimag® bridge-to-transplant for post myocardial infarction cardiogenic shock: A case report

Cardiogenic shock after myocardial infarction has a high mortality even if early revascularization is achieved. Biventricular assist devices have not been used in Chile in this critical setting. We report a case of a 55 year-old diabetic man who suffered an acute chest pain and ventricular fibrillation. Prompt outside hospital defibrillation/ reanimation restored pulse and allowed emergency room transfer on mechanical ventilation. Electrocardiogram showed an anterior myocardial infarction and early revascularization was achieved by anterior descending artery angioplasty. However, severe cardiogenic shock continued in spite of inotropic and intra aortic balloon pump support. Levitronix Centrimag® biventricular mechanical circulatory support was inserted during reanimation for recurrent ventricular fibrillation and the patient listed for urgent cardiac transplantation upon stabilization. Heart transplantation was performed successfully 28 days later and the patient was discharged after a 21-day recovery period. Twelve months after transplant the patient is in NYHA functional class I with normal biventricular function. Levitronix Centrimag® biventricular mechanical circulatory support could be used successfully as a bridge-to-transplant for myocardial infarction cardiogenic shock.

Santa Rosa de Lima: uma santa anoréxica na América Latina? / Saint Rose of Lima: an anorexic saint in Latin America?

A literatura especializada tem nos mostrado que é grande a semelhança entre o comportamento alimentar das santas jejuadoras medievais e o das anoréxicas atuais. No entanto, há poucas referências sobre a existência de santas jejuadoras na América Latina. No presente trabalho, os autores salientam aspectos da vida de Santa Rosa de Lima, Patrona da América e Filipinas, que poderiam ser descritos como comportamentos anoréxicos. Comparando os aspectos psicopatológicos da vida de Santa Rosa com o comportamento das anoréxicas atuais, pareceu confirmar-se um padrão uniforme de comportamento, especialmente quanto ao aspecto imitativo, fator que poderia levar as jovens da atualidade a desenvolverem um transtorno alimentar após terem algum tipo de informação sobre o transtorno.

Cambio secular de las variables antropométricas al nacer: una perspectiva local / Secular changes in anthropometrical variables at birth: a local perspective

Background: Anthropometrical measurements at birth are the result of the conditions during pregnancy, being an issue of current interest due to the reported relationship of birth weight with non communicable chronic diseases in adulthood. Aim: To study the change in anthropometrical measurements at birth, between the period 1974-1978 and the period 1995-1999, in two counties of Valparaiso, Chile. Material and methods: We collected information from the public health care system in a universe of 5,018 newborns of the two periods. Results: When compared to 1974-1978, the period 1995-1999, showed 38 percent decrease in the number of deliveries, 0.7 percent decrease in parity, 1.4 percent decrease in pre-term deliveries and one year increase of mother's age. Likewise birth weight increased by 246 g in males and 210 g in females (p <0.01). Birth length increased by 0.5 cm in males and 0.4 cm in females (p <0.01). Low birth weight was reduced from 9 to 4.2 percent and length under -2 standard deviations from normal, also decreased from 5.4 to 1.5 percent (p <0.001). Conclusions: In the last 20 years, an improvement in anthropometrical measurements at birth was observed. Better conditions during pregnancy probably explain these changes

Cirugía de revascularización miocárdica en pacientes diabéticos: morbimortalidad quirúrgica / Myocardial revascularization surgery in diabetic patients: surgical morbimortality

La proporción de pacientes diabéticos sometidos a cirugía de revascularización miocárdica (CRM) aumenta en forma progresiva. Se comparan las características de las poblaciones de diabéticos y no diabéticos sometidos a CRM y la morbimortalidad quirúrgica. Se analizaron en forma retrospectiva 1.787 pacientes, que incluyeron 449 diabéticos, sometidos a CRM entre abril de 1995 y febrero de 1999, en el centro de cirugía cardíaca de Casa de Galicia, GEVE. Los pacientes diabéticos presentaron mayor prevalencia de sexo femenino, de obesidad mórbida y de infarto de miocardio previo. Se comprobó en los diabéticos una mayor proporción de: cardiomegalia, enfermedad vascular periférica y clase funcional IV de NYHA, con una media de riesgo operatorio mayor. No existieron diferencias estadísticamente significativas en la mortalidad quirúrgica entre los diabéticos. Se comprobó en los diabéticos una proporción significativamente mayor de accidente vascular encefálico, delirio e insuficiencia renal. Si bien los diabéticos tienen una mayor prevalencia de factores de riesgo de mortalidad quirúrgica y de determinadas complicaciones posoperatorias, la CRM es segura en estos pacientes, lo que sumado a la creciente proporción de pacientes diabéticos en los sujetos sometidos a CRM, hace de la misma un pilar en el manejo terapéutico de los diabéticos con enfermedad coronaria

Comparación del estado nutricional entre escolares indígenas y no indígenas / Comparison of nutritional status of school children from indigenous and non indigenous ancestry

Background: The few studies in Chile assessing the nutritional status of indigenous children show a high prevalence of stunting, excess weight and feeding problems. Aim: to compare anthropometric indices in children from indigenous and non indigenous ancestry. Subjects and methods: school children aged 6 to 8 years old, living in locations with three clear cut levels of social vulnerability were studied. Children were considered indigenous if their last names, as well as those of their parents were of mapuche origin. Non indigenous were those whose last names were of spanish origin. Results: four hundred and fifty indigenous and 684 non indigenous children were studied. Indigenous children from high vulnerability communities were approximately 0.5 z score shorter than those of non indigenous origin. Heights of indigenous and non indigenous children were similar in communities with intermediate and low social vulnerability. The proportion of the lower segment followed the same trend. Weight/height ratios were higher among indigenous children in the three vulnerability levels. Among indigenous children coming from areas of low vulnerability arm circumference was 1 cm broader than that of their non indigenous counterparts. Conclusions: stunting is prevalent among school children from areas of high socioeconomic vulnerability, mainly rural, and independent from ethnicity. Among indigenous school children overweight and a broader arm circumference are frequent. These results urgently call for located and specific nutrition interventions

Déficit de crecimiento y rendimiento escolar / School performance and stunting

Objetivo: analizar la relación entre talla baja y rendimiento escolar en niños de comunas de alta vulnerabilidad social de Santiago. Pacientes y métodos: se seleccionaron niños de talla baja (-1 a -3 DE) a normal (ñ 0,5) para la edad según estandar OPS/NCHS, cuyos padres tenían talla muy baja (-2 DE) o no muy baja (entre -1,99 y 0,5 DE) para el mismo estandar a los 18 años. Se tomaron 3 grupos. El grupo 1 de 85 niños de talla baja y padres muy bajos, grupo 2 de 76 niños de talla baja y padres no muy bajos y grupo 3 de 86 niños de talla normal y padres no muy bajos. Se registraron antecedentes demográficos, escolaridad de los padres, recursos y apoyo de la familia al aprendicaje. El rendimiento escolar se midió por las notas de promoción en matemáticas y español, fracaso el año precedente, trastorno de aprendizaje e índice de rendimiento y se comparó entre los grupos. Resultados: los niños talla baja tenían menores notas de pase en castellano y matemática y mayor riesgo de trastorno de aprendizaje y repetición. En el modelo multivariado de bajo rendimiento ingresaron significativamente pertenecer al grupo 2 (razón de ventaja (OR) = 2,48; intervalo de confianza (C) = 1,13 - 5,46 y baja escolaridad de padre y madre (CR = 1,52, (C = 1,13 - 2,03). En el modelo de buen rendimiento ingresaron alta escolaridad de los padres (CR = 1,47; (C = 1, 16-1,87), bajo número de menores de 18 en el hogar (OR = 2,18; (C = 1,08 - 4,39). Conclusión: la prevención del déficit secundario de crecimiento, aplicando programs de apoyo en los grupos de riesgo, podría contribuir a la disminución del bajo rendimiento escolar

Cirugía de revascularización miocardica en pacientes mayores de 70 años / Myocardial revascularization surgery in patients aged 70 and over

Entre abril de 1995 y abril de 1996 se realizó cirugía de revascularización miocárdica aislada a 407 pacientes en el Centro de Cirugía Cardíaca de Casa de Galicia (GEVE), Montevideo, Uruguay. De ellos, 74 eran mayores de 70 años (grupo I) y 333 con edad menor o igual a 70 años (grupo II). En ambos grupos se determinaron prospectivamente, con fines comparativos entre sí y con datos de STS-Summit: 1) mortalidad operatoria: grupo I, 1,35 por ciento (1/74), grupo II, 4,2 por ciento (14/333), STS-Summit 3.7 por ciento (1.043/28.250), 2) Morbilidad hospitalaria: grupo I, predominio de fibrilación auricular 25,6 por ciento (19/74) y bajo gasto 20,3 por ciento (15/74). 3) Riesgo preoperatorio individual de muerte operatoria. En 94,5 por ciento de los pacientes (70/74) del grupo I y 97,8 por ciento de los del grupo II (326/333) fue menor o igual a 5 por ciento. 4) Uso de arteria mamaria interna: en el grupo I se utilizó en 93 por ciento (69/74) de los pacientes, mientras en el grupo II fue usada en 91 por ciento (303/333). Se concluye que la cirugía de revascularización miocárdica es aplicable a pacientes mayores de 70 años sin un incremento en el riesgo preoperatorio ni la morbimortalidad operatoria y permitiendo un uso similar de arteria mamaria interna al del resto de la población

La baja estatura de los hijos: ¿se relaciona con la de sus padres?: estudio epidemiológico interclase social / Is there a relationship between the short stature of parents and their chldren?

One thousand, eight hundred and forty two children of low socioeconomic level and 2,770 children of high socioeconomic level were initially measured. Those with a z score for height below -1 were selected (251 of low socioeconomic level and 157 of high socioeconomic level) and the height of their parents was measured. Results: Mothers and fathers of low socioeconomic level were 6.1 and 7.4 cm shorter than their counterparts of high socioeconomic level. The z score for height of low socioeconomic level children was significantly better than that of their parents and the relative risk for stunting was 2 when one of the parents had a short stature. Among children of high socioeconomic level, the relative risk of stunting was 4.8 and 11, when the mother or the father had a short stature, respectively. Conclusions: The better height adequacy of low socioeconomic level children, compared to their parents, suggests that the new generations are growing better thant their ancestors. Among children of high socioeconomic level, whose growth potential is fully expressed, the parents height is a good predictor of stunting

Accidentes vasculares encefálicos del territorio cortical de la arteria cerebral posterior: infartos occipitales / Encephalic vascular accidentes within the cortical territory of the posterior cerebral artery: occipital infarction

Los defectos del campo visual constituyen la presentación clínica más frecuente de los infartos occipitales. Su presencia en forma aislada, no asociada a otros defectos neurológicos, es la clave para el diagnóstico de un accidente vascular encefálico del territorio cortical de la Arteria Cerebral Posterior. El mecanismo implicado muy frecuentemente es embólico. Se analizan 7 casos de infartos occipitales que se presentan clínicamente con defectos en el campo visual